To find out the predictors of nocturnal arterial oxygen desaturation in patients with respiratory diseases, transcutaneous oxygen saturation(StcO2) monitoring studies using a pulse oximeter were performed during sleep in 20 patients. StcO2 was decreased more than 4% from the baseline value in 18 patients(90%) and more than 10%('Desaturator') in 8(40%). Five of the seven patients(71.4%) with awake PaO2<60mmHg and three of the thirteen patients(23.1%) with awake PaO2≥60mmHg were 'desaturators'. The awake PaO2/FIO2 and PaO2/PAO2 could distinguish 'desaturator' from 'nondesaturator, and PaO2, SaO2 or StcO2 could not. These results suggest that the nocturnal oxygen desaturation depends on the severity of the underlying disease rather than the baseline PaO2. Anthropomorphic and lung function factors could not separate between 'desaturator' and 'non-desaturator', and about a quarter of patients with a wake PaO2≥60mmHg developed significant desaturation. Therefore, it is necessary to monitor the nocturnal arterial oxygen saturation in patients with respiratory diseases regardless of their severity of airflow obstruction or awake PaO2.
Humans ; Lung ; Oxygen*

PURPOSE: The incidence of retinopathy of prematurity(ROP) which is one of the most common cause of childhood blindness has not decreased despite the restricted use of oxygen. There may be other factors responsible for ROP which could not be explained solely by improved survival of very low birth weight infants. We tried to clarify perinatal risk factors that are nrelated to the occurrence of ROP. METHODS: We enrolled 239 infants with gestational ages less than 33 wks or with birth weight less than 1,800 gm who had received ophthalrnologic examination between Jan. 1995 and Dec. 1997. The patients were categorized into two groups,' "No ROP" group as control(n=185) and ROP group as study population(n=54), and we compared the perinatal risk factors between the two. RESULTS: 54(22.6%) out of 239 infants were diagnosed as having ROP. The annual incidence of ROP decreased but the incidence of treated ROP increased. The incidence of ROP decreased with longer gestation and higher birth weight. Mean gestational age was 30.3 weeks in the study group vs 31.0 weeks in the control group, and mean birth weight was 1,390 gm and 1,586 gm, respectively. Significant factors contributing to increased incidence of ROP included: duration of oxygen therapy, ventilator therapy, total parenteral nutrition and hospitalization, frequency of hyperoxia, hypercarbia, and transfusion and respiratory distress syndrome, umbilical artery catheterization, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, use of dexamethasone and aminophylline, pneumonia, air leak syndrome, and hyperglycemia. The incidence of ROP and treated ROP was not influenced by the mode of surfactant treatment(prophylactic vs rescue) in RDS patients and the mode of dexamethasone treatment(short vs long) in BPD patients. CONCLUSION: The risk factors for retinopathy of prematurity included gestational age, birth weight and duration of oxygen, as well as other aforementioned perinatal factors. The occurrence of ROP can be decreased by preventing preterm birth, minimizing the use of oxygen, and further morbidity can be prevented by performing proper ophthalmologic examination and doing an appropriate follow-up.
Aminophylline ; Birth Weight ; Blindness ; Bronchopulmonary Dysplasia ; Catheterization ; Catheters ; Dexamethasone ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Hyperglycemia ; Hyperoxia ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Oxygen ; Parenteral Nutrition, Total ; Pneumonia ; Pregnancy ; Premature Birth ; Retinopathy of Prematurity* ; Risk Factors* ; Sepsis ; Umbilical Arteries ; Ventilators, Mechanical

BACKGROUND: In Alzheimer's disease (AD), cognitive impairment is associated with functional impairment; and neuropsychiatric symptoms are common in AD patients. However, there have been few studies about the relationship between neuropsychiatric symptoms and functional state in AD. The objective of this study is to investigate the effects of neuropsychiatric symptoms on activities of daily living in AD. METHODS: We reviewed the medical records of 60 AD patients meeting the criteria of the Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) for probable AD (mean age, 75.4+/-7.0 years; 13 men, 47 women). The relationships between the Neuropsychiatric Inventory (NPI) and two functional measures, instrumental activities of daily living (IADL) and the Barthel Index, were analysed. RESULTS: The total NPI score was significantly associated with both functional measures (IADL: r=0.543; Barthel Index: r=-0.515), as were the NPI subscale scores of delusion, hallucination, agitation, depression, anxiety, and irritability. Multivariate regression analyses showed that total NPI score and duration of dementia were significant predictive factors for both IADL and the Barthel Index. In addition, the total NPI score still significantly influenced the two functional measures after controlling for age, duration of dementia, and Mini-Mental State Examination. CONCLUSION: The total NPI score was a significant predictive factor for functional status beyond the contribution of cognitive impairment in AD. Neuropsychiatric symptoms are associated with increased functional impairments in AD. Screening and management of neuropsychiatric symptoms during the course of AD would be helpful in improving functional status.
Activities of Daily Living ; Alzheimer Disease ; Anxiety ; Communication Disorders ; Delusions ; Dementia ; Depression ; Dihydroergotamine ; Hallucinations ; Humans ; Male ; Mass Screening ; Medical Records

BACKGROUND: Daptomycin is a novel cyclic lipopeptide antibiotic that exhibits in vitro bactericidal activity against gram-positive pathogens including methicillin-resistant staphylococci and vancomycin-resistant enterococci. The aim of this study is to determine the in vitro activities of daptomycin against recent clinical isolates of methicillin-resistant staphylococci and vancomycin-resistant enterococci in Korea. MATERIALS AND METHODS: A total of 117 clinical strains of methicillin-resistant staphylococci and vancomycin-resistant enterococci were isolated at a tertiary-care hospital in Korea in 2004. Susceptibility to daptomycin was tested by the CLSI broth microdilution method using Mueller-Hinton broth (MHB) which was adjusted to contain a final concentration of 50 microgram/mL of ionized calcium (Ca2+). Susceptibilities to ampicillin, oxacillin, levofloxacin, vancomycin, and linezolid were tested by the CLSI agar dilution method. RESULTS: All isolates of methicillin-resistant S. aureus and coagulase-negative staphylococci were inhibited by 1 microgram/mL of daptomycin, and MIC90s were 1 microgram/mL, which were similar to those of vancomycin and linezolid. MIC90s of daptomycin for vancomycin-resistant E. faecalis and E. faecium were 0.5 microgram/mL and 2 microgram/mL, respectively, and all isolates were susceptible to daptomycin. MIC90s of linezolid and levofloxacin for vancomycin-resistant enterococci were 1-2 microgram/mL and 64 microgram/mL, respectively. Resistance rates of vancomycin-resistant E. faecalis and E. faecium to levofloxacin were 100% and 96%, respectively. Daptomycin MICs in MHB supplemented to 20-25 microgram/ml of Ca2+ were 2-8 fold higher than those in MHB supplemented to 50 microgram/mL of Ca2+. CONCLUSION: Daptomycin is very active in vitro against methicillin-resistant staphylococci and vancomycin-resistant enterococci isolated in Korea, and it is important to test in vitro activity of daptomycin using MHB containing 50 microgram/mL of Ca2+.
Agar ; Ampicillin ; Calcium ; Daptomycin* ; Korea* ; Levofloxacin ; Linezolid ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Vancomycin

BACKGROUND: Daptomycin is a novel cyclic lipopeptide antibiotic that exhibits in vitro bactericidal activity against gram-positive pathogens including methicillin-resistant staphylococci and vancomycin-resistant enterococci. The aim of this study is to determine the in vitro activities of daptomycin against recent clinical isolates of methicillin-resistant staphylococci and vancomycin-resistant enterococci in Korea. MATERIALS AND METHODS: A total of 117 clinical strains of methicillin-resistant staphylococci and vancomycin-resistant enterococci were isolated at a tertiary-care hospital in Korea in 2004. Susceptibility to daptomycin was tested by the CLSI broth microdilution method using Mueller-Hinton broth (MHB) which was adjusted to contain a final concentration of 50 microgram/mL of ionized calcium (Ca2+). Susceptibilities to ampicillin, oxacillin, levofloxacin, vancomycin, and linezolid were tested by the CLSI agar dilution method. RESULTS: All isolates of methicillin-resistant S. aureus and coagulase-negative staphylococci were inhibited by 1 microgram/mL of daptomycin, and MIC90s were 1 microgram/mL, which were similar to those of vancomycin and linezolid. MIC90s of daptomycin for vancomycin-resistant E. faecalis and E. faecium were 0.5 microgram/mL and 2 microgram/mL, respectively, and all isolates were susceptible to daptomycin. MIC90s of linezolid and levofloxacin for vancomycin-resistant enterococci were 1-2 microgram/mL and 64 microgram/mL, respectively. Resistance rates of vancomycin-resistant E. faecalis and E. faecium to levofloxacin were 100% and 96%, respectively. Daptomycin MICs in MHB supplemented to 20-25 microgram/ml of Ca2+ were 2-8 fold higher than those in MHB supplemented to 50 microgram/mL of Ca2+. CONCLUSION: Daptomycin is very active in vitro against methicillin-resistant staphylococci and vancomycin-resistant enterococci isolated in Korea, and it is important to test in vitro activity of daptomycin using MHB containing 50 microgram/mL of Ca2+.
Agar ; Ampicillin ; Calcium ; Daptomycin* ; Korea* ; Levofloxacin ; Linezolid ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Vancomycin

BACKGROUND AND OBJECTIVE: Assessment of quality of life (QOL) of patients with chronic illness requires reasonable tools which reflect the patients' cultural and behavioral properties. We developed the quality of life questionnaire for adult Korean asthmatics (QLQAKA) on the basis of the Korean life style and evaluated its reliability and validity. METHODS: The QLQAKA consisted of four domains; symptoms (six items), daily activity (five items), emotion (three items) and reaction to environmental stimuli (three items). Patients answered each item according to a five-response scale. The reproducibility and validity of the questionnaire was estimated from the responses of 244 patients who visited the clinics in 15 institutes within a 2-week interval. RESULTS: Items with the most frequent complaints were dyspnea (87%), difficulty in sputum discharge or throat clearing (87%), limitation in strenuous activity (84%) and coughing (82.4%). The QLQAKA reflected the changes of patients' status very well. The value of minimal important differences, such as the clinically significant minimal change in the QOL score, was 0.5. The questionnaire was also highly reproducible with the value of intraclass correlation coefficiency and intraclass standard deviation as 0.940 (p<0.001) and 0.180, respectively. The changes of mean total QLQAKA score correlated weakly with the changes of FEV1 and PEFR values. CONCLUSION: The adult version of QLQAKA was valid and may be a reproducible tool for evaluating and monitoring Korean adult asthma patients.
Academies and Institutes ; Adult* ; Asthma ; Chronic Disease ; Cough ; Dyspnea ; Humans ; Life Style ; Peak Expiratory Flow Rate ; Pharynx ; Quality of Life* ; Reproducibility of Results ; Sputum ; Surveys and Questionnaires