This study was performed to assess the effect of one year's of meal service for home-staying urban elderly with low incole on their nutritional status. One hundred and eighty three subjects, who had already completed the first nutritional survey, were assigned to two group : meal served(served) and non-meal served(non-served). A meal containing approximately on half of the RDA for energy, protein, calcium and iron was served as lunch everyday to served group. After on year of meal service, follow-up-nutritional survey was done and changes of parameters were analyzed with paired t-test. Served female showed signficantly increased intake of riboflavin and calcium, while non-served female showed significantly decreased intake of calcium. Serum total protein, serum albumin and serum cholesterol were significantly increased in female regardless of meal service. Served remale was observed with significantly elevated LDL-cholesterol, whereas non-served female showed singnificantly lowered HDL-cholesterol. Significantly decreased serum iron, serum transferrin saturaion and significantly increased TIBC were observed for female regardless of meal service. But the proportion of anemic elderly according to Hb or serum iron was decreased more in served group. Female showed significantly increased serum zinc and copper regardless of meal service, whereas only served male showed significantly increased serum copper.
Aged* ; Calcium ; Cholesterol ; Copper ; Female ; Humans ; Iron ; Lunch ; Male ; Meals* ; Nutrition Surveys ; Nutritional Status ; Riboflavin ; Serum Albumin ; Transferrin ; Zinc

Purpose: This study aimed to examine the impacts of alternative clinical practice on nursing professionalism in nursing students during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A cross-sectional study was used for this study. Data were collected from 178 junior and senior nursing students from December 28, 2022 to January 6, 2023. The nursing students’ characteristics, nursing professionalism, clinical competence, extent of alternative clinical practice, and satisfaction with alternative clinical practice were self-reported through an on-line survey. Multiple linear regressions were conducted to examine the impacts of alternative clinical practice on nursing professionalism along with the confounding variables. Results: The nursing students reported that they performed alternative clinical practice for more than half of their clinical practice throughout 2022. The extent of alternative clinical practice (β=-.11, p=.028), satisfaction with content (β=.14, p=.045), and evaluation of the alternative clinical practice (β=.17, p=.007) were found to have impacted nursing professionalism. These variables explained 55.6% of the variance in nursing professionalism. Conclusion The study results suggest that the alternative nursing practice could impact nursing students’ professionalism. However, it would be possible to develop nursing professionalism if the students’ satisfaction with the alternative clinical practice were increased. Nurse educators need to improve the content and evaluation methods of alternative clinical practice to promote nursing professionalism during the implementation of such alternative clinical practice.

Percutaneous transluminal angioplasty (PTA) is an effective method in treating arteriovenous fistula (AVF) stenosis in hemodialysis patients. But, some stenoses are resistant to these procedures. Recently, cutting balloon angiopasty has been introduced as an alternative method for resistant AVF stenosis. We here report two cases of resistant AVF stenosis successfully treated by cutting balloon angioplasty in hemodialysis patients.
Angioplasty ; Angioplasty, Balloon* ; Arteriovenous Fistula* ; Constriction, Pathologic* ; Humans ; Renal Dialysis

Uremic patients undergoing hemodialysis (HD) therapy are prone to develop encephalopathy, but the cause is often unclear. Clinical signs of encephalopathy in the uremic patient often overlap with several other affections causing neurological disorders. Chorea or hemichorea occurs very rare, when basal ganglia are injured in HD patients. We hereby report a case of hemichorea of unknown cause in a hemodialysis patients. A 57-year-old diabetic HD patient was presented with sudden onset of right hemichorea. We could not find causes of hemichorea such as hyperglycemia, hepatic failure, drug, hyponatremia, and thiamine deficiency. T1-weighted MRI demonstrated hyperintense lesion limited to the left basal ganglion. Hemichorea disappeared completely 6 months after the onset with support care.

BACKGROUND: We studied about the The different features of high-resolution CT (HRCT) findings of active pulmonary tuberculosis(TB) were studied between acid fast bacilli(AFB) smear or culture positive and negative group. METHODS: We prospectively evaluated 36 patients who had been confirmed for active pulmonary tuberculosis by the smear or culture of AFB in sputum(n=25), and changes on serial chest radiographs(n=11). The patient were divided into 3 groups by the results on sputum AFB stain and culture. Group 1(n=11) is negative in both AFB stain and culture ; group 2(n=13) is negative in AFB stain but positive in culture ; and group 3(n=12)is positive in both AFB stain and culture. We evaluated the findings of HRCT in each group randomly. RESULT: On the HRCT scans, acinar nodule(100%), macronodule(75%), and cavity(75%) in group 3 were more frequently found than group 1(63%, 18%, 9%) and group 2(46%, 15%, 23%)(p<0.05). The centrilobular nodule and branching structure in group 3(92%) was more frequently observed were more frequently observed in group 3 (92%) than in group 1(54%)(p<0.05), but not different than were similarly observed in group 2(77%)(p>0.05). AFB positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(100% vs 54%), macronodule(75% vs 17%), and cavity(75% vs 17%)(p<0.05). TB culture positive group was statistically different than the negative group in the HRCT findings such as with respect to acinar nodule(72% vs 45%) and cavity(48% vs 9%)(p<0.05). CONCLUSIONS: HRCT scans are helpful in determining disease acitivity in sputum AFB stain- negative pulmonary tuberculosis. When HRCT shows centrilobular nodule and branching structure, acinar nodule, macronodule, cavity, we are able to decide more study such further studies as sputum induction and bronchoscopy for determination of can be performed to determine the presence of bacilli in patients of AFB stain-negative tuberculosis.
Bronchoscopy ; Humans ; Prospective Studies ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Sarcoidosis is multi-systemic disorder of an unknown etiology, and this is histologically characterized by noncaseating granulomatous inflammation. Sarcoidosis may affect the lung, skin, lymph nodes and eyes, but it rarely affects the subcutaneous tissue. There has been no report of diffuse subcutaneous sarcoidosis in Korea. We experienced a 57-year-old female with diffuse subcutaneous sarcoidosis that presented as thickened extremities. The patient complained of edema and skin thickening on both upper extremities. Magnetic resonance imaging revealed the reticular form of sarcoidosis on the forearm and the biopsy showed noncaseating granuloma. She was finally diagnosed as diffuse subcutaneous sarcoidosis and she improved after treatment with corticosteroid. We report here on this unusual case along with a review of the relevant literature.
Biopsy ; Edema ; Extremities ; Eye ; Female ; Forearm ; Granuloma ; Humans ; Inflammation ; Korea ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Sarcoidosis ; Skin ; Subcutaneous Tissue ; Upper Extremity

PURPOSE:Cardiovascular disease is the predominant cause of death in patients with end stage renal disease. Approximately 33.7% of overall mortality is due to cardiovascular disease, and about 27% of these cardiovascular deaths are attributed to acute myocardial infarction (AMI). Despite the significance of AMI, there are little data on the clinical characteristics of AMI in dialysis patients. METHODS:Thirty-two dialysis patients admitted for AMI from January 2004 to December 2007 were retrospectively analyzed. One hundred twenty-three AMI patients were included as a control. The clinical and laboratory findings of AMI were compared between dialysis patients and non-dialysis patients. RESULTS:The frequency of typical chest pain was significantly lower in dialysis patients than in non- dialysis patients (18.8% vs. 62.6%, p<0.001), and typical ECG findings of STEMI were significantly less noted (28.1% vs. 82.9%, p<0.001). Increases in CPK, CK-MB, and troponin T levels were significantly lower in dialysis patients than in non-dialysis patients ( p<0.001). In contrast, dialysis patients revealed more multi-vessel diseases on coronary angiography and more left ventricular hypertrophy and were associated with higher mortality during admission than non-dialysis patients. CONCLUSION:Although dialysis patients with AMI had less typical chest pain and typical ECG findings, and had lower increases in cardiac enzyme levels, they revealed more severe coronary vessel diseases than non-dialysis patients. Therefore, efforts for early and accurate diagnosis of AMI are needed in dialysis patients with nonspecific complaints of AMI.
Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Dialysis ; Electrocardiography ; Glycosaminoglycans ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Myocardial Infarction ; Retrospective Studies ; Troponin T

PURPOSE: To evaluate the sedative effect of add-on chlorpheniramine in children with neurologic diseases failed to sedate with chloral hydrate and midazolam. METHODS: Thirty three patients who had not been successfully sedated with oral chloral hydrate and intravenous midazolam for diagnostic examinations were attempted for sedation with intravenous chlorpheniramine at Chonnam National University Hospital from September 2007 to September 2012. The sedative effects were compared on the aspects of age, sex, body weight, dosage of drug and underlying neurologic conditions with the retrospective review of medical records. RESULTS: Among 33 patients, 26(78.7%) were successfully sedated and 7(24.2%) failed to sedate. The success rates were different by age and were decreased with age: 100%(0-4y), 84.6%(5-9y), 50%(10-14y). The effectiveness of chlorpheniramine was not significantly different in terms of ages, sex, body weight, dosage of drug and the underlying neurologic conditions-developmental delay, seizures or organic brain lesions. Children with ADHD(attention-deficit hyperactivity disorder), however, showed a significantly lower success rate than the non-ADHD patient group (28.5%, P=0.002). No serious side effects were reported except for one case with transient perioral cyanosis. CONCLUSION: Chlorpheniramine appeared highly effective in children with neurologic diseases who had not been sedated with chloral hydrate and midazolam. The efficacy seemed to be higher in the younger age groups and lower in children with ADHD.
Body Weight ; Brain ; Child ; Chloral Hydrate ; Chlorpheniramine ; Humans ; Hypnotics and Sedatives ; Midazolam ; Retrospective Studies ; Seizures

Pseudoaneurysm of thoracic aorta is very rare but potentially fatal in hemodialysis patients. It results from blunt trauma, cardiovascular surgery, infection, and severe atherosclerosis. Here, we report a case of asymptomatic pseudoaneurysm of thoracic aorta in a hemodialysis patient with sepsis. A 58-year-old man was admitted with a week history of low grade fever and general weakness. He had experienced staphylococcus aureus sepsis with graft infection 6 month ago. Chest X-ray showed severe wall calcification of thoracic aorta and a newly developing round opacity in retrocardiac region. Blood culture demonstrated staphylococcus aureus. Chest computed tomography revealed a large pseudoaneurysm of descending thoracic aorta with disrupted wall calcification.
Aneurysm, False* ; Aorta, Thoracic* ; Atherosclerosis ; Fever ; Humans ; Middle Aged ; Renal Dialysis* ; Sepsis* ; Staphylococcus aureus ; Thorax ; Transplants

Osmotic demyelination syndrome (ODS) is a distinctive clinical syndrome with characteristic MR features in the central pons (central pontine myelinolysis) and in other brain locations (extrapontine myelinolysis). Rapid correction of hyponatremia is associated with ODS, but hyperosmolality rarely causes it. Here we report a case of ODS developed in a hemodialysis patient with severe uremia and concomitant hyperosmolality. A 67-year-old male was presented with general weakness and dyspnea. Laboratory findings showed severe uremia (blood urea nitrogen, 167 mg/dL; serum creatinine, 15 mg/dL), hyperosmolality (336 mOsm/kg H2O), and normal range of sodium (145 mEq/L). After the first hemodialysis treatment, his consciousness was changed to lethargic state. We initially suspected dialysis disequilibrium syndrome, but the symptoms were aggravated. MRI showed edema in central pons and symmetrical extrapotine lesions in the subcortical white matter, lateral thalamus, and posterior capsule, consistent with ODS. In spite of aggressive measures including continuous renal replacement therapy, he died of sepsis at the 26th hospital day.
Aged ; Brain ; Consciousness ; Creatinine ; Demyelinating Diseases* ; Dialysis ; Dyspnea ; Edema ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Male ; Nitrogen ; Pons ; Reference Values ; Renal Dialysis* ; Renal Replacement Therapy ; Sepsis ; Sodium ; Thalamus ; Urea ; Uremia