• Pediatric Infection and Vaccine
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• v.21 no.2
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• pp.104-113
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• 2014

Purpose: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. Methods: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. Results: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P =0.001) and eschar (P =0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P =0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P <0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. Conclusion: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.

• Childhood Kidney Diseases
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• v.14 no.2
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• pp.132-142
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• 2010

Hypokalemia usually reflects total body potassium deficiency, but less commonly results from transcellular potassium redistribution with normal body potassium stores. The differential diagnosis of hypokalemia includes pseudohypokalemia, cellular potassium redistribution, inadequate potassium intake, excessive cutaneous or gastrointestinal potassium loss, and renal potassium wasting. To discriminate excessive renal from extrarenal potassium losses as a cause for hypokalemia, urine potassium concentration or TTKG should be measured. Decreased values are indicative of extrarenal losses or inadequate intake. In contrast, excessive renal potassium losses are expected with increased values. Renal potassium wasting with normal or low blood pressure suggests hypokalemia associated with acidosis, vomiting, tubular disorders or increased renal potassium secretion. In hypokalemia associated with hypertension, plasam renin and aldosterone should be measured to differentiated among hyperreninemic hyperaldosteronism, primary hyperaldosteronism, and mineralocorticoid excess other than aldosterone or target organ activation. Hypokalemia may manifest as weakness, seizure, myalgia, rhabdomyolysis, constipation, ileus, arrhythmia, paresthesias, etc. Therapy for hypokalemia consists of treatment of underlying disease and potassium supplementation. The evaluation of hyperkalemia is also a multistep process. The differential diagnosis of hyperkalemia includes pseudohypokalemia, redistribution, and true hyperkalemia. True hyperkalemia associated with decreased glomerular filtration rate is associated with renal failure or increased body potassium contents. When glomerular filtration rate is above 15 mL/min/$1.73m^2$, plasma renin and aldosterone must be measured to differentiate hyporeninemic hypoaldosteronism, primary aldosteronism, disturbance of aldosterone action or target organ dysfunction. Hyperkalemia can cause arrhythmia, paresthesias, fatigue, etc. Therapy for hyperkalemia consists of administration of calcium gluconate, insulin, beta2 agonist, bicarbonate, furosemide, resin and dialysis. Potassium intake must be restricted and associated drugs should be withdrawn.

• Annals of Clinical Neurophysiology
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• v.9 no.1
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• pp.11-15
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• 2007

Background: The term "overlap syndromes" designates a group of diseases in which polymyositis (PM) or dermatomyositis (DM) is associated with some other disorders of connective tissues. The aim of this study was to delineate the clinical features, laboratory findings, and outcome of treatment of "overlap syndromes" Methods: We analyzed the medical records of 16 patients (PM in 10, DM in 6) with well documented "overlap syndromes" between 1997 and 2004. The diagnosis was made when the criteria for two different disorders were fulfilled. Results: All patients were female. Age of onset ranged from 14 to 52 years (mean 29.8 years) with peak incidence in the third and fourth decades. Systemic lupus erythematosus (SLE) was associated in 10, systemic sclerosis in 7, and rheumatoid arthritis in 3 patients. Four of the patients had two different connective tissue diseases simultaneously. The characteristic clinical features were muscle weakness, arthralgia, Raynaud's phenomenon, and myalgia. In laboratory tests, creatine kinase (CK), lactic dehydrogenase (LDH), and transaminases were usually abnormal. Positive antinuclear antibody (ANA), rheumatoid factor (RF), and cryoglobulin were found in 100%, 69%, and 67% of the patients, respectively. Needle electromyography (EMG) showed abnormal findings compatible with myopathy in 15 patients. The pathology of muscle biopsy from 14 patients revealed findings compatible with inflammatory myopathy. Glucocorticoids were administered to 15 patients. The muscle strength improved in all the treated patients, which was well correlated with repeat CK level and EMG findings. Conclusions: The presence of autoantibodies such as ANA, RF, and cryoglobulin in patients with PM or DM highly suggests the possibility of an overlap syndromes. These syndromes reveal a strong female predominance. The myositis associated with them usually shows a good response to glucocorticoids treatment.

• Korean Journal of Clinical Laboratory Science
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• v.51 no.4
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• pp.420-427
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• 2019

Scrub typhus is a fever-related disease that is commonly diagnosed during the autumn season. The number of patients affected by this disease continues to increase every year. However, the cause of the disease and the regional differences of its incidence are poorly understood. This study examined the epidemiological features and regional differences in the incidence of scrub typhus. The monthly incidence of cases from all reports rose to more than 90% during the fall season (October~December). Based on the analysis of the 18,851 cases in the epidemiological investigation, 14,777 (78.4%) and 4,074 (21.6%) cases occurred in high and low occurrence areas, respectively. Moreover, there were more female cases than male cases (males: 7,233 [38.4%]; females: 11,618 [61.6%]; P< 0.001). The clinical symptoms, including fever, chills, myalgia, and eschar of the body, were noted in 16,688 (89.1%), 11,533 (61.2%),11,439 (60.7%), and 6,005 (45.4%) cases, respectively. The incidence rates were higher for Gyeongnam, Jeonam, Jeonbuk, and Chungnam provinces. The areas with a high occurrence of scrub typhus were consistent with the areas experiencing a high distribution of Leptotrombidium scutellare. The incidence of scrub typhus has been rising owing to the increasing population of ticks due to global warming and increased agricultural and outdoor activities. Thus, continuous management of patients and preventive environmental measures are needed to control this disease.

• Journal of Yeungnam Medical Science
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• v.7 no.1
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• pp.151-163
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• 1990

Tsutsugamushi disease is an acute febrile disease caused by Rickettsia tsutsugamushi, and which has been reported with increasing frequency through the nation since 1986. We experienced 21 cases of Tsutsugamushi disease diagnosed with serologic test occuring in Taegu city and Kyungpook province during October-November, 1989. The results of survey are as follow. 1) Of 21 cases, 12(57%) were males and 9(43%) were females, and the peak incidence was the 4th decade. 2) The outbreak was in October to November and the peak incidence was in October. 3) The most frequent symptoms were fever and chill(100%), myalgia(95%), headache(90%). Eschar and rash were observed in 18 patients(86%) and the eschar was detected in all over the body, especially thorax(33%) and lower extremity(22%). 4) Laboratory features were SGOT elevation(83%), SGPT elevation(61%), LDH elevation(67%). leukocytosis (38%). 5) Indirect immunofluorescent antibody test was done m 18 patients and the antibody titer was above 1 : 320 in all patients. 6) The chloramphenicol, tetracycline or doxycycline regimens were very effective and mean duration of defervescence from iniation of therapy was 1.3 days. 7) The complication such as meningitis or shock, was not seen.

• Journal of Yeungnam Medical Science
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• v.6 no.1
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• pp.31-41
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• 1989

Since the first cases of tsutsugamushi disease reported in Korea in 1986. many cases has been reported and its occurrence has been increasing. Only 2 cases has been reported in Taegu city and Kyungpook area. We experienced an outbreak of 26 cases of tsutsugamushi disease in this area and their clinical manifestations are ; 1. The outbreak occurred in September to November in 1988 and its peak occurrence was in October. 2. Mean age was 52 years old (18 to 69 years old) and peak incidence was in the 6th decade. 3. Major symptoms and abnormal signs are fever/chills(88%), myalgia(65%), headache(54%), nausea and vomiting(31%), and abdominal pain(27%). The eschar was detected on lower part of body in most of cases. and more frequently in male(M : F 100 vs 58%). 4. Patients were treated with tetracyclines(TC) and/or chlorampenicol(CM) and mean duration of defervescence from initiation of antibiotic therapy was 2.1 days with TC and 2.5 days with CM. 5. Complications are 2 cases of meningitis and 1 cases of shock. and all cases were recovered without any sequlae. As above, tsutsugamushi disease occurs in Taegu city and Kyung Pook area as other part of Korea and clinical manifestations are similar to other reports.

• The Journal of Korean Obstetrics and Gynecology
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• v.32 no.4
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• pp.132-143
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• 2019

Objectives: The purpose of this study is to provide basic information on Korean medical research and treatment through analysis of breast cancer patients, who visited ${\bigcirc}{\bigcirc}$ university Korean medicine hospital. Methods: To analyze characteristics of breast cancer patients who visited korean medicine hospital, we searched medical records from January 1, 2016 to May 13, 2019, and 86 breast cancer patients were analyzed. Results: 1. The general characteristics of the subjects are as follows. The average age was $47.65{\pm}9.62years$ and 40's was the most (46.51%). The average height was $159.78{\pm}4.91cm$ and the average weight was $57.29{\pm}9.34kg$. The average body mass index (BMI) of the patients was $22.40{\pm}3.50kg/m^2$. 2. The stage distribution record indicated stage０ (9.72%), stageI (31.94%), stageII (34.72%), stageIII (20.83%) and stageIV (2.78%). 14 patients with unknown stage were excluded. 3. Before coming to the korean medicine hospital, of the 86 patients, 72 (83.72%) patients received surgical therapy, 55 (63.95%) patients received chemotherapy and 44 (51.16%) patients received radiotherapy. 11 (12.79%) patients chose oriental medicine as their primary treatment option. 4. The mean duration from diagnosis to hospital visit was $13.87{\pm}15.53months$. Among the total 86 patients, 46 (53.49%) patients visited for symptom relief during the follow-up period. 5. The most common symptom was general weakness in 29 (33.72%) patients, followed by hot flash, myalgia, insomnia, digestion disorder, numbness, edema, arthralgia, operation site pain, cold sensation and mastalgia. 6. Among 86 patients, 55 (63.95%) patients received acupuncture and moxibustion together. The most prescribed herbal medicine to subjects was Sibjeondaebo-tang-gamibang and Cheonhye-dan (25%). Conclusions: These results could be helpful to provide basic data on the Korean medical approach of breast cancer patients.

• The Journal of Internal Korean Medicine
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• v.42 no.4
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• pp.590-604
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• 2021

Objectives: The purpose of this study is to examine the safety of Korean medicine treatment in patients vaccinated with the AstraZeneca COVID-19 vaccine (ChAdOx1 nCoV-19/AZD1222). Methods: We investigated patients at Kyung Hee University Korean Medicine Hospital who were vaccinated with the AstraZeneca COVID-19 vaccine between June 1, 2021 and June 30, 2021. The safety of Korean medicine treatment was evaluated by examining adverse events that occurred within seven days of vaccination, including liver function and kidney function testing, assessment of the severity of adverse events, and examination of causality to vaccines and Korean medicine treatment. Results: Eleven patients vaccinated with the first dose of the AstraZeneca COVID-19 vaccine were included. A total of 19 adverse events were reported: 15 systemic adverse events, three local adverse events, and one alanine aminotransferase increase. The most commonly reported systemic adverse events were fatigue (4 cases, 36.4%), headache (4 cases, 36.4%), and myalgia (4 cases, 36.4%). All adverse events were rated below moderate (grade 2) in severity. Systemic and local adverse events were evaluated as definitely related to vaccination and unlikely to be related to Korean medicine treatment, while alanine aminotransferase increase was evaluated as unlikely to be related to either the vaccine or Korean medicine treatment. Aspartate transaminase, Blood urea nitrogen, and creatinine were measured within the reference range after vaccination. Conclusion: Our results suggest that the severity and frequency of adverse events in patients vaccinated with the AstraZeneca COVID-19 vaccine did not increase after Korean medicine treatment.

• Pediatric Infection and Vaccine
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• v.25 no.3
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• pp.113-122
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• 2018

Purpose: The aim of this study was to evaluate the clinical characteristics of children diagnosed as cryopyrin-associated periodic syndrome (CAPS) in Korea. Methods: Diagnosis was made based on clinical features and confirmed by a mutation in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene. Especially, osteocartilaginous overgrowth in the patella or distal femur was so characteristic that its presence warranted a diagnosis of chronic infantile neurologic cutaneous and articular/NOMID. Results: We observed the clinical features of 9 Korean CAPS patients. All the patients suffered from an urticarial rash with recurrent fever. Among the 9 patients, 6 presented with rash and 4 with fever on the 1st or 2nd days of birth. Eight patients showed myalgia, and 7 patients showed arthralgia in the joints, and 6 patients showed radiologic findings of arthropathy including cupping of the metaphysis, excessive growth of the epiphysis, osteopenia or overgrowth of the cartilage. Four patients showed brain atrophy, enlarged ventricles or leptomeningeal enhancement on magnetic resonance imaging. Intellectual disability was observed in 1 patient. Five patients had eye involvement as conjunctivitis, uveitis, chorioretinitis, avascular area or papillary edema, and 3 patients showed progressive hearing loss. All 9 patients showed increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Conclusions: All the patients carried a mutation on exon 3 of the CIAS1 gene. After the anakinra (interleukin-1 receptor antagonist) therapy, the fever and rash immediately disappeared, and CRP and ESR were improved.

• Kosin Medical Journal
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• v.33 no.3
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• pp.347-357
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• 2018

Objectives: Few studies of pediatric Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM) have been conducted in Korea. We evaluated the clinical features of children with IM to define differences according to age. Methods: We conducted retrospective chart reviews of 68 children aged 0 to 15 years who were diagnosed by EBV-associated IM with EBV-Viral Capsid Antigen(VCA) IgM at laboratory test and were admitted between 2010 and 2014. The children were classified into four age groups: aged 0-3, 4-6, 7-9, and 10-15 years. Results: The age distribution of patients was as follows: 19 (27.9%) 0-3, 25 (36.8%) 4-6, 13 (19.1%) 7-9, and 11 (16.2%) 10-15. Fever was the most common presentation regardless of age. It was more common in the 0-3 group than the 4-6 group (P = 0.018). Pharyngitis was more common in the 7-9 group than the 0-3 group (P = 0.048), and myalgia was more common in the 10-15 group than the 0-3 group (P = 0.007). Pharyngitis was accompanied by lymphadenopathy, protracted fever, and rash. In the 0-3 age group, the prevalence of rash was higher while the percentage of atypical lymphocytes was lower, but there was no statistical support for this tendency. There were no differences in the frequency of hepatosplenomegaly or laboratory findings between age groups. Conclusions: IM is not uncommon in young children and its clinical presentation varies with age. Therefore, IM should be suspected in young febrile children with pharyngitis and rash despite low percentages of atypical lymphocytes.