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Purpose@#To evaluate the postoperative changes in macular vessel density and the multifocal electroretinogram (mfERG) in the epiretinal membrane (ERM) of a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). And we compared these results with those of idiopathic ERM.Method: We retrospectively reviewed the records of 15 patients (15 eyes) with an epiretinal membrane of a CHRRPE, and 21 patients (21 eyes) with idiopathic ERM who were treated with pars plana vitrectomy and removal of the ERM. The best corrected visual acuity, central macula thickness, foveal and perifoveal vessel density, foveal avascular zone (FAZ), and mfERG rings 1 and 2 P1 amplitudes were analyzed before and 6 months after ERM removal. @*Results@#The average macular vessel density in the CHRRPE with ERM was reduced (p = 0.047) compared to an idiopathic epiretinal membrane, but the central foveal vessel density was significantly increased (p = 0.003). In CHRRPE, the preoperative FAZ was significantly reduced, and while it increased significantly 6 months postoperatively. After removing the ERM, the P1 amplitude increased significantly on mfERG, but there was no significant difference compared to the idiopathic ERM. @*Conclusions@#The macular mean superficial capillary plexus (SCP) vascular density was reduced in CHRRPE and the foveal SCP vascular density and FAZ were increased. Considering the increased size of the FAZ area after surgery, physical removal of the ERM affected the structural recovery of the fovea, but resulted in no significant improvement of the macular superficial microvascular system.
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Purpose@#This study aimed to evaluate the effectiveness of simulation-based education on communication and clinical judgment in nursing students and nurses. @*Methods@#A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Seven databases were searched to obtain articles published in Korean or English. Of 12,864 articles reviewed, 36 were included in a systematic review and 23 in a meta-analysis. To estimate the size of the effects of simulation-based education, a meta-analysis was performed using the R package meta program. The risk of bias was assessed using RoB 2.0 and ROBINS-I. @*Results@#The effect sizes (ES) of simulation-based education on communication and clinical judgment were ES=0.77, 95% confidence interval (95% CI)=0.43 to 1.12 on communication-related variables and ES=1.84, 95% CI=1.03 to 2.65 on clinical judgment. @*Conclusion@#Simulation-based education for nursing students and nurses is useful for improving their communication and clinical judgment. Thus, it is necessary to develop and apply simulation-based education programs for nursing students and nurses to improve their abilities in communications and clinical judgment.
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Purpose@#Pediatric drug poisoning is a frequent reason for emergency department (ED) visits. Considering the increasing number of mental illnesses in adolescents, it has become a serious public health problem. We aimed to investigate the drug poisoning in the ED. @*Methods@#We retrospectively analyzed children aged 1-17 years with diagnostic codes related to drug poisoning who visited the ED from January 1, 2010 through October 7, 2022. Exclusion criteria were non-pharmaceutical poisoning, insufficient data, and poisoning via respiratory, dermal or ocular route. Baseline characteristics, clinical manifestations, and outcomes of drug poisoning were analyzed in the study population, according to intention of poisoning and drug category. @*Results@#A total of 197 cases of 161 children were analyzed. Compared with non-intentional poisoning, intentional poisoning was associated a higher age, a longer time from ingestion to visit, and higher proportions of girls, antipyretics/analgesics or psychotropic drugs, symptoms related to the gastrointestinal, neurologic or cardiopulmonary systems (P = 0.034), psychiatric comorbidity, multiple drug ingestion, suicide attempt, decontamination (P = 0.017), the use of antidote, history of drug poisoning, and hospitalization (P = 0.004; all other Ps < 0.001). Acetaminophen, a representative of antipyretics/analgesics, was associated with a longer time from ingestion to visit and higher proportions of girls (P = 0.004), the presence of initial gastrointestinal symptoms, suicide attempt (P = 0.001), the use of antidote, and hospitalization (all other Ps < 0.001). Psychotropic drug was associated with higher proportions of psychiatric comorbidity (P < 0.001) and multiple drug ingestion (P = 0.012). @*Conclusion@#This study will enable pediatricians or emergency physicians to obtain an overview of the management of drug poisoning in EDs.
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Thyroid hormone plays a vital role in regulating human metabolism. They affect the functions of major organs, such as the brain, liver, skeletal muscle, and heart. Hypothyroidism can lead to dilated cardiomyopathy and decreased heart function. In this report, we describe a case of a teenage boy who developed dilated cardiomyopathy due to hypothyroidism and was considered to undergo heart transplantation. Levothyroxine monotherapy was initiated but produced no improvement. Thereafter, a combination therapy of liothyronine and levothyroxine was administered, and heart function was gradually restored; he recovered completely after 6 months. Cardiac myocytes respond more specifically to liothyronine than to levothyroxine. Therefore, we suggest that liothyronine and levothyroxine combination therapy should be considered rather than levothyroxine monotherapy for hypothyroidism accompanied by heart disease.
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Purpose@#To determine the postoperative changes in vessel density according to macular hole and macular pseudohole (MPH) subtypes and to investigate the differences in the mechanisms underlying their development. We also investigated whether changes in vessel density are correlated with changes in the multifocal electroretinogram (mfERG) and best corrected visual acuity (BCVA). @*Methods@#We reviewed the medical records of patients with MPH or a macular hole who underwent pars plana vitrectomy. We included 15 eyes of 15 patients with a full thickness macular hole (FTMH), nine eyes of nine patients with a tractional lamellar macular hole (LMH), eight eyes of eight patients with a degenerative LMH, and nine eyes of eight patients with a MPH. The BCVA, foveal avascular zone (FAZ), foveal and parafoveal vessel density, and mfERG ring 1 and ring 2 P1 amplitudes were analyzed before and 1 and 6 months after surgery. @*Results@#One month postoperatively, the foveal vessel density of patients with a MPH or tractional LMH increased (p = 0.011, p = 0.008). The parafoveal vessel density of patients with a MPH, tractional LMH, and FTMH increased (p = 0.007, p = 0.038, p = 0.031). There was no significant increase in foveal or parafoveal vessel density in patients with a degenerative LMH (p = 0.201, p = 0.171). There was a significant correlation between the change in parafoveal vessel density and that in BCVA 6 months postoperatively in patients with a FTMH (r = -0.543, p = 0.037). @*Conclusions@#By assessing changes in vessel density after vitrectomy, it is possible to estimate the effect of traction according to the type of macular hole. There was a significant correlation between parafoveal vessel density and BCVA in patients with a FTMH. Restoration of the retinal structure and vessel density might improve visual acuity.
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BACKGROUND@#Hair follicles are among a handful of organs that exhibit immune privilege. Dysfunction of the hair follicle immune system underlies the development of inflammatory diseases, such as alopecia areata. @*METHODS@#Quantitative reverse transcription PCR and immunostaining was used to confirm the expression of major histocompatibility complex class I in human dermal papilla cells. Through transcriptomic analyses of human keratinocyte stem cells, major histocompatibility complex class I was identified as differentially expressed genes. Organ culture and patch assay were performed to assess the ability of WNT3a conditioned media to rescue immune privilege. Lastly, CD8? T cells were detected near the hair bulb in alopecia areata patients through immunohistochemistry. @*RESULTS@#Inflammatory factors such as tumor necrosis factor alpha and interferon gamma were verified to induce the expression of major histocompatibility complex class I proteins in dermal papilla cells. Additionally, loss of immune privilege of hair follicles was rescued following treatment with conditioned media from outer root sheath cells. Transcriptomic analyses found 58 up-regulated genes and 183 down-regulated genes related in MHC class I? cells. Using newborn hair patch assay, we demonstrated that WNT3a conditioned media with epidermal growth factor can restore hair growth. In alopecia areata patients, CD8? T cells were increased during the transition from mid-anagen to late catagen. @*CONCLUSION@#Identification of mechanisms governing epithelial and mesenchymal interactions of the hair follicle facilitates an improved understanding of the regulation of hair follicle immune privilege.
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Purpose@#The purpose of this study was to evaluate the effect of axial length and anterior chamber depth in vitrectomy and intraocular lens intrascleral fixation with a fibrin adhesive. @*Methods@#The study retrospectively reviewed 61 eyes of 61 patients, who were followed up for over 6 months after surgery. The patients were divided into three groups according to their axial length: group 1, 25 mm. The patients were further divided into three sub-groups according to their anterior chamber depth: group A, 3.6 mm. We measured and analyzed the best-corrected visual acuity, spherical value, cylindrical value, and spherical equivalent of each group before surgery and at 6 months postoperatively. @*Results@#When comparing the groups preoperatively and postoperatively, the best-corrected visual acuity, spherical value, and spherical equivalent showed significant improvement in all groups (p < 0.05). The incidence of complications, such as haptic slippage and intraocular lens dislocation, increased with the axial length and anterior chamber depth. @*Conclusions@#The use of fibrin adhesive for intraocular lens intrascleral fixation improves visual acuity and reduces refractive error. Postoperatively, there was no significant change in cylindrical value. Because axial length and anterior chamber depth affect refractive error, both should be considered in correlation with the surgical method.
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Purpose@#The prevalence and risk factors of neovascular glaucoma (NVG) after diabetic vitrectomy were evaluated. @*Methods@#This retrospective study included 171 eyes of 141 patients who underwent diabetic vitrectomy in-hospital between March 2013 and July 2019 and were followed for >12 months postoperatively. Regardless of the presence or absence of neovascularization in the anterior segment, all patients received injections of intravitreal bevacizumab during vitrectomy. Patients with preoperative neovascularization in iris (NVI) or angle (NVA) received both intracameral and intravitreal bevacizumab injections. Data were collected regarding baseline demographics, preoperative best-corrected visual acuity, intraocular pressure, hypertension, NVG in the fellow eye, panretinal photocoagulation history, iris and angle neovascularization, and postoperative findings (e.g., rebleeding and residual retinal detachment). @*Results@#In total, 141 patients and 171 eyes were included in the study, and the incidence of postoperative NVG was 5.85% (10 patients). Five patients (27.78%) with preoperative NVI or NVA developed postoperative NVG. Significant risk factors for postoperative NVG were preoperative NVA or NVI (odds ratio [OR] = 16.428, p = 0.003), shorter diabetic duration (OR = 0.853, p = 0.033), and the absence of preoperative panretinal photocoagulation (OR = 0.006, p = 0.035). @*Conclusions@#There is a high possibility of postoperative NVG in patients with preoperative NVI or NVA, a short duration of diabetes, and no preoperative panretinal photocoagulation. In such patients, close monitoring is required after diabetic vitrectomy.
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Background and Objectives@#Biomarkers of allergic rhinitis (AR) have been studied; however, little is known regarding their practical application in the diagnosis of AR. Previous studies collected samples using saline lavage, nasal brushing, or nasal biopsy. To utilize nasal fluid as a diagnostic tool, we need to standardize the method of sample collection. Therefore, this study aimed to evaluate the difference in concentration of biomarkers depending on the method of nasal fluid collection.Materials and Method: Forty-five AR patients who had greater than moderate AR symptoms and who had positive results on skin prick test and serum-specific IgE tests were enrolled in this study. Nasal fluid was collected using the direct method or saline lavage method. The concentration of each biomarker was analyzed using enzyme-linked immunosorbent assay and the values compared. @*Results@#Nasal fluid samples were collected directly from 14 patients and were collected via saline lavage in 31 patients. No significant differences were found in the median value of each biomarker between the two methods of nasal sample collection. @*Conclusion@#Nasal fluid collection method does not significantly affect biomarker concentration.
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Purpose@#The purpose of this study was to evaluate the effect of axial length and anterior chamber depth in vitrectomy and intraocular lens intrascleral fixation with a fibrin adhesive. @*Methods@#The study retrospectively reviewed 61 eyes of 61 patients, who were followed up for over 6 months after surgery. The patients were divided into three groups according to their axial length: group 1, 25 mm. The patients were further divided into three sub-groups according to their anterior chamber depth: group A, 3.6 mm. We measured and analyzed the best-corrected visual acuity, spherical value, cylindrical value, and spherical equivalent of each group before surgery and at 6 months postoperatively. @*Results@#When comparing the groups preoperatively and postoperatively, the best-corrected visual acuity, spherical value, and spherical equivalent showed significant improvement in all groups (p < 0.05). The incidence of complications, such as haptic slippage and intraocular lens dislocation, increased with the axial length and anterior chamber depth. @*Conclusions@#The use of fibrin adhesive for intraocular lens intrascleral fixation improves visual acuity and reduces refractive error. Postoperatively, there was no significant change in cylindrical value. Because axial length and anterior chamber depth affect refractive error, both should be considered in correlation with the surgical method.
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Purpose@#The prevalence and risk factors of neovascular glaucoma (NVG) after diabetic vitrectomy were evaluated. @*Methods@#This retrospective study included 171 eyes of 141 patients who underwent diabetic vitrectomy in-hospital between March 2013 and July 2019 and were followed for >12 months postoperatively. Regardless of the presence or absence of neovascularization in the anterior segment, all patients received injections of intravitreal bevacizumab during vitrectomy. Patients with preoperative neovascularization in iris (NVI) or angle (NVA) received both intracameral and intravitreal bevacizumab injections. Data were collected regarding baseline demographics, preoperative best-corrected visual acuity, intraocular pressure, hypertension, NVG in the fellow eye, panretinal photocoagulation history, iris and angle neovascularization, and postoperative findings (e.g., rebleeding and residual retinal detachment). @*Results@#In total, 141 patients and 171 eyes were included in the study, and the incidence of postoperative NVG was 5.85% (10 patients). Five patients (27.78%) with preoperative NVI or NVA developed postoperative NVG. Significant risk factors for postoperative NVG were preoperative NVA or NVI (odds ratio [OR] = 16.428, p = 0.003), shorter diabetic duration (OR = 0.853, p = 0.033), and the absence of preoperative panretinal photocoagulation (OR = 0.006, p = 0.035). @*Conclusions@#There is a high possibility of postoperative NVG in patients with preoperative NVI or NVA, a short duration of diabetes, and no preoperative panretinal photocoagulation. In such patients, close monitoring is required after diabetic vitrectomy.
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Background and Objectives@#Biomarkers of allergic rhinitis (AR) have been studied; however, little is known regarding their practical application in the diagnosis of AR. Previous studies collected samples using saline lavage, nasal brushing, or nasal biopsy. To utilize nasal fluid as a diagnostic tool, we need to standardize the method of sample collection. Therefore, this study aimed to evaluate the difference in concentration of biomarkers depending on the method of nasal fluid collection.Materials and Method: Forty-five AR patients who had greater than moderate AR symptoms and who had positive results on skin prick test and serum-specific IgE tests were enrolled in this study. Nasal fluid was collected using the direct method or saline lavage method. The concentration of each biomarker was analyzed using enzyme-linked immunosorbent assay and the values compared. @*Results@#Nasal fluid samples were collected directly from 14 patients and were collected via saline lavage in 31 patients. No significant differences were found in the median value of each biomarker between the two methods of nasal sample collection. @*Conclusion@#Nasal fluid collection method does not significantly affect biomarker concentration.
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Purpose@#To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy.Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy-dispersive X-ray spectroscopy. @*Conclusions@#This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.
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Purpose@#To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy.Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy-dispersive X-ray spectroscopy. @*Conclusions@#This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.
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Purpose@#To investigate the clinical outcomes of refixation of a dislocated intraocular lens (IOL) and IOL exchange with intrascleral fixation. @*Methods@#We performed a retrospective study of 90 patients (91 eyes) who underwent refixation or exchange of IOLs from January 2014 to April 2019. The patients were divided into an ab externo scleral refixation group (group 1), an intrascleral refixation group (group 2), and an exchange with intrascleral fixation group (group 3). We evaluated the best-corrected visual acuity (BCVA), spherical equivalent, cylindrical power, intraocular pressure, and postoperative complications. @*Results@#The BCVA was 0.10 ± 0.17 (group 1), 0.15 ± 0.29 (group 2), and 0.31 ± 0.52 (group 3) at 6 months after surgery. The BCVA change in group 3 was significantly greater than that in groups 1 and 2 (p = 0.018 and p = 0.046, respectively). The final BCVA was not significantly different among the groups (p = 0.422). The spherical equivalent was -1.26 ± 1.72 diopters (D) (group 1), -1.32 ± 2.09 D (group 2), and -0.17 ± 1.58 D (group 3) at 6 months after surgery, showing that group 1 and group 2 were more myopic than group 3 (p = 0.004 and p = 0.001, respectively). Haptic slippage was the most common complication. @*Conclusions@#Refixation of dislocated IOLs and IOL exchange with intrascleral fixation did not differ significantly in terms of the final visual outcomes. Refixation was associated with more myopia and a higher risk of IOL dislocation or haptic slippage than exchange.
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PURPOSE: To evaluate the changes in choroidal thickness and superficial vascular density of the macula and optic disc using optical coherence tomography angiography after laser photocoagulation. METHODS: We conducted a retrospective chart review of 25 eyes of diabetic retinopathy patients who underwent panretinal photocoagulation. The macula and optic disc were divided into nine areas, and the vascular density of each area was quantitatively measured using optical coherence tomography angiography. The changes in vascular density and choroidal thickness were analyzed before laser photocoagulation and at 1 week after, 1 month after, and 3 months after treatment. RESULTS: In the panretinal photocoagulation group, the average vascular densities of the macula were 13.5 ± 3.6 mm⁻¹ before treatment, and 14.7 ± 3.1 mm⁻¹ after 1 week, 13.7 ± 2.6 mm⁻¹ after 1 month, and 12.8 ± 3.8 mm⁻¹ after 3 months of treatment. The average vascular densities of the optic disc were 14.7 ± 5.2 mm⁻¹ before treatment, and 14.1 ± 4.7 mm⁻¹ after 1 week, 14.8 ± 5.3 mm⁻¹ after 1 month, and 15.0 ± 4.7 mm⁻¹ after 3 months of treatment. The average subfoveal choroidal thicknesses were 327.5 ± 57.9 µm before treatment, and 334.4 ± 52.5 µm after 1 week, 291.2 ± 52.9 µm after 1 month, and 286.3 ± 44.4 µm after 3 months of treatment. CONCLUSIONS: The vascular density of the macula increased temporarily after 1 week of treatment but decreased afterwards. The vascular density of the optic disc decreased after 1 week of laser treatment but increased over time. The subfoveal choroidal thickness increased after 1 week of laser treatment but decreased afterwards.
Subject(s)
Humans , Angiography , Choroid , Diabetic Retinopathy , Light Coagulation , Retrospective Studies , Tomography, Optical CoherenceABSTRACT
PURPOSE: Floppy infants or congenital hypotonia indicates decreased muscle tone in infants secondary to abnormalities of the central or the peripheral nervous system, or both. Previous literature classified its causes as those attributable to a central vs. peripheral origin; however, recent studies have introduced a newer classification describing a combined origin. We invenstigated floppy infants by applying the new etiological classification and reviewed the most common etiologies based on the age of presentation. We additionally reviewed the clinical characteristics, diagnoses, and the developmental outcomes in these infants. METHODS: We retrospectively reviewed the electronic medical charts and recruited 116 infants diagnosed with floppy infant syndrome between January 2005 and December 2016 at Severance Children's Hospital. Among these infants, 66 with a confirmed diagnosis were reviewed for the etiological classification. Information regarding developmental outcomes was obtained via phone interviews with the infants' families. RESULTS: Based on the new etiological classification, among 69 infants with a confirmed diagnosis, in 40 (34.5%) this syndrome was of central origin, in 19 (16.4%) of peripheral origin, and in 10 (8.6%) of combined origin. Prader-Willi syndrome, myotonic dystrophy, and spinal muscular atrophy were the most common disorders observed and combined hypotonia showed the poorest developmental outcome. CONCLUSION: The study states the importance of proper evaluation of etiological diagnosis and optimal intervention for developmental prognosis. The introduction of a new etiological group of combined hypotonia especially emphasizes regular monitoring and timely rehabilitative intervention in patients for the better quality of life in them as well as their caregivers.
Subject(s)
Humans , Infant , Caregivers , Classification , Diagnosis , Muscle Hypotonia , Muscular Atrophy, Spinal , Myotonic Dystrophy , Peripheral Nervous System , Prader-Willi Syndrome , Prognosis , Quality of Life , Retrospective StudiesABSTRACT
Cyclophosphamide-induced cardiotoxicity is an uncommon complication especially in patients who have never undergone mediastinal irradiation or cardiotoxic chemotherapy and do not have underlying cardiac diseases. Here, we describe the case of a 19-year-old female with chronic myeloid leukemia. She was previously treated with oral tyrosine kinase inhibitors and developed cardiomyopathy after receiving infusion of 60 mg/kg intravenous cyclophosphamide for two days with a conditioning regimen for allogenic hematopoietic stem cell transplantation. Severe thickening of the left ventricle and reduced ejection fraction without triggering agents were characteristic for cyclophosphamide-induced cardiomyopathy. Her NT-pro BNP and troponin T concentrations surged to >70,000 pg/mL (0=130 pg/mL) and 2,031 pg/mL (0-14 pg/mL), respectively, during the course of the therapy and multiple organ failure seemed imminent evidenced by unresponsive decline in blood pressure. However, with close monitoring and persistent conservative management which consisted of intravenous hydration, continuous hemodialysis, and mechanical ventilation, her condition recovered.
Subject(s)
Female , Humans , Young Adult , Blood Pressure , Cardiomyopathies , Cardiotoxicity , Cyclophosphamide , Drug Therapy , Heart Diseases , Heart Failure , Heart Ventricles , Heart , Hematopoietic Stem Cell Transplantation , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Multiple Organ Failure , Protein-Tyrosine Kinases , Renal Dialysis , Respiration, Artificial , Troponin TABSTRACT
BACKGROUND: Comprehensive clinical and radiologic follow-up is needed to preserve joint functions and quality of life in hemophilia using clinimetric tools such as Hemophilia joint health score (HJHS) or Pettersson score (PS). We investigated the joint health status evaluated using the tools in Korean hemophilia patients. METHODS: We reviewed retrospectively medical records to collect clinical parameters, HJHS and PS, who were followed up in Severance Hospital, Seoul, Korea. The correlation between HJHS and PS, and the effect of the prophylaxis for hemophilia on the outcomes measured with the scores were evaluated. The prophylaxis proportion (PP) was calculated as the proportion of prophylaxis duration to each patient's life time. RESULTS: Total of 28 patients with severe hemophilia were enrolled. Twelve patients (42.8%) were less than 20 years old. Total of 23 patients had experienced prophylaxis during their lives, and median PP was 39.7%. There was significant correlation between HJHS and PS (P 20 years old. CONCLUSION: HJHS and PS were positively correlated. Each score increased as the patient's age increased. The prophylaxis had protective effect on joint health. The prospective evaluation of HJHS and PS will be needed to prove the effect of proper management on the joint health status.
Subject(s)
Humans , Follow-Up Studies , Health Status , Hemophilia A , Joints , Korea , Medical Records , Patient Outcome Assessment , Prospective Studies , Quality of Life , Retrospective Studies , SeoulABSTRACT
OBJECTIVES: To analyze laryngopharyngeal reflux (LPR) as an acidic, nonacidic, or mixed type according to 24-hour multi-channel intraluminal impedance (MII) pH monitoring and the clinical characteristics of each type. METHODS: Ninety patients were prospectively enrolled in this study. All patients underwent 24-hour MII pH monitoring as a diagnostic tool. Eighty-three patients were diagnosed with LPR. The patients were classified into three groups according to the pH of the hypopharyngeal probe: the acid reflux group, nonacid reflux group, and mixed reflux group. Subjective symptoms and objective findings were evaluated based on patients' responses to the Short Form 12 Survey (SF-12), LPR health-related quality of life (LPR-HRQOL), reflux symptom index, and reflux finding score. RESULTS: The results of each group were compared. As a result, 34 patients were classified into the nonacid reflux group and 49 into the mixed reflux group. There were no patients classified as having acid reflux alone. There was no significant difference between the two groups when comparing the reflux symptom index, reflux finding score, LPR-HRQOL, or the mental component score of the SF-12. However, the physical component score of the SF-12 was higher in the nonacid reflux group (P=0.018). The DeMeester composite score (P=0.015) and total number of LPR events (P=0.001) were lower in the nonacid reflux group than in the mixed reflux group. CONCLUSION: In conclusion, no LPR patient had only acid reflux. The nonacid reflux LPR patients showed similar clinical characteristics and findings compared to the mixed reflux group, but exhibited significantly fewer LPR episodes.