A Case of Systemic Capillary Leak Syndrome Presenting as Septic Shock

Systemic capillary leak syndrome is a rare disease characterized by life-threatening attacks of reversible plasma extravasation and vascular collapse accompanied by hypotension, hemoconcentration, and hypoalbuminemia. A 36-year-old woman was admitted to this hospital with a fever, along with symptoms consistent with an upper respiratory tract infection and hypotension. Initial laboratory tests revealed several abnormal findings, including an elevated leukocyte count and hematocrit, hypoalbuminemia, and acute renal failure. Here, we report a case of successful treatment of systemic capillary leak syndrome, which can be difficult to distinguish from septic shock.ope

Overview of Helicobacter pylori and Treatment Options

Helicobacter pylori is an important transmissible human pathogen found on the luminal surface of the gastric epithelium. The organism can persist in the stomach indefinitely and causes gastroduodenal inflammation that may proceed to atrophic gastritis, peptic ulcer, gastric MALT lymphoma, and gastric cancer. Standard triple therapy which consists of proton pump inhibitor (PPI) plus two antibiotics (amoxicillin and clarithromycin) is now generally used in Korea, however, eradication rates of H. pylori has been decreasing due to increasing antibiotic resistance. In this review, current second-line treatment regimens, difficult problems on treatment, necessity of local target therapy, applicability of clay minerals as a drug delivery system (DDS), and a new therapeutic strategy and its study plans will be discussed.ope

The risk factors in patients with candiduria associated with candidemia

Background : The early diagnosis of candidemia is critical for the management. The candidemia is known to be associated with 10% of candiduria. But the risk factors in patients with candiduria who are associated with candidemia are not known. We analyzed the risk factors in patients with candiduria who are associated with candidemia. Methods : We retrospectively reviewed 164 patients with candiduria in Yonsei Medical Center from January 1998 to December 1998. Candiduria patients were divided into two groups. Candiduria patients without candidemia (Group 1 , 147 patients) and candiduria patients with candidemia (Group 2 , 17 patients). Results : 1) The mean age of the patients were 57.5 years in group 1 and 62.5 years in group 2. There were no significant differences in the sex ratio between the two groups. 2) Central venous catheter insertion (53%, 100% in group 1 , 2 ), hypotension (14%, 59% in group 1, 2), other associated infections (64%, 100% in group 1, 2), intensive care (41, 76% in group 1, 2) and fever (46%, 82% in group 1, 2) were the very significant risk factors in patients with candiduria who were associated with candidemia. 3) Urinary tract procedure (11%, 88% in group 1, 2), urinary catheter insertion (63%, 94% in group 1, 2), thrombocytopenia (17%, 41% in group 1, 2) and DM (8%, 24% in group 1, 2) were the significant risk factors of candidemia. 4) Candida colony count (cfu/mL) of urine culture was not a significant risk factor 5 ) Mortality rate (27%, 59% in group 1, 2) was significantly high in patients with candidemia. Conclusion : Central venous catheter insertion , hypotension , other associated infections , intensive care and fever were the very significant risk factors of candidemia in patients with candiduria.ope

Two Cases of Bacteremia Caused by Vibrio Parahemolyticus in Liver Cirrhosis

We have experienced two cases of bacteremia in liver cirrhosis patients caused by Vibrio parahemolyticus. One presented with acute gastroenteritidis symptoms such as vomiting, diarrhea. Vibrio parahemolyticus was cultured in the blood. In the other patients showed vesicular rash in lower extremities with a positive blood culture. Both patients had been treated with intravenous fluid and antibiotics.ope

Diagnosis and Clinical Manifestations of HIV/AIDS

There are various diagnostic methods for detection of HIV infection. Among them, ELISA has been using most widely as a screening test. On the other hand, the Western blot method has been used as a confirmative test. The final confirmative tests are conducted on the seropositive sample and other supplementary methods such as HIV antigen test or molecular tests involving polymerase chain reaction should be performed in addition to Western blot for the confirmation. The clinical consequences of HIV infection encompass a spectrum ranging from an acute syndrome associated with primary infection to a prolonged asymptomatic state and advanced disease. It is best to regard HIV disease as beginning at the time of primary infection and progressing through various stages. Throughout the course of HIV infection, active viral replication and progressive immunologic impairment occur in most patients. With the exception of rare true long-term nonprogressors, HIV disease, when untreated, inexorably progresses even during the clinically latent stage. However, anti-retroviral therapy has had a major impact on blocking or slowing the progression of disease over extended periods of time in a substantial proportion of adequately treated patients. Overall, the clinical spectrum of HIV disease is constantly changing as patients live longer and new and better approaches to treatment and prophylaxis are developed.ope

Comparative genome analysis of novel coronavirus (SARS-CoV-2) from different geographical locations and the effect of mutations on major target proteins: An in silico insight

A novel severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) causing COVID-19 pandemic in humans, recently emerged and has exported in more than 200 countries as a result of rapid spread. In this study, we have made an attempt to investigate the SARS-CoV-2 genome reported from 13 different countries, identification of mutations in major coronavirus proteins of these different SARS-CoV-2 genomes and compared with SARS-CoV. These thirteen complete genome sequences of SARS-CoV-2 showed high identity (>99%) to each other, while they shared 82% identity with SARS-CoV. Here, we performed a very systematic mutational analysis of SARS-CoV-2 genomes from different geographical locations, which enabled us to identify numerous unique features of this viral genome. This includes several important country-specific unique mutations in the major proteins of SARS-CoV-2 namely, replicase polyprotein, spike glycoprotein, envelope protein and nucleocapsid protein. Indian strain showed mutation in spike glycoprotein at R408I and in replicase polyprotein at I671T, P2144S and A2798V,. While the spike protein of Spain & South Korea carried F797C and S221W mutation, respectively. Likewise, several important country specific mutations were analyzed. The effect of mutations of these major proteins were also investigated using various in silico approaches. Main protease (Mpro), the therapeutic target protein of SARS with maximum reported inhibitors, was thoroughly investigated and the effect of mutation on the binding affinity and structural dynamics of Mpro was studied. It was found that the R60C mutation in Mpro affects the protein dynamics, thereby, affecting the binding of inhibitor within its active site. The implications of mutation on structural characteristics were determined. The information provided in this manuscript holds great potential in further scientific research towards the design of potential vaccine candidates/small molecular inhibitor against COVID19.ope

Development of Antibiotic-intercalated Smectite Composites and Its Drug Delivery Potential in Gastric System

In this study, we aimed to make antibiotic-intercalated smectite composites using amoxicillin and clarithromycin as hygroscopic antibiotics, and gentamicin, tobramycin and netilmicin as non-hygroscopic aminoglucosides, and to check their drug delivery potential in gastric system using preliminary in-situ column release test for clarithromycinsmectite composite. All antibiotics were successfully intercalated into the interlayer of smectite by cation-exchange reaction in the batch experiment. Equilibrium batch test showed that clarithromycin-intercalation followed Langmuir isotherm and the possible maximum amount was calculated as 1.811 mmole/g. Clarithromycin was continuously released by the solutions of pH=2, 3, and 4 and the amount was decreased with pH increase.ope

The History of Antimicrobial Drug Development and the Current Situation.

Since development of the first antimicrobial agents in the 1940s, antimicrobial resistance has been an issue. Following the introduction of sulfonamides and penicillin, scientists discovered and developed a wide range of antimicrobials for treatment of bacterial diseases. Many new antimicrobials were discovered by systematic testing of soil microbes and many others were developed by chemical modification of existing agents. Discovery of new classes of antibacterial drugs slowed in the late 1960s. However, the speed with which bacteria develop resistance to antibiotics, in contrast with the slow development of new drugs, has led some experts to warn of a "post-antibiotic era." Judicious use of currently available antibiotics, through efforts such as public campaigns for 'appropriate antibiotic use', may help to conserve their effectiveness. However, even if we improve these practices, development of resistant bacteria will continue to occur, and new and better drugs will be needed. Clearly, a combination of traditional successful methods and modern technology will be needed for discovery and development of new classes of antibacterial drugs. In addition, policies that encourage and facilitate development of new antimicrobial agents are also needed.ope

Six cases of fungal endocarditis

Fungal endocarditis is rare but has been reported with increased frequency in the last few decades. Also fungal endocarditis has become an important infection in the aspect of medical progress and predisposing factors such as previous cardiac surgery, antibiotics use and hyperalimentation, immunosuppression, long-term intravenous catheterization, and drug use. We hereby describe six cases which occurred from January 1992 at Severance hospital, Yonsei University College of Medicine. In five cases infection was associated with previous cardiac surgery and in one case associated with subcutaneous central catheterization in a patient who underwent cancer chemotherapy. Only one patient survived after intensive treatment with fluconazole and surgical removal of vegetation. Others were discharged without improvement of disease or expired during therapy. Fungal endocarditis is still a serious disease with high mortality and whenever the diagnosis is suspected, transesophageal echocardiography should be performed with empirical antifungal therapy. Antifungal therapy and surgery would yield the best results. But overall survival in patient with fungal endocarditis is rather poor. Attentions and efforts for early diagnosis are needed in order to improve the prognosis of fungal endocarditis.ope

The clinical and economic burden of community-onset complicated skin and skin structure infections in Korea

Background/aims: To investigate epidemiologic characteristics, clinical and economic burdens, and factors associated with mortality in complicated skin and skin structure infection (cSSSI) patients in Korea. Methods: A retrospective, observational, nationwide study was conducted between April to July 2012 at 14 tertiary-hospitals in Korea. Eligible patients were hospitalized adults with community acquired cSSSI, who underwent surgical intervention and completed treatment between November 2009 and October 2011. Data on demography, clinical characteristics, outcomes and medical resource utilization were collected through medical record review. Direct medical costs were calculated by multiplying quantities of resources utilized by each unit price in Korea. Results: Of 473 patients enrolled, 449 patients (except 24 patients with no record on surgical intervention) were eligible for analysis. Microbiological testing was performed on 66.1% of patients and 8.2% had multiple pathogens. Among culture confirmed pathogens (n = 297 patients, 340 episodes), 76.2% were gram-positive (Staphylococcus aureus; 41.2%) and 23.8% were gram-negative. The median duration of hospital stay was 16 days. Among treated patients, 3.3% experienced recurrence and 4.2% died in-hospital. The mean direct medical costs amounted to $4,195/ person, with the greatest expenses for hospitalization and antibiotics. The in-hospital mortality and total medical costs were higher in combined antibiotics therapy than monotherapy (p < 0.05). Charlson's comorbidity index ≥ 3, standardized early warning scoring ≥ 4, sub-fascia infections and combined initial therapy, were all found to be associated with higher mortality. Conclusion: Korean patients with community-onset cSSSI suffer from considerable clinical and economic burden. Efforts should be made to reduce this burden through appropriate initial treatment.ope