Apixaban is effective and safe for preventing stroke, and its usage has increased exponentially in recent years. However, data concerning the therapeutic range of apixaban is limited. This study determined the trough and peak levels of apixaban-specific anti-factor Xa activity (AFXaA) in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF) in Korea. The study included 85 patients who received apixaban. Blood samples were taken to measure the trough and peak levels of AFXaA using a chromogenic anti-factor assay, as well as prothrombin time (PT) and activated partial thromboplastin time (aPTT). We also reviewed complications such as major bleeding of patients treated with apixaban. In patients given a 5.0-mg apixaban dose, the median trough and peak levels of AFXaA were 104.5 and 202.0 ng/mL. In patients given a 2.5-mg apixaban dose, the median trough and peak AFXaA levels were 76.0 and 151.0 ng/mL. The PT showed a positive correlation with increased AFXaA activity at both levels (Trough R = 0.486, Peak R = 0.592), but the aPTT had no relationship with AFXaA activity at both levels (Trough R = 0.181, Peak R = 0.129). Two cases with intracranial bleeding belonged to the highest AFXaA quartile (Trough, p = 0.176; Peak, p = 0.053). In conclusion, we determined the trough and peak levels of AFXaA in patients with NVAF while being treated with the apixaban in Korea. Our results could be used as a starting point when setting the reference ranges for laboratories using anti-Xa assay. Large-scale studies are needed to establish the reference range for AFXaA in patients with NVAF.
Background Surveillance and control of SARS‐CoV‐2 outbreak through gold standard detection, that is, real‐time polymerase chain reaction (RT‐PCR), become a great obstacle, especially in overwhelming outbreaks. In this study, we aimed to analyze the performance of rapid antigen home test (RAHT) as an alternative detection method compared with RT‐PCR. Methods In total, 79 COVID‐19‐positive and 217 COVID‐19‐negative patients confirmed by RT‐PCR were enrolled in this study. A duration from symptom onset to COVID‐19 confirmation of <5 days was considered a recruiting criterion for COVID‐19‐positive cases. A nasal cavity specimen was collected for the RAHT, and a nasopharyngeal swab specimen was collected for RT‐PCR. Results Sensitivity of the STANDARD Q COVID‐19 Ag Home Test (SD Biosensor, Korea), compared with RT‐PCR, was 94.94% (75/79) (95% [confidence interval] CI, 87.54%–98.60%), and specificity was 100%. Sensitivity was significantly higher in symptomatic patients (98.00%) than in asymptomatic (89.66%) patients ( p ‐value = 0.03). There was no difference in sensitivity according to the duration of symptom onset to confirmation (100% for 0–2 days and 96.97% for 3–5 days, respectively) ( p ‐value = 1.00). The RAHT detected all 51 COVID‐19 patients whose Ct values were ≤25 (100%), whereas sensitivity was 73.33% (11/15) among patients with Ct values >25 ( p ‐value = 0.01). Conclusion The RAHT showed an excellent sensitivity for COVID‐19‐confirmed cases, especially for those with symptoms. There was a decrease in sensitivity when the Ct value is over 25, indicating that RAHT screening may be useful during the early phase of symptom onset, when the viral numbers are higher and it is more transmissible.
Rationale:Parvovirus B19 (PV) infection is usually symptomless and can cause benign, short-lived conditions. Anemia associated with PRCA is the most representative hematologic manifestation, but neutropenia and thrombocytopenia have been rarely reported.Patient concerns:Three patients were admitted to the hospital with neutropenia and thrombocytopenia. The accompanying symptoms were fever, myalgia, rash, or arthralgia, and all patients were previously healthy.Diagnosis:Patients were positive for PV PCR and diagnosed with PV infection. Before the diagnosis of PV infection, 2 patients underwent BM study and almost absence of erythroid progenitor cells in BM aspiration were a clue for the PV infection. Other BM findings were hypocellular marrow and a few hemophagocytic histiocytes.Interventions:Patients received supportive care with follow-up of CBC.Outcomes:All 3 patients spontaneously recovered from neutropenia and thrombocytopenia within 3 weeks without severe complications.Lessons:The evaluation of PV infection should be considered in situations where there is neutropenia and thrombocytopenia in healthy individuals even without anemia as a differential diagnosis.
Background: Few studies have investigated the invasiveness of Streptococcus pyogenes based on whole-genome sequencing (WGS). Using WGS, we determined the genomic features associated with invasiveness of S. pyogenes strains in Korea.Methods: Forty-five S. pyogenes strains from 1997, 2006, and 2017, including common emm types, were selected from the repository at Gyeongsang National University Hospital in Korea. In addition, 48 S. pyogenes strains were randomly selected depending on their invasiveness between 1997 and 2017 to evaluate the genetic evolution and the associations between invasiveness and genetic profiles. Using WGS datasets, we conducted virulence-associated DNA sequence determination, emm genotyping, multi-locus sequence typing (MLST), and superantigen gene profiling.Results: In total, 87 strains were included in this study. There were no significant differences in the genomic features throughout the study periods. Four genes, csn1, ispE, nisK, and citC, were detected only in invasive strains. There was a significant association between invasiveness and emm cluster type A-C3, including, emm1.0, emm1.18, emm1.3, and emm1.76 (P < 0.05). The predominant emm1 lineage belonged to ST28. There were no associations between invasiveness and superantigen gene profiles.Conclusions: This is the first study using WGS datasets of S. pyogenes strains collected between 1997 and 2017 in Korea. Streptococcal invasiveness is associated with the presence of csn1, ispE, nisK, and citC. The emm1 lineage and ST28 clone are explicitly associated with invasiveness, whereas genomic features remained stable over the 20-year period.
Dear Editor, The genus Oceanobacillus comprises gram-positive bacilli that were first detected in deep-sea sediments [1]. To date, 36 Oceanobacillus species have been isolated from various sources, including sea fish, spring water, soils, food, and the human gut [2-6]. These bacteria can be easily misinterpreted as contaminants, because they cannot be identified with the typical phenotypic methods used in clinical laboratories. Moreover, their role in human pathogenesis is unknown. We report the first case of human Oceanobacillus oncorhynchi infection.This study was approved by the Institutional Review Board of
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