Background: With the introduction of Xpert MTB/RIF assay (Xpert), its incorporation into tuberculosis (TB) diagnostic algorithm has become an important issue. The aim of this study was to evaluate the performance of the Xpert assay in comparison with a commercial polymerase chain reaction (PCR) assay. Methods: Medical records of patients having results of both Xpert and AdvanSure TB/NTM real-time PCR (AdvanSure) assays using the same bronchial washing specimens were retrospectively reviewed. Results: Of the 1,297 patients included in this study, 205 (15.8%) were diagnosed with pulmonary TB. Using mycobacterial culture as the reference method, sensitivity of the Xpert assay using smear-positive specimens was 97.5%, which was comparable to that of the AdvanSure assay (96.3%, p=0.193). However, the sensitivity of the Xpert assay using smear-negative specimens was 70.6%, which was significantly higher than that of the AdvanSure assay (52.9%, p=0.018). Usng phenotypic drug susceptibility testing as the reference method, sensitivity and specificity for detecting rifampicin resistance were 100% and 99.1%, respectively. Moreover, a median turnaround time of the Xpert assay was 1 day, which was significantly shorter than 3 days of the AdvanSure assay (p<0.001). Conclusion In comparison with the AdvanSure assay, the Xpert assay had a higher sensitivity using smear-negative specimens, a shorter turnaround time, and could reliably predict rifampin resistance. Therefore, the Xpert assay might be preferentially recommended over TB-PCR in Korean TB diagnostic algorithm.

Background: Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. Methods: A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. Results: A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). Conclusion The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

Background: Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. Methods: A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. Results: A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). Conclusion The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

Diaphragm dysfunction can originate from various etiologies, and bilaterality of the dysfunction depends on the cause. Symptoms of diaphragm dysfunction vary depending on the degree of phrenic nerve denervation, spinal cord lesion, and involvement of the diaphragm. Several infectious diaphragmatic dysfunctions have been reported, including the human immunodeficiency virus, poliovirus, West Nile virus, and dengue virus. Here, we report a case of unilateral diaphragm paralysis in a 34-year-old man with neurosyphilis.

A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors’ hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.
Choriocarcinoma* ; Diagnosis, Differential ; Drug Therapy* ; Dyspnea ; Embolectomy ; Extracorporeal Membrane Oxygenation* ; Female ; Hemodynamics ; Humans ; Intensive Care Units ; Neoplastic Cells, Circulating* ; Pregnancy ; Pulmonary Embolism ; Shock ; Shock, Cardiogenic ; Tuberculosis ; Young Adult

A 60-year-old woman presented with cerebellar signs including dysarthria and ataxia, after intravenous infusion of cisplatin-based chemotherapy. Several blood tests showed mild neutropenia, normocytic normochromic anemia, but no evidence of a marked hyponatremia. Brain magnetic resonance imaging with diffusion-weighted sequences showed hyper-intense signal abnormalities in the extrapontine region, sparing the basis pontis. Here, we report on the case of a patient with reversible cerebellar ataxia related to extrapontine myelinolysis without hyponatremia after treatment with cisplatin-based chemotherapy for cholangiocarcinoma and discuss the literature on cerebellar ataxia in patients who underwent recent chemotherapy for malignancy.
Anemia ; Ataxia ; Brain ; Cerebellar Ataxia* ; Cholangiocarcinoma* ; Cisplatin ; Drug Therapy* ; Dysarthria ; Female ; Hematologic Tests ; Humans ; Hyponatremia* ; Infusions, Intravenous ; Magnetic Resonance Imaging ; Middle Aged ; Myelinolysis, Central Pontine* ; Neutropenia

Hemolytic uremic syndrome (HUS) is a rare thrombotic complication characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS may be caused by several different conditions, including infection, malignancy, and chemotherapeutic agents, such as mitomycin, cisplatin, and most recently, gemcitabine. The outcome of gemcitabine-induced HUS is poor, and the disease has a high mortality rate. This study reports a case of gemcitabine-induced HUS in a patient with pancreatic cancer in Korea.
Antimetabolites, Antineoplastic/*adverse effects ; Deoxycytidine/adverse effects/*analogs & derivatives ; Hemolytic-Uremic Syndrome/*chemically induced ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*drug therapy ; Treatment Outcome

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) with verteporfin for polypoidal choroidal vasculopathy (PCV) in Korean patients. METHODS: Clinical data of patients who were treated with PDT for PCV and followed up for more than 6 months were collected from 14 hospitals around the country. The changes in the best corrected visual acuity, angiographic outcome, retinal thickness measured by optical coherence tomography (OCT), and adverse effects of treatment were evaluated. RESULTS: Eighty six patients (86 eyes) were recruited (male: 75.6%, age: 65.9+/-8.3 years, mean follow-up: 14.8+/-10.2 months). The mean logMAR visual acuity at baseline was 0.55+/-0.32 and did not show any statistically significant difference from the final mean logMAR visual acuity (0.53+/-0.54) (p=0.639). The mean treatment session number of PDT was 2+/-1.2. Visual acuity stabilized or improved in 70.9% of patients. Visual acuity improved by more than 2 lines in 33 eyes (38.4%) and worsened by more than 2 lines in 21 eyes (24.4%) of patients. Vascular leakage decreased in 62.5% of patients in fluorescein angiography and polypoidal lesions disappeared or were reduced in 57.3% of patients in indocyanine green angiography. There was no systemic adverse effect of PDT, but increased subretinal hemorrhage after PDT occurred in 10 eyes (11.6%). CONCLUSIONS: In polypoidal choroidal vasculopathy, photodynamic therapy with verteporfin is safe and effective for preserving visual acuity and reducing vascular leakage and retinal thickness.
Angiography ; Choroid ; Eye ; Fluorescein Angiography ; Hemorrhage ; Humans ; Indocyanine Green ; Photochemotherapy ; Porphyrins ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Triazenes ; Visual Acuity

PURPOSE: We wanted to evaluate the therapeutic potential of a low dose of tamsulosin, as compared with doxazosin, for the treatment of premature ejaculation in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Ninety-six patients (mean age: 55 years) who had LUTS with premature ejaculation were randomly assigned to receive 0.2 mg of tamsulosin and 4 mg of doxazosin daily for a period of 3 months. Patients were evaluated by taking the medical history, the International Prostatic Symptom Score (IPSS) and the Male Sexual Health Questionnaire (MSHQ) for ejaculatory function. The intravaginal ejaculatory latency time (IELT) measured by the patient's estimation and the sexual satisfaction ratio of both the partner and patient were investigated twice during the screening period and after treatment. At 3 months later, we assessed the differences in the IPSS score, the MSHQ score, the IELT and the sexual satisfaction ratio between the two groups. RESULTS: The two alpha 1-adrenoceptor antagonists had significant effects on the IPSS (p<0.05). However, we failed to find a statistically significant difference for each medication and the total MSHQ ejaculatory function score after medication in each group. The IELT was prolonged from 2.7+/-1.6 to 3.5+/-1.5 minutes and from 2.9+/-1.8 to 3.5+/-1.9 minutes in the tamsulosin and doxazosin groups, respectively. However, there was also no statistically significant difference of the IELT and the sexual satisfaction ratio in either group. CONCLUSIONS: For patients with premature ejaculation and LUTS, 0.2mg of tamsulosin improved the voiding symptoms, as assessed with the IPSS, as 4mg of doxazosin did, but neither medication seemed to be effective for the treatment of premature ejaculation.
Doxazosin ; Ejaculation ; Humans ; Lower Urinary Tract Symptoms ; Male ; Mass Screening ; Premature Ejaculation ; Surveys and Questionnaires ; Reproductive Health ; Sulfonamides