Weight Gain and Lipid Profile Changes in Koreans with Human Immunodeficiency Virus undergoing Integrase Strand Transfer Inhibitor-Based Regimens / 감염과화학요법

Background@#This study explored the relationship between integrase strand transfer inhibitor (INSTI)-based anti-retroviral agents and weight gain over time, and the risk factors for weight gain in Korean people living with human immunodeficiency virus (PLWH). @*Materials and Methods@#The study was conducted retrospectively in PLWHs 18 years of age or older who took one of three INSTI-based single-tablet regimens (STRs) (tenofovir disoproxil fumarate/emtricitabine/elvitegravir/cobicistat [TDF/F/EVG/c], tenofovir alafenamide/ emtricitabine/elvitegravir/cobicistat [TAF/F/EVG/c], and abacavir/lamivudine/dolutegravir [ABC/3TC/DTG]) for more than 2 years at three university-affiliated hospitals in South Korea from May 2014 to December 2020. Analysis was performed in the treatment-naïve and treatment-experienced groups, respectively. @*Results@#Individual INSTI-based STRs were associated with weight gain at the 24-month follow up in both treatment-naïve (n = 179) and treatment-experienced (n = 290) groups.Body mass index (BMI) categories changed over time for TAF/F/EVG/c and ABC/3TC/ DTG, with significant increases in the rates of overweight and obesity in treatment-naïve patients, whereas there was no change for TDF/F/EVG/c. TAF/F/EVG/c significantly increased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) compared to other regimens over 24 months. In the treatment-naïve group, a baseline CD4+ T cell count <100 cells/mm3 , human immunodeficiency virus (HIV) viral load (VL) ≥100,000 copies/mL, no physical exercise, and TAF/F/EVG/c (vs. TDF/F/EVF/c) were risk factors for ≥10% weight gain. In the treatment-experienced group, age <45 years, BMI <25 kg/m2 , and no physical exercise were risk factors for ≥5% weight gain. @*Conclusion@#INSTI-based STR continued to increase body weight at the 24-month follow up in treated and untreated Korean PLWH. Exercise, together with demographic-, HIV-, and anti-retroviral therapy-related factors, influenced weight gain. Therefore, when prescribing an INSTI-based STR, weight gain and metabolic changes should be closely monitored in PLWH with these risk factors.

The development and evaluation of a pediatric nurse education program to improve nursing competency for newly graduated nurses in a children’s hospital / 한국간호교육학회지

Purpose@#The purpose of this study is to identify the effects of a standardized educational program to improve nursing competency on newly graduated nurses in a children's hospital after developing and applying a pediatric nurse education program. The effectiveness of the program was confirmed by evaluating the clinical competency and field adaptation. @*Methods@#In the first step, an education program was developed using the analysis, design, development, implementation and evaluation (ADDIE) model. As a second step, a similar experimental study of a single group repeat measures design was conducted to evaluate the clinical competency and field adaptation over time after application of the program. Additionally, a focus group interviews were conducted to collect subjective data on the effects and improvement points of the program. @*Results@#As a result of applying the program, there was a significant change in the clinical competence and the field adaptation of newly graduated nurses in a children’s hospital. The categories derived from the focus group interviews were “getting special guidance,” “better care,” “becoming a nurse at a children's hospital” and “winning together.” @*Conclusion@#It was confirmed that the education program enhances the clinical competency of new nurses in children's hospitals. In addition, it provided the necessary data to understand the experiences of new nurses, help them adapt effectively, and establish appropriate interventions.

Measurement Properties of Self-Report Questionnaires Measuring the Social Adjustment for Youth after Treatment of Childhood Cancer: Systematic Review

PURPOSE: The purpose of this study was to evaluate measurement properties of self-report questionnaires measuring the social adjustment for youth after treatment of childhood cancer. METHODS: Social adjustment measurement tools were identified through a two-stage systematic review. First, we searched for articles using self-report questionnaires to measure the social adjustment of youth after the treatment of childhood cancer. The appropriate tools were listed and categorized. Second, using methodological filters, we searched 5 electronic databases for articles examining the measurement properties of the tools when used with youth after the treatment of childhood cancer. The quality of these papers was then evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS: Eight tools were frequently used to measure social adjustment. Eight studies investigated the measurement properties of 4 of these tools. The PedsQL 4.0 and MMQL-AF had moderate to strong evidence in some domains, but the rest of the domains had a lack of evidence. The SF-36 and KIDSCREEN-27 were validated for only a few areas. CONCLUSION: We found a lack of evidence regarding the measurement properties of these tools. More research is required on the measurement properties of tools for use in this population.

Comparison of pharmacokinetic characteristics of sildenafil citrate chewable tablets and film-coated tablets in healthy male subjects

UI14SDF100CW is a chewable tablet of sildenafil citrate, which was developed to improve compliance through convenience of administration. The purpose of this study was to compare the pharmacokinetic (PK) properties of sildenafil citrate chewable tablets (UI14SDF100CW) and conventional sildenafil citrate film-coated tablets (Viagra®, Pfizer). A randomized, open-label, single dose, two-treatment, two-period, two-way crossover study was conducted in 60 healthy male volunteers. In each period, the subjects received a single oral dose of UI14SDF100CW or Viagra® (both tablets contain 140.45 mg of sildenafil citrate, which is equivalent to 100 mg of sildenafil). Serial blood samples were collected up to 24 h post-dose for PK analysis. The plasma concentration of sildenafil was determined using a validated HPLC-MS/MS assay. PK parameters of sildenafil were calculated using non-compartmental methods. The plasma concentration-time profiles of sildenafil in both formulations were similar. For UI14SDF100CW, the C(max) and AUC(last) of sildenafil were 1068.69 ± 458.25 (mean ± standard deviation) mg/L and 3580.59 ± 1680.29 h·mg/L, and the corresponding values for Viagra® were 1146.84 ± 501.70 mg/L and 3406.35 ± 1452.31 h·/L, respectively. The geometric mean ratios (90% confidence intervals) of UI14SDF100CW to Viagra® for C(max) and AUC(last) were 0.933 (0.853–1.021) and 1.034 (0.969–1.108), respectively, which met the bioequivalence criteria of Korean regulatory agency. In conclusion, UI14SDF100CW and Viagra® showed similar PK properties. Therefore, UI14SDF100CW can be an alternative to sildenafil for the treatment of erectile dysfunction, providing better compliance.

Simple Estimates of Symptomatic Intracranial Hemorrhage Risk and Outcome after Intravenous Thrombolysis Using Age and Stroke Severity / 대한뇌졸중학회지

No abstract available.

Participation in Prenatal Education, Knowledge and Attitude related to Delivery, Postpartum Care, Newborn Care in Nulliparous Women

PURPOSE: This study was done to identify content of prenatal education and to examine differences in prenatal education, knowledge, and attitude of nulliparous South Korean women. METHODS: A cross-sectional survey design was used with 134 conveniently recruited nulliparous women. Data were collected through self-report questionnaires. RESULTS: Average number of institutional prenatal education programs was 5.96 at clinics, 4.31 at health care centers, and 0.49 at hospitals. Women participated in an average 5.78 out of the 35 prenatal education contents: 15 types of prenatal and delivery, 10 postpartum self-care, and 10 parenting. Score for knowledge was 7.57out of 10. Women who participated in prenatal education (n=72) reported significantly higher scores in knowledge (t=2.71, p=.008) than women who did not participate (n=62). The average score for attitude was 7.22 out of 10. Nulliparous women over 36 weeks of gestational age had significantly higher scores for attitude (t=2.38, p=.019) than women under 36 weeks. There were significant positive correlations between newborn care knowledge and postpartum care self-efficacy (r=.26, p=.026), and newborn care knowledge and parenting confidence (r=.25, p=.034). CONCLUSION: Results indicate that policy is needed to increase participation in prenatal education and to establish strategies for health care centers and hospitals to provide prenatal education.

Gestational age at delivery and neonatal outcome in uncomplicated twin pregnancies: what is the optimal gestational age for delivery according to chorionicity?

OBJECTIVE: To investigate the neonatal outcome according to the gestational age at delivery and to determine the optimal timing for delivery in uncomplicated monochorionic and dichorionic twin pregnancies. METHODS: This is a retrospective cohort study of women with uncomplicated twin pregnancies delivered at or beyond 35 weeks of gestation from 1995 to 2013. The primary outcome was neonatal composite morbidity, which was defined as when either one or both twins have one or more of the followings: fetal death after 35 weeks gestation, admission to neonatal intensive care unit, mechanical ventilator requirement, respiratory distress syndrome and neonatal death. To determine the optimal gestational age for delivery according to chorionicity, we compared the neonatal composite morbidity rate between women who delivered and women who remained undelivered at each gestational week in both monochorionic and dichorionic twin pregnancies. RESULTS: A total of 697 twin pregnancies were included (171 monochorionic and 526 dichorionic twins). The neonatal composite morbidity rate significantly decreased with advancing gestational age at delivery and its nadir was observed at 38 and > or =39 weeks of gestation in monochorionic and dichorionic twins, respectively. However, the composite morbidity rate did not differ between women who delivered and women who remained undelivered > or =36 and > or =37 weeks in monochorionic and dichorionic twins, respectively. CONCLUSION: Our data suggest that the optimal gestational age for delivery was at > or =36 and > or =37 weeks in uncomplicated monochorionic and dichorionic twin pregnancies, respectively.

Fatal Rhino-Orbital-Cerebral Mucormycosis Complicated with Thrombosis and Rupture of Mycotic Aneurysm in Distal Internal Carotid Artery

Mucormycosis is a rare opportunistic infection caused by fungi of the order Mucorales that typically occurs in patients with diabetes or immunocompromised state. Rhino-orbital-cerebral mucormycosis is the most common type, often has a life-threatening outcome. Mucormycosis has specific vascular tropism complicating mucorthrombosis or mycotic aneurysm. We report a diabetic patient presenting with ophthalmoplegia, orbital necrosis, and contralateral hemiparesis, who suddenly progressed to coma and died of subarachnoid hemorrhage due to the rupture of mycotic aneurysm in distal internal carotid artery.

Fatal Rhino-Orbital-Cerebral Mucormycosis Complicated with Thrombosis and Rupture of Mycotic Aneurysm in Distal Internal Carotid Artery

Mucormycosis is a rare opportunistic infection caused by fungi of the order Mucorales that typically occurs in patients with diabetes or immunocompromised state. Rhino-orbital-cerebral mucormycosis is the most common type, often has a life-threatening outcome. Mucormycosis has specific vascular tropism complicating mucorthrombosis or mycotic aneurysm. We report a diabetic patient presenting with ophthalmoplegia, orbital necrosis, and contralateral hemiparesis, who suddenly progressed to coma and died of subarachnoid hemorrhage due to the rupture of mycotic aneurysm in distal internal carotid artery.

Dabigatran Effect on Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke / 대한뇌졸중학회지

No abstract available.

Seroprevalence of Trichinella sp. in Wild Boars (Sus scrofa) from Yanggu-gun, Gangwon-do, Korea

A total 7 outbreaks of trichinellosis have occurred in Korea, mostly as a result of consumption of raw wild boar (Sus scrofa) meat. Since only 1 serological survey on wild boars had yet been performed in Korea, the present study aimed to estimate the prevalence of trichinellosis in wild boars and some species of rodents by artificial digestion and serological examinations in Yanggu-gun, Gangwon-do, the endemic area of trichinellosis. Both the wild boar and rodent muscle samples revealed no Trichinella larvae by direct examination and artificial digestion method. However, serological examinations revealed that 4 wild boar sera samples out of 118 (3.4%) were positive to Trichinella antigen. Although the recovery of Trichinella larvae ended in a failure, it is proved for the first time that the sylvatic cycle of Trichinella has been maintained in wild boars of Gangwon-do, Korea.

Acute Myocardial Infarction in a Patient with an Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Coronary Artery / 대한내과학회지

A 55-year-old male underwent coronary artery intervention for an acute myocardial infarction of the inferior or lateral wall. The initial left coronary angiogram showed total occlusion of the proximal left circumflex artery (LCX). There was an abnormal coronary artery originating from the mid-portion of the left anterior descending artery (LAD) and running to the right ventricular side. However, we could not identify the anomalous right coronary artery (RCA). We tried to find the RCA in the right coronary cusp to confirm the infarction-related artery, but failed. A focused left coronary angiogram in the posteroanterior projection revealed the entire anatomy of the anomalous RCA. An anomalous origin of the RCA from the LAD is a rare coronary artery anomaly that might affect the physician's decision during coronary intervention. We report an anomalous origin of the RCA from the mid-LAD and discuss the anatomy and clinical significance.

A Case of Secondary Primary Malignancy after Lenalidomide Therapy for Multiple Myeloma / 대한내과학회지

Lenalidomide, an orally administered immune-modulating drug, has several mechanisms of action against multiple myeloma (MM). However, the mechanisms of action of immune-modulating drugs are not understood completely. Lenalidomide maintenance therapy prolongs the time to progression and increases the overall survival in patients with MM. However, secondary primary malignancy (SPM) has been noted as a serious adverse event in patients with MM treated with lenalidomide. Lenalidomide treatment is not covered by insurance. Consequently, physicians have little experience with the adverse events of lenalidomide treatment in patients with MM. Here, we describe a case of breast cancer after lenalidomide treatment for MM. To our knowledge, this is the first report of a lenalidomide-associated SPM in Korea. The risk factors associated with lenalidomide-associated SPM should be considered carefully when implementing chemotherapy regimens in patients with MM.

A Case of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in an Adult Presenting with an Extramedullary Bone Tumor / 대한내과학회지

Acute lymphoblastic leukemia (ALL) is a lymphoid malignancy characterized by impaired differentiation and proliferation of leukemic myeloblasts. Normal hematopoietic cells are replaced by excess myeloblasts, causing bone marrow failure. Therefore, patients with ALL typically present with symptoms related to infection, anemia, and thrombocytopenia. Extramedullary involvement of ALL as an initial presenting symptom has rarely been reported in adults, although several such cases of relapse have been described. Isolated extramedullary manifestations may lead to a late diagnosis of ALL. We describe herein a patient with Philadelphia chromosome-positive ALL presenting with an extramedullary bone tumor.

Third-line docetaxel chemotherapy for recurrent and metastatic gastric cancer

BACKGROUND/AIMS: To determine the efficacy and toxicity of docetaxel as a third-line therapy for patients with relapsed gastric cancer who have undergone modified oxaliplatin-fluorouracil (m-FOLFOX)-4 and modified irinotecan-fluorouracil (m-FOLFIRI) regimens. METHODS: We analyzed 33 patients who had been histologically diagnosed with adenocarcinoma of the stomach and who had progressed after m-FOLFOX-4 and m-FOLFIRI regimens. Patients were treated with cycles of 75 mg/m2 docetaxel on day 1 every 3 weeks. RESULTS: The median age of the patients was 56.0 years (range, 31.0 to 74.0), and 73% of the patients (24/33) had an Eastern Cooperative Oncology Group performance status of 0 or 1. All patients were evaluated in terms of tumor response: five (15%), nine (27%), and 19 (58%) patients experienced a partial response, stable disease, and progressive disease, respectively. The median time to progression was 2.1 months (95% confidence interval [CI], 1.63 to 2.58), and overall survival was 4.7 months (95% CI, 3.20 to 6.20), from the start of the docetaxel regimen. Assessing patients' toxicity profiles, the median number of cycles was 2.0 (range, 1.0 to 12.0). The major hematologic toxicities included grade 3 to 4 neutropenia (19/33, 58%), grade 3 to 4 thrombocytopenia (2/33, 6%), and grade 3 to 4 anemia (5/33, 15%). Neutropenic fever developed in three patients (3/33, 9%). The nonhematological toxicities were nausea and vomiting (10/33, 30%), abdominal pain (4/33, 12%), skin rash (1/33, 3%), and fluid retention (3/33, 9%). CONCLUSIONS: Docetaxel is a feasible third-line therapy regimen for patients with advanced gastric cancer after m-FOLFIRI and m-FOLFOX-4 regimens.

A Case of von Hippel-Lindau Disease with Aortic Valve Insufficiency / 영남의대학술지

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary disorder caused by a germline mutation of the VHL gene. It is a multi-systemic disorder that is predisposed to benign or malignant tumors of visceral organs such as hemangioblastoma of the central nervous system, renal cell carcinoma, retinal angioma and pheochromocytoma. We report herein a case of VHL disease that initially manifested with aortic valve insufficiency.

Factors Affecting Social Adjustment of Childhood Cancer Survivors

PURPOSE: The purposes of this study were to assess social adjustment of childhood cancer survivors and to identify factors affecting social adjustment. METHODS: Data were collected from 79 childhood cancer survivors and his/her parents. The survey consisted of questions related to characteristics, physical functioning, depression, self-esteem and coping strategies. The Social Competence Inventory was used to measure social adjustment in the children. RESULTS: The level of social adjustment of childhood cancer survivors was 83.5 out of a possible 155. Physical functioning, depression, self-esteem, and aggressive or proactive coping strategies were associated with social adjustment. Only physical functioning independently affected social adjustment. CONCLUSION: The results of this study indicate that there are several factors influencing social adjustment of childhood cancer survivors, and therefore there is a need for programs that deal with all aspects of children's physical as well as emotional health in order to enhance their social adjustment.

Electroacupuncture Analgesia Is Improved by Adenoviral Gene Transfer of Dopamine Beta-hydroxylase into the Hypothalamus of Rats

Electroacupuncture (EA) is a modified form of acupuncture that utilizes electrical stimulation. We previously showed that EA stimulated rats were divided into responders that were sensitive to EA and non-responders that were insensitive to EA based on the tail flick latency (TFL) test. The dopamine beta-hydroxylase (DBH) gene was more abundantly expressed in the hypothalamus of responder rats than non-responder rats. To determine whether overexpression of DBH gene expression in the hypothalamus modulate EA analgesia, we constructed a DBH encoding adenovirus and which was then injected into the hypothalamus of SD rats. Microinjection of DBH or control GFP virus into the hypothalamus had no changes on the basal pain threshold measured by a TFL test without EA treatment. However, the analgesic effect of EA was significantly enhanced from seven days after microinjection of the DBH virus, but not after injection of the control GFP virus. DBH expression was significantly higher in the hypothalamus of DBH virus injected rat than control GFP virus or PBS injected rats. Moreover, expression of the DBH gene did not affect the body core temperature, body weight, motor function or learning and memory ability. Although the functional role of DBH in the hypothalamus in the analgesic effect of EA remains unclear, our findings suggest that expression of the DBH gene in the hypothalamus promotes EA analgesia without obvious side-effects.

Comparisons of Postural Habits, Body Image, and Peer Attachment for Adolescents with Idiopathic Scoliosis and Healthy Adolescents

PURPOSE: This study was conducted to compare the postural habits, body image, and peer attachment of adolescents with idiopathic scoliosis and healthy adolescents, and to examine the correlation between body image and peer attachment in each group. METHODS: Eighty-three adolescents with idiopathic scoliosis and 83 healthy adolescents were recruited from 4 middle schools located in W city. Data were collected from November 22 to December 6 2010 using a structured questionnaire including items about postural habits, body image, and peer attachment. Data were analyzed using descriptive statistics, chi2-test, independent t-test and Pearson Correlation Coefficient. RESULTS: Compared to healthy adolescents, adolescents with idiopathic scoliosis were more likely to use one hand, to lean back while seated, and to put weight on one leg while standing. The score for body image was significantly lower for adolescents with idiopathic scoliosis compared to healthy adolescents, but peer attachment was not significantly different between the two groups. Body image was significantly correlated with peer attachment only for the adolescents with idiopathic scoliosis. CONCLUSION: Interventions to promote balanced postural habits in adolescents with idiopathic scoliosis are needed. Information on body image and peer attachment for these adolescents should also be considered when developing interventions.

Relationship of Children's Perception of Mothers' Parenting Attitude to Self-esteem and School Adjustment in Children with Congenital Heart Disease

PURPOSE: The main purpose of this study was to describe the relationship of mothers' parenting attitude as perceived by the child to self-esteem, and school adjustment of school age children with Tetrology of Fallot (TOF). METHODS: In this study a self-administered questionnaire survey was used to collect the data. The participants included 38 children who were registered in a pediatric cardiology clinic in one tertiary medical center. Their ages were between 11 and 15 years. They were diagnosed with TOF, and had no other congenital problems. Data were collected from November 1 to November 30, 2009. After obtaining telephone consent from the mothers and children, questionnaires were mailed to 64 participants and 38 questionnaires were returned. Data were analyzed using Statistical Package for the Social Sciences (SPSS) WIN 15.0 version. RESULTS: There was a significant correlation between perceived parenting attitude, self-esteem, and school adjustment of children with TOF. CONCLUSION: Children who perceive their mothers' parenting attitude to be more positive also report higher self-esteem and better school adjustment. These findings are similar to other studies done with healthy school age children. However, parents of children with TOF may require different parenting approaches to foster positive self-esteem and school adjustment.