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문경민,한민수,임창범,이준호,강민석,김지혜,김상일,정선영,조용선 대한결핵및호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.1
Background: The purpose of this study was to evaluate the risk factors for mechanical ventilation in the patients with scrub typhus admitted to intensive care unit (ICU) at a university hospital. Methods: We retrospectively selected and analyzed clinical data from the medical records of 70 patients (32 men, 38 women) admitted to the ICU with scrub typhus between 2004 and 2014. The patients had a mean±standard deviation age of 71.2±11.1 years and were evaluated in two groups: those who had been treated with mechanical ventilation (the MV group, n=19) and those who had not (the non-MV group, n=51). Mean ages of the MV group and the non-MV group were 71.2±8.3 years and 71.2±11.1 years, respectively. Results: Significant differences between the two groups were observed with respect to acute respiratory failure (p=0.008), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p=0.015), Sequential Organ Failure Assessment (SOFA) score (p=0.013), death (p=0.014), and ICU duration (p<0.01). Multivariate analysis indicated that the following factors were significantly associated with mechanical ventilation: acute respiratory failure (p=0.011), SOFA score (p=0.005), APACHE II score (p=0.011), platelet count (p=0.009), and lactate dehydrogenase (LDH) (p=0.011). Conclusion: Thus, five factors—acute respiratory failure, SOFA score, APACHE II score, platelet count, and LDH—can be the meaningful indicators for mechanical ventilation for the patients with scrub typhus admitted to ICU.
문경민,한민수,김동진,이양덕,조용선,나동집 대한감염학회 2007 Infection and Chemotherapy Vol.39 No.3
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and manifested with fever, skin rash, myalgia, and hepatitis etc. Most of patients improve with antibiotics such as doxycycline. The spectrum of the clinical severity ranges from mild to severe with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. We report a case of a 72-year-old man with scrub typhus complicating subdural hematoma. 쯔쯔가무시병은 Orientia tsutsugamushi에 의해 발생되는 급성 발열 질환으로 고열, 발진, 근육통, 간염 등의 임상 양상을 나타내며 대부분의 환자들은 doxycycline으로 호전된다. 임상양상은 불현성 감염에서 사망에 이르기까지 다양하며 뇌수막염, 폐렴, 심근염 등의 합병증이 발생할 수 있다. 쯔쯔가무시병 환자에서 지속적인 혈압상승, 두통, 의식혼탁 등의 소견이 있는 경우 경막하혈종이 합병되었을 가능성을 고려해야 하겠다. 저자들은 쯔쯔가무시병 환자에서 경막하혈종이 합병된 1예를 경험하였기에 보고하는 바이다.
문경민,한민수,김동진,이양덕,조용선,나동집 대한감염학회 2007 감염과 화학요법 Vol.39 No.3
쯔쯔가무시병은 Orientia tsutsugamushi에 의해 발생되는 급성 발열 질환으로 고열, 발진, 근육통, 간염 등의 임상 양상을 나타내며 대부분의 환자들은 doxycycline으로호전된다. 임상양상은 불현성 감염에서 사망에 이르기까지 다양하며 뇌수막염, 폐렴, 심근염 등의 합병증이 발생할 수 있다. 쯔쯔가무시병 환자에서 지속적인 혈압상승,두통, 의식혼탁 등의 소견이 있는 경우 경막하혈종이 합병되었을 가능성을 고려해야 하겠다. 저자들은 쯔쯔가무시병 환자에서 경막하혈종이 합병된 1예를 경험하였기에 보고하는 바이다. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and manifested with fever, skin rash, myalgia, and hepatitis etc. Most of patients improve with antibiotics such as doxycycline. The spectrum of the clinical severity ranges from mild to severe with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. We report a case of a 72-year-old man with scrub typhus complicating subdural hematoma.
Agranulocytosis Induced by Ethambutol in a Patient with Pulmonary Tuberculosis
문경민,한민수,정소희,김주리,김진영,정선영,조용선 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.2
We report a case of agranulocytosis caused by ethambutol in a 79-year-old man with pulmonary tuberculosis. He was referred for fever and skin rash developed on 21th day after antituberculosis drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) intake. Complete blood count at the time of diagnosis of pulmonary tuberculosis was normal. On the seventh admission day, agranulocytosis was developed with absolute neutrophil count of 70/μL. We discontinued all antituberculosis drugs, and then treated with granulocyte colony-stimulating factor. Three days later, the number of white blood cell returned to normal. We administered isoniazid, pyrazinamide, and ethambutol in order with an interval. However, fever and skin rash developed again when adding ethambutol, so we discontinued ethambutol. After these symptoms disappeared, we added rifampicin and ethambutol in order with an interval. However after administering ethambutol, neutropenia developed, so we discontinued ethambutol again. He was cured with isoniazid, rifampicin, and pyrazinamide for 9 months.
Ultrasonographic scoring system score versus liver stiffness measurement in prediction of cirrhosis
문경민,김가은,백순구,최은희,김문영,김현아,조미연,신승용,김정민,박홍준,권상옥,엄영우 대한간학회 2013 Clinical and Molecular Hepatology(대한간학회지) Vol.19 No.4
Background/Aims: We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis. Methods: Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4±9.5 y, mean±SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0–F4) were evaluated. Results: The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0–F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS ≥6: LSM ≥17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4. Conclusions: The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis. (Clin Mol Hepatol 2013;19:389-398)
문경민,민경환 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-
Background: Scrub typhus is a febrile zoonotic disease caused by Orientia tsutsugamushi. ICU management is required in patients with severe complications. It is important that intensivists determine the proper timing of mechanical ventilation (MV). Aim: Estimation of acid-base imbalance (ABI) as a predictor of MV and comparison with conventional scoring systems. Methods: A retrospective cohort study was conducted at ICU of Eulji University Hospital. We identified patients with scrub typhus and excluded less than 18 years old from May 2004 to February 2016. Study database included the clinical parameters and the conventional scoring systems at admission. The factors related to MV application were established using decision tree and multiple logistic analysis. Results: There were 91 patients admitted to ICU due to scrub typhus. The predictive power of ABI correlated with MV was high as 0.926 of area under the ROC curve. The predictive power of NEWS, APACHE II, and SOFA were moderate as 0.763, 0.75 and 0.72 of area under the ROC curve, respectively. After multiple logistic regression analysis, ABI was significantly associated with MV application(OR: 2.216, 95% CI: 1.475-3.33, p < 0.001). The rate of MV application increased(p < 0.001) with progression of ABI. There was a significant(p = 0.019) difference in survival rates between low-, moderate-, and severe risk groups based on ABI using a decision tree. Conclusions: ABI can be helpful as a simple and easy-to-use tool to determine the appropriate timing of mechanical ventilation for patients admitted to ICU with scrub typhus.