PURPOSE:Enhanced immunosuppression for preventing acute rejection, But infection is an inevitable complication. This study was performed to evaluate the risk factors of herpes simplex virus (HSV) and varicella zoster virus (VZV) infection which are frequent and serious complication of renal transplant recipients. METHOD:We evaluated the incidence and risk factors for post-transplant HSV and VZV infection in three hundred and twenty three adult renal transplant recipients. RESULTS:The averaged period of infection was 37.8 months and 42% of infection occurred within six month after transplantation. Prevalence of HSV and VZV infection in diabetes patients are higher than that of non-diabetes patients (p=0.01). The other factors such as age, sex, acute rejection and immunosuppressive regimens, antibody induction didnt affect HSV and VZV infections in renal transplant recipients. CONCLUSION:As diabetic condition suggested more susceptibility to HSV and VZV infections, it is necessary to evaluate the possible occurrence of HSV and VZV infections carefully in transplant recipients with diabetes.
Adult ; Chickenpox ; Herpes Simplex ; Herpesvirus 3, Human ; Humans ; Immunosuppression ; Incidence ; Kidney ; Kidney Transplantation ; Methylmethacrylates ; Polystyrenes ; Prevalence ; Rejection (Psychology) ; Risk Factors ; Simplexvirus ; Transplants

PURPOSE: In IgA nephropathy (IgAN), crescent formation appears to represent a nonspecific response to severe injury to the glomerular capillary wall. This study was performed to evaluate the clinicopathological manifestations of the crescents and their effects on the clinical courses of IgAN. METHODS: The patients diagnosed IgAN were included and the information about their renal biopsies, chemistries and immunohistochemistry findings were collected retrospectively. Some patients that have similar renal function and protenuria were followed up for 12 months to examine the effects of crescents on the renal prognosis. RESULTS: 38 patients with crescents and 177 patients without crescents were enrolled. The patients with IgAN with crescents showed significantly lower renal function (MDRD eGFR 58.5 vs 88.4 ml/min/1.73m2), higher blood pressure, larger amount of proteinuria and more severe hematuria than those patients without crescents. In pathologic findings, HS Lee grades were higher (2.9 vs 1.9). When we selected patients with mildly decreased renal function (serum creatinine <2.5 mg/dL, PCR 0.5-8 g/gCr), the patients with crescents presented lower renal function and higher proteinuria but no statistical significance. After 12 months of treatment, the patients with crescents showed significantly lower renal function (MDRD eGFR 78.6 vs 96.5 ml/min/1.73m2) and higher proteinuria (0.9 vs 0.6 g/gCr). CONCLUSION: The patients with IgAN with crescents showed more deteriorated clinicopathological findings than those without crescents. Despite aggressive treatments, they presented a significantly decreased renal function and larger amount of proteinuria after 1 year. So crescents are supposed to have poor effects on the clinical course.
Biopsy ; Blood Pressure ; Capillaries ; Creatinine ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Immunohistochemistry ; Polymerase Chain Reaction ; Proteinuria ; Retrospective Studies

BACKGROUND: This study aimed to analyze the barriers affecting the utilization of antenatal care (ANC) among Senegalese mothers. METHODS: Health facility staffs were surveyed to examine the availability coverage of ANC (infrastructural capacity of health posts to handle maternal and newborn healthcare). A total of 113 women of childbearing age were surveyed to identify factors associated with the accessibility coverage (physical, economic, and information accessibility factors), acceptability coverage (socio-cultural features, social acceptance, and language), and effectiveness coverage (ratio of mothers having completed 4 visits) of ANC. Further, to identify the socio-cultural factors and the specific characteristics of the barriers, 5 focus group discussions were conducted with women of childbearing age, their husbands and mothers-in-law, community health workers, and health facility staff. The effectiveness coverage of ANC was analyzed by reviewing materials from the District Health Information System 2 of Senegal. RESULTS: Key barriers of ANC utilization were associated with acceptability coverage. ANC during early pregnancy was avoided owing to the negative social stigma surrounding miscarriage. The survey results indicated an extremely high miscarriage rate of 30.9% among the participants. The social stigma towards unmarried mothers caused them to hide their pregnancy, which deterred ANC utilization. The husband was the final decision maker and social supporter on ANC utilization. CONCLUSION: To promote the utilization of ANC services among pregnant women in Senegal, it is important to alleviate the social stigma towards miscarriages and unmarried mothers, and to provide greater social support for pregnancies and newborn deliveries within family.
Abortion, Spontaneous ; Community Health Workers ; Female ; Focus Groups ; Health Facilities ; Health Information Systems ; Humans ; Illegitimacy ; Infant Health ; Infant, Newborn ; Maternal Health ; Mothers ; Patient Acceptance of Health Care ; Pregnancy ; Pregnant Women ; Senegal ; Social Distance ; Social Stigma ; Spouses

Background: As of April 30, 2020, a total of 2,039 cases of the novel coronavirus disease 2019 (COVID-19) were confirmed in the Republic of Uzbekistan after the first detection on March 15. Reports on symptoms of COVID-19 are non-specific and known to vary from asymptomatic, mild to severe, or fatal. This study aimed to analyze the symptomatic and clinical characteristics of study participants based on the medical records of participants hospitalized with COVID-19 in Uzbekistan. Methods: We collected all data from medical records of COVID-19 confirmed patients in 19 hospitals from 13 regions of Uzbekistan between March 15 and April 30. We selected 1,030 patients discharged from the hospitals after COVID-19 treatment as study participants, excluding those with missing data. Further, we collected demographics, symptoms, clinical outcomes, and treatment data through medical records. Results: More than half (57.6%) of confirmed cases of COVID-19 were males, and the median age was 36.0 years. The most frequent symptoms at the first inspection on hospital admission of all patients were fatigue (59.7%), dry cough (54.1%), pharyngalgia (31.6%), headache (20.6%), and anorexia (12.5%). Compared to the oldest group, the youngest group showed a lower frequency of symptoms. About half of the group aged 18–49 years reported that they came from abroad. One-fifth of patients in group 50–84 received oxygen support, while no patients in group aged 0–17 years received oxygen support. About two-thirds of the participants from intensive care unit (ICU) came from abroad, whereas 42.1% of the non-ICU group returned from other countries. Regarding symptoms, 16.9% of the patients in the ICU group were asymptomatic, while 5.8% in the non-ICU group were asymptomatic. Conclusion This study suggests that the medical delivery system and resource distribution need to be implemented based on clinical characteristics by age and severity to delay and effectively respond to the spread of infections in the future. This study analyzed symptoms of COVID-19 patients across Uzbekistan, which is useful as primary data for policies on COVID-19 in Uzbekistan.

PURPOSE: The adult tetanus, reduced diphtheria, and acellular pertussis (Tdap) vaccine has been introduced in order to provide individual protection and reduce the risk of transmitting pertussis to infants. We assessed the knowledge and acceptability of the Tdap vaccine around pregnancy. MATERIALS AND METHODS: This study was a cross-sectional survey of women of childbearing age (20-45 years) who visited obstetrics and gynecologic units of primary, secondary, or tertiary hospitals. They were asked to fill in a questionnaire assessing their knowledge, attitudes, and acceptability of Tdap. RESULTS: The questionnaire was completed by 308 women; 293 (95.1%) had not received information from doctors about Tdap, and 250 (81.2%) did not know about the need for vaccination. A significantly important factor related to subjects' intention to be vaccinated, identified by stepwise multiple logistic regression, was the knowledge (OR 13.5, CI 3.92-46.33) that adult Tdap is effective in preventing pertussis for infants aged 0-6 months. Additionally, 276 (89.6%) considered the recommendation of obstetric doctors as the most influencing factor about Tdap vaccination. CONCLUSION: In Korea, most women of childbearing age seem to be neither recommended nor adequately informed about the vaccination, although our population was not a nationwide representative sample. Information given by healthcare workers may be critical for improving awareness and preventing pertussis.
Adult ; Cross-Sectional Studies ; Diphtheria ; Diphtheria-Tetanus-acellular Pertussis Vaccines/*administration & dosage ; Female ; Health Knowledge, Attitudes, Practice/*ethnology ; Humans ; Immunization/*statistics & numerical data ; Infant ; Logistic Models ; Multivariate Analysis ; Patient Acceptance of Health Care/*ethnology/statistics & numerical data ; Pregnancy ; Republic of Korea/epidemiology ; Risk ; Surveys and Questionnaires ; Tetanus ; Vaccination ; Whooping Cough/diagnosis/ethnology

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) is a major cause of technical failure in peritoneal dialysis. The major pathogen is gram positive bacteria, and other main pathogens include gram negative bacteria, mixed microorganisms and fungi. The case of imipenem resistance Acinetobacter baumannii (IRAB) peritonitis are not common. We report a case of peritonitis by IRAB that was not responsive to the empirical antibiotics for CAPD-associated peritonitis. A 56-year-old male with a CAPD catheter inserted 2 weeks before visited our hospital for abdominal pain and turbid peritoneal fluid. He had been diagnosed as having an end stage renal disease (ESRD) about a month before. White blood cell and neutrophil count were elevated at the initial peritoneal fluid analysis, so we diagnosed him as having CAPD-associated peritonitis. Antibiotic therapy was initiated with intraperitoneal injections of ceftazidime/cefamezine which were soon changed to vancomycin/ceftazidime. However, vancomycin/ceftazidime regimen proved ineffective. On the fifth and sixth hospital day, IRAB was cultured from the CAPD catheter exit site swab and peritoneal fluid sampled on the first visiting day. Accordingly, we changed the antibiotics to colistin and removed the CAPD catheter, which led to clinical and laboratory improvement. In the cases of CAPD associated peritonitis in patients who have a history of ICU stay, exposure to the 3rd generation cephalosporin or imipenem, or who are elderly, we must suspect unusual pathogen or multi-drug resistance pathogen such as IRAB.
Abdominal Pain ; Acinetobacter ; Acinetobacter baumannii ; Aged ; Anti-Bacterial Agents ; Ascitic Fluid ; Catheters ; Colistin ; Drug Resistance, Multiple ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Imipenem ; Injections, Intraperitoneal ; Kidney Failure, Chronic ; Leukocytes ; Male ; Middle Aged ; Neutrophils ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis

BACKGROUND: The ideal alternative airway device should be intuitive to use, yielding proficiency after only a few trials. The Clarus Video System (CVS) is a novel optical stylet with a semi-rigid tip; however, the learning curve and associated orodental trauma are poorly understood. METHODS: Two novice practitioners with no CVS experience performed 30 intubations each. Each trial was divided into learning (first 10 intubations) and standard phases (remaining 20 intubations). Total time to achieve successful intubation, number of intubation attempts, ease of use, and orodental trauma were recorded. RESULTS: Intubation was successful in all patients. In 51 patients (85%), intubation was accomplished in the first attempt. Nine patients required two or three intubation attempts; six were with the first 10 patients. Learning and standard phases differed significantly in terms of success at first attempt, number of attempts, and intubation time (70% vs. 93%, 1.4 ± 0.7 vs. 1.1 ± 0.3, and 71.4 ± 92.3 s vs. 24.6 ± 21.9 s, respectively). The first five patients required longer intubation times than the subsequent five patients (106.8 ± 120.3 s vs. 36.0 ± 26.8 s); however, the number of attempts was similar. Sequential subgroups of five patients in the standard phase did not differ in the number of attempts or intubation time. Dental trauma, lip laceration, or mucosal bleeding were absent. CONCLUSIONS: Ten intubations are sufficient to learn CVS utilization properly without causing any orodental trauma. A relatively small number of experiences are required in the learning curve compared with other devices.
Education ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal* ; Lacerations ; Learning Curve* ; Learning* ; Lip

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of Montelukast sodium in the prevention of bronchopulmonarydysplasia (BPD). METHODS: The Interventional study was designed as a multicenter, prospective, and randomized trial, with open labeled and parallel-experimental groups, 66 infants were enrolled and allocated to either the case group (n=30) or the control group (n=36) based on gestational age (GA). Infants in the case group were given Montelukast sodium (Singulair) based on their body weight (BW). Zero week was defined as the start time of the study. RESULTS: The incidence of moderate to severe BPD was not different between the groups (case group: 13 of 30 [43.3%] vs. control group: 19 of 36 [52.8%], P=0.912). Additionally, secondary outcomes such as ventilation index, mean airway pressure and resort to systemic steroids were not significantly different. There were no serious adverse drug reactions in either group, and furthermore the rate of occurrence of mild drug related-events were not significantly different (case group: 10 of 42 [23.8%] vs. control group: 6 of 48 (15.8%), P=0.414). CONCLUSION: Montelukast was not effective in reducing moderate or severe BPD. There were no significant adverse drug events associated with Montelukast treatment.
Body Weight ; Bronchopulmonary Dysplasia* ; Drug-Related Side Effects and Adverse Reactions ; Gestational Age ; Health Resorts ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Leukotriene Antagonists ; Pharmacokinetics ; Prospective Studies ; Sodium* ; Steroids ; Ventilation

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.
Adult ; Biomarkers/blood ; Body Mass Index ; C-Reactive Protein/analysis ; Chemokines/*blood ; Creatinine/blood/urine ; Diabetes Mellitus, Type 2/*blood/diagnosis ; Female ; Humans ; Insulin/blood ; Intercellular Signaling Peptides and Proteins/*blood ; Intra-Abdominal Fat/*pathology ; Linear Models ; Lipocalins/blood ; Male ; Middle Aged ; Obesity/complications ; Triglycerides/blood

Background: Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. Methods: A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. Results: Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month (P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month (P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals (P = 0.003). A difference was also noted between occupation categories (P = 0.019), but a more significant difference was found in the comparison between nurses and doctors (P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts (P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference (P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. Conclusion In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.