Slide Session : OS-111 ; Sleep : The Effects of Dexmedetomidine for Sleep in Critically Ill Patients: Pilot Study

( Se Joong Kim ),( Jinsoo Min ),( Jisoo Park ),( Yeon Joo Lee ),( Jong Sun Park ),( Ho Il Yoon ),( Jae Ho Lee ),( Choon Taek Lee ),( Young Jae Cho ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Many critically ill patients in the intensive care unit (ICU) experience sleep disruption and delirium. For the sedation of these patients, dexmedetomidine is one of commonly recommended sedatives because of its pharmacokinetic merit. This pilot study was undertaken to identify the effects of dexmedetomidine for sleep and delirium in critically ill patients. Methods: This prospective study was conducted in medical ICU of a tertiary referral hospital. Dexmedetomidine was administered with the maintenance dose of 0.4-0.7μg/ kg/hr and adjusted by Richmond Agitation Sedation Scale score of 0 to -2. Portable polysomnography was performed in the ICU over 24 hour to assess the quantity and quality of sleep. The confusion assessment method for ICU was used for detection of delirium. Results: Total 9 patients were enrolled. Median age was 77.0 (Range: 61-90) and 3 patients experienced delirium. Median total sleep time was 283 (IQR: 56-739) min. The majority of sleep was stage 1 (median 208 [IQR: 56-356] min) and 2 (median 75 [IQR: 7-396] min) with absent REM and stage 3 sleep. The dose of dexmedetomidine was not associated with total sleep time, stage 1 and stage 2 sleep (all P>0.05). However, the patients with delirium was administered higher dose of dexmedetomidine than ones without delirium (0.67μg/kg/hr vs 0.33μg/kg/hr, P=0.006). Conclusions: Although proper sedation was met with dexmedetomidine, the quantity and quality of sleep in critically ill patients were poor. Further study is required for the promotion of good sleep and the prevention of delirium in ICU patients.

End-stage Renal Disease and Risk of Active Tuberculosis: a Nationwide Population-Based Cohort Study

Min, Jinsoo,Kwon, Soon Kil,Jeong, Hye Won,Han, Joung-Ho,Kim, Yeonkook Joseph,Kang, Minseok,Kang, Gilwon KOREAN ACADEMY OF MEDICAL SCIENCE 2018 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.33 No.53

<P><B>Background</B></P><P>The converging epidemics of tuberculosis (TB) and end-stage renal disease (ESRD) have generated a significant public health burden, however, previous studies have been limited to a small number of patients. This nationwide cohort study aimed to assess the rate of developing active TB among patients receiving dialysis for ESRD.</P><P><B>Methods</B></P><P>The Korean national health insurance database was used to identify patients receiving dialysis for new-onset ESRD during 2004–2013, who were propensity score matched to an equivalent number of non-dialysis subjects from the general population. The incidences of active TB in the ESRD and control cohorts were calculated for 2004–2013, and multivariable Cox proportional hazards model was used to evaluate the ESRD-related risk of active TB.</P><P><B>Results</B></P><P>During 2004–2013, 59,584 patients received dialysis for newly diagnosed ESRD. In the dialysis and control cohorts, 457 (0.8%) and 125 (0.2%) cases of active TB were detected, respectively. Patients with ESRD were associated with a significantly higher risk of active TB compared to the controls (incidence rate ratio, 4.80). The ESRD cohort had an independently elevated risk of active TB (adjusted hazard ratio, 4.39; 95% confidence interval, 3.60–5.37).</P><P><B>Conclusion</B></P><P>We found that patients receiving dialysis for ESRD had an elevated risk of active TB. These results highlight the need for detailed and well-organised guidelines for active TB screening among patients with ESRD.</P>

Impact of COVID-19 Pandemic on the National PPM Tuberculosis Control Project in Korea: the Korean PPM Monitoring Database between July 2019 and June 2020

Min Jinsoo,Kim Hyung Woo,Koo Hyeon-Kyoung,고유상,Oh Jee Youn,Kim Jaetae,Yang Jiyeon,Kwon Yunhyung,Park Young-Joon,Kang Ji Young,Lee Sung-Soon,Park Jae Seuk,김주상 대한의학회 2020 Journal of Korean medical science Vol.35 No.43

Background: The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems and endangered the control and prevention of tuberculosis (TB). We investigated the nationwide effects of COVID-19 on the national Public-Private Mix (PPM) TB control project in Korea, using monitoring indicators from the Korean PPM monitoring database. Methods: The Korean PPM monitoring database includes data from patients registered at PPM hospitals throughout the country. Data of six monitoring indicators for active TB cases updated between July 2019 and June 2020 were collected. The data of each cohort throughout the country and in Daegu-Gyeongbuk, Seoul Metropolitan Area, and Jeonnam-Jeonbuk were collated to provide nationwide data. The data were compared using the χ2 test for trend to evaluate quarterly trends of each monitoring indicator at the national level and in the prespecified regions. Results: Test coverages of sputum smear (P = 0.622) and culture (P = 0.815), drug susceptibility test (P = 0.750), and adherence rate to initial standard treatment (P = 0.901) at the national level were not significantly different during the study period. The rate of loss to follow-up among TB cases at the national level was not significantly different (P = 0.088);however, the treatment success rate among the smear-positive drug-susceptible pulmonary TB cohort at the national level significantly decreased, from 90.6% to 84.1% (P < 0.001). Treatment success rate in the Seoul metropolitan area also significantly decreased during the study period, from 89.4% to 84.5% (P = 0.006). Conclusion: Our study showed that initial TB management during the COVID-19 pandemic was properly administered under the PPM project in Korea. However, our study cannot confirm or conclude a decreased treatment success rate after the COVID-19 pandemic due to limited data.

Tuberculosis Surveillance and Monitoring under the National Public-Private Mix Tuberculosis Control Project in South Korea 2016-2017

( Jinsoo Min ),( Hyung Woo Kim ),( Yousang Ko ),( Jee Youn Oh ),( Ji Young Kang ),( Joosun Lee ),( Young Joon Park ),( Sung-soon Lee ),( Jae Seuk Park ),( Ju Sang Kim ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.3

Background: The national Public-Private Mix (PPM) tuberculosis (TB) control project provides for the comprehensive management of TB patients at private hospitals in South Korea. Surveillance and monitoring of TB under the PPM project are essential toward achieving TB elimination goals. Methods: TB is a nationally notifiable disease in South Korea and is monitored using the surveillance system. The Korea Centers for Disease Control and Prevention quarterly generates monitoring indicators for TB management, used to evaluate activities of the PPM hospitals by the central steering committee of the national PPM TB control project. Based on the notification date, TB patients at PPM hospitals were enrolled in each quarter, forming a cohort, and followed up for at least 12 months to identify treatment outcomes. This report analyzed the dataset of cohorts the first quarter of 2016 through the fourth quarter of 2017. Results: The coverage of sputum, smear, and culture tests among the pulmonary TB cases were 92.8% and 91.5%, respectively. The percentage of positive sputum smear and culture test results were 30.7% and 61.5%, respectively. The coverage of drug susceptibility tests among the culture-confirmed cases was 92.8%. The treatment success rate among the smear-positive drug-susceptible cases was 83.2%. The coverage of latent TB infection treatment among the childhood TB contacts was significantly higher than that among the adult contacts (85.6% vs. 56.0%, p=0.001). Conclusion: This is the first official report to analyze monitoring indicators, describing the current status of the national PPM TB control project. To sustain its effect, strengthening the monitoring and evaluation systems is essential.

Non-Surgical Management of Critically Compromised Airway Due to Dilatation of Interposed Colon

Min, Jinsoo,Cho, Young-Jae The Korean Academy of Tuberculosis and Respiratory 2016 Tuberculosis and Respiratory Diseases Vol.79 No.2

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.

Role of Fluoroquniolone in Isoniazid-monoresistant Tuberculosis : A Multicenter Study in Korea

( Jinsoo Min ),( Ju Sang Kim ),( Hyung Woo Kim ),( Ji Young Kang ),( Sung Kyoung Kim ),( Jin Woo Kim ),( Yong Hyun Kim ),( Sang Haak Lee ),( Hyoung Kyu Yoon ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background In 2018, the World Health Organization (WHO) guidelines for the treatment of isoniazid (H)-monoresistant (Hr) tuberculosis (TB) recommend a six-month four-drug regimen: rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin. However, the WHO assessed its regimen to be of very low certainty. This cohort study assessed the impact of fluoroquinolone (Fq) on treatment of effectiveness among Hr-TB patients. Methods This was a retrospective cohort study of 356 Hr-TB patients in 2010-2018. Baseline regimens were classified into 2 groups based on the duration of Z uses; 6-month REZ (6REZ) and combination of 2-month REZ and 7-month RE (2REZ/7RE). Multivariable logistic regression was performed to assess association between Fq use and negative regimen-specific outcomes, which included death due to TB, treatment failure or disease recurrence. Results Of 365 enrolled patients, 256 (71.9%) were treated with 6REZ regimen and 116 (32.6%) with additional Fq use. There were 93 (38.8%) and 39 (33.6%) cases of negative regimen-specific outcomes in patients treated without and with Fq uses, respectively. In a univariable logistic regression model comparing with and without Fq uses, there was no difference in odds of negative regimen-specific outcomes (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.50-1.27); however, compared to 2REZ/7RE regimen, 6REZ regimen was significantly associated with negative regimen-specific outcomes (OR = 2.15, 95% CI = 1.29-3.61). Results varied minimally in a multivariable model. Among patients with positive outcomes, the median overall treatment period was 274 days and additional Fq use did not reduce overall treatment period (273 days in regimen without Fq vs. 279 days in regimen with Fq, p=0.086). Conclusions We found that additional Fq use did not show more benefits for Hr-TB patients. However, 2REZ/7RE regimen was more efficacious than 6REZ regimen. The WHO’s Hr-TB recommendation needs to be carefully re-evaluated with further prospective studies.

Latent Tuberculosis Cascade of Care Among Healthcare Workers: A Nationwide Cohort Analysis in Korea Between 2017 and 2018

Min Jinsoo,Kim Hyung Woo,Choi Joon Young,Shin Ah Young,Kang Ji Young,Lee Yunhee,Myong Jun-Pyo,Jeong Hyunsuk,Bae Sanghyuk,Koo Hyeon-Kyoung,Lee Sung-Soon,Park Jae Seuk,Yim Hyeon Woo,Kim Ju Sang 대한의학회 2022 Journal of Korean medical science Vol.37 No.20

Background: In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model. Methods: We included 45,503 employees of medical institutions with positive interferongamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care. Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and notcompleting treatment. Results: Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64–0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81–0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29–1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16–1.53). Conclusion: Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.

Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study

Jinsoo Min,Yousang Ko,Hyung Woo Kim,구현경,Jee Youn Oh,Yun-Jeong Jeong,Hyeon Hui Kang,Kwang Joo Park,Yong Il Hwang,Jin Woo Kim,Joong Hyun Ahn,Yangjin Jegal,Ji Young Kang,Sung-Soon Lee,Jae Seuk Park,Ju Sa 대한의학회 2022 Journal of Korean medical science Vol.37 No.3

Background: The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems, consequently endangering tuberculosis (TB) control. We investigated delays in TB treatment among notified patients during the first wave of the COVID-19 pandemic in Korea. Methods: We systemically collected and analyzed data from the Korea TB cohort database from January to May 2020. Groups were categorized as ‘before-pandemic’ and ‘during-pandemic’ based on TB notification period. Presentation delay was defined as the period between initial onset of symptoms and the first hospital visit, and healthcare delay as the period between the first hospital visit and anti-TB treatment initiation. A multivariate logistic regression analysis was performed to evaluate factors associated with delays in TB treatment. Results: Proportion of presentation delay > 14 days was not significantly different between two groups (48.3% vs. 43.7%, P = 0.067); however, proportion of healthcare delay > 5 days was significantly higher in the during-pandemic group (48.6% vs. 42.3%, P = 0.012). In multivariate analysis, the during-pandemic group was significantly associated with healthcare delay > 5 days (adjusted odds ratio = 0.884, 95% confidence interval = 0.715–1.094). Conclusion: The COVID-19 pandemic was associated with healthcare delay of > 5 days in Korea. Public health interventions are necessary to minimize the pandemic’s impact on the national TB control project.

Tuberculosis surveillance and monitoring under the national public-private mix tuberculosis control project in South Korea between 2016 and 2017

( Jinsoo Min ),( Hyung Woo Kim ),( Yousang Ko ),( Jee Youn Oh ),( Ji Young Kang ),( Ju Sang Kim ),( Sung- Soon Lee ),( Jae Seuk Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: The Public-Private Mix (PPM) collaboration project was implemented in 2011 in order to provide comprehensive management of tuberculosis (TB) patient at PPM hospitals in South Korea. PPM collaboration was expanded from 97 hospitals in 2011 to 125 hospitals in 2018. Surveillance and monitoring of TB under the national PPM TB control project is essential to achieve TB elimination goals set by the World Health Organization. Methods: TB is a nationally notifiable disease in South Korea and is monitored using the Korean National TB Surveillance System. The Korea Centers for Disease Control and Prevention quarterly generate monitoring indicators of TB management, which are used in order to oversee activities of PPM hospitals by the steering committee of national PPM project. Based on the notification date, TB patients at PPM hospitals were enrolled in each quarter, which formed a cohort. A cohort was followed up for at least one year to identify treatment results. This report analyzed dataset of cohorts between first quarter of 2016 and fourth quarter of 2017. Results: Coverage of sputum AFB smear and culture among pulmonary TB cases were 92.8% and 91.5%, respectively. Coverage of both phenotypic and genotypic drug susceptibility test among culture-confirmed cases was 92.8%. Treatment success rate among smear-positive drug-susceptible cases was 83.2%. Coverage of latent TB infection treatment among childhood TB contacts was significantly higher than among adult contact (85.6% vs. 56.0, p-value = 0.001). Conclusions: Although the TB rate has decreased significantly after implementation of national PPM control project in South Korea, sustained efforts, such as TB monitoring systems, government supports and political wills, are still required to reduce rates further and reach the goal to end TB.

Delays of Tuberculosis Care during COVID-19 Pandemic in South Korea

( Jinsoo Min ),( Ju Sang Kim ),( Hyung Woo Kim ),( Hyeon-kyoung Koo ),( Yousang Ko ),( Jee Youn Oh ),( Ji Young Kang ),( Sung-soon Lee ),( Jae Seuk Park ),( Yunhyung Kwon ),( Jiyeon Yang ),( Jiyeon Ha 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems and endangered the control and prevention of tuberculosis (TB). We investigated delays of TB care during COVID-19 pandemic among notified patients under the national Public-Private Mix (PPM) TB control project in South Korea. Methods A multicenter cross-sectional study was performed on TB subjects who were notified to the national TB surveillance system between January and May 2020 and consecutively enrolled from the first to the tenth days each month. Demographic and clinical data were collected based on in-depth interviews by TB specialist nurses at PPM participating hospitals. Those notified between January and February and between March and May were categorized as ‘before COVID-19 group’ and ‘after COVID-19 group’, respectively. Presentation delay was defined as period between initial symptom onset and the first medical visit. Healthcare delay was defined as period between the first medical visit and treatment initiation. Results Among 1,557 enrolled subjects, 833 subjects were categorized as ‘after COVID-19 group’. Proportion of presentation delay > 14 days was not different between before and after COVID-19 groups; however, proportion of healthcare delay > 5 days was significantly higher in the after COVID-19 group (48.6% vs. 42.3%, p-value=0.012). In a multivariate analysis, after COVID-19 group was significantly associated with healthcare delay > 5 days (adjusted odds ratio=1.25, 95% confidence interval=1.01-1.55). Conclusions COVID-19 pandemic was associated with healthcare delay > 5 days under the PPM project in South Korea. Public health interventions are necessary to minimize COVID-19 pandemic’s impact on the national TB control project.