PURPOSE: The goal of this study was to characterize the patterns of antimicrobial resistance and virulence genes in samples of Staphylococcus aureus (S. aureus) isolated from periodontitis patients. METHODS: From July 2015 to August 2015, oral saliva was collected from a total of 112 patients diagnosed with periodontitis, including 80 outpatients in dental hospitals and 32 patients in dental clinics located in Seoul and Cheonan. The samples were subjected to a susceptibility test to evaluate the prevalence of antimicrobial resistance, and the pathogenic factors and antimicrobial resistance factors in the DNA of S. aureus were analyzed using polymerase chain reaction. RESULTS: A susceptibility test against 15 antimicrobial agents showed that 88% of cultures were resistant to ampicillin, 88% to penicillin, and 2% to oxacillin. Resistance to at least two drugs was observed in 90% of cultures, and the most common pattern of multidrug resistance was to ampicillin and penicillin. Enterotoxins were detected in 65.9% of samples. The cell hemolysin gene hld was detected in 100% of cultures and hla was detected in 97.6% of samples. All strains resistant to penicillin and ampicillin had the blaZ gene. The aph(3')IIIa gene, which encodes an aminoglycoside modifying enzyme, was detected in 46.3% of samples. CONCLUSIONS: In the treatment of oral S. aureus infections, it is important to identify the pathogenic genes and the extent of antimicrobial resistance. Furthermore, it is necessary to study patterns of antimicrobial resistance and cross-infection in the context of periodontological specialties in which antimicrobials are frequently used, such as maxillofacial surgery, where the frequency of antimicrobial use for minor procedures such as implant placement is increasing.
Ampicillin ; Anti-Infective Agents ; Chungcheongnam-do ; Dental Clinics ; DNA ; Drug Resistance, Multiple ; Enterotoxins ; Humans ; Mouth* ; Outpatients ; Oxacillin ; Penicillins ; Periodontitis* ; Polymerase Chain Reaction ; Prevalence ; R Factors ; Saliva ; Seoul ; Staphylococcus aureus* ; Staphylococcus* ; Surgery, Oral ; Virulence

PURPOSE: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. METHODS: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi's phenomenological research methodology. RESULTS: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: “agony and conflict in the aspects of care”, “heavy mind and regret for exhausting care”, “intentionally avoiding parents' sadness”, “comforting sadness in the heart” and “orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment.” CONCLUSION: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses.
Child* ; Humans ; Nursing Care ; Pediatric Nursing ; Qualitative Research ; Research Design ; Withholding Treatment

Background: Fresh frozen plasma (FFP) has been inappropriately using in spite of limited transfusion indications. Our institution applied the transfusion indication data-entry to a computerized order system in February 2018. Physicians should select the indication during transfusion order. In January 2019, the warning pop-up additionally applied for informing whether or not the coagulation test results correspond to FFP transfusion indications. We investigated the effects of a new applied program on the appropriateness of FFP transfusion. Methods: By comparing the appropriateness of transfusion before applying the transfusion indication data-entry, we investigated whether there were improvements of appropriateness after applying the transfusion indication data-entry and after applying the warning pop-up. We compared the percentages of performing pre-transfusion coagulation tests and transfusion among FFP requests before and after applying the warning pop-up. Results: After applying the transfusion indication data-entry, the appropriateness improved from 54.5% to 66.7%. The appropriateness of the surgery department was the lowest compared with that of the medical departments and emergency departments. The warning pop-up would be effective to induce pre-transfusion coagulation tests from surgery departments and emergency department. However, there was no further improvement in the appropriateness. Many requests from the surgery departments did not lead to transfusion. As the results of the analysis conducted by dividing each department that belonged to surgery departments, we could determine the wrong transfusion practice specific to each department. Conclusion The transfusion indication data-entry contributed to improving the appropriateness of FFP transfusion. Department-specific education and real-time auditing are needed for further improvement.

Background: Oral acitretin (ACT) has been approved for the treatment of psoriasis (PSO), whereas alitretinoin (ALI) has been prescribed off-label. Few studies have compared the efficacy of these two therapeutics. Objective: To evaluate the clinical outcomes of oral ACT versus ALI for treating PSO. Methods: Sixty-five patients diagnosed with PSO and treated with ACT or ALI were reviewed. Patient demographics, clinical efficacy, and adverse effects were evaluated. Treatment efficacy was assessed using physician’s global assessment (PGA) and psoriasis area and severity index (PASI). Results: A total of 38 cases in the ACT group and 27 cases in the ALI group in PSO were retrospectively reviewed. No significant intergroup differences were noted in the proportion of patients achieving PGA score of “clear” or “almost clear” (18.42% vs. 22.22%; p=0.71). The reduction rate of PASI from baseline was higher in the ALI group (24.30% vs. 22.74%; p=0.68), while the rate of achieving 75% improvement in PASI was higher in the ACT group (18.42% vs. 14.81%; p=0.75); no significantly differences were noted. The ALI group had fewer adverse effects (6/27 [22.22%]) than the ACT group (10/38 [26.32%]), and no severe events occurred in either group. Conclusion ALI can be considered an off-label treatment option for a limited patient population.

Doxycycline is frequently prescribed to treat urogenital infections or acne vulgaris. A 39-year-old man was prescribed doxycycline as a treatment for his skin infection. He took each tablet on an empty stomach in the morning, and just before going to bed with insufficient water. After taking the prescribed medication for approximately 3 weeks, he was diagnosed with esophageal ulcer. He had not experienced these symptoms before, and the drug label says that doxycycline rarely causes esophageal ulcer. After discontinuing the medication, the symptoms disappeared. Using the World Health Organization-Uppsala Monitoring Center criteria, the causality for doxycycline-induced esophageal ulcer was evaluated as “possible.” Additionally, using the Naranjo scale and Korean causality assessment algorithm (Ver. 2), the causality was evaluated as “probable.” Previous reports have stated that most patients who took doxycycline with insufficient water just before going to bed or in the supine position developed esophageal ulcer. Therefore, all patients taking doxycycline must be provided with detailed instructions about the appropriate administration methods.
Acne Vulgaris ; Adult ; Doxycycline ; Global Health ; Humans ; Skin ; Stomach ; Supine Position ; Ulcer ; Water

BACKGROUND: Beta₂-adrenergic receptor (ADRβ2) gene variations seem to be correlated with disease progression, prognosis, and drug response to β-blockers in cardiovascular events. In this study, we investigated the genotypes and haplotypes of ADRβ2 in Korean patients and analysed their association with coronary artery disease (CAD). METHODS: One hundred five patients diagnosed with stable angina (SA), 109 patients with acute coronary syndrome (ACS), and 88 controls were enrolled. Five single nucleotide polymorphisms (SNPs) were determined at positions 46, 79, 252, 491, and 523 nucleotides, using the polymerase chain reaction and direct sequencing analysis. The haplotype reconstruction was carried out using genotype data, and analyses of the association between the genetic variation and CAD were performed. RESULTS: There were significant differences in the allele frequencies for the 79CG SNPs among the three groups. Relative to the control group, the distribution of 79CG genotypes was significantly different in both the SA group (P=0.0003) and the ACS group (P=0.0056). Compared with the CC genotype of 79CG, subjects with CG or GG had a higher risk of CAD (adjusted odds ratio [OR], 12.851; P=0.014). The frequencies of specific ACGCA, GCACC, and GGGCC haplotypes were 6.4% vs. 0%, 8.3% vs. 0%, and 6.9% vs. 0.6%, respectively, in the ACS group and controls. The GGGCC haplotype was significantly associated with CAD (adjusted OR, 12.266; P=0.016). CONCLUSIONS: Although there are large ethnic differences in the distribution of ADRβ2 SNPs and their association with CAD, the 79G polymorphism and GGGCC haplotype in ADRβ2 might specifically contribute to CAD pathogenesis in Korean patients.
Acute Coronary Syndrome ; Angina, Stable ; Coronary Artery Disease* ; Coronary Vessels* ; Disease Progression ; Gene Frequency ; Genetic Variation ; Genotype ; Haplotypes* ; Humans ; Nucleotides ; Odds Ratio ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prognosis

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches with or without other acute neurological symptoms, and diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. A 44-year-old woman underwent heart transplantation due to primary amyloidosis with heart involvement. She started to have a seizure after three hours after the heart transplantation, and her consciousness was not recovered. Computed tomography and transcranial doppler sonography were used to diagnose RCVS, and contracted vessels were recovered after oral nimodipine administration.
Adult ; Amyloidosis ; Cerebral Arteries ; Consciousness ; Constriction ; Female ; Headache ; Heart Transplantation* ; Heart* ; Humans ; Nimodipine ; Seizures ; Ultrasonography, Doppler, Transcranial ; Vasoconstriction*

Background: Cyclosporine is an effective drug for the treatment of psoriasis. Nonetheless, little is known about the factors associated with its effectiveness. Objective: This study aimed to analyze the factors affecting the treatment efficacy of cyclosporine in patients with psoriasis. Methods: ‘Good treatment response’ and ‘treatment failure’ were each defined as achievement of 75% improvement in the psoriasis area and severity index and failure to achieve 50% improvement in the psoriasis area and severity index, respectively. The factors affecting good treatment response were investigated by comparing the group that achieved psoriasis area and severity index 75 to the not achieved group. Similarly, we also analyzed the factors affecting treatment failure and the time required to achieve psoriasis area and severity index 75. Results: In total, 78 patients (63 males and 15 females) were analyzed. Age of onset, body surface area, accompanying hypertension, accompanying psoriatic arthritis, induction phase mean dose, and cumulative dose showed a relationship with good treatment response. Body surface area, initial dose, and accompanying hypertension were correlated with treatment failure. The mean time taken to achieve psoriasis area and severity index 75 was 6.70±3.17 weeks and it did not correlate with any factor. Conclusion In patients with psoriasis vulgaris, maintaining an adequate mean dose in the induction phase may be necessary for successful treatment with cyclosporine, especially in the patients with early-onset psoriasis, severe psoriasis, or accompanying psoriatic arthritis. In addition, a sufficiently high start dose may be needed to prevent treatment failure, particularly in patients with severe psoriasis vulgaris.