Comparison of Changes Among Airway Resistance, Peak Expiratory Flow Rate, Forced Expiratory Volume in One Second / 소아알레르기및호흡기학회지

PURPOSE: We usually measure the changes of peak expiratory flow rate (PEFR) or forced expiratory volume in one second (FEV1) to check the bronchial response after inhalation of bronchodilator. Airway resistance determined by interrupter technique (Rint) is simple and easily applicable even to the infant. A comparison among PEFR, FEV1 and Rint was done to find out the feasibility of using Rint instead of PEFR or FEV1 in checking the bronchial response after inhalation of bronchodilator. METHODS: We checked PEFR, FEV1, Rint, and oxygen saturation with twenty eight asthmatic children, over 7 years old, visited emergency or out patient department with acute asthmatic attack. The same parameters were checked in 5, 10, 20 minutes after inhalation of bronchodilator. Comparison and relationship of measures as well as changes of measures after inhalation of bronchodilator among them were analyzed to confirm if Rint can replace PEFR or FEV1 in checking bronchial response after inhalation of bronchodilator. RESULTS: PEFR, FEV1 and O2 saturation increased as time goes on but airway resistance decreased. The relationship among the changes of parameters of PEFR, FEV1 and Rint checked in 5, 10 and 20 minutes after inhalation of bronchodilator showed close correlation with was statistically significant. But, the measures checked in 20 minutes after inhalation statistically insignificant. CONCLUSION: Rint can be used instead of PEFR and FEV1 in checking the bronchial response after inhalation of bronchodilator.

The Prevalence of Iron Deficiency in Preschool Children / 대한소아혈액종양학회지

BACKGROUND: Iron deficiency still remains the most common single nutrient deficiency disorder in the world, especially among young children and adolescent girls. As little is recently known about iron deficiency in infants and preschool children in Korea, this study is aimed to determine the prevalence of iron deficiency in healthy population and to determine the proportion of children in whom iron deficiency goes undetected using the current screening technique. METHODS: We collected venous samples from 410 apparently healthy preschool children during March to June, 1997, as a part of a regular health check-up program. We measured hemoglobin, hematocrit, mean corpuscular volume(MCV), mean corpuscular hemoglobin(MCH), serum ferritin, serum iron, and total iron binding capacity(TIBC). RESULTS: A total of 410 infants and preschool children aged 1~6 years were included in this study. The prevalence of anemia was 7.9%(3/38) in infants and children aged 1~2 years, 6.3%(12/190) in 3~4 years and 1.6%(3/182) in 5~6 years. The prevalence of iron deficiency(ferritin <10 ng/mL or transferrin saturation <10%) was 31.6%(12/38) in 1~2 years, 23.7%(45/190) in 3~4 years and 14.3%(26/182) in 5~6 years. The prevalence of IDA was 5.3% (2/38) in 1~2 years, 1.1% (2/190) in 3~4 years and 0.5%(1/182) in 5~6 years. Microcytic anemia was found in only 2 cases, both of which is included in 1~2 years of age. CONCLUSION: The prevalence of iron deficiency and IDA was relatively high in 1~2 years of age, critical period for neurologic development. Nutritional education including iron fortification for mothers having caring babies especially of this age group should be warranted.

The Diagnostic Significance of MCV, MCH, and RDW in Anemia of Kawasaki Disease

PURPOSE: We investigated what kind of factors are the most stable among hemoglobin (Hb), hematocrit (Hct), MCV, MCH and RDW as a marker of discriminating anemia due to an acute inflammation from anemia of different origins. METHODS: We evaluated 141 patients with Kawasaki disease who had been admitted to the Department of Pediatrics, Inha hospital from 1990 to 1995. We analyzed their blood four times each week. RESULTS: Of the patients, 132 cases (93.6%) were less than 5 years of age and the median age was 2 years 3 months. After one week of hospitalization, Hb dropped a mean of 0.6g/dl compared to when first admitted. After three weeks of hospitalization, Hb increased a mean of 1.1g/dl compared to when first admitted. Coefficient of variation (CV) mean was Hct>Hb>RDW>MCH>MCV. The CV mean of Hb, Hct, MCV, MCH and RDW showed a significant difference (P=0.0001). In groups, there was an insignificant difference between Hb and Hct, there was a significant difference among the Hb-Hct group and MCV, MCH and RDW. Except for MCV, every RBC indices were changed in accordance with the measured time. But only MCV was relatively unchanged as time went by (P<0.5). CONCLUSION: Our finding indicate that MCV, MCH and RDW can be used as a useful marker for discriminating temporary anemia of acute inflammation from the other anemia of different origins, because MCV, MCH and RDW showed little change in measured values in comparison with the change of Hb and Hct in Kawasaki disease. The MCV is an useful factor among factors.

The Optimal Dosages of Gammaglobulin and Aspirin in Treating Kawasaki Disease

PURPOSE: There are some disagreements about the optimal dosages of intravenous gammaglobulin(IVGG) and oral aspirin(ASA) in the treatment of Kawasaki disease. So authors performed a prospective clinical study to evaluate the efficacy of IVGG 1g/kg plus ASA 50mg/kg/day. METHODS: We treated 29 patients who were admitted to Inha University Hospital from June 1993 through May 1994 with IVGG 1g/kg plus ASA 50mg/kg/d. We compared the outcomes of above patients with those of two other groups of patients, group A and B in authors' previous study. Group A(20 patients) had been treated with IVGG 2g/kg plus ASA 50mg/kg/d and group B(19 patients) with IVGG 2g/kg plus ASA 100mg/kg/d. The outcomes had been similar in group A and B, which was published on this journal in 1995 (vol. 38:378-385). RESULTS: 1) Twenty five patients(86.2%; group C) were given only one dose of IVGG 1g/kg, and remaining 4 patients(13.8%; group D) were given two doses of IVGG 1g/kg because of persistent high fever. 2) The age and sex distributions, durations of fever before treatment, and durations of ASA therapy in group C were not significantly different from those in group A and B (p>0.05). 3) Laboratory findings on admission in group C were not significantly different from those in group A and B, except that the mean ESR was lower in group C than in group A and B (35.1+/-19.8 vs 55.5+/-5.95 & 50.2+/-11.4mm/hr; p0.05, respectively). 5) In group C, the mean hemoglobin concentration at the 3rd week of illness was higher than in group A (11.1+/-0.98 vs 10.1+/-1.24g/dl; p0.05, respectively). In follow-up examinations, coronary aneurysm was observed in only one(1/23; 4.3%) in group C, which was similar to group A(1/18; 5.5%) and B(1/19; 5.2%) (p>0.05, respectively). Giant aneurysm was not observed in any patients. 7) Four patients(group D) were given one more dose of IVGG 1g/kg because high fever persisted 48 hours after injection of the first dose of IVGG. Afterthen fever subsided within 1 to 7 days. Echocardiography revealed mild coronary arterial dilation in two patients initially, but follow-up examinations revealed no coronary aneurysm. CONCLUSIONS: The medium-dose combined regimen with IVGG 1g/kg plus ASA 50mg/kg/d seems to be more cost-effective than the high-dose regimen with IVGG 2g/kg plus ASA 50-100mg/kg/d. If high fever persists 48 hours or more after the first dose of IVGG 1g/kg, it is desirable to give one more dose of IVGG 1g/kg.

Epidemiologic Study of Measles Outbreak in School-Aged Children in East KyongGi-Do Area

PURPOSE: There was marked decline of measles outbreak in the world since the first measles vaccine had been introduced. Recently, however, measles outbreak in the vaccinated children have been reported worldwide, which was ascribed to the possibilities of primary or secondary vaccine failure. We investigated the incidence in the school-aged children in the Kyong-gi Do area, the larger district which covers the urban and rural area, by the questionnaire. METHODS: The questionnaires which were asked to the students' parents of 14 elementary schools in and nearest Sungnam city, Kyong-Gi Do for their present age, experience of measles attack and vaccination, and the age of measles attack. The answers of this questionnaire were analysed by SAS computer program. RESULTS: 1) Measles vaccination rate at 9 months was 70.5% and MMR vaccination rate at 15 months was 91.3%. 2) Measles attack rate among unvaccinated group was 53.8%, and 16.1% in vaccinated group. There was significant low risk of measles attack among vaccinated group than unvaccinated group(relative risk=3.35, p<0.001). 3) Vaccine efficacy of measles in this age group was 69%. 4) Age distribution of measles outbreak reveals bimodal pattern, the graph shows two peak incidence of 1 year-old and 6 years-old. 5) There were no significant differences of measles incidence in the different medical care service center that measles vaccination had been done. CONCLUSIONS: Despite high rate of measles vaccine coverage in Sungnam, the attack rate of measles in the vaccinated population was relatively high. There may be due to primary, secondary vaccine failure or the other factors. The policy of measles vaccination in Korea should be reestablished as soon as possible.

Epidemiologic Study during 1993 Measles Outbreaks in Seongnam Area

PURPOSE: Although remarkable progress has been made in efforts to control measles since measles vaccines became available for use, the longterm success of their vaccination programmes has been questioned, with the worldwide resurgence of the disease. This resurgence has increased attention on the inadequacy of current immunization programmes. In 1993 there have been measles outbreaks in Seong-nam city located near the sourthern Seoul, Korea. To characterize further the epidemiology of measles in Seong-nam city, we analysed demographic characteristics of measles cases reported for the year 1993. METHODS: With the cooperation of the nurse teacher in elimentary school, the data of measles cases were collected and each case was confirmed at local clinics, hospital or general hospital, including inha General Hospital. RESULTS: 1) Out of 645 cases(male: female = 1.08:1) the children above 5 yrs of age were 586 cases of which 529 cases(90.3%) were vaccinated on after 15 months of age. After the survey, measles occurred in 1.9% of the 11 elementary school students. Children with past MMR vaccination history showed milder course of measles than those without the vaccination history. 2) Out of 87 patients who had been brought to Inha General Hospital, 55%(n=48) was 6 to 1 5 months of age, 13%(n=11) was 15 months to 4 years of age, and 32%(n=28) was 5 to 14 years of age, which showed two major outbreaks: those in which of the cases occurred below 16 months of age and those in which considerable cases occurred among school-age persons. 3) Below 15 months of age, most of the cause of the unvaccination were inadequate access to medical care and lack of public awareness in some communities, with the resulting lack of d emand for immunization services. The causes of unvaccination above 15 months of age were neglect or oblivion in 35%(n=2 0), mild acute illness not contraindicated to vaccine use in 21%(n=12), economic difficulty in 8. 8%(n=5), vaccine omission after natural measles before 12 months of age in 7%(n=4). CONCLUSIONS: Despite the high uptake of measles vaccine there is currently a nationwide e pidemic of measles, especially among the school-age groups. Secondary vaccine failure is also thought to be important cause of measles ortbreak as well as primary vaccine failure. A booster dose of measles vaccine may be necessary to reduce the measles outbreak to allow the goal of measles elimination to be achieved, with the reinforcement of age-appropriate Immunization.