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Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis

  • Wilar, Rocky
    • Clinical and Experimental Pediatrics
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    • v.62 no.6
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    • pp.217-223
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    • 2019
  • Purpose: To determine the diagnostic value of eosinopenia and the neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of early onset neonatal sepsis (EONS). Methods: This cross-sectional study was conducted in the Neonatology Ward of R.D. Kandou General Hospital Manado between July and October 2017. Samples were obtained from all neonates meeting the inclusion criteria for EONS. Data were encoded using logistic regression analysis, the point-biserial correlation coefficient, chi-square test, and receiver operating characteristic curve analysis, with a P value <0.05 considered significant. Results: Of 120 neonates who met the inclusion criteria, 73 (60.8%) were males and 47 (39.2%) were females. Ninety (75%) were included in the sepsis group and 30 (25%) in the nonsepsis group. The mean eosinophil count in EONS and non-EONS groups was $169.8{\pm}197.1cells/mm^3$ and $405.7{\pm}288.9cells/mm^3$, respectively, with statistically significant difference (P<0.001). The diagnostic value of eosinopenia in the EONS group (cutoff point: $140cells/mm^3$) showed 60.0% sensitivity and 90.0% specificity. The mean NLR in EONS and non-EONS groups was $2.82{\pm}2.29$ and $0.82{\pm}0.32$, respectively, with statistically significant difference (P<0.001). The diagnostic value of NLR in the EONS group (cutoff point, 1.24) showed 83.3% sensitivity and 93.3% specificity. Conclusion: Eosinopenia has high specificity as a diagnostic marker for EONS and an increased NLR has high sensitivity and specificity as a diagnostic marker for EONS.

A Clinical Study on the Factors that Influence Functional Evaluation of Stroke (중풍의 기능평가에 영향을 미치는 요인에 관한 임상적 고찰)

  • 박숙자;권정남;김영균
    • The Journal of Korean Medicine
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    • v.23 no.4
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    • pp.73-90
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    • 2002
  • Objectives: This study investigated significant factors that influence functional evaluation of stroke so as to be a fundamental data for estimating prognosis of stroke patients. Methods: 204 patients were studied within 7 days of admission, after the diagnosis of stroke through brain CT scan, brain MRI scan and clinical observations. They were hospitalized in the oriental medical hospital of Dongeui University from February to July in 2001. They were examined at the early stage of onset, after 2 weeks, 4 weeks and 6 weeks, and measured for average mark and the degree of improvement by using the Activity Index. Results: Ischemic stroke, past history of stroke, hypertension, diabetes mellitus, risk factor of obesity, non-professional emergency treatment and hospitalizing time after 1 day from onset, high blood pressure, tachycardia pulse and high blood sugar in abnormal vital sign in acute stage, conscious, cognitive or communication disorder, motor aphasia, dysphagia, constipation for more than 3 days, urinary incontinence, visual field defect, insomnia, and chest discomfort in early stage of onset had a negative influence on functional evaluation. Conclusions: Type of stroke, past history, risk factors, emergency treatment and hospitalizing time after onset, abnormal vital sign and intercurrent symptoms in Acute stage were relevant factors in predicting functional evaluation of stroke.

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Studies on the Progesterone Level for Early Pregnency Diagnosis of Cheju Native Mares (혈중 Progesterone 수준 측정에 의한 제주재래마의 조기 임신진단 응용에 관한 연구)

  • 장덕지;김중계
    • Journal of Embryo Transfer
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    • v.11 no.1
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    • pp.85-91
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    • 1996
  • Plasma progesterone concentrations were measured by using radjoimmunoassay for early diagnosis of pregnancy in Cheju-native mares. A total of 226 pony mares were examined for pregnancy during breeding and non breeding seasons. Plasma progesterone levels 20~23 days after the onset of oestrus were 4.67+O.67ng /rnl and O.55+O.O4ng /ml for mares becornrning pregnant and not pregnant after the estrus, respectively, and there was a significant differences (p<0.01) between the two groups. Progesterone concentration of pregnant mares gradually increased in 30 days andreached a peak (10.3ng /ml) during the third month of gestation. However, the concentration decresed to the base line (1.llng /rnl) at 7 months and gradually increased again as foaling approached (2.lng /ml). Early diagnosis for pregnancy of Cheju mares by progesterone level at 20~23 days after onset of oestrus was 88% accurate when 4.6ng /ml was used to classify mares as pregnancy and below 1.3ng /rnl was used to determine nonpregnant mares. However, the accuracy of the diagnosis was improved to 96% when a progesterone level of above 2ng /mi was used to classify mares for pregnancy. Diagnosis for pregnancy was 69.6% accurate when mares were classified as pregnancy by horse owners during breeding season. The progesterone levels of pregnant and non-pregnant mares during non-breeding season varied greatly between individual animals, Plasma progesterone levels of pregnant animals ranged from 3.5ng /mi to above 6.2ng /mi whereas similar values were observed in non-pregnant animals. Radioirnrnunoassay technicjues can be applied for the early pregnant diagnosis of Cheju native mares when progesterone levels are measured during the early gestation period (18~23 days after onset of oestrus). However, progesterone concentration of mares in non-breeding season is conisidered unsuitable as a indicator of pregnant diagnosis.

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A Comparative Study according to Diagnostic Time on Meningitis (무균성 뇌막염에서 증상발현부터 진단까지 걸린 시간에 따른 시기별 유병기간의 검토)

  • Kim, Tag Soo;Hur, Ji Yeon;Park, Young Hee;Jung, Min Goo;Kim, Sung Won
    • Pediatric Infection and Vaccine
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    • v.3 no.2
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    • pp.168-174
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    • 1996
  • Purpose : Aseptic meningitis is relatively frequent in children and caused mostly by enterovirus. The aim of the present study was to determine the effect of early diagnosis (spinal tapping) on symptom duration of childhood aseptic meningitis. Methods : One hundred fifty-three children who were hospitalized due to aseptic menigitis in the Department of Pediatrics St. Benedict Hospital from July 1996 through October 1996 were included in this study. Patients were divided to two groups according to the duration from first symptom onset to diagnosis. Early diagnosis group is diagnosed within 3 days from first symptom onset. Later diagnosis group is diagnosed after 4 days from first symptom onset. Results : 1) The average age of these patients was 4.3 years old in early diagnosis group and 4.1 years old in later diagnosis group. The sex ratio(male: female) was 2.04:1 in early diagnosis group and 2.5:1 in later diagnosis group. 2) The mean duration of diagnosis of this study was 2.04 day in early diagnosis group and 5.12 day in later diagnosis group. 3) The percentage of symptom and sign of the early diagnosis group were fever(100%), headache(88.4%), vomiting(86.9%), abdominal pain(39%), neck stiffness(36.2%), skin rash(18.8%), diarrhea(16.9%) and that of later diagosis group were fever(100%), headache(83.3), vomiting(80.9%), abdominal pain(47.6%), neck stiffness(41.6%), skin rash(29.7%), diarrhea(16.6%). 4) Initial CSF findings revealed leukocyte $146.8{\pm}386.3/mm^3$ with PMNL 38%, protein 32.47mg/dl, sugar 66.23mg/dl in early diagnosis group and leukocyte $458.1{\pm}663.2/mm^3$, protein 31.22mg/dl, sugar 64.21 mg/dl in later diagnosis group. 5) There was no statistically significant differance in the peripheral blood findings between early diagnosis group and later diagnosis group. 6) The duration of disappearance of symptom after spinal tap were 2.3 days in early diagnosis group and 2.24 days in later diagnosis group. Total symptom duration was 4.34 days in early diagnosis group and 7.36 days in later diagnosis group. Conclusions : Our results demonstrate that early diagnosis(early spinal tap) shortened duration of clinical symptoms.

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Abnormal Oculomotor Functions in Amyotrophic Lateral Sclerosis

  • Kang, Bong-Hui;Kim, Jae-Il;Lim, Young-Min;Kim, Kwang-Kuk
    • Journal of clinical neurology
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    • v.14 no.4
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    • pp.464-471
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    • 2018
  • Background and Purpose Although traditionally regarded as spared, a range of oculomotor dysfunction has been recognized in amyotrophic lateral sclerosis (ALS) patients. ALS is nowadays considered as a neurodegenerative disorder of a third compartment comprising widespread areas of extra-motor brain including cerebellum. Our objective was to perform an observational study to examine for ocular motor dysfunction in patients with ALS and for any differences between bulbar-onset and spinal-onset patients.. Methods Thirty two ALS patients (bulbar onset: 10, spinal onset: 22) underwent the standardized systemic evaluations using video-oculography. Results Oculomotor dysfunctions such as square wave jerks, saccadic dysmetria, abnormal cogwheeling smooth pursuits and head shaking and positional nystagmus of central origin have been observed in the ALS patients at a relatively early stage. Abnormal smooth pursuits and saccadic dysmetria were increased in the bulbar-onset compared to the spinal-onset (p<0.05). Conclusions These oculomotor abnormalities may be a marker of neuro-degeneration beyond motor neurons in ALS, especially in bulbar-onset disease. Future longitudinal studies of eye movement abnormalities have provided insights into the distribution and nature of the disease process.

Clinical features and prognostic factors of early-onset sepsis: a 7.5-year experience in one neonatal intensive care unit

  • Kim, Se Jin;Kim, Ga Eun;Park, Jae Hyun;Lee, Sang Lak;Kim, Chun Soo
    • Clinical and Experimental Pediatrics
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    • v.62 no.1
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    • pp.36-41
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    • 2019
  • Purpose: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. Results: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4-1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3-1,628.7) and decreased activity (OR, 34; 95% CI, 1.8-633.4), were found to be associated with fatality. Conclusion: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.

A case of Becker muscular dystrophy with early manifestation of cardiomyopathy

  • Doo, Ki-Hyun;Ryu, Hye-Won;Kim, Seung-Soo;Lim, Byung-Chan;Hwang, Hui;Kim, Ki-Joong;Hwang, Yong-Seung;Chae, Jong-Hee
    • Clinical and Experimental Pediatrics
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    • v.55 no.9
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    • pp.350-353
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    • 2012
  • An 18-year-old boy was admitted with chest discomfort, nausea, and dyspnea at rest. At the age of 3 years, he underwent muscle biopsy and dystrophin gene analysis owing to an enlarged calf muscle and elevated serum kinase level (6,378 U/L) without overt weakness; based on the results, Becker muscular dystrophy (BMD) was diagnosed. The dystrophin gene showed deletion of exons 45 to 49. He remained ambulant and could step upstairs without significant difficulties. A chest roentgenogram showed cardiomegaly (cardiothoracic ratio, 54%), and his electrocardiogram (ECG) showed abnormal ST-T wave, biatrial enlargement, and left ventricular hypertrophy. The 2-dimensional and M-mode ECGs showed a severely dilated left ventricular cavity with diffuse hypokinesis. The systolic indices were reduced, including fractional shortening (9%) and ejection fraction (19%). Despite receiving intensive medical treatment, he died from congestive heart failure 5 months after the initial cardiac symptoms. We report a case of BMD with early-onset dilated cardiomyopathy associated with deletion of exons 45 to 49. Early cardiomyopathy can occur in BMD patients with certain genotypes; therefore, careful follow-up is required even in patients with mild phenotypes of BMD.

Early-Onset LMNA-Associated Muscular Dystrophy with Later Involvement of Contracture

  • Lee, Younggun;Lee, Jung Hwan;Park, Hyung Jun;Choi, Young-Chul
    • Journal of clinical neurology
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    • v.13 no.4
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    • pp.405-410
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    • 2017
  • Background and Purpose The early diagnosis of LMNA-associated muscular dystrophy is important for preventing sudden arrest related to cardiac conduction block. However, diagnosing early-onset Emery-Dreifuss muscular dystrophy (EDMD) with later involvement of contracture and limb-girdle muscular dystrophy type 1B is often delayed due to heterogeneous clinical presentations. We aimed to determine the clinical features that contribute to a delayed diagnosis. Methods We reviewed four patients who were recently diagnosed with LMNA-associated muscular dystrophy by targeted exome sequencing and who were initially diagnosed with nonspecific or other types of muscular dystrophy. Results Certain clinical features such as delayed contracture involvement and calf hypertrophy were found to contribute to a delayed diagnosis. Muscle biopsies were not informative for the diagnosis in these patients. Conclusions Genetic testing of single or multiple genes is useful for confirming a diagnosis of LMNA-associated muscular dystrophy. Even EDMD patients could experience the later involvement of contracture, so clinicians should consider early genetic testing for patients with undiagnosed muscular dystrophy or laminopathy.

Clinical Characteristics of Exacerbation-Prone Adult Asthmatics Identified by Cluster Analysis

  • Kim, Mi-Ae;Shin, Seung-Woo;Park, Jong-Sook;Uh, Soo-Taek;Chang, Hun Soo;Bae, Da-Jeong;Cho, You Sook;Park, Hae-Sim;Yoon, Ho Joo;Choi, Byoung Whui;Kim, Yong Hoon;Park, Choon-Sik
    • Allergy, Asthma & Immunology Research
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    • v.9 no.6
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    • pp.483-490
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    • 2017
  • Purpose: Asthma is a heterogeneous disease characterized by various types of airway inflammation and obstruction. Therefore, it is classified into several subphenotypes, such as early-onset atopic, obese non-eosinophilic, benign, and eosinophilic asthma, using cluster analysis. A number of asthmatics frequently experience exacerbation over a long-term follow-up period, but the exacerbation-prone subphenotype has rarely been evaluated by cluster analysis. This prompted us to identify clusters reflecting asthma exacerbation. Methods: A uniform cluster analysis method was applied to 259 adult asthmatics who were regularly followed-up for over 1 year using 12 variables, selected on the basis of their contribution to asthma phenotypes. After clustering, clinical profiles and exacerbation rates during follow-up were compared among the clusters. Results: Four subphenotypes were identified: cluster 1 was comprised of patients with early-onset atopic asthma with preserved lung function, cluster 2 late-onset non-atopic asthma with impaired lung function, cluster 3 early-onset atopic asthma with severely impaired lung function, and cluster 4 late-onset non-atopic asthma with well-preserved lung function. The patients in clusters 2 and 3 were identified as exacerbation-prone asthmatics, showing a higher risk of asthma exacerbation. Conclusions: Two different phenotypes of exacerbation-prone asthma were identified among Korean asthmatics using cluster analysis; both were characterized by impaired lung function, but the age at asthma onset and atopic status were different between the two.