Intraocular Hemorrhage After Transoral Endoscopic Thyroidectomy Vestibular Approach / 대한이비인후과학회지

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

Type III Usher Syndrome in the Republic of Korea

Purpose@#To report a case of type III Usher syndrome that has not been previously reported in the Republic of Korea.Case summary: A 39-year-old female visited the local eye clinic for ophthalmic evaluation and then visited our ophthalmologydepartment due to a need for further evaluation and proper management. She complained of night blindness after she becamean adult. She underwent a funduscopic examination, which revealed decolorization and atrophy of the retinal pigment epithelium,bony spicule pigmentation in the retina, and thinning of the retinal arteriole. Results of an electroretinogram and electrooculogramrevealed that responses were weak. She was diagnosed with the fourth grade of hearing impairment according to hermedical history. There was no mental retardation. According to her family history, her mother had hypermetropia, and her brotherhad astigmatism. There was no other medical history, including ophthalmic history. She was diagnosed with type III Usher syndromebased on ataxia and the dynamic visual acuity test. @*Conclusions@#It may be necessary to consider a genetic disease by assessing other systemic symptoms when a patient with retinitispigmentosa is diagnosed.

The Effect of Intra-arterial Thrombolysis in Retinal Artery Occlusion: Case Series and Literature Review

Purpose@#We performed intra-arterial thrombolysis within 6 hours of presentation in Korean patients with acute retinal artery occlusion. The treatment outcomes of our patients were compared with those from a literature review of this procedure. @*Methods@#Visual acuity, intraocular pressure, fundus photo, and fluorescein angiography were examined in five Korean patients who ultimately underwent intra-arterial thrombolysis due to central retinal artery occlusion. The visual acuity of patients was evaluated after the procedure. The treatment outcomes of our patients were compared with those presented in six foreign intra-arterial thrombolysis studies with respect to age, sex, and visual acuity before and after intra-arterial thrombolysis. @*Results@#In our five cases (three males and two females), the average age was 63.4 years and the average time to the procedure of intra-arterial thrombolysis was 4.8 hours. In the five cases, the visual acuity before intra-arterial thrombolysis were hand movements, 0.1, finger counting at 30 cm, hand movements, and 0.08. Visual acuity after intra-arterial thrombolysis were 0.9, 0.5, finger counting at 30 cm, 0.7, and 1.2. The average age of patients in the six studies from the literature was 60 years, and the most common visual acuity before intra-arterial thrombolysis was light perception and hand movements. A slight improvement in visual acuity (>0 to 0.1) was common in most of the studies; however, three studies showed a partial recovery (from 0.2 to 0.4). @*Conclusions@#For retinal artery occlusion, intra-arterial thrombolysis within 6 hours should be considered as a treatment option.

The Effect of Intra-arterial Thrombolysis in Retinal Artery Occlusion: Case Series and Literature Review

Purpose@#We performed intra-arterial thrombolysis within 6 hours of presentation in Korean patients with acute retinal artery occlusion. The treatment outcomes of our patients were compared with those from a literature review of this procedure. @*Methods@#Visual acuity, intraocular pressure, fundus photo, and fluorescein angiography were examined in five Korean patients who ultimately underwent intra-arterial thrombolysis due to central retinal artery occlusion. The visual acuity of patients was evaluated after the procedure. The treatment outcomes of our patients were compared with those presented in six foreign intra-arterial thrombolysis studies with respect to age, sex, and visual acuity before and after intra-arterial thrombolysis. @*Results@#In our five cases (three males and two females), the average age was 63.4 years and the average time to the procedure of intra-arterial thrombolysis was 4.8 hours. In the five cases, the visual acuity before intra-arterial thrombolysis were hand movements, 0.1, finger counting at 30 cm, hand movements, and 0.08. Visual acuity after intra-arterial thrombolysis were 0.9, 0.5, finger counting at 30 cm, 0.7, and 1.2. The average age of patients in the six studies from the literature was 60 years, and the most common visual acuity before intra-arterial thrombolysis was light perception and hand movements. A slight improvement in visual acuity (>0 to 0.1) was common in most of the studies; however, three studies showed a partial recovery (from 0.2 to 0.4). @*Conclusions@#For retinal artery occlusion, intra-arterial thrombolysis within 6 hours should be considered as a treatment option.

A 6-year Prospective, Observational, Multi-Center Post-Marketing Surveillance of the Safety of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Korea

BACKGROUND: Incidence of whooping cough is increasing in Korea. Since 2011, occurrence among adolescents and adults has risen putting vulnerable neonates at risk. National immunization guidelines now include Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccination during pregnancy and as a cocooning strategy (i.e., vaccinating adults and adolescents in contact with neonates). This study assessed post-marketing Tdap (Boostrix®, GSK, Belgium) vaccine safety in subjects ≥ 10 years. METHODS: This open, non-comparative multi-center study was conducted over six years at 10 hospitals in Korea. Subjects received Tdap in normal clinical practice according to local prescribing information. All adverse events (AEs) were recorded, classified as expected or unexpected, and severity and relationship to Tdap were assessed. RESULTS: The analysis included 672 Korean subjects (mean age, 44 years; range, 11–81), 451 were women and 211 were pregnant. Ninety subjects experienced 124 AEs (incidence 13.39%) of which six were serious AEs (SAEs) assessed as not related to vaccination, and 51 were non-SAEs related to vaccination (mostly administration site reactions). Overall 65/124 AEs were unexpected; the most common were 14 constipation, 5 dyspepsia, 4 common cold and 4 premature labor cases. One case of common cold was assessed as possibly related to vaccination. Pregnancy outcome was ‘live infant, no apparent congenital anomaly’ in 195 subjects (92.42%) or ‘lost to follow-up’ in 16 subjects. CONCLUSION: Tdap administration to Korean subjects ≥ 10 years, including pregnant women, for the prevention of diphtheria, tetanus and pertussis was shown to have a well-tolerated safety profile. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01929291

The Clinical Outcome of Endoscopic Endonasal Silicone Tube Intubation According to Nasolacrimal Duct Resistance

PURPOSE: To evaluate the clinical result of silicone tube intubation through Hasner's valve according to nasolacrimal duct resistance under intranasal endoscopic guidance in partial acquired nasolacrimal duct obstruction patients. METHODS: The present study enrolled a total of 50 eyes from 31 patients diagnosed with partial acquired nasolacrimal duct obstruction in the Department of Ophthalmology, Chonbuk National University Hospital from 2012 January to 2012 December. Silicone tube intubation was done through the Hasner's valve and confirmed by intranasal endoscopy and the nasolacrimal duct resistance was measured. Success was defined as the disappearance of epiphora, and failure was defined as the maintenance of epiphora after silicone tube intubation. RESULTS: There were 8 male patients and 23 female patients, ages between 32 to 80 and the average age was 61.4 years old. 3 eyes of 3 patients (6%) had no resistance, 26 eyes of 17 patients (52%) had mild resistance, 17 eyes of 15 patients (34%) had moderate resistance and 4 eyes of 3 patients (8%) had severe resistance. The success was 44 eyes (88%) and the failure was 6 eyes (12%). In the no resistance and mild resistance groups the success rates were both 100%, while an 82% of success rate in the moderate resistance group and 25% success rate in the severe resistance group were observed. The success rates showed clear distinction between severe, moderate and mild resistance patients. CONCLUSIONS: Ensuring the passage of a silicone tube through Hasner's valve increases the success rate in the functional aspect; however, the resistance of the nasolacrimal duct can highly influence the success rate. Therefore, if a patient has severe nasolacrimal duct resistance, dacryocystorhinostomy should be considered earlier.

The Efficacy of Infliximab in Refractory Uveitis

PURPOSE: To investigate the effectiveness of infliximab as treatment for refractory uveitis that recurred in spite of immunosuppressive agents. METHODS: Thirty patients who were treated for refractory uveitis from 2002 to 2011 were included in this study. We retrospectively reviewed the medical records of 15 patients who were treated with Infliximab and 15 patients not treated with Infliximab. Infliximab was injected intravenously (5 mg/kg) 3 times every 4 weeks, and the patients were followed-up at 1 week, 2 weeks, and every month thereafter. Anterior chamber cell reaction with a score greater than 0.5+ was defined as recurrence of uveitis. RESULTS: Among 15 patients treated with Infliximab, only one showed no response to the medication. The recurrence rate was significantly higher in patients receiving Infliximab treatment (1.1 +/- 0.2 times) than in those not receiving Infliximab treatment (3.1 +/- 0.3 times) (p=0.022). CONCLUSIONS: Infliximab can be used effectively on patients with refractory uveitis. However, a future prospective randomized study is needed to demonstrate the effectiveness of Infliximab and to determine an accurate protocol regarding dosage and number of injections.

Safety and Tolerability of the Dual 5-Alpha Reductase Inhibitor Dutasteride in the Treatment of Androgenetic Alopecia

BACKGROUND: After the approval of dutastride for androgenic alopecia (AGA) in 2009, Korean authority required a post-marketing surveillance to obtain further data on its safety profile. OBJECTIVE: The objective was to monitor adverse events (AEs) of dutasteride 0.5 mg in Korean AGA male patients in a clinical practice environment. METHODS: Open label, multi-center, non-interventional observational study was done from July 2009 to July 2013. AGA subjects (18~41 years of age) with no experience of dutasteride were enrolled. Dosage regimen was recommended according to the prescribing information. The incidences of any AEs, serious adverse events (SAEs), and adverse drug reactions (ADRs) were evaluated. Multiple logistic regression method was used to identify risk factors related to ADRs. Effectiveness was generally evaluated by physicians. RESULTS: During study period, 712 subjects were enrolled. The subjects of 29.3±6.0 years old exposed to dutasteride for 204.7±161.5 days. One hundred and ten (15.4%) of subjects reported 138 AEs. Four subjects (0.6%) reported 5 SAEs (right radius fracture, 2 events of chronic follicular tonsillitis, influenza infection, and acute appendicitis). Sixty-six subjects (9.3%) reported 80 ADRs. Most frequent ADRs were libido decreased (9 subjects, 1.3%), dyspepsia (8 subjects, 1.1%), impotence (7 subjects, 1.0%), and fatigue (5 subjects, 0.7%). Other interested ADRs were sexual function abnormality (4 subjects, 0.6%), gynecomastia (2 subjects, 0.3%), and ejaculation disorder (1 subject, 0.1%). Most subjects (78.6%) showed overall improvement after treatment of dutasteride in the effectiveness. CONCLUSION: Dutasteride 0.5 mg is to be well-tolerated in 18 to 41 years old AGA patients in a clinical practice environment.

Post-marketing Surveillance of the Safety of Dutasteride Prescribed to Korean Patients with Benign Prostate Hyperplasia

BACKGROUND: Dutasteride is an inhibitor of both types I and II 5 alpha-reductase and was approved in Korea in April 2004. This post-marketing surveillance was to assess the safety of dutasteride in Korean patients with benign prostate hyperplasia in real life and to elucidate the risk factors related adverse events. METHODS: From December 2004 to January 2010, 3,977 patients were enrolled by 184 urologists. According to post-marketing surveillance regulation, patients were enrolled consecutively. Patients administered dutasteride at least once were included in safety assessment. The incidences of any adverse events and serious adverse events were evaluated. Multiple logistic regression method was used to identify risk factors related to adverse events. RESULTS: The safety assessment included 3,870 patients with the mean age of 67.3 years. The incidence of adverse events was 3.8 %. The most frequent adverse event was impotence (75 cases, 1.9 %), libido decrease (49 cases, 1.3 %), ejaculation disorder (30 cases, 0.8 %), and gynecomastia (5 cases, 0.1 %). The incidence of unexpected adverse events was 0.5 % and cerebral infarction, lung cancer, pulmonary embolism, and diarrhea were reported as serious adverse events. CONCLUSION: In this survey, impotence was the most frequently reported adverse events. Dutasteride was well tolerated in Korean patients with benign prostate hyperplasia. These results updated the safety information and would provide important additional information for prescribers.

Reasons for Investigators to Participate Industry Sponsored Clinical Trials

BACKGROUND: It is getting more difficult to involve appropriate investigators in clinical trials. Knowing what investigators want from sponsor initiated clinical trials would help industry cooperate with investigators more efficiently. This study aims to describe the incentives for investigators choosing to participate or not and perform well in sponsored clinical trials. METHODS: Investigators who have participated in GSK sponsored clinical trials were interviewed face-to-face or through e-mail using the standardized questionnaire. Investigators were asked to choose five items and determine the ranking or those five items. RESULTS: Questionnaires answered by 122 investigators were collected. The top three incentives were "Academic merit" (108, 88.5 %), "Expectation of treatment potentially helpful to patient" (101, 82.8 %), and "Access to new treatments" (92, 75.4 %). The disincentives and the factors affecting an investigator's performance were analyzed separately because of the different questionnaire between investigators for medicine and vaccine. Investigators for medicine choose as disincentives "Insufficient time" (43, 61.4 %), "Difficult protocol" (41, 58.6 %), and "Adverse event concerns" (41, 58.6 %). Vaccine investigators pointed out "Limited support staff" (41, 78.8 %), "Insufficient time" (40, 76.9 %), and "Difficult blood sampling" (333, 63.5 %) as disincentives. Factors adversely affecting an investigator's performance showed similar results to those of disincentives. CONCLUSION: Investigators focused on academic curiosity and patients and insufficient time mostly inhibits them from participating and performing clinical trials. Our results would help industry cooperate with investigators more efficiently, finally making companies perform clinical trials more effectively.

Post-Marketing Surveillance for the Safety and Effectiveness of Adefovir in Patients with Chronic Hepatitis B

BACKGROUND: To investigate the safety and effectiveness of adefovir in Korean patients with chronic hepatitis B, an observational study was carried out. METHODS: A total of 4,393 patients with chronic hepatitis B were enrolled from February 2004 to February 2010. For the safety assessment, investigators recorded the occurrence of observed and patient-reported adverse events (AEs) throughout the course of treatment. Antiviral effectiveness was assessed by measuring the degree of symptom improvement and the reduction of HBV DNA after 12 weeks of treatment. RESULTS: Of the 4,393 patients, 4,158 patients were evaluated for safety and 3,867 patients for effectiveness assessment. A total of 118 AEs were reported in 4,158 patients (1.8 %). The most frequent AE was hepatic failure (0.2 %) followed by coughing (0.2 %), hepatic neoplasm (0.2 %), abdominal pain (0.1 %), dyspepsia (0.1 %), nausea (0.1 %), flatulence (0.1 %), hepatic cirrhosis (0.1 %), asthenia (0.1 %), increase in sputum production (0.1 %), and varicose vein (0.1 %). The incidence of unexpected AEs was 0.9 %. Forty-nine cases of serious AE were reported in 32 patients but all of those were thought to be unrelated to adefovir according to physician's evaluations. The rate of subjects with well effectiveness was 96.2 %. CONCLUSION: Adefovir was clinically well tolerated and effective in treatment of chronic hepatitis B patients.

Fatal Cases of 2009 Pandemic Influenza A (H1N1) in Korea

The aim of this study was to describe the features of deaths associated with the 2009 pandemic influenza A (H1N1) by 26 November 2009 in Korea. We collected standardized case reports on 115 confirmed deaths through a nationwide enhanced influenza surveillance system. The median age was 61 yr (interquartile range [IQR], 0.2-97 yr) and 58 (50.4%) were females. The case fatality rate was estimated as 16 per 100,000 cases. The age-related mortality rate had a J-shaped curve. Eighty-three patients (72.2%) had at least 1 underlying medical disease. Bacterial co-infections were detected in the blood or sputum specimens from 34 patients. Of the 63 patients who were hospitalized in the intensive care unit (ICU), the median time from symptom onset to hospital admission was 2 days (IQR, 0-22 days), and the median time from hospitalization to ICU admission was 1 day (IQR, 0-17 days). Neuraminidase inhibitors were administered to 100 patients (87.0%), 36% of whom began treatment within 2 days. In conclusion, fatal cases from the 2009 influenza A (H1N1) infection in Korea are mainly aged individuals with underlying disease, and associated with pneumonia, bacterial co-infections, and multi-organ failure.

Fatal Cases of 2009 Pandemic Influenza A (H1N1) in Korea

The aim of this study was to describe the features of deaths associated with the 2009 pandemic influenza A (H1N1) by 26 November 2009 in Korea. We collected standardized case reports on 115 confirmed deaths through a nationwide enhanced influenza surveillance system. The median age was 61 yr (interquartile range [IQR], 0.2-97 yr) and 58 (50.4%) were females. The case fatality rate was estimated as 16 per 100,000 cases. The age-related mortality rate had a J-shaped curve. Eighty-three patients (72.2%) had at least 1 underlying medical disease. Bacterial co-infections were detected in the blood or sputum specimens from 34 patients. Of the 63 patients who were hospitalized in the intensive care unit (ICU), the median time from symptom onset to hospital admission was 2 days (IQR, 0-22 days), and the median time from hospitalization to ICU admission was 1 day (IQR, 0-17 days). Neuraminidase inhibitors were administered to 100 patients (87.0%), 36% of whom began treatment within 2 days. In conclusion, fatal cases from the 2009 influenza A (H1N1) infection in Korea are mainly aged individuals with underlying disease, and associated with pneumonia, bacterial co-infections, and multi-organ failure.

In-Flight Transmission of Novel Influenza A (H1N1) / 한국역학회지

The Korea Centers for Disease Control and Prevention confirmed two patients, who had taken the same plane from Los Angeles to Seoul, with novel influenza A (H1N1). Through contact tracing, we concluded that the second patient was infected during the flight.

An Outbreak of Novel Influenza A (H1N1) in the English Language Institute / 예방의학회지

OBJECTIVES: This report describes the results of an investigation on an outbreak of novel influenza A (H1N1) in an English language Institute in Seoul, Korea in May 2009. METHODS: In this outbreak, novel influenza A (H1N1) was confirmed in 22 of 91 trainees, trainers and staff members. The trainees and 2 staff members were isolated in an assigned facility and the rest were isolated in their homes after we discovered the first patient with novel influenza A (H1N1). After the isolation, the people in the assigned facility were educated to use N95 respirators and they received oseltamivir for prophylaxis. RESULTS: The initial findings in this study suggest that the symptoms were mild and similar to those of seasonal influenza. The classmates and roommates of the infected patients were more likely to get infected with novel influenza A (H1N1) than the trainees who were not classmates or roommates of the patients (OR: 3.19, 95% CI=0.91 - 11.11 for classmates and OR: 40.0, 95% CI=7.4-215.7 for roommates). CONCLUSIONS: The public health response seems successful in terms of preventing the spread of this virus into the local community.

The Spread of Pandemic H1N1 2009 by Age and Region and the Comparison among Monitoring Tools

This report describes the pattern of the spread of the pandemic H1N1 2009 and compares 3 monitoring tools until the 57th week or January 31, 2010. The 1st week was from December 28th, 2008 to January 3rd, 2009. A total of 740,835 patients were reported to be infected with pandemic H1N1 2009 and 225 patients were reported to have died of pandemic H1N1 2009. The number of patients aged from 7 to 12 was the largest (183,363 patients in total) but the virus spread and then was suppressed most quickly among the children between 13 and 18. The region-determinant incidence of patients showed diverse patterns according to regions. The peak of the ILI per thousand was at the 45th week, the number of antiviral prescriptions reached its peak at the 44th week, and the peak based on reported patients was the 46th week. As of February 3 2010, the outbreak passed through the peak and has gradually subsided. Now it is time for the government and the academic world to review this outbreak, efficacy of vaccination, and further preparation and response for the next pandemic.

Umbilical Artery Doppler Study as a Predictive Marker of Perinatal Outcome in Preterm Small for Gestational Age Infants

PURPOSE: To evaluate the merit of umbilical artery Doppler study as a predictive marker of perinatal outcome in preterm small for gestational age (SGA) infants. MATERIALS AND METHODS: A total of 218 patients at 27 - 36 weeks of gestational age (GA) who received antenatal umbilical artery Doppler velocimetry and delivered singleton infants with SGA. The ratio of peak-systolic to end-diastolic blood flow velocities (S/D) in the umbilical artery was measured in each patient. The patients were divided into 3 groups: the normal group with S/D ratios of less than 95th percentile (n = 134), elevated S/D ratio group of 95th or more percentile (n = 41), and those with absent/reversed end diastolic flow (n = 43). Maternal characteristics and neonatal outcomes of these groups were comparatively analyzed. RESULTS: The gestational age (GA) at the time of diagnosis of SGA, the mean GA at delivery, and the mean birth weight showed statistically significant difference among three groups (p < 0.001). Also, poor perinatal outcome was significantly increased in infants with abnormal S/D ratio (13.4% vs. 31.7% vs. 67.4%, p < 0.001). Multivariate logistic regression analysis revealed umbilical artery Doppler study as a significant independent factor for prediction of poor perinatal outcome (odds ratio: 3.7, 95% confidence interval 1.4 - 9.5, p = 0.007). CONCLUSION: Antenatal umbilical artery Doppler velocimetry is shown as a significantly efficient marker in predicting perinatal outcome in preterm SGA infants.

Prognosis Factors of Clostridium difficile Associated Diarrhea

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. MATERIALS AND METHODS: A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. RESULTS: Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P< 0.001) as the independent poor prognostic factors. CONCLUSION: Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

Therapeutic Response of HAART and Analysis of Related Factors in Korean HIV-infected Persons

BACKGROUND: Recently, 2.1 persons per day are reported to be HIV infected and totally more than 4,500 HIV infected persons have been officially reported until 2006 in Korea. We started highly active antiretroviral therapy (HAART) for HIV patients from 1997. Data on the efficacy of antiretroviral therapy are limited in Korea. MATERIALS AND METHODS: HIV infected patients treated with HAART for more than 1 year were included. We studied the therapeutic response of antiretroviral therapy in patients with AIDS and without previous antiretroviral therapy who were treated until Dec 2005 in Severance hospital. RESULTS: More than 450 were diagnosed as HIV infected in Severance hospital. Among these HIV infected patients, 141 patients including 14 females were included. 121 of the 141 patients (85.8%) were treated with PI based regimen, and 20(14.2%) were treated with NNRTI based regimen. The initial mean CD4 T cell count was 207/mm3 (IQR 73-299) and the mean HIV RNA level was 70,800 copies/mL. After 6 months of HAART, 103 patients (73%) had fewer than 400 copies of HIV RNA copies/mL. After 12 months of HAART, 90 patients (63.8%) had fewer than 50 copies of HIV RNA copies/mL. The mean increase in the CD4 T cell count from baseline to 12 months was 143 cells/mm3. After 12 months, 96 patients (68.1%) had increased more than 100 cells/mm3. CONCLUSION: This report the therapeutic response of HAART in Korea which the prevalence of HIV infection is now increasing. Overall, the outcomes are similar to those in other developed countries. Further large scale prospective cohort study is needed.

Prognosis Factors of Clostridium difficile Associated Diarrhea

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. MATERIALS AND METHODS: A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. RESULTS: Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P< 0.001) as the independent poor prognostic factors. CONCLUSION: Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.