• Pediatric Infection and Vaccine
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• 제22권3호
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• pp.131-135
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• 2015

Since April 2012, more than 1,600 laboratory-confirmed human infections with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported, occurring primarily in countries in the Arabian Peninsula; the majority in Saudi Arabia. The MERS outbreak in Korea, which began in May 2015 through the importation of a single case who had recently traveled to Bahrain, the United Arab Emirates, Saudi Arabia, and Qatar. As of November 28th, 186 secondary and tertiary cases had been reported; 38 deaths, mainly associated with underlying chronic illnesses, were reported. One case was exported to China and has been recorded as the first MERS case in China. Thirty-seven confirmed cases were associated with the index case, who was hospitalized from May 15 to May 17. Emergency room at one of the nation's largest hospitals had been affected by hospital-to-hospital and intra-hospital transmissions of MERS-CoV, resulting in an outbreak of 90 infected patients. The vast majority of 186 confirmed cases are linked to a single transmission chain associated with health facilities. The median age of patients is 55 years, with a range of 16 to 87 years. The majority (61%) of patients are men. Twenty-five (14%) of the cases involve healthcare workers. The overall median incubation period was six days, but it was four days for secondary cases and six days for tertiary cases. There has been no evidence of airborne transmission and sustained human-to-human transmission in communities. Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the MERS-CoV under control in Korea. Since 4 July no new cases have been reported.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.190-193
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• 2019

Inhaled corticosteroids (ICSs) have been widely used as a key medication for asthma control. However, ICSs have been known to cause respiratory infections, such as pneumonia and pulmonary tuberculosis. Consequently, a dilemma exists regarding recommendation of persistent lifetime use of ICSs to mild asthma patients. Short-acting ${\beta}$-agonists (SABAs) have also been widely used for symptom relief. However, SABAs have been reported to increase the risk of asthma-related death, though incidences have been very rare. Consequently, a dilemma exists regarding recommendation of a SABA alone without an ICS or a controller to asthma patients even with very mild disease. In the real world, asthma patients tend to intermittently use ICS and more likely to be dependent on SABA since many patients want immediate relief of their symptoms. Consequently, a dilemma exists regarding the underuse of ICSs but the overuse of SABAs. One strategy for solving the presented dilemma would be identification of patients with asthma who require persistent use of asthma controllers. Such patients, who may be referred to as "persistent controller users," should continuously receive ICSs, even under controlled states of asthma. Another strategy would be a patient-adjusted, symptom-driven, intermittent-to-regular treatment combining low-dose ICS/rapid-onset long-acting ${\beta}$-agonists instead of using a SABA alone or with low-dose ICS for the asthma patients with mild disease. Both of these two strategies could avoid the risky treatment of a SABA alone without an ICS and could reduce the dose of ICS with the maintenance of asthma control.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.15-26
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• 2019

The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.

• 한국응급구조학회지
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• 제25권1호
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• pp.125-134
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• 2021

Purpose: The purposes of this study were to determine the changes in the pattern of patients who were transferred to the emergency room through inter-hospital private institutions and to determine how long transport takes following the COVID-19 outbreak. Methods: This retrospective observational study analyzed the emergency medical services reports of private institutions following the COVID-19 outbreak in South Korea. The study was conducted in Busan between January 19, 2019 and January 18, 2020, and between January 19, 2020 and January 18, 2021. Results: Upon comparing the patient transport times during the "Pre-COVID-19 period" and "COVID-19 period," a significant delay was noticed in the preparation for transfer of patients during the "COVID-19 period" (p<.05). There were significantly more patients with respiratory infections and patients who complained of general symptoms during the "COVID-19 period." Moreover, there was a higher frequency of patients who were transferred to a 'Level I' emergency room during the "COVID-19 period" compared to during the "Pre-COVID-19 period" (p<.05). Conclusion: Following the COVID-19 outbreak, there is a delay in patient transport to the emergency room through private institution inter-hospital transport and an increase in the number of patients complaining of respiratory infection symptoms. Thus, emergency medical services need additional administrative and economic support to transport infected patients.

• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.349-357
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• 2022

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

• Pediatric Infection and Vaccine
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• 제30권2호
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• pp.104-110
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• 2023

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)는 호흡기계 뿐만 아니라 소화기계에도 감염을 일으킨다. 이중 SARS-CoV-2가 급성 췌장염을 일으키는 경우는 성인과 소아를 포함하여coronavirus disease 2019 (COVID-19) 확진 환자의 약 0.16% 정도이다. COVID-19에 확진된 소아 환자에서의 급성 췌장염은 그 동안 소아다기관염증증후군이나 중증의 코로나 감염 환자에서 동반 질환으로 보고되는 게 대부분이며 단독으로 급성 췌장염만 일으키는 사례는 거의 없었다. 저자들은 SARS-CoV-2에 감염된 소아 환자에게서 단독으로 급성 췌장염이 발생한 예를 경험하였고 성공적으로 치료하였기에 보고하는 바이다.

• Journal of Preventive Medicine and Public Health
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• 제56권3호
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• pp.212-220
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• 2023

Objectives: This study compared the epidemiological and clinical manifestations of patients hospitalized with respiratory syncytial virus (RSV) infection before and during the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care hospital in Chiang Mai Province, Thailand. Methods: This retrospective observational study utilized data from all cases of laboratory-confirmed RSV infection at Maharaj Nakorn Chiang Mai Hospital from January 2016 to December 2021. Differences in the clinical presentation of RSV infection before (2016 to 2019) and during (2020 to 2021) the COVID-19 pandemic were analyzed and compared. Results: In total, 358 patients hospitalized with RSV infections were reported from January 2016 to December 2021. During the COVID-19 pandemic, only 74 cases of hospitalized RSV infection were reported. Compared to pre-pandemic levels, the clinical presentations of RSV infection showed statistically significant decreases in fever on admission (p=0.004), productive cough (p=0.004), sputum (p=0.003), nausea (p=0.03), cyanosis (p=0.004), pallor (p<0.001), diarrhea (p<0.001), and chest pain (p<0.001). Furthermore, vigilant measures to prevent the spread of COVID-19, including lockdowns, also interrupted the RSV season in Thailand from 2020 to 2021. Conclusions: The incidence of RSV infection was affected by the COVID-19 pandemic in Chiang Mai Province, Thailand, which also changed the clinical presentation and seasonal pattern of RSV infection in children.

• Genomics & Informatics
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• 제21권2호
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• pp.16.1-16.14
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• 2023

Coronavirus disease 2019 (COVID-19) is a viral infection produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus epidemic, which was declared a global pandemic in March 2020. The World Health Organization has recorded around 43.3 billion cases and 59.4 million casualties to date, posing a severe threat to global health. Severe COVID-19 indicates viral pneumonia caused by the SARS-CoV-2 infections, which can induce fatal consequences, including acute respiratory distress syndrome (ARDS). The purpose of this research is to better understand the COVID-19 and ARDS pathways, as well as to find targeted single nucleotide polymorphism. To accomplish this, we retrieved over 100 patients' samples from the Sequence Read Archive, National Center for Biotechnology Information. These sequences were processed through the Galaxy server next generation sequencing pipeline for variant analysis and then visualized in the Integrative Genomics Viewer, and performed statistical analysis using t-tests and Bonferroni correction, where six major genes were identified as DNAH7, CLUAP1, PPA2, PAPSS1, TLR4, and IFITM3. Furthermore, a complete understanding of the genomes of COVID-19-related ARDS will aid in the early identification and treatment of target proteins. Finally, the discovery of novel therapeutics based on discovered proteins can assist to slow the progression of ARDS and lower fatality rates.

• Nutrition Research and Practice
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• 제18권1호
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• pp.98-109
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• 2024

BACKGROUND/OBJECTIVES: The efficacy of Lab4 probiotic and vitamin C combination on the prevention of upper respiratory tract infections (URTIs) was investigated in two studies with children. Our objective was to pool dataset of 57 preschool children from the PROCHILD study (ISRCTN28722693) and the dataset of 50 preschool matched cohort from the PROCHILD-2 study (ISRCTN26587549) to evaluate the impact of probiotic/vitamin C combination on the prevention of upper respiratory tract symptoms and provide a more robust assessment of effect using detailed individual level data. SUBJECTS/METHODS: The children were supplemented daily for 6 months with either the multistrain probiotic (1.25×10¹⁰ cfu/tablet consisting of two strains of Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20 and Bifidobacterium animalis subsp. lactis CUL34) plus 50 mg vitamin C or a placebo. RESULTS: In the pooled analysis of the individual participant data (per protocol population), significant reductions were observed for the incidence (-25%; 95% confidence interval [CI], 0.66, 0.85; P < 0.0001) and duration (-14.9 days; 95% CI, -24.8, -5.1; P = 0.0030) of typical URTI symptoms in the active group compared with the placebo. The incidence rates of absenteeism from preschool (IR ratio, 0.75; 95% CI, 0.66, 0.86; P < 0.0001), paediatric visits (IR ratio, 0.56; 95% CI, 0.47; 0.68; P < 0.0001) and antibiotic usage (IR ratio, 0.53; 95% CI, 0.39, 0.71; P < 0.0001) were also significantly reduced. CONCLUSION: The pooled analysis findings of comparable preschool cohorts from two studies indicate that the supplementation with probiotic and vitamin C combination is beneficial in the prevention and management of URTI symptoms.

• Tuberculosis and Respiratory Diseases
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• 제61권6호
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• pp.554-561
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• 2006

배 경: AIDS환자에게서 기회감염은 가장 치명적인 합병증으로 대부분은 폐 감염의 형태로 발현된다. 본 연구는 타 국가에 비해 아직까지는 유병률이 낮아서 상대적으로 자료가 부족한 국내의 현황에서, HIV 감염자 및 AIDS 환자의 임상양상을 살펴보고 특히 AIDS 환자들이 주로 어떤 호흡기 질환으로 발현하며, 호흡기 질환이 발현된 AIDS 환자와 기타 폐외 질환으로 발현하거나, HIV 단순감염자와의 임상상에 어떤 차이가 있는지를 중점적으로 살펴보고자 하였다. 방 법: 2001년부터 2006년 2월까지 중앙대학교 병원에 내원한 HIV 감염자 총28명을 대상으로, 이들 환자의 의무기록을 후향적으로 조사하여 분석하였다. 결 과: 총 28명의 HIV 감염자 중 27명이 남자이었고 평균연령은 40.6세로 30대가 40%로 가장 많은 분포를 보였다. 이 중에서 폐질환을 동반한 경우가 11명이었고, 폐외질환 환자가 16명이었다. 폐질환을 동반환 환자군과 폐외질환자에서 내원시 CD4+림프구수와 HIV RNA 수는 평균 79.5/mm3, 48,903 IU/ml, $400/mm^3$, 60,256 IU/ml을 보여(P value: 0.001, 0.695) 폐감염이 동반된 경우에 더 심한 면역억제 상태가 심하였다. 폐감염의 종류로는 폐결핵, 주폐포자충 폐렴이 가장 많은 빈도를 차지하였으며, 이들의 평균 CD4+림프구 수를 보면, 폐결핵이 $56/mm^3$, 주폐포자충폐렴이 $42/mm^3$이었다. 결 론: HIV에 관련된 폐질환이 동반된 경우 그렇지 않은 경우에 비해 월등히 면역억제가 심하였다. 이 중에서 폐결핵과 주폐포포자충 폐렴이 가장 흔한 형태의 폐감염이었다. 본 연구는 일개 대학병원에서 경험한 HIV 감염자와 특히 폐질환이 발현된 AIDS 환자의 임상상의 특징을 확인할 수 있었고 빠른 조기진단과 치료의 필요성을 다시 한번 확인하였다.