Treatment should be initiated for all suspected, clinical, or confirmed cases of scabies. Patients affected should be adequately isolated, and high-risk groups with close contact histories should be treated regardless of their symptoms. Optimal treatment strategies can be selected based on age, clinical subtype, and the patient's health status. In Korea, commercially available preparations for scabies treatment include topical 5% permethrin, topical 10% crotamiton, and oral ivermectin. Topical 5% permethrin is the first-line selective treatment for both classic and crusted scabies. Alternative treatments include topical 10% crotamiton and oral ivermectin. After completing treatment, followup visits at 2 and 4 weeks are recommended to monitor the therapeutic response. Treatment is considered to have failed if scabies mites or burrows are detected, new clinical characteristics develop, or there is an aggravation of pruritus. Scabies itch should be adequately managed with emollients, oral antihistamines, and topical corticosteroids. Preventive measures, including personal hygiene, patient education, and environmental control, should be implemented to reduce the transmission of scabies.

Scabies is a skin disease caused by the parasite Sarcoptes scabiei var. hominis, which is primarily transmitted via direct skin or sexual contact or, less commonly, via contact with infested fomites. In Korea, the incidence of scabies has decreased from approximately 50,000 cases per year in 2010 to about 30,000 cases per year in 2021. However, outbreaks are consistently observed in residential facilities, such as nursing homes, especially among older adults. The clinical manifestations of scabies vary based on the patient’s age, health status, the number of mites, and the route of transmission.Typical symptoms of classic scabies include intense nocturnal itching and characteristic skin rashes (burrows and erythematous papules), with a predilection for the interdigital web spaces, inner wrists, periumbilical areas, axillae, and genital areas. In contrast, older adults with immunodeficiency or neurological disorders may exhibit hyperkeratotic scaly lesions or an atypical distribution with mild to no itching (crusted scabies). The diagnosis of scabies is based on clinical symptoms and the results of diagnostic tests aimed at identifying the presence of the parasite. While a history of close contact and characteristic clinical findings suggest scabies, confirmation of the diagnosis requires detecting scabies mites, eggs, or scybala. This can be achieved through light microscopy of skin samples, noninvasive dermoscopy, and other high-resolution in vivo imaging techniques.

Treatment should be initiated for all suspected, clinical, or confirmed cases of scabies. Patients affected should be adequately isolated, and high-risk groups with close contact histories should be treated regardless of their symptoms. Optimal treatment strategies can be selected based on age, clinical subtype, and the patient's health status. In Korea, commercially available preparations for scabies treatment include topical 5% permethrin, topical 10% crotamiton, and oral ivermectin. Topical 5% permethrin is the first-line selective treatment for both classic and crusted scabies. Alternative treatments include topical 10% crotamiton and oral ivermectin. After completing treatment, followup visits at 2 and 4 weeks are recommended to monitor the therapeutic response. Treatment is considered to have failed if scabies mites or burrows are detected, new clinical characteristics develop, or there is an aggravation of pruritus. Scabies itch should be adequately managed with emollients, oral antihistamines, and topical corticosteroids. Preventive measures, including personal hygiene, patient education, and environmental control, should be implemented to reduce the transmission of scabies.

Scabies is a skin disease caused by the parasite Sarcoptes scabiei var. hominis, which is primarily transmitted via direct skin or sexual contact or, less commonly, via contact with infested fomites. In Korea, the incidence of scabies has decreased from approximately 50,000 cases per year in 2010 to about 30,000 cases per year in 2021. However, outbreaks are consistently observed in residential facilities, such as nursing homes, especially among older adults. The clinical manifestations of scabies vary based on the patient’s age, health status, the number of mites, and the route of transmission.Typical symptoms of classic scabies include intense nocturnal itching and characteristic skin rashes (burrows and erythematous papules), with a predilection for the interdigital web spaces, inner wrists, periumbilical areas, axillae, and genital areas. In contrast, older adults with immunodeficiency or neurological disorders may exhibit hyperkeratotic scaly lesions or an atypical distribution with mild to no itching (crusted scabies). The diagnosis of scabies is based on clinical symptoms and the results of diagnostic tests aimed at identifying the presence of the parasite. While a history of close contact and characteristic clinical findings suggest scabies, confirmation of the diagnosis requires detecting scabies mites, eggs, or scybala. This can be achieved through light microscopy of skin samples, noninvasive dermoscopy, and other high-resolution in vivo imaging techniques.

Purpose: Recently, we developed allele-discriminating priming system (ADPS) technology. This method increases the sensitivity of conventional quantitative polymerase chain reaction up to 100 folds, with limit of detection, 0.01%, with reinforced specificity. This prospective study aimed to develop and validate the accuracy of ADPS epidermal growth factor receptor (EGFR) Mutation Test Kit using clinical specimens. Materials and Methods: In total 189 formalin-fixed paraffin-embedded tumor tissues resected from patients with non–small cell lung cancer were used to perform a comparative evaluation of the ADPS EGFR Mutation Test Kit versus the cobas EGFR Mutation Test v2, which is the current gold standard. When the two methods had inconsistent results, next-generation sequencing–based CancerSCAN was utilized as a referee. Results: The overall agreement of the two methods was 97.4% (93.9%-99.1%); the positive percent agreement, 95.0% (88.7%-98.4%); and the negative percent agreement, 100.0% (95.9%-100.0%). EGFR mutations were detected at a frequency of 50.3% using the ADPS EGFR Mutation Test Kit and 52.9% using the cobas EGFR Mutation Test v2. There were 10 discrepant mutation calls between the two methods. CancerSCAN reproduced eight ADPS results. In two cases, mutant allele fraction was ultra-low at 0.02% and 0.06%, which are significantly below the limit of detection of the cobas assay and CancerSCAN. Based on the EGFR genotyping by ADPS, the treatment options could be switched in five patients. Conclusion The highly sensitive and specific ADPS EGFR Mutation Test Kit would be useful in detecting the patients who have lung cancer with EGFR mutation, and can benefit from the EGFR targeted therapy.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Background/Aims: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. Methods: An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. Results: Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 minutes vs 34.3±8.3 minutes, p<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 mm 2 /min vs 18.1±4.7 mm 2 /min, p<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8%±3.4% vs 35.1%±3.9%, p<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. Conclusions The dissection speed and safety profile improved significantly with the retractable RESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.

Background: The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. Methods: A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). Results: Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). Conclusion There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications.

Treatment should be initiated for all suspected, clinical, or confirmed cases of scabies. Patients affected should be adequately isolated, and high-risk groups with close contact histories should be treated regardless of their symptoms. Optimal treatment strategies can be selected based on age, clinical subtype, and the patient's health status. In Korea, commercially available preparations for scabies treatment include topical 5% permethrin, topical 10% crotamiton, and oral ivermectin. Topical 5% permethrin is the first-line selective treatment for both classic and crusted scabies. Alternative treatments include topical 10% crotamiton and oral ivermectin. After completing treatment, followup visits at 2 and 4 weeks are recommended to monitor the therapeutic response. Treatment is considered to have failed if scabies mites or burrows are detected, new clinical characteristics develop, or there is an aggravation of pruritus. Scabies itch should be adequately managed with emollients, oral antihistamines, and topical corticosteroids. Preventive measures, including personal hygiene, patient education, and environmental control, should be implemented to reduce the transmission of scabies.