• 한국임상약학회지
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• 제24권2호
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• pp.115-125
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• 2014

Purpose: The purpose of the present study was to assess the incidence of the potentially inappropriate medication (PIM) use in Korean elderly patients with heart failure, and to evaluate factors that influence PIM use. Method: Korean National Health Insurance claims database between January 2009 and December 2009 was used. Using 2012 updated Beers criteria, PIM use in heart failure patients aged 65 years or older was examined. Result: The incidence of PIM use in elderly heart failure patients was higher than in overall elderly patients. Among the 12,759 elderly patients with heart failure, 46.2% of study subjects were prescribed PIM(s) at least once. The number of PIM per 10 medications that patients received per patient was 1.53. The most commonly used PIMs in elderly heart failure patients were benzodiazepines (30.9%), non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors (16.3%), digoxin (9.9%), and spironolactone (9.0%). Women (odds ratio, 1.20; 95% CI, 1.17-1.24), medical aid (odds ratio, 1.11; 95% CI, 1.08-1.13), and long-term facilities (odds ratio, 2.69; 95% CI, 2.44-2.96) were revealed to be important factors associated with PIM use. In addition, patient's age also seems to influence PIM use. Conclusion: Elderly heart failure patients are at a greater risk for adverse drug events attributed by inappropriate medication use. Efforts to increase awareness of PIM use in elderly heart failure patients are needed. In addition, various comprehensive strategies and policies to identify and prevent PIM use should be established nationwide.

• 대한임상독성학회지
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• 제7권1호
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• pp.19-22
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• 2009

Although Nerium indicum poisoning is a globally rare occurrence, Nerium oleander poisoning is known to occur frequently in the Mediterranean regions. To our knowledge, this is the first reported case of accidental Nerium indicum poisoning in Korea. Its poisoning symptoms and signs are similar to that of digitalis poisoning, because of the presence of cardiac glycosides in Nerium indicum. A 16-year-old boy was admitted to the emergency department four hours prior to the accidental ingestion of Nerium indicum petals. The patient complained of nausea, vomiting, and dizziness. His initial vital signs were stable; laboratory blood test results were within normal levels, except for the blood digoxin level (1.5 ng/dL). An electrocardiogram (ECG) analysis showed normal sinus rhythm, progressive PR prolongation and second-degree Morbiz type I AV block. Conservative treatments including activated charcoal administration were conducted, because toxic symptoms and signs were not severe. The patient was admitted to the intensive care unit for close observation. His ECG was converted to normal rhythm after 1 day and the toxic symptoms and signs were completely resolved after 4 days.

• Biomolecules & Therapeutics
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• 제30권5호
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• pp.427-434
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• 2022

The drug repurposing strategy has been applied to the development of emergency COVID-19 therapeutic medicines. Current drug repurposing approaches have been directed against RNA polymerases and viral proteases. Recently, we found that the inhibition of the interaction between the SARS-CoV-2 structural nucleocapsid (N) and spike (S) proteins decreased viral replication. In this study, drug repurposing candidates were screened by in silico molecular docking simulation with the SARS-CoV-2 structural N protein. In the ChEMBL database, 1994 FDA-approved drugs were selected for the in silico virtual screening against the N terminal domain (NTD) of the SARS-CoV-2 N protein. The tyrosine 109 residue in the NTD of the N protein was used as the center of the ligand binding grid for the docking simulation. In plaque forming assays performed with SARS-CoV-2 infected Vero E6 cells, atovaquone, abiraterone acetate, and digoxin exhibited a tendency to reduce the size of the viral plagues without affecting the plaque numbers. Abiraterone acetate significantly decreased the accumulation of viral particles in the cell culture supernatants in a concentration-dependent manner. In addition, abiraterone acetate significantly decreased the production of N protein and S protein in the SARS-CoV-2-infected Vero E6 cells. In conclusion, abiraterone acetate has therapeutic potential to inhibit the viral replication of SARS-CoV-2.

• 대한임상검사과학회지
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• 제37권1호
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• pp.1-7
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• 2005

The purpose of this study was to verify (i) a consistent calibration verification for the assessment of method linearity and (ii) calibration agreement with calibration settings. We validated calibration verification through method linearity with different lot number of individual calibrators that span the working range for 9 tests except salicylate with control sample in test. We evaluated that it covered broad analyte range to assay from near zero to the top of the measuring range with 5 or 6 points every three times for 10 analytes in TDM test. Target values were plotted on X-axis with assigned or observed values on the Y-axis. Working range were as follows. Calibration verification of the measuring range (maximum to minimum values) has been validated asetaminophen 0.1 to $304.6_{\mu}g/mL$, salicylate 0 to $1005_{\mu}g/mL$, valproic acid 3.2 to $154.19_{\mu}g/mL$, digoxin 0.17 to 5.65 ng/mL, vancomycine 1.3 to $80.51_{\mu}g/mL$, carbarmazepine 0.1 to $22.3_{\mu}g/mL$, phenytonin 0.6 to $40.21_{\mu}g/mL$, theophyline 0.2 to $40.21_{\mu}g/mL$, primidone 0 to $24.07_{\mu}g/mL$, phenobarbital 0.6 to $60.0_{\mu}g/mL$. Drawing a straight line through five or six points of these data showed good linearity. We are sure that it is important to assess the calibration verification of a test method to ascertain the lowest and highest test results that are reliable.

• 한국임상약학회지
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• 제16권2호
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• pp.113-122
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• 2006

Purpose: A retrospective study was performed to assess the efficacy and tolerance of ${\beta}-blocker$ administration in patients with heart failure and diabetes. Method: Records of 164 patients who were treated for the heart failure condition more than a year were studied retrospectively. Patients were divided into 4 groups based on their diabetes(DM) status and the administration of ${\beta}-blockers$ ($DM+{\beta}-blocker$ group: 14, DM w/o ${\beta}-blocker$: 19, No DM + ${\beta}-blocker$: 62, No DM + no ${\beta}-blocker$: 69). All patients had been receiving conventional therapy such as digoxin, ACE-I, ARB, diuretics, nitrates, aspirin, anticoagulants or lipid-lowering agents. The primary endpoints (death and hospital admission) were recorded during 1 year period and hemodynamic factors (HR, LVEF, SBP, DBP) were obtained from all patient groups before and after 12 months of ${\beta}-blocker$ treatment. To evaluate toxicity of ${\beta}-blocker$, SCr, BUN, AST, ALT and Alkaline phosphatase were obtained. Result: There were less death and hospital admission in DM + ${\beta}-blocker$ group than in DM without ${\beta}-blocker$ group (p=0.014). Relative risk of hospital admission for $DM+{\beta}-blocker$ group over no DM group was 1.17. Long term ${\beta}-blocker$ administration was associated with an improvement of heart rate in patients with DM (P< 0.02) with no significant improvement of LVEF, SBP, DBP. in DM patient. In patient without DM, ${\beta}-blocker$ was associated with improvement in LVEF, HR and DBP (P<0.01, P<0.03), but not in SBP. The incidence of toxicity was similar between the four group with no significant difference. Conculsion: Treatment of heart failure patients with ${\beta}-blocker$ appears to be beneficial in terms of hospital admission event and several hemodynamic factors. The toxicities of ${\beta}-blocker$ treatment were not significant and the treatment is generally well-tolerated in most of the heart failure patients.

• Childhood Kidney Diseases
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• 제7권2호
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• pp.204-210
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• 2003

막증식성 사구체 신염은 Berger와 Galle에 의해 처음 기술되어졌고, 전자 현미경상 고밀도로 보이는 물질들이 치밀층에 침착된 것을 특징으로 하므로, dense deposit disease라고 명명하기도 한다. 비록 원인과 병리기전에 대해서는 잘 알려져 있지 않지만, 보체의 대체경로를 활성화시켜 저보체혈증이 일어나는 임상양상으로 미루어 볼 때 이와 연관된 병의 발생기전이 보고되어 있다. 이 질환은 다른 신염에 비해 말기 신부전으로 진행하는 비율이 높아 그 중요성이 있으나 정립된 치료법이 없어 다양한 노력이 시도 중이며 그 효과에 대해서는 아직까지 논란이 있다. 저자들은 내원 3년 전부터 나타난 지속적 반복적 육안적 혈뇨와 단백뇨, 지속적인 보체 감소증이 있었으나 상실성 빈맥증(paroxysmal supraventricular tachycardia) 때문에 신조직 검사를 지연시켜오던 환아에서 2년 정도의 digoxin 복용 후 실시한 7세 여아의 조직검사에서 제 2형 막증식성 사구 체신염으로 진단된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 핵의학기술
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• 제13권3호
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• pp.159-164
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• 2009

목적 : 본원에서 시행하고 있는 혈액 검사 경고치 자동통보 시스템의 목적은 환자의 혈액 검사 결과에 따라 신속한 치료를 받아야 할 상황이 발생되면 구축된 자동통보 시스템을 통해 즉시 환자 주치의에게 결과를 알려주고, 이에 따른 적절한 처치가 시행되어 환자에게 발생될 수 있는 치명적 영향을 줄이기 위함이다. 최근 핵의학과 혈액 검사실에서도 TSH, FT4, $17{\alpha}$-OHPGR 3종목에 대해 혈액 검사 경고치 자동통보 시스템을 실시함에 따라 운영현황을 소개 하고자 한다. 실험재료 및 방법 : 대상은 2009년 2월 19일부터 5월 11일까지 신생아과로부터 의뢰된 TSH, FT4, $17{\alpha}$-OH-PGR 처방환자 중 다음 기준에 해당하는 환자들로 하였다. N2340 Thyroid-Stimulating Hormone: >$10{\mu}IU/mL$(참고치: 0.4~5.0) N2360 Free-Thyroxine: <$0.8{\mu}g/dL$(참고치: 0.8~1.9), N2444 $17{\alpha}$-OH-Progesterone: >$30{\mu}g/dL$(참고치: 남성(0.6~3.42), 여성 난포기(0.19~1.8)) 방법은 OCS Program에 대상 검사 종목, 진료과, 경고치보고 기준 값을 입력해 놓은 후 확정된 결과가 입력된 조건에 해당하면 처방의 및 주치의의 PDA로 SMS를 전달하게 된다. 결과 : 경고치 자동통보 시스템으로 보고된 결과는 2009년 2월 19일부터 3월 31일까지 총15건이었고 2009년 4월 1일부터 5월 11일까지 총 18건으로 3건의 증가가 있었다.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.752-759
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• 1995

연구배경: 심부전 환자에서 기관지 과민성의 여부를 확인하고 이러한 기관지 과민성과 혈역학적 지표사이의 상관관계를 알기위해 메타콜린을 이용하여 기관지 유발검사를 실시하였다. 방법: 1994년 3월부터 8월까지 본원에 내원하여 흉부 X선 촬영, 심에코도 검사, 심도자술로 승모판 심장질환이 진단되고 호흡곤란의 정도가 NYHA 기능적 분류 2인 11명의 환자를 대상으로 PARI nebulizer I을 이용하여 메타콜린 용액의 농도를 올리면서 기관지 유발검사를 시행하여 최대호기 유속이 20%이상 감소를 보이면 양성반응으로 간주하였다. 또한 각각의 환자는 심도자술을 통해서 혈역학적인 지표와 기관지 과민반응과의 상관 관계를 알아보고저 하였다. 결과: 1) 11명의 환자중 남자 2명 여자 9명이였으며 평균연령은 38.0세이였고 흡연력은 1명이외에는 없었다. 2) 각 환자의 호흡곤란 정도는 NYHA 기능적 분류 2였고 승모판 협착증만 있는 환자는 5명이였고 이외는 승모판 질환과 대동맥 판막질환이 동반되어있었다. 3) 환자들의 평균폐동맥압과 평균폐모세혈관 쐐기압은 각각 21.72mmHg(${\pm}8.55$), 15.45mmHg(${\pm}8.69$)로 정상보다 높았고 심장지수와 좌심실분획률은 각각 2.64L/min/m2(${\pm}0.41$), 61.81%(${\pm}7.21$)로 정상범위이였다. 4) 11명의 환자중 1명만 메타콜린 기관지 유발검사에 양성이었다. 결론: NYHA 기능적 분류 2인 승모판 심장질환이 있는 심부전환자 11명중 1명만 기관지 과민반응이 관찰되었으며 그 이유로 지속적인 심부전의 치료에 의한 간질성 폐부종의 소설로 인해 기관지의 반응성이 증가되지 않았다고 사료되며 NYHA 기능적 분류 3 또는 4인 승모판 심장질환 환자를 대상으로 기관지 과민 반응에 대한 추후의 검사가 필요할 것으로 생각된다.