• Journal of Korean Academy of Nursing
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• v.4 no.1
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• pp.151-161
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• 1974

Home visiting as a Public Health Horsing function is believed to be of therapeutic value to, the patient. However, home visiting is time consuming and expensive. Is the gain in knowledge and treatment for patients with Tuberculosis in Korea enough to make the necessary outlay in finances and personnel worthwhile\ulcorner While this study does not attempt to completely answer this question it does, under the following objectives, attempt to answer part of the question. The objectives of the study were to l) ascertain if there is a difference between patients, who receive home visits from the public Health Nurse and those who do not, in the following areas: a) their compliance with medical regimen, b) their ability to answer general questions about Tuberculosis, and c) their compliance with medical advice concerning prevention (B.C.G. immunization) and early diagnosis (contact X-rays), and 2) to determine if there is any correlation between the patient's answers to questions about Tuberculosis and his action both in the areas of treatment and prevention. The patients participating in the study were all newly diagnosed patients at Kwangju Christian Hospital. A control group and an experimental group were selected. The patients in the control group were seen according to the regular schedule at the Kwangju Christian Hospital except that they received no home visits from the Public Health Nurses. The patients in the experimental group were visited on an average of three times during the first two months of their treatment by the investigator, a Public Health Nurse. At the end of two months the patients in the two groups were compared as to compliance both in the treatment and preventive areas. They were also compared according to their answers to a questionnaire regarding both the prevention and treatment of Tuberculosis. The following results were obtained : 1. Patients in the experimental group (68.2%) showed a significantly higher compliance rate for medical treatment than patients in the control group (43.2%). 2. Patients in the experimental group (87.5%) showed a higher compliance rate for B.C.G. immunization than those in the control group (40%). 3. Women patients in the experimental group showed a higher mean score (7.2$\pm$2.6) on the questionnaire than did women in the control group (6.2$\pm$3.4). The results of this study seem to indicate that while home visiting is beneficial to the patient with Tuberculosis as far as treatment is concerned, something more concrete needs to be done if home visiting is to help the patient learn more about Tuberculosis and its prevention. Further study is indicated in the following areas: 1) A similar type of study over a longer period of time involving more subjects and using Korean Public Health Nurses to make the home visits. 2) Study to develop an adequate approach to education considering the problems unique to patients with Tuberculosis living in Korea.

• Tuberculosis and Respiratory Diseases
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• v.79 no.1
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• pp.1-4
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• 2016

Tuberculosis (TB) remains a major public health problem in South Korea. The Joint Committee for the Development of Korean Guidelines for Tuberculosis published the Korean Guidelines for Tuberculosis in 2011 to provide evidence-based practical recommendations to health care workers caring for patients with TB in South Korea. After reviewing recent national and international scientific data on TB, the committee updated the Korean guidelines for TB in 2014. This article presents some practical issues related to the 2014 updated guidelines: namely use of the Mycobacterium tuberculosis-polymerase chain reaction assay and the Xpert MTB/RIF assay in the diagnosis of TB, as well as medical treatment for patients with multidrug-resistant TB.

• Journal of Preventive Medicine and Public Health
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• v.7 no.2
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• pp.285-292
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• 1974

It is well known fact that many tuberculosis patients have often experienced interuption of treatment while their treatment. Because most of cases were inproved subjective symptome by adequate treatment for 3-6 months and patients misunderstood to be heal completely by their own dicision, It become the cause of emergency of drug resistance and chronic incurable diseases. The author intended to clarify the duration of treatment and its outcome by some characteristics of tuberculosis patients. The results obtained were as follows: 1. The rate of treatment for tuberculosis patients by each duration with 1-6, 7-12, 13-13, 19-24 and 25 or more months were 16, 23, 20, 14 and 25 percents respectively. The duration of treatment increased in patients with advancing age, better educated and registered at health center between 7-12 months after diagnosis for tuberculosis. 2. The rate of complete treatment, defaulters, death and migration were 43, 13, 8, and 10 percents respectively. The rate of complete treatment were high in older, better educated and registered at health center between 7-12 months after diagnosis. The rate of defaulters were high in younger, no educated and registered within 1 month after diagnosis. The rate of death was high in older and migration was high in younger.

• Tuberculosis and Respiratory Diseases
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• v.76 no.6
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• pp.261-268
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• 2014

Patients with immune-mediated inflammatory diseases (IMIDs) are increasingly being treated with anti-tumor necrosis factor (TNF) agents and are at increased risk of developing tuberculosis (TB). Therefore, diagnosis and treatment of latent TB infection (LTBI) is recommended in these patients due to the initiation of anti-TNF therapy. Traditionally, LTBI has been diagnosed on the basis of clinical factors and a tuberculin skin test. Recently, interferon-gamma releasing assays (IGRAs) that can detect TB infection have become available. Considering the high-risk of developing TB in patients on anti-TNF therapy, the use of both a tuberculin skin test and an IGRA should be considered to detect and treat LTBI in patients with IMIDs. The traditional LTBI treatment regimen consisted of isoniazid monotherapy for 9 months. However, shorter regimens such as 4 months of rifampicin or 3 months of isoniazid/rifampicin are increasingly being used to improve treatment completion rates. In this review, the screening methods for diagnosing latent and active TB before anti-TNF therapy in patients with IMIDs will be briefly described, as well as the current LTBI treatment regimens, the recommendations for managing TB that develops during anti-TNF therapy, the necessity of regular monitoring to detect new TB infection, and the re-initiation of anti-TNF therapy in patients who develop TB.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.14-21
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• 1996

Objectives: Although outbreak of MDR Tb has been a recent problem in western countries, it has been a longstanding problem in Korea. The poor outcome of MDR Tb is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. Thus, to improve the outcome of MDR Tb, it is crucial to make individualized adequate prescription based on the knowledge of the patterns of resistance to each drugs in the community as well as the natural history. The purpose of present study is to evaluate the clinical features of Korean MDR Tb patients including patterns of drug resistance and success rate of treatment which was prescribed according to the sensitivity tests. Methods: Retroscpective analysis of 71 Korean patients with MDR Tb was made. All strains isolated from patients showed resistence to at least two first line drugs. Patients profile, previous treatment history, patterns of drug resistance, outcome of treatment was analysed. Initial treatment regimen was selected according to the previous treatment history and was modified according to the sensitivity reports. The regimen was composed to include at least 4 sensitive drugs when possible. Results: The patients showed resistance to 4.1 drugs on average. 90% of them were resistant to INH and RFP. Among 71 patients, 35 patients(49%) had cavitary lesions in CXR. Treatment outcome was analysed in 55 patients. 35 patients(67%) were improved after treatment and 18 patients(33%) showed treatment failure. 5 patients showed primary resistance. Treatment outcome could be evaluated in 4 of them and all showed improvement after treatment. 14 patients(20%) had to change their regimens due to drug side effects. The most frequent side effect was elevation of liver enzymes(6 patients). Others included dizziness, hyperuricemia, tinnitus, skin rash, GI troubles. More than 50% of side effects developed within 3 months. In repeated drug sensitivity test, the concordance rate of resistance to INH was 100% and RFP 98%. EMB, PZA showed 80% concordance rate. But in the other drugs, the concordances were less than 50%. Operation was done in 5 patient - 1 patients as a adjunctive means of chemotherapy -. In that case, negative conversion of sputum AFB was done. Conclusion: 2/3 patients of multidrug-resistant tuberculosis were improved by appropriate prescription and regular medication suggesting that more aggressive management and monitoring is indicated in multidrug-resistant tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.59 no.2
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• pp.179-185
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• 2005

Background : To evaluate the clinical efficacy of pulmonary resection combined with first-line antituberculous drug therapy in patients with well-localized, cavities-containing pulmonary multidrug-resistant tuberculosis (MDR-TB). Method : From February 1998, seventeen patients with well-localized, cavities-containing pulmonary MDR-TB were enrolled and followed prospectively up to December 2004. After radical pulmonary resection, the patients were treated with antituberculous drugs comprising of isoniazid (H), rifampin (R), pyrazinamide (Z), ethambutol (E), and streptomycin (S) (3HERZS/3HERS/6HER). Results : All recovered isolates of M. tuberculosis were resistant to both isoniazid and rifampin, and to a mean of 4.8 antituberculous drugs (range, 2 to 7 drugs). Surgical procedures included lobectomy (13 patients), lobectomy plus segmentectomy (3 patients), and pneumonectomy (1 patient). The median time for postoperative sputum smear and culture conversion was 2 days (range, 1 to 23 days). Fifteen (94%) patients had durable cures (mean follow-up period, 39.0 months). One patient failed to convert her sputum and was successfully switched to second-line therapy; one patient developed active disease again almost 7 years later, likely due to re-infection with a new M. tuberculosis strain. Conclusion : Radical resection combined with administration of first-line antituberculous agents was effective in patients with well-localized, cavities-containing pulmonary MDR-TB.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.694-699
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• 1993

Background: After the introduction of more potent antituberculous drugs and the nation-wide tuberculosis management the prevalence rate and mortality rate of pulmonary tuberculosis has been reduced continuously. But we still experienced many patients who succumbed to this disease. So we investigated the causes of treatment failure and death of patients with pulmonary tuberculosis to delineate the problems in the management of these patients. Methods: Retrospective analysis of medical records of 55 patients who died of pulmonary tuberculosis in Kyung-Hee University Hospital during the period of Mar. 1979-Feb. 1990. Results: 1) Average duration of illness was $11.9{\pm}10.1$ years. 2) The mortality rate of in-patients with pulmonary tuberculosis was 2.09%. 3) 47.3% of patients had been treated more than twice and the sputum positive rate was 52.7%. 4) Causes of death were acute respiratory failure(56.4%), asphyxia by hemoptysis(14.6%), cor pulmonale(9.1%), tension pneumothotax(7.3%), vital organ involvement(9.1%) and coexisting diseases(3.5%). Conclusion: Many of these patients had long duration of illness, persistant sputum AFB and high incidence of acute respiratory failure as a fatal complication. It seemed that patient's neglect of their disease and inadequate treatment had caused aggravation of tuberculosis.

• Tuberculosis and Respiratory Diseases
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• v.38 no.2
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• pp.99-107
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• 1991

Drug resistance of M. tuberculosis has been investigated with isolates from patients screened out of the sample population of the nationwide tuberculosis prevalence surveys or from the routine cultures. The results showed a close inverse relationship between prevalence of drug resistance and efficiency of the past or current treatment regimens of NTP. Individual drug resistance also showed a close relationship with the extent of use of the relevant drugs. Drug resistance was found in 38.0% of M. tuberculosis isolates from patients found in 1965 survey and remained unchanged until it increased upto 48.0% in 1980 survey. The resistance prevalence, however, dropped to 30.8% in 1985 and further to 25.3% in 1990 survey. Such decrease was fairly well coincided with a continuous increase of the treatment efficiency (from 60% in 1984 to 77% in 1989) in 1980s. Initial drug resistance also showed a similar trend, namely 26.2% in 1965, 23.9% in 1970, 20.1% in 1975, 30.6% in 1980, 17.4% in 1985, and 15.0% in 1990. The similar figures were observed in M. tuberculosis isolates from patients diagnosed in the routine services. Higher prevalence of initial drug resistance was observed among urban patients than rural patients and among young patients than old patients. These findings signify that a continuous survey on drug resistance permits to monitor efficiency of treatment programme of the country.

• Journal of agricultural medicine and community health
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• v.32 no.3
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• pp.125-138
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• 2007

Objectives: This retrospective study is to identify related factors of treatment success of patients with tuberculosis at community health centers. Methods: The subjects of this study were 1,417 patients with tuberculosis treated in 28 community health centers. The predictors of tuberculosis treatment success were analyzed in terms of 2 areas, which were characteristics of patients and health centers(TB control program). The characteristics of patients consist of 2 factors, such as demographic & diagnosis and treatment. The present conditions of health centers consist of 3 factors, location of centers, resources, and community activities. Data were analysed using X2- test and logistic regression methods. Results: The significant differences between success group and failure group were sex(p=0.003), age(p=0.013), job(p=0.000), type of patients(p=0.001), past history(p=0.029), BCG injection(p=0.009), sputum culture examination(p=0.017), period of treatment(p=0.000), location of center(p=0.001), population per staff(p=0.015), FTE(p=0.027), education days of staff(p=0.005), BCG injection rate(p=0.001), case detection rate (p=0.003), and health education provision rate(p=0.044). Then these variables were analysed using logistic regression analysis. Significant positive factors of treatment success were occupation(95% CI:1.3-6.1), periods of treatment(95% CI:1.5-2.2), center in large city(95% CI:1.2-16.7), center in middle city(95% CI:2.1-24.3), job education related TB(95% CI:1.02-1.3), and BCG injection rate(95% CI:1.1-303.4). Significant negative factors of treatment success were male(95% CI:0.1-0.5) and treatment after default(95% CI:0.005-0.5). Conclusions: Tuberculosis is still one of serious diseases in Korea, because it causes highest mortality rate among OECD countries. This study may provide information to improve treatment effectiveness of tuberculosis at community health centers.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.17 no.1
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• pp.38-42
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• 2006

Background and Objectives: There has been a gradual decline in the incidence of laryngeal tuberculosis due to effective an-tituberculous chemotherapy and improvement in the standard of living. During the last decade, however, the disease has changed its clinical pattern. We aimed to study a clinical and telescopic evaluation of laryngeal tuberculosis. Materials and Method: A retrospective clinical analysis was done for 16 patients who diagnosed laryngeal tuberculosis from January 2000 through December 2004. All patients had a complete clinical and laboratory work-up including telescopy, chest X-rays, sputum cultures, Tbc PCR(polymerase chain reaction). Laryngeal biopsies were performed in some cases. All the patients received proper antituberculous chemotherapy. Results: The patients age ranged from 21 to 59 with a mean age 43. The male to female ratio was 10:6. The prominent presenting symptom was hoarseness. The various telescopic findings were categorized: 7 patients showed ulcerative, 4 patients granulomatous, 3 patients ulcerofungative, 2 patients had nonspecific inflammatory lesions. Involving sites were true vocal cord most commonly in 12 patients. Three of 16 patients had normal chest X-ray fmding. Among 16 patients, 4 patients showed positive response for AFB stain, 13 patients showed positive for Tbc PCR. Biopsy was done for 3 patients who were not confirmed in initial tuberculous test. All patients responded satisfactorily to antituberculous medication. Conclusion: The telescopic findings and clinical manifestations of laryngeal tuberculosis have changed and seemed to be different from those of classic reports. Thus, the clinicians who deal with the various symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease.