ABSTRACT
Social (pragmatic) communication disorder (SCD) is a new diagnosis included under communication disorders in the neurodevelopmental disorders section of Diagnostic and Statistical Manual of Mental Disorders-5. SCD is defined as a primary deficit in the social use of nonverbal and verbal communication. SCD has very much in common with pragmatic language impairment, which is characterized by difficulties in understanding and using language in context and following the social rules of language, despite relative strengths in word knowledge and grammar. SCD and Autism Spectrum Disorder (ASD) are similar in that they both involve deficits in social communication skills, however individuals with SCD do not demonstrate restricted interests, repetitive behaviors, insistence on sameness, or sensory abnormalities. It is essential to rule out a diagnosis of ASD by verifying the lack of these additional symptoms, current or past. The criteria for SCD are qualitatively different from those of ASD and are not equivalent to those of mild ASD. It is clinically important that SCD should be differentiated from high-functioning ASD (such as Asperger syndrome) and nonverbal learning disabilities. The ultimate goals are the refinement of the conceptualization, development and validation of assessment tools and interventions, and obtaining a comprehensive understanding of the shared and unique etiologic factors for SCD in relation to those of other neurodevelopmental disorders.
Subject(s)
Autism Spectrum Disorder , Communication Disorders , Diagnosis , Learning Disabilities , Neurodevelopmental Disorders , Social Communication DisorderABSTRACT
OBJECTIVES: Early intensive interventions are very important for children with autism spectrum disorder. We examined the actual conditions of hospital-based early intensive interventions for autism spectrum disorder in Seoul, in order to help develop and implement an evidence-based early intensive intervention model for use in Korea. METHODS: Nine hospital-based institutes running an early intensive intervention program for children with autism spectrum disorder responded to a questionnaire in September 2014. They provided a brief introduction to their program, explained its theoretical bases, and reported the number of children, their age, intervention time, duration and so on. RESULTS: In the majority of the institutions, the intervention was provided for over 20 hours every week, and the theoretical bases included various applied behavioral analysis (ABA) methods and other therapies (language and occupational therapy). The therapist-child ratio ranged from 1:1 to 5:3. Various types of therapists were involved, including behavioral analysts, special education teachers and (or) language pathologists. There was only one clinic where the behavioral analyst was the main therapist. Usually, the intervention was terminated just before the child entered elementary school. The main merit of the hospital-based intervention in our survey was the effectiveness of the multi-disciplinary intervention plan and its other merits were the accuracy of the diagnosis, its ability to be combined with medicine, and so on. CONCLUSION: The current hospital-based early intensive intervention programs provide interventions for over 20 hours per week and employ multidisciplinary approaches. However, there are very few institutes for children with autism and very few intervention specialists and specialist education courses in the country. We need more educational programs for intervention therapists and have to try to develop policies which encourage the implementation of an evidence-based early intensive intervention program nationwide.
Subject(s)
Child , Humans , Academies and Institutes , Autism Spectrum Disorder , Autistic Disorder , Diagnosis , Education , Education, Special , Korea , Running , Seoul , SpecializationABSTRACT
Developmental disorders such as mental retardation, autism spectrum disorders, and learning disorders are frequently associated with attention-deficit/hyperactivity disorder (ADHD) symptoms such as inattention, hyperactivity, and impulsivity. The existing data for the pharmacological treatment of ADHD symptoms with developmental disorders suggest that the agents used to treat ADHD in typically developing children appear to have some benefit. However, the risks of treatment including side effect in these population appear to be greater than in typically developing children. Therefore, when considering pharmacotherapy for developmental disorders with ADHD symptoms, a cautious approach of starting with a low dosage and close monitoring of side effect are recommended.
Subject(s)
Child , Humans , Autism Spectrum Disorder , Intellectual Disability , Learning DisabilitiesABSTRACT
Developmental disorders such as mental retardation, autism spectrum disorders, and learning disorders are frequently associated with attention-deficit/hyperactivity disorder (ADHD) symptoms such as inattention, hyperactivity, and impulsivity. The existing data for the pharmacological treatment of ADHD symptoms with developmental disorders suggest that the agents used to treat ADHD in typically developing children appear to have some benefit. However, the risks of treatment including side effect in these population appear to be greater than in typically developing children. Therefore, when considering pharmacotherapy for developmental disorders with ADHD symptoms, a cautious approach of starting with a low dosage and close monitoring of side effect are recommended.
Subject(s)
Child , Humans , Autism Spectrum Disorder , Intellectual Disability , Learning DisabilitiesABSTRACT
Asperger syndrome (AS) is a disorder of early childhood characterized by impaired social interaction, communication difficulties, play and imagination deficits and a range of routines and rituals. A review of the literature explores current issues concerning the diagnosis of AS. Despite its increasing popularity as a distinct condition, it seems to be still controversial to what extent AS differs from high-functioning autism. Especially in European perspectives, AS is a variant of autism typically occurring in high-functioning individuals, and not a separate disorder. However, the validity of AS as a different diagnostic entity has been recognized through several lines of evidence in the US. AS and nonverbal learning disabilities are often confused with some authors and practitioners not differentiating at all, others perceiving as different points along a continuum, and still others seeing them as different, albeit overlapping, disorders. The major difference is that AS is a pervasive developmental disorder, with chronically restricted repetitive and stereotyped patterns of behavior, interests, and activities, which are far beyond the narrow range of activities, social awkwardness, and slightly eccentric behaviors that are sometimes found individuals with nonverbal learning disabilities.
Subject(s)
Asperger Syndrome , Autistic Disorder , Ceremonial Behavior , Imagination , Interpersonal Relations , Learning DisabilitiesABSTRACT
BACKGROUND: Atherosclerotic cardiovascular disease and metabolic syndrome are both rapidly increasing in Koreans due to the new westernized eating habits and the aging of the population. The pulse wave velocity (PWV) reflects arterial stiffness and it may be used as an indicator of atherosclerosis. This study was conducted to investigate the association of the PWV with metabolic syndrome. METHODS: Among 1438 persons who visited the Internal Medicine Clinic or Health Center of a general hospital in Seoul, Korea, 384 adults (age range: 30-69 years old) were selected as study subjects. Those patients with cardiovascular disease or other systemic disease were excluded, but the patients with hypertension and diabetes mellitus were included. Ninety four (25.4%) subjects were classified as patients with metabolic syndrome when jointly applying the WHO Asia-Pacific criteria and NCEP ATPIII criteria. RESULTS: The PWV was higher in the older aged group and in the men compared to the other group. The greater the number of diagnostic criteria of the metabolic syndrome subjects had, the higher was their PWV. After adjustment for age, gender, blood pressure, BMI and fasting blood glucose, a PWV change of 1.0 m/sec increased the risk of metabolic syndrome by 1.31 times (95% CI: 0.81-2.09). The risk of metabolic syndrome was 7.62 times higher among the subjects with a PWV greater than 7.5 m/sec (95% CI: 1.07-54.42), as compared with that of subjects with a PWV less than 7.5 m/sec. CONCLUSIONS: The PWV may independently increase the risk of metabolic syndrome as a non-linear pattern. A prospective study needs to be conducted to confirm the meaning of PWV as a risk factor for metabolic syndrome, and especially to determine the cut off point.
Subject(s)
Adult , Humans , Male , Aging , Atherosclerosis , Blood Glucose , Blood Pressure , Cardiovascular Diseases , Diabetes Mellitus , Eating , Fasting , Hospitals, General , Hypertension , Internal Medicine , Korea , Prospective Studies , Pulse Wave Analysis , Risk Factors , Seoul , Vascular StiffnessABSTRACT
BACKGROUDN: In end-stage renal disease (ESRD) patients, cardiovascular disease (CVD) is a major cause of morbidity and mortality. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Several studies suggest that lowering plasma homocysteine may improve endothelial dysfunction, a marker of atherothrombotic risk. Pulse wave velocity (PWV) is a useful diagnostic tool to access endothelial dysfunction, and is widely used screening test for atherosclerosis. METHODS: We measured fasting total plasma homocysteine (tHcy) in 84 hemodialysis patients and 21 peritoneal dialysis patients. Subjects were assigned to two groups. Group I (tHcy or =20 umol/L) consisted of 26 ESRD patients who have taken high dose folate (5 mg/day). For 15 Group I patients and 5 Group II patients, pulse wave doppler velocity (PWV) measurements were taken before and after 3 months of folate treatment. RESULTS: The mean tHcy concentration was higher in the ESRD patients (82 HD: 16.9+/-6.4 mol/L, 20 PD: 18.0+/-16.7 mol/L). The pulse wave velocity (PWV) was faster in ESRD patients-19 HD: Aorta (Ao)-PWV 8.98+/-1.4, lower extremities (LE)-PWV 10.15+/-1.3, upper extremities (UE)-PWV 8.80+/-0.8 (m/s); 8 PD: Ao-PWV 9.32+/-1.8, LE-PWV 10.64+/-1.4, UE-PWV 9.24+/-0.7 (m/s). The PWV increased in ESRD patients with coronary heart disease and who had a history of angioplasty because of thrombosis or stenosis of vascular access. There was a significant reduction in hyperhomocysteinemia after 3 months in the high dose folate supplement group as compared to the usual dose folate supplement group with a significant statistical difference between the two groups. (15 Group I patients: 13.9+/-4.9 mol/L->13.5+/-6.1 for 5 Group II patients: 34.3+/-27.5 mol/L->23.0+/-5.9 mol/L (p0.05, paired t-test). CONCLUSIONS: We assume that PWV and homocysteine concentration have some correlation and both studies are available as part of screening tests for atherosclerosis in ESRD. Although no significant interval change was detected for the PWV, this finding suggests that high-dose folate supplementation was helpful to minimize the risk of cardiovascular disease associated with hyperhomocysteinemia in ESRD patients.
Subject(s)
Humans , Angioplasty , Aorta , Atherosclerosis , Blood Flow Velocity , Cardiovascular Diseases , Constriction, Pathologic , Coronary Disease , Fasting , Folic Acid , Homocysteine , Hyperhomocysteinemia , Kidney Failure, Chronic , Lower Extremity , Mass Screening , Mortality , Peritoneal Dialysis , Plasma , Pulse Wave Analysis , Renal Dialysis , Risk Factors , Thrombosis , Upper ExtremityABSTRACT
Candida albicans as being ubiquitous human commensals produce a broad range infections depending on host immunity and its virulency, ranging from usually local mucous membrane infection to disseminated fatal candidiasis with multisystem organ failure. Recently, candidiasis of deep organ are an increasingly important nosocomial infection. Candida lung abscess is rare relatively. Most commonly, it has been stated that they are found accompanied by hematogenously disseminated candidiasis particularly in immuno- suppressed patient. Primary lung abscess caused by C. albicans has been reported in less then 15 case in worldwide, and therapeutic guideline is poorly defined. We experienced a case of a primary lung abscess by C. albicans which may developed after aspiration of oropharyngeal contents as the mechanism of entry in a malnourished elderly patient and which was treated successfully with drainage of the abscess following by administration of fluconazole for 4 weeks. Herein we report the case with a review of the literature.
Subject(s)
Aged , Humans , Abscess , Candida albicans , Candida , Candidiasis , Cross Infection , Drainage , Fluconazole , Lung Abscess , Lung , Malnutrition , Mucous MembraneABSTRACT
Burkholderia cepacia is an important opportunistic pathogen in immunocompromised and nosocomial patients, but this bacterial infection is rare in Korea. We report a case of Burkholderia cepacia peritonitis in a patient on CAPD. A 69-year-old male on CAPD for 5 years was presented with turbid peritoneal dialysate, diffuse abdominal pain and diarrhea. He was treated initially with intraperitoneal cefazolin and ceftazidime, and then intraperitoneal meropenem and oral TMP/SMX. His symptoms had improved with antibiotic treatment, but white blood cell counts of dialysate increased, instead. Burkholderia cepacia was isoloated from peritoneal fluid culture. The patient refused catheter removal in spite of our recommendation. He died of suddenly developed acute myocardial infarction and upper gastrointestinal bleeding. Catether tip culture also revealed Burkholderia cepacia.
Subject(s)
Aged , Humans , Male , Abdominal Pain , Ascitic Fluid , Bacterial Infections , Burkholderia cepacia , Burkholderia , Catheters , Cefazolin , Ceftazidime , Diarrhea , Hemorrhage , Korea , Leukocyte Count , Myocardial Infarction , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , PeritonitisABSTRACT
OBJECTIVES: Recent studies in autistic brain samples have shown diminished acetylcholine and nicotinic receptor activity. We hypothesized that acetylcholinergic enhancement may pharmacologically improve some autistic characteristics. Donepezil hydrochloride, a cholinesterase inhibitor, was studied in few studies which showed improvement in the expressive and receptive speech of autistic children. We therefore undertook an open label trial to evaluate this effect on speech function in Korean autistic children. METHODS: Twenty-one patients (18 males, 3 females, average age 77.9+/-23.7 months), with a diagnosis of autism spectrum disorder enrolled in a 12-week open label trial of donepezil hydrochloride. Changes were evaluated by PLS (Preschool language scale). Testing was administered at baseline and at 12-week follow-up. RESULTS: Test administered at baseline and at 12-week follow-up showed gains in both expressive and receptive speech functions. CONCLUSION: Donepezil hydrochloride, a cholinesterase inhibitor, appears to improve expressive and receptive speech functions of autistic children.
Subject(s)
Child , Female , Humans , Male , Acetylcholine , Autistic Disorder , Brain , Autism Spectrum Disorder , Cholinesterases , Diagnosis , Follow-Up Studies , Receptors, NicotinicABSTRACT
Lung adenocarcinoma is the cancer originated in terminal bronchiole or alveolar epithelium and its incidence is on the increase. The most common radiologic pattern of lung adenocarcinoma is peripheral nodule or mass, but it can be showed various findings such as hilar mass, consolidation, atelectasis or multicentric lesions. Sometimes it is difficult to differentiate lung adenocarcinoma from other diseases, especially pneumonia. We experienced three patients with lung adenocarcinoma, just only presented as pneumonic consolidation on chest X-ray and CT scan. The clinician should consider seriously lung adenocarcinoma including bronchioloalveolar carcinoma in patients who did not respond to antibiotics. And in such cases, pathologic diagnosis must be perfomed at proper time to confirm disease.