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Sang-Hyun Ihm,Kwang-il Kim,Kyung Jin Lee,Jong Won Won,Jin Oh Na,Seung-Woon Rha,Hack-Lyoung Kim,Sang-Hyun Kim,Jinho Shin 대한심장학회 2022 Korean Circulation Journal Vol.52 No.1
In primary prevention for cardiovascular diseases, there are significant barriers to adherence including freedom from symptoms, long latency for therapeutic benefits, life-long duration of treatment, and need for combined lifestyle changes. However, to implement more systematic approaches, the focus on adherence improvement needs to be shifted away from patient factors to the effects of the treatment team and healthcare system. In addition to conventional educational approaches, more patient-oriented approaches such as patient-centered clinical communication skills, counseling using motivational strategies, decision-making by patient empowerment, and a multi-disciplinary team approach should be developed and implemented. Patients should be involved in a program of self-monitoring, self-management, and active counseling. Because most effective interventions on adherence improvement demand greater resources, the health care system and educational or training system of physicians and healthcare staff need to be supported for systematic improvement.
( Hyun-jin Kim ),( Jeong-hun Shin ),( Yonggu Lee ),( Ju Han Kim ),( Sun Ho Hwang ),( Woo Shik Kim ),( Sungha Park ),( Sang Jae Rhee ),( Eun Mi Lee ),( Sang Hyun Ihm ),( Wook Bum Pyun ),( Jinho Shin ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.5
Background/Aims: The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and pro-posed a prediction model for MUCH in patients with hypertension. Methods: We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP. Results: Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs com-pared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/㎡ for men, and ≥ 96 g/㎡ for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH. Conclusions: MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.
성현주(Hyun Ju Sung),임인기(In Ki Rim),천진옥(Jin Ok Chun),임성희(Sung Hee Ihm),최문기(Moon Ki Choi),유형준(Hyung Joon Yoo),박성우(Sung Woo Park),장연복(Young Bok Chang),강성원(Sung Won Kang) 대한내과학회 1994 대한내과학회지 Vol.47 No.3
N/A Postpartum thyroid dysfunction is a syndrome of thyroid dysfunction that occurs in the first year after delivery. Presenting clinically as either painless hypothyroidism or thyrotoxicosis, it usually resolves spontaneously. At the time postpartum thyroid dysfunction occurs, the relationship between thyroid antibodies and postpartum thyroid dysfunction is even stronger. The close association of these antibodies with postpartum thyroid dysfunction makes the detection of these antibodies an attractive method for screening large number of pregnant or postpartum women at risk for this disease. Of the 250 women screened on the second postpartum day, 22 women (8.8%) had positive results for serum antimicrosomal antibody. Among the normal controls, 16% had positive results. 18 of these 22 seropositive patients were followed for at least 6 months postpartum. 6 patients (2.4%) developed goiter, and 5 patients (2.0%) had biochemical thyroid dysfunction. All 5 patients developed hypothyroidism without thyrotoxic phase. The disease was mild and transient in two patients. But in remaining 3 patients, goiters and symptoms of hypothyroidism persisted and were treated. The titers of antimicrosomal antibody in women who developed the disease, increased progressively in all patients. Therefore, serum antimicrosomal antibody test after delivery will be useful as a screening test to detect thyroid dysfunction.
Streptozotocin 투여로 유발된 당뇨병성 신증 백서에서 lipoxygenase 억제제가 단백뇨 감소 및 신기능에 미치는 영향
정현철 ( Hyun Chul Chung ),김일영 ( Il Young Kim ),김서린 ( Seo Rin Kim ),손정민 ( Jung Min Son ),이동원 ( Dong Won Lee ),송상헌 ( Sang Heon Song ),성은영 ( Eun Young Seong ),곽임수 ( Ihm Soo Kwak ),이수봉 ( Soo Bong Lee ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5
Purpose: Oxidative stress leads to an increased production of lipoxygenase derivatives in diabetic nephropathy. Thus, we hypothesized that lipoxygenase inhibitor, nordihydroguaiaretic acid (NDGA), ha the effects of decreasing proteinuria and preserving renal function in streptozotocin (STZ)-induced diabetic rats. Methods: 45 Sprague-Dawley rats were divided into three groups; (A) treatment with lipoxygenase inhibitor, NDGA in diabetic nephropathy rats, (B) treatment with dimethyl sulfoxide (DMSO) as a vehicle in STZ-induced diabetic rats, (C) normal control group with subcutaneous injection of normal saline. Diabetes was induced by a single intraperitoneal injection of STZ (65 mg/kg) in rats of group A and B. After the 4th week of STZ injection, NDGA (10 mg/kg) and DMSO were given subcutaneously for another 4 weeks in group A and B respectively. Results: The NDGA-treated diabetic rats exhibited significantly decreased urinary albumin excretion. Serum creatinine and blood urea nitrogen concentrations were increased in both group A and B, and tend to be higher in group B than group A. Twenty-four-hour urine creatinine clearances were increased in both group A and B after injection of STZ. Pathologic alterations of kidney were observed after injection of STZ, and then attenuated after administration of NDGA. Conclusion: These results suggest the potential of lipoxygenase inhibitor as a complementary therapy for the prevention and treatment of diabetic nephropathy.
혈액 투석 환자에서 포도당 희석법과 초음파 희석법을 이용한 혈관 통로의 혈류 속도 비교
하상진 ( Sang Jin Ha ),이윤정 ( Yoon Jung Lee ),조병현 ( Byung Hyun Cho ),정경환 ( Kyung Hwan Jung ),문주영 ( Joo Yung Moon ),이상호 ( Sang Ho Lee ),이태원 ( Tae Won Lee ),임천규 ( Chun Gyoo Ihm ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.4
Purpose : Vascular access flow (Qa) measurements are important in the surveillance protocol of hemodialysis vascular access stenosis. The glucose pump technique (GPT) is a technique for Qa measurement based on the dilution technique of a constant glucose infusion that was introduced in 1995. The aim of this study is to verify the clinical efficacy of GPT in vascular access surveillance compared with ultrasound dilution technique. Methods : In 31 chronic hemodialysis patients with a AV fistula, we compared Qa measurements performed with GPT in pre-dialysis and the ultrasound dilution technique (Transonic HD01, Transonic System Inc., Ithaca, NY) during hemodialysis. Results : Mean Qa was 1171 ml/min by GPT versus 1028 ml/min by HD01 (p=0.262). There was a strong linear correlation between the two methods (r=0.61; p<0.01). Ultrasound dilution technique HD01 yielded 6 cases of high risk Qa measurements and GPT yielded 4 cases of high risk Qa measurements. The diagnostic accuracy of GPT tested with the ROC curve was similar with ultrasound dilution technique HD01. The specificity and sensitivity was 80% and 66.7% according to Qa=600ml/min. But sensitivity was 83.3% according to Qa=750 ml/min. Conclusion : GPT offers the advantage of a simple and economic bedside procedure easily performed before dialysis and had a similar diagnostic accuracy and efficiency compared with ultrasound dilution technique HD01.
김현창,Sang-Hyun Ihm,김근호,Ju Han Kim,Kwang-Il Kim,Hae-Young Lee,이장훈,Jong-Moo Park,박성하,편욱범,신진호,채성철 대한고혈압학회 2019 Clinical Hypertension Vol.25 No.4
The Korean Society of Hypertension guideline defines hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, where the effectiveness of pharmacological treatment has been established. It is confirmed that higher blood pressure levels are associated with increased risk of cardiovascular disease and mortality also in the Korean population. About one third of Korean adults aged 30 years or older are estimated to have hypertension, and the prevalence of hypertension gradually increases as the age increases. The awareness, treatment, and control rates of hypertension are generally improving in Korea, but more efforts are required to increase awareness and treatment among younger patients with hypertension and to improve lifestyle modification compliance at all ages. More studies are required to determine the magnitude and impact of white coat hypertension and masked hypertension in the Korean population.
우리나라 사람면역결핍바이러스 감염 환자의 톡소포자충 감염
이상현 ( Sang Hyun Lee ),이선희 ( Sun Hee Lee ),차동혁 ( Dong Hyuk Cha ),이수진 ( Su Jin Lee ),곽임수 ( Ihm Soo Kwak ),정주섭 ( Joo Seop Chung ),조군제 ( Goon Jae Cho ),이혁 ( Hyuck Lee ),정동식 ( Dong Sik Jung ),문치숙 ( Chi Soo 대한내과학회 2009 대한내과학회지 Vol.76 No.6
목적: 톡소포자충 뇌염은 사람면역결핍바이러스 환자에서 발생하는 중추신경계 기회감염증의 가장 흔한 원인 중하나이다. 우리나라에서 톡소포자충 뇌염은 HIV 감염 환자에서 발생하는 다른 기회감염증들에 비해 매우 드물게 보고되고 있다. 본 연구는 우리나라 HIV 감염 환자의 톡소포자충 감염의 특성과 현 상황에 대하여 알아보고자 하였다. 방법: 1990년부터 2008년까지 고신대병원, 동아대병원, 부산대병원, 인제대병원의 4개 대학병원에 내원한 HIV 감염환자들을 대상으로 의무기록을 후향적으로 분석하였으며, 톡소포자충 뇌염 발생률과 임상적 특성, 톡소포자충 항체 유병률, 혈청전환율 및 톡소포자충 감염의 위험인자에 대하여 조사하였다. 결과: 총 683명의 HIV 감염 환자가 연구대상에 포함되었다. 남자가 598명(87.6%)이었고, 환자들의 정중 나이는 41세(16~76세)였다. 환자들의 CD4 양성 림프구 수의 중앙값은 221/μL이었으며 49%가 처음 내원 시 에이즈로 진행한 상태였다. 총 683명 중 톡소포자충 뇌염으로 내원한 환자는 6명(0.9%)이었으며, 연구기간 동안 톡소포자충 뇌염의 발생률은 100인년당 0.34명(95% 신뢰구간: 0.17~0.72명)이었다. 6명 모두 남자였으며 톡소포자충 뇌염 진단 당시 정중 나이는 42세(32~48세)였다. 6명 중 4명(50%)은 톡소포자충 뇌염 때문에 처음 병원을 방문하였으며, 이 중 3명은 이때 HIV 감염사실을 처음으로 알게 되었다. 톡소포자충 뇌염 진단시점의 CD4 양성 림프구 수의 중앙값은 44/μL (2~99/μL)로 모두 100μL 미만이었다. 총 683명 중 414명(61%)에서 톡소포자충 항체 검사가 시행되었고, 이 중 35명(8.5%)에서 양성이었다. 처음 시행한 톡소포자충 IgG 항체 검사에서 음성이었던 376명중 95명(25.3%)에서 추적검사가 시행되었다. 총 추적기간은 207.7년이었으며 평균 추적기간은 2.2년(1~6.2년)이었다. 추적기간이 1~2년인 경우가 53명(56%)으로 가장 많았으며, 65%에서 추적기간 동안 폐포자충 예방을 위해서 trimethoprim/sulfamethoxazole을 투여한 적이 있었으며, 투여기간은 1년 미만이 38명(61%)으로 가장 많았고, 평균 투여 기간은 전체추적기간의 32%였다. 추적검사가 시행되었던 95명 중 단지 2명(2.1%)에서만 혈청전환이 있었으며, 추적기간 동안의 혈청전환율은 100인년당 0.96명(95% 신뢰구간: 0.47~3.29명)이었다. 톡소포자충 항체 검사가 시행되었던 414명 중 판정 불가였던 3명을 제외한 411명에 대하여 톡소포자충 감염 위험인자를 분석하였다. 단변량 분석에서는 나이가 많을수록, 결혼을 한 경우, 이성접촉에 의한 감염, 해외 거주력이 있는 경우가 유의한 위험인자로 나타났으나(p<0.05), 다변량 분석에서는 해외 거주력만이 통계학적으로 유의한 위험인자였다. 결론: 우리나라 HIV 감염 환자의 톡소포자충 혈청 유병률은 약 8.5%였으며, 톡소포자충 뇌염의 발생률도 100인년당 0.34명으로 전체 환자의 0.9%에서만 발병하여 혈청 유병률뿐만 아니라 발생률 모두가 다른 국가에 비해서 낮은 수준임을 알 수 있었다. 특히 해외 거주력이 있는 경우에는 톡소포자충 감염의 위험성이 4배 정도 높았다. 또한 톡소포자충에 감염되지 않았던 환자를 약 2년간 추적하는 동안 약 2%에서 새로운 감염이 발생할 수 있음을 알 수 있었다. Background/Aims: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. Methods: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. Results: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. Conclusions: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%). (Korean J Med 76:713-721, 2009)