Introduction: Tinea imbricata (TI) outbreak poses a significant health burden among indigenous populations in rainforest regions due to their geographical isolation and poor socioeconomic conditions. This study aimed to investigate the epidemiological trends, antifungal susceptibility patterns, and treatment outcomes of TI among the Bateq subtribe in Pahang, Malaysia. Materials and Methods: A cross-sectional survey was conducted between July–October 2023 in five villages within the National Rainforest Park, Malaysia. Socio-demographic characteristics, clinical manifestations, and treatment outcomes were collected through interviews, laboratory investigations, and clinical examinations. Treatment modalities were evaluated for their effectiveness in reducing disease burden. Results: 569 individuals were surveyed, revealing a TI prevalence rate of 7.91% with children aged 15 years and below exhibiting the highest susceptibility (9.22%). Antifungal susceptibility testing of clinical isolates of Trichophyton concentricum demonstrated high sensitivity to terbinafine (GM MIC=0.144 μg/ml, GM MFC=0.198 μg/ml, p<0.05) and griseofulvin (GM MIC=1.741 μg/ml, GM MFC=4.782 μg/ml, p<0.05), while clotrimazole showed moderate activity (GM MIC=5.897 μg/ml, GM MFC=22.291 μg/ml). Fluconazole demonstrated the least potency, with no fungicidal activity observed at concentrations up to 128 μg/ml. Treatment outcomes indicated that combination therapy (terbinafine gel and oral griseofulvin) significantly outperformed terbinafine gel alone, achieving an almost complete lesion resolution (LA reduced to 0.158±0.158 cm versus 3.684±1.522 cm , p<0.05). Conclusion: These findings provide critical insights into the epidemiology and emerging drug resistance of TI in the Bateq subtribe, highlighting the importance of continued surveillance, monitoring, and adaptation of treatment strategies to combat evolving antifungal resistance patterns.

Purpose: We investigated the ophthalmic manifestations of Korean patients with Williams syndrome registered at a single regional rare disease center over the past 30 years. Methods: We conducted a retrospective analysis of the medical records of 19 patients who underwent complete ophthalmic examinations among 56 patients diagnosed with Williams syndrome and enrolled between September 1994 and August 2024. Results: Nineteen patients with Williams syndrome (7 boys and 12 girls) underwent their first ophthalmic examination at a mean age of 2.6 ± 2.8 years and were followed for 5.5 ± 5.1 years. Of these, 16 patients (84%) had cardiovascular abnormalities, 2 (11%) had infantile hypercalcemia, and 17 (89%) exhibited developmental delay. All patients displayed characteristic facial features with puffy eyelids. Congenital nasolacrimal duct obstruction occurred in 3 patients (16%) and resolved spontaneously. A stellate iris pattern involving approximately half the iris width was observed in 10 patients (53%). Strabismus was present in 13 patients (68%), including 6 with exotropia (1 with Duane retraction syndrome type 2) and 7 with esotropia. At the final refractive assessment (mean age 8.1 ± 2.5 years), 4 patients had hyperopia, 4 had myopia (including 1 with high myopia), 4 had astigmatism, and 3 had anisometropia; 7 patients (37%) required spectacle correction. Of the 11 patients with measurable visual acuity, 5 (45%) had amblyopia. Retinal vascular tortuosity was observed in 11 patients (58%), and attenuated retinal vessels in 10 (53%). Optical coherence tomography performed in 5 patients with normal visual acuity revealed markedly reduced central macular thickness in all, and a wide foveal pit in 1 patient. Conclusions Williams syndrome is associated with diverse ophthalmic manifestations that warrant regular and comprehensive ophthalmic follow-up.

Background: Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is among the most important multidrug-resistant pathogens causing bloodstream infections (BSIs).Cefotaximase (CTX-M) enzymes are the most common and highly diverse ESBL family in E.coli. CTX-M-15 in group CTX-M-1 and CTX-M-14 in group CTX-M-9 are the most extensively disseminated enzymes. Multidrug-resistant E. coli strains complicate empirical therapy and increase healthcare burden globally and in Korea. We investigated the molecular epidemiology, sequence types (STs), and ESBL genotypes of E. coli bloodstream isolates in Korea and identified clinical risk factors for cefotaxime resistance. Methods: We collected all non-duplicated isolates of E. coli and related clinical information from patients with BSIs at eight sentinel hospitals in the Korean Global Antimicrobial Resistance Surveillance System (Kor-GLASS) collection network during 2017–2021. Duplicate isolates were removed to ensure representativeness of the data. Antimicrobial susceptibility was tested using disk diffusion tests, and multilocus sequence typing and betalactamase genotyping were performed. Results: Among 9,232 E. coli blood isolates, resistance rates to cefotaxime and ceftazidime were 36.4% and 11.4%, respectively. Among the clinical factors, age > 65 yrs (adjusted odds ratio [aOR], 1.36), hospital-origin infection (aOR, 2.55), and admission type (intensive care unit [ICU] vs. general ward; aOR, 1.34) were significant cefotaxime resistance risk factors. ST131 was the most prevalent among cefotaxime-resistant E. coli (64.8%, 2,180/3,363), followed by ST1193 (5.3%, N = 177), and ST69 (5.1%, N = 170).ST131, ST648, ST405, and ST410 cefotaxime-resistant E. coli isolates frequently harbored blaCTX-M-15, whereas ST1193 and ST68 showed a high proportion of blaCTX-M-27 carriers, and most ST457 and ST5150 isolates carried blaCTX-M-55. Conclusions Continuous monitoring of ESBL-producing E. coli is required to prevent further dissemination, guide empirical therapy, inform infection control policies, and ensure early detection of multidrug-resistant clones with the potential for widespread transmission.

Background: The spread of antimicrobial-resistant bacteria has close relationships among humans, animals, and the environment, necessitating the implementation of the “One Health” approach. In previous study, the prevalence and molecular epidemiology of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) were investigated across multiple pig industry sectors in Korea. In this study, animal developmental stages and antimicrobial usage policies on farms were also considered. Methods: A total of 6,288 non-duplicated samples were collected from pig farms, slaughterhouses, and their personnel from three provinces in Korea between 2020 and 2022.Antimicrobial susceptibility and ESBL gene characterization were performed on the samples. Results: Overall, 1,084 ESBL-EC isolates were collected, with positivity detection rates of 24.7%, 23.3%, 12.7%, 3.9%, 17.2% in pigs, workers, the environment, meat, and total samples, respectively. Common ESBL types were blaCTX-M-55 (N = 628), blaCTX-M-15 (N = 204), and blaCTX-M-14 (N = 127). Pig-derived E. coli isolates had antimicrobial resistance (AMR) rates of 80.4%, 47.2%, 32.6%, 36.7%, 43.4%, 62.4%, and 72.1% to ampicillin, piperacillin, cefazoline, ciprofloxacin, cotrimoxazole, chloramphenicol, and tetracycline, respectively.AMR rates were lower in the finishing stage pigs than in the lactating stage pigs and tended to decrease during animal development for most antimicrobials. AMR rates were higher in pig farms with a customary antimicrobial use policy than in those with a low-level antimicrobial use policy. Conclusions The findings highlight the significance of elucidating AMR networks among humans, animals, and the environment. Prudent antimicrobial usage and continuous AMR monitoring in the pig industry are crucial to safeguard food safety.

Purpose: Despite the global paradigm emphasizing earlier and more aggressive intervention for youth-onset type 2 diabetes mellitus (T2DM), metformin and insulin are the only drugs approved for Korean adolescents. We investigated the incidence of complications, changes in glycemic control during the transition period, the effect of second-line antidiabetic agents on glycemic control in young adults with youth-onset T2DM. Methods: Eighty-four patients diagnosed with T2DM at Seoul National University Children's Hospital between January 2001 and July 2023, before age 18 (47 males; mean age, 14 years) with available glycated hemoglobin (HbA1c) data from at least 2 distinct ages between 19 and 22 years old were retrospectively enrolled. Results: At the last follow-up (mean age, 24.9 years; median follow-up, 9.6 years), complications were found in 33.7% (nephropathy, 25.3%; eye disease, 20.6%), and 83% required insulin or second-line agents. During the transition period, HbA1c levels decreased from 8.2% at age 19 to 7.7% at age 22 (P<0.01), with greater improvements in females, those diagnosed before age 15, and those with HbA1c levels ≥7% at age 19. HbA1c level decreased significantly at 1 year after the addition of second-line medications (P=0.03) and at the last visit (P=0.03) compared with baseline. Conclusion Glycemic control improved during the transition period among youth-onset T2DM patients. Given the high incidence of complications and the beneficial effects of second-line agents on glycemic control, there is an urgent need to expand the range of approved second-line agents, along with broader insurance coverage in adolescence.

Purpose: We aimed to compare broad-spectrum antibiotic use between hospice and nonhospice patients with cancer at the end of life using nationwide data from Korea. Methods: In this retrospective cohort study, we analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. We applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportions and days of therapy per 1,000 patient-days. Results: After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospiceand 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P＜0.001).The proportion of patients receiving broad-spectrum antibiotics was generally lower amonghospice users across all time intervals (P＜0.001), and the number of days of therapy wasalso lower, with the largest differences observed during the final week and last 3 days of life.Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group. Conclusion Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.

This study aims to investigate the association of lifestyle values with lifestyle and quality of life among community-dwelling late middle-aged and older adults. Methods: This retrospective cross-sectional study analyzed secondary data of 200 late middle-aged and older adults. Lifestyle and lifestyle values were measured by Yonsei Lifestyle Profile (YLP) and YLP-Value, respectively. The mediator was quality of life, and a mediation analysis was conducted to examine the relationship between lifestyle values, lifestyle, and quality of life. Our study then repeated the analysis by dividing lifestyle into three components: physical activity, nutrition/eating habit, and activity participation. Results: Mediation analysis revealed significant associations across all pathways (all p<.001). The lifestyle values were associated with lifestyle (β=.40). Both lifestyle value (β=.40) and lifestyle (β=.18) were positively associated with quality of life. The indirect effect of lifestyle values on quality of life, mediated by lifestyle, accounted for 14.58% of the total effect, with the direct effect constituting 85.42%. Conclusion: Among the three components of lifestyle, a mediation effect was observed between lifestyle values, nutrition/eating habit, and quality of life. Our results indicate the need for education to increase lifestyle values within lifestyle programs, emphasizing the significance of lifestyle values in enhancing both lifestyle and quality of life among late middle-aged and older adults. Health professionals may integrate the results into interventions by recognizing the importance of lifestyle values.

Purpose: The Dietary Reference Intakes for Koreans (KDRIs) serve as a foundation for nutrition policy, nutrition education, and dietary intake evaluation among healthy Koreans.The KDRIs are revised every five years to ensure that the guidelines are based on a robust and up-to-date scientific foundation. For the 2025 KDRIs for calcium, the 2020 KDRIs were revisited, and references were critically evaluated. Methods: All references cited in the 2020 KDRIs were extracted, reviewed, and organized according to the framework for the estimated average requirement (EAR). Each reference was evaluated based on the participant characteristics, including age, race/ethnicity, and health status, as well as study design, exposure, and outcomes. In addition, calculations for the EAR and Recommended Nutritient Intakes were re-examined for each sex and age group and compared with the current literature. Results: Major revisions in the 2025 KDRIs were driven by updates in the reference bodyweight, improved consistency in rounding and coefficients of variation, inclusion of studies in East Asian populations, and clarification of the use of calcium balance studies.Nevertheless, further studies in Koreans, particularly in pregnant and lactating women, are needed to strengthen the scientific evidence for the calcium DRI. Conclusion The 2025 KDRIs for calcium were revised to be based on more robust logical reasoning and calculation methods. Future research conducted on Korean populations is necessary to define the calcium requirements for Koreans more accurately.

Purpose: This study aimed to evaluate age- and sex-specific dietary vitamin B12 intake among Koreans, assess adequacy relative to the 2025 Korean Dietary Reference Intakes, and identify major food groups using nationally representative data from the 2022–2024 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: Data from 19,191 participants in the KNHANES 2022–2024 aged1 year and older were analyzed after excluding individuals with extreme energy intake values. Individual vitamin B12 intake was calculated based on 24-hour dietary recall data using the Korean National Standard Food Composition Database (version 10.3). Intake levels were evaluated against age- and sex-specific Estimated Average Requirement (EAR) and Recommended Nutrient Intake (RNI) values. Complex sample general linear models and cross-tabulation analyses were conducted to examine differences in intake and adequacy. Results: The mean vitamin B12 intake of the study population was 8.27 μg/day, exceeding the RNI in most age groups. The proportion of individuals meeting or exceeding the RNI was generally high; however, the prevalence of intake below the EAR increased with age, particularly among older women, approximately 35% of whom were at risk of inadequate intake. Animal-based foods, including fish and shellfish, meat, eggs, and dairy products, were the primary contributors to vitamin B12 intake. Adults and older adults with intake below the RNI consumed significantly lower amounts of these food groups compared with those meeting the RNI. Conclusion Although overall vitamin B12 intake among Koreans appears sufficient, older adults remain at increased risk of insufficient intake. Continuous monitoring of vitamin B12 nutritional status and targeted dietary strategies, with a focus on older populations, is warranted to prevent potential deficiencies.