A Case of Fatal Plasmodium Vivax Malaria with Multi-organ Failure / 감염과화학요법

Vivax malaria is a re-emerging infectious disease in Korea with cumulating 19,416 cases as of December 2003 since 1993. Vivax malaria is generally a benign disease with few severe complications. Even in the worldwide literature, there are only small number of case reports on severe complications. We experienced a fatal vivax malaria in a previously healthy young adult with severe multi-organ failure and fatal massive pulmonary hemorrhage. The patient presented with abdominal pain and shock. There were splenic hemorrhage, disseminated intravascular coagulation, oliguric acute renal failure requiring dialysis, and pulmonary hemorrhage leading the patient finally to death. The initial parasitemia was 2,046/?L. Thin smear and PCR revealed only Plasmodium Vivax. There was no explainable cause of death except for the only serological suggestion of Mycoplasma pneumoniae infection without correlating clinical evidence. This is a first case of fatal vivax malaria in Korea since its re-emergence in 1993. Further case monitoring is needed to define whether this is a index case or an isolated one.

Analysis on the Etiology and Prognostic Factors of Community-Acquired Bacteremia in a Community-Based Tertiary Hospital / 감염과화학요법

BACKGROUND: We conducted this study to describe the epidemiology of community-acquired bacteremia and identify its prognostic factors. MATERIALS AND METHODS: All patients admitted to a community-based tertiary hospital with community-acquired bacteremia from June 2002 to May 2004 were included and analyzed retrospectively. RESULTS: During the study period, clinically significant community-acquired bacteremia occurred in 223 patients with the frequency of 5.3 patients per 1,000 patient-admission. The commonly isolated organisms were E. coli (47.1%), K. pneumoniae (13.0%), S. aureus (8.1%), and S. pneumoniae (4.5 %). The leading source of bacteremia were urinary tract infection (34.5%), intraabdominal infection (33.6%), primary bacteremia (10.3%), and skin & soft tissue infection (8.1%). The overall mortality was 17%. S. aureus (34.8%) and K. pneumoniae (30.4%) were two major organisms of primary bacteremia with high case fatality of 50% and 28.6%, respectively. Univariate analysis showed that the followings were associated with significant increase in mortality: male patient; S. aureus and other streptococci bacteremia; increasing APACHE II score; definite diagnosis after 3 days of admission; inappropriate antibiotics therapy within 24 hours of admission; emergency room; admission to ICU. The independent predictors of mortality were male patient (RR 3.02, P=0.031), increasing APACHE II score (RR 1.12, P=0.011), and admission to ICU (RR 9.73, P<0.001). CONCLUSION: Rapid definite diagnosis and prompt administration of appropriate antibiotics according to the local epidemiologic pattern are the most important controllable factors for the better outcome.

A Case of Fatal Plasmodium Vivax Malaria with Multi-organ Failure / 감염과화학요법

Vivax malaria is a re-emerging infectious disease in Korea with cumulating 19,416 cases as of December 2003 since 1993. Vivax malaria is generally a benign disease with few severe complications. Even in the worldwide literature, there are only small number of case reports on severe complications. We experienced a fatal vivax malaria in a previously healthy young adult with severe multi-organ failure and fatal massive pulmonary hemorrhage. The patient presented with abdominal pain and shock. There were splenic hemorrhage, disseminated intravascular coagulation, oliguric acute renal failure requiring dialysis, and pulmonary hemorrhage leading the patient finally to death. The initial parasitemia was 2,046/?L. Thin smear and PCR revealed only Plasmodium Vivax. There was no explainable cause of death except for the only serological suggestion of Mycoplasma pneumoniae infection without correlating clinical evidence. This is a first case of fatal vivax malaria in Korea since its re-emergence in 1993. Further case monitoring is needed to define whether this is a index case or an isolated one.

Analysis on the Etiology and Prognostic Factors of Community-Acquired Bacteremia in a Community-Based Tertiary Hospital / 감염과화학요법

BACKGROUND: We conducted this study to describe the epidemiology of community-acquired bacteremia and identify its prognostic factors. MATERIALS AND METHODS: All patients admitted to a community-based tertiary hospital with community-acquired bacteremia from June 2002 to May 2004 were included and analyzed retrospectively. RESULTS: During the study period, clinically significant community-acquired bacteremia occurred in 223 patients with the frequency of 5.3 patients per 1,000 patient-admission. The commonly isolated organisms were E. coli (47.1%), K. pneumoniae (13.0%), S. aureus (8.1%), and S. pneumoniae (4.5 %). The leading source of bacteremia were urinary tract infection (34.5%), intraabdominal infection (33.6%), primary bacteremia (10.3%), and skin & soft tissue infection (8.1%). The overall mortality was 17%. S. aureus (34.8%) and K. pneumoniae (30.4%) were two major organisms of primary bacteremia with high case fatality of 50% and 28.6%, respectively. Univariate analysis showed that the followings were associated with significant increase in mortality: male patient; S. aureus and other streptococci bacteremia; increasing APACHE II score; definite diagnosis after 3 days of admission; inappropriate antibiotics therapy within 24 hours of admission; emergency room; admission to ICU. The independent predictors of mortality were male patient (RR 3.02, P=0.031), increasing APACHE II score (RR 1.12, P=0.011), and admission to ICU (RR 9.73, P<0.001). CONCLUSION: Rapid definite diagnosis and prompt administration of appropriate antibiotics according to the local epidemiologic pattern are the most important controllable factors for the better outcome.

Apoptosis Induction by Curcumin in Human Myelogenous Leukemia Cell Lines

BACKGROUND: Curcumin, a naturally occurring biologically active compound extracted from rhizomes of Curcuma species, has been shown to possess potent anti-inflammatory, anti-tumor and anti-oxidative properties. The effects and possible mechanism of this agent were investigated on 2 human myelogenous leukemic cell lines. METHODS: K562 and KG-1 cells were the two cell lines selected. The MTT assay and flow cytometry were used to assess the cytotoxicity and for cell cycle analysis, respectively. The protein expressions were analyzed by Western blotting; the caspase activity was also checked. RESULTS: Both cell lines showed dose-dependent susceptibility to curcumin, and the cell cycle analysis showed an increased sub-G1 phase in the KG-1 cells. In the K562 cell, curcumin down regulated the expressions of PCNA (proliferating cell nuclear antigen) and cyclins D1 and B1. The expression of Akt was also down-regulated, but caspase-3 was activated to induce cleaved PARP (polyadenosine ribose polymerase) and apoptosis. However, the expression of phospho-Erk was unaffected. Co-treatment of cyclosporin A (CsA) with curcumin resulted in an attenuation of apoptosis in the K562 cells, implying curcumin-induced apoptosis is dependent on the release of cytochrome c from the mitochondria. CONCLUSION: Curcumin induced cell cycle arrest and apoptosis in both human myelogenous leukemic cell lines, with the apoptosis appearing to be dependent on the release of cytochrome c from the mitochondria.

Epidemiology for Korean Knee Osteoarthritis: Results From the Health and Nutritional Survey in Kuri city

OBJECTIVE: Osteoarthritis is one of the most common joint disorder in the world. But unfortunately there is no fundamental data as to its prevalence and risk factors in Korean population. We performed this study to understand the prevalence and risk factors related to knee osteoarthritis in Koreans. MATERIALS AND METHODS: A total 867 persons aged 20-69 years were selected from the general population in Kuri city and underwent a structured interview, clinical examination of knee joint, and radiologic study. The diagnostic criteria of knee osteoarthritis which we used was composed of clinical and radio- logical criteria reported by Altman et al. General characteristics of prevalence of knee osteoarthritis in relation to age, sex, education, job were evaluated. Risk factors such as obesity, menopause, physical activity, smoking, drinking, osteoporosis, diabetes mellitus, hypertension were evaluated by chi-squre test and logistic regression. RESULTS: This study revealed that prevalence of knee osteoarthritis in Korea is 10.2%, increasing with age. High level of physical activity in men and age, postmenopause and obesity in women can be risk factors.

Distribution and Prevalence Estimation of Cardiovascular Risk Factors through Community Based Health Examination Survey / 대한지역사회영양학회지

Cardiovascular disease is very prevalent in Korea, and many risk factors, if properly identified are possibly corrected. However, the study results on prevalence and distribution of risk factors may not be reliable while the risk factors of disease are always issued on health promotion projects conducted recently in a community. The subjects of this study were 854 adults who participated in the health and nutrition survey in a community. They were aged between 20 and 69 and sampled representatively. This study intended to estimate the prevalence and the distribution of risk factors of cardiovascular disease such as hypertention, diabetes mellitus, hypercholesterolemia, and obesity. Systolic blood pressure and diastolic blood pressure levels were estimated at 123.9+/-2.2mgHg(men), 117.9+/-1.7mgHg(women), and 80.4+/-1.5mg(men), 74.9+/-1.1mgHg(women), respectively. Glucose level was estimated at 99.1+/-2.3mg/dl in men, and 95.7+/-1.7mg/dl in women. The estimated level of total cholesterol and HDL-cholesterol were 183.4+/-3.8mg/dl(men), 181.7+/-3.1mg/dl(men), and 122.0+/-4.5mg/dl (women), and body mass index was estimated at 24.0+/-0.4kg/m2 in men and 23.9+/-0.4kg/m2 in men and 23.9+/-0.3kg/m2 in women. The prevalence of hypertension was 20.5% for men, and 14.4% for women. The prevalence of diabetes mellitus was estimated to 6.9% for men, and 6.1% for women. The estimated prevalence of hypercholesterolemia was 3.8%(men), 3.9%(women). The rate of obesity was estimated to 28.5%(men), 28.4% (women), respectively. The levels of blood pressure, glucose, and cholesterol were higher in men than in women in almost all the almost ate groups. The prevalence of hypertension for men is about 20%. It was found that the prevalence of diabetes mellitus for males aged between 40 and 59 was rapidly increased. The risk factor with highest prevalence was obesity, and hypertension and diabetes mellitus were the second and third most prevalent.

The Cross-sectional Study on the Relationship of Health Behavior and Immune Function / 한국역학회지

To investigate the association of individual health behaviors with imune response against tumor or viral infection, peripheral blood lymphocytes of 185 healthy males in aged from 35 to 44 years for natural killer(NK) cell activity, frequencies of lymphocytes subsets and proliferation response of T and B cell. NK cell activity was determined by Cr release activity assay and lymphocytes subsets were counted using surface antigens(CD4, CD8, CD56) by flow cytometry. The responsiveness of T and B were measured as proliferation stimulated by mitogens. Subjects were classified into four distinct lifestyle patterns, health promotive lifestyle, passive lifestyle, fitness lifestyle and hedonic lifestyle from information on their health behaviors(cigarette smoking, alcohol consumption, and physical activity). Health promotive lifestyle had the highest NK cell activity(Lu30/10(6)CD56) which was significantly higher than hedonic lifestyle)p<0.05). The responsiveness of T cell was significantly lower in passive lifestyle and hedonic lifestyles compared to health promotive lifestyle and fitness lifestyles(p<0.05). However, there was no significant difference in the responsiveness of B cell, CD4, and CD8 among four lifestyles. This cross-sectional study showed the NK cell activity in individuals with desirable health behaviors was lower. The variation of immunity among individuals was not considered in this study, hence the intervention study reflection individual variations is recommended.

A Study on Major Health Components of National Health Examination Survey in Korea / 예방의학회지

The purpose of this study was to identify the major health components and measurements to be conducted in National Health Examination Survey(KNHES). The prevalence and severity of disease, acceptability of population and the possibility, of standardization of measurement were considered as guideline for selecting the components. On the base of magnitude and severity of disease, chronic liver disease, hepatic cancer, gastric ulcer, stomach cancer, essential hypertension, cerebrovascular disease, ischemic heart disease, pulmonary tuberculosis, lung cancer, DM, breast cancer, cervical cancer, arthritis and intervertebral disc disorder were selected as the preliminary target diseases. Questionnaire survey for 648 persons in 'K' city and medical specialists in five clinical societies were conducted for evaluating the acceptability of general population for the measurements and the possibility of standardization for the procedures. In conclusion, the major target diseases were chronic liver disease, hypertension and DM and the total cholesterol, high density lipoprotein, triglyceride, total protein, albumin, hemoglobulin, hematocrit, platlet count, anti-HBs, HBsAg, height and weight were selected for basic physical components.

The relationship between the utilization of health center and exposed amount to solvent by using cumulative exposure index / 예방의학회지

This study was conducted in order to clarify the factors affecting the number of utilization to health center for the shipyard workers who have been work in exposed environment to solvent. At first the tendencies of the number of utilization to health center in accordance with cumulative exposure(CE), lifetime weighted average exposure(LWAE), one's place of duty, work contents, states of using safety apparatus, the degree of the knowledge on handling solvents, exposure year. 1) The increase in the cumulative exposure(CE) was significantly higher in the number of utilization to health center. The group with longer exposure year showed significantly higher number of utilization to health center(p<0.01). Considering the work contents such as power blasting, spray, mixing and touch-up, the group of touch-up showed higher number of utilization to health center and this difference was statistically significant(p<0.001). Those who were not using the safety apparatus, showed higher number of utilization to health center, which was statistically significant(p<0.05). The degree of the knowledge on handling the solvent had no relation with using health center. 2) The results conducted from this study by multiple regression analysis in clarifying the factors affecting the number of utilization to health center, CE, exposure year and using safety apparatus was significant factor in utilization of health center.

Health Behavior Patterns of Korean / 예방의학회지

The purpose of this study was to identify population subgroups with similar patterns of diet quality, physical activity, alcohol consumption and cigarette smoking of Korean. The cluster analysis was conducted using the data from Korea National Health Survey(KNHS) in 1995, which consisted of 5,805 persons. We identified six health behavior typologies: 32.9% of the sample had a good diet but sedentary activity level(good diet lifestyle), 7.2% had high activity level but less diet quality(fitness lifestyle). Individuals in the passive lifestyle cluster(39.1%) had no active health promoting activities but tended to avoid risk taking health behavior such as cigarette smoking and alcohol drinking. 1.1% of the sample were in a drinking cluster, 17.2% in a smoking cluster and 2.5% had a hedonic lifestyle characterized by heavy drinking and smoking. The other characteristics of these lifestyle clusters could be presented by demographic and socioeconomic factors.