No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Statistics as Topic*

We report a case of SLE with antiphospholipid antibodies presented initially with severe bleeding. A six-year-old boy was admitted due to severe nasal bleeding for 2 months. The boy showed typical malar rash. The laboratory tests indicated that his platelet count was 80,000/mm3 and the PT and the aPTT were markedly prolonged. A number of clotting factors were decreased, including factorsll<12%, Vll: 42%, lX : 38%, Xl: 41%, and Xll: 16%. Urinalysis showed hematuria and proteinuria, and 24-hour urine protein was 1.37g/day. Venereal Disease Research Laboratory (VDRL) test was false positive, Coombs test, lupus anticoagulants and anticardiolipin antibodies (IgG and IgM) were positive. His symptoms and laboratory tests fulfilled the criteria of SLE with antiphospholipid antibody. Renal pathology showed lupus nepritis (diffuse proliferative glomerulonephritis, class lV). After steroid therapy, his nasal bleeding stopped immediately, and laboratory findings became normalized. This case showed the tendency of paradoxic bleeding, instead of the expected thrombosis which can be found in this type of patient. We anticipate it is mainly due to pronounced prothrombin deficiency.
Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid* ; Anticoagulants ; Coombs Test ; Epistaxis ; Exanthema ; Glomerulonephritis ; Hematuria ; Hemorrhage* ; Humans ; Hypoprothrombinemias ; Lupus Erythematosus, Systemic* ; Male ; Pathology ; Platelet Count ; Proteinuria ; Sexually Transmitted Diseases ; Thrombosis ; Urinalysis

We report a case of SLE with antiphospholipid antibodies presented initially with severe bleeding. A six-year-old boy was admitted due to severe nasal bleeding for 2 months. The boy showed typical malar rash. The laboratory tests indicated that his platelet count was 80,000/mm3 and the PT and the aPTT were markedly prolonged. A number of clotting factors were decreased, including factorsll<12%, Vll: 42%, lX : 38%, Xl: 41%, and Xll: 16%. Urinalysis showed hematuria and proteinuria, and 24-hour urine protein was 1.37g/day. Venereal Disease Research Laboratory (VDRL) test was false positive, Coombs test, lupus anticoagulants and anticardiolipin antibodies (IgG and IgM) were positive. His symptoms and laboratory tests fulfilled the criteria of SLE with antiphospholipid antibody. Renal pathology showed lupus nepritis (diffuse proliferative glomerulonephritis, class lV). After steroid therapy, his nasal bleeding stopped immediately, and laboratory findings became normalized. This case showed the tendency of paradoxic bleeding, instead of the expected thrombosis which can be found in this type of patient. We anticipate it is mainly due to pronounced prothrombin deficiency.
Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid* ; Anticoagulants ; Coombs Test ; Epistaxis ; Exanthema ; Glomerulonephritis ; Hematuria ; Hemorrhage* ; Humans ; Hypoprothrombinemias ; Lupus Erythematosus, Systemic* ; Male ; Pathology ; Platelet Count ; Proteinuria ; Sexually Transmitted Diseases ; Thrombosis ; Urinalysis

Purpose: : This study aimed to understand and describe the nurses’ experiences caring for severe COVID-19 patients at isolation room with negative pressure in South Korea. Methods: : Data were collected through individual in-depth interviews from February 16 to March 31, 2021 with 11 nurses who had been caring for severe COVID-19 patients at isolation room. Verbatim transcripts were analyzed according to Colaizzi’s phenomenological analysis. Results: : As a result, 5 theme clusters were extracted about nurses’ experiences. The 5 theme clusters, “Adapting to unexpected adversity”, “Accepting unresonable and heavy work”, “Dulness and disconnection from the outside world”, “Changing in perception of new infectious diseases”, and “Pathetic isolated patients” emerged. Conclusion : The results of this study provided a deeper understanding of nurses struggling to care for COVID-19 severe patients. This study is expected to be useful in providing basic evidence for improving intensive care practices and for preparing policies in other infection disease situations.

Syndrome of 4q deletion is characterized by an abnormal shape of the skull, craniofacial dysmorphism, cardiovascular malformations, genitourinary defects, limb and digital anomalies, and developmental delay. We experienced a case of 4q interstitial deletion in a 2 day-old female neonate who showed short extremities, partial agenesis of corpus callosum and congenital heart defects. We report the case with a brief review of the literature.
Agenesis of Corpus Callosum* ; Chromosomes, Human, Pair 4 ; Extremities ; Female ; Heart Defects, Congenital ; Humans ; Infant, Newborn ; Skull

We presented here a rare case of intestinal Behecet's disease simulating Grohn's disease. A 20 year old female complained of recurrence of oral ulcer, genital ulcer, arthralgia, erythema nodosum, abdominal pain and diarrhea, but she had no anal ulcer or anal fistulas. The colonoscopic examanation disclosed diffuse colonie involvement with multiple longitudinal ulcers and inflammatory pseudopolyposis. In hospital, she received ileocecectomy because of distal ilea perforation. Postoperative specimen showed multiple geographic ulcer on ileocecal region, creeping mesenteric fat and thickening of cecal wall. Pathological examination showed perivasculitis, transmural inflammation, fissuring, multiple lymph follicles which are compatible with intestinal Behect's disease. There were no granuloma sugges tive of Crohn's disease. Clinically, the patient met the international criteria of Behcet's disease. Punched out ulcer in the ileocecal region and pathological findings described above confirmed the diagnosis of intestinal Behcet's disease.
Abdominal Pain ; Arthralgia ; Colon* ; Crohn Disease ; Diagnosis ; Diarrhea ; Erythema Nodosum ; Female ; Fissure in Ano ; Granuloma ; Humans ; Inflammation ; Oral Ulcer ; Rectal Fistula ; Recurrence ; Ulcer* ; Young Adult

Orientia tsutsugamushi, a causative agent of scrub typhus, is an obligate intracellular parasite and usually propagates in the cytoplasm of host endothelial cells and macrophages. Macrophages are the first defense line against bacterial infection and NF-kappaB is activated upon contact with bacteria, resulting in the transcription of inflammatory cytokine to control bacterial infection. In this study, we investigated whether O. tsutsugamushi modulates NF-kappaB activation in the macrophages. We examined the changes of NF-kappaB proteins upon infection with O. tsutsugamushi and found that NF-kappaB is activated at a slow rate as judged with EMSA and immunoblot analysis. Interestingly, we found that p65 was cleaved generating a 45 kDa fragment. In addition, fragment of p65 is generated only by the virulent serotype strain of O. tsutsugamushi, suggesting this cleavage may be associated with the mouse virulence. It is still unknown whether this is a direct result of O. tsutsugamushi proteins or enzymes of host cell. Further exploration of the mechanism that modulates NF-kappaB activity by O. tsutsugamushi could contribute to a better understanding of the molecular pathogenesis of O. tsutsugamushi infection.
Animals ; Bacteria ; Bacterial Infections ; Cytoplasm ; Endothelial Cells ; Macrophages ; Mice ; NF-kappa B ; Orientia tsutsugamushi ; Parasites ; Proteins ; Scrub Typhus ; Sprains and Strains

Here we report the case of a 20-year-old female patient previously diagnosed with Hashimoto's thyroiditis and overt hypothyroidism, and who had been taking synthetic thyroxine (100micro/day) for eight months. She experienced intermittent dizziness and generalized weakness, and was diagnosed as having severe autoimmune hemolytic anemia (AIHA). We prescribed prednisolone treatment and continued synthetic thyroxine administration. Two years and five months later, she developed idiopathic thrombocytopenic purpura (ITP) and was diagnosed with Evans' syndrome. Thereafter, laparoscopic splenectomy was performed because her autoimmune hemolytic anemia was refractory and dependent on steroid therapy. The HLA genotypes of the patient were HLA-A*020101/A*2602, HLA-B*270502/B*5401, HLA-Cw*0102/Cw*020202, HLA-DRB1*0404/DRB1*0405, and HLA-DQB1*0302/DQ B1*0401. Hashimoto's thyroiditis is often associated with other nonendocrine autoimmune diseases, and antithyroid antibodies are frequently observed in Evans' syndrome (coexistence of AIHA and ITP). However, there is no report of Evans' syndrome developing in patients with overt hypothyroidism and Hashimoto's thyroiditis. This case suggests that three autoimmune diseases (AIHA, ITP, and Hashimoto's thyroiditis) might share a common immunogenetic pathway in pathogenesis.
Purpura, Thrombocytopenic/blood/*complications ; Humans ; Hashimoto Disease/*complications/radionuclide imaging ; Female ; Anemia, Hemolytic, Autoimmune/blood/*complications ; Adult

Orientia tsutsugamushi, the causative agent of scrub typhus, is an obligate intracellular bacterium that replicates in the cytosol of host cells. Although several protein antigens have been characterized and cloned, little information exists regarding the polysaccharide antigen of this bacterium. In this study, we characterized two monoclonal antibodies, NT19 and WT14, against the proteinase K-resistant antigen of O. tsutsugamushi. Western blot analysis showed that MAb NT19 and WT14 strongly recognized two antigenic bands with molecular masses of 20 kDa and 24 kDa, which were resistant to proteinase K digestion. We suggest that the proteinase-resistant antigen might be polysaccharide. One patient serum reacted with a 24 kDa band that was similar to a band observed by WT14, suggesting the possibility of the role of this proteinase-resistant antigen as an antigenic molecule in human infection.
Antibodies, Monoclonal ; Blotting, Western ; Clone Cells ; Cytosol ; Digestion ; Endopeptidase K ; Humans ; Orientia tsutsugamushi ; Scrub Typhus

No abstract available.
Pregnancy*