Objective: This study evaluated the anxiety, work, and socioeconomic burden of emergency physicians (EP) during the coronavirus disease 2019 (COVID-19) pandemic in South Korea. Methods: A cross-sectional observational study was conducted using data from the 2020 Korean Emergency Physician Survey that included the following domains: hospital resources of suspected COVID-19 patients, availability of personal protective equipment, levels of home and workplace anxiety, the severity of work burnout, identification of stressors, changes in personal environments, and measures to decrease stress/anxiety. Results: Totally, 855 eligible participants were enrolled in the study. A statistically significant deterioration was observed in response to decreased working income or an unstable employment situation (0.46±0.88 points). The median number of patients with confirmed COVID-19 was 2.72. The risk of infection during emergency department (ED) work was found to be significantly increased (P<0.01). Of the 751 respondents (91.4%) who reported patient contact during their survey phase, 516 (62.8%) reported having taken the COVID-19 reverse transcription polymerase chain reaction test. The major factors that affected worsening of the work burden were determined to be unsuitable inter-hospital transfer arrangements for febrile patients (3.46±1.06 before vs. 1.99±1.16 after the pandemic, P<0.01) and delayed consultation for patients with fever or respiratory symptoms in the ED (3.20±1.06 before vs. 2.66±1.10 after the pandemic, P<0.01). Conclusion During the peak phase, the COVID-19 pandemic induced substantial workplace and socioeconomic burdens for Korean EPs. The sustained impact of the pandemic on the wellness of EPs deserves further investigation to guide targeted interventions.

BACKGROUND: Epidural steroid injection (ESI) is one of the most common procedures for patients presenting low back pain and radiculopathy. However, there is no clear consensus on what constitutes appropriate steroid use for ESIs. To investigate optimal steroid injection methods for ESIs, surveys were sent to all academic pain centers and selected private practices in Korea via e-mail. METHODS: Among 173 pain centers which requested the public health insurance reimbursements for their ESIs and were enrolled in the Korean Pain Society, 122 completed questionnaires were returned, for a rate of 70.5%; also returned were surveys from 39 academic programs and 85 private practices with response rates of 83.0% and 65.9%, respectively. RESULTS: More than half (55%) of Korean pain physicians used dexamethasone for ESIs. The minimum interval of subsequent ESIs at the academic institutions (3.1 weeks) and the private practices (2.1 weeks) were statistically different (P = 0.01). CONCLUSIONS: Although there was a wide range of variation, there were no significant differences between the academic institutions and the private practices in terms of the types and single doses of steroids for ESIs, the annual dose of steroids, or the limitations of doses in the event of diabetes, with the exception of the minimum interval before the subsequent ESI.
Consensus ; Dexamethasone ; Electronic Mail ; Humans ; Insurance ; Korea ; Low Back Pain ; Pain Clinics ; Private Practice ; Public Health ; Surveys and Questionnaires ; Radiculopathy ; Steroids ; Triamcinolone

BACKGROUND: Both systemic inflammatory reaction and regional myocardial ischemia/reperfusion injury may elicit hypercoagulability after off-pump coronary artery bypass grafting (OPCAB). We investigated the influence of ulinastatin, which suppresses the activity of polymorphonuclear leukocyte elastase and production of pro-inflammatory cytokines, on coagulation in patients with elevated high-sensitivity C-reactive protein (hsCRP) undergoing OPCAB. METHODS: Fifty patients whose preoperative hsCRP > 3.0 mg/L were randomly allocated into the ulinastatin (600,000 U) or control group. Serum concentrations of thrombin-antithrombin complex (TAT) and prothrombin fragment 1+2 (F1+2) were measured preoperatively, immediately after surgery, and at 24 h after surgery, respectively. Secondary endpoints included platelet factor (PF)-4, amount of blood loss, and transfusion requirement. RESULTS: All baseline values of TAT, F1+2, and PF-4 were higher than the normal range in both groups. F1+2 was elevated in both groups at immediate, and at 24 h after surgery as compared to baseline value, without any significant intergroup differences. Remaining coagulation parameters, transfusion requirement and blood loss during operation and postoperative 24 h were not different between the two groups. CONCLUSIONS: Intraoperative administration of ulinastatin did not convey beneficial influence in terms of coagulation and blood loss in high-risk patients with elevated hsCRP undergoing multivessel OPCAB, who already exhibited hypercoagulability before surgery.
Antithrombin III ; Blood Platelets ; C-Reactive Protein ; Coronary Artery Bypass, Off-Pump ; Cytokines ; Glycoproteins ; Humans ; Leukocyte Elastase ; Peptide Hydrolases ; Prothrombin ; Reference Values ; Thrombophilia ; Transplants

BACKGROUND: Anti-tuberculosis drugs used in combination cause adverse drug reactions, but the prevalence of the reactions and risk factors have not been determined. This study aims to identify the prevalence and risk factors of adverse drug reactions (ADR) to the use of first line anti-tuberculosis drugs. METHODS: A total of 435 newly diagnosed patients with tuberculosis (44.1 years+/-19.0 years) were eligible for this study. All patients received daily oral isoniazid (300 or 400 mg), rifampicin (450 or 600 mg) and ethambutol (800 mg) for 6 months, and pyrazinamide (20 mg/kg) for 2 months. Blood tests were performed regularly (before treatment, 2 weeks after treatment, and bimonthly there after). Patients were interviewed 2 months and 6 months after treatment. A serious ADR was defined as any ADR that resulted in the discontinuation of one or more of the drugs. RESULTS: An ADR was noted in 52.6% of all patients. Gastrointestinal (19.3%), cutaneous (17.7%), hepatic (13.8%), renal (12.6%), and neurological (10.3%) ADRs were frequent and hematological (4.4%), musculoskeletal (3.0%) ADRs were less frequent. A skin ADR was associated with an elevated baseline of liver enzymes (odds ratio, 3.48; 95% CI, 1.2 to 9.9), whereas a hepatic ADR was associated with a history of chronic liver disease (odds ratio, 4.82; 95% CI, 1.7 to 13.2). The prevalence of any serious ADR was 9.7%. Occurrence of any serious ADR was associated with a history of chronic liver disease (odds ratio, 4.29; 95% CI, 1.4 to 13.6). CONCLUSIONS: Anti-tuberculosis drugs given in combination frequently caused a ADR and the findings suggest that a patient receiving anti-tuberculosis treatment should be closely monitored.
Drug-Related Side Effects and Adverse Reactions* ; Ethambutol ; Hematologic Tests ; Hepatitis ; Humans ; Isoniazid ; Liver ; Liver Diseases ; Prevalence* ; Pyrazinamide ; Rifampin ; Risk Factors ; Skin ; Tuberculosis

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.
Adult ; Cesarean Section ; Female ; Gait* ; Humans ; Labor Pain* ; Pelvic Pain ; Pregnancy

Intrauterine contraceptive device (IUD) is the most common contraceptive method in the world, but it exists a little risk of uterine perforation and even more severe risk such as a perforation of intra-abdominal organs. In this case, the patient recognized that the previously inserted IUD was translocated but she was asymptomatic without any management. After insertion of the second IUD, she visited our hospital for lower abdominal pain. The abdominal X-ray finding and transvaginal sonography revealed one translocated IUD in peritoneal cavity and another IUD in intrauterine cavity. Thus, we report a case with the laparoscopic diagnosis of small bowel perforation by a previously inserted IUD and its removal by segmental resection of small bowel after mini-laparotomy, along with the brief review.
Abdominal Pain ; Contraception ; Diagnosis ; Humans ; Intrauterine Devices* ; Peritoneal Cavity ; Uterine Perforation

We experienced 3 cases of early stage tubal cancer incidentally recognized during the operation and diagnosed pathologically after surgery of the tubo-ovarian abscess, the symptomatic adenomyosis, the myoma with adnexal cyst patients, so we report our cases with a review of the literature.
Abscess ; Adenomyosis ; Humans ; Myoma

PURPOSE: The predictive value of c-erbB2 over-expression, and p53 mutation, to the response rate to neoadjuvant chemotherapy, were assessed in patients with breast cancer. METHODS: Between January 2000 and June 2002, 185 patients, with breast cancer, were put forward for two commonly used chemotherapy regimens prior to surgery. The first 135 received the CMF (cyclophosphamide 600 mg/m2, methotraxate 40 mg/m2, 5-FU 500 mg/m2) regimen, and the remaining 50 the CAF (cyclophosphamide 600 mg/m2, adriamycin 50 mg/m2, 5-FU 500 mg/m2) regimen. The expressions of the estrogen receptor (ER), progesterone receptor (PR), p53 mutation and c-erbB2, were evaluated by immunohistochemistry of needle biopsy samples prior to neoadjuvant chemotherapy. Tumor response was categorized according to the WHO criteria, using the largest diameter in ultrasonography or magnetic resonance imaging. RESULTS: The mean age of the patients in the CMF and CAF groups were 48.8 and 47.4 years. Forty eight (35.6%) and 24 (48.0%) of the patients, in the CMF and CAF groups, respectively, had pathologically partial or complete responses. The tumor size, axillary lymph nodes, lymphatic and vascular invasions, as clinicopathological factors, were significantly correlated with the response to chemotherapy in the CAF group. The absences of ER or PR were also significantly associated with a remission in both the CMF and CAF groups. p53 mutation was not correlated to the response rate of either chemotherapy regimen. There was no significant relationship between the expression of c-erbB2 and the response rate in the CMF group, but a higher percentage of patients with c-erbB2 positive tumors had a response to the CAF regimens. CONCLUSION: p53 mutation is not significantly associated with tumor response, but the over-expression of c-erbB2 can predict the response to the different chemotherapies used in breast cancer.
Biopsy, Needle ; Breast Neoplasms* ; Doxorubicin ; Drug Therapy* ; Estrogens ; Fluorouracil ; Humans ; Immunohistochemistry ; Lymph Nodes ; Magnetic Resonance Imaging ; Receptors, Progesterone ; Ultrasonography

OBJECTIVE: Cross-sectional survey was performed to evaluate prevalence of allergic rhinitis and its causative allergens in people in rural area of Cheju Isl~and. Subject and METHOD: A total of 1,236 people with 1,055 children and 181 adults in rural area of Cheju Island were enrolled in this study. In children, 544 were males and 511 were females, and their mean age was 12.3(ranging from 7 to 16) years. In adults, 78 were males and 103 were females, and their mean age was 50.1 (ratging from 18 to 87) years. Evaluations included a questionnaire survey, and skin prick test with extracts of Japanese cedar (Cryptomera japonica, J cedar) pollen and citrus red mite (Panonychus citri, CRM) as well as eleven common inhalant allergens. RESULTS: Prevalence of chronic nasal symptoms was 40.6% (429/1,055) in children, and 45.8 % (83/181) in adults. Prevalence of allergic rhinitis based on positive nasal symptoms on the questionnaire and positive skin response to one or more of the 13 inhalant allergens were 15.4 % (159/1.035) in children, and 19.3% (35/181) in adults. Of 1,035 children, skin-test response was positive in 37.6%, and common sensitizing allergens in order of decreasing frequency were Dermatophagoides pteronpssinus (DP) (26.6%), D. farinae (DF)(22.6%), CRM(14.2%), cockroach(11.3%) and J cedar(9.7%). Of 181 adults, skin-test response was positive in 25.9%, and t,he most common sensitizing allergen was CRM(16.5%), followed by cockroach(11.0%), DP(9. 9%), DF(9.4%), and J cedar(6.6%). Of 159 children with allergic rhinitis, the common sensitizing allergens in order of deereasing frequency were DP(79.2%), DF(67.3%), CRM(35.8%), J cedar(32.7%), and cockroach(27.0%). Of 35 adults with allergic rhinitis, the most common sensitizing allergen was CRM(68.6%), followed by DP(40%), DF(34.3%), cockroach(34.3%), and J cedar(28.9%). CONCLUSION: Allergic rhinitis is a very common disease with a prevalence of 15.4% in children and 19.3% in adults in rural area of Cheju island, and common sensitizing allergens include house dust mite, citrus red mite, cockroach, and Japanese cedar pollen.
Adult ; Allergens* ; Child ; Citrus ; Cockroaches ; Cross-Sectional Studies ; Cryptomeria ; Female ; Humans ; Jeju-do* ; Male ; Mites ; Pollen ; Prevalence* ; Pyroglyphidae ; Rhinitis* ; Skin ; Surveys and Questionnaires

There have been a few reports of occupational asthma caused by Tetranychus urticae in fruit farmers or greenhouse workers. We report a case of bronchial asthma induced by Tetranychus urticae from a pear orchard in Cheonan city. An 18-year-old female student living around a pear orchard suffered from intermittent cough, rhinorrhea, and dyspnea for the 3 years. Her PC20 -methacholine was 0.15mg/ml, and skin prick test done with 55 inhalant allergens showed negative responses except Tetranychus urticae extract which was prepared with highly parasitized pear leaves. Bronchial provocation test with Tetranychus urticae extract showed a dual asthmatic response. These findings indicate that Tetranychus urticae, which include parasites in fruit trees, herba,ceous plants, and greenhouse cultures, can cause IgE-mediated bronchoconstriction in Korea.
Adolescent ; Allergens ; Asthma* ; Asthma, Occupational ; Bronchial Provocation Tests ; Bronchoconstriction ; Chungcheongnam-do ; Cough ; Dyspnea ; Female ; Fruit ; Humans ; Korea ; Parasites ; Pyrus* ; Skin ; Trees