Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

BACKGROUND: The aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD. METHODS: A total of 355 patients on MHD were enrolled from seven dialysis units. After adhering to our strategy for one year, serum phosphorus, calcium, intact parathyroid hormone (iPTH), and alkaline phosphatase (AP) levels were compared with the baseline. The endpoint was improvement in the proportion of patients with serum mineral levels at target recommendations. RESULTS: The median serum phosphorus level and proportion of patients with serum phosphorus within the target range were not changed. Although the median serum calcium level was significantly increased, the proportion of patients with serum calcium within the target range was not significantly affected. The proportion of patients with serum iPTH at the target level was not altered, although the median serum iPTH was significantly decreased. However, both median serum AP and the proportion of patients with serum AP at the target level (70.4% vs. 89.6%, P < 0.001) were improved. CONCLUSION: In our patients with MHD, serum mineral profiles were altered and the serum AP level stabilized after implementing our recommendations. Long-term follow-up evaluations are necessary to determine whether uremic bone disease and cardiovascular calcifications are affected by these recommendations.

Vitamin D and Hypertension

Vitamin D has the pleiotropic effects in multiple organ systems, and vitamin D deficiency was suggested to be associated with high blood pressure according to previous reports. Several interventional studies have examined the effect of vitamin D supplementation on high blood pressure patients, but the results have been inconsistent. In this article, we examined the literature that have proposed a mechanism involving vitamin D in the regulation of blood pressure and review previous observational and interventional studies that have shown the relationship between vitamin D and hypertension among various populations.

Efficacy of Hemocontrol Biofeedback System in Intradialytic Hypotension-Prone Hemodialysis Patients

We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.

The Effect of Group Musical Therapy on Depression and Activities on Daily Living in Patients with Cognitive Decline

BACKGROUND: Beside pharmacological treatment, non-pharmacological interventions are a great deal of interest resides on ways that allow modulation of brain plasticity in the elderly. Music therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia, but a few studies reported it to be helpful. The aim of this study was to evaluate the effect of structured musical intervention therapy in patient with cognitive decline. METHODS: The subjects of the study were a total of fifty elderly with cognitive decline (K-MMSE: 21+/-3.99, CDR: 0.80+/-0.38). The musical therapy was applied to the group twice a week, fifty minutes per session for eight weeks. The data were analyzed by using chi-square and paired t-test before and after musical intervention. RESULTS: The study showed a significant reduction in depression and anxiety after musical therapy measured with short form-GDS and BDI (p<0.001). Activities daily living (ADL) markedly improved after the all session of musical interventions (p<0.001). CONCLUSION: Group music therapy is a safe and effective method for treating depression and anxiety, and also improving ADL in patients with cognitive decline.

First Case of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis Caused by Cryptococcus arboriformis

No abstract available.

Antibiotic resistance and molecular characterization of ophthalmic Staphylococcus pseudintermedius isolates from dogs

The prevalence, virulence potential, and antibiotic resistance of ophthalmic Staphylococcus pseudintermedius (SP) isolated from dogs were examined. Sixty-seven Staphylococcus species were isolated from ophthalmic samples and surveyed for species-specific sequences in the Staphylococcus intermedius group (SIG) nuclease gene (SInuc), exfoliative toxin gene for SIG (siet), and antibiotic resistance genes (blaZ and mecA). PCR-restriction fragment length polymorphism analysis of the pta gene was also performed. Fifty isolates were identified as SIG strains, all of which were found to be SP. The blaZ gene was detected in 42 of the 50 SP strains and mecA gene was observed in 18 of the 50 SP strains. The 50 SP strains were most susceptible to amoxicillin/clavulanic acid (94%) and chlorampenicol (70%), and highly resistant to tetracycline (94%) and penicillin (92%). It was also found that 16 (88.9%) mecA-positive SP strains were resistant to oxacillin, tetracycline and penicillin. All mecA-positive SP were resistant to more than four of the eight tested antibiotics and therefore considered SP with multi-drug resistance (MDR). Our results indicate a high prevalence of antibiotic resistance genes in ophthalmic SP along with a close relationship between MDR SP strains and the mecA gene. Based on our findings, judicious administration of antibiotics to companion dogs is necessary.

Ginkgo biloba extract (GbE) enhances the anti-atherogenic effect of cilostazol by inhibiting ROS generation

In this study, the synergistic effect of 6-[4-(1-cyclohexyl-1H-tetrazol-5-yl) butoxy]-3,4-dihydro-2(1H)-quinolinone (cilostazol) and Ginkgo biloba extract (GbE) was examined in apolipoprotein E (ApoE) null mice. Co-treatment with GbE and cilostazol synergistically decreased reactive oxygen species (ROS) production in ApoE null mice fed a high-fat diet. Co-treatment resulted in a significantly decreased atherosclerotic lesion area compared to untreated ApoE mice. The inflammatory cytokines and adhesion molecules such as monocyte chemoattractant-1 (MCP-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and VCAM-1 which can initiate atherosclerosis were significantly reduced by the co-treatment of cilostazol with GbE. Further, the infiltration of macrophages into the intima was decreased by co-treatment. These results suggest that co-treatment of GbE with cilostazol has a more potent anti-atherosclerotic effect than treatment with cilostazol alone in hyperlipidemic ApoE null mice and could be a valuable therapeutic strategy for the treatment of atherosclerosis.

Hebei Spirit oil spill exposure and acute neuropsychiatric effects on residents participating in clean-up work / 한국역학회지

OBJECTIVES: Hebei Spirit oil spill accident has brought about the worst coastal oil contamination in Korean history. Following the accident, residents and volunteers, number exceeding a million from nationwide, were exposed to chemicals from the crude oil itself and dispersants, including volatility organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and heavy metals through the clean-up works over months. This study was undertaken to investigate the effect of clean-up work on the peripheral nerve function and psychologic status of the residents after a prolonged exposure to clean-up work after the oil spill exposure. METHODS: We performed a study on the residents of Jango-do Island, Chungnam, on 5 and 12 January 2008, six to eight weeks after the accident. A questionnaire on general characteristics, Korean Beck Depression Inventory (K-BDI), color vision test (Lanthony desaturated D-15 test), and vibration perception threshold test were done. Among 210 residents with 30 years or older, 63 (30%) finished questionnaires and completed at least one among K-BDI, color vision test, or vibration perception threshold test. Descriptive statistics was done on the residents. RESULTS: The residents participated in clean-up work for average 20 days, max 30 days, during 6 weeks following the accident. Average work hours were 7.4 hours per day, max 10 hours. On K-BDI, 21 (33.3%) had a severe depressive state. Mean color confusion index was 1.29 in the right and 1.20 in the left. Mean vibration perception threshold was 3.69 VU (right) and 3.55 VU (left), respectively. DISCUSSIONS AND CONCLUSIONS: Compared to literature report, the residents had higher depression scale. Color vision threshold was not higher compared to general population near an industrial complex. Vibration perception threshold was significantly higher than the residents of similar age living near an abandoned mine in southern coastal area only in the age group of forties. These suggests there is some evidence of neuropsychiatric effect related to oil cleaning work and a mid- and long-term study of the oil exposure health effects with continuous monitoring should be done for the exposed residents in the affected area.

Paroxysmal Supraventricular Tachycardia during Right Thoracotomy Treated with Anterior-Posterior Paddle Positioned Biphasic Cardioversion: A case report / 대한마취과학회지

A 54-year-old male patient with squamous cell carcinoma of lung was scheduled for right lower lobectomy. He had suffered from diabetes mellitus during 8 years, but his preoperative electrocardiogram was normal sinus rhythm. During right thoracotomy, 2 times of unstable paroxysmal supraventricular tachycardia (PSVT) appeared but returned to normal sinus rhythm by carotid sinus massage. But, third unstable PSVT was not controlled by adenosine and anterior-lateral paddle positioned biphasic cardioversion. We changed anterior-lateral paddle position to anterior-posterior paddle position. And PSVT terminated abruptly and changed to sinus rhythm. So we present a case of unstable PSVT during right thoracotomy and treated with anterior-posterior paddle positioned biphasic cardioversion.

Effects of Maternal Massage to Newborn on Stress, Immune Function and Self-confidence of Mothers during the Postpartum Period / 여성건강간호학회지

PURPOSE: To investigate the effect of infant massage on stress, immune function and self-confidence in postpartum mothers. METHOD: From September, 2003 to February, 2004, 65 women who had delivered babies and were enrolled in the postpartum clinic were assigned to the experimental group or control group. In the experimental group, infant massage was given for 20 minute sessions twice a day from 4 days to 14 days after delivery. The instruments were Parental Stress Index, serum cortisol levels, WBCs, lymphocytes, and Self Confidence Scale. RESULTS: Stress scores, WBCs and lymphocytes showed significant differences by the time, but there weren't significant differences according to the group and interactions between the group and the time. Cortisol and self-confidence scores showed significant differences by the time and the group. CONCLUSIONS: Applying massage to their newborn baby influenced cortisol levels of postpartum mothers. Therefore stress, cortisol, and immune functions in postpartum mothers should be generally screened and follow up studies are needed for the effective application of massage in postpartum mothers.

The Effect of Biofeedback Treatment in Children with Spastic-Diplegic Cerebral Palsy

OBJECTIVE: To investigate the effect of electromyography (EMG)-biofeedback treatment in children with spastic-diplegic cerebral palsy. METHOD: Twenty patients with spastic diplegia, who could recognize the auditory and visual stimulation, were recruited. Ten patients underwent EMG-biofeedback treatment with neurodevelopmental treatment (NDT) for 12 weeks, 3 times a week, total 1 hour a day, but age-, sex- and functional-matched ten controls underwent only NDT. Before and after the treatment, active range of motion, spasticity, muscle strength and Functional Independence Measure for Children (WeeFIM) and Gross Motor Function Measure (GMFM) were measured. RESULTS: In experimental group, there was a significant increase in active range of motion of hip and ankle joints (p0.05). Muscle strength of ankle dorsiflexor and hip extensor muscles was significantly improved (p<0.05). WeeFIM and GMFM scores significantly increased in an experimental group (p<0.05). CONCLUSION: EMG-biofeedback treatment in children with spastic-diplegic cerebral palsy might be an effective adjuvant to NDT through the muscle reeducation.

Rhabdomyolysis Complicating Doxylamine Overdose / 대한신장학회잡지

BACKGROUND: Because of its ready availability in over-the-counter sleep preparations, doxylamine succinate is used frequently for suicidal attempts. Non-traumatic rhabdomyolysis is known to be a rare complication of doxylamine succinate but its pathogenesis and dose dependent effect are not known. The purpose of this study is to examine the frequency of various complications, especially rhabdomyolysis in doxylamine overdose and also to examine the effect of dose on the occurrence of these complications. METHODS: Medical records of patients who ingested doxylamine succinate from July 1996 to June 2000 were reviewed. Their age, sex, amount of ingestion and laborotory data are collected and also the occurrence of complication and dose-complication relationship were examined. RESULTS: 1) Total number of patients was 33 and average dose of ingestion was 1,510.6+/-180.7mg(150-5,000). 2) Complication rates were as follows tachycardia 20 patients(66%), hypertension 17 patients(51%), rhabdomyolysis 16 patients(48.4%), generalized seizure 7 patients(21.2%) and hyperthermia 5 patients(15.1%). 3) Tachycardia, seizure and rhabdomyolysis were occured more frequently in high dose groups. CONCLUSION: Rhbdomyolysis is not an infrequent complication in doxylamine overdose. Recognition of potential hazard for rhabdomyolysis and the institution of vigorous treatment to prevent acute renal failure, especially in patients who have taken a large amount of drugs will be required.

Joubert Syndrome with Severe Hypotonia: A case report

Joubert syndrome first described by Joubert et al. in 1969 is a very rare congenital disorder, characterized by episodic hyperpnea, abnormal eye movement, hypotonia, ataxia, and mental retardation. This syndrome generally represents as autosomal recessive inheritance and main neuropathological finding is agenesis or aplasia of the cerebellar vermis. This patient represents significant generalized muscle hypotonia which is not affected by any other tone-modifying maneuvers. And so there is no significant neuromotor improvement with neurodevelopmental treatment such as Bobath method, Vojta method, or proprioceptive nerve facilitation technique and so on. We report the Joubert syndrome showing typical features with delayed development.

The Effect of Hyperventilation on Serum Potassium Concentration During Infusion of Mannitol / 대한마취과학회지

BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.