• Title/Summary/Keyword: Hypertension guideline

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Guidelines for childhood urinary tract infection (소아 요로감염의 임상 지침)

  • Lee, Seung Joo
    • Clinical and Experimental Pediatrics
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    • v.52 no.9
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    • pp.976-983
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    • 2009
  • Urinary tract infection (UTI), the most common bacterial disease in childhood, is frequently associated with urinary tract anomalies (15-50%) and can induce renal scarring, which is a cause of hypertension and chronic kidney disease. Despite the high risk of renal scarring in infancy, the diagnosis may be delayed due to its nonspecific presenting symptoms; moreover, over-diagnosis is frequent due to the contamination of urine samples. The delay in diagnosis and treatment may induce sepsis or renal scar, while over-diagnosis is responsible for unnecessary antibiotic treatment and costly urinary imaging studies. UTI guidelines have been ever-changing for the past three decades, but some controversial issues remain. This article is a revision of the previous KSPN (Korean Society of Pediatric Nephrology) guideline and addresses the recent controversies concerning childhood UTI.

Introducing the general management of glomerular disease from a pediatric perspective based on the updated KDIGO guidelines

  • Seon Hee Lim
    • Childhood Kidney Diseases
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    • v.27 no.2
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    • pp.55-63
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    • 2023
  • In 2021, a new chapter on the general management of glomerulonephritis (GN) was added to the Kidney Disease: Improving Global Outcomes (KDIGO). It emphasizes the importance of early general management of GN for improving long-term kidney outcomes and prognosis. The chapter introduces the management of glomerular diseases in 18 subchapters. Here, kidney biopsy for the diagnosis and evaluation of kidney function and the management of complications, such as hypertension, infection, and thrombosis, are presented. Moreover, the adverse effects of glucocorticoids and immunosuppressive therapy, which are commonly used drugs for glomerular disease, are mentioned, and a guideline for drug selection is presented. Each subtheme focused on items reflecting the interpretation of the "practice points" of the expert working group are introduced. In this review of the general treatment for GN in the KDIGO guidelines, excluding pregnancy and reproductive health, we focused on and compared various references pertaining to pediatric GN management.

A Study on Safety, Performance and Clinical effectiveness Test Guideline of Versatile Ophthalmic Laser System (다목적 안과용 레이저 시스템 안전성 성능평가 및 임상적 유효성평가 가이드라인 수립을 위한 연구)

  • Kim, You Rim;Yu, Woo Jin;Park, Ho Joon;Jang, Won Seuk
    • Journal of Biomedical Engineering Research
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    • v.40 no.6
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    • pp.250-259
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    • 2019
  • Ophthalmic Laser System is widely used in Selective Laser Trabeculoplasty of Open Angle Glaucoma and Ocular Hypertension. Versatile ophthalmic laser system is a medical device with technology that checks the condition of the treatment area by irradiating a continuous laser pulse on the treatment area, and monitoring the microbubble reaction caused by the temperature increase of the melanosome through the ultrasonic signal and the optical signal sensor. It performs selective laser treatment without damaging the photoreceptor by controlling the wavelength of the laser when microbubbles are detected. This study aims to suggest a guideline for evaluating safety, performance and clinical effectiveness of Versatile Ophthalmic Laser System in accordance with the growing technology. International Standards, Regulations, and Clinical Trial Protocols were investigated and analyzed for this study. As a result of this study, the safety, performance and clinical effectiveness test guideline for Versatile Ophthalmic Laser System were proposed. This guideline will ensure the safety and efficacy of Medical device, and furthermore it is expected to be able to promote the development of technology development by supporting a clinical trial plan.

A Study on Major Health Components of National Health Examination Survey in Korea (국민건강진단조사(National Health Examination Survey) 내용선정에 관한 연구)

  • Lee, Soon-Young;Kim, Hae-Kyung;Park, Ju-Won;Shin, Seung-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.2 s.61
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    • pp.167-182
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    • 1998
  • The purpose of this study was to identify the major health components and measurements to be conducted in National Health Examination Survey(KNHES). The prevalence and severity of disease, acceptability of population and the possibility of standardization of measurement were considered as guideline for selecting the components. On the base of magnitude and severity of disease, chronic liver disease, hepatic cancer, gastric ulcer, stomach cancer, essential hypertension, cerebrovascular disease, ischemic heart disease, pulmonary tuberculosis, lung cancer, DM, breast cancer, cervical cancer, arthritis and intervertebral disc disorder were selected as the preliminary target diseases. Questionnaire survey for 648 persons in 'K' city and medical specialists in five clinical societies were conducted for evaluation the acceptability of general population for the measurements and the possibility of standardization for the procedures. In conclusion, the major target diseases were chronic liver disease, hypertension and DM and the total cholesterol, high density lipoprotein, triglyceride, total protein, albumin, hemoglobulin, hematocrit, platlet count, anti-HBs, HBsAg, height and weight were selected for basic physical components.

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Assessment of Clinical Outcome in Dogs with Naturally Infected with Dirofilaria immitis after American Heartworm Society Protocol vs Slow Kill Method

  • Choi, Miru;Yoon, Won-Kyoung;Suh, Sang-IL;Hyun, Changbaig
    • Journal of Veterinary Clinics
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    • v.34 no.1
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    • pp.1-6
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    • 2017
  • Heartworm disease (HWD) in dogs is a life-threatening mosquito-borne disease resulting in right-sided congestive heart failure and inflammatory pulmonary disease. Due to complications from adulticidal therapy with melarsomine, slow kill protocol either with preventive dose of ivermectin or combined with doxycycline has been proposed for an alternative adultcidal therapy in dogs with HWD. Therefore, this study evaluated the clinical outcome of adultcidal therapy in dogs with class II stage of HWD after treating either American Heartworm Society (AHS) or slow kill protocol for 10 months. Clinical outcome after therapy was evaluated by clinical, radiographic and echocardiographic examination along with hematology before (D0) and after therapy (D300). Although clinical signs associated with HWD were all resolved after therapy in both groups, the infection was not cleared out 67% of dogs treated by slow kill protocol at the end of therapy. Furthermore, pulmonary arterial flow of acceleration time to ejection time ratio (AT/ET) and the right pulmonary artery distensibility index (RPADI) have been firstly used for detecting pulmonary hypertension in this study group. The pulmonary hypertension was more common in dogs with mild clinical signs, although tricuspid and pulmonary regurgitation were not detectable in most dogs in this study. Our study findings suggested that the slow kill protocol might not be efficacious enough to clear out HWD in dogs and more attention on the presence of pulmonary hypertension might be necessary for effective management of HWD in dogs.

Drug Use Evaluation of Antihypertensive Agents by JNC VI Guidelines (고혈압 치료 지침 Vl에 의한 항고혈압제의 사용평가)

  • Kim, Kyung Hwa;Lee, Suk Hyang
    • Korean Journal of Clinical Pharmacy
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    • v.12 no.1
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    • pp.29-38
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    • 2002
  • Hypertension is an important public health problem because it increases the risk of stroke, angina, myocardial infarction, heart failure, and end-stage renal disease. If it is not actively treated, morbidity and mortality increase with hypertension-induced complications and quality of life decreases. This study was to evaluate the use of antihypertensive drugs and blood pressure changes and to compare algorithms chosen (or the 1st and 2nd line therapy of hypertension based on the JNC VI recommendations. The medical charts of 222 patients with essential hypertension at St. Vincent's Hospital in Suwon from January 1997 to January 2000 were reviewed retrospectively. Data collection and analysis included baseline BP underlying diseases and complications, administered antihypertensives, BP changes, changes of antihypertensive regimen, and adverse effects with treatments. As results, the higher BP the patients had, the more frequent they had target organ damages and clinical cardiovascular diseases. Mean duration to reduce blood pressure less than 140/90 mmHg was 8 weeks in $85.3\%$ of the patients. The rate of control in BP was $82.4\%$ at 6 months. The major antihypertensive drugs prescribed were calcium channel blockers $(61.8\%)$ , ACE inhibitors $(19.1\%),\;\beta-blockers\;(13.7\%)$ and diuretics $(5.3\%)$ as the 1st-line monotherapy. The methods of treatment used as the 1st-line therapy were monotherapy$(59\%)$ and combination therapy $(41\%)$. Blood pressure change was significantly greater for combination therapy than monotherapy$(-26.2\pm21.4\;vs.\;-18.56\pm16.7$ mmHg for systolic blood pressure; P<0.003, $-16.9\pm13.2\;vs.\;-9.2\pm12.8$ mmHg for diastolic blood pressure; p<0.001). When blood pressure was not completely controlled with the first antihypertensive selected, the 2nd line therapy had 4 options: addition of 2nd agent from different class; $66.2\%$, substitution with another drug, $21.9\%$ increase dose $11.9\%$ continue first regimen $27.9\%$ Calcium channel blockers were the most frequently prescribed agents. This was not comparable to the JNC VI guideline which recommended diuretics and $\beta-blockers$ for the 1st-line therapy. Most of patients achieved the goal BP and maintained it until 6 months, but the remaining patients should be controlled more tightly to improve their BP with combination of life style modification, patient education, and pharmacotherapy.

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A Study of Prescription Analysis on Patients with Ischemic Heart Disease and Evaluation of Antihypertensive Drug Use in General Hospital (종합병원 허혈성 심장질환 환자의 항고혈압약제 사용 현황 및 평가)

  • Moon, Kyoung-Sil;Song, Hyun-Ju;Sohn, Uy-Dong
    • YAKHAK HOEJI
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    • v.51 no.5
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    • pp.336-342
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    • 2007
  • Treatment of hypertension is important in reducing death and attack rates by Ischemic heart disease (IHD). The purposes of this study are to investigate recent prescriptions for patients with IHD and to evaluate antihypertensive drug use. On the basis of the guidelines proposed by Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure, we analyzed prescriptions of antihypertensive drugs for patients with IHD. It is necessary to set up new guideline for appropriate treatment to lower death and attack rates for patients with IHD.

Physical Phenotype Analysis in Obesity Study in vivo (마우스를 이용한 비만연구에서 활용되는 물리적 표현형 분석 기술)

  • Kim, Hyunkyung;Go, Gwang-woong
    • Food Science and Industry
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    • v.51 no.1
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    • pp.37-44
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    • 2018
  • The prevalence of obesity is continually increasing in South Korea; about 1/3 of adults are diagnosed with obesity and 1/2 of adults are overweight in 2016. Abnormal body fat mass increased the risk factors of metabolic syndrome (including hypertension, type II diabetes, dyslipidemia), chronic kidney failure, osteoarthritis, and cardiovascular disease. Ministry of Food and Drug Safety (MFDS) in Korea established the validation and approval system for "functional food" based on related laws and regulations. According to the guideline of MFDS, the biomarkers for obesity study in vitro, in vivo, and clinical trial are well summarized. The analysis of physical phenotypes is necessary condition to study further molecular phenotypes and pathway analysis in vivo study. Thus, we will review currently available physical phenotype analysis; dual energy X-ray absorptiometry (DEXA) and Oxylet gas analysis will be examined in-depth.

Antihypertensive effect of Chunghyul-dan(Qingxue-dan) on stage 1 hypertensive patients with stroke (중풍환자 1기 고혈압에 청혈단(淸血丹)의 항고혈압 효과)

  • Kim, Lee-Dong;Lee, Sang-Ho;Kim, Eun-Ju;Kim, Tai-Hun;Park, Young-Min;Jung, Dong-Won;Shin, Won-Jun;Jung, Woo-Sang;Bae, Hyung-Sup;Yun, Sang-Pil
    • The Journal of Internal Korean Medicine
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    • v.25 no.2
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    • pp.195-201
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    • 2004
  • Background and Purpose : Hypertension is one of the modifiable risk factors for stroke. Lowering blood pressure is a primary or secondary preventative measure for stroke. This study aims to assess the efficacy of Chunghyul-dan(Qingxue-dan) in stage 1 hypertensive patients who have suffered a stroke by 24 hour ambulatory blood pressure monitoring(24ABPM). Subjects& Methods : We enrolled 40 hospitalized stroke patients with stage 1 hypertension and divided them into 2 groups by stratified randomization; group A took 1200mg of Chunghyul-dan(Qingxue-dan) at 8:00 a.m. for two weeks without changing herbal medicine, and group B was the control group. 28 patients were included in the final analysis(15 in group A. 13 in group B). Blood pressure is monitored from 8:00 am to 7:30 am every 30 minutes for 24 hours. Blood pressure was monitored two times at baseline and again two weeks later. We used 3 parameters for evaluating the efficacy of Chunghyul-dan(Qingxue-dan); The first parameter is change from baseline to two weeks later in blood pressure and pulse rate. The second parameter is the trough/peak ratio(TPR) and smoothness index(SI). The third parameter is antihypertensive rate by antihypertensive efficacy guideline. Results : There is no significant difference in the baseline assessment hetween the two groups. Systolic blood pressure $(141.37{\pm}8.96\;mmHg\;vs\;132.28{\pm}9.46\;mmHg)$ decreased after two weeks of 1200mg(P=0.03) intake of Chunghyul-dan(Qingxue-dan). Systolic TPR and SI was 0.87 and 1.04 in group A. Antihypertensive rate was higher in group A. Conclusion: These results suggest that 1200mg doses of Clunghyul-dan(Qingxue-dan) is an effective antihypertensive agent on stage 1 hypertension patients who have suffered a stroke.

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Beta Blockers or Calcium Channel Blockers as Primary Antianginal Drug after Percutaneous Coronary Intervention: Prescription Pattern and its association with Clinical Outcome (관상동맥중재술 전후 주요 항협심증 약제로서의 베타차단제와 칼슘채널차단제: 처방패턴 및 임상결과에 미치는 영향)

  • Noh, Sun Young;Jo, Yun Hee;Cho, Yoon Sook;Hahn, Hyeon Joo;Lee, Hae-Young;Lee, Ju-Yeun
    • Korean Journal of Clinical Pharmacy
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    • v.26 no.3
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    • pp.213-219
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    • 2016
  • Objective: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. Methods: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. Results: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). Conclusion: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.