Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea. Methods: All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness. Results: The median age was 40 years (range, 20–73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required supplemental oxygen therapy, but no one needed mechanical ventilation. Lymphopenia was more common in severe cases. Higher level of C-reactive protein and worsening of chest radiographic score was observed during the 5–7 day period after symptom onset. Viral shedding was high from day 1 of illness, especially from the upper respiratory tract (URT). Conclusion The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community.

This nationwide, prospective cohort study evaluated pulmonary function and radiological sequelae according to infection severity in 73 survivors from the 2015 Middle East respiratory syndrome (MERS) outbreak in Korea. Patients with severe pneumonia in MERS-coronavirus infection had more impaired pulmonary function than those with no or mild pneumonia at the 1-year follow-up, which was compatible with the radiological sequelae. Severe pneumonia significantly impairs pulmonary function and makes long radiological sequelae in MERS.
Cohort Studies ; Coronavirus ; Coronavirus Infections* ; Follow-Up Studies ; Humans ; Korea ; Middle East* ; Pneumonia* ; Prospective Studies ; Survivors

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Kidney*

BACKGROUND/AIMS: Renal aging-related changes are characterized by oxidative stress. SIRT1 regulates cellular conditions by activating Nrf2. The present study investigated the processes of renal changes by antioxidant enzymes and the relationship between SIRT1 and Nrf2. METHODS: We used male 2-, 12-, and 24-month-old C57BL/6 mice. We measured renal function, histological changes, oxidative stress, and expression of SIRT1–Nrf2 signaling in the kidneys. RESULTS: 24-month-old mice exhibited increased albuminuria and serum creatinine. Creatinine clearance was decreased in 24-month-old mice compared with 12-month-old mice. There were increases in mesangial volume and tubulointerstitial fibrosis in 24-month-old mice. Moreover, oxidative stress marker, 3-Nitrotyrosine, expression and apoptosis were increased in 24-month-old mice. The 24 h urinary 8-isoprostane and 8-hydroxy-deoxyguanosine excretion increased with aging. The levels of expression of SIRT1 and nuclear Nrf2 were decreased in 24-month-old mice. The antioxidant enzymes HO-1 and NQO-1 were down-regulated in 24-month-old mice. Another antioxidant enzyme, SOD2, was decreased in 24-month-old mice. CONCLUSIONS: Our results demonstrated that SIRT1 was down-regulated with aging, and this may be related to changes in the expression of target molecules including Nrf2. As a result, oxidative stress was induced. The pharmacological targeting of these signaling molecules may reduce the pathological changes associated with aging in the kidney.
Aging ; Albuminuria ; Animals ; Apoptosis ; Child, Preschool ; Creatinine ; Fibrosis ; Humans ; Infant ; Kidney* ; Male ; Mice ; NF-E2-Related Factor 2 ; Oxidative Stress ; Sirtuin 1

PURPOSE: Deep vein thrombosis (DVT) is a severe and common complication that occurs after the major operation. Despite the commonality of DVT there is limited data on the incidence of DVT after kidney transplantation (KT). Furthermore, most studies have been retrospective in design and were conducted in western countries. The aim of this study was to evaluate the incidence of lower extremity DVT with mechanical thromboprophylaxis within 1 month of KT in Korea. METHODS: A total of 187 consecutive patients who underwent KT were included in this study. Patients used a graduated elastic stocking (n = 93) or an intermittent pneumatic compression device (n = 94) to prevent DVT. The frequency of DVT during the first month after KT was evaluated using serial color duplex ultrasound on postoperative days 7 +/- 2, 14 +/- 2, and 28 +/- 3. All patients were tested for eight thrombophilic factors before KT. RESULTS: DVT occurred in four patients (2.1%) during the first month after KT. All DVT developed in the graduated elastic stocking group. Interestingly, none of the patients had the factor V Leiden mutation or the prothrombin gene 20210A mutation. CONCLUSION: The incidence of DVT in this study was relatively lower than that of western populations. We did not encounter a factor V Leiden mutation or a prothrombin gene 20210A mutation in our study population. These findings suggest that inherited thrombophilic risk factors may be partially responsible for the difference in DVT incidence rates between different nationalities and/or ethnicities.
Ethnic Groups ; Factor V ; Humans ; Incidence ; Kidney Transplantation* ; Korea ; Lower Extremity* ; Prothrombin ; Retrospective Studies ; Risk Factors ; Stockings, Compression ; Ultrasonography ; Venous Thrombosis*

PURPOSE: Immediate identification of bacterial meningitis (BM) is essential in the emergency department. However, diagnosis of BM from analysis of cerebrospinal fluid has low sensitivity. The goal of this study was to determine the ability of serum procalcitonin (PCT) and C-reactive protein (CRP) for differentiation between BM and non-BM in adult patients. METHODS: This retrospective cohort study, which was conducted from Jan 1 2008 to Sep 30 2011, included patients with a diagnosis of meningitis based on compatible clinical features and cerebrospinal fluid (CSF) culture findings with a CSF leukocyte count > 5 /microL. Measurement of Serum PCT and CRP level was performed on initial admission to the emergency department. Patients were divided into two groups, according to the type of meningitis: BM or non-BM. Clinical features, laboratory results, including CSF results, serum PCT, and CRP levels were assessed. RESULTS: A total of 63 patients (age, 49+/-19) with confirmed meningitis were admitted: 43 patients with non-BM and 20 patients with BM. Significantly higher PCT and CRP levels, CSF white blood cell and neutrophil count, CSF glucose, and protein levels were observed in the BM group. The most highly discriminative parameters for differential diagnosis of BM proved to be serum PCT, with a sensitivity of 90%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 96% at a diagnostic cut-off level of 1.0 ng/mL (area under the curve 0.98; 95% confidence interval 0.00-1.00) and CRP, with a sensitivity of 85%, a specificity of 88%, a positive predictive value of 77%, a negative predictive value of 93% at a diagnostic cut-off level of 6.0 mg/dL (area under the curve 0.91; 95% confidence interval 0.76-0.97). CONCLUSION: Serum PCT and CRP levels appear to be the most highly discriminative parameters for differential diagnosis of BM and non-BM.
Adult ; C-Reactive Protein ; Calcitonin ; Cohort Studies ; Diagnosis, Differential ; Emergencies ; Glucose ; Humans ; Leukocyte Count ; Leukocytes ; Meningitis ; Meningitis, Bacterial ; Neutrophils ; Protein Precursors ; Retrospective Studies ; Sensitivity and Specificity

Poikiloderma vasculare atrophicans (PVA) is a rare variant of mycosis fungoides, and is characterized by generalized hyperkeratotic scaly papules in net-like, retiform, or zebra-like patterns. A 59-year-old Korean woman presented with asymptomatic, erythematous-to-violaceous, reticulated confluent papules on the trunk and extremities. Skin lesions were initially limited to both thighs 25 years ago, and then spread slowly over her body. Histopathological examination showed band-like inflammatory infiltrations and epidermotropism consisting of mostly CD8+ lymphocytes. Based on the clinical manifestations and histological findings, the diagnosis of PVA was made. We herein report on a case of PVA, which featured a long-benign course without progression into the tumor stage over a period of 30 years.
Extremities ; Female ; Humans ; Lymphocytes ; Middle Aged ; Mycosis Fungoides ; Skin ; Thigh

PURPOSE: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. MATERIALS AND METHODS: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. RESULTS: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9 (range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. CONCLUSION: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.
Amputation ; Ankle Joint ; Diabetes Mellitus ; Diabetic Foot ; Extremities ; Foot ; Humans ; Incidence ; Lower Extremity ; Risk Factors

Fluconazole is a fungistatic agent that is used for treating systemic and superficial fungal infections like onychomycosis and tinea pedis. Various adverse effects of fluconazole have been reported regardless of the total dosage and the duration of treatment. We consider the number of patients who visit the emergency room with nonspecific symptoms that are related to antifungal agents are not inconsiderable. In this case, 44-year-old male patient experienced mental change during taking fluconazole to treat tinea pedis. The understanding of the side effects and the drug interactions with antifungal agents like fluconazole can help to treat patients with nonspecific symptoms that are related to antifungal agents.
Adult ; Antifungal Agents ; Consciousness ; Drug Interactions ; Emergencies ; Fluconazole ; Humans ; Hyperammonemia ; Male ; Onychomycosis ; Tinea ; Tinea Pedis

STUDY DESIGN: Case report OBJECTIVES: We report a case of relatively rare multiple bilateral perineural cysts. SUMMARY OF LITERATURE REVIEW: Tarlov cysts, also known as perineural cysts are most often found in the sacral region, but there are a few cases reported in the thoracic region. In particular, there are very few cases of multiple bilateral thoracic perineural cysts. MATERIALS AND METHODS: A woman aged 65 years with perineural cysts in the bilateral T10-T11 and T11-12 neural foramens, underwent a T10-11-12 decompressive laminectomy and resection of the cyst. RESULTS: Satisfactory results were obtained for the patient after surgery. CONCLUSIONS: For more detailed and definitive treatment of thoracic perineural cysts, additional cases are required.
Aged ; Female ; Humans ; Laminectomy ; Sacrococcygeal Region ; Tarlov Cysts