BACKGROUND: Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). This study aimed to reduce ESBL-producing K. pneumoniae in the NICU by using infection control measures. METHODS: We performed prospective surveillance cultures, monitoring, and education for infection control in the NICU between May and August 2011. Specimens were collected from all infants and the environment including stethoscopes, thermometers, ventilators, incubators, etc. The anterior nares and hands of healthcare workers were also screened. We inspected infection control practices and provided feedback. The level of infection control awareness was measured using a questionnaire. RESULTS: The level of awareness and performance of hand washing increased significantly after intervention (both P<0.001). The environmental management of healthcare providers also improved significantly (P=0.001). The yield of ESBL-producing K. pneumoniae from clinical specimens decreased gradually throughout the study period (30.4% in May to 12.6% in August). Central catheter-related K. pneumoniae bacteremia decreased from 1.3/1000 to 0/1000 catheter-days. CONCLUSION: Infection control measures including education, monitoring, and surveillance can lower the incidence of ESBL-producing K. pneumoniae in the NICU.
Bacteremia ; beta-Lactamases ; Cross Infection ; Delivery of Health Care ; Hand ; Hand Disinfection ; Health Personnel ; Humans ; Incidence ; Incubators ; Infant ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Klebsiella ; Klebsiella pneumoniae ; Pneumonia ; Prospective Studies ; Stethoscopes ; Thermometers ; Ventilators, Mechanical

No abstract available.
Cervix Uteri* ; Female ; Hysterectomy*

This study was made to identify compliance in self-medication, and factors influencing the self-medication of pulmonary TB patients. Self-medication of pulmonary TB patients is a very important factor for the cure of the patients. In this study, variables were used from three theories of health behavior. These were the Health Belief Model, Health Locus of Control, Theory of Planned Behavior. These were included to examine their effect on self-medication. Data were collected during the period from July 1 to August 20, 1994 using a structured questionnaire. And they were analyzed by mean, standard deviation, ANOVA, Pearson Correlation Coefficient, and Multiple Regression analysis using the SAS program. The result were as follows : 1. The mean on the self-medication scores ranging from 6.0 to 12.0 was 10.93. The mean for the self-evaluation scores of the self-medication ranging from 50.0 to 100.0 was 86.51. 2. There were significant associations between the scores on self-medication and age(F=2.34, p=0.033), and method of treatment(F=4.65, P=0.018). And there were significant associations between the self-evaluation scores of self-medication and age (F=3.79, P=0.000), and presence of TB patients among family(F=4.92, P=0.000). 3. (a) The relationship between the scores on self-medication and perceived barrier in health belief revealed a significant correlation(r=-.2046, p=0.0082). (b) The relationship between the scores on self-medication and other-dependency in LOC revealed a significant correlation(r=0.2322, p=0.0018). (c) The relationship between the self-evaluation score of self-medication and other-dependency in LOC revealed a significant correlation(r=0.1946, p=0.0122). (d) The relationship between the attitude in self-medication of the subjects and the self-evaluation score of self-medication revealed a significant correlation(r=0.2102, p=0.0066). 4. (a) 14.8% of the score of compliance in self-medication of the subjects was explained by five variables : Behavioral Intention, Duration of Treatment, Age, Perceived Sensitivity and Perceived Sensitivity and Perceived Barrier. (b) 8.7% of the score of self-evaluation of self-medication was explained by three variables : Perceived Control, Perceived Sensitivity, and Age. In conclusion : This study provides insights and information which may be valuable for motivation and instruction to improve compliance in self-medication among pulmonary TB patients.
Compliance* ; Diagnostic Self Evaluation ; Health Behavior ; Humans ; Intention ; Internal-External Control ; Motivation ; Tuberculosis, Pulmonary* ; Surveys and Questionnaires

This study was designed to evaluate impact of kinds of dietary grain and dietary lipid level on the glucose metabolism and antithrombogenic capacity in obesity induced rats. Total of 80 Sprague-Dawley male rats were raised for one month with control diet containing 50% (w/w) well-milled rice powder and 20% (w/w) of dietary lipids. The rats were blocked into 8 groups and raised for two months with diets containing well-milled rice, brown rice, black rice, or glutinous barley powder and 8 or 20% (w/w) of dietary lipids. The contents of total dietary fiber in experimental grains were in following order; glutinous barley > black rice > brown rice > well-milled rice. Weekly food intake were lower in glutinous barley group among all experimental groups. Body weight gain was high in high level of fat groups (20% w/w) than medium level of fat groups (8% w/w). Plasma glucose concentration was not different significantly in each groups. But brown rice group was a little lower than others. Plasma insulin concentration was lower in black rice and glutinous barley group than rice group. Plasma glucagon concentration did not differ significantly among all experimental groups. Hexokinase activities in skeletal muscle are different significantly according to level of dietary fat and grain variety factors. Brown rice group was significantly highest among all experimental groups in hexokinase activity. Plasma TXB2 concentrations in black rice and glutinous barley groups were lower as compared to rice and brown rice groups. Plasma 6-keto-PGF1alpha concentrations in glutinous barley group was higher as compared to others. In conclusion brown rice has a little lowering effect glucose concentration. Black rice and glutinous barley intakes enhance antithrombogenic capacity. It is suggested that the intakes of mixed gains are recommend.
Animals ; Blood Glucose ; Body Weight ; Edible Grain* ; Diet ; Dietary Fats ; Dietary Fiber ; Eating ; Glucagon ; Glucose* ; Hexokinase ; Hordeum ; Humans ; Insulin ; Male ; Metabolism* ; Muscle, Skeletal ; Obesity* ; Plasma ; Rats* ; Rats, Sprague-Dawley

Good's syndrome is the rare association of immunodeficiency with thymoma, characterized by hypogammaglobulinemia, depleted B-cells, diminished T-cells and inversion of the CD4/CD8 ratio. Thymectomy does not usually improve hypogammaglobulinemia; thus, the patient remains prone to infections. Infections affect primarily the sinopulmonary and gastrointestinal system. Here we present a case of a 71-year-old woman with common manifestations of Good's syndrome who succumbed to disseminated tuberculosis. Serum immunoglobulin levels should be measured for patients with thymoma and susceptibility to infection.
Agammaglobulinemia ; Aged ; B-Lymphocytes ; Female ; Humans ; Immunoglobulins ; Immunologic Deficiency Syndromes ; Opportunistic Infections ; T-Lymphocytes ; Thymectomy ; Thymoma ; Tuberculosis

No abstract available.
Aged ; Early Diagnosis ; Female ; Humans ; *Immunochromatography ; Male ; Middle Aged ; Orientia tsutsugamushi/*immunology ; Predictive Value of Tests ; Prognosis ; Republic of Korea/epidemiology ; Scrub Typhus/*diagnosis/epidemiology/immunology

PURPOSE: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. METHODS: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients'electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. RESULTS: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. CONCLUSION: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.
Aluminum Hydroxide ; Carbonates ; Eating ; Emergencies ; Humans ; Incidence ; Interviews as Topic ; Intubation ; Medical Records ; Neurotoxins ; Respiratory Insufficiency ; Retrospective Studies ; Seasons ; Tetraodontiformes ; Tetrodotoxin ; Ventilation ; Ventilators, Mechanical

Osteomyelitis of the pubic symphysis or pubic osteomyelitis is a rare disease entity. Predisposing factors include trauma, pelvic or urologic surgery, intravenous drug abuse, pelvic malignancy, parturition and cardiac catheterization. Pathogens vary depending on the risk factors. The most frequent causative organism is Staphylococcus aureus . Gram-negative bacteria such as Pseudomonas aeruginosa and Escherichia coli are also common pathogens. However, pubic osteomyelitis due to community-onset extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has not previously been described. We present a patient with pubic osteomyelitis caused by ESBL-producing Escherichia coli without known predisposing factors except for diabetes.
Bacteria ; beta-Lactamases ; Cardiac Catheterization ; Cardiac Catheters ; Drug Resistance ; Escherichia ; Escherichia coli ; Gram-Negative Bacteria ; Humans ; Osteomyelitis ; Parturition ; Pseudomonas aeruginosa ; Pubic Symphysis ; Rare Diseases ; Risk Factors ; Staphylococcus aureus ; Substance Abuse, Intravenous

Background: Staphylococcus aureus bacteremia (SAB) is a common and serious infection with a high mortality. Patients with chronic kidney disease (CKD) are vulnerable to SAB, but there have been few studies performed on the clinical characteristics and outcomes of SAB in CKD patients stratified by dialysis. We aimed to estimate the all-cause mortality and identify its predictors in patients with CKD. Materials and Methods: We conducted a retrospective study on the patients with SAB hospitalized in a tertiary care center in Korea between March 2014 and December 2018.Kaplan-Meier analysis was performed to compare all-cause mortality following SAB among patients with non-dialysis dependent CKD (ND-CKD), those receiving dialysis, and those without CKD (non-CKD). The predictors of mortality among CKD patients were analyzed by Cox proportional hazards regression. Results: As a total, 278 SAB of 43 ND-CKD (31 males), 58 dialysis (39 males), and 177 nonCKD (112 males) patients were included. The 30-day mortality was 39.5% in ND-CKD, 27.6% in dialysis, and 7.9% in non-CKD patients. The hazard ratio of all-cause mortality following SAB in ND-CKD was 2.335 (95% confidence interval, 1.203 – 4.531; P = 0.003), compared to non-CKD patients. For methicillin-resistant S. aureus bacteremia (MRSAB), the hazard ratio of all-cause mortality in ND-CKD was 2.628 (95% CI, 1.074 – 6.435; P = 0.011), compared to dialysis patients. Appropriate antibiotics <48 h was independently related to improved survival following SAB among ND-CKD (adjusted HR, 0.304; 95% CI, 0,108 – 0.857; P = 0.024) and dialysis (adjusted HR, 0.323; 95% CI, 0,116 – 0.897; P = 0.030) patients. Conclusion ND-CKD patients demonstrated poor outcome following SAB and administration of appropriate antibiotics within 48 h could reduce the risk for mortality.

PURPOSE: Deep vein thrombosis (DVT) is a risk factor of pulmonary thromboembolism (PTE), however it is not clear who should be evaluated for a PTE and a DVT at the same time. The purpose of this study is to determine the clinical characteristics of PTE in patients with DVT who visited the emergency department (ED). METHODS: This was a retrospective cohort study of ED patients who visited with DVT and were simultaneously evaluated for a PTE from January 2012 to December 2013. We compared clinical characteristics between non-PTE and PTE patients with confirmed DVT in the ED. RESULTS: Of these 166 patients, 96 patients (57.8%) were confirmed PTE by computed tomography. In multivariate analysis, patients with PTE had more systemic neoplasm (OR 2.03, 95% CI 1.04-3.93, p=0.037) and right heart strain pattern in electrocardiography (OR 5.29, 95% CI 1.71-16.36, p=0.004) than patients without PTE. Femoral DVT was more likely in the non-PTE group (87.1% vs. 65.6%, p=0.002) and popliteal DVT was more likely in the PTE group (62.9% vs. 80.2%, p=0.013). However the number of DVT sites including both femoral and popliteal vein was not statistically different. CONCLUSION: In patients with systemic neoplasm or right heart strain patterns in electrocardiography, simultaneous PTE evaluation may be required in patients with DVT.
Cohort Studies ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart ; Humans ; Multidetector Computed Tomography ; Multivariate Analysis ; Popliteal Vein ; Pulmonary Embolism* ; Retrospective Studies ; Risk Factors ; Thromboembolism ; Venous Thrombosis*