7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

HFC-134a와 대체냉매 HFC-152a에 CF_3I를 혼합한 자동차냉매 특성

권일욱,박찬수,홍경한,문기선,최운수,서의경,윤갑식,이종인,하옥남 朝鮮大學校 機械技術硏究所 2002 機械技術硏究 Vol.5 No.1

These days, an attention of environment has been increasing all over the world. to prevent the green house effect and destruction of an ozone layer, an ozone destruction potential(ODP) be zero and a refrigerant for low global warming potential(GWP) is needed. HFC-134a, in which hydrogen is mixed instead of chlorine is a refrigerant used for automobile conditioners and its destruction potential is ecologically zero. However, it is not considered as a perfect substitutive refrigerant as its GWP is high. It is studied refrigerant mixtures in which HFC-134a, HFC-152a and CF_3I with low GWP and zero ODP are mixed by experimentally and concluded as follows; 1. with the variation of speed of compressor outside temperature and flow rate, the heat of evaporator and compressor and coefficient of performance was varied, and influenced the air conditioner. 2. The pressure of evaporator was decreased with increasing the speed of compressor and that of the refrigerant HFC-134a was higher 21% than that of azotrope refrigerant mixed with CF_3I. The overall capacity of condensor and evaporator was increased and HGC-134a was higher than azotrope refrigerant mixed with CF_3I 3. The capacity of evaporator with the refrigerant HFC-134a was higher 6% than azotrope refrigerant mixed with CF31 and the required power with zaotrope refrigerant mixed with CF_3I was higher 11% than that of HFC-134a. 4. The COP of the refrigerant FHC-134a was higher 31% in 1000RPM. when outside temperature was increased, COP was decreased. 5. Performance of HFC-134a is better than azotrope refrigerant mixed with CF_3I but prefered zaotrope refrigerant mixed with CF_3I considering the environment.

Positive effects of Teratogenic risk counseling in pregnant women inadvertently exposed to medications

( Hyo Yeon Gwak ),( Jung Eun Lee ),( Ju Young Choi ),( So Yeon Kim ),( Song Mi Park ),( June Seek Choi1,),( Hyun Kyong Ahn ),( Min Hyung Kim ),( Jin Hoon Chung ),( Moon Young Kim ),( Hyun Mee Ryu ),( 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

목적: To evaluate the positive effects of teratogenic risk counseling in pregnant women inadvertently exposed to medication in early pregnancy. 방법: In a prospective cohort study, 250 pregnant women exposed to medications in early pregnancy were recruited after teratogenic risk counseling at Korean MotherSafe Counsling Center, which has given information about teratogenic risk of medication to pregnant women. Positive effects are evaluated by visual analogue scale(VAS) for perception on teratogenic risk and percent prefering termination of pregnancy after medication exposures in pregnancy. 결과: Mean age of participants is 31.8±5.3years old. Mean gravidity is 2.4±2.1. Medications exposed in early pregnancy include antibiotics, analgesics, anti-inflammatory drugs, antacid and so on. Mean perceptive teratogen risk before and after the counseling is 33.9±1.6% and 15.8±1.6%, respectively. And mean percent prefering termination of pregnancy (≥5) before and after the counseling is 31.1±1.9% and 13.5±1.7%, respectively. 결론: Our data suggest that information on teratogenic risk for pregnant women inadvertently exposed to medication may have positive effects for reassuring pregnant women and preventing termination of pregnancy.

Polymorphisms in the Ghrelin Gene Are Associated with Serum High-Density Lipoprotein Cholesterol Level and not with Type 2 Diabetes Mellitus in Koreans

Choi, Hyung Jin,Cho, Young Min,Moon, Min Kyong,Choi, Hye Hun,Shin, Hyoung Doo,Jang, Hak Chul,Kim, Seong Yeon,Lee, Hong Kyu,Park, Kyong Soo The Endocrine Society 2006 The Journal of clinical endocrinology & metabolism Vol.91 No.11

Subclinical Hypothyroidism has Little Influences on Muscle Mass or Strength in Elderly People

Moon, Min Kyong,Lee, You Jin,Choi, Sung Hee,Lim, Soo,Yang, Eun Joo,Lim, Jae-Young,Paik, Nam-Jong,Kim, Ki Woong,Park, Kyong Soo,Jang, Hak C.,Cho, Bo Youn,Park, Young Joo The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.8

<P>Sarcopenia, the age-related decline in muscle mass, affects the muscle strength and muscle quality, and these changes decrease functional capacity. The prevalence of thyroid dysfunction increases with age, and changes in thyroid hormone level lead to neuromuscular deficits. We investigated the effects of subclinical hypothyroidism on the muscle mass, strength or quality in elderly people. One thousand one hundred eighteen subjects aged ≥65 yr were randomly selected from a local population and classified into a euthyroid (280 men and 358 women), subclinically hypothyroid (61 men and 75 women), or overtly hypothyroid (7 men and 16 women) group. Although women with subclinical hypothyroidism had a higher prevalence of sarcopenia, defined according to the ratio of appendicular skeletal muscle mass to the square of height, muscle mass, strength or quality did not differ in relation to thyroid status in men or in women. Multivariate analysis including age, diabetes, hypertension, acute coronary event, alcohol, smoking, presence of pain, physical activity score, and lipid profile, showed that thyroid-stimulating hormone level was not associated with muscle mass, strength or quality. In conclusion, subclinical hypothyroidism has little influences on muscle mass, strength or quality, and may not be associated with sarcopenia.</P>

S-Adenosyl-L-methionine ameliorates TNFα-induced insulin resistance in 3T3-L1 adipocytes

Min Kyong Moon,김민,정성수,Hyun Joo Lee,Sung Hee Koh,Peter Svovoda,Myung Hee Jung,Young Min Choi,Young Joo Park,Sung Hee Choi,장학철,박경수,이홍규 생화학분자생물학회 2010 Experimental and molecular medicine Vol.42 No.5

An association between inflammatory processes and the pathogenesis of insulin resistance has been increasingly suggested. The IκB kinase-β (IKK-β)/ nuclear factor-κB (NF-κB) pathway is a molecular mediator of insulin resistance. S-Adenosyl-L-methionine (SAM) has both antioxidative and anti-inflammatory properties. We investigated the effects of SAM on the glucose transport and insulin signaling impaired by the tumor necrosis factor α (TNFα) in 3T3-L1 adipocytes. SAM partially reversed the basal and insulin stimulated glucose transport, which was impaired by TNFα. The TNFα-induced suppression of the tyrosine phosphorylation of the insulin receptor substrate-1(IRS-1) and Akt in 3T3-L1 adipocytes was also reversed by SAM. In addition, SAM significantly attenuated the TNFα-induced degradation of IκB-α and NF-κB activation. Interestingly, SAM directly inhibited the kinase activity of IKK-β in vitro. These results suggest that SAM can alleviate TNFα mediated-insulin resistance by inhibiting the IKK-β/NF-κB pathway and thus can have a beneficial role in the treatment of type 2 diabetes mellitus.

항공영상을 활용한 도로개발 전·후 산림 훼손지 개체목 분석

최재용 ( Choi Jae-yong ),김성열 ( Kim Seoung-yeal ),김휘문 ( Kim Whee-moon ),송원경 ( Song Won-kyong ),이지영 ( Choi Won-tae ),최원태 ( Lee Ji-young ),문건수 ( Moon Guen-soo ) 한국환경복원기술학회(구 한국환경복원녹화기술학회) 2018 한국환경복원기술학회지 Vol.21 No.4

Although the road construction in forest is increasing and there is a need for development ecological restoration on deforest area, no consideration has been given to individual trees in there. This study analyzed aerial photographs of deforest area before and after road construction for determining the degree of forest destruction by extracting individual trees. Study area was selected in the sites where are damaged by road construction in GongJu-si, YuSung-gu, and YeongDong-gun. The aerial photograph taken 1979 before construction is panchromatic image of 80㎝ in GSD (Ground Sample Distance) and other photograph taken 2016 after construction is multi-spectral image of 10㎝ in GSD. In order to minimize the difference of GSD, we conducted image re-sampling process for setting to same GSD for the two photographs. After that we carried out visual interpretation method for de termining to change of individual tree. The result found that for GongJu-si of the number of individual tree was 1,014 in 1979 and 886 in 2016, which decreased by 128 (12.6%) and the average width of those decreased from 5.77m to 5.75m by 0.47%. In case of YoungDong-gun, the number of it was 761 in 1979 and 746 in 2016, which decreased by 2.0% and the average width of it decreased from 8.99mm to 8.90m by 1.1%. Lastly in case of YuSung-gu, the number of it was 1,578 in 1979 and 988 in 2016, which decreased by 37.4% and the average width of it decreased from 7.09m to 6.65m by 6.21%. these result imply that road construction causes destruction of forests. Since there are limitations such as errors due to researcher, it is necessary to construct a quantitative analysis method for the change of the deforest area. It is need to study the method of extracting individual tree in deforest area more accurately using high-resolution image of GSD 10cm or more as well. This study can be used as a basic data for the ecological restoration of the deforest area considering characteristics of individual tree such as height, diameter at breast height, and biomass.

Health risk assessment of pest control and disinfection workers before and after the COVID-19 outbreak in South Korea

Yun-Hee Choi(Yun-Hee Choi),Lita Kim(Lita Kim),Sang ji Lee(Sang ji Lee),Da-An Huh(Da-An Huh),Kyong Whan Moon(Kyong Whan Moon) 한국환경보건학회 2022 한국환경보건학회 학술대회 자료집 Vol.2022 No.5

Urinary metabolites of VOCs and PAHs increases the risk of NAFLD in Korean adolescents: Data analysis of Korean National Environmental Health Survey (KoNEHS) cycle 3

Yun-Hee Choi(Yun-Hee Choi),Kyong Whan Moon(Kyong Whan Moon) 한국환경보건학회 2022 한국환경보건학회 학술대회 자료집 Vol.2022 No.5

Associations of 3-Phenoxybenzoic acid and reproductive health in female lifespan: National Health and Nutrition Examination Survey 2013- 2014

Ji Yoon Choi(Ji Yoon Choi),Jiyun Lee(Jiyun Lee),Sung Yeon Kim(Sung Yeon Kim),Kyong Whan Moon(Kyong Whan Moon) 한국환경보건학회 2022 한국환경보건학회 학술대회 자료집 Vol.2022 No.5