Jeonbuk National University Hospital

Acute decompensation (AD) is defined as the development of complications related to portal hypertension and liver dysfunction that affect the progression of chronic liver disease (CLD) or liver cirrhosis (LC). Variations exist in patient demographics and prognostic outcomes of AD based on the aetiology of CLD, encompassing LC. However, limited research has been conducted to analyse these discrepancies across aetiologies.

The prospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort consisted of 1,501 patients who were hospitalized with AD of CLD from July 2015 to August 2018. In this study, we assess the clinical attributes and prognostic implications of AD with CLD/LC stratified by the aetiology.

Among 1,501 patients, the mean age was 54.7 years old and 1,118 patients (74.5%) were men. The common events of AD were GI bleeding (35.3%) and jaundice (35.0%). There was a median follow-up of 8.0 months (1.0-16.0 months). The most common aetiology of CLD was alcohol (n = 1021), followed by viral hepatitis (n = 206), viral hepatitis with alcohol-related (n = 129), cryptogenic (n = 108) and autoimmune (n = 37). Viral hepatitis with alcohol-related CLD showed a poor liver function profile and a high frequency of acute-on-chronic liver failure (ACLF) [22.1% vs. 19.6% (alcohol CLD), 8.1% (viral CLD), 5.6% (autoimmune related CLD and 16.0% (cryptogenic CLD)] with worse adverse outcomes (mortality or liver transplantation) than other aetiologies. The difference in aetiology was a significant factor for 28-day adverse outcomes in multivariate analysis even in a high MELD score (≥15), which indicated poor baseline liver function and prognosis (p < 0.001).

The aetiology of CLD constitutes a pivotal determinant influencing both short- and long-term adverse outcomes of AD in CLD, even among individuals presenting with elevated MELD scores. Notably, patients afflicted with viral hepatitis should exercise caution even in the consumption of modest quantities of alcohol that induced the exacerbations in the adverse outcomes associated with AD.

To determine effects of colonization with multidrug-resistant bacteria (MDRB) in general wards on characteristics, treatment, and prognosis of hospital-acquired pneumonia (HAP).

This was a multicenter retrospective cohort study of patients with HAP admitted to 16 tertiary or university hospitals in Korea from July 2019 to December 2019. From the entire cohort, patients who developed pneumonia in general wards with known colonization status before the onset of pneumonia were included in this study. Patients were categorized into a colonization group and a non-colonization group according to MDRB colonization. Patients of the two groups were then compared.

Among a total of 400 patients, 63 were in the MDRB colonization group. HAP caused by MDR-Staphylococcus aureus or MDR-Pseudomonas aeruginosa was more common in the colonization group than in the non-colonization group (24.4% vs. 8.1%, P = 0.006 or 20.0% vs. 5.4%, P = 0.013, respectively). Colonization with certain bacteria was correlated with subsequent infection with the same bacteria. Carbapenem use (36.5% vs. 24.3%, P = 0.044) and appropriateness of initial antibiotics (50.8% vs. 12.8%) were higher in the colonization group than in the non-colonization group. Although in-hospital mortality was similar in the two groups (34.9% vs. 32.9%, P = 0.759), hospital length of stay was longer (38 days vs. 31 days, P = 0.009) and rate of discharge to home was lower (34.1% vs 59.7%, P = 0.002) in the colonization group.

Colonization with MDRB might influence characteristics and treatment of HAP. However, prognosis of HAP was not associated with MDRB colonization.

The aim of this prospective, longitudinal study was to validate video-oculography (VOG) for early detection of myasthenia gravis (MG) in patients with clinical suspicion of MG but lacking confirmatory laboratory results.

Thirteen individuals suspected of having MG were studied using a 3-dimensional VOG system. Oculomotor fatigability, defined as the decrement (%) between the second and the last 5 average measures, was calculated.

Significant reductions in oculomotor ranges were found, exceeding previous cutoff values for horizontal saccades (16.4 ± 9.8%), vertical saccades (18.7 ± 12.6%), horizontal smooth pursuit (15.7 ± 6.0%), and vertical smooth pursuit (27.2 ± 17.4%). Despite initially negative laboratory tests, many participants later tested positive on the neostigmine test (92.3%) and repetitive nerve stimulation tests (69.2%).

VOG is a reliable diagnostic tool for MG, particularly useful for seronegative patients, allowing for earlier and more accurate diagnosis than conventional methods.