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An analysis of one-year experience of pediatric observation unit: The first report in Korea (소아 관찰병실 운영에 대한 분석)

  • Lee, Jee Young;Choi, Ui-Yoon;Lee, Soo Young;Lee, Ji-Young;Lee, Byong Chan;Hwang, Hui Sung;Mok, Hye Rin;Jeong, Dae Chul;Chung, Seung Yun;Kang, Jin Han
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.622-628
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    • 2007
  • Purpose : While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. Methods : All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. Results : There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/bed). Conclusion : Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.

Clinical application of D-dimer in Kawasaki Disease (가와사끼병에서 D-dimer의 임상적 응용)

  • Han, Jae Joon;Ko, Hong Ki;Yoo, Young;Lee, JungHwa;Lee, Kwang Chul;Son, Chang Sung;Lee, Joo Won
    • Clinical and Experimental Pediatrics
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    • v.50 no.2
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    • pp.205-208
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    • 2007
  • Purpose : Vascular endothelial cell damage and alteration of a fibrinolytic system was suggested to play a role in the development of coronary artery abnormalities in Kawasaki disease (KD). D-dimer is one of the markers of endothelial damage and fibrinolysis. We evaluated the clinical usefulness of D-dimer to differentiate KD from other febrile diseases and predict coronary artery abnormalities in KD. Methods : Sixty eight patients diagnosed as KD and twenty eight patients presented with acute febrile illnesses other than KD from September 2005 to July 2006 were included. Blood levels of D-dimer and various inflammatory markers were measured before treatment and the clinical course of KD was followed. Serial echocardiography was performed at the onset of disease and thereafter at a monthly interval for at least 2 months. Results : KD patients showed a higher D-dimer level than febrile controls, but the difference was not significant ($1.21{\pm}0.77{\mu}g/mL$ vs $0.92{\pm}0.71{\mu}g/mL$, P=0.083). Neither was the difference between KD patients who had coronary artery abnormalities and those who had not ($1.49{\pm}0.98{\mu}g/mL$ vs $1.15{\pm}0.71{\mu}g/mL$, P=0.169). D-dimer was significantly correlated with other inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate in both KD patients and febrile controls. Conclusion : D-dimer was not specific for KD. But it may be useful as an inflammatory marker to assess the severity of KD.

Pre-Harvest Residual Characteristics of Boscalid and Pyraclostrobin in Paprika at Different Seasons and Plant Parts (파프리카 재배 중 살균제 boscalid와 pyraclostrobin의 사용시기에 따른 작물 부위별 생산단계 잔류특성)

  • Cho, Kyu-Song;Lee, So-Jung;Lee, Dong-Yeol;Kim, Yeong-Jin;Choe, Won-Jo;Lee, Je-Bong;Kang, Kyu-Young
    • The Korean Journal of Pesticide Science
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    • v.15 no.3
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    • pp.269-277
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    • 2011
  • Recent outbreak of new diseases and pests which were introduced from abroad, seriously hampered both quality and safety of paprika fruits. This study has been carried out to aid an establishment of guideline for safe use of pesticides and reduction of their residues on paprika. Systemic fungicides boscalid and pyraclostrobin of either mixed (a.i.; 13.6+6.8%) or single (a.i.; 47 and 18.8%, respectively) water dispersible granule formulation(WG) products were sprayed with recommended or double dosage on paprika grown in green house at March and June. To draw pre-harvest residue limit, residues of each fungicide were analyzed from fruits collected eight times from 18 to 1 day pre-harvest. The biological half-lives of both boscalid and pyraclostrobin in mixed formulation in March and June were slightly shorter than those of single formulation which ranged from 14.4 to 20.1 days. Residue levels of both fungicides of single formulation in fruits in June were about one lower compared to those in March. However, application of double dosage frequently exceeded MRLs from fruits grown both seasons. These results showed that residue levels on fruits persisted longer period of time, more than two weeks, and so the case applied in winter season. The dissipation of fungicides on leaves and fruits was compared. The distribution of both fungicides in leaves was 20-200 times higher than that of fruits and persisted up to 18 days of pre-harvest period at the concentration of 10-40 ${\mu}g\;g^{-1}$. This study indicated that the mixed formulation product exhibited low residues in fruits, but high and long enough to pathogen growth in leaves.

Survey of the Routes and Incidence of Viral Infection of Tomato and Paprika Growing in Greenhouses in Cherwon Province, Korea During 2015-2017 (2015-2017 철원군 시설재배 과채류(토마토와 파프리카)의 바이러스병 발생 현황 및 감염경로 조사)

  • Kil, HyungBae;Kang, Minji;Choi, Won-Seok;Kim, Joong-Il;Phan, Mi Sa Vo;Im, JiHui;Kim, MeeKyoung;Park, Mi-Ri
    • Research in Plant Disease
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    • v.24 no.2
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    • pp.145-152
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    • 2018
  • During 2015-2017, we surveyed the incidence of viral infections of tomato and paprika growing in greenhouses in Cherwon province, Korea. In 2015 and 2016, we collected leaves and fruits from tomato and paprika plants growing in greenhouses. We detected viruses in the samples collected using specific primer sets for Broad bean wilt virus 2 (BBWV2), Cucumber mosaic virus (CMV), Pepper mild mottle virus (PMMoV), Pepper mottle mosaic virus (PepMoV), and Tomato spotted wilt virus (TSWV). We detected PMMoV, CMV, and TSWV in the samples, and CMV and TSWV were the most prevalent. For the prevention of future viral diseases, we then surveyed the routes of infection by these viruses in tomato and paprika plants growing in greenhouses in Cherwon province in 2017. Leaf and fruit samples were collected from seedlings and crops two and four months after transplanting into greenhouses. As a result, we found that TSWV was transferred from seedlings to plants, and outbreaks of the virus occurred at the early stage of cultivation. On the other hand, we found that CMV was a virus indigenous to the soil of some towns in Cherwon province, and thus outbreaks of this virus occurred at the middle stage of cultivation.

Low Frequency Noise Induces Stress Responses in the Rat (흰쥐에서 저주파소음에 의한 스트레스 반응)

  • Choi, Woong-Ki;Lee, Kyu-Sop;Joung, Hye-Young;Lee, Young-Chang;Sohn, Jin-Hun;Lee, Bae-Hwan;Pyun, Kwang-Ho;Shim, In-Sop
    • Science of Emotion and Sensibility
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    • v.10 no.3
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    • pp.411-418
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    • 2007
  • Exposure to low frequency noise(LFN) can lead to vibroacoustic diseases(VADs), which include a systemic disease with lesions in a broad spectrum of organs and a psychiatric condition. It is known that VAD is an established risk factor for the development of many psychological conditions in humans and rodents, including major depression and anxiety disorder. The present study investigated the effects of LFN on neuronal stress responses in the rat brain. The neuronal expression of the proto-oncogene c-fos in the paraventricular nucleus(PVN) of the hypothalamus and tyrosine hydroxylase(TH) in the LC was observed. The immunocytochemical detection of the Fos protein and TH has been used as a marker of neuronal activation in response to stress. In addition, corticosterone concentration was evaluated by using an enzyme-linked immunosorbent assay(ELISA). The LFN groups were exposed to 32.5Hz and 125Hz of noise(4hr/day for 2days). The numbers of c-fos and TH-immunoreactive cells in the PVN and LC were significantly increased in the LFN groups(32.5Hz and 125Hz) compared to the normal group. Corticosterone concentration in plasma was also increased in LFN groups. The present results demonstrated that exposure with LFN produced a pronounced increase in expression of c-Fos and TH in stress-relevant brain areas. These results suggest that the neural characteristics involved in LFN are similar to those activated by typical processive stressors. These results also suggest that the central and peripheral activations by LFN may be related to LFN-related negative behavioral dysfunctions such as VADs.

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A Study of the Correlation between Stroke Incidence by Day of the Week and Risk Factors (중풍(中風)의 요일별(曜日別) 발생(發生)과 위험요인(危險要因)과의 상관성(相關性)에 관(關)한 연구(硏究))

  • Kim, Yong-Hyung;Choi, In-Young;Ma, Mi-Jin;Gang, A-My;Choi, Dong-Jun;Han, Chang-Ho;Lee, Won-Chul;Jun, Chan-Yong;Cho, Ki-Ho;Choi, Sun-Mi
    • The Journal of Internal Korean Medicine
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    • v.29 no.1
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    • pp.285-298
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    • 2008
  • Objective : This study was aimed to investigated the correlation between the stroke incidence by day of the week and risk factors in acute stroke patients. Methods : From October in 2005 to October in 2007, 673 acute stroke patients wereincluded. Patients were hospitalized within 14 days after the onset of stroke in DongGuk University International Hospital, Kyungwon University In-cheon Oriental Medical Hospital or the Department of Cardiovascular and Neurologic Diseases (Stroke Center), Kyung Hee University Oriental hospital. We investigated general characteristics, stroke types, age group, educational backgrounds, medical history, lifestyle (the impact of stress, exercise, smoking and drinking) and Sasang constitution according to the stroke incidence by day of the week. Results : After examining each participants with day of the week, the order of days by incidence was Monday, Wednesday, Sunday, Saturday, Tuesday, Thursday and Friday respectively. Monday and Tuesday showed the highest ratio. As the aspect of demographic data of subjects, the group under 55 years and from 55 years to 70 years showed the highest ratio on Monday. In the group between 25 years to 55 years, the ratio, by the classification of actual productive age, was statistically higheron Monday. In addition, the ratio showed statistically higherby educational background, from elementary school to high school and over high school. In regard tothe medical aspect, incidence of cerebral hemorrhage showed higher ratio on Sunday, and incidence of brain infarction was higheron Monday. However, there was no difference of the past history between the two groups. With regard tothe aspect of lifestyle of subjects, the group with huge stress before the incidence of stroke showed a higher ratio of stroke incidence on Monday. Participants who didn't exercise regularly and participants who didn't smoke or drink showed higher ratio of stroke incidence on Monday. However, this was not important statistically. In regard to the aspect of Sasang constitution, Soeumin showed the highest ratio of stroke incidence on Wednesday, Taeuminon Monday, and Soyangin on Saturday and Monday. Conclusion : According to these results, several cardiovascular risk factors affect stroke incidences on Monday. Further studies will be needed to help understand the correlation between stroke incidence by day of the week and risk factors in acute stroke patients.

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Review of 2019 Major Medical Decisions (2019년 주요 의료판결 분석)

  • Yoo, Hyun Jung;Park, Noh Min;Jeong, Hye Seung;Lee, Dong Pil;Lee, Jung Sun;Park, Tae Shin
    • The Korean Society of Law and Medicine
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    • v.21 no.1
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    • pp.107-152
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    • 2020
  • During the main ruling in 2019, a number of rulings that were of interest or meaningful were handed down, such as just because the complication of medical practice has occurred, there is no presumption of negligence, a case involving a fall accident in which a lot of culpability has recently been made. the death of a well-known singer that caused a sensation, a case about damages caused by MERS in 2015, which is more meaningful in connection with damages caused by COVID-19, an infectious disease that has recently hit the world, including Korea. In preaching the principles of the law, just because there has been a complication caused by medical practice, there is no presumption of negligence, 'The scope of the complication without presumption of negligence' was determined differently by the court, the court was not able to specify the criteria. Specific circumstances were presented to limit the responsibility of the medical institution while acknowledging the malpractice of the medical institution in relation to the fall accident. In relation to the scope of damages, judgment was made on issues related to the calculation of lost profits of medical malpractice; criteria for determining celebrities' daily income, criteria for determining daily income in case of receiving survivor's pension due to medical accident, an incident in which the daily income is denied if the labor capacity is already lost at the time of a medical accident. But, it seems that judgments should be made based on clearer and more reasonable standards. Related to Medical Advertise, specific logic of judgment was presented as to whether it was interpreted as being in accordance with the specific prohibition listed in Article 27 paragraph 3 of the Medical Law, which is the criterion for violation of the Medical Law, or if it constitutes a significant harm to the order of the medical market. In response to the prohibition of operating the multiple medical institutions, the Constitutional Court decided that it was constitutional because it did not violate the regulations on excessive funding, and rationally limited the scope of the prohibited 'redundant operation'. The Supreme Court ruled for the first time that even a medical institution established and operated in violation of the Medical Service Act did not make it impossible to receive all medical care benefits implemented by a medical institution under the National Health Insurance Act. Significant rulings were finalized that recognized the existence of specific protection obligations for the people of the country in the management of infectious diseases.

Clinical Features of and Antibiotic Resistance in Recurrent Urinary Tract Infection in Children with Vesicoureteral Reflux

  • Eun, So Hyun;Kang, Ji-Man;Kim, Ji Hong;Kim, Sang Woon;Lee, Yong Seung;Han, Sang Won;Ahn, Jong Gyun
    • Pediatric Infection and Vaccine
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    • v.27 no.1
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    • pp.35-44
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    • 2020
  • Purpose: This study aimed to investigate the clinical features of recurrent urinary tract infection (UTI) in children with vesicoureteral reflux (VUR) and to compare the causative uropathogen and antibiotic susceptibility between the first and recurrent UTI episodes. Methods: We retrospectively reviewed the medical records of children with VUR who had recurrent UTI. Group 1 included patients in whom the same pathogen caused the first and recurrent UTI episodes. Group 2 included patients in whom different pathogens caused the first and recurrent UTI episodes. Results: During a 13-year study period (2005-2018), 77 children with VUR experienced at least one episode of UTI. Among these, 47 patients (61.0%) had recurrent UTI. Of the children with recurrent UTI, 19 (40.4%) were in group 1 and 28 (59.6%) were in group 2. Escherichia coli was the most commonly isolated uropathogen (n=37; 39.4%) in both episodes of recurrent UTIs, followed by Klebsiella pneumoniae (n=18; 19.1%), Enterococcus faecalis (n=14; 14.9%), and Enterobacter aerogenes (n=7; 7.4%). Although the difference was not significant, the rate of resistance to the antibiotics ceftazidime, piperacillin/tazobactam, and trimethoprim-sulfamethoxazole increased in patients with the second episode of E. coli recurrence in group 1, and that to cefotaxime, ceftazidime, piperacillin/tazobactam, and meropenem increased in children with the second episode of E. aerogenes recurrence in group 1. Conclusions: When selecting empirical antibiotics for recurrent UTI in children with VUR, it is important to consider that the pathogen and antimicrobial susceptibility of the previous UTI are not always the same in recurrent UTIs.

Clinical Significance of Enterovirus in Febrile Illness of Young Children (하절기에 발열을 주소로 입원한 3개월 이하의 영아에서 장바이러스 감염)

  • Kwak, Ji-Yeon;Cho, Mi-Hyun;Kim, Sung-Eun;Kang, Suk-Ho;Kim, Mi-Ok;Ma, Sang-Hyuk;Lee, Kyu-Man
    • Pediatric Infection and Vaccine
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    • v.8 no.1
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    • pp.94-100
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    • 2001
  • Purpose : Enterovirus is a common cause of aseptic meningitis and nonspecific febrile illness in young children. During the summer and fall months, enterovirus-infected young children are frequently admitted and evaluated to rule out bacterial sepsis and/or meningitis. The purpose of this study was to evaluate the relationship between nonpolio enterovirus infection and febrile illness in infants under 3 months of age during the summer, fall months by using a stool culture to identify the presence of enterovirus. Methods : Patients included febrile infants under 3 months of age admitted to Masan Fatima Hospital for sepsis evaluation from May 1999 to September 1999. Cultures were performed from stool and Cerebrospinal fluid samples and then were tested for enterovirus infection. Viral isolation and serotype identification were performed by cell culture and immunofluorescent testing. Enteroviruses not typed by immunofluorescent testing were confirmed by reverse transcription-polymerase chain reaction. Results : A total of 44 febrile infants were enrolled; of those, 20(45%) were positive for enterovirus. Two enterovirus culture-positive infants had concomitant urinary tract infection and one had Kawasaki disease. All infants infected with an enterovirus recovered without complications. Serotype of 20 enteroviruses were isolated from stool, 3 of echovirus type 9, 1 of echovirus type 11, 1 Coxsachievirus type B4, 15 of untyped enteroviruses. One untyped enterovirus was isolated in the CSF. Conclusion : Nonpolio enterovirus infections are associated with nonspecific febrile illnesses in infants under 3 months of age.

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The Study of Intravenous-gammaglobulin Therapy in Acute phase of Measles (급성기 홍역 환자의 정주용 인면역글로부린 치료 효과에 대한 연구)

  • Kim, Min Shik;Cha, Yoon Hwa
    • Pediatric Infection and Vaccine
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    • v.8 no.1
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    • pp.101-106
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    • 2001
  • Purpose : The outbreaks of measles in infants and school children have been reported recently, but there are no specific treatment of these patients except symptomatic therapy. This study was performed to evaluate the effectiveness of intravenous gammaglobulin(IVGG) therapy in acute febrile phase of measles. Methods : The 68 cases in measles were treated with single dose of IVGG(400~500 mg/kg), and 44 cases were treated with only symptomatic treatment during the periods of 14 months from Jan. 2000 to Feb. 2001. They were compared to duration of fever, rash, the levels of CRP and days of admission on both groups after treatment. Results : The results obtained follows. The average of age was $7.9{\pm}3.6$ year old, and male to female was 1.0 : 1.6. The duration of fever after admission was $2.4{\pm}1.2$ days in treated group and $5.7{\pm}2.4$ days in control group. The period of disappearance of systemic erythematous maculopapular rash was $4.5{\pm}1.3$ days in treated group, and $6.9{\pm}2.4$ days in control group. The durations of admission day were also shown significantly shorter duration of period in treated group(P<0.05). The levels of CRP were no significant difference between two groups before treatment. However, treated group was significantly shown by improved within 5 days after IVGG therapy(P<0.05). Conclusions : The single dose of IVGG(400~500 mg/kg) therapy is one of rapid and effective therapy for clinical symptoms and signs in acute high febrile phase of measles.

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