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대한내과학회> The Korean Journal of Internal Medicine

The Korean Journal of Internal Medicine update

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  • : 의약학분야  >  내과학
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수록범위 : 1권1호(1986)~35권6호(2020) |수록논문 수 : 2,421
The Korean Journal of Internal Medicine
35권6호(2020년 11월) 수록논문
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KCI등재 SCI

1Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu

저자 : Min Kyu Kang , Kyeong Ok Kim , Min Cheol Kim , Joon Hyun Cho , Sung Bum Kim , Jung Gil Park , Kook Hyun Kim , See Hyung Lee , Byung Ik Jang , Tae Nyeun Kim

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1261-1269 (9 pages)

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Background/Aims: Coronavirus disease 2019 (COVID-19) can reportedly cause gastrointestinal symptoms. Therefore, we investigated the clinical characteristics of COVID-19 patients with diarrhea.
Methods: We included 118 COVID-19 patients admitted to a single hospital from February 20 to March 31, 2020. Medical records with clinical characteristics, laboratory data, treatment course, and clinical outcomes were compared based on the presence or absence of diarrhea. Prognostic factors for disease severity and mortality in COVID-19 were also assessed.
Results: Among patients, 54 (45.8%) had diarrhea, whereas seven (5.9%) had only diarrhea. The median age of patients with diarrhea was 59 years (44 to 64), and 22 (40.7%) were male. Systemic steroid use, intensive care unit admission, septic shock, and acute respiratory distress syndrome were less frequent in the diarrhea group than in the non-diarrhea group. No significant differences were observed in total hospital stay and mortality between groups. On multivariate analysis, age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.01 to 1.12; p = 0.044), diabetes (OR, 3.00; 95% CI, 1.25 to 20.47; p = 0.042), and dyspnea (OR, 41.19; 95% CI, 6.60 to 823.16; p < 0.001) were independent risk factors for septic shock. On Cox regression analysis, diabetes (hazard ratio [HR], 4.82; 95% CI, 0.89 to 26.03; p = 0.043) and chronic obstructive pulmonary disease (HR, 16.58; 95% CI, 3.10 to 88.70; p = 0.044) were risk factors for mortality.
Conclusions: Diarrhea was present in 45.8% of patients and was a common symptom of COVID-19. Although patients with diarrhea showed less severe clinical features, diarrhea was not associated with disease severity or mortality.

KCI등재 SCI

2What should we prepare for the next coronavirus disease 2019 outbreak? A survey on the opinions of infectious diseases specialists in South Korea

저자 : Bongyoung Kim , Se Yoon Park , Dong Sik Jung , Sook In Jung , Won Sup Oh , Shin-woo Kim , Kyong Ran Peck , Hyun-ha Chang

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1270-1289 (20 pages)

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Background/Aims: This study aimed to collect information on the opinions of Korean infectious disease (ID) experts on coronavirus disease 2019 (COVID-19) and related issues in preparation for a future outbreak. 
Methods: A survey was conducted over the course of 5 days (from April 21 to 25, 2020), targeting all adult ID specialists currently in the medical field in South Korea (n = 265). An online-based survey was forwarded via text message and e-mail. Only one response was accepted from each participant. 
Results: Of these 265 ID specialists gotten to, 132 (49.8%) responded. The highest proportion of the respondents envisaged the current COVID-19 outbreak to end after December 2020 (47.7% for the domestic Korean outbreak and 70.5% for the global pandemic); moreover, 60.7% of them stated that a second nationwide wave is likely to occur between September and December 2020 in South Korea. N95 respirators were considered to be the most important item in hospitals in preparation for a second wave. The most important policy to be implemented at the national level was securing national hospitals designated for the treatment of ID (67.4%). 
Conclusions: ID experts in South Korea believe that the COVID-19 pandemic may not be easily controlled and that a second nationwide wave is likely to occur in South Korea. Our results indicate that Korean ID specialists believe that a high level of preparation is needed in various aspects, including the procurement of personal protective equipment, to respond efficiently to a second outbreak.

KCI등재 SCI

3Nutritional management in patients with chronic kidney disease

저자 : Sun Moon Kim , Ji Yong Jung

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1279-1290 (12 pages)

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The global prevalence of chronic kidney disease (CKD) is increasing with the aging of populations worldwide. As kidney function declines, the accumulation of metabolic waste products and excessive electrolytes can significantly impair the health of patients with CKD. As nutritional management of patients with CKD is thought to control uremic symptoms and provide beneficial effects on the progression of kidney dysfunction, the diet of patients with CKD should be an important consideration in their care. Many guidelines recommend limiting protein intake in these patients, as high-protein diets aggravate kidney dysfunction. Excess sodium may be associated with CKD progression and all-cause mortality and, therefore, limiting salt intake is generally recommended. Low potassium is associated with muscle weakness and hypertension, whereas high potassium is associated with cardiac arrhythmia. Therefore, recent guidelines recommend adjusting dietary potassium intake on an individual basis to maintain serum potassium levels within the normal range. Appropriate dietary calcium intake is recommended to maintain calcium balance in patients with CKD G3, G4. Given the many dietary considerations for patients with CKD, effective nutritional management is challenging. Individualized strategies are needed to ensure the best outcome for patients with CKD.

KCI등재 SCI

4Renal effects of uric acid: hyperuricemia and hypouricemia

저자 : Jung Hwan Park , Young-il Jo , Jong-ho Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1291-1304 (14 pages)

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The prevalence of chronic kidney disease (CKD) is increasing worldwide. Although hyperuricemia has been associated with CKD in many studies, it remains controversial whether this is the cause or the result of decreased renal function. Recent observational studies of healthy populations and patients with CKD have reported that uric acid (UA) has an independent role in the development or progression of CKD. Experimental studies have shown several potential mechanisms by which hyperuricemia may cause or promote CKD. However, other reports have indicated an association between hypouricemia and CKD. This opposing effect is hypothesized to occur because UA is a major antioxidant in human plasma and is associated with oxidative stress. In this article, we discuss the potential association between UA imbalance and CKD and how they can be treated.

KCI등재 SCI

5The clinical impact of gut microbiota in chronic kidney disease

저자 : So Mi Kim , Il Han Song

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1305-1316 (12 pages)

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Gut microorganisms play critical roles in both maintaining host homeostasis and the development of diverse diseases. Gut dysbiosis, an alteration of the composition and function of gut microorganisms, is commonly seen in patients with chronic kidney disease (CKD). CKD itself contributes to a disruption of the symbiotic relationship between the gut microbiota and the host, while the resulting gut dysbiosis may play a part in stage progression of CKD. This bidirectional relationship supports the concept that the gut microbiota is considered a novel focus for the pathogenesis and management of CKD. This article examines the interaction between the gut microbiota and the kidney, the mutual effects of dysbiosis and CKD, and possible treatment options to restore gut eubiosis, and reduce CKD progression and its related complications.

KCI등재 SCI

6Recommendations for the management of patients with systemic rheumatic diseases during the coronavirus disease pandemic

저자 : Mi Ryoung Seo , Ji-won Kim , Eun-jung Park , Seung Min Jung , Yoon-kyoung Sung , Hyungjin Kim , Gunwoo Kim , Hyun-sook Kim , Myeung-su Lee , Jisoo Lee , Jian Hur , Bum Sik Chin , Joong Sik Eom , Han Joo

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1317-1332 (16 pages)

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Patients with systemic rheumatic diseases (SRD) are vulnerable for coronavirus disease (COVID-19). The Korean College of Rheumatology recognized the urgent need to develop recommendations for rheumatologists and other physicians to manage patients with SRD during the COVID-19 pandemic. The working group was organized and was responsible for selecting key health questions, searching and reviewing the available literature, and formulating statements. The appropriateness of the statements was evaluated by voting panels using the modified Delphi method. Four general principles and thirteen individual recommendations were finalized through expert consensus based on the available evidence. The recommendations included preventive measures against COVID-19, medicinal treatment for stable or active SRD patients without COVID-19, medicinal treatment for SRD patients with COVID-19, and patient evaluation and monitoring. Medicinal treatments were categorized according to the status with respect to both COVID-19 and SRD. These recommendations should serve as a reference for individualized treatment for patients with SRD. As new evidence is emerging, an immediate update will be required.

KCI등재 SCI

7Body mass index at the crossroads of osteoporosis and type 2 diabetes

저자 : Jeonghoon Ha , Ki-hyun Baek

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1333-1335 (3 pages)

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KCI등재 SCI

8Do all patients with breast cancer benefit from neoadjuvant chemotherapy?

저자 : Kyoung Eun Lee

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1336-1337 (2 pages)

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KCI등재 SCI

9Continuous infusion versus intermittent bolus injection of propofol during endoscopic retrograde cholangiopancreatography

저자 : Jae Gon Lee , Kyo-sang Yoo , Young Jae Byun

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1338-1345 (8 pages)

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Background/Aims: It is unclear whether continuous infusion or intermittent bolus injection of propofol is better for achieving adequate sedation in endoscopic retrograde cholangiopancreatography (ERCP). We aimed to compare the efficacy and safety of continuous infusion and intermittent bolus injection of propofol during therapeutic ERCP.
Methods: In this prospective study, we randomly assigned 232 patients undergoing therapeutic ERCP to either continuous infusion (CI group, n = 113) or intermittent bolus injection (BI group, n = 119) of propofol. The primary outcome was the quality of sedation as assessed by the endoscopist. Other sedation-related parameters included sedation induction time, total dose of propofol, recovery time, involuntary patient movement, and adverse events.
Results: Overall satisfaction with sedation by the endoscopist and monitoring nurse were significantly higher in the CI group than the BI group (mean satisfaction score, 9.66 vs. 8.0 and 9.47 vs. 7.96, respectively, p < 0.01 for both). However, patients in the CI group had a significantly longer sedation induction time (5.28 minutes vs. 4.34 minutes, p < 0.01) and received a higher dose of propofol than patients in the BI group (4.22 mg/kg vs. 2.08 mg/kg, p < 0.01). There was no significant difference in adverse events between the two groups.
Conclusions: Continuous infusion of propofol during therapeutic ERCP had the advantage over intermittent bolus injection of maintaining a constant level of sedation without increasing adverse events. However, it was associated with an increased total dose of propofol and prolonged sedation induction time.

KCI등재 SCI

10Correlation of the grade of hepatic steatosis between controlled attenuation parameter and ultrasound in patients with fatty liver: a multi-center retrospective cohort study

저자 : Jeong-ju Yoo , Yang Jae Yoo , Woo Ram Moon , Seung Up Kim , Soung Won Jeong , Ha Na Park , Min Gyu Park , Jae Young Jang , Su Yeon Park , Beom Kyung Kim , Jun Yong Park , Do Young Kim , Sang Hoon Ahn ,

발행기관 : 대한내과학회 간행물 : The Korean Journal of Internal Medicine 35권 6호 발행 연도 : 2020 페이지 : pp. 1346-1353 (8 pages)

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Background/Aims: The controlled attenuation parameter (CAP), based on transient elastography, is widely used for noninvasive assessment of the degree of hepatic steatosis (HS). We investigated the correlation of the degree HS between CAP and ultrasound (US) in patients with HS.
Methods: In total, 986 patients with US-based HS who underwent transient elastography within 1 month were evaluated. The US-based grade of HS was categorized as mild (grade 1), moderate (grade 2), or severe (grade 3).
Results: The CAP was significantly correlated with the US-based grade of HS (r = 0.458, p < 0.001). The median CAP value of each US-based HS grade showed a positive correlation with grade (271.1, 303.7, and 326.7 dB/m for grades 1, 2, and 3). In a multivariate analysis, the US-based HS grade, body mass index, serum albumin, alanine aminotransferase, and total cholesterol, and liver stiffness were all significantly correlated with the CAP value (all p < 0.05). The areas under the receiver operating characteristic curves for grade 2 to 3 and grade 3 HS were 0.749 (95% confidence interval [CI], 0.714 to 0.784) and 0.738 (95% CI, 0.704 to 0.772). The optimal cut-off CAP values to maximize the sum of the sensitivity and specificity for grade 2 to 3 and grade 3 HS were 284.5 dB/m (sensitivity 78.6%, specificity 61.7%) and 298.5 dB/m (sensitivity 84.6%, specificity 55.6%).
Conclusions: The correlation of the degree of HS between CAP and US was significantly high in patients with HS, and the optimal cut-off CAP values for grade 2 to 3 and grade 3 HS were 284.5 and 298.5 dB/m.

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