Content Analysis of YouTube Videos on the Effect of Vitamin C on Common Cold / 가정의학회지

Background@#With the growth of the Internet, social media platforms have emerged as major sources of medical information. We assessed the reliability, quality, and accuracy of the most-viewed YouTube videos containing information on the effect of vitamin C on the common cold. @*Methods@#The YouTube videos were searched on August 1, 2022, using the keywords: (“ascorbic acid” OR “vitamin C” OR “Sodium Ascorbate” OR “L-ascorbic”) AND “common cold”. The 30 most-viewed videos were included in our study. The reliability and quality of the videos were analyzed using modified DISCERN and Global Quality Scales, respectively. When the videos included at least one correct or inaccurate scientific statement about the effect of vitamin C on the common cold, they were classified as accurate or misleading videos, respectively; those without any pertinent information were considered neither accurate nor misleading. If a video contained both accurate and inaccurate statements, it was classified as misleading. @*Results@#Of the 30 most-viewed videos, 73% were unreliable, and 67% contained misleading information and were of a poor quality. Of these 30 videos, 14 videos were produced and posted by customers who were not specialized in medicine or nutrition. Moreover, these videos were of significantly lower reliability, quality, and accuracy than those produced by nutrition or fitness channels or by medical or nutrition professionals. @*Conclusion@#The reliability, quality, and accuracy of videos uploaded by non-professionals were low. Therefore, video creators should upload reliable, high-quality videos to ensure the dissemination of accurate medical information.

Clinical Usefulness of Simultaneous Electroencephalography and Functional Magnetic Resonance Imaging in Children With Focal Epilepsy

Background@#and Purpose The current study analyzed the interictal epileptiform discharge (IED)-related hemodynamic response and aimed to determine the clinical usefulness of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) in defining the epileptogenic zone (EZ) in children with focal epilepsy. @*Methods@#Patients with focal epilepsy showing IEDs on conventional EEG were evaluated using EEG-fMRI. Statistical analyses were performed using the times of spike as events modeled with multiple hemodynamic response functions. The area showing the most significant t-value for blood-oxygen-level-dependent (BOLD) changes was compared with the presumed EZ. Moreover, BOLD responses between -9 and +9 s around the spike times were analyzed to track the hemodynamic response patterns over time. @*Results@#Half (n=13) of 26 EEG-fMRI investigations of 19 patients were successful. Two patients showed 2 different types of spikes, resulting in 15 analyses. The maximum BOLD response was concordant with the EZ in 11 (73.3%) of the 15 analyses. In 10 (66.7%) analyses, the BOLD response localized the EZs more specifically. Focal BOLD responses in the EZs occurred before IEDs in 11 analyses and were often widespread after IEDs. Hemodynamic response patterns were consistent in the same epilepsy syndrome or when repeating the investigation in the same patients. @*Conclusions@#EEG-fMRI can provide additional information for localizing the EZ in children with focal epilepsy, and also reveal the pathogenesis of pediatric epilepsy by evaluating the patterns in the hemodynamic response across time windows of IEDs.

Consideration for Coronavirus Disease 2019 Drug Treatment in Patients with Epilepsy on Antiepileptic Drugs

Several medications are approved to treat coronavirus disease 2019 (COVID-19) in Korea including nirmatrelvir/ritonavir, remdesivir, and regdanvimab. There is potential drug-drug interaction between antiepileptic drugs (AEDs) and the medications used to treat COVID-19. Several AEDs such as phenytoin, carbamazepine, phenobarbital, and primidone are strong cytochrome P450 inducers and can inhibit the drugs used for COVID-19. Particularly, these drugs are contraindicated with nirmatrelvir/ritonavir (Paxlovid®). There is a weaker drug-drug interaction between the AEDs and remdesivir. No significant interaction has been reported between the AEDs and molnupiravir. Pharmacokinetic interactions of the AEDs are important in effective management of COVID-19 in patients with epilepsy.

Myeloablative Hematopoietic Stem Cell Transplantation with a Non-total Body Irradiation Regimen for Treating Pediatric Acute Lymphoblastic Leukemia / 임상소아혈액종양

BACKGROUND: Total body irradiation (TBI) has been traditionally used as a conditioning regimen prior to hematopoietic stem cell transplantation (HSCT) in patients with pediatric leukemia. However, TBI can cause late sequelae such as growth impairment, cataract, hormone abnormalities, infertility, neurocognitive effects, and secondary malignancy in pediatric patients.METHODS: This single center retrospective study included 22 patients with acute lymphoblastic leukemia who were aged <18 years and underwent HSCT between May 1999 and December 2014; seven patients received a TBI-based regimen and 15 received a non-TBI regimen.RESULTS: The overall survival and event-free survival rates in the TBI group were not significantly different from those in the non-TBI group (overall survival rate 71% vs. 73%, respectively; P=0.906; event-free survival rate 71% vs. 73%, respectively P=0.923).CONCLUSION: Our results indicate that non-TBI conditioning regimens can be an alternative treatment option of the treatment of pediatric acute lymphoblastic leukemia undergoing HSCT.

Myeloablative Hematopoietic Stem Cell Transplantation with a Non-total Body Irradiation Regimen for Treating Pediatric Acute Lymphoblastic Leukemia / 임상소아혈액종양

BACKGROUND: Total body irradiation (TBI) has been traditionally used as a conditioning regimen prior to hematopoietic stem cell transplantation (HSCT) in patients with pediatric leukemia. However, TBI can cause late sequelae such as growth impairment, cataract, hormone abnormalities, infertility, neurocognitive effects, and secondary malignancy in pediatric patients. METHODS: This single center retrospective study included 22 patients with acute lymphoblastic leukemia who were aged <18 years and underwent HSCT between May 1999 and December 2014; seven patients received a TBI-based regimen and 15 received a non-TBI regimen. RESULTS: The overall survival and event-free survival rates in the TBI group were not significantly different from those in the non-TBI group (overall survival rate 71% vs. 73%, respectively; P=0.906; event-free survival rate 71% vs. 73%, respectively P=0.923). CONCLUSION: Our results indicate that non-TBI conditioning regimens can be an alternative treatment option of the treatment of pediatric acute lymphoblastic leukemia undergoing HSCT.

Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection

PURPOSE: The aim of this study was to determine the clinical characteristics, frequency of renal abnormalities and benefits of a top-down approach in children with their first febrile urinary tract infection (UTI). METHODS: We reviewed 308 patients retrospectively who were admitted to Yeungnam University Hospital and were treated for their first febrile UTI from February 2006 to December 2013. We performed a comparative analysis of laboratory findings and results of imaging techniques including a Tc-99m dimercaptosuccinic acid (DMSA) renal scan. RESULTS: Among the patients, 69% (213/308) were males, and 90% (277/308) had their first UTI episode during infancy. A DMSA renal scan was performed on all patients, and showed positive findings in 60% (184/308) of cases. Laboratory indices of inflammation were significantly higher in the DMSA-positive group (P<0.05). There was a statistically significant difference in the age distribution between the two groups. In the DMSA-positive group, 165 patients underwent voiding cystourethrography (VCUG), and 58 (35%) cases demonstrated vesicoureteral reflux. In total, 110 patients in the DMSA-positive group, underwent repeat scanning at 6 months; 33 children (30%) demonstrated static scarring, but 77 (70%) had improved completely. The concordance of the ultrasonography (US) and VCUG was low. Older patients had more renal scarring. CONCLUSION: DMSA is a sensitive method for assessing the severity of inflammation and kidney injury. However, the ability of US to predict renal parenchymal damage was limited. A top-down approach in children with their first febrile UTI showed significant value.

Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection

PURPOSE: The aim of this study was to determine the clinical characteristics, frequency of renal abnormalities and benefits of a top-down approach in children with their first febrile urinary tract infection (UTI). METHODS: We reviewed 308 patients retrospectively who were admitted to Yeungnam University Hospital and were treated for their first febrile UTI from February 2006 to December 2013. We performed a comparative analysis of laboratory findings and results of imaging techniques including a Tc-99m dimercaptosuccinic acid (DMSA) renal scan. RESULTS: Among the patients, 69% (213/308) were males, and 90% (277/308) had their first UTI episode during infancy. A DMSA renal scan was performed on all patients, and showed positive findings in 60% (184/308) of cases. Laboratory indices of inflammation were significantly higher in the DMSA-positive group (P<0.05). There was a statistically significant difference in the age distribution between the two groups. In the DMSA-positive group, 165 patients underwent voiding cystourethrography (VCUG), and 58 (35%) cases demonstrated vesicoureteral reflux. In total, 110 patients in the DMSA-positive group, underwent repeat scanning at 6 months; 33 children (30%) demonstrated static scarring, but 77 (70%) had improved completely. The concordance of the ultrasonography (US) and VCUG was low. Older patients had more renal scarring. CONCLUSION: DMSA is a sensitive method for assessing the severity of inflammation and kidney injury. However, the ability of US to predict renal parenchymal damage was limited. A top-down approach in children with their first febrile UTI showed significant value.

Applying the Bacterial Meningitis Score in Neonates Diagnosed Meningitis: A Single Center Experience

PURPOSE: To identify the factors associated with differential diagnosis of neonatal bacterial meningitis at the earliest opportunities possible and to evaluate the value of the bacterial meningitis score especially in neonates. METHODS: We conducted a single-center, retrospective study of neonates diagnosed meningitis at our hospital between January 2000 and March 2014. We compared the general characteristics, clinical manifestations, laboratory findings, bacterial meningitis scores between the bacterial group and the aseptic group. RESULTS: Bacterial meningitis differs significantly from aseptic meningitis in platelet count, the cerebrospinal fluid polymorphonuclear leukocyte count, and the serum protein including also the albumin (P<0.05). Except two infants, the bacterial meningitis score over 2 accurately predict bacterial meningitis in the other 11 infants. CONCLUSION: The bacterial meningitis score appears highly useful to identify neonatal infants with bacterial meningitis. However, its diagnostic and prognostic value is just ‘adjunctive’, because low score cannot rule out bacterial meningitis.

Effects of Human Adipose-Derived Stem Cells in Regenerating the Damaged Renal Tubular Epithelial Cells in an Animal Model of Cisplatin-Induced Acute Kidney Injury

BACKGROUND: We conducted this experimental study to examine whether human adipose-derived stem cells (ADSCs) are effective in achieving a recovery of damaged renal tubular epithelial cells in an animal model of cisplatin-induced acute kidney injury using rats. METHODS: To examine the in vitro effects of ADSCs in improving nephrotoxicity, we treated mouse renal tubular epithelial cells with both ADSCs and cisplatin mouse renal tubular epithelial cells. And we equally divided 30 male white Sprague-Dawley (SD) rats into the three groups: the control group (intraperitoneal injection of a sterile saline), the cisplatin group (intraperitoneal injection of cisplatin) and the ADSC group (intraperitoneal injection of cisplatin and the hADSC via the caudal vein). At five days after the treatment with cisplatin, serum levels of blood urine nitrogen (BUN) and creatinine were measured from each SD rat. We performed histopathologic examinations of tissue samples obtained from the kidney. RESULTS: The degree of the expression of TNF-alpha and that of Bcl-2 were significantly higher and lower respectively, in cisplatin group (P<0.05). Serum levels of BUN (P=0.027) and creatinine (P=0.02) were significantly higher in cisplatin group. On histopathologic examinations, there was a significant difference in the ratio of the renal injury between cisplatin group and ADSC group (P=0.002). CONCLUSION: The ADSCs might have a beneficial effect in regenerating the damaged renal tubular epithelial cells.

Pediatric Bacterial and Aseptic Meningitis in Daegu

PURPOSE: The aim of this study was to investigate the clinical characteristics and causative organisms of meningitis in the Daegu region and seek a useful tool for the early prediction of bacterial meningitis in children. METHODS: We retrospectively reviewed the medical records of 115 pediatric patients diagnosed with bacterial or aseptic meningitis at Yeungnam university hospital in Daegu from March 2012 to July 2013. We evaluated their clinical symptoms, laboratory findings, clinical courses, bacterial meningitis scores and complications. RESULTS: The subjects included 106 with aseptic meningitis and 9 with bacterial meningitis. At the time of visit, fever was the most frequent symptom, followed by headache, vomiting and neck stiffness. In cerebrospinal fluid (CSF) analysis, white blood cell (WBC) count were higher in the bacterial meningitis group (1423.8+/-1980.4 vs. 120.0+/-161.6 mg/dL). Mean CSF protein was 219.4+/-183.6 mg/dL in bacterial meningitis and 42.4+/-27.0 mg/dL in aseptic meningitis (P <0.001). Bacterial meningitis score (BMS) were higher in the group with bacterial meningitis. Abnormal radiological findings were found in 44% of the group with bacterial meningitis. CONCLUSION: Although the clinical features between the groups were similar, the CSF analysis revealed significant differences statistically. Furthermore, BMS could be helpful to predict bacterial meningitis in children. During the outbreak of aseptic meningitis, it might reduce unnecessary hospital admissions and antibiotic treatments.

A Case of Cecal Volvulus Presenting with Chronic Constipation in Lissencephaly / 대한소아소화기영양학회지

Cecal volvulus is uncommon in pediatric patients and there are few reports of cecal volvulus with cerebral palsy. Here, we report the case of a 19-year-old male patient who presented with abdominal distension, a history of cerebral palsy, refractory epilepsy due to lissencephaly, and chronic constipation. An abdominal x-ray and computed tomography without contrast enhancement showed fixed dilated bowel intensity in the right lower abdomen. Despite decompression with gastric and rectal tube insertion, symptoms did not improve. The patient underwent an exploratory laparotomy that revealed cecal volvulus. Cecal volvulus usually occurs following intestinal malrotation or previous surgery. In this patient, however, intestinal distension accompanying mental disability and chronic constipation resulted in the development of cecal volvulus. We suggest that cecal and proximal large bowel volvulus should be considered in patients presenting with progressive abdominal distension combined with a history of neuro-developmental delay and constipation.

Neurologic Complications and Outcomes of Pandemic (H1N1) 2009 in Korean Children

Neurologic complications of children with influenza A H1N1 2009 pandemic, diagnosed in two consecutive influenza seasons were retrospectively reviewed to seek better outcomes in future outbreaks. Patient demographics, clinical manifestations and neurologic outcomes were reviewed. A total of 1,389 children were diagnosed with influenza A H1N1 by real-time reverse transcriptase-polymerase chain reaction. Of these, 23 (1.7%) patients had neurologic involvement. Their mean age was 5.9 +/- 3.6 yr (range, 6 months to 11 yr) and 16 (69.9%) were boys. None of the 23 patients had been vaccinated for influenza A H1N1 and seasonal influenzas. Twenty-two of the 23 patients presented with seizures. Clinical features included febrile convulsion (n = 19), afebrile convulsion (n = 1), aseptic meningitis (n = 1), encephalopathy (n = 1), and acute necrotizing encephalopathy (n = 1). They all were treated with Oseltamivir twice daily for 5 days immediately after nasal and throat swab testing. Twenty-one of the subjects recovered fully, but the youngest two infants experienced severe neurological sequelae. The results indicate that neurologic complications associated with influenza A H1N1 2009 pandemic were mostly mild, but rarely were serious. Prompt intervention leads to a better outcome and vaccination may prevent the disease, thus staving off serious neurological complications following influenza, especially in young infants.

Clinical Analysis of Restless Legs Syndrome in Korean Children

PURPOSE: Restless legs syndrome (RLS) is a common neurologic sleep disorder, but it is frequently undiagnosed in Korean children. This study aimed to investigate clinical features of RLS in Korean children. METHODS: We reviewed the medical records of seven patients who had been diagnosed with RLS at the pediatric department of Kyungpook National University Hospital from March to September 2011. RESULTS: The mean age was 7.5+/-3.4 years (M:F=5:3). Chief complaints included abnormal movement during sleep (n=5, 71.4%), leg pain (n=1, 14.3%), and headache (n=1, 14.3%). Three showed inattention or hyperactivity, and one patient was taking medication for attention deficit hyperactivity disorder (ADHD). Six (85.7%) had sleep disturbance, and family history for RLS was positive in 3 (42.9%). Three patients (42.9%) showed a periodic limb movement index of 5 or more per hour of sleep that was compatible with supportive criteria of RLS. Serum testing, including a complete blood count, iron, total iron binding capacity, and ferritin, was performed. Among 5 children who demonstrated iron deficiency, 1 showed very low ferritin of 7 ng/mL, and after oral iron supplementation (3 mg/kg/day) over 1 month, there was dramatic improvement in leg pain and daytime behavior. Two patients who underwent treatment with pramipexole (0.125 mg) also had much improvement in sleep onset and daytime behavior. CONCLUSION: RLS can have a serious impact on quality of life in pediatric patients, so we need to find the children with RLS. Iron repletion therapy is effective for the patient with RLS who shows iron deficiency. In addition, use of a dopamine agonist is an effective treatment option for pediatric RLS.