No abstract available.
Dyskeratosis Congenita*

Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, KoreaCarbamazepine (CBZ) is the common antiepileptic drug prescribed for the management of neuropathic pain in patients with neurologic injury. CBZ can rarely be the causative agent to result in drug-induced hypersensitivity syndrome (DIHS), which is a life-threatening drug reaction. Delayed diagnosis of DIHS may occur in complicated clinical settings. We have reported a case of a 12-year-old girl whose initial manifestations of CBZ-induced DIHS were atypical due to concurrent administration of corticosteroids. After open biopsy of brainstem glioma, she was administered corticosteroids and CBZ to mitigate postoperative complications, including mild weakness of ankle dorsiflexion and otalgia. Not only fever but also elevation of liver enzymes and inflammatory markers were presented 1 month after CBZ initiation, without any skin rash or leukocytosis. A maculopapular rash on the whole body and leukocytosis developed afterward; consequently, the diagnostic criteria for DIHS were fulfilled. After discontinuation of CBZ, her fever and increased liver enzymes subsided and the rash slowly improved. This case indicates that typical signs, such as skin rash or leukocytosis, can be initially masked or delayed in CBZ-induced DIHS if it overlaps with corticosteroid administration. The atypical manifestations of DIHS should be considered if CBZ is concurrently administered with corticosteroids.

Background: Onychomycosis, a common fungal nail infection, particularly affects the elderly. The diagnostic accuracy of a potassium hydroxide (KOH) smear, a primary diagnostic method, can vary based on the examiner’s proficiency. Objective: To evaluate the diagnostic utility of KOH smears in a real-world setting and the influence of clinical and practical factors on onychomycosis. Methods: This study included 381 patients who underwent KOH smear and histopathological staining for nail diseases at Seoul National University Hospital between March 2020 and February 2023. The study evaluated the diagnostic utility of the KOH smear, including its sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio. We investigated the influence of factors such as training duration of examiners, prior history of antifungal treatment, and lesion location on diagnostic utility. Results: Of the 381 patients, 139 were male (36.5%) and 242 were female (63.5%). Onychomycosis was the most common diagnosis (59.3%), with 34.1% of patients reporting prior antifungal therapy within the past 6 months. The sensitivity of the monthly KOH smear varied from 16.7% to 70.0% with an annual sensitivity of 48.1%. The specificity ranged from 83.3% to 100.0%, with an annual specificity of 90.3%. While prior antifungal therapy decreased the sensitivity and specificity, no statistical significance was observed. Examiner's experience, measured by training duration, was not associated with sensitivity or specificity. Among patients with a history of antifungal treatment, an increasing number of KOH smear tests showed reduced sensitivity. Conclusion Variations in the diagnostic utility of the KOH smear test, influenced by various factors, highlight the necessity for cautious interpretation in clinical settings.

BACKGROUND: Lifestyle is an important risk factor for many diseases. We need to educate medical students for advocating health promoting behaviors to their patients. Teaching knowledge, however, was not enough for medical students to change their health-related lifestyle. In this study, we investigated health promoting behaviors of medical students, and the improvement of their health behaviors after competitive lifestyle modification program. METHODS: All sophomores of medical college in Seoul National University were included in this study. We performed lifestyle modification program consisting of lecture, group competition, and feedback. We focused on reforming health behaviors like smoking, drinking, exercise, stress management and eating habits. And we also checked common symptoms of functional diseases, medication frequency for relieving these symptoms and general life satisfaction. RESULTS: After 2 months of lifestyle modification program, the obese (P = 0.0455) and the average value of BMI (P < 0.001) were decreased and two of smokers quitted smoking. Numbers of medical students with health related habits such as regular exerciser (P = 0.027), frequent user of symptom-relief medication (P < 0.001), breakfast skipper (P = 0.005) were signifi cantly changed in positive way, and the average value of general life satisfaction score (P = 0.003) was improved. CONCLUSION: Lifestyle modification program improved medical students' health habits and enhanced general life satisfaction.
Breakfast ; Drinking ; Eating ; Health Behavior ; Humans ; Life Style ; Risk Factors ; Smoke ; Smoking ; Students, Medical

Objectives: The objective of this study was to estimate the distribution of the usual dietary intake of foods with respect to the probability of consumption derived from the Food Frequency Questionnaire (FFQ) of the 2009 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: The intake quantity and frequency of 63 food items were assessed from the 2009 KNHANES which was completed by 7,708 participants. The participants completed one or two 24-h dietary recalls and one FFQ. The usual intake distribution was estimated using the multiple source method (MSM), and the proportion of nonconsumers was calculated through the usual intake distribution. This was then compared with the proportion of non-consumers from the 24-hour recall method. Results: The difference in the proportion of non-consumers ranged from 2% to 82.9%, indicating that there is a very large difference based on food groups. The food groups in which the proportion of non-consumers did not differ was composed of foods consumed daily, such as ‘rice’, ‘cereal and barley’, and ‘Chinese cabbage and kimchi’, or foods with distinct palatability such as ‘coffee’ and ‘alcohol’. On the other hand, in the case of the food groups with a high difference in the proportion of non-consumers, most comprised fruits that emphasized seasonality. Conclusions In the case of foods or food groups that are occasionally consumed, it is desirable to use 2 recalls with additional FFQ data by combining the consumption frequency and the quantity consumed.

Purpose: To evaluate the risk factors and effects of fluctuations in oxygen saturation on the occurrence and severity of retinopathy of prematurity (ROP). Methods: From January 1, 2013 to January 31, 2020, 260 patients hospitalized in the neonatal intensive care unit of Ajou University Hospital were retrospectively analyzed. Results: Sixty-six patients (25%) were diagnosed with ROP; of them 39 required treatment. In the multivariate regression analysis of ROP severity, the odds ratio (OR) of gestational age was 0.32 (95% confidence interval [CI], 0.22 to 0.47; P<0.0001). The OR of saturation of peripheral oxygen (SpO2) fluctuations at the 4th week after birth was 1.02 (95% CI, 1.02 to 1.12; P=0.041). Conclusion SpO2 fluctuations in premature infants younger than 30 weeks’ gestational age affects ROP severity, especially at the 4th week of life.

Objectives: The objective of this study was to estimate the distribution of the usual dietary intake of foods with respect to the probability of consumption derived from the Food Frequency Questionnaire (FFQ) of the 2009 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: The intake quantity and frequency of 63 food items were assessed from the 2009 KNHANES which was completed by 7,708 participants. The participants completed one or two 24-h dietary recalls and one FFQ. The usual intake distribution was estimated using the multiple source method (MSM), and the proportion of nonconsumers was calculated through the usual intake distribution. This was then compared with the proportion of non-consumers from the 24-hour recall method. Results: The difference in the proportion of non-consumers ranged from 2% to 82.9%, indicating that there is a very large difference based on food groups. The food groups in which the proportion of non-consumers did not differ was composed of foods consumed daily, such as ‘rice’, ‘cereal and barley’, and ‘Chinese cabbage and kimchi’, or foods with distinct palatability such as ‘coffee’ and ‘alcohol’. On the other hand, in the case of the food groups with a high difference in the proportion of non-consumers, most comprised fruits that emphasized seasonality. Conclusions In the case of foods or food groups that are occasionally consumed, it is desirable to use 2 recalls with additional FFQ data by combining the consumption frequency and the quantity consumed.

Purpose: To evaluate the risk factors and effects of fluctuations in oxygen saturation on the occurrence and severity of retinopathy of prematurity (ROP). Methods: From January 1, 2013 to January 31, 2020, 260 patients hospitalized in the neonatal intensive care unit of Ajou University Hospital were retrospectively analyzed. Results: Sixty-six patients (25%) were diagnosed with ROP; of them 39 required treatment. In the multivariate regression analysis of ROP severity, the odds ratio (OR) of gestational age was 0.32 (95% confidence interval [CI], 0.22 to 0.47; P<0.0001). The OR of saturation of peripheral oxygen (SpO2) fluctuations at the 4th week after birth was 1.02 (95% CI, 1.02 to 1.12; P=0.041). Conclusion SpO2 fluctuations in premature infants younger than 30 weeks’ gestational age affects ROP severity, especially at the 4th week of life.

BACKGROUND: Cardiac tamponade is associated with the expiratory increase and the expira-tory decrease in left ventricular filling flow. With Doppler echocardiography, we analyzed the respiratory variations of mitral and tricuspid inflows, and pulmonary and hepatic venous flows in patients with cardiac tamponade. METHODS: Respiratory hemodynamic changes in mitral and tricuspid inflows and pulmonary and hepatic venous flows were evaluated using Doppler echocardiography in 13 patients (6 men and 7 women; mean age 51+/-13 years) with large pericardial effusion and clinical cardiac tamponade, and compared the results with those of 11 control subjects (3 men and 8 women, mean age 53+/-13 years). Doppler examination was repeated after pericardiocentesis in 6 patients. RESULTS: Peak velocity of early diastolic mitral inflow (E velocity) decreased during inspiration compared with expiratory increase; the mean percentage change was 40%. Peak velocity of late diastolic mitral inflow (A velocity) decreased 13% during inspiration. E/A ratio decreased 31% during inspiration. Deceleration time (DT) and isovolumic relaxation time (IVRT) increased by 26% and 44%, respectively, during inspiration. But respiratory variations of tricuspid inflow were opposite to those of mitral inflow. Tricuspid E velocity increased during inspiration and decre-ased during expiration. The mean percentage change was 123%, which was larger than thte 40% of mitral inflow. The most characteristic findings of pulmonary venous flow during respiration were the expiratory increases of peak diastolic velocity (DV) and diastolic time-velocity integral (D-TVI). The mean percentage changes of peak systolic velocity (SV), DV and D-TVI during respiration were 27%, 45% and 53% respectively. In contrast, the SV and DV of hepatic venous flow increased during inspiration and decreased during expiration. The respiratory variations of peak systolic reverse flow velocity (SR) and peak diastolic reverse flow velocity (DR) were opposite to those of SV and DV. DR notably increased during expiration, and the mean percentage change was 61%. The ratio of RFI (Inspiratory reverse flow integral) to FFI (forward flow integral) of the tamponade group was 270%. The mean percentage changes of each parameters decreased after pericardiocentesis. CONCLUSION: Patients with cardiac tamponade showed inspiratory increases of diastolic tri-cuspid filling flow and hepatic forward flow. Expiratory increases included diastolic mitral filling flow, pulmonary venous systolic and diastolic flow, and hepatic venous reverse flow. Such res-piratory variations decreased after pericardiocentesis.
Cardiac Tamponade* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Male ; Pericardial Effusion ; Pericardiocentesis ; Relaxation ; Respiration

No abstract available.
Burkitt Lymphoma* ; Skin*