Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on Kawasaki disease (KD) has not yet been established. We investigated changes in the observed number and severity of KD cases and accompanying coronary artery complications during the COVID-19 pandemic in Korea. Methods This retrospective observational study included patients aged < 18 years with acute-phase KD diagnosed between March 2018 and February 2021. Data were extracted from the Clinical Data Warehouse that houses data from five affiliated university hospitals in Korea. We analyzed changes in the number of patient admissions and clinical characteristics, including cardiac complications, before and after the onset of the COVID-19 pandemic. Results A total of 475 admissions were included in the analysis. After March 2020, we observed a significant decrease of 33% in the number of hospitalizations for KD compared with the average number of hospitalizations during the previous 2 years. The number of admissions per month significantly decreased by 7.9 persons/month (95% confidence interval, −13.8 to −2.0; P < 0.05) compared with that before COVID-19. By contrast, the proportion of patients aged < 1 year with KD increased. The proportion of patients with refractory KD and the rate of cardiac complications did not change significantly. Conclusion Since the onset of the COVID-19 pandemic, the total number of hospital admissions for KD has decreased in Korea. Although the proportion of admissions of infants aged < 1 year increased, no changes were observed in clinical courses and complications.
Background/Aims: Based on the Kyoto classification of gastritis, mucosal atrophy, endoscopic intestinal metaplasia, fold enlargement, nodularity, and diffuse redness may be associated with gastric cancer and Helicobacter pylori (H. pylori) infection. In this study, we investigated the association between Kyoto scores based on the aforementioned five variables and current H. pylori infection. Materials and Methods: We reviewed medical records of consecutive patients who underwent endoscopic biopsies between January and June 2019. The study included 687 patients (370 and 317 patients with H. pylori-negative and -positive results, respectively). The Kyoto score was evaluated by the endoscopist who performed the test and was reconfirmed by another endoscopist. The total Kyoto score was analyzed using a receiver operating characteristic (ROC) curve for each score from 0 to 8. Multivariate analysis was used to determine the variables associated with H. pylori infection. Results: The maximum value of the Youden index (which reflects the ideal cut-off score of the Kyoto score on the ROC curve) was a Kyoto score of 2 points (Youden index 0.5905). Nodularity (OR 24.69, 95% CI 8.57~71.16, P<0.001) and diffuse redness (1 point: OR 18.29, 95% CI 10.29~32.52, P<0.001 and 2 points: OR 30.82, 95% CI 14.07~67.52, P<0.001) showed the highest OR on multivariate analysis. Conclusions: A Kyoto classification cut-off score of 2 points was suggestive of H. pylori infection, and mucosal nodularity and diffuse redness were most significantly associated with the risk of infection.
Background: ICD-11 was officially released at the World Health Assembly on 25 May 2019. Objective: To find effective ways to increase the accuracy of coding for diagnostic terms in Korea for a stable transition from Korean modification of ICD-10 (7th Revision of Korean Classification of Disease, KCD-7) to ICD-11. Method: A total of 27 skilled Korean health information managers performed KCD-7 and ICD-11 coding simultaneously (line coding [56]; case coding [17]). Accuracy rates and percentage agreements were calculated, and granularity and difficulty of the ICD-11 were rated by participants. Results: The average accuracy rate of line coding was 71.6 % in ICD-11 and 80.2% in KCD-7, which was similar to results in other studies. The mean percentage agreements for ICD-11 and KCD-7 for line coding were 64.2% and 72.1%, respectively; while for case coding it was 15.3% and 26.6%. Selection criteria for the case scenarios may have influenced the low agreements in case coding. Cluster coding, changes of terms in ICD-11 and removal of codes used in ICD-10 contributed to low agreement in ICD-11 (46.6% of participants reported that granularity of ICD-11 was similar to ICD-10, while 36.9% reported that ICD-11 had finer granularity). In terms of difficulty, 15.3% of participants found line coding difficult and 10.9% found case coding difficult. Conclusion: Provision of more detailed reference guidelines and efficient training for coding professionals by the World Health Organization would enable ICD-11 to be an excellent tool for gathering relevant information about diseases in Korea.
Background The risk of vertebral fractures is increased in inflammatory bowel disease (IBD) patients. However, whether the severity of vertebral fractures differs between IBD patients and the general population, or between patients with Crohn’s disease (CD) and ulcerative colitis (UC), is unknown. Methods We investigated risk factors associated with the occurrence and severity of vertebral fractures in IBD patients using The National Healthcare Insurance Service (NHIS) database. We defined the patients who underwent vertebroplasty or kyphoplasty after being diagnosed with a vertebral fracture as having a severe vertebral fracture than those with only diagnosis codes. Results From 2008 to 2018, there were 33,778 patients with IBD (24,370 UC patients and 9,408 CD patients) and 101,265 patients in the reference population. The incidence rate ratio of vertebral fractures in the IBD patients was 1.27 per 1,000 person-years (95% confidence interval [CI], 1.26–1.27). The risk of vertebral fracture was higher in CD and UC patients than in the matched reference group (hazard ratio [HR], 1.59; 95% CI, 1.31–1.92; P < 0.001 and HR, 1.26; 95% CI, 1.14–1.41; P < 0.001, respectively). In a multivariate analysis, the occurrence of vertebral fracture was associated with CD (HR, 1.31; 95% CI, 1.08–1.59; P = 0.006), older age (CD: HR, 1.09; 95% CI, 1.08–1.09; P < 0.001 and UC: HR, 1.09; 95% CI, 1.08–1.09; P < 0.001), female sex (CD: HR, 1.81; 95% CI, 1.63–2.01; P < 0.001 and UC: HR, 2.02; 95% CI, 1.83–2.22; P < 0.001), high Charlson Comorbidity Index (CCI) score (CD: HR, 1.42; 95% CI, 1.23–1.63; P < 0.001 and UC: HR, 1.46; 95% CI, 1.29–1.65, P < 0.001), and long-term steroid use (CD: HR, 3.71; 95% CI, 2.84–3.37; P < 0.001 and UC: HR, 3.88; 95% CI, 3.07–4.91; P < 0.001). The severity of vertebral fractures was associated with IBD (CD: HR, 1.82; 95% CI, 1.17–2.83; P = 0.008 and UC: HR, 1.49; 95% CI, 1.17–1.89; P < 0.001) and older age (HR, 1.06; 95% CI, 1.05–1.07; P < 0.001). Conclusion Vertebral fractures occur frequently and more severely in IBD patients, particularly those with CD. Therefore, we suggest monitoring of bone density, regular vitamin D supply, and reducing the use of corticosteroids to prevent vertebral fractures in IBD patients who are older, female, or have comorbidities.
Background 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) is known as a lung carcinogen. The objective of this study was to investigate associations of urine NNAL concentrations and smoking status. Methods This was a cross-sectionally designed study based on data from the 2016–2018 Korean National Health and Nutrition Examination Survey. A total of 2,845 participants were classified into past-smoker, electronic cigarette (e-cigar) only, dual-user, and cigarette only smoker groups. All sampling and weight variables were stratified and analysis was conducted accounting for the complex sampling design. Analysis of covariance was used to compare the geometric mean of urine NNAL concentrations and log-transformed urine NNAL level among smoking status with weighted survey design. Post hoc paired comparisons with Bonferroni adjustment was performed according to smoking status. Results The estimated geometric mean concentrations of urine NNAL were 1.974 ± 0.091, 14.349 ± 5.218, 89.002 ± 11.444, and 117.597 ± 5.459 pg/mL in past-smoker, e-cigar only, dual-user, and cigarette only smoker groups, respectively. After fully adjusting, log-transformed urine NNAL level was significantly different among groups ( P < 0.001). Compared with the past-smoker group, e-cigar only, dual-user, and cigarette only smoker groups showed significantly higher log-transformed urine NNAL concentrations in post hoc test (all P < 0.05). Conclusion E-cigar only, dual-user, and cigarette only smoker groups showed significantly higher geometric mean concentrations of urine NNAL than the past-smoker group. Conventional cigarette, dual users, and e-cigar users can potentially show harmful health effects from NNAL.
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