Poisoning patients’ clinical features according to the blood level of propranolol

Purpose@#Propranolol is widely prescribed to psychiatric patients to control adrenergic symptoms. However, propranolol poisoning can be fatal due to cardiovascular complications. We analyzed associations between blood levels of propranolol and patients’ clinical features, with the aim of predicting progression to severe complications. @*Methods@#Data were collected from patients aged 18 years or older who presented to the emergency department with propranolol poisoning between January 2016 and May 2022. We retrospectively analyzed their medical records and compared blood levels of propranolol between those who had cardiovascular complications and those who did not. @*Results@#Two hundred patients were included in this study. The blood levels of propranolol were significantly higher in patients with hypotension, bradycardia, and prolonged QT intervals, with median values of 247.0 ng/mL (interquartile range [IQR], 56.5–333.8 ng/mL), 275.8 ng/mL (IQR, 154.3–486.4 ng/mL), and 159.0 ng/mL (IQR, 33.9–310.8 ng/mL), respectively. In the predictive analysis of cardiovascular complications using a receiver operating characteristic curve, the area under the curve was 0.729 with a cut-off value of 72.40 ng/mL (sensitivity, 0.667; specificity, 0.819). In addition, the correlation coefficient between blood levels and the amount of drug described during the history-taking at the time of presentation was 0.634, which was found to have a significantly higher relationship. @*Conclusion@#Because blood levels of propranolol can be used as predictors of exacerbation in patients with propranolol poisoning, patients with blood levels above 72.40 ng/dL require careful treatment and observation from their initial presentation at the emergency department.

Immunogenicity of SARS-CoV-2 Vaccine in Kidney Transplant Recipients:A Cross-Sectional Study in Korea

Eighty-five Korean kidney transplant recipients who received three doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine were tested with anti-receptor binding domain (RBD) antibody and neutralizing antibody. High anti-RBD antibody (≥ 100 U/mL) and neutralizing antibody responses (≥ 30%) were detected in 51/85 (60.0%) patients.When we divided the patients with the time from transplantation to vaccination (< 1, 1–2.4, 2.5–4.9, and ≥ 5-year), anti-RBD antibody titers were 3.2 U/mL, 27.8 U/mL, 370.2 U/mL, and 5,094.2 U/mL (P < 0.001) and anti-neutralizing antibody levels were 2.2%, 11.6%, 45.6%, and 93.0% (P < 0.001), respectively. Multivariate analysis revealed increased antibody responses when the time from transplantation to vaccination was five years or longer (odds ratio, 12.0; confidence interval, 2.7–52.8). Korean kidney transplant recipients had suboptimal antibody responses after the third dose of SARS-CoV-2 vaccine. A shorter time from transplantation to vaccination was a risk factor for a low antibody response.

Molecular characterization of dysplasia-initiated colorectal cancer with assessing matched tumor and dysplasia samples

Purpose@#Ulcerative colitis (UC) is known to have an association with the increased risk of colorectal cancer (CRC), and UC-associated CRC does not follow the typical progress pattern of adenoma-carcinoma. The aim of this study is to investigate molecular characteristics of UC-associated CRC and further our understanding of the association between UC and CRC. @*Methods@#From 5 patients with UC-associated CRC, matched normal, dysplasia, and tumor specimens were obtained from formalin-fixed paraffin-embedded (FFPE) samples for analysis. Genomic DNA was extracted and whole exome sequencing was conducted to identify somatic variations in dysplasia and tumor samples. Statistical analysis was performed to identify somatic variations with significantly higher frequencies in dysplasia-initiated tumors, and their relevant functions were investigated. @*Results@#Total of 104 tumor mutation genes were identified with higher mutation frequencies in dysplasia-initiated tumors. Four of the 5 dysplasia-initiated tumors (80.0%) have TP53 mutations with frequent stop-gain mutations that were originated from matched dysplasia. APC and KRAS are known to be frequently mutated in general CRC, while none of the 5 patients have APC or KRAS mutation in their dysplasia and tumor samples. Glycoproteins including mucins were also frequently mutated in dysplasia-initiated tumors. @*Conclusion@#UC-associated CRC tumors have distinct mutational characteristics compared to typical adenoma-carcinoma tumors and may have different cancer-driving molecular mechanisms that are initiated from earlier dysplasia status.

The association between the neutrophil-to-lymphocyte ratio and bacteremia in elderly patients admitted to the emergency department

Objective@#Bacteremia is a common cause of increased morbidity and mortality in elderly patients, but early diagnosis and identification are complex. The neutrophil-to-lymphocyte count ratio (NLR) is suggested as a useful indicator for diagnosing bloodstream infections. This study evaluated whether the NLR at admission is associated with bloodstream infections in older patients admitted to the emergency department. @*Methods@#A retrospective, multicenter analysis was performed on patients admitted to the emergency department from November 2016 to February 2017. We included patients aged 65 years and older who visited the emergency department with medical problems. Baseline NLR values were measured upon admission to the emergency department. The primary outcome was a positive blood culture. @*Results@#A total of 1,815 patients were included in this study. The median age was 77.25±7.38 years, and bacteremia was identified in 290 older patients (15.9%). The NLR was significantly higher in the bacteremia group (15.95±22.03) than in the non-bacteremia group (8.76±8.74, P<0.001). In the multivariate logistic regression analysis, the NLR was associated with bacteremia after adjusting for confounding factors as continuous variables (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.009-1.057) and categorical variables (NLR ≥10; OR, 2.018; 95% CI, 1.246-3.268). The area under the curve of the NLR was determined to be 0.667 (95% CI, 0.639-0.694). @*Conclusion@#These results indicate that the NLR at admission to the emergency department is associated with bloodstream infections. Early suspicion of bacteremia, by determining the initial NLR value, will help treat bacteremia in elderly patients.

Risk factors for repeated febrile seizures during the same febrile illness

Purpose@#We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. @*Methods@#We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. @*Results@#Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH 30 minutes (1.90; 1.30-2.78) as the factors for RFS. @*Conclusion@#In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.

Incidentally Detected Asymptomatic Perianal Abscess in an Adolescent during Crohn's Disease Diagnosis: Is Routine Pelvic Imaging Required in Korean Pediatric Patients at Diagnosis? / 대한소아소화기영양학회지

Perianal fistulizing diseases, namely perianal fistulas and/or abscesses, are well-known complications of Crohn's disease (CD). These are known to develop more frequently in Asian children with CD, especially in the early stages of the disease course. Approximately half of the pediatric CD cases in Korea present with perianal fistulizing diseases at diagnosis. We report a rare case of a 12-year-old boy with CD with an incidental discovery of a perianal abscess on pelvic magnetic resonance imaging during CD diagnosis. No symptoms or signs of perianal fistulizing disease were identified. The early diagnosis of the perianal abscess enabled timely and effective treatment. Considering the high incidence of concomitant perianal CD in Korean children at diagnosis, perianal imaging may be useful and should be considered during diagnostic evaluation, even in patients with no subjective or objective findings indicating perianal CD.

Risk factors for repeated febrile seizures during the same febrile illness

Purpose@#We aimed to identify the factors associated with the repeated febrile seizures (RFS), defined as recurrent seizures during the same febrile illness. @*Methods@#We reviewed the medical records of children with febrile seizure who visited 4 academic emergency departments from October 2016 through September 2018. Differences were identified in variables regarding clinical and laboratory characteristics between the children with and without RFS. The RFS was the primary outcome. Logistic regression was conducted to identify factors associated with the occurrence of RFS. @*Results@#Among 1,551 children, 922 were included in the study, of whom, 198 (21.5%) underwent RFS. Of the children with RFS, 188 (94.9%) underwent the recurrences within the initial 24 hours. Logistic regression showed focal seizure (adjusted odds ratio, 6.67; 95% confidence interval, 2.37-18.82), venous pH 30 minutes (1.90; 1.30-2.78) as the factors for RFS. @*Conclusion@#In children with febrile seizure, focal seizure, acidosis, and prolonged postictal state may be independent risk factors for RFS. These findings may be informed to healthcare professionals and parents caring for children with febrile seizure.

Congenital Torticollis with Bilateral Sternocleidomastoid Muscle Contracture

Congenital muscular torticollis is a common musculoskeletal disorder characterized by the shortening of the sternocleidomastoid muscle, thus leading to an ipsilateral tilt of the head and contralateral rotation of the face. Most of the congenital muscular torticollis is ipsilateral. Bilateral congenital muscular torticollis is extremely rare. Congenital muscular torticollis is known to be associated with several musculoskeletal and neurologic disorders including brachial plexus injury. Therefore, early diagnosis and intervention are crucial for the treatment and prevention of associated complications. Here, we report a case of a 1-month-old infant with bilateral congenital muscular torticollis suspicious of Erb-Duchenne palsy.

Relationship between Waist Circumference and Cardiovascular Risk Factors in Adolescents: Analysis of the Korea National Health and Nutrition Examination Survey Data

Background and Objectives@#High waist circumference (WC) is associated with increased cardiovascular risk (CVR) in adulthood. We investigated this association in adolescents. @*Methods@#We performed a cross-sectional analysis of data for 10–18-year-olds included in the Korea National Health and Nutrition Examination Survey (KNHANES) (2005–2014). The association between WC and CVR factors was evaluated. We analyzed this relationship according to age. @*Results@#We analyzed 8,153 participants (4,319 boys and 3,834 girls) from the KNHANES. High WC was associated with increased incidence of CVR factors: hypertension (odds ratio [OR], 3.5 in boys, 1.9 in girls), high total cholesterol (OR, 3.9 in boys, 1.9 in girls), high triglycerides (OR, 4.9 in boys, 3.2 in girls), high low-density lipoprotein (LDL) cholesterol (OR, 5.0 in boys, 1.8 in girls), low high-density lipoprotein (HDL) cholesterol (OR, 2.6 in boys, 3.0 in girls), and hyperglycemia (OR, 2.8 in girls). In boys, the association between high WC and hypertension, high triglycerides, and low HDL cholesterol was noted in early adolescence. High WC was associated with high total cholesterol and high LDL cholesterol in middle adolescence. In girls, high WC was correlated with high total cholesterol, high triglycerides, and low HDL cholesterol in early adolescence. High WC was shown to be associated with hyperglycemia in middle adolescence, and with hypertension and high LDL cholesterol in late adolescence. @*Conclusions@#High WC in adolescents is associated with increased CVR. The timing of this association differs according to sex and CVR factors.

Hypertension in children and adolescents

Hypertension is a major health problem in most developed and developing countries. Worldwide, approximately 1 billion people have hypertension, and 13% of all deaths are closely related to hypertension. Recently, the prevalence of elevated blood pressure (BP) in children and adolescents has increased, probably due to the increased prevalence of overweight and obesity among youths. Increasing evidence suggests that adult hypertension has its antecedents in childhood, as childhood BP predicts adult BP. Additionally, pediatric hypertension may cause premature atherosclerosis and early development of cardiovascular disease. Therefore, the identification and treatment of hypertension in childhood is likely to have an important impact on long-term outcomes of cardiovascular disease. International hypertension guidelines for children and adolescents have recently been significantly revised, especially regarding the diagnosis of hypertension. This review presents the recent guidelines for the diagnosis, evaluation, management, and treatment of hypertension in children and adolescents.

Usefulness of 3-Dimensional Body Surface Scanning in the Evaluation of Patients with Pectus Carinatum

Background@#Radiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC. @*Methods@#The medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed. @*Results@#Based on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60). @*Conclusion@#Based on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.

Incontinentia Pigmenti with Extensive Brain Infarction in a Newborn

Incontinentia pigmenti (IP) is a rare X-linked dominant neuroectodermal multisystemic disorder with characteristic skin lesions. In addition to skin lesions, the teeth, nails, hair, eyes, and central nervous system are involved. Central nervous system involvement in the neonatal period may cause intellectual disabilities, severe neurologic impairment, or death. IP is associated with mutations in the NF-kappa B essential modulator gene located on chromosome Xq28 and is most commonly seen in female patients. We experienced one case of a newborn with multiple vesiculobullous skin lesions over the entire body after birth and partial seizures with secondary generalization. The brain magnetic resonance imaging showed extensive cerebral infarction, and retinal hemorrhage was observed in the fundus examination. The patient was clinically diagnosed with incontinentia pigmenti.

Congenital Torticollis with Bilateral Sternocleidomastoid Muscle Contracture

Congenital muscular torticollis is a common musculoskeletal disorder characterized by the shortening of the sternocleidomastoid muscle, thus leading to an ipsilateral tilt of the head and contralateral rotation of the face. Most of the congenital muscular torticollis is ipsilateral. Bilateral congenital muscular torticollis is extremely rare. Congenital muscular torticollis is known to be associated with several musculoskeletal and neurologic disorders including brachial plexus injury. Therefore, early diagnosis and intervention are crucial for the treatment and prevention of associated complications. Here, we report a case of a 1-month-old infant with bilateral congenital muscular torticollis suspicious of Erb-Duchenne palsy.

Mesenchymal Stem Cells Decrease Oxidative Stress in the Bowels of Interleukin-10 Knockout Mice

Background/Aims@#Inflammatory bowel disease (IBD) is an autoimmune disease characterized by chronic inflammation mainly in the large intestine. The interleukin-10 knockout (IL-10 KO) mouse is a well-known animal model of IBD that develops spontaneous intestinal inflammation resembling Crohn’s disease. Oxidative stress is considered to be the leading cause of cell and tissue damage. Reactive oxygen species (ROS) can cause direct cell injury and/or indirect cell injury by inducing the secretion of cytokines from damaged cells. This study evaluated the effects of mesenchymal stem cell (MSC) on the progression of IBD. @*Methods@#In this study, human bone marrow-derived MSCs were injected into IL-10 KO mice (MSC). Oxidative stress and inflammation levels were evaluated in the large intestine and compared with those in control IL-10 KO mice (CON) and normal wild-type control mice (Wild). @*Results@#The levels of ROS (superoxide and hydrogen peroxidase) and a secondary end-product of lipid peroxidation (malondialdehyde) were considerably higher in the CON, while superoxide dismutase and catalase levels were lower in the MSC. Inflammation-related marker (interferon-γ, tumor necrosis factor-α, IL-4, and CD8) expression and inflammatory histological changes were much less pronounced in MSC than in CON. @*Conclusions@#MSCs affect the redox balance, leading to the suppression of IBD.

Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department

Objective@#The National Early Warning Score (NEWS), based on the patients’ vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED). @*Methods@#We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged >65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality. @*Results@#In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3–8] vs. 1 [IQR, 0–3], P65 years.

Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998–2016: The Korean Working Group of Pediatric Hypertension

BACKGROUND AND OBJECTIVES@#Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents.@*METHODS@#BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles.@*RESULTS@#The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP.@*CONCLUSIONS@#We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

Blood Pressure Reference Values for Normal Weight Korean Children and Adolescents: Data from The Korea National Health and Nutrition Examination Survey 1998–2016: The Korean Working Group of Pediatric Hypertension

BACKGROUND AND OBJECTIVES: Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents. METHODS: BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles. RESULTS: The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP. CONCLUSIONS: We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

Polymicrobial Keratitis of Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi

PURPOSE: To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi. CASE SUMMARY: A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation. CONCLUSIONS: We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.

Superficial course of the medial plantar nerve: case report / 대한해부학회지

The medial and lateral plantar nerves are branched from the tibial nerve and move to the tip of the toes. A variation of medial plantar nerve was found on the left side of a 78-year-old Korean male cadaver. The tibial nerve was divided into the lateral and medial plantar nerves beneath the plantar flexor. The medial plantar nerve passed deep to plantar aponeurosis and superficial to the flexor digitorum brevis. It gave off a common plantar digital nerve and then divided into three proper plantar digital nerves near the metatarsal bases. In this article, we report a superficial course of the medial plantar nerve and describe its unique morphology and discuss the clinical significance of this variation.

A Case of a Patent Omphalomesenteric Duct Presenting with Meconium Discharge from the Umbilicus

The omphalomesenteric duct is a link between the primitive midgut and the yolk sac. Normally, the duct obliterates around 6 weeks of gestation, yet varying degrees of incomplete obliteration can take place in 1%–4% of infants. This study described the case of a newborn with a patent omphalomesenteric duct remnant fistula identified at birth with meconium in the umbilical cord. At birth, the infant presented meconium staining and meconium discharged within the umbilical cord. Physical examination and other examinations showed no other specific findings. The omphalomesenteric duct fistula was confirmed through the imaging study (abdominal ultrasonography, gastrografin enema). A surgery was carried out where the remnant was resected. The patient did well and was discharged soon after without complication.