• Pediatric Infection and Vaccine
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• v.27 no.2
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• pp.83-89
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• 2020

Purpose: Group A streptococcus (GAS) is a common pathogen in pediatric patients and often causes acute pharyngotonsillitis and skin and soft tissue infections. In addition, bacteremia with significant morbidity and mortality can also occur. This study was conducted to describe the clinical manifestations and treatment outcomes of pediatric GAS bacteremia patients in Korea. Methods: This was a single-center, retrospective study. From January 2000 to December 2016, pediatric patients aged ≤18 years with GAS bacteremia were studied. Clinical manifestations, underlying diseases, intensive care unit stay, and antibiotic susceptibility were evaluated. Results: During the study period, 19 patients had GAS bacteremia. Ten (53%) were male, and the median age was 7.4 years (range, 0.3-17.4 years). Fourteen (74%) had chronic underlying diseases. Five (26%) were immunocompromised (leukemia and chronic kidney disease). Eight (42%) had lymphatic or vascular malformations, of which seven had lesions with signs of inflammation. Three (16%) developed pneumonia, and two of them received ventilator care. The 30-day mortality rate was 6% (1/19), and the cause of death was bacteremic pneumonia. All GAS isolates were sensitive to penicillin. Fifteen (79%) were sensitive to both erythromycin and clindamycin. Conclusions: This study identified various clinical manifestations of GAS bacteremia. GAS should be considered as a potential pathogen that can cause bacteremia and result in a serious clinical course.

• Tuberculosis and Respiratory Diseases
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• v.72 no.4
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• pp.360-366
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• 2012

Background: Carbapenem-resistance is rapidly evolving among the pathogenic microbes in intensive care units (ICUs). This study aimed to determine annual trend of carbapenem-resistance in the ICU for 4 years, since the opening of a university-affiliated hospital in South Korea. Methods: From 2005 to 2008, microbial samples from consecutive 6,772 patients were screened in the ICU. Three hundred and ninety-seven patients (5.9%) and their first isolates of carbapenem-resistant pathogens were analyzed. Results: The percentage of patients infected with carbapenem-resistant organisms increased constantly during the initial three years (2.3% in 2005, 6.2% in 2006, 7.8% in 2007), then it declined to 6.5% in 2008. Acute Physiology and Chronic Health Evaluation (APACHE) III score at admission was $58.0{\pm}23.5$, the median length of the ICU stay was 37 days, and the mortality rate was 37.5%. The sampling sites were endotracheal suction (67%), catheterized urine (17%), wound (6%) and others (10%). Bacteria with carbapenem-resistance were Pseudomonas aeruginosa (247 isolates, 62%), Acinetobacter baumannii (117 isolates, 30%), Enterobacteriaceae (12 isolates, 3%), and others (21, 5%). Of note, peak isolation of carbapenem-resistant microorganisms in medical ICU was followed by the same epidemic at surgical ICU. Conclusion: Taken together, carbapenem-resistant pathogens are of growing concern in the ICU.

• Quality Improvement in Health Care
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• v.15 no.2
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• pp.73-81
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• 2009

문제: 뇌졸중 환자를 돌보는 간호현장에서는 급성기 뇌졸중 환자의 증상악화에 대한 조기사정과 적절한 대처가 매우 중요한 문제이다. 그러나 임상현장에서는 이를 객관화하고 수치화하여 모든 의료진이 의사소통할 수 있는 유용한 도구를 사용하고 있지는 못하는 실정이다. 이러한 문제를 해결하기위해 NIHSS(National Institute of Health Stroke Scale)를 신경과 진료의사를 중심으로 활용하고 있지만 아직 간호현장에서는 보편적으로 사용하지 않고 있다. 이에 뇌졸중 환자 간호에 NIHSS를 활용하여 뇌졸중 증상악화의 조기사정과 빠른 대처로 궁극적으로는 뇌졸중 환자 간호의 질을 보다 향상시키기 위하여 본 활동이 시도되었다. 목적: 첫째, 간호사의 NIHSS 측정 신뢰도의 현수준을 점검하고 이를 향상시키기 위한 프로그램을 개발 적용한다. 둘째, 간호사가 급성기 뇌졸중환자에게 NIHSS 측정을 통하여 뇌졸중 악화를 얼마나 예측할 수 있는지 분석하고 이를 향상시킬 수 있는 방법을 모색한다. 셋째, 궁극적으로 급성기 뇌졸중 환자의 증상악화의 조기 발견과 치료를 위한 의료진의 올바른 대처지침을 마련하여 이를 적용한다. 의료기관: 경기도에 소재한 대학병원의 뇌졸중 집중치료실. 질 향상 활동: 첫째, 간호사의 NIHSS 측정 신뢰도 향상을 위해 "NIHSS 간호사 교육 프로그램"을 마련하였다. 둘째, NIHSS 측정을 통한 뇌졸중 악화 예측율 향상을 위하여 "뇌졸중 악화 발생 시 의사, 간호사 대처 활동 프로토콜"을 개발하고 추적 관찰하였다. 개선효과: NIHSS 측정 신뢰도는 질 향상 활동 전 89%에서 92%로 향상되었다. 그리고 간호사의 뇌졸중 악화 양성 예측율은 58.7%에서 87.1%로 향상되었다(참고 : 간호사의 뇌졸중 악화 음성 예측율 100% 유지). 즉 "NIHSS 간호사 교육 프로그램 활용", "뇌졸중 악화 발생 시 의사, 간호사 대처 활동 프로토콜"의 적용으로 뇌졸중의 조기 발견 및 치료가 가능하였고, 향후 환자 예후에 긍정적인 영향을 줄 수 있을 것이라 기대된다.

• Acute and Critical Care
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• v.33 no.4
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• pp.246-251
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• 2018

Background: Target temperature management (TTM) improves neurological outcomes for comatose survivors of out-of-hospital cardiac arrest. We compared the efficacy and safety of a gel pad cooling device (GP) and a water blanket (WB) during TTM. Methods: We performed a retrospective analysis in a single hospital, wherein we measured the time to target temperature ($<34^{\circ}C$) after initiation of cooling to evaluate the effectiveness of the cooling method. The temperature farthest from $33^{\circ}C$ was selected every hour during maintenance. Generalized estimation equation analysis was used to compare the absolute temperature differences from $33^{\circ}C$ during the maintenance period. If the selected temperature was not between $32^{\circ}C$ and $34^{\circ}C$, the hour was considered a deviation from the target. We compared the deviation rates during hypothermia maintenance to evaluate the safety of the different methods. Results: A GP was used for 23 patients among of 53 patients, and a WB was used for the remaining. There was no difference in baseline temperature at the start of cooling between the two patient groups (GP, $35.7^{\circ}C$ vs. WB, $35.6^{\circ}C$; P=0.741). The time to target temperature (134.2 minutes vs. 233.4 minutes, P=0.056) was shorter in the GP patient group. Deviation from maintenance temperature (2.0% vs. 23.7%, P<0.001) occurred significantly more frequently in the WB group. The mean absolute temperature difference from $33^{\circ}C$ during the maintenance period was $0.19^{\circ}C$ (95% confidence interval [CI], $0.17^{\circ}C$ to $0.21^{\circ}C$) in the GP group and $0.76^{\circ}C$ (95% CI, $0.71^{\circ}C$ to $0.80^{\circ}C$) in the WB group. GP significantly decreased this difference by $0.59^{\circ}C$ (95% CI, $0.44^{\circ}C$ to $0.75^{\circ}C$; P<0.001). Conclusions: The GP was superior to the WB for strict temperature control during TTM.

• YAKHAK HOEJI
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• v.58 no.5
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• pp.349-356
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• 2014

With the advent of highly active anti-retroviral therapy (HAART), the perceptions of HIV therapy have changed from treating acute and terminal diseases to managing complex chronic diseases. Due to needs for specialists with professional knowledge on anti-retroviral therapies, pharmacists have been recognized as established and integral members in HIV multi-disciplinary care teams. Nevertheless, the roles of Korean pharmacists for HIV/AIDS therapy were highly limited. According to the transition of '2+4'-year pharmacy school curricula in Korea, it is necessary for pharmacy students to possess improved knowledge about and proper attitudes toward HIV/AIDS as future pharmacists. However, there have been little studies regarding the assessment of HIV/AIDS knowledge, attitudes, and risk perceptions of pharmacy students in Korea. Thus, this study was to examine Korean pharmacy students' knowledge levels, attitudes, and risk perceptions about HIV/AIDS and compare them according to pharmacy educational systems. The self-reported questionnaire was utilized to collect data. Total 238 students responded to the survey questionnaires. Most pharmacy students who participated in this study knew that the main transmission routes of HIV were unprotected sex, unscreened blood, occupational exposure, and intravenous drug use. However, they did not properly know post exposure prophylaxis for HIV. The pharmacy students under '2+4'-year curricula were more competent with treatment, care, counseling for HIV patients than those under 4-year curricula. Most pharmacy students thought that all healthcare students and professionals should receive mandatory HIV testings. The results from this study may contribute to developing new educational programs about HIV/AIDS. Additionally, further studies regarding the changes of Korean pharmacy students' attitudes and risk perceptions will need to be performed after they participate in these kinds of the programs.

• The Korean journal of internal medicine
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• v.33 no.6
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• pp.1194-1202
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• 2018

Background/Aims: This study evaluated the role of hypomethylating agents (HMA) compared to best supportive care (BSC) for patients with high or very-high (H/VH) risk myelodysplastic syndrome (MDS) according to the Revised International Prognostic Scoring System. Methods: A total of 279 H/VH risk MDS patients registered in the Korean MDS Working Party database were retrospectively analyzed. Results: HMA therapy was administered to 205 patients (73.5%), including 31 patients (11.1%) who then received allogeneic hematopoietic cell transplantation (allo-HCT), while 74 patients (26.5%) received BSC or allo-HCT without HMA. The 3-year overall survival (OS) rates were $53.1%{\pm}10.7%$ for allo-HCT with HMA, $75%{\pm}21.7%$ for allo-HCT without HMA, $17.3%{\pm}3.6%$ for HMA, and $20.8%{\pm}6.9%$ for BSC groups (p < 0.001). In the multivariate analysis, only allo-HCT was related with favorable OS (hazard ratio [HR], 0.356; p = 0.002), while very poor cytogenetic risk (HR, 5.696; p = 0.042), age ${\geq}65years$ (HR, 1.578; p = 0.022), Eastern Cooperative Oncology Group performance status (ECOG PS) 2 to 4 (HR, 2.837; p < 0.001), and transformation to acute myeloid leukemia (AML) (HR, 1.901; p = 0.001) all had an adverse effect on OS. Conclusions: For the H/VH risk group, very poor cytogenetic risk, age ${\geq}65years$, ECOG PS 2 to 4, and AML transformation were poor prognostic factors. HMA showed no benefit in terms of OS when compared to BSC. Allo-HCT was the only factor predicting a favorable long-term outcome. The use of HMA therapy did not seem to have an adverse effect on the transplantation outcomes. However, the conclusion of this study should be carefully interpreted and proven by large scale research in the future.

• Journal of Environmental Health Sciences
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• v.45 no.1
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• pp.30-41
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• 2019

Objectives: The effects of particulate matter and ozone on health are being reported in a number of studies. These effects are likely to be stronger on the elderly population, but studies in this regard are scarce. The purpose of this study was to examine the effects of particulate matter ${\leq}2.5{\mu}m$ and ozone on the acute health status of the elderly population. Methods: In order to analyze the health status of the elderly population, the NHIS-Senior Cohort data was used. In this study of people 60 years or older in Seoul, the number of outpatient visits and ER visits between 2002 and 2013 were calculated. Each disorder and the lag effect were analyzed separately. Particulate matter and ozone were analyzed using both the single exposure model and the adjusted multi-exposure model. Results: In the single exposure analysis with PM2.5 as the exposure variable, with each increase of $10{\mu}g/m^3$, the number of outpatient visits increased by 1.0081 times, vascular disease 1.0065 times, chronic pulmonary disease 1.0086 times, and diabetes 1.0055 times. In the multi-exposure model adjusting for ozone, the number of outpatient visits increased by 1.0066 times. There was a one-day lag effect and 1.0066 times increase between PM2.5 and ER visits in the multi-exposure model and 1.0057 times when adjusted for ozone (p value <0.10). There was a one-day lag effect in all multi-exposure models with ozone as the main variable, and when the particulate matter was adjusted, there was a one-day delay and 1.0143 times increase in ER visits. Conclusions: In our study, an increase in the number of outpatient and ER visits in the elderly population in accordance with the increase in PM2.5 and ozone was found. The association found in our study could also produce a socioeconomic burden. Future studies need to be performed in regards to younger populations and other air pollutants.

• Journal of Nutrition and Health
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• v.54 no.5
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• pp.489-500
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• 2021

Purpose: This study aimed at investigating the nutritional status, nutritional support, and nutritional indicators of critically ill patients on extracorporeal membrane oxygen (ECMO) in intensive care units (ICU). Methods: This descriptive study obtained data from the medical records of 37 patients who were treated using ECMO at a university hospital in Korea. The patients were admitted to the Korea University Anam Hospital ICU with acute or serious damage to vital organs from January 1, 2014 to June 30, 2016. Results: Although 32 patients (86.5%) were at a high risk of malnutrition, 26 patients (70.3%) were considered normal in terms of nutritional status by the nutritionist at the beginning of their ICU stay. However, after two weeks, nine patients had passed away and only one patient maintained normal status. Parenteral nutrition was started first but took 4.25 ± 6.95 days till initiation. Only eight patients (21.6%) were able to meet their requirement for both calories and protein. The group provided with adequate calorie and protein showed significantly longer use of the ECMO and respirator and longer ICU and total hospital stay than their counterparts. Normal levels of serum albumin and protein of the group at low-risk for malnutrition on the day of initiation of ECMO, which were significantly higher than the high-risk group, declined by the last day of ECMO leading to a lack of significant differences between the two groups. Conclusion: Considering that the nutritional indicators of patients deteriorated as the days on ECMO increased, more aggressive nutritional management to ensure adequate nutritional support should be emphasized from the beginning and throughout the ICU stay.

• The Korea Journal of Herbology
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• v.34 no.1
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• pp.117-124
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• 2019

Objective : Chronic acid reflux esophagitis (CARE), one of gastroesophageal reflux disease (GERD) is increasing worldwide. Coptidis rhizoma extract (CRE) is a traditional herb that cures a variety of diseases. This study was conducted to evaluate the protective effect of CR on rats with chronic acid reflux esophagitis. Methods : The antioxidant activities were evaluated through radical scavenging assays using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzothiazolin-6-sulfonic acid) (ABTS) radical scavenging assays. CARE was surgically induced in 5-week-old male SD rats by ligating the border between forestomach and glandular portion with a 2-0 silk tie and covering the duodenum using 18-Fr $N{\acute{e}}laton$ catheter. To evaluate the esophageal protective effect of CRE, rats were divided into 3 groups: Nor (normal rats), Veh (chronic acid reflux esophagitis induced rats), CR (chronic acid reflux esophagitis induced rats treated with CRE 200 mg/kg body weight). Results : The administration of CRE significantly prevented the mucosal injury of the esophagus tissue and histological findings improved the esophageal lesion. It has been shown that inflammation is prevented by the increase of antioxidant-related factors (Nrf-2, HO-1, SOD, catalase, and GPx-1/2) through the antioxidant pathway of esophageal tissue. The administration of CRE reduced the increase of serum peroxynitrite ($ONOO^-$) and markedly reduced the protein expression of inflammatory mediator such as $NF-{\kappa}Bp65$, $p-I{\kappa}B{\alpha}$, iNOS, and IL-6. Conclusions : Overall, these results suggest that CRE administration confirmed the protective effect of esophageal mucosa, suggesting that it is a potential treatment for chronic acid reflux esophagitis.

• Korean Journal of Radiology
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• v.22 no.6
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• pp.994-1004
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• 2021

Objective: To extract pulmonary and cardiovascular metrics from chest CTs of patients with coronavirus disease 2019 (COVID-19) using a fully automated deep learning-based approach and assess their potential to predict patient management. Materials and Methods: All initial chest CTs of patients who tested positive for severe acute respiratory syndrome coronavirus 2 at our emergency department between March 25 and April 25, 2020, were identified (n = 120). Three patient management groups were defined: group 1 (outpatient), group 2 (general ward), and group 3 (intensive care unit [ICU]). Multiple pulmonary and cardiovascular metrics were extracted from the chest CT images using deep learning. Additionally, six laboratory findings indicating inflammation and cellular damage were considered. Differences in CT metrics, laboratory findings, and demographics between the patient management groups were assessed. The potential of these parameters to predict patients' needs for intensive care (yes/no) was analyzed using logistic regression and receiver operating characteristic curves. Internal and external validity were assessed using 109 independent chest CT scans. Results: While demographic parameters alone (sex and age) were not sufficient to predict ICU management status, both CT metrics alone (including both pulmonary and cardiovascular metrics; area under the curve [AUC] = 0.88; 95% confidence interval [CI] = 0.79-0.97) and laboratory findings alone (C-reactive protein, lactate dehydrogenase, white blood cell count, and albumin; AUC = 0.86; 95% CI = 0.77-0.94) were good classifiers. Excellent performance was achieved by a combination of demographic parameters, CT metrics, and laboratory findings (AUC = 0.91; 95% CI = 0.85-0.98). Application of a model that combined both pulmonary CT metrics and demographic parameters on a dataset from another hospital indicated its external validity (AUC = 0.77; 95% CI = 0.66-0.88). Conclusion: Chest CT of patients with COVID-19 contains valuable information that can be accessed using automated image analysis. These metrics are useful for the prediction of patient management.