Group B streptococcus (GBS) is the leading cause of neonatal sepsis and meningitis in developed countries. This article reviews the neonatal invasive GBS disease, maternal GBS colonization, and prevention strategies in the context of recent epidemiological changes in Korea. Although Korean neonates had been supposed to have low incidence of invasive GBS disease, GBS has been recently reported to be the most common cause of invasive neonatal infection after 1990s. Among Korean pregnant women, GBS carriage rate in the vagina and rectum has been reported to be much lower than that in Western countries. However, it has increased in recent studies. For decision making about preventive strategy for neonatal GBS disease in Korea, further studies are required in terms of the incidence of neonatal GBS infection and serotype distribution. In addition, studies about maternal carriage rate and serotype distribution have to be continued.
Colon ; Decision Making ; Developed Countries ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Korea ; Meningitis ; Pregnant Women ; Rectum ; Sepsis ; Streptococcus ; Streptococcus agalactiae ; Vagina

Goblet cell adenocarcinoma (GCA) is a rare and distinctive amphicrine tumor comprised of goblet-like mucinous cells and neuroendocrine cells. It is believed to originate from pluripotent stem cells located at the base of crypts. GCA predominantly arises from the appendix, with a few reported cases in extra-appendiceal locations such as the colorectum, small intestine, and stomach. In this case report, we present a unique instance of a 64-year-old male who initially received a diagnosis of neuroendocrine carcinoma in the distal esophagus based on biopsy but, following resection, was subsequently re-diagnosed with GCA arising from Barrett’s esophagus.

Invasive infection of the Streptococcus bovis group in a neonate is rare. In cases reported to date, the pathogen of neonatal S. bovis infections is usually Streptococcus gallolyticus subsp. pasteurianus (S. bovis biotype II/2). Streptococcus lutetiensis (S. bovis biotype II/1) was identified using 16S rRNA and tuf gene sequence analysis of the isolates from blood and cerebrospinal fluid (CSF) of a fever-presenting 28-day-old male. Blood culture analysis was performed using automatic equipment (VITEK 2) and identified Streptococcus infantarius supsp. infantarius, yet we were unable to get accurate results from the CSF culture. The fever subsided on the second day of hospitalization, and the patient was discharged without neurologic complication after 14 days of antibiotic therapy. In this case, we were able to accurately identify the pathogen using molecular genetic methods. To our knowledge, this is the first case of late onset neonatal bacteremia and meningitis caused by S. lutetiensis.
Bacteremia* ; Cerebrospinal Fluid ; Fever ; Hospitalization ; Humans ; Infant, Newborn ; Male ; Meningitis* ; Molecular Biology ; Sequence Analysis ; Streptococcus bovis ; Streptococcus*

Background: We investigated how quiz activities can improve summative assessment outcomes by analyzing the relationship between them. Methods: We used 217 first-year medical students’ medical informatics data from 3 consecutive years. We analyzed summative assessment outcomes between quiz completion and incompletion groups, one-time and multiple-time quiz learning groups, and three combined comparisons between subgroups of quiz learning activity frequencies: 1 versus 2, 3, 4, and 6 (group 1), 1 and 2 versus 3, 4, and 6 (group 2), and 1, 2, and 3 versus 4 and 6 (group 3). We then analyzed correlations between the final quiz scores and summative assessment outcomes. Results: The summative assessment means for students who completed quizzes and those who did not were 87.16±8.73 and 83.22±8.31, respectively (p=0.001). The means for the one-time and multiple-time quiz learning groups were 86.54±8.94 and 88.71±8.10, respectively (p=0.223). The means for combined subgroups were not significantly different between groups (p>0.05), although a statistically significant increasing trend was found from groups 1 to 3 (0.223>0.203>0.075 using the t-test and 0.225>0.150>0.067 using the Mann-Whitney test, respectively). Summative assessment scores were not significantly correlated with quiz scores (r=0.115, p=0.213). Conclusions Quizzes helped students who used self-directed learning obtain better summative assessment outcomes. Formative quizzes presumably did not provide students with direct knowledge, but showed them their weak points and motivated them to work on areas where their knowledge was insufficient.

PURPOSE: This study was performed to investigate the prevalence of Staphylococcus aureus (S. aureus) nasal carriage in Korean children attending day care centers. METHODS: During September and October 2009, a survey for nasal carriage of S. aureus and methicillin-resistant S. aureus (MRSA) was conducted among children attending day care centers located in Seoul with questionnaire survey for evaluation of risk factors of acquisition of MRSA was obtained from their guardians. A culture of the anterior nares swabs using enrichment broth was executed for isolating S. aureus and oxacillin susceptibility was assessed by the disk diffusion method. RESULTS: Out of the 428 children enrolled whose mean age was 55 months old, 163 (38.1%) were colonized with S. aureus. Of the 163 isolates, 40 (24.5%) were MRSA. The nasal carriage rate of S. aureus showed an increasing trend with increase of age. Based on the answer to the questionnaire, 9.2% and 3.6% of children had a recent history of hospitalization and surgery, respectively, and approximately 40% of children had a history of prescription of antibiotics within 1 year prior to enrollment. Of the 428 subjects, 40 (9.3%) were MRSA nasal carriers. CONCLUSION: S. aureus and MRSA carriage rate of children attending day care center in Korea was 38.1% and 9.3%, respectively. Continued surveillance for nasal carriage rate of S. aureus and MRSA (especially community-associated MRSA) is mandatory.
Anti-Bacterial Agents ; Child ; Colon ; Day Care, Medical ; Diffusion ; Hospitalization ; Humans ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Prescriptions ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Staphylococcus ; Staphylococcus aureus

PURPOSE: The aim of this study was to identify mutations associated with macrolide resistance in Mycoplasma pneumoniae (MP) and to establish a cultural method to determine antimicrobial susceptibility. METHODS: Nasopharyngeal aspirates (NPAs) were collected from 62 children diagnosed with MP pneumonia by a serologic method or polymerase chain reaction. The 23S rRNA and L4 ribosomal protein genes of MP were amplified and sequenced. To identify mutations in these 2 genes, their nucleotide sequences were compared to those of the reference strain M129. MP cultivation was carried out for 32 (28 frozen and 5 refrigerated) NPAs and M129 strain using Chanock's glucose broth and agar plate in a 5% CO2 incubator at 37degrees C and examined at 2-3 day intervals for 6 weeks. RESULTS: Among the 62 specimens, 17 had M144V mutations in ribosomal protein L4. The A2064G mutation was observed in 1 specimen; its 23S rRNA gene was successfully sequenced. Culture for MP was successful from the M129 strain and 2 of the 5 NPAs that were refrigerated for no longer than 3 days. However, MP did not grow from the 28 NPAs that were kept frozen at -80degrees C since 2003. CONCLUSION: We found the M144V mutation of L4 protein to be common and that of domain V of 23S rRNA gene was relatively rare among MP. Studies on the prevalence of macrolide-resistant MP and the relationship between the mutations of 23S rRNA gene and ribosomal protein L4 will aid in understanding the mechanism of macrolide resistance in MP.
Agar ; Base Sequence ; Child ; Genes, rRNA ; Glucose ; Humans ; Incubators ; Macrolides ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Prevalence ; Ribosomal Proteins ; Sprains and Strains

PURPOSE:This study was performed to investigate the serotype distribution of group B streptococcus (GBS) isolated from pregnant Korean women using molecular methods. METHODS:The study materials included 42 GBS isolates obtained from the vagina and anorectum of pregnant women in Seoul, Korea between 2005 and 2006. Four clinical isolates with known serotypes (Ia, Ib, III, and V) were used for validation of molecular serotyping. We used serotype-specific primers for identification of the serotypes (Ia, Ib, III, V, and VI). To determine the ambiguous serotypes by serotype-specific PCR, sequence analysis of the PCR amplicons which had been amplified with GBS-common primers was used. RESULTS:The serotypes determined by the molecular methods agreed with the previously known 4 serotypes (Ia, Ib, III, and V). The serotypes of all 42 isolates were successfully determined by molecular methods. The distribution of the GBS serotype was as follows in order of frequency: serotype III was found in 12 isolates (28.6%), serotype V was found in 11 isolates (26.2%), serotype Ia was found in 11 isolates (26.2%), serotype VI was found in 4 isolates (9.5%), serotype Ib was found in 2 isolates (4.8%), and serotype II was found in 2 isolates (4.8%). CONCLUSION:Serotypes III, V, and Ia were the most frequently identified serotypes in pregnant Korean women. Molecular serotyping is useful for surveillance of the serotype distribution of GBS in colonized pregnant women and GBS diseases of neonates.
Colon ; Female ; Humans ; Korea ; Polymerase Chain Reaction ; Pregnant Women ; Sequence Analysis ; Serotyping ; Streptococcus ; Vagina

PURPOSE: N-(3-[18F]Fluoroporpy)-2beta- carbomethoxy-3beta-(4-iodophenyl) nortropane ([18F]FP-CIT) has been shown to be very useful for imaging the dopamine transporter. However, synthesis of this radiotracer is some what troublesome. In this study, we used a new method for the preparation of [18F]FP-CIT to increase radiochemical yield and effective specific activity. MATERIALS AND METHODS: [18F]FP-CIT was prepared by N-alkylation of nor-beta-CIT (2 mg) with 3-bromo-l-[18F]fluoropropane in the presence of Et3N (5-6 drops of DMF/CH3CN, 140 degree C, 20 min). 3-Bromo-l-[18F]fluoropropane was synthesized from 5 microliter of 3-bromo-l-trifluoromethanesulfonyloxypropane (3-bromopropyl -l-triflate) and nBu4N18F at 80 degree C. The final compound was purified by reverse phase HPLC and formulated in 13% ethanol in saline. RESULTS: 3-Bromo-l-[18F]fluoropropane was obtained from 3-bromopropyl-l-triflate and nBu4N18F in 77-80% yield. N-Alkylation of nor-beta-CIT with 3-bromo-l-[18F]fluoropropane was carried out at 140 degree C using acetonitrile containing a small volume of DMF as the solvents. The overall yield of [18F]FP-CIT was 5-10% (decay-corrected) with a radiochemical purity higher than 99% and effective specific activity higher than the one reported in the literature based on their HPLC data. The final [18F]FP-CIT solution had the optimal pH (7.0) and it was pyrogen-free. CONCLUSION:: In this study, 3-bromopropyl-l-triflate was used as the precursor for the [18F]fluorination reaction and new conditions were developed for purification of [18F]FP-CIT by HPLC. We established this new method for the preparation of [18F]FP-CIT, which gave high effective specific activity and relatively good yield.
Chromatography, High Pressure Liquid ; Dopamine Plasma Membrane Transport Proteins* ; Dopamine* ; Ethanol ; Hydrogen-Ion Concentration ; Positron-Emission Tomography ; Solvents

PURPOSE: The inappropriate prescription of antibiotics in children with upper respiratory tract infection (URTI) is common. This study evaluated the factors that influence antibiotics use in hospitalized children with viral URTI confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR)assay. METHODS: The medical records of admitted patients who performed RT-PCR assay for respiratory virus pathogens from January 2013 to November 2014 were examined. The demographic and clinical features were compared between patients who were administered antibiotics at admission and those who were not. We also investigated differences between children who continued antibiotics and those who stopped antibiotics after a viral pathogen was identified. RESULTS: In the total 393 inpatients, the median age was 23 months (interquartile range, 13 to 41.3 months). Antimicrobial agents were prescribed in 79 patients (20.1%) at admission. Patients with acute otitis media (AOM) had higher rates of antibiotics prescription than those without AOM (48.1% vs. 2.2%, P <0.001), with an adjusted odds ratio of 91.1 (95% confidence interval, 30.5 to 271.7). Level of high-sensitivity C-reactive protein and the proportion of acute rhinosinusitis were also significantly associated with antibiotics use (P <0.001). Among the 44 patients with viruses identified using the RT-PCR method during hospitalization, antibiotic use was continued in 28 patients (63.6%). AOM was statistically associated with continued antibiotic use in the patients (P =0.002). CONCLUSIONS: Although the respiratory virus responsible for URTI etiology is identified, clinicians might not discontinue antibiotics if AOM is accompanying. Therefore, careful diagnosis and management of AOM could be a strategy to reduce unjustified antibiotic prescriptions for children with URTI.
Anti-Bacterial Agents ; Anti-Infective Agents ; C-Reactive Protein ; Child ; Child, Hospitalized* ; Diagnosis ; Hospitalization ; Humans ; Inappropriate Prescribing ; Inpatients ; Medical Records ; Methods ; Odds Ratio ; Otitis Media ; Polymerase Chain Reaction ; Prescriptions ; Respiratory System* ; Respiratory Tract Infections* ; Retrospective Studies*

The authors found an error in the title. Th etitle has been updated from “A Retrospective Analysis of Use in Hospitalized Children with Upper Respiratory Tract Infection” to “A Retrospective Analysis of Antibiotic Use in Hospitalized Children with Upper Respiratory Tract Infection.”
Child ; Child, Hospitalized* ; Humans ; Respiratory System* ; Respiratory Tract Infections* ; Retrospective Studies*