Respiratory syncytial virus (RSV) is a major cause of severe respiratory illness and hospitalization in older adults with chronic cardiopulmonary or metabolic conditions. After six decades without a preventive option, three RSV vaccines are now available: an adjuvanted prefusion F protein vaccine (Arexvy), a bivalent prefusion F protein vaccine (Abrysvo), and an mRNA vaccine (mResvia). All three have shown efficacy against RSV-associated lower respiratory tract disease in older adults and effectiveness against hospitalization after licensure, but none have been compared head-to-head. All three are now approved for high-risk adults younger than 60 years, and Abrysvo alone for maternal immunization at 32-36 weeks of gestation. In the United States, vaccination is recommended for all adults aged 75 years and older and for those aged 50-74 years with risk factors; these recommendations reflect United States public health policy and do not automatically apply to Korean practice. In Korea, Arexvy and mResvia are licensed and Abrysvo is under review, but only Arexvy is marketed and none is included in the National Immunization Program. Post-marketing surveillance has identified a Guillain-Barré syndrome signal with the two protein-based vaccines (fewer than 10 excess cases per million doses), although regulators judge that benefits outweigh risks. This review compares the three vaccines and summarizes practical recommendations for Korean clinicians on patient selection, timing, coadministration, revaccination, and special populations.
Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), requires a structured diagnostic roadmap to prevent delayed diagnosis and unnecessary imaging. This review outlines a step-by-step approach from clinical suspicion to objective confirmation and early risk stratification. For suspected PE, hemodynamic stability is the initial branch point. Hemodynamically stable patients are evaluated using pretest probability tools and validated D-dimer strategies, including age-adjusted thresholds, YEARS, or clinical-probability-adjusted approaches such as PEGeD, followed by computed tomography pulmonary angiography when indicated. Pregnancy-adapted YEARS can reduce thoracic imaging in selected pregnant patients. For suspected DVT, the Wells score, D-dimer, and compression ultrasonography are applied sequentially. Once PE is confirmed, risk assessment should integrate clinical severity, right ventricular dysfunction, cardiac biomarkers, hemodynamic and respiratory compromise to guide management decisions. The final diagnosis should specify thrombus location and extent, risk category, provoking factors, and remaining diagnostic uncertainty. Standardizing this roadmap may reduce diagnostic delay and unnecessary imaging while linking diagnosis to appropriate disposition, monitoring, and follow-up.
This case report describes a 70-year-old woman with advanced diabetic kidney disease who developed end-stage kidney disease (ESKD) and complete anuria within seven weeks of initiating finerenone therapy. This case highlights the need for caution when prescribing finerenone to patients with severely impaired renal function, particularly those with minimal residual renal reserve. Clinicians should be vigilant for signs of renal decompensation during the early phases of therapy.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major global cause of chronic liver disease and is closely associated with obesity and metabolic syndrome. Obesity contributes to MASLD progression and increases the risk of liver fibrosis, cirrhosis, and hepatocellular carcinoma. However, the management of obesity in patients with cirrhosis is complex, as the catabolic state characteristic of cirrhosis predisposes patients to sarcopenia, malnutrition, and frailty. Excessive weight reduction may therefore worsen muscle loss and adversely affect clinical outcomes. Accordingly, obesity management in cirrhosis should prioritize not only weight reduction but also optimizing body composition by preserving muscle mass and physical function. A comprehensive assessment of nutritional status, sarcopenia, and frailty is essential before initiating weight management strategies. Lifestyle interventions are the cornerstone of therapy and include individualized nutritional support and exercise programs. Moderate caloric restriction with adequate protein intake is recommended for patients with compensated cirrhosis, whereas maintenance of nutritional status is prioritized in those with sarcopenia or decompensated cirrhosis. Pharmacological therapies, such as glucagon-like peptide-1 receptor agonists, demonstrate potential benefits in MASLD; however, evidence in established cirrhosis remains limited. Bariatric surgery should be considered in carefully selected patients with compensated cirrhosis. Overall, obesity management in MASLD-related cirrhosis requires an individualized, multidisciplinary approach.
Hospitalist systems have been shown to significantly improve clinical outcomes, including shorter hospitalizations and lower readmission rates. However, the structural nature of hospital medicine inherently challenges continuity of care due to frequent transitions between clinical settings and providers. Transitional care management (TCM) is a critical strategy to mitigate these vulnerabilities. While TCM is broadly applicable across various general clinical settings to ensure patient safety, its implementation in the hospitalist model requires specialized strategies for admission, handoffs, and discharge. In this review, we provide concrete, evidence-based TCM strategies, including structured handoff protocols and comprehensive discharge planning, to enhance the quality of hospital medicine in Korea.
