• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.1
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• pp.70-78
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• 2022

Purpose: Cholestasis resulting from cytomegalovirus (CMV)-induced hepatitis manifests in 40% of patients with a CMV infection. Ganciclovir treatment in children with CMV infections has proven to be highly effective. Until now, there are very few studies have identified predictive factors for liver biochemistry improvement after ganciclovir therapy. This study aimed to identify the predictors of liver biochemistry improvement in patients with CMV cholestasis after ganciclovir treatment. Methods: A retrospective cohort study was conducted using medical records from Dr. Sardjito General Hospital Yogyakarta, Indonesia from 2013 to 2018. CMV cholestasis was confirmed based on serum CMV IgG and IgM positivity and/or blood and urine CMV antigenemia positivity. Incomplete medical records and other etiologies for cholestasis, such as biliary atresia, choledochal cyst, metabolic diseases, and Alagille syndrome, were excluded. Patient age at cholestasis diagnosis and ganciclovir treatment, duration of CMV cholestasis, history of prematurity, central nervous system involvement, and nutritional status were analyzed and presented as an odds ratio (OR) with a 95% confidence interval (95% CI). Results: CMV cholestasis with ganciclovir therapy was found in 41 of 54 patients. Multivariate analysis showed that a shorter duration of CMV cholestasis (OR: 4.6, 95% CI: 1.00-21.07, p=0.04) was statistically significant for liver biochemistry improvement after 1 month of ganciclovir treatment. The remaining factors that were analyzed were not significant predictors of liver biochemistry improvement in patients with CMV cholestasis after ganciclovir treatment. Conclusion: A shorter duration of CMV cholestasis is the predictor of liver biochemistry improvement after 1 month gancyclovir treatment.

• Pediatric Infection and Vaccine
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• v.29 no.1
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• pp.46-53
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• 2022

It is challenging to treat ventriculitis with parenteral treatment alone in some cases because of the difficulty involved in maintaining an appropriate level of antibiotics in cerebrospinal fluid (CSF). We report two cases of ventriculitis who did not respond to intravenous (IV) antibiotics but were successfully treated with intraventricular antibiotics using IV agents. The first case was a four-month-old male patient with X-linked hydrocephalus. He showed ventriculitis due to Klebsiella pneumoniae not producing extended-spectrum β-lactamase and susceptible to third-generation cephalosporins and gentamicin, following ventriculoperitoneal (VP) shunt. His condition did not improve during the 47 days of treatment with IV cefotaxime and meropenem. We achieved improvement in clinical presentation and CSF profile after three times of intraventricular gentamicin injection. The patient was discharged from the hospital with antiepileptic drugs. The second case was a six-month-old female patient with a history of neonatal meningitis complicated with hydrocephalus at one month of age, VP shunt at two months of age, followed by a methicillin-resistant coagulase-negative staphylococci (CoNS) shunt infection with ventriculitis after the shunt operation. CoNS ventriculitis recurred four weeks later. We failed to treat intractable methicillin-resistant CoNS ventriculitis with IV vancomycin for ten days, and thus intraventricular antimicrobial treatment was considered. Five times of intraventricular vancomycin administration led to improvement in clinical parameters. There were only neurological sequelae of delayed language development but no other major complications. Patients in these two cases responded well to intraventricular antibiotics, with negative CSF culture results, and were successfully treated for ventriculitis without serious complications.

• Korean Journal of Clinical Pharmacy
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• v.19 no.1
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• pp.1-17
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• 2009

Adverse drug reactions (ADR) caused by inappropriate prescription are responsible for major socioeconomic loss. Drug-drug interactions (DDI) has been recognized as a major part of ADRs and, therefore, healthcare professionals should prevent possible DDIs to minimize preventable ADRs. This study aimed to examine DDI information in drug information references and Korea Food & Drug Administration (KFDA) drug labeling information. Drug ingredients from the formulary of Health Insurance Review and Assessment Service in Korea (HIRA) were included for the study. DDI information source used for the study were Micromedex Drugdex and Drug Information Facts (DIF) with the DDI severity level of "moderate" or more. The DDI information in KFDA drug labeling were collected and compared. Drug ingredients were classified with KFDA Drug Classification and ATC Classification of WHO for the analysis. Among the total 1,355 drug ingredients satisfying inclusion criteria, 738 ingredients involved at least one DDI, which was described in Micromedex and/or DIF. Drug Ingredients of 176 involved DDI only described in KFDA drug labeling, but not Micromedex nor DIF. Drug ingredients of 35 which DDIs were described in Micromedex or DIF did not have DDI based on KFDA drug labeling. Micromedex and DIF retrieved 7,582 and 3,071 DDIs, respectively 57.6% and 58.5% of DDIs were also described in KFDA drug labeling. Central nervous system (CNS) drugs, cardiovascular system (CVS) drugs and the antiinfectives appeared to have higher frequency of DDIs among all drug classes. The highest number of DDIs with high severity level ("contraindicated" or "major") were the DDIs of CNS drugs. The antiinfectives are the second drug group having serious DDIs. The DDI pairs of the CNS drug and the antiinfective had the highest contraindication risk (13.6%). DDI information from Micromedex and DIF were not consistent with the result that only 465 ingredients' DDIs are common in both literature (total DDI numbers were 715 vs 488, respectively). And 1,652 DDI information are common in both references among 7,582 vs 3,071 DDIs, respectively. Only 55.2% of DDI information in the database contained in the KFDA drug labeling. Prescribers and pharmacists should pay attention to the drugs for CV system, CNS and infections because of higher risk of possible DDIs compared to other drug classes. KFDA drug labeling is not likely to be recommended as a good information source for DDI due to significant inconsistency of information. Drug information providers should be aware that DDI information from different sources are not consistent and therefore multiple references should be used.

• Parasites, Hosts and Diseases
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• v.32 no.2
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• pp.93-100
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• 1994

In order to know the species and frequency of human parasitic infection diagnosed by biopsy, 149 cases (0.18%) of parasitic infection were reviewed, which were selected from 80,947 biopsied materials submitted for routine histopathological examination during a period of 10 years from 1980 to 1989 at Department of Pathology, Chonnam National University Hospital. They consisted of 112 cases of cysticercosis, 17 paragonimiasis, 7 clonorchiasis, 4 amebiasis, 1 sparganosis, 1 enterobiasis, 1 anisakiasis, and 1 fascioliasis respectively Based on morphological preservation of cysticercus, they could be divided into mild (20.2%), moderate (40.4%), and severe (39.4%) degeneration. Except 2 cases biopsied at the lungs, 15 cases of ectopic paragonimiasis were located at abdominal cavity (8 cases) and central nervous system (7 cases). One case of intrahepatic fascioliasis was observed. This is the 13th human fasciollasis reported in Korea. From the above results, the frequency of parasitic infections found in biopsied specimens was on the decrease as the year passed by, but biopsy is very useful diagnostic method on tissue parasites such as cystlcercosis and ectopic paragonimiasis.

• Parasites, Hosts and Diseases
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• v.22 no.2
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• pp.223-228
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• 1984

Seven cases of surgically proven sparganosis were serologically tested by means of microELISA for their specific IgG antibody levels. For that purpose, crude saline extract of spargana from snake, Natrix tigrina lateralis was prepared and used as antigen. The sparganosis sera were also tested with Paragonimus and Cysticercus antigens to observe the cross reactivity. A total of 71 sera from normal control, ectopic and pulmonary paragonimiasis, clonorchiasis, cysticerCOSIS and Taenia saginata cases were also included. Except for one case of old calcified infection, all of 6 human sparganosis showed higher serum levels of specific IgG antibody when the differential point of positive reaction was set at the absorbance value of 0.25 (the sensitivity being 85.7%). In control and other helminthic infections, all except 3 cases of T. saginata infection showed negative reaction to sparganum antigen (the specificity being 90.7%). None of sparganosis cases showed cress reactivity to Paragonimus and Cysticercus antigens. Undiluted cerebrospinal l1uid also showed high levels of antibody when central nervous system was invaded. The serologic diagnosis by means of micro ELISA could be a useful tool in epidemiological study of human sparganosis in susceptible population, as well as in individual diagnosis.

• Korean Journal of Veterinary Research
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• v.25 no.2
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• pp.103-112
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• 1985

A total of 1-0 colostrum-deprived pigs (1 or 2-day-old) and 6 pigs (35-day-old), which had been raised by natural maternal nursing, were used to study the pathogenicity of the porcine enteroviruses by the intracerebral and intramuscular routes of inoculation, which the enterovirus were isolated from the diseased pigs in Korea. The porcine enteroviruses produced an identical polioencephalomyelitis in colostrum-deprived pigs and 35-day-old pigs, which manifested clinical signs and histopathological changes. Clinically it was characterized by incoordination, rise in rectal temperature, ataxia, flaccid paralysis in all the experimental groups. Histopathologically, the lesions were present in both grey and white matter at all levels of central nervous system, though usually more severe in the grey matter. These changes were characterized by meningeal infiltration, degeneration of nerve cells, neuronophagia, diffuse and focal gliosis, glial nodules and perivascular lymphocytic infiltrations. Ganglionitis of the dorsal root ganglia was frequently observed. On the basis of the clinical and histopathological changes mentioned above, it was concluded that porcine enteroviruses isolated in Korea were pathogenic strains which could produce polioencephalomyelitis in pigs. The most severe Jisease was prcduced by the inoculation of both enterovirus and hog cholera vaccine in the 35-day-old pigs at a time when colostral immunity presumably was low. The porcine enterovirus infections seemed to be associated with certain stress factor such as hog cholera vaccine in or immediately following the weanling period.

• Journal of Life Science
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• v.20 no.6
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• pp.907-913
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• 2010

Human enteroviruses (HEV) are considered one of the major infectious causes of central nervous system infections such as aseptic encephalomeningitis in pediatrics. This study was focused on providing information related to genetic characteristics and diversities of HEV which prevailed between 2007 and 2009 in Busan, Korea. A total of 2,743 specimens were collected from children and screened for isolation of HEV by cell culture and RT-PCR. Among the specimins, 240 isolates were grouped into 21 different HEV serotypes using VP1 RT-PCR. The major etiological agents were CV-A6 and CV-B2 in 2007, E-6 and E-30 in 2008 and CV-B1 in 2009. The occurrence of HEV infections was the most frequent in the summer (May to August, 188 cases, 78.3%). Most of the isolates were identified from specimens from children under 10 years old, with the highest occurrence in the 2 to 4 year old range (15.2%). However, there were no significant differences between male and female children for the isolates. For analyzing genetic characterization, VP1 gene was amplified by RT-PCR and sequenced. The phylogenetic tree was established by Clustal W method using DNASTAR software. Using the sequence analysis of the VP1 region, it was classified into 2 groups; HEV-A and HEV-B. The HEV-A group contained 6 serotypes and sequences of 31 isolates were compared within each serotype. The HEV-B group contained 10 serotypes and the sequences of 41 isolates were compared within each serotype. Homology analysis of the VP1 region showed that the identity scores of HEV-A and B isolates were different. In conclusion, genetic divergences were observed among the isolates from children between 2007 and 2009 in Busan.