Background: Digital panoramic dental X-ray equipment (PDX) is frequently used by patients and dental workers for diagnosis andexamination in dental institutions; however, infection control has not been properly implemented. Therefore, in this study, we aimed to systematically review the potential risk of cross-infection in the dental environment by investigating the contamination level of general aerobic bacteria and Staphylococcus aureus, which are important in hospital infections, in PDX areas that people mainly contact. Methods: This survey was conducted from March to May 2023 and covered one general hospital, three dental hospitals, and ninedental clinics equipped with PDX. Bacteria samples were collected from the left-handle, right-handle, forehead support, and head side support as the patient’s contact areas, as well as the X-ray exposure switch and left-click mouse button as the dental hygienist’s contact areas of the PDX. The collected bacteria were spread on Petrifilm, and colonies formed after 48 hours of culture were counted. Results: General aerobic bacteria and S. aureus were detected in all areas investigated. Significant differences in bacterial counts between different regions of the PDX were observed in both groups (p＜0.001). The detection rates of general aerobic bacteria (p＜0.001) and S. aureus (p＜0.001) were significantly higher in the contact areas of patients than those of dental hygienists. A positive correlation was observed between the forehead and the temple region in terms of general aerobic bacteria and S. aureus detection (r=1) (p＜0.01). Conclusion Taken together, the presence of many bacteria, including S. aureus, detected in PDX indicates that PDX has a potential cross-infection risk. Our results therefore highlight the need for the development of appropriate disinfection protocols for reusable medical devices such as PDX and periodic infection prevention training for hospital-related workers, including dental hygienists.

BACKGROUND: Spontaneous echo contrast (SEC) of the left atrium (LA) is associated with increased risk of thromboembolism in patients with mitral stenosis(MS). The determination of the presence and severity of LA spontaneous echo contrast(SEC) is of prognostic importance in these patients. Harmonic imaging(HI), a novel echocardiographic technique that differs from conventional fundamental imaging(FI) by transmitting ultrasound at one frequency and receiving at twice the transmitted frequency, produces better endocardial border definition and myocardial opacification. However, there are no data about its value on the detection of LA SEC. The purpose of this study was to investigate the utility of transthoracic noncontrast HI in the detection of LA SEC in patients with. METHODS: Seventy-four consecutive patients with MS (49 female, mean age 51) underwent standard transthoracic echocardiograms (TTE) in both HI and FI and transesophageal echocardiography (TEE) to determine the presence and severity of LA SEC. LA SEC was graded by TEE; mild if only seen at high gain, severe if visible in the entire LA at normal gain control of the equipment. Control subjects comprised of 30 patients randomly selected from patients who did not have LA SEC at TEE examination. RESULTS: Atrial fibrillation was found in 46 patients (62.2%). The mean mitral valve area and mean mitral gradient were 1.0+/-0.3cm2 and 8.2+/-4.1mmHg, respectively. Nine patients (12.2%) had episodes of systemic embolism; stroke in 8 and peripheral embolism in 1. LA thrombus was found in 11 patients (14.9%) by TEE. LA SEC was present in all but one patient by TEE (mild in 35, severe in 38 patients). FI of TTE, however, revealed LA SEC in only 5 (6.8%) of the 73 patients. In contrast, in HI, LA SEC could be detected in 63 (86.3%) of the 73 patients. In the detection of severe LA SEC, the sensitivity of FI and HI were 13.2% (5/38) and 100% (38/38), respectively. LA SEC was not observed in control subjects either by FI or HI. CONCLUSION: Transthoracic HI significantly enhances the detection of LA SEC in patients with MS.
Atrial Fibrillation ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Female ; Heart Atria ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Stroke ; Thromboembolism ; Thrombosis ; Ultrasonography

Purpose: To determine whether the cornea remodeling-related genes aldehyde dehydrogenase 3A1 (ALDH3A1), lysyl oxidase (LOX), and secreted protein acidic and rich in cysteine (SPARC) were potential susceptibility candidate genes for keratoconus in Korean patients, we investigated the associations of single nucleotide polymorphisms (SNPs) in these three genes in Korean patients with keratoconus.
Methods: Genomic DNA was extracted from blood samples of unrelated patients with keratoconus and healthy control individuals. For screening of genetic variations, all exons from the entire coding regions of the ALDH3A1, LOX, and SPARC genes were directly sequenced to determine the presence of mutations. Control individuals were selected from the general population without keratoconus.
Results: In this study, we detected nine SNPs in ALDH3A1, four SNPs in LOX, and 18 SNPs in SPARC. rs116992290, IVS3-62c>t, rs116962241, and rs2228100 in ALDH3A1 and rs2956540 and rs1800449 in LOX were significantly different between patient and control groups. In the SPARC gene, the distribution of the *G allele of EX10+225 T>G (p = 0.018; odds ratio, 1.869) was strongly associated with the risk of keratoconus in the Korean population. In haplotype analysis, C-G of rs2956540-rs2288393 in LOX(p = 0.046) and C-C-G and G-G-G of rs60610024-rs2228100-rs57555435 (p = 0.021 and p < 0.001), G-A of IVS3-62 a>g - rs116962241 in ALDH3A1(p = 0.048) predisposed significantly to keratoconus. After cross-validation consistency and permutation tests, two locus model was the best SNP variations interaction pattern.
Conclusions Our results suggested that genetic variations in ALDH3A1, LOX, and SPARC genes were associated with a predisposition for keratoconus in Korean individuals. Moreover, variations in ALDH3A1 and LOX may serve as strong biomarkers for keratoconus.

OBJECTIVE: Children are sedated before undergoing diagnostic imaging tests in emergency medicine or pediatric sedation anesthesia units. The aim of this study was to identify variables potentially affecting the dose of ketamine required for induction of sedation in pediatric patients undergoing diagnostic imaging.METHODS: This retrospective study included children aged 0 to 18 years who underwent sedation with ketamine for computed tomography or magnetic resonance imaging in the pediatric sedation anesthesia unit of a tertiary medical center between January 2011 and August 2016. The children’s hemodynamic status and depth of sedation were monitored during the examination. We recorded data on demographics, categories of imaging tests, ketamine doses administered, adverse events, respiratory interventions, and duration of sedation. Data for patients who experienced adverse events were excluded.RESULTS: Sixty-six patients were included in the final analysis. Univariate linear regression analysis revealed that patient age, height, and body surface area (BSA) affected the sedative dose of ketamine administered. These three variables showed multicollinearity in multivariate linear regression analysis and were analyzed in three separate models. The model with the highest adjusted R-squared value suggested the following equation for determination of the dose of ketamine required to induce sedation: ketamine dose (mg)=-1.62+0.7×age (months)+36.36×BSA (m²).CONCLUSION: Variables such as age and BSA should be considered when estimating the dose of ketamine required for induction of sedation in pediatric patients.
Anesthesia ; Body Surface Area ; Child ; Demography ; Diagnostic Imaging ; Emergency Medicine ; Hemodynamics ; Humans ; Ketamine ; Linear Models ; Magnetic Resonance Imaging ; Patient Care ; Retrospective Studies

Objectives: The aim of this study was to investigate dietary intakes and nutritional status among Uganda primary school children from two selected schools in urban and rural areas. Methods: Data were collected from 350 pupils (6-14 years) in Mpigi district, Uganda. All participants were offered a school lunch meal (usually maize porridge and boiled beans). Dietary survey was conducted in October 2016. Data for dietary intake levels were collected by the 24-hour recall method with trained school staffs. The data were converted into nutrient intakes using the CAN-Pro 5.0 Program and compared with KDRIs to evaluate the nutritional status of the subjects. Diet quality indexes such as nutrient density, nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and index of nutritional quality (INQ) and a diet diversity index such as diet diversity score (DDS) were calculated to evaluate nutritional status among subjects. Data were analyzed using SPSS statistical programs. Results: Results show that the intakes of most nutrients were significantly different by schools. The nutritional status of micro-nutrients was very low in both schools according to analysis of nutritional indexes such as NARs and INQs. Students from both schools should improve intakes of micro-nutrients related to child growth such as calcium, Vitamin B6, zinc and folate. According to the analysis of dietary diversity, there was difference in dietary patterns by schools presumably due to their locations. Conclusions This suggests that current meals could not provide adequate nutrients for the subjects and urgent nutrition interventions for school food services are needed to improve their nutritional well-being. New foods supplements based on local cuisine are also needed to ensure dietary diversity and sustainable development plans.

Background and Objectives: This study aimed to evaluate the clinical features and the clinical factors associated with prognosis of sudden sensorineural hearing loss (SSNHL) in diabetic patients. Subjects and Methods: Forty-nine diabetic with unilateral SSNHL were retrospectively included. All patients received systemic high dose steroid therapy within one month after onset and had more than one month of follow-up audiogram. The basic characteristics of the patients, initial and follow-up audiograms, laboratory data, and methods of steroid treatment were collected. Results: Compared to reference values in healthy subjects, 79%, 55%, and 45% of the patients had higher values of mean neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), respectively. Older patients had significantly less degree of hearing loss, but they also had significantly worse hearing thresholds in the unaffected ear. After steroid treatment, less than half patients (47%) showed hearing recovery. Simultaneous intratympanic dexamethasone (ITD) injections with systemic steroid did not confer an additional hearing gain or an earlier recovery rate in diabetic patients with SSNHL. In the multivariate analysis, initial hearing thresholds of affected ear and timing of steroid treatment were significantly associated with hearing prognosis in diabetic patients with SSNHL. Conclusions Diabetic patients with SSNHL tended to have increased NLR, LMR, and PLR, which are reported to be associated with microvascular angiopathy. Simultaneous ITD injections to improve hearing recovery in diabetic patients with SSNHL seems unnecessary.

Purpose: To determine whether the cornea remodeling-related genes aldehyde dehydrogenase 3A1 (ALDH3A1), lysyl oxidase (LOX), and secreted protein acidic and rich in cysteine (SPARC) were potential susceptibility candidate genes for keratoconus in Korean patients, we investigated the associations of single nucleotide polymorphisms (SNPs) in these three genes in Korean patients with keratoconus.
Methods: Genomic DNA was extracted from blood samples of unrelated patients with keratoconus and healthy control individuals. For screening of genetic variations, all exons from the entire coding regions of the ALDH3A1, LOX, and SPARC genes were directly sequenced to determine the presence of mutations. Control individuals were selected from the general population without keratoconus.
Results: In this study, we detected nine SNPs in ALDH3A1, four SNPs in LOX, and 18 SNPs in SPARC. rs116992290, IVS3-62c>t, rs116962241, and rs2228100 in ALDH3A1 and rs2956540 and rs1800449 in LOX were significantly different between patient and control groups. In the SPARC gene, the distribution of the *G allele of EX10+225 T>G (p = 0.018; odds ratio, 1.869) was strongly associated with the risk of keratoconus in the Korean population. In haplotype analysis, C-G of rs2956540-rs2288393 in LOX(p = 0.046) and C-C-G and G-G-G of rs60610024-rs2228100-rs57555435 (p = 0.021 and p < 0.001), G-A of IVS3-62 a>g - rs116962241 in ALDH3A1(p = 0.048) predisposed significantly to keratoconus. After cross-validation consistency and permutation tests, two locus model was the best SNP variations interaction pattern.
Conclusions Our results suggested that genetic variations in ALDH3A1, LOX, and SPARC genes were associated with a predisposition for keratoconus in Korean individuals. Moreover, variations in ALDH3A1 and LOX may serve as strong biomarkers for keratoconus.

BACKGROUND AND OBJECTIVES: Cardiac resynchronization therapy (CRT) has been known to improve the outcome of advanced heart failure (HF) but is still underutilized in clinical practice. We investigated the prognosis of patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We also developed a risk model to predict mortality to improve the facilitation of CRT. SUBJECTS AND METHODS: Patients with symptomatic HF with left ventricular ejection fraction < or =35% and QRS interval >120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy, 239 patients (160 males, mean 67+/-11 years) were eventually recruited. RESULTS: During a follow-up of 308+/-236 days, 56 (23%) patients died. Prior stroke, heart rate >90 bpm, serum Na < or =135 mEq/L, and serum creatinine > or =1.5 mg/dL were identified as independent factors using Cox proportional hazards regression. Based on the risk model, points were assigned to each of the risk factors proportional to the regression coefficient, and patients were stratified into three risk groups: low- (0), intermediate-(1-5), and high-risk (>5 points). The 2-year mortality rates of each risk group were 5, 31, and 64 percent, respectively. The C statistic of the risk model was 0.78, and the model was validated in a cohort from a different institution where the C statistic was 0.80. CONCLUSION: The mortality of patients with advanced HF who were managed conventionally was effectively stratified using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis.
Cardiac Resynchronization Therapy ; Cohort Studies ; Creatinine ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Rate ; Humans ; Male ; Mustard Compounds ; Prognosis ; Risk Factors ; Stroke ; Stroke Volume

BACKGROUND: The purpose of this study was to evaluate the risk factors for mechanical ventilation in the patients with scrub typhus admitted to intensive care unit (ICU) at a university hospital. METHODS: We retrospectively selected and analyzed clinical data from the medical records of 70 patients (32 men, 38 women) admitted to the ICU with scrub typhus between 2004 and 2014. The patients had a mean+/-standard deviation age of 71.2+/-11.1 years and were evaluated in two groups: those who had been treated with mechanical ventilation (the MV group, n=19) and those who had not (the non-MV group, n=51). Mean ages of the MV group and the non-MV group were 71.2+/-8.3 years and 71.2+/-11.1 years, respectively. RESULTS: Significant differences between the two groups were observed with respect to acute respiratory failure (p=0.008), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p=0.015), Sequential Organ Failure Assessment (SOFA) score (p=0.013), death (p=0.014), and ICU duration (p<0.01). Multivariate analysis indicated that the following factors were significantly associated with mechanical ventilation: acute respiratory failure (p=0.011), SOFA score (p=0.005), APACHE II score (p=0.011), platelet count (p=0.009), and lactate dehydrogenase (LDH) (p=0.011). CONCLUSION: Thus, five factors-acute respiratory failure, SOFA score, APACHE II score, platelet count, and LDH-can be the meaningful indicators for mechanical ventilation for the patients with scrub typhus admitted to ICU.
APACHE ; Blood Platelets ; Humans ; Intensive Care Units* ; Critical Care* ; L-Lactate Dehydrogenase ; Male ; Medical Records ; Multivariate Analysis ; Platelet Count ; Respiration, Artificial* ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors* ; Scrub Typhus*

PURPOSE: The aim of this study is to evaluate the relationship between initial body mass index (BMI) and BMI after gonadotropin-releasing hormone agonist (GnRHa) treatment in idiopathic true precocious puberty girls. METHODS: The subjects were 99 idiopathic true precocious puberty girls treated with GnRHa for more than 1 year. The patients were categorized into two groups according to initial BMI; normal weight group (BMI < 85 percentile) and overweight/obesity group (BMI > or = 85 percentile). We investigated chronologic age (CA), bone age (BA), BA advancement (BA-CA), height (Ht), Ht-standard deviation score (Ht_zs), BMI, BMI_zs, predicted adult height (PAH), and PAH_zs before initiation of GnRHa treatment and 1 year later. RESULTS: Baseline CA, BA, BA-CA, Ht_zs, and PAH showed no differences between normal weight group and overweight/obesity group. BMI_zs increased only in normal weight group, and DeltaBMI_zs was negatively correlated with initial BMI_zs (r = -0.501, P < 0.001). PAH_zs increased less in normal weight group (DeltaPAH_zs = 0.30) than in overweight/obesity group (DeltaPAH_zs = 0.66) (P = 0.02), but there was no correlation between initial BMI_zs and DeltaPAH_zs. DeltaBA-CA and DeltaHt_zs were not different between two groups either. Comparing patients with increased BMI_zs with those whose BMI_zs decreased or remained the same, there were no differences in DeltaBA-CA, DeltaHt_zs, and DeltaPAH_zs. On multiple regression analysis, DeltaBMI_zs was negatively correlated with initial BMI_zs, and it showed no correlation with CA, BA, BA-CA, height, and dose of GnRHa. CONCLUSION: BMI_zs increased after 1yr of GnRHa treatment in idiopathic true precocious puberty girls whose initial BMI_zs was normal, and its increment was negatively correlated with initial BMI_zs.
Adult ; Body Mass Index ; Gonadotropin-Releasing Hormone ; Humans ; Obesity ; Puberty, Precocious