Background: Although almost all interventional pulmonologists agree that rigid bronchoscopy is irreplaceable in the field of interventional pulmonology, less is known about the types of diseases that the procedure is used for and what difficulties the operators face during the procedure. The purpose of this study is to evaluate what diseases rigid bronchoscopy is used for, whether it is widely used, and what challenges the operators face in Korea. Methods: We enrolled 14 hospitals in this retrospective cohort of patients who underwent rigid bronchoscopy between 2003 and 2020. An online survey was conducted with 14 operators to investigate the difficulties associated with the procedure. Results: While the number of new patients at Samsung Medical Center (SMC) increased from 189 in 2003–2005 to 468 in 2018–2020, that of other institutions increased from 0 to 238.The proportion of SMC patients in the total started at 100% and steadily decreased to 59.2%.The proportion of malignancy as the indication for the procedure steadily increased from 29.1% to 43.0%, whereas post-tuberculous stenosis (25.4% to 12.9%) and post-intubation stenosis (19.0% to 10.9%) steadily decreased (all P for trends < 0.001). In the online survey, half of the respondents stated that over the past year they performed less than one procedure per month. The fewer the procedures performed within the last year, the more likely collaboration with other departments was viewed as a recent obstacle (Spearman correlation coefficient, r s = −0.740, P = 0.003) and recent administrative difficulties were encountered (r s = −0.616, P = 0.019). Conclusion This study demonstrated that the number of patients undergoing rigid bronchoscopy has been increasing, especially among cancer patients. For this procedure to be used more widely, it will be important for beginners to systematically learn about the procedure itself as well as to achieve multidisciplinary consultation.

Objective: The vulnerable and frail elderly individuals are at a compounded risk of worsening, rather than recovering, from external stress such as sepsis. Ambulation is majorly considered as a phenotype and determining factor of frailty. This study was undertaken to determine whether inability of ambulation is predictive for the prognosis of elderly patients afflicted with sepsis. Methods: Data were collected retrospectively from the medical records of an emergency medical center, from 1 November 2016 to 28 February 2017. Patients older than 65 years, who underwent blood culture or with a diagnosis of sepsis or septic shock and with Sequential Organ Failure Assessment (SOFA) score above 2 points, were included in the study. The predictive ability of the clinical factors was analyzed by comparing with the primary outcome of in-hospital mortality. Results: A total of 105 patients were included in the study; 58 (55.2%) male and 47 (44.8%) female patients, with median age 78 years (range, 65-96 years). Of these, 89 (84.8%) patients were independently ambulatory before presentation. The median SOFA score was 3 (2-12), and 20 (19%) patients had expired in the hospital. Logistic regression revealed that inability of ambulation is not predictive of mortality (odds ratio, 0.872; 95% confidence Interval, 0.176-4.309; P=0.866). However, correlation analysis with the SOFA score revealed an association with inability of ambulation (r=0.277, P=0.004), and multiple regression analysis also showed that ambulation affects the SOFA score (t=2.435, P=0.017; t=-2.521, P=0.013). Conclusion Inability of ambulation does not predict in-hospital mortality, but affects the SOFA score of elderly patients afflicted with sepsis or in septic shock.

Objective: The vulnerable and frail elderly individuals are at a compounded risk of worsening, rather than recovering, from external stress such as sepsis. Ambulation is majorly considered as a phenotype and determining factor of frailty. This study was undertaken to determine whether inability of ambulation is predictive for the prognosis of elderly patients afflicted with sepsis. Methods: Data were collected retrospectively from the medical records of an emergency medical center, from 1 November 2016 to 28 February 2017. Patients older than 65 years, who underwent blood culture or with a diagnosis of sepsis or septic shock and with Sequential Organ Failure Assessment (SOFA) score above 2 points, were included in the study. The predictive ability of the clinical factors was analyzed by comparing with the primary outcome of in-hospital mortality. Results: A total of 105 patients were included in the study; 58 (55.2%) male and 47 (44.8%) female patients, with median age 78 years (range, 65-96 years). Of these, 89 (84.8%) patients were independently ambulatory before presentation. The median SOFA score was 3 (2-12), and 20 (19%) patients had expired in the hospital. Logistic regression revealed that inability of ambulation is not predictive of mortality (odds ratio, 0.872; 95% confidence Interval, 0.176-4.309; P=0.866). However, correlation analysis with the SOFA score revealed an association with inability of ambulation (r=0.277, P=0.004), and multiple regression analysis also showed that ambulation affects the SOFA score (t=2.435, P=0.017; t=-2.521, P=0.013). Conclusion Inability of ambulation does not predict in-hospital mortality, but affects the SOFA score of elderly patients afflicted with sepsis or in septic shock.

BACKGROUND: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. METHODS: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. RESULTS: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. CONCLUSION: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.
Delivery of Health Care ; Efficiency ; Health Care Costs ; Humans ; Korea* ; Nursing ; Pulmonary Disease, Chronic Obstructive*

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
Acute Kidney Injury* ; Body Mass Index* ; Epidemiologic Studies ; Humans ; Mortality* ; Obesity ; Observational Study ; Renal Replacement Therapy*

Immunoglobulin G subclass deficiency (IgGSCD) is a relatively common primary immunodeficiency disease (PI) in adults. The biological significance of IgGSCD in patients with chronic airway diseases is controversial. We conducted a retrospective study to characterize the clinical features of IgGSCD in this population. This study examined the medical charts from 59 adult patients with IgGSCD who had bronchial asthma or chronic obstructive pulmonary disease (COPD) from January 2007 to December 2012. Subjects were classified according to the 10 warning signs developed by the Jeffrey Modell Foundation (JMF) and divided into two patient groups: group I (n = 17) met ≥ two JMF criteria, whereas group II (n = 42) met none. IgG3 deficiency was the most common subclass deficiency (88.1%), followed by IgG4 (15.3%). The most common infectious complication was pneumonia, followed by recurrent bronchitis, and rhinosinusitis. The numbers of infections, hospitalizations, and exacerbations of asthma or COPD per year were significantly higher in group I than in group II (P < 0.001, P = 0.012, and P < 0.001, respectively). The follow-up mean forced expiratory volume (FEV1) level in group I was significantly lower than it was at baseline despite treatment of asthma or COPD (P = 0.036). In conclusion, IgGSCD is an important PI in the subset of patients with chronic airway diseases who had recurrent upper and lower respiratory infections as they presented with exacerbation-prone phenotypes, decline in lung function, and subsequently poor prognosis.
Adult* ; Asthma ; Bronchitis ; Follow-Up Studies ; Forced Expiratory Volume ; Hospitalization ; Humans ; Immunoglobulin G* ; Immunoglobulins* ; Lung ; Phenotype ; Pneumonia ; Prognosis ; Pulmonary Disease, Chronic Obstructive ; Respiratory Tract Infections ; Retrospective Studies

BACKGROUND: Dengue fever is one of the most dominant vector-borne diseases, putting approximately 3.9 billion people at risk worldwide. While it is generally vector-borne, other routes of transmission such as needlestick injury are possible. Laboratory workers can be exposed to dengue virus transcutaneously by needlestick injury. This is the first case, to our knowledge, of dengue virus infection by needlestick injury in a laboratory environment. This paper evaluates the risk and related health concerns of laboratory workers exposed to dengue virus. CASE PRESENTATION: We evaluated a 30-year-old female laboratory worker exposed to the dengue virus by needlestick injury while conducting virus filtering. During admission, she showed symptoms of fever, nausea, myalgia, and a characteristic maculopapular rash with elevated aspartate aminotransferase (AST) of 235 IU/L and alanine aminotransferase (ALT) of 269 IU/L. She had been diagnosed by a positive nonstructural protein 1 (NS1) antigen (Ag) rapid test one day prior to symptom onset along with positive immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) on the ninth day of symptom onset. Reverse transcription polymerase chain reaction (RT-PCR), also conducted on the ninth day, was negative. After proper symptomatic treatment, she recovered without any sequelae. As a result of thorough epidemiologic investigation, it was determined that she had tried to recap the needle during the virus filtering procedure and a subsequent needlestick injury occurred. CONCLUSIONS: In the context of health promotion of laboratory workers, we suggest that the laboratory biosafety manual be revised and reinforced, and related prevention measures be implemented. Furthermore, health authorities and health care providers in Korea should be fully informed of proper dengue fever management.
Adult ; Alanine Transaminase ; Aspartate Aminotransferases ; Dengue Virus* ; Dengue* ; Enzyme-Linked Immunosorbent Assay ; Exanthema ; Female ; Fever ; Health Personnel ; Health Promotion ; Humans ; Immunoglobulin M ; Korea* ; Myalgia ; Nausea ; Needles ; Needlestick Injuries* ; Polymerase Chain Reaction ; Reverse Transcription

Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P = 0.059) and readmission rates (78.9% vs. 43.8%; P = 0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r = 0.558), and delta BNP also correlated with delta RV systolic pressure (n = 25; r = 0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.
Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain/*blood ; Patient Readmission ; Prognosis ; Pulmonary Disease, Chronic Obstructive/complications ; Pulmonary Heart Disease/*blood/mortality ; ROC Curve ; Retrospective Studies ; Tuberculosis, Pulmonary/complications

PURPOSE: A recent study demonstrated that exertional desaturation is a predictor of rapid decline in lung function in patients with chronic obstructive pulmonary disease (COPD); however, the study was limited by its method used to detect exertional desaturation. The main purpose of this study was to explore whether exertional desaturation assessed using nadir oxygen saturation (SpO2) during the 6-minute walk test (6MWT) can predict rapid lung function decline in patients with COPD. MATERIALS AND METHODS: A retrospective analysis was performed on 57 patients with moderate to very severe COPD who underwent the 6MWT. Exertional desaturation was defined as a nadir SpO2 of <90% during the 6MWT. Rapid decline was defined as an annual rate of decline in forced expiratory volume in 1 second (FEV1) > or =50 mL. Patients were divided into rapid decliner (n=26) and non-rapid decliner (n=31) groups. RESULTS: A statistically significant difference in exertional desaturation was observed between rapid decliners and non-rapid decliners (17 vs. 8, p=0.003). No differences were found between the groups for age, smoking status, BODE index, and FEV1. Multivariate analysis showed that exertional desaturation was a significant independent predictor of rapid decline in patients with COPD (relative risk, 6.8; 95% CI, 1.8 to 25.4; p=0.004). CONCLUSION: This study supports that exertional desaturation is a predictor of rapid lung function decline in male patients with COPD.
Aged ; Anoxia/diagnosis/etiology ; Exercise/*physiology ; Female ; Forced Expiratory Volume/physiology ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/*physiopathology ; Respiratory Function Tests ; Retrospective Studies

Caplan's syndrome is characterized by multiple small distinct nodules with progressive massive fibrosis and rheumatic arthritis in pneumoconiosis. Although pleural effusions occur infrequently as an extra-articular manifestation, pleuritis can develop without joint involvement in patients with rheumatoid arthritis. We treated an 81-year-old man who had been diagnosed with silicosis with progressive massive fibrosis. He suffered from progressive dyspnea, and chest computed tomography (CT) and echocardiography revealed pleural and pericardial effusions. We speculated that the multiple serositis was related to a rheumatic disorder because the rheumatic factor was elevated in both the pleural and pericardial effusions. After corticosteroid treatment, the serositis improved. We suggest that this case is an atypical pattern of Caplan's syndrome presenting as serositis without arthritis. Rheumatoid serositis should be considered as the cause of pleural or pericardial effusions in patients with pneumoconiosis.
Arthritis ; Arthritis, Rheumatoid ; Caplan Syndrome ; Dyspnea ; Echocardiography ; Fibrosis ; Humans ; Joints ; Pericardial Effusion ; Pericarditis ; Pleural Effusion ; Pleurisy ; Pneumoconiosis ; Rheumatic Fever ; Serositis ; Silicosis ; Thorax