Purpose: The association between reactogenicity and immunogenicity of the ChAdOx1 nCOV-19 is controversial. We aimed to evaluate this association among South Korean healthcare workers (HCWs). Materials and Methods: Participants received two doses of the ChAdOx1vaccine 12 weeks apart. Blood samples were tested for anti-severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) spike protein receptor binding domain antibodies about 2 months after the first and second doses using the Elecsys Anti-SARS-CoV-2 S assay kits. Adverse events were noted using an online self-reporting questionnaire. Results: Among the 232 HCWs, pain (85.78% after the first dose vs. 58.62% after the second dose, p<0.001) was the most prominent local reaction, and myalgia or fatigue (84.05% vs. 53.02%, p<0.001) was the most prominent systemic reaction. The frequency of all adverse events was significantly reduced after the second dose. After the first dose, the anti-SARS-CoV-2 S showed significantly higher titer in the group with swelling, itching, fever, and nausea. Also, the anti-SARS-CoV-2 S titer significantly increased as the grade of fever (p=0.007) and duration of fever (p=0.026) increased; however, there was no significant correlation between immunogenicity and adverse event after the second dose. The group with pain after the first dose showed a greater increase in the anti-SARSCoV-2 S difference between the second and first doses compared to the group without pain (542.2 U/mL vs. 363.8 U/mL, p=0.037). Conclusion The frequency of adverse events occurring after the first dose of the ChAdOx1 was significantly reduced after the second dose. Interestingly, the elevation of anti-SARS-CoV-2 S titer was significantly increased in the group with pain after the first dose.

Background/Aims: Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching. Methods: Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidicon-acidic. Belch characteristics were compared between patients with BD and those with GERD. Results: Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005).Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007). Conclusions BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Background/Aims: Belching disorder (BD) is clinically distinct from gastroesophageal reflux disease (GERD) with belching. Supragastric belching (SGB) is closely associated with reflux episodes. This study investigates belch characteristics in association with reflux, compared between patients with BD and those who had GERD with belching. Methods: Impedance pH monitoring data from 10 patients with BD and 10 patients with GERD who exhibited belching were retrospectively analyzed. Belches were considered “isolated“ or “reflux-related” and acidicon-acidic. Belch characteristics were compared between patients with BD and those with GERD. Results: Symptomatic belches were more frequent in patients with BD than in patients with GERD (median, 160.5 vs 56.0, P < 0.05). SGB was the most common type in both groups; common subtypes comprised “isolated“ in patients with BD and “isolated during the reflux period” in patients with GERD. Reflux-related SGB was more common in patients with GERD than in BD (78.3% vs 45.2%, P < 0.005).Both “preceding belching” including the reflux period and acidic SGB were more common in patients with GERD than in BD (31.8% vs 8.6% and 38.1% vs 8.9%, both P < 0.05). Supragastric belch number positively correlated with all reflux episodes in patients with GERD (adjusted R2 = 0.572, P = 0.007). Conclusions BD is characterized by more belching, compared to GERD. SGB is more frequently associated with reflux in GERD than in BD; acidity may be related to GERD. In BD, SGB is typically non-acidic and unrelated to reflux. Distinct SGB characteristics may reflect different pathogenic mechanisms of reflux and associated symptoms.

Background/Aims: We aimed to evaluate associations between comorbidities, peripheral neuropathy, and spontaneous internal anal sphincter relaxation (SAR) in patients with defecatory disorders. Methods: A patient was considered to exhibit SAR during high-resolution anorectal manometry (HR-ARM) when the nadir pressure is < 15 mmHg and the time from onset to relaxation was ≥ 15 seconds in the resting pressure frame. A case-control study was performed using HR-ARM data collected from 880 patients from January 2010 to May 2015. We identified 23 cases with SAR (median age 75 years; 15 females; 12 fecal incontinence and 11 constipation). We compared HR-ARM values, Charlson index comorbidity scores, neuropathy, and the prevalence of diseases that potentially cause neuropathy between controls and SAR patients. Each SAR case was compared to 3 controls. Controls were selected to match the age, gender, and examination year of each SAR case. Results: Compared to controls (26.1%), SAR patients (52.2%) exhibited a significantly higher frequency of fecal incontinence. SAR patients also had higher Charlson index scores (5 vs 4, P = 0.028). Nine of 23 SAR patients (39.1%) exhibited peripheral neuropathy— this frequency was higher than that for the control group (11.6%; P = 0.003). Diseases that potentially cause neuropathy were observed in 17 of 23 SAR cases and 32 of 69 controls (P = 0.022). Conclusions SAR develops in patients with constipation and fecal incontinence but is more common in patients with fecal incontinence. Our controlled observational study implies that SAR is associated with peripheral neuropathy and more severe comorbidities.

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
Abdominal Pain ; Administration, Rectal ; Adult ; Aged, 80 and over ; Bisacodyl* ; Child ; Colitis ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility ; Humans ; Mucous Membrane ; Proctitis* ; Rectum ; Ulcer*

Congenital diaphragmatic eventration is defined as an abnormal elevation of the diaphragm resulting from developmental abnormality of muscle fibers during gestation. Differentiation between congenital diaphragmatic hernia (CDH) and eventration is very difficult but important for perinatal management and prognosis, because CDH is associated with higher perinatal and neonatal mortality. We describe a case that was initially diagnosed by prenatal sonography as a right CDH and later confirmed as a congenital diaphragmatic eventration after the delivery with a brief review of the literatures.
Diaphragm ; Diaphragmatic Eventration ; Hernia, Diaphragmatic ; Humans ; Infant ; Infant Mortality ; Muscles ; Pregnancy ; Prognosis

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.
Bacteremia ; Bacterial Toxins ; Ciprofloxacin ; Clindamycin ; Delivery of Health Care ; Exotoxins ; Gentamicins ; Humans ; Incidence ; Leukocidins ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Risk Factors ; Tetracycline ; Trimethoprim, Sulfamethoxazole Drug Combination

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.
Bacteremia ; Bacterial Toxins ; Ciprofloxacin ; Clindamycin ; Delivery of Health Care ; Exotoxins ; Gentamicins ; Humans ; Incidence ; Leukocidins ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Risk Factors ; Tetracycline ; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND: To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. MATERIALS AND METHODS: Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. RESULTS: The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. CONCLUSION: In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.
Endocarditis ; Hospitals, University ; Humans ; Korea ; Medical Records ; Prognosis ; Renal Dialysis ; Retrospective Studies ; Staphylococcus ; Staphylococcus aureus

BACKGROUND: To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. MATERIALS AND METHODS: Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. RESULTS: The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. CONCLUSION: In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.
Endocarditis ; Hospitals, University ; Humans ; Korea ; Medical Records ; Prognosis ; Renal Dialysis ; Retrospective Studies ; Staphylococcus ; Staphylococcus aureus