This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

Objectives: Pandemic diseases like COVID-19 could affect people even after they are cured. In this study, we asked COVID-19 survivors whether they showed post-traumatic stress disorder (PTSD) symptoms, and tried to figure out what factors can affect their symptoms. Methods: Approximately 3 months after their discharge, a psychological survey was conducted with 83 adults (38 men and 45 women, mean age 38.6±11.3 years) who had been hospitalized with COVID-19 in an isolation ward. The group was divided according to the presence or absence of PTSD symptoms, and differences in demographic, psychological, and hospitalizationrelated factors between the groups were analyzed using the independent t-test. We conducted hierarchical multiple regression analysis exploring variables affecting PTSD symptoms. Results: Fourteen of the survey respondents (15.8%) reported experiencing PTSD symptoms, including partial PTSD symptoms. The group with PTSD symptoms appeared to have more pain upon admission to hospital, compared to the group without PTSD symptoms. The group with PTSD symptoms showed higher anxiety and depression than the group without PTSD symptoms, and their physical quality of life was found to be low. The presence of PTSD symptoms seemed to be influenced by anxiety sensitivity. Conclusion Our findings suggest that hospitalization in an isolation ward due to COVID-19 may be associated with the development of PTSD symptoms. Anxiety sensitivity could influence the level of PTSD symptoms after discharge. The results of this study suggest the need to monitor and care for the mental health of patients admitted to and discharged from isolation wards due to infection.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

We analyzed the manner and cause of death in 1,193 forensic autopsies from the Jungbu province (central part of South Korea) conducted by the National Forensic Service Daejeon Institute in 2022. Analysis of the manner of deaths revealed that 43.1% (514/1,193 cases) were natural deaths; 42.8% (511/1,193 cases) were unnatural deaths; and 14.1% (168/1,193 cases) were unknown. Among the unnatural deaths, the major manner of death was 44.6% (228/511 cases) by accidents, 34.1% (174/511 cases) by suicide, 13.5% (69/511 cases) undetermined, and 7.8% (40/511 cases) by homicide. Among the unnatural deaths, the major causes of death was 38.4% (196/511 cases) by trauma, 20.4% (104/511 cases) by poisoning, and 17.6% (90/511 cases) by asphyxia. Falling was the major cause of death by trauma (58.7%, 115/196 cases), and strangulation was the major cause of death by asphyxia (75.6%, 68/90 cases). Among the natural deaths, heart disease was the major cause (46.7%, 240/514 cases), followed by endocrine, nutritional and metabolic diseases (14.0%, 72/514 cases). A time-series statistical analysis and comparison of the manner and cause of deaths in this province may facilitate more advanced interpretations relating to both public safety and healthcare in the future.

We analyzed the manner and cause of death in 1,193 forensic autopsies from the Jungbu province (central part of South Korea) conducted by the National Forensic Service Daejeon Institute in 2022. Analysis of the manner of deaths revealed that 43.1% (514/1,193 cases) were natural deaths; 42.8% (511/1,193 cases) were unnatural deaths; and 14.1% (168/1,193 cases) were unknown. Among the unnatural deaths, the major manner of death was 44.6% (228/511 cases) by accidents, 34.1% (174/511 cases) by suicide, 13.5% (69/511 cases) undetermined, and 7.8% (40/511 cases) by homicide. Among the unnatural deaths, the major causes of death was 38.4% (196/511 cases) by trauma, 20.4% (104/511 cases) by poisoning, and 17.6% (90/511 cases) by asphyxia. Falling was the major cause of death by trauma (58.7%, 115/196 cases), and strangulation was the major cause of death by asphyxia (75.6%, 68/90 cases). Among the natural deaths, heart disease was the major cause (46.7%, 240/514 cases), followed by endocrine, nutritional and metabolic diseases (14.0%, 72/514 cases). A time-series statistical analysis and comparison of the manner and cause of deaths in this province may facilitate more advanced interpretations relating to both public safety and healthcare in the future.

We analyzed the manner and cause of death in 1,193 forensic autopsies from the Jungbu province (central part of South Korea) conducted by the National Forensic Service Daejeon Institute in 2022. Analysis of the manner of deaths revealed that 43.1% (514/1,193 cases) were natural deaths; 42.8% (511/1,193 cases) were unnatural deaths; and 14.1% (168/1,193 cases) were unknown. Among the unnatural deaths, the major manner of death was 44.6% (228/511 cases) by accidents, 34.1% (174/511 cases) by suicide, 13.5% (69/511 cases) undetermined, and 7.8% (40/511 cases) by homicide. Among the unnatural deaths, the major causes of death was 38.4% (196/511 cases) by trauma, 20.4% (104/511 cases) by poisoning, and 17.6% (90/511 cases) by asphyxia. Falling was the major cause of death by trauma (58.7%, 115/196 cases), and strangulation was the major cause of death by asphyxia (75.6%, 68/90 cases). Among the natural deaths, heart disease was the major cause (46.7%, 240/514 cases), followed by endocrine, nutritional and metabolic diseases (14.0%, 72/514 cases). A time-series statistical analysis and comparison of the manner and cause of deaths in this province may facilitate more advanced interpretations relating to both public safety and healthcare in the future.

This case report details a rare presentation of multifocal osteomyelitis with bilateral femoral pathologic fractures caused by Klebsiella pneumoniae sepsis in a 54-year-old female patient. In the initial evaluation, the patient presented with swelling and pain in the left lower limb. Imaging revealed multiple liver abscesses and deep vein thrombosis. Further bone scan assessments confirmed extensive osteolytic lesions in the femurs and left tibias, which is consistent with multifocal osteomyelitis. Initial management involved broad-spectrum antibiotics and debridement. On the other hand, temporary circular wiring and intramedullary nailing were required for stabilization as fractures developed in both femurs, including additional fixation for a fracture at the curettage site on the contralateral femur. Infected tibial lesions were treated with antibiotic-loaded cement beads after abscess drainage to control local infection. Despite the complexities, the patient ultimately achieved bone union after a year-long recovery, including dynamic conversion of femoral fixation. This paper reports a rare experience in treating multiple osteomyelitis and introduces the emergence of a highly pathogenic hypervirulent K. pneumoniae strain (hvKP), causing invasive infections, including metastatic and severe infections (e.g., osteomyelitis). Furthermore, the authors emphasize that early identification of hvKP and coordinated treatment strategies are crucial for improving the outcomes in severe hvKP-related infections.

We analyzed the manner and cause of death in 1,193 forensic autopsies from the Jungbu province (central part of South Korea) conducted by the National Forensic Service Daejeon Institute in 2022. Analysis of the manner of deaths revealed that 43.1% (514/1,193 cases) were natural deaths; 42.8% (511/1,193 cases) were unnatural deaths; and 14.1% (168/1,193 cases) were unknown. Among the unnatural deaths, the major manner of death was 44.6% (228/511 cases) by accidents, 34.1% (174/511 cases) by suicide, 13.5% (69/511 cases) undetermined, and 7.8% (40/511 cases) by homicide. Among the unnatural deaths, the major causes of death was 38.4% (196/511 cases) by trauma, 20.4% (104/511 cases) by poisoning, and 17.6% (90/511 cases) by asphyxia. Falling was the major cause of death by trauma (58.7%, 115/196 cases), and strangulation was the major cause of death by asphyxia (75.6%, 68/90 cases). Among the natural deaths, heart disease was the major cause (46.7%, 240/514 cases), followed by endocrine, nutritional and metabolic diseases (14.0%, 72/514 cases). A time-series statistical analysis and comparison of the manner and cause of deaths in this province may facilitate more advanced interpretations relating to both public safety and healthcare in the future.

Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs.13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient’s prognosis.