The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 can result in fatal comorbidities, including acute respiratory distress syndrome (ARDS). Several reports suggest that children have milder illness, though severe cases have still been reported. We report a 9-year-old boy with ARDS caused by the SARS-CoV-2 delta (B.1.617.2) variant. He was admitted to our hospital and carefully observed due to underlying Lennox-Gastaut syndrome. He developed intractable seizures with a high fever. Although the seizures were controlled, his respiratory condition deteriorated to severe ARDS. High-dose methylprednisolone was administered with high positive end-expiratory pressure and low tidal volume. After ARDS treatment, oxygenation improved sufficiently to permit extubation. This case suggests that close observation is required in pediatric patients with neurologic comorbidities because of an increased risk for severe COVID-19.

Croup is a common upper airway infection characterized by a barking cough, stridor, and hoarseness. It is usually caused by viral infection. A small number of croup caused by coronavirus disease 2019 (COVID-19) has been reported in children before the omicron variant surge. Previously reported cases indicated that croup caused by COVID-19 can be treated in the same manner as those with other viral causes. We describe two cases (9-monthold girl and 11-month-old boy) of previously healthy infants who presented with a barking cough and chest retraction and required endotracheal intubation and cardiopulmonary resuscitation. Despite receiving dexamethasone and nebulized racemic epinephrine (NRE) treatment for croup in the emergency department, these patients still developed acute respiratory failure. Reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal samples revealed severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) omicron BA.2 variant (Stealth omicron) and no other common respiratory viral pathogens. Both patients were treated with mechanical ventilation, dexamethasone, and NRE in the pediatric intensive care unit. The duration of intubation was 112 hours and 80 hours, respectively. Both patients were discharged without complications. To the best of our knowledge, this is the first report of life-threatening croup produced by the omicron BA.2 variant and confirmed by RT-PCR. We suggest that this SARS-CoV-2 variant may cause severe croup that may not improve with conventional treatment, even in children without underlying diseases.

PURPOSE: To explore the meaning of prayer in Korean patients with end-stage cancer who profess Christianity or Buddhism, given the significant differences between these religions. METHODS: The Colaizzi (1978) analysis method was employed. In-depth interview were performed with 13 participants (seven Christians and six Buddhists) who were admitted to a University-affiliated hospital in Korea. RESULTS: The six categories emerged: 1) communication with God, 2) mind discipline, 3) spiritual growth, 4) mysterious experiences, 5) perception of death and after-life, and 6) various forms of prayers. CONCLUSION: The participants' prayer experiences were described in a religious context. Christians believed that prayer is communication with God while Buddhists regarded it as disciplining of minds. Despite some differences between the religious groups, a general meaning of prayer was a desperate desire to solve their health issues by relying on God or someone who is more powerful than themselves. They also experienced personal and spiritual growth through prayer. This study explains the phenomenon of prayer experiences and shows that prayer is an important coping mechanism.
Buddhism ; Christianity ; Faith Healing ; Humans ; Korea ; Methods ; Religion*

Capillary hemangioma is the most common vascular tumor in childhood; however, its occurrence in the bronchus is extremely rare. We recently performed a sleeve resection of the left main bronchus on a four-month-old infant with a severe emphysema caused by bronchial capillary hemangioma.
Bronchi* ; Capillaries* ; Emphysema ; Hemangioma, Capillary* ; Humans ; Infant*

Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort. Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology. Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22-41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort. Conclusion It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.

Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort. Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology. Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22-41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort. Conclusion It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.

The Korean hemorrhagic fever is an acute febrile disease, which characteristically accompanies high fever, abdominal pain, headache, vomiting, bleeding tendency and renal failure. The Korean hemorrhagic fever displays various clinical manifestations and courses. Complication includes hypertension, intra-organ bleeding, respiratory problems including pulmonary edema, pituitary insufficiency, infection and anemia. In rare cases, cardiac complications, such as acute myocarditis and atrioventricular conduction block were reported. In addition, an acute pancreatitis, which accompanied serum amylase and lipase elevation, was rarely reported as one of the cause of abdominal pain in the patients with the Korean hemorrhagic fever. We report a patient, who were diagnosed with Korean hemorrhagic fever and displayed persistent abdominal pain, elevation of serum amylase and lipase, and detection of diffuse edema of the pancreas and fluid collection in the retroperitoneal space, especially around the pancreas and kidney, in the ultrasound and CT scan.
Abdominal Pain ; Amylases ; Anemia ; Atrioventricular Block ; Edema ; Fever ; Headache ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Hypertension ; Hypopituitarism ; Kidney ; Lipase ; Myocarditis ; Pancreas ; Pancreatitis* ; Pulmonary Edema ; Renal Insufficiency ; Retroperitoneal Space ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting

Background: Monitoring mortality trends can help design ways to improve survival, but observation of national mortality trends in critically ill children is lacking for the Korean population Methods: We analyzed the incidence and mortality trends of children younger than 18 years admitted to an intensive care unit (ICU) from 2012 to 2018 using the Korean National Health Insurance database. Neonates and neonatal ICU admissions were excluded. Multivariable logistic regression analyses were performed to estimate the odds ratio of in-hospital mortality according to admission year. Trends in incidence and in-hospital mortality of subgroups according to admission department, age, presence of intensivists, admissions to pediatric ICU, mechanical ventilation, and use of vasopressors were evaluated. Results: The overall mortality of critically ill children was 4.4%. There was a significant decrease in mortality from 5.5% in 2012 to 4.1% in 2018 (Pfor trend < 0.001). The incidence of ICU admission in children remained around 8.5/10,000 population years (Pfor trend = 0.069). In-hospital mortality decreased by 9.2% yearly in adjusted analysis (P < 0.001). The presence of dedicated intensivists (Pfor trend < 0.001, mortality decrease from 5.7% to 4.0%) and admission to pediatric ICU (Pfor trend < 0.001, mortality decrease from 5.0% to 3.2%) were associated with significant decreasing trends in mortality. Conclusion Mortality among critically ill children improved during the study period, and the improving trend was prominent in children with high treatment requirements. Varying mortality trends, according to ICU organizations, highlight that advances in medical knowledge should be supported structurally.

Diabetic gastroparesis is a pathologic condition of delayed gastric emptying with gastrointestinal symptoms such as nausea, early satiety and vomiting in the absence of mechanical obstruction in patients with diabetes mellitus. We report a case of diabetic gastroparesis who had diabetes mellitus for 13 years and suffered from nausea and vomiting with marked gastric dilatation of acute onset. Blood glucose level of the patient was very high and any mechanical obstruction was not found by gastroduodenal endoscopy, hypotonic duodenography, celiac angiography, electrogastrography and CT scan. Acute gastric dilatation was resolved with conservative treatment of gastric drainage, glucose control and hydration. Gastrointestinal symptoms of nausea and vomiting improved and diet was well tolerated thereafter.
Angiography ; Blood Glucose ; Diabetes Mellitus ; Diet ; Drainage ; Endoscopy ; Gastric Dilatation* ; Gastric Emptying ; Gastroparesis* ; Glucose ; Humans ; Nausea ; Tomography, X-Ray Computed ; Vomiting

Anomalous origin of the right coronary artery from the pulmonary artery is a rare congenital anomaly that has generally been found incidentally during autopsy or surgery. Sudden death may occur without antecedent symptoms in apparently healthy, asymptomatic patients and hence operation is recommended when the lesion is recognized. As opposed to the more frequent anomalous origin of the left coronary artery from the pulmonary artery, only a few children with this anomaly have been reported to have undergone surgical treatment. This report describes a 2-year old patient whose diagnosis was made by echocardiography, confirmed by angiocardiography, and successfully corrected by reimplantation of the anomalous coronary artery into the aorta.
Angiocardiography ; Aorta ; Autopsy ; Child ; Child, Preschool ; Coronary Vessels* ; Death, Sudden ; Diagnosis ; Echocardiography ; Humans ; Pulmonary Artery* ; Replantation