Intradiscal electrothermal therapy (IDET) is a minimally invasive procedure used to treat discogenic back pain and offers an alternative to surgical intervention in selected patients. Although it is generally considered safe, rare but significant complications can occur and may be difficult to diagnose because their symptoms overlap with those of other spinal conditions. We describe the case of a 69-year-old woman who presented with severe lower back and left buttock pain that was unresponsive to conservative treatment. Magnetic resonance imaging revealed disc bulging with a high-intensity zone at the L4–5 and L5–S1 levels. IDET was performed at the L4–5 level, resulting in initial pain relief. However, the patient returned 7 days later with recurrent pain. Despite undergoing percutaneous epidural neuroplasty at the left L5–S1 level, a medial branch block, and a piriformis muscle block, her symptoms persisted. Further evaluation with spinal computed tomography revealed a retroperitoneal hematoma near the left psoas muscle. Referred pain from the hematoma mimicked discogenic pain, resulting in delayed diagnosis and unnecessary interventions. The patient remained hemodynamically stable and gradually improved with conservative management alone. This case highlights retroperitoneal hematoma as a rare complication of IDET and emphasizes the importance of accurate and timely diagnosis in patients with persistent or worsening symptoms after spinal procedures. Clinicians should consider non-discogenic sources of pain when treatment outcomes deviate from expected patterns.

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Although glycopeptides remain the preferred treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, the treatment of persistent MRSA bacteremia has been challenging. We investigated real-world treatment strategies for persistent MRSA bacteremia, with a specific emphasis on the use of antimicrobial agents and the frequency of changes during the treatment course. We retrospectively identified patients with persistent MRSA bacteremia in four university-affiliated hospitals between 2017 and 2021. The primary objective of this study was to investigate the patterns of antimicrobial uses for MRSA bacteremia. The secondary objectives were evaluating the associated factors with 1) overall 30-day mortality and 2) changing agents during the treatment course. Time-dependent Cox regression analysis was used to adjust for immortal time bias. Among 116 patients, 37.1% underwent antimicrobials switching, primarily prompted by persistent bacteremia. The 30-day mortality rates of groups with and without antimicrobial switching were 21.4% and 44.2%, respectively (p=0.010 by log-rank test); however, after adjustment for immortal time bias, there was no statistical significance between the two groups (adjusted hazard ratio 0.24, 95% confidence interval 0.03–2.17, p=0.238). Only the Pitt bacteremia score on day 4 and pneumonia were associated with 30-day mortality. Meanwhile, the factors associated with antimicrobial switching were the duration of bacteremia, the initial use of teicoplanin, echocardiogram, and Charlson comorbidity index. This study showed that while over one-third of persistent MRSA bacteremia patients experience changes in antimicrobial agents during treatment, this practice does not significantly improve the 30-day mortality. Our study suggests the need for more effective treatment strategies in managing persistent MRSA bacteremia.

Although glycopeptides remain the preferred treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, the treatment of persistent MRSA bacteremia has been challenging. We investigated real-world treatment strategies for persistent MRSA bacteremia, with a specific emphasis on the use of antimicrobial agents and the frequency of changes during the treatment course. We retrospectively identified patients with persistent MRSA bacteremia in four university-affiliated hospitals between 2017 and 2021. The primary objective of this study was to investigate the patterns of antimicrobial uses for MRSA bacteremia. The secondary objectives were evaluating the associated factors with 1) overall 30-day mortality and 2) changing agents during the treatment course. Time-dependent Cox regression analysis was used to adjust for immortal time bias. Among 116 patients, 37.1% underwent antimicrobials switching, primarily prompted by persistent bacteremia. The 30-day mortality rates of groups with and without antimicrobial switching were 21.4% and 44.2%, respectively (p=0.010 by log-rank test); however, after adjustment for immortal time bias, there was no statistical significance between the two groups (adjusted hazard ratio 0.24, 95% confidence interval 0.03–2.17, p=0.238). Only the Pitt bacteremia score on day 4 and pneumonia were associated with 30-day mortality. Meanwhile, the factors associated with antimicrobial switching were the duration of bacteremia, the initial use of teicoplanin, echocardiogram, and Charlson comorbidity index. This study showed that while over one-third of persistent MRSA bacteremia patients experience changes in antimicrobial agents during treatment, this practice does not significantly improve the 30-day mortality. Our study suggests the need for more effective treatment strategies in managing persistent MRSA bacteremia.

Background: The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril. Methods: Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy. Results: The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk: 0.45, 95% CI [0.24, 0.85], absolute risk reduction: 29.8%, number needed to treat: 3). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group. Conclusions The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.

Purpose: We examined the association between age-related macular degeneration (AMD) and arthritis. Methods: Using data from the Korea National Health and Nutrition Examination Survey for 2017 and 2018, we conducted a complex sample analysis of 6,993 individuals with recorded information on AMD, as well as the diagnosis and treatment of osteoarthritis (OA) and rheumatoid arthritis (RA). We compared the diagnosis and treatment of arthritis between the AMD and control groups using logistic regression analysis, with a specific focus on the treatment among patients with arthritis. Results: In the AMD group (n = 1,118) and the control group (n = 5,875), univariate logistic regression analysis showed substantial differences in the diagnosis and treatment of OA and RA. However, after adjusting for age, alcohol consumption, diabetes mellitus, and hypertension in multivariate logistic regression analysis, these differences were no longer substantial. Among patients with OA (n = 246 in the AMD group and n = 821 in the control group), there was a significant association between AMD and OA treatments (odds ratio 1.511, 95% confidence interval 1.051-2.172). Conclusions Patients diagnosed with and treated for OA had a higher likelihood of concurrent AMD than those who did not receive treatment. Therefore, ophthalmic examinations and closer monitoring are recommended for these patients.

Although glycopeptides remain the preferred treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, the treatment of persistent MRSA bacteremia has been challenging. We investigated real-world treatment strategies for persistent MRSA bacteremia, with a specific emphasis on the use of antimicrobial agents and the frequency of changes during the treatment course. We retrospectively identified patients with persistent MRSA bacteremia in four university-affiliated hospitals between 2017 and 2021. The primary objective of this study was to investigate the patterns of antimicrobial uses for MRSA bacteremia. The secondary objectives were evaluating the associated factors with 1) overall 30-day mortality and 2) changing agents during the treatment course. Time-dependent Cox regression analysis was used to adjust for immortal time bias. Among 116 patients, 37.1% underwent antimicrobials switching, primarily prompted by persistent bacteremia. The 30-day mortality rates of groups with and without antimicrobial switching were 21.4% and 44.2%, respectively (p=0.010 by log-rank test); however, after adjustment for immortal time bias, there was no statistical significance between the two groups (adjusted hazard ratio 0.24, 95% confidence interval 0.03–2.17, p=0.238). Only the Pitt bacteremia score on day 4 and pneumonia were associated with 30-day mortality. Meanwhile, the factors associated with antimicrobial switching were the duration of bacteremia, the initial use of teicoplanin, echocardiogram, and Charlson comorbidity index. This study showed that while over one-third of persistent MRSA bacteremia patients experience changes in antimicrobial agents during treatment, this practice does not significantly improve the 30-day mortality. Our study suggests the need for more effective treatment strategies in managing persistent MRSA bacteremia.

Background: The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril. Methods: Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy. Results: The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk: 0.45, 95% CI [0.24, 0.85], absolute risk reduction: 29.8%, number needed to treat: 3). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group. Conclusions The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.

Background: The incidence of epistaxis during nasotracheal intubation via the left nostril is more frequent than that during intubation via the right nostril. This study evaluated the effect of the reverse bevel and tip direction of the nasotracheal tube on the incidence of epistaxis during nasotracheal intubation via the left nostril. Methods: Patients undergoing right-sided maxillofacial surgery requiring left nasotracheal intubation were randomly allocated to the control (tracheal tube in the conventional direction) or reverse (a 180˚ reverse direction, with the tube bevel facing the nasal septum and the leading edge (i.e., the tip) of the bevel pointing away from the nasal septum) groups (n = 37 for both). The primary outcome was the incidence of epistaxis evaluated using videolaryngoscopy. Results: The incidence of epistaxis in the reverse group was significantly lower than that in the control group (9 [24.3%] vs. 20 [54.1%], P = 0.009; relative risk: 0.45, 95% CI [0.24, 0.85], absolute risk reduction: 29.8%, number needed to treat: 3). The severity of epistaxis was significantly lower in the reverse group (P = 0.002). The first attempt nasal passage (P = 0.027) was significantly higher in the reverse group. Postoperative nasal pain was lower (P < 0.001), and patient satisfaction was higher (P < 0.001) in the reverse group. Nasotracheal tube-related complications did not occur in either group. Conclusions The reverse bevel and tip direction of the nasotracheal tube reduced the incidence and severity of epistaxis and increased patient satisfaction among patients undergoing left nasotracheal intubation.

Although glycopeptides remain the preferred treatment for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, the treatment of persistent MRSA bacteremia has been challenging. We investigated real-world treatment strategies for persistent MRSA bacteremia, with a specific emphasis on the use of antimicrobial agents and the frequency of changes during the treatment course. We retrospectively identified patients with persistent MRSA bacteremia in four university-affiliated hospitals between 2017 and 2021. The primary objective of this study was to investigate the patterns of antimicrobial uses for MRSA bacteremia. The secondary objectives were evaluating the associated factors with 1) overall 30-day mortality and 2) changing agents during the treatment course. Time-dependent Cox regression analysis was used to adjust for immortal time bias. Among 116 patients, 37.1% underwent antimicrobials switching, primarily prompted by persistent bacteremia. The 30-day mortality rates of groups with and without antimicrobial switching were 21.4% and 44.2%, respectively (p=0.010 by log-rank test); however, after adjustment for immortal time bias, there was no statistical significance between the two groups (adjusted hazard ratio 0.24, 95% confidence interval 0.03–2.17, p=0.238). Only the Pitt bacteremia score on day 4 and pneumonia were associated with 30-day mortality. Meanwhile, the factors associated with antimicrobial switching were the duration of bacteremia, the initial use of teicoplanin, echocardiogram, and Charlson comorbidity index. This study showed that while over one-third of persistent MRSA bacteremia patients experience changes in antimicrobial agents during treatment, this practice does not significantly improve the 30-day mortality. Our study suggests the need for more effective treatment strategies in managing persistent MRSA bacteremia.