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Coagulopathy Caused by Concurrent Ciprofloxacin and Warfarin Use: What Other Factors Induce Coagulopathy?.

Sungmo JUNG ; Misung PARK ; Won Jin KIM ; Chang Oh KIM

Journal of the Korean Geriatrics Society.2013;17(1):47-54. doi:10.4235/jkgs.2013.17.1.47

BACKGROUND: To assess factors affecting the prolongation of the international normalized ratio (INR) with concurrent warfarin and ciprofloxacin use. METHODS: A retrospective case-control study was performed at a single, 2,000-bed tertiary hospital between January 2007 and December 2009. Thirty-three patients who were on warfarin and ciprofloxacin concurrently were enrolled. Demographics and clinical data were collected from medical records. RESULTS: Nine patients were assigned to the case group (prolonged INR) and 19 patients to the control group (normal INR). Activities of daily living (ADL) and total number of classes of medications taken demonstrated significant differences between the groups (15.33 vs. 7.11, p<0.001; 7.11 vs. 5.47, p=0.041). No bleeding complications occurred during this study. CONCLUSION: As ADL reflects patient performance status and general condition of an individual, we conclude that a poor general condition is associated with coagulopathy in persons concurrently using warfarin and ciprofloxacin.
Activities of Daily Living ; Case-Control Studies ; Ciprofloxacin ; Demography ; Hemorrhage ; Humans ; International Normalized Ratio ; Retrospective Studies ; Tertiary Care Centers ; Warfarin

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Clinical Significance of Hyperhomocysteinemia Between Alzheimer's Disease and Vascular Dementia.

Hyung Eun PARK ; Hyun Ji CHO ; In Uk SONG ; Sung Woo CHUNG

Journal of the Korean Geriatrics Society.2013;17(1):41-46. doi:10.4235/jkgs.2013.17.1.41

BACKGROUND: Recent research has shown that risk factors for cerebrovascular disorders are also causes of dementia. Of these risk factors, hyperhomocysteinemia is well known to be positively correlated with all types of dementias including Alzheimer's disease (AD) and vascular dementia (VaD). But it is not know if there is a difference in the concentration of homocysteine in AD and VaD. We analyzed the homocysteine concentrations in AD and VaD and investigated the relationship between homocysteine and the progression of these two dementias. METHODS: A total of 193 patients to the dementia clinic at our hospital were enrolled. Fifty-four patients had AD and 48 patients had VaD. The remaining patients were the healthy control. Data for analysis consisted of the results of neuropsychological tests and homocysteine levels. RESULTS: Homocysteine levels were higher in AD and VaD patients than in healthy subjects, and no statistical difference was seen between AD and VaD. With lower mini-mental state examination scores, the homocysteine concentration increased significantly in VaD, but not in AD. The homocysteine concentration and the sum of box of clinical dementia rating were positively correlated in both AD and VaD. Other neuropsychological tests had no correlation with the homocysteine level. CONCLUSION: This study suggests that hyperhomocysteinemia, resulting in inflammation of vessel walls and oxidative stress, is a risk factor for both AD and VaD. However, our results did not clarify if hyperhomocysteinemia is related to the progression of dementia symptoms.
Alzheimer Disease ; Cerebrovascular Disorders ; Dementia ; Dementia, Vascular ; Glycosaminoglycans ; Homocysteine ; Humans ; Hyperhomocysteinemia ; Inflammation ; Neuropsychological Tests ; Oxidative Stress ; Risk Factors

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Clinical Characteristics of Elderly Patients Undergoing Coronary Angiography for Chest Pain.

Dong Hee KIM ; Hyun Jun JOUNG ; Se Yun KIM ; Weon Jin KO ; Eun Sun JIN ; Chong Jin KIM

Journal of the Korean Geriatrics Society.2013;17(1):37-40. doi:10.4235/jkgs.2013.17.1.37

BACKGROUND: Elderly persons are rapidly increasing in Korea. Atherosclerotic cardiovascular disease is the leading cause of morbidity and mortality in this age group. In this research, we evaluated the clinical characteristics of the elderly patients presenting chest pain. METHODS: A total of 471 patients who visited cardiovascular center of Kyung Hee University Hospital at Gangdong for chest pain were reviewed and divided by three groups, via age; under 40, from 40 to 69 and over 70 years old. RESULTS: The number of patients over 70 years was 142 (30.1%). The proportion of patients diagnosed as having significant, multivessel coronary diseases was higher than that of younger patients (p=0.0002). The rate of atypical chest discomfort presenting as a cardiac symptom was not higher than in the middle-aged group (4.8% vs. 2.1%, p=0.255). CONCLUSION: In elderly patients, the proportion of female patients and significant multivessel diseases were more common than younger patients.
Aged ; Angina Pectoris ; Cardiovascular Diseases ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Female ; Humans ; Korea ; Thorax

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Comparison Between Beers Criteria and Screening Tool of Older Person's Prescriptions as a Screening Tool for the Detection of Potentially Inappropriate Medicines and Adverse Drug Events in the Elderly Patients.

Joo Hyung LEE ; Ju Hyun ROH ; Ye Won SUH ; Jung Hwa LEE ; Eun Sook LEE ; Byung Koo LEE ; Kwang Il KIM ; Cheol Ho KIM

Journal of the Korean Geriatrics Society.2013;17(1):28-36. doi:10.4235/jkgs.2013.17.1.28

BACKGROUND: Beers criteria are used to identify the potentially inappropriate medications (PIMs) in elderly patients. However, the criteria have limitations such as lacking consideration of drug-drug and duplicated prescriptions. The aim of this study is to compare the efficacy of newly developed screening tool of older person's prescriptions (STOPP) with Beers criteria in identifying PIMs and adverse drug events (ADEs) in elderly patients. METHODS: We included 115 elderly patients older than 65 years who visited the outpatients' clinic or have been hospitalized for medical illness. Comprehensive geriatric assessments including medication review by the pharmacists were performed by the multidisciplinary team. Beers criteria and STOPP were used to find out PIMs. The association between PIMs defined by both criteria with ADEs was also evaluated. RESULTS: A total of 59 patients (50.4%) by Beers criteria and 76 patients (65.0%) by STOPP had been prescribed with PIMs. Compared with Beers criteria, STOPP had advantage in identifying more PIMs. In addition, STOPP could identify more ADEs related medications than Beers criteria. STOPP was also useful to detect duplicate drug class prescription and nonsteroidal anti-inflammatory drugs for renal impaired patients. CONCLUSION: STOPP criteria PIMs can detect more duplicated prescription and are significantly associated with avoidable ADEs in older individuals compared with that of Beers criteria PIMs.
Aged ; Beer ; Drug Toxicity ; Geriatric Assessment ; Humans ; Imidazoles ; Mass Screening ; Nitro Compounds ; Pharmacists ; Prescriptions

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Development and Validity and Reliability of Korean Comprehensive Assessment Tools for Geriatric Ambulatory Care.

Belong CHO ; Ki Young SON ; Bumjo OH ; Seok Joong KIM ; In Soon KWON ; Byung Joo PARK ; Duk Sun WOO ; Jong Lull YOON ; Chang Won WON ; Hwan Sik HWANG ; Hyuk GA

Journal of the Korean Geriatrics Society.2013;17(1):18-27. doi:10.4235/jkgs.2013.17.1.18

BACKGROUND: The purpose of this study was to develop and to evaluate the applicability of the Korean comprehensive geriatric assessment tools through reliability and validity testing. METHODS: We developed standard and short-form assessment tools comprised of questionnaires on medical, functional, mental, socioeconomic status and lifestyle information and functional tests. The tools were administered as test-retest on 111 elderly outpatients at four university hospitals and two welfare centers in Seoul. Weighted kappa value, kappa value, Pearson's correlation coefficients and overall percent agreement were calculated to evaluate reliability. Validity coefficient was estimated by using the reliability coefficient. RESULTS: Reliability and validity coefficients were higher than 0.50 (fair or good) for 29 of 36 items. For test-retest reliability, the median was 0.66 (range, 0.29 to 1.00) for the kappa value and 0.83 (range, 0.53 to 1.00) for the Pearson's correlation coefficients. Compared to the standard form, the short-form assessment questionnaires showed to be reliable and valid. CONCLUSION: The Korean Comprehensive Assessment Tools, both the standard form and the short form, were shown to be a reliable and valid screening medium for assessing the health status of the elderly in the ambulatory care setting. These instruments can be used conveniently for comprehensive outpatient geriatric assessment.
Aged ; Ambulatory Care ; Ambulatory Care Facilities ; Geriatric Assessment ; Hospitals, University ; Humans ; Life Style ; Mass Screening ; Outpatients ; Surveys and Questionnaires ; Reproducibility of Results ; Social Class

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Health Care Behavior of People 60 Years and Older in Korea According to Family Type and Sociodemographic Factors - The 5th Korea National Health and Nutrition Examination Survey.

Young Jin TAK ; Yun Jin KIM ; Sang Yeoup LEE ; Jeong Gyu LEE ; Dong Wook JUNG ; Yu Hyeon YI ; Young Hye CHO ; Eun Jung CHOI ; Kyung Jee NAM

Journal of the Korean Geriatrics Society.2013;17(1):7-17. doi:10.4235/jkgs.2013.17.1.7

BACKGROUND: This study evaluated the effects of family type and sociodemographic factors on medical treatment, health behavior, and subjective health status in Koreans 60 years and older. METHODS: This study was based on data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide health interview survey using a rolling sampling design involving complex, stratified, multistage, probability cluster. Our subjects included those > or =60 years of age (n=1,946) participating in the KNHANES 2010. Family type was categorized into 7 groups according to cohabitation: alone, couple cohabitation (living with a spouse), parent(s) cohabitation (couple living with parent(s)), offspring cohabitation (no spouse, living with offspring), couple offspring cohabitation (couple living with offspring), couple offspring parents cohabitation (couple living with parent(s) and offspring), and others. Logistic regression analyses were used to examine the association of family type and sociodemographic factors with health care. RESULTS: The most common family type was couple cohabitation (38.26+/-1.8%). In this group, the percentage of non-receipt of needed medical care (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.42 to 0.87) and current smoking rate (OR, 0.32; 95% CI, 0.20 to 0.50) were significantly lower than those living alone. Among the sociodemographic charicteristics, male gender, apartment dwelling, high middle household income, 2 member family, education higher than middle school, and possessing own house were associated with good health care behavior. CONCLUSION: This study shows that couples have better health care behavior than other family types, in particular, limited smoking, appropriate medical treatment, and positive subjective health status. Those living alone visit medical clinics less often and have a negative subjective health status.
Delivery of Health Care ; Family Characteristics ; Health Behavior ; Humans ; Korea ; Logistic Models ; Male ; Nutrition Surveys ; Parents ; Smoke ; Smoking ; Spouses

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The Management of Shoulder Pain in the Elderly: Focusing on Clinical Characteristics and Conservative Treatment.

Eun Sil KOH ; Jae Young LIM

Journal of the Korean Geriatrics Society.2013;17(1):1-6. doi:10.4235/jkgs.2013.17.1.1

Shoulder pain is a common problem in the elderly, which can frequently lead to disabilities. Adhesive capsulitis, rotator cuff disease, and osteoarthritis are main causes of shoulder pain in the elderly. Because the use of the upper extremity is especially pertinent to maintain independence in the elderly, proper management of shoulder pain is crucial to preserve or restore functional independence by reducing the degree of pain as much as possible. Successful treatment of shoulder pain in the elderly depends on not only an accurate diagnosis of etiologies and appropriate treatments according to clinical characteristics, but also understanding that the mechanisms of developing those diseases were closely related to the degenerative changes with age.
Aged ; Bursitis ; Geriatrics ; Humans ; Osteoarthritis ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Upper Extremity

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A Case of Intramedullary Myelitis due to Bacterial Meningitis with Cervical Epidural Abscess.

Go Un YUN ; Jung Hwa SEO ; Jong Kuk KIM ; Kyung Won PARK ; Sang Ho KIM

Journal of the Korean Geriatrics Society.2005;9(1):62-65.

Intramedullary myelitis due to bacterial meningitis associated with cervical epidural abscess is very rare. Its cause and clinical features are non-specific, therefore exact diagnosis is often missed or mistaken for other disease and immediate treatment may be delayed. We report a case of intramedullary myelitis due to epidural abscess presented with prominent symptoms of meningitis and manifestations of acute cerebrovacular accident. A 69 -year-old man was admitted due to right hemicranial headache with pain on right posterior neck and febrile sensation. At first, the patient's headache was improved by conservative therapy. Three weeks later, the patient showed abrupt right hemiparesis (MRC grade 2/5) with drowsy mentality. The CSF findings of the patient were compatible with acute bacterial meningitis. Cervical spine MRI showed cervical epidural abscess and extensive intramedullary myelitis from cervical to lumbar spinal cord. After antibiotic therapy, mentality of the patient became to be alert and right hemiparesis was improved to MRC grade 4/5. Follow up cervical spine MRI after several weeks represented that the lesions of cervical epidural abscess and intramedullary myelitis were significantly diminished.
Diagnosis ; Epidural Abscess* ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Bacterial* ; Myelitis* ; Neck ; Paresis ; Sensation ; Spinal Cord ; Spine

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The War on Anti-Aging Medicine.

Sang Beom KIM ; H KWAK

Journal of the Korean Geriatrics Society.2005;9(1):1-14.

Anti-aging medicine has become a popular topic, in the lay press, the (semi-) scientific literature and the Internet. In almost all instances, claims of drugs, health supplements and other types of intervention are not based on any evidence supported by sound scientific knowledge. Specifically, the aging process itself, in contrast to age-related diseases, has so far neither been fully understood, nor significantly influenced in higher species, notably humans. In addition to the ill-defined effects, claims of anti-aging medicine also pose a considerable economic burden on the usually poorly informed older segment of the population. The present paper is based on a recent report by the United States General Accounting Office (GAO) on the questionable and even harmful effects of anti-aging health products for seniors
Aging ; Humans ; Internet ; United States

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Status Epilepticus after Mye lography with Inadve rtent Injection of Diatrizoate.

Hui Chul CHOI ; Sang Moo LEE ; Jong Hee SON

Journal of the Korean Geriatrics Society.2004;8(1):47-50.

A 37-year-old male patient was transferred from a local orthopedic clinic due to status epilepticus following a myelography with diatrizoate. On his laboratory findings, metabolic acidosis was prominent. Non-enhanced brain CT scan showed a high densinty in the subarchnoid space. With careful respiratory support, hydration, correction of acid-base balance, administration of dexamethasone, and anticonvulsant therapy, he completely recovered after 3 days. Diatrizoate is an ionic, iodinated and hyperosmolar X-ray contrast medium. It must not be injected intrathecally because of the risk to the central nervous system. The possible mechanisms are anaphylactic reaction due to iodine hypersensitivity, hyperosmolar effect, and direct chemotoxicity by ionicity and chemical structure itself.
Acid-Base Equilibrium ; Acidosis ; Adult ; Anaphylaxis ; Brain ; Central Nervous System ; Dexamethasone ; Diatrizoate* ; Humans ; Hypersensitivity ; Injections, Spinal ; Iodine ; Male ; Myelography ; Orthopedics ; Status Epilepticus* ; Tomography, X-Ray Computed

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