PURPOSE: Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). METHODS: We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. RESULTS: The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. CONCLUSION: VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.
Anti-Bacterial Agents ; Birth Weight ; Central Venous Catheters ; Colon ; Heart Diseases ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Medical Records ; Parturition ; Prevalence ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Thorax ; Vancomycin ; Vancomycin Resistance

Polyvinyl chloride (PVC) is a widely used chemical for production of plastics. However occupational asthma (OA) caused by PVC has been reported only rarely. We report a 34-yr-old male wallpaper factory worker with OA due to PVC and nickel (Ni) whose job was mixing PVC with plasticizers. He visited the emergency room due to an asthma attack with moderate airflow obstruction and markedly increased sputum eosinophil numbers. A methacholine challenge test was positive (PC20 2.5 mg/mL). Bronchoprovocation tests with both PVC and Ni showed early and late asthmatic responses, respectively. Moreover, the fractional concentration of exhaled nitric oxide (FeNO) was increased after challenge with PVC. To our knowledge, this is the first case of OA in Korea induced by exposure to both PVC and Ni. We suggest that eosinophilic inflammation may be involved in the pathogenesis of PVC-induced OA and that FeNO monitoring can be used for its diagnosis.
Adult ; Asthma, Occupational/*chemically induced/*diagnosis ; Breath Tests ; Bronchial Provocation Tests ; Environmental Exposure ; Eosinophilia/*diagnosis ; Exhalation ; Humans ; Leukocyte Count ; Male ; Nickel ; Nitric Oxide/metabolism ; Occupational Exposure ; Plasticizers ; Polyvinyl Chloride

OBJECTIVES: The aim of this study was to identify the risk factors for tooth loss over three years, according to the number of pre-existing teeth, in middle and old aged people in a rural area. METHODS: This was a 3-year follow-up study including participants from KoGES-ARIRANG. Eight-hundred and fifty-five participants took part in both initial and follow-up oral examinations and surveys, conducted between 2010 and 2016. The number of existing teeth was determined through oral examination, and the subjects' sociodemographic characteristics, subjective periodontal statuses, and oral health behaviors were identified through oral questionnaires via 1:1 interviews. Chi-square analysis was used to compare tooth loss in participants with less than 20 pre-existing teeth to tooth loss in those with 20 or more pre-existing teeth. Multivariate logistic regression analyses were used to identify risk factors for tooth loss. RESULTS: Four-hundred and thirty-nine (51.4%) subjects lost more than one tooth over three years. After adjusting for demographic characteristics, subjective periodontal statuses, and oral health behaviors in subjects with 20 or more pre-existing teeth, the odds for tooth loss were as follows: 2.11 (1.42-3.14) times higher in people aged over 65 years compared to less than 65 years, 1.59 (1.06-2.38) times higher in those with a low (below elementary school) compared to high educational level, and 2.01 (1.33-3.02) times higher in those with a severe compared to normal subjective periodontal status. CONCLUSIONS: The risk of tooth loss was different in subjects with less than 20 pre-existing teeth compared to those with 20 or more pre-existing teeth. Therefore, the approach to prevent tooth loss should be different depending on the number of teeth present.
Cohort Studies* ; Diagnosis, Oral ; Follow-Up Studies ; Logistic Models ; Oral Health ; Risk Factors* ; Tooth Loss* ; Tooth*

PURPOSE: Pulmonary sequestration is characterized by a mass of non-functioning pulmonary tissue lacking normal communication with the tracheobronchial tree and receiving an aberrant systemic arterial blood supply. Two types have been described:intralobar and extralobar. Symptoms vary from the incidental finding of a mass to recurrent bronchitis or pneumonia, chest pain and hemoptysis. In this study, we evaluated clinical features and outcomes of pulmonary sequestration. METHODS: The records of the patients diagnosed with pulmonary sequestration by thoracic computerized tomography and aortography between January 1997 and July 2007 were retrospectively reviewed. RESULTS: Fourteen patients (6 males and 8 females) with an median age of 5.5 years in children, 35 years in adults were diagnosed with pulmonary sequestration. Nine patients had clinical symptoms including recurrent respiratory infections, chest pain and hemoptysis. Six patients were symptom free. The aberrant arteries originated from the descending thoracic aorta in 12 cases, abdominal aorta in 2 cases, inferior phrenic artery in 1 case. Thirteen patients received surgical operations with open thorax in 11 patients and with video-assisted thoracotomy surgery (VATs) in 2 cases recently diagnosed. Eleven cases (84.6%) were found to be of intralobar type and 2 cases (15.4%) were of extralobar type. One patient had bilateral pulmonary sequestration. All patients with preoperative symptoms improved after surgical treatment. CONCLUSION: The patients who presented with recurrent pneumonia in the same site, hemoptysis and chest pain should be studied to rule out pulmonary sequestration.
Adult ; Angiography ; Aorta, Abdominal ; Aorta, Thoracic ; Aortography ; Arteries ; Bronchitis ; Bronchopulmonary Sequestration ; Chest Pain ; Child ; Hemoptysis ; Humans ; Incidental Findings ; Male ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Thoracotomy ; Thorax

PURPOSE: Pleural effusion is a common complications of pediatric bacterial pneumonia. Intrapleural administration of fibrinolytic agents such as urokinase have been used in the management of complicated parapneumonic effusions. But the safety and effectiveness of intrapleural urokinase instillations in children has not been confirmed. The aim of this study is to evaluate the safety and effectiveness of intraperitoneal urokinase in children. METHODS: We reviewed a total of 29 children diagnosed as parapneumonic effusion with septation by chest CT or chest ultrasonography. We divided them into two groups. Fourteen children treated with urokinase after thoracostomy (Group A) were compared with 15 children treated only with thoracostomy (Group B). The urokinase, 3,000 IU/kg/day, was injected into the pleural cavity twice a day. RESULTS: There was no statistical difference in sex and age between the two groups. Total drainage volume during thoracostomy in group A and B was 375.5 mL and 350.0 mL, respectively. It was not statistically significant. But the amounts of pleural fluid of group A on day 1, day 2 and day 3 were 102.5 mL, 100.0 mL, and 70.0 mL respectively and those of group B on day 1, day 2 and say 3 were 120.0 mL, 50.0 mL and 15.0 mL respectively. To compare group A with group B in the amounts of drainage volume on day 1 was not statistically significant, but the amounts of drainage volumes on day 2 and day 3 in group A were statistically more significant than group B (Day 1 P=0.371, Day 2 P=0.049, Day 3 P=0.048, respectively). The duration of fever, antibiotics, thoracostomy and total hospital days. Were not statistically significant between the two groups. But the frequency of complications in Group A was statictically significantly lower than in group B. CONCLUSION: Intrapleural instillation of urokinase facilitates the drainage of loculated pleural effusions, especially during the first 3 days, and it could reduce complications, such as pleural thickening, surgical managements, re-positioning of tube and re-thoracostomy. So intrapleural urokinase injection was and effective and safe treatment of pleural effusion in children (P=0.014).
Anti-Bacterial Agents ; Child* ; Drainage ; Fever ; Fibrinolytic Agents ; Humans ; Pleural Cavity ; Pleural Effusion* ; Pneumonia, Bacterial ; Thoracostomy ; Thorax ; Tomography, X-Ray Computed ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

PURPOSE: We aimed to investigate the clinical and phylogenetic characteristics of Escherichia coli Urinary Tract Infections (E. coli UTI). METHODS: We enrolled patients with culture-proven E. coli UTI, who were admitted at the study hospital from September 2008 to August 2009. We investigated clinical data of patients with E. coli UTI and characteristics of isolated E. coli strains. The phylogenetic groups were classified using triplex polymerase chain reaction (PCR), and the distribution of nine virulent genes was determined by multiplex PCR. RESULTS: A total of 47 patients have participated in this study. Thirty (63.8%) were under 6 months; eight (17.0%) were between 6-12 months; and nine (19.1%) were over 12 months. We compared two age groups between under 6-month and over 6-month. In the age group under 6-month, higher proportion of male (P=0.002) and group B2 strains (P=0.020) were observed. In contrast, higher proportion of female and group non-B2 strains were observed in age group over 6-month. Frequencies of papC, papGII, papGIII, sfa/foc, hlyC, cnf1, fyuA, iroN and iucC were estimated as 68.1%, 57.4%, 42.6%, 46.8%, 46.8%, 31.9%, 87.2%, 48.9% and 63.8%, respectively. In the comparison of phylogenetic groups, group B2 showed higher distribution of virulent genes, while group D included more strains resistant to trimethoprim/sulfamethoxazole (TMP/SMZ) than other groups. CONCLUSION: We showed the age group-specific difference in the distribution of sex ratios and phylogenetic groups; more male and group B2 strains in age group under 6-month, while more female and group non-B2 in age group over 6-month. However, further evaluation including larger number of patients will be necessary to confirm above thesis in future molecular epidemiological studies.
Epidemiologic Studies ; Escherichia ; Escherichia coli ; Female ; Humans ; Infant ; Iron ; Male ; Multiplex Polymerase Chain Reaction ; Sex Ratio ; Urinary Tract ; Urinary Tract Infections

The objective of this study was to realize research demands by gathering the research agenda from the Korean Dental Hygienists Association and affiliated groups through a Delphi survey. The study subjects were the heads of eight groups. The Delphi survey was conducted by e-mail after a researcher explained the objective of the study to the heads. The research agenda was classified according to the Korean dental hygiene academic classification and the National Dental Hygiene Research Agenda classification. To compare the number of research agendas according to classification among the groups, we conducted a chi-squared test by using IBM SPSS 20.0. In total, 316 agendas were submitted. According to the Korean dental hygiene academic classification, there was a significant difference among the groups, and the agendas associated with clinical dental hygiene (36.7%) were the best. According to the National Dental Hygiene Research Agenda classification, there was no significant difference and the agendas associated with health promotion and disease prevention (27.8%) were the best. In conclusion, the Korean Dental Hygienists Association and affiliated groups demanded similar research agendas, corresponding to the purpose of each establishment. However, the groups did not seem to show unique characteristics according to the purpose of each establishment. In other words, the groups should corroborate such characteristics and suggest a corresponding agenda to establish specific areas of research in dental hygiene. Also, dental hygiene researchers should mark the academic classification of the studies they want to submit.
Classification ; Dental Hygienists* ; Electronic Mail ; Head ; Health Promotion ; Humans ; Oral Hygiene*

Extra-ovarian yolk sac tumor arising in the omentum is extremely rare. As yolk sac tumor originated from the omentum has been rarely reported, its clinical information is very limited. The authors encountered a case of yolk sac tumor originated from the omentum, and reported the case herein. A 32-year-old woman was presented with developed low abdominal distension for a month. Magnetic resonance imaging findings were suggestive of ovarian malignancy with ascites and peritoneal seeding nodules. Explorative laparotomy was performed and then the findings from frozen biopsy of omentum were suggestive of poorly differentiated tumor though whether it was primary or metastatic was uncertain. Thus, staging laparotomy were performed. Histopathology confirmed that the tumor was a yolk sac tumor of omentum origin. Then, 6 cycles of postoperative adjuvant chemotherapy at intervals of 3 weeks were performed using bleomycin, etoposide, and cisplatin regimen. Four-year outpatient follow-up thereafter showed no relapse.
Adult ; Ascites ; Biopsy ; Bleomycin ; Chemotherapy, Adjuvant ; Cisplatin ; Endodermal Sinus Tumor* ; Etoposide ; Female ; Follow-Up Studies ; Humans ; Laparotomy ; Magnetic Resonance Imaging ; Omentum* ; Outpatients ; Rare Diseases ; Yolk Sac

PURPOSE: In this study, the risk factors of failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA) were investigated. METHODS: Among 403 preterm infants (<32 weeks gestation) born between January 2010 and December 2012, 125 infants treated with ibuprofen for hsPDA were retrospectively reviewed. The preterm infants were divided into the following groups according to their response to the 1st and 2nd cycles of ibuprofen treatment: responder groups I and II, closure of the ductus arteriosus after the 1st and 2nd cycles of ibuprofen treatment; and non-responder groups I and II, persistency of hsPDA after the 1st and 2nd cycles of ibuprofen treatment. RESULTS: One hundred twenty five infants were enrolled in the study: 74 in responder group I, 51 in non-responder group I, 14 in responder group II, and 22 in non-responder group II. In non-responder group I, the gestational age and birth weight were smaller, the postnatal steroid treatment was more frequent, and the duration of mechanical ventilation and the days spent in the hospital were prolonged.I n non-responder group II, the gestational age and birth weight were smaller, the diameters of the ductus arteriosus were larger, and the inotropics use was more frequent. CONCLUSION: Failure of ibuprofen treatment of hsPDA is associated with the diameter of the ductus arteriosus and with inotropics use. Obtaining data regarding these is expected to help in determining if early direct surgical ligation is needed.
Birth Weight ; Ductus Arteriosus ; Ductus Arteriosus, Patent* ; Gestational Age ; Humans ; Ibuprofen* ; Infant ; Infant, Newborn ; Infant, Premature* ; Ligation ; Respiration, Artificial ; Retrospective Studies ; Risk Factors*

During summer and fall months (from June to November), enteroviral infection is more common than group B streptococcal infection or herpes simplex viral infection in neonates. Enteroviruses are divided into polioviruses, coxsackieviruses A, coxsackieviruses B, and echoviruses. Enteroviruses can cause a wide spectrum of acute illnesses ranging from non-specific febrile illness, upper respiratory tract infection or gastroenteritis, to severe diseases such as myocarditis, and encephalitis. Coxsackieviruses B are important neonatal pathogens, which can cause meningoencephalitis, disseminated intravascular coagulopathy, and cardiomyopathy. Transplacental transmission of coxsackievirus or perinatal transmission by inhalation or swallowing of cervical secretion or feces during delivery causes more severe diseases than postnatal transmission by horizontal transmission in nursery or neonatal intensive care unit, due to larger load of viruses. Four preterm infants had severe coxsackieviral B infection with thrombocytopenia, meningitis, disseminated intravascular coagulopathy, and myocarditis within seven days of age during this June. Coxsackieviruses B were detected from their feces, cerebrospinal fluid, and blood. Viruses might be transmitted prenatally through placenta from mother to fetus, which caused severe disease. Coxsackieviruses B infections have to be considered in the neonates with sepsis-like illness during summer and fall months, or enteroviral seasons.
Cardiomyopathies ; Cerebrospinal Fluid ; Deglutition ; Encephalitis ; Enterovirus ; Enterovirus B, Human ; Feces ; Fetus ; Gastroenteritis ; Herpes Simplex ; Humans ; Infant, Newborn ; Infant, Premature ; Inhalation ; Intensive Care, Neonatal ; Meningitis ; Meningoencephalitis ; Mothers ; Myocarditis ; Nurseries ; Placenta ; Poliovirus ; Respiratory Tract Infections ; Seasons ; Streptococcal Infections ; Thrombocytopenia