Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) can range from mild cutaneous symptoms to life-threatening anaphylaxis. In patients with a history of ICM hypersensitivity, avoidance of the culprit agent is generally recommended. This case report describes a successful desensitization in a 56-year-old man with recurrent HSRs to multiple agents including ioversol, iohexol, iobitridol, and iopamidol. Intradermal testing was performed to identify potentially safe alternatives; however, all tested agents, including iohexol, ioversol, iobitridol, iopamidol, iodixanol, iomeprol, and iopromide, yielded positive results. Given the clinical necessity of transcatheter arterial chemoembolization, a 13-step rapid desensitization protocol with iodixanol was implemented. The procedure was completed without any breakthrough reactions. This case highlights desensitization as a feasible and effective strategy for patients with hypersensitivity to multiple ICM agents.

Cerebrospinal fluid (CSF) dynamics are increasingly recognized as central to brain waste clearance. Beyond the classical view of unidirectional CSF circulation, recent studies have identified the glymphatic system and meningeal lymphatic vessels as major complementary pathways. Glymphatic transport is driven by arterial pulsation, respiration, vasomotion, and strongly enhanced during slow-wave sleep. Advances in neuroimaging, including DTI-ALPS, EPVS quantification, contrast-enhanced magnetic resonance imaging (MRI), and ultrafast functional MRI, have enabled in vivo assessment of these mechanisms. Impaired glymphatic function has been linked to neurodegenerative and cerebrovascular diseases, highlighting its clinical relevance. Potential interventions range from lifestyle measures such as sleep optimization, exercise, and vascular risk control, to pharmacological and experimental strategies aiming to modulate CSF flow. These insights open new opportunities to target the glymphatic-lymphatic axis for the prevention and treatment of neurological disorders.

Objectives: This study investigated a cluster of secondary human-to-human transmission of severe fever with thrombocytopenia syndrome (SFTS) in a hospital setting, focusing on infection risk factors and the role of personal protective equipment (PPE). Methods: A descriptive epidemiological investigation was conducted following the death of anindex patient with laboratory-confirmed SFTS. A total of 27 close contacts, including healthcareworkers and a funeral director, were monitored for symptoms. Suspected cases underwent real-time reverse transcription polymerase chain reaction testing. Clinical features, PPE use, and exposure histories were analyzed. The Fisher exact test was used to assess associations between PPE use and infection. Viral genotyping and sequence analyses were performed to evaluate transmission routes. Results: The index patient deteriorated rapidly and died after repeated cardiopulmonaryresuscitation (CPR), during which 8 secondary cases occurred. Most infections were identifiedamong individuals involved in CPR or postmortem care without adequate PPE. Although notstatistically significant, infection rates were higher among those who did not wear masks or who used low-filtration masks. Proper use of gloves, gowns, and goggles was associated withlower infection rates. Cycle threshold values in secondary cases (range, 34–39) were higherthan in the index case (14.07), suggesting lower viral loads. Sequence analysis demonstrated99.6%–100% homology between the index and secondary cases; all isolates were genotype B, indicating direct transmission. Conclusion This study provides molecular and epidemiological evidence of nosocomial SFTS transmission. Inadequate PPE use during aerosol-generating procedures likely facilitated infection, underscoring the importance of strict adherence to PPE protocols and reinforced infection control practices.

Objectives: In May 2025, clusters of salmonellosis were identified in 7 cities in the Republic of Korea, all associated with consumption of identical bakery products. This investigation aimed to characterize the outbreak, identify potential contributing factors, and inform strategies for preventing similar multi-facility foodborne outbreaks. Methods: A case series study was conducted among individuals who consumed Manufacturer H’s Product I and Product II on May 15–16, 2025 at 7 facilities (n = 1,235). Clinical specimens from symptomatic individuals, retained food samples, and environmental samples were collected and tested. Food-exposure histories were assessed, and active case finding was implemented across all supplied facilities. Traceback investigations were conducted at the manufacturer, distributor, and egg farms. Human and food isolates underwent pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS). Results: A total of 323 cases met the outbreak case definition (attack rate, 26.2%), of which 48 were laboratory-confirmed. Salmonella Enteritidis was isolated from both clinical specimens and retained bakery products. PFGE patterns were indistinguishable between human and food isolates, and WGS demonstrated high genetic relatedness. These findings confirmed a common-source outbreak linked to the implicated bakery products. Conclusion This outbreak underscores the value of integrating epidemiological investigation, active case finding, and molecular typing to identify common food vehicles in outbreaks involving widely distributed manufactured foods. Coordinated collaboration between public health and food safety authorities is essential for the effective detection, response, and prevention of multi-facility foodborne outbreaks.

Background: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is among the most important multidrug-resistant pathogens causing bloodstream infections (BSIs).Cefotaximase (CTX-M) enzymes are the most common and highly diverse ESBL family in E.coli. CTX-M-15 in group CTX-M-1 and CTX-M-14 in group CTX-M-9 are the most extensively disseminated enzymes. Multidrug-resistant E. coli strains complicate empirical therapy and increase healthcare burden globally and in Korea. We investigated the molecular epidemiology, sequence types (STs), and ESBL genotypes of E. coli bloodstream isolates in Korea and identified clinical risk factors for cefotaxime resistance. Methods: We collected all non-duplicated isolates of E. coli and related clinical information from patients with BSIs at eight sentinel hospitals in the Korean Global Antimicrobial Resistance Surveillance System (Kor-GLASS) collection network during 2017–2021. Duplicate isolates were removed to ensure representativeness of the data. Antimicrobial susceptibility was tested using disk diffusion tests, and multilocus sequence typing and betalactamase genotyping were performed. Results: Among 9,232 E. coli blood isolates, resistance rates to cefotaxime and ceftazidime were 36.4% and 11.4%, respectively. Among the clinical factors, age > 65 yrs (adjusted odds ratio [aOR], 1.36), hospital-origin infection (aOR, 2.55), and admission type (intensive care unit [ICU] vs. general ward; aOR, 1.34) were significant cefotaxime resistance risk factors. ST131 was the most prevalent among cefotaxime-resistant E. coli (64.8%, 2,180/3,363), followed by ST1193 (5.3%, N = 177), and ST69 (5.1%, N = 170).ST131, ST648, ST405, and ST410 cefotaxime-resistant E. coli isolates frequently harbored blaCTX-M-15, whereas ST1193 and ST68 showed a high proportion of blaCTX-M-27 carriers, and most ST457 and ST5150 isolates carried blaCTX-M-55. Conclusions Continuous monitoring of ESBL-producing E. coli is required to prevent further dissemination, guide empirical therapy, inform infection control policies, and ensure early detection of multidrug-resistant clones with the potential for widespread transmission.

Background: Rapid pathogen identification and antibiotic-susceptibility tests (ASTs) are important for treating bloodstream infections. We compared the performance of the QMAC-dRAST and BD Phoenix M50 direct AST (dPhoenix) systems using bacterial pellets prepared from positive blood culture broth and evaluated their impact on treatment modification. Methods: Direct AST results for 106 Enterobacterales isolates were retrospectively reviewed. Conventional broth microdilution was used to calculate categorical agreement (CA), very major error (VME), major error (ME), and minor error (mE). For isolates showing high VMEs in both methods, supplementary tests were performed. Clinical impact was evaluated by calculating the time required to obtain AST results (time-to-result) and observing changes in antibiotics prescribed after performing ASTs. Results: Both systems showed acceptable overall CA, VME, ME, and mE values (QMACdRAST: 93.6%, 1.6%, 0.9%, and 5.3%, respectively; dPhoenix: 93.1%, 0.9%, 0.6%, and 6.2%, respectively). Piperacillin–tazobactam showed high VMEs with QMAC-dRAST (4/20, 20.0%) and dPhoenix (3/20, 15.0%). Colony AST on 13 isolates revealed that QMACdRAST testing yielded lower minimal inhibitory concentrations (MICs) for piperacillin–tazobactam with three isolates, whereas dPhoenix testing yielded higher MICs with two isolates and lower MICs with two isolates. The average time-to-result was 20.8 hr and 30.1 hr for QMAC-dRAST and dPhoenix, respectively (P < 0.001). After AST, the number of optimal treatments increased from 43 (46.7%) to 72 (78.3%) (P < 0.001). Conclusions The QMAC-dRAST and dPhoenix systems provided reliable AST results with a short time-to-result. However, we recommend performing complementary tests, such as the disk diffusion test, for piperacillin–tazobactam.

Purpose: Psychiatric conditions are common in children and adolescents with diabetes and can hinder disease management. In this study, we examined whether mental health status at diagnosis predicts glycemic control at 1 year. Methods: We included 57 patients aged 6–18 years diagnosed with type 1 or type 2 diabetes between 2019 and 2023 at Seoul National University Bundang Hospital. Mental health was assessed within 3 months of diagnosis using the Eating Disorder Inventory-2, Children’s Depression Inventory, and Child Behavior Checklist (CBCL) for ages 6–18. Poor glycemic control was defined as glycated hemoglobin >6.5% at 1 year. Associations between screening results and glycemic control were analyzed using Fisher exact test and multivariate logistic regression. Results: Of the 57 patients, 32 (56.1%) had type 1 diabetes, and the mean age at diagnosis was 12.9±3.1 years; 31 (54.4%) were male. Poor glycemic control at 1 year was observed in 16 patients (28.1%). Although individual subscale positivity was not significantly associated with glycemic control, borderline somatic complaints on the CBCL were significantly associated with poor control (p=0.022). In multivariate analysis, having 2 or more positive CBCL subscales showed a trend toward association with poor glycemic control (adjusted odds ratio=21.47, p=0.054). Conclusion Early psychological screening, especially for somatic symptoms or multiple psychological problems, may help identify those at risk for poor glycemic control in pediatric diabetes. These findings underscore the importance of early detection and intervention in optimizing diabetes management.

Purpose: Despite the global paradigm emphasizing earlier and more aggressive intervention for youth-onset type 2 diabetes mellitus (T2DM), metformin and insulin are the only drugs approved for Korean adolescents. We investigated the incidence of complications, changes in glycemic control during the transition period, the effect of second-line antidiabetic agents on glycemic control in young adults with youth-onset T2DM. Methods: Eighty-four patients diagnosed with T2DM at Seoul National University Children's Hospital between January 2001 and July 2023, before age 18 (47 males; mean age, 14 years) with available glycated hemoglobin (HbA1c) data from at least 2 distinct ages between 19 and 22 years old were retrospectively enrolled. Results: At the last follow-up (mean age, 24.9 years; median follow-up, 9.6 years), complications were found in 33.7% (nephropathy, 25.3%; eye disease, 20.6%), and 83% required insulin or second-line agents. During the transition period, HbA1c levels decreased from 8.2% at age 19 to 7.7% at age 22 (P<0.01), with greater improvements in females, those diagnosed before age 15, and those with HbA1c levels ≥7% at age 19. HbA1c level decreased significantly at 1 year after the addition of second-line medications (P=0.03) and at the last visit (P=0.03) compared with baseline. Conclusion Glycemic control improved during the transition period among youth-onset T2DM patients. Given the high incidence of complications and the beneficial effects of second-line agents on glycemic control, there is an urgent need to expand the range of approved second-line agents, along with broader insurance coverage in adolescence.

Purpose: Endoscopic submucosal dissection (ESD) has become a standard minimally invasive treatment for selected patients with early gastric cancer (EGC). This study presents the first nationwide survey of patients with EGC treated with ESD in 2023, conducted by the Korean College of Helicobacter and Upper Gastrointestinal Research. Materials and Methods: Data were retrospectively collected from participating referral centers across Korea using a standardized case report form covering patient characteristics, tumor features, procedural details, histopathological findings, and clinical outcomes.Descriptive and comparative analyses were conducted to summarize nationwide ESD practice patterns and outcomes. Results: Data from 5,460 ESD cases from 5,250 patients across 27 institutions were analyzed. The mean age was 67.4 years, with 74.1% males. Multiple synchronous lesions were identified in 3.7%. Most lesions were located in the lower third of the stomach (64.0%), and differentiated-type adenocarcinomas accounted for 87.8%. The en bloc and complete resection rates were 99.2% and 91.4%, respectively. Curative resection was achieved in 80.5%, whereas local non-curative resection (L-NCR) and surgical non-curative resection (S-NCR) were identified in 2.8% and 16.7%, respectively. Additional surgery was performed more frequently in patients with S-NCR than in those with L-NCR (59.3% vs. 24.7%). The bleeding and perforation rates were 3.6% and 0.9%, respectively, and were mostly managed conservatively or endoscopically. The median length of hospitalization was 4.0 days. Conclusions This first nationwide survey provides a comprehensive overview of the current practice of EGC treatment using ESD in Korea, demonstrating high technical success and safety, and establishing a baseline dataset for future longitudinal research.