Characteristics of pediatric rhabdomyolysis and the associated risk factors for acute kidney injury: a retrospective multicenter study in Korea

Background@#The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. @*Methods@#This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. @*Results@#Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. @*Conclusions@#Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

The Effects of Menopausal Hormone Therapy on Serum Level of C-reactive Protein in Postmenopausal Korean Women

OBJECTIVES: Inflammation is a major mechanism underlying coronary heart disease (CHD) and C-reactive protein (CRP) is a marker of inflammation. When administered soon after menopause, menopausal hormone therapy (MHT) prevents CHD. This study was conducted to examine the impact of estrogen by administration route on CRP in postmenopausal Korean women using micronized progesterone (MP4) for endometrial protection. METHODS: This retrospective cohort study included 129 healthy women without CHD risk factors. Eighty-nine women took oral estrogen (conjugated equine estrogen, 0.625 mg/day or equivalent), and 40 women applied a 1.5-mg/day 0.1% percutaneous estradiol gel. MP4 was added in 82 women with an intact uterus. The CRP level was measured at baseline and three and six months after initiation of MHT. RESULTS: The baseline characteristics were comparable between the MHT groups except current age and age at menopause. After controlling for age, menopausal age, body mass index, and basal CRP, no significant change in CRP was observed in the oral estrogen group (n = 29). Follow-up CRP levels were also similar to the baseline in the percutaneous estrogen group (n = 18). However, three-month CRP was significantly lower than six-month CRP, and there was a significant time trend within the percutaneous estrogen group. However, the group difference did not reach statistical significance. CRP also did not differ by addition of MP4 in either group. CONCLUSIONS: In postmenopausal Korean women, no change in CRP was observed with oral estrogen, while percutaneous estrogen might decrease CRP. The estrogenic impacts were not influenced by adding MP4.

Relationship among Nursing Professionalism, Nursing Work Environment, and Patient Safety Nursing Activities in General Hospital Nurses / 간호행정학회지

PURPOSE: This study was done to identify the relationships among nursing professionalism, nursing work environment, and patient safety activities, and to analyze the factors influencing nurses' patient safety nursing activities. METHODS: This descriptive study included 270 nurses from six general hospitals. Questionnaires were used to collect data between August 20 and September 21, 2018, using questionnaires. Analyses included descriptive statistics, t-test, analysis of variance, Pearson correlation coefficient, and stepwise multiple regression, conducted using IBM SPSS/WIN 21.0. RESULTS: Mean scores on nursing professionalism, nursing work environment, and patient safety nursing activities were 3.51±0.41, 2.44±0.45, and 4.39±0.50, respectively. The patient safety nursing activities score was positively correlated with subscales of nursing professionalism variable: professional self-concept (r=.15, p=.019), social recognition (r=.10, p=.036), professional identity in nursing (r=.24, p<.001), role of nursing practice (r=.16, p=.012), nursing foundation for quality of care (r=.19, p=.003), and nurse manager's ability (r=.14, p=.031). Patient safety nursing activities were influenced by professional identity in nursing (β=.22, p=.001) and nursing foundation for quality of care (β=.15, p=.001), which explained 8.0% of the variance. CONCLUSION: These results suggest that nurse managers should focus on creating an appropriate nursing environment and facilitating nursing professionalism to enhance hospital nurses' patient safety nursing activities.

Acute kidney injury associated with Yersinia pseudotuberculosis infection: Forgotten but not gone

BACKGROUND: Yersinia pseudotuberculosis is known to cause fever, gastroenteritis, or acute kidney injury (AKI). There have been several Y. pseudotuberculosis infection outbreaks to date associated with ingestion of contaminated food or unsterile water. While this disease was considered to have practically been eradicated with the improvement in public health, we encountered several cases of AKI associated with Yersinia infection. METHODS: We retrospectively collected data from medical records of patients with suspected Y. pseudotuberculosis infection who visited Seoul National University Children’s Hospital in 2017. RESULTS: There were nine suspected cases of Yersinia infection (six males and three females; age range 2.99–12.18 years). Among them, five cases occurred in May, and seven patients were residing in the metropolitan Seoul area. Three patients had history of drinking mountain water. Every patient first presented with fever for a median of 13 days, followed by gastrointestinal symptoms and oliguria. Imaging studies revealed mesenteric lymphadenitis, terminal ileum wall thickening, and increased renal parenchymal echogenicity. Creatinine levels increased to 5.72 ± 2.18 mg/dL. Urinalysis revealed sterile pyuria, proteinuria, and glycosuria. Oliguria continued for 4 to 17 days, and two patients required dialysis; however, all of them recovered from AKI. Mucocutaneous manifestations developed later. In the diagnostic work-up, Yersinia was isolated from the stool culture in one patient. Anti-Yersinia immunoglobulin (Ig) A and IgG were positive in 6 patients. CONCLUSION: Y. pseudotuberculosis infection is an infrequent cause of interstitial nephritis presenting with AKI. When a patient presents with fever, gastroenteritis, and AKI not resolving despite hydration, the clinician should suspect Y. pseudotuberculosis infection.

Reninoma: a rare cause of curable hypertension / 소아과

The most common type of refractory hypertension found in children is secondary hypertension, which is a potentially curable disease. Reninoma, a renin-secreting juxtaglomerular cell tumor, is a rare cause of severe hypertension that is usually diagnosed in adolescents and young adults. Surgical resection of the tumor completely cures the hypertension of patients with reninoma. The typical clinical presentation of reninoma includes hypokalemia, metabolic alkalosis, and features secondary to the increased activation of the renin-angiotensin system without renal artery stenosis. We report a case of reninoma in a female adolescent with a typical clinical presentation, in which surgical removal of the tumor completely cured hypertension. We discuss here the clinical features, imaging studies, and immunohistochemical examination of the tumor used to establish the diagnosis of reninoma and for the management of the condition.

Corrigendum to “Associations between Social and Physical Environments, and Physical Activity in Adults from Urban and Rural Regions”Osong Public Health Res Perspect 2018;9(1):16–24

The authors regret to report that in the original paper, the OR and 95% CI values of the individual level variables in Table 4 are missing. Furthermore, the OR values and 95% CI values of individual and community level variables are missing or incorrectly presented in Table 5.

Moderating Effect of Professor-Student Interaction on the Relationship between Career Decision Self-efficacy and Major Satisfaction among Nursing Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate the effect of career decision self-efficacy on major satisfaction among nursing students, and to examine the moderating effect of professor-student interaction on career decision self-efficacy and major satisfaction. METHODS: This study analyzed the data of 307 students among fourth-year university nursing students in A and C cities from May 2017 to July 2017 using the SPSS 24.0 statistics program. RESULTS: There were significantly positive relationships between career decision self-efficacy, major satisfaction, and professor-student interaction. The professor-student interaction showed moderating effects in the relationship between career decision self-efficacy and major satisfaction, with 52.7% of explanatory power. CONCLUSION: This finding suggests the importance of career decision self-efficacy and the moderating effects of professor-student interaction to increase nursing students' satisfaction in their major. Therefore, it is necessary to make diverse efforts in the field of education to improve students' career decision self-efficacy and professor-student interaction.

A Case of an Ureteropelvic Junction Obstruction Caused by a Crossing Vessel

Ureteropelvic junction obstruction is one of the common causes of hydronephrosis in infancy and childhood. Most cases of ureteropelvic junction obstruction are diagnosed prenatally and are usually asymptomatic. Although less common, older children can experience ureteropelvic junction obstruction that presents with symptoms including flank or abdominal pain. Here, we present the case of a nine-year-old healthy girl who had repeated flank pain and abdominal symptoms, with mild left hydronephrosis, for several months. Computed tomography that was performed during the period of acute flank pain revealed aggravated hydronephrosis on her left kidney, which was secondary to an ureteropelvic junction obstruction. She underwent laparoscopic pyeloplasty, and a crossing vessel that passed the ureteropelvic junction was identified. In addition, we reviewed the current literature of this rare entity.

Associations between Social and Physical Environments, and Physical Activity in Adults from Urban and Rural Regions

OBJECTIVES: This study investigates investigated the relationship between social and physical environments, and moderate to vigorous physical activity (MVPA) amongst adults in both rural and urban areas within Korea. METHODS: A sample of 128,735 adults from the 2013 Community Health Survey (CHS) was analyzed using a multilevel logistic analysis. RESULTS: Urban residents with higher satisfaction in public transportation satisfaction and rural residents with more access to sports parks, hiking trails, and bike cycle paths were more likely to be active. The MVPA of adults from rural areas correlated urban adults was uncorrelatedwith neighborhood factors, but that of rural adults was whereas no correlations were observed in adults from urban areas. CONCLUSION: These differences should be considered when developing interventions strategies to enhance adult physical activity in different communities.

Long-term repeated rituximab treatment for childhood steroid-dependent nephrotic syndrome

BACKGROUND: Rituximab (RTX) can be used as a rescue therapy for steroid-dependent nephrotic syndrome (SDNS). However, the efficacy and safety of long-term, repeated use of RTX are not established. This study was conducted to assess the efficacy and safety of long-term, repeated RTX treatment in children. METHODS: Eighteen consecutive child patients with SDNS who were treated with three or more cycles of RTX for one year or longer were recruited, and their medical records were retrospectively reviewed. RESULTS: The patients were followed for 4.7 ± 1.9 years and received 5.2 ± 2.3 cycles of RTX over 2.8 ± 1.1 years. Approximately 70% of the additional RTX cycles were administered due to recovery of B-cells without relapse. The relapse rate decreased from 3.4 ± 2.0 per year initially to 0.4 ± 0.8 per year at the third year after RTX treatment. Approximately 10% of the RTX infusions were accompanied by mild infusion reactions. Eight patients showed sustained remission without any oral medication after the last cycle of RTX, while 10 patients had one or more episodes of relapse after the last cycle of RTX. The relapse rate in the latter group decreased from 2.8 ± 1.5 per year before RTX treatment to 1.3 ± 0.8 per year after cessation of RTX treatment. No significant differences in clinical parameters were found between the two groups. CONCLUSION: This retrospective study showed that pre-emptive and long-term, repeated RTX treatment is relatively effective and safe in children with SDNS. However, well-designed prospective studies are needed to confirm these findings.

Genotype and Phenotype Analysis in Pediatric Patients with Cystinuria

Cystinuria is an inherited disorder characterized by defective renal reabsorption of cystine and dibasic amino acids leading to nephrolithiasis. This study was conducted to analyze the genotypes and phenotypes of pediatric patients with cystinuria. Eight children from Seoul National University Hospital and Asan Medical Center presenting with cystinuria from January 2003 to June 2016 were retrospectively analyzed. Mutational studies were performed by direct sequencing. Two of the 8 were male and 6 were female. The median ages at onset and diagnosis were 1.5 (range, 0.3–13.6) and 2.6 (range, 0.7–16.7) years, respectively. The median followed up was 7.7 (range, 3.4–14.0) years. Mutational analyses were performed in 7 patients and revealed biallelic SLC3A1 mutations (AA genotype) in 4 patients, a single heterozygous SLC3A1 mutation (A- genotype) in 1 patient, biallelic SLC7A9 mutations (BB genotype) in 1 patient, and a single heterozygous SLC7A9 mutation (B- genotype) in 1 patient. Two of the mutations were novel. No genotype-phenotype correlations were observed, except for earlier onset age in patients with non-AA genotypes than in patients with the AA genotype. All patients suffered from recurrent attacks of symptomatic nephrolithiasis, which lead to urologic interventions. At the last follow-up, 3 patients had a mild-to-moderate degree of renal dysfunction. This is the first study of genotypic and phenotypic analyses of patients with cystinuria in Korea.

A Case of Severe Hypercalcemia Causing Acute Kidney Injury: An Unusual Presentation of Acute Lymphoblastic Leukemia

Severe hypercalcemia is rarely encountered in children, even though serum calcium concentrations above 15-16 mg/dL could be life-threatening. We present a patient having severe hypercalcemia and azotemia. A 14-year-old boy with no significant past medical history was referred to our hospital with hypercalcemia and azotemia. Laboratory and imaging studies excluded hyperparathyroidism and solid tumor. Other laboratory findings including a peripheral blood profile were unremarkable. His hypercalcemia was not improved with massive hydration, diuretics, or even hemodialysis, but noticeably reversed with administration of calcitonin. A bone marrow biopsy performed to rule out the possibility of hematological malignancy revealed acute lymphoblastic leukemia. His hypercalcemia and azotemia resolved shortly after initiation of induction chemotherapy. Results in this patient indicate that a hematological malignancy could present with severe hypercalcemia even though blast cells have not appeared in the peripheral blood. Therefore, extensive evaluation to determine the cause of hypercalcemia is necessary. Additionally, appropriate treatment, viz., hydration or administration of calcitonin is important to prevent complications of severe hypercalcemia, including renal failure and nephrocalcinosis.

A Case of Azathioprine Induced Severe Myelosuppression and Alopecia Totalis in IgA Nephropathy

Azathioprine is commonly used as immunosuppressive therapy for various inflammatory diseases including chronic glomerulonephritis. Myelosuppression is a common side effect of azathioprine, resulting in the need for dose reduction. However, severe pancytopenia or alopecia is not often encountered. Here, we report a case of severe myelosuppression, and alopecia totalis that occurred after azathioprine treatment in a patient with IgA nephropathy. A 10-year-old boy with IgA nephropathy was treated with oral deflazacort and later with azathioprine. After 4 weeks, the patient complained of hair loss, and despite a dose reduction in azathioprine, he developed bone marrow suppression and alopecia totalis in two weeks. The blood indices and alopecia of the patient had returned to normal after azathioprine withdrawal and 3 consecutive doses of granulocyte colony-stimulating factor. We suggest that physicians remain vigilant to the side effects of azathioprine. Unusual hair loss after azathioprine treatment might suggest a defect in the metabolism of the drug, warranting the discontinuation of azathioprine to prevent more severe side effects.

Estrogen-mediated Height Control in Girls with Marfan Syndrome

This study evaluated the efficacy of a stepwise regimen of estradiol valerate for height control in girls with Marfan syndrome. Eight girls with Marfan syndrome who had completed estrogen treatment for height control were included. Estradiol valerate was started at a dose of 2 mg/day, and then was increased. The projected final height was estimated using the initial height percentile (on a disease-specific growth curve for Korean Marfan syndrome [gcPFHt]), and the initial bone age (baPFHt). After the estrogen treatment, the projected final height was compared to the actual final height (FHt). The median baseline chronological and bone age were 10.0 and 10.5 years, respectively. After a median of 36.5 months of treatment, the median FHt (172.6 cm) was shorter than the median gcPFHt (181.0 cm) and baPFHt (175.9 cm). In the six patients who started treatment before the age of 11 years, the median FHt (171.8 cm) was shorter than the median gcPFHt (181.5 cm) and baPFHt (177.4 cm) after treatment. The median differences between the FHt and gcPFHt and baPFHt were 9.2 and 8.3 cm, respectively. In two patients started treatment after the age of 11, the differences between FHt and gcPFHt, and baPFHt after treatment were -4 and 1.4 cm, and -1.2 and 0 cm for each case, respectively. A stepwise increasing regimen of estradiol valerate may be an effective treatment for height control in girls with Marfan syndrome, especially when started under 11 years old.

Gender Differences in the Association between Eating Behavior and Depression of Adolescents: Evidence from a National Korean Cross-sectional Survey

PURPOSE: The purpose of this study was to determine the relationship between unhealthy eating behavior and depression in adolescents, with confounding variables adjusted. METHODS: This study is a secondary analysis of the data collected from the 2013 Korean Youth Risk Behavior Web-based Survey (KYRBWS). The analysis included 72,435 participants (36,655 male and 35,780 female). The data were analyzed by χ2 test, t-test, and logistic regression analysis using SPSS Version 21 by complex samples analysis. RESULTS: Compared with male adolescents with healthy eating behavior, those who with unhealthy eating behavior were more likely to suffer depression with other factors controlled (OR=1.37, 1.07~1.75). On the other hand, female adolescents with unhealthy eating behavior were less likely to feel depressed compared with female adolescents with unhealthy eating behavior and with other factors controlled (OR=0.98, 0.64~1.50). However, it was not statistically significant. CONCLUSION: Our findings suggest that healthy eating behavior may be a protective factor against depression in male adolescents, but not in female adolescents. Furthermore, our results suggest that the longitudinal associations between mental health and healthy eating behavior and other lifestyle factors are complex.

A Study on the Relationship between Fatigue Level, Job Stress and Quality of Life for Workers / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to seek ways to improve the quality of life of workers by separating workers into the low fatigue group and the severe fatigue group depending on the level of fatigue level, and analyzing and understanding the difference between quality of life and job stress according to the fatigue level. METHODS: For the 'Development of Mibyeong management system which was a consumer-directed health care service', the data of job stress, fatigue and quality of life was collected from 115 workers who visited the oriental hospitals located in J city and C city from Jul, 2012 to Dec, 2012. RESULTS: The severe fatigue group showed significantly higher job stress than the low fatigue group in physical environment (p=.004), job demand (p<.001), interpersonal conflict (p=.012), lack of reward (p=.062). The severe fatigue group showed lower degrees both in physical component summary (PCS) (p<.001) and mental component summary (MCS) (p<.001) measured by SF-12 and the quality of life (p<.001) measured by EQ5D than the lower fatigue group. A relatively strong negative correlation was found in the item of mental component summary (MCS) measured by SF-12. CONCLUSION: Considering our results that high fatigue level show negative impact on quality of life and job stress, we suggest to provide a variety of health promotion strategies to improve the quality of life through the prevention and relief of fatigue for workers.

Effects of Hormone Therapy on Serum Lipid Levels in Postmenopausal Korean Women

OBJECTIVES: This study was conducted to examine the effects of hormone therapy on serum lipid levels in postmenopausal Korean women. METHODS: This retrospective cohort study included 154 healthy postmenopausal Korean women. Seventy-nine women took oral estrogen (conjugated equine estrogen 0.625 mg/day or equivalent), and 75 applied estrogen transdermally using 0.1% 17beta-estradiol gel. Micronized progesterone (MP) was added to 40 women of oral group and 49 women in transdermal group. Serum levels of triglyceride, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and lipoprotein (a) were measured before, 3 and 6 month after hormone therapy. RESULTS: At baseline, mean body mass index (BMI) were lower (22.76 vs. 23.74 kg/m2) and proportion of family history of cardiovascular disease (CVD) (61 vs. 39%) were higher in oral group. In oral group, LDL-C and lipoprotein(a) levels decreased, and triglyceride and HDL-C levels increased significantly after 3 and 6 months. There was no significant change in lipoprotein levels compared to the baseline in transdermal group. There were also no differences with additional MP. Changing pattern of HDL-C during 6 months was significantly different by the route of estrogen administration. CONCLUSION: Oral estrogen therapy might be more beneficial than transdermal estrogen in terms of lipid in postmenopausal Korean women. The estrogen effects are not influenced by adding MP.

Efficacy and safety of a 24-day regimen of drospirenone-containing combined oral contraceptive in Korean women

This study assesses the efficacy and safety of a 24-day regimen of drospirenone-containing combined oral contraceptive, and demonstrates that it is an effective and safe option for contraception, releasing symptom of premenstrual dysphoric disorder and acne in Korean women.

Nutritional Status and Risk Factors for Malnutrition in Low-income Urban Elders

PURPOSE: The purpose of this study was to evaluate the nutritional status of low-income urban elders by diversified ways, and to analyze the risk factors for malnutrition. METHODS: The participants in this study were 183 low-income elders registered at a visiting healthcare facility in a public health center. Data were collected using anthropometric measurements, and a questionnaire survey. For data analysis, descriptive statistics, chi2-test, t-test, Fisher's exact test, multiple logistic regression analysis were performed using SPSS 20.0. RESULTS: Regarding the nutritional status of low-income elders as measured by the Mini Nutritional Assessment (MNA), 10.4% of the elders were classified as malnourished; 57.4% as at high risk for malnutrition; and 32.2% as having normal nutrition levels. The main factors affecting malnutrition for low-income elders were loss of appetite (OR=3.34, 95% CI: 1.16~9.56) and difficulties in meal preparation (OR=2.35, 95% CI: 1.13~4.88). CONCLUSION: In order to effectively improve nutrition in low-income urban elders, it is necessary to develop individual intervention strategies to manage factors that increase the risk of malnutrition and to use systematic approach strategies in local communities in terms of a nutrition support system.

The Attitude, Use and Adverse Effects of Complementary and Alternative Medicine (CAM) Therapies among Vulnerable, Community Dwelling Old Adults

PURPOSE: The purpose of this study is to obtain information of use of complementary and alternative medicines (CAMs) and any reported adverse effects of them on vulnerable elders in a community. METHODS: 1,837 elderly subjects aged 65 or higher with health problems were selected from those who were enrolled in a public health care center and received visiting health management services. A proportional stratified sampling method was used. Data collection was completed by face to face interviews using a structured questionnaire. The descriptive statistics and chi2-test were used to analyze the data. RESULTS: The prevalence of CAM use last year was 57.5%, and 10.4% of the subjects reported adverse effects of the therapies. The mean score of the subjects' attitudes towards CAM was 4.1+/-3.44 (range 1~10). The major sources of advice and exposure to CAM therapies were most likely to be from family and friends (72.5%). The primary reason for choosing CAM was to manage symptoms and relieve pain (86.6%). CONCLUSION: These findings suggest the need to develop nursing strategies for reducing and preventing adverse effects of CAM use by promoting awareness of using safe and appropriate CAM therapies.