Objectives: Community Water Fluoridation (CWF) was suspended in Ansan city in 2018. The purpose of this study was to inspect the status of caries in the permanent teeth of adolescents and suggest the index as the baseline for cohort study in the CWF suspended area. Methods: Oral examinations and questionnaire surveys were conducted on adolescents aged 12 years. Of 1,479 individuals, 890 (60.2%) consented to the examinations. Frequency and logistic regression analyses were used to investigate the status of permanent dental caries by demographic, sociological, and health behavioral characteristics. The study was conducted with approval from IRB Kyung Hee University. Results: The findings reveal gaps in the prevalence of caries among the study sample according to demographic, sociological and health behavioral factors. Rates of untreated caries were higher among adolescents who stayed in the area for a lesser duration, had foreign parents, or had cariogenic drinks more often (p<0.05). Conclusions A gap in untreated caries was observed based on demographic, sociological, and health behavioral factors. The findings of the study suggest the need to monitor oral health following cessation of CWF, along with developing alternative programs in the near future.

Objectives: Community Water Fluoridation (CWF) was suspended in Ansan city in 2018. The purpose of this study was to inspect the status of caries in the permanent teeth of adolescents and suggest the index as the baseline for cohort study in the CWF suspended area. Methods: Oral examinations and questionnaire surveys were conducted on adolescents aged 12 years. Of 1,479 individuals, 890 (60.2%) consented to the examinations. Frequency and logistic regression analyses were used to investigate the status of permanent dental caries by demographic, sociological, and health behavioral characteristics. The study was conducted with approval from IRB Kyung Hee University. Results: The findings reveal gaps in the prevalence of caries among the study sample according to demographic, sociological and health behavioral factors. Rates of untreated caries were higher among adolescents who stayed in the area for a lesser duration, had foreign parents, or had cariogenic drinks more often (p<0.05). Conclusions A gap in untreated caries was observed based on demographic, sociological, and health behavioral factors. The findings of the study suggest the need to monitor oral health following cessation of CWF, along with developing alternative programs in the near future.

BACKGROUND: Transfusion is one of the most important treatments in patient care. It has been known that there is a lack of transfusion medicine knowledge of doctors in other countries, however it has not been investigated yet in Korea. In this study, we assessed the educational need and the knowledge on transfusion medicine for trainees to provide basic raw data for future education in transfusion medicine. METHODS: Transfusion is one of the most important treatments in patient care. It has been known that there is a lack of transfusion medicine knowledge of doctors in other countries, however it has not been investigated yet in Korea. In this study, we assessed the educational need and the knowledge on transfusion medicine for trainees to provide basic raw data for future education in transfusion medicine. RESULTS: Among trainees, 89.9% said they received more than one hour of transfusion medicine education at medical schools, but 57.3% did not receive transfusion medicine education after finishing medical school. Moreover, 76.4% and 86.5% of respondents stated that additional transfusion medicine education was needed during and after medical school respectively. Among respondents, 43.5%, 53.9%, and 28.1% reported their knowledge on blood products, pretransfusion testing, and transfusion reactions as low or very low. In the assessment of knowledge of transfusion medicine, the mean percentage of correct answers was 65.2%. The rates of correct answers (average) ranged from 25.8% to 80.9% (58.2%), 49.4% to 94.4% (75.7%) 70.8% to 89.9% (80.2%) in case of blood products, pretransfusion testing, and transfusion reactions respectively. CONCLUSION: Transfusion medicine education among trainees after finishing medical school was found to be insufficient, and additional education for transfusion medicine is demanded by trainees.
Education ; Korea ; Patient Care ; Schools, Medical ; Surveys and Questionnaires ; Transfusion Medicine* ; Transfusion Reaction

OBJECTIVE: To investigate the interobserver reproducibility and diagnostic feasibility of a visual grading system for assessing atrophy of the supraspinatus muscle on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Three independent radiologists retrospectively evaluated the occupying ratio of the supraspinatus muscle in the supraspinatus fossa on 192 shoulder MRI examinations in 188 patients using a 3-point visual grading system (1, > or = 60%; 2, 30-59%; 3, < 30%) on oblique sagittal T1-weighted images. The inter-reader agreement and the agreement with the reference standard (3-point grades according to absolute occupying ratio values quantitatively measured by directly contouring the muscles on MRI) were analyzed using weighted kappa. The visual grading was applied by a single reader to a group of 100 consecutive patients who had undergone rotator cuff repair to retrospectively determine the association between the visual grades at preoperative state and postsurgical occurrences of retear. RESULTS: The inter-reader weighted kappa value for the visual grading was 0.74 when averaged across three reader pairs (0.70-0.77 for individual reader pairs). The weighted kappa value between the visual grading and the reference standard ranged from 0.75 to 0.83. There was a significant difference in retear rates of the rotator cuff between the 3 visual grades of supraspinatus muscle atrophy on MRI in univariable analysis (p < 0.001), but not in multivariable analysis (p = 0.026). CONCLUSION: The 3-point visual grading system may be a feasible method to assess the severity of supraspinatus muscle atrophy on MRI and assist in the clinical management of patients with rotator cuff tear.
Adult ; Aged ; Feasibility Studies ; Female ; Humans ; Joint Diseases ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscular Atrophy/diagnosis/*pathology ; Observer Variation ; Reference Standards ; Reproducibility of Results ; Retrospective Studies ; Rotator Cuff/*pathology ; Young Adult

Stenotrophomonas maltophilia is an emerging pathogen associated with morbidity and mortality in hospitalized patients. The treatment of S. maltophilia infection is challenging because clinical isolates are frequently resistant to most antimicrobial agents except trimethoprim-sulfamethoxazole (TMP-SMX). S. maltophilia osteomyelitis is a rare disease and requires a prolonged treatment with TMP-SMX. Here, we report an interesting case of a patient with S. maltophilia osteomyelitis who developed a delayed hypersensitivity reaction during TMP-SMX treatment and successfully treated after desensitization. TMP-SMX desensitization should be considered in patients with hypersensitivity to TMP-SMX, especially when there are no effective alternative drugs in S. maltophilia infection.
Anti-Infective Agents ; Desensitization, Immunologic ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Mortality ; Osteomyelitis* ; Rare Diseases ; Stenotrophomonas maltophilia ; Trimethoprim, Sulfamethoxazole Drug Combination*

OBJECTIVES: Renal transplantation has become the ther apy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the num ber of ideal kidneys available for transplantation, increas ing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal def inition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we per formed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mis matched living related kidney transplantation. METHODS: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(> OR =55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retro spectively reviewed. Patient death with a functioning graft was considered graft loss. RESULTS: Demographic characteristics between 2 groups were similar. The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regard less of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly dif ferent (91.4% and 63.9% vs 92.7% and 79.3%, respec tively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). CONCLUSION: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kid neys may be used from donors over 55 years old on con dition that the donors undergo complete and exhaustive work-up.
Cadaver ; Creatinine ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Korea ; Middle Aged ; Parents ; Prejudice ; Survival Rate ; Tissue Donors* ; Transplants

Vogt-Koyanagi-Harada (VKH) disease is a multisystem syndrome characterized by ocular (uveitis and retinal detachment), neurological (headache, tinnitus, and meningitis), and integumentary (vitiligo, alopecia, and poliosis) involvement. Although the pathogenesis of VKH disease is not well understood, an autoimmune T-cell response to a melanocyte-associated antigen is considered to be a cause of VKH disease. The complex immunological response to interferon and ribavirin may induce or exacerbate the autoimmune condition; however, VKH disease is a very rare complication associated with interferon therapy in chronic hepatitis C. We report a case of VKH disease occurring during pegylated interferon-alpha2b and ribavirin combination therapy for chronic hepatitis C.
Anti-Inflammatory Agents/therapeutic use ; Antiviral Agents/*adverse effects/therapeutic use ; Drug Therapy, Combination ; Female ; Fluorescein Angiography ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon Alfa-2b/*adverse effects/therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Polyethylene Glycols/*adverse effects/therapeutic use ; Prednisolone/therapeutic use ; Ribavirin/*adverse effects/therapeutic use ; Tomography, X-Ray Computed ; Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy/etiology

PURPOSE: Tissue adhesion is a well-known postsurgical phenomenon, causing pain, functional obstruction, and difficult reoperative surgery. To overcome these problems, various synthetic and natural polymer membranes have been developed as postoperative tissue adhesion barriers. However, limitation in their use has hindered its actual application. We prepared a hyaluronate membrane (HM) to evaluate its efficacy and safety as an adhesion barrier compared to a commercialized product (Interceed, Ethicon). METHODS: To evaluate the antiadhesion effect, a cecum-abdominal wall abrasion model was adopted in a rabbit. The denuded cecum was covered by Interceed or HM or neither and apposed to the abdominal wall (each, n = 10). Four weeks after surgery, the level of adhesion was graded. Acute and chronic toxicity of the three groups were also evaluated. RESULTS: Blood samples drawn to evaluate acute toxicity at postoperative day 3 and 7 showed no significant difference among the three groups. The grade and area of adhesion were significantly lower in the HM compared to those of the control and Interceed at four weeks after surgery. Histologic evaluations, which was carried out to estimate tissue reactions at the site of application, as well as to assess chronic toxicity for the major organs, were not significantly different in the three groups. CONCLUSION: This study showed that the antiadhesion efficacy of HM was superior to commercialized antiadhesion membrane, Interceed. Low inflammatory response and nontoxicity were also demonstrated. From these results, we suggest that the HM is a good candidate as a tissue adhesion barrier.
Abdominal Wall ; Cecum ; Cellulose, Oxidized ; Hyaluronic Acid ; Membranes ; Polymers ; Tissue Adhesions

We describe a 37-yr-old man who developed central pontine myelinolysis (CPM) after allogeneic hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia. After HSCT, desquamation developed on the whole body accompanied by hyperbilirubinemia. The liver biopsy of the patient indicated graft-versus-host disease- related liver disease, and the dose of methylprednisolone was increased. Then, the patient developed altered mentality with eye ball deviation to the left, for which electroencephalogram and magnetic resonance imaging (MRI) scans were done. Brain MRI scan demonstrated the imaging findings consistent with central pontine myelinolysis and extrapontine myelinolysis. He did not have any hyponatremia episode during hospitalization prior to the MRI scan. To the best of our knowledge, presentation of CPM after allogeneic HSCT is extremely rare in cases where patients have not exhibited any episodes of significant hyponatremia. We report a rare case in which hepatic dysfunction due to graft-versus-host disease has a strong association with CPM after HSCT.
Adult ; Biopsy ; Brain/pathology ; Electroencephalography ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Hyperbilirubinemia/etiology ; Liver/pathology ; Magnetic Resonance Imaging ; Male ; Myelinolysis, Central Pontine/complications/*etiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/*therapy ; Time Factors ; Treatment Outcome

PURPOSE: Identification of tolerable alternative analgesics is crucial for management in nonsteroidal anti-inflammatory drug (NSAID)-sensitive patients. We investigated cross-reactivity of acetaminophen and celecoxib according to the type of aspirin/NSAID hypersensitivity and aimed to determine the risk factors for cross-intolerance. METHODS: We retrospectively reviewed the medical records of patients intolerant to aspirin and NSAIDs who had undergone an acetaminophen and/or celecoxib oral provocation test. Aspirin/NSAID hypersensitivity was classified into 4 types according to a recently proposed classification: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated chronic urticaria (AECU), aspirin-induced acute urticaria/angioedema (AIAU), and NSAID-induced blended reaction (NIRD). RESULTS: A total of 180 patients with hypersensitivity to aspirin and NSAIDs were enrolled; 149 acetaminophen provocation test results and 145 celecoxib provocation test results were analyzed. The overall cross-reaction rates to acetaminophen and celecoxib were 24.8% and 10.3%, respectively. There was a significant difference in the cross-reactivity to acetaminophen according to the type of NSAID hypersensitivity. Cross-reactivity to acetaminophen was highest in the AECU group (43.9%), followed by the AERD (33.3%), NIBR (16.7%), and AIAU (12.5%) groups. Underlying chronic urticaria was more prevalent in patients with cross-intolerance to both acetaminophen (P=0.001) and celecoxib (P=0.033). Intolerance to acetaminophen was associated with intolerance to celecoxib (P<0.001). CONCLUSIONS: Acetaminophen and celecoxib may induce adverse reactions in a non-negligible portion of aspirin/NSAID-sensitive patients. Physicians should be aware of the possible cross-reactions of these alternative drugs and consider an oral challenge test to confirm their tolerability.
Acetaminophen* ; Analgesics ; Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Classification ; Cross Reactions ; Drug Hypersensitivity* ; Humans ; Hypersensitivity ; Medical Records ; Methods ; Retrospective Studies ; Risk Factors ; Urticaria ; Celecoxib