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다제내성결핵 균주에서 Reverse Hybridization Assay를 이용한 Fluoroquinolone, Kanamycin 신속 내성 검사의 유용성
박진수 ( Chin Su Park ),성낙문 ( Nack Moon Sung ),황수희 ( Soo Hee Hwang ),전재현 ( Jae Hyun Jeon ),원영섭 ( Young Sub Won ),민진홍 ( Jin Hong Min ),김천태 ( Cheon Tae Kim ),강형석 ( Hyung Seok Kang ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1
Multidrug-resistant tuberculosis (MDR-TB) is an increasing public health problem and poses a serious threat to global TB control. Fluoroquinolone (FQ) and aminoglycoside (AG) are essential anti-TB drugs for MDR-TB treatment. REBA MTB-FQ? and REBA MTB-KM? (M&D, Wonju, Korea) were evaluated for rapid detection of FQ and kanamycin (KM) resistance in MDR-TB clinical isolates. M. tuberculosis (n=67) were isolated and cultured from the sputum samples of MDR-TB patients for extracting DNA of the bacilli. Mutations in genes, gyrA and rrs, that have been known to be associated with resistance to FQ and KM were analyzed using both REBA MTB-FQ? and REBA MTB-KM?, respectively. The isolates were also utilized for a conventional phenotypic drug susceptibility test (DST) as the gold standard of FQ and KM resistance. The molecular and phenotypic DST results were compared. Sensitivity and specificity of REBA MTB-FQ? were 77 and 100%, respectively. Positive predictive value and negative predictive value of the assay were 100 and 95%, respectively, for FQ resistance. Sensitivity, specificity, positive predictive value and negative predictive value of REBA MTB-KM? for detecting KM resistance were 66%, 94%, 70%, and 95%, respectively. REBA MTB-FQ? and REBA MTB-KM? evaluated in this study showed excellent specificities as 100 and 94%, respectively. However, sensitivities of the assays were low. It is essential to increase sensitivity of the rapid drug resistance assays for appropriate MDR-TB treatment, suggesting further investigation to detect new or other mutation sites of the associated genes in M. tuberculosis is required.
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객담 전처리 방법에 따른 객담 항산균 도말 및 배양 양성률 비교연구
강형석 ( Hyung Seok Kang ),성낙문 ( Nack Moon Sung ),이선숙 ( Sun Sook Lee ),김도형 ( Do Hyung Kim ),전두수 ( Doo Soo Jeon ),황수희 ( Soo Hee Hwang ),민진홍 ( Jin Hong Min ),김진희 ( Jin Hee Kim ),원영섭 ( Young Sub Won ),박승규 ( 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
연구배경: NaOH (sodium hydroxide) 기법을 이용한 전처리 객담과 NALC-NaOH (N-acetyl-L-cysteine-sodium hydroxide) 기법을 이용한 객담의 항산균 도말 및 결핵균 배양 양성률 그리고 배지 오염률을 비교하여 실험실 검사과정 중의 일부분을 개선함으로써 검사 결과의 개선이 가능한 지 확인하고자 하였다. 방법: 2007년 6월부터 2008년 6월까지 국립마산병원에서 객담 검사가 시행된 환자를 대상으로 환자에게서 객담배출 요령을 충분히 교육한 후 두개의 객담 검체를 채취하여 통상적인 NaOH 기법과 NALC-NaOH 기법을 각각 적용한 후 도말 및 배양 결과 그리고 배지 오염률을 비교하였다(n=436). 결과: 항산균 도말 검사에서는 NaOH 기법에 비하여 NALC-NaOH 기법이 다소 높은 양성률(33.0% vs. 39.0%)을 보였으나 통계적인 유의성은 없었다(p=0.078). 결핵균 배양 검사에서는 배지 오염률(culture contamination)은 각각 3.2%와 3.0%로 유의한 차이는 보이지 않았다. 배양 양성률은 NALC-NaOH 기법이 통계적으로 유의하게 높은 배양 양성률(39.7% vs. 28.0%, p=0.0003)을 보였으며, 배양 결과를 도말 검사 결과와 연관 지어 분석하였을 때 도말 검사상 음성인 경우 NaOH 기법과 NALC-NaOH 기법은 각각 7.2%와 15.8% (p=0.0017), scanty를 보인 객담의 경우 각각 42.9%와 60.8% (p=0.036)의 배양 양성률을 보여 통계적으로 의미 있는 차이를 보였다. 결론: 도말 검사에서 음성이나 scanty를 보여 상대적으로 결핵균의 수가 적은 객담의 경우 NALC-NaOH를 이용함으로써 배양 양성률을 개선 시킬 수 있었으며 이는 임상적으로 폐결핵의 진단과 치료 경과 관찰에 직접적인 도움을 줄 수 있음을 보여주었다. Background: Sputum decontamination with NALC-NaOH (N-acetyl-L-cysteine-sodium hydroxide) is known to better detect Mycobacterium tuberculosis (M. tb) by culture than that with using NaOH, which is widely used in Korean hospitals. In this report, sputum samples collected from pulmonary tuberculosis (TB) patients were treated with either NaOH or NALC-NaOH, and we compared the results of smear and culture positivity to determine whether the NALC-NaOH treatment method improves culture positivity in the sputum samples, and especially for those sputum samples that are smear negative and scanty. Methods: For each decontamination method, 436 sputum samples from pulmonary TB patients in the National Masan Tuberculosis Hospital were collected for this study. Sputum from a patient was collected two times for the first and second day of sampling time, and these samples were employed for the decontamination process by performing the 4% NaOH and NALC-2% NaOH treatment methods, respectively, for detecting M. tb by an AFB (Acid Fast Bacilli) smear and also by culture in solid Ogawa medium. Results: The NaOH and NALC-NaOH treatment methods did not significantly affect the AFB smear positivity of the sputum samples (33.0% vs 39.0%, respectively, p=0.078). However, the culture positive percents of M. tb in the Ogawa medium treated with NALC-NaOH and NaOH were 39.7% and 28.0%, respectively, which was a significantly different (p=0.0003). This difference in culture was more prominent in the sputum samples that were smear negative (the positive percents with NALC-NaOH and NaOH were 15.8% and 7.2%, respectively, p=0.0017) and scanty (NALC-NaOH and NaOH were 60.8% and 42.9%, respectively, p=0.036), but not for a smear that was 1+ or higher (p>0.05). Conclusion: NALC-NaOH treatment is better than NaOH treatment for the detection of M. tb by culture, but not by smear, and especially when the AFB smear is negative and scanty. (Tuberc Respir Dis 2008;65:379-384)
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온도 및 기계적 자극에 대한 진통제의 심맥관계 반응 억제효과 비교
권재영,백승완,김해규,정규섭,김인세,원영섭 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7
One of the important functions of nervous system is to supply the information related to the injury. Therefore, for various kinds of injuries, to feel pain is thought to be the part of this important function. There are A-fiber (Type I AMHs, Type II AMHs) & C-fiber (CMHs) which respond to the mechanical & thermal stimuli as the nerve fibers of peripheral unit performing this function. The phenomena expressed to us by these stimuli are those reaction like the in- crease of heart rate and the elevation of blood pvessure by stimulation of the autonomic nervous system as well as pain. As it is, using these reactions which are the most popular parameter of pain expression during anesthesia, we make the depth of anesthesia deeper or use analgesics as adjuvants. In general, there are many kinds of analgesics for adjuvants of anesthesia or for elimination of postoperative pain. To compare the efficiency of those analgesics toward pain, the authors studied the inhibitory effects of analgesics on the increase of pulse rate and mean arterial pressure evoked by the thermal and mechanical stimulations in rats. We used the agents popularly used in nowadays 1) Tramadol HC1, known as a potent analgesics, 2) Nalbuphine, antagonist of opioids, 3) Meperidine and Morphine, opioids to com- pare the efficiency of hemodynamic augumentation by the thermal and mechanical stimulations with the control group. The results were as follows; 1) The inhibitory effects on the increase in pulse rate and mean arterial pressure evoked by the stimulations were in the decsing order of morphine, meperidine, nalbuphine, and tramadol. 2) The inhibitory effect of morphine on the incmnent of pulse rate and mean arterial pressme was evident. 3) Meperidine and nalbuphine, not so much potent as morphine in inhibitory also inhibit to a considerable degree. 4) In the case of tramadol, the increament of pulse rate evoked by the stimulations were inhibited to some extent, but it was proven not to inhibit the elevation of mean arterial pressure.
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