개정된 대한췌장담도학회 급성췌장염 임상진료지침: 초기 치료, 영양지원, 회복기 치료

김의주 ( Eui Joo Kim ),이재민 ( Jae Min Lee ),이태훈 ( Tae Hoon Lee ) 대한췌장담도학회 2022 대한췌담도학회지 Vol.27 No.1

Initial and convalescent treatment of acute pancreatitis (AP) is important in order to improve the prognosis and prevent the recurrence in the patients with AP. Initial intensive treatment includes fluid therapy, pain control, antimicrobial therapy, endoscopic retrograde cholangiopancreatography (ERCP), and nutritional support. Goal-directed therapy is recommended for fluid therapy, and the routine use of prophylactic antibiotics is not recommended. In acute gallstone pancreatitis, urgent ERCP should be performed only in patients with cholangitis or persistent cholestasis. Early oral feeding is advisable as tolerated and enteral feeding via nasogastric or nasojejunal tube appear comparable. In convalescent treatment, cholecystectomy during the initial admission is advisable for mild biliary pancreatitis with gallstone as possible, and treatment against alcohol dependence is considerable for recurrent acute alcoholic pancreatitis. In this review, we recommend practice guidelines for initial treatment, nutritional support, and convalescent treatment. Korean J Pancreas Biliary Tract 2022;27(1):22-31

열처리 조건이 시금치의 이화학적 특성 및 영양 조성에 미치는 효과

이지선, 황인국, 유선미, 민상기, 김광일, 조연지, 최미정 忠北大學校 農業科學硏究所 2015 農業科學硏究 Vol.31 No.1

This study investigated the effect of thermal treatment (blanching) conditions on the physicochemical and nutritional properties of spinach. For thermal treatments, fresh spinach was treated by three blanching methods including boiled water, steam and pan frying treatments. At the varying time intervals of treatments, pH, color, shear force, proximate composition, organic acid content, peroxidase activity and microbial counts were evaluated. The pH of all treatments tended to increase with increasing blanching time, however, no significant differences among treatments were obtained. The shear force of spinach decreased with blanching time, particularly hot water treatment showed the rapid decrease in the shear force of spinach. The lightness of spinach showed similar pattern with shear force. For proximate compositions, the highest moisture content was found in hot water treatment, while crude protein and ash were highest in steam treatment. Due to the usage oil, pan frying treatment involved in the highest lipid content. The organic acid content treatment was in the order of hot water, pan frying and steam treatment. The thermal treatments attributed to low total plate count of spinach. In addition, thermophilic bacteria, coliform, mold and yeast were not detected in all thermal treatments. Peroxidase activity was lowered by applied thermal treatments. Based on the results, the best blanching condition for spinach was found in steam treatment for 60 s where the spinach showed the minimal changes in physicochemical and nutritional properties of spinach.

의료에 관한 가톨릭 생명윤리의 맥락과 연명의료 결정에 관한 성찰

정재우 ( Jung Jae-woo ) 한국가톨릭철학회 2013 가톨릭철학 Vol.0 No.21

생명 말기의 환자에 대한 연명의료 결정은 우리 사회에서 커다란 문제가 되고 있다. 왜냐하면 많은 의사들의 의료행위가 종종 법적 소송과 처벌에 대한 두려움의 영향을 받고 있기 때문이다. 이런 현실을 평가하고 바람직한 방향을 제시하기 위해, 지금까지 생명윤리 분야에서 다양하지만 일관된 성찰을 제공해 온 가톨릭 교회의 생명윤리의 맥락이 어떠한지를 살펴보는 일은 적절하다. 그 맥락은 네 가지로 정리할 수 있다. 첫째, 생명 존중의 맥락, 둘째, 의사-환자 관계의 맥락, 셋째, 질병 상황의 맥락, 넷째, 합리적 치료의 맥락이다. 이들은 의료적으로나 윤리적으로 좋은 의료행위가 이루어지기 위한 기본 조건이라고 할 수 있다. 이를 토대로, 우리는 환자에게 필수적인 처치 가령 영양과 수분을 공급하지 않아 환자를 죽게 하는 일이 없어야 할 뿐만 아니라, 환자에게 불균형적이고 따라서 무익한 처치를 고집하는 일도 없어야 한다고 결론 내릴 수 있다. 또한 모든 결정은 역시 이런 네 가지 맥락 안에서 내려질 필요가 있는데, 즉 환자의 실제 질병 상태를 알고 영양과 수분을 마지막 순간까지 공급한다는 것을 전제로 담당의사와 환자의 대화속에서 적절한 처치를 위한 계획을 수립하는 것이다. 이런 개념 내지 원칙을 실현하기 위해서는, 의료적으로나 윤리적으로 좋은 연명의료 결정이 내려지기 위한 사회적 기반을 조성하는 일이 법규범을 만드는 일보다 더 중요하고 시급하다. 법규범은 사실 부당한 의료행위를 정당화하는데 이용될 위험도 도사리고 있는 것이다. 사회적 기반을 조성한다는 것은 호스피스-완화의료의 활성화, 병원윤리위원회의 활성화, 생명과 고통과 죽음의 의미에 관한 성찰과 토론 증진, 의료인에 대한 생명윤리와 좋은 의료행위에 관한 교육 등을 가리킨다. 그러나 불행히도 이런 사회적 기반을 마련하기 위한 움직임은 그다지 나타나지 않고 있으며, 이는 법제화에 대한 우려를 증가시키는 요인이 된다. Decision making regarding life-sustaining treatments to patients in terminal stage of life is a big problem in our society, in that medical practices of treating those patients are being conditioned by worries about legal litigations or punishments. In considering this situation and finding an appropriate solution to it, we can find an insight from catholic perspective in bioethics, which has been providing various but coherent reflections on this topic. Teachings of Catholic Church on medical practices can be listed in four contexts: respect of human bodily life, interpersonal relationship between medical doctors and patients, real condition of disease of a patient, proportionality of the treatments. They are fundamental conditions in which clinically and morally good medical practices can be realized. Considering them, we can conclude that it should be excluded both to kill a patient by omitting necessary treatments like nutrition and hydration and to insist on using some treatments which are disproportionate and, therefore, futile to the patient. In addition, every decision should be also made in those four contexts; a plan about applying adequate treatments should be made in a real recognition of disease of a patient, never foregoing nutrition and hydration until the last moment of life, in an interpersonal dialogue between medical doctors and the patient. To implement these principles, it is important and urgent to prepare and establish social conditions, in which clinically and morally good decision regarding life-sustaining treatments shall be realized, more than to set legal norms which will fall in the risk of being exploited to justify clinically and morally undue practices. Building social conditions includes promoting hospice and palliative care, activating hospital bioethics committees, promoting reflection and discussion on meaning of life, suffering and death, educating medical professionals with bioethics and good medical practices, and so on. But unfortunately, it is hard to see a social movement to do this, which is one of reasons of concerning the legalization of this topic.

우리나라 비만치료의 현황: 2020 대한비만학회 비만진료지침을 중심으로

이은정 대한의사협회 2022 대한의사협회지 Vol.65 No.7

Background: Obesity is a complex disease, and its prevalence is gradually increasing globally. The increasing prevalence of obesity is shown to significantly affect the development of obesity-related comorbidities. This paper describes the recent updates on obesity treatment in Korea based on the 2020 Korean Society for the Study of Obesity guidelines for obesity management. Current Concepts: Accurate evaluation of obesity is important before treatment initiation. Obesity in Korean adults is defined as body mass index ≥25 kg/m2, and abdominal obesity is defined as waist circumference ≥90 cm ≥ for men and ≥85 cm for women. It is recommended that energy intake be reduced and that the degree of energy ≥ restriction be individualized based on patient characteristics and medical conditions. Guidelines recommend assessment of the exercise participation and health status before prescribing exercise therapy; aerobic exercise for at least 150 min/week or 3.5 times/week is advised to facilitate weight loss. Although nutrition and behavior therapy and increased physical activity constitute the mainstay of obesity treatment, pharmacotherapy is recommended concomitant with comprehensive lifestyle modification. Bariatric surgery should be actively considered in patients with severe obesity and in those with obesity-related comorbidities. Discussion and Conclusion: Obesity and the associated comorbidities result in an increased socioeconomic and medical burden. Multifactorial intervention using a team approach is warranted for optimal management of obesity. This guideline will benefit primary care physicians for safe and effective decision-making regarding obesity management and treatment.

Recommendations for Optimizing Tuberculosis Treatment: Therapeutic Drug Monitoring, Pharmacogenetics, and Nutritional Status Considerations

최리화,정병호,고원중,이수연 대한진단검사의학회 2017 Annals of Laboratory Medicine Vol.37 No.2

Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host. These factors should be considered for effective tuberculosis control. Therefore, therapeutic drug monitoring (TDM), which is individualized drug dosing guided by serum drug concentrations during treatment, and pharmacogenetics-based personalized dosing guidelines of anti-tuberculosis drugs could reduce the incidence of adverse drug reactions and increase the likelihood of successful treatment outcomes. Moreover, assessment and management of comorbid conditions including nutritional status could improve anti-tuberculosis treatment response.

위장관 ; 응급 위장관 수술 후 조기 경장 섭취의 안전성

이형순 ( Hyung Soon Lee ),심홍진 ( Hong Jin Shim ),이호선 ( Ho Sun Lee ),이재길 ( Jae Gil Lee ),김경식 ( Kyung Sik Kim ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.6

Background/Aims: Postoperative early feeding has many advantages, and current guidelines recommend the early diet or enteral feeding after gastrointestinal surgery. However, there are controversies in emergency situation. The aim of this study was to assess the safety of early enteral feeding in patients underwent emergency gastrointestinal (GI) surgery. Methods: We reviewed the patients underwent emergency GI surgery by single surgeon from March 2008 to December 2010, retrospectively. The early feeding was defined when feeding was started within 72 hours after operation. Results: Fifty-three patients were enrolled. Men were 31, with mean 60.6 (±18.5) years old age. Thirty-three patients were treated in the intensive-care unit after operation. The most common cause of operation was bowel perforation, and followed by intestinal obstruction. Segmental resection with primary anastomosis of small bowel is the most common operation. Thirty-two of them started the diet within 48 hours postoperatively. Twenty-nine patients had post-operative complications. Wound complications were the most common, and followed by the abdominal pain, and ileus. Wound complications were developed in 18 patients, and the post-feeding abdominal pain was in 7 patients. Anastomotic leakage and intraabdominal abscess were developed in 2 patients, and 1 patient required reoperation to treat the anastomotic disruption. One patient developed pneumonia and sepsis, and resolved under conservative treatment. There was no mortality in these patients. Conclusions: Early enteral feeding may be safe in cases of emergency GI surgery. However, it may require further studies to confirm the safety and feasibility of the early feeding in emergency situations. (Korean J Gastroenterol 2011;58:318-322)

치과치료 이용이 민간보험 가입에 미치는 영향: 국민건강영양조사 2013, 2016, 2019 자료를 중심으로

손은교(Eun Gyo Son) 한국산학기술학회 2022 한국산학기술학회논문지 Vol.23 No.10

본 연구는 한국의 국민건강영양조사 2013년, 2016년, 2019년 자료를 통하여 치과 치료 이용이 민간보험 가입에 미치는 영향을 살펴보기 위해 시행되었다. 통계 처리는 SPSS Statistics 24.0을 사용하여 분석하였고, 분석 방법은 ANOVA와 다중 회귀분석을 사용하였다. 연구 결과 연령이 높고, 학력이 낮고, 소득이 ‘하’인 경우, 민간보험 가입률이 높게 나타났고, 가입자는 ‘단순 충치 치료’의 이용이 많은 것으로 나타났다. 또한, 치과 치료가 민간보험 가입에 미치는 영향에서는 ‘발치 또는 구강 내 수술’이 가장 많은 영향을 미쳤다. 향후 연구에서는 국민건강보험과 민간보험의 상생을 위해, 특정 치과 질환별 치과 의료비 지출에 대한 추가연구가 필요하다고 생각한다. 또한, 민간보험의 역할에 대한 체계적 연구가 필요하며, 치료보다는 예방에 집중하는 국민건강보험 정책 강화가 필요하다. 이러한 국민건강보험의 정책 보완으로 국가는 국민의 민간보험 가입 부담을 줄여야겠다. This study was conducted to examine the effect of the use of dental treatment on private insurance subscriptions using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2013, 2016, and 2019. Statistical analysis was carried out using the SPSS Statistics 24.0 software, and the methods used were ANOVA and multiple regression analysis. The results of the study showed that the higher the age, the lower the educational level, and the lower the income, the higher the private insurance subscription rate, and the more frequent the use of simple tooth decay treatment. In addition, in terms of the effect of dental treatment on private insurance, extraction or intraoral surgery had the greatest impact. In the future, additional research on dental medical expenses categorized by specific dental diseases would be necessary for the coexistence of national health insurance and private insurance. In addition, a systematic study on the role of private insurance is required, and it is necessary to strengthen the national health insurance policy focusing on prevention rather than treatment. By improving the coverage of the national health insurance policy, the government should reduce the burden of private insurance subscriptions.

Non-pharmacological interventions for depression in Persian medicine

Mohammad Yousofpour,Mohammad Kamalinejad,Mohammad Mahdi Esfahani,Sharzad Iran-nejad,Seyed Afshin Shorofi,Jamal Shams 셀메드 세포교정의약학회 2015 셀메드 (CellMed) Vol.5 No.4

Depression is an important medical problem in today’s world. Despite its high prevalence, treatment of depression remains problematic, as its cause is still not fully understood. Of the ways recommended to tackle this problem is implementing the potentials of various medical schools. A medical school which has played an important role in the history of medicine in the world is Persian medicine. This study was intended to identify non-pharmacological interventions for depression in the most reliable references on Persian medicine, classify these interventions and compare them with the latest medical findings. The study was set to review the most reliable references on Persian medicine. In addition, relevant keywords were used to search the PubMed and Scopus databases. In Persian medicine sources, melancholia is categorized into three main types. One type is regarded as cerebral melancholia, which resembles modern psychiatry’s depression closely. Therefore, some key points put forth by Persian medicine scholars regarding melancholia can be used to answer questions concerning depressive disorders and their etiology and treatment. Although recent studies have confirmed most approaches offered by Persian medicine physicians in ancient Persia, it is imperative to design and conduct clinical trial studies according to these approaches.

연명의료중단의 허용범위 제한에 관한 헌법적 검토

김현귀(Kim Hyun gui) 한국헌법학회 2015 憲法學硏究 Vol.21 No.3

Now a day, several legislative bills are presented to protect the self-determination right to refusal of life-sustaining treatment identified by Korean Supreme court and Constitutional court. The main issues are whether allow to stop the artificial nutrition and hydration and how determine qualified patients to refusal of life-sustaining treatment. At first, considering meaning and content of the constitutional right on the refusal of life-sustaining treatment and limits of its protection, I will point out that banning all cases of refusal the artificial nutrition and hydration can make some infringement of the constitutional right. Further if it is social consensus to restrict the qualified patient to a terminal or dying case narrowly, the qualifying criteria and process must be arranged by law according to the statute reservation principle at least, because unqualified patients can be deprived their rights. In addition, it is argued that the dying in a short time criteria is not valid for allowing the refusal of life-sustaining treatment, considering and comparing Grandma Kim case of Korean Supreme court in 2009 and Vincent Lambert case of European Court of Human Rights in 2015.

간암환자의 영양상태와 치료결과와의 관련성

한부,김영옥,Han, Bu,Kim, Young-ok 한국식품영양학회 2000 한국식품영양학회지 Vol.13 No.5

This study was conducted to investigate the association between initial nutritional status and treatment outcome of hepatoma patients. Initial nutritional status was measured based on weight, serum albumin and total lymphocyte counts. Treatment outcome was measured in the three categories such as complication, treatment status at discharge and mortality. The study subjects were 120 patients with hepatoma cancer admitted at a university hospital in Seoul. The information about initial nutritional status and treatment outcome was collected from medical records. Chi-square test was used to test the association between initial nutritional status and treatment outcome As a result. 76.6% of the subjects were classified as the nutritional risk group based on initial nutritional states. Prevalence of complication was higher in nutritional risk group I and II than that in non-risk group(p<0.05). Death rare of the nutritional risk group was significantly higher than that of non-risk group(p<0.001). The findings suggest the strong association between the initial nutritional status and treatment outcome of hepatoma cancer.