The novel coronavirus disease 2019 (COVID-19) pandemic has spread across the world, reducing social interactions and causing substantial psychological distress and economic losses. This review summarizes the psychological effects of the COVID-19 pandemic in terms of uncertainty, the loss of autonomy associated with preventive measures, and secondary stressors such as potential future economic losses. (Korean J Med 2020;95:360-363)

In December 2019, a new strain of betacoronavirus, severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), emerged in Wuhan, China. Subsequently, the virus quickly spread worldwide and the World Health Organization declared COVID-19 a global pandemic on March 11, 2020. In response to the pandemic, many researchers are working on repurposing existing drugs to alter the course of severe COVID-19, and are testing experimental treatments. Among antiviral agents, remdesivir, an RNA-dependent RNA polymerase inhibitor, showed clinical benefit in a randomized clinical trial. In October 2020, the Food and Drug Administration approved remdesivir for treating hospitalized patients with COVID-19, making it the first drug approved for the disease. The race to produce safe, effective vaccines is also progressing at unprecedented speed, with over 200 under development and 45 candidates already being tested in human clinical trials (as of October 2020). (Korean J Med 2020;95:364-369)

Allergen-specific immunotherapy (AIT) can alter the natural course of an allergic disease. It is widely held that the efficacy of a given therapeutic modality should be proven by well-designed double-blind placebo-controlled randomized clinical trials and meta-analyses. In this article, the therapeutic efficacy of AIT for allergic respiratory diseases, such as allergic rhinitis and asthma, is reviewed. In addition, potential clinical and experimental predictors of the treatment response are reviewed for AITs requiring long-term treatment, and for some allergic rhinitis and asthma patients who show no response to AIT. (Korean J Med 2020;95:370-376)

Hypertriglyceridemia is an important cause of acute pancreatitis, and its symptoms are similar to those of pancreatitis of other causes. Moreover, the possibility of recurrence renders accurate diagnosis critical, and treatment, lifestyle modifications, and education should be performed simultaneously. For treatment during the acute phase of the disease, insulin or plasmapheresis can be combined with modalities used for acute pancreatitis of other causes; fibrate administration is recommended. In addition, hypertriglyceridemia- induced acute pancreatitis requires daily management, such as continuous administration of lipid-lowering agents, and lifestyle modifications are needed even after completion of acute-phase treatment. (Korean J Med 2020;95:377-381)

Precision medicine is the modern era version of “personalized medicine”, which integrates data from genomics and clinical information to optimize the care delivered to patients. As next generation sequencing (NGS) revolutionized the speed and cost of genomic sequencing, precision medicine entered clinical practice in 2017 via the national reimbursement of oncology and rare diseases. In parallel, the digitalization of clinical data through electronic health recording (EHR) and hospital information systems has allowed data collection and analysis. This has led to the integration of biomarkers and clinical records, which have introduced precision medicine into clinical practice. Today, many countries and medical institutes are endeavoring to create systems that will enable precision medicine to be applied to clinical practice. These data systems will benefit the patient by providing accurate data based on his/her characteristics rather than the conventional approach of using “average data”. Internal medicine will transform into a data-driven science that enables physicians to translate molecular biomarkers and big data analysis into improved clinical care. (Korean J Med 2020;95:382-386)

목적: 좌심실의 구조적 변화는 심혈관계 이환율과 사망률의 위험 증가와 관련이 있다고 알려져 있다. 본 연구에서는 급성 심근경색증 환자에서 좌심실 비대와 그 형태적 분류에 따라 임상경과의 차이와 주요심장사건(major adverse cardiac events, MACE)에 미치는 영향을 파악하고자 하였다. 방법: 2014년 1월부터 2015년 10월까지 Korea Acute Myocardial Infarction Registry-National Institute of Health(KAMIR-NIH)에 등록된 환자 중 급성 심근경색증으로 전남대학교병원에 입원한 환자 중에서 관상동맥 중재술을 시술받고 2년 동안 임상 추적 관찰이 되어 분석 가능한 환자 852명(남:여 = 603:249)을 대상으로 하였다. 좌심실의 형태적 구조에 따라 정상군 470명(62.4 ± 12.8세, 남자 389명)과 좌심실비대군 382명(67.1 ± 12.1세, 남자 214명)으로 분류하여, 양군 간의 임상적 특성, 혈액 검사 특성, 심장초음파 및 관상동맥 조영술 소견 및 MACE를 비교·분석하였다. 좌심실 비대군은 좌심실 벽의 상대적 두께(relative wall thickness, RWT)와 좌심실 질량지수(left ventricular mass index, LVMI)에 따라 동심성 재형성군(concentric remodeling; RWT ≥ 0.42, LVMI ≤ 115 g/m² in male, ≤ 95 g/m² in female), 동심성 비대군(concentric hypertrophy; RWT ≥ 0.42, LVMI > 115 g/m² in male, > 95 g/m² in female) 및 편심성 비대군(eccentric hypertrophy; RWT < 0.42, LVMI > 115 g/m² in male, > 95 g/m² in female)으로 세분하여 평가하였다. 결과: 대상 환자를 21 ± 7.8개월간의 임상적 경과 관찰 중에 MACE는 173명(사망 55명, 재발성 심근경색증 26명, 재입원 34명)에서 발생하였다. MACE의 발생은 좌심실 비대군에서 정상군에 비하여 유의하게 높았으며(16.0% vs. 25.5%, p = 0.001), Kaplan-Meier 생존곡선을 이용한 사망률 분석 결과에서 좌심실 비대군이 정상군에 비하여 유의하게 생존율이 낮았다(p = 0.008). 좌심실 비대군의 형태적 분류에 따른 MACE의 분석 결과에서는 편심성 비대에서 MACE의 발생이 유의하게 많았다(동심성 재형성 vs. 동심성 비대 vs. 편심성 비대; 11.2% vs. 15.5% vs. 22.1%, p = 0.046). 결론: 급성 심근경색증 환자에서 좌심실 비대는 불량한 예후와 관련이 있었으며, 좌심실 비대 중 편심성 비대를 동반한 경우에 예후가 가장 불량하였다. 따라서, 한국인 급성심근경색증 환자에서 좌심실 비대를 보이는 경우, 특히 편심성 비대를 동반한 경우에 적극적인 치료가 필요할 것으로 사료되었다.

Most upper gastrointestinal lipomas occur in the duodenal second portion, and gastric lipomas are rare. Most lipomas are usually asymptomatic, but symptoms such as abdominal pain, intussusception, ulceration, and intestinal obstruction may occur depending on the size and location and, rarely, can cause bleeding. Endoscopic polypectomy, endoscopic mucosal resection, and surgical resection are the treatments of choice for lipomas with intestinal obstruction or bleeding. Upper gastrointestinal bleeding from lipoma is mostly of duodenal origin and very rarely from the stomach. Here, we report a case of successful treatment of gastric lipoma with massive bleeding by endoscopic resection. (Korean J Med 2020;95:398-403)

Dapagliflozin is a recently developed oral anti-diabetic drug and SGLT2 inhibitor with well-known cardioprotective and renoprotective effects. Although a reduction of the glomerular filtration rate is induced by volume depletion and tubule-glomerular feedback during the early period after administering a SGLT2 inhibitor, the renal prognosis improves more with a decrease of proteinuria. However, the risk of acute kidney injury increases in heart failure and hypovolemia patients, and in those taking certain drugs, such as non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers, or diuretics. We report acute kidney injury after dapagliflozin administration in a diabetic patient with acute cerebral infarction accompanied by right hemiplegia, motor aphasia, and dysphagia. (Korean J Med 2020;95:404-408)

MCTD 환자의 신증후군은 대개 막사구체신염의 형태로 나타나지만 저자들은 MCD로 나타난 신증후군을 진단하고 스테로이드와 cyclosporine으로 치료하였기에 보고하는 바이다.