Plasma Exchange for Patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) in Pusan National University Hospital (2003~2011) / 대한수혈학회지

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are related diseases with high rates of fatality. Plasma exchange therapy improves survival rates in patients with TTP and HUS. The aim of this study is to evaluate our experience in conduct of plasma exchange procedures for treatment of patients with TTP-HUS over the past nine years, and to identify risk factors for poor response to this treatment. METHODS: Between January 2003 and August 2011, 230 plasma exchange procedures were performed for treatment of 22 TTP-HUS patients at Pusan National University Hospital. We conducted a retrospective analysis of data from clinical records and plasma exchange records for these patients. RESULTS: Fourteen female patients and eight male patients were included in the study. The majority of patients (86%) had neurologic symptoms; and 41% of patients had a fever. Eight patients presented with an additional disorder; three patients presented with Systemic Lupus Erythematosus. The mean number of plasma exchange procedures was 10.5 per patient. The overall rate of mortality following plasma exchange therapy was 27% and relapse was observed in only one patient. Rate of mortality varied with different comorbid diseases. Female patients and patients who underwent fewer plasma exchange procedures tended to be unresponsive to plasma exchange therapy, but the results are not statistically significant. Aggressive treatment involving two plasma exchange procedures within 24 hours of diagnosis and choice of any replacement fluid did not show an association with improved mortality. CONCLUSION: No association of the factors analyzed with mortality rate and responsiveness to plasma exchange was observed.

The Reliability and Validity of the Korean Versions of the International Restless Legs Scale and the Restless Legs Syndrome Quality of Life Questionnaire

BACKGROUND: The International Restless Legs Scale (IRLS) and the Restless Legs Syndrome Quality of Life questionnaire (RLSQoL) are valid and reliable tools for assessing RLS severity and the impact of RLS on daily life in Western countries. The purpose of this study was to validate the Korean versions of these questionnaires in Korean RLS patients. METHODS: We developed the Korean versions of the IRLS and the RLSQoL. In total, 250 Korean primary RLS patients were included in this study. These questionnaires were used for the initial interview and a subsequent retest approximately 1 month later. The findings were compared with those obtained using the Clinical Global Impression, Short Form 36 Health Survey, and other instruments. The percentage agreement and Cronbach's alpha were calculated for each question, and the validity coefficients were estimated from these statistics. RESULTS: The scores for the Korean versions of the IRLS (range: 0-40) and the RLSQoL (range 0-100) proved reliably consistent (Cronbach's alpha=0.96 and 0.92, respectively) and had good test-retest reliability (intraclass correlation coefficient=0.61-0.85 and 0.61-0.89, respectively). The Korean version of the RLSQoL could be used to distinguish between groups with none, mild, moderate, severe, and very severe symptoms (F=66.10, P<0.0001). The two questionnaires proved to have high reliability and validity coefficients. CONCLUSIONS: The Korean versions of the IRLS and the RLSQoL are valid and reliable tools for assessing RLS severity and the impact of RLS on the daily life of Korean RLS patients.

Clinical usefulness of rapid antigen test to detect respiratory syncytial virus infection / 소아과

PURPOSE: Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory infections in infants and young children. Early detection allows quarantining of infected inpatients to prevent nosocomial transmission and to choose a treatment. To achieve rapid reporting, to facilitate prompt antiviral therapy, and to avoid unnecessary use of antibiotics, an easy, rapid diagnostic method for RSV is needed. We evaluated a lateral flow immunochromatography (RSV Respi-Strip test) and EIA (Enzyme immuno assay) compared to RT-PCR. METHODS: From April 2007 to March 2008, 112 consecutive respiratory specimens (nasopharyngeal aspirates, throat swabs, tracheal aspirates, sputum) from patients who were suffering from the clinical signs and symptoms of respiratory tract infection were enrolled in Busan. A total of 112 patients were tested with RSV Respi-Strip (Corio-BioConcept, Belgium), EIA, and RT-PCR at the same time. RESULTS: Of the 112 specimens tested, the number of children who showed positive results at RT-PCR and Respi-Strip were 45 and 42, respectively. The Respi-Strip rapid antigen test had a sensitivity of 88% and a specificity of 94%. The positive and negative predictive values were 90% and 92%, respectively. The agreement was 83%. CONCLUSION: In our study, the rapid antigen test had as much sensitivity as any method for detection of RSV. The test has many advantages such as easy performance, simple interpretation, and rapid results. If the rapid antigen test is widely applied in the clinical setting, the may be useful for diagnostic and epidemiological studies of RSV infection.

The Consequence of Cardiovascular Sympathetic Nervous System in Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The previous studies have shown that patients with obstructive sleep apnea (OSA) have shown high levels of cardiovascular diseases. These cardiovascular diseases are related to imbalance of cardiac autonomic systems. Alteration of QT interval in EKG reflects the increased cardiac sympathetic activity. The purpose of this study is to compare the cardiac sympathetic nerve activity between the control and OSA patients. SUBJECTS AND METHOD: All the patients were divided into the control group (n=20), whose RDI was less than 5 and the OSA group (n=40), whose RDI was more than 5. The OSA group was also divided into 3 groups, mild, moderate and severe, according to their RDI. The corrected QT interval (QTc) in EKG was checked at day time and during polysomnography. RESULTS: The number of hypertensive patients was significantly greater in the OSA group than the control group (p<0.001). The QTc interval was increased proportional to the RDI (p<0.001). There was a significant difference in the QTc intervals between the daytime period and apnea peak (p=0.031). CONCLUSION: Our results showed that the QT prolongation might be a prognostic factor in predicting the cardiac sympathetic hyperactivity in obstructive sleep apnea patients.

Further Increase of Vancomycin-Resistant Enterococcus faecium, Amikacin- and Fluoroquinolone-Resistant Klebsiella pneumoniae, and Imipenem-Resistant Acinetobacter spp. in Korea: 2003 KONSAR Surveillance

Monitoring temporal trends of antimicrobial resistance can provide useful information for the empirical selection of antimicrobial agents to treat infected patients and for the control of nosocomial infections. In this study, we analyzed antimicrobial resistance of clinically relevant bacteria in 2003 at Korean hospitals and at a commercial laboratory. The following organism-antimicrobial agent resistance combinations were very prevalent: oxacillin-resistant Staphylococcus aureus (68%), expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (25%), and fluoroquinolone-resistant Escherichia coli (33%), Acinetobacter spp. (58%), and Pseudomonas aeruginosa (40%). Moreover, gradual increases in vancomycin-resistant Enterococcus faecium (20%), cefoxitin-resistant E. coli (10%) and K. pneumoniae (23%), and imipenem-resistant P. aeruginosa (20%) and Acinetobacter spp. (13%) were also observed. The resistance rates of Acinetobacter spp. to most antimicrobial agents at hospitals and at the commercial laboratory were similar. Among the Acinetobacter spp. isolated at a tertiary-care hospital, 46.2% were multidrug-resistant to 9-12 of 13 antimicrobial agents, and 18.3% were panresistant. The exclusion of duplicate isolates at a tertiary-care hospital significantly lowered the proportion of oxacillin-resistant S. aureus, vancomycin-resistant E. faecium, and fluoroquinolone-resistant E. coli.

Evaluation of Diagnostic Utility of Intradermal Test for the Diagnosis of Clonorchis sinensis Infestation / 대한임상미생물학회지

BACKGROUND: The intradermal test for the screening of Clonorchis sinensis is difficult to interpret because the sensitivity and persistence rates of reactions after treatment are not well known. METHODS: Stool egg examinations and intradermal tests for C. sinensis and Paragonimus westermani were performed for 1,207 persons who lived in endemic areas of C. sinensis infestation, and epidemiologic data were also surveyed. RESULTS: The infestation rate of C. sinensis was 12% (male 14%, female 9%). It was higher in Southeastern area of Gyungsang Namdo Province and Ulsan (22%) than in Busan (10%), whereas much higher in Gangseo/Buk/Sasang (28%) than in other areas of Busan. The performance of C. sinensis intradermal test was as belows; sensitivity 45%, specificity 80.8%, positive predictive value 24%, negative predictive value 92%, and diagnostic efficiency 77%. Positive C. sinensis intradermal reaction persisted for longer than 40 years after treatment of C. sinensis infestation in at least 30% of patients. C. sinensis intradermal reaction turned to be positive within 4 months after intake of raw fish in more than half the patients. CONCLUSION: The infestation rate of C. sinensis was still very high in inhabitants around Nakdong River, an endemic area. We think that C. sinensis intradermal test is inadequate to diagnose current clonorchiasis.

Fatal Acute Hemolytic Transfusion Reaction Due to Anti-E+Fy(a) / 대한진단검사의학회지

A 72-year-old man with a regrowing tongue mass and refractory anemia received two units of compatible red blood cells by saline and albumin phase crossmatching tests. One hour after the last unit, he had a hemolytic transfusion reaction manifested by chest discomfort, fever, redcolored urine, fall in hemoglobin, hemoglobinuria and bilirubinemia. He developed acute renal failure and pulmonary edema and died three days later. Anti-E+Fy(a) antibodies were identified in the patient's serum. This case suggests that indirect antiglobulin crossmatching tests or antibody screening tests are needed for routine pretransfusion tests in Korea.

Evaluating the Usefulness of the ICT Tuberculosis Test Kit for the Diagnosis of Tuberculosis / 결핵

BACKGROUND: Early diagnosis of tuberculosis is critical, especially in Korea, an area where tuberculosis is endemic. Because antibody responses to some membrane proteins of Mycobacterium tuberculosis are not comparable, and the policy of BCG vaccination and the prevalence of tuberculosis are different from country to country, the usefulness of the serological diagnostic tests is questionable in Korea, even though they have been confirmed to be useful in other countries. In the specific context of Korea, we tried to evaluate the validity of the ICT Tuberculosis Test (ICT), a membrane-based antibody kit that purports to detect the 5 M. tuberculosis complex-specific antigens including 38-kDa protein. METHOD: 68 patients with tuberculosis were tested: 37 had no history of previous tuberculosis, and 31 were reactivated cases. The control group comprised 77 subjects: 25 healthy adults, 35 hospital workers with frequent contact with tuberculosis patients, and 17 in-patients with non-tuberculous respiratory diseases. RESULTS: The diagnostic sensitivities of the ICT were 87% and 73% in patients with versus without previous history of tuberculosis, respectively. The sensitivities of smear-positive and smear-negative patient groups were 81% and 73%, respectively. Both of the two patients with extrapulmonary tuberculosis tested positive through the ICT. The specificities of the ICT were 88%, 94%, and 94% in healthy adults, hospital workers, and non-tuberculous patients, respectively, with an overall specificity of 92%. Conclusion: It is suggested that when combined with traditional techniques, the ICT is an useful tool for the diagnosis of pulmonary tuberculosis. The procedure is simple, easy to perform, rapid, and needs no equipment. It shows 73% sensitivity and 92% specificity for the diagnosis of tuberculosis.

Evaluating the Usefulness of the ICT Tuberculosis Test Kit for the Diagnosis of Tuberculosis / 결핵

BACKGROUND: Early diagnosis of tuberculosis is critical, especially in Korea, an area where tuberculosis is endemic. Because antibody responses to some membrane proteins of Mycobacterium tuberculosis are not comparable, and the policy of BCG vaccination and the prevalence of tuberculosis are different from country to country, the usefulness of the serological diagnostic tests is questionable in Korea, even though they have been confirmed to be useful in other countries. In the specific context of Korea, we tried to evaluate the validity of the ICT Tuberculosis Test (ICT), a membrane-based antibody kit that purports to detect the 5 M. tuberculosis complex-specific antigens including 38-kDa protein. METHOD: 68 patients with tuberculosis were tested: 37 had no history of previous tuberculosis, and 31 were reactivated cases. The control group comprised 77 subjects: 25 healthy adults, 35 hospital workers with frequent contact with tuberculosis patients, and 17 in-patients with non-tuberculous respiratory diseases. RESULTS: The diagnostic sensitivities of the ICT were 87% and 73% in patients with versus without previous history of tuberculosis, respectively. The sensitivities of smear-positive and smear-negative patient groups were 81% and 73%, respectively. Both of the two patients with extrapulmonary tuberculosis tested positive through the ICT. The specificities of the ICT were 88%, 94%, and 94% in healthy adults, hospital workers, and non-tuberculous patients, respectively, with an overall specificity of 92%. Conclusion: It is suggested that when combined with traditional techniques, the ICT is an useful tool for the diagnosis of pulmonary tuberculosis. The procedure is simple, easy to perform, rapid, and needs no equipment. It shows 73% sensitivity and 92% specificity for the diagnosis of tuberculosis.