Jin Nyeong Chae

Two Cases of Hypophosphatemic Osteomalacia After Long-term Low Dose Adefovir Therapy in Chronic Hepatitis B and Literature Review.

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.

SAT0451 Quality of sleep (QOS) and quality of life (QOL) in patients with osteoarthritis and rheumatoid arthritis

Background Patients with musculoskeletal disorders, such as osteoarthritis (OA) and rheumatoid arthritis (RA) suffer from not only pain but also insomnia, day time sleepiness, and other sleep disturbances. Poor sleep may also affect disability in musculoskeletal disorders. However, in the previous study, there was less data about the comparison of quality of sleep (QOS) and quality of life (QOL) in OA and RA patients. Objectives In this study, we aimed to assess the impact of OA on QOS comparing it with that of RA patients and control subjects. We also studied the QOS and QOL of these two musculoskeletal disorders. Methods 149 patients with OA, 130 patients with RA, and 117 voluntary control subjects participated in the study. The groups were compared in terms of demographic characteristics. QOS was evaluated by using the PSQI (Pittsburgh Sleep Quality Index) Health Survey and ESS (Epworth Sleepiness Scale) in all study participants. The Pain VAS (Visual Analog Scale) and McGill Pain Questionnaire were used to evaluate significant pain experienced by OA and RA patients. QOL was estimated by using Korean versions of the SF-36 (Short Form 36). Results The subjective sleep quality, sleep latency, sleep duration, sleep disturbance, use of sleeping medication, and total PSQI score were higher in OA and RA patients than in control subjects (p<0.05). The between-groups comparisons revealed that OA patients had significantly scored high in sleep latency, sleep duration, habitual sleep efficiency, and total PSQI score than RA patients (p<0.05). All parameters of McGill Pain score and Pain VAS score were significantly higher in OA than in RA patients (p<0.01). The total SF-36 score was lower in OA patients than in RA patients (51.02±20.68 vs. 60.05±20.82, respectively, p<0.01). The PSQI score correlated with McGill Pain Questionnaire, Pain VAS, and total SF-36 score in OA (p<0.05) and RA (p<0.01). Pain VAS also correlated significantly with the total PSQI score and total SF-36 score in OA (p<0.01) and RA (p<0.01). Conclusions Looking at the study’s findings, we need a slightly different approach on evaluating patients with either OA or RA suffering from sleep disturbance. The pain score is associated with QOS and QOL in OA and RA patients; thus, appropriate pain control of OA and RA patients 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. Ko SH, Chang SC, Chen CH. A comparative study of sleep quality between pregnant and nonpregnant Taiwanese women. J Nurs Scholarsh 2010;42:23-30. 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 rheumatoid arthritis by using SF-36 Health Survey. Clin Rheumatol 2007;26:679-84. Wells G, Li T, Tugwell P. Investigation into the impact of abatacept on sleep quality in patients with rheumatoid arthritis, and the validity of the MOS-Sleep questionnaire Sleep Disturbance Scale. Ann Rheum Dis 2010;69:1768-73. Disclosure of Interest None Declared

Critical Care Medicine

The year of 2009∼2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patien ts with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.