• Journal of Yeungnam Medical Science
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• 제29권2호
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• pp.89-95
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• 2012

Background: As Mycoplasma pneumoniae pneumonia has increased in Korea, its relevance to infants, toddlers, and adolescents has magnified as well as. However, it is difficult to perform the serological test and PCR test routinely for diagnosis in actual clinical practice. Thus, the authors conducted this study to help clinicians do presumptive diagnosis of Mycoplasma pneumoniae pneumonia using clinical, radiological, and hematological findings. Methods: The study population consisted of 224 children between 1 month and 14 years old, hospitalized for radiographically confirmed pneumonia. Patients were divided into two groups of 100 children with Mycoplasma pneumoniae pneumonia, as diagnosed using the ELISA method. Groups with negative result in Mycoplasma IgM antibody test were classified into the viral group (98 patients with respiratory virus) and the bacterial group (46 patients with the bacteria detected in the blood sputum culture or antibiotic treatment except macrolide improved the patient's condition). These groups were compared and analyzed using clinical, hematological, and radiographic differences and scoring system. Results: Clinical, hematological, and radiographic characteristics of Mycoplasma pneumoniae pneumonia have shown the intermediate level results between bacterial pneumonia and viral pneumonia. In terms of scoring system, the mean score of Mycoplasma pneumoniae pneumonia was 4.23, which was the intermediate level between bacterial pneumonia (mean score=6.67) and viral pneumonia (mean score=1.48). Conclusion: Results suggest that the combination of the scoring system information can increase the accuracy in the diagnosis even if they may have difficulties on diagnosis, because clinical manifestations, hematological, and radiographic findings are nonspecific.

• 대한임상독성학회지
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• 제13권2호
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• pp.95-102
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• 2015

Purpose: Drug overdose is easily found in the emergency department (ED). Sedative-hypnotics overdose causes the aspiration pneumonia in patients with decreased mental status. The purpose of this study was to investigate the risk factors of aspiration pneumonia in patients poisoned with sedative-hypnotics. Methods: One hundred seventy eight patients who were poisoned with sedative-hypnotics and who visited ED between 2009 and 2015 were included. This study was conducted retrospectively, with collection of data by review of medical records. We collected the data concerning the characteristics of patients and classified them into two groups based on the development of aspiration pneumonia. Logistic regression analysis was performed to investigate the factors for the development of aspiration pneumonia. Results: Thirty five patients had an aspiration pneumonia during their hospital stay in 178 patients. The age, amount of ingestion, Glasgow Coma Scale (GCS) score at admission, a history of hypertension and diabetes mellitus, and the hypotension at admission were significantly different between two groups in univariate analysis. The age, amount of ingestion and GCS score at admission were associated with the development of aspiration pneumonia in the multivariate logistic regression analysis (OR 1.028 (95%CI, 1.002-1.056, p=0.037), 1.026 (95%CI, 1.004-1.043, p=0.001), 0.737 (95%CI, 0.683-0.915, p=0.002)). All patients with aspiration pneumonia were discharged without a sequelae. Conclusion: The development of aspiration pneumonia in the patients of sedative-hypnotics overdose is associated with old age, amount of drug ingestion, and GCS score at admission.

• Journal of Chest Surgery
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• 제46권2호
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• pp.130-134
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• 2013

Background: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. Materials and Methods: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. Results: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). Conclusion: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.

• 대한임상독성학회지
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• 제14권1호
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• pp.26-32
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• 2016

Purpose: Aspiration pneumonia is an important complication of drug intoxication with decreased mental status. The purpose of the study is to investigate the risk factors of aspiration pneumonia in the patients of benzodiazepine overdose with or without co-ingestion of other drugs. Methods: A retrospective chart review of patients who visited the emergency department between January 2012 and December 2014 was conducted. Demographic data, time from ingestion to visit, initial vital signs, symptoms, mental status, medical history, laboratory results, chest radiological findings and co-ingested medications were recorded. Multiple logistic analyses were performed to verify the association between variables and the development of aspiration pneumonia. Results: A total of 249 patients presented to the emergency department with benzodiazepine overdose. Aspiration pneumonia had developed in 24 patients (9.6%). Univariate analysis revealed time from ingestion to visit was longer, Glasgow coma scale score was lower, hypoxia was presented, leukocytosis was shown, types of ingested drugs was high, less activated charcoal was applied and tricyclic antidepressants was taken in patients that developed aspiration pneumonia. Time from ingestion to visit (odds ratio (OR) 1.121, 95% confidence interval (CI), 1.057-1.189, p=0.000), GCS score (OR 0.724. 95% CI, 0.624-0.839, p=0.000), oxygen saturation (OR 0.895, 95% CI, 0.835-0.959, p=0.002), and co-ingestion of TCA (OR 4.595, 95% CI, 1.169-18.063, p=0.029) were identified as risk factors of morbidity of aspiration pneumonia upon multiple logistic regression analysis. Conclusion: Time from ingestion to visit, low GCS score, low oxygen saturation and co-ingestion of TCA were risk factors of the development of aspiration pneumonia in benzodiazepine overdose patients.

• 한국동물위생학회지
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• 제23권2호
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• pp.113-124
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• 2000

A total of 500 sera and lungs of slaughtered pigs were examined to investigate antibody titer, prevalence of pulmonary lesion, and interrelation among lung lesion score, type of pulmonary lesion and antibody titers by ELISA. The results obtained were as follows ; 1. The highest distribution of antibody titer was showed at 20 - 80 in M hyopneumoniae, 160-640 in P multocida type A and 160 - 640 in A pleuropneumoniae serotype 2 and 5. 2. The prevalence of pulmonary lesions was 84.0%, mean pulmonary lesion and mean lung score listed as 24.0$\pm$19.8% and 2.5$\pm$1.6, respectively. 3. In the prevalence of type of pulmonary lesion, enzootic pneumonia, pleuropneumonia and pleuritis were 58.2%, 10.0% and 15.8%, respectively. 4. Lung lesion score and type of pulmonary lesion were not interrelated with the distribution of antibody titer to specific pathogens, and causative pathogens of respiratory diseases were complicated with various bacteria.

• 한국방사선학회논문지
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• 제15권4호
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• pp.547-554
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• 2021

흉부 X선 영상의 폐렴을 신속하고 정확하게 진단하기 위하여 동일한 Xception 딥러닝 모델에 배치 사이즈를 4, 8, 16, 32로 다르게 적용하여 각각 3회의 모델링을 실시하였다. 그리고 성능평가 및 metric 평가에 대한 결과값을 3회 평균값으로 산출하여 배치 사이즈별 흉부 X선 영상의 폐렴 특징 추출과 분류의 정확도 및 신속성을 비교 평가하였다. 딥러닝 모델링의 성능평가 결과 배치 사이즈 32를 적용한 모델링의 경우 정확도, 손실함수 값, 평균제곱오차, 1 epoch 당 학습 소요 시간의 결과가 가장 우수한 결과를 나타내었다. 그리고 Test Metric의 정확도 평가는 배치 사이즈 8을 적용한 모델링이 가장 우수한 결과를 나타내었으며, 정밀도 평가는 모든 배치 사이즈에서 우수한 결과를 나타내었다. 재현율 평가는 배치 사이즈 16을 적용한 모델링이 가장 우수한 결과를 나타내었으며, F1-score는 배치 사이즈 16을 적용한 모델링이 가장 우수한 결과를 나타내었다. 그리고 AUC score 평가는 모든 배치 사이즈의 결과가 동일하였다. 이러한 결과를 바탕으로 배치 사이즈 32를 적용한 딥러닝 모델링이 높은 정확도, 안정적인 인공신경망 학습 및 우수한 신속성의 결과를 나타내었다. 향후 딥러닝을 이용한 흉부 X선 영상의 폐렴에 대한 특징 추출 및 분류에 관하여 자동진단 연구 시 배치 사이즈를 32로 적용한다면 정확하면서도 신속한 병변 검출이 가능할 것이라고 사료된다.

• 한국임상약학회지
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• 제26권1호
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• pp.46-52
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• 2016

Background: The use of acid suppressive agents became a standard therapy in an intensive care unit (ICU) to prevent stress related gastrointestinal mucosal damage. However, the risk of infectious diseases has been concerned. Objective: The study was to determine the differences between histamine 2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) in incidence of nosocomial pneumonia and pseudomembranous colitis (PMC) by Clostridium difficile with patients in ICU. Methods: This is a retrospective comparative study including patients admitted to the ICU who were at least 18 years of age and stayed for more than 48hrs from August 1, 2014 to January 31, 2015. The propensity score analysis and propensity matched multivariable logistic regression were used in analyzing data to control for confounders. Results: A total of 155 patients were assessed. H2RA were prescribed in 110 (53.9%) and PPI were in 45 (22.1%). Nosocomial pneumonia developed in 37 (23.9%); 25 (22.7%) were on H2RA and 12 (26.7%) were on PPI. The unadjusted incidence of nosocomial pneumonia was slightly higher in the patients with PPI (odds ratio (OR) 1.24; 95% confidence interval (CI): 0.54-2.71) compared to them with H2A. After adjusting with propensity score, the adjusted OR with PPI was 1.35 (95% CI: 0.44-4.11). The propensity score matched analyses showed similar results. Conclusion: The uses of PPI and H2RA as a stress ulcer prophylaxis agent showed similarity in the incidence of nosocomial pneumonia and PMC.

• Journal of Chest Surgery
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• 제50권5호
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• pp.346-354
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• 2017

Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6-12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

• 한국임상약학회지
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• 제21권2호
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• pp.170-181
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• 2011

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

• Tuberculosis and Respiratory Diseases
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• 제69권1호
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• pp.24-30
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• 2010

Background: A novel 2009 influenza A (H1N1) virus emerged and disseminated to all over the world. There are few reports on the clinical characteristics of patients with complications. We describe the clinical features of pneumonia in adult patients hospitalized, who have novel influenza infection. Methods: There were 43 adult patients enrolled into the study with pneumonia of 528 hospitalized patients confirmed influenza A (H1N1) virus infection by real-time reverse transcriptase polymerase chain reaction testing, between 24 August 2009 and 31 January 2010. The clinical data of patients with pneumonia were collected retrospectively. Results: There were 22 of 43 (51.2%) influenza patients with pneumonia that had higher risk factors for complications. Compared to 28 patients with influenza A (H1N1) viral pneumonia and 15 patients, who had isolated bacteria from cultures, those with mixed viral and bacterial pneumonia were significantly more likely to have unilobar consolidations on chest radiographs (53.3 vs. 10.7%, p<0.01) and higher scores of pneumonia severity index (PSI; 90 [66~100] vs. 53 [28~90], p=0.04). Six patients required mechanical ventilation support in an Intensive Care Unit and were more likely to have dyspnea (83.3 vs. 29.3%, p=0.02) and low levels of $PaO_2$ (48.3 [37.0~70.5] vs 64.0 [60.0~74.5] mm Hg, p=0.02) and high levels of pneumonia severity index (PSI) score (108.0 [74.5~142.8] vs. 56.0 [40.5~91.0], p=0.03). Conclusion: The majority of pneumonia patients infected with novel influenza improved. Chest radiographic findings of unilobar consolidations suggest that mixed pneumonia is more likely. Initial dyspnea, hypoxemia, and high levels of PSI score are associated with undergoing mechanical ventilation support.