Background: Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin-23. It has shown good efficacy and safety profile in several clinical trials of plaque psoriasis. However, studies on the efficacy of guselkumab in patients treated with other biologics are lacking. Objective: We aimed to investigate the efficacy and safety profile of guselkumab in patients with moderate-to-severe plaque psoriasis. We also compared the efficacy of guselkumab between biologic-naïve (Bio-Naïve) and biologicexperienced (Bio-Ex) patients. Methods: This multicenter, retrospective study included 72 patients treated with guselkumab. The patients’ clinical characteristics and psoriasis area and severity index (PASI) scores were recorded at each visit. The PASI90 and PASI100 responses and mean PASI scores were compared between the Bio-Naïve and Bio-Ex groups. Results: Fifty-five Bio-Naïve patients and 17 Bio-Ex patients were included in the study. At week 20, there were no significant differences in the PASI90 (64.2% vs. 53.8%) and PASI100 (28.3% vs. 15.4%) responses between the groups. However, at weeks 36 and 44, the PASI90 response (week 36: 89.2% vs. 36.4% and week 44: 97.8% vs. 63.6%) and the PASI100 response (week 36: 64.9% vs. 18.2% and week 44: 68.9% vs. 27.3%) were significantly higher in the Bio-Naïve group (p＜0.05). There were no differences in PASI90 and PASI100 responses between the groups in terms of other clinical characteristics and comorbidities at week 20. Conclusion The efficacy of guselkumab remained consistent among patients in whom other biologics had failed. However, the efficacy was slightly lower in the Bio-Ex group than in the Bio-Naïve group.

BACKGROUND: Recently, the number of nationwide medical researches on psoriasis using the National Health Insurance Service database has been on the rise. However, identification of psoriasis using diagnostic codes alone can lead to misclassification. Accuracy of the diagnostic codes and their concordance with medical records should be validated first to identify psoriasis patients correctly. OBJECTIVE: To validate the diagnostic codes of psoriasis (International Classification of Diseases, 10th Revision L40) and to find the algorithm for the identification of psoriasis. METHODS: We collected medical records of patients who received their first diagnostic codes of psoriasis during 5 years from five hospitals. Fifteen percent of psoriasis patients were randomly selected from each hospital. We performed a validation by reviewing medical records and compared 5 algorithms to identify the best algorithm. RESULTS: Total of 538 cases were reviewed and classified as psoriasis (n=368), not psoriasis (n=159), and questionable (n=11). The most accurate algorithm was including patients with ≥1 visits with psoriasis as primary diagnostic codes and prescription of vitamin D derivatives. Its positive predictive value was 96.5% (95% confidence interval [CI], 93.9%~98.1%), which was significantly higher than those of the algorithm, including patients with ≥1 visits with psoriasis as primary diagnostic codes or including ≥1 visits with diagnostic codes of psoriasis (primary or additional) (91.0% and 69.8%). Sensitivity was 90.8% (95% CI, 87.2%~93.4%) and specificity was 92.5% (95% CI, 86.9%~95.9%). CONCLUSION Our study demonstrates a validated algorithm to identify psoriasis, which will be useful for the nationwide population-based study of psoriasis in Korea.

BACKGROUND: Although adults in 30s and 40s are at risk for hypertension management due to low rates of awareness, treatment, and control of hypertension, there has been a lack of study on hypertension management for this population. Thus, the purpose of this study is to examine blood pressure screening and other associated factors with hypertension management in terms of awareness, control, and treatment. METHODS: Secondary data analysis was performed on the data from the Fourth Korea National Health and Nutrition Examination Survey in 2007-2009. To examine whether blood pressure screening affects hypertension management in 929 subjects aged 30s and 40s with hypertension. Other factors, such as socio-demographics, health status, and health behaviors, were also included for data analysis. Chi-square test and multiple logistic regression analysis were carried out using SAS 9.1. RESULTS: Hypertension awareness rates were high in those who had diabetes mellitus (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.27-3.90), self-rated their health status as poor (OR 2.89; 95% CI 1.82-4.58), and received a blood pressure check up (OR 5.96; 95% CI 2.90-12.25). Hypertension treatment rates were high in women (OR 2.50; 95% CI 1.47-4.27), and high in those who had diabetes mellitus (OR 2.59; 95% CI 1.49-4.47), self-rated their health status as poor (OR 2.53; 95% CI 1.54-4.14), self-reported as past smoker (OR 2.01; 95% CI 1.22-3.29), and received a blood pressure check up (OR 12.64; 95% CI 4.87-32.77). Hypertension control rates were high in women (OR 2.47; 95% CI 1.29-4.72), and high in those who self-reported as past smoker (OR 2.46; 95% CI 1.35-4.50), and received a blood pressure check up (OR 9.24; 95% CI 3.15-27.15). CONCLUSIONS: For effective hypertension management in 30s and 40s, we should encourage this population to have a regular blood pressure screening.
Adult ; Aged ; Blood Pressure ; Diabetes Mellitus ; Female ; Health Behavior ; Humans ; Hypertension ; Korea ; Logistic Models ; Mass Screening ; Nutrition Surveys ; Phenothiazines ; Statistics as Topic

We describe a case of idiopathic CD4+ T-lymphocytopenia (ICL) in a 59-year-old patient who presented with various opportunistic infections. The patient was diagnosed with disseminated Mycobacterium avium infection, cytomegalovirus colitis and retinitis, and esophageal candidiasis. He was successfully treated with anti-mycobacterial drugs, ganciclovir, and fluconazole, respectively. However, the patient was diagnosed with primary central nervous system lymphoma, and then died of a Trichosporon beigelii sepsis during the 2nd cycle of systemic chemotherapy.
Candidiasis ; Central Nervous System ; Colitis ; Cytomegalovirus Infections ; Fluconazole ; Ganciclovir ; Humans ; Lymphoma ; Lymphopenia ; Middle Aged ; Mycobacterium avium ; Opportunistic Infections ; Retinitis ; Sepsis ; T-Lymphocytopenia, Idiopathic CD4-Positive ; Trichosporon

BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. However, IA is difficult to diagnose, especially in the aforementioned patient group. Recently, galactomannan assay (GMA) using enzyme immunoassay has been introduced in Korea. We evaluated its diagnostic usefulness in the diagnosis of IA and we analyzed the results according to the underlying diseases. MATERIALS AND METHODS: All patients who underwent GMA during the period from October 2007 to June 2008 were evaluated retrospectively. According to the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group, IA was classified into four clinical categories: 'proven', 'probable', 'possible', and 'non' IA. Patients with 'proven' and 'probable' IA were used as the reference standards for IA. GMA was performed using Platelia Aspergillus EIA (Bio-Rad, Hercules, CA, USA). Optical density index > or =0.5 was considered positive. RESULTS: Of the 144 patients who underwent GMA, two patients were classificed as 'proven' IA and sixteen patients were 'probable' IA. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 50% (95% confidence interval [CI95], 26-74%), 88% (CI95, 81-93%), 38% (CI95, 19-59%), and 93% (CI95, 86-97%), respectively. Among the 99 patients with underlying hematologic diseases, GMA showed 67% (CI95, 35-90%) sensitivity and 89% (CI95, 80-94%) specificity, whereas in 45 patients with underlying diseases other than hematologic diseases, sensitivity and specificity of the assay were 17% (CI95, 0-64%) and 87% (CI95, 73-96%), respectively. CONCLUSION: GMA showed high specificity, irrespective of the patient population. However, sensitivity of GMA was low and the assay was less sensitive in patients with underlying diseases other than hematologic diseases than in patients with hematologic diseases.
Aspergillosis ; Aspergillus ; Hematologic Diseases ; Humans ; Immunocompromised Host ; Immunoenzyme Techniques ; Korea ; Mannans ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. However, IA is difficult to diagnose, especially in the aforementioned patient group. Recently, galactomannan assay (GMA) using enzyme immunoassay has been introduced in Korea. We evaluated its diagnostic usefulness in the diagnosis of IA and we analyzed the results according to the underlying diseases. MATERIALS AND METHODS: All patients who underwent GMA during the period from October 2007 to June 2008 were evaluated retrospectively. According to the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group, IA was classified into four clinical categories: 'proven', 'probable', 'possible', and 'non' IA. Patients with 'proven' and 'probable' IA were used as the reference standards for IA. GMA was performed using Platelia Aspergillus EIA (Bio-Rad, Hercules, CA, USA). Optical density index > or =0.5 was considered positive. RESULTS: Of the 144 patients who underwent GMA, two patients were classificed as 'proven' IA and sixteen patients were 'probable' IA. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 50% (95% confidence interval [CI95], 26-74%), 88% (CI95, 81-93%), 38% (CI95, 19-59%), and 93% (CI95, 86-97%), respectively. Among the 99 patients with underlying hematologic diseases, GMA showed 67% (CI95, 35-90%) sensitivity and 89% (CI95, 80-94%) specificity, whereas in 45 patients with underlying diseases other than hematologic diseases, sensitivity and specificity of the assay were 17% (CI95, 0-64%) and 87% (CI95, 73-96%), respectively. CONCLUSION: GMA showed high specificity, irrespective of the patient population. However, sensitivity of GMA was low and the assay was less sensitive in patients with underlying diseases other than hematologic diseases than in patients with hematologic diseases.
Aspergillosis ; Aspergillus ; Hematologic Diseases ; Humans ; Immunocompromised Host ; Immunoenzyme Techniques ; Korea ; Mannans ; Retrospective Studies ; Sensitivity and Specificity

Diabetic foot infection is one of the important complications in patients with advanced diabetes mellitus. Limb threatening infections such as osteomyelitis, abscess, and necrotizing fasciitis are frequently accompanied by the disease. Non-tuberculous mycobacterium (NTM) is a rare causative organism of diabetic foot infection. Thus, if one is not suspicious or meticulous, infection due to NTM will be easily overlooked and this will result in delayed diagnose and treat. Therefore, it is necessary to consider NTM as the causative organism if the wound does not respond to the conventional antibiotic treatment and the culture from the adequately obtained specimen reveals atypical acid-fast bacilli. We present a case of diabetic foot infection with osteomyelitis and abscess due to Mycobacterium mageritense, one of the rapid growing mycobacteria, that was successfully treated with surgical debridement and appropriate antibiotic treatment.
Abscess ; Debridement ; Diabetes Mellitus ; Diabetic Foot ; Extremities ; Fasciitis, Necrotizing ; Humans ; Mycobacterium ; Osteomyelitis

Diabetic foot infection is one of the important complications in patients with advanced diabetes mellitus. Limb threatening infections such as osteomyelitis, abscess, and necrotizing fasciitis are frequently accompanied by the disease. Non-tuberculous mycobacterium (NTM) is a rare causative organism of diabetic foot infection. Thus, if one is not suspicious or meticulous, infection due to NTM will be easily overlooked and this will result in delayed diagnose and treat. Therefore, it is necessary to consider NTM as the causative organism if the wound does not respond to the conventional antibiotic treatment and the culture from the adequately obtained specimen reveals atypical acid-fast bacilli. We present a case of diabetic foot infection with osteomyelitis and abscess due to Mycobacterium mageritense, one of the rapid growing mycobacteria, that was successfully treated with surgical debridement and appropriate antibiotic treatment.
Abscess ; Debridement ; Diabetes Mellitus ; Diabetic Foot ; Extremities ; Fasciitis, Necrotizing ; Humans ; Mycobacterium ; Osteomyelitis

Good's syndrome is the association of thymoma with immunodeficiency, characterized by hypogammaglobulinemia, B-cell lymphopenia and variably defects in cellular immunity with CD4+ T-cell lymphopenia and an inverted CD4+:CD8+ T-cell ratio. We report a 43-year-old male patient who presented with a 18-month history of productive cough and postnasal drip. One year ago, he underwent the operation for resection of a thymoma. Despite of appropriate management, sinusitis relapsed multiple times. He was found to have hypogammaglobulinemia with nearly absent B cells(4/microliter). The CD4+ T-cell count was 554/microliter with an inverted CD4+:CD8+ T-cell ratio of 0.6. His symptoms and signs improved with antibiotic treatment and monthly administration of intravenous immunoglobulin (IVIG, 400 mg/kg).
Adult ; Agammaglobulinemia ; B-Lymphocytes ; Cough ; Humans ; Immunity, Cellular ; Immunoglobulins ; Lymphopenia ; Male ; Sinusitis ; T-Lymphocytes ; Thymoma

Good's syndrome is the association of thymoma with immunodeficiency, characterized by hypogammaglobulinemia, B-cell lymphopenia and variably defects in cellular immunity with CD4+ T-cell lymphopenia and an inverted CD4+:CD8+ T-cell ratio. We report a 43-year-old male patient who presented with a 18-month history of productive cough and postnasal drip. One year ago, he underwent the operation for resection of a thymoma. Despite of appropriate management, sinusitis relapsed multiple times. He was found to have hypogammaglobulinemia with nearly absent B cells(4/microliter). The CD4+ T-cell count was 554/microliter with an inverted CD4+:CD8+ T-cell ratio of 0.6. His symptoms and signs improved with antibiotic treatment and monthly administration of intravenous immunoglobulin (IVIG, 400 mg/kg).
Adult ; Agammaglobulinemia ; B-Lymphocytes ; Cough ; Humans ; Immunity, Cellular ; Immunoglobulins ; Lymphopenia ; Male ; Sinusitis ; T-Lymphocytes ; Thymoma