Journal of Korean Medical Science最新文献

Background: Atypical antipsychotics (AAPs) are increasingly prescribed to children and adolescents. Most AAPs are prescribed off-label for children and adolescents with depressive disorders. We investigated the longitudinal trends and patterns of AAP prescription in Korean children and adolescents with depressive disorders.

Methods: We conducted a population-based study using data from the Korean National Health Insurance Review and Assessment Service to assess AAP prescriptions among Koreans aged 0-18 years with depressive disorders between 2010 and 2022. An annual cross-sectional assessment was used to analyze longitudinal trends. Additionally, we focused on the most recent year (2022) to assess the current prescription patterns of AAP.

Results: The annual proportion of AAP prescriptions among children and adolescents with depressive disorders will increase from 10.4% in 2010 to 40.0% in 2022 (average annual percentage change: 14.9; 95% confidence interval, 14.3 to 16.3). This trend was more pronounced in patients with depressive disorders with psychiatric comorbidities than in those without psychiatric comorbidities. Over the last 13 years, the predominantly prescribed AAPs have shifted from risperidone to aripiprazole. According to recent data (2022), the most-prescribed AAP for children and adolescents with depressive disorders was aripiprazole, followed by risperidone, quetiapine, and olanzapine. Children and adolescents with depressive disorders and psychiatric comorbidities, particularly Attention-Deficit Hyperactivity Disorder, were more frequently prescribed AAPs (P < 0.001).

Conclusion: The use of AAPs has progressively increased among Korean children and adolescents with depressive disorders, particularly among those with psychiatric comorbidities. Further studies are needed to establish safer and more evidence-based AAP treatments for depressive disorders in children and adolescents.

Background: Coronavirus disease 2019 (COVID-19) vaccine-related myocarditis (C-VRM) is a potential adverse event following mRNA-based vaccination. Cardiac magnetic resonance imaging (CMR) is pivotal for diagnosing and monitoring myocarditis. This study compared quantitative CMR findings among C-VRM, COVID-19 myocarditis, and other myocarditis in the Korean population, and identified prognostic factors associated with adverse outcomes.

Methods: This retrospective multicenter study included patients diagnosed with various types of myocarditis who underwent CMR in four tertiary-care hospitals between October 2018 and January 2023. Clinical data and CMR findings, including cine, native T1, T2, extracellular volume (ECV), and late gadolinium enhancement (LGE) were analyzed. Differences in CMR parameters among myocarditis types were analyzed using linear regression. Predictors of adverse outcomes, defined as a composite of left ventricular ejection fraction (LVEF) of < 40% at follow-up and all-cause mortality, were assessed using logistic regression analysis.

Results: A total of 82 patients (mean age, 42.8 ± 19.2 years; 40 men) were included: 29 with C-VRM, 7 with COVID-19 myocarditis, and 46 with other myocarditis. C-VRM showed significantly lower native T1, T2, and ECV than other myocarditis (P = 0.001, 0.022, and 0.001, respectively), after adjustment for age, sex, and time from symptom onset to CMR. Among the 74 patients with follow-up LVEF data, seven (9.5%) experienced adverse outcomes. Maximum ECV z-score (odds ratio [OR], 1.457; 95% confidence interval [CI], 1.062-1.998; P = 0.020) and LGE extent (OR, 1.109; 95% CI, 1.029-1.194; P = 0.007) remained independent predictors after adjusting for age and initial LVEF, while myocarditis type was not associated with prognosis.

Conclusion: In this Korean multicenter cohort, CMR markers of myocardial injury were lower in C-VRM than in other myocarditis types, whereas prognosis was more strongly associated with injury severity than with disease subtype.

Background: Pertussis was considered a neglected respiratory infection for decades in Korea due to the national immunization program, which includes six doses of vaccination. The final dose is administered between 11 and 12 years of age. In recent years, the number of reported pertussis cases has risen, with a rapid surge observed in 2024. This study investigates a pertussis outbreak in a middle school and explores potential reasons for the resurgence, particularly in relation to completion of the final Tdap booster dose.

Methods: All 22 confirmed cases were investigated descriptively, and a case-control study was conducted involving 22 cases and 44 controls. Participant information, including vaccination history, was obtained through a field epidemiological investigation.

Results: The epidemic curve of the 22 cases indicated a human-to-human transmission, with 16 transmission routes identified through the investigation. The average time from symptom onset to diagnosis was 8 days (3 to 30 days). Eight cases (36.4%) had completed all six doses of vaccination, including the final Tdap booster. In the control group, 28 out of 44 individuals (63.6%) had received the Tdap booster. A marginal statistical difference was observed between the groups (P = 0.065). Among the eight cases, the mean interval between Tdap vaccination and symptom onset was 23.1 ± 11.1 months, compared to 13.3 ± 9.0 months until the end of the outbreak for the 28 controls (P = 0.014).

Conclusion: These findings suggest that individuals who did not receive the Tdap booster may be more susceptible to pertussis infection. It is necessary to consider standardizing the final adolescent booster as Tdap within Korea's National Immunization Program. Health authorities should use nationwide data to address the implications of permitting both Tdap and Td as the final booster dose and resolve the inconsistencies in current guidelines. While this manuscript was under review, the guideline was updated in March 2025 to recommend Tdap, not Td, as the booster at 11-12 years of age.

Background: Highly sensitive measurable residual disease (MRD) assays play a crucial role in predicting prognosis and guiding further treatment in multiple myeloma (MM). This study aimed to compare the diagnostic performance and clinical utility of next-generation flow (NGF)- and next-generation sequencing (NGS)-based MRD assays in patients with MM.

Methods: We evaluated 55 bone marrow (BM) aspirate samples from 41 MM patients for MRD. NGF-MRD was performed on fresh BM specimens in accordance with EuroFlow standard operating procedures, whereas NGS-MRD was conducted on archived BM DNA using the LymphoTrack^® IGH FR1 assay.

Results: The MRD detection rates were 43.6% (24/55) for NGF-MRD and 29.1% (16/55) for NGS-MRD with 67.3% (37/55) concordance rate between two MRD assays, and correlation coefficient (ρ) was 0.506. The 3-year progression-free survival (PFS) estimates were 37.5% and 71.6% for the NGF-MRD-positive and -negative groups, respectively (P = 0.056), and 40.4% and 69.1% for the NGS-MRD-positive and -negative groups (P = 0.167). In patients who MRD-positive by either NGF or NGS, the 3-year PFS was 40.0%, whereas those negative by both assays exhibited 75.9% (P = 0.035). Revised International Staging System stage III (hazard ratio [HR], 3.30) and combined MRD positivity (HR, 3.01) were most strongly associated with PFS in univariate analysis.

Conclusion: Both NGF-MRD and NGS-MRD play critical and complementary roles in monitoring MRD in MM. Notably, even isolated MRD positivity detected by either method was associated with disease progression in certain cases, underscoring the importance of both MRD assays.

Background: This study investigated drug resistance status and trends in patients with extrapulmonary tuberculosis (EPTB) and compared them with those in patients with pulmonary tuberculosis (PTB).

Methods: The phenotypic drug susceptibility test (DST) results of patients with culture-confirmed tuberculosis (TB) diagnosed at seven hospitals in South Korea between 2010 and 2019 were retrospectively analyzed.

Results: Overall, 10,557 patients were included in the analysis (747 and 9,810 patients in the EPTB and PTB groups, respectively). The proportion of EPTB among all patients with TB demonstrated an increasing trend over the study period. In the EPTB group, the pleura was the most commonly involved site (n = 246, 32.9%), followed by the lymph nodes (n = 152, 20.3%) and bones and joints (n = 138, 18.5%). Among 706 new patients with EPTB, the resistance rates to isoniazid (INH) and rifampicin (RIF) were 8.5% and 2.4%, respectively. The proportions of RIF-susceptible, INH-resistant TB, multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB), and pre-extensively drug-resistant TB were 6.7%, 2.4%, and 0.7%, respectively. When comparing new patients in the EPTB group with those in the PTB group (8,607 patients), the resistance rates to RIF, ethambutol, and rifabutin and the proportion of MDR/RR-TB were significantly lower in the EPTB group. During the study period, the proportion of MDR/RR-TB among new patients showed a decreasing trend in both the EPTB and PTB groups.

Conclusion: This study provides important information on the resistance status and trends among patients with EPTB in South Korea. To improve the management of patients with EPTB, efforts to identify drug resistance and regular updates to the DST database are essential.

Background: Childhood obesity is a critical public health issue that often persists into adulthood, posing significant treatment challenges. Establishing long-term healthy habits is essential, and South Korea has implemented various policies to manage pediatric obesity. However, a gap remains between policy, medical efforts, and actual outcomes. This study aimed to explore physicians' perspectives on clinical practices, awareness of governmental policies, and the key barriers and facilitators in pediatric obesity management (POM).

Methods: The questionnaire was developed through a comprehensive literature review and expert feedback, followed by a validity assessment and pilot study, resulting in a finalized 42-question version. Using a convenience sampling approach, 200 physicians specializing in pediatric obesity were recruited via academic societies and online channels. Data analysis involved descriptive statistics, presenting categorical data as frequencies and percentages, and continuous variables as averages.

Results: Among the 200 participating physicians, 87.5% were pediatricians. Most had over five years of experience, and more than half were affiliated with primary clinics. Counseling was the primary treatment approach, with liraglutide being the most commonly used medication. However, POM effectiveness was largely unsatisfactory, with 42.0% considering their efforts a "failure." Only 46.0% reported having institutional protocols, and training experiences varied by institution and region. Awareness and satisfaction with governmental policies were low, with limited recognition of national programs. Physicians emphasized the need for early childhood interventions and stronger medical involvement. Key priorities for improvement included better insurance reimbursement and stronger school partnerships.

Conclusion: This study lays the groundwork for developing targeted strategies and policies to address the complex challenges of POM, ultimately improving health outcomes across all age groups, particularly children and adolescents.

Herpes zoster (HZ) poses a growing public health burden, particularly in aging populations. This study investigated long-term trends in the incidence, hospitalization, and recurrence of HZ in Korea. We analyzed National Health Insurance Service data covering adults aged ≥ 20 years from 2010 to 2022. HZ cases were defined using International Classification of Diseases-10 codes and antiviral treatment criteria. Rates were stratified by age, sex, and income level. The incidence of HZ increased until 2018 and then stabilized. Women and older adults consistently showed higher incidence, hospitalization, and recurrence rates. The medical aid beneficiaries had significantly higher hospitalization rates. Despite recent stabilization, the burden of HZ remains substantial among older adults, women, and medical aid beneficiaries. Targeted vaccination and ongoing surveillance are essential to mitigate disease burden and reduce disparities.

Background: Given the increased vulnerability of people with disabilities to poor health outcomes, we evaluated the impact of disability on long-term mortality among tuberculosis (TB) survivors.

Methods: We conducted a nationwide population-based cohort study using the linked national registry databases in the Republic of Korea. The study included 305,055 TB patients diagnosed between 2008 and 2016 who survived at least 1 year. The primary outcome was to compare long-term mortality after TB diagnosis between people with and without disabilities. Long-term mortality was defined as all-cause mortality at least 1 year after TB diagnosis. Cox proportional hazard models were used to evaluate the risk of long-term mortality. Subgroup and sensitivity analyses were performed based on disability type, severity, and cause of death.

Results: Disabilities were present in 10.1% of survivors and were associated with higher mortality rates (46.3 vs. 16.3 per 1,000 person-years, P < 0.001). Cox analysis revealed that disabilities increased long-term mortality risk, with severe disabilities posing the highest risk. Respiratory disabilities were strongly linked to deaths both related and unrelated to TB.

Conclusion: Long-term mortality risk is significantly higher in TB survivors with disabilities.

Background: Numerous studies have explored blood sugar management in patients with diabetes through telemedicine. However, since the implementation of the telemedicine pilot project, no studies have assessed changes in healthcare utilization for diabetes. This study examined medical outcomes and utilization among diabetes patients comparing telemedicine to traditional in-person care, focusing on medical utilization, care continuity, prescription adherence, and safety.

Methods: This study used data from the National Health Insurance Service to identify patients with diabetes who did or did not receive telemedicine. We analyzed medical utilization, medical sustainability, prescription continuity, and safety through propensity score matching (PSM). To evaluate the telemedicine pilot project's impact, changes and differences in outcome indicators were calculated using a Difference-in-Differences (DID) approach.

Results: After PSM, the total number of patients in the telemedicine group (Tele_G) and the face-to-face treatment group (Control_G) was 59,954 each. Medical utilization of telemedicine decreased in both groups, but the DID was 0.16 (-0.04 in Tele_G vs. -0.20 in Control_G, P < 0.001). Medical continuity also differed significantly between the Tele_G and Control_G (all P < 0.001). The DIDs for the ratio of diabetes medication prescription days and appropriate prescription continuation rate were 0.95 (-0.72 vs. -1.67, P < 0.001) and 1.26 (-1.80 vs. -3.07, P < 0.001), respectively, with statistically significant differences. There were no significant differences in hospitalization experience for safety assessment (DID = -0.14, P = 0.139) or emergency room visits (DID = 0.00, P = 0.950).

Conclusion: DID analysis revealed the potential of the telemedicine pilot project, with slightly lower continuity than face-to-face care; hence, it is acceptable as a supplementary service. To improve this, a telemedicine system specializing in diabetes and blood glucose management is needed, along with a clear protocol that allows patient blood glucose data to be integrated into the telemedicine platform.

This prospective cohort study evaluated ultra-low-dose computed tomography (ULDCT) as a tool for quantifying airway and parenchymal abnormalities in 24 patients with asthma. Quantitative indices included the percentage of low-attenuation area (LAA%) for emphysema, parametric response mapping for functional small airway disease (PRM^fSAD), and Pi10 for airway thickening, assessed against spirometric parameters at baseline and 1-year follow-up. PRM^fSAD showed the strongest and most consistent associations with forced expiratory volume in 1 second (FEV₁) %pred, forced expiratory flow between 25% and 75% (FEF25-75) %pred, and the ratio of FEV₁ to forced vital capacity (FVC). The LAA% correlated mainly with the ratio of FEV₁ to FVC. Pi10 showed significant association only with FEF25-75%pred in the multivariable model. Despite dose-related variability in raw values, correlations with lung function parameters remained stable over time. These findings suggest that indices derived from ULDCT, particularly PRM^fSAD, provide practical low-radiation biomarkers of lung function abnormalities in asthma.