Medication Adherence and the Occurrence of Complications in Patients with Newly Diagnosed Hypertension

BACKGROUND AND OBJECTIVES: In this retrospective cohort study, we sought to elucidate the relationship between medication adherence (MA) and the incidence of complications in patients with newly diagnosed hypertension. SUBJECTS AND METHODS: Using claims data from the National Health Insurance Service, we measured health outcomes based on levels of MA, analyzed the incidence of complications in patients with a good MA, and clarified factors that may affect or predict MA. RESULTS: In 2008, a total of 4294773 patients were diagnosed with hypertension and were subsequently prescribed anti-hypertensive medications. In the present study, we enrolled 564782 patients who met our inclusion/exclusion criteria. The 40-59% medication possession ratio (MPR) group had a 1.36 times higher risk of developing complications (95% confidence interval [CI]: 1.27-1.45) than did the MPR≥ 80% group, as revealed through Cox's proportional hazards analysis. Similarly, the <20% MPR group was 2.01 times more likely to develop complications than the good MA group (95% CI: 1.82-2.23). Overall, patients who had a lower level of MA had a higher risk of developing complications. CONCLUSION: Our results demonstrate that MA is tightly correlated with hypertension health outcomes. Improving MA could be one strategy for reducing the risk of cerebrovascular disease complications and the loss of productivity in these patients.

Effects of the Mobile Phone Speaker Function on the Dispatcher-assisted Layperson Performance of Early Phase Cardiopulmonary Resuscitation

PURPOSE: The effects of the mobile phone speaker function, which makes it possible to communicate continuously and to allows the free use of two hands, during the early phase of cardiopulmonary resuscitation (CPR) by dispatcher-assisted laypersons were investigated through a mannequin-based simulation study. METHODS: Fifty volunteers were randomly assigned to "non-speaker function CPR" (NSFCPR) (n=25) and "speaker function CPR" (SFCPR) (n=25). Fifty compressions of "Hands-only CPR" were performed according to telephone-instructed CPR by dispatchers with or without the speaker function. The quality of CPR administered and interviews from laypersons on the difficulties of performing CPR were examined. RESULTS: There were no significant differences in compression rate, depth, incomplete chest recoil, and time to first compression between the two groups. However, fourteen participants in the NSFCPR group (56.0%) and five participants in the SFCPR group (20.0%) reported interrupted chest compression (p=0.042). There were twenty-eight events of interruption in the NSFCPR group and twelve in the NSFCPR group (p=0.008). The most common cause of interrupted chest compression were difficulties in hearing the dispatcher's instructions (23, 57.5%). All 13 cases for position correction (32.5%) were observed in the NSFCPR group. There were significant differences between the two groups in causes and counts of compression interruption (p=0.004). CONCLUSION: There was difference in the interruption of compression and there were no differences in CPR performance between two groups. Still, the speaker function may reduce the interruption of chest compression due to phone holding, permitting a clearer hearing of instructions.

Vogt-Koyanagi-Harada disease occurring during pegylated interferon-alpha2b and ribavirin combination therapy for chronic hepatitis C / 대한간학회지

Vogt-Koyanagi-Harada (VKH) disease is a multisystem syndrome characterized by ocular (uveitis and retinal detachment), neurological (headache, tinnitus, and meningitis), and integumentary (vitiligo, alopecia, and poliosis) involvement. Although the pathogenesis of VKH disease is not well understood, an autoimmune T-cell response to a melanocyte-associated antigen is considered to be a cause of VKH disease. The complex immunological response to interferon and ribavirin may induce or exacerbate the autoimmune condition; however, VKH disease is a very rare complication associated with interferon therapy in chronic hepatitis C. We report a case of VKH disease occurring during pegylated interferon-alpha2b and ribavirin combination therapy for chronic hepatitis C.

Diagnostic Value and Utility of the Simplified International Autoimmune Hepatitis Group (IAIHG) Criteria for Autoimmune Hepatitis in Korea / 대한내과학회지

BACKGROUND/AIMS: The diagnostic criteria for autoimmune hepatitis (AIH) were created and revised by the International Autoimmune Hepatitis Group (IAIHG) in 1999. Simplified scoring criteria based on four clinical components were recently proposed. The aim of this study was to assess the diagnostic value and usefulness of these simplified criteria in Korea. METHODS: We applied the simplified scoring criteria to 22 AIH patients diagnosed according to the original revised scoring criteria proposed in 1999. Furthermore, in order to compare the predictive power of these two sets of diagnostic criteria, we included 84 patients with liver diseases [toxic hepatitis (n = 50), nonalcoholic fatty liver disease (n = 18), primary biliary cirrhosis (PBC) (n = 11), and PBC/AIH overlap syndrome (n = 5)] other than AIH. RESULTS: Twenty (90.9%) patients with AIH and five (100%) with PBC/AIH overlap syndrome were diagnosed with AIH according to the simplified scoring criteria. Three (27.3%) patients with PBC were false-positive for AIH according to the simplified scoring criteria. Those patients diagnosed according to the simplified scoring criteria showed an increased frequency of ANA and/or SMA of > or = 1:80 (p = 0.491) and an increased frequency of serum IgG levels at or above the upper normal limit compared to patients with PBC (p = 0.006). The sensitivity and specificity of the simplified scoring criteria for the diagnosis of AIH were 90.9 and 96.2%, respectively. CONCLUSIONS: The simplified scoring criteria offer a reliable and simple method for excluding AIH; however, these criteria may have limitations in the diagnosis of patients with atypical features, especially those with low autoantibody and IgG levels.

Clinical Characteristics and Pathological Findings in Patients with Toxic Hepatitis / 대한내과학회지

BACKGROUND/AIMS: Although many individual cases of toxic hepatitis have been reported, there are few comprehensive systematic studies and few reports of the pathological findings in toxic hepatitis. We studied the clinical characteristics, pathology, and prognosis of patients with toxic hepatitis. METHODS: A retrospective analysis examined the medical records of 184 cases of toxic hepatitis diagnosed from January 2004 to January 2010. Liver biopsies were performed in 62 of these cases. Patients were included in this study it they had a RUCAM score > or =4. RESULTS: The incidence was higher in women (n = 125) than in men (n = 59). The mean age of the patients was 45.9 +/- 14.4 years. The most common symptom was jaundice (56/184; 30.4%). The causative agents of the disease included herbal medications (43.5%), traditional therapeutic preparations (33.7%), and prescribed medications (21.7%). The pathological findings of toxic hepatitis included necrosis (n = 62), cholestasis (n = 43), steatosis (n = 23), eosinophilic infiltrations (n = 22), and ballooning degeneration (n = 20). The patients with cholestasis and necrosis were hospitalized longer and showed delayed recovery. The only prognostic factor associated with the hospitalization and recovery periods was the serum total bilirubin at the time of admission (p < 0.001). CONCLUSIONS: The common pathological findings of toxic hepatitis were necrosis and cholestasis, although these are not specific to toxic hepatitis. Only the total bilirubin at the time of admission was significantly associated with the duration of hospitalization and recovery.

A Fetal Case of Pandemic Influenza (H1N1 2009) by the Aggravated Heart Faiure / 감염과화학요법

On April, 2009, pandemic influenza (H1N1 2009) emerged in the United States at first. Clinical outcomes of this infection are reported as ranging from self-limited illness to respiratory failure or death. There were more than 250 deaths due to pandemic influenza until March 2010. Influenza-related deaths occurred in the elderly and in patients with underlying medical conditions. Most of the critically ill patients showed severe hypoxia and acute respiratory distress syndrome and required ventilator care. We experienced a 70-year-old man presenting with pandemic influenza (H1N1 2009) with heart failure. He was treated with antival agents, ventalator and extracorporeal membrane oxygenation. But his heart function was aggravared and resulted in his death.

Occurrence of diabetic ketoacidosis and autoimmune thyroiditis in a patient treated with pegylated interferon-alpha 2b and ribavirin for chronic hepatitis C / 대한간학회지

Combined pegylated interferon and ribavirin therapy for chronic hepatitis C infection cause a wide range of side effects, including flu-like syndrome, hematological abnormalities, cardiovascular symptoms, gastrointestinal symptoms, pulmonary dysfunction, depression, and retinopathy. Interferon-alpha has been shown to be related to the development of various autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroid disease, and type 1 diabetes mellitus (DM). Type 1 DM and thyroid disease respectively develop in 0.08~2.61% and 10~15% of patients treated with combined interferon-alpha and ribavirin for chronic hepatitis C. The coexistence of type 1 DM and autoimmune thyroiditis was rarely reported. We report a case of a 33-year-old female patient with chronic hepatitis C who simultaneously developed diabetic ketoacidosis and autoimmune thyroiditis after treatment with pegylated interferon-alpha 2b and ribavirin.

Ganciclovir and Leflunomide Combination Therapy for a Patient with Cytomegalovirus Pneumonia after Unrelated Allogenic Stem Cell Transplantation

Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality among transplant recipients. The first line standard therapy for CMV pneumonia is treatment with a combination of ganciclovir and immunoglobulin. Nevertheless, the mortality of CMV pneumonia is 30~70%. Leflunomide has been recently reported to have novel anti-CMV activity by inhibiting viron assembly. It is also cheaper and is more easily given orally as compared to ganciclovir. We report here on an allogenic stem cell transplant recipient who developed CMV pneumonia that was refractory to ganciclovir and immunoglobulin. The patient was successfully treated with a combination of leflunomide and ganciclovir.