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Clinical Characteristics and Outcome of SCMP in Severe Sepsis Patients Receiving Successful EGDT
( Hea Won Ann ),( Jae Kyung Kim ),( Heun Choi ),( Su Jin Jeong ),( Sun Bean Kim ),( Nam Su Ku ),( Sang Hoon Han,),( Chang Oh Kim ),( Jun Yong Choi ),( Young Goo Song ),( June Myung Kim ) 대한내과학회 2013 대한내과학회 추계학술발표논문집 Vol.2013 No.1
Objectives: The early-goal directed therapy (EGDT) is the current standard approach in severe sepsis patients, which can ameliorate the survival rate up to 10-15 percent. Stress-induced cardiomyopathy (SCMP) is regarded as an acute reversible cardiomyopathy that mimics acute coronary syndrome and increasingly being observed during intensive care with critical ill patients. However, there is no known whether the development of SCMP can affect the clinical outcome in severe sepsis patients received EGDT. Methods: The retrospective cohort study was performed in single center, Severance Hospital. We enrolled total 144 severe sepsis patients with more than 20-years old who received EGDT and transthoracic echocardiography (TTE) within 3 days after emergency department arrival during from January 2008 to June 2012. The demographic, clinical, and laboratory data including EGDT-associated parameters was retrospectively collected from electric medical record. The primary end-point was the 28-day all-cause mortality. The diagnosis of SCMP was defined through the following modified ‘Proposed Mayo Clinic criteria’: (1) an acute cardiac event typically presenting with chest pain and/or dyspnea; (2) transient systolic dysfunction with marked LV contraction abnormality; (3) new ECG abnormalities or modest elevation in cardiac troponin level. Results: The SCMP was identified in 29 (20.1%) patient. The frequency of male and history of diabetes mellitus in patients with SCMP was higher than those in patients without SCMP (72.4% vs. 50.4%, p=0.038 and 48.3% vs. 25.7%, p=0.024, respectively). The patients with SCMP had the higher levels of delta neutrophil index and APACHE II score (27.8±24.1 vs. 14.7±15.4, p=0.006 and 23.3±6.8 vs. 19.5±7.1, p=0.016, respectively). The 7- and 28-day all-cause mortalities were higher in patients with SCMP compared with patients without SCMP (20.7% vs. 6.2%, p=0.026, 37.9% vs. 18.6%, p=0.044). In the Cox`s regression model, the presence of SCMP was the independent factor associated with 28-day all-cause mortality (OR, 2.7, 95% CI 1.8-8.6, p=0.034). Conclusions: The development of SCMP in spite of successful management by EGDT in severe sepsis patients can increase all-cause mortality.
Mycobacterium abscessus에 의해 발생한 지속적 외래 복막투석 관련 복막염 1예
안혜원 ( Hea Won Ann ),조용인 ( Yong In Cho ),한상훈 ( Sang Hoon Han ),최준용 ( Jun Yong Choi ),송영구 ( Young Goo Song ),최규헌 ( Kyu Hun Choi ),김준명 ( June Myung Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1
Mycobacterium abscessus has been reported to cause opportunistic infections in immunocompromised patients. It is a very rare pathogen in continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis. However, we experienced a single case of peritonitis caused by M. abscessus in a patient on CAPD in South Korea. A 52-year-old female on CAPD for 9 years with a past history of recurrent CAPD-associated peritonitis presented with fever, abdominal pain and turbid peritoneal dialysate. CAPD-associated peritonitis did not improve with broad-spectrum antibiotic treatment, and pathogens were not detected in a routine peritoneal fluid bacterial culture. M. abscessus was isolated from a peritoneal fluid mycobacterial culture. The patient recovered after treatment with clarithromycin and levofloxacin for 24 months. (Korean J Med 2014;87:110-114)
Short Communication: HIV-1 Transmission Networks Across South Korea
Ahn, Mi Young,Wertheim, Joel O.,Kim, Woo Joo,Kim, Shin-Woo,Lee, Jin Soo,Ann, Hea Won,Jeon, Yongduk,Ahn, Jin Young,Song, Je Eun,Oh, Dong Hyun,Kim, Yong Chan,Kim, Eun Jin,Jung, In Young,Kim, Moo Hyun,Je Mary Ann Liebert 2017 AIDS RESEARCH AND HUMAN RETROVIRUSES Vol.33 No.8
Jeong, Su Jin,Kim, Min Hyung,Song, Je Eun,Ahn, Jin Young,Kim, Sun Bean,Ann, Hea Won,Kim, Jae Kyung,Choi, Heun,Ku, Nam Su,Han, Sang Hoon,Kim, June Myung,Smith, Davey M.,Kim, Hyon-Suk,Choi, Jun Yong MARY ANN LIEBERT INC PUBL 2014 AIDS Research and Human Retroviruses Vol. No.
<P>Less costly but still accurate methods for monitoring HIV treatment response are needed. We prospectively evaluated if a qualitative polymerase chain reaction (PCR) amplification assay for virologic monitoring could maintain accuracy while reducing costs in Seoul, South Korea. We conducted the first prospective study comparing a qualitative PCR amplification of HIV-1 reverse transcriptase (RT) versus a commercial real time PCR assay (i.e., viral load) for virologic monitoring of 150 patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. A total of 215 blood plasma samples from 150 patients receiving ART for more than 6 months were evaluated. Using the individual viral load assay, 12 of 215 (5.6%) plasma samples had more than 500 HIV RNA copies/ml. The qualitative PCR amplification assay detected individual samples with 500 HIV RNA copies/ml with 100% sensitivity. The specificities of the qualitative PCR amplification of the HIV-1 RT assay were 94.1%, 93.6%, and 93.2% compared to the real time PCR at 500, 1,000, and 5,000 threshold of HIV RNA copies/ml, respectively, and $24,940 USD would have been saved for 150 patients during 10 months. The qualitative PCR amplification of the HIV-1 RT assay might be a useful approach to effectively monitor patients receiving ART and save resources.</P>
Characteristics of Clostridium difficile Ribotype 078
( Jae Kyoung Kim ),( Hea Won Ann ),( Heun Choi ),( Su Jin Jeong ),( Sun Bean Kim ),( Nam Su Ku ),( Sang Hoon Han ),( Chang Oh Kim ),( Jun Yong Choi ),( Young Goo Song ),( June Myung Kim ) 대한내과학회 2013 대한내과학회 추계학술발표논문집 Vol.2013 No.1
Objectives: The concern for PCR ribotype 078 strain of Clostridium difficile has recently risen worldwide with the epidemics of another hypervirulent PCP ribotype 027 (NAP1/BI/027) strain in North America and Europe, because of 078 strain`s increased prevalence and hypervirulence in humans. We evaluate the clinical overview of C. difficile infection (CDI) caused by 078 strain in comparison with other ribotypes except 027 strain in South Korea. Methods: This retrospective study was conducted at the Severance Hospital, a tertiary care University-affiliated facility in Seoul, South Korea. We collected total 20 CDI cases by 078 strain (case group) from May 2001 to December 2011. The 38 CDI cases by other non-hypervirulent ribotype including 017, 018 and 014 strains (control group) from December 2011 to May 2012 in same hospital were retrospectively retrieved from the data of clinical microbiology department. The data about clinical symptom and laboratory findings at the time of CDI diagnosis were collected by medical record review. Results: The mean temperature in case group was significantly higher than that in control group (37.3±1.3 vs. 37.0±0.5, p=0.005). The median CDI severity score was significantly higher in case group than that in other control group (2 vs. 1, p=0.019). Invasive procedure during current admission was more common in control group than case group (94.7% vs. 75.0%, p=0.041). The antipseudomonal penicillins during last 3 months from CDI diagnosis were more frequently used in control group than case group (52.6% vs. 20%, p=0.016). In underlying disease analysis, hematologic malignancy were more common in case group than control group (35% vs. 2.6%, p=0.002). In multivariate logistic regression analysis, temperature (OR 7.36, p=0.011) and hematologic malignancy (OR 33.07, p=0.015) were independent clinical factors associated with CDI by ribotype 078 strain. Conclusion: CDI by ribotype 078 has more severe than CDI by other ribotypes except 027 strain and occurs more frequently in patients with hematologic malignancy.
( Yong Duk Jeon ),( Jung Ho Kim ),( Hea Won Ann ),( Jin Young Ahn ),( Sun Bean Kim ),( Nam Su Ku ),( Sang Hoon Han ),( Jun Yong Choi ),( Dongeun Yong ),( Kyungwon Lee ),( June Myung Kim ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Backgrouond: Aggregatibacter aphrophilus (A. aphrophilus) is a gram negative, capnophilic, fermentative, coccobacillus that is occasionally isolated from patients with infective endocarditis. It has also been reported to cause brain abscess, empyema, meningitis, osteomyelitis and joint infection. Herein we report the first case of brain abscess caused by A. aphrophilus in Korea. Case: A 26-year-old man visited hospital for a headache during three weeks. He presented fever, nausea and vomiting for three days. His blood pressure was 108/69 mmHg and his body temperature was 36.9 ℃ at that time. His past medical history was unremarkable. Brain magnetic resonance imaging (MRI) was performed and revealed the 4 cm sized abscess in the frontal lobe with profound perilesional edema and subdural empyema. He received empirical intravenous antibiotic treatment with ceftriaxone 2.0 g every 12 hours, vancomycin 1.0 g every 12 hours and metronidazole 500 mg every 8 hours. On the 4th hospital day, he had decompressive craniectomy and drainage of the abscess. On the 8th hospital day, A. aphrophilus was identified in the culture of abscess. Vancomycin and metronidazole were discontinued and ceftriaxone monotherapy was maintained because it was susceptible to the 3rd generation cephalosporin. On the 11th hospital day, transthoracic echocardiography was performed, but there was no evidence of endocarditis. After a eight-week course of intravenous ceftriaxone therapy, follow-up MRI revealed almost resolved abscess. Intravenous ceftriaxone was changed to oral cefixime 100 mg every 12 hours and he was discharged. He treated with oral cefixime for 12 weeks in outpatient clinic until the complete resolution of brain abscess on MRI.
Kim, Sun Bean,Kim, Hye Won,Kim, Hyon-Suk,Ann, Hea Won,Kim, Jae Kyoung,Choi, Heun,Kim, Min Hyung,Song, Je Eun,Ahn, Jin Young,Ku, Nam Su,Oh, Dong Hyun,Kim, Yong Chan,Jeong, Su Jin,Han, Sang Hoon,Kim, Ju Informa Healthcare 2014 Scandinavian journal of infectious diseases Vol.46 No.2
<P><I>Background</I>: There have been various efforts to identify less costly but still accurate methods for monitoring the response to HIV treatment. We evaluated a pooling method to determine if this could improve screening efficiency and reduce costs while maintaining accuracy in Seoul, South Korea. <I>Methods</I>: We conducted the first prospective study of pooled nucleic acid testing (NAT) using a 5 minipool + algorithm strategy versus individual viral load testing for patients receiving antiretroviral therapy (ART) between November 2011 and August 2012 at an urban hospital in Seoul, South Korea. The viral load assay used has a lower level of detection of 20 HIV RNA copies/ml, and the cost per assay is US$ 136. The 5 minipool +algorithm strategy was applied and 43 pooled samples were evaluated. The relative efficiency and accuracy of the pooled NAT were compared with those of individual testing. <I>Results</I>: Using the individual viral load assay, 15 of 215 (7%) plasma samples had more than 200 HIV RNA copies/ml. The pooled NAT using the 5 minipool + algorithm strategy was applied to 43 pooled samples; 111 tests were needed to test all samples when virologic failure was defined at HIV RNA ≥ 200 copies/ml. Therefore, 104 tests were saved over individual testing, with a relative efficiency of 0.48. When evaluating costs, a total of US$ 14,144 was saved for 215 individual samples during 10 months. The negative predictive value was 99.5% for all samples with HIV RNA ≥ 200 copies/ml. <I>Conclusions:</I> The pooled NAT with 5 minipool + algorithm strategy seems to be a very promising approach to effectively monitor patients receiving ART and to save resources.</P>
( Jung Ho Kim ),( Yong Duk Jeon ),( Hea Won Ann ),( Heun Choi ),( Min Hyung Kim ),( Je Eun Song ),( Jin Young Ahn ),( Sun Bean Kim ),( Su Jin Jeong ),( Nam Su Ku ),( Sang Hoon Han ),( Jun Yong Choi ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Background: Spontaneous bacterial peritonitis (SBP) in cirrhotic patients is known to be mostly caused by Gram-negative bacteria. Although SBP due to Gram-positive bacteria is increasing, less is known about the predictive factors of the infection. Methods: We performed a retrospective, observational cohort study consisting of patients, aged 18 years or older, with SBP due to Gram-positive and Gram-negative bacteria from Jan 2006 to Dec 2013 at Severance hospital, Seoul, Korea. Only the first episode for each patient was included in the analysis. Results: We identified 77 patients with SBP. 27 (35%) patients had Gram-positive infection and 50 (65%) patients had Gram-negative infection. Univariate analysis revealed that low SOFA score (P = 0.001), having catheters or prosthetic devices (OR, 12; 95% CI, 2.36~60.95; P = 0.001) and previous use of antibiotics within 30 days (OR, 3.07; 95% CI, 1.15~8.2; P = 0.023) were associated with Gram-positive infection. Multivariate analysis showed that having catheters or prosthetic devices was a remarkable predictor of Gram-positive bacterial infection (OR, 5.72; 95% CI, 1.01~32.33; P = 0.048). And, previous use of antibiotics within 30 days was also a remained independent predictive factor of Gram-positive infection (OR, 4.04; 95% CI, 1.16~14.13; P = 0.029). Gram-negative infection had higher SOFA score than Gram-positive (4.93 vs 6.68; P = 0.001), but there was no statistically significant difference in 28-day mortality between two groups (37% vs 48%; P = 0.407). Conclusions: In the current study, indwelling catheters or prosthetic devices, prior antimicrobial therapy within 30 days and a lower SOFA score were significantly associated with SBP caused by Gram-positive bacteria in patients with cirrhosis.
Park, Hye Jung,Lee, Jae-Hyun,Park, Kyung Hee,Ann, Hea Won,Jin, Moo-Nyun,Choi, Soo-Young,Lee, Yong-Won,Hong, Chein-Soo,Park, Jung-Won The Korean Academy of Asthma, Allergy and Clinical 2014 Allergy, Asthma & Immunology Research Vol.6 No.3
<P><B>Purpose</B></P><P>The higher prevalence of respiratory allergic disease may be due to increased exposure to inhalation allergens. We conducted a survey of allergic diseases in autumn and winter with detection of major indoor allergens in major cities in Korea.</P><P><B>Methods</B></P><P>We enrolled 110 subjects from the fourth Korea National Health and Nutrition Examination Survey with stratified, cluster, and systematic sampling procedures. All participants answered a health questionnaire as well as underwent a skin prick test (SPT) and ImmunoCAP for 11 indoor major allergens. We also measured the levels of 5 major allergens (Der f 1, Der p 1, Can f 1, Bla g 1, and Asp f 1) in fine indoor dust from the houses of 60 subjects with a 2-site ELISA.</P><P><B>Results</B></P><P>The prevalence of allergic rhinitis and asthma were 25.5% and 7.3%, respectively. The most common sensitized allergens identified by SPT and ImmunoCAP were <I>Dermatophagoides farinae</I> (40.9%, 36.8%), followed by cockroach (23.6%, 19.5%), mugwort (13.6%, 22.9%), oak (9.1%, 22.9%), Japanese hop (9.1%, 8.6%), and dog dander (8.2%, 6.9%). There was a modest discrepancy between SPT and ImmunoCAP. Der f 1 and Der p 1 were detected in 91.7% and 45.0% of the enrolled houses, respectively. Der f 1 indicated high concentrations in all specific provinces in Korea; however, Der p 1 measured high only in the south. Dog dander allergens were present in 71.7% of houses; however, Bla g 1 was present in only 11.7% of houses and Asp f 1 was not detected in any houses.</P><P><B>Conclusions</B></P><P>The most important inhalant allergens in Korea are house dust mites followed by cockroach, mugwort, oak, Japanese hop, and dog dander in indoor environment, in which The dominant species of house dust mites were different according to region.</P>