Background: This study aimed to evaluate whether fluvoxamine reduces clinical deterioration in adult patients with mild to moderate coronavirus disease 2019 (COVID-19), and to identify risk factors for clinical deterioration in patients admitted to a community treatment center (CTC). Materials and Methods: A randomized, placebo-controlled trial was conducted in a CTC, in Seoul, Korea from January 15, 2021, to February 19, 2021. Symptomatic adult patients with positive results of severe acute respiratory syndrome coronavirus 2 real timepolymerase chain reaction within 3 days of randomization were assigned at random to receive 100 mg of fluvoxamine or placebo twice daily for 10 days. The primary outcome was clinical deterioration defined by any of the following criteria: oxygen requirement to keep oxygen saturation over 94.0%, aggravation of pneumonia with dyspnea, or World Health Organization clinical progression scale 4 or greater. Results: Of 52 randomized participants [median (interquartile range) age, 53.5 (43.3 - 60.0) years; 31 (60.0%) men], 44 (85.0%) completed the trial. Clinical deterioration occurred in 2 of 26 patients in each group (P >0.99). There were no serious adverse events in either group. Clinical deterioration occurred in 15 (6.0%) of 271 patients admitted to the CTC, and all of them were transferred to a hospital. In multivariate analysis, age between 55 and 64, fever and pneumonia at admission were independent risk factors for clinical deterioration. Conclusion In this study of adult patients with symptomatic COVID-19 who were admitted to the CTC, there was no significant differences in clinical deterioration between patients treated with fluvoxamine and placebo (ClinicalTrials.gov Identifier: NCT04711863).

The classification of the bone pieces excavated from Gasan-ri archaeological site Ⅰ in Jinju, presumed to be relics was investigated macroscopically. The remains of the animal bone were 3 classes (Mammalia, Aves, Amphibia), 5 orders (Carnivora, Artiodactyla, Passeriformes, Rodentia, Salientia), and 6 species (Sus scrofa, Cervidae sp., Nyctereutes procyonides, Passeriformes sp., Rattus norvegicus caraco, Rana nigromaculata). The total weight of the animal bone remains was 1,002.80 g, with the identified bones comprising 975.30 g and an identification rate of 97.26%. A total of 447 animal bone fragments were identified, including 204 bone pieces of S. scrofa (468.00 g, 47.99%), 102 bone pieces of Cervidae sp. (453.79 g, 46.53%), 68 bone pieces of R. nigromaculata (4.69 g, 0.48%), 59 bone pieces of N. procyonides (47.14 g, 4.83%), 9 bone pieces of Passeriformes sp. (0.98g, 0.10%), and 5 bone pieces of Rattus norvegicus caraco (0.70 g, 0.07%). The bone pieces of the animal relics consisted of 81 skull (18.12%), 161 axial skeleton (36.02%), 64 forelimb (14.32%), and 141 hindlimb (31.54%) fragments. The archaeological significance of the animal bones excavated in this investigation was that wild boars and deer were presumed to have been mainly used animals in the Gasan-ri area of Jinju during the Three Kingdoms period.

Fungi are a major cause of human infections with diverse clinical manifestations. The incidence of fungal infections has increased over time, particularly in patients who have risk factors such as neutropenia, immune suppression, an intravascular catheter, parenteral nutrition, a prosthetic device, and prior broad spectrum antibiotic therapy. Here, we present an unusual case of co-infection by 2 distinct fungi, Candida parapsilosis and Trichosporon asahii, isolated from a patient who did not have any known risk factors initially, except active pulmonary tuberculosis. Despite the negative conversion of sputum acid-fast bacilli (AFB) culture test after treatment, clinical symptoms were refractory to therapy. The patient developed symptoms suggesting septic shock, and 2 distinct colonies were isolated from a blood specimen, which were identified as C. parapsilosis and T. asahii by MALDI-TOF and rRNA sequencing. Fever and hypotension were relieved after anti-fungal agent injection, and pulmonary lesions identified by imaging also improved.
Candida ; Catheters ; Coinfection ; Fever ; Fungemia ; Fungi ; Humans ; Hypotension ; Incidence ; Neutropenia ; Parenteral Nutrition ; Risk Factors ; Shock, Septic ; Sputum ; Trichosporon ; Tuberculosis, Pulmonary

The aim of this study was to investigate morphological development of filiform papillae (FP) in Korean native goats by using scanning electron microscopy. Tongues were removed from goat fetuses (days 60, 90, and 120), neonates, and juveniles (days 30, 60, 90, 120, 150, and 180 after birth). During the prenatal period, primordia of FP appeared at fetal day 60 and were observed to be developed at day 90. At fetal day 120, the FP were observed like flower leaves of a double flower bud. In neonates, FP were shaped like an obliquely sectioned cylinder with secondary papillae irregularly arranged in a saw blade-like manner. In 60-day-old juvenile goats, the FP were densely distributed at the inner base of 1/3–1/2 degrees. In 90-, 120-, and 150-day-old goats, FP were compacted at the inner base of 1/2–2/3, 3/4, and 4/5 degrees, respectively. In 180-day-old goats, FP were found to be completely compacted on the inner surface with complete morphogenesis. Microridges, microplicae, and micropits were well-developed on the epithelial surface of lingual papillae from embryonic day 120 to juvenile day 180. These results indicate that FP of goats have different shapes and sizes during development both before and after birth.
Fetus ; Flowers ; Goats ; Humans ; Infant, Newborn ; Microscopy, Electron, Scanning ; Morphogenesis ; Parturition ; Tongue

The aim of this study was to investigate morphological development of filiform papillae (FP) in Korean native goats by using scanning electron microscopy. Tongues were removed from goat fetuses (days 60, 90, and 120), neonates, and juveniles (days 30, 60, 90, 120, 150, and 180 after birth). During the prenatal period, primordia of FP appeared at fetal day 60 and were observed to be developed at day 90. At fetal day 120, the FP were observed like flower leaves of a double flower bud. In neonates, FP were shaped like an obliquely sectioned cylinder with secondary papillae irregularly arranged in a saw blade-like manner. In 60-day-old juvenile goats, the FP were densely distributed at the inner base of 1/3–1/2 degrees. In 90-, 120-, and 150-day-old goats, FP were compacted at the inner base of 1/2–2/3, 3/4, and 4/5 degrees, respectively. In 180-day-old goats, FP were found to be completely compacted on the inner surface with complete morphogenesis. Microridges, microplicae, and micropits were well-developed on the epithelial surface of lingual papillae from embryonic day 120 to juvenile day 180. These results indicate that FP of goats have different shapes and sizes during development both before and after birth.

BACKGROUND/AIMS: This study aimed to evaluate the efficacy of computed tomography (CT)-guided bone biopsy for the diagnosis of spinal infection and compared the clinical outcomes between tuberculous and pyogenic spinal infections. METHODS: The retrospective cohort study included patients who received CT-guided bone biopsy at a tertiary hospital over the 13 years. RESULTS: Among 100 patients, 67 had pyogenic spondylitis and 33 had tuberculous spondylitis. Pathogens were isolated from bone specimens obtained by CT-guided biopsy in 42 cases, with diagnostic yields of 61% (20/33) for tuberculous spondylitis and 33% (22/67) for pyogenic spondylitis. For 36 culture-proven pyogenic cases, Staphylococcus aureus was the most commonly isolated organism. Patients with pyogenic spondylitis more frequently presented with fever accompanied by an increase in inflammatory markers than did those with tuberculosis. Among all patients who underwent surgery, the incidence of late surgery performed one month after diagnosis was higher in patients with tuberculous infection (56.3%) than in those with pyogenic disease (23.3%, p = 0.026). CONCLUSIONS: Results obtained by CT-guided bone biopsy contributed to prompt diagnoses of spinal infections, especially those caused by tuberculosis. Despite administration of anti-tuberculous agents, patients with tuberculous spondylitis showed an increased tendency to undergo late surgery.
Biopsy* ; Cohort Studies ; Diagnosis ; Fever ; Humans ; Incidence ; Retrospective Studies ; Spondylitis* ; Staphylococcus aureus ; Tertiary Care Centers ; Tuberculosis

BACKGROUND: Next-generation sequencing (NGS) can detect many more microorganisms of a microbiome than traditional methods. This study aimed to analyze the vaginal microbiomes of Korean women by using NGS that included bacteria and other microorganisms. The NGS results were compared with the results of other assays, and NGS was evaluated for its feasibility for predicting vaginitis. METHODS: In total, 89 vaginal swab specimens were collected. Microscopic examinations of Gram staining and microbiological cultures were conducted on 67 specimens. NGS was performed with GS junior system on all of the vaginal specimens for the 16S rRNA, internal transcribed spacer (ITS), and Tvk genes to detect bacteria, fungi, and Trichomonas vaginalis. In addition, DNA probe assays of the Candida spp., Gardnerella vaginalis, and Trichomonas vaginalis were performed. Various predictors of diversity that were obtained from the NGS data were analyzed to predict vaginitis. RESULTS: ITS sequences were obtained in most of the specimens (56.2%). The compositions of the intermediate and vaginitis Nugent score groups were similar to each other but differed from the composition of the normal score group. The fraction of the Lactobacillus spp. showed the highest area under the curve value (0.8559) in ROC curve analysis. The NGS and DNA probe assay results showed good agreement (range, 86.2-89.7%). CONCLUSIONS: Fungi as well as bacteria should be considered for the investigation of vaginal microbiome. The intermediate and vaginitis Nugent score groups were indistinguishable in NGS. NGS is a promising diagnostic tool of the vaginal microbiome and vaginitis, although some problems need to be resolved.
Area Under Curve ; Bacteria/*genetics/isolation & purification ; Bacterial Proteins/genetics ; Candida/*genetics/isolation & purification ; Female ; Fungal Proteins/genetics ; Gardnerella vaginalis/genetics/isolation & purification ; High-Throughput Nucleotide Sequencing ; Humans ; *Microbiota ; RNA, Ribosomal, 16S/chemistry/genetics/metabolism ; ROC Curve ; Sequence Analysis, DNA ; Trichomonas vaginalis/genetics/isolation & purification ; Vagina/*microbiology ; Vaginitis/*diagnosis/microbiology

Rapid and accurate identification of an influenza outbreak is essential for patient care and treatment. We describe a next-generation sequencing (NGS)-based, unbiased deep sequencing method in clinical specimens to investigate an influenza outbreak. Nasopharyngeal swabs from patients were collected for molecular epidemiological analysis. Total RNA was sequenced by using the NGS technology as paired-end 250 bp reads. Total of 7 to 12 million reads were obtained. After mapping to the human reference genome, we analyzed the 3-4% of reads that originated from a non-human source. A BLAST search of the contigs reconstructed de novo revealed high sequence similarity with that of the pandemic H1N1 virus. In the phylogenetic analysis, the HA gene of our samples clustered closely with that of A/Senegal/VR785/2010(H1N1), A/Wisconsin/11/2013(H1N1), and A/Korea/01/2009(H1N1), and the NA gene of our samples clustered closely with A/Wisconsin/11/2013(H1N1). This study suggests that NGS-based unbiased sequencing can be effectively applied to investigate molecular characteristics of nosocomial influenza outbreak by using clinical specimens such as nasopharyngeal swabs.
Databases, Genetic ; Genotype ; High-Throughput Nucleotide Sequencing ; Humans ; Influenza A Virus, H1N1 Subtype/classification/*genetics/isolation & purification ; Influenza, Human/diagnosis/*virology ; Nasopharynx/*virology ; Nucleic Acid Amplification Techniques ; Phylogeny ; RNA, Viral/analysis/metabolism ; Sequence Analysis, RNA ; Viral Proteins/genetics

BACKGROUND: The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside Middle East Asia in 2015 has necessitated the rapid expansion of laboratories that conduct MERS-CoV molecular testing in Korea, together with external quality assessment (EQA) to evaluate the assays used. METHODS: The EQA program consisted of two phases; self-validation and blind assessment. For the first EQA phase, in vitro transcribed upstream region of the envelope gene (upE) and the open reading frame (ORF)1a RNAs were used at a concentration of 1,000 copies/microL. The test panel for the second EQA phase consisted of RNA extracts from three samples, which were obtained from two MERS-CoV positive patients and one MERS-CoV negative patient. RESULTS: The first EQA phase results for 46 participants showed a linear relationship between the threshold cycle (CT) values of RNA materials and the logarithmic concentrations for both upE and ORF1a gene targets (R2=0.73 and 0.75, respectively). The mean CT value for each concentration was different depending on which commercial kit was used for the assay. Among the three commonly used kits, PowerChek MERS Real-Time PCR kit (KogeneBiotech, Korea) showed the lowest CT values at all concentrations of upE and most concentrations of ORF1a. The second EQA phase results for 47 participants were 100% correct for all tested samples. CONCLUSIONS: This EQA survey demonstrates that the MERS-CoV molecular testing performed in Korea during the 2015 outbreak is of robust capability. However, careful establishment and validation of a cut-off value are recommended to ensure good analytical sensitivity.
Coronavirus Infections/*diagnosis/epidemiology/virology ; Disease Outbreaks ; Humans ; Middle East Respiratory Syndrome Coronavirus/*genetics/isolation & purification ; Molecular Diagnostic Techniques/*standards ; Quality Assurance, Health Care ; RNA, Viral/analysis ; Real-Time Polymerase Chain Reaction ; Republic of Korea/epidemiology ; Surveys and Questionnaires

No abstract available.