1.Brain Oxygen Monitoring via Jugular Venous Oxygen Saturation in a Patient with Fulminant Hepatic Failure.
Yerim KIM ; Chi Kyung KIM ; Seunguk JUNG ; Sang Bae KO
Korean Journal of Critical Care Medicine 2016;31(3):251-255
Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbidity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvO₂) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvO₂ was used for appropriate brain oxygen monitoring.
Brain Edema
;
Brain Injuries
;
Brain*
;
Early Diagnosis
;
Hepatic Encephalopathy
;
Humans
;
Intracranial Pressure
;
Jugular Veins
;
Liver Failure, Acute*
;
Mortality
;
Oxygen Consumption
;
Oxygen*
2.First-Time Mothers’ Grit, Spousal Support, and Age, and Their Relationships with Nurturing Passion, Postpartum Depression, and Happiness
Yerim JEONG ; Yaebon KIM ; Sujin YANG
Journal of the Korean Society of Maternal and Child Health 2021;25(3):177-183
Purpose:
This study aimed to examine whether first-time mothers’ grit, spousal support, and age can make significant differences in latent means of child-rearing passion, postpartum depression, and happiness.
Methods:
Data were collected from April 2 to July 16, 2019. Two hundred sixteen first-time mothers of infants and toddlers aged 0–2 years participated in a self-reported questionnaire study in which scales of nurturing passion, postpartum depression, happiness, grit, and spousal support were included. The collected data were analyzed with IBM SPSS ver. 18.0 (IBM Co., Armonk, NY, USA) for descriptive statistics and Pearson correlation analyses. In addition, Mplus (ver. 7.0) was used for the Multiple Indicators Multiple Causes (MIMIC) model approach.
Results:
The MIMIC model yielded an appropriate fit to the data (χ2=103.74, degrees of freedom=53, comparative fit index=0.96, root mean square error of approximation=0.07, standardized root mean square residual=0.05). The paths from grit and spousal support all had significantly positive beta coefficients (p<0.05) to child-rearing passion (β=0.3 and β=0.26, respectively) and happiness (β=0.22 and β=0.39, respectively), while the corresponding paths to postpartum depression were all negatively significant (β= -0.24 for both). These results suggest that unlike chronological maturity (i.e., age), grittier individuals with stronger spousal support display greater passion for child-rearing, as well as greater happiness. In a similar vein, they suffered less from postpartum depression.
Conclusion
These results imply that grit can be employed to enhance first-time mothers’ child-rearing passion and happiness as it can also concurrently offset the effects of a negative labor and child-birth experience on first-time mothers’ mental health, e.g., in terms of reducing postpartum depression.
3.First-Time Mothers’ Grit, Spousal Support, and Age, and Their Relationships with Nurturing Passion, Postpartum Depression, and Happiness
Yerim JEONG ; Yaebon KIM ; Sujin YANG
Journal of the Korean Society of Maternal and Child Health 2021;25(3):177-183
Purpose:
This study aimed to examine whether first-time mothers’ grit, spousal support, and age can make significant differences in latent means of child-rearing passion, postpartum depression, and happiness.
Methods:
Data were collected from April 2 to July 16, 2019. Two hundred sixteen first-time mothers of infants and toddlers aged 0–2 years participated in a self-reported questionnaire study in which scales of nurturing passion, postpartum depression, happiness, grit, and spousal support were included. The collected data were analyzed with IBM SPSS ver. 18.0 (IBM Co., Armonk, NY, USA) for descriptive statistics and Pearson correlation analyses. In addition, Mplus (ver. 7.0) was used for the Multiple Indicators Multiple Causes (MIMIC) model approach.
Results:
The MIMIC model yielded an appropriate fit to the data (χ2=103.74, degrees of freedom=53, comparative fit index=0.96, root mean square error of approximation=0.07, standardized root mean square residual=0.05). The paths from grit and spousal support all had significantly positive beta coefficients (p<0.05) to child-rearing passion (β=0.3 and β=0.26, respectively) and happiness (β=0.22 and β=0.39, respectively), while the corresponding paths to postpartum depression were all negatively significant (β= -0.24 for both). These results suggest that unlike chronological maturity (i.e., age), grittier individuals with stronger spousal support display greater passion for child-rearing, as well as greater happiness. In a similar vein, they suffered less from postpartum depression.
Conclusion
These results imply that grit can be employed to enhance first-time mothers’ child-rearing passion and happiness as it can also concurrently offset the effects of a negative labor and child-birth experience on first-time mothers’ mental health, e.g., in terms of reducing postpartum depression.
4.Normal Magnetic Resonance Perfusion Imaging and Atypical Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease
Journal of Neurocritical Care 2017;10(1):41-45
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is classically characterized by symmetric vasogenic edema in the parietooccipital areas, but may occur at other sites with varying imaging appearances. CASE REPORT: A 55-year old female with chronic kidney disease (CKD) was admitted to the emergency room, presenting with nausea, vomiting and seizure. The initial blood pressure was 145/90 mmHg. Fluid attenuated inversion recovery demonstrated diffuse vasogenic edema in the bilateral cortical and subcortical white matters involving the frontal lobes. Perfusion magnetic resonance imaging (MRP) showed no hyper- or hypoperfusion at blood pressure levels of 140/50 mmHg. A follow-up magnetic resonance imaging at 3 weeks later demonstrated complete resolution of previous lesions. CONCLUSIONS: Earlier reports have demonstrated that PRES can occur in cases of atypical distributions, and features of imaging findings and normotensive settings. It is important to note that PRES is a dynamic process. As a result, we suggest that MRP must be considered in the appropriate temporal framework, to avoid misinterpretation of the other diseases, especially in CKD patients.
Blood Pressure
;
Edema
;
Emergency Service, Hospital
;
Female
;
Follow-Up Studies
;
Frontal Lobe
;
Humans
;
Magnetic Resonance Angiography
;
Magnetic Resonance Imaging
;
Nausea
;
Perfusion Imaging
;
Perfusion
;
Posterior Leukoencephalopathy Syndrome
;
Renal Insufficiency, Chronic
;
Seizures
;
Vomiting
;
White Matter
5.Long-term HbA1c Variability and Treatment Outcomes of Intravitreal Injection in Diabetic Macular Edema
Yerim AN ; Sung Pyo PARK ; Yong-Kyu KIM
Journal of the Korean Ophthalmological Society 2020;61(8):911-920
Purpose:
To evaluate the association between long-term glycated hemoglobin A (HbA1c) variability and treatment outcomes ofanti-vascular endothelial growth factor (VEGF) injection in diabetic macular edema patients.
Methods:
The medical records of 49 eyes (38 patients) that received anti-VEGF injection for diabetic macular edema were reviewedretrospectively. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) before injection and at onemonth and six months after injection were analyzed. HbA1c variability (HbA1c coefficient of variation [CV]) was calculated usingthe HbA1c results from the year prior to (before) and the year after injection and compared with clinical results.
Results:
In the group with a low mean HbA1c level before injection, the group with lower HbA1c CV showed greater reduction inmacular edema one month after injection (low HbA1c CV, 122.4 ± 123.2 μm versus high HbA1c CV, 5.2 ± 37.0 μm, p= 0.027).In the group with high mean HbA1c, there was no significant difference between HbA1c variability and clinical features. In a multivariateanalysis, the factor related to the reduction of macular edema was initial CMT (one month adjusted hazard ratio (aHR)0.5, p< 0.001; six months aHR 0.3, p= 0.023). The factor associated with visual gain was initial visual acuity (LogMAR) (onemonth aHR 0.4, p< 0.001; six months aHR 0.4, p< 0.001). The association between mean HbA1c or HbA1c variability and clinicaloutcome was not significant.
Conclusions
Unlike initial CMT or BCVA, mean HbA1c and HbA1c variability were not significantly associated with clinical outcomesof anti-VEGF injection in diabetic macular edema patients.
6.Perfusion-Weighted MRI Parameters for Prediction of Early Progressive Infarction in Middle Cerebral Artery Occlusion.
Hoon KIM ; Yerim KIM ; Young Woo KIM ; Seong Rim KIM ; Seung Ho YANG
Journal of Korean Neurosurgical Society 2016;59(4):346-351
OBJECTIVE: Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI. METHODS: We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ≥2 points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI. RESULTS: Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI. CONCLUSION: The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.
Cerebrovascular Circulation
;
Diabetes Mellitus
;
Hospitalization
;
Humans
;
Incidence
;
Infarction*
;
Infarction, Middle Cerebral Artery*
;
Magnetic Resonance Imaging*
;
Middle Cerebral Artery*
;
National Institutes of Health (U.S.)
;
Perfusion
;
Retrospective Studies
;
Stroke
7.Tractional Retinal Detachment in Eyes with Vitreous Hemorrhage and Proliferative Diabetic Retinopathy and Posterior Vitreous Detachment in Fellow Eye
Chan Woong JOO ; Yerim AN ; Yong-Kyu KIM ; Yong Dae KIM ; Sung Pyo PARK ; Kyoung Lae KIM
Korean Journal of Ophthalmology 2023;37(3):207-215
Purpose:
To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the status of posterior vitreous detachment (PVD) in fellow eyes using optical coherence tomography (OCT).
Methods:
A total of 44 eyes from 22 patients who underwent vitrectomy due to dense VH with PDR were enrolled. Using OCT, the PVD status in the fellow eye was divided into two groups (incomplete and complete PVD). The incomplete PVD group included eyes without PVD and eyes with partial PVD. B-scan ultrasonography was performed on eyes with dense VH to evaluate the presence of TRD. Both OCT and B-scan images were reviewed by four ophthalmologists (two novices and two experienced), and the interobserver agreement was evaluated.
Results:
There was a difference in the interobserver agreement regarding the presence of TRD in eyes with dense VH evaluated by B scan between novice and experienced ophthalmologists (novice, κ = 0.421 vs. experienced, κ = 0.814), although there was no difference between novice and experienced ophthalmologists in the interobserver agreement regarding the status of PVD in the fellow eye evaluated by OCT (novice, κ = 1.000 vs. experienced, κ = 1.000). All observed TRD during vitrectomy occurred in eyes with incomplete PVD in the fellow eye. Logistic regression analysis revealed a statistically significant relation between TRD and the age of the patient (odds ratio [OR], 0.874; p = 0.047), and between TRD and incomplete PVD in the fellow eye evaluated by OCT (OR, 13.904; p = 0.042).
Conclusions
Evaluation of the PVD status in the fellow eye using OCT may be a useful predictor for detecting the presence of TRD in eyes with dense VH and PDR.
8.Brain Oxygen Monitoring via Jugular Venous Oxygen Saturation in a Patient with Fulminant Hepatic Failure
Yerim KIM ; Chi Kyung KIM ; Seunguk JUNG ; Sang Bae KO
The Korean Journal of Critical Care Medicine 2016;31(3):251-255
Fulminant hepatic failure (FHF) is often accompanied by a myriad of neurologic complications, which are associated with high morbidity and mortality. Although appropriate neuromonitoring is recommended for early diagnosis and to minimize secondary brain injury, individuals with FHF usually have a high chance of coagulopathy, which limits the ability to use invasive neuromonitoring. Jugular bulb venous oxygen saturation (JvO₂) monitoring is well known as a surrogate direct measures of global brain oxygen use. We report the case of a patient with increased intracranial pressure due to FHF, in which JvO₂ was used for appropriate brain oxygen monitoring.
Brain Edema
;
Brain Injuries
;
Brain
;
Early Diagnosis
;
Hepatic Encephalopathy
;
Humans
;
Intracranial Pressure
;
Jugular Veins
;
Liver Failure, Acute
;
Mortality
;
Oxygen Consumption
;
Oxygen
9.An Unusual Case of Benign Episodic Bilateral Mydriasis
Ye Rim AHN ; Han Ul KIM ; Yerim KIM ; Youn Joo CHOI
Journal of the Korean Ophthalmological Society 2019;60(9):901-904
PURPOSE: Although benign episodic mydriasis has been rarely reported worldwide, most of the reports so far have occurred in unilaterally. To report an unusual case of benign episodic bilateral mydriasis. CASE SUMMARY: Nineteen-year-old woman who presented with intermittent dilation of both pupils two months ago. She had difficulty on reading and doing tasks because of her visual blur. This symptom usually lasted for 1–2 hours, occurred once every 2–3 days, most frequently during stressful situations. Headaches and dizziness accompanied the eye symptoms, and her pupils were both 5 mm in a lighted room and both 7 mm in a dark room. All tests, including brain magnetic resonance imaging, showed no abnormal findings. We diagnosed her as benign episodic bilateral mydriasis. The frequency of her symptoms decreased during the university vacation period. CONCLUSIONS: In the absence of ophthalmologic or neurologic abnormalities other than headaches in patients with transient mydriasis, benign episodic mydriasis should be considered as a differential diagnosis. Although benign episodic bilateral mydriasis has a unilateral predominance, for the first time the authors report that benign episodic mydriasis may occur in both eyes during same episode.
Brain
;
Diagnosis, Differential
;
Dizziness
;
Female
;
Headache
;
Humans
;
Magnetic Resonance Imaging
;
Mydriasis
;
Pupil
10.Predictors of functional outcome of patients in neurological intensive care unit
Yerim Kim ; Seok-Beom Kwon ; Hyun-Ju Park ; Min-Ji Kim ; SeongSook Hong ; Suk Yun Kang ; San Jung ; Sung-Hee Hwang
Neurology Asia 2012;17(3):219-225
Background: Little is known regarding the functional outcome and quality of life of neuro-ICU
survivors. In Korea, the neuro-ICU concept was introduced relatively late and data about long term
outcome and predictors concerning functional outcome is scarce. The main objective of this study was
to analyze functional outcome and mortality, and to determine prognostic predictors for the outcome
in patients admitted to Korean neuro-ICUs. Methods: Consecutive adult (≥ 15-years-of-age) patients
admitted to a neuro-ICU due to various causes including ischemic or hemorrhagic stroke, and other
neurological or neurosurgical problems such as traumatic brain injury, seizure, or drug intoxication
during an 18-month period from July 2008 through December 2009 were included. Demographic and
clinical variables were compared between groups stratifi ed based on 6-month modifi ed Rankin scale
score. Results: Of 555 patients, there were signifi cant differences in age (P=0.013), sex (P=0.02),
hospital stay (P<0.01), neuro-ICU stay (P<0.01), admission diagnosis (P=0.001), intubation (P<0.01),
mechanical ventilation (P<0.01), tracheostomy (P<0.01), comorbid conditions such as atrial fi brillation
(P<0.01), cardiac complication (P<0.01) and pulmonary complication (P<0.01), a high Therapeutic
Intervention Scoring System (TISS-28) score (P<0.01), and a high Acute Physiology and chronic health
evaluation (APACHE) II score (P<0.01) between favorable and unfavorable outcome groups. The
overall mortality rate was 15.0% (n=83). In multivariable logistic regression analysis, age, sex, high
TISS-28, high APACHE II score, intubation, and cardiac complication were independent predictors
of unfavorable outcome.
Conclusion: The identifi ed predictors for functional outcomes in Korean neuro-ICU patients will be
an important aid in diagnosing and treating neuro-ICU patients.