An open clinical trial was conducted to evaluate the efficacy and tolerability of isradipine in 30 cases (male 16, female 14 cases, average age 52.6+/-7.94) of mild to moderate essential hypertension using 1.25-2.5mg twice a day for 8 weeks of active treatment. Blood pressure was significantly reduced from 168.5+/-14.33/108.3+/-6.37mmHg, 163.7+/-9.74/105.5+/-7.1mmHg to 141.0+/-13.69/92.0+/-9.27mmHg, 138.8+/-13.46/92.3+/-11.16mmHg in sitting and standing position respectively. The extent of reduction was 27.5/16.3mmHg in sitting position and 29.9/13.2mmHg in standing position. This comprised the mean response rate in terms of reduction of DBP of 10mmHg or more being 90% and the normalization rate, deficed as DBP lowering to 90mmHg or below, being 70%. Heart rate, hematology and blood chemistry including blood sugar and lipids were not changed significantly after treatment with isradipine. No significantl side effect was observed except 2 cases of mild transient facial flushing and nausea during the treatment, so could proceed the trial without drug discontinuation in all 30 cases. The results suggest that isradipine is one of the useful and safe drugs in the treatment of mild to moderate essential hypertension.
Blood Glucose ; Blood Pressure ; Chemistry ; Female ; Flushing ; Heart Rate ; Hematology ; Humans ; Hypertension* ; Isradipine* ; Nausea

PURPOSE: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. METHODS: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets, changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. RESULTS: After executing the indirect medical oversight, there was significant improvement in the accuracy of 119 rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. CONCLUSION: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.
Classification ; Emergencies* ; Emergency Medical Services* ; Emergency Medical Technicians* ; Humans ; Medical Records ; Retrospective Studies

A recent study showed that comparative sequence analysis of rpoB DNAs could reveal natural relationships in genus Mycobacterium [J Clin Microbiol. 37 (6). 1999]. rpoB DNAs showed interspecies variation and intraspecies conservation, Based on these data, we developed polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) protocols which enable species differentiation in genus Mycabacterium. When this assay was applied to 24 clinical isolates identified as M. avium complex (MAC) by biochemical test, these were successfully differentiated into M. avium and M. intracellulare. These results were concordant with those obtained by 16s rDNA analysis. It is the first report that PCR-SSCP analysis of rpoB DNA could be used for species differentiation of MAC strains.
DNA* ; DNA, Ribosomal ; Mycobacterium avium Complex* ; Mycobacterium avium* ; Mycobacterium* ; Polymerase Chain Reaction* ; Polymorphism, Single-Stranded Conformational* ; Sequence Analysis

PURPOSE: The normal values for lung resistance and lung capacity of children, as determined by impulse oscillometry (IOS), are different for children of different ethnicities. However, reference values there is no available reference value for Korean preschool children have yet to be determined. The aim of the present study was to determine the normal ranges of IOS parameters in Korean preschool children. METHODS: A total of 133 healthy Korean preschool children were selected from 639 children (aged 3 to 6 years) who attended kindergarten in Seongnam, Gyeonggi province, Korea. Healthy children were defined according to the European Respiratory Society (ERS) criteria. All subjects underwent lung function tests using IOS. The relationships between IOS value (respiratory resistance (Rrs) and reactance (Xrs) at 5 and 10 Hz and resonance frequency (RF)) and age, height, and weight were analyzed by simple linear and multiple linear regression analyses. RESULTS: The IOS success rate was 89.5%, yielding data on 119 children. Linear regression identified height as the best predictor of Rrs and Xrs. Using stepwise multiple linear regressions based on age, height, and weight, we determined regression equations and coefficients of determination (R2) for boys (Rrs5=1.934-0.009xHeight, R2=12.1%; Xrs5=0.774+0.006xHeight-0.002xAge, R2=20.2% and for girls (Rrs5=2.201-0.012xHeight, R2=18.2%; Xrs5=-0.674+0.004xHeight, R2=10.5%). CONCLUSION: This study provides reference values for IOS measurements of normal Korean preschool children. These provide a basis for the diagnosis and monitoring of preschool children with a variety of respiratory diseases.
Airway Resistance ; Child ; Child, Preschool ; Electric Impedance ; Humans ; Korea ; Linear Models ; Lung ; Lung Volume Measurements ; Oscillometry ; Reference Values ; Respiratory Function Tests ; Respiratory System

PURPOSE: Ureteral calculi are commonly encountered in the emergency department. Ureteral calculi influence the quality of life of patients, causing pain and economic burden. The optimal management of ureteral calculi remains a challenge for practicing physicians; therefore, this study was designed to determine which factors are related to the failure of their spontaneous passage. METHODS: This study was a retrospective review of the medical records of one hundred ninety-five patients who visited the emergency department complaining of renal colic from February 2012 to December 2012. Bivariate analyses were conducted relating physical, laboratory, and radiological methods to predict the failure of spontaneous passage. A multivariate logistic regression model was then derived, with all variables in the final model significant at p<0.05. RESULTS: One hundred twenty-eight stones were spontaneously expelled and sixty-seven were not. The mean stone size was significantly larger in the non-passage group than the passage group (p<0.001). When the stones were located in the upper ureter, or on the right side, the spontaneous passage rate was lower (p<0.001, p=0.035). Increased neutrophils and positive tests for urinary protein and bilirubin were also associated with the decreased likelihood of spontaneous passage (p=0.046, p=0.029, and p=0.048, respectively). In addition, the longer duration of symptoms and a previous history of ureteral calculi were related to a lower chance of spontaneous passage (p=0.005, p=0.019). CONCLUSION: Prognostic factors of failure, after the initial expectant management of ureteral calculi, included: calculi size, location (e.g., side), the duration of symptoms, the previous history, neutrophil levels, urinary bilirubin levels, and urinary protein levels. Therefore, emergency physicians need to cautiously decide between watchful waiting and interventions in these patients.
Bilirubin ; Calculi ; Emergencies ; Humans ; Logistic Models ; Medical Records ; Neutrophils ; Quality of Life ; Renal Colic ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Watchful Waiting

BACKGROUND: Cardiovascular mortality is increased in ESRD patients and is not completely explained by common cardiovascular risk factors. Therefore, more attention is being focused on non-traditional risk factors such as endothelial dysfunction, malnutrition, chronic inflammation. This study was performed to investigate whether chronic inflammation and malnutrition plays an important role on the endothelial dysfunction in ESRD patients. METHODS: Seventy-five patients undergoing CAPD for more than six months were enrolled in the study. To evaluate the extent of endothelial dysfunction, flow-mediated vasodilation (FMD) of brachial artery was measured using doppler ultrasonography. The degree of chronic inflammation was assessed by measuring inflammatory markers (IL-6, hsCRP) and SGA was used to assess the nutritional status. RESULTS: According to SGA grade, the patients were divided into 2 groups (group 1: normal nutritional status, group 2: malnourished status). In group 2, IL-6 was significantly higher compared to group 1. FMD and albumin level were significantly lower in group 2 (11.37+/-4.93 vs. 8.41+/-4.23%, 3.7+/-0.4 vs. 3.4+/-0.3 g/dL, p<0.05). When the patients were divided into groups according to hsCRP level (group 1: > or =3 mg/L, group 2: <3 mg/L), BMI and fasting glucose were significantly higher in group 1 compared to group 2 (25.9+/-3.5 vs. 23.9+/-2.8 kg/m2, 105.8+/-22.3 vs. 93.3+/-11.4 mg/dL). HDL-cholesterol was significantly lower in group 1 (37.4+/-9.3 vs. 45.3+/-12.9 mg/dL). FMD was decreased in group 1 compared to group 2 (7.35+/-4.23 vs. 11.57+/-4.76%). Multiple regression analysis showed that average hsCRP concentration was an independent factors affecting brachial FMD. CONCLUSION: These findings suggest that endothelial dysfunction is associated with markers of inflammation and malnutrition, and chronic inflammation and malnutrition can be a predisposing factors for atherosclerosis in CAPD patients.
Atherosclerosis ; Brachial Artery ; Causality ; Fasting ; Glucose ; Humans ; Inflammation* ; Interleukin-6 ; Kidney Failure, Chronic ; Malnutrition ; Mortality ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory* ; Risk Factors ; Ultrasonography, Doppler ; Vasodilation

Background: For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients. Methods: Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927). Results: The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]). Conclusions In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.