PURPOSE: Streptococcus pyogenes is an important cause of invasive diseases in children. We aimed to describe the clinical characteristics of invasive infections due to S. pyogenes in children in Korea. METHODS: A retrospective study of children under 18 years of age with invasive infections due to S. pyogenes at Seoul National University Children's Hospital between March 1992 and December 2012, and Seoul National University Bundang Hospital between March 2003 and December 2012 was conducted. Demographic factors, clinical characteristics, laboratory findings, treatment, mortality and morbidity of all patients were reviewed. RESULTS: A total of 30 among 36 cases identified as invasive disease due to S. pyogenes were available for review. There was a predominance for male subjects (male:female=2.75:1). The median age was 50 months (range 12 days to 15 years) and 53.3% were under 5 years of age. Skin and soft tissue infections (9/30, 30.0%), bacteremia without identified focus (4/30, 13.3%) and bone and joint infections (6/30, 20.0%) were the most frequent clinical presentations. Streptococcal toxic shock syndrome (3/30, 10.0%) pulmonary, abdomen and central nervous system infections (2/30, 6.7%) were also seen. There was a peak in number of patients in year 2012 (9/30, 30.0%). There were no cases of mortality. Erythromycin and clindamycin resistance rates were low by 3.8% and 7.5%, respectively. CONCLUSION: We studied the clinical presentations of invasive infections due to S. pyogenes during the past 20 years in Korean children. The findings of this study help us understand the characteristics of the disease, enhancing early recognition and prompting adequate antibiotic therapy which is important in reducing morbidity and mortality.
Abdomen ; Bacteremia ; Bacterial Infections ; Central Nervous System Infections ; Child* ; Clindamycin ; Demography ; Erythromycin ; Humans ; Joints ; Korea ; Male ; Mortality ; Retrospective Studies ; Seoul ; Shock, Septic ; Skin ; Soft Tissue Infections ; Streptococcus pyogenes*

The present study investigated caffeinated beverage consumption and screen time in the association with excessive daytime sleepiness (EDS) and sleep duration. We conducted a cross-sectional study including 249 Korean male high school students. These participants responded to a questionnaire inquiring the information on lifestyle factors, consumption of caffeinated beverages, time spent for screen media, and sleep duration as well as to the Epworth Sleepiness Scale (ESS) questionnaire. EDS was defined as ESS scores of 9 or greater. Students with EDS consumed greater amount of chocolate/cocoa drinks and spent longer time for a TV and a mobile phone than those without EDS (p < 0.05). In addition, students with short sleep (≤ 6 hours) consumed greater amount of coffee than others whereas students with long sleep (> 8 hours) consumed greater amount of chocolate/cocoa drinks than others (p < 0.05). Screen time did not differ according to the categories of sleep duration. Although these findings do not support causal relationships, they suggest that screen time is associated with EDS, but not with sleep duration, and that consumption of certain types of caffeinated beverages is associated with EDS and sleep duration. Adolescents may need to reduce screen time and caffeine consumption to improve sleep quality and avoid daytime sleepiness.
Adolescent ; Beverages* ; Caffeine ; Cell Phones ; Coffee ; Cross-Sectional Studies ; Humans ; Life Style ; Male

Interleukin-17 (IL-17) is secreted by a class of helper T cells called Th17 cells, which stimulates keratinocytes to secrete proinflammatory mediator and to recruit other inflammatory cells in psoriatic skins. IL-17A inhibitor was approved for the management of psoriatic arthritis by FDA. It is the one of the biologics approved as first-line therapy for the management of psoriasis. But several studies show some side effects of IL-17A inhibitor such as upper respiratory infection and fungal infection like Candida albicans. Herein we report a widespread dermatophytosis during IL-17A inhibitor treatment. A 66-year-old male patient, with tinea unguium and chronic plaque psoriasis for several decades, presented with multiple erythematous scaly macules and patches for 2 weeks. He medicated IL-17A inhibitor for treating psoriasis total 3 times and last injection was 1 week ago. Dermatological examination revealed the involvement of 20% body surface area in the form of erythematous scaly macules and patches. KOH mount revealed the presence of numerous hyphae. The patient was started on oral terbinafine, topical isoconazole and efinaconazole. His skin lesions were improved after 1 month of anti-fungal therapy. IL-17 plays an important role in mucocutaneous microbial defense. So, fungal infection should be checked in using IL-17A inhibitor patients periodically.

Background: Despite the increasing number of syphilis cases, there has been a considerable lack of recent data comparing the efficacy and duration of benzathine penicillin G, ceftriaxone, and tetracycline in Korean patients. Objective: To compare the efficacy and duration of benzathine penicillin, ceftriaxone, and tetracycline in Korean patients with syphilis. Methods: We retrospectively reviewed 145 cases of syphilis from 2004 to 2019 and statistically analyzed the treatment efficacy and duration. Results: Patients in the benzathine penicillin, ceftriaxone, and tetracycline treatment groups showed no significant statistical difference in terms of treatment rate (chi-square test, p=0.962). Similarly, treatment duration among groups was not statistically significant (one-way analysis of variance, p=0.792). Co-infection with human immunodeficiency virus resulted in reduced treatment rate (p=0.016) and increased treatment duration (p=0.007). Conclusion This retrospective study showed no significant difference between penicillin, ceftriaxone, and tetracycline in terms of treatment rate and duration. However, a difference in treatment rate and duration was evident between the non-infection and HIV co-infection groups.ng

Little is known as to why elevated red cell distribution width (RDW) is associated with adverse clinical outcomes in patients with atrial fibrillation (AF). We hypothesized that RDW value might predict the intensity of anticoagulation, resulting in higher adverse events in patients with AF taking warfarin. We analyzed 657 patients with non-valuvular AF who took warfarin. The intensity of anticoagulation was assessed as mean time in the therapeutic range (TTR) and defined TTR ≥60% as an optimal intensity. The primary end-point was the composite of stroke/systemic embolism and major bleeding. The secondary end-point was the composite of stroke/systemic embolism, major bleeding and death. The relationship between the baseline RDW with TTR and clinical outcomes was assessed using categorical variables as quartiles or dichotomous variables. The mean value of TTR decreased as an increment of the RDW (45.2% vs. 44.7% vs. 40.8% vs. 35.2%, p < 0.001). Primary and secondary end-points were significantly increased when TTR was less than 60% and RDW was more than 13.6%. Ratio of patients achieving optimal anticoagulation were significantly decreased as an increment of RDW. A RDW of ≥13.6% was a significant predictor for poor anticoagulation control (adjusted Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23–0.82), stroke (adjusted hazard ratio [HR] 3.86, 95% CI 1.11–13.40), primary (adjusted HR 1.88, 95% CI 1.12–3.16) and secondary end-point (adjusted HR 2.46, 95% CI 1.26–4.81). RDW was negatively associated with TTR in patients with AF. Therefore, RDW might be a useful marker for the prediction of anticoagulation response and clinical outcomes in patients with AF.
Anticoagulants ; Atrial Fibrillation* ; Embolism ; Erythrocyte Indices* ; Hemorrhage ; Humans ; Odds Ratio ; Prognosis ; Stroke ; Warfarin

Data are limited on the association between dietary patterns and screen time among Korean adolescents. The present study identified dietary patterns of 691 adolescents, aged 13-18 years, who had participated in the Third Korean National Health and Nutrition Examination Survey (KNHANES III) and analyzed their associations with screen time. Screen time was defined as the time spent watching TV, using a computer, or playing video games was calculated as a sum of all these times. Dietary patterns and their factor scores were derived from a food frequency questionnaire using the factor analysis method. To analyze the association between dietary patterns and screen time, we conducted multiple linear regression analysis. We also performed multiple logistic regression analysis to estimate odds ratios (OR) of excessive screen time (2 hours or longer per day) and 95% confidence intervals (CI). We identified 2 dietary patterns labeled "the Korean healthy dietary pattern" and "the Western diet and fast foods pattern". The former included mixed grains, legumes, potatoes, red meat, eggs, fish, dairy products, fruits, vegetables, seaweeds, and mushrooms, whereas the latter included noodles, bread, red meat, poultry, fast foods, snack, and soft drinks. After controlling for potential confounding factors, factor scores for the Korean healthy dietary pattern were inversely associated (P-value for trend < 0.01) and those for the Western diet and fast foods pattern were positively associated with the screen time (P-value for trend < 0.01). Adolescents in the top tertile of the scores for the Korean healthy dietary pattern had a multivariable-adjusted OR [95% CI] of 0.44 (0.25-0.75) for excessive screen time compared with those in the lowest tertile. On the basis of these findings, adolescents who have excessive screen time may need to be encouraged to consume a more healthy diet.
Adolescent ; Agaricales ; Aged ; Bread ; Carbonated Beverages ; Edible Grain ; Dairy Products ; Diet ; Eggs ; Fabaceae ; Fast Foods ; Fruit ; Humans ; Linear Models ; Logistic Models ; Meat ; Nutrition Surveys ; Odds Ratio ; Ovum ; Poultry ; Surveys and Questionnaires ; Snacks ; Solanum tuberosum ; Vegetables ; Video Games

BACKGROUND: Flow cytometric crossmatching (FCXM) is widely used in hospitals performing solid organ transplantation. Pronase treatment of lymphocytes can increase the sensitivity and specificity of B-cell FCXM. However, it can also affect human leukocyte antigen (HLA) expression and results of FCXM. We treated lymphocytes with various concentrations of pronase and analysed the effect of the treatment on the FCXM results. METHODS: The peripheral blood mononuclear cells isolated from 10 renal transplant donors were treated with three different concentrations of pronase (0.5, 1.0, and 2.0 mg/mL). The effects of pronase on median fluorescence intensity (MFI) values of AB serum (Fcγ receptor), HLA class I and II, and on the MFI ratio of HLA class I and II were analysed. RESULTS: In B-cell FCXM, the MFI values of AB serum (Fcγ receptor) and HLA class I were significantly decreased by the pronase treatment. The MFI ratio of HLA class II was significantly increased upon treatment with 0.5, 1.0, and 2.0 mg/mL pronase (P<0.05, P<0.01, and P<0.01, respectively). In T-cell FCXM, the MFI ratio of HLA class I was significantly decreased by the pronase treatment (all P<0.01). CONCLUSIONS: When performing FCXM, it is recommended that B-lymphocytes should be treated with 1.0 or 2.0 mg/mL pronase. In the case of T-lymphocytes, pronase treatment should be adopted with caution.
B-Lymphocytes ; Flow Cytometry ; Fluorescence ; Humans ; Leukocytes ; Lymphocytes ; Organ Transplantation ; Pronase* ; Sensitivity and Specificity ; T-Lymphocytes ; Tissue Donors ; Transplants

In this study, the Autokit Total Ketone Bodies kit (Wako Pure Chemical, Japan), a total ketone measurement assay using an enzymatic method, was evaluated using a Roche Cobas e702 instrument (Roche Diagnostics, Germany). Precision, linearity, carryover, and reference range verification were evaluated with reference to Clinical Laboratory Standards Institute guidelines. Standard materials provided by the manufacturer and patient samples were used for the evaluation. The precision and carryover of the evaluation result satisfied the acceptance criteria. Linearity was also acceptable at more than 0.99. The quantitative Autokit Total Ketone Bodies kit is precise, and can be widely used in clinical laboratories.
3-Hydroxybutyric Acid ; Evaluation Studies as Topic ; Humans ; Ketone Bodies* ; Methods ; Reference Values

Clinical outcomes of living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) in patients with multiple myeloma (MM) have not been established in terms of HCC recurrence and MM deterioration after LDLT. A 51-year-old man with chronic hepatitis B was diagnosed with HCC and MM. Since the patient also had decompensated liver cirrhosis (LC), he underwent LDLT prior to autologous peripheral blood stem cell transplantation (PBSCT) to prevent fulminant hepatitis due to HBV reactivation. The patient received Epstein-Barr virus prophylaxis and a triple immunosuppressive regimen of tacrolimus, everolimus, and steroid after LDLT. Autologous PBSCT was performed 7 months after LDLT. He showed a complete response to treatment of MM without post-LT complications or HCC recurrence. In conclusion, LDLT could be adapted for treatment of MM patients with combined HCC and decompensated LC because it is an effective strategy of preventing HBV reactivation and HCC recurrence after induction therapy of MM.
Carcinoma, Hepatocellular* ; Everolimus ; Hepatitis B, Chronic ; Hepatitis* ; Herpesvirus 4, Human ; Humans ; Liver Cirrhosis* ; Liver Transplantation* ; Liver* ; Living Donors* ; Middle Aged ; Multiple Myeloma* ; Peripheral Blood Stem Cell Transplantation ; Recurrence ; Tacrolimus