Pediatrician Perspectives on the Evaluation and Treatment of Acute Gastrointestinal Infections, Jeonbuk, South Korea, 2002

PURPOSE: This study was conducted to assess clinical practices related to the evaluation and treatment of patients with acute gastrointestinal infection(AGI) in infants and children. This survey also evaluated the current opinion regarding the use of rotavirus vaccine. METHODS: This survey was conducted using a self-administered questionnaire provided to 82 pediatricians in private clinics of Jeonbuk province. From April to June, 2002, 63 of 82 pediatricians(76.8 %) responded to the survey. RESULTS: The annual proportion of patients with AGI was 13%. The highest proportion of patients with diarrhea were reported for the months of October through December. For the treatment of diarrhea, pediatricians preferred to prescribe lactobacillus products, oral rehydration solution, enzyme products, anti-emetics, anti-diarrheal formula, nothing by mouth(NPO) and bowel movement inhibitors in descending order of frequency. Most pediatricians(79.4%) prescribed antibiotics in less than 20% of patients with AGI. Amoxicillin was the most commonly prescribed antibiotics followed by trimethoprim/sulfamethoxazole(TMP/SMX) and amoxicillin/clavulanate. Clinical manifestations that pediatricians considered as important factors in prescribing antibiotics were bloody diarrhea, mucoid diarrhea, high fever, persisting disease and abdominal pain. Diagnostic procedures that pediatricians preferred for AGI patients were stool examination(rotavirus antigen, RBC, WBC), abdominal X-ray, and serum electrolytes. Pediatricians had a strong interest in rotavirus vaccine(71.4%). CONCLUSIONS: Acute gastrointestinal illness remains a common problem, especially during the winter months in Korea. AGI manifesting as watery diarrhea is appropriately treated with commonly available agents but pediatricians appear ready to consider additional approaches to decrease the sizable disease burden of AGI among children in Korea.

Alteration of Growth Factor Expression after Acute Ischemic Renal Injury

PURPOSE: Regeneration and repair after ischemic renal injury appears to be modulated by circulating or locally produced growth factors. This study examined the changes of serum insulin like growth factor(IGF-I) and renal expression of IGF-I and II, vascular endothelial growth factor(VEGF), transforming growth factor-beta(TGF-beta), and connective tissue growth factor(CTGF) during the active regeneration period after acute ischemic injury. METHODS: Sera and kidney tissue samples(whole kidney, cortex, outer medullae and inner medullae) were obtained before and after one, three, five and seven days of 40 minutes bilateral renal pedicle clamping. Acute renal failure was assessed by measuring the concentration of serum creatinine. Serum IGF-I level was measured by radioimmunoassay. The mRNA expression in kidney was measured by RT-PCR. The distribution of IGF-I and CTGF was detected by immunohistochemistry. RESULTS: Serum IGF-I concentration after one day following acute ischemic renal injury was significantly decreased compared to preischemic value. The mRNA levels of IGF-I, IGF-II, TGF-beta1 and VEGF in whole kidney were temporally decreased on day one of ischemic injury. IGF-I and IGF-II expressions in outer medullae were significantly decreased on day one after ischemic injury. TGF- beta, CTGF and VEGF expressions were markedly decreased in medullae after one day of ischemic injury compared to other kidney sections. IGF-I was markedly decreased in cortical tubules on day one of uremic rat. CTGF was markedly increased on tubule within three days of ischemic injury. CONCLUSION: These findings suggest that IGFs, TGF-beta and CTGF may involve in the pathogenesis or the recovery from acute ischemic renal injury.