Purpose: We report two cases of sudden intraocular pressure (IOP) elevation in children after steroid treatment.Case summary: (Case 1) An 8-year-old boy visited the hospital with vomiting and headache that had begun 3 days after application of dexamethasone eyedrops. IOPs were 55 and 62 mmHg in the right and left eyes, respectively; both anterior chambers were normal. The eyedrops were stopped and timolol/dorzolamide was applied twice daily. After intravenous mannitol injection, the IOPs of both eyes decreased to 18 mmHg within 24 hours. (Case 2) A 10-year-old boy diagnosed with coronavirus disease 2019 three days prior had been prescribed methylprednisolone 4 mg twice daily; he visited the hospital with headache, eye pain, and decreased vision that began 1 day after medication. IOPs were 41 and 54 mmHg in the right and left eyes, respectively; both anterior chambers were normal. After drug discontinuation, timolol/dorzolamide, brimonidine, and latanoprost eyedrops were applied. Subsequently, after intravenous mannitol injection, the IOPs decreased within 24 hours to 7 and 16 mmHg in the right and left eyes, respectively; they remained stable. However, thinning was observed in the retinal nerve fiber and ganglion cell-inner plexiform layer. Conclusions Children can develop rapid IOP elevation after even 1 day of steroid use; residual structural damage may be present, despite prompt treatment. Clinicians must closely monitor such patients for atypical IOP elevation.

Purpose: To identify clinical factors associated with the early reduction of corneal sensitivity (CS) in patients with herpes zoster ophthalmicus (HZO). Methods: Total 30 subjects were divided into two groups according to the occurrence of an early reduction of CS (group 1, normal CS; group 2, decreased CS). The demographics, ocular manifestations of HZO, and the ocular surface parameters were compared between two groups. Then, the relative risks of variables were analyzed to expect the early decrease of CS by HZO using logistic regression analysis. Results: Among total 30 subjects, the CS decreased in 10 subjects (3.2 ± 1.4 cm, group 2) and the other 20 subjects revealed normal CS (6.0 ± 0.0 cm, group 1). The age was higher in the group 2 (67.0 ± 16.6 years) than in group 1 (48.0 ± 17.6 years, p = 0.013), but sex and the comorbidity of diabetes mellitus was not difference between groups. The presence of corneal punctate epithelial erosions was a single factor among the ocular manifestations of HZO, which discriminated group 1 (5%) and group 2 (60%, p = 0.002). The ocular surface staining scores (i.e., National Eye Institute scores and Sjögren’s International Collaborative Clinical Alliance ocular surface score) were higher in group 2 (p = 0.001 and p = 0.021, respectively) than in group 1. The existence of corneal punctate epithelial erosions revealed as a sole risk factor for the early reduction of CS (odds ratio = 33.085; p = 0.016). Conclusions It is necessary to pay attention to the possible occurrence of neurotrophic keratopathy especially in older patients with HZO showing an initial presence of corneal punctate epithelial erosions.

Purpose: We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. Methods: In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). Results: Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. Conclusions Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.

Purpose: We explored changes in the various clinical parameters of dry eye disease (DED), including the tear matrix metalloproteinase 9 (MMP-9) level, soon after cataract surgery. We sought correlations between such changes and ocular surface discomfort. Methods: In 106 patients (106 eyes) who underwent cataract surgery, we evaluated meibomian gland dysfunction, tear secretion, corneal sensitivity, tear break-up time, corneal erosion status, the Sjögren’s International Collaborative Clinical Alliance (SICCA) ocular staining score, tear osmolarity, the tear MMP-9 level, and the ocular surface disease index (OSDI) before, and 1 week and 1 month after surgery. All eyes were instilled with topical moxifloxacin, a steroid, and a non-steroidal anti-inflammatory drug daily for 1 month postoperatively. The 1-month delta OSDI scores correlated with the 1-month delta DED parameters. We compared the latter parameters between patients in whom the MMP-9 level decreased (MMP-9-decreased group) at 1 month with those in whom it did not (MMP-9-not decreased group). Results: Overall, 89.5% of total patients exhibited preoperative DED. The tear MMP-9 level fell at 1 month postoperatively, tear secretion (evaluated using the Schirmer I test) decreased at 1 week, and the OSDI scores fell at both 1 week and 1 month. We found no significant correlation between the 1-month delta OSDI scores and the 1-month delta DED parameters. The 1-month OSDI score fell to a significantly greater extent in the MMP-9-decreased group. Conclusions Routine, local anti-inflammatory treatment after cataract surgery may briefly reduce the tear MMP-9 level and ocular surface discomfort.

Purpose: Some patients with neonatal seizures show diffuse, symmetric diffusion-restricted lesions in the cerebral white matter. The aim of this study was to describe clinical and imaging findings of patients with neonatal seizures who had diffuse, symmetric diffusion-restricted lesions without any structural or metabolic etiology. Materials and Methods: A total of 56 neonates aged less than 1 week underwent brain magnetic resonance imaging (MRI) for evaluation of seizures from November 2008 to February 2017. After excluding 43 patients, 13 patients showed diffuse white matter abnormality on diffusion-weighted imaging. Initial and follow-up clinical and MRI findings were analyzed retro-spectively. Results: All 13 patients were born at full term. Among the ten patients who underwent a stool test for viruses, six were positive for rotavirus and one for astrovirus. MRI revealed diffuse, symmetric diffusion-restricted lesions distributed along the cerebral white matter, thalami, and midbrain variably. Conclusion Diffuse, symmetric diffusion-restricted lesions involving the cerebral white matter can be seen in patients with neonatal seizures without any structural or metabolic etiology. Rotavirus is commonly but not exclusively detected in these patients. Nevertheless, viral infection-associated encephalopathy should be considered for patients with characteristic clinical and MRI findings.

No abstract available.
Diagnosis, Differential ; Doxycycline/therapeutic use ; Female ; Guillain-Barre Syndrome/*diagnosis/pathology ; Humans ; Immunoglobulins/therapeutic use ; Male ; Middle Aged ; Respiration, Artificial ; Respiratory Insufficiency/*diagnosis/pathology ; Scrub Typhus/*diagnosis/pathology

BACKGROUNDS/AIMS: Hepatitis B virus (HBV) infection and chronic alcoholism are major risk factors for chronic liver disease in Korea. METHODS: We investigated the prevalence of occult HBV infection in 198 non-alcoholic (group I) and 85 chronic alcoholic subjects (group II), none of whom showed the hepatitis B surface antigen (HBsAg). Among chronic alcoholics, 25 patients showed cirrhosis. Using serum samples stored at -70 degrees C, liver enzymes, anti-Hbs, and IgG anti-HBc were measured via EIA and serum HBV DNA was quantified via real time PCR. RESULTS: IgG anti-HBc seropositivity, an indicator of past infection, was higher in group II (64.7%) than in group I (43.4%; p<0.01). Eleven of 283 patients (3.2%) were seropositive for HBV DNA, indicating occult infection, but this value did not differ between groups (group I: 3.5%, 7/198; group II: 4.7%, 4/85; p=0.64). In group II, HBV DNA seropositivity was higher in cirrhotic patients (12%, 3/25) than in non-cirrhotic alcoholic liver disease (1.7%, 1/60; p=0.074). CONCLUSIONS: Past HBV infection was more prevalent in alcoholics than non-alcoholics, but the prevalence of occult HBV infection did not differ between groups. However, alcoholics with cirrhosis tended to show a higher prevalence of occult HBV infection.
Alcoholics ; Alcoholism ; DNA ; Fibrosis ; Hepatitis ; Hepatitis B ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Humans ; Immunoglobulin G ; Korea ; Liver ; Liver Diseases ; Liver Diseases, Alcoholic ; Prevalence ; Real-Time Polymerase Chain Reaction ; Risk Factors

Sodium azide (NaN3) is a white to colorless, crystalline powder that is highly water soluble, tasteless, and odorless. It is used mainly as a preservative in aqueous laboratory reagents and biologic fluids and also as an automobile airbag gas generant. Although it has caused deaths for decades, the toxic properties and effects of sodium azide in humans remains unknown. A 31-year-old comatose female was transported to the emergency department with an empty bottle labeled sodium azide. She developed cardiac arrest 15 minutes after arrival and expired in spite of 30 minutes of resuscitative effort. Subsequently, resuscitation team members incidentally suffered from sodium azide's exposure and developed eye discomfort, skin rashes parasthesias, pruritus, sore throat, and headache.
Adult ; Air Bags ; Automobiles ; Coma ; Crystallins ; Eating ; Emergencies ; Exanthema ; Eye ; Female ; Headache ; Heart Arrest ; Humans ; Indicators and Reagents ; Pharyngitis ; Pruritus ; Resuscitation ; Sodium ; Sodium Azide

PURPOSE: CPR Anytime(R), a self-instructional video program, has gained popularity amongst CPR instructors for training non-healthcare providers. This instructional kit enables second-tier instruction. The purpose of this study is to determine the status of second-tier instruction CPR by CPR Anytime(R) trainees. METHODS: Questionnaires were sent to 606 CPR Anytime(R) trainees from 12 BLS training sites. The training period was from October 2006 to July 2007. Questionnaires included provider's basic information, post-course self exercise, amount of second-tier instruction, and multiplier status. RESULTS: The response rate of the questionnaire was 53.6%(325). The mean age was 20.4+/-10.3 years old. The professions of respondents were as follows: students (76.3%), office workers(13.2%), teachers(4.4%), and service providers(1.9%). The post-course self exercise rate was 49% with three fourths of those completing the exercises using both the DVD and MiniAnne(R). Second-tier instruction tools use rates(48%) were as follows: DVD and manikin(35%), manikin only(9%), verbal only(2%), and DVD only(1%). The total multiplier effect was 1.77(575/ 325) with the multiplier effect of teachers significantly higher than others. CONCLUSION: This study found that 48% of CPR Anytime(R) providers perform second-tier instruction to family and friends. Amongst them, the total multiplier effect was 1.77 (575/325).
Cardiopulmonary Resuscitation ; Surveys and Questionnaires ; Exercise ; Friends ; Humans ; Manikins

To evaluate the prevalence and the role of mutation of p53 gene in the transitional ceI1 carcinoma of the urinary bladder with special attention to the clinicopathologic features, we examined p53 expression in paraffin-embedded tissues from 95 transitional cell carcinomas with various stages and grades and 5 specimens of morphologically normal bladder. Nuclear expression of p53 protein was detected by immunohistochemical analysis with avidin -alkaline phosphatase method, using the monoclonal antibody DO-7. And to evaluate the correlation of p53 expression with cell proliferation, expression of proliferating cell nuclear antigen(PCNA) was also assessed immunohistochemically in 43 specimens, using the monoclonal antibody PC1O. Median follow-up duration was 36 months(12-117 months). Immunohistochemical staining with p53 in 5 normal bladder specimens showed that 4 specimens exhibited absence of nuclear staining in urothelial and stromal cells and 1 specimen exhibited nuclear staining less than 5% of urothelial cells in the basal layer. Forty six(48%) of 95 specimens with transitional cell carcinoma of the bladder showed positive nuclear staining. Nuclear expression of p53 was observed with significantly higher frequency and stronger intensity(p<0.01 and p<0.005, respectively) in cases with invasive tumors(17,27, 70%) than superficial tumors(27/68, 40%). Nuclear expression of p53 was observed with signi6cantly higher frequency and stronger intensity(p<0.005 and p<0.005, respectively) in. cases with high grade tumors(32,43, 74%) than in cases with low grade tumors(14/52, 27%). Patients with bladder tumors were stratified into two groups with different patterns of staining for p53 protein (group A: <20%, group B: >20%). Recurrence rates of patients with superficial tumors were 2.2% per month for group A and 4.2% for group B, and patients in group B had a significantly 1ower disease-free interval(P<0.005). Disease progression rates of patients with T1 tumors were 4% per year and 21.2% for group B, and patients in group B had a significantly lower progression- free interval(P<0.025). Difference of survivorship of patients with invasive tumors between group A and B was not statistically significant(p>O.1). Mean value of PCNA expression rates of 43 transitional cell carcinomas of the bladder was 12.1+8.34%(mean + SD). Mean value of PCNA expression rates was slightly higher in p53 positive-stained group(13.2+/-7.81%) than negative stained group(10.8+/-8.89%), but difference was not statistically significant(p>0.1). These results suggest that p53 mutations play an important role in the acquisition of aggressive biological natures in invasive bladder transitional cell carcinomas rather than in the genesis of tumors of low malignant potentials. This study also suggests that immunohistochemical examination of p53 in superficial bladder transitional cell carcinomas (especially, T1 tumors) offers significant information, and the degree of p53 expression might be a useful prognostic indicator which can be considered in treatment planning.
Avidin ; Carcinoma, Transitional Cell* ; Cell Proliferation ; Disease Progression ; Follow-Up Studies ; Genes, p53 ; Humans ; Immunohistochemistry ; Prevalence ; Proliferating Cell Nuclear Antigen ; Recurrence ; Stromal Cells ; Survival Rate ; Urinary Bladder Neoplasms ; Urinary Bladder*