To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measles-mumps-rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and theKorean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measlesmumps- rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Glechoma longituba is a common medicinal plant that is common in wet and sunny land. This plant is used to treat various illnesses including jaundice and edema. But, ingestion of the plant can cause severe pain and swelling on lip and mouth. We experienced three cases that had oral pain and sensory change after ingestion of G. longituba, which we report with a literature review.
Eating ; Edema ; Jaundice ; Lamiaceae ; Lip ; Mouth ; Paresthesia ; Plants ; Plants, Medicinal

Superwarfarin, such as brodifacoum, is a highly lethal vitamin K antagonist used as a rodenticide. Brodifacoum has a particularly long half-life in the body, which ranges to several months, and therefore requires prolonged treatment with antidotal vitamin K. We experienced a case whereby an 18-year-old male was presented to the hospital with a severe bleeding disorder. It was discovered that he had ingested brodifacoum rodenticide with intent to commit suicide. Despite continual treatment with vitamin K, the bleeding disorder persisted for several months before he recovered. We report this case with literature review.
4-Hydroxycoumarins ; Adolescent ; Half-Life ; Hemorrhage ; Humans ; Male ; Suicide ; Vitamin K ; Vitamins

PURPOSE: The success of cardiopulmonary resuscitation (CPR) depends on how soon after a heart attack the intervention is done and on how the quality of the CPR is. Although in Korea there are several CPR education courses, CPR done by bystanders to an attack remains very low. This might be related to different causes such as the complexity of the CPR sequence and the difficulty of learning CPR, specifically ventilation maneuvers. The American Heart Association (AHA) has recently recommended 'Hands Only(TM) CPR', without ventilation, for bystander rescuers. In the present study, we investigated the educational effects of 'Hands Only(TM) CPR' in elementary school students. We further analyzed the effects of this variable on CPR skill learning and retention for a 3 months period. METHODS: We selected two groups of 5th grade elementary school students to perform this study. One group received CPR education with ventilation (CPR with ventilation group); the other received 'Hands Only(TM) CPR' education ('Hands Only(TM) CPR' group). The Laerdal PC Skill Reporting system was used for both education sessions and for evaluation immediately after the sessions. Skill performance data, together with ventilation data and compression data were recorded for further comparisons. RESULTS: There were no differences between the two groups regarding chest compression (average rate, average duty cycle, registered with no error, average depth, etc.). The average chest compression count per minute was 118+/-12/min in the 'Hands Only(TM) CPR' group and 85+/-13/min in the CPR with ventilation group (p=0.001). Registered adequate compression depth was 23+/-29% in the 'Hands Only(TM) CPR' group and 23+/-31% in the CPR with ventilation group (p=0.962). The total hands off time was 18+/-7 seconds in the 'Hands Only(TM) CPR' group and 40+/-11 seconds in the CPR with ventilation group. After 3 months there were still no differences in chest compression between the two groups. The average count per minute at 3 months was 109+/-15/min in the 'Hands Only(TM) CPR' group and 83+/-17/min in the CPR with ventilation group (p=0.001). Registered adequate compression depth was 26+/-31% in the 'Hands Only(TM) CPR' group and 31+/-35% in the CPR with ventilation group (p=0.334). The total hands off time was 12+/-5 seconds in the 'Hands Only(TM) CPR' group and 31+/-12 seconds in the CPR with ventilation group (p=0.001). CONCLUSION: The 'Hands Only(TM) CPR' program in elementary school children increased the chest compression rate. However, there was no between groups difference in adequate compression depth. We were unable to demonstrate that the 'Hands Only(TM) CPR' education program in elementary school children led to a better effect.
American Heart Association ; Cardiopulmonary Resuscitation ; Child ; Hand ; Heart ; Humans ; Korea ; Learning ; Retention (Psychology) ; School Health Services ; Thorax ; Ventilation

PURPOSE: Dynamic changes in the dimensions of the left ventricle (LV) during cardiac arrest might influence the efficacy of CPR. However, the relationship between change in LV dimensions during cardiac arrest and CPR hemodynamics and outcomes have not yet been addressed. In the present study, we investigated changes in left ventricular volume and area during prolonged, untreated ventricular fibrillation (VF); we related those change to coronary perfusion pressure (CPP) during CPR and resuscitation outcomes. METHODS: In 12 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and left untreated for 15 min. CPR was performed for 5 min prior to defibrillation. CPR was continued until the return of spontaneous circulation (ROSC) or for a maximum of 15 minutes. Mean aortic pressure and right atrial pressures were measured and CPP was calculated. LV dimensions were continuously assessed by echocardiographic measurement during the 15 minutes of interval VF. RESULTS: Six animals were successfully resuscitated. During the 15 minute interval of VF, LV area and volume were reduced in all animals. In animals that were not resuscitated, LV dimensions were significantly lower than those in resuscitated animals (p<0.01). These differences were observed after 10 minutes of VF. The animals with greater reduction in LV dimension during VF achieved significantly lower CPP during CPR in contrast to animals with larger LVs during VF. CONCLUSION: Greater decreases in LV volume and area during cardiac arrest are associated with low CPP during CPR and poor resuscitation outcomes. LV dimensions prior to starting CPR might therefore modulate the effectiveness of resuscitation interventions.
Animals ; Arterial Pressure ; Atrial Pressure ; Cardiopulmonary Resuscitation ; Heart Arrest ; Heart Ventricles ; Hemodynamics ; Humans ; Male ; Perfusion ; Piperazines ; Resuscitation ; Swine ; Ventricular Fibrillation

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.
Carcinoma ; Follow-Up Studies ; Humans ; Pathology ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

Antibiotic Prophylaxis ; Chronic Periodontitis ; Diagnosis ; Drug Users ; Endocarditis ; Heart Defects, Congenital ; Humans ; Incidence ; Mortality ; Oral Health ; Rheumatic Heart Disease ; Tooth Extraction