Effects of Vacuuming Mattresses on Allergic Rhinitis Symptoms in Children

PURPOSE: To evaluate the effects of daily vacuuming of mattresses on the concentration of house dust mite (HDM) allergens and on allergic rhinitis (AR) symptoms in children sensitized to HDM. METHODS: Forty children between the ages of 6 and 12 years with mild persistent AR and sensitized only to HDM were enrolled and randomly allocated to 2 groups. Caregivers of children in the experimental group cleaned the children's rooms and vacuumed their mattresses daily for 2 weeks. Caregivers of children in the control group cleaned the children's rooms without vacuuming mattresses. Symptoms of AR were checked weekly and dust samples were collected from the mattresses before and after the study. RESULTS: Demographics at the beginning of the study were not significantly different between the 2 groups. In the experimental group, symptoms of AR and dust weight were significantly decreased after 2 weeks (total symptoms of AR, P <0.001; sneezing, P < 0.001; rhinorrhea, P <0.001; nasal obstruction, P < 0.001; itching, P <0.001; and dust weight, P = 0.006). The concentrations of HDM allergens were not changed significantly (Der p1, P = 0.333; Der f1, P = 0.841). In the control group, there were no significant changes in symptoms of AR, dust weight, or the concentration of HDM allergens. CONCLUSIONS: Our findings showed that daily vacuuming of mattresses reduced dust weight and symptoms of AR. However, the concentration of HDM allergens did not significantly decrease.

Comparison of Cervical-lymph-node-first Presentation of Kawasaki Disease and Typical Kawasaki Disease

PURPOSE: The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease. METHODS: We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed. RESULTS: The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08). CONCLUSIONS: The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.

A Multicenter Retrospective Case Study of Anaphylaxis Triggers by Age in Korean Children

PURPOSE: Although anaphylaxis is recognized as an important, life-threatening condition, data are limited regarding its triggers in different age groups. We aimed to identify anaphylaxis triggers by age in Korean children. METHODS: We performed a retrospective review of medical records for children diagnosed with anaphylaxis between 2009 and 2013 in 23 secondary or tertiary hospitals in South Korea. RESULTS: A total of 991 cases (mean age=5.89±5.24) were reported, with 63.9% involving patients younger than 6 years of age and 66% involving male children. Food was the most common anaphylaxis trigger (74.7%), followed by drugs and radiocontrast media (10.7%), idiopathic factors (9.2%), and exercise (3.6%). The most common food allergen was milk (28.4%), followed by egg white (13.6%), walnut (8.0%), wheat (7.2%), buckwheat (6.5%), and peanut (6.2%). Milk and seafood were the most common anaphylaxis triggers in young and older children, respectively. Drug-triggered anaphylaxis was observed more frequently with increasing age, with antibiotics (34.9%) and nonsteroidal anti-inflammatory drugs (17.9%) being the most common causes. CONCLUSIONS: The most common anaphylaxis trigger in Korean children was food. Data on these triggers show that their relative frequency may vary by age.

In Reply: Treatment for Acute Tympanic Membrane Perforation

No abstract available.

Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis

PURPOSE: Breast-feeding is recommended to prevent allergies, particularly in high-risk infants, but the evidence of protective effects that breast-feeding has on food allergy (FA) remains elusive. The aim of this study was to investigate risk factors of FA and the association between breast-feeding and FA symptoms/food sensitization (FS) in children with atopic dermatitis under 2 years of age. METHODS: We reviewed the medical records of 384 children with atopic dermatitis under 2 years of age who visited our pediatric allergy clinic from March 1, 2009 through December 31, 2014. Symptoms of FA, feeding type, and family history of allergic disease were assessed. Laboratory tests were conducted, including serum total IgE, eosinophil (%), serum 25-hydroxyvitamin D, and specific IgE to egg white, milk, soy, peanut, and wheat. RESULTS: Subjects were divided into 3 groups based on FA symptoms and evidence of sensitization: The FA symptom group (n=240), no symptom group (n=53) and no FS group (n=91). The FA symptom group had a higher log total IgE level (2.0 vs. 1.3, P<0.001) and eosinophil (%) (7.0% vs. 4.7%, P=0.001) than the no FA symptom group. In multivariate analysis, breast-feeding was associated with FS (adjusted odds ratio [aOR], 2.43; 95% confidence intervals [CI], 1.03-5.74) but was not associated with FA symptoms (aOR, 0.65; 95% CI, 0.23-1.83). CONCLUSION: Breast-feeding may increase the risk of FS, but not immediate-type FA symptoms in children with atopic dermatitis.

An Unusual Cause of Acute Maxillary Sinusitis in a 9-year-old Child: Odontogenic Origin of Infected Dentigerous Cyst with Supernumerary Teeth

Acute maxillary sinusitis is a common disorder affecting children. Untreated acute sinusitis can develop into chronic sinusitis, and complications, such as orbital cellulitis or abscess, can occur. Maxillary sinusitis of odontogenic origin is not a well-recognized condition and is frequently missed in children. As an odontogenic source of sinusitis, the dentigerous cyst is one of the most prevalent types of odontogenic cysts, and it is associated with the crown of an unerupted or developing tooth. This report concerns a nine-year-old boy who was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. The boy visited our pediatric clinic presenting with rhinorrhea and nasal obstruction and was initially diagnosed with maxillary sinusitis only. With antibiotic treatment, his symptoms seemed to improve, but after 2 months, he came to our clinic with left facial swelling with persistent rhinorrhea and nasal obstruction. Radiographic examinations of the sinuses were performed, and he was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. After a surgical procedure involving the removal of the dentigerous cyst with supernumerary teeth, the symptoms of sinusitis gradually diminished. There are only very few cases in the pediatric medical literature that remind us that odontogenic origin can cause maxillary sinusitis in children. Our patient can act as a reminder to general pediatricians to include dentigerous cysts in the differential diagnosis of maxillary sinusitis.

Clinical Outcomes of Silk Patch in Acute Tympanic Membrane Perforation

OBJECTIVES: The silk patch is a thin transparent patch that is produced from silk fibroin. In this study, we investigated the treatment effects of the silk patch in patients with traumatic tympanic membrane perforation (TTMP). METHODS: The closure rate, otorrhea rate, and closure time in all patients and the closure time in successful patients were compared between the paper patch and silk patch groups. RESULTS: Demographic data (gender, site, age, traumatic duration, preoperative air-bone gap, and perforation size and location) were not significantly different between the two groups. The closure rate and otorrhea rate were not significantly different between the two groups. However, the closure time was different between the two groups (closure time of all patients, P=0.031; closure time of successful patients, P=0.037). CONCLUSION: The silk patch which has transparent, elastic, adhesive, and hyper-keratinizing properties results in a more efficient closure time than the paper patch in the treatment of TTMP patients. We therefore believe that the silk patch should be recommended for the treatment of acute tympanic membrane perforation.

Human Leukocyte Antigen-DRB1 Associations in Korean Juvenile Rheumatoid Arthritis

OBJECTIVE: The aim of this study is to investigate the association of different subgroups of juvenile rheumatoid arthritis (JRA) with human leukocyte antigen (HLA) class II DR alleles. METHODS: One hundred and nineteen Korean juvenile rheumatoid arthritis patients were classified as HLA-DRB1 allele. To assess the frequency, phenotype frequencies of all JRA cases and each subtypes were compared to those of 485 adult controls. RESULTS: HLA-DRB1*01 was associated with increased risk of JRA. Furthermore, DRB1*01 was associated with polyarticular JRA and pauciarticular JRA. The frequencies of DRB1*14 and DRB1*15 were higher in systemic JRA patients than the controls. CONCLUSION: The data of this study on Korean children with JRA suggests that HLA-DRB1*01 was associated with the susceptibility of JRA. The study should be extended to include larger numbers of patients.

Clinical and Epidemiological Study of 1,165 Hospitalized Cases of Rotaviral Gastroenteritis Before and After the Introduction of Rotavirus Vaccine, 2006-2013 / 소아감염

PURPOSE: This study was performed to assess the clinical and epidemiological changes after the introduction of the rotavirus vaccine in Korea, as well as to determine the efficacy of the rotavirus vaccine among hospitalized rotaviral gastroenteritis patients over the past two years. METHODS: We analyzed yearly and seasonal patterns of 1,165 inpatients who were hospitalized for rotaviral gastroenteritis under the age of 5 years between 2006 and 2013. We also conducted a survey among 460 gastroenteritis patients who were hospitalized between 2012 and 2013 regarding the rotavirus vaccination and the symptoms of gastroenteritis. Among those individuals surveyed, clinical indices were analyzed for 124 patients who were tested positive for the rotavirus antigen. RESULTS: The incidence of Rotaviral gastroenteritis have decreased significantly by year 2010. After the introduction and widespread dissemination of the rotavirus vaccine, the onset of the disease and the seasonal peak have been delayed. Overall, the vaccinated group showed a lower rate of positivity than the unvaccinated group. Among the hospitalized rotaviral gastroenteritis patients, the vaccinated group had a shorter hospitalization period, less severe clinical symptoms of gastroenteritis, and better laboratory test results. CONCLUSIONS: After introduction of the rotavirus vaccine in Korea, there were two main trends observed: 1) the overall level of disease incidence was reduced; 2) the severity of rotaviral gastroenteritis cases also decreased. Based on this data, more children should receive vaccination in order to prevent the rotavirus infection and decrease the severity of rotaviral gastroenteritis.

Intestinal Microflora and Atopy Development in Infants during the First Nine Months / 대한임상미생물학회지

BACKGROUND: The intestinal microflora varies according to the factors such as age, diet and environment. It is debated whether the changes of microbiota after birth are associated with atopic disease. The purpose of this study was to investigate colonization rates of some intestinal microflora during the initial 9 months after birth, and their association with the development of atopy. METHODS: Stool specimens were collected at 1, 3, 7 days and at 1, 2, 4, 6, 9 months after birth, and Escherichia coli, Lactobacillus, Bifidobacterium, Staphylococcus aureus were cultured with selective media. Diagnosis for atopy was accomplished via clinical history of atopy, serum total IgE, and skin prick test. RESULTS: By 12 months of age, among 48 infants, 36 (75.0%) were non-atopic while 12 (25.0%) had developed atopy. Although not statistically significant, the intestinal microflora of infants with atopy vs. non-atopy was characterized by being less often colonized with E. coli (12.5% vs. 52.4%; P=0.093) and S. aureus (0% vs. 38.1%; P=0.066) at three days after birth. Colonization rates of E. coli reached 50% after 3 days of birth in non-atopy group whereas this rate was not achieved until after 1 month in the atopy group. CONCLUSION: The intestinal colonization rates of bacteria in this study were not statistically different between atopy and non-atopy groups. Rapid colonization of E. coli and S. aureus was observed within 1 week after birth in the non-atopy group. The exact association between atopy and the bacterial colonization and/or diversity in the early days after birth has yet to be determined.

The Clinical Significance of Anti-cyclic Citrullinated Peptide Antibodies in Juvenile Rheumatoid Arthritis

OBJECTIVE: The aim of this study was to determine the clinical significance of anti-cyclic citrullinated peptide (anti-CCP) antibody in juvenile rheumatoid arthritis (JRA). METHODS: Sera for anti-CCP assay were obtained from 142 patients with arthralgia in our hospital during the period between November 2010 and October 2011. On the basis of medical records, 83 patients with JRA were designated to the study group, and 59 patients with arthralgia but were treated as transient arthritis to the control group. The values of anti-CCP were then analyzed retrospectively. We used the enzyme linked immunosorbent assay (ELISA) for detecting anti-CCP. RESULTS: Positive anti-CCP values were found in the sera of 11 patients with JRA (13.3%), one patient presented with pauciarticular JRA and the others with polyarticular JRA. There was a statistically significant difference in the anti-CCP values between the JRA group and the control group. However, patients with systemic JRA and arthralgia without JRA had no anti-CCP. Especially, 10 out of 14 (71.4%) patients with RF-positive polyarticular JRA had anti-CCP. In addition, the rate of positive anti-CCP was significantly higher in patients with polyarticular JRA than in the control group. CONCLUSION: We expect that the presence of anti-CCP may help to evaluate the severity of diseases in patients with JRA. Anti-CCP can be an important biomarker for making early intensive therapeutic decision in patients with polyarticular JRA, which might have more severe course and longer disease duration.

Erratum: Table 1, Table 3: Human Leukocyte Antigen-DRB1 Associations in Korean Juvenile Rheumatoid Arthritis

These are being published to correct the typo in Table 1 and Table 3.

Vitamin D insufficiency is associated with food sensitization in children under 2 years with atopic dermatitis

PURPOSE: Vitamin D levels are known to be associated with development of allergic diseases. However, existing data are controversial. The aim of this study was to investigate whether vitamin D levels are associated with food sensitization (FS) in young children with atopic dermatitis (AD). METHODS: We performed a medical record review of all patients under 2 years presenting to pediatric allergic clinic in Hallym University Sacred Heart Hospital for atopic dermatitis between March 1, 2012 and February 28, 2013. Serum 25-hydroxyvitamin D (25(OH)D)levels and six specific immunoglobulin E (IgE) to common food allergens were measured in 132 young children with AD. We defined vitamin D insufficiency was 25(OH)D or =0.35 IU/mL to any of six common food allergens. Associations between serum 25(OH)D levels and FS were examined by using multiple logistic regression, adjusting for potential risk and confounding factors. RESULTS: The mean age was 10.1 months. Among the 132 children with AD, 65.9% had FS. In this group, there was a negative correlation between 25(OH)D levels and serum eosinophil percentage (correlation coefficient [r]=-0.335, P<0.01), but not correlated with serum total IgE levels. Children with vitamin D insufficiency were more likely to have FS (adjusted odds ratio, 17.1; 95% confidence interval, 1.36 to 215; P=0.028) than those with adequate vitamin D levels. CONCLUSION: Vitamin D insufficiency is associated with FS in young children with AD. Further research is needed to confirm these findings.

Renal Insufficiency Secondary to Leukemic Infiltration in Chronic Lymphocytic Leukemia: A Case Report / 대한내과학회지

Renal infiltration is common in chronic lymphocytic leukemia (CLL), but renal impairment caused by leukemic infiltration is rare. This report describes the case of a 38-year-old man with CLL who required no medical treatment for 1 year and was admitted with nonoliguric renal insufficiency (proteinuria > 2,000 mg/day). A renal biopsy subsequently revealed leukemic infiltration by CLL. Treatment with fludarabine plus cyclophosphamide resulted in the improvement of renal function. Leukemic infiltration should be considered in the differential diagnosis of a patient with CLL and impaired renal function because renal impairment often responds well to chemotherapy.

Multicenter Study on Factors Influencing the Quality of Life of Asthmatic Children and Their Caregivers / 소아알레르기및호흡기학회지

PURPOSE: Pediatric asthma is the most common chronic disease in children. It negatively affects the health-related quality of life (QoL) in children with this disease and of their caregivers. This study evaluated the relationship between clinical disease severity and the QoL of patients with asthma and their caregivers. METHODS: The study included 247 patients with asthma and their caregivers. The patients and caregivers completed the Korean Pediatric Asthma Quality of Life Questionnaire and the Korean Pediatric Asthma Caregivers Quality of Life Questionnaire, respectively, during clinic visits. The results were expressed as the mean score for each domain. All items were rated from 1 to 5: 1, low QoL; and 5, satisfactory QoL. RESULTS: The emotion and activity QoL scores of boys were significantly higher than those of girls (P=0.001). The QoL of both patients and their caregivers was correlated more with the patients' subjective symptom scores than with the clinical severity of asthma or with lung function. CONCLUSION: The QoL of patients with asthma and their caregivers decreased as asthmatic symptoms became worse. Controlling asthma symptoms is important for improving the QoL of both patients and their caregivers. Patients and their caregivers need to be evaluated and counseled during asthma treatment to improve their QoL.

The role of the Korean Hospital Association in Korea's healthcare accreditation system

One way to improve quality and safety in healthcare organizations is through accreditation. The Hospital Standardization Programme (HSP) started by the Korean Hospital Association (KHA) in 1981 was the first hospital accreditation body in Korea. The KHA developed the HSP into the Hospital Accreditation Programme (HAP) in 2003, which was designed to evaluate the quality of physicians' training, hospital facilities, and systems. In 2004, the Association adopted a Pass/Fail system by medical department. The introduction of the HAP has a significant meaning in the history of Korean healthcare policy. First, through self-regulating assessment, the HAP plays a major role not only in improving Korean healthcare services but also in establishing mutual confidence between healthcare providers and customers. Secondly, the HAP became the starting point of the quality assurance movement in hospital services, which transformed the mainstream of healthcare services from quantitative change to qualitative change. In response to customer demand, several healthcare evaluation programs such as the Hospital Performance Evaluation Programme (1995-1999), Healthcare Organization Evaluation Programme (2004-2009), and Korea Healthcare Accreditation System (2010-present) have been adopted. In implementing those healthcare evaluation systems, the KHA has played a critical role. Moreover, the KHA plans to revise the HAP Survey Forms, reducing areas overlapping with KHAS and enhancing the training programs to produce the best qualified medical specialists who will provide the best medical services to customers.

A Case of Pulmonary Paragonimiasis with Involvement of the Abdominal Muscle in a 9-Year-Old Girl

In Korea, many people enjoy eating raw or underkooked freshwater crayfish and crabs which unfortunately may cause paragonimiasis. Here, we describe a case of pulmonary and abdominal paragonimiasis in a 9-year-old girl, who presented with a 1-month history of abdominal pain, especially in the right flank and the right inguinal area, with anorexia. A chest radiograph revealed pleural effusion in both lungs, and her abdominal sonography indicated an inflammatory lesion in the right psoas muscle. Peripheral blood analysis of the patient showed hypereosinophilia (66.0%) and an elevated total serum IgE level (>2,500 IU/ml). The pleural effusion tested by ELISA were also positive for antibodies against paragonimiasis. Her dietary history stated that she had ingested raw freshwater crab, 4 months previously. The diagnosis was pulmonary paragonimiasis accompanied by abdominal muscle involvement. She was improved after 5 cycles of praziquantel treatment and 2 times of pleural effusion drainage. In conclusion, herein, we report a case of pulmonary and abdominal paragonimiasis in a girl who presented with abdominal pain and tenderness in the inguinal area.

Multicenter Analysis of the Current Status of Unproved Complementary/Alternative Medicine Other than Herbal Medication in Allergy Patients / 대한내과학회지

BACKGROUND/AIMS: The use of unproven complementary/alternative medicine (CAM) to treat allergies is popular in Korea. We conducted a multicenter survey of the current use of CAM other than herbal medication in Korean allergy patients. METHODS: This study enrolled 510 adults with allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, from ten hospitals. They underwent a structured questionnaire interview and clinical assessment of the prevalence, motivation, costs, and subjective assessment of CAM. RESULTS: Of the patients, 16.7% used at least one type of CAM to treat their allergic diseases. Common types of CAM were diet (48.6%), aroma therapy (23.8%), massage (14.3%), breathing exercises (7.6%), baths (5.7%), and mind control (5.7%). The therapeutic effects of CAM included "improved" in patients using mind control (50%), diet (50%), breathing exercises (75%), and baths (33.3%), but "worse" in patients using aroma therapy (28%), and massage (26.7%). About 36.4% of the patients used CAM more than four times per year, and the average cost per CAM user was 370,000 won/year. The main reason for trying CAM was 'hope to improve my constitution'. CONCLUSIONS: CAM is used widely for treating allergic diseases in Korea. Detailed knowledge of CAM and patient education are important. Further studies of the clinical efficacy of CAM are needed.

Clinical Review of the of Seizures among Children

PURPOSE: The purpose of this study was to evaluate childhood seizures to provide appropriate medical services. METHODS: We retrospectively reviewed the medical records of 221 chidren under 18 years of age with seizures (excluding febrile convulsion), who were admitted to the pediatric department of Sacred Heart Hospital, Hallym University from 2007 to 2009. RESULTS: The male to female was 1.3:1 and the peak age was 6 years or less, accounting for 63%. The most common causes of seizures according to age were listed as follows; hypocalcemia (41%) and hypoxic ischemic encephalopathies (41%) in the neonatal period, benign convulsion with mild gastroenteritis (BCwMG, 47%) in preschool children (1month and 5 years), and unprovoked seizure (80%) more than 6 years. Electroencephalogram and neuroimaging abnormalities were found in the ratio from 20% and 14% respectively. CONCLUSION: Seizure is the most common neurologic disease in the childhood. The above results reveal that the causes of childhood seizures in the different age group are different. Therefore, the exact diagnosis of disease according to age is needed. We hope that further clinical studies on this topic will be performed.

Isolation of Healthcare-Associated Pathogens from Cellular Phones Used by Medical Personnel / 병원감염관리

BACKGROUND: Cellular phone has become a necessary device for communicating in hospitals. Cellular phones contaminated with bacteria may serve as a fomite in the transmission of pathogens by the hands of medical personnel. We investigated the bacterial contamination of cellular phones used by medical personnel in a tertiary hospital. METHODS: Culture swabs were obtained from 101 cellular phones and 99 anterior nasal cavities from medical personnel using cellular phones. The swabs were inoculated on blood agar, MacConkey agar, mannitol salt agar, and enterococcal broths containing 6microgram/mL vancomycin for 48 h at 37degrees C. The bacteria were identified on the basis of colony morphology, gram staining characteristics, catalase test, coagulase test, and DNase test; Microscan (Siemens, USA) was used for the identification of enterococci. RESULTS: Of the 101 cellular phones, 13 were contaminated with Staphylococcus aureus (including 4 methicillin-resistant S. aureus [MRSA]), 61 with coagulase-negative staphylococci (CoNS) (including 38 methicillin-resistant CoNS), 27 with Micrococcus spp., 11 with diphtheroids, 67 with Bacillus spp., and 4 with viridans streptococci. No gram-negative bacilli were isolated. Nasal swabs yielded 36 S. aureus, including 9 MRSA. Only 1 of 9 cellular phones used by the MRSA carriers was contaminated with MRSA. CONCLUSION: Cellular phones used by some medical personnel were contaminated with pathogens such as S. aureus or MRSA. Although, the clinical implications of pathogens isolated from cellular phones have not been fully investigated, pathogens could be transmitted by the hands of medical personnel who are cellular phone users.