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A New Korean Nomenclature for Steatotic Liver Disease 韩国脂肪肝新命名法
Pub Date : 2024-07-23 DOI: 10.3904/kjm.2024.038
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引用次数: 0
Non-carbapenem Drugs for Patients with Bacteremia caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Piperacillin-Tazobactam 针对由产扩展谱β-内酰胺酶肠杆菌科细菌引起的菌血症患者的非碳青霉烯类药物:哌拉西林-他唑巴坦
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.149
Hyunjoo Oh, Seunghee Lee, Misun Kim, S. Heo, J. Yoo
Background/Aims: Carbapenems are recommended for treating bacteremia caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E). However, this has resulted in a significant rise in the utilization of carbapenems in cases of ESBL-E infection. We evaluated the clinical outcomes of patients with ESBL-E bacteremia treated with non-carbapenem antimicrobials.Methods: We conducted a retrospective case-control study of a cohort of patients with documented ESBL-E bacteremia from January 2021 to December 2021. The patients were divided into two groups according to whether they received non-carbapenem or carbapenem therapy. The rates of treatment failure, 30-day mortality and microbiologic failure, and the durations of hospitalization and of antimicrobial therapy were compared between the two groups. Antimicrobial susceptibility testing and phenotypic identification of ESBL-E were performed using the Vitek 2 system.Results: Of 118 patients with ESBL-E bacteremia, 54 received non-carbapenem drugs (non-carbapenem group [NCG]) and 64 received carbapenems (carbapenem group [CG]). Treatment failure at 30 days occurred in 16.7% of the patients in the NCG and in 18.8% in the CG (p = 0.65). The 30-day mortality rate was 14.8% in the NCG and 17.2% in the CG (p = 0.63). Extra-urinary tract infection and prior antimicrobial therapy within 30 days were risk factors for treatment failure in patients with ESBL-E bacteremia. The clinical outcomes did not differ significantly between the two groups, challenging the prevailing preference for carbapenems in the treatment of ESBL-E bacteremia.Conclusions: Non-carbapenem antimicrobials such as piperacillin/tazobactam are recommended for patients with mild ESBL-E bacteremia in South Korea.
背景/目的:碳青霉烯类被推荐用于治疗由产扩展谱β-内酰胺酶(ESBL)肠杆菌科细菌(ESBL-E)引起的菌血症。然而,这也导致了在 ESBL-E 感染病例中碳青霉烯类药物使用率的显著上升。我们评估了使用非碳青霉烯类抗菌药物治疗 ESBL-E 菌血症患者的临床疗效:我们对 2021 年 1 月至 2021 年 12 月期间记录在案的 ESBL-E 菌血症患者队列进行了一项回顾性病例对照研究。根据患者接受的是非碳青霉烯类治疗还是碳青霉烯类治疗,将其分为两组。比较了两组患者的治疗失败率、30 天死亡率和微生物学失败率,以及住院时间和抗菌治疗时间。使用 Vitek 2 系统对 ESBL-E 进行抗菌药物药敏试验和表型鉴定:118名ESBL-E菌血症患者中,54人接受了非碳青霉烯类药物治疗(非碳青霉烯类组 [NCG]),64人接受了碳青霉烯类药物治疗(碳青霉烯类组 [CG])。在 30 天内治疗失败的患者中,NCG 组为 16.7%,CG 组为 18.8%(P = 0.65)。NCG组的30天死亡率为14.8%,CG组为17.2%(P = 0.63)。ESBL-E菌血症患者尿路外感染和30天内曾接受抗菌治疗是治疗失败的风险因素。两组患者的临床结果无明显差异,这对目前治疗ESBL-E菌血症时首选碳青霉烯类抗生素的观点提出了质疑:结论:韩国建议对轻度ESBL-E菌血症患者使用哌拉西林/他唑巴坦等非碳青霉烯类抗菌药物。
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引用次数: 0
Management of Subclinical Hypothyroidism: The 2023 Korean Thyroid Association Guidelines 亚临床甲减的管理:2023 年韩国甲状腺协会指南
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.127
Hyun-Kyung Chung
Subclinical hypothyroidism (SCH) is characterized by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine levels. The Korean Thyroid Association recently issued guidelines for managing SCH. Based on the Korea National Health and Nutrition Examination Survey (2013-2015), a serum TSH level of 6.8 mIU/L is the reference value for SCH. SCH is classified as mild (TSH 6.8-10.0 mIU/L) or severe (TSH > 10.0 mIU/L), and patients are categorized as adult (age < 70 years) or elderly (age ≥ 70 years). Levothyroxine treatment (LT4-Tx) is not recommended for mild or even severe SCH in elderly patients. Immediate LT4-Tx can be given to adults in most cases, but not to women who are pregnant, patients with progressive disease, or patients with underlying coronary artery disease, heart failure, or dyslipidemia.
亚临床甲状腺功能减退症(SCH)的特点是血清促甲状腺激素(TSH)水平升高,而游离甲状腺素水平正常。韩国甲状腺协会最近发布了管理亚临床甲减的指南。根据韩国国民健康与营养调查(2013-2015 年),血清促甲状腺激素水平为 6.8 mIU/L 是 SCH 的参考值。SCH分为轻度(促甲状腺激素6.8-10.0 mIU/L)和重度(促甲状腺激素>10.0 mIU/L),患者分为成人(年龄<70岁)和老年人(年龄≥70岁)。对于老年患者的轻度甚至重度 SCH,不建议使用左旋甲状腺素治疗(LT4-Tx)。大多数情况下,成人可立即服用左旋甲状腺素,但妊娠期妇女、疾病进展期患者或患有潜在冠状动脉疾病、心力衰竭或血脂异常的患者不能服用。
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引用次数: 0
Jaundice That Has Persisted for 5 Days 持续 5 天的黄疸
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.140
Young Chang
Hepatitis B virus (HBV) reactivation associated with various therapeutic interventions is a significant cause of morbidity and mortality among patients with current or resolved HBV infection. Since no curative treatment for HBV infection is currently available, a large number of individuals in the general population are at risk for HBV reactivation. Populations vulnerable to HBV reactivation include those currently infected with HBV or those who have had past exposure to the virus. The potential consequences of HBV reactivation are particularly concerning when these populations undergo anti-cancer chemotherapy, immunosuppressive or immunomodulatory therapies for managing various malignancies, rheumatologic diseases, inflammatory bowel disease, or undergo solid-organ or hematologic stem cell transplantation. This article aims to increase awareness of HBV reactivation and to elucidate the mechanisms and risks associated with HBV reactivation in various clinical settings.
与各种治疗干预相关的乙型肝炎病毒(HBV)再激活是目前或已治愈的 HBV 感染患者发病和死亡的一个重要原因。由于目前还没有治疗 HBV 感染的方法,因此普通人群中的许多人都面临着 HBV 再激活的风险。易受 HBV 再激活影响的人群包括目前已感染 HBV 或过去曾接触过该病毒的人。当这些人群接受抗癌化疗、免疫抑制或免疫调节治疗以控制各种恶性肿瘤、风湿病、炎症性肠病,或接受实体器官或血液干细胞移植时,HBV 再激活的潜在后果尤其令人担忧。本文旨在提高人们对 HBV 再激活的认识,并阐明在各种临床环境中与 HBV 再激活相关的机制和风险。
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引用次数: 0
A Rare Case of Acute Pyelonephritis Leading to Bilateral Subcapsular Renal Hematoma: A Case Report 急性肾盂肾炎导致双侧肾囊下血肿的罕见病例:病例报告
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.158
Hae Won Park, Minsuk Seo, Chung Sik Lee
This case underscores the rarity of bilateral subcapsular renal hematoma (SCH) as a complication of acute pyelonephritis, and this is the first reported case in South Korea. SCH can have various underlying causes, including cysts, bleeding tendencies, cancer, vascular diseases and, less commonly, infections. A patient with uncontrolled diabetes mellitus and alcohol dependency presented with weakness. Bilateral SCH from acute pyelonephritis was diagnosed and treated with antibiotics and renal replacement therapy. Despite improved renal function, 30-day bilateral percutaneous drainage was necessary due to a persistent fever and elevated infection markers, resulting in a bloody, pus-like discharge. This case report sheds light on the rare etiology of bilateral SCH as a result of acute pyelonephritis. It serves as a reminder of the critical importance of timely intervention, to prevent deteriorating outcomes.
该病例强调了急性肾盂肾炎并发双侧肾囊下血肿(SCH)的罕见性,这也是韩国报告的首个病例。肾囊下血肿的病因多种多样,包括囊肿、出血倾向、癌症、血管疾病,感染也不常见。一名糖尿病和酒精依赖症患者因乏力而就诊。急性肾盂肾炎引起的双侧肾积水被确诊,并接受了抗生素和肾脏替代治疗。尽管肾功能有所改善,但由于持续发热和感染指标升高,导致血性脓性分泌物,不得不进行为期 30 天的双侧经皮引流术。本病例报告揭示了急性肾盂肾炎导致双侧 SCH 的罕见病因。该病例提醒人们,及时干预对防止病情恶化至关重要。
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引用次数: 0
Clinical Significance and Interpretation of Allergen-Specific IgE Testing in Regard to Food Allergy 过敏原特异性 IgE 检测对食物过敏的临床意义和解释
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.145
Hyun Jung Jin
Food allergy is an adverse reaction that occurs after ingesting food and is caused by an aberrant immune response. Taking a detailed medical history is the most important part of diagnosing food allergies. When an immunoglobulin E (IgE)-mediated food allergy is suspected, food-specific IgE testing can confirm the diagnosis. Allergen skin-prick tests or serum tests for specific IgE should be considered as the first line of testing, and depending on the offending food, a further prick-to-prick test with fresh food or a component-resolved diagnostic test may be helpful. Interpretation of the results should be based on the patient’s medical history.
食物过敏是摄入食物后出现的一种不良反应,由异常的免疫反应引起。详细询问病史是诊断食物过敏最重要的部分。如果怀疑是免疫球蛋白 E(IgE)介导的食物过敏,食物特异性 IgE 检测可以确诊。过敏原皮肤点刺试验或特异性 IgE 血清检测应被视为第一道检测线,根据过敏食物的不同,使用新鲜食物进行进一步的点刺试验或成分解析诊断试验可能会有所帮助。对结果的解释应以患者的病史为基础。
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引用次数: 0
Updated Guidelines for Acute Coronary Syndrome 急性冠状动脉综合征的最新指南
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.134
Sung Soo Kim, Hyun Kuk Kim
Despite medical and invasive advancements, cardiovascular mortality attributable to ischemic heart disease, including acute coronary syndrome (ACS), persists at a substantial level. Clinical guidelines have been issued by the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association to support clinicians in making appropriate decisions and improving the prognosis of ACS patients. ESC recently introduced a new ACS guideline in August 2023. This review discusses the recent modification in the diagnosis and management of early-phase ACS in the 2023 ESC guideline.
尽管医疗和侵入性治疗取得了进步,但包括急性冠状动脉综合征(ACS)在内的缺血性心脏病导致的心血管疾病死亡率仍居高不下。欧洲心脏病学会(ESC)和美国心脏病学会/美国心脏协会发布了临床指南,以支持临床医生做出适当的决策,改善急性冠脉综合征患者的预后。欧洲心脏病学会最近于 2023 年 8 月推出了新的 ACS 指南。本综述讨论了 2023 年 ESC 指南中对早期 ACS 诊断和管理的最新修改。
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引用次数: 0
The Opportunity for Educational Innovations and Requirements in Academic System Reform of Medical Schools 医学院学制改革中的教育创新机遇与要求
Pub Date : 2024-06-01 DOI: 10.3904/kjm.2024.99.3.123
Bo Young Yoon
The amendment to the Higher Education Act enforced on February 20, 2024, abolishing the traditional 2-year pre-med and 4-year medical school programs, marks a significant shift in medical education in Korea. The academic system reform is expected to be a driving force for large-scale curriculum revision, presenting an opportunity to introduce new educational innovations not only in curriculum but also in student assessment and support systems. Addressing these challenges requires collaborative efforts among educators, students, and communities to navigate the evolving landscape of medical education effectively. In this regard, I will illustrate the recruitment and development of educators to implement the reform and the collaboration between communities and medical schools to innovate medical education.
2024 年 2 月 20 日实施的《高等教育法》修正案废除了传统的 2 年制医学预科和 4 年制医学院课程,标志着韩国医学教育的重大转变。学制改革预计将成为大规模课程修订的推动力,不仅在课程方面,而且在学生评估和支持系统方面都将提供一个引入新的教育创新的机会。要应对这些挑战,需要教育工作者、学生和社区通力合作,才能有效驾驭不断变化的医学教育格局。在这方面,我将说明招聘和培养教育工作者以实施改革的情况,以及社区与医学院合作创新医学教育的情况。
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引用次数: 0
Recent Progression of Incretin-Based Obesity Treatment 基于胰岛素的肥胖症治疗的最新进展
Pub Date : 2024-04-01 DOI: 10.3904/kjm.2024.99.2.78
Dughyun Choi
Incretin-based obesity treatments are making remarkable progress, marking a new era in the field of obesity pharmacotherapy. These treatments not only meet the long-standing demands for safety and sustainability in obesity medications but also go beyond, significantly improving complications associated with obesity, such as cardiovascular diseases. This review explores the advancement in obesity treatments through the latest research findings on semaglutide and tirzepatide, two incretin-based obesity treatments currently receiving considerable attention.
基于胰岛素的肥胖症治疗正在取得显著进展,标志着肥胖症药物治疗领域进入了一个新时代。这些疗法不仅满足了肥胖症药物治疗长期以来对安全性和可持续性的要求,而且还大大改善了与肥胖症相关的并发症,如心血管疾病。本综述通过对目前备受关注的两种基于胰高血糖素的肥胖症治疗药物--塞马鲁肽和替扎帕肽的最新研究成果,探讨肥胖症治疗的进展。
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引用次数: 0
A Case of Metapneumovirus Pneumonia-Related Acute Respiratory Distress Syndrome in a Young Adult Patient 一例年轻成人患者因跨肺病毒肺炎引发的急性呼吸窘迫综合征病例
Pub Date : 2024-04-01 DOI: 10.3904/kjm.2024.99.2.111
Tae Wan Kim, Won-Young Kim
Human metapneumovirus (hMPV) infections commonly present as mild upper respiratory tract infections in healthy adults, although severe respiratory complications have been observed, particularly in elderly and immunocompromised patients. We report a case in whom pneumonia caused by hMPV progressed to acute respiratory distress syndrome (ARDS) in a healthy adult without underlying diseases. A 31-year-old female presented with fever and dyspnea, prompting transfer to our hospital for mechanical ventilation 3 days after symptom onset. Auscultation revealed coarse breath sounds and crackles in both lung fields, and chest X-ray showed non-specific infiltrative nodules with poorly defined borders throughout both lungs. ARDS caused by community-acquired pneumonia was diagnosed. hMPV was identified via rapid testing of respiratory samples for genes that encode pneumonia pathogens and drug resistance markers; we employed reverse transcription polymerase chain reactions to these ends. Six days later, the patient was weaned off the mechanical ventilator, and discharged from the hospital in good clinical condition.
人类偏肺病毒(hMPV)感染在健康成人中通常表现为轻微的上呼吸道感染,但也观察到严重的呼吸道并发症,尤其是在老年人和免疫力低下的患者中。我们报告了一例由 hMPV 引起的肺炎发展为急性呼吸窘迫综合征(ARDS)的病例,患者为健康成年人,无基础疾病。一名 31 岁的女性患者出现发热和呼吸困难,症状出现 3 天后转入我院接受机械通气治疗。听诊发现呼吸音粗,双肺野有噼啪声,胸部 X 光片显示双肺有边界不清的非特异性浸润性结节。通过快速检测呼吸道样本中编码肺炎病原体和耐药性标记的基因,我们确定了 hMPV;为此我们采用了反转录聚合酶链反应。六天后,患者脱离了机械呼吸机,出院时临床状况良好。
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引用次数: 0
期刊
The Korean Journal of Medicine
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