Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998–2016: The Korean Working Group of Pediatric Hypertension

BACKGROUND AND OBJECTIVES: Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents. METHODS: BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles. RESULTS: The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP. CONCLUSIONS: We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998–2016: The Korean Working Group of Pediatric Hypertension

BACKGROUND AND OBJECTIVES@#Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents.@*METHODS@#BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles.@*RESULTS@#The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP.@*CONCLUSIONS@#We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

Differential Diagnosis of Congenital Heart Diseases

The diagnosis of congenital heart disease includes rare and diverse disorders. Children with congenital heart disease represent a growing population: The incidence of congenital heart defects is almost 1 in 100 live births, and of these, approximately 23 of 1000 newborns will require invasive treatment or will die as a consequence of their diagnosis by 1 year of age. Because of improved interventions, >1 million adults are now living with congenital heart disease. Selected congenital heart defects (or the process of their repair) lead to an increased risk for adult cardiovascular disease compared with the general population. Now we reviewed the methods of assessment for differential diagnosis of congenital heart diseases.

Relationships of Serum Leptin Levels with Bone Metabolism in the Childhood Obesity / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to evaluate the influence of leptin on biochemical markers of bone metabolism in childhood obesity. METHODS: A total of 50 male children (25 obese and 25 controls) were recruited from the pediatric outpatient clinic at the Chosun University Hospital from November 1st 2005 to May 30th 2006. BMI, body fat percentage, serum leptin, bone-specific alkaline phosphatase (B-ALP), C-terminal propeptide of type 1 collagen (CICP), total deoxypyridinoline crosslinks (total DPD) were measured. The correlations of leptin with BMI, body fat percentage, B-ALP, CICP, total DPD were analyzed by Pearson's correlation. In a multiple stepwise regression analysis, leptin after correction for body weight was evaluated if there was a correlation with biochemical markers of bone formation and resorption respectively. RESULTS: The leptin levels of the obese group were significantly higher than those of the control group (p=0.012). In the obese group, the leptin level was significantly positively correlated with the BMI (r=0.551, p=0.01) and the percentage of body fat (r=0.584, p=0.018). In the obese group, of bone markers, B-ALP (r=-0.613, p=0.026) and CICP (r=-0.583, p=0.037) were negatively correlated with leptin. B-ALP (r=-0.728, p=0.007) and CICP (r=-0.684, p=0.014) were negatively correlated with leptin when corrected for body weight. In the control group, bone markers were not correlated with leptin. In the multiple stepwise regression analyses, there was a negative correlation between the leptin and B-ALP (Y=-39.653X+356.341, p=0.026), CICP (Y=-13.437X+116.013, p=0.037) respectively in the obese group. CONCLUSION: Leptin was a significant factor in the bone formation but not in bone resorption in childhood obesity.

Usefulness of a Alvarado Scoring System for the Diagnosis of Acute Appendicitis in Children / 대한소아소화기영양학회지

PURPOSE: Alvarado scoring system was evaluated regarding its usefulness for the early diagnosis of acute appendicitis in adult and in reduction of the incidence of negative appendicectomies. To evaluate the accuracy of diagnosing appendicitis using the Alvarado score in children. METHODS: Prospectively, we surveyed 122 patients (male 67, female 55) suffering from abdominal pain, who had visited to the emergency department of Chosun University Hospital from June 2002 to May 2003. The Alvarado score has been computed from the white blood cell count, neutrophil count, body temperature, resistance in the right lower quadrant, length of symptoms, nausea and vomiting. Each patient was evaluated by a pediatric resident and then by a general surgeon independently. RESULTS: Out of 170 total children who visited to the emergency department due to abdominal pain, 122 patients were associated with appendicitis. A total of 122 patients (67 male and 55 female) were visited to the emergency room with suspected appendicitis. From 105 operated patients, 92 (87.6%) were diagnosed acute appendicitis and erronous diagnostic rate was 12.4%, pathologically. Mean alvarado score of appendicitis group was 5.40+/-1.24 whereas those of non-appendicitis group was 3.73+/-1.82 (p<0.05). From 6 Alvarado score high sensitivity (86.4%) and high specificity (80.0%) were observed. Sensitivity of ultrasonography or computed tomography was 92.5%. CONCLUSION: We found that Alvarado score system is a noninvasive, safe diagnostic method, which is simple, reliable and repeatable. Alvarado score is useful system for a first, rapid and economic evaluation for the appendicitis in children.

Utilization Patterns of Medical Care of Elementary School Children after the Implementation of Medical Reform: Comparison with a Previous Study in 1998 / 소아과

OBJECTIVE: The purpose of this study was to assess the patterns of medical care utilization and factors which determine medical care utilization of elementary school children after the implementation of medical reform. METHODS: We performed the questionnaires on 1,031 children from two elementary schools in Gwangju city from June 1 to 30 June, 2001. These data were compared with data from a previous study in 1988 to evaluate the changes in medical care utilization after the implementation of medical reform. RESULTS: The prevalence rate of illness was 52.2%. The rate of persons who received medical treatment when they were sick, was 53.6%. The reasons for not treating illness were mild symptoms (84.7%), no time and too busy(4.3%), and economic causes(9.3%). The selection distribution among various medical facilities was pediatric hospital(47.2%), otolaryngologic hospital(25.8%), internal medicine(11.2%), family medicine(4.9%) and pharmacy(4.6%). The most frequently utilized medical facility for respiratory and gastrointestinal symptoms was a pediatric hospital. The major factors influencing the selection of a medical facility were geographic accessibility and good results. The most common reason for the first visit to pediatric hospital, otolaryngologic hospital or internal medicine department was geographic accessibility. CONCLUSION: Compared with a previous study in 1998, this data showed a decreased treatment rate in spite of an increased prevalence rate. The useage of pharmacies markedly decreased but visits to pediatric hospitals did not increase.

The Relationship between the Perception of Height and Self-Esteem in Children / 소아과

PURPOSE: The aim of this study was to evaluate the behavioral and affective characteristics of children who thought they were short. METHODS: Fifteen hundred and twenty-two students of four elementary and middle schools in Gwangju City completed a battery of questionnaires asking about stature-related stress, self-esteem, and personality characteristics. The children were divided into three groups and compared according to their answers: group I(who thought they were short, n=466), group II(who thought their heights were normal, n=802), and group III(who thought they were tall, n=254). The degree of depression was calculated using Korean Kovasc's Children's Depression Inventory. RESULTS: Four hundred and sixty-six children(30%) thought they were short. Thirty-two percent of children in group I thought that they were short although their heights were above 50 percentile. Only two percent of children that thought themselves to be short answered that they compared their height with the standard value. Twenty-seven percent of children were not satisfied with their height. No statistically significant difference of depression score was found between males and females. There were statistically significant differences of the depression score according to age(P< 0.05). The average depression scores of the three groups were 15.7+/-6.4, 13.6+/-6.8, and 12.6+/-6.3 respectively(P<0.05). In group I, no significant differences were found in depression score between the subgroups classified according to the standard height distribution. The depression score in the group of those dissatisfied with their height was significantly high(P<0.05). CONCLUSION: Correct perceptions of their height are needed for children's psychiatric healthcare. Continuous medical and psychological guidance is therefore recommended.

Predictors of Clinically Non Specific Bacterial Infection in Febrile Children Less than 3 Years of Age: WBC, ESR and CRP

PURPOSE: Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity. METHODS: We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups: those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups. RESULTS: Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were 20,000/mm3, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively. CONCLUSION: These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.

Two Cases of Nocturnal Enuresis Associated with Carbamazepine / 대한간질학회지

Urinary voiding disorders owing to anticonvulsants medications have been reported rarely. I have recently seen 2 patients in whom carbamazepine (Tegretol) therapy was associated with nocturnal enuresis. The first patient was a 7-year-old boy in whom carbamazepine 150 mg twice a day (15 mg/kg, early morning plasma level 10 microgram/mL before the morning dose) was prescribed for control of complex partial seizure. Approximately 5 months after starting to take the drug he developed frequency of micturition and urgency. Soon followed by nocturnal enuresis. His development was normal. Sphincter control was complete at 3 years of age. Urinalysis was negative. Carbamazepine discontinued and within 1 week all urinary symptoms disappeared. Second patient was a 6-year-old girl in whom carbamazepine 100 mg twice a day (15 mg/kg, early morning plasma level 7.06 microgram/mL before the morning dose) was prescribed for control of simple partial seizure. Approximately 10 weeks after starting to take the drug he developed urgency, and then after 2 weeks followed by daily nocturnal enuresis. Her development was normal. Urinalysis was negative. Carbamazepine was changed to oxcarbazepine, and the patient's urinary symptoms abated within 2 weeks disappeared and did not recur. The nocturnal enuresis in both patients can be attributed to carbamazepine;it appeared after 3-4 months of the start of treatment;during seizure-free period and disappeared on discontinuation of carbamazepine. The drug should be discontinued before any other invasive investigations are undertaken to clarify the cause of the urinary symptoms.

The Relationship Between Obesity and Depressive Trends in Elementary School Children

PURPOSE: This study was designed to evaluate the relationship between obesity and depressive trends in elementary school children. METHODS: In 1999, we surveyed 2,091 elementary school children(1,079 boys and 1,012 girls) whose ages ranged from 10 to 12 years. Obesity was defined as an obesity index over 20 percent. The degree of depression was compared between the obese group and the normal body weight group according to Korean Children's Depression Inventory(CDI) of Kovacs and Beck. RESULTS: Among the subjects, 1,884(88.2%) formed the normal body weight group, 128(6.1%) formed mildly obese group, 98(4.7%) formed the moderately obese group and 21(1.0%) formed the severely obese group. The mean depression score in the obese group was significantly higher than that of the normal body weight group, and the more severely obese the more significantly the depression score increased. The depression score of the obese girls' group was higher than the obese boys' group. The depression score was significantly higher in the obese group who hate exercise and like computer games, than in the group who like exercise and don't play computer games. The depression score was significantly higher in the obese group who hate physical education than the group who like it. CONCLUSION: The depression score of the obese group was significantly higher than normal body weight group in elementary school children. Physicians should provide psychological support in the treatments of obese children.

A Study on the Status of Utilization and Criteria for Selection of Medical Care Facilities of Elementary School Children

PURPOSE: The aim of this study is to find out the distribution of illness, patterns of medical care utilization and factors determining medical care utilization in elementary school children. METHODS: We performed the questionnaires in Gwangju city on 2,036 children of two elementary schools from June 1 to June 30, 1998. RESULTS: The prevalence rate of illness was 32.3%. The distribution of illness was respiratory disease(64.7%), gastrointestinal disease(12.8%), injury & poisoning. The rate of persons having received medical treatment when they were sick, was 89.8%. The selection distribution among various medical facilities was pediatric hospital(46.7%), otolaryngologic hospital(19.8%), pharmacy (13.2%) and internal medicine in the decreasing frequency sequence. The major factors influencing the selection of medical facility were geographic accessibility and good results. The most common reason for the first visit to the pediatric hospital was geographic accessibility. The most common reason for a visit and to otolaryngologic hospital was a good result. The most frequently utilized medical facility for respiratory symptoms and gastrointestinal symptoms was pediatric hospital. The persons influencing the selection of medical facility in the children were mother(73.3%), father(10.8%), doctor and others in decreasing sequence. The persons answering the questionaire thought that the optimal age of pediatric care was from 0 to 12 years(47.8%), to 10 years(22.4%) and to 15 years(18.5%) in decreasing rate. CONCLUSION: Other departments instead of pediatrics have treated children. Children have particular growth and development process, which is different to those of adults. So, it is necessary to choose special medical care and adequate medical facilities for children.

The Relationship of Maternal Disorder with Neonatal Cord Blood Leptin - Preeclampsia, Diabetes Mellitus, Antenatal Steroid Treatment -

PURPOSE: Leptin, the product of the ob gene is primarily by adipose tissue but also by the human placenta. Leptin may also have a role as a regulator of fetal growth and development during normal pregnancy as well as in pregnancies associated with anomalous fetal growth. Our study aimed to discover whether or not leptin concentration in neonatal cord blood correlates with maternal disorder(preeclampsia, antenatal steroid). METHODS: Seventy newborns - twenty of preeclampsia, twenty of antenatal steroid treatment, ten of diabetes mellitus, twenty of neonatal asphyxia- and their mother were enrolled in this study. Gestational age, birth weight, length and placental weight were measured. Maternal age and weight were measured. Cord blood and maternal venous samples were collected and serum was separated and stored at -70dgreesC. Leptin was measured by radioimmunoassay. RESULTS: Neonatal cord leptin concentration was significantly elevated in infants whose mothers received antenatal steroid, preeclamptic mothers and diabetic mothers Also, neonatal cord leptin concentration was correlated with maternal serum leptin concentration in those maternal disorders. Cord blood leptin concentration in neonatal asphyxia group was significantly elevated, but wasn't significantly correlated with their maternal serum leptin concentration. CONCLUSION: Neonatal cord leptin concentration was significantly increased in mothers with preeclampsia, diabetes mellitus, and exposure of the antenatal steroid. We find that maternal disorders affected leptin concentration in cord blood, and that increased cord blood leptin in neonatal asphyxia was shown to be a product of fetus.

Ultrastructural and Immunohistochemical Study of Hepatic Fibrosis after the Ligation of the Common Bile Duct in Rats / 대한소아소화기영양학회지

PURPOSE: Proliferation of bile duct-like structures and fibrosis is a hepatic cellular reaction observed in most forms of human liver disease and in a variety of experimental conditions associated with liver injury. The aim of this study was to investigate the activation of Ito cells and bile duct proliferation in the rat after common bile duct ligation (CBDL). METHODS: Hepatic morphological abnormalities were examined in rats whose bile ducts had been irreversibly ligated for 15, 21, 24 and 28 days. The liver was examined by immunohistochemical staining for alpha-smooth muscle actin, the known marker of activated Ito cells, and light and electron microscopes. RESULTS: After CBDL, the bile canalicular proliferation and interstitial fibrosis were gradually increased in the periportal areas extended to hepatic sinusoids. Ito cells positive for alpha-smooth muscle actin were frequently observed in the periductular space and in perisinusoidal space of Disse. Ito cells and myofibroblasts were gradually increased in the interstitial fibrosis until the 28th day after CBDL. Ito cells and myofibroblasts had microfilaments with dense body at the periphery of the cell. CONCLUSIONS: Our results suggest that Ito cells may be fibroblastic or myogenic. It has also been postulated that during the development of hepatic fibrosis, Ito cells become myofibroblasts or fibroblast like cells.

A Case of VATER association Variant with a 46, XY, inv (6)(q11q16) Inversion

VATER association of vertebral defects, imperforate anus, tracheoesophageal (T-E) fistula with esiphageal atresia, and radial and renal dysplasia are utilized to identify this complex. Other anomalies are vascular anomalies (cardiac defects and single umbilical artery), and prenatal and postnatal growth deficiency, defects of external genital and urinary tract as well as bone defects (preaxial lower extremity anomalies, supernumerary digits, rib anomaly). This pattern of malformation generally occurs sporadically in an otherwise normal family, and may occur as a part of a broader pattern, such as the trisomy 18, del (4p, 6q, and 13q) syndromes, and sirenomelia. As inversion of chromosome does not lose of genetic materials, phenotypic abnormalities does not occur. But rare cases have been reported. We report a neonate who had multiple congenital anomalies, including the VATER association defects associated with an unusual chromosomal abnormality, a paracentric inversion of chromosome 6 : 46, XY, .inv (6)(q11q16).

The activities of antioxidant enzymes in erythrocytes of newborn infants

No abstract available.

The effect of pertussis vaccine on streptozotocin induced diabetic rats

No abstract available.

Seroconversion rate of measles specific IgG antibody in previously vaccinated children

No abstract available.

A Case of Autoimmune Hemolytic Anemia Associated with Chronic Hepatitis in Children

No abstract available.

A Case of Hydranencephaly

No abstract available.

A Case of Apert's Syndrome

No abstract available.