The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during the epidemics of seasonal influenza as many of those affected were previously healthy young people. Current predictions estimate that during a pandemic wave, 12~30% of the population will develop clinical influenza (compared with 5~15% for seasonal influenza) with 4% of those patients requiring hospital admissions and one in five requiring critical care. Until July 6, 94,512 people have been infected in 122 countries, of whom 429 have died with an overall case-fatality rate of <0.5%. Most of the confirmed cases of S-OIV (Swine- Origin Influenza A Virus) infection have been characterized by a self-limited, uncomplicated febrile respiratory illness and 38% of the cases have also included vomiting or diarrhea. Efforts to control these outbreaks are based on our understanding of novel S-OIV (Swine-Origin Influenza A Virus) and the previous influenza pandemics. So, this review covers the experience with S-OIV (Swine-Origin Influenza A Virus) for the admission and background data and the clinical presentation, diagnosis and treatment of H1N1 in pediatric patient with S-OIV (Swine-Origin Influenza A Virus) at YUMC, 2009.
Critical Care ; Disease Outbreaks ; Humans ; Influenza, Human ; Pandemics ; Seasons ; Vomiting

Appendicitis is a common cause of acute abdomen in pediatrics. Periappendiceal abscesses are frequently found in the pediatric population. Acute appendicitis in children can, at times, be a difficult clinical diagnosis because of its highly variable history? and physical manifestations and its unpredictable course. Despite the uncertainty of the diagnosis, appendicitis demands prompt treatment because of the risk of perforation, which occurs in approximately one third of cases. Urological manifestations of appendicitis and appendiceal abscess can vary. Acute appendicitis presenting with ureteral stenosis and hydronephrosis is very rare. Here, we report a case of acute appendicitis with perforation and left hydronephrosis in a 3-year-old female. This case presents a 3-year-old girl with dysuria having hydronephrosis that originated from a perforated appendix.
Abdomen, Acute ; Abscess ; Appendicitis ; Appendix ; Child ; Constriction, Pathologic ; Dysuria ; Female ; Humans ; Hydronephrosis ; Pediatrics ; Preschool Child ; Uncertainty ; Ureter ; Ureteral Obstruction ; Urological Manifestations

Crohn's disease is a chronic inflammatory bowel disease that mainly affects children and young adults. Its cause remains unknown. The incidence of pediatric Crohn's disease is increasing, so it is important for clinicians to be aware of the presentation of this disease in the pediatric population. The majority of patients complain of abdominal pain (72%), with only 25% presenting with the 'classical triad' of abdominal pain, weight loss, and diarrhea. Many children with Crohn's disease present in a 'non-classical' manner, with vague complaints such as lethargy or anorexia, which may be associated with only mild abdominal discomfort. Other symptoms include fever, nausea, vomiting, growth retardation, malnutrition, delayed puberty, psychiatric symptoms, arthropathy, and erythema nodosum. Severe constipation and abdominal distension are uncommon symptoms at diagnosis. We report a case of pediatric Crohn's disease, which was diagnosed after the patient presented with severe constipation and abdominal distension.
Abdominal Pain ; Anorexia ; Child ; Constipation ; Crohn Disease ; Diarrhea ; Erythema Nodosum ; Fever ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Lethargy ; Malnutrition ; Nausea ; Puberty, Delayed ; Vomiting ; Weight Loss ; Young Adult

PURPOSE: The aim of this study was to assess the relationship between serum 25-hydroxyvitamin D3 levels and the severity of atopic dermatitis (AD), markers of atopy (total IgE, total eosinophil count, and eosinophil cationic protein) in AD children according to allergen sensitization. METHODS: This cross-sectional study was carried out on 160 AD patients aged 1 to 18 years between March 2012 and August 2014. The AD patients (AD group) were subdivided into 2 categories according to the results of the allergic skin prick and Unicap tests: the allergic and nonallergic AD groups. We compared 25-hydroxyvitamin D3 levels between the AD and control groups. We also investigated relationships between serum 25-hydroxyvitamin D3 levels, the severity of AD, and markers of AD (total IgE, total eosinophil count, and eosinophil cationic protein) in the allergic and nonallergic AD groups. RESULTS: The average 25-hydroxyvitamin D3 levels were 30.6+/-11.7 and 23.7+/-10.0 ng/mL, respectively, in the control and AD groups (P<0.001). The average 25-hydroxyvitamin D3 levels were 19.7+/-8.6 and 27.5+/-9.8 ng/mL, respectively, in the allergic and nonallergic AD groups, with clinical implications (P<0.001). The 25-hydroxyvitamin D3 levels were not significantly associated with SCORing Atopic Dermatitis index in the allergic (P=0.004, r=-0.092) or nonallergic (P=0.610, r=-0.58) AD groups. The 25-hydroxyvitamin D3 levels were not significantly associated with the aforementioned markers of atopy in the AD group. CONCLUSION: These results suggest that 25-hydroxyvitamin D3 may play a role in the pathogenesis of AD.
Allergens ; Calcifediol* ; Child* ; Cross-Sectional Studies ; Dermatitis, Atopic* ; Eosinophils ; Humans ; Immunoglobulin E ; Skin

PURPOSE: Airborne pollen is the most common causative agents of allergic disease. Since 2000, there isn't no more report about airborne pollen in Busan. This study is that pollen in one area of Busan was collected to investigate species, particle counts, seasonal distribution, and of its correlation with reactivity to skin prick test in children during 1998-2012. METHODS: Rotorod sampler was installed on the rooftop of St. Mary Hospital in Busan. A 24-hour sampling of airborne allergens over a fifteen-year period was conducted 6 days/wk from January 1, 1998 to December 31, 2012. After staining they were identified, counted and recorded with the weather in Busan. RESULTS: Major pollens collected were Pine, Alder, Oak, Juniperus, Humulus. The pollen season is relatively short and the pollen dispersed mainly during the period from March to May in case of tree pollen, from April to September in case of grass pollen and from August to October in case of weed pollen. Total annual pollen count ranged from 36,412 grains/m3 (2002) to 1,342 grains/m3 (2006). The peak pollen season was seen for spring and autumn, especially in May and September during 1998-2012. In skin prick tests, birch was the highest sensitization rate (15.1%), followed by alder (14.7%), hazel (14.1%) in the tree for 15 years. And in weed, mugwort and ragweed were the highest sensitization rate (10.6%, 10.3%), followed by humulus (5.5%) for 15 years, but since 2008, was increased. CONCLUSION: Analysis of pollens sampled in the atmosphere of Busan, Korea, for a 15-year period identified 24 species of pollens with seasonal variation of some clinically important pollen load. Analysis of data, it showed that alder and birch are main allergen in spring for 15 years, and in 1998-2008, ragweed and artemisia was main allergen in fall, since 2009, followed by humulus.
Allergens ; Alnus ; Ambrosia ; Artemisia ; Atmosphere ; Betula ; Busan ; Child ; Humans ; Humulus ; Hypersensitivity* ; Juniperus ; Korea ; Poaceae ; Pollen* ; Seasons ; Skin ; Weather

PURPOSE: Many studies have shown the importance for bronchial hyperresponsiveness (BHR) in children with bronchial asthma and allergic rhinitis. However, studies have not been done in BHR in school age and adolescence with atopic dermatitis (AD). METHODS: The patients with history of bronchial asthma were excluded and methacholine challenge test (MCT) was performed in 103 children with atopic dermatitis. The positive of MCT result is defined as provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second (PC20)< or =8 mg/mL. According of the level of PC20, the patients were divided into two groups. RESULTS: The group 1 (BHR+) was observed in 43 of all patients (41.7%). Of two groups, significant differences were observed in age, body mass index. No significant differences were observed in the number of male, SCORing Atopic Dermatitis (SCORAD) index, admission history, smoking exposure history, other allergic disease, parental allergic disease. The group 1 (BHR+) have higher levels of total eosinophil count compared with the group 2 (BHR-) (629.8+/-360.5/microL vs. 470.2+/-253.9/microL, P=0.01). But no significant association was found between severity of BHR and SCORAD score, total immunoglobulin E, total eosin ophil count and eosinophil cationic protein (r=0.008, P=0.961; r=-0.217, P=0.162; r=0.225, P=0.147; r=-0.032, P=0.841). The list of allergen is that the house dust mite, tree, weed, food, animal hair, and fungus. The house dust mite has correlation with bronchial hypersensitivity statistically and the any of allergen groups, either. CONCLUSION: No significant relationship was observed between degree of BHR and allergy laboratory finding, severity of AD.
Adolescent* ; Animals ; Asthma ; Body Mass Index ; Bronchial Hyperreactivity ; Child ; Dermatitis, Atopic* ; Eosine Yellowish-(YS) ; Eosinophil Cationic Protein ; Eosinophils ; Forced Expiratory Volume ; Fungi ; Hair ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Male ; Methacholine Chloride* ; Parents ; Pyroglyphidae ; Rhinitis ; Risk Factors* ; Smoke ; Smoking

Traumatic aneurysm is known to be very rare vascular disease. The authors experienced one case of traumatic aneurysm that occured on pericallosal artery after closed head injury. Traumatic aneurysm was suspected by enlarged traumatic ICH on the corpus callosum in brain CT scan and presence of signal voiding at the center of the hematoma in brain MRI scan and then confirmed by transfermoral carotid angiography. Clipped neck of this traumatic aneurysm successfully via interhemispheric approach, we report a case of traumatic pericallosal artery aneurysm with review of literatures.
Aneurysm* ; Angiography ; Arteries* ; Brain ; Corpus Callosum ; Head Injuries, Closed ; Hematoma ; Magnetic Resonance Imaging ; Neck ; Tomography, X-Ray Computed ; Vascular Diseases

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is the major pathogen of nosocomial infections. There are many reports that MRSA nasal cariers play a major role in the transmission of MRSA. We studied to assess the nasal carriage rates, therapeutic effects of nasal carriers and control of MRSA outbreak in a tertiary, acute and educational hospital. METHODS: From 1990 to 1997, eight MRSA epidemics were detected and investigated for outbreak control. We surveyed the MRSA colonization of anterior nares and hands of health care workers (HCW). MRSA was identified by staphylococcal broth, mannitol-salt- agar, Muller-Hinton-oxacillin agar. To identify the permanent carriers in the HCWs, the nasal swab was done weekly for 3 weeks. Two percent povidone iodine ointment or 2% mupirocin ointment was applied topically to treat the permanent MRSA nasal carriers. RESULTS: Of eight MRSA outbreaks, five epidemics occurred in the intensive care unit, all of them occurred in surgical departments and five of them occurred in winter seasons. For eight MRSA outbreaks, 351 HCWs were surveyed. The rates of transient carriers was 10.8% (38/351) and the rates of that were 9.0% (10/111) in medical doctors (MD), 12.5% (24/192) in registered nurses (RN) and 11.4% (4/35) in aid nurses (P=0.470). The rate of permanent carrier in doctors was 1.8%, and that in RNs was 3.7% (P=0.490). After topical therapy with 2% povidone iodine ointment or 2% mupirocin ointment for permanent carriers, MRSA was not identified for 2 months follow up. CONCLUSION: In MRSA epidemics, the rate of the transient carrier rate of MRSA in HCWs was 10.8% and the rate of the permanent carrier was 2.6%. The difference of carrier rates in HCWs was not significant statistically. The therapy for the permanent nasal carriers in HCWs with two percent povidone iodine ointment or 2% mupirocin ointment was very effective. And MRSA outbreaks were ended and controlled for 6months follow up.
Agar ; Colon ; Cross Infection ; Delivery of Health Care* ; Disease Outbreaks ; Follow-Up Studies ; Hand ; Intensive Care Units ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mupirocin ; Povidone-Iodine ; Seasons

OBJECTIVES: As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. METHODS: The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. RESULTS: The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. CONCLUSIONS: The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information.
Coat Protein Complex I ; Compliance ; Electronics ; Electrons ; Humans ; Insurance Carriers ; Logistic Models ; Medical Records ; Outpatients ; Tertiary Care Centers

PURPOSE: The aim of this study was to compare the clinical usefulness of serum procalcitonin (PCT) levels in Mycoplasma pneumoniae pneumonia (M. pneumonia) and viral pneumonia in children. METHODS: We retrospectively analyzed the medical records of 348 patients admitted between June 2015 and December of 2015. There were 162 patients with M. pneumonia without virus coinfection (group 1) and 186 patients with viral pneumonia (group 2). All subjects had radiographic evidence of pneumonia with available specimens for both M. pneumonia and viral testing, and levels of serum PCT, white blood cell counts (WBC), neutrophil portion, and C-reactive protein (CRP). Fifty-eight children who performed follow-up sampling at the time of no fever for more than 48 hours were subdivided into group 3 (M. pneumonia with follow-up sampling, n=41) and group 4 (viral pneumonia with follow-up sampling, n=17). RESULTS: No difference was noted in the levels of serum PCT (P=0.168), CRP (P=0.296), WBC (P=0.732), and neutrophil proportion (P=0.069) between groups 1 and 2, after adjusting for age. Serial changes in serum PCT levels between the first and second samples were significant in group 3 (P=0.046). Serial changes in serum CRP levels between the first and second samples were significant in group 4 (P=0.008). CONCLUSION: Serum PCT and CRP levels may change differently after infection according to the etiology of pneumonia.
C-Reactive Protein ; Child* ; Coinfection ; Cross-Sectional Studies* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Medical Records ; Mycoplasma pneumoniae ; Mycoplasma* ; Neutrophils ; Pneumonia ; Pneumonia, Mycoplasma* ; Pneumonia, Viral* ; Retrospective Studies