• Title/Summary/Keyword: Immunosuppressants

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Incidence of Low Seroimmunity to Hepatitis B Virus in Children with Inflammatory Bowel Disease: A Single Center Experience

  • Hala H. Mansour ;Ayman E. Eskander;Sara M. Osman;Normeen H. Rady
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.27 no.2
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    • pp.104-112
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    • 2024
  • Purpose: Immunosuppressive therapy is frequently administered to patients with inflammatory bowel disease (IBD), which may make them more susceptible to infections like hepatitis B. Methods: A cross-sectional study was conducted on patients aged 5-18 years diagnosed with IBD who visited a gastroenterology clinic along with controls who were the same age as the patients with IBD and were healthy overall. A logistic regression analysis using the independent variables of age, sex, race, disease phenotype, surgery, and medications and the dependent variable of adequate hepatitis B surface antibody (HBsAb) titers (>10 mIU/mL) was performed on quantitative serum HBsAb titers. Results: The study enrolled 62 patients, including 37 males and 25 females. Crohn's disease, ulcerative colitis, and indeterminate colitis were diagnosed in 16, 22, and 24 patients, respectively. Thirty-nine patients were taking corticosteroids at the time of the study, 42 were taking immunomodulators, and four were taking biologics. Compared to 44.7% of the control group, 9.3% of the patients had protective titers. Only 12 out of 62 patients had HBsAb titers greater than 10 million IU/mL. None of the patients who received biologics or corticosteroids and 3.2% of those who received immunomodulators were found to be seroimmuned. Conclusion: The younger patients had the highest titers. Patient-specific factors that may impact these low titers include the length of the patient's illness and the use of immunosuppressants.

Effect of Panax ginseng on the Graft-versus-Host Reaction, Production of Leucocyte Migration Inhibitory Factor and Expulsion of Adult Trichinella spiralis in Mice (인삼이 이식편대숙주반응, 대식세포유주저지반응 및 Trichinella spiralis의 expulsion에 미치는 영향)

  • Ha, Tai-You;Lee, Jeong-Ho;Kim, Sang-Hyung
    • The Journal of the Korean Society for Microbiology
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    • v.21 no.1
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    • pp.133-144
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    • 1986
  • This study was undertaken to assess the effect of ginseng administration on T lymphocyte induced local xenogenic graft-versus-host(GVM) reactions which were induced with thymocyte, spleen cell and lymph node cell of ICR mice. Mice received daily 10mg of 70% alcohol ginseng extract oral1y for 100days and control mice remained untreated for the same period of time. The cells from donor mice were injected intradermally into the closely shaven abdominal skin of Sprague-Dawley rats for GVH tests. The thymocyte from control(ginseng-untreated) mice showed a negative local GVH reaction, whereas thymocyte from experimental(ginseng-treated) mice showed a positive reaction with the rate of 17.4%. When spleen cells were injected, the incidence of positive local GVH reaction was 66.7% among ginseng-treated mice, as opposed to incidence of 45.5% of positive local GVH reaction among control mice. The incidence of positive local GVH reaction of the lymph node cells when injected into a recipient was 71.4% among ginseng-treated mice as compared with that of 18.9% among control mice. The relationship between spleen cell inoculum and intensity of the local GVH reaction was assessed in ginseng-untreated mice. The intensity of GVH reaction clearly appears to be dose related. In ginseng-treated mice, a minimum of $1{\times}10^7$ spleen cell was required for production of positive local GVH reaction with almost linear relationship up to an inoculum of $5{\times}10^8$ cells. In control mice, however, a minimum of $1{\times}10^8$ spleen cells was required for positive GVH reaction. These results strongly suggest that the ginseng administration augments significantly the local xenogenic GVH reaction which was used to assess T lymphocyte function and immunocompetence of mice and in addition to this, these results appear to support previous suggestions that the local GVH reaction consitutes a qualitative test of the functional activity of T lymphocytes. These results may be the first to induce local GVH reaction, employing rats as recipient and mice as donor. This study was also desingned to investigate some of the effects of ginseng extract on lymphocyte-macrophage interactions. This was accomplished by in vitro quantification of 1) migratory inhibitory factor(MIF) synthetic capacity of splenic lymphocytes in mice previously primed with ginseng 2) MIF responsiveness of mouse peritoneal macrophages or chicken peripheral leucocytes under the presence of ginseng extract 3) migration ability of chicken peripheral leucocytes by direct stimulation of ginseng extract or ginseng saponin and 4) immunosuppressive effects of immunosuppressants such as cyclophosphamide, cyclosporin A or dexamethasone. Mice divided equally into the ginseng and the saline groups, which received intraperitoneally daily 0.2ml of ginseng absolute alcohol-extract(5mg/ml) and same amount of saline for 15 days, respectively. The cellular immune responsiveness of these mice was assayed 15 days after ginseng pretreatment. Splenic lymphocytes of mice treated with ginseng, when stimulated with sensitized specific-antigen such as sheep red blood cells or toxoplasmin, or with polyclonal activator concanavalin A, produced significantly more MIF than those of control saline group. MIF responsiveness of normal mouse macrophages was significantly augmented when assayed under the presence of ginseng extract (1mg/ml). The migratory ability of normal chicken leucocytes in the absence of MIF was significantly decreased by the stimulation of ginseng extract alone. MIF response was significantly decreased by immunosuppressants and this impaired response was not restored by ginseng pretreatment. This study was additionally performed to evaluate the effect of ginseng on the expulsion of adult Trichinella spiralis in mice. ICR mice were infected experimentally by esophageal incubation of 300 T. spiralis infective muscle larvae prepared by acid-pepsin digestion of infected mice. and received oral administration of 70% alcohol ginseng extract(10mg/mouse/day) for the indicated days plus 4 days before infection. At various times after infection, the number of adult T. spiralis worms in small intestines was determined. Interestingly, ginseng-treatment was accompanied by accelerated expulson of T. spiralis. These results led to the conclusion that Panax ginseng caused some enhancing effect on GVH reaction, macrophage migration inhibition reaction and expulsion of T. spiralis. In addition these results suggested that the mechanisms responsible for this enhancement of ginseng may be chiefly or partially due to nonspecific stimulation of cell-mediated immune response.

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Management of Osteoporosis in Liver Transplant Recipients (간이식 후 골다공증 관리)

  • Choi, Hojeong;Kim, Boram;Kim, Yoonhee;Lee, Jungwha;Lee, Eunsook;Lee, Euni;Cho, Jai Young;Choi, YoungRok
    • Korean Journal of Clinical Pharmacy
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    • v.30 no.1
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    • pp.51-58
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    • 2020
  • Background: Prevention of osteoporosis and bone fracture is one of the important issues for liver transplant recipients because a long history of liver disease and lifelong use of immunosuppressants, including corticosteroids, may cause these diseases. In this study, we aimed to analyze liver recipient bone status, 10-year fracture risk, and medication history. Methods: The electronic medical records of adult patients aged >40 years who received liver transplantation at Seoul National University Bundang Hospital between January 2009 and June 2017 were reviewed retrospectively. On the basis of their bone mineral density and fracture history, their fracture risks were analyzed using the Korean fracture risk assessment tool. Results: A total of 57 liver transplant recipients were treated with corticosteroids during a mean of 8.8 months after transplantation. 30 patients (52.6%) showed bone metabolism dysfunction such as osteopenia or osteoporosis. The 10-year femoral fracture risk was 2.1%, and dual-energy X-ray absorptiometry monitoring was performed, including right before liver transplantation every 27.5±19.2 months. The mean femoral bone mineral density decreased by -7.2%±7.3%. Four patients (7.0%) had a fracture after liver transplantation. Osteoporotic fracture occurred in 3 patients with osteoporosis (25.0%). Among the osteopenia patients with moderate fracture risk who were not treated with bisphosphonate, 1 patient (12.5%) had a history of bone fracture after liver transplantation. Conclusions: Considering the deterioration of bone density and moderate fracture risk, medication for osteoporosis should be prescribed to liver transplant recipients with regular monitoring of bone density after transplantation.

Gene Transfer Optimization via E. coli-driven Conjugation in Nocardiopsis Strain Isolated via Genome Screening (유전체 스크리닝으로 선별된 Nocardiopsis 균주의 대장균 접합을 통한 유전자 도입전략 최적화)

  • Jeon, Ho-Geun;Lee, Mi-Jin;Kim, Hyun-Bum;Han, Kyu-Boem;Kim, Eung-Soo
    • Microbiology and Biotechnology Letters
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    • v.39 no.2
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    • pp.104-110
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    • 2011
  • Actinomycetes, Gram positive soil bacteria, are valuable microorganisms which produce useful secondary metabolites including antibiotics, antiparasitic substances, anti-cancer drugs, and immunosuppressants. Although a major family of actinomycetes, known as streptomycetes, has been intensively investigated at the molecular level for several decades, a potentially valuable and only recently isolated non-streptomycetes rare actinomycetes (NSRA) family has been poorly characterized due to lack of proper genetic manipulation systems. Here we report that a PCR-based genome screening strategy was performed with approximately 180 independently isolated actinomycetes strains to isolate potentially valuable NSRA strains. Thanks to this simple PCR-based genome screening strategy we were able to identify only seven NSRA strains, followed by 16S rRNA sequencing for confirmation. Through further bioassays, one potentially valuable NSRA strain (tentatively named Nocardiopsis species MMBL010) was identified which possessed both antifungal and antibacterial activities, along with the presence of polyketide synthase and non-ribosomal peptide synthase genes. Moreover, Nocardiopsis species MMBL010, which was intrinsically recalcitrant to genetic manipulation, was successfully transformed via E. coli-driven conjugation. These results suggest that PCR-based genome screening, followed by the establishment of an E. coli-driven conjugation system, is an efficient strategy to maximize potentially valuable compounds and their biosynthetic genes from NSRA strains isolated from various environments.

Spontaneous teeth migration after periodontal treatment in the patients with drug-induced gingival enlargement (약물성 치은비대로 인한 병적인 치아 이동이 있는 환자에서 치주치료 이후 자발적 치아 이동을 보인 증례)

  • Choi, Youn-Kyung;Jung, Kyoung-Hwa;Kim, So-Yeun;Jeon, Hye-Mi;Choi, Jeomil;Lee, Ju-Youn;Joo, Ji-Young;Kwon, Eun-Young
    • Journal of Dental Rehabilitation and Applied Science
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    • v.33 no.1
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    • pp.34-41
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    • 2017
  • Anticonvulsants, calcium channel blockers and immunosuppressants are representative drugs related with gingival enlargement. Clinical signs and symptoms caused by drug-induced gingival enlargment frequently appear within 1 to 3 months after medication. At initial stage, it is limited to attached gingiva but may extend coronally and interfere with esthetics, mastication and speech. Interproximal spaces are common beginning area and pathologic teeth migration could be occurred by the lesion. Withdrawal or substitution of medication would be the most effective treatment of drug-induced gingival enlargement. However, periodontal treatment and further supportive periodontal therapy should be provided where change in medication is impossible. The present study reports the cases which show the resolution of inflammation with spontaneous teeth migration without change in medication. In all cases discussed in this report could be efficiently managed with proper periodontal treatment and further supportive periodontal therapy.

A Tapping the usefulness of Whole Blood Interferon-${\gamma}$ Assay for Diagnosing Tuberculosis Infection in Children (소아 결핵 감염 진단에 있어서 결핵 특이항원 자극 Interferon-${\gamma}$ 분비능 측정의 진단적 유용성)

  • Soon, Eu-Gene;Lim, Baek-Keun;Kim, Hwang-Min;NamGoong, Mee-Kyung;Cha, Byung-Ho;Uh, Young;Chun, Jin-Kyong
    • Tuberculosis and Respiratory Diseases
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    • v.68 no.5
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    • pp.280-285
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    • 2010
  • Background: $QuantiFERON^{(R)}$-TB Gold In Tube (QFT-G IT) has been used for diagnosing latent tuberculosis infection and active tuberculosis (TB) since 2007. However, there has not been enough data on QFT-G IT for universal use in children. In this study, we evaluated the clinical usefulness of the QFT-G IT in pediatric practice. Methods: We retrospectively reviewed the clinical records of 70 patients younger than 18 years of age who had taken QFT-G IT and had a tuberculin skin test (TST) between July 2007 and July 2009 at Wonju Christian Hospital. The subjects were divided into two groups, asymptomatic TB exposure group and disease group. Four patients who were taking immunosuppressants during the study period were excluded. Results: A total of 66 immunocompetent children were included in this study. Among 27 asymptomatic children who had contact histories of TB, 6 (22.2%) were found to be positive by QFT-G IT. Eleven (40.7%) and 5 (18.5%) children were found to be positive by TST with cutoff values of ${\geq}5mm$ and ${\geq}10mm$, respectively. Agreement was fair to good between QFT-G IT and TST (${\kappa}=0.59$: cutoff value ${\geq}5mm$, ${\kappa}=0.7$: cutoff value ${\geq}10mm$). In disease group, 14 patients (35.9%) were diagnosed with active tuberculosis, 8/14 (57.1%) were positive on TST and 9/14 (64.3%) on QFT-G IT. The positive rate of acid-fast bacilli smear, TB-polymerase chain reaction, and culture for tuberculosis was 11% (1/9), 27.3% (3/11) and 33.3% (3/9), respectively. Conclusion: Our data support that the QFT-G IT can be used as an additional diagnostic tool for latent and active tuberculosis infection in children.

A Case of Idiopathic Bronchiolocentric Interstitial Pneumonia (특발성 세기관지중심성 간질성 폐렴 1예)

  • Kang, Ji Young;Jung, Jung Im;Lee, Kyo-Young;Kim, Tae-Jung;Lee, Jung-Woo;Lee, Wook-Hyun;Chung, Hui Sung;Yoon, Hyoung Kyu;Song, Jeong Sup
    • Tuberculosis and Respiratory Diseases
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    • v.66 no.3
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    • pp.230-235
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    • 2009
  • Idiopathic bronchiolocentric interstitial pneumonia is one of idiopathic interstitial pneumonia, which has a relatively aggressive course and poor prognosis. It is characterized by diffuse centrilobular nodules radiologically with mainly bronchiolocentric inflammation and fibrosis associated with patchy alveolitis lacking interstitial granuloma histologically. This disorder is a recently classified disease category, and to our knowledge, there is no case report in Korea. We present a case of idiopathic bronchiolocentric interstitial pneumonia. A 62-year-old man presented with exertional dyspnea with a 1 month duration. The radiological findings showed extensive centrilobular lesions at both lungs. The surgical lung biopsy specimen demonstrated a centrilobular inflammatory process with small airway fibrosis and inflammation partially radiating into the interstitium. Therefore, the patient was diagnosed with idiopathic bronchiolocentric interstitial pneumonia. He was treated with immunosuppressants including steroids and azathioprine. However, his symptoms did not improve and he expired 7 months later due to an acute exacerbation of the interstitial pneumonia and probable infectious pneumonia.

Microbiology and Epidemiology of Infectious Spinal Disease

  • Jeong, Se-Jin;Choi, Seung-Won;Youm, Jin-Young;Kim, Hyun-Woo;Ha, Ho-Gyun;Yi, Jin-Seok
    • Journal of Korean Neurosurgical Society
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    • v.56 no.1
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    • pp.21-27
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    • 2014
  • Objective : Infectious spinal disease is regarded as an infection by a specific organism that affects the vertebral body, intervertebral disc and adjacent perivertebral soft tissue. Its incidence seems to be increasing as a result of larger proportion of the older patients with chronic debilitating disease, the rise of intravenous drug abuser, and the increase in spinal procedure and surgery. In Korea, studies assessing infectious spinal disease are rare and have not been addressed in recent times. The objectives of this study are to describe the epidemiology of all kind of spinal infectious disease and their clinical and microbiological characteristics as well as to assess the diagnostic methodology and the parameters related to the outcomes. Methods : A retrospective study was performed in all infectious spinal disease cases presenting from January 2005 to April 2010 to three tertiary teaching hospitals within a city of 1.5 million in Korea. Patient demographics, risk factors, clinical features, and outcomes were assessed. Risk factors entailed the presence of diabetes, chronic renal failure, liver cirrhosis, immunosuppressants, remote infection, underlying malignancy and previous spinal surgery or procedure. We comparatively analyzed the results between the groups of pyogenic and tuberculous spinal infection. SPSS version 14 statistical software was used to perform the analyses of the data. The threshold for statistical significance was established at p<0.05. Results : Ninety-two cases fulfilled the inclusion criteria and were reviewed. Overall, patients of tuberculous spinal infection (TSI) and pyogenic spinal infection (PSI) entailed 20 (21.7%) and 72 (78.3%) cases, respectively. A previous spinal surgery or procedure was the most commonly noted risk factor (39.1%), followed by diabetes (15.2%). The occurrence of both pyogenic and tuberculous spondylitis was predominant in the lumbar spine. Discs are more easily invaded in PSI. At initial presentation, white cell blood count and C-reactive protein levels were higher in PSI compared to TSI (p<0.05). Etiological agents were identified in 53.3%, and the most effective method for identification of etiological agents was tissue culture (50.0%). Staphyococcus aureus was the most commonly isolated infective agent associated with pyogenic spondylitis, followed by E. coli. Surgical treatment was performed in 31.5% of pyogenic spondylitis and in 35.0% of tuberculous spondylitis cases. Conclusion : Many previous studies in Korea usually reported that tuberculous spondylitis is the predominant infection. However, in our study, the number of pyogenic infection was 3 times greater than that of tuberculous spinal disease. Etiological agents were identified in a half of all infectious spinal disease. For better outcomes, we should try to identify the causative microorganism before antibiotic therapy and make every effort to improve the result of culture and biopsy.

$CO_2$ Laser Application for Treatment of the Hairy Tongue (이산화탄소 레이저를 이용한 모설의 치료)

  • Jung, Da-Woon;Cho, Eunae;Ahn, Hyung-Joon
    • Journal of Oral Medicine and Pain
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    • v.38 no.2
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    • pp.97-101
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    • 2013
  • Hairy tongue is a disease caused by hypertrophy of filiform papillae on the tongue dorsum. Clinically, it occurs on the posterior 1/3 of the tongue dorsum and is rarely observed on the lateral and tip of the tongue. Several types of colored pigmentation from white to brown and black appear depending on the ingested food and the existing pigmentation inducing bacteria. Although clinically asymptomatic, patients will visit the clinic for esthetic problems and at rare intervals experience nausea, halitosis, dysgeusia and unpleasant sensation. The exact etiology is yet not known but causes such as inappropriate oral hygiene control, a shift in oral bacterium, infection, radiotherapy, use of antibacterial drugs or immunosuppressants, excessive smoking or alcohol drinking and decrease of salivary flow rate may be a factor of the disease. Clinical symptoms are quite typical and diagnosis may be made simply by observation, not necessarily biopsy. Treatment of hairy tongue is done by eliminating the etiology factors, brushing the tongue gently with a tongue cleaner and in some cases using keratolytic agent. Although it is rare to treat hairy tongue surgically, we will introduce a case successfully treated using carbondioxide laser($CO_2$ laser), after no sufficient improvement had been made by conservative treatment.

Behavior patterns of patients with oral mucosal disease (구강점막질환 환자의 행동패턴 연구)

  • Ok, Soo-Min;Kim, Kyung-Hee;Jeon, Hye-Mi;Heo, Jun-Young;Ahn, Yong-Woo;Jeong, Sung-Hee
    • The Journal of the Korean dental association
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    • v.52 no.12
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    • pp.744-752
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    • 2014
  • There are many causes of oral mucosal diseases, so accordingly, there are various treatments available. The most commonly used agents include adrenocortical hormones, antifungals, antivirals, antibacterials, and immunosuppressants. However, it must also be noted that improving oral hygiene and nutrition, and reducing stress are effective in symptom relief. Furthermore, patients with existing diseases of the oral mucosa should avoid behavior that may cause an increase in pain. Unfortunately, many patients are unaware of the activities that may lead to increased pain and therefore do not avoid these activities. The aim of this study was to investigate and analyze the behavior of patients with oral mucosal disease with regard to activities that led to increase pain. This cross-sectional study was performed on a sample of patients with oral mucosal disease selected from the Oral Medicine Clinic of the Pusan National Hospital during March to August 2013. These patients were randomly selected. From a total of 479 patients, 116 patients with mucosal disease were selected and 73 fully completed questionnaires were included in the analysis. Data were collected by using self-completed questionnaires. The results were as follows: Mean score of Question 13 (Not smoking) is $2.47{\pm}1.11$. Mean score of Question 11 (Not drinking alcohol or not using mouthwash containing alcohol) is $2.22{\pm}1.15$. The other questions resulted in scores lower than 1.5. The answers to the questions were scored according to the following assigned numerical values: not keeping = score of 0; little keeping = score of 1; often keeping = score of 2; always keeping = score of 3. In conclusion, patients with oral mucosal diseases unknowingly engage in activities that result in an increase in pain. Therefore, they need to be educated about how to behave to protect oral mucosal lesion.