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Children with obstructive sleep apnea (OSA) show symptoms such as snoring, sleep apnea, and oral breathing. The diagnosis of the disease can be made through polysomnography and as the most common causes are tonsillar and adenoid hypertrophy, tonsillectomy and adenoidectomy (T et A) are considered as initial treatment. OSA is an increasingly recognized problem in children with Down syndrome, who are more prone to facial hypoplasia, hypoplasia of the mandible, and have a large tongue. In OSA Down syndrome patients, T et A can be performed if tonsillar hypertrophy is present. However, because these patients have underlying diseases (atlatoaxial unstability, airway problem, heart problem, endocrine problem), general anesthesia may be difficult and cervical extension may be limited during the operation. We describe a case of 10-year-old child with Down syndrome and OSA, who underwent T et A under general anesthesia through multidisciplinary care.
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Objectives@#. We evaluated the usefulness of the standardized nasal provocation test (NPT) protocol recently published by the European Academy of Allergy and Clinical Immunology (EAACI) and compared the utility of several parameters for diagnosing allergic rhinitis (AR) caused by house dust mites (HDM). Subjective parameters were nasal and ocular symptoms measured using a visual analog scale (VAS), and objective parameters were peak nasal inspiratory flow (PNIF), minimal cross-sectional area (MCA), and total nasal volume (TNV). @*Methods@#. Before and after spraying Dermatophagoides pteronyssinus (DP) allergen (1,000 AU/mL, 100 μL) into both nostrils of 13 patients with AR (AR group) and 22 patients with non-AR (NAR group), we used VAS scores to measure nasal symptoms (nasal obstruction, rhinorrhea, sneezing, and itching) and ocular symptoms and assessed PNIF, MCA, and TNV. @*Results@#. The AR group had significantly worse symptoms than the NAR group 15 minutes after DP challenge (P<0.001). After 30 minutes, nasal obstruction and rhinorrhea remained worse in the AR group (P<0.001); a similar but less marked difference was seen for sneezing (P=0.012) and itching (P=0.039). Ocular symptoms, PNIF, MCA, and TNV differed between groups after both 15 and 30 minutes (P<0.05). The area under the receiver operating characteristic curve was higher for nasal obstruction (0.977), rhinorrhea (0.906), and TNV (0.979) than for sneezing (0.755), itching (0.673), and MCA (0.836). @*Conclusion@#. NPT performed according to the EAACI guidelines could help diagnose AR caused by HDM. TNV and VAS changes in nasal obstruction and rhinorrhea had higher diagnostic accuracy than other parameters.
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Purpose@#We aimed to determine appropriate antigen concentrations and the right time to evaluate intranasal changes when performing a nasal provocation test (NPT). Also, we sought to analyze the diagnostic usefulness of individual nasal symptom and peak nasal inspiratory flow (PNIF). @*Materials and Methods@#We divided 46 patients into allergic rhinitis (AR) group (n=19) and a non-allergic rhinitis (NAR) group (n=27). We performed intranasal challenge with 100 AU/mL of Dermatophagoides pteronyssinus (DP) and measured changes in nasal symptoms [scored using the visual analogue scale (VAS)] and PNIF%. If the patient showed significant changes, VAS and PNIF were assessed again after another 15 minutes. In patients without significant changes, we administered 1000 AU/mL and measured changes in nasal symptoms and PNIF% after 15 and 30 minutes. @*Results@#Fifteen minutes after the 100 AU/mL challenge, the AR group showed more significant VAS changes in all nasal symptoms, total nasal symptom score (TNSS), and PNIF% change than the NAR group. Among the AR group, patients who did not respond to 100 AU/mL exhibited less significant differences relative to the NAR group, even after 1000 AU/mL challenge. Receiver operating characteristic curve analysis for VAS changes 15 minutes after 100 AU/mL challenge revealed that all nasal symptoms had area under the curve (AUC) values of ≥0.84 (p<0.001). TNSS change had an AUC value of 0.929 (p<0.001), while PNIF% change had an AUC value of 0.834. @*Conclusion@#We could determine the optimal concentration (100 AU/mL), timing (15 minutes after challenge), and parameters (changes in TNSS and PNIF%) when performing NPT.
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Purpose@#We aimed to determine appropriate antigen concentrations and the right time to evaluate intranasal changes when performing a nasal provocation test (NPT). Also, we sought to analyze the diagnostic usefulness of individual nasal symptom and peak nasal inspiratory flow (PNIF). @*Materials and Methods@#We divided 46 patients into allergic rhinitis (AR) group (n=19) and a non-allergic rhinitis (NAR) group (n=27). We performed intranasal challenge with 100 AU/mL of Dermatophagoides pteronyssinus (DP) and measured changes in nasal symptoms [scored using the visual analogue scale (VAS)] and PNIF%. If the patient showed significant changes, VAS and PNIF were assessed again after another 15 minutes. In patients without significant changes, we administered 1000 AU/mL and measured changes in nasal symptoms and PNIF% after 15 and 30 minutes. @*Results@#Fifteen minutes after the 100 AU/mL challenge, the AR group showed more significant VAS changes in all nasal symptoms, total nasal symptom score (TNSS), and PNIF% change than the NAR group. Among the AR group, patients who did not respond to 100 AU/mL exhibited less significant differences relative to the NAR group, even after 1000 AU/mL challenge. Receiver operating characteristic curve analysis for VAS changes 15 minutes after 100 AU/mL challenge revealed that all nasal symptoms had area under the curve (AUC) values of ≥0.84 (p<0.001). TNSS change had an AUC value of 0.929 (p<0.001), while PNIF% change had an AUC value of 0.834. @*Conclusion@#We could determine the optimal concentration (100 AU/mL), timing (15 minutes after challenge), and parameters (changes in TNSS and PNIF%) when performing NPT.
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In Vol. 31, No. 3, our journal prepared three review articles, an original paper, and two case reports. First, as COVID-19 continues for a long time, aviation workers, including pilots, are also experiencing mental problems such as depression.Therefore, we have compiled the basic principles for improving the mental health of pilots. Next, it is difficult to properly perform cardio-pulmonary resuscitation (CPR) when a cardiac arrest situation occurs in an aircraft. Moreover, in the context of the COVID-19 pandemic, CPR is more difficult because medical staff and other passengers may also be exposed to infections. Therefore, we have summarized the principles of CPR on board and ways to perform CPR while keeping the safety of medical staff and other passengers in the COVID-19 situation. The sudden change of gravity caused by space travel has various effects on the human body, and among them, the effect on the immune system is profound. Therefore, we reviewed the research methods to study the effect of gravity on the immune system and the results. In addition, we analyzed the demographic characteristics and health status of immigrant visa applicants who intended to immigrate to the United States over the past five years. Next, through two case reports, we reported cases of determining physical fitness for aviation service in patients who recovered after receiving appropriate treatment for chronic myeloid leukemia or renal cell carcinoma.
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Changes the gravity has a significant affect on the immune system. Astronauts experience the gravity changing during spaceflight, especially when launching and landing they experience hypergravity, and during spaceflight they feel microgravity. Both hypergravity and microgravity has an impact to the immune system, but not the same effect. These impacts have been investigated extensively during spaceflight in astronauts and in model experiments conducted on Earth as well. Astronauts during spaceflight feel the hypergravity, psychological stress, fear, high doses of radiation and microgravity. All these factors and changes may affect immune system directly or indirectly.
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In Vol. 31, No. 2, our journal prepared a review article, two original papers, and three case reports. First, autonomous systems are increasingly being introduced in aircraft systems. Therefore, it is crucial that flight crews are trained to adapt and handle these autonomous systems better. Consequently, we discussed crew resource management for handling autonomous systems. The fatigue of aviation workers is one of the biggest threats to aviation safety. Therefore, we analyzed the degree of fatigue in commercial aircraft pilots and evaluated the relationship between fatigue and their workload and the effect of fatigue on sleep. Since obesity has a significant impact on the health of aviation workers, we also comparatively analyzed the prevalence of obesity in Korea and Japan based on the data from the National Health and Nutrition Examination Survey. We defined cases that are difficult for aviation medical examiners to evaluate. This issue included cases of peripheral dizziness and tinnitus, cases of atopic dermatitis treated with biological agents, and cases of malignant tumors.
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Aviation medical examiners should always keep two principles in mind when evaluating patients with vertigo: Does this disease render him or her incapacitated? And does this disease recur? Meniere's disease accompanies vertigo and hearing symptoms such as hearing loss and tinnitus and is particularly important because it can render the patient incapacitated and has recurrent consequences.In this case, we intended to investigate the course of a patient who was evaluated with symptoms of dizziness and tinnitus and to review the patient's judgment result according to the principles of aeromedical evaluation.
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In Vol. 31, No. 1, our journal prepared four review articles and two original papers. First, in commemoration of the 30th anniversary of our journal, the first review article described the history, development, and recent efforts for the qualitative improvement of the journal. For aviation workers, dizziness is an important disease that can interfere with their work. So, in the second review, we introduced guidelines that aviation medical examiners should be aware of in evaluating aviation workers who complain of dizziness. In the era of coronavirus disease 19 (COVID-19) pandemic, it is very important for aviation workers to get the vaccination safely and return to their work. So, Kwon introduced the latest updated guidelines for vaccination for aviation workers. In addition, Kim described the relationship between COVID-19 infection and respiratory allergic disease, and appropriate treatment guidelines. Lim investigated the recent trend of human papillomavirus vaccination for foreigners during the COVID-19 period, and investigated its implications. Finally, Ra developed various programs to strengthen students’ global competencies and analyzed their satisfaction.
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The year 2021 is a significant year in which the Korean Journal of Aerospace and Environmental Medicine (KJAsEM) celebrates its 30th anniversary. Therefore, in this review, we look back on the history and development of KJAsEM and suggest the direction we should go forward. In particular, the recent development of KJAsEM was described in more detail, such as opening the KJAsEM journal homepage, an online submission system, and adopting an open access policy.
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Aircraft accidents caused by dizziness of aviation workers are so common that they account for 5% to 10% of the total, and in most cases, have fatal consequences. Therefore, it is essential to diagnose and treat the dizziness of aviation workers properly. Common diseases caused by abnormal vestibular function include benign paroxysmal positional vertigo, Meniere’s disease, and vestibular neuritis. In this paper, we first proposed an overview of these diseases’ pathophysiology, diagnosis, and treatment. Also, we evaluated the importance of these diseases in aerospace medicine and presented aerospace medical dispositions for aviation medical examiners.
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As the coronavirus disease 2019 (COVID-19) pandemic continues, doctors face many difficulties in managing patients with respiratory allergies. As research continues, much new knowledge has emerged about the link between COVID-19 infection and respiratory allergies. Studies to date have shown that there is no significant increase in the risk of COVID-19 infection in patients with respiratory allergies. However, in patients undergoing treatment for moderate to severe asthma or allergic rhinitis, more severe clinical manifestations, increased hospitalization period, and increased mortality may occur, so patients need to be managed with more care.In addition to personal efforts, social consideration should be accompanied to prevent deterioration in patients’ quality of life with respiratory allergies due to COVID-19.Lastly, as clinical doctors, we should treat patients with respiratory allergies to protect ourselves appropriately by actively utilizing remote medical treatment and minimizing tests that generate droplets. Also, by appropriately educating patients and continuing drug treatment, efforts should be made to ensure that patients receive the best treatment even in a pandemic situation.
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In commemoration of Vol. 30, Issue 2, our journal prepared three reviewarticles, two original papers, and a case report. The first review analyzed aircraftaccidents caused by pilots' fatigue and presented a protocol to measure their fatigue,such as primary background survey, subjective drowsiness/arousal evaluation,sleep and activity log, sleep data, and performance measurement. The secondreview analyzed shift work patterns and work characteristics that may affect thefatigue of aviation mechanics. Also, desirable work principles for aviation mechanics(restrictions on working hours, appropriate rest hours, and night shift restrictions)were presented. The third review discussed the effects that allergic rhinitis canhave on pilots (drowsiness and decreased arousal) and introduced a safe treatmentmethod that can prevent these adverse effects. In the first original article, the ratioof 'incompatible (non-fit)' result in aerospace medical examination among Koreanaircraft pilots for the past five years was investigated by age group and the commoncauses of nonconformity were analyzed. In the second original article, the prevalence,mortality, prevalence according to age groups, and regional characteristics of severefebrile thrombocytopenia syndrome were compared and analyzed in Korea and Japanfor the past five years. Finally, in the case report, the cases of a patient diagnosed asgastrointestinal stromal tumors who received surgical treatment and chemotherapywere discussed, and the results of the judgment were presented.
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Since allergic rhinitis is a disease with a very high prevalence, it is common to find patients with allergic rhinitis among aviation workers. However, they are so afraid that the report of rhinitis will have a negative effect on the evaluation of one's work suitability. Therefore, aviation medical examiners (AMEs) must be able to accurately understand the nature of allergic rhinitis, and confidently explain that appropriate treatment of rhinitis has a positive effect on their performance. In the treatment of allergic rhinitis, there are some medications that may cause drowsiness,which may impair the accuracy and safety of the aviation service. Therefore, AMEs should accurately know safe drugs that do not cause drowsiness and prescribe them to patients. In addition, it is necessary to know exactly whether air workersmay receive the latest treatments for allergic rhinitis, such as surgical treatment andimmunotherapy, and be able to recommend these treatments appropriately. Therefore,in this paper, we first briefly describe the pathophysiology, genetics, causative antigen,symptoms, diagnosis, and treatment of allergic rhinitis. We also aimed to discuss safemedication and other treatment modalities for allergic rhinitis.
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In commemoration of Vol. 30, Issue 1, our journal prepares four review articles and two original papers. The first review article provides guidelines for medical treatment for emergencies in an aircraft furing flight. This guideline addresses the resources and medical equipment available to physicians on board, common medical conditions, how to deal with them, including legal issues. The second review article covers historically meaningful animals that have contributed to aerospace research and the role of a veterinarian. The third one describes cardiovascular, musculoskeletal, and vestibular physiological effects of microgravity on the human body. As we are about to enter an aging society, the fourth review article introduces guidelines for safe overseas travel for senior passengers. The role of the aviation medical examiner is to maintain aircrew's health and to help them work long and healthy. In this regard, Choi et al. analyzed the physical examination data and sick leave data of an airline. Han et al. investigated the aerospace medical examination data of the Republic of Korea and suggested a solution to some common health problems of the crew.
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Background and Objectives@#The immunomodulatory effects and mechanism of probiotics in allergic airway disease are largely unknown. We studied whether Bacillus clausii (BC), a probiotic derived from mudflats, had anti-allergic effects and compared the results with those of Lactobacillus paracasei (LP). We also examined whether the anti-allergic mechanisms of probiotics are associated with hypoxia signaling.Materials and Method: Forty-two BALB/c mice were randomly assigned to six experimental groups: controls, ovalbumin (OVA)-induced mice for inducing asthma, and OVA-induced mice that were orally administered LP or BC, at 1×109 or 5×109 CFU/mL each. We performed differential cell count testing on bronchoalveolar lavage fluid (BALF), lung histopathology, serum totals and OVA-specific IgE and IgG1 assessments, Th2 cytokine titers (IL-4, IL-5) in BALF and pulmonary parenchyma, quantitative PCR for heme oxygenase (HO)-1 and Hif-1α, and immunohistochemistry. @*Results@#Compared to the OVA group mice, OVA-sensitized mice treated with LP or BC showed significantly reduced numbers of eosinophils and neutrophils in the BALF (p<0.05). Both probiotics also significantly reduced pulmonary inflammation and eosinophil infiltration. Mice in the LP or BC group had a substantially lower titer of IL-4 and IL-5 in BALF, and decreased IL-4 and IL-5 expression in the lung parenchyma. Real-time PCR and immunohistochemistry showed that both LP and BC could significantly suppress HO-1 and Hif-1α expression in asthmatic mice (p<0.05). @*Conclusion@#BC can attenuate murine allergic asthma by regulating HIF-1α signaling, and its anti-allergic effect is comparable to that of LP.
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PURPOSE: We evaluated the severity of olfactory disturbance (OD) in the murine model of allergic rhinitis (AR) and local allergic rhinitis (LAR) in mice. We also investigated the therapeutic effect of an intranasal steroid on OD. METHODS: Forty BALB/c mice were divided into 5 groups (n = 8 for each). The control group was sensitized intraperitoneally (i.p.) and challenged intranasally (i.n.) with saline. Mice in the AR group got i.p. and i.n. ovalbumin (OVA) administration for AR induction. The LAR group was challenged i.n. with 1% OVA for inducing local nasal allergic inflammation, without inducing the systemic allergy. The OD group got an i.p. methimazole administration (75 mg/kg) to induce total destruction of olfactory mucosa. Mice in the intranasal budesonide group received i.n. budesonide (12.8 μg per time, 30 minutes after the i.n. OVA challenge) while using OVA to cause systemic allergies. We conducted a buried-food pellet test to functionally assess the degree of OD in each group by measuring the time taken until finding hidden food. We evaluated the damage to olfactory epithelium using histopathologic evaluation and compared the degree of olfactory marker protein (OMP) expression in olfactory epithelium using immunofluorescent staining. RESULTS: Mice of the AR (81.3 ± 19.8 seconds) and LAR groups (66.2 ± 12.7 seconds) spent significantly more time to detect the pellets than the control group (35.6 ± 12.2 seconds, P < 0.01). After treatment, the intranasal budesonide group exhibited significantly better results (35.8 ± 11.9 seconds) compared with the AR and LAR groups (P < 0.01). The AR and LAR groups showed considerable olfactory epithelial damage and suppression of OMP expression compared with the control group. In the intranasal budesonide group, the olfactory lesions and OMP expression had improved substantially. CONCLUSIONS: OD may be caused by olfactory epithelial damage and suppression of OMP expression in nasal allergic inflammation and could be reversed using an intranasal steroid.
Subject(s)
Animals , Mice , Budesonide , Hypersensitivity , Inflammation , Methimazole , Olfaction Disorders , Olfactory Marker Protein , Olfactory Mucosa , Ovalbumin , Ovum , Quality of Life , Rhinitis, Allergic , SteroidsABSTRACT
In commemoration of Vol. 30, Issue 3, our journal prepared five review articles and one original paper. The global outbreak of COVID-19 in 2020 has impacted our society, and especially the aviation and travel industries have been severely damaged. Kwon presented the aviation medical examination regulations related to COVID-19 announced by the Ministry of Land, Infrastructure, and Transport of the Republic of Korea. Lim summarized various efforts of airlines to overcome the crisis in the aviation industry. He also discussed the management of these aircraft as the number of airplanes landing for long periods increased. Finally, he suggested various quarantine guidelines at airports and onboard aircraft. COVID-19 has had a profound impact on mental health as well as physical effects. Kim investigated the impact of COVID-19 on mental health and suggested ways to manage the stress caused by it.The Internet of Things (IoT) refers to a technology in which devices communicate with each other through wired or wireless communication. Hyun explained the current state of the technology of the IoT and how it could be used, especially in the aviation field. In the area of airline service, various situations arise between passengers and crew. Therefore, role-playing is useful in performing education to prepare and respond to passengers’ different needs appropriately. Ra introduced the conceptual background and general concepts of role-playing and presented the actual role-play’s preparation process, implementation, evaluation, and feedback process. For a fighter to fly for a long time and perform a rapid air attack, air refueling is essential, which serves refueling from the air rather than from the aircraft base. Koo developed a questionnaire based on the HFACS (Human Factors Analysis and Classification System) model and used it to conduct a fighter pilot survey and analyze the results.
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Mucocele of the paranasal sinuses is a benign, expansible, and cystic mass filled with mucous collection. Infraorbital cells are extramural ethmoid cells that develop into the roof of the maxillary sinus and the base of the orbital cavity. Although infraorbital cells are asymptomatic in most cases, inflammation or mucocele in those cells may cause various symptoms including facial pain, hypoesthesia, and secondary rhinosinusitis. They sometimes invade the orbital cavity, which may cause ophthalmic symptoms such as visual disturbance, orbital swelling, and orbital pain. Most of the cases with ophthalmic symptoms are related to sphenoethmoidal cell mucocele. Delayed treatment of more than two days is known to have a poor prognosis for visual disturbances caused by acute optic nerve compression. We describe a case of 61-year-old man who complained of visual disturbance related to infraorbital cell mucocele and fully recovered right after surgical management.
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BACKGROUND AND OBJECTIVES@#We investigated the seasonal variation of nonspecific hyperreactivity by performing the cold dry air (CDA) provocation test in both summer and winter in patients with rhinitis.SUBJECTS AND METHOD: We performed the CDA provocation test in 57 patients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhinitis, we divided patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after CDA provocation in each group.@*RESULTS@#When the CDA provocation was performed for AR patients in summer, nasal symptoms improved slightly, which was significantly different from those shown in winter (Summer AR vs. Winter AR, p=0.012). In addition, there was a significant difference in symptom change between AR and NAR patients in the summer (Summer AR vs. Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after CDA provocation depending on the type of rhinitis and season (p>0.05).@*CONCLUSION@#When performing CDA provocation in AR patients in summer, the examiner should pay attention to the possible paradoxical response.