• Clinical and Experimental Pediatrics
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• v.64 no.2
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• pp.68-75
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• 2021

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading worldwide since December 2019. Hundreds of cases of children and adolescents with Kawasaki disease (KD)-like hyperinflammatory illness have been reported in Europe and the United States during the peak of the COVID-19 pandemic with or without shock and cardiac dysfunction. These patients tested positive for the polymerase chain reaction or antibody test for SARS-CoV-2 or had a history of recent exposure to COVID-19. Clinicians managing such patients coined new terms for this new illness, such as COVID-19-associated hyperinflammatory response syndrome, pediatric inflammatory multisystem syndrome temporally associated with COVID-19, or COVID-19-associated multisystem inflammatory syndrome in children (MIS-C). The pathogenesis of MIS-C is unclear; however, it appears similar to that of cytokine storm syndrome. MIS-C shows clinical features similar to KD, but differences between them exist with respect to age, sex, and racial distributions and proportions of patients with shock or cardiac dysfunction. Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), interleukin-1 receptor antagonist (anakinra), or monoclonal antibody to tumor necrosis factor (infliximab) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy. The prognosis of MIS-C seemed favorable without sequelae in most patients despite a reported mortality rate of approximately 1.5%.

• Tuberculosis and Respiratory Diseases
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• v.84 no.3
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• pp.182-187
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• 2021

Background: Fractional exhaled nitric oxide (FeNO) is a non-invasive marker for eosinophilic airway inflammation and a good predictor of response to corticosteroids. There is a need for a reliable and accurate measurement method, as FeNO measurements have been widely used in clinical practice. Our study aimed to compare two FeNO analyzers and derive a conversion equation for FeNO measurements in adults. Methods: We included 99 participants who had chief complaints of chronic cough and difficulty in breathing. The participants underwent concurrent FeNO measurement using NIOX VERO (Circassia AB) and NObreath (Bedfont). We compared the values of the two devices and analyzed their correlation and agreement. We then formulated an equation to convert FeNO values measured by NObreath into those obtained by NIOX VERO. Results: The mean age of the participants was 51.2±17.1 years, with a female predominance (58.6%). Approximately 60% of the participants had asthma. The FeNO level measured by NIOX VERO (median, 27; interquartile range [IQR], 15-45) was significantly lower than that measured by NObreath (median, 38; IQR, 22-58; p<0.001). There was a strong positive correlation between the two devices (r=0.779, p<0.001). Additionally, Bland-Altman plots and intraclass correlation coefficient demonstrated a good agreement. Using linear regression, we derived the following conversion equation: natural log (Ln) (NObreath)=0.728×Ln (NIOX VERO)+1.244. Conclusion: The FeNO values of NIOX VERO and NObreath were in good agreement and had positive correlations. Our proposed conversion equation could help assess the accuracy of the two analyzers.

• Tuberculosis and Respiratory Diseases
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• v.82 no.3
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• pp.190-193
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• 2019

Inhaled corticosteroids (ICSs) have been widely used as a key medication for asthma control. However, ICSs have been known to cause respiratory infections, such as pneumonia and pulmonary tuberculosis. Consequently, a dilemma exists regarding recommendation of persistent lifetime use of ICSs to mild asthma patients. Short-acting ${\beta}$-agonists (SABAs) have also been widely used for symptom relief. However, SABAs have been reported to increase the risk of asthma-related death, though incidences have been very rare. Consequently, a dilemma exists regarding recommendation of a SABA alone without an ICS or a controller to asthma patients even with very mild disease. In the real world, asthma patients tend to intermittently use ICS and more likely to be dependent on SABA since many patients want immediate relief of their symptoms. Consequently, a dilemma exists regarding the underuse of ICSs but the overuse of SABAs. One strategy for solving the presented dilemma would be identification of patients with asthma who require persistent use of asthma controllers. Such patients, who may be referred to as "persistent controller users," should continuously receive ICSs, even under controlled states of asthma. Another strategy would be a patient-adjusted, symptom-driven, intermittent-to-regular treatment combining low-dose ICS/rapid-onset long-acting ${\beta}$-agonists instead of using a SABA alone or with low-dose ICS for the asthma patients with mild disease. Both of these two strategies could avoid the risky treatment of a SABA alone without an ICS and could reduce the dose of ICS with the maintenance of asthma control.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.1
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• pp.72-79
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• 2019

Purpose: The efficacy of exclusive enteral nutrition (EEN) with a polymeric diet has not been confirmed in Korean pediatric patients with Crohn's disease (CD). This study aimed to compare the effectiveness of EEN with a specific polymeric diet ($Encover^{(R)}$) and corticosteroids (CSs) for the induction of remission in Korean pediatric CD patients. Methods: We retrospectively compared data from 51 pediatric CD patients who underwent induction therapy with EEN (n=19) or CSs (n=32) at Severance Children's Hospital or Incheon St. Mary's Hospital in Korea. The primary endpoint of this study was the rate of clinical remission, defined as a Pediatric Crohn's Disease Activity Index (PCDAI) score <10, after 8 weeks of induction treatment. Clinical, laboratory, and growth data at post-induction as well as their changes from baseline were also compared between groups. Results: After 8 weeks of induction therapy, clinical remission rates were 78.9% (15/19) and 65.6% (21/32) in the EEN and CS groups, respectively (p=0.313). No significant differences in PCDAI scores, laboratory variables, and growth parameters were noted between the two groups at post-induction. However, significant changes in albumin levels at post-induction were observed in the EEN group compared to the CS group (p=0.038). Conclusion: Our results suggest that the effectiveness of EEN with a polymeric diet and CSs for induction therapy did not differ in Korean pediatric CD patients. EEN with a polymeric diet is a good first-line treatment option for the induction of remission in these patients.

• Korean journal of dermatology
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• v.56 no.10
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• pp.581-593
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• 2018

Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects both children and adults. AD is the cause of considerable morbidity including severe pruritus and impaired quality of life. Treatments for active disease include avoidance of triggering factors, barrier repair, topical medications including topical corticosteroids (TCs) and topical calcineurin inhibitors (TCIs), phototherapy, antibacterial agents, and systemic immunosuppressants including cyclosporine. Until recently, the only Food and Drug Administration (FDA)-approved systemic treatment options for patients with moderate-to-severe AD were steroids and cyclosporine. Systemic steroids are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants. In 2018, the Korean FDA approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. The implementation of treatment guidelines for AD is challenging. Herein, we review the several treatment modalities for AD and recommend a treatment algorithm.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.30 no.1
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• pp.42-44
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• 2019

Hashimoto's encephalopathy (HE) is a rare and underdiagnosed neuropsychiatric illness. We present the case of a 17-year-old girl who was admitted to a tertiary-care psychiatric center with acute onset psychosis and fever. Her psychotic symptoms were characterized by persecutory and referential delusions, as well as tactile and visual hallucinations. Her acute behavioral disturbance warranted admission and treatment in a psychiatric setting (risperidone tablets, 3 mg/day). She had experienced an episode of fever with a unilateral visual acuity defect approximately 3 years before admission, which was resolved with treatment. Focused clinical examination revealed an enlarged thyroid, and baseline blood investigations, including thyroid function test results were normal. Abnormal laboratory investigations revealed elevated anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) levels (anti-TPO of 480 IU/mL; anti-TG of 287 IU/mL). Results of other investigations for infection, including cerebrospinal fluid examination, electroencephalography, and brain magnetic resonance imaging were normal. She was diagnosed with HE and was treated with intravenous corticosteroids (methylprednisolone up to 1 g/day; tapered and discontinued after a month). The patient achieved complete remission of psychotic symptoms and normalization of the anti-thyroid antibody titers. Currently, at the seventh month of follow-up, the patient is doing well. This case highlights the fact that in the absence of well-defined clinical diagnostic criteria, a high index of suspicion is required for early diagnosis of HE. Psychiatrists need to explore for organic etiologies when dealing with acute psychiatric symptoms in a younger age group.

• The Korean Journal of Pain
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• v.32 no.4
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• pp.301-306
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• 2019

Background: Ganglion impar blockade is a reliable and effective treatment option used in patients with coccydynia. Our primary objective was to specify the role of corticosteroids in impar blockade. We compared applications of local anesthetic with the local anesthetic + corticosteroid combination in terms of treatment efficiency in patients with chronic coccydynia. Methods: Our study was a prospective randomize double-blind study. The patients were divided into 2 groups after randomization. The first group (group SL) was made up of patients where a corticosteroid + local anesthetic were used during ganglion impar blockade. In the second group (group L) we used only local anesthetic. We evaluated numeric rating scale (NRS) and Beck depression scale, which were employed before the procedure and in 1st and 3rd months after the procedure. Results: Seventy-three patients were included in the final analysis. We detected a significantly greater decrease in NRS values in the 1st month in group SL than in group L (P = 0.001). In the same way, NRS values in the 3rd month were significantly lower in the group with steroids (P = 0.0001). During the evaluation of the Beck test, we detected significantly greater decreases in the 1st month (P = 0.017) and 3rd month (P = 0.021) in the SL group than in the L group. Conclusions: Ganglion impar blockade decreases pain in the treatment of chronic coccydynia and improve depression. Addition of steroids in a ganglion impar blockade is required for treatment response that should accumulate over a long period of time.

• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.79-86
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• 2019

Background: Increased oxidative stress and inflammation play a critical role in the etiopathogenesis of chronic tendinopathy. Melatonin is an endogenous molecule that exhibits antioxidant and anti-inflammatory activity. The aim of this study was to evaluate the biochemical and histopathological effects of exogenous melatonin administrations in supraspinatus overuse tendinopathy. Methods: Fifty rats were divided into the following four groups: cage activity, melatonin treatment, corticosteriod therapy, and control. Melatonin (10 mg/kg, intraperitoneal; twice a day) and triamcinolone (0.3 mg/kg, subacromial; weekly) were administered to the treatment groups after the overuse period. Biochemical and histopathological evaluations were performed on serum samples and biopsies obtained from rats. Plasma inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were evaluated biochemically. Results: The TAS, TOS, OSI, iNOS, and VEGF values were significantly lower than the pre-treatment levels in rats receiving exogenous melatonin treatment (3 or 6 weeks) (p<0.05). TOS, iNOS, VEGF, and OSI values after 3 weeks of triamcinolone administration, and TOS, VEGF, and OSI levels after 6 weeks of triamcinolone application, were significantly lower than the pre-treatment levels (p<0.05). Conclusions: Exogenous melatonin application in overuse tendinopathy reduces oxidative stress and inflammation. Melatonin might be an alternative potential molecule to corticosteroids in the treatment of chronic tendinopathy.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.34 no.1
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• pp.66-88
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• 2021

Objectives : This study aims to report 3 cases of systemic atopic dermatitis improved by Korean medicine hospitalization care. Methods : Unlike outpatients, inpatients were supervised their lifestyle including dietary habits by physicians every morning and daily treated with acupuncture, herbal medicine including Bangpungtongseongsan-gagam, and Hwangryunhaedok-tang wet dressing therapy during all week. For dressing preparation, Hwangryunhaedok-tang was used to skin lesion except face. Mixed decoction of Lonicerae Flos and Forsythiae Fructus was used to facial lesion. Hwangryunhaedok-tang pharmacopuncture was injected to 2 patients. Western oral medicine and injection such as antihistamine or corticosteroids were prescribed by physician depending on each patient's condition. Symptoms were assessed with SCORAD index, IGA, and taking photos. Results : All patients showed the decrease in SCORAD index, IGA, skin lesion amelioration, and patient-subjective improvement. As time passes, dependence on western treatment also decreased and patients were able to endure pruritus without antihistamine injection during hospitalization. Conclusions : This study suggests that Korean medicine hospitalization care including acupuncture, herbal medicine, external therapy is effective for improving atopic dermatitis through decrease SCORAD index, IGA and ameliorating skin lesion.

• Journal of Veterinary Clinics
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• v.38 no.3
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• pp.152-158
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• 2021

A 3-year-old spayed female beagle dog was presented with epiphora, severe hemorrhagic and purulent ocular discharge in the right eye (OD). A reflux of the discharge through the other canaliculi, associated with signs of chronic inflammation, was observed on cytology. Dacryocystorhinography revealed retention of contrast media ventral to the lower punctum, indicating complete obstruction and the potential presence of radiolucent foreign body. Ocular discharge subsided after the first treatment, including flushing of the nasolacrimal duct and application of topical antibiotics and corticosteroids, but clinical symptoms of the dacryocystitis waxed and waned thereafter. Surgical treatment was delayed for 8 months due to Dirofilaria immitis infection, and topical treatment and monthly flushing were maintained. On the day of operation, a foreign body was released through the fistula, while flushing for disinfection under general anesthesia, just before the surgery. Dacryocystectomy was performed to remove necrotic tissue and residual foreign body around the nasolacrimal cyst. Upon histopathologic findings, the removed foreign body was considered to be a plant, and the nasolacrimal cyst was comprised of chronic active ulcerative inflammation and necrotic tissues. At the 1-week recheck, improvement of epiphora and ocular discharge and healing of the surgical site was noted. In conclusion, nasolacrimal duct foreign body can be considered in recurrent dacryocystitis, despite nasolacrimal flushing and topical medication. In this study, dacryocystectomy was curative without recurrence of dacryocystitis or epiphora.