CRISIS AFAR: An International Collaborative Study of the Impact of the COVID-19 Pandemic on Youth with Autism and Neurodevelopmental Conditions.

ImportanceHeterogeneous mental health outcomes during the COVID-19 pandemic are recognized in the general population, but it has not been systematically assessed in youth with neurodevelopmental disorders (NDD), including autism spectrum (ASD). ObjectiveIdentify subgroups of youth with ASD/NDD based on the pandemic impact on symptoms and service changes, as well as predictors of outcomes. Design, Setting, and ParticipantsThis is a naturalistic observational study conducted across 14 North American and European clinical and/or research sites. Parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) adapted for Autism and Related Neurodevelopmental Conditions (AFAR) were cross-sectionally collected from April to October 2020. The sample included 1275, 5-21 year-old youth with ASD and/or NDD who were clinically well-characterized prior to the pandemic. Main Outcomes and MeasuresTo identify impact subgroups, hierarchical clustering analyzed eleven AFAR factors measuring pre- to pandemic changes in clinically relevant symptoms and service access. Random forest classification assessed the relative contribution in predicting subgroup membership of 20 features including socio-demographics, pre-pandemic service, and clinical severity along with indices of COVID-19 related experiences and environments empirically-derived from AFAR parent responses and global open sources. ResultsClustering analyses revealed four ASD/NDD impact subgroups. One subgroup - broad symptom worsening only (20% of the aggregate sample) - included youth with worsening symptoms that were above and beyond that of their ASD/NDD peers and with similar service disruptions as those in the aggregate average. The three other subgroups showed symptom changes similar to the aggregate average but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Pre-pandemic factors (e.g., number of services), pandemic environments and experiences (e.g., COVID-19 cases, related restrictions, COVID-19 Worries), and age emerged in unique combinations as distinct protective or risk factors for each subgroup. Together they highlighted the role of universal risk factors, such as risk perception, and the protective role of services before and during the pandemic, in middle childhood. Conclusions and RelevanceConcomitant assessment of changes in both symptoms and services access is critical to understand heterogeneous impact of the pandemic on ASD/NDD youth. It enabled the delineation of pathways to risk and resilience that include universal and ASD/NDD specific contributors.

Clinical Study of Scabies in Children and Adolescents:A 10-Year Retrospective Review at a Single Institution / 대한피부과학회지

Background@#Scabies is a parasitic infection caused by the Sarcoptes scabiei var. hominis mite. Its incidence has been increasing in recent years; however, no study has evaluated the clinical aspects of scabies in children and adolescents in Korea. @*Objective@#To evaluate the clinical characteristics and epidemiological features of scabies among children and adolescents and to investigate the clinical efficacy of topical therapies for the treatment of scabies. @*Methods@#We retrospectively reviewed the medical records of 62 patients under 18 years of age with scabies during a 10-year-period. @*Results@#Sixty-two patients with 62 scabies were investigated. These patients showed scabies mites or eggs under microscopic examination or showed clinical improvement after treatment. There were 36 boys (58.1%) and 26 girls (41.9%). The mean age of the boys was 9.3 years and that of the girls was 8.2 years. The most common primary lesions were erythematous papules (93.5%), and the commonest sites of the skin lesions were the hand (64.5%) and the trunk (61.3%). The most common suspected mode of transmission was through contact among families living together. The mean time to complete treatment was 46.1 days using 1% gamma benzene hexachloride lotion, 37.1 days using 10% crotamiton ointment, and 22.8 days using 5% permethrin cream. @*Conclusion@#We confirmed the epidemiological features and clinical characteristics of scabies in children and adolescents, including contact sources and treatment. This study could provide useful data for the prevention and management of scabies in children and adolescents.

A Case of Methicillin-Sensitive Staphylococcus aureus Bacteremia Superimposed on Eczema Herpeticum in a Patient with Uncontrolled Atopic Dermatitis / 대한피부과학회지

Eczema herpeticum is a widespread herpes simplex infection that favors eczema-damaged skin, including skin involved with atopic dermatitis. Here we report a case of a 27-year-old woman who presented with febrile, painful, punched-out, erosive, macular eruptions and crusts on her face, upper trunk, and antecubital fossae. Polymerase chain reaction analyses of the blood and skin lesions were positive for type 1 herpes simplex virus, and blood cultures established on admission showed methicillin-sensitive Staphylococcus aureus. She was diagnosed with bacteremia superimposed on eczema herpeticum. True bacteremia rather than contaminated blood cultures was suspected because her fever did not improve after 2 days despite the administration of antivirals. Repeated scratches to the lesional skin most likely aggravated the epidermal barrier damage, enabling the penetration of the dermal vessels by colonized S. aureus.

Clinical Study of Scabies in Children and Adolescents:A 10-Year Retrospective Review at a Single Institution / 대한피부과학회지

Background@#Scabies is a parasitic infection caused by the Sarcoptes scabiei var. hominis mite. Its incidence has been increasing in recent years; however, no study has evaluated the clinical aspects of scabies in children and adolescents in Korea. @*Objective@#To evaluate the clinical characteristics and epidemiological features of scabies among children and adolescents and to investigate the clinical efficacy of topical therapies for the treatment of scabies. @*Methods@#We retrospectively reviewed the medical records of 62 patients under 18 years of age with scabies during a 10-year-period. @*Results@#Sixty-two patients with 62 scabies were investigated. These patients showed scabies mites or eggs under microscopic examination or showed clinical improvement after treatment. There were 36 boys (58.1%) and 26 girls (41.9%). The mean age of the boys was 9.3 years and that of the girls was 8.2 years. The most common primary lesions were erythematous papules (93.5%), and the commonest sites of the skin lesions were the hand (64.5%) and the trunk (61.3%). The most common suspected mode of transmission was through contact among families living together. The mean time to complete treatment was 46.1 days using 1% gamma benzene hexachloride lotion, 37.1 days using 10% crotamiton ointment, and 22.8 days using 5% permethrin cream. @*Conclusion@#We confirmed the epidemiological features and clinical characteristics of scabies in children and adolescents, including contact sources and treatment. This study could provide useful data for the prevention and management of scabies in children and adolescents.

A Case of Methicillin-Sensitive Staphylococcus aureus Bacteremia Superimposed on Eczema Herpeticum in a Patient with Uncontrolled Atopic Dermatitis / 대한피부과학회지

Eczema herpeticum is a widespread herpes simplex infection that favors eczema-damaged skin, including skin involved with atopic dermatitis. Here we report a case of a 27-year-old woman who presented with febrile, painful, punched-out, erosive, macular eruptions and crusts on her face, upper trunk, and antecubital fossae. Polymerase chain reaction analyses of the blood and skin lesions were positive for type 1 herpes simplex virus, and blood cultures established on admission showed methicillin-sensitive Staphylococcus aureus. She was diagnosed with bacteremia superimposed on eczema herpeticum. True bacteremia rather than contaminated blood cultures was suspected because her fever did not improve after 2 days despite the administration of antivirals. Repeated scratches to the lesional skin most likely aggravated the epidermal barrier damage, enabling the penetration of the dermal vessels by colonized S. aureus.

Prevalence of and Factors Associated with School Bullying in Students with Autism Spectrum Disorder: A Cross-Cultural Meta-Analysis

Through this meta-analysis, we sought to examine the prevalence of, risks for, and factors associated with bullying involvement (victimization, perpetration, perpetration-victimization) among students with autism spectrum disorder (ASD). Additionally, we attempted to examine sources of variance in the prevalence and effect sizes of bullying in students with ASD across studies. Systematic database and literature review identified 34 relevant studies (31 for Western countries, three for Eastern countries). Pooled prevalence estimates for victimization, perpetration, and perpetration-victimization in general were 67%, 29%, and 14%, respectively.The risk of victimization in students with ASD was significantly higher than that in typically developing students and students with other disabilities. Further, deficits in social interaction and communication, externalizing symptoms, internalizing symptoms, and integrated inclusive school settings were related to higher victimization, and externalizing symptoms were related to higher perpetration. Finally, moderation analyses revealed significant variations in the pooled prevalences thereof depending on culture, age, school settings, and methodological quality and in the pooled effect sizes according to publication year and methodological quality. Our results highlight needs for bullying intervention for students with ASD, especially those who are younger, are in an inclusive school setting, and have higher social difficulties and externalizing/internalizing symptoms; for intensive research of bullying experiences among students with ASD in Eastern countries; and for efforts to improve the methodological quality of such research.

Effects of Particulate Matter in a Mouse Model of Oxazolone-Induced Atopic Dermatitis

Background@#Recent epidemiological studies have demonstrated that air pollution is associated with the inflammatory response and may aggravate inflammatory skin diseases such as atopic dermatitis (AD). However, it is unclear whether particulate matter (PM) aggravates AD symptoms. @*Objective@#The aim of this study was to investigate whether PM exposure affects the skin barrier dysfunction and aggravates AD symptoms using human keratinocytes (HaCaT) cells and a mouse model of oxazolone-induced AD-like skin. @*Methods@#Standard reference material (SRM) 1649b, which mainly comprises polycyclic aromatic hydrocarbons, was used as the reference PM. HaCaT cells and mouse model of oxazolone-induced AD-like skin were treated with PM. The mRNA or protein expression levels of stratum corneum (SC) and tight junction (TJ) proteins, inflammatory cytokines, as well as clinical and histological changes of the AD-like skin of mouse model were evaluated. The expression of genes and proteins was analyzed by real-time polymerase chain reaction and Western blotting. Levels of inflammatory cytokines were measured by enzyme-linked immunosorbent assay. @*Results@#The results revealed that PM downregulates the expression levels of several SC and TJ-related proteins in the mouse model with AD-like skin. Clinically, epidermal and dermal thickness was significantly increased and dermal inflammation was prominent in PM treated AD-like skin. @*Conclusion@#In conclusion, we found that PM aggravates skin barrier dysfunction, clinically augmenting epidermal and dermal thickening with dermal inflammation in AD-like skin. These results suggest that PM may trigger the exacerbation of AD symptoms via skin barrier dysfunction-related mechanisms.

Age-related Changes in the Frequency of Intrinsic and Extrinsic Atopic Dermatitis: A Single-center Retrospective Study / 대한피부과학회지

No abstract available.

Urine Malondialdehyde and 8-hydroxydeoxyguanosine Levels as Indices of Oxidative Damage in Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The involvement of oxidative stress in the pathogenesis of various skin diseases has been suggested. OBJECTIVE: Urinary malondialdehyde (MDA) and 8-hydroxydeoxyguanosine (8-OHdG) levels served as indices of oxidative stress. We explored whether MDA and 8-OHdG levels were higher in patients with atopic dermatitis (AD) than in healthy controls. In addition, we evaluated the optimal cut-off values for 8-OHdG and MDA in the diagnosis of AD. We explored the associations between AD severity and the levels of serum IgE and oxidative products. METHODS: Urine samples were obtained from 52 AD patients and 27 healthy controls. We measured MDA levels (reflecting lipid oxidation) and 8-OHdG levels (reflecting DNA oxidation). Disease severity was assessed using the Scoring of Atopic Dermatitis (SCORAD) index. RESULTS: The urinary 8-OHdG level was 208.37±145.39 ng/mg Cr in AD patients and 115.65±63.95 ng/mg Cr in healthy controls. The urinary MDA level was 2.92±1.06 mmol/mg Cr in AD patients and 2.20±0.54 mmol/mg Cr in healthy controls. Both the urinary 8-OHdG and MDA levels were significantly higher in AD patients than in healthy controls (p=0.007, p=0.001, respectively). However, we found no correlation between disease severity or serum IgE and oxidative product levels. Levels of oxidative products did not differ significantly between children and adolescents and adults, males and females, or patients with intrinsic or extrinsic AD. CONCLUSION: MDA and 8-OHdG levels were higher in AD patients than in healthy controls. Oxidative stress may be involved in the pathophysiology of the disease.

Perception of Patient Safety Risk Factors and Performance Level of Safety Care Activities among Hospital Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the level of perception of safety risk factors and the degree of performance of safety nursing activities in order to develop an education program to improve the safety of patients. METHODS: The subjects were 217 nurses from 3 university hospitals in Incheon. Data were collected with structured questionnaires and analyzed using descriptive analysis, t-test, and ANOVA using SPSS 22.0. RESULTS: The level of perception of patient's safety risk factors and safety care activities was 2.93 and 4.68, respectively. Perception of patient safety risk factors which belonging to the risk type of therapeutic devices, equipment, service and infrastructure all scored below average; also in addition, behavior, performance, and violence risk type and work system, information and communication risk type showed relatively low perception levels. Safety nursing activities showed a low level of performance in accurate communication among medical teams, management of fire and disaster, security management, use of restraints, identification of patients, and correct performance of operations and procedures. CONCLUSION: Based on these results, it is necessary to improve the safety of patients by taking proper management measures along with education.

Cross-Cultural Aspect of Behavior Assessment System for Children-2, Parent Rating Scale-Child: Standardization in Korean Children

PURPOSE: Our study aimed to examine psychometric properties and cross-cultural utility of the Behavior Assessment System for Children-2, Parent Rating Scale-Child (BASC-2 PRS-C) in Korean children. MATERIALS AND METHODS: Two study populations were recruited: a general population sample (n=2115) of 1st to 6th graders from 16 elementary schools and a clinical population (n=219) of 6–12 years old from 5 child psychiatric clinics and an epidemiological sample of autism spectrum disorder. We assessed the validity and reliability of the Korean version of BASC-2 PRS-C (K-BASC-2 PRS-C) and compared subscales with those used for US populations. RESULTS: Our results indicate that the K-BASC-2 PRS-C is a valuable instrument with reliability and validity for measuring developmental psychopathology that is comparable to those in Western population. However, there were some differences noted in the mean scores of BASC-2 PRS-C between Korean and US populations. CONCLUSION: K-BASC-2 PRS-C is an effective and useful instrument with psychometric properties that permits measurement of general developmental psychopathology. Observed Korean-US differences in patterns of parental reports of children's behaviors indicate the importance of the validation, standardization and cultural adaptation for tools assessing psychopathology especially when used in populations different from those for which the instrument was originally created.

Two Cases of Retinal Hemorrhage in Alcoholic Cirrhosis

PURPOSE: To report 2 cases of retinal hemorrhage due to anemia and thrombocytopenia in patients with alcoholic cirrhosis. CASE SUMMARY: (Case 1) A 45-year-old female with alcoholic cirrhosis who was treated in the gastroenterology department presented with reduced vision in both eyes. Fundus examination showed multiple preretinal and subretinal hemorrhages with macular involvement in both eyes. Hematological findings revealed severe anemia and thrombocytopenia. One month after the transfusion treatment her visual acuity was improved and retinal hemorrhages resolved. (Case 2) A 47-year-old male presented with painless loss of vision in the left eye 3 days after orthotopic liver transplantation for the treatment of alcoholic cirrhosis. Fundus examination showed preretinal hemorrhages in both eyes with macular involvement in the left eye. During the transplantation, hematological findings revealed severe anemia and thrombocytopenia. Three months after the transfusion treatment his visual acuity was improved and retinal hemorrhages nearly completely resolved. CONCLUSIONS: Hematological abnormalities due to alcoholic cirrhosis can cause retinal hemorrhage. In the present cases the retinal hemorrhages were resorbed and the visual acuity recovered.

Spectral-Domain Optical Coherence Tomography Findings of Vogt-Koyanagi-Harada Disease

PURPOSE: To report characteristics of Vogt-Koyanagi-Harada (VKH) disease as observed on spectral-domain optical coherence tomography (SD-OCT) images. CASE SUMMARY: (Case 1) A 38-year-old female presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, serous retinal detachment and cystoid macular edema in the outer retina were observed and the intraretinal fluid space was divided by a membranous structure forming an intraretinal compartmentalized cystic space. Under the diagnosis of VKH disease, the patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed decreased serous retinal detachment. (Case 2) A 58-year-old male presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, choroidal folds were observed and the membranous structure showed continuity with ellipsoid zone, suggesting the membranous structure was part of the outer photoreceptor layer of the adjacent attached retina. The patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed cystic space was decreased. CONCLUSIONS: SD-OCT images of VKH disease demonstrated multiple serous retinal detachments and intraretinal compartmentalized cystic space divided by a membranous structure. The membranous structure may be considered a part of the outer photoreceptor layer of the attached retina.

Ocular Manifestations of Acquired Immunodeficiency Syndrome

PURPOSE: To investigate the patterns and risk factors of the ocular manifestations of acquired immunodeficiency syndrome (AIDS) and their correlation with CD4+ count in the era of highly active antiretroviral therapy (HAART). METHODS: This retrospective study examined 127 AIDS patients who presented to Soonchunhyang University Hospital. Data were collected from patient interviews, clinical examinations, and laboratory investigations. Ophthalmologic examinations included the best-corrected visual acuity, intraocular pressure, anterior segment and adnexal examination, and dilated fundus examination. RESULTS: Of the 127 patients with AIDS, 118 were on HAART and 9 were not. The mean CD4+ count was 266.7 +/- 209.1 cells/microL. There were ocular manifestations in 61 patients (48.0%). The incidence of anterior segment manifestations was higher than posterior segment manifestations at 28.3% and 19.7%, respectively. The mean CD4+ count was significantly (p 35 years were independent risk factors for developing ocular manifestations.

Nutritional Status of Korean Hospitalized Patients: A Multi-Center Preliminary Survey

PURPOSE: The purpose of this study is to examine the prevalence of malnutrition in hospitalized patients aged 18 years old or older at the time of admission in Korea. METHODS: This multi-center, preliminary survey included patients over 18 years old who were admitted on a given day from six hospitals in Korea. Nutritional status was assessed using Subjective Global Assessment tool. Data collected included hospital characteristics, patient characteristics, nutrition screening, and nutrition assessment. RESULTS: Among the 99 patients recruited (47 males, 47.5%), 18 (18.2%) and 2 (2.0%) patients were moderately malnourished and severely malnourished, respectively. The mean age of the malnourished group was older than that of the well-nourished group (49.7+/-17.1 vs. 60.5+/-13.6 years old, P-value=0.010). Patients admitted for medical treatment were more malnourished than those admitted for surgical treatment. CONCLUSION: Results of the multi-center preliminary survey showed 20.2% prevalence of malnutrition on admission. A national survey was piloted and will be followed by full implementation.

A Case of Primary Mediastinal Choriocarcinoma Mimicking Large Cell Carcinoma of the Lung in a Male Patient in His 50s / 대한내과학회지

Primary mediastinal choriocarcinoma is an extremely rare extragonadal germ cell malignancy. A 58-year-old male presented with a lung mass, which was incidentally discovered during a periodic medical checkup. Percutaneous needle biopsy showed poorly differentiated carcinoma with large pleomorphic morphology. After the patient underwent right upper lobectomy and lymphadenectomy, the final diagnosis was choriocarcinoma. The patient received four sequential cycles of BEP chemotherapy (bleomycin, etoposide, cisplatin). After completion of BEP chemotherapy, follow-up positron emission tomography (PET) showed a complete metabolic response. Although the mediastinum is one of the most common primary sites of extragonadal germ cell tumors, primary mediastinal choriocarcinoma is liable to be misdiagnosed as lung cancer or Hodgkin lymphoma. Notably, large cell carcinoma of the lung can be confused with choriocarcinoma even after percutaneous needle biopsy. We report a case of primary mediastinal choriocarcinoma mimicking large cell carcinoma of the lung in a male patient in his 50s.

Cyberbullying, Problematic Internet Use, and Psychopathologic Symptoms among Korean Youth

To evaluate the associations between cyberbullying behaviors and problematic internet use, and to compare psychopathologic symptoms in victims, perpetrators, and victims-perpetrators of cyberbullying to those in youths who were not involved in cyberbullying. A total of 4531 youths (11-14 years of age) were recruited from elementary and middle schools. Among 4531 youths, 9.7% were involved in cyberbullying; 3.3% were only victims; 3.4% were only perpetrators; and 3.0% were victims-perpetrators. Cyberbullying behaviors were associated with problematic internet use as well as various psychopathologic symptoms. Depressive symptoms were associated with cyberbullying victimization, and rule-breaking behaviors and aggressive behaviors have relevance to cyberbullying perpetration. Greater attention needs to be paid to identify youths earlier who are involved in cyberbullying and prevent serious adverse consequences in them.

Hemorrhagic cystitis with massive bleeding from nontyphoidal Salmonella infection: A case report

Hemorrhagic cystitis is defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage and is caused by viral or bacterial infection or chemotherapeutic agents. Reports of hemorrhagic cystitis caused by non-typhoidal salmonella (NTS) are extremely rare. We report a case of a 41-year-old man with hemorrhagic cystitis from NTS that caused massive bleeding and shock. The patient was hospitalized for uncontrolled diabetes and obstructive uropathy related to severe cystitis. A urine culture was positive for group D NTS. This case demonstrated that hemorrhagic cystitis in a patient with a risk factor such as diabetes can be a manifestation of local extraintestinal NTS infection.

A Case of Reversible Very Low Voltage Electrocardiogram in Fulminant Myocarditis

Clinical features of acute myocarditis range from a subclinical state to a fulminant state. Fulminant myocarditis with ventricular arrhythmia or atrioventricular block is associated with a high mortality rate. In cases in which aggressive medical therapy for fulminant myocarditis is not likely to be successful, intensive and emergency mechanical circulatory support, such as extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump, should be considered. We report life salvage of acute fulminant myocarditis in a 53-year-old woman presented with malignant arrhythmia and cardiogenic shock supported by ECMO.

A Case of Salmonella Typhi Complicating Acute Appendicitis Proven by Gene STY0312 Polymerase Chain Reaction (PCR)

Typhoid fever frequently manifests as gastrointestinal complications, such as ileitis or colitis, but appendicitis is quite rare. A 37-year-old man was admitted due to abdominal pain, fever and diarrhea. Two weeks before admission, he underwent an appendectomy. The blood culture upon admission revealed Salmonella Typhi. A polymerase chain reaction(PCR) was performed on the tissue of the vermiform appendix and the STY0312 gene of S. Typhi was detected. This is the first case of acute appendicitis complicated with typhoid fever proven by PCR in Korea.