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Objective This study aimed to assess the efficacy and safety of intravenous ramosetron for pain relief in patients with fibromyalgia (FM) unresponsive to conventional treatments. Methods In this prospective, double-blind, placebo-controlled trial, 80 FM patients were randomly allocated to receive either placebo (n  = 40) or ramosetron (n  = 40) at a dosage of 0.3 mg/day intravenously for five consecutive days. The primary outcome was the reduction in pain intensity at the end of the treatment period, evaluated using a visual analogue scale (VAS). Secondary outcome measures included the FM Impact Questionnaire, Beck Depression Inventory (BDI), Multi-Dimensional Health Assessment Questionnaire (MDHAQ), EQ-5D and State-Trait Anxiety Inventory on days 5 (end of treatment), 7, 10 and 28. Safety was continuously monitored throughout the study. Results At the end of the treatment phase, the ramosetron group demonstrated a significantly greater reduction in VAS pain scores compared with the placebo group (1.18 ± 1.60 vs 0.54 ± 1.59, P  < 0.05). Additionally, the ramosetron group exhibited significant improvements in BDI (4.42 ± 5.18 vs 1.33 ± 4.87, P  < 0.05) and MDHAQ pain scale (0.37 ± 0.74 vs 0.04 ± 0.52, P  < 0.05) scores. However, these improvements in pain VAS and BDI scores were not sustained through day 28. The safety profile of ramosetron was favorable, with gastrointestinal symptoms, particularly constipation, being the most commonly reported adverse events. Conclusions Intravenous administration of ramosetron provided safe and effective short-term relief of pain intensity in FM patients with inadequate response to standard treatments. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hyperuricemia is associated with a variety of comorbidities. The objective of this study was to investigate the association between hyperuricemia and hearing impairment in Korean adults. Materials and Methods: Audiometric and laboratory test data from the 2019 to 2020 Korean National Health and Nutrition Examination Survey (KNHANES) were used for analysis. Hearing impairment was defined as a pure-tone average (0.5, 1, 2, 4 kHz) threshold level ≥ 41 decibels. The definition of hyperuricemia was different for males and females: >7 mg/dL for males vs. >6 mg/dL for females. Results: A total of 4857 (weight n = 17,990,725) subjects were analyzed. The mean age was 56.8 years old. The weighted prevalence was 12.1% for hyperuricemia and 2.5% for gout. The prevalence of hearing impairment was 13.4%. In the univariable analysis, hyperuricemia was significantly associated with hearing impairment. However, the diagnosis of gout was not associated with hearing impairment. In the multivariable analysis, hyperuricemia (odds ratios (OR): 1.41, 95% confidence interval [CI]: 1.03–1.92, p = 0.030) was associated with hearing impairment along with age (OR: 1.12, 95% CI: 1.10–1.14, p < 0.001), female sex (OR: 0.43, 95% CI: 0.34–0.64, p < 0.001), education (OR: 0.43, 95% CI: 0.30–0.63, p = 0.001), and occupational noise exposure (OR: 1.67, 95% CI: 1.25–2.22, p = 0.001). In the subgroup analysis, hyperuricemia was associated with hearing impairment in females (OR: 1.59, 95% CI: 1.02–2.48, p = 0.041) and the elderly aged 60 years or more (OR: 1.45, 95% CI: 1.05–1.99, p = 0.023). Conclusions: Hyperuricemia was independently associated with hearing impairment, especially in females and the elderly aged 60 years or more. [ABSTRACT FROM AUTHOR]

Aim: Coronavirus disease 2019 (COVID‐19) has been proposed as triggering autoimmunity. The aim of this study was to evaluate the presence and clinical significance of autoantibodies in patients with COVID‐19. Methods: We retrospectively collected data from 245 patients who were hospitalized for COVID‐19. All patients were tested for the presence of antinuclear antibody (ANA), rheumatoid factor (RF), anti‐citrullinated peptide antibody (ACPA), and anti‐cytoplasmic neutrophil antibody (ANCA). Risk factors for death and critical COVID‐19, defined as the need for invasive mechanical ventilation or extracorporeal membrane oxygenation, were analyzed. Results: Ninety (36.7%) patients tested positive for ANA, and 51 (20.8%) patients tested positive for RF. Three patients each (1.2%) tested positive for ACPA and ANCA. RF‐positive patients had higher rates of invasive mechanical ventilation and death than RF‐negative patients (70.6% vs 28.4%, P < 0.001 and 45.1% vs 18.6%, P < 0.001, respectively). Underlying lung disease, kidney disease, heart disease, quick COVID severity index (qCSI), and lactate dehydrogenase (LDH) were associated with in‐hospital death. RF (odds ratio [OR] 7.31, 95% CI 2.50–21.37, P < 0.001), qCSI (OR 1.42, 95% CI 1.19–1.69, P < 0.001), and LDH (OR 1.004, 95% CI 1.002–1.005, P < 0.001) were associated with critical COVID‐19. Combination of RF, qCSI, and LDH showed good prognostic value (area under the curve = 0.903, P < 0.001) for critical COVID‐19. Conclusions: ANA and RF were frequently detected in COVID‐19 patients. RF could be a risk factor for critical COVID‐19. The results of this study suggest immune dysfunction contributes to the complications of COVID‐19. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinical characteristics and natural history of non‐radiographic axial spondyloarthritis (nr‐axSpA) using KOrean Nonradiographic Axial SPondyloArthritis (KONASPA) data. Methods: Data were collected from 11 centers in South Korea. A total of 278 patients with nr‐axSpA from January 2018 to July 2020 were included. Demographic data, clinical features, comorbidities, disease activity, medications, and laboratory results were collected. Results: Mean age at symptom onset was 28.2 ± 14.2 years. Of 278 patients, 152 (54.7%) were male. Mean Bath Ankylosing Spondylitis Disease Activity Index at diagnosis was 3.5 ± 2.1. Dyslipidemia was the most common comorbidity (8.4%), followed by hypertension (6.1%). Mean age at diagnosis of nr‐axSpA was older in female patients than in male patients (31.8 ± 15.8 years vs 24.9 ± 12.0 years, P < 0.001). Enthesitis and uveitis were more frequently found in female patients than in male patients. Thirty‐one (11.1%) participants with nr‐axSpA progressed to ankylosing spondylitis. The median follow‐up duration was 48 months. In multivariable Cox regression analysis, age at symptom onset (hazard ratio [HR] 0.93, 95% confidence interval (CI) 0.88‐0.97, P = 0.006), body mass index (BMI) (HR 1.24, 95% CI 1.06‐1.44, P = 0.005) and sacroiliitis grade (HR 1.86, 95% CI 1.19‐2.92, P = 0.006) were associated with progression to ankylosing spondylitis. Conclusions: Results of nationwide data revealed that women with nr‐axSpA showed a late disease onset and more extra‐articular manifestations than men. Young age at symptom onset, high BMI, and presence of radiographic sacroiliitis at diagnosis were risk factors for progression to AS. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of tumor necrosis factor a inhibitors (TNFi) on spinal radiographic progression in patients with ankylosing spondylitis (AS). Methods: Subjects were selected from patients at a single tertiary hospital between 1995 and 2014. Patients who used TNFi with baseline and paired follow-up radiographic data with a minimum interval of 2 years were included. Time to start TNFi was defined as the time from symptom onset to the start of TNFi use. TNFi index was defined as the ratio of the period of TNFi use to the entire period of disease. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Univariable and multivariable linear regression analyses were used to identify factors associated with radiographic progression. Results: A total of 151 patients were included in the analysis. Seventeen (11.3%) patients were female and mean DmSASSS/year was 1.01 units/year. Mean X-ray follow-up duration was 102.9 ± 54.9 months. Mean time from symptom onset to start of TNFi use was 104.8 ± 83.6 months (median 84 months) and mean TNFi index was 42.9 ± 23.8% (median 40.9%). In multivariable analysis, initial mSASSS, initial C-reactive protein, body mass index, current smoker, and delayed start of TNFi use were associated with radiographic progression. Presence of peripheral arthritis and the TNFi index were negatively associated with radiographic progression. Conclusions: A delay in starting TNFi use and low TNFi index were associated with radiographic progression. Early and long-term use of TNFi appear to reduce spinal radiographic progression in patients with AS. [ABSTRACT FROM AUTHOR]

The soil vulnerability index (SVI) classifies vulnerability to cropland pollutant transport by surface runoff and leaching, helping to categorize areas with a high contribution of pollutant loads. This study aims to 1) adopt the SVI classification scheme in South Korea and 2) suggest a modified SVI classification scheme for surface runoff to anticipate climate change impacts. The precipitation amount was considered in an original scheme to make a modified scheme. The results with an original SVI classification scheme predicted that the SVI surface runoff vulnerability was relatively greater in areas with a steep slope than in those with a plain topography, and a high level of the SVI leaching vulnerability was frequently observed in plain areas. When a modified SVI classification scheme was applied, "High" vulnerability class increased from 44.0% to 57.4% and the greater increase rate was observed in the regions susceptible to heavy precipitation defined as a day with more than 80 mm precipitation. When compared with observational suspended solids, the results with a modified SVI classification scheme were more consistent with observations than those with an original SVI classification scheme. Relative to the baseline period, the SVI surface runoff vulnerability of "High" class increased by 47.1–88.7% during the climate change period. When the number of vulnerability classes was increased, the differences on "Very extremely high" class between the baseline and projection periods were clear with the increase rate of 16.4–343%. The results with an original SVI classification scheme matched well with the topographic characteristics, and a modified SVI classification scheme captured the impacts of regional precipitation patterns and climate change impacts. As a first approach to adopting the SVI classification system to South Korea, increasing the number of classifications in regions with excessive rainfall amounts can improve identifying those most vulnerable areas. • The SVI was developed to classify soil vulnerability classes to cropland pollutant. • The SVI classification scheme was tested on croplands across South Korea. • The SVI classification results agreed well with topographic characteristics. • An original classification scheme was modified to consider precipitation amount. • A modified classification scheme showed enhanced SVI classification results. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the association of knee osteoarthritis (OA) with comorbidities and health-related quality of life (HRQOL). Methods: A total of 8,907 (weighted n = 13,687,058) participants aged ≥50 years who had undergone knee radiography were selected from the 2010–2012 Korea National Health and Nutrition Examination Survey. OA was classified into four subgroups based on the presence or absence of pain and radiographic OA (ROA): non-OA (Pain-/ROA-), pain only (Pain+/ROA-), ROA only (Pain-/ROA+), and painful ROA (Pain+/ROA+). ROA was defined as Kellgren–Lawrence grade ≥ 2. HRQOL measurements including EuroQOL visual analogue scale (EQ-VAS) scores and the five dimensions and summary index of the EuroQOL-5 dimension (EQ-5D index) were also analyzed. Multivariable logistic regression and linear regression analyses were performed. Results: After adjustment for socioeconomic and lifestyle characteristics, cardiovascular disease, malignancy, and other comorbidities were not significantly associated with OA. Pain only and painful ROA were each significantly associated with limitations in physical activity (odds ratio (OR) 2.66, 95% CI 2.07–3.44, p < 0.001 and OR 2.83, 95% CI 2.25–3.58, p < 0.001, respectively), lower EQ-VAS (β-coefficient = -10.95, p < 0.001 and β-coefficient = -9.75, p < 0.001, respectively), and EQ-5D index (β-coefficient = -0.10, p < 0.001 and β-coefficient = -0.13, p < 0.001) compared with the non-OA group, whereas ROA only was not associated with limitations in physical activity or lower HRQOL score. Conclusions: Comorbidities were not significantly associated with knee OA after adjustment. Knee OA was associated with physical activity and HRQOL. Painful knee OA, with or without ROA, was more strongly associated with decreased physical activity and lower quality of life than ROA without pain. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the prevalence of comorbidities in patients with rheumatoid arthritis (RA) compared with the non-RA population. The 2010–2012 Korea National Health and Nutrition Examination Survey (KNHANES), which assesses the general health status of populations in South Korea using interviews and basic health assessment, was analyzed retrospectively. Weighted prevalence and odds ratio (OR) of comorbidities were analyzed in patients with RA compared with the non-RA population. The overall weighted (n = 37,453,158) prevalence of RA was 1.5%. Patients with RA were older and more female predominant than subjects without RA. The prevalence of living in an urban area, college graduation, alcohol consumption and smoking was lower in patients with RA than non-RA. Patients with RA had more comorbidities including hypertension, dyslipidemia, myocardial infarction (MI) or angina, stoke, osteoarthritis, lung cancer, colon cancer, pulmonary tuberculosis, asthma, diabetes, depression, thyroid disease and chronic kidney disease. After adjusting socioeconomic and lifestyle characteristics, RA was associated with an increased prevalence of MI or angina (OR 1.86, 95% CI 1.17–2.96, p = 0.009), pulmonary TB (OR 1.95, 95% CI 1.24–3.09, p = 0.004), asthma (OR 1.97, 95% CI 1.05–3.71, p = 0.036), thyroid disease (OR 1.71, 95% CI 1.05–2.77), depression (OR 2.38, 95% CI 1.47–3.85, p < 0.001) and hepatitis B (OR 2.34, 95% CI 1.15–4.80, p = 0.020) compared with the non-RA population. Prevalence of solid cancer was not significantly associated with RA after adjustment. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association between rheumatoid arthritis (RA) and hearing impairment in the Korean adult population. Audiometric and laboratory test data from the 2010–2012 Korean National Health and Nutrition Examination Survey (KNHANES) were used for analysis. The relationship between RA and hearing impairment was analyzed, adjusting for various known risk factors associated with hearing impairment. RA was defined in the questionnaire as “RA diagnosed by a physician (yes/no) through a standardized interview.” We defined hearing impairment according to 2 categories of frequency (low/mid and high) as follows (average values in kHz): low/mid frequency, 0.5, 1.0, and 2.0, and high frequency, 3.0, 4.0, and 6.0. Of the subjects, 15,158 (weighted n = 32,035,996) completed the audiometric tests. The overall weighted prevalence of RA was 1.5%. The prevalence of hearing impairment was higher in the subjects with RA than in those without RA, in both, the low/mid- and high-frequency categories (21.1% vs 7.5%, p < 0.001 and 43.3% vs. 26.2%, p < 0.001, respectively). In the multivariable logistic analysis, RA (odds ratios [OR] 1.47, 95% confidence interval [CI] 1.05–2.06, p = 0.025) was an independent risk factor of low/mid-frequency hearing impairment along with age (OR 1.12, 95% CI 1.12–1.13, p < 0.001), current smoking (OR 1.27, 95% CI 1.03–1.56, p = 0.026), and college graduation (OR 0.53, 95% CI 0.39–0.72, p < 0.001). In the multivariable analysis of high-frequency hearing impairment, RA did not show any association with hearing impairment. This study suggests that RA is associated with low/mid-frequency hearing impairment after adjustment for various known risk factors. Further study is needed to verify the hearing impairment in RA. [ABSTRACT FROM AUTHOR]

Abstract: Colchicine is a relatively safe medication that is widely used for both prevention and treatment of gout attack. However, serious adverse events, including myoneuropathy and multiorgan failure, have been reported. We report a case of colchicine-induced myoneuropathy in a female kidney transplant recipient who had been taking cyclosporine. She developed gastrointestinal discomfort and paresthesia 5 days after the initiation of colchicine. She showed signs of myoneuropathy, and hepatic and renal injury. Colchicine toxicity was suspected, and colchicine was discontinued. Her symptoms and laboratory findings improved gradually. Literature was reviewed for previous reports of colchicine-induced myoneuropathy in solid organ transplant recipients. [Copyright &y& Elsevier]

Abstract: A 48-year-old man presented with acute right flank pain. A computed tomography scan revealed right renal infarction. Because he had no thrombosis in the renal vessels and no clear embolic source, a further examination was performed to find the cause of the renal infarction. On transesophageal echocardiography, a right-to-left shunt during the Valsalva maneuver established a diagnosis of patent foramen ovale. This is a case of paradoxical embolism through a PFO leading to renal infarction. [Copyright &y& Elsevier]