This study aimed to describe the occurrence and to evaluate the predictive factors of thrombocytopenia caused by parenteral linezolid in hospitalised patients without haemato-oncologic diseases. Using electronic medical records, a retrospective safety evaluation was performed among all hospitalised adult patients who received parenteral linezolid therapy between January 2005 and June 2016. Of all identified 264 patients with an average age of 63.4 (SD 15.8) years, thrombocytopenia occurred at a rate of 29.2% after an average of 11.2 (SD 7.4) days of the initiation of linezolid therapy. Significant predictive factors for thrombocytopenia included the duration of linezolid therapy longer than or equal to 7 days (adjusted odds ratios [ORs] 7.25, 19.51 and 28.80; 95% confidence intervals [CIs] 1.92-27.38, 4.76-79.95 and 6.48-127.92 for 7-13 days, 14-20 days and ≥21 days, respectively; P < 0.01 for all values), baseline platelet count <150 × 10 /mm (adjusted OR, 5.08; 95% CI, 2.06-12.55; P < 0.001), creatinine clearance <30 mL/min (adjusted OR, 4.19; 95% CI, 1.59-11.06; P = 0.004) and concurrent low-dose aspirin therapy (adjusted OR, 2.99; 95% CI, 1.26-7.08; P = 0.013). Baseline platelet count less than 150 × 10 /mm was an independent predictor of early-onset (≤6 days) thrombocytopenia (adjusted OR, 5.07; 95% CI, 1.46-17.58; P = 0.011). Closer monitoring of platelet count is required in patients who receive parenteral linezolid therapy for 7 days or more, and have low baseline platelet counts or impaired renal function.

Background/AimsThe aim of this study was to compare the sleep quality between rheumatoid arthritis (RA) patients and healthy controls; and to evaluate the relationship between RA disease activity and sleep quality in Korea.MethodsA total of 130 RA patients and 67 age- and sex-matched healthy controls were enrolled in a comparative study of sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Age, gender, concomitant medication, erythrocyte sedimentation rate, serum C-reactive protein, Beck Depression Inventory second edition (BDI-II), 28 joints disease activity score (DAS28), pain visual analog scale (VAS), and PSQI were analyzed as covariates. We also analyzed the sleep quality of RA patients according to the disease activity (DAS28 ≤ 3.2, 3.2 < DAS28 < 5.1, and DAS28 ≥ 5.1, respectively).ResultsThe total PSQI score and the frequency of poor sleep quality, were higher in the RA patients (5.62 ± 4.19, 38.5%) than in the control subjects (3.57 ± 2.17, 13.4%). The patients with poor sleep quality (PSQI > 5) were older and had a higher BDI-II and VAS score than the patients without sleep disturbance (PSQI ≤ 5). The score in subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction, total PSQI, and frequency of poor sleep quality were increased when RA activity was high.ConclusionsSleep disturbance was observed in RA patients (38.5%), and high RA disease activity was associated with poor sleep quality in Korea.

Adefovir dipivoxil (ADV) is a nucleotide used as long-term therapy of chronic hepatitis B. Many published reports have shown that long-term high-dose therapy with adefovir can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemia, renal insufficiency and osteomalacia. We have encountered two patients who developed evidence of hypophosphatemic osteomalacia while on long-term low-dose adefovir therapy for chronic hepatitis B. We report on its clinical features and its potential resolution with cessation of the drug and supplementation with phosphate. We also reviewed the other published cases associated with hypophosphatemic osteomalacia after low-dose adefovir therapy. The symptoms and the hypophosphatemia improved after cessation of the drug and supplementation with phosphate in most cases. Patients taking adefovir long-term should receive regular investigation of the phosphate level and renal function.

Background: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU) are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%), followed by parenteral/enteral nutritional support (n = 228, 18.1%), the provision of drug information (n = 228, 18.1%), and advice regarding pharmacokinetics (n = 118, 9.3%). Antimicrobial agents (n = 516, 42.6%) were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%). Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

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Background Patients with rheumatoid arthritis (RA) suffer from not only pain but also sleep disturbance and depression. However, in the previous study, there was less data about quality of sleep (QOS), quality of life (QOL), and depression in RA patients. Objectives In this study, we aimed to assess the impact of RA on QOS comparing it with that of control subjects. We also studied the relationship between QOS, QOL, and depression according to disease activity and by using TNF-alpha blocker. Methods 130 patients with RA and 117 voluntary control subjects participated in the study. The groups were compared in terms of demographic characteristics. In the RA patients, disease activity score-28 joint count (in DAS-28, a below 3.2 score indicates a low disease activity group and above 3.2 indicates a moderate to high disease activity group), use of TNF-alpha blocker, and dose of methotrexate (MTX) were checked. QOS was evaluated by using the PSQI (Pittsburgh Sleep Quality Index) Health Survey in all the study participants. BDI (Beck Depression Inventory) was used to evaluate depression and QOL was estimated by using Korean versions of the SF-36 (Short Form 36) in the RA patients. Results The subjective sleep quality, sleep latency, habitual sleep efficiency, sleep duration, use of sleeping medication, and total PSQI score were higher in RA than control subjects (p<0.05). The low disease activity group had significantly scored low in subjective sleep quality, sleep duration, sleep disturbance, and total PSQI than moderate to high disease activity group (p<0.05). The BDI score was significantly lower in the low disease activity group (p<0.05). The total SF-36 score and MTX dose (mg/wk) were high in low disease activity group than moderate to high disease activity group (65.23±19.83 vs. 55.34±20.72, respectively, p<0.01; 8.95±5.19 vs. 6.25±5.12, respectively, p<0.01). But there was no significant difference in the dose of PDN, number of DMARDs used, BMI, and disease duration between the two groups. There were seventeen patients who used TNF blocker. There was no significant association with PSQI, total SF-36, and BDI scores between the TNF blocker using group and the non-TNF blocker using group, respectively. The DAS 28 score correlated with the PSQI, total SF-36, and BDI score in RA patients (p<0.01). Conclusions Considering the results, we need to recognize that the patients with RA suffer from sleep disturbance and depression, and their disease activity is associated with QOS, QOL, and depression. Appropriate disease control of RA could lead to improve their QOS and QOL. References Wells GA, Li T, Kirwan JR, et al. Assessing quality of sleep in patients with rheumatoid arthritis. J Rheumatol 2009;36:2077-86. Wolfe F, Michaud K, Li T. Sleep disturbance in patients with rheumatoid arthritis: evaluation by medical outcomes study and visual analog sleep scales. J Rheumatol 2006;33:1942-51. Birtane M, Uzunca K, Tastekin N, Tuna H. The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoi...

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Pyoderma gangrenosum (PG) is a rare disease that causes chronic skin ulcers, and it has recently been known to be related to changes in the immune system such as dysfunction of neutrophils. Over 50% of patients with PG have an underlying systemic disease, and rarely are there various medicines causing the disease, including iodide, bromide, and isotretinoin. A 49-year-old man had recurrent skin ul-cers in his lower extremities. He had a history of taking propylthiouracil (PTU) for 10 years as a treatment for Graves' disease. Here, we describe a case of PTU-induced ANCA positive PG in a patient with hyperthyroidism, who has been improved after the cessation of PTU. 서 론 괴저성 농피증은 만성적인 피부궤양과 점액농성 또는 출 혈성 삼출액 및 동통을 동반하는 드문 질환으로 1930년 Brunsting 등이 처음 기술하였다. 통증이 동반된 구진성 수 포나 농포로 시작하여 빠르게 중심부 괴사 및 궤양을 형성 하며 궤양의 가장자리로 잠식성 경계가 나타나는 것이 특 징이며, 발병률은 매년 백만 명당 3∼10명 정도이다 (1,2). 괴저성 농피증의 원인은 세균 감염과 더불어 최근에는 호 중구의 기능이상 등 변화된 면역체계와의 연관성이 제기 되고 있으며 50%의 환자에서 전신질환과 동반되며 염증성 대장질환과 동반된 경우가 가장 많았고 그 외 C형 간염, 류마티스관절염, 척추염, 단일클론성 감마글로불린 혈증, 백혈병, 림프종, 골수이형성 증후군 등이 동반된 사례들이 보고되었다 (3). 항호중구세포질항체(antineutrophil cytoplasmic antibody, ANCA)와 관련하여 생기는 괴저성 농피증도 드물게 보고된 바 있으며 이는 propylthiouracil (PTU), hydralazine, carbimazole, minocycline, penicillamine 등 약물에 의해 이차적으로 생긴 혈관염과 관련되어 있다. 1999년 Darben 등 (4)에 의해 PTU에 의한 ANCA 양성인 괴저성 농피증이 보고 되었다. 저자들은 PTU 사용 후 발생된 ANCA 양성 괴저성 농피증 사례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.