Chong Guk Lee

Increasing incidence of type 1 diabetes among Korean children and adolescents: analysis of data from a nationwide registry in Korea

The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents has increased worldwide. However, the epidemiology of T1DM among Korean youth has not been reported since 2001. We investigated the incidence of T1DM in Korean children and adolescents from 2012 to 2014 and compared it with data from 1995 to 2000.

Validation study of the Dinamap ProCare 200 upper arm blood pressure monitor in children and adolescents

PURPOSE To validate the Dinamap ProCare 200 blood pressure (BP) monitor against a mercury sphygmomanometer in children 7 to 18 years old in accordance with the 2010 International Protocol of European Society of Hypertension (ESH-IP2) and the British Hypertension Society (BHS) protocol. METHODS Forty-five children were recruited for the study. A validation procedure was performed following the protocol based on the ESH-IP2 and BHS protocols for children and adolescents. Each subject underwent 7 sequential BP measurements alternatively with a mercury sphygmomanometer and the test device by trained nurses. The results were analyzed according to the validation criteria of ESH-IP2. RESULTS The mean (±SD) difference in the absolute BP values between test device and mercury sphygmomanometer readings was 1.85±1.65 mmHg for systolic BP (SBP) and 4.41±3.53 mmHg for diastolic BP (DBP). These results fulfilled the Association for the Advancement of Medical Instrumentation criterion of a mean±SD below 5±8 mmHg for both SBP and DBP. The percentages of test device-observer mercury sphygmomanometer BP differences within 5, 10, and 15 mmHg were 96%, 100%, and 100% for SBP, and 69%, 92%, and 100% for DBP, respectively, in the part 1 analysis; both SBP and DBP passed the part 1 criteria. In the part 2 analysis, SBP passed the criteria but DBP failed. CONCLUSION Although the Dinamap ProCare 200 BP monitor failed an adapted ESH-IP2, SBP passed. When comparing BP readings measured by oscillometers and mercury sphygmomanometers, one has to consider the differences between them, particularly in DBP, because DBP can be underestimated.

Massive pulmonary hemorrhage in enterovirus 71-infected hand, foot, and mouth disease.

Hand, foot, and mouth disease (HFMD) is an acute, mostly self-limiting infection. Patients usually recover without any sequelae. However, a few cases are life threatening, especially those caused by enterovirus 71 (EV71). A 12-month-old boy was admitted to a primary hospital with high fever and vesicular lesions of the mouth, hands, and feet. After 3 days, he experienced 3 seizure episodes and was referred to our hospital. On admission, he was conscious and his chest radiograph was normal. However, 6 hours later, he suddenly lost consciousness and had developed a massive pulmonary hemorrhage that continued until his death. He experienced several more intermittent seizures, and diffuse infiltration of both lung fields was observed on chest radiography. Intravenous immunoglobulin, dexamethasone, cefotaxime, leukocyte-depleted red blood cells, fresh frozen plasma, inotropics, vitamin K, and endotracheal epinephrine were administered. The patient died 9 hours after intubation, within 3 days from fever onset. EV71 subgenotype C4a was isolated retrospectively from serum and nasopharyngeal swab by real-time reverse transcription-polymerase chain reaction. Here, we report a fatal case of EV71-associated HFMD with sudden-onset massive pulmonary hemorrhage and suspected encephalitis.

Change in the height of Korean children and adolescents: analysis from the Korea National Health and Nutrition Survey II and V

Purpose The mean adult height of Koreans has increased since nationwide anthropological measurements began in 1967. The objective of this study was to evaluate differences in heights of Korean late adolescents and young adults within and between the Second and Fifth Korea National Health and Nutrition Examination Surveys (KNHANES II and V). Methods Koreans aged ≤22 years with available measurements of height were enrolled from the KNHANES surveys (KNHANES II: n=3,372 [1,732 males and 1,640 females]; KNHANES V: n=6,190 [3,198 males and 2,992 females]). Differences in the height of KNHANES respondents within and between surveys were evaluated according to age and sex. Results In KNHANES II, there was no significant difference in height between males aged 17-19 years and those aged 20-22 years (174.3±0.5 cm vs. 174.3±0.6 cm, P=0.995). Females aged 20-22 years were taller than those aged 17-19 years (159.8±0.4 cm vs. 161.0±0.4 cm, P=0.017). Females aged 17-19 years were significantly taller in KNHANES V than in KNHANES II (161.2±0.3 cm vs. 159.8±0.4 cm, P=0.004). Respondents aged 20-22 years were taller in KNHANES V than in KNHANES II, although not significantly so; the difference was 0.3±0.8 cm in males (P=0.721) and 0.5±0.6 cm in females (P=0.386). Conclusion Koreans appear to continue growing even in their late adolescence and early twenties. Consequently, it may be necessary to expand the reference age ranges of the Korean growth chart. Additionally, a longitudinal growth survey is needed to determine growth patterns and secular trend in height among Koreans.

Concomitant occurrence of Turner syndrome and growth hormone deficiency

Turner syndrome (TS) is a genetic disorder in phenotypic females that has characteristic physical features and presents as partial or complete absence of the second sex chromosome. Growth hormone deficiency (GHD) is a condition caused by insufficient release of growth hormone from the pituitary gland. The concomitant occurrence of TS and GHD is rare and has not yet been reported in Korea. Here we report 2 cases of TS and GHD. In case 1, GHD was initially diagnosed. Karyotyping was performed because of the presence of the typical phenotype and poor response to growth hormone therapy, which revealed 45,X/45,X+mar. The patient showed increased growth velocity after the growth hormone dose was increased. In case 2, a growth hormone provocation test and chromosomal analysis were performed simultaneously because of decreased growth velocity and the typical TS phenotype, which showed GHD and a mosaic karyotype of 45,X/46,XX. The patient showed spontaneous pubertal development. In female patients with short stature, it is important to perform a throughout physical examination and test for hormonal and chromosomal abnormalities because diagnostic accuracy is important for treatment and prognosis.

826 AGE EFFECTS ON THE DIFFERENCES BETWEEN AUTOMATIC OSCILLOMETRIC BLOOD PRESSURE MONITORS AND MANUAL MERCURY SPHYGMOMANOMETER BLOOD PRESSURE READINGS

Purpose: To evaluate the age effects on the differences of oscillometric BP monitors, Dinamap ProCare 200(A) and Omron HEM 907 XL(B), against auscultatory mercury sphygmomanometer in children aged 7 – 18 years. Methods: The evaluations through 2 methods; A validation study in accordance with a modified 2010 International Protocol of European Society of Hypertension(ESH-IP2) and British Hypertension Society(BHS) protocol, and a comparison study of BP readings of alternate measurements with oscillometric and manual devices on children and adolescents. For a validation study, the results were analyzed according to the criteria of ESH-IP2 and AAMI. As for the comparison study, total 861subjects were divided by devices. Means of last 2 of 3 readings were used for the analysis. Results: 1. Validation tests: The mean BP (±SD) differences of absolute value between the test devices and a mercury sphygmomanometer fulfilled the AAMI criterion for both SBP and DBP. Those differences of measurements of both devices against mercury sphygmomanometer satisfied the part 1 criteria of the ESH-IP2 for SBP and DBP, however, though differences of SBP of both devices passed part 2, DBP of both devices failed. Mean SBP difference device-A and –B group were 0.64/1.96mmHg, respectively and DBP -3.9/-0.45mmHg, respectively. 2. Comaprison studies: Mean SBP difference device-A(n = 426) and –B group(n = 435) were 3.8 ± 9.1/5.8 ± 10.3 mmHg, respectively and DBP -5.9 ± 7.9/-1.7 ± 8.2 mmHg, respectively. Conclusion: Dinamap ProCare 200 and Omron HEM 907 XL seemed to be high in SBP readings, but low in DBP as compared to BP readings of mercury sphygmomanometer on children and adolescents.