Background: Clostridioides (Clostridium) difficile is an important pathogen that causes diarrhea in people who take antibiotics. The recent status of C. difficile infection is not wellknown in Korea. Methods: The long-term trend of C. difficile infection in Korean hospitals was analyzed using a nationwide sample cohort. The data also included sociodemographic characteristics, disease severity, and healthcare facilities. C. difficile infection was defined by the prescription of oral vancomycin or all metronidazole prescriptions under C. difficile infectious disease code (A047). Results: The rate of C. difficile infection has steadily increased from 0.030% in 2006 to 0.317% in 2015. The increased rate correlated to age (0.033% for <50 years, 0.421% for 70-79 years, and 0.758% for >80 years of age) and the Charlson comorbidity index score (0.048% for zero versus 0.378% for three or more points). It differed by the type of medical institution (0.270 % at referral hospitals versus 0.056 % at general hospitals and mental hospitals). Conclusion The rate of C. difficile infection in Korea is significant in patients with advanced age and disease severity. The results show that C. difficile infection trend has been increasing steadily in Korea.

OBJECTIVES: Despite severe oligospermia, males with Y chromosome microdeletion can achieve conception through ICSI (Intracytoplasmic Sperm Injection). However, ICSI may not only result in the transmission of microdeletions but also the expansion of deletion to the offspring. The purpose of this study was to screen vertical transmission, expansion of microdeletions and de novo deletion in male fetuses conceived by ICSI. MATERIALS AND METHODS: A total of 32 ICSI treated patients with their 33 (a case of twin) male fetuses conceived by ICSI were used to make this study group. Sequence-tagged sites (STSs)-based PCR analyses were performed on genomic DNA isolated from peripheral blood of fathers and from the amniocytes of male fetuses. Ten primer pairs namely, sY134, sY138, MK5, sY152, sY147, sY254, sY255, SPGY1, sY269 and sY158 were used. The samples with deletions were verified at least three times. RESULTS: We detected a frequency of 12.5% (4 of the 32 patients) of microdeletions in ICSI patients. In 4 patients with detected deletions, two patients have proven deletions on single STS marker and their male fetuses have the identical deletion in this region. Another two patients have two and three deletions, but their male fetuses have more than 3 deletions which include deletions to their father's. Meanwhile, seven male fetuses, whose fathers were analyzed to have all 10 STS markers present, have deletions present in at least one or more of the markers. CONCLUSIONS: Although the majority of deletions on the Y chromosome are believed to arise de novo, in some cases a deletion has been transmitted from the fertile father to the infertile patient. In other cases the deletion was transmitted through ICSI treatment, it is likely that one sperm cell is injected through the oocyte's cytoplasm and fertilization can be obtained from spermatozoa. Our tests for deletion were determined by PCR and our results show that the ICSI treatment may lead to vertical transmission, expansion and de novo Y chromosome microdeletions in male fetuses. Because the sample group was relatively small, one should be cautious in analyzing these data. However, it is important to counsel infertile couples contemplating ICSI if the male carries Y chromosomal microdeletions.
Cytoplasm ; DNA ; Family Characteristics ; Fathers ; Fertilization ; Fetus* ; Humans ; Male* ; Oligospermia ; Polymerase Chain Reaction ; Sequence Tagged Sites ; Sperm Injections, Intracytoplasmic* ; Spermatozoa ; Y Chromosome*

Although digital gangrene is an uncommon clinical feature, it may lead to serious complications, such as amputation. Therefore, it requires prompt evaluation and treatment. Digital gangrene is often seen in systemic sclerosis, but is rare in systemic lupus erythematosus (SLE). In SLE, digital gangrene results from vasculitis, vasospasm, and thromboembolism. Here, we report a 15-year-old male SLE patient who initially presented with digital gangrene, and present a review of the relevant literature.
Amputation ; Gangrene ; Humans ; Lupus Erythematosus, Systemic ; Male ; Scleroderma, Systemic ; Thromboembolism ; Vasculitis

This study reports a case who presented with swallowing difficulty after orthognathic surgery. A female patient, who had undergone orthognathic surgery for esthetic purpose, presented with dysphagia. Administration of botulinum toxin injection to the cricopharyngeus muscle did not relieve or improve the severe dysphagia. The patient required nasogastric tube feeding for about three months. Swallowing ability was recovered after daily rehabilitation therapy and prescribing pyridostigmine. Injuries to the suprahyoid muscles (involved in laryngeal elevation during the pharyngeal phase of swallowing) during orthognathic surgery, and the inadvertent dissemination of inadequately injected botulinum toxin to adjacent muscles, are possible mechanisms of the severe dysphagia experienced by this patient. The authors also reviewed literature on the prevention and management of dysphagia following the orthognathic surgery.

Purpose: We explored the role of parental social class in preterm birth (PTB) and low birth weight (LBW) in association with child mortality in Korea. Materials and Methods: A total of 7,302,732 births in Korea between 1995 and 2007 were used for designing the national retrospective cohort study. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the risk of child death after adjusting for covariates. Results: Parental social class was associated with adverse birth outcomes and child mortality in Korea. Parental social class increased the strength of the relationship of adverse birth outcomes with child mortality. Child mortality was higher among PTB and LBW infants from parents with a lower social class than normal births from parents with a higher social class. In particular, the disparity in child mortality according to parental social class was greater for LBW and PTB than intrauterine growth retardation births.When one of the parents had a middle-school education or lower, the disparity in child mortality due to adverse birth outcomes was large regardless of the other spouse’s educational status. Inactive economic status for the father, as well as an occupation in manual labor by the mother, increased the risk of child mortality. Conclusion Strong relationships for social inequalities and adverse birth outcomes with inequalities in child mortality in South Korea were found in this study. Tackling social inequalities, as well as reducing adverse birth outcomes, are needed to reduce the disparities in child mortality in South Korea.

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was noted to cause coronavirus disease 2019 (COVID-19) in 2019, there have been many trials to develop vaccines against the virus. Messenger ribonucleic acid (mRNA) vaccine as a type of the vaccine has been developed and commercialized rapidly, but there was not enough time to verify the long-term safety. An 82-year-old female patient was admitted to the emergency room with dyspnea accompanied by stridor three days after the 3rd COVID-19 mRNA vaccination (Comirnaty, Pfizer-BioNTech, USA). The patient was diagnosed with bilateral vocal fold paralysis (VFP) by laryngoscope. Respiratory distress was improved after the intubation and tracheostomy in sequence. The brain, chest, and neck imaging tests, serological tests, cardiological analysis, and immunological tests were performed to evaluate the cause of bilateral VFP. However, no definite cause was found except for the precedent vaccination.Because bilateral VFP can lead to a fatal condition, a quick evaluation is necessary in consideration of VFP when dyspnea with stridor occurs after vaccination.

The coronavirus disease 2019 (COVID-19) epidemic originated in Wuhan, China and spread rapidly worldwide, leading the World Health Organization to declare an official global COVID- 19 pandemic in March 2020. The upper aero-digestive tract is known to be the highest viral load reside. The infection spreads via droplets or direct contact with contaminated surfaces via aeorsol. The otolaryngologists deal with diseases of the upper-aerodigestive tract and routinely are engaged in respiratory droplet and aerosol-generating procedures (AGP). In particular, because airborne transmission occurs during examination and AGP, otolaryngologists are considered to be at a high risk of contracting COVID-19 during this pandemic. Therefore otolaryngologists need to do precautions to protect staff and patients and minimize transmission of the disease. We also need to wear adequate personal protective equipment according to the examination and procedure. This article discusses the disease transmission and clinical characteristics of COVID-19 as well as precaution guidelines in outpatient clinics of otorhinolaryngology.

PURPOSE: To evaluate mortality and morbidity of very low birth weight (VLBW) infants born in Busan from 1996 to 2001. METHOD: Seven neonatal intensive care units (including 3 university hospitals and 4 general hospitals) in Busan participated for this study. We performed retrospective review of 756 VLBW infants who were born in this area during study period was done to assess their mortality and morbidity. RESULT: The total number of VLBW infant was 756 (incidence: 0.97%, mean gestational age: 29.5 +/- 2.9 wk, mean birth weight: 1165+/-232 g) including 187 extremely low birth weight infants who were less than 1, 000 g birth weight (24.7%). The survival rate was 61.0% (461 of 756). It increased from 56.4% in early period (1996 to 1998) to 65.2% in late period (1999 to 2001) (P<0.01). The incidence of respiratory distress syndrome was 61.5% (466 of 756), patent ductus arteriosus 12.3% (93 of 756), blood culture positive sepsis 10.2% (77 of 756), bronchopulmonary dysplasia 9.3% (70 of 756), severe intracranial hemorrhage 6.5% (49 of 756), necrotizing enterocolitis 4.9% (37 of 756), severe retinopathy of prematurity 3.7 % (28 of 756). The main causes of death were respiratory distress syndrome and sepsis. CONCLUSION: The survival rate of VLBW infant in Busan area during recent 6 years was 61.0%, which is lower than other single unit result of our country, recent Japanese or North American data. We think both modernized facilities in NICU and well-trained medical personnel are needed to improve survival.
Asian Continental Ancestry Group ; Birth Weight ; Bronchopulmonary Dysplasia ; Busan* ; Cause of Death ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Gestational Age ; Hospitals, University ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care Units, Neonatal ; Intracranial Hemorrhages ; Mortality* ; Retinopathy of Prematurity ; Retrospective Studies ; Sepsis ; Survival Rate

PURPOSE: The prognosis of papillary thyroid carcinoma is determined by such risk factors as old age, male gender, a large tumor size and extrathyroid extension. The aim of this study was to investigate the value of extrathyroid extension for the recurrence of papillary microcarcinoma and its association with the risk factors for papillary thyroid carcinoma. METHODS: We retrospectively studied 167 patients with papillary microcarcinoma and who underwent thyroidectomy from Feb. 2003 to Dec. 2008. Papillary microcarcinoma (PTMC) was defined as a tumor smaller than 1 cm and an extrathyroid extension was identified by the pathological findings. Age, gender, extrathyroid extensions, the operative methods, lymph node metastasis and the MACIS score were analyzed by the appropriate statistical methods. RESULTS: Patients with PTMC showed a lower MACIS score, fewer lymph node metastasis and less extrathyroid extension, as compared to the patients with papillary thyroid carcinoma. Total thyroidectomy and selective lymph node dissection were less frequently done in the patients suffering with PTMC. Analysis of the risk factors showed that PTMC had a close relationship with lymph node metastasis, the extent of surgery and multifocal cancer. The disease free survival rate of the patients with PTMC was statistically related with lymph node metastasis, but not with an extrathyroid extension (P=0.001). CONCLUSION: The patients with PTMC showed less lymph node metastasis and extrathyroid extension as compared to the patients with PTC. Lymph node metastasis of PTMC is an independent factor for disease free survival, but minimal extrathyroid extension is not related with recurrence. PTMC with lymph node metastasis should be regarded as an aggressive large tumor and lymph node dissection should be done.
Disease-Free Survival ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

Little is known about the prevalence of atopic dermatitis and food allergy outside North America and Europe. We evaluated the prevalence of atopic dermatitis and food allergy with the comparison of prevalence between 1995 and 2000 in Korea and evaluated the correlation of prevalence between atopic dermatitis and food allergy. A cross-sectional questionnaire survey was conducted on random samples of schoolchildren 6 to 14 yr at two time points, 1995 and 2000 throughout Korea. The last twelve months prevalence of atopic dermatitis in Korean school-aged children was increased from 1995 to 2000. The twelve-month prevalence of atopic dermatitis and food allergy were higher in Seoul than in any other provincial cities in 1995, but the prevalence of both diseases in Seoul and Provincial Centers became to be similar in 2000. The rate responded to food allergy of children with atopic dermatitis (9.5%) was lower than that of the western countries (60%). And our data demonstrated paternal and maternal allergy history is very significantly correlated to developing atopic dermatitis in their offspring. The further objective evaluations are required to confirm these outcomes because the environmental and risk factors may be different among the countries according to their living cultures.
Adolescent ; Child ; Dermatitis, Atopic/*epidemiology ; Female ; Food Hypersensitivity/*epidemiology ; Humans ; Korea/epidemiology ; Male ; Prevalence ; Questionnaires ; Risk Factors ; Rural Population/statistics & numerical data ; Urban Population/statistics & numerical data