Epidemiological evidence suggests that the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is lesser and morbidity and mortality rates are lower in children than in adults. Although respiratory viral infections are major triggers of asthma exacerbations in children, the association between asthma and SARS-CoV-2 infection remains unclear. We describe a previously healthy 13-year-old male adolescent who developed severe acute asthma exacerbation following coronavirus disease 2019 (COVID-19) infection. This case report describes new-onset asthma as severe exacerbation following COVID-19 infection and highlights the importance of ongoing surveillance of the wide spectrum of COVID-19 manifestations in children.

OBJECTIVES: Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. METHODS: Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. RESULTS: The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. CONCLUSIONS: The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.
Antipsychotic Agents ; Brain ; Brief Psychiatric Rating Scale ; Clozapine ; Humans ; Inpatients ; Schizophrenia ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Hormones ; Thyrotropin ; Thyroxine ; Triiodothyronine

There are several cases of partial monosomy or partial trisomy derived from maternal balanced translocation, but partial monosomy 6q and partial trisomy 14q derived from maternal balanced translocation has not been reported around the world. The authors experienced a case of partial monosomy 6q and partial trisomy 14q derived from maternal reciprocal balanced translocation t (6;14) in a neonate with multiple anomalies including intrauterine growth retardation, facial and cardiac anomalies. We report the case with a brief review of associaed lieratures.
Chromosome Deletion ; Chromosomes, Human, Pair 6 ; Fetal Growth Retardation ; Humans ; Infant, Newborn ; Trisomy

PURPOSE: Taurine is a simple sulfur-containing amino acid and enriched in brain, retina, heart and skeletal muscles. In the central nervous system, taurine has been implicated in major phenomena. Current studies have demonstrated the neuroprotective effect of taurine in adult rat model, but limited data are available for those during the neonatal periods. The aim of this study was to determine whether taurine could reduce hypoxic-ischemic (HI) brain injury in the developing brain via modulation of nitric oxide synthase. METHODS: In in vitro model, embryonic cortical neuronal cell culture procedure was done in Sprague-Dawley (SD) rats at 18 days of gestation. The cells were divided into the hypoxia group, taurine-treated group before and after a hypoxic insult. The each groups compared with normoxia group. In in vivo model, left carotid artery ligation was done in 7-day-old SD rat pups. the pups were exposed to hypoxia, received an injection of 30 mg/kg of taurine, and sacrificed at day 1, day 3, day 7, day 14 and day 28. We assayed the expression of iNOS, eNOS and nNOS mRNA using real-time PCR and western-blotting. RESULTS: In in vitro model, brain cell damage of hypoxia group was more than in the normoxia group. Cell damage's recovery was more in the taurine-treated group before a hypoxic insult than in the taurine-treated group after a hypoxic insult. The expression of iNOS mRNA was less in the hypoxia group than in the normoxia group both in vitro and in vivo models. The expression of eNOS and nNOS was more in the hypoxia group. CONCLUSION: Taurine has neuroprotective property over perinatal HI brain injury due to modulation of NOS, as evidenced by causing a decrease in eNOS and nNOS and increase in iNOS expression. The neuroprotective effect of taurine administration was maximal at day 7 and day 14 after a hypoxic injury.
Adult ; Animals ; Anoxia ; Brain ; Brain Injuries ; Carotid Arteries ; Cell Culture Techniques ; Central Nervous System ; Heart ; Humans ; Ligation ; Muscle, Skeletal ; Neurons ; Neuroprotective Agents ; Nitric Oxide ; Nitric Oxide Synthase ; Pregnancy ; Rats ; Real-Time Polymerase Chain Reaction ; Retina ; RNA, Messenger ; Taurine

BACKGROUND: As the result of renal transplantation improving, also increasing the number of graft failure which will be a candidate for second renal transplantation. The purpose of this study is to evaluate the factors that influence the survival of retransplanted kidney. METHODS: Among 775 renal transplantations that have been performed in Dongsan Medical Center until August 2007, 225 cases were failed their graft function and 59 of them were retransplanted during their follow up period. Graft survival of retransplanted kidney was compared with primary renal transplantation and factors that affecting the survival of kidney retransplantation were evaluated. RESULTS: Main causes of graft failure of first kidney transplantation were chronic rejection, followed by recurrence of original disease of recipient and acute vascular rejection. Mean survival time was 72.6 months (15 days~161 months). One and 5 years graft survivals were 94.6%, 90.7%, and patient survivals were 100.0%, 97.8%, respectively. Among the factors which showed significance in univariate analysis, short interval between failure of first transplantation and retransplantation, and graft failure due to chronic rejection were statistically significant unfavorable factors for survival of retransplanted kidney. CONCLUSIONS: Kidney retransplantation showed similar graft and patient survival compare to the first one. However, retransplantation should be performed after enough time after graft failure and should be cautious in a patient who lost their graft due to chronic rejection.
Follow-Up Studies ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Recurrence ; Rejection (Psychology) ; Survival Rate ; Transplants

PURPOSE: The prevalence of blood eosinophilia in patients who are maintained on regular hemodialysis has been well established. Blood eosinophilia in patients initiating peritoneal dialysis has been mentioned, but its prevalence and etiologic factors have not been well delineated. Therefore, we performed this retrospective study to find out prevalence and possible etiologic factors of blood eosinophilia in patients undergoing continuous ambulatory peritoneal dialysis. METHODS: Between May 2001 to May 2004, the patients who began continuous ambulatory peritoneal dialysis at one renal center were included in this study. Patients with allergic history or allergic reaction during observed period were excluded. The routine peripheral WBC counts of 47 patients were reviewed and possible predisposing factors of eosinophilia were investigated. RESULTS: Blood eosinophilia was observed in 17 of 47 patients (35% of all patients). In most patients with blood eosinophilia, the time in which the eosinophil count began to be rise was within 40 days, and duration of eosinophilia was variable (mean+/-SD;74+/-67 days). The mean of the peak eosinophil count was 750+/-257/mm3 (mean+/-SD). Possible predisposing factors included recent parenteral iron therapy, but not statistically significant (p=0.09). CONCLUSION: Our retrospective study showed that the eosinophil counts in patients with end stage renal disease on continuous ambulatory peritoneal dialysis were frequently elevated. Predisposing factors for this eosinophilia were not clear, suggesting that immunologic disturbance by uremia or dialysis itself might have influence on eosinophil homeostasis.
Causality ; Dialysis ; Eosinophilia* ; Eosinophils ; Homeostasis ; Humans ; Hypersensitivity ; Iron ; Kidney Failure, Chronic ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Prevalence ; Renal Dialysis ; Retrospective Studies ; Uremia

OBJECTIVES: The purpose of this study is to investigate the clinical significance of activity of daily living(ADL) and to identify the influencing factors on ADL in elderly patients admitted to the hospital-based acute geriatric care unit. METHODS: We studied a total of 279 patients aged 65 years and older who admitted to the Acute Elderly Care Unit at Seoul National University Bundang Hospital between May, 2004 and April, 2005. Comprehensive geriatric assessment including medical, psychosocial and functional evaluation was performed by the geriatric team. RESULTS: Most of the patients need ADL(62.7%) and IADL(68.8%) assistance. Dependent ADL patients were older (p<0.01), admitted via emergency room(p<0.01), demented(p<0.01), and associated with depression(p<0.01), malnutrition(p<0.01), and stroke(p<0.05) compared to independent ADL group. The length of stay was also significantly increased in dependent ADL group(p<0.01) and six-month mortality rate was higher in dependent ADL group(p<0.01). In correlation analysis, MMSE-KC score(r=0.708, p<0.01), nutritional state(r=0.581, p<0.01), the length of stay(r=-0.433, p<0.01), depression(r=-0.309, p<0.01), the numbers of chronic disease(r=-0.287, p<0.01), age (r=-0.236, p<0.01) showed significant association with ADL. In multivariate analysis, cognitive impairment(OR=5.80), emergent admission(OR=4.33), over the 75 years old age(OR=3.33), malnutrition(OR=2.86), and depression(OR=2.61) were identified as the independent influencing factors on ADL dependency. CONCLUSION: ADL dependency is common in elderly inpatient and significantly associated with poor prognosis. Identifying and controlling the influencing factor on ADL decline may improve the patients' functional status and clinical outcome.
Activities of Daily Living ; Aged* ; Cognition ; Depression ; Emergencies ; Geriatric Assessment ; Humans ; Inpatients ; Length of Stay ; Mortality ; Multivariate Analysis ; Prognosis ; Seoul

PURPOSE: Gallbladder carcinoma (GBC) is a rare neoplasm with poor prognosis. With the introduction and the wide acceptance of laparoscopic surgery, the diagnostic rate of incidental GBC has increased. We report our experience with the reoperated GBC diagnosed after simple cholecystectomy. METHODS: From March 2001 to July 2005, 17 patients with a postoperative diagnosis of GBC after prior simple cholecystectomy were referred to our center for curative reoperation. The types of simple cholecystectomy were open cholecystectomy in 5 cases, and laparoscopic cholecystectomy in 12 cases. The types of reoperation were hepatic wedge resection with lymph node dissection (HWR /(c) LND, n=9), HWR with LND and bile duct resection (HWR /(c) LND and BDR, n=4), right hepatectomy (RH) with LND and BDR (n=1), extended RH with LND, BDR and caudate lobectomy (n=1) and extended left hepatectomy with LND and BDR (n=1). Residual tumor is defined as the tumor tissue detected on reoperation; bile duct, liver, lymph node, lymphatics, vessels and nerves. RESULTS: There is no operative mortality. The median hospital stay was 18.5days (range, 8 - 44 days). The median interval between 1st and 2nd operation was 23.5 days (range, 6 - 44 days). The median operative time was 379 minutes (range, 240-726). Five complications occurred in 4 patients. One patient received intraoperative transfusion. The depth of tumor invasion in 17 patients was T2 in 15, T3 in 1, and T4 in 1. There was no residual tumor in 8 out of 17 patients. In the other 9 patients, the residual tumor was identified after reoperation; liver in 2, lymph node in 7, bile duct in 3, lymphatics in 6, vessels in 3, and nerves in 3. Three patients of 17 patients recurred and 2 patients of them died. In curative reoperation after simple cholecystectomy, the median follow-up length was 14.7 months (1-53 months). One- and two-year survival rates were 90.9%, 79.6%, respectively. Vascular, lymphatic, and neural invasions were the significant risk factors for recurrence by the log-rank test. CONCLUSION: Reoperation of GBC diagnosed after simple cholecystectomy is safe and may be effective. Lymphatic, vascular, and neural invasion may have a dismal effect on the disease-free survival.
Bile Ducts ; Cholecystectomy* ; Cholecystectomy, Laparoscopic ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Gallbladder* ; Hepatectomy ; Humans ; Laparoscopy ; Length of Stay ; Liver ; Lymph Node Excision ; Lymph Nodes ; Mortality ; Neoplasm, Residual ; Operative Time ; Prognosis ; Recurrence ; Reoperation ; Risk Factors ; Survival Rate

PURPOSE: The long-term outcome after liver resection for hepatocellular carcinoma (HCC) is somewhat disappointing because of tumor recurrence. The purposes of this study were to evaluate the prognostic factors and to suggest the data to improve the long-term outcome of hepatic resection for HCC. METHODS: A retrospective survey was carried out in 200 patients undergoing hepatic resection for HCC from April 2001 to June 2004. The various clinicopathologic factors were analysed for the overall survival (OS) and the disease-free survival (DFS) rates by the univariate test (log rank test) and multivariate test (Cox regression model). RESULTS: There were one hospital mortality and 23% morbidity after partial hepatectomy. Intraoperative transfusion was given to 20 patients (10%). Mean follow-up period was 19 months (range, 2-43). The 1-, 2- and 3-year OS rates after hepatic resection for HCC were 90.5%, 86.8% and 76.2% and the 1-, 2- and 3-year DFS rates were 65.5%, 54.3% and 49.4%, respectively. By the univariate analysis for OS, aspartate aminotransferase (AST), Child-Pugh classification, Edmondson-Steiner histologic grade, microvascular invasion, major vessel invasion, alpha-fetoprotein (AFP), TNM stage, transfusion, surgical margin involvement and presence of complication were significant for survival. By the multivariate analysis, Child-Pugh classification, Edmondson-Steiner histologic grade, major vessel invasion and complication were independent risk factors for OS. Whereas viral marker, Child-Pugh classification, microvascular invasion, major vessel invasion, AFP, TNM stage, surgical margin involvement and presence of complication were the significant risk factors for DFS by the univariate analysis, viral marker, microvascular invasion, major vessel invasion, surgical margin involvement and presence of complication were the independent predictive factors of the DFS. CONCLUSION: Hepatic resection for HCC has become safe. To improve the long-term outcome of hepatic resection for HCC, the patients with poor liver function or major vessel invasion should be precluded in hepatic resection, if possible, and adequate surgical margin and avoidance of complication are mandatory.
alpha-Fetoproteins ; Aspartate Aminotransferases ; Biomarkers ; Carcinoma, Hepatocellular* ; Classification ; Disease-Free Survival ; Factor Analysis, Statistical* ; Follow-Up Studies ; Hepatectomy ; Hospital Mortality ; Humans ; Liver ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Risk Factors

BACKGROUND: Autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), and autoimmune cholangiopathy (AIC) are major classes of liver diseases currently considered autoimmune. We investigated the clinical, biochemical, and immunologic findings in Korean patients with these disease entities. METHODS: We retrospectively analyzed 47 patients with AIH, 27 with PBC, 3 with Overlap syndrome, 15 with AIC, and 5 with PSC. RESULTS: About 90% of the patients were women, while 40% in PSC. The mean age of onset ranged from 47 to 57 years, while it was 28 years in PSC. Fatigue and jaundice were the most frequent manifestations at diagnosis. In AIH, 13% of patients had an acute onset and 1 died of fulminant hepatic failure. The serum level of IgG was elevated in 67.5%, and antinuclear antibody and anti-smooth muscle antibody were detected in 95.7% and 43.2%. Fifty eight per cent of the patients who received immunosuppressive therapy showed a complete response. In patients with PBC, the level of IgM was elevated in 75% and all of the patients were positive for anti-mitochondrial antibody. Biochemical remission was observed in 37% on ursodeoxycholic acid therapy. Except for the negative anti-mitochondrial antibody, the clinical and biochemical features in AIC were not different from those in PBC. CONCLUSION: Autoimmune liver diseases are not rare in Korea. Considering that these entities are potentially treatable diseases, a high index of suspicion is needed, especially in patients negative for the serologic markers of viral hepatitis.
Age of Onset ; Antibodies, Antinuclear ; Cholangitis ; Cholangitis, Sclerosing ; Diagnosis ; Fatigue ; Female ; Hepatitis ; Hepatitis, Autoimmune ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Jaundice ; Korea* ; Liver Cirrhosis ; Liver Cirrhosis, Biliary ; Liver Diseases* ; Liver Failure, Acute ; Liver* ; Retrospective Studies ; Ursodeoxycholic Acid