Aerosolized antibiotics in the treatment of hospital-acquired pneumonia/ventilator-associated pneumonia

Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in critically ill patients is especially significant. They are also used as an efficient alternative to overcome the issues caused by systemic administration of antibiotics, including the occurrence of drug-resistant strains, drug toxicity, and insufficient drug concentration at the target site. However, the rationale for the use of aerosolized antibiotics is limited owing to their insufficient efficacy and the potential for underestimated risks of developing side effects. Despite the lack of availability of high-quality evidence, the use of aerosolized antibiotics is considered as an attractive alternative treatment approach, especially in patients with multidrug-resistant pathogens. In this review, we have discussed the effectiveness and side effects of aerosolized antibiotics as well as the latest advancements in this field and usage in the Republic of Korea.

Infectivity of Coronavirus Disease 2019: A Prospective Cohort Study in the Korean Metropolitan Area

Background@#Although several characteristics of coronavirus disease 2019 (COVID-19), an ongoing pandemic disease, have been identified, data on the infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are limited. @*Methods@#This prospective cohort study was conducted to analyze the infectivity of SARSCoV-2 based on data of all patients diagnosed with COVID-19 confirmed using real-time polymerase chain reaction test from January to April 2020 in Gyeonggi-do, the largest province in Korea. @*Results@#Of the 502 patients, 298 consisting of 106 clusters with 5,909 contacts were included. Of these, 277 (93.0%) were symptomatic, and the most common symptoms were cough, fever, sputum, sore throat, and headache. A total of 94 patients (31.5%) had pneumonia, while 8 (2.7%) died during the follow-up period. The secondary attack rate (SAR) in the study population was 3.5% (204/5,909). In exposure settings, the SAR was higher in religious gathering (13.5% [95% confidence interval, 10.7–16.8%]), workplaces (8.49% [95% CI, 6.08–11.74%]), and schools (6.38% [95% CI, 3.39–11.69%]) than in health care facilities (1.92% [95% CI, 1.45–2.55%]). Sore throat at any period, dyspnea at diagnosis or any period, lower cycle threshold value in the lower respiratory tract samples, leukocytosis, and higher bilirubin levels were associated with higher infectivity of COVID-19. The presence of symptoms was not related to the infectivity. @*Conclusion@#In establishing the infection control strategies for COVID-19, the variables associated with high infectivity may be considered.

Effects of coffee powder supplementation on the blood glucose and antioxidative enzyme activity of liver tissue in STZ-induced diabetic rats / 한국영양학회지

PURPOSE: The purpose of this study was to evaluate the role of coffee in diabetic rats in order to prevent hyperglycemia and hyperlipidemia, and to improve antioxidant enzyme activity in streptozotocin induced diabetic rats. METHODS: Thirty two male Sprague-Dawley rats (body weight 200 +/- 5 g) were divided into two groups; diabetic and nondiabetic groups. The groups were each randomly divided into two subgroups; fed control and coffee (5 g coffee powder/kg diet) diets. Diabetes was induced by intramuscular injection of 50 mg streptozotocin/kg body weight. Rats with blood glucose concentrations > or = 300 mg/dL were considered diabetic for these experiments. All rats were fed an experimental diet and deionized water ad libitum for 4 weeks. RESULTS: The results of this study indicate that body weight gain was significantly lower in diabetic groups than in nondiabetic groups regardless of diet. Mean food intake was significantly higher in diabetic groups than in nondiabetic groups, and significantly higher in the coffee group than in the control group in diabetic rats. Food efficiency ratio (FER) was significantly lower in diabetic groups than in nondiabetic groups regardless of diet. The fasting blood glucose of coffee supplemented groups was significantly lower compared with the control group in diabetic and nondiabetic rats. The levels of serum LDL-cholesterol and atherogenic index were significantly lower in the coffee group than in the control group in diabetic and nondiabetic rats, and serum HDL-cholesterol was significantly higher in the coffee group than in control groups. The contents of hepatic triglyceride were significantly lower in the coffee group than in the control group in diabetic and nondiabetic rats. The lipid peroxidation of malondialdehyde (MDA) contents was significantly lower in the coffee group than in the control group in diabetic and nondiabetic rats. Activity of superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase in liver was not significantly different by experimental diets among all groups. CONCLUSION: In conclusion, effects of 0.5% coffee powder supplemented diet were beneficial on blood glucose and lipids in diabetic rats.

Effects of combined intervention of isoflavone supplementation and exercise on bone metabolism in growing rats / 한국영양학회지

PURPOSE: This study examined the effects of combined intervention of isoflavones and exercise on bone mineral density, bone mineral content, and biochemical bone markers. METHODS: Forty rats were divided into four groups; Control, Isoflavones (IF), Isoflavones + Running (IFR), and Isoflavones + Swimming (IFS). All of the rats in this study were fed an experimental diet and deionized water ad libitum for nine weeks. Bone mineral density (BMD) and bone mineral content (BMC) were estimated using PIXImus (GE Lunar Co, Wisconsin.) in spine and femur nine weeks after feeding or training. RESULTS: The combined intervention did not affect weight gain, mean food intake, or food efficiency ratio. The serum concentrations of ALP and osteocalcin were not significantly different by combined intervention. The urinary DPD crosslinks values were not significantly different by combined intervention. There were no significant differences in serum PTH, calcitonin, and estradiol among all groups. Spine BMD, spine BMC and femur BMC were not significantly different by combined intervention. However, femur BMD was significantly higher in the IFR group than in the control group. Compared with the control group, spine BMD, spine BMC, and femur BMD per weight were markedly increased in the isoflavones supplementation and combined intervention group. In addition, femur BMC per weight was significantly higher in the IFS group than in the control group. Compared with the isoflavones supplemented group, BMD and BMC were not significantly different by combined intervention. CONCLUSION: It can be concluded that isoflavones supplementation or combined intervention of isoflavone and exercise had a beneficial effect on spine and femur peak bone mass in growing female rats.

The Significance of Caspase-Cleaved Cytokeratin 18 in Pleural Effusion / 결핵및호흡기질환

BACKGROUND: Apoptosis plays a role in the development of pleural effusion. Caspase-cleaved cytokeratin 18, a marker for epithelial cell apoptosis, was evaluated in pleural effusion. METHODS: A total of 79 patients with pleural effusion were enrolled. The underlying causes were lung cancer (n=24), parapneumonic effusion (n=15), tuberculous effusion (n=28), and transudates (n=12). The levels of M30, an epitope of caspase-cleaved cytokeratin 18, were measured in blood and pleural fluids using enzyme-linked immunosorbent assay along with routine cellular and biochemical parameters. The expression of M30 was evaluated in the pleural tissues using immunohistochemistry for M30. RESULTS: The M30 levels in pleural fluid were significantly higher in patients with tuberculosis (2,632.1+/-1,467.3 U/mL) than in patients with lung cancer (956.5+/-618.5 U/mL), parapneumonic effusion (689.9+/-413.6 U/mL), and transudates (273.6+/-144.5 U/mL; all p<0.01). The serum levels were not significantly different among the disease groups. Based on receiver operating characteristics analysis, the area under the curve of M30 for differentiating tuberculous pleural effusion from all other effusions was 0.93. In the immunohistochemical analysis of M30, all pathologic types of cancer cells showed moderate to high expression, and the epithelioid cells in granulomas showed high expression in tuberculous pleural tissues. CONCLUSION: Caspase-cleaved cytokeratin 18 was most prominently observed in tuberculous pleural effusion and showed utility as a clinical marker. The main source of M30 was found to be the epithelioid cells of granulomas in tuberculous pleural tissues.

The Significance of Sedation Control in Patients Receiving Mechanical Ventilation / 결핵및호흡기질환

BACKGROUND: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. METHODS: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. RESULTS: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, 1.3+/-0.5 microg/kg/min; day 2, 0.9+/-0.4 microg/kg/min; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; rs=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; rs=0.77), and RASS and BIS (rs=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. CONCLUSION: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.

Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation / 결핵및호흡기질환

BACKGROUND: Adaptive support ventilation (ASV), an automated closed-loop ventilation mode, adapts to the mechanical characteristics of the respiratory system by continuous measurement and adjustment of the respiratory parameters. The adequacy of ASV was evaluated in the patients with acute lung injury (ALI). METHODS: A total of 36 patients (19 normal lungs and 17 ALIs) were enrolled. The patients' breathing patterns and respiratory mechanics parameters were recorded under the passive ventilation using the ASV mode. RESULTS: The ALI patients showed lower tidal volumes and higher respiratory rates (RR) compared to patients with normal lungs (7.1+/-0.9 mL/kg vs. 8.6+/-1.3 mL/kg IBW; 19.7+/-4.8 b/min vs. 14.6+/-4.6 b/min; p<0.05, respectively). The expiratory time constant (RCe) was lower in ALI patients than in those with normal lungs, and the expiratory time/RCe was maintained above 3 in both groups. In all patients, RR was correlated with RCe and peak inspiratory flow (rs=-0.40; rs=0.43; p<0.05, respectively). In ALI patients, significant correlations were found between RR and RCe (rs=-0.76, p<0.01), peak inspiratory flow and RR (rs=-0.53, p<0.05), and RCe and peak inspiratory flow (rs=-0.53, p<0.05). CONCLUSION: ASV was found to operate adequately according to the respiratory mechanical characteristics in the ALI patients. Discrepancies with the ARDS Network recommendations, such as a somewhat higher tidal volume, have yet to be addressed in further studies.

Evaluation of Respiratory Parameters in Patients with Acute Lung Injury Receiving Adaptive Support Ventilation / 결핵및호흡기질환

BACKGROUND: Adaptive support ventilation (ASV), an automated closed-loop ventilation mode, adapts to the mechanical characteristics of the respiratory system by continuous measurement and adjustment of the respiratory parameters. The adequacy of ASV was evaluated in the patients with acute lung injury (ALI). METHODS: A total of 36 patients (19 normal lungs and 17 ALIs) were enrolled. The patients' breathing patterns and respiratory mechanics parameters were recorded under the passive ventilation using the ASV mode. RESULTS: The ALI patients showed lower tidal volumes and higher respiratory rates (RR) compared to patients with normal lungs (7.1+/-0.9 mL/kg vs. 8.6+/-1.3 mL/kg IBW; 19.7+/-4.8 b/min vs. 14.6+/-4.6 b/min; p<0.05, respectively). The expiratory time constant (RCe) was lower in ALI patients than in those with normal lungs, and the expiratory time/RCe was maintained above 3 in both groups. In all patients, RR was correlated with RCe and peak inspiratory flow (rs=-0.40; rs=0.43; p<0.05, respectively). In ALI patients, significant correlations were found between RR and RCe (rs=-0.76, p<0.01), peak inspiratory flow and RR (rs=-0.53, p<0.05), and RCe and peak inspiratory flow (rs=-0.53, p<0.05). CONCLUSION: ASV was found to operate adequately according to the respiratory mechanical characteristics in the ALI patients. Discrepancies with the ARDS Network recommendations, such as a somewhat higher tidal volume, have yet to be addressed in further studies.

Prediction of compensated liver cirrhosis by ultrasonography and routine blood tests in patients with chronic viral hepatitis / 대한간학회지

BACKGROUND/AIMS: Liver biopsy is a standard method for diagnosis of liver cirrhosis in patients with chronic hepatitis. Because liver biopsy is an invasive method, non-invasive methods have been used for diagnosis of compensated liver cirrhosis in patients with chronic hepatitis. The current study was designed to evaluate the usefulness of ultrasonography and routine blood tests for diagnosis of compensated liver cirrhosis in patients with chronic viral hepatitis. METHODS: Two hundred three patients with chronic viral hepatitis who underwent liver biopsy were included in this study and ultrasonography and routine blood tests were analyzed retrospectively. Ultrasonographic findings, including surface nodularity, parenchyma echogenecity, and spleen size, were evaluated. The diagnostic accuracy of ultrasonography and routine blood tests were examined. RESULTS: Discriminant analysis with forward stepwise selection of variables showed that liver surface nodularity, platelet count, and albumin level were independently associated with compensated liver cirrhosis (p95% specificity: platelet count 1.3; and surface nodularity. If at least one of the four variables exists in a patient with chronic viral hepatitis, we can predict liver cirrhosis with 90% specificity and 61% sensitivity. CONCLUSIONS: These results suggest that four variables (platelet count 1.3, and surface nodularity) can be used for identification of liver cirrhosis in patients with chronic viral hepatitis with high specificity.

Entecavir-induced Tubulointerstitial Nephritis / 대한신장학회지

Acute interstitial nephritis is an important cause of acute kidney injury and most often induced by drug therapy. Entecavir is a potent antiviral agent approved for chronic hepatitis B. The antiviral therapy in chronic hepatitis B management is important because it reduces viral replication and liver injury, prevents development of complications, such as liver cirrhosis and hepatocellular carcinoma, and thus improves patient's survival. The advantage of entecavir is its safety profile, particularly in patients with renal dysfunction. Although doses of entecavir are needed to be adjusted for patients with renal dysfunction, there has been no known renal toxicity of the drug itself. Here we report a patient with chronic hepatitis B and normal renal function who developed acute kidney injury due to tubulointerstitial nephritis after 10 months of entecavir therapy. Renal biopsy showed not only acute changes of interstitial nephritis such as marked cortical infiltration with lymphoplasma cells and neutrophils, mesangial matrix expansion, eosinophilic granular casts and degenerative epithelial cells within tubular lumen but also chronic changes, minimal tubular atrophy and interstitial fibrosis. After immunosuppressant therapy with steroids and mycofenolate mofetil, the patient's renal function improved.

A Case Report of Hajdu-Cheney Syndrome

Hajdu-Cheney syndrome (HCS) is a rare skeletal dysplasia that is characterized by acroosteolysis of the distal phalanges, distinctive craniofacial and skull changes, dental abnormalities and generalized osteoporosis. The clinical and radiologic characteristics are variable and these characteristics progress with age. This syndrome shows autosomal dominant inheritance with sporadic cases. The genetic defects or molecular pathogenesis of HCS are still unknown. We experienced a case of Hajdu-Cheney syndrome in a 20-year-old man who had generalized osteoporosis with multiple non-traumatic spine compression fractures. He had acroosteolysis of the hands and feet, wormian bones in the skull, facial dysmorphism (mid-facial flattening, micrognathia and bushy eyebrows), a high arched palate, malocclusion and short dental alveolar processes. HCS was diagnosed based on the clinical and radiologic evidence. For the differential diagnosis, we excluded the other possible causes of the acroosteolysis and wormian bones, including hyperparathyroidism, osteogenesis imperfecta, hypophosphatemia and mandibuloacral dysplasia. The specific treatment of HCS is unknown, but case reports with bisphosphonate treatment have been reported.

The Effects of Isoflavones Intake Level on Bone Markers and Bone Related Hormones in Growing Female Rats

The overall purpose of this study was to investigate the effects of level of isoflavones supplementation on bone metabolism in growing female rats. Forty-five rats divided into three groups; Control, 1/2IF, and 1IF. Serum osteocalcin and alkaline phosphatase (ALP) activity, urinary deoxypyridinoline (DPD) crosslinks value were measured to monitor bone formation and resorption at the ninth week after feeding. Hormones related to bone metabolism were determined, included parathyroid hormone (PTH), calcitonin, estradiol, growth hormone and insulin-like growth factor I (IGF-I). The results of this study were as follows: the isoflavones intake level did not affect weight gain, mean food intake and food efficiency ratio. The serum concentration of osteocalcin and the activity of ALP were not significantly different by different levels of isoflavones supplementation. The urinary DPD crosslinks value was not significantly different by different levels of isoflavones supplementation. There were no significant differences in serum PTH, estradiol and IGFI among all groups. However, calcitonin was shown significantly higher in the groups of 1IF and 1/2IF than control group. And growth hormone was shown significantly higher in the groups of 1IF than control group.

The Effects of Level of Isoflavones Supplementation on Bone Mineral Density in Growing Female Rats

The overall purpose of this study was to investigate the effects of level of isoflavones supplementation on bone metabolism in growing female rats. The effects of level of isoflavones supplementation on bone mineral density (BMD) and bone mineral content (BMC) were inspected in this study. Forty-five rats divided into three groups: Casein, 1/2IF, IF. The serum and urine concentrations of calcium and phosphorus were determined. BMD and BMC were estimated by using PIXImus (GE Lunar Co, Wisconsin.) in spine and femur on 3, 6, 9 weeks after feeding. This study of results were as follows: The isoflavones supplementation level did not affect weight gain, mean food intake and food efficiency ratio. The serum concentration of calcium, phosphorus were not significantly different by different level of isoflavones supplementation. The urinary calcium and phosphorus excretion were not significantly different, too. Spine and femur BMD, BMC were not significantly increased by different level of isoflavones supplementation on 3 and 6 weeks after feeding. Spine BMD and spine BMC per weight, femur BMC per weight were significantly increased in the groups 1/2IF and IF at the ninth week after feeding, but there was no significant difference by different level of isoflavones supplementation. Spine BMD per weight and femur BMD per weight were significantly higher in the group of IF than in the group of Casein and 1/2IF at the ninth week after feeding. These results suggest that the group of IF with rich isoflavones supplementation was effective to the increase of BMD spine and femur in growing female rats, respectively.

Complement-mediated tail degradation of Neodiplostomum seoulense cercariae

The furcocercus cercariae of Neodiplostomum seoulense (Digenea: Neodiplostomidae) penetrate the skins of tadpoles and shed their tails. The speculated mechanism of this tail loss was physical efforts required to produce a vigorous zigzag motion during skin penetration; no other mechanism has been proposed. We examined the relationship between the host serum and cercarial tail loss. Cercariae of N. seoulense were collected from experimentally infected Segmentina hemisphaerula, and lots of 300 cercariae were cultured in medium 199 contained several types of sera. Cercarial tail degradation was induced in all media, but all the cercariae cultured except those cultured in media containing fetal bovine serum (FBS) died within 48 hr. After 72 hr cultivation in media containing FBS, cercarial tail degradation was induced in 67.0%; in continuous cultivation 13.3% of larvae survived for 7 days. Tail degradation did not occur in the absence of serum and when serum was heat inactivated at 56 degrees C for 30 min. The addition of 20 mM ethylenediaminetetraacetic acid (EDTA) blocked cercarial tail degradation completely. Moreover, the addition of 20 mM MgCl2 restored tail degradation blocked by EDTA. These results suggest that the alternative complement pathway is related with the N. seoulense cercarial tail degradation induced by serum.