PURPOSE: The aim of this study was to compare the clinical usefulness of serum procalcitonin (PCT) levels in Mycoplasma pneumoniae pneumonia (M. pneumonia) and viral pneumonia in children. METHODS: We retrospectively analyzed the medical records of 348 patients admitted between June 2015 and December of 2015. There were 162 patients with M. pneumonia without virus coinfection (group 1) and 186 patients with viral pneumonia (group 2). All subjects had radiographic evidence of pneumonia with available specimens for both M. pneumonia and viral testing, and levels of serum PCT, white blood cell counts (WBC), neutrophil portion, and C-reactive protein (CRP). Fifty-eight children who performed follow-up sampling at the time of no fever for more than 48 hours were subdivided into group 3 (M. pneumonia with follow-up sampling, n=41) and group 4 (viral pneumonia with follow-up sampling, n=17). RESULTS: No difference was noted in the levels of serum PCT (P=0.168), CRP (P=0.296), WBC (P=0.732), and neutrophil proportion (P=0.069) between groups 1 and 2, after adjusting for age. Serial changes in serum PCT levels between the first and second samples were significant in group 3 (P=0.046). Serial changes in serum CRP levels between the first and second samples were significant in group 4 (P=0.008). CONCLUSION: Serum PCT and CRP levels may change differently after infection according to the etiology of pneumonia.
C-Reactive Protein ; Child* ; Coinfection ; Cross-Sectional Studies* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Medical Records ; Mycoplasma pneumoniae ; Mycoplasma* ; Neutrophils ; Pneumonia ; Pneumonia, Mycoplasma* ; Pneumonia, Viral* ; Retrospective Studies

Two external quality assessment (EQA) trials of conventional newborn screening tests for phenylketonuria, galactosemia, congenital adrenal hyperplasia, maple syrup urine disease, homocystinuria, and congenital hypothyroidism, as well as newborn screening tests using tandem mass spectrometry, were performed in 2015. A total of 44 specimens in the form of dried blood spots were distributed to 16 laboratories and the response rate of these laboratories was 100%. The mean, standard deviation, coefficient of variation, median, and cut-offs were evaluated for each analyte in the newborn screening tests. Two EQA trials for the analyses of methylmalonic acid, vanillylmandelic acid, catecholamines, metanephrines, organic acids, and amino acids were also performed. A well-designed EQA program and continuous education would improve the performance of biochemical genetics tests.
Adrenal Hyperplasia, Congenital ; Amino Acids ; Catecholamines ; Congenital Hypothyroidism ; Education ; Galactosemias ; Homocystinuria ; Humans ; Infant, Newborn ; Korea* ; Maple Syrup Urine Disease ; Mass Screening ; Methylmalonic Acid ; Molecular Biology* ; Phenylketonurias ; Tandem Mass Spectrometry ; Vanilmandelic Acid

Two trials of external quality assessment (EQA) of conventional newborn screening tests for phenylketonuria, galactosaemia, congenital adrenal hyperplasia, maple syrup urine disease, homocystinuria, and congenital hypothyroidism, as well as newborn screening tests were performed using tandem mass spectrometry in 2014. A total of 39 specimens in the form of dried blood spots were distributed to 16 laboratories and the response rate of these laboratories was 100%. Screening tests for phenylketonuria and congenital hypothyroidism did not meet the accepted performance criteria in some laboratories. The mean, standard deviation, coefficient of variation, median, and cut-offs were evaluated for each analyte in the newborn screening tests. Two trials of EQA for the analyses of methylmalonic acid, vanillylmandelic acid, catecholamines, metanephrines, organic acids, and amino acids were also performed. A well-designed EQA program and continuous education would improve the performance of biochemical genetic testing.
Adrenal Hyperplasia, Congenital ; Amino Acids ; Catecholamines ; Congenital Hypothyroidism ; Education ; Homocystinuria ; Humans ; Infant, Newborn ; Korea ; Maple Syrup Urine Disease ; Mass Screening ; Methylmalonic Acid ; Molecular Biology* ; Phenylketonurias ; Tandem Mass Spectrometry ; Vanilmandelic Acid

OBJECTIVES: This study attempted to identify the factors that contribute to successful telemedicine service. This was done by analyzing the operational state of successful telemedicine services offered in Gangwon Province of Korea and their outcome for the last fifteen years. METHODS: A comparative analysis was made based on reports and a thesis on the satisfaction rate of patients and providers, patient compliance to treatment, and economic assessment of Gangwon telemedicine service, which were carried out in three periods: the years 2006, 2010, and 2012. RESULTS: The satisfaction surveys in all three periods showed similar results for patients (4.46+/-0.70 point) and healthcare practitioners, including nurses (3.82+/-0.62 point) and physicians (3.60+/-0.56 point), in decreasing order from the year 2012. Through the survey of patients' compliance with treatment, it was confirmed that telemedicine services increased patients' compliance with drug administration, facilitated improvement of lifestyle habits, improved glycated hemoglobin for patients with diabetes mellitus, and enhanced the rate of blood pressure control. In the survey conducted on patients' willingness to pay for telemedicine services in 2007, it was found that those patients were willing to pay about $3.5 for services. CONCLUSIONS: The telemedicine services of Gangwon Province increased patients' compliance with drug administration, improved blood glucose control, enhanced blood pressure control for patients with hypertension, and provided economic advantage.
Blood Glucose ; Blood Pressure ; Compliance ; Cost-Benefit Analysis ; Delivery of Health Care ; Diabetes Mellitus ; Gangwon-do* ; Hemoglobin A, Glycosylated ; Humans ; Hypertension ; Korea* ; Life Style ; Patient Compliance ; Patient Satisfaction ; Rural Health Services ; Telemedicine*

BACKGROUNDS: Patient counseling has been forced since June. 19, 2014. Prior to this, there was no study to try to standardize medication counseling to improve quality. PURPOSE: This study was to investigate satisfaction level and comprehension level between the pharmacist group and the patient group about standardized medication counseling sheet. METHODS: Questionnaires to assess standardized patient counseling sheet were posted at online survey software (Qualtrics) to pharmacists who worked at community pharmacy and patients who had visited community pharmacy before. RESULTS: Three hundred thirty five patients and three hundred nineteen pharmacists were responded to the questionnaire (Response rate: 72.9%). More than half of each group were satisfied with standardized medication counseling sheets 'for the general public', 'for the pregnant women and nursing mothers', 'for the chronic patient', and 'for the aged' and patient group were more satisfied than pharmacist group. Similarly, more than half of each group comprehended with the medication counseling sheets 'for the general public', 'for the pregnant women and nursing mothers', 'for the chronic patient', and 'for the aged'. Patient group tended to expect longer patient counseling time per one drug than pharmacist group. Also, the majority of both groups wanted to provide standardized medication counseling sheets constantly and extend for all drugs. CONCLUSION: Both groups were satisfied and comprehended standardized medication counseling sheets, and agreed to expand standardized medication counseling sheets to all drugs. So, it is necessary to build the standardized medication counseling of all drugs.
Comprehension* ; Counseling* ; Female ; Humans ; Nursing ; Pharmacies ; Pharmacists* ; Pregnant Women

PURPOSE: There is a dearth of information on maternal drug exposure during lactation. The Korean Mothersafe Professional Counseling Center launched helpline to provide information and clinical consultation service on drug safety during lactation as well as in pregnancy. Here, we reviewed our 5 years' experience of counseling with drug exposed breastfeeding mothers. METHODS: The questionnaires were given to drug exposed breastfeeding mothers from January 2005 to April 2010 who contacted our helpline and follow-up survey data was collected by phone call. The questionnaires included lists of symptoms that exposed mothers experienced and that was observed in their infants, as well as demographic questions and questions about lactation. RESULTS: A total of 278 mothers completed the survey and lactational exposure was estimated. Majority of them reported that their infants and themselves never experienced serious side effects of drugs during lactation. Only 3 (1.1%) babies reported side effects and 20 (7.2%) mothers reported decreased production of breast milk. Two hundred thirty two (83.5%) mothers continued breastfeeding after counseling. Lactation was stopped temporarily in 20 (7.2%) mothers and permanently in 26 (9.3%) mothers. CONCLUSION: Most of the drugs exposed during lactation did not cause serious side effects to infants and mothers. As many drugs have inadequate data to assure safety, the clinician is left with a dilemma as to where the balance of risks and benefits lie with respect to the mother and her baby. The author expect that analyses of these counseling will contribute to provide practical answers to clinicians as well as exposed mothers and to establish correct breastfeeding practice.
Breast Feeding ; Counseling ; Female ; Follow-Up Studies ; Humans ; Infant ; Lactation ; Milk, Human ; Mothers ; Pregnancy ; Surveys and Questionnaires ; Risk Assessment

OBJECTIVE: In this study, we evaluated whether different methods of conization of the cervix were associated with an increased risk of adverse pregnancy outcomes in subsequent pregnancy. METHODS: A retrospective case-control study was conducted. The study group included women who had undergone cold knife conization (n=170) or a loop electrosurgical excision procedure (LEEP) (n=86) and then had subsequent singleton pregnancies. The control group (n=497) included women with no history of cervical surgery. The outcomes were spontaneous preterm delivery and various neonatal outcomes such as low birth weight (LBW) and perinatal mortality. RESULTS: Cold knife conization was associated with a significantly increased risk of preterm delivery less than 34 weeks (relative risk 4.9, 95% confidence interval 1.6-15.1), preterm delivery less than 28 weeks (7.6, 15-39.6), LBW (2.6, 1.2-5.8), and perinatal mortality (11.9, 1.3-107.6). LEEP was not associated with a increased risk of adverse pregnancy outcomes. CONCLUSION: Cold knife cone biopsy, but not LEEP of the cervix, is associated with an increased risk of preterm delivery less than 34 weeks of gestation and adverse neonatal outcomes. Clinicians counsel women appropriately before conservative treatment of cervical intraepithelial lesions.
Biopsy ; Case-Control Studies ; Cervix Uteri ; Cold Temperature ; Conization ; Female ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Perinatal Mortality ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies

PURPOSE: Ibuprofen is a non steroidal anti-inflammatory drug used for treating fever and pain including headache, arthralgia, and back pain. There is scarce information on the safety of ibuprofen associated with fetal anomaly when used early in pregnancy. Epidemiology studies have suggested that use of NSAIDs, including ibuprofen, during pregnancy may increase the risk of cardiac defects and gastroschisis. The aim of the study was to evaluate fetal outcomes among pregnant women who were unintentionally exposed to ibuprofen in early pregnancy. METHODS: Total 381 pregnant women who were unintentionally exposed to ibuprofen during early pregnancy were prospectively followed up. In addition, 643 age and gravity matched pregnant women not exposed to any potential teratogenic agent during pregnancy were recruited as controls. Patients were followed-up until delivery or loss to follow-up. Newborns were examined in order to identify any major congenital malformation. RESULTS: Mean age of exposed women was 31.2+/-3.4 years, with a mean number of previous pregnancies of 2.3+/-1.2 and mean gestational weeks at exposure of 4.4+/-2.2. All gestations were confirmed by ultrasonography. Of exposed women, 17 (5.6%) had spontaneous abortions, 16 were on- going pregnancies, 1 had an intra-uterine fetal death, 21 artificial abortion and 55 cases were lost to follow-up. Therefore, 271 pregnancies unintentionally exposed to ibuprofen were evaluated, each delivering a singleton baby. Three babies had congenital anomalies: one had unilateral hydronephrosis, another baby was born with a unilateral inguinal hernia. The last baby was born with unilateral kidney dysplasia with megaureter. In the control group, 6 babies were born with major malformations [1.11% vs. 1.31% (P=0.552, OR: 0.841, 95% CI: 0.2 to 3.4)]. CONCLUSION: These preliminary results suggest that the ibuprofen may not be a major human teratogen.
Abortion, Spontaneous ; Anti-Inflammatory Agents, Non-Steroidal ; Arthralgia ; Back Pain ; Female ; Fetal Death ; Fever ; Follow-Up Studies ; Gastroschisis ; Gravitation ; Headache ; Hernia, Inguinal ; Humans ; Hydronephrosis ; Ibuprofen ; Infant, Newborn ; Kidney ; Lost to Follow-Up ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, First ; Pregnant Women ; Prospective Studies

STATEMENT OF PROBLEM: Titanium is well known as a proper metal for the dental restorations, because it has an excellent biocompatibility, resistance to corrosion, and mechanical property. However, adhesion between titanium and dental porcelains is related to the diffusion of oxygen to the reaction layers formed on cast-titanium surfaces during porcelain firing and those oxidized layers make the adhesion difficult to be formed. Many studies using mechanical, chemical and physical methods to enhance the titanium-ceramic adhesion have been actively performed. PURPOSE: This study meant to comparatively analyse the adhesion characteristics depending on different titanium surface coatings after coating the casts and wrought titanium surfaces with Au and TiN. MATERIAL AND METHOD: In this study, the titanium specimens (CP-Ti, Grade 2, Kobe still Co. Japan) were categorized into cast and wrought titanium. The wrought titanium was cast by using the MgO-based investment(Selevest CB, Selec). The cast and wrought titanium were treated with Au coating(ParaOne(R), Gold Ion Sputter, Model PS-1200) and TiN coating(ATEC system, Korea) and the ultra low fusing dental porcelain was fused and fired onto the samples. Biaxial flection test was done on the fired samples and the porcelain was separated. The adhesion characteristics of porcelain and titanium after firing and the specimen surfaces before and after the porcelain fracture test were observed with SEM. The atomic percent of Si on all sample surfaces was comparatively analysed by EDS. In addition, the constituents of specimen surface layers after the porcelain fracture and the formed compound were evaluated by X-ray diffraction diagnosis. RESULT: The results of this study were obtained as follows : 1. The surface characteristics of cast and wrought titanium after surface treatment(Au, TiN, Al2O3 sandblasting) were similar and each cast and wrought titanium showed similar bonding characteristics. 2. Before and after the biaxial flection test, the highest atomic weight change of Si component was found in Al2O3 sandblasted wrought titanium(28.6at.% --> 8.3at.%). On the other hand, the least change was seen in Au-Pd-In alloy(24.5at.%--> 19.1at.%). 3. Much amount of Si components was uniformly distributed in Au and TiN coated titanium, but less amount of Si's was unevenly dispersed on Al2O3 sandblasting surfaces. 4. In X-ray diffraction diagnosis after porcelain debonding, we could see Au2Ti compound and TiN coating layers on Au and TiN coated surfaces and TiO2, typical oxide of titanium, on all titanium surfaces. 5. Debonding of porcelain on cast and wrought titanium surface after the biaxial flection is considered as a result of adhesion deterioration between coating layers and titanium surfaces. We found that there are both adhesive failure and cohesive failure at the same time. CONCLUSION: These results showed that the titanium-ceramic adhesion could be improved by coating cast and wrought titanium surfaces with Au and TiN when making porcelain fused to metal crowns. In order to use porcelain fused to titanium clinically, it is considered that coating technique to enhance the bonding strength between coating kKlayers and titanium surfaces should be developed first.
Adhesives ; Corrosion ; Crowns ; Dental Porcelain* ; Diagnosis ; Diffusion ; Fires ; Hand ; Oxygen ; Tin ; Titanium* ; X-Ray Diffraction

Esophageal and duodenal tuberculosis are rare form of gastrointestinal tuberculosis. The common complications due to esophageal and duodenal tuberculosis are fistulous communications with the adjacent structures, perforation, obstruction, and upper gastrointestinal bleeding. Massive bleeding in esophageal and duodenal tuberculosis is quite rare. We encountered a case of a 55-year-old male who presented with hematemesis and melena. Esophageal and Duodenal tuberculosis with a duodenal fistula was diagnosed by an endoscopic and radiology examination. He improved after treatment with anti-tuberculosis medication over a 9 month period. We report this case of esophageal and duodenal tuberculosis associated with pulmonary tuberculosis with a review of the relevant literature.
Duodenum* ; Esophagus* ; Fistula ; Hematemesis ; Hemorrhage ; Humans ; Male ; Melena ; Middle Aged ; Tuberculosis* ; Tuberculosis, Gastrointestinal ; Tuberculosis, Pulmonary*