Epidemiology and Prevention Strategies of Avian Influenza / 한국역학회지

Natural infections with influenza A viruses have been reported in a variety of animal species including humans, pigs, horses, sea mammals, and birds. Although viruses of relatively few haemagglutinin(HA) and neuraminidase(NA) subtype combinations have been isolated from mammalian species, all subtypes, in most combinations, have been isolated from birds. During the past few years, several subtypes of avian influenza A have been shown to cross the species barrier and infect humans. During an outbreak of a highly pathogenic influenza A(H5N1) virus among poultry in Hong Kong in 1997, 6 of 18 people with confirmed infection died. And a total of 89 human infections with influenza A(H7N7), including 1 resulting in the death of a Dutch veterinarian, occurred during the extensive outbreak in 2003. During late 2003 and early 2004, there were reports of large outbreaks of H5N1 among poultry throughout Asia (including Korea, Japan, Indonesia, Vietnam, Thailand, Laos, Cambodia, and China). In Korea, we had also highly pathogenic avian influenza(HPAI) outbreak in 2003~2004 with a first suspected case reported on 10 December 2003. The case was reported at a parent stock farm for broilers, which was located in Chungbuk province, and the farm was immediately placed under movement restrictions. Laboratory tests confirmed the outbreak of HPAI on 12 December 2003. Up to 20 March 2004, a total of 19 farms were confirmed as having been infected with HPAI virus. No further outbreaks occurred after that date. Fortunately there were no human cases founded in this epidemic in Korea. In January 2004, there was confirmation that influenza A(H5N1) virus had been isolated from patients who had died of a respiratory illness in Vietnam. Total 107 human confirmed cases were reported until June 2005 to WHO, threatening new pandemic outbreak. We reviewed our prevention and control strategies of avian influenza and preparedness to the pandemic outbreak.

Sexuality and Quality of Life after Hematopoietic Stem Cell Transplantation

BACKGROUND: The quality of sexuality is significantly affected by physical changes following hematopoietic stem cell transplantation (HSCT) and the dissatisfied and/or dysfunctional sexuality may cause deterioration in the quality of life (QOL). METHODS: With two models of questionnaires, we interviewed thirty-eight patients who remained in the disease-free status after HSCT and had sex partners, to assess: 1) the changes in sexuality, 2) QOL in physical, psychological, social and spiritual domains and 3) the correlation between sexuality and QOL. RESULTS: The common physical changes that may affect sexuality in women were secondary amenorrhea (69.2%), loss of sexual interest (53.8%), diminished vaginal secretion (50%), menopausal syndrome (34.6%), dyspareunia (30.8%) and failure to orgasm (23.1%), while men complained of impotence (41.7%) and difficulty in ejaculation (16.7%). For sexuality, satisfaction of sexual activity, attainment of orgasm and frequency of intercourse decreased significantly after HSCT as compared with the pre-transplant levels. A score measuring QOL after HSCT marked 5.91 on a full score of 10; social domain ranked the lowest (5.01) while physical domain the highest (6.70). Among the items of sexuality, only sexual desire was significantly correlated with QOL; satisfaction, orgasm and frequency were not significantly correlated with QOL. CONCLUSION: Although sexuality is affected by the physical changes following HSCT, we should not overlook the psychological and social effects on the sexuality of post-transplant patients. Therefore, educational and counseling programs are very important to restore and improve their sexuality.

Analysis of Usefulness of Biochemical Enzyme Assay and MR Spectroscopy(MRS) in Leigh Syndrome / 대한소아신경학회지

PURPOSE: Leigh syndrome is a kind of mitochondrial disease with a pathological production of lactate and variable clinical manifestations. Recently biochemical assay of the mitochondrial enzyme activity and MRS are becoming a powerful tool for the definitive antemorterm diagnosis of this disease. The aim of this study was designed to determine the usefulness of biochemical enzyme assay and MRS in Leigh syndrome. METHODS: A clinical study of 8 cases of pediatric patients were diagnosed as Leigh syndrome on the basis of clinical manifestations and MRI features at the department of pediatrics, Ulsan university hospital, from July, 1992 to June, 1997. Biochemical enzyme assay of the cultured skin fibroblasts was consulted to hospital for sick children, Toronto, Canada. Cerebral lactates were detected on MRS were analysed in relation to the MRI findings and lactate levels in the CSF. RESULTS: 1) Age at diagnosis ranged from 7 months to 8.9 years; seven were boys and one was girl. 2) Main clinical symptoms were as follows in the order of frequency; seizure(75%), ophthalmoplegia(50%), hemiplegia(50%), hypotonia(50%), respiratory difficulty(50%), developmental delay(38%), consciousness change(38%), mental retardation( 25%). 3) Anatomical locations of the focal lesions detected on the initial MRI were as follows in the order of frequency; putamen(75%), caudate nuclei(63%), medulla oblongata (18,50%), substantia nigra(38%), thalamus(38%). 4) Biochemical enzyme assay revealed deficiency of NADH cytochrome c reductase (complex I) and deficiency of cytochrome c oxidase(complex N) respectively in 2 patients who had markedly elevated serum and CSF lactate levels and lactate/pyruvate ratio. 5) Cerebral lactates were detected by MRS from 6 lesions of 1 week-4 months old in 6 patients who had normal or mildly elevated serum and CSF lactate levels and lactate/pyruvate ratio. CONCLUSION: MRS detected the brain parenchymal lactate non-invasively from the acute or subacute lesions. Therefore, combined evaluation by MRS and biochemical enzyme assay will provide an important information for the diagnosis and estimation of disease activity in pediatric patients who are suspected to have Leigh syndrome.