PURPOSE: To determine whether pain control using fentanyl would effectively reduce behavioral distress, physiologic and hormonal responses to postoperative pain and mechanical ventilation in neonates. METHODS: Neonates who were admitted to the NICU(neonate intensive care unit) of Kyungpook University Hospital, requiring surgery or mechanical ventilation were evaluated. Twelve neonates undergoing operation were randomised into two groups. After operation, one group received fentanyl and the other was given saline. Behavioral distress using postoperative comfort scores, heart rate, blood pressure and blood glucose were evaluated before and after operation. Cortisol concentration and beta endorphin were measured before and at the end of operation and at 60 minutes after fentanyl infusion. The values were compared between the two groups. In eight neonates on mechanical ventilation, behavioral distress using pain scores, heart rate, blood pressure, oxygen saturation and concentrations of cortisol and beta endorphin were measured before and 60 minutes after fentanyl infusion. RESULTS: In neonates undergoing surgery, fentanyl infusion diminished the elevation of post operation heart rate and blood glucose(P<0.05) and induced the improvement of postoperation comfort scores(P<0.05). Cortisol levels were significantly lower in neonates receiving fentanyl(P< 0.01) at 60min after infusion. In neonates on mechanical ventilaion, fentanyl infusion diminished the elevation of systolic blood pressure and heart rate on endotracheal suction(P<0.05). At 60 minutes after infusion, cortisol levels were markedly lower in neonates receiving fentanyl(P<0.05). CONCLUSION: Neonates feel pain during postoperation and on mechanical ventilation. As fentanyl therapy appears to be effective in controlling the pain, anaesthetic agents should be given to all neonates undergoing painful procedures or under painful situations.
beta-Endorphin ; Blood Glucose ; Blood Pressure ; Fentanyl* ; Gyeongsangbuk-do ; Heart Rate ; Humans ; Hydrocortisone ; Infant, Newborn* ; Critical Care* ; Oxygen ; Pain, Postoperative ; Respiration, Artificial

PURPOSE: Early detection and proper treatment of retinopathy of prematurity (ROP) is crucial. The postnatal age of 4-6 weeks has been considered the most optimal time to screen the high risk infants for ROP. However, ROP rarely appears even before this period of age and we experienced several cases ROP detected before 4 weeks of age at NICU of Kyungpook University Hospital. This study was conducted to evaluate the most optimal time of first ophthalmic examination for ROP screening. METHODS: A retrospective analysis of ROP screening records of 106 infants who admitted to the NICU of Kyungpook University Hospital from January 1996 to March 1999 was performed. Infants with a gestational age <34 weeks, birth weight <1,500 gm and perterm infants who exposed to supplemental oxygen were included in this study. ROP infants were grouped according to birth weight : Group I (birth weight > or =1,500 gm) and Group II (birth weight <1,500 gm). Ophthalmic examinations were commenced between 3 weeks and 6 weeks postnatal age and recorded using the International Classification of ROP. RESULTS: Out of 106 infants screened, 35 infants were found to have some degree of ROP in at least one eye on at least 1 occasion. Of 35 infants with ROP, 11 infants were screened before the postnatal age 4 weeks. Eight ROP, including one stage 3 ROP, were detected at this first ophthalmic examination. Review for the time of first detection of ROP by postconceptional age revealed that stage 3 ROP and threshold ROP did not develop before 34 weeks. Postnatally ROP developed and progressed earlier in Group I than in Group II. The time of onset and highest stage represented by postnatal age in Group I and II were 28+/-7 days, 57+/-19 days and 32+/-15 days, 69+/-26 days respectively. The time of onset and highest stage represented by postconceptional age in Group I and II were 35.4+/-2.3, 36.3+/-2.9 weeks and 36.0+/-1.6, 38.0+/-3.6 weeks respectively, revealed no significant difference between two groups. CONCLUSION: These data indicate that the time of onset and progression of ROP are correlated more closely with postconceptional age than with postnatal age. In other words, the postconceptional age is superior to postnatal age in determining when to initiate ROP examination. Our study suggests that screening infants at 34 weeks postconceptional age seems to reliable for early detection of severe ROP in larger, and more mature preterm infants.
Birth Weight ; Classification ; Gestational Age ; Gyeongsangbuk-do ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Mass Screening* ; Oxygen ; Retinopathy of Prematurity* ; Retrospective Studies

Necrotizing enterocolitis(NEC) is considered to be the leading cause of intestinal perforation in extremely low birth weight infants. We have seen an infant with intestir 1 perforation whose clinical, surgical and histopathological features were different from the presenting features of NEC. A male infant, the 995 gm product of 29-week gestation revealed intermittent abdominal distension which was managed conservatively with fluid and antibiotics. On the nineteenth day of life, free peritoneal air was seen on radiograph, and laparotorny was performed. At surgery, a discrete perforation was found in the terminal ileum. The intestine surrounding the perforation appeared normal without evidence of NEC. Biopsy specimen at the site of perforation was noted to have Candida invading the bowel wall. All blood cultures obtained before surgery were subsequently negative.
Anti-Bacterial Agents ; Biopsy ; Candida* ; Humans ; Ileum ; Infant ; Infant, Extremely Low Birth Weight* ; Infant, Low Birth Weight ; Infant, Newborn ; Intestinal Perforation* ; Intestines ; Male ; Pregnancy

Carbol fuchsin is a mixture of phenol and basics fuchsin, used in bacterial staining procedures. It is a component of Ziehl-Neelsen stain. Phenol in Carbol fuchsin is a toxic agent which can lead to various gastrointestinal, ocular, skin, neurologic and renal side effects. We hereby report a case of Carbol fuchsin poisoned patient. Acute renal failure with metabolic acidosis was rapidly progressed. However, she was treated successfully by continuous veno-venous hemodiafiltration.
Acidosis ; Acute Kidney Injury ; Dialysis ; Hemodiafiltration ; Hemoperfusion ; Humans ; Phenol ; Rosaniline Dyes ; Skin

PURPOSE: We compared the therapeutic efficacy of low dose with that of standard dose of interferon (IFN) treatment and also compared the first IFN treatment with retreatment. METHODS: We have studied 51 children (age, 2~14) treated for chronic hepatitis B from March 1990 to August 1999. Twenty seven children had been treated with 3 MU/m2 (2.66+/-0.66 MU/m2) of IFN-alpha three times a week for 6 months (range, 6~12 months), whereas 24 children with 6 MU/m2 (4.45+/-0.94 MU/m2). There was no significant difference in gender, age, initial ALT and HBV DNA levels between each comparative group. RESULTS: Among the 27 children treated with 3 MU/m2 of IFN, ALT level had normalized in 11 children (41%) and anti-HBe seroconversion occurred in 9 children (33%) one year after the initiation of treatment. In comparison, among the 24 children treated with 6 MU/m2 of IFN, ALT normalized in 12 children (50%) and anti-HBe seroconversion occurred in 7 children (29%). In comparing the first treatment group to retreatment group, ALT level had normalized in 23 children (45%) and anti-HBe seroconversion occurred in 16 children (31%) among the 51 children treated with the first course of IFN treatment. In comparison, ALT normalized and anti-HBe seroconversion occurred in 3 children (25%) among the retreated 12 children. CONCLUSION: There was no significant difference in the therapeutic efficacies between 3 MU/m2 and 6 MU/m2 dose of IFN treated groups in ALT normalization and anti-HBe seroconversion. The retreatment efficacy of IFN-alpha was as effective as the first treatment.
Child* ; DNA ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha* ; Interferons ; Retreatment*

Background: Data on severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) delta variant virulence are insufficient. We retrospectively compared the clinical features of adult coronavirus disease 2019 (COVID-19) patients without risk factors for severe COVID-19 who entered residential treatment centers (RTCs) before and after the delta variant outbreak. Methods: We collected medical information from two RTCs in South Korea. On the basis of nationwide delta variant surveillance, we divided the patients into two groups: 1) the delta-minor group (diagnosed from December 2020–June 2021, detection rate < 10%) and 2) the delta-dominant group (diagnosed during August 2021, detection rate > 90%). After propensity-score matching, the incidences of pneumonia, hospital transfer and need for supplemental oxygen were compared between the groups. In addition, risk factors for hospital transfer were analysed. Results: A total of 1,915 patients were included. The incidence of pneumonia (14.6% vs.9.2%, P = 0.009), all-cause hospital transfer (10.4% vs. 6.3%, P = 0.020) and COVID-19-related hospital transfer (7.5% vs. 4.8%, P = 0.081) were higher in the delta-dominant group than those in the delta-minor group. In the multivariate analysis, the delta-dominant group was an independent risk factor for all-cause (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.16–3.13; P = 0.011) and COVID-19-related hospital transfer (aOR, 1.86; 95% CI, 1.04–3.32; P = 0.036). Conclusion Hospitalization rates were increased in the adult COVID-19 patients during the delta variant nationwide outbreak. Our results showed that the delta variant may be more virulent than previous lineages.

Rhomboid family member 2 gene (Rhbdf2) is an inactive homologue lacking essential catalytic residues of rhomboid intramembrane serine proteases. The protein is necessary for maturation of tumor necrosis factor-alpha (TNF-α) converting enzyme, which is the molecule responsible for the release of TNF-α. In this study, Rhbdf2 knockout (KO) mice were produced by CRISPR/CAS9. To see the effects of the failure of TNF-α release induced by Rhbdf2 gene KO, collagen-induced arthritis (CIA), which is the representative TNF-α related disease, was induced in the Rhbdf2 mutant mouse using chicken collagen type II. The severity of the CIA was measured by traditional clinical scores and histopathological analysis of hind limb joints. A rota-rod test and grip strength test were employed to evaluate the severity of CIA based on losses of physical functions. The results indicated that Rhbdf2 mutant mice showed clear alleviation of the clinical severity of CIA as demonstrated by the significantly lower severity indexes. Moreover, a grip strength test was shown to be useful for the evaluation of physical functional losses by CIA. Overall, the results showed that the Rhbdf2 gene has a significant effect on the induction of CIA, which is related to TNF-α.
Animals ; Arthritis, Experimental* ; Chickens ; Collagen Type II ; Extremities ; Hand Strength ; Humans ; Joints ; Mice ; Mice, Knockout* ; Serine Proteases ; Tumor Necrosis Factor-alpha

No abstract available.
Advanced Cardiac Life Support* ; Cardiopulmonary Resuscitation*

Background: Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrugresistant organisms, and significant patient and social cost burdens. This study investigated the nationwide situation of how antibiotics are prescribed to patients during the last 14 days of life to guide future actions. Methods: This nationwide multicenter retrospective cohort study was conducted at 13 hospitals in South Korea from November 1 to December 31, 2018. All decedents were included in the study. Antibiotic use during the last two weeks of their lives was investigated. Results: A total of 1,201 (88.9%) patients received a median of two antimicrobial agents during the last two weeks of their lives. Carbapenems were prescribed to approximately half of the patients (44.4%) in the highest amount (301.2 days of therapy per 1,000 patient-days).Among the patients receiving antimicrobial agents, 63.6% were inappropriate and only 327 patients (27.2%) were referred by infectious disease specialists. The use of carbapenem (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.13–2.03; P = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20–2.01, P = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23–2.89, P = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15–2.73; P = 0.010) were independent predictors for inappropriate antibiotic prescribing. Conclusion A considerable number of antimicrobial agents are administered to patients with chronic or acute illnesses nearing their end-of-life, a high proportion of which are prescribed inappropriately. Consultation with an infectious disease specialist, in addition to an antimicrobial stewardship program, may be necessary to induce the optimal use of antibiotics.