• Childhood Kidney Diseases
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• v.25 no.2
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• pp.112-116
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• 2021

Hyperammonemia is mainly caused by diseases related to liver failure. However, there are also non-hepatic causes of hyperammonemia, such as urinary tract infection (UTI) due to urease-producing organisms. Urease production by these bacteria induces a hydrolysis of urinary urea into ammonia that can cross the urothelial cell membrane and diffuse into blood vessels, leading to hyperammonemia. Delayed diagnosis and treatment of hyperammonemia can lead to lethal encephalopathy that can cause brain damage and life-threatening conditions. In the presence of obstructive uropathy, UTI by urease-producing bacteria can lead to more severe hyperammonemia due to enhanced resorption of ammonia into the systemic circulation. In this report, we present a case of acute severe hyperammonemic encephalopathy leading to brain death due to accumulation of ammonia in blood caused by Morganella morganii UTI in a 10-year-old girl with cloacal anomaly, causing obstructive uropathy even after multiple corrections.

• Journal of Periodontal and Implant Science
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• v.48 no.2
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• pp.92-102
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• 2018

Purpose: This study investigated the validity of the Charlson comorbidity index (CCI) as a predictor of periodontal disease (PD) over a 12-year period. Methods: Nationwide representative samples of 149,785 adults aged ${\geq}60$ years with PD (International Classification of Disease, 10th revision [ICD-10], K052-K056) were derived from the National Health Insurance Service-Elderly Cohort during 2002-2013. The degree of comorbidity was measured using the CCI (grade 0-6), including 17 diseases weighted on the basis of their association with mortality, and data were analyzed using multivariate Cox proportional-hazards regression in order to investigate the associations of comorbid diseases (CDs) with PD. Results: The multivariate Cox regression analysis with adjustment for sociodemographic factors (sex, age, household income, insurance status, residence area, and health status) and CDs (acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and human immunodeficiency virus [HIV]) showed that the CCI in elderly comorbid participants was significantly and positively correlated with the presence of PD (grade 1: hazard ratio [HR], 1.11; P<0.001; grade ${\geq}2$: HR, 1.12, P<0.001). Conclusions: We demonstrated that a higher CCI was a significant predictor of greater risk for PD in the South Korean elderly population.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.174-179
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• 1986

Augmentin is a formulation of amoxycillin trihydrate and potassium clavulanate, a fused beta-lactam molecule produced by the fermentation of Streptomyces clavuligerus. Most clinically important resistance is due to the production by bacteria of antibiotic destroying enzymes. In the case of penicillins and cephalosporins these enzymes are termed beta-lactamase as they destroy the beta-lectern ring of these antibiotics, completely inactivating them. The presence of clavulanic acid extends the spectrum of amoxycillin to include bet On clinical study of the intravenous Augmentin in the field of thoracic and cardiovascular surgical cases, we selected randomly 30 patients, 21 male and 9 female, age from 13 to 72, in the period from April to December 1985. Among the total 30 patients, 22 were preoperatively infected [11 thoracic empyema, 5 lobar pneumonia, 2 lung abscess, 2 bronchiectasis, one acute pyelonephritis with ureter stone and one rheumatic carditis], and 8 were not infected preoperatively [Table 1, 2]. Of the preoperatively infected group, 11 cases [50%] were culture positive [4 staphylococcus, 3 pseudomonas, 2 Serratia group, and one E. coli], and preoperatively non-infected group [8 cases] revealed expectedly negative findings on bacterial culture. All of the culture positive bacteria were sensitive to Augmentin on disc culture sensitivity test except one case of E. coli. Daily doses of intravenous Augmentin were 2.-1-6.0gm divided in 2-5 injections. Every injection administered [1.2gm at Augmentin dissolved in 20ml distilled water] slowly for more than 20 minutes. Duration of injection was variable according to the clinical conditions from minimum 5 to maximum 31 days. The results of antibiotic treatment with Augmentin and some other antibiotic combinations pre- and postoperatively were subgrouped as EXCELLENT, EFFECTIVE, and FAILURE. Clinical criteria of the therapeutic result were symptomatic, objective and laboratory improvement. 8 cases were excellent, 13 effective, and one failure among the preoperatively infected group, and all 8 cases of the preoperatively non-infected group were effective as pro;hylactive antibiotic therapy. Overall effective ratio was 97% in both subgroup. There was no side effect clinically and laboratory study including liver and kidney function test during and after the I.V. administration of Augmentin. Oral swallow tablets which were administered after discharge from hospital also revealed good effects with some degree of gastrointestinal trouble.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.2
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• pp.78-84
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• 2020

Purpose: In acute acetaminophen poisoning, the administration of N-acetylcysteine (NAC) can effectively treat the main complications, such as kidney injury and liver failure. In the current situation, measurements of the acetaminophen concentration are not checked in the usual medical facilities. Therefore, this study examined the factors of determining the administration of NAC in addition to the stated amount of intake. Methods: The medical records of patients who visited Ajou University Hospital emergency center with acetaminophen poisoning from January 2015 to December 2019 were reviewed retrospectively. One hundred and seventy-nine patients were initially included. Among these patients, 82 patients were finally selected according to the inclusion criteria in the study. The inclusion criteria were as follows: patients who were 15 years of age or older; those whose ingested dose, ingested time, and body weight were clearly identified; and patients whose acetaminophen sampling time was within 24 hours. Patients were divided into two groups: NAC administered vs. non-NAC administered. The following variables were compared in these two groups: ingested dose, ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, psychiatric disease history, classification of toxic/non-toxic groups, duration of hospitalization, and laboratory results. Results: Univariate analysis revealed the ingested dose per body weight, hospital arrival time after ingestion, suicide attempt history, and psychiatric disease history to be the determining factors in administering NAC. Logistic regression analysis confirmed that the ingested dose per body weight was the only significant factor leading to an NAC treatment decision. (Odds ratio=1.039, 95% Confidential interval=1.009-1.070, p=0.009) Conclusion: The ingested dose per body weight was the only determining factor for administering NAC in patients with acute acetaminophen poisoning. On the other hand, additional criteria or indicators for the NAC administration decision will be necessary considering the inaccuracy of the ingested dose per body weight and the efficiency of NAC administration.

• Korean Journal of Food Science and Technology
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• v.44 no.5
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• pp.638-642
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• 2012

Human pathogenic viruses such as hepatitis A and E virus (HAV and HEV), which lead to acute liver failure and death, are foodborne pathogens associated with the consumption of virus-contaminated meats, filter-feeding bivalves, fruits, and salads. Two of the three swine farms examined in this study had HAV and HEV positive stool samples in a nested RT-PCR assay. The use of the immunomagnetic separation (IMS) facilitated the separation of HAV through interactions between the ligand on the virion surface and the antibody from the swine feces containing both HAV and HEV. The nested RT-PCR analysis was performed for the detection of HAV obtained from hepatocarcinoma cell line (PLC/PRF/5) contaminated with eluent fraction of IMS. This indicated that IMS has the potential to simultaneously isolate and concentrate target viruses by changing antibodies linked on the magnetic beads.

• Journal of Physiology & Pathology in Korean Medicine
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• v.22 no.4
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• pp.810-814
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• 2008

Most inflammatory disorders are usually treated using anti-inflammatory drugs including non-steroidal anti-inflammatory drugs (NSAID) and steroidal anti-inflammatory drugs (SAID). Prolonged uses of NSAIDs and SAIDs may frequently cause adverse side-effects such as nausea, vomiting, diarrhea, constipation, decreased appetite, kidney and liver failure, ulcers, and prolonged bleeding after an injury or surgery. Thus, it is necessarily required to develop a new anti-inflammatory drug with little side-effects. Dandelion (Taraxacum officinale) possesses the therapeutic abilities to eliminate body heat and toxins and to remove swelling and inflammation. In order to verify the anti-inflammatory activity of dandelion, TPA(12-O-tetra decanoylphorbol-acetate)-induced or croton oil-induced acute edema was developed in the mouse ears, and dandelion extract dissolved in acetone was applied to both sides of inflamed ears. It was found that dandelion could significantly reduce the ear swelling, compared to that of non-treated control. In the case of $20{\mu}{\ell}$ application of $100mg/m{\ell}$ dandelion solution (DA-100), its anti-inflammatory effect was comparable to that of indomethacin, a non - steroidal anti-anflammatory drug. Taken together, it could be concluded that topically applied dandelion extract exhibited its potentials as a new drug candidate with an effective anti-inflammatory activity.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.2
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• pp.121-127
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• 2015

Purpose: To evaluate clinical and laboratory profile of Wilson's disease (WD) in children. Methods: This cross sectional study was conducted at Bangabandhu Sheikh Mujib Medical University Hospital. Bangladesh, over a period of 3 years. One hundred consecutive children of WD between 3 to 18 years of age were evaluated. Results: Mean age was $8.5{\pm}1.5years$. Male female ratio was 2:1. Ninety-one percent of patients were Muslim and 9% Hindu. A total of 53% cases of hepatic WD presented between 5 to 10 years of age and most of the neurologic WD manifested in 10-15 years age group. Sixty-nine children presented only with hepatic manifestations, 6 only with neurological manifestations, 14 with both hepatic and neurological manifestation, 10 children was asymptomatic and 1 patient presented with psychiatric features. WD presented as chronic liver disease (CLD) in 42%, CLD with portal hypertension in 34%, acute hepatitis in 20% and fulminant hepatic failure in 4% cases. Stigmata of CLD were found in 18% patients. Keiser-Fleischser ring was found in 76% total patients. Elevated serum transaminase was found in 85% cases, prolonged prothrombin time in 59% cases and hypoalbuminaemia in 53% cases. A total of 73% patients had low serum ceruloplasmin, basal urinary copper of >$100{\mu}g/day$ was found in 81% cases and urinary copper following penicillamine challenge of >$1,200{\mu}g/day$ was found in 92% cases. Conclusion: Majority of studied WD children presented with hepatic manifestation of which 76% presented with CLD. Any child presented with jaundice after the age of 3 years should be investigated for WD.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.432-439
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• 1982

Congenital posterolateral diaphragmatic hernia [Bochdalek hernia] is the result of a congenital diaphragmatic defect in the posterior costal part of the diaphragm in the region of the tenth and eleventh ribs. There is usually free communication between the thoracic and abdominal cavities. The defect is most commonly found on the left [90%], but may occurs on the right, where the liver often prevents detection. The male to female ratio is 2:1. Owing to the negative intrathoracic pressure, herniation of abdominal contents through the defects occurs, with resultant collapse of the lung. Shifting of mediastinum to the opposite side and compression of the opposite lung occurs. Most often these hernias are manifestated by acute respiratory distress in the newborn. A second, but less well recognized, group of patient with Bochdalek hernia survive beyond the neonatal period, usually present at a later time with "failure of thrive, intermittent vomiting, or progressive respiratory difficulty. " The diagnosis can often be made on clinical ground from the presence of respiratory distress, absence of breath sounds on the chest presence of bowel sounds over the chest . Roentgenogram of the chest confirm the diagnosis. Obstruction and strangulation have been reported but are rare. Treatment consists of early reliable identification of these congenital diaphragmatic hernia with high risk and surgical repairment. and postoperative pharmacological management with extracorporeal membranous oxygenation [=ECMO] support in the period of intensive care. On the surgical approach, for defects on left side, an abdominal incision is preferred, because of the high incidence of malrotation and obstructing duodenal bands. In the neonate, the operative mortality may be appreciable, but, later repair almost always is successful. During the period from 1972 to 1982, 4 cases of congenital Bochdalek hernia were experienced at the Kyung-Hee University Hospital.

• Journal of health informatics and statistics
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• v.43 no.4
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• pp.329-335
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• 2018

Objectives: In recent years, there has been an increased need for a way to extract desired information from multiple medical literatures at once. This study was conducted to confirm the usefulness of unstructured data analysis using previously published medical literatures to search for new indications. Methods: The new indications were searched through text mining, network analysis, and topic modeling analysis using 5,057 articles of atorvastatin, a treatment for hyperlipidemia, from 1990 to 2017. Results: The extracted keywords was 273. In the frequency of text mining and network analysis, the existing indications of atorvastatin were extracted in top level. The novel indications by Term Frequency-Inverse Document Frequency (TF-IDF) were atrial fibrillation, heart failure, breast cancer, rheumatoid arthritis, combined hyperlipidemia, arrhythmias, multiple sclerosis, non-alcoholic fatty liver disease, contrast-induced acute kidney injury and prostate cancer. Conclusions: Unstructured data analysis for discovering new indications from massive medical literature is expected to be used in drug repositioning industries.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.68-74
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• 2005

Purpose : There is growing use of continuous renal replacement therapy(CRRT) for pediatric patients, but reports about the use and outcome of CRRT in children is rare in Korea. We report our experiences of CRRT in critically ill pediatric patients. Methods : We reviewed the medical records of 23 pediatric patients who underwent CRRT at Asan Medical Center between May 2001 and May 2004. We evaluated underlying diseases, clinical features, treatment courses, CRRT modalities and outcomes. Results : Ages ranged from three days to 16 years with a median of five years. Patients weighed 2.4 to 63.9 kg(median 23.0 kg; 10 patients ${\leq}20kg$). The underlying diseases were malignancy(nine cases), multiple organ dysfunction syndrome(five cases), hyperammonemia(four cases), acute renal failure associated with liver failure(three cases), dilated cardiomyopathy(one case) and congenital nephrotic syndrome(one case). Pediatric Risk of Mortality(PRISM) III score was $17.6{\pm}7.6$ and the mean number of failing organs was $3.0{\pm}1.7$. Duration of CRRT was one to 27 days(median : nine days). Eleven patients(47.8%) survived. Chronic renal failure developed in two cases, intracranial hemorrhage in one case, and chylothorax in one case among the survivors. PRISM III score and the number of vasopressor before the start of CRRT was significantly lower in the survivors($12.7{\pm}4.2$ and $0.9{\pm}1.1$) compared with nonsurvivors($22.1{\pm}7.8$ and $2.4{\pm}1.4$)(P<0.05). Conclusion : CRRT driven in venovenous mode is an effective and safe method of renal support for critically-ill infants and children to control fluid balance and metabolic derangement. Survival is affected by PRISM III score and the number of vasopressors at the initiation of CRRT.