A case of peritoneal dialysis-associated peritonitis caused by Brevundimonas vesic ularis

( Hannah Ra ),( Jun Hyoung Ahn ),( Junseok Ho ),( Jae Seon Song ),( Hyun Ju Yoon ),( In O Sun ),( Kwang Young Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Brevundimonas vesicularis are a non-lactose fermenting, gram-negative bacillus that is assigned to a group IV Pseudomonas species and considered to have low virulence. There are sporadic reports of the organism causing endocarditis, meningitis, septicemia, and pneumonia; however, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. Furthermore, recommendations for treatment of PD-associated refractory peritonitis induced B. vesicularis were not included in the International Society for Peritoneal Dialysis guidelines. One day, a 71-year-old Korean woman who had been treated with CAPD for 2 years was admitted to our hospital because of turbid peritoneal effluent accompanied by constant abdominal pain that began 5 days prior to her admission. The underlying causes of herend- stage renal disease were hypertension and diabetes mellitus. On admission, her blood pressure was 119/74 mmHg, heart rate was 94 beats/min, respiratory rate was 20/min, and body temperature was 37.7℃. Her abdomen was diffusely tender with normal bowel sounds, and no evidence of infection was identified around the catheter exit site. The laboratory findings showed PD peritonitis: the white blood cell (WBC) count of the peritoneal effluent was 2,800/mm3 with a neutrophil predominance (95%). Her WBC count was 6.4 × 109/L, and C-reactive protein was 4.32 mg/dL. Bacteria were not observed on Gram stain examination After peritoneal fluid was sent for bacterial culture, a single 1-g dose of cefazolin and a single 1-g dose of ceftazidime were given intraperitoneally per day. Culture of the peritoneal dialysate revealed B. vesicularis which was susceptible to cefepime, cefotaxime, imipenem, piperacillin, and gentamicin. Despite the use of intraperitoneal antibiotics for 5 days, the patient’s abdominal pain and intermittent fevers persisted, and the WBC count of the peritoneal effluents was elevated to 430/mm3. In the end, the PD catheter had to be removed on the 5th day after starting intraperitoneal antibiotics. We conclude this is the first refractory case of PD-associated peritonitis due to B. vesicularis, which resolved following catheter removal in South Korea.

SVR Rate (12 Weeks and 1 Year) and Improvement of Fibrosis after Daclatasvir/Asunaprevir Treatment in Gen-otype 1b HCV-Infected Patients

( Hannah Ra ),( Seung Kak Shin ),( So Jeong Kim ),( Gyu Cheon Kyung ),( Youn-i Choi ),( Oh Sang Kwon ),( Jong-beom Shin ),( Young-joo Jin ),( Jin-woo Lee ),( Sangheun Lee ),( Ki Jun Han ),( Young Nam 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The long term data with daclatasvir (DCV)/asunaprevir (ASV) treatment for genotype 1b (GT1b) HCV-infected patients was not reported in Korea. This study investigated the efficacy in virologic response (SVR12 and SVR_48~60), improvement of liver function and fibrosis markers after DCV/ASV treatment. Methods: HCV GT1b patients who had not resistant associated substitute (RAS) were enrolled in 5 tertiary Korean hospitals. A total of 287 patients treating with DCV/ASV were observed for SVR₁₂. Virologic response was measured at 12 weeks (SVR₁₂), and 48-60 weeks (SVR_48-60) after the end of treatment. In patients with cirrhosis, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) were compared between before and after treatment (at SVR_48-60). Results: SVR₁₂ was obtained in 97.6% (280/287) patients. Among them, 189 patients were observed for SVR_48-60. Baseline characteristics (n=189): age (55±11 years), male 91(48%), cirrhosis 57(30.2%), treatment-naive 135(71.4%), ALT (58±53 IU/L), and HCV RNA (1,738,132±2,279,517 IU/mL) were shown. SVR_48-60 was obtained in 96.8 % (183/189) patients. In cirrhotic patients (n=57), changes of ALT (52±36 to 25±13 IU/L, P<0.001), total bilirubin (1.0±0.8 to 0.9±0.5 mg/dL, P=0.112), albumin (3.9±0.7 to 4.2±0.5 g/dL, P=0.003), and platelet (130±96 to 144±80 103/mm3, P=0.132) were observed. The changes of APRI score (2.1±0.3 to 0.8±0.1, P<0.001), FIB-4 index (7.2±0.9 to 3.7±0.4, P<0.001), FI (2.8±0.2 to 2.4±0.2, P=0.021), and LSM (n=16, 19.3±3.1 to 13.0±2.0 kPa, P=0.015) were observed. The characteristics of patients who failed SVR_48~60 (n=6) were such as: age 62(47-78) years, female 5(83%), treatment-naive 3(50%), cirrhosis 2(33%), ALT 40(14- 62) IU/L, HCV RNA 2,599,557(459,017-12,149,394) IU/mL. Conclusions: DCV and ASV treatment for HCV GT1b infected Korean patients without RAS achieved high SVR rates. However, 3% patients who achieved SVR₁₂ failed in SVR_48~60. The cirrhotic patients with SVR_48~60 showed improvement of liver function and fibrosis markers.

Strongyloidiasis Presenting as yellowish nodules in Colonoscopy of an Immunocompetent Patient

Hannah Ra,Jun-Won Chung,Dong Hae Chung,Jung Ho Kim,Yoon Jae Kim,Kyoung Oh Kim,Kwang An Kwon,Dong Kyun Park 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.1

Strongyloides stercoralis is endemic to tropical and subtropical regions, and infections are usually asymptomatic. However,immunocompromised patients, such as those receiving immunosuppressive therapy, high-dose steroids, or chemotherapy, can developfatal hyperinfections. An 84-year-old man without any symptoms was diagnosed with strongyloidiasis during a regular screeningcolonoscopy. His medical history only involved a gastric endoscopic submucosal dissection for early gastric cancer 6 months previously. Few cases have been published about asymptomatic strongyloidiasis diagnosed in an immunocompetent host via endoscopic mucosalresection with characteristic colonoscopic findings. We report a case of colon-involved asymptomatic strongyloidiasis with specificcolonic findings of yellowish-white nodules. This finding may be an important marker of S. stercoralis infection, which could preventhyperinfections.

근무기관의 조직건강성이 유아교사의 창의적 인성에 미치는 영향: 놀이교수효능감의 매개효과 검증

임한나(Hannah Im),최인숙(Insuk Choi),김헤라(He-ra Kim),채진영(Jin-Young Chae) 한국보육지원학회 2019 한국보육지원학회지 Vol.15 No.4

Objective: This study was conducted to examine the mediating effects of play teaching efficacy in the relationship between the organizational health of teacherworkplaces and the creative personality of the teachers. Methods: The Pearson product-moment correlation analysis and one-way ANOVA were conducted for data analysis using SPSS 25.0. For mediatinganalysis, Baron & Kenny’s (1986) multiple regression analysis using SPSS 25.0 and the Sobel test were also implemented. Results: There were significant differences in the organizational health of the workplaces according to age, years of working experience, type of workplace, and daily working hours. For play teaching efficacy, there were significant differences according to age, education level, years of working experience, type of workplace,and daily working hours of the teacher. On the other hand, significant differences were found in terms of age and education level in relation to the teacher having a creative personality. Play teaching efficacy was found to have a full mediation effect on the relationship between the organizational health of the workplace andthe creative personality of the teacher. Conclusion/Implications: The organizational health of the workplace and play teaching efficacy should be improved in order to enhance the creative personality of teachers in early childhood education.

Durability of Sustained Virologic Response and Improvement of Fibrosis Markers after Daclatasvir and Asunaprevir Treatment in Genotype 1b Hepatitis C Virus-Infected Patients: a Real Life and Multicenter Study

신승각,이진우,Hannah Ra,권오상,신종범,진영주,이상헌,한기준,김영남,김태헌,김윤수,김주현 대한의학회 2019 Journal of Korean medical science Vol.34 No.41

Background: The long-term data with direct acting antiviral agents were rare. This study investigated the durability of a sustained virologic response (SVR) and the improvement of fibrosis after daclatasvir and asunaprevir (DCV/ASV) treatment in genotype 1b (GT1b) hepatitis C virus (HCV)-infected patients. Methods: A total of 288 HCV GT1b patients without baseline non-structural 5A (NS5A) resistance-associated substitution (RAS) treated with DCV/ASV were enrolled. Virologic response was measured at 12 weeks and 1 year after treatment completion. In cirrhotic patients, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) at baseline and 1 year after treatment completion were evaluated. Results: SVR12 was obtained in 278 patients (96.5%). Six patients who checked NS5A RAS after treatment failure were RAS positive. Only one patient showed no durability of SVR. In cirrhotic patients who achieved SVR12 (n = 59), the changes of albumin (3.8 [2.2–4.7] to 4.3 [2.4–4.9] g/dL; P < 0.001), platelet count (99 [40–329] to 118 [40–399] × 103 /mm3 ; P < 0.001), APRI (1.8 [0.1–14.8] to 0.6 [0.1–4.8]; P < 0.001), FIB-4 index (5.45 [0.6–32.8] to 3.3 [0.4–12.2]; P < 0.001), FI (5.5 [0.6–32.8] to 3.3 [0.4–12.2]; P < 0.001), and LSM (17.2 [5.3–48.0] to 11.2 [3.7–28.1] kPa; P = 0.001) between baseline and 1 year after treatment completion were observed. Conclusion: DCV/ASV treatment for HCV GT1b infected patients without RAS achieved high SVR rates and showed durable SVR. Cirrhotic patients who achieved SVR12 showed the improvement of liver function and fibrosis markers.

A case report of continuous veno-venous hemodialysis (CVVHD) in acute methanol poisoning

( Jun Hyoung Ahn ),( Hannah Ra ),( Jun Seok Ho ),( Jae Sun Song ),( Hyun Ju Yoon ),( In O Sun ),( Kwang Young Lee ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Methanol is a common ingredient in many products such as illicit liquors, windshield washer fluids, and homemade alcoholic beverages. Whether accidental or intentional, the ingestion of methanol can be potentially fatal if not diagnosed and treated promptly. Methanol is oxidized first by hepatic alcohol dehydrogenase to formaldehyde then to formic acid, which results in acidosis, neurotoxicity and death in severe poisoning. Here reported is the case of a 46-year-old Korean woman who survived methanol intoxication. She was presumed to have ingested methanol six hours before arriving at the emergency department. She was drowsy with a Glasgow Coma Scale score of E2V4M5. She was afebrile with a blood pressure of 103/73 mmHg, a pulse rate of 77 beats/min and a respiratory rate of 24 breaths/min. Initial arterial blood gas showed a pH of 7.180, bicarbonate of 12.3 mmol/L, PaCO2 of 33.0 mmHg and base excess of -14.9. Her serum osmolar gap was 249 mOsm/kg H2O and the serum anion gap was 21.7 mmol/L. Based on the history and the blood test, we diagnosed the methanol intoxication and promptly initiated continuous veno-venous hemodiafiltration (CVVHDF). CVVHDF was performed for 39 hours using the Prismaflexi system (Gambro Lundia AB, Sweden) on the first day of admission at the following settings: blood flow, 150 mL/min; replacement volume, 1,000 mL/h; and dialysate, 1,000 mL/h. Two days after hospitalization, we stopped CVVHDF after the anion gap normalized. On day 5, the patient was discharged without any complications. We received the result of methanol concentrations in serum and urine from our reference laboratory when the patient discharged. The analysis detected high concentrations of methanol in blood and urine and high concentrations had decreased in both serum and urine during CVVHDF. In conclusion, our case supports that CVVHDF enhances the elimination of serum methanol by a decrease in half-life. Keywords: Methanol; Hemodiafiltration; Acidosis

Usefulness of Linear Type Wireless Hand-Held Ultrasound for the Evaluation of Liver Surface Nodularity in Patents with Liver Cirrhosis

( Seung Kak Shin ),( Yun Soo Kim ),( Hannah Ra ),( Sangho Jeong ),( Hyung Nam Kim ),( Oh Sang Kwon ),( Duck Joo Choi ),( Ju Hyun Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Sonographic liver surface nodularity (LSN) is a useful parameter for diagnosis of liver cirrhosis (LC). Recently, easy-to-use linear type wireless hand-held ultrasound (wireless US) has been introduced. We aimed to assess the performance of wireless US compared to conventional ultrasound system (conventional US) in evaluating the LSN, and to verify the usefulness of LSN measured by wireless US in diagnosing LC. Methods: We enrolled 104 patients who underwent wireless US (SONON 300L, 10 MHz linear transducer, Healcerion), conventional US (Logic E9, 9 MHz linear transducer, GE) and Fibroscan for evaluation of liver diseases between March 2017 and January 2018. LSN measurement (LSNM, defined as the length of curve line in liver surface matching the 2-cm linear segment in left lateral segment) was used to objectively evaluate the LSN. Diagnosis of LC was based on clinical criteria, and was compared with fibroscan results. Results: Among 104 patients, 54 (51.9%) patients were diagnosed with LC. The mean liver stiffness measurement (LSM) on fibroscan (28.1±22.3 vs. 6.7±4.8, P<0.001) and LSNM on conventional US (2.075±0.459 vs. 2.028±0.119, P<0.001) were significantly different between LC and non-LC group. The mean LSNMs (2.051±0.034 vs. 2.052±0.041, P=0.13) on between wireless and conventional US by paired t-test were not significantly different. The sensitivity, specificity, positive predictive value, and negative predictive value of high LSNMs (≥ 2.04) on wireless US in diagnosing LC were 88.9%, 90.0%, 90.6%, and 88.2%, respectively. The mean LSMs (25.7±22.8 vs. 9.6±10.6 kPa, P<0.001) were significantly different between high LSNMs (≥ 2.04) and low LSNMs (<2.04) group. Conclusions: The ability of liver surface nodularity evaluation with wireless US was not inferior to conventional US. Linear type wireless hand-held ultrasound can be a useful tool to easily identify the liver surface nodularity for diagnosis of LC.

Taper-free and kinked germanium nanowires grown on silicon via purging and the two-temperature process

Kim, Jung Hyuk,Moon, So Ra,Kim, Yong,Chen, Zhi Gang,Zou, Jin,Choi, Duk Yong,Joyce, Hannah J,Gao, Qiang,Tan, H Hoe,Jagadish, Chennupati IOP Pub 2012 Nanotechnology Vol.23 No.11

<P>We investigate the growth procedures for achieving taper-free and kinked germanium nanowires epitaxially grown on silicon substrates by chemical vapor deposition. Singly and multiply kinked germanium nanowires consisting of ⟨111⟩ segments were formed by employing a reactant gas purging process. Unlike non-epitaxial kinked nanowires, a two-temperature process is necessary to maintain the taper-free nature of segments in our kinked germanium nanowires on silicon. As an application, nanobridges formed between (111) side walls of V-grooved (100) silicon substrates have been demonstrated.</P>

윤거 오차를 갖는 미끄럼 조향 차량의 측위 기법

명철우(Cheol Woo Myung),김경준(Kyoung Jun Kim),송한나(Hannah Song),나원상(Won-Sang Ra) 대한전기학회 2017 대한전기학회 학술대회 논문집 Vol.2017 No.7