The extended-spectrum β-lactamase (ESBL) CTX-M-55, a CTX-M-15 variant distinguished by an amino-acid substitution (Ala77Val), has enhanced enzymatic activity due to higher structural stability. In Korea, CTX-M-55 remains insufficiently characterized, particularly in the context of urinary tract infections (UTIs). We identified CTX-M-55 among uropathogenic Escherichia coli isolates and compared its microbiological characteristics with those of CTX-M-15. In total, 247 E. coli isolates were collected from patients with acute pyelonephritis at Hanyang University Seoul Hospital, an 860-bed tertiary-care hospital, between July 2019 and December 2021. ESBL production was confirmed using a double-disk synergy test, and minimum inhibitory concentrations (MICs) were determined. Resistance genes were detected using PCR, and CTX-M-15 sequences were analyzed. Among 38 isolates detected using PCR, eight were confirmed as CTX-M-55 using further sequence analysis. CTXM-55 showed (P > 0.05) a trend toward increased resistance to aztreonam, cefotaxime, ceftazidime, and cefepime, while showing decreased resistance to amoxicillin/clavulanate and piperacillin/tazobactam. CTX-M-55 had higher MIC 50 values than CTX-M-15 for ceftazidime ( > 16 vs. 8 µg/mL), cefepime (32 vs. 1 µg/mL), and piperacillin/tazobactam (0.5 vs.0.25 µg/mL). Virulence factors and coexisting resistance genes did not significantly differ.Our findings suggest that, given its increased resistance to ceftazidime and cefepime, CTXM-55 should be considered when treating UTIs in Korea.

Primary aldosteronism is one of the most common cause of secondary hypertension and can be accompanied with hypokalemia. Rhabdomyolysis with hypokalemia in primary aldosteronism has been rarely reported. We describe a patient of primary aldosteronism who presented with limb-girdle type weakness.
Humans ; Hyperaldosteronism* ; Hypertension ; Hypokalemia* ; Rhabdomyolysis*

Controlled-release carbamazepine (CBZ) could be more harmful than the regular form in special situations due to their respective biochemical characteristics. When primary treatment is not effective in acute intoxication, extracorporeal treatment (ECTR) could be an option. We recently applied ECTR to a patient with combined intoxication of topiramate and controlled-release CBZ who deteriorated despite receiving primary treatment. The patient improved after administering ECTR. Early ECTR intervention may be beneficial for the treatment of CBZ intoxication, especially of the controlled-release form.
Carbamazepine* ; Extracorporeal Circulation ; Humans

Background: Hypertension results from an impaired baroreceptor reflex and enhanced sympathetic activity. The prevalence of hypertension differs among ethnicities and is more frequent in South Asians than in Caucasians, suggesting that baseline autonomic nervous system functions and their regulation may also differ among ethnic groups. In most studies, the reference values for clinical autonomic function tests are obtained from heterogeneous ethnic populations, or ethnic factors are not considered in the study design. Obtaining reference data in a homogenous ethnic group and comparing them within various ethnic groups could be helpful to detect ethnic differences in autonomic functions. The aim of this study was to identify normative reference values for standard autonomic reflex measurements in a homogeneous Korean population. Methods: A total of 181 healthy Korean volunteers (age, 20–74 years) underwent standard autonomic function tests: heart rate difference during deep breathing, Valsalva maneuver, and the quantitative sudomotor axon-reflex test. Mean and 5th and 95th percentile values were obtained for each age group. We also analyzed factors (age, sex, and body mass index) that can influence autonomic functions. Results: The heart rate difference during deep breathing and expiratory-inspiratory ratio were higher in males than in females and were inversely related to age. The Valsalva ratio was inversely related to age. Males had higher sweat volumes at all body areas evaluated than those of females, and only forearm sweat volume was significantly different between the age groups. Conclusions: Cardiovagal function was affected by age and sex in Koreans. Sudomotor function was affected by sex, and only forearm sweat volume was affected by age and sex. These results represent preliminary normative clinical autonomic data in a Korean population comprised of a single ethnicity
Hypertension

Artemisia annua is a wormwood. Because it may induce Cytochrome P450 2C19 enzyme, Artemisia annua may have an influence on antiepileptic drugs which are substrates for the enzyme. This influence may negatively affect seizure control of epilepsy patient. We present a patient whose seizures were induced by Artemisia annua, despite he was taking levetiracetam which is not a substrate for the hepatic enzyme. Therefore there would be another mechanism of seizure induction of Artemisia annua besides hepatic metabolism.
Anticonvulsants ; Artemisia ; Artemisia annua* ; Cytochrome P-450 Enzyme System ; Epilepsy* ; Humans ; Metabolism ; Seizures*

Amyloidosis is a systemic disorder associated with clonal plasma cell dyscrasia. Nephrotic syndrome, congestive heart failure, autonomic and peripheral neuropathy is often associated features in amyloidosis. Early diagnosis is most important because of different prognosis by stage. The diagnosis can be delayed since symptoms of amyloidosis may vary or nonspecific. We describe a patient of myeloma-associated amyloidosis, who showed orthostatic intolerance as the first symptom of the disease.
Amyloidosis* ; Diagnosis ; Early Diagnosis ; Heart Failure ; Humans ; Nephrotic Syndrome ; Orthostatic Intolerance* ; Paraproteinemias ; Peripheral Nervous System Diseases ; Prognosis

Objectives: White matter hyperintensities are known to influence dementia in Alzheimer’s disease. Genetic components are suggested as putative risk factors for vascular pathology and cognitive decline. This study aimed to determine whether there is an association between candidate genetic polymorphisms and the severity of white matter hyperintensities in patients with Alzheimer’s disease. Methods: Seventy-five patients diagnosed with Alzheimer’s disease underwent genetic tests for specific alleles of apolipoprotein E, angiotensin-converting enzyme, and methylenetetrahydrofolate reductase. All patients underwent brain magnetic resonance imaging scans and neuropsychological tests. The severity of white matter hyperintensities was semiquantified using the CREDOS rating scale, and patients were divided into three groups according to their rating. Results:The severity of white matter hyperintensities was related to age and hypertension. However, none of the gene polymorphisms we tested was found to be associated with the severity of white matter hyperintensities. Conclusion:The genetic polymorphisms found in apolipoprotein E, angiotensin-converting enzyme and methylenetetrahydrofolate reductase did not contribute to white matter hyperintensities in Alzheimer’s disease.Only age and hypertension factors were found to be contributory to white matter hyperintensities.
Alzheimer Disease ; Dementia

No abstract available.
Encephalomyelitis, Acute Disseminated ; Meningoencephalitis ; Orientia tsutsugamushi ; Scrub Typhus

Psoriatic arthritis is an immune-mediated chronic inflammatory disease triggered and maintained by inflammatory mediators, including tumor necrosis factor-alpha. Although TNF-alpha antagonist is effective for the treatment of psoriatic arthritis, infections caused by tuberculosis or fungus have emerged as significant complications of therapy. We report a case of pulmonary cryptococcosis in a patient with psoriatic arthritis treated with adalimumab.
Antibodies, Monoclonal, Humanized ; Arthritis, Psoriatic ; Cryptococcosis ; Fungi ; Humans ; Tuberculosis ; Tumor Necrosis Factor-alpha ; Adalimumab

Alpha coma is a coma state with predominant alpha activities in electroencephalography. There are two different patterns of alpha coma, depending upon the distribution of alpha activity. The causes may vary with the distribution pattern. To clarify the difference in alpha-activity distribution, we conducted current-source analysis of the alpha-frequency band in two patients with alpha-coma caused by drug intoxication and pontine infarction, respectively. The current-source analysis of alpha-frequency bands may make it easier to distinguish the distribution patterns.
Coma ; Electroencephalography ; Humans ; Infarction