Warfarin is widely used for the prevention of cerebral infarction, especially in patients with atrial fibrillation or artificial valve. Although hemorrhagic problems are well known, skin necrosis is a rare complication. Failures of early diagnosis or management may lead to serious results. We report a case of skin necrosis induced by warfarin therapy.
Identification of mite and tick bite sites provides important clinical information. The predominant mite species in Korea associated with scrub typhus are Leptotrombidium pallidum and Leptotrombidium scutellare . The most abundant tick species is Haemaphysalis longicornis . To date, there has been no comparative study on preferred bite sites between mites and ticks in humans. This study included a review of medical records and a field study. For mite bite sites, eschars were checked on 506 patients with scrub typhus, confirmed by indirect immunofluorescence assay or nested polymerase chain reaction on the 56-kDa type-specific antigen gene of Orientia tsutsugamushi . Tick bite sites were identified and marked on a diagram for 91 patients who experienced tick bites within the previous year through a field epidemiological investigation. The mite and tick bite sites in Koreans were compared. The most frequently observed mite bite sites were the anterior chest, including the axillae (29.1%) and the abdominal region, including the inguinal area (26.1%). Tick bite sites were most frequent on the lower extremities (33.0%), followed by the abdominal region, including the inguinal area (26.4%), and upper extremities (26.4%). The distribution was significantly different between mite and tick bite sites ( P < 0.001). There was a statistically significant difference in the mite bite ( P = 0.001), but not tick bite sites ( P = 0.985), between men and women. This is the first report on the differences between tick and mite bite sites, and may help clinicians reach a rapid diagnosis of mite- or tick-borne infection.
Abstract Background Accurate infarct volume measurement requires manual segmentation in diffusion weighted image (DWI) which is time-consuming and prone to variability. We compared two DWI infarct segmentation programs based on deep learning and the apparent diffusion coefficient threshold (JBS-01K and RAPID DWI, respectively) in a comprehensive stroke center. Method We included 414 patients whose DWI were evaluated using RAPID DWI and JBS-01K. We used the Bland-Altman plot to compare estimated and manually segmented infarct volumes. We compared R-squared, root mean squared error, Akaike information criterion, and log likelihood after linear regression of manually segmented infarct volumes. Results The mean age of included patients was 70,0±12.4 years, and 60.9% were male. The median time between the last known well and a DWI was 12.4 hours. JBS-01K segmented infarct volumes were more comparable to manually segmented volumes compared to RAPID DWI. JBS-01K had a lower root mean squared error (6.9 vs. 10.8) and log likelihood (p<0.001) compared to RAPID DWI. In addition, compared to RAPID DWI, JBS-01K more correctly classified patients according to the infarct volume threshold used in endovascular treatment trials (overall accuracy 98.1% vs. 94.0%; p = 0.002). In 35 patients who received DWI prior to endovascular treatment, JBS-01K infarct volume segmentation was more closely related to manual infarct volume segmentation. Conclusion We demonstrated that a deep learning method segmented infarct on DWI more accurately than one based on the apparent diffusion coefficient threshold.
ABSTRACT New antibiotics are required to have the antibacterial activity against doxycycline-resistant Orientia tsutsugamushi . An in vitro sensitivity study showed that telithromycin was more effective than erythromycin for Rickettsia , Bartonella , and Coxiella burnetii . In this prospective, open-label, randomized trial, we enrolled patients with mild-to-moderate scrub typhus. We compared the efficacy and safety of a 5-day telithromycin therapy with those of a 5-day doxycycline therapy at Chosun University Hospital or one of its two community-based affiliated hospitals (Jangheung Hospital and Cheomdan Hospital), which are all located in southwestern Korea, between September and December 2005. A total of 92 patients were randomly assigned to either the telithromycin group ( n = 47) or the doxycycline group ( n = 45). After the treatment, fever control time was 20.45 ± 12.9 h in the telithromycin group and 22.60 ± 21.44 h in the doxycycline group ( P > 0.05). After the treatment, the cure rate was 100% in the telithromycin group and 97.8% in the doxycycline group ( P > 0.05). Furthermore, there were no significant differences in time elapsed until such symptoms as headache, myalgia, and rash disappeared. No serious adverse events or death were noted following the treatment in both groups. There were no significant differences in adverse events. In conclusion, the efficacy and safety of a 5-day once-a-day regimen of 800 mg telithromycin were equivalent to those of a 5-day twice-a-day regimen of 100 mg doxycycline in patients with mild-to-moderate scrub typhus. Telithromycin could be considered a promising new antibacterial agent for patients with scrub typhus.
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