Changes in prescribing patterns and resultant disease control after lamotrigine-related adverse drug reactions: A descriptive analysis

Purpose@#This study aimed to describe the desperate situation where the clinician should make decisions to further manage patients having experienced adverse drug reaction (ADR) to lamotrigine that is indicated to not easily controlled neuropsychiatric diseases. @*Methods@#A descriptive analysis was done by thoroughly reviewing medical records of patients who were reported to have ADR to lamotrigine in a regional drug-safety center between 2010 and 2018. @*Results@#Eighty-four cases of lamotrigine-related ADRs occurred in 80 patients. Skin lesions were most commonly observed in 70 cases (83.3%) and 14 cases (16.7%) had severe ADRs. Sixty-three subjects (78.8%) discontinued lamotrigine, while 17 (21.3%) continued it.At the time of discontinuation, 30.0% were prescribed aromatic antiepileptic drugs. Among 4 subjects who were eventually prescribed lamotrigine again after a period of discontinuation, 3 (75.0%) experienced its recurrence. Among patients who had taken alternative medications, the incidence of ADRs was higher in those being prescribed aromatic antiepileptic drugs than in the others being prescribed other than aromatic antiepileptic drugs (P = 0.013). Regarding the control of underlying diseases, as many as 65 (86.7%) and 68 (90.7%) failed to reach maintaining the resolved state from 6 months and 12 months after the substitution, respectively. @*Conclusion@#Patients can be easily trapped between the recurrence of ADRs and the treatment failure to a certain drug like lamotrigine, in which we can hardly find a reasonable alternative to manage them.

A 10-Year Single-Center Experience of Adverse Drug Reaction Monitoring / 대한내과학회지

Background/Aims@#Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. @*Methods@#Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. @*Results@#During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). @*Conclusions@#The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.

A 10-Year Single-Center Experience of Adverse Drug Reaction Monitoring / 대한내과학회지

Background/Aims@#Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. @*Methods@#Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. @*Results@#During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). @*Conclusions@#The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.

Development of Warfarin Talk: A Messenger Chatbot for Patients Taking Warfarin

Background@#Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. @*Methods@#We developed “WafarinTalk” as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. @*Results@#We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. @*Conclusion@#This study showed that warfarin-related information could be provided to patients through a messenger applicationbased chatbot.

Development of Warfarin Talk: A Messenger Chatbot for Patients Taking Warfarin

Background@#Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. @*Methods@#We developed “WafarinTalk” as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. @*Results@#We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. @*Conclusion@#This study showed that warfarin-related information could be provided to patients through a messenger applicationbased chatbot.

Factors Influencing Imatinib-Induced Hepatotoxicity / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Although imatinib-induced hepatotoxicity may aggravate the patient’s clinical condition and alter the treatment plan, the underlying mechanism of and factors influencing imatinibinduced hepatotoxicity have rarely been investigated. The purpose of this study was to investigate factors affecting on the incidence of hepatotoxicity within 90 days after starting imatinib treatment and time to onset of imatinib-induced hepatotoxicity. @*Materials and Methods@#We retrospectively evaluated the records of 177 patients receiving imatinib from October 2012 to September 2017. The analyzed factors included sex, age, body weight, body surface area, underlying disease, and concomitant drugs. @*Results@#The proportion of patients with hepatotoxicity within 90 days after imatinib administration was 33.9%. Proton pump inhibitors (PPIs) increased the incidence of hepatotoxicity approximately 3.8-fold and doubled the hazard of time to reach hepatotoxicity. Patients with liver disease or hepatitis B virus (HBV) carriers had a more than 8-fold higher risk of hepatotoxicity and a 5.2-fold increased hazard of hepatotoxicity compared to those without liver disease or HBV. Patients with body weight under 55 kg had a 2.2-fold higher risk for occurrence of hepatotoxicity. Patients with an imatinib dose > 400 mg had a 2.3-fold increased hazard of time to reach hepatotoxicity compared to those with an imatinib dose ≤ 400 mg. @*Conclusion@#The findings of this study suggest that the use of PPIs and presence of liver disease or HBV were associated with imatinib-induced hepatotoxicity. Thus, close liver function monitoring is recommended, especially in patients with liver impairment or using PPIs.

Real-world Treatment Pattern and Outcomes of Hypercalcemia among Solid Tumor Patients

BACKGROUND: Hypercalcemia is an important metabolic emergency condition in cancer patients. Bisphosphonate is the treatment of choice for hypercalcemia, whereas calcitonin and hydration with furosemide are recommended for acute supportive therapy. However, data regarding real-world treatment patterns and outcomes of pharmacological treatments are limited. Therefore, we aimed to investigate the treatment patterns and clinical outcomes of hypercalcemia treatment in solid tumor patients. METHODS: Electronic medical records of 123 adults with solid cancers and albumin-corrected calcium levels >10.5 mg/dL or ionized calcium levels >1.35 mmol/L were reviewed. We retrospectively analyzed the pharmacological treatment and recovery rate according to the severity of hypercalcemia. RESULTS: A total of 177 cases were identified, of which 49 were not treated and 30 were treated with hydration only. In moderate-to-severe cases, 86.5% received pharmacological treatment. Thirty-four cases (19.2%) were treated with bisphosphonate alone and 58 cases (32.8%) were treated with bisphosphonate and calcitonin. In mild hypercalcemia cases, the recovery rate was higher for those receiving hydration only or pharmacological treatment (79.7%) than for those receiving no treatment (61.4%, p = 0.041). Most moderate-to-severe cases were treated with medication and of those treated, 56.3% recovered. The recovery rate was lower in those treated with bisphosphonate alone (38.2%) than in those who underwent calcitonin combination treatment (73.7%, p = 0.001). CONCLUSIONS: Bisphosphonate combined with calcitonin was found to be more effective than bisphosphonate alone for the treatment of moderate-to-severe hypercalcemia. Considering the current shortage of calcitonin, further efforts are required to ensure its stable supply.

Effects of Early Phosphorus Intake on Respiratory Distress in Extremely Low-Birth-Weight Infants

PURPOSE: This study was aimed to investigate the effect of early phosphorus intake on respiratory distress in extremely low-birth-weight infants (ELBWIs) with a high incidence of hypophosphatemia. METHODS: We performed a retrospective study to target 164 ELBWIs admitted to the neonatal intensive care unit in Seoul National University Children's Hospital. Birth characteristics, nutritional intake, and electrolyte levels during the first week were investigated as predictors that would affect the clinical outcomes. The correlations among invasive ventilation at postnatal age of 2 weeks, moderate-to-severe bronchopulmonary dysplasia (BPD), and phosphorous intake were analyzed. RESULTS: Hypophosphatemia (phosphorus level <4 mg/dL) was observed in 72.0% of the subjects. The rates of invasive ventilation (P=0.001) and moderate-to-severe BPD (P=0.005) were significantly lower in the high phosphorus intake group (≥0.7 mM/kg/day) than in the low phosphorus intake group (<0.7 mM/kg/day). Phosphorus intake during the first week was a significant factor affecting invasive ventilation at 2 weeks of age (adjusted odds ratio [OR], 8.212; 95% confidence interval [CI], 2.256 to 28.896; P=0.001) and moderate-to-severe BPD (adjusted OR, 3.402; 95% CI, 1.274 to 9.084; P=0.015). CONCLUSION: Early insufficient phosphorus intake confers a significantly higher risk with invasive ventilation at 2 weeks of age and moderate-to-severe BPD. Therefore, early sufficient phosphorus supply may improve respiratory outcomes in ELBWIs.

Corrigendum: Infection Control in Parenteral Nutrition Preparation and Compounding

The authors revised some errors regarding Table 5 and 6 in the article as the corrigendum. Because it is not official and may be changed in the revision due out in June 2019, Table 5 and 6 should be deleted and do not refer to it.

Infection Control in Parenteral Nutrition Preparation and Compounding

Recently, in Korea, the importance of preparation and use of injectable drugs has been emphasized due to successive fatal accidents caused by injection infections. Parenteral nutrition (PN) has also been identified as a cause of infection. Cases of infection due to PN have been reported not only in Korea, but also abroad, and contamination occurs mainly during the preparation of PN. Because sterile preparation and compounding of injections are very important for infection control and patient safety, this article reviews the major guidelines outlined thus far. The Korea Ministry of Food and Drug Safety in 2006 published guidelines and the KSHP (Korean Society of Health-System Pharmacists) recently issued guidelines for the aseptic preparation of injections. In addition, as US guidelines, the ASHP (American Society of Health-System Pharmacists) guidelines and United States Pharmacopeia (USP) are also reviewed. The recent guidelines published by the KSHP have significance in that they were adopted in accordance with the domestic reality, even though they conform to foreign guidelines, and are expected to be guidelines for hospital pharmacists performing aseptic preparation work. In addition, the Korea Ministry of Health and Welfare is considering appropriate guidelines for the safe management of medications, training staff for infection prevention and strengthening staff capacity. Furthermore, the gradual expansion of aseptic compounding facilities and human resources, as well as the provision of adequate medical costs are also considered. Based on the establishment and standardization of injectable drugs compounding guidelines for Korean hospitals, it is believed that if human resources and facilities are supported and medical charges are improved, it will be possible to expect the safer preparation and use of injections.

Comparison of Native Escherichia coli L-Asparaginase versus Pegylated Asparaginase, in Combination with Ifosfamide, Methotrexate, Etoposide, and Prednisolone, in Extranodal NK/T-Cell Lymphoma, Nasal Type / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to compare asparaginase-related toxicities in two asparaginase preparations, namely native Escherichia coli L-asparaginase (L-ASP) and pegylated asparaginase (PEG-ASP) in combination with ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) in natural killer (NK)/T-cell lymphoma (NTCL). MATERIALS AND METHODS: A total of 41 NTCL patients who received IMEP plus native E. coli L-ASP or PEG-ASP at Seoul National University Hospital were included in this study between January 2013 and March 2016. IMEP/ASP treatment consisted of ifosfamide, methotrexate, etoposide, plus native E. coli L-ASP (6,000 IU/m2 on days 1, 3, 5, 7, 9, and 11) or PEG-ASP (2,500 IU/m2 on day 1) every 3 weeks. ASP-related toxicities, toxicity patterns, length of hospital stay, and clinical outcomes were compared between the different treatment groups. RESULTS: The frequency of ASP-related toxicities was similar between the IMEP plus native E. coli L-ASP group and the PEG-ASP group apart from hypofibrinogenemia (native E. coli L-ASP vs. PEG-ASP group, 86.4% vs. 36.8%; p=0.001). Although post-treatment transaminase and albumin levels were significantly high and low, respectively, hepatotoxicity gradients before and after treatment did not differ significantly between the groups. Since PEG-ASP was given at an outpatient clinic in some patients, length of hospital stay was significantly shorter in the IMEP plus PEG-ASP group (median, 4.0 vs. 6.0 days; p=0.002). A favorable tendency of clinical outcomes was observed in NTCL patients treated with IMEP plus PEG-ASP (complete remission rate, 73.7% vs. 45.5%; p=0.067). CONCLUSION: IMEP plus PEG-ASP showed similar ASP-related toxicities, shorter length of hospital stay, and a trend towards improved clinical outcomes compared with IMEP plus native E. coli L-ASP in NTCL.

Comparison of Sugammadex and Neostigmine on First Spontaneous Breathing and Adverse Effects for Laparoscopic Cholecystectomy

OBJECTIVE: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. METHODS: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). RESULTS: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p < 0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p < 0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p < 0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p < 0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p < 0.05). CONCLUSION: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.

A case series of eperisone-induced immediate hypersensitivity

Eperisone is a widely used muscle relaxant and believed to be relatively free of adverse drug reactions. However, a rare case of fatal anaphylaxis has been reported in the literature. Poor awareness due to its rarity and combined administration with other drugs are the major hurdles in diagnosing eperisone-induced anaphylaxis. We experienced 3 cases of immediate hypersensitivity reaction occurring after eperisone administration. Case 1, a 63-year-old female, was admitted via the Emergency Department with urticaria, generalized erythroderma, sore throat, chest discomfort, and dyspnea within 1 hour after administration of common cold remedy. Case 2, a 58-year-old male, visited our allergy clinic to detect culprit drugs. He experienced itching, urticaria, hypotension for several hours after administration of the pills for back pain in the last 3 years. Case 3, a 58-year-old male developed urticaria and dyspnea after administration of medication for a headache. He also experienced urticaria and facial edema after administration of the common cold remedy. Among the medications, eperisone hydrochloride was proven as the culprit drug and others were excluded through oral provocation tests. We advised them to avoid eperisone and issued drug safety card. Clinicians should be aware that eperisone hydrochloride is a potential culprit agent of fatal anaphylaxis.

Beta Blockers or Calcium Channel Blockers as Primary Antianginal Drug after Percutaneous Coronary Intervention: Prescription Pattern and its association with Clinical Outcome

OBJECTIVE: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. METHODS: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. RESULTS: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). CONCLUSION: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.

Evaluation of Peri-procedural Warfarin Therapy Undergoing Cardioversion in Patients with Atrial fibrillation

OBJECTIVE: Direct current cardioversion for atrial fibrillation could be associated with the risk of thromboembolic events. Anticoagulation therapy with warfarin (INR 2.0-3.0) is recommended 3 weeks before and 4 weeks after cardioversion to reduce the risk of thromboembolism. This study evaluated warfarin therapy in pharmacist-managed anticoagulant services (ACS). METHODS: This retrospective study was performed in 106 patients with atrial fibrillation from 2012 to 2013. The primary efficacy endpoint was the composite of stroke, transient ischemic attack, myocardial infarction, and cardiovascular death. The primary safety measure was major bleeding. To evaluate the peri-procedural effects of warfarin treatment, we studied whether target INR was maintained, as well as the maintenance period of the therapeutic range. Quality of treatment was measured by time in therapeutic range (TTR) by using the Rosendaal method. RESULTS: There were no thromboembolic events, but TEE examination at time of cardioversion showed a left atrial thrombus in three patients (2.8%). Bleeding complications after cardioversion occurred in 2 patients (1.9%). The average INR value at the time of cardioversion was 2.59±0.8, and was within the therapeutic range in 83 patients (78%). Analysis of the patients in whom the value was within the therapeutic range twice consecutively showed that the ratio of TTR was 80% and the therapeutic range was maintained in 67 patients (63%) for an average of 4.90 weeks prior to cardioversion. Similarly, 76 patients (72%) had a stable INR within the therapeutic range for an average of 5.70 weeks and a mean TTR of 83%. CONCLUSION: Pharmacists significantly contributed to appropriate warfarin treatment with close monitoring during cardioversion. Likewise, active pharmacist monitoring and systemic management should be considered to reduce thromboembolism and bleeding complications in the peri-cardioversion period.

A Study on the Validity of the Hospital Infection Surveillance Records Collected by Ward Liaison Nurses / 감염

BACKGROUND: Hospital infection surveillance is a dynamic process for gathering, managing, analyzing, reporting and re-evaluating the data. Recently there has been an increased awareness of the importance of hospital infection surveillance and management program in Korea. The most ideal way among the hospital infection surveillance systems is known to be the "reference method". In this method all hospital patient records and charts are reviewed and the infected patient are investigated in daily basis. However it requires enormous efforts to apply this method in hospitals with limited personnel resources. Although the number of the hospital having full-time hospital infection control nurses has been increased considerably in Korea the effective hospital control programs have not been established yet in most hospitals owing to the lack of full-time hospital infection control nurses. Nevertheless it became indispensable to develop an alternative hospital infection surveillance program that is readily available. This study was carried out to investigate epidemiologic characteristics, and assess the efficiency and validity of ward liaison surveillance method for nosocomial infection surveillance in a general hospital without full-time infection control nurses. METHOD: During the period of the study, from March 1 to March 31, 2000, cases of hospital infection collected by two different methods, reference method and ward liaison nurse surveillance, were compared. The validity of ward liaison surveillance data was examined using the data collected by the reference method as gold standard. RESULT: In the data collected by the reference method, 94 cases of hospital infection were identified whereas 83 cases by the ward liaison nurses. The incidence rate of hospital infection was 9.5% during one month; the incidence rates were higher in males (12.6%) than female (6.7%) and in age group of 50s. The incidence rates by ward were 38.8% in intensive care unit, 45.5% in neurosurgery, 18.6% in neurology ward, 12.8% in internal medicine, 10.6% in orthopedic ward, and 8.6% in general surgery. Sites of hospital infection in the order of decreasing frequency were urinary tract (24.8/1000 discharge patients), lung (22.2), wound (18.2), and other respiratory systems (15.2). The type of microorganisms isolated were 16: three gram-positive bacteria, eleven gram-negatives and two fungi. Staphylococcus was the most frequently isolated organism, 21 strains, among which 17 strains were methicillin-resistant Staphylococcus aureus (only one strain was sensitive to methicillin) and three strains were methicillin resistant Staphylococcus epidermidis. Seventeen strains of Pseudomonas aeruginosa were isolated from pneumonia, urinary tract, and wound. Escherichia. coli, Serratia marcencecs, Acinetobacter baumannii, Klebsiella pneumoniae, Enterococcus faecalis, E. faecium, Enterobacter cloacae, Streptococcus pneumoniae, and Candida albicans were also isolated. There were twenty-two specimens that revealed no growth of any organisms. In the ward liaison nurse surveillance method, the number of false positive hospital infection was eleven cases and the false negative was 22 cases. The validity evaluated by four different measurements were sensitivity 76,7%, specificity 98.7%, positive predicted value 86.7%, negative predicted value 97.5%. Thus the ward liaison nurse surveillance method was shown to be a valid method with high efficiency. The false positive and false negative cases were mainly occurred by the deficient knowledge in the definition of hospital infection, and deficient skills of investigating the patient's symptoms and clinical course; the liaison nurses had not checked all the surgical site resulting in low sensitivity in surgical site infection. CONCLUSION: According to the results, the epidemiologic characteristic of hospital infection in this particular community hospital studied was not much different from other study results; the incidence rate of hospital infection for one month was 9.5%. On the other hand the ward liaison nurse surveillance method was shown to be satisfactory in detecting hospital infection. This could be a useful method for hospitals without full-time infection control nurses. Furthermore, the validity of this method could be improved by accumulation of the knowledge and skills on hospital infection surveillance through a well planned on-the-job training program for the nurses.

A Combined Therapy for Hyperphosphatemia in the Tumor Lysis Syndrome: Hemodialysis and Continuo Arteriovenous Hemofiltration / 대한신장학회잡지

The acute tumor lysis syndrome is an acute illness caused by massive cell lysis after chemotherapies. This syndrome is characterized by hyperuricemia, hyperphosphatemia with hypocalcemia and hyperkalemia. Among these electrolyte abnormalities, the most serious complication is the severe hyperphosphatemia (greater than 14mg/dL) that could result in sudden cardiac arrest or respiratory failure. In order to correct the severe hyperphosphatemia, hemodialysis has been used commonly as the renal replacement therapy . However the hemodialysis can make posthemodialysis serum phosphate rebounded unless the patient take this treatment for more than 6 hours. Therefore it is not sufficient to use hemodialysis treatment alone. To solve this problem, hemodialysis has been used with or replaced by the uninterrupted dialysis technique such as CRRT (continuous renal replacement therapy). We report a 33-year-old man with Burkitt lymphoma who showed severe hyperphosphatemia (peak phosphate value was 18.6mg/dL) during the course of chemotherapy. used with 5 day CAVH (continuous arteriovenous hemofiltration) his phosphate level could be maintained without any rebound. Therefore we concluded that CAVH in conjunction with hemodialysis would be a successful way to control severe hyperphosphatemia associated with tumor lysis syndrome.

Correlation of Urine Ammonium with Urine Osmolal Gap in High Anion Gap Matabolic Acidosis: Comparison to Urine Anion Gap / 대한내과학회지

OBJECTIVES: Urine anion gap(UAG) and urine osmolal gap(UOG) were proposed as indirect measures of urine ammonium(NF4+). While the former is known to have its usefulness limited to hyperchloremic metabolic acidosis, the latter is reported to have its correlation with urine NE4+ in ketoacidosis. This study was undertaken to evaluate the correlation of urine NH with IJOG in high anion gap metabolic acidosis(AGMA) and to compare it with UAG. METHODS: We measured urine NH' by enzymatic determination, UOG(=0.5 X [urine osmolality-{2 X (Na++K+)+urea+glucose)]), and UAG(=Na++K+-Cl-) in 18 patients(serum AG=24.4+/-1.6mmol/L ) with AGMA. RESULTS: When they were grouped into those with acute disorders(n=11) and those with chronic disorder(n=7), urine Nk4+ concentration was higher (p40mmol/d) had the UOG>40mmol/L. CONCLUSION: In contrast to the UAG, the UOG has a significant correlation with urine NH4+ in AGMA.

The 24-Hour Ambulatory Blood Pressure in Normotensive Korean Adults

BACKGROUND: Twenty-four-hour ambulatory blood pressure(ABP) monitoring has become increasingly popular for diagnosing and treating hypertension. Therefore the reference value of normotensive subjects was necessary for interpretation of hypertensive subjects. Several studies were reported on reference values in normotensive subjects. The purpose of this study was to determine 24-hour ABP in normotensive Korean adults stratified for sex and five age groups. This study also assessed ABP in relation to a family history of hypertension, smoking and body mass index(BMI). METHODS: ABP monitoring was performed in 200 healthy normotensive volunteers(ranged in age from 20 to 69 years, five decades, 20 men and 20 women per each decade), over 24 hours, taking measurement at 30-min intervals. The 24-hour interval was divided into day-time(6am-10pm) and night-time(100pm-6am) periods. Mean ABP and pressure loads(percentage of systolic readings>140mmHg, diastolic readings>90mmHg) were obtained. RESULTS: The mean ABP in 200 subjects was 113+/-8.6/72+/-6.9mmHg over 24 hours, 117+/-9.7/75+/-7.0mmHg during day-time, and 106+/-9.8/67+/-8.3mmHg at night-time, and pressure loadd averaged 5.1+/-7.4/7.9+/-8.9% over 24 hours. The +2 standard deviation(SD) as the upper limit of normal was 130/86mmHg over 24 hours in 200 subjects. The mean ABP and pressure load were 116+/-7.6/74+/-7.6mmHg and 6.4+/-8.3/10.1+/-10.2% in 100 subjects of men, and 110+/-8.3+/-70+/-6.6mmHg, 3.7+/-6.0/5.7+/-6.8% in women. Mean ABP and pressure load showed significant difference in relation to age group and sex, however, no significant difference in relation to a family history of hypertension or smoking. In relation to BMI group, diastolic blood pressure and diastolic pressure load were significantly different.

Pseudo-Bartter's syndrome with nephrocalcinosis caused by long-term surreptitious furosemide ingestion / 대한내과학회지

No abstract available.