Microalbuminuria in Normal Korean Children

곽병옥,김교순,이상택,정소정 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.3

Purpose: Although microalbuminuria is known as a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated the incidence and reference range of microalbuminuria in healthy children. This study aimed to establish a reference range and to study the age-related trend for spot urine microalbumin/creatinine ratio in a Korean pediatric population. Materials and Methods: 352 healthy children were studied from July 2007 through March 2010. Height, weight, serum creatinine, spot urine microalbumin/creatinine ratio, and glomerular filtration rate (GFR) were obtained for each subject. We divided the study population into 5 groups according to age, and compared the spot urine microalbumin/creatinine ratio with other variables using one-way analysis of variance (ANOVA), regression analysis and Pearson’s correlation analysis. Results: In this study, the data showed that the spot urine microalbumin/creatinine ratio decreased with age: 1-12 months, 22.72±13.80 mg/mmol (2SD: 3.33-54.40 mg/mmol); 13-28 months, 16.34±9.58 mg/mmol (2SD: 3.16-35.19 mg/mmol); 29-48 months, 13.12±9.74 mg/mmol (2SD: 3.01-41.57 mg/mmol); 4-6 years, 10.58±8.13 mg/mmol (2SD: 0.00-30.19 mg/mmol); and 7-19 years, 5.13±5.44 mg/mmol (2SD: 0.45-14.45 mg/mmol). The spot urine microalbumin/creatinine ratio showed correlation with age, height, height z-score, weight, weight z-score, GFR, body mass index (BMI) and body surface area (BSA). Conclusion: The spot urine microalbumin/creatinine ratio in normal Korean children decreased with age. This ratio could potentially be used to establish reference ranges and cutoff values for Korean children and to predict nephropathy and cardiomyopathy.

Necrotizing fasciitis and streptococcal toxic shock syndrome secondary to varicella in a healthy child

곽병옥,이민정,박혜원,송민경,정소정,김교순 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.12

Varicella is usually considered to be a benign disease in healthy children; however, serious complications can occur such as necrotizing fasciitis and toxic shock syndrome. We describe a 38-month-old girl with necrotizing fasciitis and streptococcal toxic shock syndrome following varicella. She was previously healthy and vaccinated against varicella at 12 months of age. She had been diagnosed with varicella three days prior to presenting at our facility; she developed fever, vomiting, and painful swelling on her left flank. Her skin lesions worsened, she became lethargic, and had episodes of hypotension and coagulopathy. Necrotizing fasciitis on the left abdominal wall, buttocks, and left thigh was diagnosed by magnetic resonance imaging, and group A Streptococcus was isolated from a tissue culture. She was diagnosed as necrotizing fasciitis and streptococcal toxic shock syndrome, and successfully treated with repeated surgical debridement and fasciotomy, in addition to intensive antibiotics. Our experience suggests that necrotizing fasciitis in patients with varicella should be considered to be a rare complication even with widespread vaccine use. Early diagnosis and intensive treatment are required to prevent a fatal outcome.

페니실린으로 완치한 버섯 중독에 의한 소아 급성 간부전 1예

곽병옥,배선환,Kwak, Byung-Ok,Bae, Sun-Hwan 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.2

Hyperacute liver failure from mushroom intoxication in children is rare and has a low survival rate. We report a case of hyperacute liver failure from mushroom intoxication in a 29-month-old boy. The patient ingested a mushroom about three days prior to presentation. He was admitted to the hospital with vomiting, abdominal pain, seizures, and hematemesis. During the hospitalization the patient developed hepatic encephalopathy (stage IV-a), and a coagulopathy. He recovered fully with specific medication, Penicillin GK and N-acetylcysteine. 저자들은 버섯 중독 후 간성 뇌증을 동반한 급성 간부전으로 발현된 소아를 Penicillin GK를 사용한 약물 요법으로 완치할 수 있었다. 소아에서 급성 간부전은 사망률이 높은 위중한 질병이며, 생존을 위하여 간이식이 필요한 경우가 많다. 그러나 일부의 경우에는 본 증례와 같이 정확한 병력 청취에 의하여 특별한 치료를 시행하면 간이식을 시행하지 않고서도 환아의 생명을 구할 수 있다.

식별자 기반 미래 인터넷에서의 요구사항 분석

곽병옥,이상호 중소기업융합학회 2016 융합정보논문지 Vol.6 No.3

현재의 주소 기반 인터넷은 인터넷의 성장과 더불어 여러 가지 한계를 노출하기 시작하였다. 대부분의 문제는 인터넷에 새로운 기능을 추가하거나 기존 기능을 일부 수정하여 해결되었지만 일부 문제는 인터넷의 구조적인 한계로 인하여 해결이 불가능한 것으로 여겨진다. 기존 인터넷의 한계를 원천적으로 극복하려는 식별자 기반 미래 인터넷 연구가 미국과 유럽의 경쟁적 분위기에서 활발한 연구가 진행 중에 있다. 하지만 대부분의 연구가 특정 분야에서 제한된 영역에 집중되어 추진되고 있다. 미래 인터넷을 위하여는 기존 연구의 특징 및 장점을 수용하고 한계점을 극복하기 위한 요구사항을 도출할 필요성이 있다. 본 논문에서는 식별자 기반의 미래 인터넷 연구들에 대한 특징 및 장단점을 비교 분석하고, 식별자 기반의 미래 인터넷이 가져야 할 요구사항들에 대하여 기술하였다. Current address-based Internet has started to expose the number of limitations, with the growth of the Internet. Most of the problems have been solved by adding new features to the Internet or some modification of existing features but some problems can not be solved because it is believed that the structural limitations of the Internet. Overcoming to fundamentally the limitations of the Internet, ID-based Future Internet research is under active research going on in the competitive atmosphere of the United States and Europe. However, most studies have been promoted in a specific field is concentrated in a limited area. For the future Internet, there is a need to derive the requirements to overcome the limitation and accommodate the features and advantages of the existing studies. This paper compares and analyzes the characteristics and advantages and disadvantages for the ID-based Future Internet Research, and describes the requirements to have the ID-based Future Internet.

수두-대상포진 바이러스 감염으로 입원한 소아에 대한 임상 고찰

곽병옥,김동현,이환종,최은화,Kwak, Byung Ok,Kim, Dong Hyun,Lee, Hoan Jong,Choi, Eun Hwa 대한소아감염학회 2013 Pediatric Infection and Vaccine Vol.20 No.3

목적: 본 연구는 단일 기관에서 수두-대상포진 바이러스 감염으로 입원한 소아 환자의 임상 경과를 알아보고자 하였다. 방법: 2009년부터 2012년까지 서울대학교 어린이병원에서 피부 병변의 수포액으로 시행한 수두-대상포진 바이러스 배양검사와 중합효소 연쇄반응검사로 수두-대상포진 바이러스 감염증이 확진된 40명의 입원환자를 대상으로 하였다. 환자들의 의무기록을 통하여 진단 시 연령 및 성별, 수두 백신 시행유무, 임상증상 및 경과, 기저질환, 치료와 합병증에 대하여 분석하였다. 결과: 대상자 중 수두 환자는 16명, 대상포진 환자는 24명이었고, 연령 중앙값은 10.5세로 생후 16일부터 19세까지 분포하였다. 기저질환이 동반된 환자는 35명(87.5%)이었고, 24명의 대상포진 환자 중 과거에 수두를 앓았던 경우가 11례에서 있었고, 재발한 대상포진은 1례에서 있었다. 20명(50%)은 이전에 수두 백신의 접종력이 있었고, 이 중 19명은 면역저하환자였다. 대부분의 환자(95%)는 정맥용 또는 경구용 항바이러스제로 치료받았고, 정맥용 항바이러스제 투여 후 치료 실패는 관찰되지 않았다. 면역저하환자에서 발열의 기간은 평균 4.4일(1-10일)로 정상 면역력을 가진 환자와 비교하였을 때 유의한 차이는 없었으나, 항바이러스제의 투여기간은 평균 12일(7-23일)로 유의하게 길었다(P=0.014). 두 명(5.0%)의 환자에서 Streptococcus pyogenes와 Klebsiella oxytoca에 의한 이차 세균 감염이 확인되었으며, 1명(2.5%)에서 폐렴이, 11명(27.5%)에서 대상포진후 신경통이 합병되었다. 결론: 수두-대상포진 바이러스 감염은 면역저하 소아에서 발생할 시에 장기간의 항바이러스제 치료가 필요하므로 이 같은 환자들을 적극적으로 치료하고, 면밀하게 관찰하는 것이 필요하다. Purpose: This study was performed to describe the clinical manifestations of hospitalized children due to varicella-zoster virus (VZV) infection Methods: This study included 40 children who were hospitalized for varicella or herpes zoster at Seoul National University Children's Hospital, 2009-2012. Diagnosis of VZV infection was confirmed by VZV PCR or culture from vesicular fluid. Medical records were reviewed to collect clinical features and outcome, antiviral treatment, history of varicella vaccination, and underlying diseases. Results: Sixteen patients with varicella and 24 patients with herpes zoster were included. Their median age was 10.5 years (16 days-19 years). Thirty-five (87.5%) patients had underlying diseases. Among 24 patients with herpes zoster, 11 patients had previous history of varicella and 1 had herpes zoster. Twenty patients (50%) had a history of varicella vaccination, and 19 immunocompromised patients had VZV infection despite of vaccination. Most (95%) patients were treated by intravenous or oral acyclovir, and no treatment failure of intravenous acyclovir was found. The median duration of fever was 4.4 days (1-10 days), and that of antiviral treatment was 12 days (7-23 days) in immunocompromised patients. Immunocompromised patients received longer duration of antiviral treatment than imunocompetent patients (P=0.014). Eleven (27.5 %) immunocompromised patients had postherpetic neuralgia, 2 (5%) had proven co-infection by Streptococcus pyogenes and Klebsiella oxytoca, and 1 (2.5%) complicated with pneumonia. Conclusion: Immunocompromised children require longer duration of treatment and are at risk of severe complication associated with VZV infection. Early initiation of antiviral therapy and close monitoring are necessary for those in immunocompromised conditions.

The Association between Asthma and Invasive Pneumococcal Disease: A Nationwide Study in Korea

곽병옥,정지태,박용민 대한의학회 2015 Journal of Korean medical science Vol.30 No.1

The purpose of this study was to investigate the association between asthma and invasivepneumococcal disease (IPD) in Korea. A retrospective population-based cohort study wasconducted using the Korean Health Insurance Review and Assessment database 2010-2011. The subjects included 935,106 (2010) and 952,295 (2011), of whom 398 (2010) and 428(2011) patients with IPD were identified. There was significant difference in the prevalenceof IPD in patients with and without asthma (0.07% vs. 0.02% in 2010 and 0.08% vs. 0.01% in 2011; P < 0.001). After adjusting for age and gender, patients with asthmashowed over a three-fold increased risk of IPD compared with patients without asthma(adjusted odds ratio [aOR] 3.90, 95% confidence interval [CI] 3.02-5.03 in 2010 / aOR,5.44; 95% CI, 4.10-7.22 in 2011; P < 0.001). These findings were also significant inchildren (aOR, 2.08; 95% CI, 1.25-3.45 in 2010; P = 0.005 / aOR, 3.26; 95% CI,1.74-6.11 in 2011; P < 0.001). Although diabetes mellitus was also significantly associatedwith IPD, relatively low ORs compared with those of asthma were noted (aOR, 1.85; 95%CI, 1.35-2.54 in 2010 / aOR, 2.40; 95% CI, 1.78-3.24 in 2011; P < 0.001). Both childrenand adults with asthma are at increased risk of developing IPD.

A case of Plasmodium vivax malaria occurring during a school excursion to Pocheon-gun

곽병옥,정소정,김교순 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.1

Malaria caused by Plasmodium species is characterized by paroxysms of fever, chills, fatigue, anemia, and splenomegaly. Vivax malaria has lately re-emerged as an infectious disease and has exhibited high transmission rate in northern Gyeonggi-do province. We encountered a case of malaria in a child presenting with fever and thrombocytopenia who had recently made a school excursion to Pocheon-gun, Gyeonggi-do. The child was diagnosed with Plasmodium vivax malaria and treated with hydroxychloroquine and primaquine. Here, we present this case with a brief review of the literature.

Microalbuminuria in children with urinary tract infection

곽병옥,정소정,김교순 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.9

Purpose: Microalbuminuria is defined as increased urinary albumin excretion (30-300 mg/day) or microalbumin/creatinine ratio (30-300 mg/g) in a spot urine sample. Although microalbuminuria is a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated microalbuminuria in children with urinary tract infection (UTI). Therefore, we compared the spot urine microalbumin/creatinine ratio in pediatric UTI patients with that of control subjects. Methods: We investigated the correlation between the ratio in children with UTI and age, height, weight, blood pressure, glomerular filtration rate (GFR), hematuria, vesicoureteral reflux, renal parenchymal defect,and renal scar, and its predictability for UTI complications. Results: We studied 66 patients (42 boys, 24 girls) and 52 healthy children (24 boys, 28 girls). The mean microalbumin/creatinine ratio in UTI patients was statistically significantly increased compared to the control group (340.04±321.36 mg/g vs. 225.68±154.61 mg/g, P=0.0141). The mean value of spot urine microalbumin/creatinine ratio (384.70±342.22 mg/g vs. 264.92±158.13 mg/g, P=0.0341) in 1-23 months age patient group showed statistically significant increase compared to control group. Microalbumin/creatinine ratio showed negative correlation to age (r=-0.29, P=0.0167), body surface area (BSA) (r=-0.29, P=0.0173) and GFR (r=-0.26, P=0.0343). The presence of hematuria (P=0.0169) was found to be correlated. Conclusion: The spot urine microalbumin/creatinine ratio in children with UTI was significantly greater than that in normal children,and it was positively correlated with GFR. This ratio is a potential prescreening and prognostic marker in UTI patients. Further studies are required to validate the predictability of microalbuminuria in pediatric UTI patients.

신뢰도 기반 개인 정보 관리 방법에 관한 연구

곽병옥(Byeong Ok Kwak),김상기(Sang Ki Kim) 한국통신학회 2009 한국통신학회 학술대회논문집 Vol.2009 No.11

코로나바이러스감염증-19: 소아청소년의 임상 경과가 성인에 비하여 양호한 이유

곽병옥 ( Byung Ok Kwak ),김동현 ( Dong Hyun Kim ) 대한소아감염학회 2021 Pediatric Infection and Vaccine Vol.28 No.1

소아청소년 코로나바이러스감염증-19 환자들의 유병률과 사망률이 성인에 비하여 낮지만, 임상적인 중증도가 낮은 이유는 아직 잘 알려져 있지 않다. 소아청소년 환자들이 비교적 가벼운 임상 경과를 보이는 이유에 관하여 지금까지 알려진 내용들을 살펴보면, 코로나바이러스감염증-19의 임상 경과에 영향을 줄 수 있는 면역 체계의 특성과 면역 상호작용, 안지오텐신전환효소 2 수용체의 역할, 호흡기계의 특징, 동반 질환과 위험 요인 보유, 방역 조치의 영향 등에서 소아청소년은 성인과 구별되는 차이점이 있었다. 그러나 상대적으로 양호한 임상 경과를 보이는 소아청소년 환자들이라 하더라도 필요한 의료 자원이 적시에 제공되어야 한다. There have been several reports on why the clinical course of coronavirus disease 2019 (COVID-19) in pediatric patients is milder than in adults. There are distinctive points in the immune system between children and adults, as well as in the angiotensin-converting enzyme 2 gene expression, the characteristics of the respiratory system, the effects of comorbidities and risk factors, and the effect of infection control. Even though children tend to have mild forms of COVID-19, this does not mean that we should not regard it as a matter of importance.