코로나-19 검사를 위한 음압컨테이너형 선별진료소 CFD 해석

정민지(Minji Jung),한수하(Su Ha Han),유소연(So Yeon Yoo),이재갑(Jacob Lee),홍진관(Jin Kwan Hong) 대한설비공학회 2021 설비공학 논문집 Vol.33 No.2

Fast screening centers are being widely utilized in response to outbreaks and epidemics such as the COVID-19 pandemic. Although various types of screening centers exist, those that use negative pressurized medical rooms have the advantage of being operational regardless of the weather. A computational fluid dynamics (CFD) simulation was used in order to determine the required minimum ventilation rate of a sample collection booth, as well as the corresponding pressure difference between a medical examination room and a sample collection room. In order to prevent cross-contamination between the healthcare worker and testee, the sample collection booth exhaust volume flow rate should be higher than 450 CMH when the sample collection room air change rate is 15 air changes per hour. When maintaining the exhaust volume flow rate at these levels, suspending particles decreased to 2% of the total discharged particles within 2 minutes, and particle removal efficiency reached 99.9% in approximately 6 minutes. Discharged particles were dispersed throughout the sample collection room and deposited on the test subject, chair, sidewalls, ceiling, and floor. Therefore, these results show that surface disinfection should be performed after the testee is tested.

진료지침 : 중증 인플루엔자 치료 지침

최원석 ( Won Suk Choi ),백지현 ( Ji Hyeon Baek ),서유빈 ( Yu Bin Seo ),기세윤 ( Sae Yoon Kee ),정혜원 ( Hye Won Jeong ),이희영 ( Hee Young Lee ),은병욱 ( Byung Wook Eun ),추은주 ( Eun Ju Choo ),이재갑 ( Jacob Lee ),김영근 ( Young 대한내과학회 2014 대한내과학회지 Vol.86 No.1

진료지침 : 의료기관 내 계절인플루엔자 관리지침

백지현 ( Ji Hyeon Baek ),서유빈 ( Yu Bin Seo ),최원석 ( Won Suk Choi ),기세윤 ( Sae Yoon Kee ),정혜원 ( Hye Won Jeong ),이희영 ( Hee Young Lee ),은병욱 ( Byung Wook Eun ),추은주 ( Eun Ju Choo ),이재갑 ( Jacob Lee ),김성란 ( Sung R 대한내과학회 2014 대한내과학회지 Vol.86 No.3

Candida glabrata 감염에 의해 발생한 엉덩허리근 농양 1예

김미,이재갑,정창수,장주현,안병무,송원근 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Infections due to Candida species are becoming more frequent in several patient population and settings. The proportion of non-albicans Candida spp. causing candidemia has increased during the recent decades. Especially, fungaemia due to Candida glabrata has reduced susceptibility to azoles. We report a case of iliopsoas abscess caused by Candida glabrata. A 51-year-old male diabetic patient was admitted with fever and both hip joint pain. Abdominal CT scan revealed huge left iliopsoas intramuscular abscess and left perinephric abscess. The abscess was drained percutaneously. Cultures of the pus were positive for Candida glabrata. The patient’s condition improved after abscess drainage and was discharged with oral antifungal agent.

경련을 첫 증상으로 보인 급성 사람면역결핍바이러스 증후군 1예

안병무,이경민,나동길,신윤호,정성웅,이재갑 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Acute human immunodeficiency virus (HIV) syndrome is defined as transient symptomatic illness associated with high-titer HIV replication and an expansive immunologic response to the invading pathogen. Seizure and epilepsy are not rare among the HIV-infected patients. Major causes of HIV-related seizure are focal brain lesion, meningitis, metabolic derangement, and no identified causes other than HIV itself. Generally, seizure in HIV infected patients develops during the advanced stages of the disease; decreased immunity and increased chances of developing opportunistic infection in the central nervous system (CNS) predispose them to have seizures attacks. We report a case of acute HIV syndrome which presented as new-onset seizure. Since no evidence of focal brain lesion or any opportunistic infection could be found, the most probable cause of seizure could be attributed to acute HIV syndrome. The patient got better after taking anti-epileptic drug and there have been no further recurrence of episodes so far.

감염성 당뇨 족부 궤양 : 심부 조직 배양 검사 결과에 기초한 원인균 분석

서유빈,노지윤,허중연,이재갑,송준영,한승규,김우주,정희진 대한감염학회 2007 감염과 화학요법 Vol.39 No.5

목적 : 심부 조직 검사를 통한 배양 결과를 토대로 감염성 당뇨 족부 궤양의 원인 균에 대한 분포 파악하고, 감염성 족부 궤양의 위험 인자로 알려져 있는 당뇨병 이환기간 및 혈당 조절 정도, 조직 허혈 정도와 원인균 분포의 상관 관계를 분석하고자 하였다 재료 및 방법 : 2006년 9월 1일부터 2007년 3월 31일까지 총 7개월 동안 1개 대학 병원에 중증의 감염성 당뇨 족부궤양으로 입원한 환자 94명 중 심부 조직 배양 검사를 시행한 74명의 환자를 대상으로 연구를 진행하였다. 원인 균의 분포를 조사하고, 원인 균에 따라서 성별, 나이, 재원 기간, 당뇨 종류, 당뇨 이환 기간, 혈당화색소(HbA1c), 신경병증, 혈관병증 및 당뇨성 신병증 유무, 조직 산소 농도, 골수염 유무, 내원 전 항생제 노출력, 입원 시 발열 유무, 백혈구(WBC), 적혈구 침강계수(ESR), C-반응성 단백질(CRP)의 차이가 있는지 조사하였다. 결과 : 호기성 그람양성균에 의한 감염이 76.4% (39예)로 대부분이었으며, MRSA가 29.4% (15예)로 가장 많았다. 그 외 호기성 그람음성균에 의한 감염이 전체 감염의 33.3% (17예)을 차지하였으며, 그 중 Enterobacteriaceae가 13.7% (7예)로 가장 많았다. 혐기성 균은 동정되지 않았으며 곰팡이 감염은 한 예에서만 관찰되었다. 호기성 그람양성균과 호기성 그람음성균에 감염된 환자들에서의 임상상과 검사실 소견을 비교하였으나 차이가 없었으며, MSSA와 MRSA 또한 차이가 없었다. 이전 항생제 노출이 있었던 환자들 중에서는 MRSA가 27.2% (12예)으로 가장 많이 동정되었고, 혼합감염은 이전 항생제 노출력이 있었던 6명에서만 관찰되었다. 결론 : 감염성 당뇨 족부 궤양의 치료를 위해 입원한 환자들의 가장 흔한 원인균은 MRSA 였다. 그람양성균과 그람음성균, MSSA와 MRSA 감염에 따른 임상상과 검사실 소견의 차이는 보이지 않았다. 이전 항생제 노출력이 있는 경우 혼합 감염이 흔하게 관찰되었으며, 항생제 노출력이 있는 중증 감염의 경우는 그람양성균과 그람음성균에 모두 감수성 있는 광범위 항생제를 투약하는 것이 적합할 것이다. Background : The annual prevalence of foot ulcer in Korea is 99.5 per 100,000 people with diabetes and 49.8 cases among them go through amputation. Moreover, amputation due to uncontrolled infection accounts for 50% of all non-traumatic limb amputations. Therefore, reliable microbiological documentation is important. Materials and Method : We enrolled 74 patients with diabetic foot infection, who referred to Korea University Hospital from September 2006 to March 2007. Deep tissue biopsies were taken from the base of ulcer after surgical debridement and cleansing at admission. We analyzed the microbiological differences according to the sex, age, type and duration of diabetes, glycemic control, presence of neuropathy or angiopathy, diabetic nephropathy, osteomyelitis, transcutaneous oxygen tension and prior antibiotic use. Result : Gram-positive aerobic bacteria were the most common organisms isolated (76.4%), followed by Gram-negative aerobic bacteria (33.3%) and fungus (2.0%). Of the Gram-positive aerobes, methicillin-resistant Staphylococcus aureus (MRSA) was found most frequently (29.4%). The clinical and laboratory findings showed no significant clinical differences between gram-positive and gram-negative infections. Moreover, there was no difference in clinical findings between methicillin-susceptible and methicillin-resistant S. aureus infections. Mixed infection was not common (average, 1.2 organisms with each diabetic foot infection). Of note, mixed infection was more frequently found in patients with prior antibiotic use. Conclusion : MRSA was the most common pathogen in diabetic foot infection among patients referred to tertiary hospital. There was no significant difference of clinical and laboratory findings with regard to gram stain results and methicillin resistance in S. aureus. Mixed infection was not common, but broad spectrum antibiotics are recommended for severe diabetic foot infection with prior antibiotic exposure.

치료 경험이 없는 HIV 감염자에서의 항바이러스제 일차내성 분석 : 한국HIV/AIDS 코호트 연구

송준영,이진수,정혜원,최희정,이진서,이재갑,엄중식,정희진,정문현,김우주 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Primary anti-retroviral resistance is considered one of the major problems of HIV treatment. Contrary to reports from western countries, prior Korean studies have reported a relatively low primary resistance rate (less than 5%). Based on Korean HIV/AIDS cohort data, we estimated the primary resistance rate among treatment-na¨ıve HIVinfected patients. According to the results, the primary resistance rate was higher (8.8%) than reported previously in Korean studies. However, the major PI mutation was not found.

A Case of Disseminated Tuberculosis with Miliary Central Nervous System Tuberculoma

Noh, Ji Yun,Heo, Jung Yeon,Lee, Kwang Gyun,Yoon, Young Kyung,Lee, Jacob,Song, Joon Young,Cheong, Hee Jin,Kim, Woo Joo 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Disseminated tuberculosis occurs through lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli. The exact incidence of disseminated tuberculosis is still unknown and its diagnosis presents a challenge since the symptoms are not specific of the disease. Brain tuberculoma is one of the complications of tuberculosis. The literary review of brain tuberculoma shows that it mainly occurs in the cerebrum and cerebellum, whereas involvement of the brainstem is rare. Recently, we have experienced a case of 46-year-o1d man with fever of 2 months duration who was diagnosed with disseminated tuberculosis with miliary central nervous system (CNS) tuberculomas; brain tuberculomas were found even in the brainstem and the spinal cord. Pulmonary, intestinal, renal, and choroidal involvements were also noted.

Voriconazole로 치료한 침습성 아스페르길루스부비동염 1예

은채령,허중연,노지윤,윤영경,이현주,신봉경,이재갑,송준영,정희진,김우주 대한감염학회 2008 감염과 화학요법 Vol.40 No.2

두개저를 침범한 침습성 아스페르길루스증은 드물지만 이환되었을 경우 사망률이 높은 심각한 질환이다. 하지만, 임상양상이 비 특이적이기 때문에 진단이 쉽지 않고, 치료 방법이 명확하게 확립되어 있지 않다. 제 2형 당뇨병력이 있는 52세 여자 환자가 우안 시력 저하 및 우측 안구통 주소로 내원하였다. 뇌 자기공명영상 촬영에서 부비동-안와를 포함하고 두 개저까지 침범한 병변을 확인하였고 치료 및 진단적 수술을 통해서 침습성 아스페르길루스증을 진단하였다. 진단 후 amphotericin B로 치료를 시작하였으나 치료 반응이 좋지 않아 vohconazole로 치료 약제를 변경하였다. Voriconazole은 1일 째에 300 mg씩 2회 부하 용량으로 정맥 투여한 후, 총 7주간 200 mg씩 1일 2회 정맥 투여하고, 이어서 총 7주간 200mg씩 1일 2회 경구 투여하였다. 뇌 자기공명영상으로 치료 반응을 추적 관찰하였으며, 치료 종료 1년 후까지 추적한 결과 임상 소견 및 영상 검사 결과 모두 호전된 것을 확인하였다. 당뇨 환자에서 발생한 두개저를 침범한 침습성 아스페르길루스증에 대해서 종괴에 대한 조대술(marsupialization) 후 voriconazole 3개월 치료로 완치를 보인 증례를 문헌고찰과 함께 보고하는 바이다. Skull base-invading, invasive aspergillosis is rare, but it is a potentially life-threatening disease. Nevertheless, the standard method and the optimal duration of treatment are not known yet. A 52-year-o1d female diabetic patient complained of ophthalmalgia and decreased visual acuity. MRI and CT scan revealed an enhancing mass in the right orbital fissure and showed an infiltratina process in the skull base around the right orbit apex and paranasal sinuses. The histological investigation revealed invasive aspergillosis of paranasal sinuses and the skull base. Clinical improvement occurred after marsupialization and post-operative systemic antifungal therapy with voriconazole for 14 weeks. We suggest that voriconazole treatment could show effective results for invasive aspergillosis of skull base and paranasal sinuses.