8년간(1990∼1998) Influenza Virus의 유행양상

나송이,박수은,박진영,이환종 대한감염학회 1999 감염 Vol.31 No.3

10년간(1986∼1995) 소아 살모넬라 감염증의 발생양상 및 임상상

나송이,박진영,이환종,서정기 대한감염학회 1999 감염 Vol.31 No.2

8년간(1990∼1998) Influenza Virus의 유행 양상

나송이 대한적십자사 2000 적십자병원지 Vol.27 No.1

영아의 결핵

김이경,나송이,박진영,최은화,이환종,Kim, Ee-Kyung,Nah, Song-Yi,Park, Jin-Young,Choi, Eun-Hwa,Lee, Hoan-Jong 대한소아감염학회 1998 Pediatric Infection and Vaccine Vol.5 No.1

목 적 : 1세 미만 영아들은 결핵에 이환될 경우 뇌막염이나 속립성 결핵 등의 심한 질환으로 진행할 위험이 다른 연령군에 비하여 높으므로 이들에서 결핵의 조기 진단에 의한 신속한 치료가 매우 중요하다. 본 연구는 1세 미만 영아 결핵 환아들의 임상적인 특징을 관찰하여 향후 진단, 치료 및 예방에 도움을 얻고자 하였다. 방 법 : 1985년 7월부터 1997년 4월까지 서울대학교 어린이병원 소아과에 입원했던 1세 미만의 결핵 환아 29명의 의무 기록을 검토하여 후향적으로 분석하였다. 결핵의 진단은 각종 가검물에서 M. tuberculosis가 분리되거나(13례) 병리학적으로 결핵과 부합하는 소견을 보이는 경우(1례)를 포함하였으며, 미생물학적 병리학적 증거를 얻지 못한 예들에서는 성인결핵 환자에의 노출력, 임상 양상, 흉부 방사선 소견, 5 투베르쿨린 단위로 시행한 망토우 반응 결과 및 치료에 대한 반응 등을 종합하여 개별적으로 판단하였다. 결 과 : 질환의 형태는 단독 폐결핵으로 나타난 경우가 12례로 가장 많았고, 뇌막염이 동반된 폐결핵 5례, 폐결핵과 림프절염 3례, 뇌막염 3례 및 속립 결핵 6례 등이었다. 환아들의 평균 나이는 7개월이었다. 감염원을 찾을 수 있었던 경우가 19례였으며, 이 중 환아에서 결핵이 의심되어 주변 어른을 검사한 결과 결핵이 발견된 경우가 7례였다. 처음 방문시 증상이 있었던 경우가 27례였으며 주소는 호흡기 증상이 12례, 중추신경계 증상이 10례였다. 호흡기 증상은 기침, 가래 외에도 빈호흡, 천명 등의 호흡 곤란 증상이 7례에서 있었다. 폐 청진상 수포음이 6례, 천명이 7례, 호흡음의 감소가 9례에서 있었고, 간비종대가 흔하였다. 흉부 방사선 검사상 이상이 26례에서 있었고 이 중 폐문부 림프절을 동반한 폐실질의 병변을 보였던 경우가 18례로 가장 많았다. 국소적 또는 전반적인 기종성 변화가 7례에서 있었다. 결 론 : 영아들은 결핵 진단시 증상을 갖고 있는 경우가 대부분이었고, 폐결핵의 발병시 천명, 기종성 변화, 호흡음 감소 등의 기관지 폐쇄의 징후가 흔하며 호흡 부전으로 진행할 수 있으므로 진단 및 치료에 주의를 요한다. 성인 결핵 환자 발생시 노출된 영아에 대한 예방 요법을 철저히 시행하여야 하며, 영아에서 결핵이 의심될 때 감염원을 찾음으로써 진단에 도움을 줄 수 있다는 사실을 재확인하였다. Purpose : The risk of severe tuberculous disease such as meningitis or miliary tuberculosis increases as younger is the child at the time of infection. Therefore, the early diagnosis and prompt treatment is mandatory for infants with tuberculosis. This study was undertaken to describe the epidemiology, clinical and radiographic manifestations, and response to therapy in infants with tuberculous disease. Methods : Medical records of 29 infants with tuberculosis diagnosed at the Seoul National University Children's Hospital from July, 1985, to April, 1997, were reviewed, retrospectively. A case of tuberculosis was confirmed if M. tuberculosis was isolated from any body site or if there was histologic proof of tuberculosis. Otherwise, the diagnoses were individualized considering history of contact with contagious adult case, clinical manifestations, chest X-ray findings, result of a Mantoux test reaction with 5 tuberculin unit of PPD, and the response to therapy. Results : The mean age at diagnosis was $7.00{\pm}2.65$ months (range, 3 to 12 months). Twelve cases had isolated pulmonary diseases, and the rest had pulmonary disease and meningitis, 5 cases; pulmonary disease and cervical lymphadenitis, 3; isolated meningitis, 3; and miliary tuberculosis, 6. Source case was identified in 19 cases, 7 of which were detected with retrograde manner. Twenty seven of 29 were symptomatic at their initial visit. The presenting symptoms were mainly respiratory or neurologic, and respiratory difficulty was accompanied in 7 cases. Physical examination revealed wheezing in 7 cases and decreased breath sounds in 9. Hepatomegaly or hepatosplenomegaly were frequent. Chest radiographs showed lung parenchymal disease with hilar lymphadenopathy in 18 cases, and focal or generalized emphysematous change in 7 cases. Conclusion : Most of the infants with tuberculosis are symptomatic at diagnosis, and many of infants with intrathoracic tuberculosis presented with symptoms of bronchial obstruction. When tuberculosis is suspected in an infant, the adult source case should be vigorously investigated to aid in diagnosis and for the prevention of further transmission of tuberculous disease. Almost half of infant tuberculosis are preventable if prophylaxis were given when adult cases were diagnosed.

자매에서 발생한 한국 토착형 소아 말라리아 2례

곽영호,최승은,나송이,이환종,채종일,Kwak, Young Ho,Choi, Seong Eun,Na, Song Yi,Lee, Hoan Jong,Chae, Chong Il 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.2

Malaria is a febrile disease caused by protozoan parasites, genus Plasmodium. In Korea., indigenous malaria has been believed to be eradicated by 1984, and, thereafter, all of the reported cases were imported malaria. But since the first case report of re-emerging indigenous malaria in 1993, increasing number of cases were reported reaching more than 350 cases in 1996. However, indigenous malaria in children has not been reported yet. We experienced two cases of indigenous malaria in sisters who were 7 and 5 years old, respectively. Elder sister was presented with periodic fever, splenomegaly and mild headache. She had been to Guam before 4 months of the onset of symptoms. Younger sister was suffered from fever and splenomegaly and has not been abroad. They were diagnosed by examination of peripheral blood smear to be infected with Plasmodium vivax and were treated with hydroxychloroquine and primaquine successfully. These cases are believed to be first re-emerging cases of indigenous malaria in children, and malaria should be included in the differential diagnosis of unexplained febrile children.

가와사끼 병에 합병된 간기능 이상소견에 대한 임상적 및 병리조직학적 소견

이성철,차한,나송이,김희섭,박호진,신미경,Lee, Sung-Chul,Tchah, Hann,Na, Song-Yi,Kim, Hee-Sup,Park, Ho-Jin,Shin, Mi-Kyeong 대한소아소화기영양학회 2000 Pediatric gastroenterology, hepatology & nutrition Vol.3 No.1

Purpose: The aim of this research is to examine the abnormal liver function complicated with Kawasaki disease (KD) and to analyze its clinical characteristics and complications. Methods: Ninty eight cases were diagnosed as having KD, among which thirty four cases had abnormal alanine aminotransferase (ALT) (>30 IU/L). These abnormal ALT cases were evaluated in terms of age and sex distribution, major symptoms, complications, laboratory and histopathologic findings. Results: Male to female ratio was 2.4:1 and most patients (91.2%) were under 5 years of age. Cervical lymphadenopathy was observed in 3 cases (8.8%); and recurred cases were two (5.8%). Average fever duration was 8 days; average length of hospitalization was 9 days; and average recovery period was 13 days. Immediately after admission, positive CRP was observed in 31 cases (91.2%), leukocytosis (> $10,000/mm^3$) in 26 cases (76.0%), thrombocytosis (> $450,000/mm^3$) in 7 cases (20.6%), and anemia (<10 gm/dl) in 7 cases (20.6%), respectively. GB hydrops or cholecystitis were noted in 3 cases (8.8%), abnormal ECG finding in 1 case (2.9%), coronary dilatation or aneurysm in 2 cases (5.9%). Liver biopsy was done in four cases and revealed mild infiltration of lymphocytes on the portal area and mild bile duct proliferations. Conclusion: The abnormal liver function was noted in 34.7% of KD patients, and subsided all within one month. But the liver function test should be checked closely in patients of the abnormal liver function test complicated with KD despite of its good prognosis.

심한 Respiratory Syncytial Virus 감염증과 선천성 면역에 관련된 유전적 소인에 관한 연구 : Mannose Binding Lectin 유전자 다형성

최은화,김희섭,윤보영,최승은,나송이,김동호,박기원,이환종,Choi, Eun Hwa,Kim, Hee Sup,Yun, Bo Young,Choi, Seung Eun,Nah, Song Yi,Kim, Dong Ho,Park, Ki Won,Lee, Hoan Jong 대한소아감염학회 2006 Pediatric Infection and Vaccine Vol.13 No.1

목 적 : 본 연구는 어린 연령의 소아에서 선천성 면역력의 중요한 인자인 Mannose Binding Lectin(MBL2) 유전자의 다형성 및 일배체형의 분포를 심한 respiratory syncytial virus(RSV) 감염증 환자군과 정상대조군에서 분석함으로써, MBL2 유전자의 다양성이 소아 RSV 감염증의 발생과 예후에 기여하는지를 밝히고자 하였다. 방 법 : 1993년부터 2000년까지 7년 동안 서울대학교 어린이병원 소아과에서 RSV 감염증으로 치료받은 심한 RSV 감염증 환아 99명을 환자군, 건강한 성인 224명을 대조군으로 선정하였다. 유전형 분석은 선천성 면역의 중추적 역할을 하는 MBL2 유전자의 promoter -221 X/Y와 exon 1의 구조 변이의 분포를 환자대조군에서 비교하여 분석하였다. 결 과 : 환자군 99명의 중앙 연령은 9.5개월로, 6개월 미만 48명(49%), 6~24개월 사이 39명(39%), 그리고 24개월 이상이 12명(12%)이었다. 남아는 58명(59%)이었다. 환자군에서 MBL2 대립유전자 B다형성의 빈도는 유전형 AA 60(61%), 이형접합 AB 34(34%), 그리고 유전형 BB 5(5%)로 나타났다. 환자군의 promoter -221 X/Y 유전형의 분포는 유전형 YY 84(85%), 이형접합 XY 15(15%)이었으며, 유전형 XX는 발견되지 않았다. Exon 1의 구조 변이와 promoter 변이 모두 환자군과 대조군간에 차이가 없었다. MBL2 일배체형의 분포에도 두 군간에 차이가 없었다. 결 론 : 본 연구 결과, 한국인 소아에서 MBL2 유전자의 다형성과 일배체형이 심한 RSV 감염증에 기여하는 예후 인자임을 밝히지 못하였다. 향후 전향적으로 수집한 더 많은 수의 환자군과 적절한 대조군을 통한 연구가 시행되어야 할 것으로 생각한다. Purpose : We hypothesized that mannose binding lectin gene(MBL2), a key molecule of innate immunity, may contirbute to the development and the outcome of respiratory syncytial virus(RSV) disease in early childhood. This study was performed to investigate the genetic basis of polymorphisms and haplotypes of MBL2 for RSV disease severity in Korean children. Methods : Cases with severe RSV diseases are 99 children with severe RSV lower respiratory tract infections, who were admitted to the Seoul National University Children's Hospital through 1993~2000. The control subjects consisted of 224 anonymous healthy Korean blood donors. The frequency of promoter variant(-221, X/Y) and structural variant(codon 54) were compared between the case patient group and the control subject group. Results : The mean age of patients was 11.8 months; 49% were <6 months, 39% were 6-24 months and 12% were >24 months. In the cohort of cases of severe RSV diseases, the genotypic frequencies of structural variant in codon 54 were 61% for AA, 34% for AB, and 5% for BB. Those of the promoter X/Y variant were 85% for YY and 15% for XY. There were no significant differences in overall distribution of both structural and promoter variants between the cases and the control subjects. We did not observe statistical difference in the haplotypic frequencies of MBL2. Conclusion : Common variants of MBL2 gene most likely do not contribute to the risk for severe RSV diseases in Korean children. Further genetic association studies should be conducted in a larger propsectively recruited cohort of children with RSV infection.

응급의학과 임상실습 과정 중 시행된 논술형 시험의 경험 및 채점 기준표 사용에 따른 채점자간 신뢰도 분석

이호진,박송이,정진우,권인호,최유리,나 현 대한응급의학회 2020 대한응급의학회지 Vol.31 No.3

Objective: An essay test is difficult to carry out because of the effort for hand scoring and the concerns about inter-rater reliability, even though the use of a rubric can increase inter-rater reliability. This study examined the feasibility of an essay test in medical school students and whether the use of a rubric increases inter-rater reliability. Methods: An essay test was given to 51 undergraduate students in the third grade of emergency medicine clinical clerkship. Three raters assessed the essay test independently with a prepared rubric immediately after the test. They then did the same essay test without a rubric three months later. The researchers compared the Pearson’s correlation coefficients between raters. The researchers analyzed the validity comparing the correlation coefficient between the essay test and previous multiple-choice questions (MCQ) and feasibility by acceptance. Results: Fifty-one students took the essay test. The Pearson’s correlation coefficient using rubric between raters 1 and 2, 1 and 3, and 2 and 3 were 0.898 (P<0.001), 0.896 (P<0.001), and 0.856 (P<0.001), respectively. Without a rubric, the correlation coefficients were 0.838 (P<0.001), 0.888 (P<0.001), and 0.824 (P<0.001), respectively. The new essay test showed a positive correlation (0.367) with the previous MCQ, and the evidence for validity and feasibility was acceptable. Conclusion: In this study, the rubric did not increase the inter-rater reliability of the essay test. On the other hand, the inter-rater reliability was higher than 0.8, even without a rubric. In addition, the essay test showed evidence of validity and feasibility.