An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8℃), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission. Keywords: DRESS syndrome; Allopurinol; Jaundice
Tuberculosis infection is prevalent in Korea and health care workers are vulnerable to tuberculosis infection in the hospital. The aims of this study were to develop and validate an education program that teaches senior medical students how to wear and choose the proper size and type of respiratory protective equipment (RPE), which may help reduce the risk of contracting Mycobacterium tuberculosis (MTB) from patients. Overall, 50 senior medical students participated in this education program. Methods of choosing the proper type of RPE, performing a fit check of the RPE, and choosing a suitable mask size were taught by certified instructors using the real-time quantitative fit test (QNFT). The validity of education program was evaluated with qualitative fit test (QLFT) before and after the education as pass or fail. The education program was effective, as shown by the significantly pass rate (increased 30 to 74%) in the QLFT after the education program (p<0.05). Among study participants, changing mask size from medium to small significantly increased the pass rate (p<0.001). Incorporation of this program into the medical school curriculum may help reduce risk of MTB infection in medical students working in the hospital.
Background: The aim of this study was to evaluate factors associated with increased risk of mortality from pneumonia among patients with pneumoconiosis.Methods: Medical records of 103 pneumoconiosis patients hospitalized for pneumonia were investigated.Seven patients who had lung cancer or other malignancy and 13 patients with insufficient medical record were excluded.Two female patients were excluded due to small number to analyze.The subjects were divided into two groups by clinical outcome of pneumonia, the deceased group and the survival group.The two groups were compared in terms of age, smoking history, episode of recent pneumonia, concomitancy of interstitial fibrosis or fungal ball infection, extent of small opacities, grade of large opacities and results of spirometry.Multiple logistic regression was applied to determine the association between these variables and mortality from pneumonia.Results: The deceased group showed more frequent history of recent pneumonia (p = 0.006), higher prevalence of interstitial fibrosis (p = 0.007) and longer hospitalization period (p = 0.044).The proportion of subjects who had decreased FVC, less than 70 % of predicted value, was higher in the deceased group (p < 0.001).In multiple logistic regression, after adjusting age, smoking history, recent pneumonia, fungal ball, large opacity, profusion and FVC (or FEV 1 ) less than 70 % of predicted value, history of recent pneumonia, concomitancy of interstitial fibrosis, type of pneumoconiosis and fungal ball presented statistically significant association with mortality from pneumonia.Conclusions: The concomitancy of fungal ball or interstitial fibrosis, history of recent pneumonia within last 90 days, type of pneumoconiosis, FVC less than 70 % of predicted value, FEV 1 less than 70 % of predicted value presented statistically significant association with mortality from pneumonia.More attention should be given to patients who have such factors when treating pneumonia with pneumoconiosis.
Although Mycobacterium avium complex (MAC) is the most common pathogen in nontuberculous mycobacterial (NTM) pulmonary diseases, endobronchial lesions caused by MAC infections are very rare even in an immunocompromised host. Herein, we describe the case of a 59-year-old, HIV-negative and non-immunocompromised woman who developed multifocal pulmonary infiltrations with endobronchial lesion caused by M. avium. Bronchoscopic examination revealed white- and yellow-colored irregular mucosal lesions in the bronchus of the left lingular division. M. avium was identified using sputum culture and bronchial washing fluid culture. Following the recommendations of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA), the patient was begun on treatment with antimycobacterial drugs. After treatment, pneumonic infiltration decreased.
Human adenovirus type 55 (HAdV-55), an emerging epidemic strain, has caused several large outbreaks in the Korean military since 2014, and HAdV-associated acute respiratory illness (HAdV-ARI) has been continuously reported thereafter.To evaluate the epidemiologic characteristics of HAdV-ARI in the Korean military, we analyzed respiratory virus polymerase chain reaction (RV-PCR) results, pneumonia surveillance results, and severe HAdV cases from all 14 Korean military hospitals from January 2013 to May 2018 and compared these data with nationwide RV surveillance data for the civilian population.A total of 14,630 RV-PCRs was performed at military hospitals. HAdV (45.4%) was the most frequently detected RV, followed by human rhinovirus (12.3%) and influenza virus (6.3%). The percentage of the military positive for HAdV was significantly greater than the percentage of civilians positive for HAdV throughout the study period, with a large outbreak occurring during the winter to spring of 2014 to 2015. The outbreak continued until the end of the study, and non-seasonal detections increased over time. The reported number of pneumonia patients also increased during the outbreak. Case fatality rate was 0.075% overall but 15.6% in patients with respiratory failure. The proportion of severe patients did not change significantly during the study period.A large HAdV outbreak is currently ongoing in the Korean military, with a trend away from seasonality, and HAdV-55 is likely the predominant strain. Persistent efforts to control the outbreak, HAdV type-specific surveillance, and vaccine development are required.
Objectives:The most common occupational disease that is compensated by Industrial Accident Compensation Insurance (IACI) in Korea is musculoskeletal disease (MSD).Although complaints about the workers' compensation system have been raised by injured workers with MSD, studies that examine workers' experiences with the Korean system are rare.This paper is a qualitative study designed to examine injured workers' experiences with the workers' compensation system in Korea.The aim of this study is to explore the drawbacks of the workers' compensation system and to suggest ways to improve this system.Methods: All workers from an automobile parts factory in Anseong, GyeongGi province who were compensated for MSD by IACI from January 2003 to August 2013 were invited to participate.Among these 153 workers, 142 workers completed the study.Semi-structured open-ended interviews and questionnaires were administered by occupational physicians.The responses of 131 workers were analyzed after excluding 11 workers, 7 of whom provided incomplete answers and 4 of whom were compensated by accidental injury.Based on their age, disease, department of employment, and compensation time, 16 of these 131 workers were invited to participate in an individual in-depth interview.In-depth interviews were conducted by one of 3 occupational physicians until the interview contents were saturated.Results: Injured workers with MSD reported that the workers' compensation system was intimidating.These workers suffered more emotional distress than physical illness due to the workers' compensation system.Injured workers reported that they were treated inadequately and remained isolated for most of the recuperation period.The compensation period was terminated without ample guidance or a plan for an appropriate rehabilitation process.Conclusions: Interventions to alleviate the negative experiences of injured workers, including quality control of the medical care institutions and provisions for mental and psychological care for injured workers, are needed to help injured workers return to work earlier and more healthy.
To evaluate clinical factors associated with mortality from pneumonia among patients with pneumoconiosis.
Methods
Medical records of pneumoconiosis patients hospitalised for pneumonia (n = 103) were reviewed retrospectively. Patients who had lung cancer or other malignancy (n = 7) and patients with insufficient medical record (n = 13) were excluded. Female patients (n = 2) were excluded due to small number to analyse. The eligible subjects (n = 81) were divided into two groups by clinical outcome of pneumonia; the deceased group and the survival group. The two groups were compared in terms of age, smoking history, episode of recent pneumonia, concomitancy of interstitial fibrosis or fungal ball infection, type of pneumoconiosis, extent of small opacities, grade of large opacities and results of spirometry. Multiple logistic regression was applied to determine the association between these variables and mortality from pneumonia.
Results
The deceased group showed more frequent history of recent pneumonia (p = 0.006), higher prevalence of interstitial fibrosis (p = 0.007) and longer hospitalisation period (p = 0.044). The proportion of subjects who had decreased FVC or FEV1, less than 70% of predicted value, was significantly higher in the deceased group (p < 0.001, P < 0.012). In multiple logistic regression, history of recent pneumonia, concomitancy of interstitial fibrosis, type of pneumoconiosis and fungal ball presented statistically significant association with mortality from pneumonia after adjusting age, smoking history, recent pneumonia, fungal ball, large opacity, type of pneumoconiosis, profusion and FVC (or FEV1) less than 70% of predicted value.
Conclusions
The concomitancy of fungal ball or interstitial fibrosis, history of recent pneumonia within last 90 days, type of pneumoconiosis, FVC or FEV1 less than 70% of predicted value presented statistically significant association with mortality from pneumonia. More attention should be given to patients who have such factors when treating pneumonia with pneumoconiosis.
Background: There were several suicide events of subway drivers in Korea.The aim of this study is to explore work-related factors associated with suicide ideation among subway drivers.Methods: We analyzed data from 980 male subway drivers.A section of the Korean version of the Composite International Diagnostic Interview (K-CIDI 2.1) was administered by trained interviewers to judge whether a driver has suicide ideation and to diagnose psychiatric disorders.A questionnaire was also administered to collect data on sociodemographic characteristics, work environments, occupational stress, person under train (PUT) experience, and work-related problems.Occupational stress was examined by using the Korean Occupational Stress Scale (KOSS).Logistic regression was applied to evaluate the association between work-related factors and suicide ideation among subway drivers.Results: Regarding work-related problems, conflict with passengers and sudden stops due to the emergency bell were significantly associated with suicide ideation.MDD, PTSD, and panic disorder were strongly associated with suicide ideation.In the analysis of occupational stress, insufficient job control (OR 2.34) and lack of reward (OR 2.52) were associated with suicide ideation even after being adjusted for psychiatric disorders and other work-related factors.Conclusions: Insufficient job control and lack of reward were associated with suicide ideation among subway drivers.Strategies for drivers to have autonomy while working and to achieve effort-reward balance should be implemented.Furthermore, drivers who have experienced negative work-related problems should be managed appropriately.
To investigate and manage subway drivers’ mental health, we conducted a temporary mental health checkup on the subway drivers of one transportation company, and analysed the relationship between the suicide ideation and occupational stress factors.
Method
The subway drivers (n = 995) were asked to fill out a questionnaire and individual interviews were conducted afterwards. Interviews were performed using Korean Composite International Diagnostic Interview (K-CIDI). Participants were classified into two groups; suicide ideation group (SIG) and non suicide ideation group (NSIG). Socio-demographic factors, health information, occupational characteristics, Korean Occupational Stress Scale (KOSS), Davidson Trauma Scale (DTS) and Centre for Epidemiological Studies-Depression Scale (CES-D) were included in the questionnaire. Relationship between occupational stress and the suicide ideation within a year were analysed using multiple logistic regression.
Results
Logistic regression model after adjusting the age showed that domains of Job demand, Insufficient job control, Interpersonal conflict, Lack of reward, Occupational climate had significant relationship with suicidal ideation. Another model that adjusted factors that was significant in descriptive statistics revealed that domains of Insufficient job control (OR=2.223), Interpersonal conflict (OR=2.478), Lack of reward (OR=2.701) had significant relationship with suicidal ideation.
Conclusions
Three occupational stress domains of KOSS had statistically significant relationship with the suicidal ideation within a year after adjusting occupational factors that was related to it. To prevent subway drivers’ suicide ideation, stress management program should be applied to this group.
To estimate self-reported sleep health of shift workers and construct plans to minimise harm of the shiftwork.
Methods
A cross-sectional survey was conducted by using structured questionnaires on workers who were employed in a steel company. They divided into 3 groups (daytime workers, 4 teams 3 shifts, and other shifts). The survey contains questionnaires about demographic characteristics, sleep hygiene, condition of their work place, Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) to evaluate workers' sleep disorder and daytime sleepiness. Among shift-workers, 'insomnia group' is compared to 'normal sleep group' with chi-square test. The multiple logistic regression analysis was performed to explore risk factors of 'severe insomnia'.
Results
Workers with severe insomnia were 6.7% in other shifts group, and 2.3% in 4 teams 3 shifts group. There was no severe insomnia in daytime workers. Among 4 teams 3 shifts group, 12.9% workers complained severe daytime sleepiness. With the practice of sleep hygiene, generally the items for improving environment to sleep well showed higher rate in 'severe insomnia group' than 'normal sleep group'. It might be that the workers who suffered from insomnia tried to overcome it. The items which disrupt sleep were concordantly higher in 'insomnia group' than in 'normal sleep group', suggesting that such kind of adverse sleep habits are negatively affect sleep of shift workers.
Conclusion
The results of present study suggest relationship between sleep hygiene and sleep disorders among shift workers. To minimise shift worker's sleep problem, proper sleep hygiene is necessary.
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