Severe Hypoglycemia Is a Serious Complication and Becoming an Economic Burden in Diabetes

하원철,오수진,김지현,이정민,장상아,손태서,손현식 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.4

Background: The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guide-lines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary’s Hospital. Methods: The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary’s Hospital from January 1, 2006 to December 31, 2009. Results: Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m2. In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes. Conclusion: Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

만성 폐쇄성 폐질환 환자에서 장기간의 스테로이드 복용 중 발생한 중증 분선충 감염 1예

하원철,이영현,하경임,안명희 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

Strongyloides stercoralis is a soil-transmitted intestinal nematode that may cause long-lived auto-infection in the host. It is distributed worldwide, especially in the tropical and subtropical regions, but has been rarely reported in Korea. Chronic infections by S. stercoralis are mostly inapparent infections that carry nonspecific gastrointestinal and pulmonary symptoms. However, In immunocompromised patients such as those receiving long-term steroid therapy and patients with AIDS or malignant tumors, S. stercoralis can induce hyperinfection by autoinfection. This may lead to increased rate of complications such as resistance to chemotherapy and sepsis, In such cases mortality rate of up to 87% has been reported. We report a case of severe strongyloidiasis in a patient with chronic obstructive pulmonary disease who was receiving long-term steroid therapy. The chief complaint was repeated dyspnea and hematochezia, and strongyloidiasis was diagnosed by the presence of rhabditiform larvae of S. stercoralis in the fecal smear and isolation of filari-form larvae from the stool culture. The patient developed septic shock during treatment with albendazole and showed clinical signs of hyperinfection of S. stercoralis. He eventually died despite aggressive treatment.

65세 이상 외래 방문환자를 대상으로 한 심전도 소견

하원철,성낙일,김강,이경미,박준형,배준호,나득영 동국대학교 의학연구소 2008 東國醫學 Vol.15 No.1

The electrocardiogram is one of the most widely used diagnostic tools. Especially it is useful to the patients who have cardiovascular disease. Because elderly population are the fastest growing component of national population, I analyzed the frequencies of specific electrocardiogram findings in patients aged 65 years and older living in Gyeong-ju to collecting ECG data. Sinus bradycardia (17.0%) and Left ventricular hypertrophy (25.2%), QT prolongation (30.9%) were the most common abnormalities found in the population as a whole. Left-axis deviation (11.6% vs. 3.1%, p = 0.001) and right bundle branch block (11.9% vs. 4.1%, p= 0.001) were more common in men than women. First-atrioventricular block (2.2% vs. 5.5%, p = 0.025) and T wave abnormalities (4.1% vs. 13.2%, p = 0.001), left ventricular hypertrophy (21.6% vs. 28.0%, p = 0.049) were more common in women. QT prolongation were more common in 75 years and older (26.7% vs. 38.1%, p = 0.001). Left-axis deviation (9.4% vs. 3.9%, p = 0.024) and Right bundle branch blocks (9.8% vs. 3.0%, p = 0.003) were more common in men aged 65~74 years. Left ventricular hypertrophy (20.9% vs. 30.0%, p = 0.025) and T wave abnormalities (4.3% vs. 12.2%, p = 0.002) were more common in women aged 65~74 years. Atrial fibrillation (7.1% vs. 1.1%, p = 0.013) and left-axis deviation 17.6% vs. 2.1%, p = 0.001), Right bundle branch block (17.6% vs. 5.3%, p = 0.001) were more common in men aged 75 years and older. First-atrioventricular block (0% vs. 5.9%, p = 0.020) and T wave abnormalities (3.5% vs. 14.4%, p = 0.008) were more common in women aged 75 years and older. In conclusion, Left ventricular hypertrophy and sinus bradycardia, QT prolongation were most common electrocardiographic findings in as a whole. Left-axis deviation and right bundle branch block, fist-atrioventricular block, T wave abnormalities, QT prolongation were significantly different in age and gender. 심전도는 전 세계적으로 가장 널리 사용되는 진단적 도구로서, 특히 심혈관계 질환이 있는 환자에게 그 유용성이 크다. 현대 사회는 고령화 사회로 노인 인구에 대한 사회적, 의학적 관심이 높다. 이에 본 연구자는 노인 인구에 대한 심전도 자료를 수집하기 위해 동국대 경주 병원 외래 진료실을 방문한 65세 이상 노인 환자 737명을 대상으로 심전도 검사를 시행하였다. 좌심실 비대(25.2%), QT 간격 연장(30.9%)과 동성 서맥(17.0%)을 보인 경우가 가장 많았고, 좌축 편위 (11.6% vs. 3.1%, p = 0.001), 우각 차단(11.9% vs. 4.1%, p = 0.001)의 경우 여자 환자보다 남자 환자에서 빈도가 높았고, 1도 방실 차단(2.2% vs. 5.5%, p = 0.025)과 비정상적인 T파 양상(4.1% vs. 13.2%, p = 0.001), 좌심실 비대(21.6% vs. 28.0%, p = 0.049)의 경우 남자 환자보다 여자 환자에서 빈도가 높았다. 75세 이상 환자 군에서 QT 간격 연장(26.7% vs. 38.1%, p = 0.001)이 65세에서 74세 사이 환자 군에 비해 빈도가 높은 것 외에 유의한 차이는 없었다. 결론적으로 고령 환자에서 비정상적인 심전도 소견으로 좌심실 비대와 QT 간격 연장, 동성 서맥의 빈도가 높았으며 좌축 편위, 우각 차단, 1도 방실 차단 등은 성별, 연령대별로 유의한 차이가 있었다.

만성 폐쇄성 폐질환 환자에서 장기간의 스테로이드 복용 중 발생한 중증 분선충 감염 1예

하원철,이영현,하경임,안명희 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.5

Strongyloides stercoralis is a soil-transmitted intestinal nematode that may cause long-lived autoinfection in the host. It is distributed worldwide, especially in the tropical and subtropical regions, but has been rarely reported in Korea. Chronic infections by S. stercoralis are mostly inapparent infections that carry nonspecific gastrointestinal and pulmonary symptoms. However, In immunocompromised patients such as those receiving long-term steroid therapy and patients with AIDS or malignant tumors, S. stercoralis can induce hyperinfection by autoinfection. This may lead to increased rate of complications such as resistance to chemotherapy and sepsis. In such cases mortality rate of up to 87% has been reported. We report a case of severe strongyloidiasis in a patient with chronic obstructive pulmonary disease who was receiving long-term steroid therapy. The chief complaint was repeated dyspnea and hematochezia, and strongyloidiasis was diagnosed by the presence of rhabditiform larvae of S. stercoralis in the fecal smear and isolation of filariform larvae from the stool culture. The patient developed septic shock during treatment with albendazole and showed clinical signs of hyperinfection of S. stercoralis. He eventually died despite aggressive treatment.

동국대 경주병원 수혈 예정자의 비예기항체 빈도 및 분포

하원철,이정우,원기범,송준화,하경임 동국대학교 의학연구소 2008 東國醫學 Vol.15 No.1

수혈 예정자에서 비예기항체의 검출은 수혈 시 용혈성 수혈부작용을 예방하기 위해서 필수적인 검사이다. 최근 수혈의 증가와 검사기법의 발전 등에 따라 비예기항체의 발견 빈도가 높아지고 있으므로 동국대 경주병원을 내원하여 혈액은행에 비예기항체 선별검사를 의뢰한 환자들에서 비예기항체의 빈도, 분포, 및 임상적 특성을 알아보고자 하였다. 2005년 1월부터 2007년 5월까지 동국대 경주병원을 내원한 8,436명의 수혈 예정환자에서 DiaMed-ID System (DiaMed, Murten, Switzerland)을 이용한 microcolumn agglutination test로 비예기항체의 선별 및 동정검사를 시행하였으며, 임상적 특성은 의무기록을 후향적으로 조사하여 분석하였다. 비예기항체 선별검사에서 대상환자 8,436예 중 53예(0.62%)에서 양성 결과를 보였다. 이 중 가장 많은 빈도로 검출된 것은 항-E 항체(16예, 30.2%)였고, 다음으로 항-Lewis항체(8예, 15.1%)였다. 비예기항체가 검출된 53명의 기저질환으로는 악성종양, 간질환 및 산부인과 질환이 많았으며, 27명(50.9%)에서 수혈기왕력이 있었고, 28명의 여성 중 25명(89.2%)에서 임신력이 있었다. 본 조사에서 수혈 예정자에서 비예기항체의 빈도는 국내 타병원과 유사하였으며 안전한 수혈을 위해서는 수혈전에 이러한 환자들에서 주의깊게 항체 선별검사 및 동정검사가 이루어져야 할 것이다. In a patient who is planning for transfusion, screening for unexpected antibodies is essential for prevention of hemolytic complications during transfusion. Recently, the detection rate of unexpected antibodies is increasing due to the increase of transfusion rates and improvement of screening methods. Therefore we have studied on the frequency, distribution, and clinical characteristics of unexpected antibodies of the patients who have admitted the Dongguk University Hospital. On 8,436 people who have admitted the Dongguk University Hospital from January 2005 to May 2007, we have screened and identified unexpected antibodies with a microcolumn agglutination test using DiaMed-ID System(DiaMed Murten, Switzerland), and clinical characteristics were analyzied by medical record retrospective studies. 53 patients (0.62%) out of 8,436 transfusion candidates who were screened for unexpected antibodies had a positive result. Anti-E antibody(16 cases, 30.2%) was detected most frequently with anti-Lewis antibody(8 cases, 15.1%) following right behind. 53 patients m whom unexpected antibodies were detected had underlying diseases mainly composed of malignant tumor, liver disease and OBGY disease. 27 patients(50.9%) had history of transfusion, and 25 out of 28 women(89.2%) had history of pregnancy. The frequency of unexpected antibody in transfusion candidates was similar to other hospitals in Korea. Therefore, careful screening and identification of antibodies should be performed for safe transfusion.

디지털 방식의 UPS 산업실태

하원철 대한전기협회 1992 대한전기협회지 Vol.- No.191

Angiotensin II Inhibits Insulin Binding to Endothelial Cells

오수진,하원철,이지인,손태서,김지현,이정민,장상아,홍옥기,손현식 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.3

Background: Insulin-mediated glucose uptake in insulin target tissues is correlated with interstitial insulin concentration, rather than plasma insulin concentration. Therefore, insulin delivery to the interstitium of target tissues is very important, and the endothelium may also play an important role in the development of insulin resistance. Methods: After treating bovine aortic endothelial cells with angiotensin II (ATII), we observed the changes in insulin binding capacity and the amounts of insulin receptor (IR) on the cell membranes and in the cytosol. Results: After treatment of 10-7M ATII, insulin binding was decreased progressively, up to 60% at 60 minutes (P<0.05). ATII receptor blocker (eprosartan) dose dependently improved the insulin binding capacity which was reduced by ATII (P<0.05). At 200 μM, eprosartan fully restored insulin binding capacity, althogh it resulted in only a 20% to 30% restoration at the therapeutic concentration. ATII did not affect the total amount of IR, but it did reduce the amount of IR on the plasma membrane and increased that in the cytosol. Conclusion: ATII decreased the insulin binding capacity of the tested cells. ATII did not affect the total amount of IR but did decrease the amount of IR on the plasma membrane. Our data indicate that ATII decreases insulin binding by translocating IR from the plasma membrane to the cytosol. The binding of insulin to IR is important for insulin-induced vasodilation and transendothelial insulin transport. Therefore, ATII may cause insulin resistance through this endothelium-based mechanism.

메티실린내성 황색포도알균에 의한 지역사회획득 폐렴 2예

남지형,송준화,하원철,이정우,원기범,김성자,이영현 東國大學校醫學硏究所 2007 東國醫學 Vol.14 No.1

지역사회획득 폐렴은 병원이 아닌 지역사회에서 발생한 폐렴으로 비교적 흔하게 발병하며 감염성 질환에 의한 사망의 중요한 원인이다. 병원내 감염 폐렴의 대표적인 원인균으로 알려져 있는 메티실린내성 황색포도알균에 의한 지역사회획득 폐렴이 점차 증가추세에 있으며 기존의 vancomycin 계통의 항생제 외에 여러 항생제에 감수성을 보이는 경향이 있어 치료의 폭이 넓다. 지역사회획득 페렴에 대한 적절한 치료와 항생제 남용이나 vancomycin 내성 획득 환자를 줄이기 위해서 메티실린내성 황색포토알균에 의한 원내 폐렴과 지역사회획득 폐렴을 구별하는 것이 중요하다. Community acquired pneumonia (CAP) is a common infectious disease acquired from community and an important cause of death in infectious diseases. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of hospital-acquired pneumonia (HAP), but there are increasing cases of community-acquired pneumonia caused by MRSA which is susceptible to several antibiotics including vancomycin. It is important to differentiate HAP from CAP for more effective treatments to reduce the overuse of antibiotics and the development of vancomycin resistance.

근골격계 질환의 수기요법에 관한 경제성 평가 : 체계적 문헌 고찰 및 근거 합성 연구

김창곤(Chang-Gon Kim),이진현(Jin-Hyun Lee),김가나(Ka-Na Kim),신병철(Byung-Cheul Shin),고연석(Youn-Suk Ko),박태용(Tae-Yong Park),하원배(Won-Bae Ha),이정한(Jung-Han Lee) 척추신경추나의학회 2020 척추신경추나의학회지 Vol.15 No.1

연구 목적 : 본 연구는 근골격계 질환에 대한 수기치료가 갖는 경제적 효과를 체계적으로 평가해 보기 위해 시행되었다. 연구 방법 : 2017년 2월 2일까지 국내외 관련 문헌을 체계적으로 검색 하였으며, 연관된 체계적 고찰 논문의 참고문헌을 조사하였다. 두 명의 연구자가 독립적으로 문헌을 선택하고, 비뚤림 위험 평가 및 경제성 평가 질 평가, 자료 추출을 시행하였다. 연구 결과 : 총 3,327개의 논문을 검토하여 최종적으로 18개의 무작위 대조 연구가 포함되었다. 경제성 평가는 수기요법과 다른 치료방법간의 유효성 비교를 통해 시행되었다. 요부 통증, 견관절 통증 및 외측 상과염 치료에 있어 침치료, 견인치료, 주사치료, 일반의 치료, 척추 안정화 기법 및 통증관리 치료보다 비용 효과적인 것으로 나타났다. 또한 또한, 수기치료는 경항통, 흉통, 고관절염 혹은 슬관절염, 경추신경병증 및 수부손상 치료에 있어 일반적 치료, 물리치료, 자가 치료 프로그램, 견인 치료에 비하여 효과적인 치료인 것으로 확인되었다. 결론 : 18개의 논문 중 10개의 논문에서 근골격계 질환 치료에 있어 수기치료가 경제적으로 효과가 있는 것으로 나타났다. 이러한 결과는 다른 치료방법에 비해 수기요법이 근골격계 질환에 있어서 경제적 가치가 있음을 시사하는 내용이다. 하지만, 근골격계 질환 수기치료의 경제성 평가에 대한 선행 연구는 전반적으로 부족한 실정으로, 보다 정확한 결과를 제시하고 정책결정을 위한 효과적인 제안을 위해서는 체계적인 추가 연구가 필요하다 사료되는 바이다.

마이크로/나노 기술을 적용한 약물전달시스템

추원식(Won-Shik Chu),김성근(Sung-Geun Kim),안성훈(Sung-Hoon Ahn),하원식(Won-Shik Ha),지상철(Sang-Chul Chi) Korean Society for Precision Engineering 2006 한국정밀공학회지 Vol.23 No.12