A Case of Azathioprine Induced Warfarin Resistance in Behçet’s Disease

Behçet’s disease is characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Thrombosis associated with vascular inflammation in patients with Behçet’s disease presents various clinical symptoms. Warfarin is usually administered for treatment of thrombosis. However, warfarin can interact with many medications that cause various problems. A 43-year-old woman with Behçet’s disease presented with a swollen right leg. Deep vein thrombosis (DVT) was confirmed, and treated with warfarin. Due to exacerbation of Behçet’s disease, she received azathioprine along with warfarin. Subsequently, the international normalized ratio (INR) decreased and DVT was exacerbated. Despite an increase in the warfarin dose, the patient did not reach the target INR. After discontinuation of azathioprine, DVT improved and the warfarin dose was decreased. There were no specific findings associated with a hypercoagulable status. This finding suggests the interaction of azathioprine and warfarin. Therefore, clinicians should be cautious regarding the possibility of drug interactions between azathioprine and warfarin.ope

Drug-Induced Anaphylaxis in a Single Korean Tertiary Hospital

Background/Aims: Drug-induced anaphylaxis (DIA) is a severe, acute, and potentially life-threatening condition. In Korea, only a few well-documented cases of DIA have been described. Therefore, the aim of this study was to investigate the clinical characteristics, causes, and management of DIA in a single Korean medical institute. Methods: This was a retrospective medical record review of all DIA patients who visited the in-patient, out-patient, and emergency departments of our hospital from January 1 2006 to October 30 2013. Results: Among 605 cases of anaphylaxis, 167 were drug-induced. The culprit drugs were contrast agents (43 cases, 25.7%), antibiotics (38, 22.8%), non-steroidal anti-inflammatory drugs (35, 21.0%), anti-cancer drugs (22, 13.2%), parenteral vitamins (9, 5.4%), ranitidine (6, 3.6%), and neuromuscular blockers (3, 1.8%). The most common organ-specific symptoms/signs were cardiovascular (74.3%), cutaneous (71.3%), respiratory (55.7%), and gastrointestinal manifestations (19.2%). In most cases, DIA was treated with antihistamines (77.2%) and systemic corticosteroids (76.5%); the use of epinephrine was considerably less frequent (35.3%). Conclusions: In our institution, contrast agents were the leading cause of DIA. Although epinephrine is the drug of choice in the treatment of acute anaphylaxis, fewer than 50% of the study patients received epinephrine to treat DIA.ope

Adverse drug reactions after taking the extract of Cudrania tricuspidata

Cudrania tricuspidata is a deciduous tree belonging to the Moraceae plant, which has been widely used as a folk remedy or health supplements in the Asian countries including Korea. As far as we know, side effects from taking the extract of C. tricuspidata has not yet been reported. We reviewed the electronic medical records of 2 patients who had adverse drug reactions to C. tricuspidata. The first case was a 30-year-old woman without a specific medical history. She was admitted with a 2-week history of jaundice and dyspepsia after taking extract of C. tricuspidata for 3 days. Initial laboratory findings were as follows: aspartate aminotransferase, 364 IU/L; alanine aminotransferase, 574 IU/L; total bilirubin, 36.3 mg/dL; and direct bilirubin, 18.3 mg/dL. She was conservatively treated for liver and renal failure while awaiting liver transplantation. However, she was expired due to combined pneumonia and progressed hepatic and renal failure. The second case was a 42-year-old woman who has chronic urticaria without other medical history. She was admitted with a 3-month history of whole body rash with small pustular vesicle after taking extract of C. tricuspidata. She was treated with intravenous steroids and antihistamines. Skin lesions were improved after 1 week. Here, we report 2 cases of adverse drug reaction to C. tricuspidata. It should be considered that C. tricuspidata ingestion could cause severe adverse drug reactions such as liver failure and acute generalized exanthematous pustulosis.ope

Critical pathway of acute asthma attack for the Emergency Center: patients' outcomes and effectiveness

Purpose: Early recognition and management of asthma attack is critical before it becomes worse. We developed critical pathway (CP) of asthma attack at Emergency Center (EC) for making undelayed decision and management of asthma attack. Methods: Acute asthma attack assessment and treatment (4AT) CP began on April 1st 2012 and recruited the patients for 18 months. This study enrolled the patients who were older than 15 years and visited EC for dyspnea and wheezing. Initial assessment was done measuring peak expiratory flow rate (PEFR), oxygen saturation (SaO2). Once CP is activated, oxygen, inhalation of short acting β2 agonist, and injection of corticosteroid were administered to the patients. Every hour after CP activated, we reassess the patients’ response and make decisions whether to admit or discharge. Results: Until January 10th 2014, 62 patients enrolled in this study. Seven patients hospitalized for asthma and 40 patients discharged. The other 15 patients were deactivated as they were diagnosed of heart failure, myocardial infarction, aortic dissection, anaphylaxis, chronic obstructive pulmonary disease and pneumonia for the causes of dyspnea. Mean Interval from EC arrival to 4AT activation was 32.6±29.1 minutes and the mean interval from 4AT activation to position decision was 254.5±302.0 minutes. Among 47 patients who were diagnosed with asthma attack, 13 patients were not aware of asthma before this attack. Forty patients were discharged at EC after management of CP. Among them, 34 patients revisited clinic, but 6 patients did not. We called back to the lost 6 patients but only 3 patients were connected. Even they visited EC due to asthma attack, 2 patients had no insight of importance of regular management and the other one promised to revisit. Conclusion: CP was successful for early management of asthma attack. However, 15% of discharged patients never show up again. So, education program about the importance of ongoing management of asthma for prevention of asthma attack is needed.ope

USING EWOD (ELECTROWETTING-ON-DIELECTRIC) ACTUATION

Maste

북서태평양 태풍의 진로 및 강도 예측에서 선행 태풍과 근접 태풍의 영향

본 연구는 북서태평양에서 발생하는 태풍의 진로 및 강도 예측에서 선행 태풍과 근접 태풍이 미치는 영향에 대해 조사하였다. 이를 위해 Weather Research Forecasting(WRF) 대기모형과 Regional Ocean Model System(ROMS) 해양모형을 Message Passing Interface(MPI) II로 연결한 지역접합모형을 개발하였고, 접합모형의 민감도 연구를 통해 최적의 물리 모수화 방법을 선정한 후, 2개의 수치실험을 수행하였다. 첫 번째 실험은 태풍 빌리스(0604)의 강도 예측에서 선행 태풍 에위니아(0603)에 의한 해수면 냉각 효과가 미치는 영향을 조사하였고, 두 번째 실험은 태풍 곤파스(1007)의 진로 예측에서 근접 태풍 라이언락(1006)과 남테운(1008)의 보거싱 효과가 미치는 영향을 조사하였다. 수치실험을 분석한 결과, 첫 번째 실험에서는 선행 태풍 에위니아(0603)에 의해 상당한 표층 냉각이 발생한 지역을 통과한 태풍 빌리스(0604)가 냉각 효과를 고려하지 않은 실험에 비해 강도가 많이 줄어들어 강도 예측의 향상된 결과를 보였고, 두 번째 실험에서는 태풍 곤파스(1007)가 근접해 있던 태풍 라이언락(1006), 남테운(1008)과 함께 보거싱 효과가 고려된 대기 초기조건의 향상으로 진로 예측 오차가 감소했음을 보였다. 따라서 본 연구는 태풍 예측 향상을 위해서 선행 및 근접 태풍에 대한 고려가 필요함을 제시하였다.2

Using EWOD(Electrowetting-on-Dielectric) Actuation in a Micro Conveyor System

1

Effect of preceding and adjacent typhoons on the intensity and track prediction of typhoon in the western North Pacific

This study investigates the impact of preceding and adjacent typhoons on the track and intensity prediction of a typhoon in western North Pacific. For this, we developed a regional coupled model(WRF+ROMS) using a MPI(Message Passing Interface) II coupler. After determining optimal physical parameterizations of WRF based on sensitivity tests, we conducted two numerical experiments: one is to examine the sea surface cooling effect of a preceding typhoon, Ewiniar(0603), on the intensity prediction of typhoon Bilis(0604) and the other is to examine the bogussing effect for adjacent typhoons, Namtheun(1008) and Lionrock(1006), on the track prediction of Kompasu(1007). The results show that the intensity of Bilis(0604), passed over the region where a significant surface cooling occurred by the preceding typhoon Ewiniar (0603), was greatly reduced, compared to the experiment without considering the cooling effect, resulting in the improvement of intensity prediction. For the track prediction of Kompasu(1007), additional consideration of a bogussing scheme to adjacent typhoons reduced the track errors, mainly due to an improvement of initial condition. These results suggest that for not only the targeted typhoon but also the preceding and adjunct typhoons, accurate simulations of oceanic and atmospheric conditions are required for the improvement of typhoon prediction.1

Another look of the time series of satellite-derived Chlorophyll in the Northwestern Pacific

지연 상관관계를 이용하여 환경변수 또는 기후 변수들이 클로로필과 어떠한 상관성이 있는지 알아보았다. 양자강 방출량과 클로로필 농도와의 지연 상관관계를 통해서 양자강 저염수는 해류를 통해서 동중국해와 제주도를 통과하여 동해쪽으로 흘러 들어가는 것을 확인 할 수 있었다. 양자강 방출량은 NINO3.4 지수와 관련성이 있는 것 또한 확인 하였다.가는 것을 확인 할 수 있었다. 양자강 방출량은 NINO3.4 지수와 관련성이 있는 것 또한 확인 하였다.1

북서태평양에서의 클로로필의 중장기 변동성

최근 지구 온난화로 인하여 전지구의 환경이 바뀌고 있으며 이로 인해서 해양 생태계 또한 변하고 있다. 특히 한반도 주변 해역에서는 기후변화와 더불어 양자강 방출량 등의 인위적인 영향을 받는다, 본 연구에서는 이러한 환경변화에 따른 북서태평양의 생체량 지수인 위성 클로로필의 중장기 변동성을 분석하였다.각 환경변수들과 클로로필의 상관성을 알아보기 위하여 지연 상관관계를 조사하였으며 지역별로 시계열 자료도 분석하였다.클로로필 농도는 ENSO와 직접 연관된 적도 서태평양지역에서는 NINO3.4 지수와 강한 양의 상관을 보였다. 양자강 어귀에서는 양자강 방출량과 강한 양의 상관을 보였으며 제주도 남부 지역에서는 2개월 지연된 양자강 방출량과 양의 상관관계를 보였다. 또한 적도 지역과 북위 20도 지역에서는 해수면 온도와는 음의 상관을 보였으며 풍속과는 양의 상관을 보임을 알 수 있었다. 이 연구 결과는 지역에 따라 해양생체량의 변동성을 결정하는 요인이 다름을 나타낸다. 생체량 지수인 위성 클로로필의 중장기 변동성을 분석하였다.각 환경변수들과 클로로필의 상관성을 알아보기 위하여 지연 상관관계를 조사하였으며 지역별로 시계열 자료도 분석하였다.클로로필 농도는 ENSO와 직접 연관된 적도 서태평양지역에서는 NINO3.4 지수와 강한 양의 상관을 보였다. 양자강 어귀에서는 양자강 방출량과 강한 양의 상관을 보였으며 제주도 남부 지역에서는 2개월 지연된 양자강 방출량과 양의 상관관계를 보였다. 또한 적도 지역과 북위 20도 지역에서는 해수면 온도와는 음의 상관을 보였으며 풍속과는 양의 상관을 보임을 알 수 있었다. 이 연구 결과는 지역에 따라 해양생체량의 변동성을 결정하는 요인이 다름을 나타낸다.2