Risk factors of colistin safety according to administration routes: Intravenous and aerosolized colistin

BACKGROUND: Nephrotoxicity of intravenous (IV) colistin has impeded its clinical use; aerosolized (AS) colistin may be an alternative, but safety data are lacking. Therefore, this study aimed to evaluate the incidence of acute kidney injury (AKI) and risk factors associated with IV and AS colistin administration. METHODS: A retrospective study was performed in a tertiary referral hospital. Data were collected before and after colistin administration between October 2012 and April 2016. Exclusion criteria were as follows: age less than 18 years, previous colistin administration, concurrent use of IV and AS colistin, dialysis before colistin use, and colistin use for less than 3 days. We compared AKI incidence following administration of IV versus AS colistin and analyzed risk factors for colistin-associated nephrotoxicity. RESULTS: A total of 464 patients were enrolled (n = 311, IV group; n = 153, AS group). Incidence of AKI was significantly higher in the IV group (IV vs AS, 20.26% vs 7.84%, p-value < 0.001). Duration of colistin use (OR 1.033, 95% CI 1.009-1.058, p-value 0.008) and presence of chronic kidney disease (OR 2.710, 95% CI 1.348-5.448, p-value 0.005) were associated with nephrotoxicity. There were no significant risk factors associated with AS colistin. CONCLUSIONS: Although AS colistin was not associated with any significant risk factors for nephrotoxicity, duration of colistin use and baseline kidney function may affect AS colistin-associated nephrotoxicity.ope

(A) clinical and histological study on anaphylactoid (Henoch-Schonlein purpura) nephritis in children

의학과/석사[한글] Anaphylactoid(Henoch-Schonlein purpura) 신염은 하지와 둔부에 비혈소판감소성자반증, 복통, 관절부종등을 주증상으로 하는 Anaphylactoid자반증에서 합병되는 질환으로서 대체로 좋은 예후를 보이나 그중 일부에서는 심한 신침범을 일으킨다고 하였다. 심침범의 정도는 신기능에 영향을 미치지 않는 경미한 현미경적 혈뇨에서부터 생명을 위협하는 심한 신증후군 및 신부전증에 이르는 것까지 들 수 있다. Amaphylactoid자반증은 그 증상이 뚜렷하기 때문에 비교적 조기에 발견되어 치료할 수 있으나 여기서 합병되는 신침범은 관심을 갖고 꾸준히 관찰하지 않으며 지나쳐 버리거나 심한 신침범 증상이 수반되었을 때에야 비로소 알게 되는 경우가 많다. 이에 본 저자는 우리나라의 소아에서 볼 수 있는 Anaphylactoid자반증 중에서 특히 신침범을 일으켰던 예들을 대상으로 임상적 관찰을 통하여 이 질병의 제인식과 주의를 환기시켜 그 조기발견 및 치료에 보탬이 되고자 하였다. 1974년 1월부터 1979년 5월까지 세브란스병원 소아과에 Anaphylactoid신염으로 입원하였던 환아 25예를 대상으로 임상적 관찰을 통하여 다음과 같은 결과를 얻었다. 1. Anaphylactoid자반증 75예중 25예서 신침범을 일으켜 그 병발율은 약 33퍼센트에 달하였다. 이중 남아가 16예, 여아가 9예로서 남아가 많았다. 연령분포는 3년 5개월에서부터 15세 사이였으며 그중 5-7세 사이가 11예로서 제일 많았다. 2. Anaphylactoid자반증 발생후 신염이 병발될때까지의 기간은 2주이내가 15예로서 제일 많았다. 3. 임상증상으로는 피부발진, 복통, 관절통, 부종, 육안적혈뇨, 혈변등의 순이었다. 4. 신기능에 따라 분류하여 보면 일시적혈뇨 4예, 급성신염 7예, 재발성혈뇨 1예, 지속성담백뇨 및 혈뇨 1예, 신증후군 4예, 기타 8예였다. 5. 검사소견으로는 일반적인 신기능장애의 소견 이외에 혈청내 면역글로부린인 IgA치를 6예에서 측정하여 4예에서 상승치를 보여 주었다. 6. 병리조직학적 및 면역학적 검사소견으로는 신생검을 시행하였던 9예중 8예에서 focal proliferative glomerulonephritis였고 나머지 1예에서 diffuse proliferative glomerulonephritis였으며 사구체내에 면역글로부린인 IgA, IgG 및 IgM과 fibrin의 축적을 볼 수 있었다. 7. 치료로는 전 예에서 푸레드니손을 사용하였고 4예에서만 면역억제제인 azathioprine을 병용하였으나 2가지 방법 모두에서 뚜렷한 효과는 없었다. [영문] Anaphylctoid nephritis is a disease complicated by anaphylactoid purpura manifested by a non-thrombocytopenic purpura, abdominal pain, and joint pain. The manifestation of nephritis may vary from icroscopic hematuria to acute rapidly progressive nephritic and nephrotic syndrome. This paper reports on anaphylactoid nephritis in children. These cases were collected from the department of Pediatrics, Yonsei University Medical College from January 1, 1974 to May 31, 1979. The results are as follows; 1. Among 75 cases of anaphylactoid purpura, 25 cases developed nephritis(33%). 16 cases were male and 9 cases female. The age distribution was from 3 years and 5 months to 15 years. The peak incidence occured between 5 and 7 years of age with 11 cases. 2. The evidence of renal involvement in 18 cases among 25 were detected within 4 weeks of onset of skin manifestation. 3. The clinical manifestations were skin rashes, abdominal pain, joint pain, pitting edema, gross hematuria, and melena in orders. 4. The classification of renal involvement were transient hematuria 4 cases, acute nephritis 7 cases, recurrent hematuria 1 case, nephrotic syndrome 5 cases, and undetermined 8 cases. 5. In addition to the usual signs of renal involvement, serum levels of IgA ere checked. The elevation of IgA was 4 cases among the tested 6 cases. 6. According to the pathologic findings and immunofluorescent technique, 8 cases among 9 cases by kidney biopsy were focal proliferative glomerulonephritis and 1 case diffuse proliferative glomerulonephritis. The deposit of glomeruli by immunofluorescent technique was IgA, IgG, IgM, and fibrin. 7. All the cases were treated with prednisone and only 4 cases were combined with immunosuppressant, azathioprine without benefit.prohibitio

Interprofessional Collaboration Between a Multidisciplinary Palliative Care Team and the Team Pharmacist on Pain Management

PURPOSE: The purpose of the study was to evaluate the impact on pain management by multidisciplinary palliative care team (mPCT) and the team pharmacist. METHODS: Patients who were admitted to palliative care unit (PCU) for at least 7 days between April 2014 and December 2015 were included. The mPCT consisted of a physician, a pharmacist, nurses, and non-clinical support staff. The team was on charge of pain management of patients who were admitted to PCU. Pain intensity was assessed at 3 time points in each patient; 1 week before PCU admission (day -7), on the day of admission (day 0), and 1 week after admission (day 7) using 0 to 10 numerical rating scale (NRS). Analgesic use was evaluated with 6 categories based on National Comprehensive Cancer Network and Korean pain management guidelines. Pain intensity and analgesic use appropriateness were compared at day -7, day 0, and day 7 for the patients who were admitted to the PCU. RESULTS: Pain intensity decreased significantly on day 7 of PCU admission compared to it on day 0 (NRS: 4.05 vs 2.66, P < .001). A significant negative correlation was found between pain intensity and the proper use of analgesics ( r = -0.407; P < .001, r = -0.309; P = .001, r = -0.241; P = .009, on day -7, day 0, day 7, respectively). CONCLUSION: The mPCT contributed to the reduction of inappropriate use of analgesics and improved pain control. Pharmacist intervention appeared to have improved pain control in patients under palliative care. Each team member's role should be individualized and developed further.restrictio

Thermal energy storage of themochemical reaction of CaSO4CaSO_4·1/2H2O/CaSO4{1/2}H_2O/CaSO_4

학위논문(석사) - 한국과학기술원 : 화학공학과, 1992.2, [ vii, 99 p. ]한국과학기술원 : 화학공학과