Background/Aims: Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. Methods: All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. Results: Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. Conclusions Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.

Background/Aims: Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. Methods: All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. Results: Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. Conclusions Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.

Cancer and ischemic stroke (IS) are leading causes of death and disability, worldwide. It is reported that cancer increases IS incidence with various unknown mechanism. We retrospectively reviewed medical records of single tertiary medical center between January 2012 and December 2016. A total of 40,047 patients with cancer were analyzed and 63 patients (0.16%) were diagnosed of IS with underlying cancer. Lung (27.0%), gastric (14.3%) and colorectal (12.7%) cancers were the most frequent types of cancers and adenocarcinoma was the most common histologic type. We compared the clinical variables (demographic data, comorbidities, cancer stage, infarction pattern and severity) between adenocarcinoma and non-adenocarcinoma groups. And the results showed low coexistence of dyslipidemia and smoking history, and higher rate of multiple vascular territory infarct in adenocarcinoma group (p < 0.05). Six-month post stroke mortality rate was 34.6% and systemic metastasis and multi-territorial infarction were significantly relevant with the six-month mortality (p < 0.001). Also, initial National Institute of Health Stroke Scale (p < 0.05) and modified Rankin Scale scores were statistically significantly worse in mortality group (p < 0.05). In conclusion, the most frequent cancer type was lung cancer and adenocarcinoma the most common histologic type. Mortality at 6-month post stroke was high, and it was associated with stage of cancer and initial neurological severity.
Adenocarcinoma ; Cause of Death ; Comorbidity ; Dyslipidemias ; Humans ; Incidence ; Infarction ; Lung ; Lung Neoplasms ; Medical Records ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Smoke ; Smoking ; Stroke

PURPOSE: The aim of this study was to evaluate the details of the clinical characteristics and food exposure types at the first symptom onset in immediate-type cow's milk allergy (CMA) and egg white allergy (EWA) in Korean children. METHODS: This study included children with immediate-type CMA (n=288) or EWA (n=233) with symptom onset time of 2 hours or less, who visited Samsung Medical Center, Ajou University Hospital, and Soonchunhyang University Seoul Hospital between September 2014 and August 2015. The details of clinical features and food exposure types at the first symptom onset were evaluated by retrospective medical record review using a standardized case report form. RESULTS: The median ages of first symptom onset were 10 months in CMA and 12 months in EWA. The most common types of exposure at the first symptom in CMA were formula milk (29.5%) and milk (29.5%), followed by cheese (17.7%) and yogurt (14.2%). The most common type of exposure in EWA was boiled eggs (35.6%), followed by rice/porridge/soup containing eggs (27.5%), pan-fried eggs (17.6%), and baked goods (9.9%). Cutaneous symptoms were most common in both CMA and EWA, and anaphylaxis was noticed in 36.1% and 30.3%, respectively. Baked goods containing milk or eggs also induced anaphylaxis. The symptom onset time was less than 30 minutes in the majority of patients and the most common place of occurrence was home in both CMA and EWA. CONCLUSION: This study provides comprehensive information on CMA and EWA, and therefore helps clinicians diagnose and guide appropriate food restriction in children with CMA and EWA.
Anaphylaxis ; Cheese ; Child* ; Egg Hypersensitivity ; Egg White* ; Eggs ; Humans ; Hypersensitivity* ; Hypersensitivity, Immediate ; Medical Records ; Milk Hypersensitivity ; Milk* ; Ovum* ; Retrospective Studies ; Seoul ; Yogurt

PURPOSE: Although anaphylaxis is recognized as an important, life-threatening condition, data are limited regarding its triggers in different age groups. We aimed to identify anaphylaxis triggers by age in Korean children. METHODS: We performed a retrospective review of medical records for children diagnosed with anaphylaxis between 2009 and 2013 in 23 secondary or tertiary hospitals in South Korea. RESULTS: A total of 991 cases (mean age=5.89±5.24) were reported, with 63.9% involving patients younger than 6 years of age and 66% involving male children. Food was the most common anaphylaxis trigger (74.7%), followed by drugs and radiocontrast media (10.7%), idiopathic factors (9.2%), and exercise (3.6%). The most common food allergen was milk (28.4%), followed by egg white (13.6%), walnut (8.0%), wheat (7.2%), buckwheat (6.5%), and peanut (6.2%). Milk and seafood were the most common anaphylaxis triggers in young and older children, respectively. Drug-triggered anaphylaxis was observed more frequently with increasing age, with antibiotics (34.9%) and nonsteroidal anti-inflammatory drugs (17.9%) being the most common causes. CONCLUSIONS: The most common anaphylaxis trigger in Korean children was food. Data on these triggers show that their relative frequency may vary by age.
Anaphylaxis* ; Anti-Bacterial Agents ; Arachis ; Child* ; Contrast Media ; Egg White ; Epidemiology ; Fagopyrum ; Humans ; Juglans ; Korea ; Male ; Medical Records ; Milk ; Retrospective Studies* ; Seafood ; Tertiary Care Centers ; Triticum

PURPOSE: To evaluate a therapeutic efficacy of probiotics mixture (probiotics) in the treatment of children with mild-to-moderate atopic dermatitis (AD). METHODS: Randomized, double-blind, placebo-controlled, parallel trial with a washout period of 2 weeks and an intervention period for 6 weeks, conducted from November 2010 to October 2011. One hundred children with mild to moderate AD (2-9 years old) were randomly allocated to the probiotics (Lactobacilluss casei, Lactobacillus rhamnosus, Lactobacillus plantarum, and Bifidobacterium lactis) or placebo groups. The assessment of efficacy was based on the change in eczema area severity index (EASI), visual analogue scale for pruritus (VASP), fecal cell counts of each strains (log10[cell counts/g stool]), and serum cytokine levels (Interleukin-4 [IL-4]; IL-10; Tumor necrosis factor alpha, [TNF-alpha]) in weeks 0 and 6. RESULTS: Demographics and baseline characteristics at the week 0 were not significantly different between the 2 groups. The significant increments in fecal-cell counts were observed in the probiotcs group at week 6 (P=0.00), while the cytokine levels between the 2 groups were not significantly different in week 6 (IL-4, P=0.50; IL-10, P=0.58; TNF-alpha, P=0.82). The probiotics significantly improved clinical severity after 6 weeks' intervention of probiotics; however, the placebo group also showed significant improvement (EASI; P=0.00, VASP; P=0.00). CONCLUSIONS: Our findings showed that probiotics successfully colonized in the intestine after 6 weeks' intervention; nevertheless, we could not find an additional therapeutic or immunomodulatory effects on the treatment of AD. Further long-term studies will be necessary to clarify the therapeutic efficacy of probiotics.
Bifidobacterium ; Cell Count ; Child* ; Colon ; Cytokines ; Demography ; Dermatitis, Atopic* ; Eczema ; Humans ; Interleukin-10 ; Intestines ; Lactobacillus plantarum ; Lactobacillus rhamnosus ; Probiotics* ; Pruritus ; Tumor Necrosis Factor-alpha

PURPOSE: Bacterial infection with Staphylococcus aureus is a common complication of atopic dermatitis (AD) and involved in the worsening of this disease. Recent studies have revealed an increasing prevalence of community-associated methicillin-resistant S. aureus (MRSA) among patients with AD and the role of vitamin D in the immunopathogenesis of AD. We carried out a study to see whether levels of vitamin D correlate with MRSA skin colonization in AD. METHODS: Total 60 patients with AD aged between 3 months and 6 years old were enrolled. We measured disease severity using the Scoring Atopic Dermatitis (SCORAD) index, serum levels of 25-hydroxyvitamin D (25(OH)D), total immunoglobulin E levels, eosinophil cationic protein and bacterial colonization by skin swab and culture method. RESULTS: S. aureus was cultured in 20 patients of the total (33.3%). MRSA was comprised 35% of the S. aureus-positive group. SCORAD value was significantly higher in S. aureus-positive group. Serum levels (mean+/-standard deviation) of 25(OH)D were lower in MRSA group (22.6+/-11.5 ng/mL) compared with those of methicillin-sensitive S. aureus group (31.3+/-10.2 ng/mL) or S. aureus negative group (34.3+/-15.8 ng/mL). But there was no statistically significant difference. CONCLUSION: Our study shows that the serum levels of 25(OH)D were lower in MRSA group. But there was no statistically significant difference. Therefore further studies including large numbers of cases are necessary.
Aged ; Bacterial Infections ; Colon ; Dermatitis, Atopic ; Eosinophil Cationic Protein ; Humans ; Immunoglobulin E ; Immunoglobulins ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Skin ; Staphylococcus ; Staphylococcus aureus ; Vitamin D

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.
Child ; Complementary Therapies ; Humans ; Korea ; Male ; Medicine, East Asian Traditional ; Parents ; Prevalence ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial

PURPOSE: Gastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms. METHODS: Thirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multi-channel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position. RESULTS: A mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time. CONCLUSIONS: The upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants.
Electric Impedance ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Infant ; Meals ; Postprandial Period ; Retrospective Studies

The funding acknowledgment in this article was omitted as published.