Korean Journal of Internal Medicine最新文献

Background/aims: The Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire was developed to measure quality of life and disease impact in patients with psoriatic arthritis (PsA). We aimed to translate the English PsAID-12 into Korean and to evaluate its reliability and validity.

Methods: The PsAID-12 questionnaire was translated into Korean following international cross-cultural adaptation guidelines. After expert review and cognitive debriefing with 10 patients, the final Korean version of the PsAID-12 was established. For validation, 21 patients with PsA completed the Korean PsAID-12 questionnaire, and a retest was conducted one week later to assess reliability. Demographic data and disease activity indices, including the Disease Activity in Psoriatic Arthritis (DAPSA) and Visual Analog Scale (VAS) pain were collected. Correlations between PsAID-12 scores and disease activity indices were analyzed.

Results: Minor discrepancies in the translation process were resolved during the synthesis and review. The mean PsAID-12 scores were 3.9 ± 2.6 and 3.6 ± 2.3 for the first and second assessments, respectively. The mean response time was 2.6 ± 1.0 min. The intraclass correlation coefficient was 0.856 (95% CI 0.682-0.939, p < 0.050), indicating good reliability. The first PsAID-12 score was strongly correlated with the second PsAID-12 (r = 0.79), DAPSA (r = 0.66), and VAS pain (r = 0.67).

Conclusion: The Korean PsAID-12 questionnaire was well translated and validated, showing strong reliability and correlation with disease activity measures. It is therefore appropriate for assessing the impact of PsA in Korean patients.

Background/aims: Drug hypersensitivity reactions (DHRs) are unpredictable adverse drug reactions that can present with varied clinical manifestations, including anaphylaxis. However, data on DHRs initially diagnosed in the emergency department (ED) and subsequently confirmed by allergy specialists remain limited. This study investigated the clinical characteristics of ED-diagnosed DHRs and the outcomes of culprit-drug identification during outpatient allergy follow-ups.

Methods: We retrospectively analyzed adverse drug reaction reports from the ED of a university hospital in Korea between January 2021 and December 2023. Cases meeting the World Health Organization-Uppsala Monitoring Center criteria for DHRs were included. Clinical features, suspected culprit drugs, reaction phenotypes, severity, and outpatient follow-up outcomes were evaluated.

Results: Among 668 patients (mean age 43.3 yr), 63.9% had immediate-type and 36.1% had delayed-type reactions. Radiocontrast media, nonsteroidal anti-inflammatory drugs (NSAIDs), and β-lactams were the most common suspected culprits. Cutaneous manifestations predominated in both immediate- and delayed-type reactions. Anaphylaxis occurred in 33.5% of the immediate-type reactions and was significantly associated with allergic comorbidities. Outpatient follow-up was completed in only 12.9% of patients, and a culprit drug was identified in 59.3% of those patients by history, specific IgE, skin testing, or drug provocation. The most frequently confirmed causative agent was cefaclor, followed by amoxicillin/amoxicillin- clavulanate, NSAIDs, and eperisone.

Conclusion: Immediate-type DHRs were the predominant presentation in the ED and were predominantly caused by radiocontrast media and NSAIDs. Given the low rate of outpatient follow-up, early referral to allergists is essential to improve patient safety and prevent reexposure.

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. Recently, there has been a global resurgence of syphilis cases. In South Korea, the reported rate of syphilis steadily increased from 1.93 per 100,000 individuals in 2011 to 3.41 per 100,000 individuals in 2019. Notably, the incidence of the disease has been rising sharply among men in their 20s and 30s since 2016. Diagnosing syphilis based on its stage is complex and time-consuming. The combination of nontreponemal and treponemal tests has long been the cornerstone of syphilis diagnosis. Automated versions of nontreponemal tests and treponemal immunoassays have replaced the traditional manual nontreponemal and treponemal tests. Additionally, traditional direct methods, such as dark-field microscopy and silver staining, have been replaced by polymerase chain reaction testing and immunohistochemistry. Point-of-care tests are promising tools that facilitate the rapid and easy diagnosis of active syphilis. To ensure the proper diagnosis and control of syphilis, a comprehensive surveillance system and a thorough understanding and appropriate interpretation of diagnostic tests are necessary.

Background/aims: Infection remains the second leading cause of mortality in patients with end-stage renal disease (ESRD). Despite the direct relationship between hemodialysis vascular access-related infections (HD-VARI) and both prognosis and mortality in ESRD patients, there is a paucity of research in this area.

Methods: This retrospective study was performed at a tertiary care hospital in Seoul, Korea, from 2009 to 2020. Medical records of adult patients diagnosed with HD-VARI were assessed. We analyzed the distribution of microorganisms, clinical characteristics according to vascular access type, and evaluated risk factors for treatment failure.

Results: Data from a total of 367 patients were included over the 12-year study period. Based on vascular access type, 293 (79.8%) had arteriovenous graft infections, 29 (7.9%) had arteriovenous fistula infections, and 45 (12.3%) had tunneled cuffed catheter infections. Thirty-one (8.4%) patients experienced treatment failure within 90 days. Multivariate analysis identified male sex (odds ratio [OR], 2.343; 95% confidence interval [CI], 1.041-5.274) and metastatic infection (OR, 4.297; 95% CI, 1.516-12.178) as independent predictors of 90-day infection-related treatment failure. Subtotal or total excision (removal) of the infected vascular access significantly decreased the risk of 90-day infection-related treatment failure (OR, 0.337; 95% CI, 0.129-0.876).

Conclusion: Removal of infected vascular access played a crucial role in reducing infection-related deaths or relapses within 90 days. Management of vascular access infection should be individualized based on patient-specific factors.

Background/aims: Polatuzumab vedotin combined with bendamustine and rituximab (Pola-BR) is a treatment option for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), particularly as bridging therapy before chimeric antigen receptor (CAR) T-cell infusion. However, real-world data regarding its feasibility, efficacy, and safety in Korean patients are limited.

Methods: We conducted a single-center retrospective study of 52 patients with R/R DLBCL treated with Pola-BR between April 2021 and April 2024. Patients were categorized into three groups: salvage (n = 26), post-CAR T (n = 13), and bridging (n = 13). The primary endpoints were objective response rate (ORR) and complete response (CR) rate; progression-free survival (PFS), overall survival (OS), and safety were secondary endpoints.

Results: The overall ORR was 51.9% (27/52), with 36.5% (19/52) of the patients achieving CR. The ORRs were 46.2%, 53.8%, and 61.5% in the salvage, post-CAR T, and bridging groups, respectively, with corresponding CR rates of 30.8%, 38.5%, and 46.2%. The bridging group achieved the highest response rates despite receiving a median of only one cycle, and patients with fewer prior treatment lines demonstrated superior responses. Grade 3-4 hematologic toxicities occurred in nearly all post-CAR T (100%) and salvage (92.3%) patients but were significantly lower in the bridging group (46.2%).

Conclusion: Pola-BR provided meaningful disease control in patients with R/R DLBCL. Its use as a bridging therapy before CAR T-cell infusion was associated with high response rates, favorable safety, and a successful transition to cellular therapy, underscoring its value as a practical option in this setting.

Background/aims: Thyroid hormone suppression therapy (THST) is widely used for long-term management of differentiated thyroid cancer (DTC). However, studies have suggested that THST may increase the risk of atrial fibrillation (AF) in patients with DTC. We aimed to evaluate whether the risk of AF in patients with DTC differs according to treatment modality.

Methods: This retrospective cohort study used data from the Korean National Health Information Database between 2006 and 2019. We included 113,791 patients with DTC and age- and sex-matched 455,188 controls. The risk of AF was assessed according to the following treatment modalities: lobectomy or total thyroidectomy with or without radioactive iodine therapy (RAIT). A Cox proportional hazards model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: Patients with DTC had a two-fold higher risk of incident AF than controls (HR, 2.07; 95% CI, 1.98-2.17). All the treatment groups showed a higher risk of AF than the control group. Patients with DTC who underwent total thyroidectomy without RAIT (HR, 2.20; 95% CI, 2.06-2.34) or with RAIT (HR, 2.07; 95% CI, 1.95-2.20) had a higher risk of AF in contrast to those who underwent lobectomy (HR, 1.93; 95% CI, 1.72-2.15).

Conclusion: Patients with DTC had an increased risk of incident AF. The risk of AF was higher in patients with DTC who underwent total thyroidectomy than those who underwent lobectomy alone. For long-term management of patients with DTC, increased vigilance is required for AF screening, particularly in this high-risk group.

Advances in treating multiple myeloma (MM) have improved survival, shifting the management focus toward quality of life. Peripheral neuropathy (PN) is a common treatment-related toxicity that significantly impairs quality of life. However, standardized assessment methods for PN in patients with MM are currently lacking. A comprehensive search of multiple databases (PubMed, Embase, Cochrane Library, and KoreaMed) was conducted to identify relevant records. Eligible studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-two studies were included, and 17 PN assessment tools were identified. Nerve conduction studies and the National Cancer Institute Common Terminology Criteria for Adverse Events were the most commonly used clinician-based tools, whereas the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity was the most frequently used patient-reported outcome measure. The use of these tools varies depending on whether their purpose is diagnostic or evaluative. To the best of our knowledge, this is the first systematic review to evaluate PN assessment tools for patients with MM, revealing substantial heterogeneity across studies. By organizing these diverse approaches, our findings can guide researchers and clinicians toward a more consistent and standardized PN evaluation, ultimately improving the management of treatment-related neuropathy in MM.