Pub Date : 2023-05-10DOI: 10.5124/jkma.2023.66.5.285
Jin Park, S. Ko
Background: Monitoring and managing elevated intracranial pressure (ICP) is one of the core topics in neurocritical care. Although invasive methods are regarded as standard means, the recent development of non-invasive monitoring devices help clinicians handle ICP issues without additional risks of device-related complications.Current Concepts: According to the Monro–Kellie hypothesis, any brain injury that can cause a mass effect will lead to ICP elevation. Therefore, an ICP surge beyond the capacity of a compensatory reserve will decrease cerebral blood flow and may end up causing secondary brain damage. Indications for invasive ICP monitoring may vary according to the underlying conditions or the severity of brain damage. Regardless, ICP monitoring is considered when there is a risk of ICP elevation. In addition to pressure monitoring, external ventricular drainage catheters are used therapeutically to drain cerebrospinal fluid to reduce ICP. Several ICP monitoring probes are available based on pressure measurement types. Recently, non-invasive ICP monitoring methods have been developed and are increasingly used in patients with severe brain injuries. Pulsatility index from transcranial Doppler ultrasonography, quantitative pupillary light reflex from an automated pupillometer, and optic nerve sheath diameter using ultrasonography are commonly used surrogates for ICP surges in neurointensive care units.Discussion and Conclusion: ICP monitoring is essential for managing patients with severe brain injuries. Understanding the differences among the ICP monitors and determining the appropriate methods for ICP monitoring is necessary for optimizing patients’ care in the neurocritical care unit.
{"title":"Assessment of increased intracranial pressure in patients with brain injury","authors":"Jin Park, S. Ko","doi":"10.5124/jkma.2023.66.5.285","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.5.285","url":null,"abstract":"Background: Monitoring and managing elevated intracranial pressure (ICP) is one of the core topics in neurocritical care. Although invasive methods are regarded as standard means, the recent development of non-invasive monitoring devices help clinicians handle ICP issues without additional risks of device-related complications.Current Concepts: According to the Monro–Kellie hypothesis, any brain injury that can cause a mass effect will lead to ICP elevation. Therefore, an ICP surge beyond the capacity of a compensatory reserve will decrease cerebral blood flow and may end up causing secondary brain damage. Indications for invasive ICP monitoring may vary according to the underlying conditions or the severity of brain damage. Regardless, ICP monitoring is considered when there is a risk of ICP elevation. In addition to pressure monitoring, external ventricular drainage catheters are used therapeutically to drain cerebrospinal fluid to reduce ICP. Several ICP monitoring probes are available based on pressure measurement types. Recently, non-invasive ICP monitoring methods have been developed and are increasingly used in patients with severe brain injuries. Pulsatility index from transcranial Doppler ultrasonography, quantitative pupillary light reflex from an automated pupillometer, and optic nerve sheath diameter using ultrasonography are commonly used surrogates for ICP surges in neurointensive care units.Discussion and Conclusion: ICP monitoring is essential for managing patients with severe brain injuries. Understanding the differences among the ICP monitors and determining the appropriate methods for ICP monitoring is necessary for optimizing patients’ care in the neurocritical care unit.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"13 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78508736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.5124/jkma.2023.66.5.291
T. J. Kim, S. Ko
Background: Increased intracranial pressure (ICP) is a pathological condition associated with severe neurological conditions in patients with acute brain injuries. Managing increased ICP based on optimal cerebral perfusion pressure (CPP) is crucial for improving outcomes.Current Concepts: Cerebral autoregulation, the intrinsic ability to maintain stable cerebral blood flow across a wide range of CPP, is impaired in several brain injuries. CPP, the difference between the mean arterial pressure and the ICP, is a critical factor in maintaining cerebral blood flow. Therefore, optimal CPP is important in managing patients with acute brain injuries. In addition, monitoring cerebral autoregulation and its response to pathological derangements can help diagnose, manage, and predict acute brain injury outcomes. Goal-directed therapy using cerebral autoregulation is beneficial in managing patients with ICP elevation. If blood pressure is excessively low in a patient with elevated intracranial pressure, a treatment to increase blood pressure should be considered as a first step, called optimizing cerebral perfusion pressure. However, if CPP is excessively high in a patient with elevated ICP, a treatment to lower CPP by controlling blood pressure to an appropriate level to prevent worsening of edema due to hyperperfusion should be considered.Discussion and Conclusion: Monitoring cerebral autoregulation to guide optimal management of increased ICP based on optimal CPP may be helpful in goal-directed therapy and improving prognosis among patients with acute brain injuries.
{"title":"Cerebral perfusion pressure optimization for the regulation of brain edema and intracranial pressure","authors":"T. J. Kim, S. Ko","doi":"10.5124/jkma.2023.66.5.291","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.5.291","url":null,"abstract":"Background: Increased intracranial pressure (ICP) is a pathological condition associated with severe neurological conditions in patients with acute brain injuries. Managing increased ICP based on optimal cerebral perfusion pressure (CPP) is crucial for improving outcomes.Current Concepts: Cerebral autoregulation, the intrinsic ability to maintain stable cerebral blood flow across a wide range of CPP, is impaired in several brain injuries. CPP, the difference between the mean arterial pressure and the ICP, is a critical factor in maintaining cerebral blood flow. Therefore, optimal CPP is important in managing patients with acute brain injuries. In addition, monitoring cerebral autoregulation and its response to pathological derangements can help diagnose, manage, and predict acute brain injury outcomes. Goal-directed therapy using cerebral autoregulation is beneficial in managing patients with ICP elevation. If blood pressure is excessively low in a patient with elevated intracranial pressure, a treatment to increase blood pressure should be considered as a first step, called optimizing cerebral perfusion pressure. However, if CPP is excessively high in a patient with elevated ICP, a treatment to lower CPP by controlling blood pressure to an appropriate level to prevent worsening of edema due to hyperperfusion should be considered.Discussion and Conclusion: Monitoring cerebral autoregulation to guide optimal management of increased ICP based on optimal CPP may be helpful in goal-directed therapy and improving prognosis among patients with acute brain injuries.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"6 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77227111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.224
H. Cho, S. Sohn
Background: Patients with chronic myeloid leukemia (CML) now have an improved life expectancy similar to that of the general population due to the introduction of tyrosine kinase inhibitors (TKIs). However, many patients experience mild to severe adverse events while undergoing TKI treatment. This review aimed to discuss the adverse events of TKIs, including myocardial infarction and hypertension, and comprehensively analyze strategies for minimizing vascular complications.Current Concepts: Near-fatal cardiovascular events (CVEs) are common among patients receiving nilotinib and ponatinib. However, those receiving other TKIs, such as imatinib and dasatinib, rarely experience CVEs. Among these CVEs, vascular complications, including peripheral arterial occlusion, venous occlusion, and hypertension, are exacerbated in patients with pre-existing vascular risk factors and prolonged TKI use. Therefore, it is crucial to assess predisposing factors to vascular complications and select the optimal TKI to minimize serious CVEs before initiating therapy. Additionally, patients should be closely monitored for vascular complications during nilotinib and ponatinib treatment.Discussion and Conclusion: Despite advancements in therapeutic approaches and research on CML leading to the development of target-specific TKIs aiming to minimize side effects, newer generations are not entirely devoid of adverse events. Hence, it is important for patients and physicians to be knowledgeable about these medications to effectively monitor for side effects, particularly those that are life-threatening, such as vascular toxicity. It is now more important than ever to carefully observe symptoms and perform adequate testing to identify at-risk individuals early and avoid preventable adverse events.
{"title":"Vascular complications in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors","authors":"H. Cho, S. Sohn","doi":"10.5124/jkma.2023.66.4.224","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.224","url":null,"abstract":"Background: Patients with chronic myeloid leukemia (CML) now have an improved life expectancy similar to that of the general population due to the introduction of tyrosine kinase inhibitors (TKIs). However, many patients experience mild to severe adverse events while undergoing TKI treatment. This review aimed to discuss the adverse events of TKIs, including myocardial infarction and hypertension, and comprehensively analyze strategies for minimizing vascular complications.Current Concepts: Near-fatal cardiovascular events (CVEs) are common among patients receiving nilotinib and ponatinib. However, those receiving other TKIs, such as imatinib and dasatinib, rarely experience CVEs. Among these CVEs, vascular complications, including peripheral arterial occlusion, venous occlusion, and hypertension, are exacerbated in patients with pre-existing vascular risk factors and prolonged TKI use. Therefore, it is crucial to assess predisposing factors to vascular complications and select the optimal TKI to minimize serious CVEs before initiating therapy. Additionally, patients should be closely monitored for vascular complications during nilotinib and ponatinib treatment.Discussion and Conclusion: Despite advancements in therapeutic approaches and research on CML leading to the development of target-specific TKIs aiming to minimize side effects, newer generations are not entirely devoid of adverse events. Hence, it is important for patients and physicians to be knowledgeable about these medications to effectively monitor for side effects, particularly those that are life-threatening, such as vascular toxicity. It is now more important than ever to carefully observe symptoms and perform adequate testing to identify at-risk individuals early and avoid preventable adverse events.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"31 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84047082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.234
J. Cheong, Y. Min
Background: Acute myeloid leukemia (AML) is a representative blood cancer, accounting for most adult leukemia cases in Korea. Until recently, intensive chemotherapy and hematopoietic stem cell transplantation were the only curative treatment options for AML. However, the recent introduction of new drugs is bringing about changes in the strategic paradigm for the treatment of AML.Current Concepts: Along with the clinical eligibility for receiving intensive treatment and hematopoietic stem cell transplantation, the most critical determinants in treating AML are precise classification and risk stratification based on cytogenetic and molecular information. The recently revised World Health Organization classification, newly proposed International Consensus Classification, and the latest version of the European LeukemiaNet risk stratification reflect the importance of cytogenetic and molecular information. Although there have been no significant changes for a long time in the landscape of AML, especially in the field of treatment, the treatment paradigm has started to evolve with the introduction of new drugs. This evolution is led by FLT3 inhibitors, Bcl-2 inhibitors, isocitrate dehydrogenase inhibitors, target agents against CD33 antigens, and liposomal formulations of chemotherapeutics.Discussion and Conclusion: Successful initial treatment to induce complete remission followed by post-remission treatment to remove residual disease can lead to the achievement of long-term survival and cure goals in AML. We hope that new drugs will markedly improve the treatment outcomes for patients with AML.
{"title":"Changing the strategic paradigm for the treatment of adult acute myeloid leukemia","authors":"J. Cheong, Y. Min","doi":"10.5124/jkma.2023.66.4.234","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.234","url":null,"abstract":"Background: Acute myeloid leukemia (AML) is a representative blood cancer, accounting for most adult leukemia cases in Korea. Until recently, intensive chemotherapy and hematopoietic stem cell transplantation were the only curative treatment options for AML. However, the recent introduction of new drugs is bringing about changes in the strategic paradigm for the treatment of AML.Current Concepts: Along with the clinical eligibility for receiving intensive treatment and hematopoietic stem cell transplantation, the most critical determinants in treating AML are precise classification and risk stratification based on cytogenetic and molecular information. The recently revised World Health Organization classification, newly proposed International Consensus Classification, and the latest version of the European LeukemiaNet risk stratification reflect the importance of cytogenetic and molecular information. Although there have been no significant changes for a long time in the landscape of AML, especially in the field of treatment, the treatment paradigm has started to evolve with the introduction of new drugs. This evolution is led by FLT3 inhibitors, Bcl-2 inhibitors, isocitrate dehydrogenase inhibitors, target agents against CD33 antigens, and liposomal formulations of chemotherapeutics.Discussion and Conclusion: Successful initial treatment to induce complete remission followed by post-remission treatment to remove residual disease can lead to the achievement of long-term survival and cure goals in AML. We hope that new drugs will markedly improve the treatment outcomes for patients with AML.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"42 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75134885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.269
Tae-Woo Kim
Background: Post-traumatic seizures and epilepsy are major complications that increase the mortality rate among patients with traumatic brain injury (TBI) and hinder functional recovery. It is important to establish prophylaxis and treatment strategies for high-risk patients. The use of antiseizure medications may not only adversely affect the cognitive function following TBI but also may be associated with a worse rehabilitation outcome.Current Concepts: The level of evidence in the current international guidelines related to the prophylaxis and management of post-traumatic seizure is not robust. Furthermore, the use of antiseizure medications after TBI remains unclear, indicating substantial variations in clinical practice.Discussion and Conclusion: Prophylactic antiseizure medications can reduce the risk of early seizures and partially prevent the secondary injury process of TBI; however, they do not seem to inhibit epileptogenesis. Therefore, if the benefits of preventing early seizures outweigh the potential risks associated with antiseizure medication, it is recommended to use them for a short period of about one week after the injury. Then, it is not recommended to continue using them routinely without considering the individual risk of seizure recurrence and potential adverse effects of long-term use. The treatment duration of anticonvulsant in patients with post-traumatic epilepsy should also be determined based on the individual risk of seizure recurrence, and the decision should take into account the opinions of both the patient and the caregiver, while considering not only the potential benefits but also the risks associated with long-term use.
{"title":"Use of antiseizure medications after traumatic brain injury","authors":"Tae-Woo Kim","doi":"10.5124/jkma.2023.66.4.269","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.269","url":null,"abstract":"Background: Post-traumatic seizures and epilepsy are major complications that increase the mortality rate among patients with traumatic brain injury (TBI) and hinder functional recovery. It is important to establish prophylaxis and treatment strategies for high-risk patients. The use of antiseizure medications may not only adversely affect the cognitive function following TBI but also may be associated with a worse rehabilitation outcome.Current Concepts: The level of evidence in the current international guidelines related to the prophylaxis and management of post-traumatic seizure is not robust. Furthermore, the use of antiseizure medications after TBI remains unclear, indicating substantial variations in clinical practice.Discussion and Conclusion: Prophylactic antiseizure medications can reduce the risk of early seizures and partially prevent the secondary injury process of TBI; however, they do not seem to inhibit epileptogenesis. Therefore, if the benefits of preventing early seizures outweigh the potential risks associated with antiseizure medication, it is recommended to use them for a short period of about one week after the injury. Then, it is not recommended to continue using them routinely without considering the individual risk of seizure recurrence and potential adverse effects of long-term use. The treatment duration of anticonvulsant in patients with post-traumatic epilepsy should also be determined based on the individual risk of seizure recurrence, and the decision should take into account the opinions of both the patient and the caregiver, while considering not only the potential benefits but also the risks associated with long-term use.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"59 12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73105354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.245
S. Jung
Background: Multiple myeloma (MM) is a malignant plasma cell neoplasm characterized by anemia, renal failure, hypercalcemia, and osteolytic bone lesions. Although it is a complex and challenging disease, recent advances in treatment options have improved outcomes for patients with MM. In this review, we will discuss the recent treatment strategies for MM and introduce emerging agents.Current Concepts: One breakthrough in the field of MM has been the development of proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. These agents have been shown to markedly improve survival in patients with MM. Furthermore, high-dose chemotherapy with autologous stem cell transplantation remains important in the treatment of transplant-eligible patients. More recently, new immunotherapies such as chimeric antigen receptor (CAR) T-cell therapy or bispecific monoclonal antibodies and agents with new mechanisms of action, have shown promise in the treatment of MM, particularly in patients with relapsed or refractory MM. The recent advancements in MM treatment have greatly improved patient outcomes and offer hope for a cure.Discussion and Conclusion: MM remains an incurable blood cancer owing to repeated relapses. However, the development of CAR T-cell therapies and double-antibody therapies has resulted in remarkable effects in recent clinical trials. Furthermore, combination therapies based on these agents have emerged, and the effectiveness of these agents and combination therapies in the early stages of the disease is being assessed in various clinical trials. Therefore, a cure for MM may soon be possible if the results of these clinical trials are reported and adopted into practice.
{"title":"Recent advances in the treatment of multiple myeloma","authors":"S. Jung","doi":"10.5124/jkma.2023.66.4.245","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.245","url":null,"abstract":"Background: Multiple myeloma (MM) is a malignant plasma cell neoplasm characterized by anemia, renal failure, hypercalcemia, and osteolytic bone lesions. Although it is a complex and challenging disease, recent advances in treatment options have improved outcomes for patients with MM. In this review, we will discuss the recent treatment strategies for MM and introduce emerging agents.Current Concepts: One breakthrough in the field of MM has been the development of proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. These agents have been shown to markedly improve survival in patients with MM. Furthermore, high-dose chemotherapy with autologous stem cell transplantation remains important in the treatment of transplant-eligible patients. More recently, new immunotherapies such as chimeric antigen receptor (CAR) T-cell therapy or bispecific monoclonal antibodies and agents with new mechanisms of action, have shown promise in the treatment of MM, particularly in patients with relapsed or refractory MM. The recent advancements in MM treatment have greatly improved patient outcomes and offer hope for a cure.Discussion and Conclusion: MM remains an incurable blood cancer owing to repeated relapses. However, the development of CAR T-cell therapies and double-antibody therapies has resulted in remarkable effects in recent clinical trials. Furthermore, combination therapies based on these agents have emerged, and the effectiveness of these agents and combination therapies in the early stages of the disease is being assessed in various clinical trials. Therefore, a cure for MM may soon be possible if the results of these clinical trials are reported and adopted into practice.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"325 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75465957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.218
Sun Huh
Background: Several chatbots that utilize large language models now exist. As a particularly well-known example, ChatGPT employs an autoregressive modeling process to generate responses, predicting the next word based on previously derived words. Consequently, instead of deducing a correct answer, it arranges the most frequently appearing words in the learned data in order. Optimized for interactivity and content generation, it presents a smooth and plausible context, regardless of whether the content it presents is true. This report aimed to examine the reliability of ChatGPT, an artificial intelligence (AI) chatbot, in diagnosing diseases and treating patients, how to interpret its responses, and directions for future development.Current Concepts: Ten published case reports from Korea were analyzed to evaluate the efficacy of ChatGPT, which was asked to describe the correct diagnosis and treatment. ChatGPT answered 3 cases correctly after being provided with the patient’s symptoms, findings, and medical history. The accuracy rate increased to 7 out of 10 after adding laboratory, pathological, and radiological results. In one case, ChatGPT did not provide appropriate information about suitable treatment, and its response contained inappropriate content in 4 cases. In contrast, ChatGPT recommended appropriate measures in 4 cases.Discussion and Conclusion: ChatGPT’s responses to the 10 case reports could have been better. To utilize ChatGPT efficiently and appropriately, users should possess sufficient knowledge and skills to determine the validity of its responses. AI chatbots based on large language models will progress significantly, but physicians must be vigilant in using these tools in practice.
{"title":"Can we trust AI chatbots’ answers about disease diagnosis and patient care?","authors":"Sun Huh","doi":"10.5124/jkma.2023.66.4.218","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.218","url":null,"abstract":"Background: Several chatbots that utilize large language models now exist. As a particularly well-known example, ChatGPT employs an autoregressive modeling process to generate responses, predicting the next word based on previously derived words. Consequently, instead of deducing a correct answer, it arranges the most frequently appearing words in the learned data in order. Optimized for interactivity and content generation, it presents a smooth and plausible context, regardless of whether the content it presents is true. This report aimed to examine the reliability of ChatGPT, an artificial intelligence (AI) chatbot, in diagnosing diseases and treating patients, how to interpret its responses, and directions for future development.Current Concepts: Ten published case reports from Korea were analyzed to evaluate the efficacy of ChatGPT, which was asked to describe the correct diagnosis and treatment. ChatGPT answered 3 cases correctly after being provided with the patient’s symptoms, findings, and medical history. The accuracy rate increased to 7 out of 10 after adding laboratory, pathological, and radiological results. In one case, ChatGPT did not provide appropriate information about suitable treatment, and its response contained inappropriate content in 4 cases. In contrast, ChatGPT recommended appropriate measures in 4 cases.Discussion and Conclusion: ChatGPT’s responses to the 10 case reports could have been better. To utilize ChatGPT efficiently and appropriately, users should possess sufficient knowledge and skills to determine the validity of its responses. AI chatbots based on large language models will progress significantly, but physicians must be vigilant in using these tools in practice.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"5 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72814638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.253
Sung-Yong Kim
Background: Hydroxyurea is administered to control elevated blood counts in patients with myeloproliferative neoplasms (MPNs) to reduce the risk of thrombosis and mortality. We reviewed the side effects of hydroxyurea, development of secondary malignancies, and drug resistance observed in some patients.Current Concepts: The low incidences of malformed births, intrauterine deaths, and spontaneous abortions associated with hydroxyurea therapy suggest that adverse pregnancy and fetal effects are unlikely. However, animal studies have reported malformations; therefore, the use of hydroxyurea during pregnancy is not recommended. Low-grade adverse events associated with hydroxyurea therapy include gastrointestinal symptoms such as nausea, upper gastrointestinal discomfort, and diarrhea. These symptoms are usually resolved by dose adjustment or temporary discontinuation. Approximately 10% of patients with MPNs are resistant to hydroxyurea, and another 10% are unable to tolerate it owing to side effects. Drug intolerance and resistance are the most common causes of inadequate cytoreductive control in patients with MPNs. Second-line cytoreductive agents should be considered to overcome the high risk of thrombosis and poor survival. The evolution to secondary hematologic cancers is related to the duration of the disease, not hydroxyurea administration.Discussion and Conclusion: In pregnant patients accidentally exposed to hydroxyurea, the risk should be discussed with the patient to determine whether to continue the pregnancy. Hydroxyurea administration increases the risk of skin cancer but does not affect the incidence of other secondary hematologic or solid cancers. Ropeginterferon or Janus kinase (JAK) inhibitors, including ruxolitinib, are recommended as alternative treatments if the patient is intolerant or resistant to hydroxyurea, as this is associated with poorer survival.
{"title":"Adverse effects of hydroxyurea used for the treatment of myeloproliferative neoplasms","authors":"Sung-Yong Kim","doi":"10.5124/jkma.2023.66.4.253","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.253","url":null,"abstract":"Background: Hydroxyurea is administered to control elevated blood counts in patients with myeloproliferative neoplasms (MPNs) to reduce the risk of thrombosis and mortality. We reviewed the side effects of hydroxyurea, development of secondary malignancies, and drug resistance observed in some patients.Current Concepts: The low incidences of malformed births, intrauterine deaths, and spontaneous abortions associated with hydroxyurea therapy suggest that adverse pregnancy and fetal effects are unlikely. However, animal studies have reported malformations; therefore, the use of hydroxyurea during pregnancy is not recommended. Low-grade adverse events associated with hydroxyurea therapy include gastrointestinal symptoms such as nausea, upper gastrointestinal discomfort, and diarrhea. These symptoms are usually resolved by dose adjustment or temporary discontinuation. Approximately 10% of patients with MPNs are resistant to hydroxyurea, and another 10% are unable to tolerate it owing to side effects. Drug intolerance and resistance are the most common causes of inadequate cytoreductive control in patients with MPNs. Second-line cytoreductive agents should be considered to overcome the high risk of thrombosis and poor survival. The evolution to secondary hematologic cancers is related to the duration of the disease, not hydroxyurea administration.Discussion and Conclusion: In pregnant patients accidentally exposed to hydroxyurea, the risk should be discussed with the patient to determine whether to continue the pregnancy. Hydroxyurea administration increases the risk of skin cancer but does not affect the incidence of other secondary hematologic or solid cancers. Ropeginterferon or Janus kinase (JAK) inhibitors, including ruxolitinib, are recommended as alternative treatments if the patient is intolerant or resistant to hydroxyurea, as this is associated with poorer survival.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"120 1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88754297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-10DOI: 10.5124/jkma.2023.66.4.258
H. Jeon
Background: Sleep is vital for adolescents’ physical and emotional development; however, sleep disturbances and disorders frequently occur in this age group and affect their health and well-being. In this review, we investigated the prevalence, etiology, diagnosis, clinical characteristics, and treatment of sleep disorders observed among adolescents.Current Concepts: The diagnostic criteria for insomnia disorder among adolescents include difficulties in falling asleep, maintaining sleep, or waking up too early and feeling unrefreshed, which are observed at least 3 days per week over 3 or more months. Cognitive-behavioral therapy for insomnia typically includes identifying and addressing negative thoughts and behaviors associated with sleep and establishing a consistent sleep-wake schedule. Delayed sleep phase syndrome is diagnosed in individuals in whom sleep onset and wake times are persistently delayed by 2 or more hours beyond the desired or existing sleep schedule, which leads to excessive daytime sleepiness or impaired functioning. Behavioral interventions comprise sleep hygiene education, relaxation techniques, and phototherapy. Symptoms such as pronounced snoring, apnea observed by others, and gasping or pauses in breathing during sleep may indicate sleep apnea. Continuous positive airway pressure therapy is an effective treatment strategy for sleep apnea. A history of excessive daytime sleepiness and cataplexy suggests narcolepsy, and treatment options include pharmacotherapy, behavior modification, and lifestyle adjustments. Restless leg syndrome treatments include behavioral therapy, as well as anticonvulsant and dopamine receptor agonist administration.Discussion and Conclusion: Addressing sleep disorders is important to promote optimal health and well-being of adolescents and requires a multidisciplinary approach. Early detection, accurate diagnosis, and individualized treatment improve sleep and overall health outcomes and promote academic and social success.
{"title":"Clinical presentation, diagnosis, and treatment of sleep disorders in adolescents","authors":"H. Jeon","doi":"10.5124/jkma.2023.66.4.258","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.4.258","url":null,"abstract":"Background: Sleep is vital for adolescents’ physical and emotional development; however, sleep disturbances and disorders frequently occur in this age group and affect their health and well-being. In this review, we investigated the prevalence, etiology, diagnosis, clinical characteristics, and treatment of sleep disorders observed among adolescents.Current Concepts: The diagnostic criteria for insomnia disorder among adolescents include difficulties in falling asleep, maintaining sleep, or waking up too early and feeling unrefreshed, which are observed at least 3 days per week over 3 or more months. Cognitive-behavioral therapy for insomnia typically includes identifying and addressing negative thoughts and behaviors associated with sleep and establishing a consistent sleep-wake schedule. Delayed sleep phase syndrome is diagnosed in individuals in whom sleep onset and wake times are persistently delayed by 2 or more hours beyond the desired or existing sleep schedule, which leads to excessive daytime sleepiness or impaired functioning. Behavioral interventions comprise sleep hygiene education, relaxation techniques, and phototherapy. Symptoms such as pronounced snoring, apnea observed by others, and gasping or pauses in breathing during sleep may indicate sleep apnea. Continuous positive airway pressure therapy is an effective treatment strategy for sleep apnea. A history of excessive daytime sleepiness and cataplexy suggests narcolepsy, and treatment options include pharmacotherapy, behavior modification, and lifestyle adjustments. Restless leg syndrome treatments include behavioral therapy, as well as anticonvulsant and dopamine receptor agonist administration.Discussion and Conclusion: Addressing sleep disorders is important to promote optimal health and well-being of adolescents and requires a multidisciplinary approach. Early detection, accurate diagnosis, and individualized treatment improve sleep and overall health outcomes and promote academic and social success.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"26 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84392641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-10DOI: 10.5124/jkma.2023.66.3.200
Tae-Joong Kim, Beomman Ha, Ji-in Yang, Mi-Jung Kim, K. Seo
Background: This study aimed to identify the incidence rate of post-coronavirus disease-2019 (COVID-19) conditions in the Republic of Korea (ROK) Army and to investigate the trend of the incidence rate according to changes in dominant variants.Methods: We used the results of a 19-item, self-completed survey of those who had recovered from COVID-19 in the ROK Army between March 24, 2020, and April 30, 2022. We used both descriptive and multiple logistic regression analyses to identify factors associated with the incidence rate of post-COVID-19 conditions.Results: Among the total of 48,623 COVID-19 episodes in the ROK Army, the overall incidence rate of post-COVID-19 conditions was 32.9%. Based on the survey, the incidence of cough was the highest at 15.4%, followed by fatigue (15.1%) and sputum (13.8%). The delta variant had the highest incidence rate of post-COVID-19 conditions at 50.7%, whereas the omicron variant had the lowest at 19.7%. Concerning the type of post-COVID-19 condition, the neuropsychiatric symptoms had the highest incidence at 27.4% when the delta variant was dominant, and the respiratory symptoms were highest at 37.3% when the omicron variant was dominant. In the case of smell and taste symptoms, the incidence rate was high at 21.1% only when the delta variant was predominant.Conclusion: The overall incidence rate of post-COVID-19 conditions in the ROK Army was 32.9%. When the delta variant was dominant, the overall incidence as well as the proportion of neuropsychiatric symptoms were high. However, as the omicron variant became dominant, the overall incidence decreased, but the proportion of respiratory symptoms increased.
{"title":"Descriptive analysis of the incidence rate of post-acute COVID-19 syndrome in the Republic of Korea Army","authors":"Tae-Joong Kim, Beomman Ha, Ji-in Yang, Mi-Jung Kim, K. Seo","doi":"10.5124/jkma.2023.66.3.200","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.3.200","url":null,"abstract":"Background: This study aimed to identify the incidence rate of post-coronavirus disease-2019 (COVID-19) conditions in the Republic of Korea (ROK) Army and to investigate the trend of the incidence rate according to changes in dominant variants.Methods: We used the results of a 19-item, self-completed survey of those who had recovered from COVID-19 in the ROK Army between March 24, 2020, and April 30, 2022. We used both descriptive and multiple logistic regression analyses to identify factors associated with the incidence rate of post-COVID-19 conditions.Results: Among the total of 48,623 COVID-19 episodes in the ROK Army, the overall incidence rate of post-COVID-19 conditions was 32.9%. Based on the survey, the incidence of cough was the highest at 15.4%, followed by fatigue (15.1%) and sputum (13.8%). The delta variant had the highest incidence rate of post-COVID-19 conditions at 50.7%, whereas the omicron variant had the lowest at 19.7%. Concerning the type of post-COVID-19 condition, the neuropsychiatric symptoms had the highest incidence at 27.4% when the delta variant was dominant, and the respiratory symptoms were highest at 37.3% when the omicron variant was dominant. In the case of smell and taste symptoms, the incidence rate was high at 21.1% only when the delta variant was predominant.Conclusion: The overall incidence rate of post-COVID-19 conditions in the ROK Army was 32.9%. When the delta variant was dominant, the overall incidence as well as the proportion of neuropsychiatric symptoms were high. However, as the omicron variant became dominant, the overall incidence decreased, but the proportion of respiratory symptoms increased.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78526356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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