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1.
Article in English | WPRIM | ID: wpr-919197

ABSTRACT

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.

2.
Article in English | WPRIM | ID: wpr-913530

ABSTRACT

Purpose@#Various hemostatic agents have been introduced in therapy as postoperative bleeding is a poor prognostic factor for postoperative outcomes. These products can be divided into those that directly promote the hemostatic cascade and those that physically form a barrier by absorbing blood. The latter, powder-type hemostatic agents have the advantages of being inexpensive and more absorbable with less foreign body reactions (FBRs) and are applicable to a relatively wide area. This study was conducted to verify the safety and efficacy of a newly invented polysaccharide product (OOZFIX, Theracion Biomedical), which improves blood absorption and hemostatic effects. @*Methods@#Two separate animal experiments were performed. The first evaluated FBRs histologically at 3 days, 2 weeks, and 4 weeks, after implantation of OOZFIX in rats, and the second compared hemostatic performance of OOZFIX and Arista AH (Bard) in the porcine liver punch biopsy model. @*Results@#We found minimal FBRs in the 3-day group and no reactions in both the 2-week and 4-week groups after implantation of hemostatic agents. The time to hemostasis of OOZFIX was not significantly different from that of Arista AH (median [interquartile range]: 9 [6–10] minutes vs. 8 [6–10] minutes, respectively; P = 0.522). When comparing the serial bleeding grade tendency, there was no statistical difference between OOZFIX and Arista AH (P = 0.656). @*Conclusion@#OOZFIX caused a minimal FBR that disappeared within 2 weeks in vivo, and its hemostatic performance was comparable with that of an existing agent, Arista AH. Further clinical studies are required in the future.

3.
Article in English | WPRIM | ID: wpr-875352

ABSTRACT

Since a novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in December 2019, there has been a rapid global spread of the virus. Genomic surveillance was conducted on samples isolated from infected individuals to monitor the spread of genetic variants of SARS-CoV-2 in Korea. The Korea Disease Control and Prevention Agency performed whole genome sequencing of SARS-CoV-2 in Korea for 1 year (January 2020 to January 2021). A total of 2,488 SARSCoV-2 cases were sequenced (including 648 cases from abroad). Initially, the prevalent clades of SARSCoV-2 were the S and V clades, however, by March 2020, GH clade was the most dominant. Only international travelers were identified as having G or GR clades, and since the first variant 501Y.V1 was identified (from a traveler from the United Kingdom on December 22 nd , 2020), a total of 27 variants of 501Y.V1, 501Y.V2, and 484K.V2 have been classified (as of January 25 th , 2021). The results in this study indicated that quarantining of travelers entering Korea successfully prevented dissemination of the SARS-CoV-2 variants in Korea.

4.
Article in English | WPRIM | ID: wpr-903007

ABSTRACT

The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.

5.
Korean Journal of Medicine ; : 101-109, 2021.
Article in English | WPRIM | ID: wpr-902241

ABSTRACT

Although fever of unknown origin (FUO) was first defined in 1961, it remains a diagnostic challenge. The revised 1991 definition categorized FUO into classic FUO, nosocomial FUO, neutropenic FUO, and human immunodeficiency virus-related FUO, each requiring at least three outpatient visits or 3 days of in-hospital stay. The causes of classic FUO differ greatly geographically and temporally, and are divided into infections, noninfectious inflammatory diseases, neoplasms, and miscellaneous diseases. A systematic, comprehensive and rational approach is required for appropriate diagnosis. A medical history and physical examination are very important; they may reveal diagnostic clues. Here, we review the literature on the causes and diagnostic approaches of classical FUO.

6.
Article in English | WPRIM | ID: wpr-895303

ABSTRACT

The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.

7.
Korean Journal of Medicine ; : 101-109, 2021.
Article in English | WPRIM | ID: wpr-894537

ABSTRACT

Although fever of unknown origin (FUO) was first defined in 1961, it remains a diagnostic challenge. The revised 1991 definition categorized FUO into classic FUO, nosocomial FUO, neutropenic FUO, and human immunodeficiency virus-related FUO, each requiring at least three outpatient visits or 3 days of in-hospital stay. The causes of classic FUO differ greatly geographically and temporally, and are divided into infections, noninfectious inflammatory diseases, neoplasms, and miscellaneous diseases. A systematic, comprehensive and rational approach is required for appropriate diagnosis. A medical history and physical examination are very important; they may reveal diagnostic clues. Here, we review the literature on the causes and diagnostic approaches of classical FUO.

8.
Article in Korean | WPRIM | ID: wpr-919774

ABSTRACT

Purpose@#The purpose of this study was to test a hypothetical model about health literacy and cancer preventive behaviors among medically-underserved, low-income populations. @*Methods@#Data were collected by questionnaire survey from 284 medical aid beneficiaries in three metropolitan cities from August to September 2018. Based on Von Wagner’s health literacy and health outcome framework, the hypothetical model was developed which designates health literacy as the exogenous variable, cancer preventive behaviors as the endogenous variables, and knowledge, beliefs and attitudes about cancer prevention, and self-efficacy for mediating variables. Structural modeling analysis was conducted using SPSS/WIN 21.0 and AMOS 25.0 program. @*Results@#Health literacy had a significant direct effect on knowledge, beliefs and attitude about cancer prevention, and self-efficacy but not on cancer preventive behaviors. Knowledge, beliefs and attitudes about cancer prevention, and self-efficacy, fully mediated in the relationship between health literacy and cancer preventive behaviors. Model fit indices for the hypothetical model showed good agreement. @*Conclusion@#Health literacy among the medically-underserved, low-income populations influences cancer preventive behaviors through the full mediation of knowledge, beliefs and attitude, and self-efficacy. Therefore, to promote cancer preventive behaviors among medically-underserved, low-income populations, consideration should be given to health literacy level and development of strategies to enhance knowledge, beliefs and attitudes, and self-efficacy.

9.
Article in English | WPRIM | ID: wpr-915439

ABSTRACT

In November 2021, 14 international travel-related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (omicron) variant of concern (VOC) patients were detected in South Korea. Epidemiologic investigation revealed community transmission of the omicron VOC. A total of 80 SARS-CoV-2 omicron VOC-positive patients were identified until December 10, 2021 and 66 of them reported no relation to the international travel.There may be more transmissions with this VOC in Korea than reported.

10.
Infection and Chemotherapy ; : 786-791, 2021.
Article in English | WPRIM | ID: wpr-914618

ABSTRACT

In preparation for the surge of coronavirus disease 2019 (COVID-19), it is crucial to allocate medical resources efficiently for distinguishing people who remain asymptomatic until the end of the disease. Between January 27, 2020, and April 21, 2020, 517 COVID-19 cases from 13 healthcare facilities in Gyeonggi province, Korea, were identified out of which the epidemiologic and clinical information of 66 asymptomatic patients at the time of diagnosis were analyzed retrospectively. An exposure-diagnosis interval within 7 days and abnormal aspartate aminotransferase levels were identified as characteristic symptom development in asymptomatic COVID-19 patients. If asymptomatic patients without these characteristics at the time of diagnosis could be differentiated early, more medical resources could be secured for mild or moderate cases in this COVID-19 surge.

11.
Article in English | WPRIM | ID: wpr-875544

ABSTRACT

Background@#The coronavirus disease (COVID-19) can manifest in a range of symptoms, including both asymptomatic systems which appear nearly non-existent to the patient, all the way to the development of acute respiratory distress syndrome (ARDS). Specifically, COVID-19–associated pneumonia develops into ARDS due to the rapid progression of hypoxia, and although arterial blood gas analysis can assist in halting this deterioration, the current environment provided by the COVID-19 pandemic, which has led to an overall lack of medical resources or equipment, has made it difficult to administer such tests in a widespread manner. As a result, this study was conducted in order to determine whether the levels of oxygen saturation (SpO2) and the fraction of inhaled oxygen (FiO2) (SF ratio) can also serve as predictors of ARDS and the patient’s risk of mortality. @*Methods@#This was a retrospective cohort study conducted from February 2020 to Mary 2020, with the study’s subjects consisting of COVID-19 pneumonia patients who had reached a state of deterioration that required the use of oxygen therapy. Of the 100 COVID-19 pneumonia cases, we compared 59 pneumonia patients who required oxygen therapy, divided into ARDS and non-ARDS pneumonia patients who required oxygen, and then investigated the different factors which affected their mortality. @*Results@#At the time of admission, the ratios of SpO2, FiO2, and SF for the ARDS group differed significantly from those of the non-ARDS pneumonia support group who required oxygen (p<0.001). With respect to the predicting of the occurrence of ARDS, the SF ratio on admission and the SF ratio at exacerbation had an area under the curve which measured to be around 85.7% and 88.8% (p<0.001). Multivariate Cox regression analysis identified that the SF ratio at exacerbation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.846–0.991; p=0.029) and National Early Warning Score (NEWS) (HR, 1.277; 95% CI, 1.010–1.615; p=0.041) were significant predictors of mortality. @*Conclusion@#The SF ratio on admission and the SF ratio at exacerbation were strong predictors of the occurrence of ARDS, and the SF ratio at exacerbation and NEWS held a significant effect on mortality.

12.
Article in English | WPRIM | ID: wpr-875507

ABSTRACT

Background/Aims@#The efficacies of lopinavir-ritonavir or hydroxychloroquine remain to be determined in patients with coronavirus disease 2019 (COVID-19). To compare the virological and clinical responses to lopinavir-ritonavir and hydroxychloroquine treatment in COVID-19 patients. @*Methods@#This retrospective cohort study included patients with COVID-19 treated with lopinavir-ritonavir or hydroxychloroquine at a single center in Korea from February 17 to March 31, 2020. Patients treated with lopinavir-ritonavir and hydroxychloroquine concurrently and those treated with lopinavir-ritonavir or hydroxychloroquine for less than 7 days were excluded. Time to negative conversion of viral RNA, time to clinical improvement, and safety outcomes were assessed after 6 weeks of follow-up. @*Results@#Of 65 patients (mean age, 64.3 years; 25 men [38.5%]), 31 were treated with lopinavir-ritonavir and 34 were treated with hydroxychloroquine. The median duration of symptoms before treatment was 7 days and 26 patients (40%) required oxygen support at baseline. Patients treated with lopinavir-ritonavir had a significantly shorter time to negative conversion of viral RNA than those treated with hydroxychloroquine (median, 21 days vs. 28 days). Treatment with lopinavir-ritonavir (adjusted hazard ratio [aHR], 2.28; 95% confidence interval [CI], 1.24 to 4.21) and younger age (aHR, 2.64; 95% CI 1.43 to 4.87) was associated with negative conversion of viral RNA. There was no significant difference in time to clinical improvement between lopinavir-ritonavir- and hydroxychloroquine-treated patients (median, 18 days vs. 21 days). Lymphopenia and hyperbilirubinemia were more frequent in lopinavir-ritonavir-treated patients compared with hydroxychloroquine-treated patients. @*Conclusions@#Lopinavir-ritonavir was associated with more rapid viral clearance than hydroxychloroquine in mild to moderate COVID-19, despite comparable clinical responses. These findings should be confirmed in randomized, controlled trials.

13.
Article | WPRIM | ID: wpr-836811

ABSTRACT

Abstract: This study aimed to evaluate the effects of a bioabsorbable bone hemostatic agent comprising poly (ethylene glycolpropylene glycol) copolymers (PEG-PPG) on hemostasis and osteogenesis. Bilateral 3 mm diameter calvarial defects were created in 99 male Sprague-Dawley rats. The defects were filled with PEG-PPG or bone wax. The defects of control group were left unfilled.Virtual autopsy was performed to evaluate bioabsorption. The calvaria were subjected to x-ray microtomography (microCT) and histological examination. Bone volume fraction (BV/TV) and bone mineral density (BMD) were measured using microCT;furthermore, white blood cell count and histological examination were performed. After application of PEG-PPG and bone wax, immediate hemostasis was achieved. Autopsy revealed that PEG-PPG disappeared within 48 h at the application site; in contrast, bone wax remained until 12 weeks. The PEG-PPG and control groups showed significantly more osteogenesis than the bone wax group with respect to BV/TV and BMD at 3, 6, and 12 weeks (p < 0.05). Histology revealed that the bone wax group exhibited little bone formation with inflammation. In contrast, PEG-PPG and control groups showed significantly more qualitative osteogenesis than the bone wax group (p < 0.01). In conclusion, PEG-PPG showed immediate hemostasis and was absorbed to allow progressive osteogenesis.

14.
Article | WPRIM | ID: wpr-836315

ABSTRACT

Objectives@#We investigated the differences in cognitive and emotional empathic ability between adolescents and adults, and the differences of the brain activation during cognitive and emotional empathy tasks. @*Methods@#Adolescents (aged 13–15 years, n=14) and adults (aged 19–29 years, n=17) completed a range of empathic ability questionnaires and were scanned functional magnetic resonance imaging (fMRI) during both cognitive and emotional empathy task. Differences in empathic ability and brain activation between the groups were analyzed. @*Results@#Both cognitive and emotional empathic ability were significantly lower in the adolescent compared to the adult group. Comparing the adolescent to the adult group showed that brain activation was significantly greater in the right transverse temporal gyrus (BA 41), right insula (BA 13), right superior parietal lobule (BA 7), right precentral gyrus (BA 4), and right thalamus whilst performing emotional empathy tasks. No brain regions showed significantly greater activation in the adolescent compared to the adult group while performing cognitive empathy task. In the adolescent group, scores of the Fantasy Subscale in the Interpersonal Reactivity Index, which reflects cognitive empathic ability, negatively correlated with activity of right superior parietal lobule during emotional empathic situations (r=-0.739, p=0.006). @*Conclusion@#These results strongly suggest that adolescents possess lower cognitive and emotional empathic abilities than adults do and require compensatory hyperactivation of the brain regions associated with emotional empathy or embodiment in emotional empathic situation. Compensatory hyperactivation in the emotional empathy-related brain areas among adolescents are likely associated with their lower cognitive empathic ability.

15.
Article | WPRIM | ID: wpr-835142

ABSTRACT

Objectives@#The Korea Centers for Disease Control and Prevention has published “A Guideline for Unknown Disease Outbreaks (UDO).” The aim of this report was to introduce tabletop exercises (TTX) to prepare for UDO in the future. @*Methods@#The UDO Laboratory Analyses Task Force in Korea Centers for Disease Control and Prevention in April 2018, assigned unknown diseases into 5 syndromes, designed an algorithm for diagnosis, and made a panel list for diagnosis by exclusion. Using the guidelines and laboratory analyses for UDO, TTX were introduced. @*Results@#Since September 9th , 2018, the UDO Laboratory Analyses Task Force has been preparing TTX based on a scenario of an outbreak caused by a novel coronavirus. In December 2019, through TTX, individual missions, epidemiological investigations, sample treatments, diagnosis by exclusions, and next generation sequencing analysis were discussed, and a novel coronavirus was identified as the causal pathogen. @*Conclusion@#Guideline and laboratory analyses for UDO successfully applied in TTX. Conclusions drawn from TTX could be applied effectively in the analyses for the initial response to COVID-19, an ongoing epidemic of 2019 - 2020. Therefore, TTX should continuously be conducted for the response and preparation against UDO.

16.
Infection and Chemotherapy ; : 352-359, 2020.
Article | WPRIM | ID: wpr-834276

ABSTRACT

Background@#Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is not differentiated clinically from other respiratory infections, and intensive care units (ICUs) are vulnerable to in-hospital transmission due to interventions inducing respiratory aerosols.This study evaluated the effectiveness of universal SARS-CoV-2 screening in ICUs in terms of screened-out cases and reduction in anxiety of healthcare personnel (HCP).Materials and @*Methods@#This prospective single-armed observational study was conducted in 2 ICUs of a single hospital. The number of patients diagnosed with SARS-CoV-2 infection by the screening program and healthcare workers in ICUs that visited the SARS-CoV-2 screening clinic or infection clinic were investigated. @*Results@#During the 7-week study period, no positive screening case was reported among a total of 142 patients. Among 86 HCP in the ICUs, only 2 HCP sought medical consultation for SARS-CoV-2 infection during the initial 2 weeks. @*Conclusion@#A universal screening program for SARS-CoV-2 infection in ICUs with the coordination of other countermeasures in the hospital was reasonably effective in preventing in-hospital transmission in a pandemic situation and making clinical practices and HCP stable.

17.
Yonsei Medical Journal ; : 826-830, 2020.
Article | WPRIM | ID: wpr-833402

ABSTRACT

We retrospectively reviewed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who wereadmitted to an intensive care unit in Daegu, South Korea. The outcomes of patients who did (cases) or did not (controls) receivedarunavir-cobicistat (800–150 mg) therapy were compared. Fourteen patients received darunavir-cobicistat treatment, and 96 receivedother antiviral therapy (controls). Overall, the darunavir-cobicistat group comprised patients with milder illness, and thecrude mortality rate of all patients in the darunavir-cobicistat group was lower than that in the controls [odds ratio (OR) 0.20, 95%confidence interval (CI) 0.04–0.89, p=0.035]. After 1:2 propensity-score matching, there were 14 patients in the darunavir-cobicistatgroup, and 28 patients in the controls. In propensity score-matched analysis, the darunavir-cobicistat group had lower mortalitythan the controls (OR 0.07, 95% CI 0.01–0.52, p=0.009). In conclusion, darunavir-cobicistat therapy was found to be associatedwith a significant survival benefit in critically ill patients with SARS-CoV-2 infection.

18.
Psychiatry Investigation ; : 147-156, 2020.
Article | WPRIM | ID: wpr-832505

ABSTRACT

Objective@#This study aimed to investigate resilience as a protective factor for suicidality among Korean workers. @*Methods@#Participants were workers from 26 organizations in Korea, aged 18 to 63 years, who completed a self-reported questionnaire comprising items on sociodemographic factors, job stress, resilience, and suicidality. Completed questionnaires were collected from 4,405 persons, with 4,389 valid responses. Hierarchical logistic regression analyses were performed using suicidality as the dependent variable. @*Results@#Results of the logistic regression analyses indicated that among the sociodemographic factors, older age, being female, and being single were statistically significantly associated with suicidal ideation. A high level of job stress, depressive mood, and anxiety, in addition to a short job duration, were also associated with suicidal ideation. Resilience was a significant protective factor for suicidal ideation after adjusting for all other variables. Older age and high anxiety levels were associated with having a suicide plan among participants with suicidal ideation. The association of resilience with suicide plans and suicide attempts was non-significant. @*Conclusion@#In this study, we found that a high level of resilience was associated with a low incidence of suicidal ideation in Korean workers. Based on these results, we suggest the need to develop and implement interventions to improve resilience in the workplace, thereby protecting workers, especially those with a high level of work stress, from suicidal ideation.

19.
Article in English | WPRIM | ID: wpr-811196

ABSTRACT

PURPOSE: The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual introduced a new prognostic staging system for breast cancer. This study aimed to evaluate the changes in staging distribution and predictive power of the new staging system.METHODS: Of the 12,275 patients with breast cancer identified from the Severance Breast Cancer Registry who underwent surgery between 1978 and 2016, 12,125 patients met the inclusion criteria.RESULTS: In both the 7th and 8th staging systems, stage I patients constituted the largest proportion (38.2% and 48.4%). Migration from the 7th to 8th edition of the AJCC manual resulted in a decrease in stage II population and an increase in stage I and III populations. A total of 1,293 (15.4%) patients were upstaged, and 1,201 (14.3%) were downstaged. Downstaged patients had better recurrence-free and overall survival (p < 0.001). Pathologic complete response after neoadjuvant therapy showed good prognosis as p stage 0, and yp stages I and III showed poorer outcomes than the same p stage (p < 0.001).CONCLUSIONS: Staging migrations are common in early breast cancer under the prognostic staging system. The prognostic staging system of the 8th edition of the AJCC manual discriminates survival outcomes better than the anatomical staging system of the 7th edition of the AJCC manual.


Subject(s)
Breast Neoplasms , Breast , Humans , Joints , Neoadjuvant Therapy , Prognosis
20.
Article in Korean | WPRIM | ID: wpr-719523

ABSTRACT

PURPOSE: Croup is a common respiratory disease in children. The aim of this study was to analyze the epidemiology, etiology, and seasonal variations of respiratory virus infections in children with croup. METHODS: From October 2009 to September 2017, children admitted with croup to Gachon University Gil Medical Center under the age of 18 years were enrolled in this study. We retrospectively reviewed patients' medical records. RESULTS: A total of 1,053 of 27,330 patients (3.9%) infected with lower respiratory infections were diagnosed as having croup. In the age distribution, croup was most common (50.0%) in children aged 1 to <2 years. There were 2 peaks, the major in summer (July to August) and the minor in spring (March to May). Parainfluenza virus type 1 (15.8%) was most prevalent and coincided with the summer peaks of croup. Influenza virus type B and parainfluenza virus type 3 were the most frequent etiologic agents in a spring peak of croup. Although parainfluenza virus type 1 was predominant of all ages, human coronavirus was a significant cause of croup in children younger than 1 year, whereas influenza virus played an important role in children above the age of 3 years. CONCLUSION: Seasonality and epidemiology of croup varied with age and regions. Two peaks of seasonal fluctuation were in summer and spring, which were related to the seasonality of respiratory viruses in croup. These results may be helpful in planning clinical and research needs.


Subject(s)
Age Distribution , Child , Coronavirus , Croup , Epidemiology , Humans , Medical Records , Orthomyxoviridae , Parainfluenza Virus 1, Human , Parainfluenza Virus 3, Human , Respiratory System , Respiratory Tract Infections , Retrospective Studies , Seasons
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