BACKGROUND: 8,000 children in North Korea died before they reached the 1 year after births in 2013. The high mortality rate of children under five years of age is mainly caused by infectious diseases and malnutrition. The need for national pediatric immunization and supply of vaccines will be vital when the abrupt reunification occurs. OBJECTIVE: The purpose of this study is to scrutinize the pediatric immunization coverage of North Korea. Additionally it is to estimate the amount and the costs needed to vaccinate. METHODS: The target population is the children of North Korea. The method is based on a pre-survey and an interview of North Korea defectors. The target interviewees searched for are as follows; doctors, teachers, and others. The interview includes questions on mortality rates and immunization coverage. The analysis is largely based on the statements of the health care providers within the selected group. RESULTS: The interviewees are 8; 7 female and 1 male. The birth years range from 1956 to 1982. 3 out of 8 are former health care providers; a doctor, a pharmacist, and a nurse. The morbidity rate of infectious diseases exceeds the data from WHO. The immunization coverage is nearly 0% after 1980s. In order to ensure the welfare of North Korean children, at least 8,234,000 vaccine doses, requiring over 105 million U.S. dollars, are needed. CONCLUSION: The morbidity rate of infectious disease in North Korea is conspicuous. The preparation for supply and expenditure of vaccines is vital.
Child ; Communicable Diseases ; Democratic People's Republic of Korea* ; Female ; Health Expenditures ; Health Personnel ; Health Services Needs and Demand ; Humans ; Immunization* ; Male ; Malnutrition ; Mortality ; Parturition ; Pharmacists ; Vaccines

Purpose: To analyze the relationship between corneal morphological factors and polysomnographic factors in patients with obstructive sleep apnea (OSA). Methods: In all, 22 eyes of 22 patients with OSA were analyzed retrospectively under specular microscopy. The central corneal thickness (CCT), endothelial cell density (ECD), hexagonal cell percentage, and cell variation coefficient were measured using specular microscopy, and polysomnographic factors including the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index, and lowest O2 saturation were compared and analyzed between the OSA group and a control group consisting of 32 subjects. Additionally, we examined the statistical correlation between retinal nerve fiber layer (RNFL) thickness and the polysomnographic factors for the 12 OSA patients in which the RNFL thickness was measured. Results: The mean CCT and mean ECD were significantly lower in the OSA group than in controls (p = 0.033, p = 0.021, respectively). As the severity of OSA worsened, a significant negative correlation developed, such that the CCT decreased as the AHI and RDI increased (r = -0.519, p = 0.013 and r = -0.542, p = 0.009, respectively); in addition, the ECD decreased as the RDI increased (r = -0.454, p = 0.034). As OSA progressed, the nasal RNFL thickness decreased with the lowest O2 saturation (r = 0.703, p = 0.011). Conclusions CCT and ECD were significantly lower in OSA patients than in controls and there was a significant correlation between corneal morphological factors and polysomnographic factors. Due to the possibility of hypoxia and various ophthalmic clinical diseases associated with OSA, close observation of ophthalmic abnormalities in OSA patients is required.

Purpose: We report a case of xeroderma pigmentosum in a pediatric patient with a progressive pterygium-like lesion.Case summary: A 2-year-old girl with photophobia and localized, scattered, small, round brownish macules on skin areas exposed to the sun visited hospital. During follow-up, at the age of 7, she was diagnosed with xeroderma pigmentosum in Japan, and pigmented freckles on the upper and lower eyelids of both eyes were observed. At the age of 11, a possible medial limbal pingueculum and lower lid telangiectasis of the right eye were observed via slit-lamp examination, and one year later, a pterygium-like lesion and gradual fibrovascular tissue growth were found in the same location of the right eye. At the last visit, the progressive pterygium-like lesion and, lower lid telangiectasis of the right eye, and lid pigmentations of both eyes (xeroderma pigmentosum) were observed. The size of pterygium-like lesion continues to increase, but the patient remains under observation because the lesion was too small to remove. Conclusions We report the first case of xeroderma pigmentosum in a pediatric patient with a progressive pterygium-like lesion that showed age-related degeneration. We suggest that the pterygium-like lesion may reflect the photosensitivity to ultraviolet radiation characteristic of xeroderma pigmentosum.

Purpose: To analyze the relationship between corneal morphological factors and polysomnographic factors in patients with obstructive sleep apnea (OSA). Methods: In all, 22 eyes of 22 patients with OSA were analyzed retrospectively under specular microscopy. The central corneal thickness (CCT), endothelial cell density (ECD), hexagonal cell percentage, and cell variation coefficient were measured using specular microscopy, and polysomnographic factors including the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index, and lowest O2 saturation were compared and analyzed between the OSA group and a control group consisting of 32 subjects. Additionally, we examined the statistical correlation between retinal nerve fiber layer (RNFL) thickness and the polysomnographic factors for the 12 OSA patients in which the RNFL thickness was measured. Results: The mean CCT and mean ECD were significantly lower in the OSA group than in controls (p = 0.033, p = 0.021, respectively). As the severity of OSA worsened, a significant negative correlation developed, such that the CCT decreased as the AHI and RDI increased (r = -0.519, p = 0.013 and r = -0.542, p = 0.009, respectively); in addition, the ECD decreased as the RDI increased (r = -0.454, p = 0.034). As OSA progressed, the nasal RNFL thickness decreased with the lowest O2 saturation (r = 0.703, p = 0.011). Conclusions CCT and ECD were significantly lower in OSA patients than in controls and there was a significant correlation between corneal morphological factors and polysomnographic factors. Due to the possibility of hypoxia and various ophthalmic clinical diseases associated with OSA, close observation of ophthalmic abnormalities in OSA patients is required.

Purpose: To report two cases of early onset oculopharyngeal muscular dystrophy, which were suspected to be chronic progressive external ophthalmoplegia.Case summary: Case 1, a 15-year-old male and Case 2, a 13-year-old male brother, visited the clinic with persistent diplopia 6 years prior. The older brother’s best-corrected visual acuity was 0.6 in both eyes and showed an exodeviation of 25 prism diopters. Bilateral ptosis was observed with ocular muscle movement limitations in all directions, and bilateral macular edema was found on fundus examinations. The younger brother had a best-corrected visual acuity of 1.0 in both eyes and showed exodeviation of 45 prism diopters. Bilateral ptosis and ocular muscle movement limitations were also observed. Both patients were suspected to have chronic progressive external ophthalmoplegia and were referred to a neurologist for a neurological examination and muscle biopsy. The muscle biopsies showed that both patients were diagnosed with oculopharyngeal muscular dystrophy. Conclusions It is important, initially, to report a case of early onset oculopharyngeal muscular dystrophy that has eyelid and eye movement symptoms, but no other typical symptoms.