Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the PfizerBioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks.This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.

Objective: This study standardizes the Parental Stress Scale (PSS) for Republic of Korean parents of children with attention-deficit/hyperactivity disorder (ADHD) and verifies its reliability and validity. Methods: Data from 160 parents of children with ADHD who completed the following self-reported questionnaires were analyzed: the Korean ADHD Rating Scales, the Patient Health Questionnaire-9, the State–Trait Anxiety Inventory, the PSS, and the Global Assessment of Recent Stress Scale. All scale items were measured for reliability and validity, and the appropriate factors for measuring stress in Korean parents with ADHD children were extracted. Results: Exploratory and confirmatory factor analyses derived two sub-factors and 11 items. Goodness of fit was confirmed, and the scale was deemed suitable for explaining stress in parents of children with ADHD. Conclusion In this study, the validity and reliability of the K-PSS-ADHD were investigated. We expect that the K-PSS-ADHD will be used as a basis for future studies on stress in parents of children with ADHD.

PURPOSE: Depression is common in patients with chronic renal failure on maintenance hemodialysis, though success rate of treatment is low. This study aimed to investigate the features and severity of the depressive symptoms and nutritional indices, and significant changes after antidepressant treatment. METHODS: The authors assessed 45 patients. Diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using Hamilton Rating Scale for Depression via semi- structured interview. Subjective global assessment, anthropometric measurements and nutritional indices such as Kt/V, nPCR were examined. Depressive patients were treated for 8 weeks with SSRI (citalopram), and all the variables were examined again after the treatment. RESULTS: 19 (42.2%) patients were diagnosed as depression. Nutritional status was not different between patients with depression and those without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, guilty feeling, suicide idea, psychic and somatic anxiety, lower work and activities, psychomotor retardation, sleep disturbances, general somatic symptoms and hypochondriasis. After antidepressant treatment, depressed mood, guilty feeling, suicide idea, psychic anxiety, initial insomnia, middle insomnia, early awakening, work and activities and general somatic symptoms were improved significantly. TSF (p<0.05), handgrip strength (p<0.01) and hematocrit (p<0.05) were significantly increased. CONCLUSION: Antidepressant treatment is helpful not only for the improvement of depressive symptoms such as sleep and somatic symptoms but for the improvement of quality of life. Proper treatment should be more actively attempted for the hemodialytic patients with depression.
Anxiety ; Depression ; Hematocrit ; Humans ; Hypochondriasis ; Kidney Failure, Chronic ; Nutrition Assessment ; Nutritional Status ; Quality of Life ; Renal Dialysis ; Sleep Initiation and Maintenance Disorders ; Suicide ; Tosyl Compounds

BACKGROUND: Carcinoembryonic antigen (CEA), a serological marker of malignant tumors, demonstrates a modest increase under nonmalignant conditions such as aging and smoking. Also, recent study results suggested that serum CEA levels may be related to insulin resistance or low-grade inflammation. The aim of this study was to investigate the factors associated with serum CEA levels in healthy non-smokers. METHODS: Data was gathered from 21,501 adults aged 20 and over. We excluded 19,081 subjects who had omissions in anthropometric measurements or laboratory tests, or who had previous or current smoking history. RESULTS: The mean CEA level was 1.18 +/- 0.85 ng/dL in males and 0.93 +/- 0.73 ng/dL in females. After adjustment for age, CEA level was positively correlated with fasting glucose, glycosylated hemoglobin (HbA1C), high density lipoprotein (HDL) cholesterol, estimated glomerular filtration rate in males. In females, CEA level was positively correlated with fasting glucose, HbA1C, HDL cholesterol, aspartate aminotransferase, and high-sensitivity C-reactive protein. In both gender groups, HbA1C had a strong influence on CEA levels when all other variables were included in the regression model (P < 0.05). CONCLUSION: Within normal range, serum CEA levels were significantly associated with HbA1C levels but not with homeostasis model assessment of insulin resistance in the non-smoking population. These findings suggest that serum CEA levels are influenced by the glucose level itself instead of insulin resistance.
Adult ; Aging ; Aspartate Aminotransferases ; C-Reactive Protein ; Carcinoembryonic Antigen* ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Fasting ; Female ; Glomerular Filtration Rate ; Glucose ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Inflammation ; Insulin Resistance ; Lipoproteins ; Male ; Reference Values ; Smoke ; Smoking

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.
Anesthesia, General ; Dexamethasone ; Female ; Humans ; Intubation ; Laryngoscopy ; Lingual Nerve Injuries ; Lingual Nerve ; Macroglossia ; Middle Aged ; Radius Fractures ; Tongue

BACKGROUND: This study was conducted to compare two models of the pediatric logistic organ dysfunction (PELOD) score and the pediatric index of mortality (PIM) 2 score in the emergency department (ED) and intensive care unit (ICU). METHODS: 90 pediatric patients who were admitted to the ICU in ED from January 2003 to December 2008 were enrolled in this study. PELOD score and PIM 2 score calculations were performed in the ED and ICU. We classified these patients into either the survivor or non-survivor groups and analyzed the clinical variables between two groups. We used Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration, receiver operating characteristic (ROC) curves and standardized mortality ratio (SMR). RESULTS: Among the 90 pediatric patients, 56 (62.2%) were male, and 9 (10.0%) patients died. Expected mortalities were PIM 2 = 10.35, PELOD = 8.33 in ED and PIM 2 = 8.84, PELOD = 8.26 in ICU. PIM 2 showed fit calibration (x(2) = 6.228, p = 0.622) in the ED. In the ICU, both PELOD and PIM 2 showed calibration (x(2) = 4.625, p = 0.185) and (x(2) = 7.616, p = 0.472), respectively. PIM 2 in ED showed the best discrimination, with area under the curve (AUC) = 0.949 (95% CI, 0.881-0.984). CONCLUSIONS: PIM 2 score in ED was fit. Also, PELOD and PIM 2 score in ICU was fit. But PELOD in ED was unfit.
Calibration ; Discrimination (Psychology) ; Emergencies ; Humans ; Critical Care ; Intensive Care Units ; Male ; Pediatrics ; Prognosis ; ROC Curve ; Survivors

Mercuric chloride, a model nephrotoxicant was used to elucidate time- and dose-dependent global gene expression changes associated with proximal tubular toxicity. Rat kidney cell lines NRK-52E cells were exposed for 2, 6 and 12 hours and with 3 different doses of mercuric chloride. Cell viability assay showed that mercuric chloride had toxic effects on NRK-52E cells causing 20% cell death (IC20) at 40micrometer concentration. We set this IC20 as high dose concentration and 1/5 and 1/25 concentration of LC20 were used as mid and low concentration, respectively. Analyses of microarray data revealed that 738 genes were differentially expressed (more than two-fold change and p<0.05) by low concentration of mercuric chloride at least one time point in NRK-52E cells. 317 and 2,499 genes were differentially expressed at mid and high concentration of mercuric chloride, respectively. These deregulated genes showed a primary involvement with protein trafficking (CAV2, CANX, CORO1B), detoxification (GSTs) and immunity and defense (HMOX1, NQO1). Several of these genes were previously reported to be up-regulated in proximal tubule cells treated with nephrotoxicants and might be aid in promoting the predictive biomarkers for nephrotoxicity.
Animals ; Cell Death ; Cell Line ; Cell Survival ; Gene Expression ; Kidney ; Mercuric Chloride ; Protein Transport ; Rats ; Biomarkers

PURPOSE: This study was conducted to see the effect of alcohol ingestion on clinical features of acute drug intoxicated patients. METHODS: We prospectively investigated drug intoxicated patients who visited the emergency department 6 hours after acute poisoning from January 2004 to December 2007. Patients were classified into two groups according to serum alcohol levels: an alcohol group (serum alcohol level>10 mg/dl) and a non-alcohol group. The type of toxic material, age, sex, duration of time to arrive to the emergency department (ED) after poisoning, mean arterial pressure, respiratory rate, base excess level, AST level, serum creatinine level, cause of poisoning, suicide attempt, past psychiatric history, discharge against medical advice rate, and admission rate were checked. The initial and final Poisoning Severity Score (PSS), the Glasgow coma scale, the length of stay in the intensive care unit (ICU), the usage of a mechanical ventilator, and death rate were also checked. RESULTS: The study enrolled 222 intoxicated patients of which 75 fell into the non-alcohol group and 147 into the alcohol group. Alcohol ingestion of acute poisoning in males was higher than in females. The AST level and discharge against medical advice rates in the alcohol group were higher than the non-alcohol group. The base excess level, length of stay in ICU, past psychiatric history rate, and admission rates in the non-alcohol group were higher than the alcohol group. The PSS were not correlated with alcohol consumption between the two groups. CONCLUSION: Alcohol ingestion is not associated with PSS. However, alcohol ingestion is commonly found in acute drug intoxicated patients. The discharge against medical advice rate in the alcohol group was higher than the non-alcohol group.
Alcohol Drinking ; Arterial Pressure ; Creatinine ; Eating ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Prospective Studies ; Respiratory Rate ; Severity of Illness Index ; Suicide ; Ventilators, Mechanical

BACKGROUND: Incidents of suicide attempts and acute poisonings in the elderly population is rising. This study com- pared elderly and younger patients to investigate the influence of age on the clinical nature of acute poisoning. METHODS: We retrospectively investigated 147 patients with acute poisoning who visited the emergency department within 6 hours of exposure. Patients were divided into two groups, young adult(20-40 yrs) and elderly(> or =55 yrs). Information on type of toxic material, age, sex, duration of time to arrive to the emergency department(ED) after poisoning, cause of poisoning, usage of activated charcoal and gastric lavage, previous suicide attempts, and past psy- chiatric history were collected. And, the mean arterial pressure, respiratory rate, base excess, aspartate aminotransfe- rase(AST), serum creatinine, rate of discharge against medical advice, intensive care unit(ICU) admission rate, discharge rate, duration in ICU, usage of mechanical ventilator, and death rate were analyzed. Initial and final Poisoning Severity Scores(PSS) of each patient were calculated. RESULTS: The mean age of the young adult group and the elderly group were 30.6+/-6.1 yrs and 66.6+/-8.2 yrs, respectively. Cause of poisoning was accidental more often in the elderly group than in the young adult group. AST and creatinine levels were higher and base excess was lower in the elderly group. ICU admission rate, duration in ICU, usage of mechanical ventilator, death rate, and initial and final PSS were all higher in the elderly group as well. CONCLUSION: This study showed that the PSS and death rate from acute poisoning were higher in the elderly group than in the young adult group.
Aged ; Arterial Pressure ; Aspartic Acid ; Charcoal ; Creatinine ; Emergencies ; Gastric Lavage ; Humans ; Critical Care ; Respiratory Rate ; Retrospective Studies ; Suicide ; Ventilators, Mechanical ; Young Adult

This study was performed to evaluate the effects of microstructural change of zirconia surface on tensile bond strength with resin cement. The zirconia partially sintered block was cut into a size of 18 × 18 × 7 mm, and then the Zirface slurry (DMAX, Daegu, Korea) containing 15% and 30% zirconia was applied and followed by sintering at 1530 ℃ for 2 hours. Resin cement (PermaCem 2.0, DMG, Hamburg, Germany) was applied on zirconia specimen and polymerized to prepare an 18 × 18 × 14 mm block. In addition, for comparison of bond strength, specimens were prepared for the group that was polished and the group that was blasted at 3 atm using 110 µm alumina. Thereafter, all blocks were cut into a cross-sectional area of 1.0 × 1.0 mm to prepare 12 specimens. The specimens were immersed in distilled water at 37 ℃. for 10 days for aging treatment. A holder for tensile testing was attached to each of the specimens, and then a tensile force was applied at a crosshead speed of 0.5 mm/min to measure the fracture load. The fracture surfaces of each test piece was observed with a high-resolution field emission scanning electron microscope. Through the above tests, the following results were obtained. 1. On the blasted surface, zirconia grains were locally removed but on the Zirface treated surface, a porous microstructure was created on the zirconia surface. 2. Arithmetical mean deviation from the mean line ra was the highest in the blasted group and the lowest in the polished group, and as a result of Tukey analysis, there were statistically significant differences between all test groups (P<0.05). 3. The maximum tensile bond strength was 18.8±5.4 MPa in the Zirface 30% group, and as a result of Tukey analysis, there was a statistically significant difference from the other test groups (P<0.05). 4. As a result of observing the fracture surface after the tensile test with a high-resolution field emission scanning electron microscope, in the Zirface 30% group, cohesive fracture and interfacial fracture in the resin was observed, but the other test groups showed the interfacial fracture pattern. In conclusion, within the limits of this study, treating the zirconia surface with Zirface 30% to form a porous microstructure can contribute to the improvement of the bond strength between zirconia and resin cement.