An Epidemiological Investigation on an Outbreak of Shigellosis during Travelling Cambodia and Vietnam among Korean Rural People, 2005 / 農村醫學 地域保健

OBJECTIVES: A group consisted of 32 Korean rural people had been travelled to Cambodia and Vietnam. During their travel for 7 days, first diarrheal case had occurred on 3rd day of travel and overall 8 people had diarrhea during travel. So we investigated the case for determination of the cause and route of infection. METHODS: We interviewed all 32 people by visiting or telephone and took 23 stool samples from them, which are examined by Gyeungsangbuk-do Government Public Institute of Health & Environment in Korea. We interviewed travel agency for travel route and schedule. RESULTS: The attack rate was 25.0% (8 cases) among 32 people. Of them, 3 cases were microbiologically confirmed to have the infection of Shigella flexneri (Serotype 3a). The result of this epidemiological investigation showed that the infection of shigellosis was happened in foreign countries. We assumed the water from Angkor-Watt was contaminated by S. flexneri. We could not able to test environmental specimens because of the infection is thought to be occurred in foreign countries. CONCLUSIONS: Most common infectious diseases from foreign countries are transmitted by water or food. Travellers to foreign countries must take caution for communicable diseases and must do report and get appropriate treatment when symptoms developed after travel.

Clinical Characteristics and Laboratory Findings of Children who were Newly Diagnosed with Diabetes Mellitus (From 2001 to 2008) / 대한소아내분비학회지

PURPOSE: The incidence of type 2 diabetes mellitus is increasing worldwide because of the increase in the incidence of obesity. We performed this study to determine the type of diabetes and the clinical characteristics and laboratory data of the children who were newly diagnosed with diabetes mellitus (DM). METHOD: We reviewed the medical data of 75 children (35 boys and 40 girls) who were diagnosed with DM at Kyungpook National University Hospital between January 2001 and June 2008. RESULTS: Sixty patients (80%) were diagnosed with type 1 DM and 15 (20%) with type 2 DM. Approximately 70% of the study subjects developed DM in spring and winter. Further, 38% and 60% of the patients had a family history of type 1 and type 2 DM, respectively. The average age of the patients with type 1 DM was 10.6+/-2.6 years. Diabetic ketoacidosis was the first symptom in 15% of these patients. The average body mass index of these patients was 18.2+/-4.5 kg/m2. At least one of autoantibodies against pancreas was positive in 69%. The average age of the patients with type 2 DM was 13.4+/-1.2 years. Fifty-three percent of these patients was diagnosed without any symptom. Fatty liver and hypertension were diagnosed in 20% of the patients. Fifty-three percent of these patients were obese or overweight. CONCLUSION: Twenty percent of the children who were newly diagnosed with diabetes at our institute had type 2 DM. Since the incidence of type 2 DM in children appears to be increasing with an increase in the occurrence of childhood obesity, special attention should be provided to obese children.

Two Cases of Slipped Capital Femoral Epiphysis in Children Receiving Growth Hormone Therapy / 대한소아내분비학회지

Slipped capital femoral epiphysis is a rare hip disorder that mainly occurs in pubertal children. Although the exact cause of this disorder is unknown, it is known to be associated with obesity, trauma, delayed sexual development, delayed bone maturation, chronic renal failure, genetic diseases, endocrine disorders (growth hormone deficiency, hypothyroidism, hypogonadism), growth hormone therapy, and gonadotropin releasing hormone agonist (GnRH agonist) therapy. We report 2 cases of slipped capital femoral epiphysis in adolescent females who were receiving growth hormone therapy. The first case is of a 16 year-old-girl with chronic renal failure and renal osteodystrophy. The second case is of an 11 year-old-girl with idiopathic precocious puberty who had received GnRH agonist and growth hormone therapy. Unilateral or bilateral slipped capital femoral epiphysis developed at 1 year 3 months after treatment in both the cases. The chief complaints were pain in the hip joint and lower extremities. Growth hormone and/or GnRH agonist therapy was stopped, and in situ screw fixations of the involved hip epiphyses were performed.

Changes of Bone Mineral Densities in Children with Idiopathic Hypercalciuria / 대한신장학회지

PURPOSE: Idiopathic hypercalciuria is a common clinical disorder in children with hematuria or nephrolithiasis. Recently, it has been reported that idiopathic hypercalciuria may disturb the metabolism of bone and induce its loss. We measured the biochemical markers of bone metabolism and bone mineral densities (BMD) by dual energy X-ray absorptiometry (DEXA) in children with idiopathic hypercalciuria to elucidate the prevalence and clinical significance of osteopenia. METHODS: From 1997 to 2005, 52 children with idiopathic hypercalciuria were included in this study. The biochemical markers of bone metabolism were measured in all 52 patients. BMD was measured in 21 patients initially and additional 6 patients during the follow-up. RESULTS: Mean age of patients was 6 years 7 months, and the male to female ratio was 1.26:1. BMD Z-scores were less than -1 in 10 of initial 21 patients (osteopenia), and -2.5 in 2 of 10 osteopenic patients (osteoporosis). There was a negative correlation between BMD Z-score and the level of osteocalcin. However, there were no significant differences in BMD Z-scores and other biochemical markers of bone metabolism among groups divided by sex, the type of idiopathic hypercalciuria, and the presence of urinary stone. CONCLUSION: Idiopathic hypercalciuria can be not only the cause of hematuria, but also of osteopenia in children. We suggest that the measurement of BMD in children with idiopathic hypercalciuria should be performed routinely with regular follow-up.

A Clinical Profile of Peripheral Neuropathy in Korean Children / 대한소아신경학회지

PURPOSE: To analyze the clinical features of peripheral neuropathy in Korean children. METHODS: A total of 62 children with acute flaccid paralysis, longstanding weakness of extremities, or abnormal electrophysiological studies, suggestive of peripheral neuropathy, were evaluated retrospectively from the hospital records. The subjects were recruited at the pediatric neurology and endocrine clinic, Kyungpook National University Hospital from 2000 to 2002 and they all went through neurological examination and electrophysiological studies with or without nerve biopsy. RESULTS: Thirty nine children(Male 24:Female 15; Mean age 7.6+/-4.3 years) were found to have clinical peripheral neuropathy. Inflammatory neuropathy(5 children with Guillain Barre syndrome, 1 children with chronic inflammatory demyelinating polyneuropathy, 12 children with Bell's palsy; 46%) was the most common, followed by hereditary neuropathy(4 children, 10%), Chemotherapy induced neuropathy(3 children, 8%), metachromatic leukodystrophy(2 children, 5%), trauma(2 children, 5%), diabetic neuropathy(1 children, 3%) and so on. Thirty two children had motor neuropathy(82%), six children had combined motor and sensory neuropathy(15%), two had pure sensory(5%), but nobody had autonomic neuropathy. With respect to the type of involvement, polyneuropathies constitute 59%(23 children), mononeuropathy simplex accounted for 38%(15 children), mononeuropathy multiplex was found in 3%(1 child). Based on electrophysiological studies and biopsy results, demyelinating neuropathy was seen in 22 children(56%), axonal neuropathy in 12 children(31%), combined neuropathy in 5 children(13%). Eighteen children(46%) were completely or almost completely recovered from the illness. CONCLUSION: Inflammatory neuropathy was the most common among the acquired neuropathies and hereditary motor sensory neuropathy was the most common among the genetic neuropathies. Treatable neuropathies took up 46%. Potentially preventable neuropathies accounted for 36%. Early diagnosis and early intervention may have significant impacts on the prognosis of peripheral neuropathy in children.

Changes of Neutrophil Count in Peripheral Blood of the Neonate with Periventricular Leukomalacia

PURPOSE: It is now well established that infection and inflammation play an important role in the pathogenesis of ischemic brain damage. The loss of neutrophils from systemic circulation is an associated finding in injury mediated by granulocyte. Periventricular leukomalacia(PVL) caused by ischemia is the principal form of brain injury in premature infants. This study was conducted to evaluate whether the low neutrophil count is associated with periventricular leukomalacia(PVL) in premature infants. METHODS: Retrospective review of medical records was undertaken. Subjects were premature infants with a birth weight of less than 1,500 gm, admitted to the Neonatal Intensive Care Unit of Kyungpook University Hospital. A complete blood count of peripheral blood was done within the 1st hour of life. Neutropenia was defined as absolute neutrophil count <1,500/mm3, PVL as increased periven tricular echodensities followed by cyst formation on ultrasonography or corresponding signs on brain MRI. RESULTS: Thirteen infants out of a total population of 37 revealed neutropenia. Respiratory distress syndrome and requirement for respiratory support were not different between infants with neutropenia(neutropenia group) and infants without neutropenia(control group). Intraventricular hemorrhage (IVH) and grade 3 and 4 IVH were more frequent in neutropenia group(P<0.05). There was no statistically significant increase of PVL in neutropenia group. The neutrophil count was 18,760.0+/-10,266.1/mm3, 7,272.0+/-7,435.0/mm3 infants with PVL and 11,131.7+/-3,386.5/mm3, 2,407.5+/-1,933.1/mm3 in infants without PVL, respectively. The frequency of mechanical ventilation and artificial surfactant therapy was higher in infants with PVL compared with infants without PVL, but statistical analysis was not performed due to small number of subjects. CONCLUSION: A low number of neutrophils in the systemic circulation was not associated with an increased risk of PVL in premature infants.

Changes of Plasma and Urinary TNF-alpha in Children with Minimal Change Nephrotic Syndrome and Its Role in Albumin Permeability

PURPOSE: Minimal Change Disease(MCD) is the most common primary nephrotic syndrome in children. Some suggested that tumor necrosis factor-alpha(TNF-alpha) are involved in the pathogenesis of MCD. This study was done to see the changes of plasma and urinary TNF-alpha, and their effects on the permeability of glomerular basement membrane. METHODS: Study patients consisted of 19 biopsy-proven MCD children aged 2-15 years old. Both plasma and urinary TNF-alpha were measured. Employing the Millicell system, TNF-alpha were screened for the permeability factors. RESULTS: Urinary TNF-alpha during relapse was significantly increased(P<0.01). No significant change was seen in the plasma TNF-alpha during relapse when compared to those in remission and the healthy controls. Furthermore, in the in vitro Millicell system, TNF-alpha did not produce a significant change in albumin permeability. CONCLUSION: Therefore, it seems that TNF-alpha may not play a disease-specific role in the pathogenesis of MCD.

The effect of exercise on daily minor stress

BACKGROUND: Stress can be induced from minor daily life event, and it is widely accepted that this daily minor stress is better predictive factor for relationship between disease and stress. In a number of laboratory studies, investigator reported that perception of stress can be reduced by physical exercise. So in this study, we observed relationship between exercise and stress from minor daily life event, and tried to clarify the effect of exercise on daily stress. METHODS: Volunteer was recruited from health promotion center of one university hospital. and they were doing regular exercise in more than three days per week. Participants completed measures of daily stress inventory and amount of daily exercise for seven days. To compare the daily stress amount between exercise day and no exercise day, we used repeated measures analysis of variance. We used the Wilcoxon signed rank test to compare difference of stress in different sex and different trait anxiety group. RESULTS: There was significant difference in appraisal of daily stress between exercise days and no exercise days. The amount of daily stress was significantly reduced in continuous low level of anxiety group and male by exercise. CONCLUSION: Exercise is associated with a reduction of daily stress appraisal from minor life event. And there is different effect of exercise on daily minor stress in the different anxiety level group and different sex group.

Effect of smoking on pulmonary function in ex\smokers and current smokers

BACKGROUND: Smoking is closely related to pulmonary diseases, especially pulmonary function. Past studies were defective in that pulmonary function was not included for ex-smokers and the study population being too small. This study attempted to show the change of pulmonary function parameters according to post-smoking years of ex-smokers and pack-years of current smokers. METHODS: We analyzed the results of parameters derived from the forced expiratory spirogram in 3,713 adults who visited Kyungpook National University Hospital Health Screening Center between May 1997 and March 1998. Independent variables used were age, sex, height, weight and smoking status. Dependent variables were pulmonary function parameters. Multiple regression analysis was used. RESULTS: 1.Overall, there was a significant change in pulmonary function parameters among the subjects studied. Significant variables shown were age, sex, height and pack-years. Weight and post-smoking years turned out to be relatively less significant variables. 2. Positive correlation was seen in both FEV1/FVC and FEF25-75% in ex-smokers with longer post-smoking years. 3. There was negative correlation in all the parameters of current smokers with longer pack-years. CONCLUSION: The results of this test show that smoking slowly reduce pulmonary function and even those smokers who quit smoking can not be expected to have normal pulmonary function as healthy nonsmokers. However, ex-smokers can expect some improvement in certain pulmonary function parameters as the post-smoking years become longer.

The relation between psychosocial factor of inorganic chest pain and neurotic symptoms

BACKGROUND: Compared to Europe and America neurotic chest pain patients seems to be much more prevalent in Korea. This study was designed to depict various neurotic symptoms of patients with inorganic chest pain. METHOD: In the course of one year(from March, 1997 to March, 1998), 70 subjects were selected among the people who visited the outpatient clinic of department of family medicine with symptom of chest pain. The control group was selected from a healthy population which matched nearly the same number as the chest pain group. Patients were tested by EKG, treadmill, chest X-ray, 2D-UCG and requested to answer SCL-MPD questionnaire. Statistical analysis by means of SPCC/PC+ and for significance using non-parametric Mann-Whitney U test was done. RESULTS: The chest pain group scored significantly higher than the control group in obsessive and compulsive, anger-hostility, depression, anxiety, and somatization scale. male chest pain group scored higher in somatization, anxiety, obsessive-compulsive, hypochondriasis, and depression scale. The female chest pain group scored higher in depression scale. CONCLUSION: Many inorganic chest pain patients complain through various neurotic symptoms. When approaching chest pain patients we should consider the possibility of a psychosocial cause.

The relationship between low serum cholesterol and depression

BACKGROUND: Although elevated serum cholesterol level has been considered as a significant health problem because it is associated with coronary artery disease, the relation with various health problem (esp. depression) from low serum cholesterol is not well known in Korean people. The authors tried to observe the degree of depression in low serum cholesterol group for its better management. METHODS: The study population was selected among adults who visited the National University Hospital Health Screening Center between May and July 1998. They had no history of cancer and liver disease and no significant medical illnesses which may affect blood cholesterol level. Using the Korean standard BDI, we evaluated the degree of depression scale. RESULTS: The number of subjects with low serum cholesterol was 77 (males 42, females 35) and that of the control group was 82 (males 47, females 34). The low serum cholesterol group had a statistically significantly higher BDI score(12.2+/-8.2) than the control group (7.6+/-6.3) (P<0.05). In males the mean BDI score of 11.9+/-7.4 in the low serum cholesterol group was significantly higher than the mean score of 5.0+/-3.8 in the control group (P<0.05). In females, there was no significant difference in depression scale between both groups. CONCLUSION: Since the male low serum cholesterol group had a high depression scale, the multi-disciplinary approaches which include psychological supports may be required to manage and treat them. And persistent significant association between low serum total cholesterol level and psychological problems suggests that further long-term study on the association of low cholesterol with depression is necessary.