Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection / 소아과

PURPOSE: To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. METHODS: We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. RESULTS: A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. CONCLUSION: UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR.

Analysis of clinical information and reverse transcriptase-polymerase chain reaction for early diagnosis of enteroviral meningitis / 소아과

PURPOSE: Meningitis is among the most common infections affecting the central nervous system. It can be difficult to determine the exact pathogen responsible for the infection and patients are often treated with empiric antibiotics. This study was conducted to identify the most common clinical characteristics of enteroviral meningitis in children and evaluate the diagnostic efficacy of reverse transcriptase-polymerase chain reaction (RT-PCR) for early detection of an enterovirus. METHODS: We analyzed the medical records of children admitted to Korea University Medical Center and diagnosed with meningitis on the basis of cerebrospinal fluid (CSF) analysis and RT-PCR from CSF and other samples from January 2010 to August 2013. RESULTS: A total of 333 patients were enrolled and classified into four groups based on diagnosis: enteroviral meningitis (n=110), bacterial meningitis (n=23), other viral meningitis (n=36), and unknown etiology (n=164). Patients with bacterial meningitis were younger than those in the other groups (P<0.001). Pleocytosis in CSF was similar across all groups. Of patients in the enteroviral meningitis group, 92.7% were diagnosed based on RT-PCR findings. Mean length of hospital stay for patients with enteroviral meningitis was 6.08 days, which was significantly shorter than that for patients with meningitis of bacterial etiology (19.73 days, P<0.001). CONCLUSION: Diagnosis of enteroviral meningitis before viral culture results are available is possible using RT-PCR. Accurate diagnosis reduces the length of hospital stay and helps to avoid unnecessary empiric antibiotic treatment.

Clinical Comparison among Patients with Enteroviral Meningitis According to the Presence of CSF Pleocytosis / 대한소아신경학회지

PURPOSE: The aim of this study was to evaluate the difference of clinical features among patients with enteroviral mengitis according to the presence of cerebrospinal fluid (CSF) pleocytosis. METHODS: This was a retrospective analysis of the patients' data diagnosed with enteroviral meningitis by CSF reverse transcriptase polymerase chain reaction (RT-PCR). We reviewed the medical records of children younger than 16 years who visited Korea University Ansan Hospital and Guro Hospital for meningitis or encephalitis between March 2013 and August 2013. Clinical and laboratory variables were compared with regard to the presence of CSF pleocytosis. RESULTS: Among 49 patients with enteroviral meningitis, eight of 49 (16.3%) did not have pleocytosis. The enteroviral meningitis patients without pleocytosis had lower CSF protein level than patients with pleocytosis (18.9+/-4.3 vs 34.9+/-18.3 mg/dL; P=0.002). Age, duration of hospital stay, severity of clinical symptom, peripheral white cell blood counts, absolute neutrophil counts and CSF/serum glucose ratio were not different between two groups. CONCLUSION: Enteroviral meningitis could manifest without pleocytosis. We therefore think that CSF RT-PCR is helpful for the diagnosis, especially in suspected cases, which leads to shorter hospital stay and minimal use of antibiotics.

An Adolescent Case of Castleman Disease of the Plasma Cell Type Treated with Radiotherapy / 임상소아혈액종양

Castleman disease (CD) is a disorder with distinct lymphoid hyperplasia of unknown origin, and it is rare in children. There are two major forms of CD: unicentric (localized) and multicentric. Pathologically, it can be categorized into three subtypes: hyaline- vascular, plasma cell, and mixed types. We experienced a 15-year-old boy with histopathologically proven mediastinal CD of the plasma cell type. He was referred to our hospital because of mediastinal widening in a chest x-ray found by chance. Surgery was performed to resect two right paratracheal masses and subtotal excision was done. As complete surgical resection was not possible, the patient subsequently received three-dimensional conformal radiation therapy (total 5,400 cGy in 27 fractions). The size of the mass decreased, and his clinical symptoms regressed without any side effects from radiotherapy. Here we report a case of unicentric plasma cell type CD, treated with radiotherapy due to incomplete surgical resection.

An Adolescent Case of Castleman Disease of the Plasma Cell Type Treated with Radiotherapy / 임상소아혈액종양

Castleman disease (CD) is a disorder with distinct lymphoid hyperplasia of unknown origin, and it is rare in children. There are two major forms of CD: unicentric (localized) and multicentric. Pathologically, it can be categorized into three subtypes: hyaline- vascular, plasma cell, and mixed types. We experienced a 15-year-old boy with histopathologically proven mediastinal CD of the plasma cell type. He was referred to our hospital because of mediastinal widening in a chest x-ray found by chance. Surgery was performed to resect two right paratracheal masses and subtotal excision was done. As complete surgical resection was not possible, the patient subsequently received three-dimensional conformal radiation therapy (total 5,400 cGy in 27 fractions). The size of the mass decreased, and his clinical symptoms regressed without any side effects from radiotherapy. Here we report a case of unicentric plasma cell type CD, treated with radiotherapy due to incomplete surgical resection.

Qualitative assessment of atopic dermatitis-related mobile applications in Korea

PURPOSE: As the mobile internet spread, patients can access to health information via mobile applications. But this information must be a reliable for treatment. This study evaluated the quality of information of mobile applications that with atopic dermatitis. METHODS: On April 2014, the 98 mobile applications that had been searched on three application markets using the keywords, 'atopic dermatitis' etc. were enrolled. Thirty-one applications with information about atopic dermatitis written in Korean were surveyed. The informational quality of each application was examined using DISCERN tool and we also examined authorship, price, number of downloads. And we analyzed relations between these factors and informational quality. RESULTS: The mean score (+/-standard deviation) of overall rating of the publications of the 31 applications were 1.55 (+/-0.888) points. The overall quality of the publication was 'low' in 80.6% of applications, 'moderate' in 16.1%, 'high' in 3.2% of the applications we evaluated. There were no significant differences between the score of price of applications in all questions. However the mean score of group of downloads 1,000 and more were 2.25 (+/-1.035), significantly higher than group of downloads less than 1,000, 1.30 (+/-0.703) (P=0.043). CONCLUSION: The quality of mobile applications providing health information on atopic dermatitis needs significant improvement. Some guidelines and certifications of the mobile application are needed to provide health information about atopic dermatitis, association with experts.