Five Year Experience of Preexposure and Postexposure Rabies Prophylaxis in Korean Children at the National Medical Center / 소아감염

PURPOSE: This study aims to investigate preexposure prophylaxis and postexposure prophylaxis of rabies that the National Medical Center (NMC) handled and to check whether appropriate measures were performed according to the recent domestic and overseas guidelines after animal bites. METHODS: This study surveyed 41 people who were 18 years or under and received preexposure and postexposure prophylaxis of rabies at the NMC from November 2006 to December 2011. Their medical records were reviewed for their age, gender, the reason for preexposure prophylaxis, the body sites of animal bite, the kind of the animal that bit children, the region where the biting occurred and rabies vaccination and inoculation of immunoglobulin. RESULTS: Eleven children took rabies vaccination for preexposure prophylaxis and 30 children received post exposure prophylaxis of rabies. Of patients who were bitten by unvaccinated animals including wild animals or by animals which were not certain to be vaccinated, 50% (13 of 26 children) received postexposure prophylaxis, while 75% (3 of 4 children) of patients who were bitten by vaccinated animals received postexposure prophylaxis of rabies. Ten of 30 bitten patients knew whether or not the biting animals had received rabies vaccination. Of them, four people (40%) were bitten by animals which had received rabies vaccination. CONCLUSION: To prevent the occurrence of rabies, people and health care providers need to correctly understand latest guideline for rabies preexposure and postexposure prophylaxis and the information for bitten patient, biting animal and area at bitten by animal should be accurately recorded.

A Case of Epstein-Barr Virus Infection with Gall Bladder and Common Bile Duct Stones in an Otherwise Healthy Child / 대한소아소화기영양학회지

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis.

Clinical Features of Patients with Anaphylaxis at a Single Hospital / 소아알레르기및호흡기학회지

PURPOSE: The studies concerning the clinical features of patients with anaphylaxis, who meet the newly established diagnostic criteria, are reported in Korea, but comparative studies regarding the clinical features of children and adult patients with anaphylaxis are lacking. The purpose of this study is to compare the clinical features of the children and adults with anaphylaxis, who meet the new diagnostic criteria at a single hospital. METHODS: We reviewed the medical records of patients who were diagnosed with anaphylaxis, anaphylactic shock, urticaria, and angioedema, including inpatients, outpatients and emergency room visited patients, at the National Medical Center from July, 2005 to August, 2011. The clinical characteristics of children and adults, who met the new diagnostic criteria for anaphylaxis, were analyzed. RESULTS: We identified 91 patients with anaphylaxis. Sixteen were children and 75 were adults. The sex ratio (male:female) and the mean age were 1:1.7 and 9.6 years among children, respectively, and 1:2.3 and 42.3 years, respectively, among adults. The most common cause of anaphylaxis based on clinical history was foods in 15 children (93.7%) and 35 adults (46.7%). Twelve children (75%) and 36 adults (48%) were rediagnosed with anaphylaxis. Patients with cardiovascular symptoms and severe severity were 1 (6.3%) and 1 (6.3%), respectively, among children, and 28 (37.3%) and 23 (30.3%), respectively, among adults. CONCLUSION: We rediagnosed some cases of anaphylaxis, using the new diagnostic criteria and most of the cases were diagnosed initially as urticaria or angioedema. The adults had more severe and more cardiovascular symptoms than children. In the future, a nationwide, multiinstitutional research will be necessary for the prevalence and the clinical features of anaphylaxis by the new diagnostic criteria in Korea.

Validation study of the Dinamap ProCare 200 upper arm blood pressure monitor in children and adolescents / 소아과

PURPOSE: To validate the Dinamap ProCare 200 blood pressure (BP) monitor against a mercury sphygmomanometer in children 7 to 18 years old in accordance with the 2010 International Protocol of European Society of Hypertension (ESH-IP2) and the British Hypertension Society (BHS) protocol. METHODS: Forty-five children were recruited for the study. A validation procedure was performed following the protocol based on the ESH-IP2 and BHS protocols for children and adolescents. Each subject underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device by trained nurses. The results were analyzed according to the validation criteria of ESH-IP2. RESULTS: The mean (+/-SD) difference in the absolute BP values between test device and mercury sphygmomanometer readings was 1.85+/-1.65 mmHg for systolic BP (SBP) and 4.41+/-3.53 mmHg for diastolic BP (DBP). These results fulfilled the Association for the Advancement of Medical Instrumentation criterion of a mean+/-SD below 5+/-8 mmHg for both SBP and DBP. The percentages of test device-observer mercury sphygmomanometer BP differences within 5, 10, and 15 mmHg were 96%, 100%, and 100% for SBP, and 69%, 92%, and 100% for DBP, respectively, in the part 1 analysis; both SBP and DBP passed the part 1 criteria. In the part 2 analysis, SBP passed the criteria but DBP failed. CONCLUSION: Although the Dinamap ProCare 200 BP monitor failed an adapted ESH-IP2, SBP passed. When comparing BP readings measured by oscillometers and mercury sphygmomanometers, one has to consider the differences between them, particularly in DBP, because DBP can be underestimated.

Three Cases of Prevention Therapy to Reduce Perinatal HIV Transmission / 소아감염

In 2008, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that about 430,000 children worldwide became infected with HIV, mostly through mother-to-child transmission (MTCT) during pregnancy, labor, delivery, or breast-feeding. The MTCT prevention program proved to be feasible and effective in reduction of perinatal HIV transmission. Three babies born from HIV-infected mothers were admitted to the National Medical Center in 2009. Only two women received antiretroviral (ARV) therapy during pregnancy, labor, and after delivery, and their infants received zidovudine (AZT) for 6 weeks. The outcome, after a follow-up period of 4 months to 16 months, was favorable in all patients. Thus, we emphasize the need for expansion of antenatal HIV screening of pregnant women, implemented for early HIV diagnosis and effective ARV therapy for reduction of perinatal HIV transmission.

Validation study of the Dinamap ProCare 200 upper arm blood pressure monitor in children and adolescents / 소아과

PURPOSE: To validate the Dinamap ProCare 200 blood pressure (BP) monitor against a mercury sphygmomanometer in children 7 to 18 years old in accordance with the 2010 International Protocol of European Society of Hypertension (ESH-IP2) and the British Hypertension Society (BHS) protocol. METHODS: Forty-five children were recruited for the study. A validation procedure was performed following the protocol based on the ESH-IP2 and BHS protocols for children and adolescents. Each subject underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device by trained nurses. The results were analyzed according to the validation criteria of ESH-IP2. RESULTS: The mean (+/-SD) difference in the absolute BP values between test device and mercury sphygmomanometer readings was 1.85+/-1.65 mmHg for systolic BP (SBP) and 4.41+/-3.53 mmHg for diastolic BP (DBP). These results fulfilled the Association for the Advancement of Medical Instrumentation criterion of a mean+/-SD below 5+/-8 mmHg for both SBP and DBP. The percentages of test device-observer mercury sphygmomanometer BP differences within 5, 10, and 15 mmHg were 96%, 100%, and 100% for SBP, and 69%, 92%, and 100% for DBP, respectively, in the part 1 analysis; both SBP and DBP passed the part 1 criteria. In the part 2 analysis, SBP passed the criteria but DBP failed. CONCLUSION: Although the Dinamap ProCare 200 BP monitor failed an adapted ESH-IP2, SBP passed. When comparing BP readings measured by oscillometers and mercury sphygmomanometers, one has to consider the differences between them, particularly in DBP, because DBP can be underestimated.

A Study on the Adverse Events of the Yellow Fever Vaccine at an International Travelers' Clinic / 감염과화학요법

BACKGROUND: Yellow fever (YF) can be prevented through vaccination, but YF vaccination causes adverse events. The increasing number of travelers to YF-endemic areas prompted an investigation of YF vaccination's adverse events on Koreans. MATERIALS AND METHODS: From January to December 2007, 318 live-17DD vaccinees at the International Travelers' Clinic of the National Medical Center were enrolled in this study. RESULTS: The adverse events were evaluated through six telephone interviews of 309 subjects (male: 168, 54.4%) on days 3, 6, 9, 16, 23, and 30 after the administration of the vaccine. There were 106 adverse events in 97 (31.4%) subjects aged 11 months to 70 years (male: 56, 18.1%). Of the 34 (11.0%) subjects who had underlying diseases, 3 (1.0%) reported adverse events (P=0.06). Nineteen (6.1%) of the 72 (23.3%) subjects who concurrently received other vaccines also experienced adverse events (P=0.29). Those who had underlying illnesses and those aged 10 to 19 years reported more frequent adverse events (P=0.06 and 0.14, respectively), but the significance of this finding is uncertain. Most of the adverse events occurred within 10 days after the vaccination and spontaneously subsided. CONCLUSION: This study shows that most of the YF vaccine's adverse events are well tolerated and that the vaccine safely protects a vaccinee from YF.

A Study on the Adverse Events of the Yellow Fever Vaccine at an International Travelers' Clinic / 감염과화학요법

BACKGROUND: Yellow fever (YF) can be prevented through vaccination, but YF vaccination causes adverse events. The increasing number of travelers to YF-endemic areas prompted an investigation of YF vaccination's adverse events on Koreans. MATERIALS AND METHODS: From January to December 2007, 318 live-17DD vaccinees at the International Travelers' Clinic of the National Medical Center were enrolled in this study. RESULTS: The adverse events were evaluated through six telephone interviews of 309 subjects (male: 168, 54.4%) on days 3, 6, 9, 16, 23, and 30 after the administration of the vaccine. There were 106 adverse events in 97 (31.4%) subjects aged 11 months to 70 years (male: 56, 18.1%). Of the 34 (11.0%) subjects who had underlying diseases, 3 (1.0%) reported adverse events (P=0.06). Nineteen (6.1%) of the 72 (23.3%) subjects who concurrently received other vaccines also experienced adverse events (P=0.29). Those who had underlying illnesses and those aged 10 to 19 years reported more frequent adverse events (P=0.06 and 0.14, respectively), but the significance of this finding is uncertain. Most of the adverse events occurred within 10 days after the vaccination and spontaneously subsided. CONCLUSION: This study shows that most of the YF vaccine's adverse events are well tolerated and that the vaccine safely protects a vaccinee from YF.

Adverse Events Following Yellow Fever Vaccination in Korean Children / 소아감염

PURPOSE:Yellow fever, a mosquito-borne viral hemorrhagic fever, is one of the most lethal diseases. Recently there have been an increasing number of Korean children who have travelled to yellow fever endemic zones and were administered yellow fever vaccine (YFV). Therefore, we carried out this study to provide child travelers with safety information of YFV. METHODS:This study was conducted at the International Clinic of National Medical Center in Seoul between April 2007 and June 2008 for the evaluation of adverse events of YFV. One hundred twenty- five children received YFV (17-DD) and were prospectively monitored for adverse events through telephone interviews on day 3, 6, 9, 16, 23 and 30 after vaccination. RESULTS:Adverse events were observed in 31 (24.8%) of 125 child travelers who received the YFV. The mean age was 12.5+/-5.0 years. Sixty-six of the child travelers (52.8%) were males. The common adverse events were pain in 11 (8.8%), swelling in 8 (6.4%) and redness in 7 children (5.6%) at the injection site. The systemic adverse events included mild fever in 5 (4.0%), headache in 5 (4.0%), cough in 4 (3.2%), abdominal pain in 3 (2.4 %), and vomiting in 2 children (1.6%). Most of the adverse events were detected within 7 days of administration and there were no differences in adverse events by gender or age. All travelers who had complained of symptoms improved spontaneously or following symptomatic treatment. CONCLUSION:This study showed that YFV is well-tolerated and there were no reports of severe adverse events. Studies are ongoing to clarify the cause and risk factors for rare adverse events.

Study on Short Term Test-Retest Reliability of High Frequency Audiometry / 대한이비인후과학회지

Although high frequency threshold has been regarded as a early detector of cochlear damage, there has been no standardized system for calibration or measurement of high frequency threshold. Compared measurement of the high frequency(10-20KHz) with measurement of the low frequency(250-8000Hz), it is difficult to establish high frequency normative values because thresholds vary widely with age, calibration system and kinds of audiometer, etc.... But short term test-retest may not be influenced by calibration variance. So we tried to obtain intrasubjective test-retest threshold difference of high frequency threshold difference within 4 weeks intervals. 47 ears of normal low frequency hearing(250-8000Hz) young adults were tested with commercial high frequency audiometer(Beltone 2000) and Sennheiser HD 250 linear headphone. The results were as follows: 1) Test-retest difference within 10dB SPL was more than 89% in every frequency. 2) Test-retest difference within 15dB SPL was more than 96% in every frequency. Results of this study suggest that acceptable range of intrasubjective difference of high frequency threshold within 4 weeks intervals is 15dB SPL.