Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 76
Filter
1.
Article in English | WPRIM | ID: wpr-919478

ABSTRACT

Background@#Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. @*Methods@#A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma–COPD (ACO) and pure COPD was performed. @*Results@#We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). @*Conclusion@#Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

2.
Article in English | WPRIM | ID: wpr-904135

ABSTRACT

Background@#Asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) is a condition characterized by the overlapping clinical features of asthma and COPD. To evaluate the appropriateness of different sets of ACO definition, we compared the clinical characteristics of the previously defined diagnostic criteria and the specialist opinion in this study. @*Methods@#Patients enrolled in the KOrea COpd Subgroup Study (KOCOSS) were evaluated. Based on the questionnaire data, the patients were categorized into the ACO and non-ACO COPD groups according to the four sets of the diagnostic criteria. @*Results@#In total 1,475 patients evaluated: 202 of 1,475 (13.6%), 32 of 1,475 (2.2%), 178 of 1,113 (16.0%), and 305 of 1,250 (24.4%) were categorized as ACO according to the modified Spanish Society of Pneumonology and Thoracic Surgery (SEPAR), American Thoracic Society (ATS) Roundtable, Global Initiative for Asthma (GINA)/Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, and the specialists diagnosis, respectively. The ACO group defined according to the GINA/GOLD criteria showed significantly higher St. George's Respiratory Questionnaire and COPD Assessment Test scores than the non-ACO COPD group. When the modified SEPAR definition was applied, the ACO group showed a significantly larger decrease in the forced expiratory volume in 1 second (FEV1, %). The ACO group defined by the ATS Roundtable showed significantly larger decrease in the forced vital capacity values compared to the non-ACO COPD group (–18.9% vs. –2.2%, p=0.007 and –412 mL vs. –17 mL, p=0.036). The ACO group diagnosed by the specialists showed a significantly larger decrease in the FEV1 (%) compared to the non-ACO group (–5.4% vs. –0.2%, p=0.003). @*Conclusion@#In this study, the prevalence and clinical characteristics of ACO varied depending on the diagnostic criteria applied. With the criteria which are relatively easy to use, defining ACO by the specialists diagnosis may be more practical in clinical applications.

3.
Article in English | WPRIM | ID: wpr-896431

ABSTRACT

Background@#Asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) is a condition characterized by the overlapping clinical features of asthma and COPD. To evaluate the appropriateness of different sets of ACO definition, we compared the clinical characteristics of the previously defined diagnostic criteria and the specialist opinion in this study. @*Methods@#Patients enrolled in the KOrea COpd Subgroup Study (KOCOSS) were evaluated. Based on the questionnaire data, the patients were categorized into the ACO and non-ACO COPD groups according to the four sets of the diagnostic criteria. @*Results@#In total 1,475 patients evaluated: 202 of 1,475 (13.6%), 32 of 1,475 (2.2%), 178 of 1,113 (16.0%), and 305 of 1,250 (24.4%) were categorized as ACO according to the modified Spanish Society of Pneumonology and Thoracic Surgery (SEPAR), American Thoracic Society (ATS) Roundtable, Global Initiative for Asthma (GINA)/Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, and the specialists diagnosis, respectively. The ACO group defined according to the GINA/GOLD criteria showed significantly higher St. George's Respiratory Questionnaire and COPD Assessment Test scores than the non-ACO COPD group. When the modified SEPAR definition was applied, the ACO group showed a significantly larger decrease in the forced expiratory volume in 1 second (FEV1, %). The ACO group defined by the ATS Roundtable showed significantly larger decrease in the forced vital capacity values compared to the non-ACO COPD group (–18.9% vs. –2.2%, p=0.007 and –412 mL vs. –17 mL, p=0.036). The ACO group diagnosed by the specialists showed a significantly larger decrease in the FEV1 (%) compared to the non-ACO group (–5.4% vs. –0.2%, p=0.003). @*Conclusion@#In this study, the prevalence and clinical characteristics of ACO varied depending on the diagnostic criteria applied. With the criteria which are relatively easy to use, defining ACO by the specialists diagnosis may be more practical in clinical applications.

4.
Article in English | WPRIM | ID: wpr-124435

ABSTRACT

BACKGROUND: Isolation of M. tuberculosis (MTB) is required in cases of Tuberculous pleural effusion (TBPE) for confirming diagnosis and successful therapy based on drug sensitivity test. Several studies have focused on predictors of MTB culture positivity in TBPE. However, the clinical role of loculated TBPE as a predictor of MTB cultivation from TBPE remains unclear. The aim of this study was to examine possible predictors including loculation of TBPE of MTB culture positivity in TBPE. METHODS: We retrospectively examined associations between clinical, radiological, microbiological, and laboratory characteristics and positive MTB culture from TBPE to determine a potent predictor of culture positivity. RESULTS: From January 2011 to August 2015, 232 patients with TBPE were identified. Of these, 219 were finally analyzed. Among them, 69 (31.5%) were culture positive for MTB in TBPE and 86 (39.3%) had loculated TBPE. In multivariate logistic regression analysis, the loculation of TBPE was independently associated with culture positivity for MTB in TBPE (adjusted odds ratio [OR], 40.062; 95% confidence interval [CI], 9.355–171.556; p<0.001). In contrast, the lymphocyte percentage of TBPE (adjusted OR, 0.934; 95% CI, 0.899–0.971; p=0.001) was inversely associated with culture positivity for MTB in TBPE. CONCLUSION: In clinical practice, identification of loculation in TBPE is easy, reliable to measure, not uncommon and may be helpful to predict the possibility of positive mycobacterial culture.


Subject(s)
Diagnosis , Humans , Logistic Models , Lymphocytes , Odds Ratio , Pleural Effusion , Pleurisy , Retrospective Studies , Tuberculosis
5.
Yonsei Medical Journal ; : 1144-1151, 2017.
Article in English | WPRIM | ID: wpr-15479

ABSTRACT

PURPOSE: Pleural effusion, an accumulation of fluid in the pleural space, usually occurs in patients when the rate of fluid formation exceeds the rate of fluid removal. The differential diagnosis of tuberculous pleurisy and malignant pleural effusion is a difficult task in high tuberculous prevalence areas. The aim of the present study was to identify novel biomarkers for the diagnosis of pleural fluid using proteomics technology. MATERIALS AND METHODS: We used samples from five patients with transudative pleural effusions for internal standard, five patients with tuberculous pleurisy, and the same numbers of patients having malignant effusions were enrolled in the study. We analyzed the proteins in pleural fluid from patients using a technique that combined two-dimensional liquid-phase electrophoresis and matrix assisted laser desorption/ionization-time of flight-mass spectrometry. RESULTS: We identified a total of 10 proteins with statistical significance. Among 10 proteins, trasthyretin, haptoglobin, metastasis-associated protein 1, t-complex protein 1, and fibroblast growth factor-binding protein 1 were related with malignant pleural effusions and human ceruloplasmin, lysozyme precursor, gelsolin, clusterin C complement lysis inhibitor, and peroxirexdoxin 3 were expressed several times or more in tuberculous pleural effusions. CONCLUSION: Highly expressed proteins in malignant pleural effusion were associated with carcinogenesis and cell growth, and proteins associated with tuberculous pleural effusion played a role in the response to inflammation and fibrosis. These findings will aid in the development of novel diagnostic tools for tuberculous pleurisy and malignant pleural effusion of lung cancer.


Subject(s)
Biomarkers , Carcinogenesis , Ceruloplasmin , Chaperonin Containing TCP-1 , Clusterin , Diagnosis , Diagnosis, Differential , Electrophoresis , Fibroblasts , Fibrosis , Gelsolin , Haptoglobins , Humans , Inflammation , Lung Neoplasms , Methods , Muramidase , Pleural Effusion , Pleural Effusion, Malignant , Prevalence , Proteomics , Spectrum Analysis , Tuberculosis , Tuberculosis, Pleural
6.
Article in English | WPRIM | ID: wpr-213787

ABSTRACT

The prevalence of pneumothorax cases among Intensive Care Unit patients who require mechanical ventilation ranges from 4%-15%. A pneumothorax remains one of the most serious complications of positive pressure ventilation. It can be diagnosed in a critically ill patient through a physical examination or radiographic studies that include chest radiographs, ultrasonography, or computed tomography scanning. However, in a critically ill patient, the diagnosis of a pneumothorax is often complicated by other diseases and by difficulties in imaging sick and unconscious patients. Although electrocardiogram changes associated with a pneumothorax have been described for many years, there has been no report of such among patients who require mechanical ventilation. In this paper, we report 2 cases of a spontaneous pneumothorax with paroxysmal supraventricular tachycardia in patients who required invasive mechanical ventilation due to acute respiratory failure.


Subject(s)
Critical Illness , Diagnosis , Electrocardiography , Humans , Intensive Care Units , Physical Examination , Pneumothorax , Positive-Pressure Respiration , Prevalence , Radiography, Thoracic , Respiration, Artificial , Respiratory Insufficiency , Tachycardia, Supraventricular , Ultrasonography
7.
Article in English | WPRIM | ID: wpr-61309

ABSTRACT

Data on the clinical outcomes and role of brain natriuretic peptide (BNP) levels in patients with chronic cor pulmonale are limited. A total of 69 patients with chronic cor pulmonale, admitted for dyspnea (January 2007 to September 2011) to three university hospitals, were retrospectively reviewed. All of the patients had right ventricular (RV) dysfunction on echocardiography. The median age was 70.0 yr, and chronic obstructive pulmonary disease (40.6%) and tuberculosis-destroyed lung (TDL, 27.5%) were the leading causes of chronic cor pulmonale. At the 1-yr follow-up, the mortality rate was 15.9%, and the readmission rate was 53.7%; patients with TDL had higher mortality (31.6% vs. 10.0%; P = 0.059) and readmission rates (78.9% vs. 43.8%; P = 0.009) than those with non-TDL diseases. The area under the receiver operating characteristic curve for admission BNP levels to predict readmission was 0.788 (95% confidence interval [CI], 0.673-0.904), and the sensitivity and specificity of the cut-off value were 80.6% and 77.4%, respectively. In multivariate analysis, high admission BNP levels were a significant risk factor for subsequent readmission (hazard ratio, 1.049; 95% CI, 1.005-1.094). Additionally, admission BNP levels were well correlated with cardiac troponin I (r = 0.558), and delta BNP also correlated with delta RV systolic pressure (n = 25; r = 0.562). In conclusion, among hospitalized patients with chronic cor pulmonale, admission high BNP levels are a significant risk factor for subsequent readmission. Therefore, more intensive monitoring and treatment are needed in patients with higher BNP levels.


Subject(s)
Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Patient Readmission , Prognosis , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Heart Disease/blood , ROC Curve , Retrospective Studies , Tuberculosis, Pulmonary/complications
8.
Yonsei Medical Journal ; : 212-219, 2015.
Article in English | WPRIM | ID: wpr-174631

ABSTRACT

PURPOSE: The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory failure (ARF). MATERIALS AND METHODS: From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. RESULTS: Overall, 68% of patients survived among those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcome with a 94% survival rate. CONCLUSION: VV ECMO is an excellent, life-saving treatment option in patients suffering from acute and life-threatening respiratory failure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients.


Subject(s)
Acute Disease , Adult , Cause of Death , Extracorporeal Membrane Oxygenation , Female , Humans , Male , Middle Aged , Respiratory Insufficiency/complications , Survival Analysis , Treatment Outcome
9.
Article in English | WPRIM | ID: wpr-183076

ABSTRACT

The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged > or = 18 yr) who had an acute illness with a new cough and sputum (< or = 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and beta-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bordetella parapertussis/genetics , Bordetella pertussis/genetics , Bronchitis/drug therapy , Chlamydophila pneumoniae/genetics , Community-Acquired Infections/microbiology , Female , Humans , Hypertension/complications , Legionella pneumophila/genetics , Male , Middle Aged , Mycoplasma pneumoniae/genetics , Real-Time Polymerase Chain Reaction , Republic of Korea , Sputum/microbiology
10.
Article in English | WPRIM | ID: wpr-15357

ABSTRACT

BACKGROUND: Interferon-gamma assays based on tuberculosis (TB)-specific antigens have been utilized for diagnosing and ruling out latent TB and active TB, but their utility is still limited for TB incidence countries. The aim of this study is to understand the clinical utility of enzyme-linked immunospot (ELISpot) assays among patients with clinically suspected TB and healthy adults in clinical practices and community-based settings. METHODS: The ELISpot assays (T SPOT.TB, Oxford Immunotec, UK) were prospectively performed in 202 patients. After excluding those with indeterminate results, 196 were included for analysis: 41 were TB patients, 93 were non-TB patients, and 62 were healthy adults. RESULTS: The sensitivity and negative predictive values of the T SPOT.TB assays for the diagnosis of TB were 87.8% and 89.1%, respectively, among patients with suspected TB. The agreement between the tuberculin skin test (10-mm cutoff) and the T SPOT.TB assay was 66.1% (kappa=0.335) in all participants and 80.0% (kappa=0.412) in TB patients. Among those without TB (n=155), a past history of TB and fibrotic TB scar on chest X-rays were significant factors that yielded positive T SPOT.TB results. There was a significant difference in the magnitude of T SPOT.TB spot counts between TB patients and non-TB patients or healthy adults. CONCLUSION: The T SPOT.TB assay appeared to be a useful test for the diagnostic exclusion of TB. A positive result, however, should be cautiously interpreted for potential positives among those without active TB in intermediate TB incidence areas.


Subject(s)
Adult , Cicatrix , Diagnosis , Enzyme-Linked Immunospot Assay , Humans , Incidence , Interferon-gamma , Prospective Studies , Skin Tests , Thorax , Tuberculin , Tuberculosis
11.
Article in English | WPRIM | ID: wpr-79647

ABSTRACT

Epidemiological data of Bordetella pertussis infection among adolescents and adults are limited in Korea. Patients (> or = 11 yr of age) with a bothersome cough for less than 30 days were enrolled during a 1-yr period at 22 hospitals in Korea. Nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and for bacteriologic culture. In total, 490 patients were finally enrolled, and 34 (6.9%) patients tested positive for B. pertussis; cough duration (14.0 days [7.0-21.0 days]) and age distribution were diverse. The incidence was the highest in secondary referral hospitals, compared to primary care clinics or tertiary referral hospitals (24/226 [10.6%] vs. 3/88 [3.4%] vs. 7/176 [4.0%], P = 0.012), and the peak incidence was observed in February and August (15.8% and 15.9%), with no confirmed cases between March and June. In the multivariate analysis, post-tussive vomiting was significantly associated with pertussis (odds ratio, 2.508; 95% confidence interval, 1.146-5.486) and secondary referral hospital showed a borderline significance. In conclusion, using a PCR-based method, 6.9% of adolescent and adult patients with an acute cough illness had pertussis infection in an outpatient setting. However, hospital levels and seasonal trends must be taken into account to develop a better strategy for controlling pertussis.


Subject(s)
Adolescent , Adult , Bordetella pertussis/genetics , Child , DNA, Bacterial/analysis , Demography , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Polymerase Chain Reaction , Republic of Korea/epidemiology , Seasons , Vomiting/etiology , Whooping Cough/epidemiology , Young Adult
12.
Yonsei Medical Journal ; : 732-738, 2014.
Article in English | WPRIM | ID: wpr-159379

ABSTRACT

PURPOSE: A recent study demonstrated that exertional desaturation is a predictor of rapid decline in lung function in patients with chronic obstructive pulmonary disease (COPD); however, the study was limited by its method used to detect exertional desaturation. The main purpose of this study was to explore whether exertional desaturation assessed using nadir oxygen saturation (SpO2) during the 6-minute walk test (6MWT) can predict rapid lung function decline in patients with COPD. MATERIALS AND METHODS: A retrospective analysis was performed on 57 patients with moderate to very severe COPD who underwent the 6MWT. Exertional desaturation was defined as a nadir SpO2 of or =50 mL. Patients were divided into rapid decliner (n=26) and non-rapid decliner (n=31) groups. RESULTS: A statistically significant difference in exertional desaturation was observed between rapid decliners and non-rapid decliners (17 vs. 8, p=0.003). No differences were found between the groups for age, smoking status, BODE index, and FEV1. Multivariate analysis showed that exertional desaturation was a significant independent predictor of rapid decline in patients with COPD (relative risk, 6.8; 95% CI, 1.8 to 25.4; p=0.004). CONCLUSION: This study supports that exertional desaturation is a predictor of rapid lung function decline in male patients with COPD.


Subject(s)
Aged , Hypoxia/diagnosis , Exercise/physiology , Female , Forced Expiratory Volume/physiology , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/physiopathology , Respiratory Function Tests , Retrospective Studies
13.
Article in English | WPRIM | ID: wpr-163314

ABSTRACT

Knowledge of clinical demographics and outcomes of mechanically ventilated patients is important but there are few prospectively collected data in Korea. The objective of the present study was to describe the current status of mechanically ventilated patients in Korea as of 2010. We analyzed the data of Korean patients (275 patients in 12 Korean intensive care units [ICU]) participating in a multinational prospective cohort study on mechanical ventilation. The most common indication for mechanical ventilation was pneumonia (23%). Pressure-limited ventilation modes were preferred over volume-cycled ventilation modes. Non-invasive positive pressure ventilation was used in only seven (2%) patients as the initial ventilatory support. Median duration of mechanical ventilation was 7 days and ICU mortality was 36%. The multiple logistic regression model revealed that the Simplified Acute Physiology Score II (SAPS II) score at ICU admission (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.001-1.036; P=0.033), peak pressure (OR, 1.054; 95% CI, 1.016-1.095; P=0.006), and the number of failed organs (OR, 2.132; 95% CI, 1.634-2.781; P<0.001) were independently associated with ICU mortality. This study provides a snapshot of current practice of mechanical ventilation in Korea.


Subject(s)
Acute Disease , Aged , Cohort Studies , Demography , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Length of Stay , Male , Middle Aged , Odds Ratio , Prognosis , Prospective Studies , Republic of Korea , Respiration, Artificial , Respiratory Insufficiency/diagnosis , Sepsis/etiology , Severity of Illness Index
14.
Article in English | WPRIM | ID: wpr-194717

ABSTRACT

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.


Subject(s)
Adrenal Cortex Hormones , Aspergillosis , Bacterial Infections , Bronchi , Bronchoscopy , Humans , Hyperemia , Immunocompetence , Immunocompromised Host , Influenza A virus , Influenza, Human , Intensive Care Units , Invasive Pulmonary Aspergillosis , Mortality , Mucous Membrane , Pulmonary Disease, Chronic Obstructive , Trachea
15.
Article in English | WPRIM | ID: wpr-159650

ABSTRACT

This study was performed to estimate the direct medical costs and epidemiology of pneumonia in adults of Korea. We conducted a multi-center, retrospective, observational study and collected data targeting for community-acquired pneumonia patients ( > or = 50 yr) from 11 hospitals. Costs attributable to the treatment of pneumonia were estimated by reviewing resource utilization and epidemiology data (distribution of pathogen, hospital length of stay, overall outcome) were also collected. A total 693 patients were included; average 70.1 ( +/- 10.5) aged, 57.3% male and average 1.16 CURB-65 (confusion, blood urea nitrogen, respiratory rate, blood pressure, age > 65 yr) scored. The pathogen was identified in the 32.9% (228 patients); Streptococcus pneumoniae accounted for 22.4% (51 patients) of identified pathogens. The hospital mortality was 3.2% (especially, for S. pneumoniae was 5.9%) and average length of stay was 9 days. The mean total cost for the treatment of pneumonia was US dollar (USD) 1,782 (SD: USD 1,501). Compared to the cost of all caused pneumonia, that of pneumococcal pneumonia was higher, USD 2,049 ( +/- USD 1,919), but not statistically significant. Charge of hospitalization accounted the greatest part of total medical costs. The economic burden of pneumonia was high in Korea, and the prevention of pneumonia should be considered as effective strategy.


Subject(s)
Aged , Aged, 80 and over , Asians , Community-Acquired Infections/economics , Female , Health Care Costs , Hospital Mortality , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Pneumonia/economics , Pneumonia, Pneumococcal/economics , Republic of Korea/epidemiology , Retrospective Studies , Severity of Illness Index , Streptococcus pneumoniae/isolation & purification
16.
Article in English | WPRIM | ID: wpr-159023

ABSTRACT

The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P or = 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.


Subject(s)
Adult , Aged , Anti-Bacterial Agents/therapeutic use , Area Under Curve , Community-Acquired Infections/diagnosis , Female , Hospital Mortality , Humans , Intensive Care Units , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Odds Ratio , Pneumonia/diagnosis , Predictive Value of Tests , ROC Curve , Severity of Illness Index
17.
Article in Korean | WPRIM | ID: wpr-643728

ABSTRACT

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.


Subject(s)
Adult , APACHE , Critical Illness , Health Facility Size , Humans , Influenza, Human , Critical Care , Intensive Care Units , Korea , Logistic Models , Pandemics , Retrospective Studies , Risk Factors
18.
Article in English | WPRIM | ID: wpr-22405

ABSTRACT

BACKGROUND: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. METHODS: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. RESULTS: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). CONCLUSION: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.


Subject(s)
Blister , Bronchi , Bronchoscopy , Chest Pain , Chest Tubes , Drainage , Empyema , Ethanolamine , Fever , Fistula , Humans , Length of Stay , Lung , Needles , Oleic Acid , Oleic Acids , Pleurodesis , Pneumothorax , Pulmonary Disease, Chronic Obstructive , Thoracic Surgery , Thoracoscopy , Thoracotomy , Thorax
19.
Yonsei Medical Journal ; : 363-368, 2012.
Article in English | WPRIM | ID: wpr-154806

ABSTRACT

PURPOSE: A new spirometric reference equation was recently developed from the first national chronic obstructive pulmonary disease (COPD) survey in Korea. However, Morris' equation has been preferred for evaluating spirometric values instead. The objective of this study was to evaluate changes in severity staging in Korean COPD patients by adopting the newly developed Korean equation. MATERIALS AND METHODS: We evaluated the spirometric data of 441 COPD patients. The presence of airflow limitation was defined as an observed post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) less than 0.7, and the severity of airflow limitation was assessed according to GOLD stages. Spirometric values were reassessed using the new Korean equation, Morris' equation and other reference equations. RESULTS: The severity of airflow limitation was differently graded in 143 (32.4%) patients after application of the new Korean equation when compared with Morris' equation. All 143 patients were reallocated into more severe stages (49 at mild stage, 65 at moderate stage, and 29 at severe stage were changed to moderate, severe and very severe stages, respectively). Stages according to other reference equations were changed in 18.6-49.4% of the patients. CONCLUSION: These results indicate that equations from different ethnic groups do not sufficiently reflect the airflow limitation of Korean COPD patients. The Korean reference equation should be used for Korean COPD patients in order to administer proper treatment.


Subject(s)
Adult , Aged , Aged, 80 and over , Asians , Female , Humans , Korea , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Retrospective Studies , Spirometry/methods
20.
Korean Circulation Journal ; : 160-163, 2011.
Article in English | WPRIM | ID: wpr-224361

ABSTRACT

Paraplegia secondary to spinal cord infarction is a recognized complication of open thoracic and thoracoabdominal aortic aneurysm (TAA) repair. TAA is serious and unpredictable condition. Therefore, aortic repair requires thorough information on managing the potential complications will facilitate improve control the problem. We report the symptoms and management of paraplegia in a patient who underwent stent insertion as TAA.


Subject(s)
Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Humans , Infarction , Paraplegia , Spinal Cord , Spinal Cord Ischemia , Stents
SELECTION OF CITATIONS
SEARCH DETAIL