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1.
J Korean Med Sci ; 35(11): e77, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32193903

RESUMO

BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with high mortality in East Asia. This study aimed to develop, for primary care providers, a prediction score using initial symptoms and basic laboratory blood tests to differentiate between SFTS and other endemic zoonoses in Korea. METHODS: Patients aged ≥ 18 years diagnosed with endemic zoonoses during a 3-year period (between January 2015 and December 2017) were retrospectively enrolled from 4 tertiary university hospitals. A prediction score was built based on multivariate logistic regression analyses. RESULTS: Of 84 patients, 35 with SFTS and 49 with other endemic zoonoses were enrolled. In multivariate logistic regression analysis, independent predictors of SFTS included neurologic symptoms (odds ratio [OR], 12.915; 95% confidence interval [CI], 2.173-76.747), diarrhea (OR, 10.306; 95% CI, 1.588-66.895), leukopenia (< 4,000/mm³) (OR, 19.400; 95% CI, 3.290-114.408), and normal C-reactive protein (< 0.5 mg/dL) (OR, 24.739; 95% CI, 1.812-337.742). We set up a prediction score by assigning one point to each of these four predictors. A score of ≥ 2 had 82.9% sensitivity (95% CI, 71.7%-87.5%) and 95.9% specificity (95% CI, 88.0%-99.2%). The area under the curve of the clinical prediction score was 0.950 (95% CI, 0.903-0.997). CONCLUSION: This study finding suggests a simple and useful scoring system to predict SFTS in patients with endemic zoonoses. We expect this strategic approach to facilitate early differentiation of SFTS from other endemic zoonoses, especially by primary care providers, and to improve the clinical outcomes.


Assuntos
Febre Hemorrágica com Síndrome Renal/diagnóstico , Febre por Flebótomos/diagnóstico , Tifo por Ácaros/diagnóstico , Adulto , Idoso , Animais , Proteína C-Reativa/análise , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Phlebovirus , República da Coreia , Estudos Retrospectivos , Zoonoses/diagnóstico
2.
J Cardiothorac Vasc Anesth ; 34(2): 383-391, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31585685

RESUMO

OBJECTIVE: Researchers have assumed that compressing the point beneath which the left ventricle (LV) diameter is maximum (P_max.LV) would improve cardiopulmonary resuscitation outcomes. Defining the midsternum, the currently recommended location for chest compression, as the reference (x = 0), the lateral deviation (x_max.LV) of personalized P_max.LV has become estimable using posteroanterior chest radiography. The authors investigated whether out-of-hospital cardiac arrest (OHCA) patients, whose x_max.LV was closer to the midsternum and thus had their P_max.LV compressed closer during cardiopulmonary resuscitation, showed better chances of return of spontaneous circulation (ROSC) and survival to discharge. DESIGN: Retrospective, cross-sectional study. SETTING: A university hospital. PARTICIPANTS: Adult OHCA patients with available previous posteroanterior chest radiography. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: For each clinical outcome, multivariable logistic regression was performed, grouping x_max.LV into tertiles and adjusting the variables selected among the core elements of the Utstein template showing possible differences (p > 0.10) in univariate analysis. Odds ratios were presented as OR (95% confidence interval). Among 268 cases (age 64.4 ± 15.8 y, female 89 [33.2%]), 123 (45.9%) achieved ROSC and 40 (14.9%) survival to discharge. Compared with the third tertile of x_max.LV (59 to ∼101 mm), the first (31 to ∼48 mm) and second (48 to ∼59 mm) tertiles, which had a P_max.LV closer to the midsternum, were negatively associated with ROSC (OR 0.502 [0.262-0.960]; p = 0.037 and OR 0.442 [0.233-0.837]; p = 0.012, respectively) and survival to discharge (OR 0.286 [0.080-1.03]; p = 0.055 and OR 0.046 [0.007-0.308]; p = 0.002, respectively). CONCLUSIONS: OHCA patients with a P_max.LV located closer to the midsternum showed worse chances of ROSC and survival to discharge, which challenges the traditional assumption of identifying P_max.LV as the optimum compression point.

3.
Infect Chemother ; 51(3): 284-294, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31583862

RESUMO

BACKGROUND: Vertebral osteomyelitis (VO) is a rare but serious condition, and a potentially significant cause of morbidity. Methicillin-susceptible Staphylococcus aureus (MSSA) is the most common microorganism in native VO. Long-term administration of parenteral and oral antibiotics with good bioavailability and bone penetration is required for therapy. Use of oral ß-lactams against staphylococcal bone and joint infections in adults is not generally recommended, but some experts recommend oral switching with ß-lactams. This study aimed to describe the current status of antibiotic therapy and treatment outcomes of oral switching with ß-lactams in patients with MSSA VO, and to assess risk factors for treatment failure. MATERIALS AND METHODS: This retrospective study included adult patients with MSSA VO treated at nine university hospitals in Korea between 2005 and 2014. Treatment failure was defined as infection-related death, microbiological relapse, neurologic deficits, or unplanned surgical procedures. Clinical characteristics and antibiotic therapy in the treatment success and treatment failure groups were compared. Risk factors for treatment failure were identified using the Cox proportional hazards model. RESULTS: A total of 100 patients with MSSA VO were included. All patients were treated, initially or during antibiotic therapy, with one or more parenteral antibiotics. Sixty-nine patients received one or more oral antibiotics. Antibiotic regimens were diverse and durations of parenteral and oral therapy differed, depending on the patient and the hospital. Forty-two patients were treated with parenteral and/or oral ß-lactams for a total duration of more than 2 weeks. Compared with patients receiving parenteral ß-lactams only, no significant difference in success rates was observed in patients who received oral ß-lactams for a relatively long period. Sixteen patients had treatment failure. Old age (adjusted hazard ratio [HR] 5.600, 95% confidence interval [CI] 1.402 - 22.372, P = 0.015) and failure to improve C-reactive protein levels at follow-up (adjusted HR 3.388, 95% CI 1.168 - 9.829, P = 0.025) were independent risk factors for treatment failure. CONCLUSION: In the study hospitals, diverse combinations of antibiotics and differing durations of parenteral and oral therapy were used. Based on the findings of this study, we think that switching to oral ß-lactams may be safe in certain adult patients with MSSA VO. Since limited data are available on the efficacy of oral antibiotics for treatment of staphylococcal VO in adults, further evaluation of the role of oral switch therapy with ß-lactams is needed.

4.
Korean J Gastroenterol ; 74(3): 175-182, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554034

RESUMO

Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare but critical disease with a high mortality rate. The diagnostic dilemma of PPP syndrome is the fact that symptoms occur unexpectedly. A 48-year-old man presented with fever and painful swelling of the left foot that was initially mistaken for cellulitis and gouty arthritis. The diagnosis of PPP syndrome was made based on the abdominal CT findings and elevated pancreatic enzyme levels, lobular panniculitis with ghost cells on a skin biopsy, and polyarthritis on a bone scan. The pancreatitis and panniculitis disappeared spontaneously over time, but the polyarthritis followed its own course despite the use of anti-inflammatory agents. In addition to this case, 30 cases of PPP syndrome in the English literature were reviewed. Most of the patients had initial symptoms other than abdominal pain, leading to misdiagnosis. About one-third of them were finally diagnosed with a pancreatic tumor, of which pancreatic acinar cell carcinoma was the most dominant. They showed a mortality rate of 32.3%, associated mainly with the pancreatic malignancy. Therefore, PPP syndrome should be considered when cutaneous or osteoarticular manifestations occur in patients with pancreatitis. Active investigation and continued observations are needed for patients suspected of PPP syndrome.


Assuntos
Artrite/diagnóstico , Pancreatite/diagnóstico , Paniculite/diagnóstico , Artrite/tratamento farmacológico , Artrite/patologia , Artrite Gotosa/diagnóstico , Osso e Ossos/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Pancreatite/tratamento farmacológico , Pancreatite/patologia , Paniculite/tratamento farmacológico , Paniculite/patologia , Tomografia Computadorizada por Raios X
5.
Korean J Intern Med ; 34(4): 902-909, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29117665

RESUMO

BACKGROUND/AIMS: Severe fever with thrombocytopenia syndrome (SFTS) is a viral hemorrhagic fever with a high fatality rate. However, effective treatments for SFTS cases not responded to supportive therapy have not been established. Herein, we introduced the therapeutic plasma exchange (TPE) in SFTS patients in a tertiary hospital between 2013 and 2015. METHODS: TPE was performed in patients with rapidly progressing SFTS. Clinical, laboratory, and virological parameters were compared before and after TPE. RESULTS: Among 27 confirmed SFTS patients, two patients were treated with TPE and ribavirin combination in May 2013, then, 14 patients with rapidly progressing SFTS patients were treated with only TPE from June 2013 to September 2015: their median age was 58 years (interquartile range, 50 to 70) and eight (57.1%) were male. Body temperature, pressure-adjusted heart rate, white blood cell and platelet counts, coagulation profile, serum creatinine, and multiple organ dysfunction score improved immediately after TPE. In addition, the mean cyclic threshold value of real-time reverse transcriptase polymerase chain reaction for SFTS virus after TPE (mean ± standard deviation, 31.3 ± 2.9) was significantly higher than that before TPE (26.5 ± 2.9; p < 0.001), indicating that serum viral loads decreased after TPE. Finally, 13 of 14 TPE-treated patients (92.8%) recovered from rapidly progressing SFTS without sequelae. CONCLUSION: SFTS patients treated with TPE showed improvements in clinical, laboratory, and virological parameters. These results suggest that TPE would be a therapeutic modality as rescue therapy in patients with rapidly progressing SFTS.


Assuntos
Infecções por Bunyaviridae/terapia , Febre/terapia , Phlebovirus/patogenicidade , Troca Plasmática , Trombocitopenia/terapia , Idoso , Infecções por Bunyaviridae/sangue , Infecções por Bunyaviridae/diagnóstico , Infecções por Bunyaviridae/virologia , Progressão da Doença , Feminino , Febre/sangue , Febre/diagnóstico , Febre/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombocitopenia/sangue , Trombocitopenia/diagnóstico , Trombocitopenia/virologia , Resultado do Tratamento , Carga Viral
6.
Pediatr Crit Care Med ; 19(11): e576-e584, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30395117

RESUMO

OBJECTIVES: The optimum chest compression site (P_optimum) in children is debated: European Resuscitation Council recommends one finger breadth above the xiphisternal joint, whereas American Heart Association proposes the lower sternal half. Using a coordinate system imposed on CT, we aimed to determine the pediatric P_optimum to maximize stroke volume, the key point for successful cardiopulmonary resuscitation, while minimizing hepatic injury. DESIGN: Retrospective, cross-sectional study. SETTING: University hospital. PATIENTS: Children 1-15 years old who underwent chest CT. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We defined zero point (0, 0) as the center of the xiphisternal joint designating leftward and upward directions of the patients as positive on each axis. P_optimum (x_max. left ventricle, y_max. left ventricle) was defined as the center of the maximum diameter of the left ventricle, whereas P_aorta (x_aorta, y_aorta) as that of the aortic annulus. To compress the left ventricle exclusively, y_max. left ventricle should range above the y coordinate of hepatic dome (y_liver_dome) and below y_aorta. Data were presented as median (interquartile range) and compared among age groups 1.0-5.0, 5.1-10.0, and 10.1-15.0 years using Kruskal-Wallis test. For universal application regardless of age, y coordinates were converted into relative ones with unit of sternal top: 1 unit of sternal top was the y coordinate of the sternal top. A total of 163 patients were enrolled, median age 8.8 year (4.2-14.3 yr). Among age groups, no significant difference was observed in y_max. left ventricle, relative y_max. left ventricle, y_aorta, and y_liver_dome: 1.0 cm (0.1-1.9 cm), 0.10 unit of sternal top (0.01-0.18 unit of sternal top), 0.39 unit of sternal top (0.30-0.47 unit of sternal top), and -0.14 unit of sternal top (-0.25 to -0.03 unit of sternal top), respectively. The probability to compress the left ventricle exclusively was greater than or equal to 96% when placing hand at 0.05-0.20 unit of sternal top. Subgroup analysis demonstrated the following regression equation: x_max. left ventricle (mm) = 0.173 × (height in cm) + 13 (n = 106; p < 0.001; R = 0.278). CONCLUSIONS: Theoretically, pediatric P_optimum is located 1 cm (or 0.1 unit of sternal top) above the xiphisternal joint.


Assuntos
Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Massagem Cardíaca/métodos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X
7.
Resuscitation ; 128: 97-105, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29746985

RESUMO

AIM: Cardiopulmonary resuscitation guidelines suggest the lower sternal half be compressed. However, stroke volume has been assumed to be maximized by compressing the 'point' (P_max.LV) beneath which the left ventricle (LV) is at its maximum diameter. Identifying 'personalized' P_max.LV on computed tomography (CT), we derived and validated rules to estimate P_max.LV using posteroanterior chest radiography (chest_PA). METHODS: A retrospective, cross-sectional study was performed with non-cardiac arrest (CA) adults who underwent chest_PA and CT within 1h (derivation:validation = 3:2). On chest_PA, we defined CD (cardiac diameter), RB (distance from right cardiac border to midline) and CH (cardiac height, from carina to uppermost point of left hemi-diaphragm). Setting P_zero (0, 0) at the midpoint of xiphisternal joint and designating leftward and upward directions as positive on x and y axes, we located P_max.LV (x_max.LV, y_max.LV). Mathematically, followings were inferable: x_max.LV = α0*CD-RB; y_max.LV = ß0*CH + γ0. (α0: mean of (x_max.LV + RB)/CD; ß0, γ0: representative coefficient and constant of linear regression model, respectively). We investigated their feasibility by applying them to in-hospital (IHCA) and out-of-hospital CA (OHCA) adults. RESULTS: Among 266 (57.6 ±â€¯16.4 years, 120 females), followings were derived: x_max.LV = 0.664*CD-RB; y_max.LV = 40 - 0.356*CH. Estimated P_max.LV was closer to the reference than other candidates and thus validated: 15 ±â€¯9 vs 17 ±â€¯10 (averaged P_max.LV, p = 0.025); 76 ±â€¯13, 54 ±â€¯11 and 63 ±â€¯13 mm (3 equidistant points as per guidelines, all p < 0.001). Among IHCA and OHCA patients, 70.7% (106/150) and 38.0% (57/150) had previous chest_PA with measurable parameters to estimate P_max.LV. CONCLUSION: Personalized P_max.LV, which is potentially superior to the lower sternal half and feasible in CA, is estimable with chest_PA.


Assuntos
Reanimação Cardiopulmonar/métodos , Massagem Cardíaca/métodos , Coração/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos Transversais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imagem Tridimensional , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Guias de Prática Clínica como Assunto , Medicina de Precisão , Estudos Retrospectivos , Esterno/anatomia & histologia , Esterno/diagnóstico por imagem , Tórax/anatomia & histologia
8.
Yonsei Med J ; 58(4): 867-871, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28541003

RESUMO

Despite a high mortality rate, no specific treatment for severe fever with thrombocytopenia syndrome (SFTS) has been established. This study compared the clinical outcomes of SFTS patients treated with plasma exchange (PE group) with those who were not treated (non-PE group) at nine Korean hospitals between May 2013 and August 2015. A total of 53 SFTS patients were included: 24 (45.3%) PE cases and 29 (54.7%) non-PE cases. The overall in-hospital mortality rate was 32.1% (17/53). The in-hospital mortality rate of the PE group did not differ from that of the non-PE group (29.3% vs. 34.5%, p=0.680). Of the 24 PE cases, 16 (66.7%) were treated with PE within 7 days of symptom onset (early PE group). The early PE group survived longer than the non-PE group (mean 28.4 days vs. 22.6 days, p=0.044). Multivariate analysis showed an inverse association between early PE implementation and 30-day mortality (adjusted hazard ratio 0.052, 95% confidence interval 0.004-0.678, p=0.024). The results of this study suggest that early PE implementation may have a beneficial effect on the clinical outcome of SFTS patients.


Assuntos
Febre/complicações , Febre/mortalidade , Troca Plasmática/mortalidade , Trombocitopenia/complicações , Trombocitopenia/mortalidade , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
10.
Dement Neurocogn Disord ; 16(3): 83-86, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30906376

RESUMO

Background: An infection known to be a major cause of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Rapidly progressive dementia is a neurological condition in which dementia progresses in a short period of time. Case Report: We report on a 78-year-old woman presenting with a rapid decline in cognitive function resulting from a scrub typhus infection. Diffusion weighted images showed a signal intensity at the splenium, and subcortical white matter of both hemispheres suggesting MERS. On the neuropsychological test, the patient showed frontal executive dysfunction. Conclusions: This case suggests that diagnosticians should consider the possibility that a MERS patient with a rapidly cognitive decline could have a scrub typhus infection because early diagnosis of scrub typhus is very important in this aspect of the treatment.

11.
J Infect Dev Ctries ; 10(11): 1222-1229, 2016 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-27886035

RESUMO

INTRODUCTION: Among patients with urinary tract infection (UTI), bacteremic cases show higher mortality rates than do nonbacteremic cases. Early identification of bacteremic cases is crucial for severity assessment of patients with febrile UTI. This study aimed to identify predictors associated with bacteremia in women with community-onset febrile UTI and to develop a prediction model to estimate the probability of bacteremic cases. METHODOLOGY: This cross-sectional study included women consecutively hospitalized with community-onset febrile UTI at 10 hospitals in Korea. Multiple logistic regression identified predictors associated with bacteremia among candidate variables chosen from univariate analysis. A prediction model was developed using all predictors weighted by their regression coefficients. RESULTS: From July to September 2014, 383 women with febrile UTI were included: 115 (30.0%) bacteremic and 268 (70.0%) nonbacteremic cases. A prediction model consisted of diabetes mellitus (1 point), urinary tract obstruction by stone (2), costovertebral angle tenderness (2), a fraction of segmented neutrophils of > 90% (2), thrombocytopenia (2), azotemia (2), and the fulfillment of all criteria for systemic inflammatory response syndrome (2). The c statistic for the model was 0.807 (95% confidence interval [CI], 0.757-0.856). At a cutoff value of ≥ 3, the model had a sensitivity of 86.1% (95% CI, 78.1-91.6%) and a specificity of 54.9% (95% CI, 48.7-91.6%). CONCLUSIONS: Our model showed a good discriminatory power for early identification of bacteremic cases in women with community-onset febrile UTI. In addition, our model can be used to identify patients at low risk for bacteremia because of its relatively high sensitivity.


Assuntos
Bacteriemia/diagnóstico , Infecções Comunitárias Adquiridas/patologia , Técnicas de Apoio para a Decisão , Infecções Urinárias/complicações , Infecções Urinárias/patologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , República da Coreia , Sensibilidade e Especificidade , Adulto Jovem
12.
Am J Trop Med Hyg ; 95(5): 1021-1025, 2016 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-27645781

RESUMO

Identification of mite and tick bite sites provides important clinical information. The predominant mite species in Korea associated with scrub typhus are Leptotrombidium pallidum and Leptotrombidium scutellare The most abundant tick species is Haemaphysalis longicornis To date, there has been no comparative study on preferred bite sites between mites and ticks in humans. This study included a review of medical records and a field study. For mite bite sites, eschars were checked on 506 patients with scrub typhus, confirmed by indirect immunofluorescence assay or nested polymerase chain reaction on the 56-kDa type-specific antigen gene of Orientia tsutsugamushi Tick bite sites were identified and marked on a diagram for 91 patients who experienced tick bites within the previous year through a field epidemiological investigation. The mite and tick bite sites in Koreans were compared. The most frequently observed mite bite sites were the anterior chest, including the axillae (29.1%) and the abdominal region, including the inguinal area (26.1%). Tick bite sites were most frequent on the lower extremities (33.0%), followed by the abdominal region, including the inguinal area (26.4%), and upper extremities (26.4%). The distribution was significantly different between mite and tick bite sites (P < 0.001). There was a statistically significant difference in the mite bite (P = 0.001), but not tick bite sites (P = 0.985), between men and women. This is the first report on the differences between tick and mite bite sites, and may help clinicians reach a rapid diagnosis of mite- or tick-borne infection.


Assuntos
Mordeduras e Picadas/diagnóstico , Infestações por Ácaros/diagnóstico , Doenças Transmitidas por Carrapatos/diagnóstico , Carrapatos , Trombiculidae , Animais , Mordeduras e Picadas/parasitologia , Feminino , Humanos , Masculino , Orientia tsutsugamushi/isolamento & purificação , Reação em Cadeia da Polimerase , Estudos Prospectivos , República da Coreia , Tifo por Ácaros/parasitologia , Tifo por Ácaros/transmissão
13.
Infect Chemother ; 48(2): 118-26, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27433382

RESUMO

BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.

14.
Am J Emerg Med ; 34(8): 1415-20, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27130586

RESUMO

BACKGROUND: Acute pyelonephritis (APN) is one of the most common bacterial infections. Because health care-associated (HCA) infections in the community setting have similar characteristics to hospital-acquired infections, HCA infections should be distinguished from community-acquired (CA) infections. However, the impact of HCA-APN on treatment outcomes has not been clearly defined. This study aimed to analyze the impact of HCA-APN on the appropriateness of empiric antibiotic therapy and outcomes in community-onset APN. METHODS: We prospectively identified women older than 18years who were hospitalized with APN via the emergency department and whose urine culture grew bacteria at 10 acute care hospitals in South Korea. RESULTS: Of the 388 APN episodes that were included, 99 (25.5%) were HCA-APN and 289 (74.5%) were CA-APN. Compared with patients with CA-APN, patients with HCA-APN had comorbid conditions and septic shock more frequently. Health care-associated APN was caused by resistant uropathogens more often. Patients with HCA-APN had poorer outcomes (ie, early/final clinical and microbiologic failures); however, this was not statistically significant. Patients with HCA-APN had significantly longer hospital stays than did patients with CA-APN. In the multivariable logistic regression analysis for inappropriate empiric therapy, HCA-APN (odds ratio, 1.96; 95% confidence interval, 1.07-3.57; P=.03) and being bed-ridden (odds ratio, 3.04; 95% confidence interval, 1.31-7.07; P=.01) were significant. CONCLUSIONS: Health care-associated APN was associated with inappropriate empiric antibiotic therapy, which might lead to worse outcomes. These HCA factors should be considered when prescribing empiric antibiotic therapy in patients with community-onset APN.


Assuntos
Antibacterianos/efeitos adversos , Infecção Hospitalar , Serviço Hospitalar de Emergência , Erros de Medicação , Pielonefrite/etiologia , Doença Aguda , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Prospectivos , Pielonefrite/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco
15.
J Korean Med Sci ; 31(5): 814-6, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27134507

RESUMO

Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.


Assuntos
Soluções Isotônicas/uso terapêutico , Modelos Teóricos , Choque Hemorrágico/prevenção & controle , Choque Hemorrágico/terapia , Volume Sanguíneo , Hematócrito , Humanos
16.
Am J Trop Med Hyg ; 93(3): 468-74, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26033016

RESUMO

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease. The SFTS virus (SFTSV) has been detected in the Haemaphysalis longicornis, which acts as a transmission host between animals and humans. SFTSV was first confirmed in China in 2009 and has also been circulating in Japan and South Korea. However, it is not known if a genetic connection exists between the viruses in these regions and, if so, how SFTSV is transmitted across China, South Korea, and Japan. We therefore hypothesize that the SFTSV in South Korea share common phylogenetic origins with samples from China and Japan. Further, we postulate that migratory birds, well-known carriers of the tick H. longicornis, are a potential source of SFTSV transmission across countries. Our phylogenetic analysis results show that the SFTSV isolates in South Korea were similar to isolates from Japan and China. We connect this with previous work showing that SFTSV-infected H. longicornis were found in China, South Korea, and Japan. In addition, H. longicornis were found on migratory birds. The migratory bird routes and the distribution of H. longicornis are concurrent with the occurrence of SFTSV. Therefore, we suggest that migratory birds play an important role in dispersing H. longicornis-borne SFTSV.


Assuntos
Migração Animal , Aves/virologia , Infecções por Bunyaviridae/transmissão , Phlebovirus/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Vetores Aracnídeos/fisiologia , Vetores Aracnídeos/virologia , Aves/parasitologia , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/virologia , China/epidemiologia , Vetores de Doenças , Feminino , Humanos , Ixodes/fisiologia , Ixodes/virologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Filogenia , Filogeografia , Reação em Cadeia da Polimerase em Tempo Real , República da Coreia/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa
17.
Infect Chemother ; 47(4): 278-302, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26788414

RESUMO

Middle East Respiratory Syndrome (MERS) is an acute viral respiratory illness with high mortality caused by a new strain of betacoronavirus (MERS-CoV). Since the report of the first patient in Saudi Arabia in 2012, large-scale outbreaks through hospital-acquired infection and inter-hospital transmission have been reported. Most of the patients reported in South Korea were also infected in hospital settings. Therefore, to eliminate the spread of MERS-CoV, infection prevention and control measures should be implemented with rigor. The present guideline has been drafted on the basis of the experiences of infection control in the South Korean hospitals involved in the recent MERS outbreak and on domestic and international infection prevention and control guidelines. To ensure efficient MERS-CoV infection prevention and control, care should be taken to provide comprehensive infection control measures including contact control, hand hygiene, personal protective equipment, disinfection, and environmental cleaning.

18.
Am J Trop Med Hyg ; 92(2): 256-61, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25448236

RESUMO

Scrub typhus usually presents as acute undifferentiated fever. This cross-sectional study included adult patients presenting with acute undifferentiated fever defined as any febrile illness for ≤ 14 days without evidence of localized infection. Scrub typhus cases were defined by an antibody titer of a ≥ fourfold increase in paired sera, a ≥ 1:160 in a single serum using indirect immunofluorescence assay, or a positive result of the immunochromatographic test. Multiple regression analysis identified predictors associated with scrub typhus to develop a prediction rule. Of 250 cases with known etiology of acute undifferentiated fever, influenza (28.0%), hepatitis A (25.2%), and scrub typhus (16.4%) were major causes. A prediction rule for identifying suspected cases of scrub typhus consisted of age ≥ 65 years (two points), recent fieldwork/outdoor activities (one point), onset of illness during an outbreak period (two points), myalgia (one point), and eschar (two points). The c statistic was 0.977 (95% confidence interval = 0.960-0.994). At a cutoff value ≥ 4, the sensitivity and specificity were 92.7% (79.0-98.1%) and 90.9% (86.0-94.3%), respectively. Scrub typhus, the third leading cause of acute undifferentiated fever in our region, can be identified early using the prediction rule.


Assuntos
Febre/etiologia , Tifo por Ácaros/diagnóstico , Doença Aguda , Fatores Etários , Idoso , Estudos Transversais , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Febre/diagnóstico , Técnica Indireta de Fluorescência para Anticorpo , Hepatite A/diagnóstico , Humanos , Influenza Humana/diagnóstico , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco , Tifo por Ácaros/epidemiologia , Tifo por Ácaros/etiologia , Sensibilidade e Especificidade
20.
J Int Med Res ; 42(6): 1335-47, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25256381

RESUMO

OBJECTIVES: To identify characteristics associated with particular groups of uropathogens in catheter-associated urinary tract infection (CA-UTI) and to develop clinical prediction rules for identifying these groups. METHODS: Demographic, clinical and microbiological data were analysed from patients with CA-UTI. Infections were categorized into enteric Gram-negative rods, nonfermenters, Gram-positive cocci and fungal. Variables were analysed using univariate and multiple logistic regression analyses, and were used to develop clinical prediction rules. RESULTS: A total of 492 patients were included in the study. Candida species were the most common uropathogens (30.7%), followed by enterococci (17.3%), Escherichia coli (12.0%), Pseudomonas spp. (10.8%), Klebsiella spp. (7.9%) and staphylococci (6.5%). Clinical prediction rules for the bacterial uropathogenic groups showed poor-to-fair discriminatory power, with sensitivities of <40% and specificities of >90%. However, clinical prediction rules showed good discriminatory power for fungal infections, with a sensitivity of 67.3% and a specificity of 78.1%. CONCLUSIONS: Clinical prediction rules developed for identifying specific groups of bacterial uropathogens in patients with CA-UTI had a low sensitivity, whereas those for fungal infections showed good discriminatory power. Further studies to develop more refined and sensitive tools for predicting specific bacterial uropathogens in CA-UTI are warranted.


Assuntos
Infecções Relacionadas a Cateter/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micoses/microbiologia , Infecções Urinárias/microbiologia , Idoso , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Estudos de Coortes , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Previsões , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Cocos Gram-Positivos/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia
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