Vaccination history in elementary school children enrolled in the varicella epidemic investigations held in Jeju-si, Korea in the first half of 2017 / 한국역학회지

OBJECTIVES: The reported incidence rate of varicella infection in Jeju-do is higher compared with the national average. This study aimed to examine varicella vaccination history and evaluate clinical manifestation of varicella cases in Jeju-do.METHODS: Based on the guideline suggested by the Korea Centers for Disease Control and Prevention (KCDC), two epidemic investigations for varicella infection were conducted in the first half of 2017. The history of varicella vaccination was confirmed using the Integrated Control System for Diseases and Health operated by the KCDC.RESULTS: Out of a total of 60 elementary school children as the study subjects, all had been previously vaccinated against varicella. Twenty cases (33%) showed mild clinical manifestations and no complications.CONCLUSIONS: As the government of Jeju-do has supplied a single-labeled vaccine since 2011, there is a need to evaluate the type of vaccination failure such as primary or secondary.

Vaccination history in elementary school children enrolled in the varicella epidemic investigations held in Jeju-si, Korea in the first half of 2017 / 한국역학회지

OBJECTIVES: The reported incidence rate of varicella infection in Jeju-do is higher compared with the national average. This study aimed to examine varicella vaccination history and evaluate clinical manifestation of varicella cases in Jeju-do. METHODS: Based on the guideline suggested by the Korea Centers for Disease Control and Prevention (KCDC), two epidemic investigations for varicella infection were conducted in the first half of 2017. The history of varicella vaccination was confirmed using the Integrated Control System for Diseases and Health operated by the KCDC. RESULTS: Out of a total of 60 elementary school children as the study subjects, all had been previously vaccinated against varicella. Twenty cases (33%) showed mild clinical manifestations and no complications. CONCLUSIONS: As the government of Jeju-do has supplied a single-labeled vaccine since 2011, there is a need to evaluate the type of vaccination failure such as primary or secondary.

The Relationship between Socioeconomic Status and Gastric Cancer Screening in the Population of a Metropolitan Area / 農村醫學 地域保健

OBJECTIVES: Socioeconomic status plays an important role in health care and disease prevention. This study aimed to examine the association between socioeconomic status, measured by education levels and household income, and gastric cancer screening. METHODS: A total of 21,220 community-dwelling adults aged 40 to 69 years within a defined geographic area participated in a community health survey in 2009 and 2010. The survey was conducted using a structured questionnaire by trained investigators who visited the subjects' households directly. Logistic regression analysis was used to determine the relationship between self-reported participation in gastric cancer screening and socioeconomic variables (education and household income). RESULTS: The gastric cancer screening rate was 52.1% for subjects in their forties, 63.7% for those in their fifties, and 67.3% for those in their sixties. In multivariate analysis, higher education and income levels were associated with higher rates of gastric cancer screening (high school vs. elementary school: odds ratio [OR] 1.41, 95 % confidence interval [CI] 1.26-1.58; highest income quartile vs. lowest income quartile: OR 1.62, 95% CI 1.44-1.84). The gradient between income and screening rate was more pronounced in the population aged 40 to 49 years than in the other age groups. CONCLUSIONS: This study demonstrates that lower socioeconomic status is associated with decreased participation in gastric cancer screening. Our findings suggest that the screening program should be focused on low-income and less-educated populations, especially among younger adults, to reduce health disparities.

Management of Diabetes Mellitus and Factors Associated with Poor Glycemic Control in an Urban Area

BACKGROUND: We evaluated the current status of diabetes management and the predictors for poor glycemic control in an urban area. METHODS: This study included 1,138 community-dwelling adults (> or =50 years) with diabetes, of which 584 participated in the diabetes care survey. Logistic regression was used to identify the factors predicting poor glycemic control (hemoglobin A1c[HbA1c]> or =7%) in the total sample and to evaluate the relationship between the history of diabetes management checkup and poor glycemic control in the diabetes care survey sample. RESULTS: Of the 1,138 patients, 53.2% had blood pressure less than 130/80 mmHg, 41.7% had fasting glucose between 70 and 130 mg/dL, 48.6% had HbA1c below 7.0%, 60.1% had triglycerides below 150 mg/dL, 41.4% had low density lipoprotein cholesterol below 100 mg/dL, and 59.1% had normoalbuminuria (urine albumin-to-creatinine ratio <30 mg/g creatinine). Of the 584 patients completing the diabetes care survey, 63.9% had one or more lipid tests, 32.0% had one or more HbA1c tests, 43.8% had one or more microalbuminuria tests, and 42.5% had one or more fundoscopic examinations annually. Female gender (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.23-2.36), duration of diabetes (OR, 1.07; 95% CI, 1.06-1.09), and alcohol use (OR, 1.40; 95% CI, 1.06-1.85) were associated with an increased risk for poor glycemic control while age (OR, 0.97; 95% CI, 0.96-0.99) and antihypertensive medication (OR, 0.64; 95% CI, 0.50-0.83) were associated with a decreased risk. CONCLUSIONS: This study shows that glycemic control is likely to be poor in urban areas. We need to develop appropriate community-based strategies to achieve optimal glycemic control and prevent diabetes complications.

The influence of pH and lactic acid concentration on the formation of artificial root caries in acid buffer solution / 대한치과보존학회지

The purpose of this study is to compare and to evaluate the effect of pH and lactic acid concentration on the progression of artificial root caries lesion using polarizing microscope, and to evaluate the morphological changes of hydroxyapatite crystals of the demineralized area and to investigate the process of demineralization using scanning electron microscope. Artificial root caries lesion was created by dividing specimens into 3 pH groups (pH 4.3, 5.0, 5.5), and each pH group was divided into 3 lactic acid concentration groups (25 mM, 50 mM, 100 mM). Each group was immersed in acid buffer solution for 5 days and examined. The results were as follows: 1. Under polarized microscope, the depth of lesion was more effected by the lactic acid concentration rather than the pH. 2. Under scanning electron microscope, dissolution of hydroxyapatite crystals were increased as the lactic acid concentration increased and the pH decreased. 3. Demineralized hydroxyapatite crystals showed peripheral dissolution and decreased size and number within cluster of hydroxyapatite crystals and widening of intercluster and intercrystal spaces as the pH decreased and the lactic acid concentration increased. 4. Under scanning electron microscope evaluation of the surface zone, clusters of hydroxyapatite crystals were dissolved, and dissolution and reattachment of crystals on the surface of collagen fibrils were observed as the lactic acid concentration increased. 5. Under scanning electron microscope, demineralization of dentin occurred not only independently but also with remineralization simultaneously. In conclusion, the study showed that pH and lactic acid concentration influenced the rate of progression of the lesion in artificial root caries. Demineralization process was progressed from the surface of the cluster of hydroxyapatite crystals and the morphology of hydroxyapatite crystals changed from round or elliptical shape into irregular shape as time elapsed.

Successful Hemoperfusion in Acute Phenobarbital Intoxication / 대한신장학회잡지

Phenobarbital is long acting barbiturate with low lipid solubility that act as central nervous system depressants and used as anticonvulsant, sedative, hypnotic drug. In acute severe barbiturate intoxication, through CNS depression, coma, respiratory arrest and hypotension may occur, which are the major causes of mortality. Mortality is 3% for blood levels over 80 mg/mL and the lethal dose in adult is estimated as 6 to 10 g. We report a case of phenobarbital intoxication in a 20 years old female, who was successfully treated by emergency hemoperfusion. She was in semicomatous state and had respiratory difficulty on the day of admission. It was estimated that she intakes 1.6 g of phenobarbital. She was treated with mechanical ventilation, urine alkalization and charcoal administration. Hemoperfusion was attempted to remove rapidly phenobarbital from blood. After hemoperfusion the blood phenobarbital level was decreased from 96 mg/mL to 67 mg/mL. On 2nd hospital day, the blood phenobarbital level was 56 mg/mL and she recovered her self respiration and mentality.

The Effect of Erythropoietin Therapy on Renal Function in Predialysis Patients with Chronic Renal Failure / 대한신장학회잡지

BACKGROUND: Erythropoietin therapy is known to be associated with reduction of cardiovascular complication and mortality as well as correction of anemia in patients with chronic renal failure (CRF). But, it is uncertain whether EPO therapy improves renal function in patients with CRF. The purpose of this study was to evaluate whether EPO therapy is a significant factor affecting renal progression in predialysis patients with CRF. METHODS: We analyzed medical records of 35 predialysis patients (18 EPO users and 17 non-users) with serum creatinine 1.4 to 5.0 mg/dL or MDRD (Modification of Diet in Renal Disease) GFR<60 mL/min/ 1.73m2 and compared the change of MDRD GFR and serum creatinine. Rssults: Baseline serum creatinine in EPO users and non-users were not different (2.98+/-0.89 mg/dL vs 2.42+/-0.97 mg/dL, p=0.084), but MDRD GFR was lower in EPO users (21.16+/-6.90 mL/min/1.73m2 vs 32.92+/-14.86 mL/min/1.73m2, p=0.007). Mean follow up duration was 29.22+/-14.49 and 30.71+/-19.10 months in EPO users and non-users, respectively (p=NS). Baseline hemoglobin and hematocrit were significantly lower in EPO users (9.20+/-1.10 g/dL, 26.93+/-3.25%) compared to non-users (13.18+/-1.90 g/dL, 38.68+/-5.89%). During follow up period, there was no significant difference in mean BP, hemoglobin, hematocrit, fasting blood glucose and HbA1C in diabetic patients and the amount of proteinuria between the two groups. The slope of 1/Cr decrease (-0.0021+/-0.0036 dL/mg/month vs -0.0088+/-0.0123 dL/mg/month, p= 0.033) and of GFR decrease (-0.143+/-0.229 mL/min/ 1.73m2/month vs -0.678+/-1.002 mL/min/1.73 1.73m2/ month, p=0.046) were significantly lower in EPO- users than non-users. CONCLUSION: Our data suggests that EPO therapy in predialysis patients with CRF can retard progression of renal failure.

The Effect of Erythropoietin Therapy on Renal Function in Predialysis Patients with Chronic Renal Failure / 대한신장학회잡지

BACKGROUND: Erythropoietin therapy is known to be associated with reduction of cardiovascular complication and mortality as well as correction of anemia in patients with chronic renal failure (CRF). But, it is uncertain whether EPO therapy improves renal function in patients with CRF. The purpose of this study was to evaluate whether EPO therapy is a significant factor affecting renal progression in predialysis patients with CRF. METHODS: We analyzed medical records of 35 predialysis patients (18 EPO users and 17 non-users) with serum creatinine 1.4 to 5.0 mg/dL or MDRD (Modification of Diet in Renal Disease) GFR<60 mL/min/ 1.73m2 and compared the change of MDRD GFR and serum creatinine. Rssults: Baseline serum creatinine in EPO users and non-users were not different (2.98+/-0.89 mg/dL vs 2.42+/-0.97 mg/dL, p=0.084), but MDRD GFR was lower in EPO users (21.16+/-6.90 mL/min/1.73m2 vs 32.92+/-14.86 mL/min/1.73m2, p=0.007). Mean follow up duration was 29.22+/-14.49 and 30.71+/-19.10 months in EPO users and non-users, respectively (p=NS). Baseline hemoglobin and hematocrit were significantly lower in EPO users (9.20+/-1.10 g/dL, 26.93+/-3.25%) compared to non-users (13.18+/-1.90 g/dL, 38.68+/-5.89%). During follow up period, there was no significant difference in mean BP, hemoglobin, hematocrit, fasting blood glucose and HbA1C in diabetic patients and the amount of proteinuria between the two groups. The slope of 1/Cr decrease (-0.0021+/-0.0036 dL/mg/month vs -0.0088+/-0.0123 dL/mg/month, p= 0.033) and of GFR decrease (-0.143+/-0.229 mL/min/ 1.73m2/month vs -0.678+/-1.002 mL/min/1.73 1.73m2/ month, p=0.046) were significantly lower in EPO- users than non-users. CONCLUSION: Our data suggests that EPO therapy in predialysis patients with CRF can retard progression of renal failure.

Three Cases of Stress Induced Transient LV Dysfunction: Stress Induced Cardiomyopathy

A recently reported cardiac syndrome of transient left ventricular dysfunction, clinically resembles acute myocardial infarction and presents with chest pain, ECG changes and minimal elevation of cardiac enzymes in absence of myocardial ischemia or injury. The clinical presentation includes a wide range of symptoms and left ventricular function is normalized completely within days to weeks. This syndrome is likely a non-ischemic, metabolic-dependent syndrome caused by stress-induced activation of the cardiac adrenoreceptors. We report three cases of stress-induced transient LV dysfuction.