Occurrence and characterization of oseltamivir-resistant influenza virus in children between 2007-2008 and 2008-2009 seasons / 소아과

PURPOSE: There was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B). METHODS: A prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients. RESULTS: There was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1. CONCLUSION: Establishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required.

Change of interictal epileptiform discharges after antiepiletic drug treatment in childhood epilepsy / 소아과

PURPOSE: Electroencephalography (EEG) findings can play a critical role in a variety of decisions, including initiation and withdrawal of antiepileptic drugs (AEDs) therapy. Interictal epileptiform discharges (IEDs) are predictor of recurrent seizures. We investigated IEDs in EEG after AED therapy and related factors in epileptic children. METHODS: The subjects were 257 children [151 males and 106 females; age, 6.79 (3.40) years; duration of therapy, 2.48 (1.85) years] diagnosed with epilepsy at the Department of Pediatrics, Pusan National University Hospital between January 2001 and December 2007, who received AEDs for more than 6 months. EEG was performed at the intervals of 6-12 months. We divided patients into 4 groups according to IED detection before and after AEDs treatment. Related clinical factors, including gender, age at the start of treatment, seizure type, cause of seizure, AED frequency, seizure control, duration of AED therapy, and background activity were investigated in the 4 groups. RESULTS: Generalized epilepsy was relatively frequen in patients who did not show IEDs in last follow-up EEG. There were no clinically significant differences according to gender, age at the start of treatment, cause of seizure, AED frequency, seizure control, duration of AED medication, and background activity in the 4 groups (P>0.05). CONCLUSION: IEDs changed after AED treatment in one-third of the patients. Generalized epilepsy is positive factor for negative IEDs in last follow-up EEG.

The Effect of Valproic Acid on Serum Total Cholesterol Level in Children with Epilepsy

PURPOSE: Weight gain is a known side effect of valproic acid(VPA), which is associated with change of serum total cholesterol(TC) level. However, there are controversies on the correlation between VPA and serum TC. This investigation was undertaken to evaluate the change of TC level in children with epilepsy on long-term VPA monotherapy and the related factors. METHODS: Epileptic patients on VPA monotherapy for more than one year were recruited at the Department of Pediatrics, Pusan National University Hospital. The body mass index (BMI) and TC before and after VPA treatment were obtained from all patients. We analyzed the change of serum TC according to dosage of VPA, serum drug level and other clinical data such as gender, age at start of treatment, type of seizure, etiology of seizure, duration of VPA medication and BMI. which could affect the serum TC. RESULTS: 82 children(49 male and 33 female) were included in this study. Mean serum TC of pre- and post-VPA medication was 153.5+/-31.0 mg/dL and 158.1+/-30.2 mg/dL(P>0.05), respectively. There were no clinically significant changes of serum TC level according to dosage of VPA, serum drug level and other clinical data such as gender, age at start of treatment, seizure type, etiology of seizure, duration of VPA medication and BMI(P>0.05). CONCLUSION: Our results suggest that long-term VPA medication does not affect serum TC, and overweight at pre-VPA medication is not a risk factor.