Background and Objectives: Heart failure (HF) is a leading cause of hospitalization and death worldwide. The Steady Movement with Innovating Leadership for Heart Failure (SMILE HF) aims to evaluate the clinical characteristics, management, hospital course, and long-term outcomes of patients hospitalized for acute HF in South Korea. Methods: This prospective, observational multicenter cohort study was conducted on consecutive patients hospitalized for acute HF in nine university hospitals since September 2019. Enrolment of 2000 patients should be completed in 2024, and follow-up is planned through 2025. Results: Interim analysis of 1,052 consecutive patients was performed to understand the baseline characteristics. The mean age was 69±15 years; 57.6% were male. The mean left ventricular ejection fraction was 39±15%. The prevalences of HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction were 50.9%, 15.3%, and 29.2%. Ischemic cardiomyopathy (CMP) was the most common etiology (32%), followed by tachycardia-induced CMP (12.8%) and idiopathic dilated CMP (9.5%). The prescription rate of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers/angiotensin receptor/ neprilysin inhibitor, beta-blockers, spironolactone, and sodium-glucose cotransporter-2 inhibitors at discharge were 76.8%, 66.5%, 50.0%, and 17.5%, respectively. The post-discharge 90-day mortality and readmission rates due to HF aggravation were 2.0% and 6.4%, respectively. Our analysis reveals the current state of acute HF in South Korea. Conclusions Our interim analysis provides valuable insights into the clinical characteristics, management, and early outcomes of acute HF patients in South Korea, highlighting the current state and treatment patterns in this population.

Background: Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) can cause more rapid progression to cirrhosis than HCV-monoinfection. In this study, incident HCV case (IHCV)s were investigated in a HIV clinic in Korea. Materials and Methods: A retrospective HIV cohort was constructed who visited National Medical Center in Korea from 2013 to 2022 and performed ≥ 1 anti-HCV antibody tests (anti-HCV) during the study period. IHCV was defined as newly confirmed HCV infection by PCR with a prior negative anti-HCV and factors associated with IHCV were investigated among alanine aminotransferase (ALT) >150 IU/mL sub-cohort without plausible reasons for ALT elevation. Results: Overall, 2,567 HIV clinic visitors were recruited during the study period and 42 (1.63%) were confirmed as HIV/HCV co-infection. Fifteen IHCVs were identified during the study period. While no IHCV was observed in 2013–2015, incidence of 2016–2019 and 2020–2022 were 0.84 and 1.48 per 1000 person-year, respectively. Subtype 1a were more common among IHCVs in 2020–2022 (8/9) while subtype 2 dominated in 2016–2019 (5/6, P=0.003). Most IHCVs were identified during the evaluation of de novo liver enzyme elevation which was identified through the regularly performed blood tests (86.7%, 13/15). Comparing twelve IHCVs with ALT>150 IU/mL with 58 HIV mono-infection comparators whose peak ALT exceeded 150 IU/mL during the study period, age, sex, HIV/HCV infection risk factor, CD4 cell count, and HIV-RNA viral load were not different between two groups. However, mean peak ALT of IHCVs was higher than comparators (776 vs. 237, P<0.001) and syphilis treatment within prior 24 months of ALT elevation was more common in IHCV group (41.7% vs. 12.7%, P=0.026). Conclusion Incidence rate of HCV among PLH revealed increasing trend between 2013 and 2022 among visitors at a HIV clinic in Korea. Subtype 1a dominated among IHCVs after 2020 and recent syphilis treatment was associated with IHCVs.

Background: Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) can cause more rapid progression to cirrhosis than HCV-monoinfection. In this study, incident HCV case (IHCV)s were investigated in a HIV clinic in Korea. Materials and Methods: A retrospective HIV cohort was constructed who visited National Medical Center in Korea from 2013 to 2022 and performed ≥ 1 anti-HCV antibody tests (anti-HCV) during the study period. IHCV was defined as newly confirmed HCV infection by PCR with a prior negative anti-HCV and factors associated with IHCV were investigated among alanine aminotransferase (ALT) >150 IU/mL sub-cohort without plausible reasons for ALT elevation. Results: Overall, 2,567 HIV clinic visitors were recruited during the study period and 42 (1.63%) were confirmed as HIV/HCV co-infection. Fifteen IHCVs were identified during the study period. While no IHCV was observed in 2013–2015, incidence of 2016–2019 and 2020–2022 were 0.84 and 1.48 per 1000 person-year, respectively. Subtype 1a were more common among IHCVs in 2020–2022 (8/9) while subtype 2 dominated in 2016–2019 (5/6, P=0.003). Most IHCVs were identified during the evaluation of de novo liver enzyme elevation which was identified through the regularly performed blood tests (86.7%, 13/15). Comparing twelve IHCVs with ALT>150 IU/mL with 58 HIV mono-infection comparators whose peak ALT exceeded 150 IU/mL during the study period, age, sex, HIV/HCV infection risk factor, CD4 cell count, and HIV-RNA viral load were not different between two groups. However, mean peak ALT of IHCVs was higher than comparators (776 vs. 237, P<0.001) and syphilis treatment within prior 24 months of ALT elevation was more common in IHCV group (41.7% vs. 12.7%, P=0.026). Conclusion Incidence rate of HCV among PLH revealed increasing trend between 2013 and 2022 among visitors at a HIV clinic in Korea. Subtype 1a dominated among IHCVs after 2020 and recent syphilis treatment was associated with IHCVs.

Background: Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) can cause more rapid progression to cirrhosis than HCV-monoinfection. In this study, incident HCV case (IHCV)s were investigated in a HIV clinic in Korea. Materials and Methods: A retrospective HIV cohort was constructed who visited National Medical Center in Korea from 2013 to 2022 and performed ≥ 1 anti-HCV antibody tests (anti-HCV) during the study period. IHCV was defined as newly confirmed HCV infection by PCR with a prior negative anti-HCV and factors associated with IHCV were investigated among alanine aminotransferase (ALT) >150 IU/mL sub-cohort without plausible reasons for ALT elevation. Results: Overall, 2,567 HIV clinic visitors were recruited during the study period and 42 (1.63%) were confirmed as HIV/HCV co-infection. Fifteen IHCVs were identified during the study period. While no IHCV was observed in 2013–2015, incidence of 2016–2019 and 2020–2022 were 0.84 and 1.48 per 1000 person-year, respectively. Subtype 1a were more common among IHCVs in 2020–2022 (8/9) while subtype 2 dominated in 2016–2019 (5/6, P=0.003). Most IHCVs were identified during the evaluation of de novo liver enzyme elevation which was identified through the regularly performed blood tests (86.7%, 13/15). Comparing twelve IHCVs with ALT>150 IU/mL with 58 HIV mono-infection comparators whose peak ALT exceeded 150 IU/mL during the study period, age, sex, HIV/HCV infection risk factor, CD4 cell count, and HIV-RNA viral load were not different between two groups. However, mean peak ALT of IHCVs was higher than comparators (776 vs. 237, P<0.001) and syphilis treatment within prior 24 months of ALT elevation was more common in IHCV group (41.7% vs. 12.7%, P=0.026). Conclusion Incidence rate of HCV among PLH revealed increasing trend between 2013 and 2022 among visitors at a HIV clinic in Korea. Subtype 1a dominated among IHCVs after 2020 and recent syphilis treatment was associated with IHCVs.

Purpose: The use of an ostomy for urination and defecation leads to reduced quality of life. Although many ostomy management strategies are needed, such strategies are often implemented by patients. Thus, there is a need for a home health care service platform that can be used in ostomy patient management. Methods: We developed an ostomy patient management platform by identifying the needs of patients and medical staff through the Chronic Care Ostomy Self-Management Training Program in the United States and from studies conducted in Korea. Results: The platform encompassed physical management, psychological management, maintenance of social function, spiritual stability, and home medical care. These components were implemented through monitoring, self-care guidance, and a community platform. For the monitoring function, patients entered their health status in a mobile application (app); the medical staff at the affiliated hospital then monitored the stoma status through a web interface. Conclusion Our platform allows medical staff to monitor ostomy patients through a web interface and help such patients to fully manage their ostomy at home using an app. We expect that the continued development of patient-oriented functions in our app will allow ostomy patients to experience quality-of-life improvements.

Background: Older adults are at a higher risk of severe adverse drug events (ADEs) because of multimorbidity, polypharmacy, and lower physiological function. This study aimed to determine whether polypharmacy, defined as the use of ≥ 5 active drug ingredients, was associated with severe ADEs in this population. Methods: We used ADE reports from the Korea Institute of Drug Safety and Risk Management-Korea Adverse Event Reporting System Database, a national spontaneous ADE report system, from 2012 to 2021 to examine and compare the strength of association between polypharmacy and severe ADEs in older adults (≥ 65 years) and younger adults (20–64 years) using disproportionality analysis. Results: We found a significant association between severe ADEs of cardiac and renal/ urinary Medical Dictionary for Regulatory Activities System Organ Classes (MedDRA SOC) with polypharmacy in older adults. Regarding individual-level ADEs included in these MedDRA SOCs, acute cardiac arrest and renal failure were more significantly associated with polypharmacy in older adults compared with younger adults. Conclusion The addition of new drugs to the regimens of older adults warrants close monitoring of renal and cardiac symptoms.

Objectives: This study aimed to analyze trends in the timely diagnosis of malaria cases over the past 10 years in relation to the utilization of different types of healthcare facilities. Methods: The study included 3,697 confirmed and suspected cases of malaria reported between January 1, 2013, and December 31, 2022, in the national integrative disease and healthcare management system. Some cases lacking a case report or with information missing from the case report were excluded from the analysis. A generalized linear model with a Poisson distribution was constructed to estimate rate ratios and 95% confidence intervals adjusted for other variables, such as distance. Results: When cases involving diagnosis >5 days after symptom onset in confirmed patients (5DD) were examined according to the type of healthcare facility, the rate ratio of 5DD cases was found to be higher for public health facilities than for tertiary hospitals. Specifically, the rate ratio was higher when the diagnosis was established at a tertiary hospital, even after a participant had visited primary or secondary hospitals. In an analysis adjusted for the distance to each participant’s healthcare facility, the results did not differ substantially from the results of the crude analysis. Conclusion It is imperative to improve the diagnostic capabilities of public facilities and raise awareness of malaria at primary healthcare facilities for effective prevention and control.

Background: There are several differences in the clinical course of hypertension due to the biological and social differences between men and women. Resistant hypertension is an advanced disease state, and significant gender difference could be expected, but much has not been revealed yet. The purpose of this study was to compare gender differences on the current status of blood pressure (BP) control and clinical prognosis in patients with resistant hypertension. Methods: This is a multicenter, retrospective cohort study using common data model databases of 3 tertiary hospitals in Korea. Total 4,926 patients with resistant hypertension were selected from January 2017 to December 2018. Occurrence of dialysis, heart failure (HF) hospitalization, myocardial infarction, stroke, dementia or all-cause mortality was followed up for 3 years. Results: Male patients with resistant hypertension were younger but had a higher cardiovascular risk than female patients. Prevalence of left ventricular hypertrophy and proteinuria was higher in men than in women. On-treatment diastolic BP was lower in women than in men and target BP achievement rate was higher in women than in men.During 3 years, the incidence of dialysis and myocardial infarction was higher in men, and the incidence of stroke and dementia was higher in women. After adjustment, male sex was an independent risk factor for HF hospitalization, myocardial infarction, and all-cause death. Conclusion In resistant hypertension, men were younger than women, but end-organ damage was more common and the risk of cardiovascular event was higher. More intensive cardiovascular prevention strategies may be required in male patients with resistant hypertension.

Educational evaluation involves data collection and the analysis of various education-related factors to make decisions that improve educational quality. Systematic educational evaluation is essential for enhancing the quality of education. This study reports a case of student-conducted process evaluation of a medical school’s student support system and the procedure for devising improvement plans. Sixteen Inje University College of Medicine students participated in the Education Evaluation Committee (IUCM-EEC) to understand the educational improvement process as learners and actively achieve improvement. The Quality Improvement Committee of the Inje University College of Medicine (IUCM-QIC) decided to reform its student support system based on a previous educational evaluation in 2019. The evaluation of the student support system was conducted for 10 months in 2021 by the student subcommittee, under the guidance of the IUCM-EEC. The CIPP (context-input-process-product) evaluation model was used for a systematic evaluation. Accordingly, the subcommittee developed evaluation criteria and indicators, and analyzed relevant data collected from surveys and the previous literature. For further recommendations and revision ideas, the student subcommittee members interviewed faculty members from six other medical schools and also conducted a focus group interview with the dean and vice deans of IUCM. Finally, the student subcommittee submitted a report to the IUCM-QIC. Communication with various stakeholders is essential for a successful evaluation process. In this case, students, as key stakeholders in education, evaluated the student support system. Their active participation helped improve their understanding of the evaluation process.

Background: There is growing evidence that abnormal liver function tests (LFTs) are common in patients with coronavirus disease 2019 (COVID-19). However, it is not known whether viral involvement in the liver differs according to the strain. We investigated the impact on liver injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) variants. Materials and Methods: We conducted a single-center, retrospective cohort study, including 372 patients admitted during the pre-Delta period (PDP: between February 1 and November 30, 2020) and 137 patients admitted during the Delta period (DP: between August 1 and August 31, 2021). Initial liver injury was defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels ≥3 × the upper limit of normal (ULN) or alkaline phosphatase (ALP) or total bilirubin ≥2 × the ULN within 3 days from admission. Results: Of 509 patients with COVID-19 included in our study, 38 (7.5%) patients had initial liver injury. The DP group had a significantly higher rate of initial liver injury than the PDP group (PDP: 5.9% vs. DP: 11.7%, P = 0.028). The DP group (adjusted odds ratio [aOR]: 2.737, 95% confidence interval [CI]: 1.322 – 5.666) was independently associated with initial liver injury. During hospitalization, 160 (31.4%) patients had severe COVID-19. The DP group and initial liver injury had higher odds of progressing to severe COVID-19 (aOR: 2.664, 95% CI: 1.526 - 4.648, and aOR: 4.409, 95% CI: 1.816 - 10.707, respectively). The mediation analysis suggested that initial liver injury mediates the relationship between SARS-CoV-2 Delta variant infection and severe COVID-19 (unstandardized beta coefficient = 0.980, Standard error = 0.284, P = 0.001). Conclusion Initial liver injury is more common in COVID-19 patients with Delta variants. Also, Delta variants and initial liver injury are associated with poor clinical outcomes.