The two distinctive clinical features of varicella-zoster virus (VZV) are varicella (chickenpox) by primary infection and zoster (singles) by the reactivation of latent infection. In addition to the two typical clinical symptoms mentioned above, diverse clinical manifestations have been reported as a result of VZV reactivation, including chronic radicular pain without rash, visual loss, facial palsy, dysphagia, sore throat, odynophagia, otalgia, hearing loss, dizziness, headache, hemiplegia, etc. Most of these symptoms are derived from neuropathy and vasculopathy of affected nerves and arteries. Diagnosis of VZV disease can be difficult if there is no appearance of a skin rash during development of atypical symptoms. In addition to natural infection, vaccination and anti-viral agent treatment have influenced the changes of epidemics and clinical presentations of varicella and zoster. In this article, diverse clinical manifestations caused by VZV reactivation, particular without skin rash, are reviewed.
Arteries ; Chickenpox ; Cranial Nerve Diseases ; Deglutition Disorders ; Diagnosis ; Dizziness ; Earache ; Exanthema ; Facial Paralysis ; Headache ; Hearing Loss ; Hemiplegia ; Herpes Zoster ; Herpesvirus 3, Human* ; Pharyngitis ; Vaccination ; Zoster Sine Herpete

Varicella vaccine has been included in the national immunization program for children since 2005 and zoster vaccine has been released since 2012 in Korea. Even though both varicella and zoster are caused by varicella-zoster virus (VZV), pathogeneses are different. In varicella, neutralizing antibody is very important to protect disease because VZV spreads via blood or lymph. In contrast, cell-mediated immunity is more important in zoster because of the neuronal spread of VZV. Therefore, the measurement methods of the immunogenicity against varicella and zoster vaccines are different. Fluorescent antibody to membrane antigen (FAMA) assay is the gold standard method to detect the protective antibody against VZV. It is still used as a reference test for the other methods. However, the fastidious nature required to perform the FAMA assay limits its use as a routine assay for the evaluation of vaccine immunogenicity. Nowadays, glycoprotein ELISA (gpEIA) is used as an alternative method for FAMA assay. However, there is no agreement over the protective level of gpEIA antibody titer with WHO standard international unit. The immunogenicity of zoster vaccine has been evaluated by responder cell frequency assay and IFN-gamma ELISpot assay. Nevertheless, skin test is considered to be a more accurate biomarker for cell-mediated immunity against zoster. For the evaluation of varicella vaccine, it is necessary to standardize the FAMA assay and to set the cut-off value for the gpEIA antibody titer through long-term follow-up study. For zoster vaccine, the evaluation of cell-mediated immunity in Korean adults is urgently needed.
Adult ; Antibodies, Neutralizing ; Chickenpox Vaccine ; Chickenpox* ; Child ; Enzyme-Linked Immunosorbent Assay ; Enzyme-Linked Immunospot Assay ; Follow-Up Studies ; Glycoproteins ; Herpes Zoster Vaccine ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Immunization Programs ; Korea ; Membranes ; Methods* ; Neurons ; Skin Tests ; Vaccines*

Streptococcus pneumonia is a very important pathogen for children and elderly people. Two types of pneumococcal vaccines are available in the market: pneumococcal polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine (PCV). PPSVs have been used for more than 30 years, and PCVs for about 10 years. There have been many reports concerning the evaluation of the vaccines' efficacies in preventing pneumococcal diseases such as meningitis, pneumonia, and otitis media and bacteremia, but the clinical trials had been performed with different conditions, such as diverse vaccine valencies, age groups, races, target outcomes, immunological cut-off values, and follow-up periods. PPSV is recommended for elderly people and chronic disease patients such as asthma, diabetes mellitus, chronic renal failure, and hyposplenic patients. According to the data from several systemic reviews and population-based surveillances, PPSV is effective for pneumococcal pneumonia and vaccine-type bacteremia among healthy adults. Until now, however, there is insufficient evidence of the effectiveness of PPSV among high-risk adults. PCV is very effective in preventing vaccine-type invasive pneumococcal disease (IPD) among children, but its efficacy for pneumonia is very low among children. The incidence of vaccine-related or non-vaccine-type IPDs is increasing after the introduction of 7-valent PCV (PCV7) as a routine immunization for children. Recently, 10- and 13-valent PCVs have been used for children, instead of PCV7. Therefore, continuous surveillance for serotype change among pneumococcal diseases is necessary to evaluate the vaccines' efficacy.
Adult ; Aged ; Asthma ; Bacteremia ; Child ; Chronic Disease ; Continental Population Groups ; Diabetes Mellitus ; Humans ; Immunization ; Incidence ; Kidney Failure, Chronic ; Meningitis ; Otitis Media ; Pneumococcal Vaccines ; Pneumonia ; Pneumonia, Pneumococcal ; Streptococcus

No abstract available.
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We report a patient who was diagnosed as subacute combined degeneration (SCD) with elevated homocysteine and methylmalonic acid levels in the situation of a spurious elevation of the vitamin B12 concentration. A false-positive elevation of the vitamin B12 level could lead to a delayed diagnosis and cause irreversible changes in the nervous systems. We therefore suggest that the homocysteine and methylmalonic acid levels should be checked in patients with a normal or elevated vitamin B12 level for whom there is a high clinical suspicion for vitamin B12 deficiency, as a further evaluation for SCD.
Delayed Diagnosis ; Gastritis, Atrophic* ; Homocysteine ; Humans ; Methylmalonic Acid ; Nervous System ; Subacute Combined Degeneration* ; Vitamin B 12 Deficiency ; Vitamin B 12* ; Vitamins*

The purpose of this study is to provide a fundamental basis for defining measures to prevent suicide by specifically examining the relationship between suicide and alcohol consumption, which is thought to be a key factor in suicide. This study reviewed 426 suicide autopsies diagnosed by the department of forensic medicine, National Forensic Service (2007-2009) and analyzed the preliminary data on variables such as gender, age, and cause of death, with particular focus on the relationship between these variables and blood alcohol concentration. The relationship between each variable and alcohol consumption was as follows. First, alcohol was present in 48.4% of suicides. Second, blood alcohol concentration wrere twice as high in women as in men. Third, the relationship between suicide and alcohol consumption was greater in people in their 30s and 40s. The correlation between suicide and alcohol intake was evident this age group. These results are more specific and practical than the results of previous studies on the correlation between suicide and alcohol intake. The results of this study will help define measures to facilitate suicide prevention as an important reference and may eventually help lower the suicide rate in Korea.
Alcohol Drinking ; Autopsy ; Cause of Death ; Drinking ; Female ; Forensic Medicine ; Humans ; Korea ; Male ; Suicide

PURPOSE: To evaluate a recently marketed commercial glycoprotein enzyme-linked immunosorbent assay (gpEIA) kit, the VaccZyme(TM) VZV gpEIA, for measuring the immunity of varicella-vaccinated children. MATERIALS AND METHODS: We investigated the accuracy and reproducibility of the VaccZyme(TM) VZV gpEIA kit for the detection of antibodies to VZV. We also examined the sensitivity, specificity, and correlation between antibody titers calculated with gpEIA versus fluorescent antibody to membrane antigen (FAMA) by using sera of 349 children, ranging from 1 to 6 years old. RESULTS: VaccZyme(TM) VZV gpEIA gave precise and reproducible intra- and inter-assay results. FAMA and gpEIA titers showed a linear correlation (Pearson correlation coefficient=0.987). The sensitivity and specificity of the VaccZyme(TM) gpEIA was 31.4% and 100%, respectively, when the guidelines of the gpEIA (<100 mIU/mL) and FAMA 1:4 were adopted as cutoff values. However, the maximum sensitivity and specificity were 88.9% and 95.1%, respectively, with the highest correlation (kappa=0.840), if the cutoff values were set with gpEIA at 49.7 mIU/mL and FAMA 1:16. CONCLUSION: These results demonstrate that the VaccZyme(TM) VZV gpEIA kit gave precise and reproducible data for measuring antibody titer after varicella vaccination. The results also showed that the antibody titer calculated with the VaccZyme(TM) gpEIA kit strongly correlated with the FAMA titer. However, cutoff values should be re-optimized for the evaluation of vaccine immunity.
Antibodies ; Chickenpox* ; Child ; Enzyme-Linked Immunosorbent Assay* ; Glycoproteins* ; Humans ; Membranes ; Methods ; Sensitivity and Specificity ; Vaccination

OBJECTIVES: The prevalence of aged individuals in the Korean workforce continues to increase. This research determined the health and working conditions of Korean older wage workers and confirmed the effects of factors on the health-related quality of life of Korean older workers. METHODS: Of the 25,534 persons surveyed in the fifth Korea National Health and Nutrition Examination Survey, 1368 older (>55 years of age) wage workers without missing variables were selected. Their general characteristics, health status (cardiovascular disease, musculoskeletal disease, and mental health), working conditions (type of occupation, employment status, full- or part-time work, weekly average working hours, and shift work), and health-related quality of life assessed by the EQ-5D questionnaire were examined. RESULTS: The mean values of the EQ-5D index of the male and female older workers were 0.956 +/- 0.087 and 0.917 +/- 0.124, respectively (p < 0.001). The factors that caused statistically significant differences in the EQ-5D index for all subjects were age, education, household income, cerebro-cardiovascular event, osteoarthritis, musculoskeletal pain, stress, occupation type, employment status, and working hours. In logistic regression analysis, the factors that associated with perceived problems in each EQ-5D dimensions were age, musculoskeletal pain, stress, diabetes, smoking, occupation type, employment status, and working hours. CONCLUSIONS: To eventually raise the quality of life of older workers through health maintenance and management, it is necessary to manage related factors that include of musculoskeletal pain and diseases, stress, diabetes, smoking, occupation, employment status, and working hours.
Education ; Employment ; Family Characteristics ; Female ; Humans ; Korea ; Logistic Models ; Male ; Musculoskeletal Diseases ; Musculoskeletal Pain ; Nutrition Surveys ; Occupations ; Osteoarthritis ; Prevalence ; Quality of Life* ; Salaries and Fringe Benefits ; Smoke ; Smoking

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 +/- 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9 +/- 7.1. The subjects received 2.3 +/- 1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: < 140 mg/dl vs > or = 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P = 0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.
APACHE ; Blood Glucose ; Critical Illness ; Diabetes Mellitus ; Glucose ; Humans ; Hyperglycemia ; Intensive Care Units ; Length of Stay ; Linear Models ; Nutritional Status ; Parenteral Nutrition ; Parenteral Nutrition, Total ; Retrospective Studies

Although parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 +/- 2.2 days vs. 1.9 +/- 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.
APACHE ; Catheter-Related Infections ; Enteral Nutrition ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Parenteral Nutrition* ; Retrospective Studies