Delta neutrophil index as a predictor of vesicoureteral reflux in children with febrile urinary tract infection

Purpose@#Delta neutrophil index (DNI) indicates immature granulocytes in peripheral blood and has been confirmed to be effective as a prognostic factor for neonatal sepsis. Also, it has been reported to have diagnostic value in acute pyelonephritis and in predicting vesicoureteral reflux (VUR) in the infant. We conducted the study to verify whether DNI is also helpful in the entire pediatric age group with febrile urinary tract infection (UTI). @*Methods@#Medical records of children hospitalized for febrile UTIs were analyzed retrospectively. All subjects underwent kidney ultrasound and voiding cystourethrography. In the group with and without VUR, we compared sex and age, and the following laboratory values: the white blood cell count, neutrophil, polymorphonuclear leucocyte, eosinophil, hemoglobin, platelet count, C-reactive protein, DNI value, and the finding of ultrasound. @*Results@#A total of 315 patients (163 males and 152 females; range, 0–127 months) were eligible, and 41 patients (13%) had VUR. As a result of univariate analysis, the white blood cell count, neutrophil, DNI, and ultrasonic abnormalities were high in the reflux group, and the hemoglobin and lymphocyte fraction values were low. The value of DNI and the abnormal ultrasound were significantly higher in the reflux group on the multivariate analysis. The area under the curve value of the receiver operating curve was higher in DNI (0.640; 95% confidence interval, 0.536–0.744; P=0.004), and the DNI cutoff value for VUR prediction was 1.85%. @*Conclusions@#We identified that ultrasound findings and DNI values were helpful predictors of VUR in pediatric febrile UTIs.

Factors Influencing Patient Safety Nursing Activities of Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: The purposes of this study were to examine the levels of job stress, perceptions of the patient safety culture, and patient safety nursing activities, and to identify factors influencing patient safety nursing activities among intensive care unit (ICU) nurses. @*Methods@#: For this cross-sectional study, data were collected from 161ICU nurses working in two university-affiliated hospitals in Gyeonggi-do between June 30 and July 30, 2020.The data were analyzed with descriptive statistics, an independent t-test, a one-way ANOVA, the Pearsoncorrelation method, and multiple regression using the SPSS program. @*Results@#: The average levels of job stress, perception of patient safety culture, and patient safety nursing activities were 3.48, 3.44, and 4.45 out of 5, respectively. Multiple regression showed that perception of patient safety culture and career in current workplace were found to be statistically significant correlates of patient safety nursing activities. @*Conclusion@#: In order to promote patient safety nursing activities, patient safety culture needs to be incorporated into the education of ICU nurses. Perception of patient safety should be enhanced to improve patients safety nursing activity.

Factors Influencing Patient Safety Nursing Activities of Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: The purposes of this study were to examine the levels of job stress, perceptions of the patient safety culture, and patient safety nursing activities, and to identify factors influencing patient safety nursing activities among intensive care unit (ICU) nurses. @*Methods@#: For this cross-sectional study, data were collected from 161ICU nurses working in two university-affiliated hospitals in Gyeonggi-do between June 30 and July 30, 2020.The data were analyzed with descriptive statistics, an independent t-test, a one-way ANOVA, the Pearsoncorrelation method, and multiple regression using the SPSS program. @*Results@#: The average levels of job stress, perception of patient safety culture, and patient safety nursing activities were 3.48, 3.44, and 4.45 out of 5, respectively. Multiple regression showed that perception of patient safety culture and career in current workplace were found to be statistically significant correlates of patient safety nursing activities. @*Conclusion@#: In order to promote patient safety nursing activities, patient safety culture needs to be incorporated into the education of ICU nurses. Perception of patient safety should be enhanced to improve patients safety nursing activity.

Status of Oral Care according to the Type of Surgery for Inpatients at Dental Hospitals / 치위생과학회지

Background@#The aim of this study was to understand the importance of professional oral care for inpatients by examining the type and frequency of surgery and hospital discharge period at dental hospitals, and identify the types of professional oral care actually in progress. @*Methods@#In this study, the type of surgery and length of hospitalization were investigated among patients admitted to the dental hospital for oral and maxillofacial surgery, and the professional oral care status of inpatients who had difficulty self-managing their oral care was retrospectively identified by collecting data on oral care before and after surgery, including the type and frequency. @*Results@#The majority of inpatients at dental hospitals were male (57.6%), elderly patients over 60 years accounted for 20% of patients, and the average length of hospitalization was 4 days. In the 20s (aged 20∼29 y), the number of orthognathic surgery patients (73.1%) was high, and the incidence of cysts was high in middle-aged patients. Regarding the oral care of hospitalized patients, scaling was performed once by a dentist before surgery. After surgery, surgical dressings using H2O2 balls were applied and oral care education was introduced before discharge. @*Conclusion@#Based on the results of this study, professional oral care is essential to prevent infection and complications caused by oral bacteria among inpatients at dental hospitals. It is necessary to use various oral hygiene aids for inpatients and to conduct effective oral care instruction according to each patient’s situation. In addition, it is necessary to raise awareness and the role of dental hygienists in professional oral care.

A study on stress experiences of Korean veterinary students

The quality of a veterinary service depends on the veterinarian’s physical and mental health. However, a veterinarian’s mental health is generally considered to be more vulnerable than that of other health care professionals. As many veterinary students will enter the veterinary profession in near future, it is necessary to investigate their psychological status. This study examined stressors affecting student life in one veterinary school. Anxiety, depression, and stress levels were assessed using questionnaires and qualitative research techniques. The results obtained from questionnaires showed that the proportion of veterinary students with psychological distress was higher than expected. The major stressors experienced by the veterinary students were academic, economic, and environmental. Qualitative study using a photovoice method revealed that the students in this study felt relatively deprived compared with those in other veterinary schools. In addition, they were distressed by the school environment and limited human relationship. Our results suggest that veterinary school administrators should be aware of students’ psychological distress and should undertake systematic improvement in their educational system by altering counseling programs, curricula, and school culture principles.

Withaferin A Inhibits Helicobacter pylori-induced Production of IL-1beta in Dendritic Cells by Regulating NF-kappaB and NLRP3 Inflammasome Activation

Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer, and gastric cancer. There is evidence that IL-1beta is associated with the development of gastric cancer. Therefore, downregulation of H. pylori-mediated IL-1beta production may be a way to prevent gastric cancer. Withaferin A (WA), a withanolide purified from Withania somnifera, is known to exert anti-inflammatory and anti-tumor effects. In the present study, we explored the inhibitory activity of WA on H. pylori-induced production of IL-1beta in murine bone marrow-derived dendritic cells (BMDCs) and the underlying cellular mechanism. Co-treatment with WA decreased IL-1beta production by H. pylori in BMDCs in a dose-dependent manner. H. pylori-induced gene expression of IL-1beta and NLRP3 (NOD-like receptor family, pyrin domain containing 3) were also suppressed by WA treatment. Moreover, IkappaB-alpha phosphorylation by H. pylori infection was suppressed by WA in BMDCs. Western blot analysis revealed that H. pylori induced cleavage of caspase-1 and IL-1beta, as well as increased procaspase-1 and pro IL-1beta protein levels, and that both were suppressed by co-treatment with WA. Finally, we determined whether WA can directly inhibit ac tivation of the NLRP3 inflammasome. NLRP3 activators induced IL-1beta secretion in LPS-primed macrophages, which was inhibited by WA in a dose-dependent manner, whereas IL-6 production was not affected by WA. Moreover, cleavage of IL-1beta and caspase-1 by NLRP3 activators was also dose-dependently inhibited by WA. These findings suggest that WA can inhibit IL-1beta production by H. pylori in dendritic cells and can be used as a new preventive and therapeutic agent for gastric cancer.

A Case of Metastatic Renal Cell Carcinoma to the Maxillary Sinus Treated with Tyrosine Kinase Inhibitor / 대한이비인후과학회지

Renal cell carcinoma is a rare metastatic malignant neoplasm of the paranasal sinus. The clinical picture and radiologic findings might sometimes be insufficient to suspect metastatic renal cell carcinoma. Therefore, the definite diagnosis should be made according to the result of intraoperative biopsy. Recently, tyrosine kinase inhibitor, sunitinib, is considered as an effective agent in the treatment of metastatic renal cell carcinoma. We report a case of 69-year-old patient with metastatic renal cell carcinoma of the right maxillary sinus with accompanying fungal sinusitis. After 6 times of chemotherapy with sunitinib malate, there was no sign of recurrence or local advancement of the tumor during the 1-year follow-up period.

A case of huge extramedullary plasmacytoma arising from both nasal cavity

A 52-year-old patients suffering from nasal stuffiness had necrotic, ulcerative polypoid mass in both nasal cavity. CT and MRI revealed bilateral polypoid mass with bony invasion in left maxillary anterior and posterior wall, left pterygopalatine fossa and right central skull base. The patient was diagnosed as plasmacytoma by histologic examination. To rule out multiple myeloma, several additive studies such as bone scan, bone marrow biopsy, urine Bence-Jons protein, serum protein electrophoresis, peripheral blood smear were performed and all results were negative. The patient was transferred to department of hemato-oncology and got 2 times of chemotherapy consisting of cyclophosphamide and dexamethasone and radiotherapy (5400 cGy / 30 fractionation). A month after the completion of chemoradiotherapy, the sized of mass decreased significantly without evidence of progression.

Severe airway obstruction in an infant with congenital tracheal stenosis and congenital heart disease: A case report / 대한마취과학회지

Congenital tracheal stenosis (CTS), though rare, is important because the mortality and morbidity rates are high in infants. Especially, associated congenital heart disease (CHD) in these infants may compound the effects of airway pathology. A 3-week-old patient with long-segmental tracheal stenosis below an anomalous right-upper lobe (RUL) bronchus had undergone a total correction of double outlet right ventricle. On third postoperative day, hypercarbia developed, and severe airway obstruction and atelectasis were detected. An emergency slide tracheoplasty was performed under cardiopulmonary bypass (CPB). The patient recovered well after the surgery. Thus, special attention needs to be paid during the postoperative intensive care of patients with congenital tracheal anomalies. Early detection and prompt diagnosis of airway obstruction can help reduce the morbidity and mortality rates. Further, it is important to select the suitable treatment of CTS associated with CHD.

Clinical Characteristics of Pediatric Dizziness / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Pediatric dizziness is difficult to diagnose because of the nonspecific nature of symptom, and difficulty in history taking, physical examination or diagnostic tests. The authors tried to analyze the proportion of diseases in children suffering from dizziness, and introduce cases with atypical clinical characteristics and uncommon diagnosis. MATERIALS AND METHODS: The medical records of 53 pediatric patients suffering from dizziness were analyzed retrospectively. We analyzed the findings of history taking, physical examination for nystagmus and cerebellar function, pure tone audiogram and caloric tests in all patients. RESULTS: Diagnosis of migrainous vertigo was most common (32.7%), followed by psychological cause (11.5%) and labyrinthitis due to the otitis media (7.7%). Cases of cerebellar hemangioblastoma, neurofibromatosis and drug intoxication were also found. CONCLUSION: The clinical characteristics and causative diseases of pediatric dizziness are different from those of adults. Appropriate history taking and diagnostic tests are improtant for differential diagnosis.

Influence of Head Position in Rotation Test / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Rotation test is a widely used method to evaluate the function of the vestibular system. Generally, the head position to be tilted forwards 30degrees during rotation is preferred in order to bring the horizontal semicircular canals into the plane of rotation, thus ensuring maximum response. However literatures do not provide a clear reference concerning head position during the rotation test. So, we evaluated the vestibuloocular reflex (VOR) induced by sinusoidal rotation in the horizontal plane in the two different head positions: the head tilted forward 30degrees and with the head upright. MATERIALS AND METHODS: A total of 20 men with no known neuro-otological disorders and 9 guinea pigs were studied. The rotations of slow harmonic acceleration on various frequencies were performed with the subject's head in the upright position and in the 30 pitched down position. Computerized electronystagmography in human and magnetic coil in guinea pigs were used to measure the maximum velocity of slow component of horizontal nystagmus and to calculate gain, phase and symmetry of VOR responses. RESULTS: In both groups, results showed no significant differences in gain, phase and symmetry. CONCLUSION: In the two different head positions, there were no significant differences in gain, phase and symmetry. The posture of head upright is more comfortable for the patient and gives enough response for the evaluation of vestibular function.

Comparison of Collecting Methods of Nasal Fluids Using Albumin after Nasal Provocation in Allergic Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although different methods of collecting nasal fluid exist and can influence the result of the study, there have not been any studies made yet to compare the different methods. The authors aimed to evaluate the usefulness of these methods by comparing the albumin concentration of nasal fluid after nasal provocation in patients with allergic rhinitis. SUBJECTS AND METHOD: In 22 patients with allergic rhinitis, we measured the change of nasal obstruction and rhinorrhea after nasal provocation using Visual Analogue Scale (VAS). In Group A (n=10), the nasal lavage and direct suction method were used and in Group B (n=12), nasal lavage and filter paper method were used. Nasal fluids were obtained before, 20 min after and 8 hours after provocation. The concentration of albumin was calculated using rate nephelometry. RESULTS: Patients' nasal symptoms were aggravated in early allergic reaction but subsided in late reaction. There was meaningful increase of albumin concentration with the use of direct suction and filter paper methods. In contrast, there was no significant increase of concentration with the use of lavage method. CONCLUSION: The filter paper method is superior in the quantitative analysis of mediators in nasal fluid after nasal provocation in allergic patients. The lavage method, however, is considered inappropriate because of its dilution effect.

Rational Use of Antimicrobial Agents in Traumatic Simple Wounds

PURPOSE: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. METHODS: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman's University Mokdong Hospital. Structured data sheets were completed at the times of the patient's visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. RESULTS: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). CONCLUSION: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate.

The Impacts of Helmet Use on Injuries in Motorcycle Crash Patients in Korea

PURPOSE: To determine the helmet use rate, factors affecting helmet use in Korea, and the effects of helmet use on injuries. METHODS: This is a prospective study with patients who visited two emergency centers in Seoul during 7 months due to accidents that they had while riding a motorcycle. We examined the patients' general characteristics, whether to wear a helmet, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) on admission, and whether to be hospitalized. In addition, factors such as the patients' position, accident season, day of the week, hour and whether to drink were analyzed to see if they affect helmet use and injuries. RESULTS: A total of 178 patients participated in this study, and 57.3% wore a helmet. Around 20% of patients had head injuries. Head injuries were more frequent in those who did not wear a helmet. According to the result of analyzing factors affecting helmet use, the helmet non-use rate was high in patients whose age was 30 or less and drinkers. For the two groups, the odds ratios for helmet non-use were 2.3 (95% CI 1.2~4.5) and 4.2 (95% CI 1.2~ 15.2), respectively. CONCLUSION: This study shows that helmet use can prevent head injuries in motorcycle patients. Thus, in order to prevent head injuries, helmet use should be increased and, for this, education and regulation on helmet use should be reinforced, particularly for those aged 30 or younger and drinkers.

ICECI Based External Causes Analysis of Severe Pediatric Injury

PURPOSE: Injury is a leading cause of morbidity and mortality for children. As an injury prevention measure, the differences in external causes of severe pediatric injuries based on ICECI were analyzed according to age groups. METHODS: A retrospective study was performed for pediatric patients under 15 years of age, who had been admitted to the emergency department with severe injuries from January 1998 to December 2004. The external causes of injury were investigated according to the ICECI: intent, mechanisms, places of occurrence, objects/substances producing injury, and related activities. The patients were divided into four groups based on age: infant (< 0 year), toddler (1~4 years), preschool age (5~8 years), and school age (9~15 years). RESULTS: The injury mechanisms, the places of occurrence and the related objects/substances vary with the age groups. The most common subtype of traffic accidents was pedestrian injury in pre-school age group. Falls most frequently occurred in the toddler group. But falls from a height of less than l meter height (6 patients) occurred only in the infant group. The most common place of occurrence in the infant group was the home, and that of other groups was the road. The related objects/substances for falls, for example, household furnitures and playground equipment depended on the age group. CONCLUSION: The age-group specific characteristics of severe pediatric injury were analyzed successfully through the ICECI. Therefore, when establishing a plan for the prevention of pediatric injury, consideration must be given to the differences in the external causes of injuries according to age group.

Surgical Treatment of Postencephalitic Epilepsy

Encephalitis is often followed by chronic intractable epilepsy. Many of these patients pose significant challenges to the localization of seizure generators and to the strateges for management of intractable epilepsy. The authors analysed 17 patients with postencephalitic epilepsy(PEE), who underwent resective surgeries. Most patients had been accompanied by coma, convulsive status epilepticus, and focal motor deficit at the time of encephalitis. MRI studies showed variable degree of brain damage: hippocampal sclerosis only(n=5), neocortical gliosis only(n=6), and both(n=5). Analysis of ictal semiology revealed a predominant temporo-limbic seizure pattern in 7, a variable extralimbic patterns in 6, and unclassified in 4 patients. Surgical resection includes temporal(n=11), frontal(n=3), centroparietal(n=1), multilobar(n=2), and callosotomy(n=2). Surgical outcome was graded as class 1(n=8), class 2(n=2), class 3(n=4), and class 4(n=3). It is concluded that surgical result was promising despite the traditional concerns about localizing problem in the setting of PEE. Surgical treatment should be, therefore, considered if localizing information is persistent. Intracranial EEG recording was very useful to delineate the area of seizure onset. MRI abnormalities were not always correlated with ictal onset zone in the patients with PEE.

Clinical Results of Internal Fixation Using Several Instruments in Unstable Thoracolumbar Bursting Fracture

Fifty six patients with unstable thoracolumbar bursting fractures were treated using variable internal fixation devices such as the Kaneda Anterior Fixation System(Kaneda device), the Z-Plate-ATL(TM) Anterior Fixation System(Z-Plate ATL(TM) device), the Harrington device, Cotrel-Ducousset(CD) or Compact Contrel Dubousset(CCD) device or Steffee Transpedicular System with or without decompression. Such internal fixation devices were grouped into anterior and posterior internal fixation devices and compared with each other in the aspect of the degree of neurological improvement, the changes of the vertebral height and the kyphotic angle, the duration of admission, and postoperative complications. In conclusion, the anterior internal fixation device appears to be of more benefit in the management of patients with unstable thoracolumbar bursting fracture.

Results of Anterior Cervical Discectomy without Interbody Fusion

Anterior cervical discectomy with or without interbody fusion has been conventionally used to treat patients with cervical disc diseases. However, discectomy without bone fusion has been abandoned due to the feat of early collapse of interbody space and recurrency. The author has analysed twenty-two cases of microsurgical cervical discectomy without bone fusion between Jan. 1993 and Mar. 1994. All patients were followed up for more than 6 months or as long as 21 months with repeat interview, physical examination, and radiological evaluation. The analysis revealed that the results were highly satisfactory in 21 cases with radiculopathies in terms of early ambulation, no discomfort in the iliac bone, and shorter hospital stay, but unsatisfactory in one cases which needed reoperation due to postoperative scar. The above method which had demonstrated promising results is recommended for the patients suffering from radiculopathy.

Surgical Results of Herniated Lumbar Disc

The surgical outcome for lumbar discectomy has improved with development of surgical techniques and strict selection of patients. The authors could follow up and analyse 818 cases who underwent surgery due to herniated lumbar disc from Jan. 1980 to Dec. 1991 at Chonbuk National University Hospital. The early operative complications were delayed wound healing(36 cases), extradural hermatoma(2 cases), discitis(2 cases), but there was no injury to nerve root and abdominal vessels. The specially designed paravertebral muscle retractor and nerve root retractor were useful in reducing the operative complications. Sixteen patients were reoperated due to acute recurrent symptoms(within one month). More than one-third of these(7/16) were due to missed disc material, and all of them had good results after reoperation. Twenty five patients were reoperated due to late recurrent symptoms(more than 6 months later). In almost two-third of them(14/25), rerupture of remained disc material was found. Reoperation of these cases had a good result as well. Epidural fibrosis and severe adhesion of nerve root were showed for reoperation in 9 of the 25 cases. These complications had a poor result except 1 case even after reoperation. The surgical outcome of 818 cases were classified ; Excellent 618 cases(82%), Good 110 cases(13.5%), Fair 29 cases(3.5%) and Poor 8 cases(1%). Surgical technique and proper selection of patients were considered as important facter obtaining the better result.

Direct Anterior Screw Fixation for Odontoid Fractures

No abstract available.