Relief of Symptoms by Early Administration of Infliximab in Patients with Suspected Spondyloarthritis: A Case Report

Low back pain is one of the most common musculoskeletal symptoms, and it can be difficult to make an accurate diagnosis based on symptoms alone. Osteitis condensans ilii (OCI) is one of the benign etiologies of low back pain and buttock pain mainly in young multiparous women. It can be diagnosed by radiological findings of the triangular sclerotic bone lesion, in the bilateral iliac bone of sacroiliac joints. Spondyloarthritis is a group of chronic inflammatory rheumatic diseases with common features, including axial and peripheral inflammatory arthritis, enthesitis, and an association with the human leukocyte antigen B27. Since both diseases may have similar clinical symptoms, the differential diagnosis may be difficult. We present a case of relief of symptoms by administration of infliximab in patients with suspected early spondyloarthritis that may be confused with OCI.

Relationship of Sleep Quality, Physical Stress, Psychological Stress, and Job Stress among Residents

BACKGROUND: The purpose of this study is to identify the relationship of sleep quality, physical stress, psychological stress, and job stress among residents and to examine correlations of sleep quality, physical stress, psychological stress, and job stress according to average of working hours per day, frequency of night duty, sleep onset time on night duty and sleeping hour on night duty. METHODS: A descriptive correlation study included 164 residents working at 13 secondary and tertiary hospitals in Gyeong-gi Province who completed a self-administered structured questionnaires. The data were collected from June 1 to August 31, 2016. and analyzed through frequency, percentage, t-test, ANOVA, Scheffe's test, multiple regression analysis by SPSS program version 22.0 (IBM Corp., Chicago, IL, USA). RESULTS: The average level of residents' sleep quality, physical stress, psychological stress, and job stress were 40.30, 16.74, 15.96, and 26.79, respectively. Sleep quality, physical, psychological and job stress have shown statistically significant correlations according to average of working hours per day, frequency of night duty, sleep onset time on night duty and sleeping hour on night duty. Poor sleep quality is related to higher physical, psychological and job stress. CONCLUSIONS: Residents' average of working hours per day is long and sleeping hour on night duty is scarce. Due to this, the level of residents' sleep quality is poor and physical, psychological and job stress are severe. Obviously, sleep quality showed a positive correlation with physical, psychological and job stress. It is necessary to develop effective program to improve the residents' sleep quality and reduce physical, psychological and job stress.

A Comparison of the Efficacy and Safety of Non-Steroidal Anti-Inflammatory Drugs versus Acetaminophen in Symptom Relief for the Common Cold: A Meta-Analysis of Randomized Controlled Trial Studies / 가정의학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used for common cold symptom relief. The objective of this study was to evaluate and compare the efficacy and safety of acetaminophen and NSAIDs in common cold symptom relief using meta-analysis of randomized controlled trial. METHODS: We searched MEDLINE (PubMed), Cochrane, EMBASE, CINAHL, KMbase, KoreaMed, National Assembly Library, and Riss4u for studies released through June 2012. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. The Review Manager ver. 5.1 (RevMan) was used for statistics. RESULTS: We identified 5 studies. The relative benefit for participants with pain relief was 1.00 (95% confidence interval [CI], 0.96 to 1.05) and I2 = 0%. The existence of the heterogeneity between studies was not important in this study, thus subgroup analysis was not implemented. The relative benefit for participants with rhinorrhea was 1.02 (95% CI, 0.77 to 1.35) and I2 = 0%, which also indicates the existence of heterogeneity was not important. The relative risk of adverse events was 1.14 (95% CI, 0.93 to 1.40), I2 = 0%. There was no apparent asymmetry in the funnel plot. CONCLUSION: There was no difference between NSAIDs and acetaminophen in common cold symptom relief.

Interleukin-21 Receptor Gene Polymorphisms in Kawasaki Disease

BACKGROUND AND OBJECTIVES: Interleukin-21 receptor (IL-21R) gene polymorphism is related with the development of systemic vasculitis. In this study, we investigated the polymorphisms of IL-21R gene in patients with Kawasaki disease (KD). SUBJECTS AND METHODS: We genotyped the promoter region of IL-21R gene (-2500 bp to +1 bp) in 100 patients with KD and 100 healthy controls. All study subjects were Korean. We designed five pairs of primers and performed polymerase chain reaction (PCR) and direct sequencing. We analyzed whole promoter sequences of 200 individuals with comparison to reference sequences of IL-21R gene (NG_012222.1/NC_000016.9). RESULTS: We found five single nucleotide polymorphisms (SNPs) of which minor allele frequency (MAF) >0.01 in the promoter region of IL-21R gene. Those are -1681 G>T (chromosome site 27411802), -379 G>A (27413104), -332 G>C (27413151, rs2214537), -237 A>T (27413246), and -53 G>A (27413430). There is no significant difference in MAF of each SNP between patients with KD and healthy controls except -237 A>T. Twenty five patients with KD had more than 1 SNP in contrast to only seven healthy controls had. The patients with KD have significantly more IL-21R gene polymorphisms than controls (odds ratio: 3.0, 95% confidence interval: 1.6-5.6, p=0.0005). There was no significant correlation between IL-21R gene polymorphisms and the serum level of IL-21. The serum level of total IgE was not significantly correlated with the presence of IL-21R gene polymorphisms. CONCLUSION: Our data suggest that the genetic susceptibility profile for KD may include IL-21R gene.

Use of Femorofemoral Bypass for Life Saving before the Emergency Replacement of Thrombotic Prosthetic Mitral Valve / 대한구급학회지

Mechanical valves have generally good hemodynamic function and indefinite durability, but they have a higher thromboembolic potential and thus a requirement for permanent anticoagulation, because thrombotic occlusion is a potentially fatal complication of heart valve replacement surgery. We had experienced mitral valve replacement because of thrombosis around the replaced prosthetic valve. The patient's mechanical prosthetic valve was acutely obstructed by thrombosis, and it was a life threatening condition. We performed partial bypass through femorofemoral bypass for life saving. Femorofemoral bypass improved oxygenation and cardiovascular stability, and mitral valve replacement was successfully performed without complication.

Transient Swelling of both Parotid Glands Following General Anesthesia / 대한마취과학회지

Parotid gland swelling in association with general anesthesia is an unusual complication. Benign postoperative parotid swelling should be recognized as a noninfectious, self-limiting process occurring immediately after surgery. This enlargement is non-tender, rubbery in consistency, without crepitus, and may be accompanied by variable salivation. The mechanism of the occurrence remains unknown, but two factors most frequently associated with this phenomenon appear to be physical stimulation or manipulation of the airway or coughing and/or straining. We report bilateral parotid gland swelling in a middle-aged man after surgery under general anesthesia.