BACKGROUND: Microalbuminuria is the main parameter used in diabetic patients for clinical evaluation of early diabetic nephropathy and other complications. The most common method for quantitative urinary protein relies on a 24-hour urine collection or overnight urine collection; however, this method is time consuming and sometimes obtains inaccurate results. This study is aimed to test whether the microalbumin to creatinine ratio (Uma/Ucr) in the first-morning urine samples correlates with the microalbumin content in the 24-hour urine collection. METHODS: 59 urine samples from 59 type 2 diabetic patients were analyzed for Uma/Ucr, and for 24-hour urine microalbumin that were successively collected. RESULTS: Daily microalbumin excretion varied from 2.4 to 168.7 mg/24 hr with a median value of 22.9 mg, and Uma/Ucr ranged from 3.4 to 200 g/mg with a median value of 29.0 g/mg. An excellent correlation was found between the microalbumin excretion measured from the 24-hour urine collections and the first-morning urine Uma/Ucr ratio (R=0.93, P<0.001). All patients that excreted more than 30 mg albumin in the 24-hour urine samples also had an Uma/Ucr of more than 30 g/mg. Patients who had less than 30 g/mg of Uma/Ucr were unlikely candidates for microalbuminuria. CONCLUSIONS: This study indicates that measurements of Uma/Ucr in first-morning urine samples are a simple and reliable alternative to measurements of the urinary albumin excretion rate in the 24-hour urine collections.
Creatinine* ; Diabetic Nephropathies ; Humans ; Urine Specimen Collection

The introduction of a new, fully automated system into the clinical microbiology laboratory contributes to a rapid identification of microorganisms with accurate and reliable results, but such a system requires a high cost and additional tests for identification of some species. For instance, additional tests on oxidase, indole, motility, hemolysis, and pigmentation are needed in the correct identification by using Vitek GNI+ system (bioMerieux Vitek Inc., MO, USA). In particular, Vibrio and Aeromonas species are occasionally identified incorrectly when an automated system is used, and thus conventional biochemical tests may be more reliable in the identification of such species. We experienced three cases of incorrect identification of Vibrio parahaemolyticus, Vibrio cholerae, and Aeromonas veronii biovar sobria as Vibrio alginolyticus by using Vitek GNI+ card.
Aeromonas ; Hemolysis ; Oxidoreductases ; Pigmentation ; Vibrio alginolyticus* ; Vibrio cholerae ; Vibrio parahaemolyticus ; Vibrio*

Background: As the role of immunotherapies and personalized medicine grow, cancer patients have faced many choices in treatments and have suffered financial toxicity. These challenges brought the need for the value framework (VF) to guide treatment decision making. Methods: A survey was taken to 102 oncologists about perception for VF. They were asked about priorities among several considerations when they prescribe cancer drugs. Their views on the need for development and potential implications of VF in Korea were assessed, also. Results: The survey shows that 90% of the respondents choose clinical efficacy as the most important value in cancer drugs selection, and the cost of drug was more weighted value in immune checkpoint inhibitors (13.7%). Approximately half (53.9%) answered that they were aware of the existing VFs. Over 90% of respondents agreed with the need for development of a VF for cancer drugs based on Korean healthcare system and further usefulness for decisions about reimbursement issues. Seventy-one percent answered that two representative VFs (American Society Clinical Oncology-VF and European Society for Medical OncologyMagnitude of Clinical Benefit Scale) should be reflected in value measurement of cancer drugs in Korea. Conclusion The Korean oncologists recognized the necessity for the clinical application of VF. Further discussion between the stakeholders should be followed to alleviate the financial burden through the value-based decision making of cancer drugs.

Background: As the role of immunotherapies and personalized medicine grow, cancer patients have faced many choices in treatments and have suffered financial toxicity. These challenges brought the need for the value framework (VF) to guide treatment decision making. Methods: A survey was taken to 102 oncologists about perception for VF. They were asked about priorities among several considerations when they prescribe cancer drugs. Their views on the need for development and potential implications of VF in Korea were assessed, also. Results: The survey shows that 90% of the respondents choose clinical efficacy as the most important value in cancer drugs selection, and the cost of drug was more weighted value in immune checkpoint inhibitors (13.7%). Approximately half (53.9%) answered that they were aware of the existing VFs. Over 90% of respondents agreed with the need for development of a VF for cancer drugs based on Korean healthcare system and further usefulness for decisions about reimbursement issues. Seventy-one percent answered that two representative VFs (American Society Clinical Oncology-VF and European Society for Medical OncologyMagnitude of Clinical Benefit Scale) should be reflected in value measurement of cancer drugs in Korea. Conclusion The Korean oncologists recognized the necessity for the clinical application of VF. Further discussion between the stakeholders should be followed to alleviate the financial burden through the value-based decision making of cancer drugs.

No abstract available.
Humans ; Infant, Newborn*

Although spontaneous bacterial peritonitis is a frequent complication in the childhood nephrotic syndrome, it is very rare in adults with nephrotic syndrome. It frequently develops when the patients are either in relapse or receiving steroid therapy at the time peritonitis is diagnosed. We report an unusual case of a spontaneous bacterial peritonitis as the presenting feature in a 15-year-old male patient with nephrotic syndrome. He presented with diffuse abdominal pain and distension for 15 days. Abdominal paracentesis revealed the diagnostic laboratory findings of peritonitis, and the bacterial culture of the ascites showed a mixed growth of Escherichia coli and Pseudomonas aeruzinosa. His serum albu- min level was 1.6gldL and the amount of 24 hours proteinuria was 21.0g/day. Although he was treated with adequate antibiotics for 3 weeks, the peritonitis was more aggravated. We decided to insert a catheter into the peritoneal cavity for continuous drainage of the intractable ascites. Two weeks after drainage, the peritonitis improved as the peritonitis subsided, the proteinuria disappeared completely without a steroid therapy. Six months after spontaneous remission, the proteinuria have recurred, and the kidney biopsy then showed focal segmental glomerulorsclerosis.
Abdominal Pain ; Adolescent ; Adult ; Anti-Bacterial Agents ; Ascites ; Biopsy ; Catheters ; Drainage ; Escherichia coli ; Humans ; Kidney ; Male ; Nephrotic Syndrome* ; Paracentesis ; Peritoneal Cavity ; Peritonitis* ; Proteinuria ; Pseudomonas ; Recurrence ; Remission, Spontaneous

Iodinated contrast-induced acute renal failure is estimated to occur in 0.15 to 2% of all patients undergoing contrast imaging studies. Incidence is higher in patients with renal insufficiency, diabetes mellitus, dehydration, multiple myeloma, congestive heart failure, advanced age. We here report successful vascular interventional procedure by using gadopentetate dimeglumine(Gd-DTPA) as a contrast agent in a patient with chronic renal insufficiency and right superficial femoral artery stenosis. The patient had a history of iodinated contrast-induced acute renal failure. Gd-DTPA(0.17mmoVkg) diluted 1: 1 with 0.9% norrnal saline was used as contrast agent for the interventional procedure. Percutaneous transluminal angioplasty was successfully performed and there was no evidence of contrast material- induced acute renal failure after the procedure. Gd- DTPA is an alternative contrast agent for patients with chronic renal insufficiency.
Acute Kidney Injury ; Angioplasty* ; Constriction, Pathologic ; Dehydration ; Diabetes Mellitus ; Femoral Artery ; Gadolinium DTPA* ; Heart Failure ; Humans ; Incidence ; Multiple Myeloma ; Pentetic Acid ; Renal Insufficiency ; Renal Insufficiency, Chronic*

Tularemia is a major laboratory acquired zoonoses caused by Francisella tularensis that have high virulence, and usually transmitted to humans from direct contact with infected wild animals like rabbits or insect vectors like ticks. Clinical tularemia can be divided with 6 major syndromes that are delineated by the mode of organism aquisition, in which ulceroglandular type is the most common. F. tularensis have 3 different biogroups which have homogeneous antigenecity, type A (biogroup tularensis), type B (biogroup palearctica) and biogroup novicida, and can be confirmed by serology most frequently. In the domestic area, there was no reports of tularemia in humans or presence of bacteria in the reservoirs. Authers experienced a case of tularemia which is suspected as F. tularensis type B, ulceroglandular type. A healthy 40-year-old man admitted the hospital for lymph node swelling in both axillary and upper arm area and for furuncles in both forearm and palm. He contacted with dead rabbit and eated it after cooking before 20 days from admission day. In laboratory cultures, F. tularensis did not grow in any of the routine or anaerobic culture media except for one blood agar plate at 5 days. After subculturing that to cystine containing chocolate agar plate at 37C degree, 5% CO2 incubator, we could see the accelerating growth of colony. In microbiological test, it was oxidase and urease negative. In acid production in cystine trypticase agar base, it was glucose positive and sucrose, maltose, glycerol negative. In agglutinating test, F. tularensis antiserum titer (Difco, USA) with isolates was 1:160 or over and antibody titer to F. tularensis antigen (Difco, USA) was 1:320 or over. Anti-F. tularensis-IF assay and Anti-F. tularensis-indirect-EIA with isolates were positive.
Adult ; Agar ; Animals ; Animals, Wild ; Arm ; Bacteria ; Cacao ; Cooking ; Culture Media ; Cystine ; Forearm ; Francisella tularensis* ; Francisella* ; Furunculosis ; Glucose ; Glycerol ; Humans ; Incubators ; Insect Vectors ; Lymph Nodes ; Maltose ; Oxidoreductases ; Rabbits ; Sucrose ; Ticks ; Tularemia* ; Urease ; Virulence ; Zoonoses

Cystinuria is an inherited renal and intestinal disease characterized by defective amino acids reabsorption and cystine urolithiasis. It is unusually associated with neurologic symptoms. Mutations in two genes, SLC3A1 and SLC7A9, have been identified in cystinuric patients. This report presents a 13-yr-old boy with cystinuria who manifested difficulty in walking, ataxia, and mental retardation. Somatosensory evoked potential of posterior tibial nerve stimulation showed the central conduction dysfunction through the posterior column of spinal cord. He was diagnosed non-type I cystinuria by urinary amino acid analysis and oral cystine loading test. We screened him and his family for gene mutation by direct sequencing of SLC3A1 and SLC7A9 genes. In this patient, we identified new missence mutation G173R in SLC7A9 gene.
Adolescent ; Amino Acid Substitution ; Amino Acid Transport Systems, Basic/*genetics ; Amino Acids/urine ; Ataxia/complications/diagnosis/*genetics ; Base Sequence ; Cystine/blood ; Cystinuria/complications/diagnosis/*genetics ; Humans ; Intellectual Disability/complications/diagnosis/*genetics ; Male ; *Mutation, Missense ; Pedigree ; Republic of Korea

The aim of this study is to assess the actual epidemiologic features of Kawasaki disease (KD) in Korea using the data from Health Insurance Review & Assessment Service (HIRA) claims from 2007 to 2014. We investigated HIRA claims of patients who had KD (International Classification of Diseases-10, M30.3) as a major diagnosis and were given intravenous immunoglobulin (IVIG) from 2007 to 2014. A total of 39,082 patients were reported during the period. The male-to-female ratio was 1.42 and the median age was 28 months. The incidence rates were 168.3 per 100,000 population aged 0 to 4 years in 2007, 159.1 in 2008, 167.3 in 2009, 190.4 in 2010, 188.2 in 2011, 190.2 in 2012, 210.4 in 2013 and 217.2 in 2014. These rates were much higher than those in the previous studies in Korea. KD occurred more often in early summer (May, June and July) and winter (December and January). The annual incidence rate of KD had been increasing every year, reaching 217.2 per 100,000 population aged 0 to 4 years in 2014. It is the second highest incidence rate of KD in the world after Japan.
Classification ; Diagnosis ; Epidemiologic Studies* ; Epidemiology ; Humans ; Immunoglobulins ; Incidence ; Insurance, Health* ; Japan ; Korea* ; Mucocutaneous Lymph Node Syndrome*