Showing papers by "Joon Sup Yeom published in 2009"
TL;DR: Hydroxychloroquine is an antimalarial drug used as chemoprophylaxis against malaria caused by Plasmodium vivax in the Republic of Korea Army (ROKA), and a significant cause of prophylactic failure among the individuals in ROKA was ascribed to plasma concentrations of HCQ lower than those predicted by the PK model.
Abstract: Hydroxychloroquine (HCQ) is an antimalarial drug used as chemoprophylaxis against malaria caused by Plasmodium vivax in the Republic of Korea Army (ROKA). In this study, we evaluated the pharmacokinetics (PK) of HCQ and its metabolites and the relationship between the PK of HCQ and the effect of treatment of HCQ on vivax malaria in South Koreans. Three PK studies of HCQ were conducted with 91 healthy subjects and patients with vivax malaria. Plasma concentrations were analyzed by noncompartmental and mixed-effect modeling approaches. A two-compartment model with first-order absorption best described the data. The clearance and the central and peripheral volumes of distribution were 15.5 liters/h, 733 liters, and 1,630 liters, respectively. We measured the plasma concentrations of HCQ in patients with prophylactic failure of HCQ and compared them with the prediction intervals of the simulated concentrations for HCQ from the final PK model built in this study. In 71% of the patients with prophylactic failure, the plasma concentrations of HCQ were below the lower bounds of the 95% prediction interval, while only 8% of them showed higher levels than the upper bounds of the 95% prediction interval. We report that a significant cause of prophylactic failure among the individuals in ROKA was ascribed to plasma concentrations of HCQ lower than those predicted by the PK model. However, prophylactic failure despite sufficient plasma concentrations of HCQ was confirmed in several individuals, warranting continued surveillance to monitor changes in the HCQ susceptibility of Plasmodium vivax in the Republic of Korea.
160 citations
TL;DR: The annual incidence of Plasmodium vivax malaria that reemerged in the Republic of Korea (ROK) in 1993 increased annually, reached 4,142 cases in 2000, decreased to 864 cases in 2004, and once again increased to reach more than 2,000 cases by 2007.
Abstract: The annual incidence of Plasmodium vivax malaria that reemerged in the Republic of Korea (ROK) in 1993 increased annually, reaching 4,142 cases in 2000, decreased to 864 cases in 2004, and once again increased to reach more than 2,000 cases by 2007. Early after reemergence, more than two-thirds of the total annual cases were reported among military personnel. However, subsequently, the proportion of civilian cases increased consistently, reaching over 60% in 2006. P. vivax malaria has mainly occurred in the areas adjacent to the Demilitarized Zone, which strongly suggests that malaria situation in ROK has been directly influenced by infected mosquitoes originating from the Democratic People's Republic of Korea (DPRK). Besides the direct influence from DPRK, local transmission within ROK was also likely. P. vivax malaria in ROK exhibited a typical unstable pattern with a unimodal peak from June through September. Chemoprophylaxis with hydroxychloroquine (HCQ) and primaquine, which was expanded from approximately 16,000 soldiers in 1997 to 200,000 soldiers in 2005, contributed to the reduction in number of cases among military personnel. However, the efficacy of the mass chemoprophylaxis has been hampered by poor compliance. Since 2000, many prophylactic failure cases due to resistance to the HCQ prophylactic regimen have been reported and 2 cases of chloroquine (CQ)-resistant P. vivax were reported, representing the first-known cases of CQ-resistant P. vivax from a temperate region of Asia. Continuous surveillance and monitoring are warranted to prevent further expansion of CQ-resistant P. vivax in ROK.
54 citations
TL;DR: Treatment responses of P. vivax malaria patients in the Republic of Korea monitored during 2003-2007 were monitored, and CQ resistance was confirmed in 2 of 484 enrolled patients, the first report of CQ-resistant P.vivax in a temperate region of Asia.
Abstract: The number of Plasmodium vivax malaria patients in the Republic of Korea and North Korea since the re-emergence of malaria in 1993 is estimated to be approximately one million. To cope with this situation, the Army of the Republic of Korea has performed chemoprophylaxis with hydroxychloroquine and primaquine since 1997. The cumulative number of soldiers in the Army of the Republic of Korea given chemoprophylaxis exceeded 1.4 million by 2007. Extensive chemoprophylaxis contributed to preventing a rapid increase of malaria patients in the Army of the Republic of Korea, but increased the possibility of the occurrence of chloroquine (CQ)-resistant P. vivax strains. In this study, treatment responses of P. vivax malaria patients in the Republic of Korea monitored during 2003-2007, and CQ resistance was confirmed in 2 of 484 enrolled patients. Our results are the first report of CQ-resistant P. vivax in a temperate region of Asia. Continuous surveillance is warranted to monitor the change in CQ resistance frequency of P. vivax in the Republic of Korea.
45 citations
TL;DR: Appropriate use of ceftriaxone was higher than inappropriate use at university hospitals in Korea, however, including continued empiric use for presumed infections and prophylactic perioperative injection remained high.
Abstract: Background/Aims: As bacterial resistance to antimicrobial agents has grown due to the increasing use of antimicrobial agents, we sought to evaluate the suitability of ceftriaxone usage (representative of third generation cephalosporins) at 10 university hospitals in Korea. Methods: We prospectively evaluated the appropriateness of antibiotic usage in 400 adult patients who received ceftriaxone between February 1, 2006 and June 30, 2006. Drug utilization evaluation (DUE) methods were based on standards set forth by the American Society of Hospital Pharmacists. The DUE criteria used in this study were modified to be more suitable in our hospital setting: justification of drug use, critical and process indications, complications, and outcome measures. Results: The average patient age was 64.4 years. The utilization of ceftriaxone was appropriate in 262 cases (65.5%) for the justification of use, while inappropriate use was observed in 138 cases (34.5%). Common reasons for inappropriate use of ceftriaxone included continued empiric use for presumed infections, prophylactic perioperative injection, and empiric therapy for fever. Most of the critical indications showed a high rate of suitability (66.5-98.5%). Complications occurred in 37 cases (9.3%). With respect to outcome measures, clinical responses were observed in 60.7% of cases, while only 15.7% of cases showed evidence of infection eradication via negative cultures. Conclusions: Appropriate use (65.5%) of ceftriaxone was higher than inappropriate use (34.5%) at university hospitals in Korea. Inappropriate utilization, however, including continued empiric use for presumed infections and prophylactic perioperative injection remained high. Intensification of educational programs and antibiotic control systems for ceftriaxone is needed to improve the suitability of antimicrobial use.
40 citations
TL;DR: Continuous surveillance and monitoring are warranted to prevent further expansion of P. vivax malaria caused by climate change in ROK.
Abstract: Plasmodium vivax malaria, which re-emerged in the Republic of Korea (ROK) in 1993, had decreased since 2001. However, case numbers began to increase again in 2005. The number of cases rose 54.0% in 2006, but the rate of increase slowed down in 2007. Among the total of 4,206 cases of P. vivax malaria during 2006-2007, 756 cases (18.0%) were ROK military personnel, 891 cases (21.2%) were veterans, and 2,559 cases (60.8%) were civilians. The rapid increase during this period was mostly contributed by the western part of the malaria-risk areas that is under the influence of adjacent North Korea. Local transmission cases in ROK have also increased gradually and the transmis- sion period seemingly became longer. Chemoprophylaxis in the military should be re-assessed in view of chloroquine- resistance. Continuous surveillance and monitoring are warranted to prevent further expansion of P. vivax malaria caused by climate change in ROK.
23 citations
6 citations
TL;DR: This work presents a novel and scalable approaches that can be applied to the rapidly changing and rapidly changing landscape of infectious disease in South Korea.
Abstract: Submitted : 21 August 2008, Accepted : 2 December 2008 Corresponding author : Dae-Kyu Oh, M.D., Ph.D. Department of Preventive Medicine, Graduate School of Medicine, Gachon University of Medicine and Science Room 1006, Mirae-gwan, 534-2 Yeonsoo-dong, Yeonsoo-gu, Incheon 406-799, Korea Tel : +82-32-820-4816, Fax : +82-32-820-4817 E-mail jsodk@gachon.ac.kr *Jae-Won Park and Jee-Young Hong contributed equally to this work. 본 연구는 2007년도 질병관리본부 학술연구용역사업(2007-E00096-00)의 지원으로 수행되었슴. 서 론
4 citations
Journal Article•
TL;DR: A case of P. malariae infection is reported, in a previously healthy man, that was imported from Nigeria to Korea, and was first treated with atovaquone/proguanil in Korea.
Abstract: There have been several reports of malaria in Korea; however, there have been no reports of Plasmodium malariae infection since 1962. P. malariae infection is most common in sub-Saharan Africa and is described as an infrequent infection with a relatively mild clinical course, low mortality, and high sensitivity to chloroquine. Here we report a case of P. malariae infection, in a previously healthy man, that was imported from Nigeria to Korea. The patient was diagnosed using a malaria smear and nested polymerase chain reaction, and was first treated with atovaquone/proguanil in Korea.
3 citations
Journal Article•
TL;DR: It’s time to get used to the idea that there is no such thing as a “normal” friendship between a friend and a stranger.
Abstract: 말 까지는 환자의 대부분이 현역 군인이었으나 이후 민간인 의 비율이 점차 증가하여 2002년부터는 민간인의 비율이 전 체 환자의 절반 이상을 차지하고 있다. 지역별 발생 분포를 보면 재출현 초기에는 파주, 연천 등지에서 주로 발생하던 것이 1997년부터 휴전선 인접 지역을 중심으로 동서로 빠르 게 확산되어 2000년에는 휴전선에 인접해 있는 전 지역으로 그 범위가 확산되었으며 고양, 김포, 인천 등 서울 인접지역 으로까지 확산되었다. 최근에는 경기도 서쪽인 강화군, 김포 시, 인천광역시, 파주시, 고양시 등에서 집중 발생되는 양상 을 보이고 있다(표 1). 환자는 연중 발생 가능하나 주로 5월 말부터 나타나기 시작하여 7~9월에 많이 발생하고 10월부터 감소하여 겨울철에는 거의 발생하지 않는다. 일반적으로 열 대 지역에서 발생하는 삼일열 말라리아의 잠복기는 평균 2 주 정도이나 국내 삼일열 말라리아의 짧게는 2주부터 길게 는 6~12개월의 긴 잠복기를 가지고 있는 것이 특징이다.
3 citations
Journal Article•
TL;DR: This work reports on a rather interesting case of Kaposi's sarcoma distributed on a dermatome that was previously involved by herpes zoster.
Abstract: Kaposi's sarcoma (KS) is a neoplastic, vascular tumor that involves the skin or internal organs. KS is an extremely common tumor in tropical Africa and it is also a prime marker of acquired immunodeficiency syndrome (AIDS). An isotopic response describes the occurrence of a new skin disorder on the site of another, unrelated and already healed skin disease. The most common cause of an isotopic response in the skin is the herpes zoster virus. We report here on a rather interesting case of Kaposi's sarcoma distributed on a dermatome that was previously involved by herpes zoster.
1 citations