• Title/Summary/Keyword: exacerbation

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Effects of and barriers to hospital-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

  • Kim, Sang Hun;Jeong, Jong Hwa;Lee, Byeong Ju;Shin, Myung-Jun;Shin, Yong Beom
    • Physical Therapy Rehabilitation Science
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    • v.9 no.2
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    • pp.82-89
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    • 2020
  • Objective: The purpose of this study was to assess the effect of hospital-based pulmonary rehabilitation (PR) on exercise capacity and quality of life as well as barriers to participation in persons with chronic obstructive pulmonary disease (COPD) in South Korea. Design: One-group pretest-posttest design. Methods: A total of 14 patients were enrolled in this study in an 8-week PR program with two 60-minute sessions per week. The program included: flexibility exercises, breathing techniques, strengthening exercises, and aerobic exercises. The outcomes were defined as changes in the variables before and after the PR program. A change in the 6-minute walk distance (6MWD) was defined as the primary outcome, and changes in pulmonary function test, respiratory and grip strength, and the St. George's Respiratory Questionnaire (SGRQ) about quality-of-life results were secondary outcomes. A dropout was defined as missing >3 of the 16 sessions. Results: Patients who completed the program showed a significant improvement of 43.57±39.43 m in the 6MWD (p<0.05), but no significant differences were noted for the other function tests. The SGRQ showed a significant improvement in the activity and total score (p<0.05). The total dropout rate was 53.3%. Newly developed symptoms, exacerbation of COPD, transport problems, and lack of motivation were major barriers to PR. Conclusions: Our study showed that an 8-week hospital-based PR program improved exercise capacity and quality of life but had a high dropout rate in individuals with COPD. Since comprehensive PR has only recently been established in South Korea, patient motivation and education are critical.

Systemic Pemphigus Vulgaris: A Case Report (전신성 심상성 천포창의 치험례)

  • Seo, Bo-Mmie F.;Seo, Je-Won;Oh, Deuk-Young;Ahn, Sang-Tae;Rhie, Jong-Won
    • Archives of Plastic Surgery
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    • v.38 no.5
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    • pp.687-690
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    • 2011
  • Purpose: Pemphigus vulgaris, a rare autoimmune blistering disease of the skin and mucous membranes remains a challenging disease to treat. Management is focused on immunotherapy against autoimmune antibodies that target keratinocyte cell adhesion molecules, and antibiotics preventing secondary infections. There is no established dressing protocol and skin is usually manipulated the least amount possible in order to minimize irritation. The authors suggest that early initiation of aggressive bathing and debridement of skin lesions, with nutritional support, is essential in accelerating resolution. Methods: A 40 year-old male previously diagnosed with pemphigus vulgaris was admitted due to exacerbation of mucocutaneous lesions involving the epidermis and mucosa of the whole body. Steroids, immunosuppressants, intravenous immunoglobulin and antibiotics were administrated, but infection and de-epithelialization progressed, while his general condition deteriorated with a weight loss of over 20 kilograms. The plastic surgery department intervened with daily bathing, debridement of unhealthy debris and non-traumatizing coverage of growing epithelium. Total parenteral nutrition and mobilization with rehabilitation therapy was initiated as early as possible. Results: After bathing, healthy epithelium gradually covered the patient's entire body, while his general condition improved with a corresponding weight gain of 14 kgs. Conclusion: Treatment of pemphigus vulgaris focuses on immunotherapy and infection control. However, an equal amount of attention should be laid on early intervention with daily dressings including bathing and irrigation, nutritional support, and exercise as this accelerates resolution of existing infections, promotes healthy epithelialization and leads to faster recovery.

Idiopathic Polymyositis in a Young Mature Alaskan malamute (젊은 성숙 알라스칸 말라뮤트에서 특발성 다발성근염 증례)

  • Lee, Jae-Il;Hong, Sung-Hyeok;Son, Hwa-Young;Kim, Myung-Cheol
    • Journal of Veterinary Clinics
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    • v.24 no.2
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    • pp.244-246
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    • 2007
  • Clinical and histopathologic features of idopathic polymyositis in twenty-month-old Alaskan malamute dog are described. The clinical signs were progressive exercise intolerance with acute exacerbation of weakness, muscle atrophy, synchronous pelvic limb gait, short stiff steps and tip-toeing as like walking on eggshells. Physical and clinical examination revealed no evidence of neurologic, skeletal and secondary muscular disorders associated with other diseases. Therefore muscle biopsy was performed at the most severe muscle atrophy lesions to confirm by histopathology. Histopathologic findings documented mononuclear cell infiltration and necrosis of muscle fiber and it was diagnosed as idiopathic polymyositis. Initial treatment was focused on pain relief. Prednisone at immunosuppressive dose (2 mg/kg) was administered orally twice daily. After 3 weeks of starting treatment, the patient showed improvement of gait, appetite, exercise as well as gradually return to normal state of hematologic and serum chemistry profiles.

Lamivudine Therapy Exacerbates Bilirubinemia in Patients Underlying Severely Advanced Hepatitis

  • Choi, Young Hee;Lee, Chang Ho;Ko, Myong Suk;Han, Hyun Joo;Kim, Sang Geon
    • Toxicological Research
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    • v.33 no.4
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    • pp.343-350
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    • 2017
  • Lamivudine belongs to the set of antiviral agents effective against hepatitis B virus infection. Given case reports on liver injuries after certain antiviral agent treatments, this study examined the effects of lamivudine on alanine aminotransferase (ALT) and total bilirubin (TB) using a medical system database. A total of 1,321 patients taking lamivudine alone or with others were evaluated using laboratory hits in an electronic medical system at Seoul National University Hospital from 2005 through 2011. The patients were grouped according to prior ALT results: G#1, ALT < 40 IU/L; G#2, 40 IU/L ${\leq}$ ALT < 120 IU/L; G#3, 120 IU/L ${\leq}$ ALT < 240 IU/L; and G#4, ALT ${\geq}$ 240 IU/L. In G#1 and G#2 patients, lamivudine or adefovir treatment decreased ALT and TB compared to prior values. In G#3 and G#4 patients with three times the upper limit of normal (ULN) ${\leq}$ ALT < 15 times the ULN, both ALT and TB were decreased after treatment with lamivudine alone, or adefovir following lamivudine therapy, indicating that lamivudine therapy ameliorated liver functions. However, in G#4 patients who experienced severely advanced hepatitis (ALT ${\geq}$ 15 times the ULN, or ${\geq}$ 600 IU/L), lamivudine augmented TBmax ($6.3{\rightarrow}13.3mg/dL$) despite a slight improvement in ALT ($839{\rightarrow}783IU/L$), indicative of exacerbation of bilirubinemia. Patients who used adefovir after lamivudine also showed a high incidence of hyperbilirubinemia when they experienced severely advanced hepatitis. Treatment with adefovir alone did not show the effect. In conclusion, lamivudine may increase the risk of hyperbilirubinemia in patients with severely advanced hepatitis, implying that caution should be exercised when using lamivudine therapy in certain patient populations.

Associations of Ambient Air Pollutant Concentrations With Respiratory Symptoms and Perceived Health Status in Japanese Adults With and Without Chronic Respiratory Diseases: A Panel Study

  • Nakao, Motoyuki;Yamauchi, Keiko;Mitsuma, Satoshi;Odaira, Tetsuro;Obata, Hideto;Chijimatsu, Yoichi;Ishihara, Yoko
    • Journal of Preventive Medicine and Public Health
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    • v.52 no.6
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    • pp.416-426
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    • 2019
  • Objectives: In recent years, transboundary air pollution from mainland East Asia has led to growing concerns about air pollution in Japan. Air pollution is reportedly associated with the exacerbation of respiratory diseases. In this study, we assessed the effects of air pollution on respiratory symptoms and the health status of participants with and without chronic respiratory diseases. Methods: Participants (n=2753) with and without chronic respiratory diseases who visited healthcare facilities in Japan during February from 2010 to 2015 filled out a self-report questionnaire regarding their symptoms and perceived health status. Participants were followed up during April-May and June-July. Results: Oxidant concentrations were associated with respiratory symptoms, overall health, and quality of life (QoL). Suspended particulate matter (SPM) and particulate matter <$2.5{\mu}m$ levels were associated with physical fitness; SPM was also associated with QoL. Recent experience of an Asian sand dust event had a significant effect on allergic symptoms, change in health, and QoL. Conclusions: Respiratory symptoms were more strongly affected by oxidants than by other pollutants. Significant associations of air pollutants were found with a comprehensive range of items related to perceived health status, including overall health and QoL. Although the effects of air pollutants on respiratory symptoms and health status were more apparent among patients with respiratory diseases, the adverse effects of air pollutants were significant even among participants without such conditions.

The Severity of COVID-19 in Patients with Nonalcoholic Fatty Liver Disease in Korea

  • Park, Hyeki;Joe, Hyun
    • Health Policy and Management
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    • v.31 no.4
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    • pp.472-478
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    • 2021
  • Background: Early identification of patients who are highly likely to develop severe illness among confirmed cases of coronavirus disease 19 (COVID-19) can be expected to lead to effective treatment. This study therefore aimed to determine whether the presence of nonalcoholic fatty liver disease (NAFLD) has an impact on the exacerbation of COVID-19 symptoms. Methods: The study used the Korean National Health Insurance claim data for treatment of COVID-19 patients in 2020. NAFLD includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The outcome variables used were hospitalization and the use of medical devices. Hospitalization was defined by a length of stay exceeding one day and the use of medical devices was defined as one or more uses of a ventilator or extracorporeal membrane oxygenation. Multivariable logistic regression analysis was performed to determine if there was a difference in the hospitalization and use of medical devices of COVID-19 patients depending on the presence of NAFLD. Results: The odds ratio of hospitalization was 1.059, indicating slightly higher odds of hospitalization for patients with NAFL or NASH compared to those without the conditions, but it was not statistically significant (0.969-1.156). On the other hand, the odds ratio of use of medical devices was high at 1.667 and was statistically significant (1.111-2.501). Conclusion: The study results found NAFLD to be a risk factor that can exacerbate symptoms in COVID-19 patients. Accordingly, it is necessary to identify NAFLD patients through preemptive screening and provide them with appropriate treatments.

The Pattern of Labor Migration in Ansan and Their Local-Social Relationship (안산지역 이주노동자의 노동이주 유형과 지역-사회관계)

  • Lee, Taejeong
    • Korean Journal of Labor Studies
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    • v.24 no.3
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    • pp.73-107
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    • 2018
  • The purpose of this study is to shed light on the characteristics of the social relations of migrant workers in the Ansan area and the factors for the construction of those characteristics. The social relations of migrant workers in the Ansan area are affected by the Korean government's policy of EPS, a short-term rotation policy and its ban on the settlement of migrant workers. These workers are likely to form a temporary and bounded social relationship. The bounded social relationship of migrant workers to society is one of the major factors that put them in social poverty. Ethnic communities, support organizations for migrant workers, and local government agencies have assumed the task of helping build the network among migrant workers of various ethnic backgrounds as well as aiding their participation in local social activities. The status of a temporary resident is the prime reason for spatial exclusion and social poverty among migrant workers. To prevent the exacerbation of these phenomena, this study suggests that the government reconsider its short-term work permit policy for less skilled workers.

Metabolic profile according to the parity and stage of lactation of high-performance Holstein-Friesian cows

  • Kuczynska, Beata;Puppel, Kamila;Golebiewski, Marcin;Wisniewski, Konrad;Przysucha, Tomasz
    • Animal Bioscience
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    • v.34 no.4
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    • pp.575-583
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    • 2021
  • Objective: The aim of the study was to determine the effect of parity and the stage of lactation on the metabolic profile of cows based on the basic chemical milk components and the blood parameters. Methods: The study material consisted of high-yielding Holstein-Friesian cows. In total, 473 cows were examined. According to the parity, cows were divided into four groups: primiparous (P), and multiparous in the second (M2), in the third (M3), and in subsequent lactations (M4). The feeding of cows was based on total mixed ration (TMR) ad libitum. Milk and blood samples were collected individually from each cow three times per standard lactation period. Results: Greater exacerbation of changes in the dynamics of the blood plasma parameters examined was proved for multiparous cows. The highest value of β-hydroxybutyrate acid (0.946 mmol/L) was found for multiparous cows from group M3 at the beginning of lactation. However, it was still in the normal range. The results showed aspartate aminotransferase, and gamma-glutamyl transferase (GGT) activities in dairy cows during lactation had significant variations taking in to account stage of lactation. The highest activity of GGT was found in the group of the oldest cows and measured from 26.36 U/L at the beginning of lactation to 48.75 U/L at the end of the lactation period. Conclusion: The time-related changes in the concentrations of the biochemical parameters described differ markedly among lactating cows, though the housing conditions on the research dairy farm are highly standardised. This indicates that the ability to cope with metabolic stress is mainly affected by the individual predispositions of cows and feed nutrient supply in different stage of lactation. Especially, the feed nutrient supply (in net energy for lactation), which was the best in TMR 1 in comparison TMR 3.

Involvement of Macrophages in Proliferation of Prostate Cancer Cells Infected with Trichomonas vaginalis

  • Kim, Kyu-Shik;Moon, Hong-Sang;Kim, Sang-Su;Ryu, Jae-Sook
    • Parasites, Hosts and Diseases
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    • v.59 no.6
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    • pp.557-564
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    • 2021
  • Macrophages play a key role in chronic inflammation, and are the most abundant immune cells in the tumor microenvironment. We investigated whether an interaction between inflamed prostate cancer cells stimulated with Trichomonas vaginalis and macrophages stimulates the proliferation of the cancer cells. Conditioned medium was prepared from T. vaginalis-infected (TCM) and uninfected (CM) mouse prostate cancer (PCa) cell line (TRAMP-C2 cells). Thereafter conditioned medium was prepared from macrophages (J774A.1 cell line) after incubation with CM (MCM) or TCM (MTCM). When TRAMP-C2 cells were stimulated with T. vaginalis, protein and mRNA levels of CXCL1 and CCL2 increased, and migration of macrophages toward TCM was more extensive than towards CM. Macrophages stimulated with TCM produced higher levels of CCL2, IL-6, TNF-α, their mRNAs than macrophages stimulated with CM. MTCM stimulated the proliferation and invasiveness of TRAMP-C2 cells as well as the expression of cytokine receptors (CCR2, GP130, CXCR2). Importantly, blocking of each cytokine receptors with anti-cytokine receptor antibody significantly reduced the proliferation and invasiveness of TRAMP-C2 cells. We conclude that inflammatory mediators released by TRAMP-C2 cells in response to infection by T. vaginalis stimulate the migration and activation of macrophages and the activated macrophages stimulate the proliferation and invasiveness of the TRAMP-C2 cells via cytokine-cytokine receptor binding. Our results therefore suggested that macrophages contribute to the exacerbation of PCa due to inflammation of prostate cancer cells reacted with T. vaginalis.

The Long-term Efficacy of Domiciliary Noninvasive Positive-Pressure Ventilation in Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials

  • Park, So Young;Yoo, Kwang Ha;Park, Yong Bum;Rhee, Chin Kook;Park, Jinkyeong;Park, Hye Yun;Hwang, Yong Il;Park, Dong Ah;Sim, Yun Su
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.47-55
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    • 2022
  • Background: We evaluated the long-term effects of domiciliary noninvasive positive-pressure ventilation (NIPPV) used to treat patients with chronic obstructive pulmonary disease (COPD). Methods: Databases were searched to identify randomized controlled trials of COPD with NIPPV for longer than 1 year. Mortality rates were the primary outcome in this meta-analysis. The eight trials included in this study comprised data from 913 patients. Results: The mortality rates for the NIPPV and control groups were 29% (118/414) and 36% (151/419), suggesting a statistically significant difference (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65-0.95). Mortality rates were reduced with NIPPV in four trials that included stable COPD patients. There was no difference in admission, acute exacerbation and quality of life between the NIPPV and control groups. There was no significant difference in withdrawal rates between the two groups (RR, 0.99; 95% CI, 0.72-1.36; p=0.94). Conclusion: Maintaining long-term nocturnal NIPPV for more than 1 year, especially in patients with stable COPD, decreased the mortality rate, without increasing the withdrawal rate compared with long-term oxygen treatment.