The treatment success rate for tuberculosis (TB) has stagnated at 80-81% in South Korea, indicating unsatisfactory outcomes. Enhancing treatment success rate necessitates the development of individualized treatment approaches for each patient. This study aimed to identify the risk factors associated with unfavorable treatment outcomes to facilitate tailored TB care.
Heavy metal exposure may contribute to inflammation in the lungs via increased oxidative stress, resulting in tissue destruction and obstructive lung function (OLF). In this study, we evaluated the relationship between lead and cadmium levels in blood, and lung function in the Korean population.Pooled cross-sectional data from 5,972 subjects who participated in the Korean National Health and Nutrition Examination Survey 2008-2012 were used for this study. OLF was defined as forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.7. Graphite-furnace atomic absorption spectrometry was used to measure levels of lead and cadmium in blood.Adjusted means for age, sex, body mass index, and smoking status in blood lead and cadmium levels were increased with age and were higher in men and current smokers. The FEV1/FVC ratio was lower in the highest quartile group of lead (78.4% vs 79.0%; P=0.025) and cadmium (78.3% vs 79.2%; P<0.001) concentrations, compared with those in the lowest quartile groups. Multiple linear regression demonstrated an inverse relationship between the FEV1/FVC ratio and concentrations of lead (estimated -0.002; P=0.007) and cadmium (estimated -0.005; P=0.001). Of the 5,972 subjects, 674 (11.3%) were classified into the OLF group. Among current smokers, the risk of OLF was higher in subjects in the highest quartile group of cadmium concentration than in those in the lowest quartile group (odds ratio 1.94; 95% confidence interval 1.06-3.57).We demonstrated a significant association between the FEV1/FVC ratio and blood concentrations of lead and cadmium in the Korean population. The risk for OLF was elevated with increasing concentrations of cadmium among current smokers.
Abstract Background The long-term relationship between body composition and lung function has not yet been fully demonstrated. We investigated the longitudinal association between muscle-to-fat (MF) ratio and lung function among middle-aged general population. Methods Participants were enrolled from a community-based prospective cohort between 2005 and 2014. Lung function parameters (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV 1 ], and FEV 1 /FVC) and the MF ratio (total body muscle mass [kg]/fat mass [kg]) were assessed biannually via spirometry and bioelectrical impedance analysis, respectively. Results We followed up 4,712 participants (age 53.9 ± 7.9 years, men 45.8%) for 8 years. With an increase in MF ratio of 1, in men, the FVC increased by 43.9 mL, FEV 1 by 37.6 mL, and FEV 1 /FVC by 0.320%, while in non-smoking women, the FVC increased by 55.8 mL, FEV 1 by 44.3 mL, and FEV 1 /FVC by 0.265% (all P < 0.001). The MF ratio-decreased group showed further annual deterioration in lung function than the MF ratio-increased group (men: FVC − 44.1 mL vs. -28.4 mL, FEV 1 -55.8 mL vs. -39.7 mL, FEV 1 /FVC − 0.53% vs. -0.42%; non-smoking women: FVC − 34.2 mL vs. -30.3 mL, FEV 1 -38.0 mL vs. -35.2 mL; all P < 0.001, except FEV 1 in non-smoking women; P = 0.005). The odds ratio for the incidence of airflow obstruction according to the MF ratio was 0.77 (95% CI, 0.68–0.87) in men and 0.85 (95% CI, 0.74–0.97) in non-smoking women. Conclusions Long-term changes in the MF ratio are related to lung function deterioration and incidence of airflow obstruction in middle-aged general population.
Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only hospital acquired pneumonia, but also non-nosocomial pneumonia. However, the risk factors for non-nosocomial MRSA pneumonia are not clearly defined. Our objective was to identify risk factors at admission that were associated with non-nosocomial MRSA pneumonia.We evaluated 943 patients admitted to a university-affiliated hospital with culture-positive bacterial pneumonia developed outside the hospital from January 2008 to December 2011. We compared the clinical characteristics between MRSA and non-MRSA pneumonia, and identified risk factors associated with MRSA pneumonia.Of 943 patients, MRSA was identified in 78 (8.2%). Higher mortality was observed in MRSA than in non-MRSA patients (33.3% vs. 21.5%; P = 0.017). In a logistic regression analysis, MRSA pneumonia was observed more frequently in patients with a previous history of MRSA infection (OR = 6.05; P < 0.001), a PSI score ≥120 (OR = 2.40; P = 0.015), intravenous antibiotic treatment within 30 days of pneumonia (OR = 2.23; P = 0.018). By contrast, non-MRSA pneumonia was observed more often in patients with a single infiltrate on chest radiography (OR = 0.55; P = 0.029).Anti-MRSA antibiotics could be considered in hospitalized non-nosocomial patients with several risk factors identified herein. The presence or absence of these factors would provide useful guidance in selecting initial empirical antibiotics.
Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only healthcare-associated pneumonia (HCAP) but also community-acquired pneumonia (CAP).We determined the impact of MRSA on differences in clinical characteristics, courses, and outcomes between CAP and HCAP.Materials and Methods: We conducted a retrospective observational study on 78 adult patients admitted with MRSA pneumonia at a university-affiliated tertiary hospital between January 2008 and December 2011.We compared baseline characteristics, chest radiographs, treatment outcomes, and drug resistance patterns between the CAP and HCAP groups.Results: Of the 78 patients with MRSA pneumonia, 57 (73.1%) were HCAP and 21 (26.9%) were CAP.MRSA infection history in the previous year (29.8% vs. 14.3%, p=0.244) tended to be more common in HCAP than in CAP.Despite similar Pneumonia Severity Index scores (151 in CAP vs. 142 in HCAP), intubation rates (38.1% vs. 17.5%;p=0.072) and intensive care unit admission (42.9% vs. 22.8%; p=0.095) tended to be higher in the CAP group, while 28-day mortality was higher in the HCAP group (14.3% vs. 26.3%;p=0.368), although without statistical significance.All patients showed sensitivity to vancomycin and linezolid; meanwhile, HCAP patients showed greater resistance to gentamicin than CAP patients (58.3% vs. 16.6%;p=0.037).The median total hospital charges were 6899 American dollars for CAP and 5715 American dollars for HCAP (p=0.161).Conclusion: MRSA pneumonia showed significantly differences in baseline characteristics, chest radiographs, treatment outcomes, and medical expenses between HCAP and CAP groups.
Related innate immune system activation and diagnostic factors of sepsis are not fully understood. The aim of this study was to analyze the clinical value of full-length tryptophanyl-tRNA synthetase (WRS) induced through inflammatory stimuli for the detection of sepsis and prediction of mortality in critically ill patients.This was a retrospective analysis of blood samples collected prospectively from patients in the medical intensive care unit (ICU) at Yonsei University College of Medicine, from March 2015 to June 2018. The ability of WRS to detect sepsis and predict mortality were compared to those of procalcitonin (PCT), C-reactive protein (CRP), and interleukin 6 (IL-6), and with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores.A total of 241 study patients were enrolled, of whom 190 (78.8%) had been diagnosed with sepsis on ICU admission. The areas under the receiver operating characteristics curves (AUROCs) for sepsis discrimination with WRS, PCT, CRP, and IL-6 levels, and SOFA and APACHE II scores were 0.864, 0.727, 0.625, 0.651, 0.840, and 0.754, respectively. The prediction of 28-day mortality in patients with sepsis using WRS levels was possible and non-inferior to that with the SOFA score.WRS secreted early in sepsis may be useful not only for the early detection of sepsis, but also for the prediction of mortality in critically ill patients.
Background Flexible bronchoscopy is one of the essential procedures for the diagnosis and treatment of pulmonary diseases. The purpose of this study was to identify the risk factors associated with the occurrence of hypoxia in adults undergoing flexible bronchoscopy under sedation. Methods We retrospectively analyzed 2,520 patients who underwent flexible bronchoscopy under sedation at our tertiary care university hospital in South Korea January 1, 2013-December 31, 2014. Hypoxia was defined as more than 5%-point reduction in the baseline percutaneous oxygen saturation (SpO2) or SpO2 <90% for >1 minute during the procedure. Results The mean age was 64.7±13.5, and 565 patients developed hypoxia during the procedure. The mean sedation duration and midazolam dose for sedation were 31.1 minutes and 3.9 mg, respectively. The bivariate analysis showed that older age, a low forced expiratory volume in one second (FEV1), use of endobronchial ultrasound, the duration of sedation, and the midazolam dose were associated with the occurrence of hypoxia during the procedure, while the multivariate analysis found that age >60 (odds ratio [OR], 1.32), a low FEV1 (OR, 0.99), and a longer duration of sedation (>40 minutes; OR, 1.33) were significant risk factors. Conclusion The findings suggest that patients older than age 60 and those with a low FEV1 tend to develop hypoxia during the bronchoscopy under sedation. Also, longer duration of sedation (>40 minutes) was a significant risk factor for hypoxia. Keywords: Bronchoscopy; Hypoxia; Risk Factors
Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation.Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation.We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation.Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation.Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow.Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted.The patient was immediately treated with etoposide and dexamethasone.Despite aggressive therapy, the patient deteriorated and died.Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.
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