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Objectives@#Severe fever with thrombocytopenia syndrome (SFTS) has no vaccine or treatment and an extremely high fatality rate. We aimed to analyze and evaluate the risk factors for death associated with SFTS. @*Methods@#Among reports from 2018 to 2022, we compared and analyzed 1,034 inpatients aged 18 years or older with laboratory-confirmed SFTS who underwent complete epidemiological investigations. @*Results@#Most of the inpatients with SFTS were aged 50 years or older (average age, 67.6 years). The median time from symptom onset to death was 9 days, and the average case fatality rate was 18.5%. Risk factors for death included age of 70 years or older (odds ratio [OR], 4.82); agriculture-related occupation (OR, 2.01); underlying disease (OR, 7.20); delayed diagnosis (OR, 1.28 per day); decreased level of consciousness (OR, 5.53); fever/chills (OR, 20.52); prolonged activated partial thromboplastin time (OR, 4.19); and elevated levels of aspartate aminotransferase (OR, 2.91), blood urea nitrogen (OR, 2.62), and creatine (OR, 3.21). @*Conclusion@#The risk factors for death in patients with SFTS were old age; agriculture-related occupation; underlying disease; delayed clinical suspicion; fever/chills; decreased level of consciousness; and elevated activated partial thromboplastin time, aspartate aminotransferase, blood urea nitrogen, and creatine levels.
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Purpose@#This study aims to explore mothers’ experiences of anger while raising a child in South Korea based on a qualitative descriptive approach. @*Methods@#A total of ten mothers of children aged 1-3 years participated in the study. In-depth individual interviews were conducted from August to September 2019 to collect data, which were then subjected to thematic analysis. @*Results@#A total of 4 main themes and 10 subthemes were identified. The 4 themes were “individual and environmental factors that influence anger,” “a vicious cycle of anger expression and guilt,” “being a little bit more mature as a mother,” and “need for anger management.” This study described various causes, ways of expressing, and effects of anger, as well as the mother’s coping strategies. These experiences were viewed as milestones along the journey to becoming a real parent and helped mothers develop empathy for other children and mothers. The participants expressed support for expanding the social support system for child-rearing and providing psychological programs for mothers. @*Conclusion@#Mothers of children aged 1-3 years experienced anger owing to various factors, but adapted by developing coping skills. This study recommends family-based support interventions to help mothers manage their emotions and parenting roles.
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May–Thurner syndrome (MTS) is a condition in which the left common iliac vein is irritated by chronic pulsatile compression between the right common iliac artery and the upper iliac or lumbar spine. It mainly causes swelling and pain in the left lower extremity, venous thrombosis, and repeated deep venous thrombosis. In patients with sudden swelling and pain in the left lower extremity and suspected lower extremity thrombosis, when no other obvious cause can be found, the possibility of MTS should be considered. We experienced a rare case of an older patient with atypical MTS caused by bone spur of the 4th and 5th lumbar vertebrae, which has been reported here along with a review of the literature.
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Purpose@#Extremely low birth weight (ELBW) infants exhibit immature thermoregulation and are easily exposed to hypothermia. We investigated the association between hypothermia on admission with short- and long-term outcomes. @*Methods@#Medical records of ELBW infants admitted to the neonatal intensive care unit of a tertiary medical center between June 2012 and February 2017 were retrospectively analyzed. Upon admission, the axillary body temperature was measured. Moderate hypothermia was defined as admission temperature below 36 ℃. @*Results@#A total of 208 infants with gestational age of 26.4±2.3 weeks and birth weight of 746.7±154.9 g were included. Admission temperature ranged from 33.5 to 36.8 ℃ (median 36.1 ℃). Univariate analyses of maternal and infant characteristics were performed for moderately hypothermic and control (normothermic to mildly hypothermic) infants. Lower gestational age, lower birth weight, and vaginal delivery correlated with moderate hypothermia. Logistic regression analyses adjusted for confounders revealed that the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) was associated with moderate hypothermia in ELBW infants. Moreover, abnormal mental developmental index scores on the Bayley Scales of Infant Development II at a corrected age of 18 to 24 months were associated with moderate hypothermia, but not with the psychomotor developmental index, incidence of blindness, deafness, or cerebral palsy. @*Conclusion@#Moderate hypothermia at admission is not only correlated with short-term neonatal morbidities such as hsPDA, but may also be associated with long-term neurodevelopmental impairment in ELBW infants. Future large-scale studies are required to clarify the long-term consequences of hypothermia upon admission.
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Purpose@#This study aimed to investigate the differences in sleep disturbance changes between patients receiving two hormone therapies (“tamoxifen plus ovarian function suppression group [T+OFS group]” versus “tamoxifen group [T group]”) and the chronological changes in sleep disturbances in each group. @*Methods@#Premenopausal women with unilateral breast cancer who underwent surgery and were scheduled to receive hormone therapy (HT) with tamoxifen alone or with tamoxifen plus gonadotropin-releasing hormone (GnRH) agonist for ovarian function suppression were included. The enrolled patients wore an actigraphy watch for two weeks and completed questionnaires (insomnia, sleep quality, physical activity [PA], and quality of life [QOL]) at five time points: immediately before HT and 2, 5, 8, and 11 months after HT. @*Results@#Among the 39 enrolled patients (21 and 18 patients in the T+OFS group and T group, respectively), 25 (17 and 8 patients in the T+OFS group and T group, respectively) were finally analyzed. There were no differences between the two groups in time-dependent changes in insomnia, sleep quality, total sleep time, rapid eye movement sleep rate, QOL, and PA;however, the severity of hot flashes was significantly higher in the T+OFS group than in the T group. Although the interaction between group and time was not significant, insomnia and sleep quality significantly worsened at 2–5 months of HT when changes over time were analyzed within the T+OFS group. In both the groups, PA and QOL were maintained without significant changes. @*Conclusion@#Unlike tamoxifen alone, tamoxifen plus GnRH agonist initially worsened insomnia and sleep quality, but gradually improved with long-term follow-up. Patients who initially experience insomnia during tamoxifen plus GnRH agonist administration can be reassured based on the results of this study, and active supportive care may be used during this period.
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Drug-induced hypersensitivity syndrome (DiHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening condition induced by drug hypersensitivity that leads to significant morbidity and mortality and often occurs in patients undergoing combination antibiotic therapy. Due to a recent increase in the incidence of methicillin-resistant Staphylococcus aureus infections, the occurrence of vancomycin-induced DiHS/DRESS has increased rapidly. However, because of insufficient pharmacogenetic data on vancomycin-induced drug eruptions in Asians coupled with the risk of re-eliciting the symptoms by provocation tests, confirmation of the culprit drug in vancomycin-induced DiHS/DRESS is often challenging. Here, we report a case of vancomycin-induced DiHS/DRESS, where the causal relationship was confirmed using a lymphocyte transformation test (LTT). A 51-year-old woman was treated with combination antibiotics, including vancomycin, for infective pericarditis. The patient subsequently developed fever, facial edema, generalized rash followed by multiple internal organ involvement, including the kidney, lung, liver, and heart. Thus, based on the International Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) criteria, the case was diagnosed as ‘definite’ DiHS/ DRESS, although the culprit drug was obscured by combination antibiotic therapy. The LTT confirmed that vancomycin, but not other glycopeptide antibiotics, specifically induced Tcell proliferation in this case. Collectively, our case suggests that clinicians can utilize LTT to identify the causative medication of DiHS/DRESS when the clinical information is limited to defining the culprit drug.
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Objectives@#The purpose of this study was to explore and evaluate the characteristics and quality of infant and maternal sleep (total sleep time, sleep efficiency, and wakefulness after sleep onset) using an actigraph. @*Methods@#The characteristics and quality of sleep were assessed in 22 dyads of mothers and infants aged 3–12 months. The quality of infant and mother sleep was collected using an actigraph for 12 consecutive days; this was repeated three times at 4-week intervals, and characteristics of infant sleep were measured using the Brief Infant Sleep Questionnaire-Revised. @*Results@#Bedsharing with infants at 7–12 months of age was higher (12.5%) than with those at 3–6 months of age (50.0%). Regarding the sleeping position, half of the infants aged 3–6 months adopted the lateral (25.0%) and prone (25.0%) positions, and the remaining half (50.0%) aged 7–12 months adopted the lateral position. It was found that 45.5% of mothers of infants used breastfeeding and pacifiers to induce sleep in infants and to help their babies go back to sleep when they woke up. The total sleep time and sleep efficiency of infants and mothers were 434.68 minutes per day and 73.1% and 379.53 minutes per day and 82.8%, respectively, indicating that both infants and mothers had low sleep quality. @*Conclusions@#To safeguard infants’ sleep, it is necessary to provide appropriate information and education to parents and necessary interventions for resolving sleep problems and improving the quality of sleep for both infants and mothers.
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Striatal changes in the pathogenesis of Alzheimer’s disease (AD) is not fully understood yet. We compared structural and functional image differences in the striatum between patients with early onset AD (EOAD) and late onset AD (LOAD) to investigate whether EOAD harbors autosomal dominant AD like imaging findings. The clinical, neuropsychological and neuroimaging biomarkers of 77 probable AD patients and 107 elderly subjects with normal cognition (NC) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI)-2 dataset were analyzed. Enrolled each subject completed a 3-Tesla MRI, baseline 18F-FDG-PET, and baseline 18F-AV-45 (Florbetapir) amyloid PET studies. AD patients were divided into two groups based on the onset age of clinical symptoms (EOAD <65 yrs; LOAD ≥65 yrs). A standardized uptake value ratio of the striatum and subcortical structures was obtained from both amyloid and FDG-PET scans. Structural MR imaging analysis was conducted using a parametric boundary description protocol, SPHARM-PDM. Of the 77 AD patients, 18 were EOAD and 59 were LOAD. Except for age of symptom onset, there were no statistically significant differences between the groups in demographics and detailed neuropsychological test results. 18F-AV-45 amyloid PET showed marked β-amyloid accumulation in the bilateral caudate nucleus and left pallidum in the EOAD group. Intriguingly, the caudate nucleus and putamen showed maintained glucose metabolism in the EOAD group compared to the LOAD group. Our image findings in the striatum of EOAD patients suggest that sporadic EOAD may share some pathophysiological changes noted in autosomal dominant AD.
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When a patient represents pain in foot, physician can easily overlook compression neuropathy of peripheral nerve as it is uncommon. Among nerve entrapment syndrome encountered in the foot, selective compression in lateral branch of deep peroneal nerve (DPN) is rare. We report a case of a patient with pain and dysesthesia in dorsolateral foot which turned out as lateral branch of deep peroneal nerve entrapment syndrome caused by talonavicular joint effusion. We would like to share diagnostic work up flow and conservative treatment courses. This case manifests the importance of the deep peroneal nerve and its branches in clinical setting of pain and ankle instability.
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Background@#This study aimed to investigate the survival and morbidities of infants in the Korean Neonatal Network (KNN) with birth weight (BW) < 500 g. @*Methods@#The demographic and clinical data of 208 live-born infants with a BW < 500 g at a gestational age of ≥ 22 weeks who were treated in the neonatal intensive care units of the KNN between 2013 and 2017 were reviewed. @*Results@#The survival rate of the infants was 28%, with a median gestational age and BW of 24 3/7 weeks (range, 22 0/7 –33 6/7 ) and 440 g (range, 220–499), respectively. Multivariable Cox proportional hazards analysis demonstrated that survival to discharge was associated with longer gestation, higher BW, female sex, singleton gestation, use of any antenatal corticosteroids, and higher Apgar scores at 5 minutes. The overall survival rates were significantly different between the BW categories of < 400 g and 400–499 g. However, there was no significant difference in the incidence of any morbidity between the BW groups.Half of the deaths of infants with BW < 500 g occurred within a week of life, mainly due to cardiopulmonary and neurologic causes. The major causes of death in infants after 1 week of age were infection and gastrointestinal disease. Among the surviving infants, 79% had moderate to severe bronchopulmonary dysplasia, 21% underwent surgical ligation of patent ductus arteriosus, 12% had severe intraventricular hemorrhage (grade III–IV), 38% had sepsis, 9% had necrotizing enterocolitis (stage ≥ 2), and 47% underwent laser treatment for retinopathy of prematurity. The median length of hospital stay was 132 days (range, 69–291), and 53% required assistive devices at discharge. @*Conclusion@#Despite recent advances in neonatal intensive care, the survival and morbidity rates of infants with BW < 500 g need further improvement.
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Background@#This study aimed to investigate the survival and morbidities of infants in the Korean Neonatal Network (KNN) with birth weight (BW) < 500 g. @*Methods@#The demographic and clinical data of 208 live-born infants with a BW < 500 g at a gestational age of ≥ 22 weeks who were treated in the neonatal intensive care units of the KNN between 2013 and 2017 were reviewed. @*Results@#The survival rate of the infants was 28%, with a median gestational age and BW of 24 3/7 weeks (range, 22 0/7 –33 6/7 ) and 440 g (range, 220–499), respectively. Multivariable Cox proportional hazards analysis demonstrated that survival to discharge was associated with longer gestation, higher BW, female sex, singleton gestation, use of any antenatal corticosteroids, and higher Apgar scores at 5 minutes. The overall survival rates were significantly different between the BW categories of < 400 g and 400–499 g. However, there was no significant difference in the incidence of any morbidity between the BW groups.Half of the deaths of infants with BW < 500 g occurred within a week of life, mainly due to cardiopulmonary and neurologic causes. The major causes of death in infants after 1 week of age were infection and gastrointestinal disease. Among the surviving infants, 79% had moderate to severe bronchopulmonary dysplasia, 21% underwent surgical ligation of patent ductus arteriosus, 12% had severe intraventricular hemorrhage (grade III–IV), 38% had sepsis, 9% had necrotizing enterocolitis (stage ≥ 2), and 47% underwent laser treatment for retinopathy of prematurity. The median length of hospital stay was 132 days (range, 69–291), and 53% required assistive devices at discharge. @*Conclusion@#Despite recent advances in neonatal intensive care, the survival and morbidity rates of infants with BW < 500 g need further improvement.
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Trisomy 9 mosaicism syndrome is a rare chromosomal abnormality with a high incidence of natural abortion and perinatal death. This syndrome is characterized by intrauterine growth retardation, mental retardation, craniofacial dysmorphism including a prominent nasal bridge with a short root and a fish-shaped mouth with thin lips, skeletal abnormalities, congenital heart defects, and genital abnormalities. The incidence and severity of malformations depend on the percentage of trisomic cells in the different tissues. We report a neonate who had the characteristic features of trisomy 9 syndrome with dysmorphic features including micrognathia, microcephaly, a low-set and malformed ear, a prominent lip, and cardiac defect. No chromosomal abnormalities were detected on a routine peripheral blood chromosomal analysis; however, a chromosomal abnormality with trisomy 9 mosaicism (low-level mosaic type) was detected on genetic tests. This is thought to be due to the low proportion of trisomic cells, and for this reason, the patient in this case shows a better prognosis than four patients previously reported in Korea, they were all diagnosed by peripheral blood chromosome testing.
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Coronavirus disease 2019 (COVID-19) is a new type of epidemic infectious disease that threatens the world after it first broke out in Wuhan, China, in December 2019. By early March, Korea had the second largest number of confirmed cases of COVID-19 in the world after China, among which about 90% of patients reported in Daegu and Gyeongsangbuk-do province. As a neurologist, the author experienced various neurological diseases while working at hub-hospitals for COVID-19 in Daegu. I would like to describe the role of a neurologist in the emerging outbreak of infectious diseases, along with my experience working at the hub-hospital for Middle East Respiratory Syndrome (MERS) in 2015.
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It is essential to identify the causative artery in case of active intra-abdominal or gastrointestinal bleeding. A thorough understanding of the basic arterial anatomy is required to identify the causative artery on contrast-enhanced CT angiography and conventional catheter angiography. If one is familiar with the basic arterial anatomy, obtaining access to the bleeding artery will be easier, despite the variations in the origin and course of the vessels. We describe the basic arterial anatomy that will help beginners in diagnostic radiology to identify the blood vessels that can cause active intra-abdominal or gastrointestinal bleeding.
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Trisomy 9 mosaicism syndrome is a rare chromosomal abnormality with a high incidence of natural abortion and perinatal death. This syndrome is characterized by intrauterine growth retardation, mental retardation, craniofacial dysmorphism including a prominent nasal bridge with a short root and a fish-shaped mouth with thin lips, skeletal abnormalities, congenital heart defects, and genital abnormalities. The incidence and severity of malformations depend on the percentage of trisomic cells in the different tissues. We report a neonate who had the characteristic features of trisomy 9 syndrome with dysmorphic features including micrognathia, microcephaly, a low-set and malformed ear, a prominent lip, and cardiac defect. No chromosomal abnormalities were detected on a routine peripheral blood chromosomal analysis; however, a chromosomal abnormality with trisomy 9 mosaicism (low-level mosaic type) was detected on genetic tests. This is thought to be due to the low proportion of trisomic cells, and for this reason, the patient in this case shows a better prognosis than four patients previously reported in Korea, they were all diagnosed by peripheral blood chromosome testing.
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Radiation recall is an uncommon phenomenon in which administration of a chemotherapy or another systemic agent induces an acute inflammatory reaction in previously irradiated tissues, often weeks to years after completion of radiotherapy.Gemcitabine can induce an inflammatory reaction within an area of prior radiation. Radiation recall is known to medical oncologists, however only few cases have been reported in Korean journals, therefore physiatrist who diagnose and treat the treatment-related physical impairments of cancer patients must know about it. We emphasize the importance of knowledge of this phenomenon when considering the differential diagnosis of painful limb edema in a patient who has received cancer treatment.
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Radiation recall is an uncommon phenomenon in which administration of a chemotherapy or another systemic agent induces an acute inflammatory reaction in previously irradiated tissues, often weeks to years after completion of radiotherapy.Gemcitabine can induce an inflammatory reaction within an area of prior radiation. Radiation recall is known to medical oncologists, however only few cases have been reported in Korean journals, therefore physiatrist who diagnose and treat the treatment-related physical impairments of cancer patients must know about it. We emphasize the importance of knowledge of this phenomenon when considering the differential diagnosis of painful limb edema in a patient who has received cancer treatment.
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Symmetrical proximal weakness and characteristic dermatologic manifestations are important in the diagnosis of dermatomyositis. We report a case of atypical presentation of dermatomyositis due to previous steroid use and also report steroid-induced myopathy which may occur from steroid administration during the course of treatment. A 77-year-old man, previous steroid user, showed rapidly progressing weakness after abruptly stopped medication. He has presented erythematous papule on face and anterior chest but no heliotrope rash and Gottron's papules were observed. Muscle enzyme (creatine kinase) concentration is increased, and needle electromyography shows increased spontaneous activity on proximal limb muscle. The muscle biopsy confirmed dermatomyositis. During the course of treatment, he revealed persistent weakness despite the continuous steroid use and stable creatine kinase level. Electrodiagnostic study suggests steroid-induced myopathy and after tapering steroid, proximal muscle strength improved. This case reports the effect of steroid use on dermatomyositis patients and a process of diagnosing coexisting steroid induced myopathy during treatment.
Subject(s)
Aged , Humans , Biopsy , Creatine Kinase , Dermatomyositis , Diagnosis , Electromyography , Exanthema , Extremities , Muscle Strength , Muscular Diseases , Needles , ThoraxABSTRACT
OBJECTIVES: It was supposed to analyze status and affecting factors in water and food-borne communicable disease by screening entrants with diarrhea symptom at the point of entry in Korea METHODS: Symptomatic travelers with water and food-borne communicable diseases who entered Korea were diagnosed by a health declaration and detection of causative agents in water and food using laboratory tests. Among those entered in 2017, the affecting factors in the incidence of communicable diseases among those who had diarrhea at the entry into Korea, were analyzed, with frequency and chi-square test. RESULTS: The number of travel entrants with gastrointestinal communicable diseases increased by 40.19% from 2013 to 2017. The percentage of causative agents of water and food-borne communicable diseases was the highest at 69.2% from July to September. The rate of detection of causative agents of communicable disease pathogens in travelers from Southeast Asia entering Korea was 70.2%, which was higher than people arriving from East Asia and Central Asia (57.5%; p < 0.001). CONCLUSION: The positive ratio of causative agents of water and food-borne communicable diseases was high among travelers that had entered Korea from July to September, with a high number among entrants from Southeast Asia. Based on the positive detection of causative agents, the entry period and countries visited were statistically significant affecting factors (p < 0.001).
Subject(s)
Asia , Asia, Southeastern , Communicable Diseases , Diarrhea , Asia, Eastern , Foodborne Diseases , Incidence , Korea , Mass Screening , Quarantine , Water , Waterborne DiseasesABSTRACT
PURPOSE: To prevent surgical site complications, many plastic surgeons use the so-called “conventional protocol,” which immobilizes the shoulder and upper arm for 1 month after reconstruction. In an effort to improve the shoulder mobility of patients who received immediate breast reconstruction with tissue expander insertion (TEI), we introduced an early rehabilitation protocol with a short-term immobilization period of 2 weeks. This study aims to compare this early rehabilitation exercise program with the conventional protocol and to determine factors affecting shoulder mobility and quality of life of patients after immediate breast reconstruction. METHODS: A total of 115 patients with breast cancer who underwent reconstructive surgery were retrospectively reviewed. For patients who underwent reconstruction before January 2017, the conventional protocol was followed with immobilization of their shoulder for over 4 weeks. Patients who underwent reconstruction after January 2017 were educated to undergo a self-exercise program after a short-term immobilization period of 2 weeks. We compared shoulder mobility, pain, quality of life, and complications at postoperative 1 and 2 months between the groups. RESULTS: Patients who received early rehabilitation showed greater shoulder flexion and abduction range at postoperative 1 month than those who received the conventional protocol. This increased shoulder abduction range continued until postoperative 2 months. There were no significant surgical site problems in both groups during the 2 months of follow-up. CONCLUSION: To enhance the recovery of shoulder mobility, early rehabilitation with a shorter immobilization period should be recommended to patients with breast cancer undergoing reconstruction surgery with TEI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541161