This study presents the development and validation of a risk assessment program of highly pathogenic avian influenza (HPAI). This program was developed by the Korean government (Animal and Plant Quarantine Agency) and a private corporation (Korea Telecom, KT), using a national database (Korean animal health integrated system, KAHIS).

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

Tumor necrosis factor-alpha (TNF-alpha) is a major proinflammatory cytokine involved in the pathophysiology of juvenile rheumatoid arthritis. Etanercept is an effective inhibitor of TNF-alpha and has shown a beneficial effect in patients with JRA. However, the most important cause of concern related to etanercept administration is infection. We report a case of encephalitis in a JRA patient receiving long-term treatment with etanercept. The patient was a 4-year-old boy with refractory JRA, and he received etanercept subcutaneously at a dose of 0.4 mg kg(-1) day(-1) twice a week for 14 months, along with non-steroidal anti-inflammatory drugs, methotrexate, oral steroids, and sulfasalazine. The patient presented with sudden fever, headache, vomiting, a generalized tonic seizure, and changes in mental status. We suspected a central nervous system infection, and simultaneously administered antibiotics, an antiviral agent, and steroids. After 2 days of hospitalization, his mental function returned to normal, and he showed no further seizure-like movements. Brain magnetic resonance imaging scan of the patient showed a multifocal cortical lesion on both sides of the temporoparietooccipital lobe, which indicated encephalitis. Although we were unable to identify the causative organism of encephalitis, we think that the encephalitis may be attributed to infection, and the use of etanercept may have increased the risk of severe infection. Therefore, etanercept was discontinued and the patient recovered shortly after. To the best of our knowledge, this is the first case of encephalitis in a juvenile rheumatoid arthritis patient treated with etanercept.
Anti-Bacterial Agents ; Arthritis, Juvenile Rheumatoid ; Brain ; Central Nervous System Infections ; Encephalitis ; Fever ; Headache ; Hospitalization ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging ; Methotrexate ; Preschool Child ; Receptors, Tumor Necrosis Factor ; Seizures ; Steroids ; Sulfasalazine ; Tumor Necrosis Factor-alpha ; Vomiting ; Etanercept

BACKGROUND: Metabolic syndrome (MetS) is characterized by a core set of disorders, including abdominal obesity, dyslipidemia, glucose intolerance and hypertension. Many studies have shown that MetS is associated with increased risk of developing cardiovascular diseases and related mortality. However, the relationship of MetS with early stage of cardiovascular diseases, which is even more important from a prevention prespective, has not been examined extensively. Brachial-ankle pulse wave velocity (baPWV) is known to predict future cardiovascular events. Thus, we examined the relationship of MetS, defined using the NCEP-ATP III criteria, with baPWV. METHODS: We examined a total of 400 participants who did not have a past history of either coronary heart disease or peripheral vascular disease. All subjects underwent physical examination, blood chemistry, and baPWV. RESULTS: Compared with subjects without MetS, subjects with MetS had increased age, body mass index (BMI), and ALT. Mean value of baPWV (adjusted for age, BMI, and blood pressure) was significantly higher in subjects with MetS (P=0.002). The baPWV was positively correlated with age, BMI, systolic and diastolic blood pressure in subjects with MetS. In group without MetS, the baPWV was associated with age, waist circumference, blood pressure, total cholesterol, LDL cholesterol, triglyceride, fasting blood sugar, AST, ALT, homocysteine, CRP, and ferritin. The mean values of baPWV with 0, 1, 2, 3, 4, 5 components of MetS were 1,362.3+/-182.2 cm/s, 1,531.3+/-267.0 cm/s, 1,694.1+/-315.8 cm/s, 1,777.0+/-334.0 cm/s, 2,087.7+/-192.3 cm/s, respectively. CONCLUSION: In this study, the MetS was associated with the risk for increased baPWV.
Ankle* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Chemistry ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Dyslipidemias ; Fasting ; Ferritins ; Glucose Intolerance ; Homocysteine ; Hypertension ; Mortality ; Obesity, Abdominal ; Peripheral Vascular Diseases ; Physical Examination ; Pulse Wave Analysis* ; Triglycerides ; Waist Circumference

BACKGROUND: Metabolic syndrome (MetS) is characterized by a core set of disorders, including abdominal obesity, dyslipidemia, glucose intolerance and hypertension. Many studies have shown that MetS is associated with increased risk of developing cardiovascular diseases and related mortality. However, the relationship of MetS with early stage of cardiovascular diseases, which is even more important from a prevention prespective, has not been examined extensively. Brachial-ankle pulse wave velocity (baPWV) is known to predict future cardiovascular events. Thus, we examined the relationship of MetS, defined using the NCEP-ATP III criteria, with baPWV. METHODS: We examined a total of 400 participants who did not have a past history of either coronary heart disease or peripheral vascular disease. All subjects underwent physical examination, blood chemistry, and baPWV. RESULTS: Compared with subjects without MetS, subjects with MetS had increased age, body mass index (BMI), and ALT. Mean value of baPWV (adjusted for age, BMI, and blood pressure) was significantly higher in subjects with MetS (P=0.002). The baPWV was positively correlated with age, BMI, systolic and diastolic blood pressure in subjects with MetS. In group without MetS, the baPWV was associated with age, waist circumference, blood pressure, total cholesterol, LDL cholesterol, triglyceride, fasting blood sugar, AST, ALT, homocysteine, CRP, and ferritin. The mean values of baPWV with 0, 1, 2, 3, 4, 5 components of MetS were 1,362.3+/-182.2 cm/s, 1,531.3+/-267.0 cm/s, 1,694.1+/-315.8 cm/s, 1,777.0+/-334.0 cm/s, 2,087.7+/-192.3 cm/s, respectively. CONCLUSION: In this study, the MetS was associated with the risk for increased baPWV.
Ankle* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Chemistry ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Dyslipidemias ; Fasting ; Ferritins ; Glucose Intolerance ; Homocysteine ; Hypertension ; Mortality ; Obesity, Abdominal ; Peripheral Vascular Diseases ; Physical Examination ; Pulse Wave Analysis* ; Triglycerides ; Waist Circumference

Lung isolation in a neonate can be a challenge for the anesthesiologist. We report on our anesthetic experience with a neonate who had giant bronchopulmonary sequestration (BPS). The BPS was large enough to shift the mediastinum to the contralateral hemithorax. The trachea was immediately intubated after delivery and the lungs were mechanically ventilated in the neonatal intensive care unit. To prevent desaturation during the attempt of lung isolation, a 3 Fr Fogarty catheter was inserted into the trachea alongside the endotracheal tube without extubation. A fiberscope was then passed through the blocker port of a multiport adapter instead of the bronchoscopy port to minimize leakage by tightening the Touhy-Borst valve. Hypoxemia or leakage did not occur during the procedure. For early extubation, we provided caudal analgesia with ropivacaine and morphine. The giant BPS was successfully resected and the neonate was in excellent condition for early extubation. However, reintubation was needed for the pneumothorax caused by the inadequate placement of a chest drain 9 hours after extubation.
Amides ; Analgesia ; Analgesia, Epidural ; Anoxia ; Bronchopulmonary Sequestration ; Bronchoscopy ; Catheters ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Lung ; Mediastinum ; Morphine ; One-Lung Ventilation ; Pneumothorax ; Thorax ; Trachea

Heterotopic ossification is an abnormal bone formation after surgery or without any reason. Large joint, such as hip and knee joint, is a known most common site. Operation itself and postoperative early range of motion exercise are risk factors. We present a case of heterotopic ossification mimics neurogenic tumor after high tibial osteotomy.
Hip ; Joints ; Knee Joint ; Ossification, Heterotopic* ; Osteogenesis ; Osteotomy ; Range of Motion, Articular ; Risk Factors

PURPOSE: Insufficient production of the parathyroid hormone (PTH) by the parathyroid glands known as hypoparathyroidism, or a resistance against its action on target organs known as pseudohypoparathyroidism, cause PTH-related hypocalcemia associated with hyperphosphatemia. Signs and symptoms are caused by hypocalcemia. This study aimed to assess clinical characteristics, treatment, severity, onset time, and therapeutic responses of hypoparathyroidism and pseudohypoparathyroidism. METHODS: From January 2000 to February 2010, 21 hypoparathyroid and 10 pseudohypoparathyroid children were selected from Severance Hospital. Clinical manifestations and laboratory data were analyzed retrospectively. RESULTS: In hypoparathyroid patients, there were 14 with idiopathic hypothyroidism (66%) and 7 with 22q11.2 deletion syndrome (33%). Patients with hypoparathyroidism had more frequent neurologic symptoms compared to those with pseudohypoparathyroidism (2.89 +/- 1.75 vs. 1.25 +/- 1.67, P = 0.01). Required amounts of calcium to control hypocalcemia were larger in hypoparathyroidism than in pseudohypoparathyroidism (37.98 +/- 26.64 vs. 15.64 +/- 7.87 mg/day/kg, P = 0.034). After treatment, neurologic symptoms decreased significantly in hypoparathyroidism (P < 0.05) from 2.01 +/- 1.68 to 0.89 +/- 0.96. CONCLUSION: Hypoparathyroidism presented more severe symptoms than pseudohypoparathyroidism. Larger amounts of calcium were required to correct hypocalcemia in hypoparathyroidism than in pseudophypoparathyroidsm. These differences may be explained by the findings that distal tubules respond to PTH, in contrast to proximal tubules, in pseudohypoparathyroidism, because the GNAS gene coding is not imprinted at the distal tubular cells responsible for calcium reabsorption.
Calcium ; Child ; Clinical Coding ; DiGeorge Syndrome ; Humans ; Hyperphosphatemia ; Hypocalcemia ; Hypoparathyroidism ; Hypothyroidism ; Neurologic Manifestations ; Parathyroid Glands ; Parathyroid Hormone ; Pseudohypoparathyroidism

Survival sepsis campaign recommends that vasopressor therapy is required to maintain mean arterial pressure (MAP) > or = 65 mmHg. However, the absolute maximum dose of vasopressor is difficult to determine. Herein, we report 2 cases of severe skin necrosis after high dose vasopressor infusion to maintain the recommended MAP in septic shock. In our first case, norepinephrine 1.0-2.0 microg/kg/min and vasopressin 0.03-0.1 U/min were infused for 5 days; in the second case, dopamine 10-20 microg/kg/min and norepinephrine 0.25-2.5 microg/kg/min were infused for 7 days. Severe ischemic skin lesions, which required amputations, developed in both cases. The clinical appearance of the skin lesions in the 2 cases was different because of the unique distribution of target receptors for different vasopressors. Thus, when high dose vasopressors are required to achieve recommended MAP, extra vigilance is required. Further studies for dose adjustment are needed.
Amputation ; Arterial Pressure ; Dopamine ; Gangrene ; Necrosis ; Norepinephrine ; Sepsis ; Shock, Septic ; Skin ; Vasoconstrictor Agents ; Vasopressins