Effects of Compliance with the Nutrition Support Team in Critically Ill Pediatric Patients

PURPOSE: This study performed a comparative evaluation of nutritional condition's improvement and clinical effects in accordance with the Nutrition Support Team (NST) consultation compliance of critically ill pediatric patients. METHODS: The medical records of 64 critically ill pediatric patients (2 to 18 years old), who were officially referred to a NST consultant in pediatric intensive care unit from January to August 2015, were reviewed. The patients were divided into 2 groups according to the compliance of NST consultation answers. The total delivered/required caloric and protein ratio, weight, serum total protein, serum albumin, hemoglobin, and hematocrit were compared. RESULTS: According to the NST consultation answer, 'nutrition support increase' occupied the largest proportion at 38.5%; 'maintenance' and 'decrease' accounted for 35.7% and 18.2% respectively. The NST compliance group and non-compliance group were 20 and 14 patients, respectively. Although total delivered/required caloric ratio was significantly increased in the NST compliance group (19.7%, P=0.036), there was no significant difference in the NST non-compliance group (5.1%, P=0.692). The total delivered/required protein ratio was increased (15.1%, P=0.163) in the NST compliance group and decreased (-4.7%, P=0.774) in the NST non-compliance group. The NST non-compliance group (-8.6%, P=0.219) was further reduced weight than the NST compliance group (-1.0%, P=0.820). The serum albumin was significantly increased in the NST compliance group (13.1%, P=0.003), but there was no difference in the NST non-compliance group (7.1%, P=0.433). CONCLUSION: Although 56.7% of NST consultations were needed for nutritional interventions, a lower NST compliance (53.8%) is the limit of nutritional support. The NST compliance group was supplied adequately with more calories and protein than before consultation and a more improved nutritional status. Therefore, aggressive NST consultation can help increase the therapeutic effect by improving the nutritional status. This study will form the basis to seek ways to further enhance NST compliance.

Do Acute Changes in Heart Rate by Isoproterenol Affect Aortic Stiffness in Patients with Hypertension?

BACKGROUND: Increased aortic stiffness is a independent risk factor of cardiovascular disease in patients with hypertension. Acute changes of the heart rate (HR) have been reported not to affect the aortic stiffness in pacing. However, it is unknown whether acute changes in HR caused by sympathomimetics can affect the aortic stiffness in patients with hypertension. We investigated the effect of acute changes in HR produced by isoproterenol on the aortic stiffness in 17 hypertensive patientss (mean age: 59 +/- 9 years). METHODS: All vasoactive drugs were discontinued at least 3 days before the study. The carotid-tofemoral pulse wave velocity (PWV) was measured by the foot-to-foot method. The pulse waves were recorded at the baseline and at every increase of HR by 5 to 10 bpm with a gradual increase of the dose of isoproterenol. The blood pressures and HR were measured simultaneously. For the analysis, HR, PWV, compliance (C), and compliance index (Ci) were converted as percent changes (delta) from the baseline values. Percent changes of the parameters of the aortic stiffness, i.e., delta PWV, delta C, and delta Ci, were grouped by every 10% increase in delta HR. RESULTS: There was no significant difference among groups in delta PWV, delta C and delta Ci (p> 0.05 for each of the group). The regression analysis showed no significant correlation of delta HR with delta PWV and delta C (r=0.18, 0.13 respectively, p> 0.05 for each). delta Ci had a poor correlation with delta HR (r=0.22, p< 0.05). However, only 4.6% of delta Ci could be referred to delta HR (r2=0.046). CONCLUSION: Aortic stiffness was not affected by acute changes in HR produced by isoproterenol which suggests that it is not necessary to consider acute changes in HR when measuring aortic PWV.

Association of the myeloperoxidase-463G->A polymorphism with development of atrophy in Helicobacter pylori-infected gastritis / 대한내과학회지

BACKGROUND: Helicobacter pylori (H. pylori) infection is characterized by extensive infiltration of neutrophils and induces atrophic gastritis, however, the host factors governing the development of atrophy have not been defined. Myeloperoxidase (MPO) in neutrophils amplifies the oxidative potential, thus MPO is suspected to play a role in H. pylori-induced gastric atrophy. Therefore, we explored the association of host MPO genetic polymorphism with atrophic gastritis upon H. pylori infection. METHODS: Biopsy specimens taken from the gastric mucosa were examined histologically in 127 patients. The PCR-RFLP assay was used to characterize MPO genotypes. RESULTS: The distributions of MPO genotypes were MPO (G/G) 81.9% and MPO (G/A) 18.1%. None of MPO (A/A) genotype was observed in 127 patients studied. The degree of active inflammation increased with the increase in H. pylori colonization. A strong positive correlation between the levels of neutrophil infiltration and gastric atrophy was found only in MPO (G/G) but not in MPO (G/A) genotype. CONCLUSION: MPO G/G genotype may be a critical determinant in the pathogenesis of atrophic gastritis subsequent to H. pylori infection.

Does changes in heart rate by isoproterenol affect aortic stiffness in patients with hypertension? / 대한내과학회지

BACKGROUND: Increased aortic stiffness (AS) is an independent risk factor of cardiovascular disease in patients with hypertension. Elevation of blood pressure (BP) or sympathetic tone increases AS. It was reported that acute changes in heart rate by artificial pacemaker did not affect AS. However, it is unknown whether changes in HR by sympathomimetics can affect AS in patients with hypertension. We investigated the effect of changes of HR by isoproterenol (ISO) on AS in 17 hypertensives (mean age: 59+/-9 years). METHODS: All vasoactive drugs were discontinued at least 3 days before the study. Carotid-to-femoral pulse wave velocity (PWV) was measured by foot-to-foot method. Pulse wave recordings were done at baseline and at every increase of HR by 5 to 10 bpm with gradual increase of dose of ISO. BPs were measured simultaneously by the fluid-filled manometer system through the side arm of arterial sheath of femoral artery. HR was measured by electrocardiography. Compliance (C) and compliance index (Ci) were calculated from PWV, pulse pressure, systolic and diastolic blood pressure by established formulas. For analysis, HR, PWV, C and Ci were converted as percent changes (delta) from the baseline values. Percent changes of parameters of AS, i.e., deltaPWV, deltaC, and deltaCi, were grouped by every 10% increase in HR. RESULTS: There was no significant difference among groups in deltaPWV, deltaC and deltaCi (p>0.05 for each). With simple regression analysis, deltaPWV and deltaC showed no significant correlation with deltaHR (r=0.18, 0.13 respectively, p>0.05 for each). deltaCi was weakly correlated with deltaHR (r=0.22, p<0.05). However, only 4.6% of deltaCi could be referable to deltaHR (r2=0.046). CONCLUSION: AS was not affected by changes in heart rate by isoproterenol, suggesting that it is not necessary to consider changes of HR when measuring aortic PWV.

Web-Based Asthma Care System / 대한의료정보학회지

Asthma is a chronic disease, which requires a successive and long-term management. In this paper, we implemented a web-based caring system for a more effective management of the asthmatics. The service of this asthmatic-caring system targeted on both the doctor and the patient. The patient connects to the asthma management server through the Internet everyday and inputs his or her daily condition and dosage. Then the doctor will give a proper comment or order to the patient according to the data that patient has filled in. By merely connecting to this web-site, doctors can manage asthmatics everyday and the patient can be under the doctor's management without frequently visiting the hospital. The test verifying the user's satisfaction of the implemented system has been taken by both the doctor- and the patient-groups. The doctor-group pointed out the successive management, an easy inspection of the patient condition, and the accumulation of clinical data for future researches as advantages. The patientgroup pointed out being under the daily management without visiting hospital and the active attitude they can have toward their diseases as advantages.

Laboratory animal allergy in laboratory animal workers / 천식및알레르기

BACKGROUND: Laboratory animal workers who are in regular contact with furred animals commonly develop laboratory animal allergy (LAA). LAA is one of the most common occupational allergic diseases. OBJECTIVES: This study was performed to estimate the prevalence of sensitization and symptoms of LAA, and to determine important host factors for the development of LAA. METHOD: Sixteen subjects with laboratory animal workers in one medical research center were enrolled in this study. They responded to a questionnaire about work-related symptoms and underwent allergy skin prick test to common inhalant and laboratory animal allergens. RESULTS: The prevalence of sensitization to laboratory animal allergens was 18.8%, and all sensitized workers were atopic (positive skin reactivity to one or more common inhalant allergens). Prevalence rate of allergy symptoms caused by working with laboratory animals was 31.3%. Positive skin prick responses to dog or cat allergens were highly associated with specific sensitization to laboratory animal allergens, and positive skin responses to laboratory animal allergens were associated with laboratory allergy symptoms. Among sixteen subjects, we found out one case of occupational asthma due to mouse allergy and also reported the case here. CONCLUSION: Some laboratory animal workers showed sensitization to laboratory animal allergens and had allergic symptoms attributed to contact with laboratory animals. Atopy, especially atopy to dogs or cats may be an important host factor for the development of LAA.

The resistance mechanisms of b-lactam antimicrobials in clinical isolates of Acinetobacter baumannii

BACKGROUND: Despite increasing importance of Acinetobacter baumannii in nosocomial infections and rapid development of multi-antimicrobial resistance in this strain, the resistance mechanisms of beta-lactam antimicrobials in A. baumannii were not clearly defined. In order to observe the resistance mechanisms against beta-lactams and carbapenem, we characterized the production of beta-lactamases and outermembrane protein (OMP) profiles for the 44 clinical isolates of A. baumannii. METHODS: The MICs of antimicrobials were determined by agar dilution test. The secondary beta-lactamases were characterized by isoelectric focusing, polymerase chain reactions and nucleotide sequencing, and the production of chromosomal beta-lactamases was quantitated by spectrophotometric method. For two strains with an elevated MIC of carbapenem, outermembrane protein (OMP) profile was analyzed by ultracentrifugation of the sonicated bacteral cells and SDS-PAGE. RESULTS AND CONCLUSION: Twenty two or 4 of 44 strains produced TEM-1-like beta-lactamase or PER-1 extended-spectrum beta-lactamase, respectively. However, when we analyzed the MICs of several beta-lactams with the beta-lactamase production, the resistance level of beta-lactam was mainly determined by the production of chromosomal beta-lactamase, not by the secondary beta-lactamases in the clinical isolates of A. baumannii. In two strains with an elevated MIC of imipenem, a decrease or loss of about 35 kDa and 22 kDa proteins in OMP was observed, which suggested that the change of OMP played a role in carbapenem resistance.

A Case of Severe Bradyarrhythmia after Ingestion of Rhododendron Brachycarpum

Rhododendron brachycarpum has been known as a panacea in Korean folk medicine, and is used to treat various diseases including hypertension. Excessive ingestion can cause intoxication by grayanotoxin. We experienced a 59 year-old man suffering of grayanotoxin intoxication following excessive ingestion of Rhododendron brachycarpum. The patient presented dizziness, weakness, and chest discomfort with cold sweats. Electrocardiography showed marked sinus bradycardia with atrio-ventricular dissociation. With intravenous saline and atropine, the patient recovered. This case calls attention to the potential cardiotoxicity of Korean folk medicine Rhododendron brachycarpum.

A Case of Mediastinal Pancreatic Pseudocyst / 결핵

A pancreatic pseudocyst with a mediastinal extension is a rare clinical entity. Intrathoracic symptoms such as dysphagia or dyspnea due to compression or associated pleural effusions are quite common. The pseudocysts transverse the diaphragm via the esophageal hiatus or aortic hiatus or by eroding directly through the diaphragm. Here, we report a case of a pancreatic pseudocyst with a mediastinal extension presenting as dysphagia and dyspnea. The diagnosis was confirmed by computerized axial tomography of the chest and abdomen. Usually, the proper management of a larger pseducocyst includes percutaneous or surgical internal drainage, but in this case the mediastinal components disappeared with conservative medical treatment.

A Case of Mediastinal Angiomyolipoma

Angiomyolipoma is a common tumor of the kidney but has rarely been found in the mediastinum. We report a case of angiomyolipoma of the posterior mediastinum in a 62-year-old woman. She experienced exertional dyspnea and intermittent cough at admission. Computed tomography indicated a tumor located at the left paravertebral and upper posterior mediastinum and MRI imaging demonstrated a mass with low signal intensity in T1-weighted image at T4-5 level. Thoracotomy was done for surgical removal of the tumor and histologic examination revealed a mesenchymal tumor composed of mature fat, capillaries and smooth muscle fibers. The tumor was immunohistochemically positive for CD34 and factor-VIII (for vascular component) smooth muscle actin (for smooth muscle component) and S-100 protein (for fat component). There have been four case reports about mediastinal angiomyolipoma, namely three Japanese cases and one French case. It is suggested that angiomyolipoma could be considered for the differential diagnosis of mediastinal tumors.