In patients with recurrent spontaneous bacterial peritonitis, repeated inflammation may occasionally lead to fibrosis and adhesions within the peritoneal cavity, resulting in fibrous septations that give ascites a spider web-like appearance. These septations can interfere with the diffusion of antibiotics and hinder effective drainage of ascitic fluid, rendering standard treatment with antibiotics and paracentesis less effective—particularly when accompanied by refractory ascites. In this case, intraperitoneal administration of tissue plasminogen activator (tPA) via an indwelling catheter helped dissolve the fibrous septa and led to noticeable clinical improvement in a patient unresponsive to the standard therapy. However, intraperitoneal tPA therapy carries potential risks, including bleeding and infection. Therefore, it should be considered only after a thorough evaluation of the patient’s overall condition and bleeding risk, weighing the potential benefits against the possible complications.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disease that most often affects the optic nerves and spinal cord. We describe a case of 36-year-old woman presented at 13 weeks of gestation with 4 extremities paresthesia and weakness that had lasted for two months at her first visit to our hospital. She had two previous uncomplicated full-term vaginal deliveries and no significant medical or family history. Spine magnetic resonance imaging (MRI) showed extensive cervical cord lesion and aquaporin-4 antibodies were strongly positive, confirming the diagnosis of NMOSD. Initial management with high-dose corticosteroids and plasmapheresis was done and she showed substantial improvement, but she revisited hospital at 26 weeks of gestational age due to visual disturbance and aggravated weakness. Relapse of NMOSD was confirmed by spine MRI, so rituximab therapy was initiated at 28 weeks of gestational age for prevention of recurrence.The patient showed clinical improvement with no adverse effects and relapse of symptoms. She successfully delivered a healthy male infant at 39 weeks and 3 days of gestational age through uncomplicated vaginal delivery. This case demonstrates successful management of new-onset NMOSD during pregnancy using a multi-modal treatment approach including rituximab.

Background: The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus. Methods: Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis. Results: During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration. Conclusion Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Background: The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus. Methods: Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis. Results: During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration. Conclusion Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Background: The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus. Methods: Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis. Results: During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration. Conclusion Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Background: The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus. Methods: Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis. Results: During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration. Conclusion Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Background: Atopic dermatitis (AD) is a common skin disease with a wide range of symptoms. Due to the rapidly changing treatment landscape, regular updates to clinical guidelines are needed. Objective: This study aimed to update the guidelines for the treatment of AD to reflect recent therapeutic advances and evidence-based recommendations. Methods: The Patient characteristics, type of Intervention, Control, and Outcome framework was used to determine 48 questions related to AD management. Evidence was graded, recommendations were determined, and, after 2 voting rounds among the Korean Atopic Dermatitis Association (KADA) council members, consensus was achieved. Results: This guideline provides treatment guidance on advanced systemic treatment modalities for AD. In particular, the guideline offers up-to-date treatment recommendations for biologics and Janus-kinase inhibitors used in the treatment of patients with moderate to severe AD.It also provides guidance on other therapies for AD, along with tailored recommendations for children, adolescents, the elderly, and pregnant or breastfeeding women. Conclusion KADA’s updated AD treatment guidelines incorporate the latest evidence and expert opinion to provide a comprehensive approach to AD treatment. The guidelines will help clinicians optimize patient-specific therapies.