Iodine status and characteristics of Korean adolescents and their parents based on urinary iodine concentration: a nationwide cross-sectional study

PURPOSE: Iodine is a major component of thyroid hormones. Both deficiency and excess of iodine are major risk factors for thyroid disease, making it important to accurately assess iodine level in the human body. Urinary iodine concentration (UIC) is a commonly used measure of iodine status. However, there is little research on iodine status and related characteristics in Korean adolescents. METHODS: Using data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI) for the years 2013–2015, we analyzed UIC and thyroid function test results in adolescents aged 10–18 years and their parents. We also investigated the influence of socioeconomic factors and family history of thyroid disease on iodine status. RESULTS: Mean UIC in Korean adolescents was 963.5±55.7 μg/L. Among evaluated subjects, 6.6%±1.0%, 29.8%±1.7%, and 63.9%±1.9% had low (UIC<100 μg/L), adequate (UIC: 100–299.9 μg/L), and excess (UIC≥300 μg/L) iodine concentrations, respectively. Based on regional trends, the incidence of iodine deficiency exceeded 10% in several regions, even though there was a dominance of regions with excess iodine. Parental UIC, female sex, average monthly income, and expenditure were all found to affect the iodine status of Korean adolescents. CONCLUSIONS: Although regional differences exist, the iodine status in Korean adolescents is mainly affected by the eating habits of their families and socioeconomic factors. Therefore, monitoring of iodine status is necessary in this population.

Family History as a Risk Factor for Iron Deficiency Anemia among Korean Adolescents: Data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES) / 임상소아혈액종양

BACKGROUND: Iron deficiency anemia (IDA) is a disease prevalent throughout the world. However, there is limited information regarding whether familial factors are associated with the risk of adolescent IDA. METHODS: This study evaluated the association between adolescent IDA and family history of IDA using data from the fifth Korea National Health Nutrition Survey (2010–2012). Data from 10-18-year-old children who underwent laboratory testing were analyzed. RESULTS: The overall prevalence of IDA was 3.1% (95% confidence interval [CI]: 2.4−4.1%), with prevalence of 0.5% among boys (95% CI: 0.2−1.3%) and 6.2% among girls (95% CI: 4.6−8.3%). The prevalence of IDA was associated with female sex (odds ratio [OR]: 13.43, 95% CI: 4.92−36.65; P < 0.001) and a family history of IDA (OR: 3.12, 95% CI: 1.11−8.76; P=0.03). Other risk factors for IDA were receiving social welfare support (OR: 3.31, 95% CI: 1.45−7.56; P=0.031), low maternal education (OR: 3.12, 95% CI: 1.39−6.99; P=0.006), receiving charitable food support (OR: 2.27: 95% CI: 0.9−5.44; P=0.04), poor body-image (OR: 2.14, 95% CI: 1.16−3.93; P=0.026), and weight-loss efforts (OR: 2.42, 95% CI: 1.27−4.61; P=0.01). Nutritional supplementation protected against IDA (OR: 0.40, 95% CI: 0.19−0.82; P=0.007), although adolescents with awareness of nutritional labels had a high IDA prevalence (OR: 8.06, 95% CI: 1.71−38.05; P < 0.001). CONCLUSION: A family history of IDA was an independent risk factor for IDA. Further studies are needed to determine whether family-level educational interventions can reduce the risk of adolescent IDA.

Analysis of pediatric adverse drug reactions reported to regional pharmacovigilance center of a single university hospital

PURPOSE: Adverse drug reactions (ADRs) are a recurring problem among pediatric patients, and the incidence is increasing. However, there have been only a few studies on the clinical presentation of pediatric ADRs in Korea. This study investigated the clinical presentation of ADRs and the causative drugs in pediatric patients from a single university hospital. METHODS: We retrospectively collected the data on pediatric ADRs as reported to the Regional Pharmacovigilance Center in Dong-A University Hospital between March 2013 and July 2016. We analyzed clinical presentations associated with the events. To determinate causality, we evaluated each ADR according to the Naranjo probability scale, the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria and the Korean ADR algorithm. RESULTS: A total of 365 ADR cases were reported. Sixty-eight patients (26.5%) responded to 2 or more drugs. Antibiotics (43.3%) were the most common causative drugs, of whom the third generation cephalosphorins caused most ADRs. The most common clinical presentations were gastrointestinal manifestations (36.6%). A total of 312 ADRs were reported in 257 patients based on both the Naranjo probability scale and the Korean ADR algorithm. In addition, 323 ADRs were reported in 257 patients based on the WHO-UMC criteria. CONCLUSION: Various drugs are related to ADRs in pediatric patients. Further efforts to improve ADR-reporting systems and to increase awareness of ADRs in pediatric patients are needed.

Factors associated with the treatment of chronic spontaneous urticaria in children

PURPOSE: Chronic spontaneous urticaria (CSU) in children is a common skin disorder, but its clinical course varies. We investigated the clinical course and associated factors for CSU treatment in children. METHODS: A total of 107 children, diagnosed with CSU from 2001 to 2016 in Dong-A University Hospital, who had been followed up for more than 6 months after treatment, were enrolled. The laboratory findings, and clinical aspects and courses were retrospectively investigated by a medical record review. We divided the 152 patients into 3 groups according to the treatment modalities: group 1, 1 antihistamine; group 2, more than 2 kinds of antihistamines; and group 3, antihistamines plus leukotriene receptor antagonist. RESULTS: The mean age of patients in group 3 was 3.4 years (range, 2.6–4.2 years), which was significantly lower than those at the other 2 group patients (P=0.01). The urticaria activity score (UAS) of group 3 (6.1 [5.7–6.6]) was significantly higher compared to those of the other 2 groups (P=0.01). The improvement rate of the condition in children with positive specific immunoglobulin E (sIgE) reactivity to food or inhalant allergens was significantly lower than that of children with negative sIgE reactivity (P=0.01). Sex, age, history of allergic diseases, disease duration, UAS, previous treatment, and treatment modality were not correlated with the symptom improvement rate. CONCLUSION: Younger children and those with higher UAS needed more medication to ensure the improvement in symptoms. Moreover, it took more time for the improvement in symptoms in children who were sensitized to food or inhalant allergens.

Continuous Distal Ileostomy Drip Feeding with the Secretion of the Proximal Stoma in a Neonate with IIIa Ileal Atresia / 대한소아소화기영양학회지

Short-bowel syndrome is functionally defined as a state of malabsorption following loss of small bowel, which comprises the sequelae of nutrient, fluid, and weight loss. The proximal segment of the bowel of a patient with intestinal atresia is usually grossly distended and atonic. In contrast, distal segment is smaller. For this reason, anastomosis of the proximal and the distal segment is technically difficult and may cause no propulsion even when they are anastomosed. We experienced that continuous drip ileostomy feeding with the secretions from the proximal stoma stimulated the distal bowel to accommodate and resolved many sequelae following loss of small bowel in a patient with short-bowel syndrome due to IIIa ileal atresia.

Clinical Significance of Dual-probe Esophageal pH Monitoring in Pathological Gastroesophageal Reflux Disease with Recurrent Respiratory Symptoms / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to determine clinical significance of dual-probe esophageal pH monitoring and to compare four pH monitoring parameters between proximal and distal esophagus in pathological gastroesophageal reflux disease with recurrent respiratory symptoms. METHODS: Among the thirty-four patients who were performed 24 hr pH monitoring, seventeen patients with pathological distal reflux were classified into two groups: Group I (n:12) had recurrent respiratory symptoms and Group II (n:5) hadn't recurrent respiratory symptoms. The ambulatory dual-probe esophageal pH monitoring was performed for 18~24 hr. A pathologic GER was defined when reflux index (percent of the investigation time a pH<4) exceeded the 95th percentile of normal value. RESULTS: Among the sixteen patients with recurrent respiratory symptoms, twelve patients (75%) have pathological distal reflux. Whereas among the eighteen patients without recurrent respiratory symptom, five patients (28%) have pathological distal reflux. In the Group I, the significant differences between proximal and distal esophageal pH recordings persisted for all parameters, but didn't persist in group II except for longest episode. Comparing esophageal pH four parameters between group I and group II at the proximal esophageal site, all parameters didn't show statistically significant differences. CONCLUSION: Regardless of respiratory symptoms, patients with pathological distal reflux didn't show statistically significant differences in the all parameters at the proximal esophageal site. Therefore we may reconsider usefulness of dual probe pH meter in patients with recurrent respiratory symptoms.

A Case of Fetal Valproate Syndrome Associated with Both Elbow Joint Contractures

Fetal valproate syndrome has been described as a distinctive pattern of minor anomalies of the face and digits. This pattern has not been delineated completely but appears to involve brachycephaly with a high forehead, shallow orbit, ocular hypertelorism, small nose, small mouth, low set posteriorly rotated ears, long overlapping fingers and toes, and hyperconvex fingernail. Cleft palate and congenital heart disease have occasionally been described in babies exposed to valproate during embryogenesis. We report a neonate born from an epileptic mother receiving sodium valproate during pregnancy. This neonate presented with characteristic facial abnormalities, both elbow contractures, and overlapping of right first and second toe, forth and fifth toe, and left first and second toe. This case raises the possibility that these abnormal appearances might be caused by intrauterine valproate exposure.