• Pediatric Infection and Vaccine
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• v.23 no.3
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• pp.194-201
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• 2016

Purpose: Monitoring pneumococcal carriage rates is important. We developed and evaluated the accuracy of a real-time reverse transcription polymerase chain reaction (RT-PCR) protocol for the detection of Streptococcus pneumoniae. Methods: In October 2014, 157 nasopharyngeal aspirates were collected from patients aged <18 years admitted to Chung-Ang University Hospital. We developed and evaluated a real-time PCR method for detecting S. pneumoniae by comparing culture findings with the results of the real-time PCR using genomic DNA (gDNA). Of 157 samples, 20 specimens were analyzed in order to compare the results of cultures, real-time PCR, and real-time RT-PCR. Results: The concordance rate between culture findings and the results of real-time PCR was 0.922 (P<0.01, Fisher exact test). The 133 culture-negative samples were confirmed to be negative for S. pneumoniae using real-time PCR. Of the remaining 24 culture-positive samples, 21 were identified as S. pneumonia -positive using real-time PCR. The results of real-time RT-PCR and real-time PCR from 20 specimens were consistent with culture findings for all S. pneumoniae -positive samples except one. Culture and real-time RT-PCR required 26.5 and 4.5 hours to perform, respectively. Conclusions: This study established a real-time RT-PCR method for the detection of pneumococcal carriage in the nasopharynx. Real-time RT-PCR is an accurate, convenient, and time-saving method; therefore, it may be useful for collecting epidemiologic data regarding pneumococcal carriage in children.

• Tuberculosis and Respiratory Diseases
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• v.55 no.1
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• pp.59-68
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• 2003

Background : In intubated patients, cultures of endotracheal aspirates (EA) are apt to contamination throughout the endotracheal tube. Therefore, the identification of etiologic agents via conventional EA cultures is not always reliable. In order to differentiate a pulmonary infection from a non-infectious disease, and to identify the true etiologic agent of acute pulmonary infection, blinded protected specimen brushing (PSB) was used, and its efficacy evaluated. Methods : In 51 intubated patients, with suspected pneumonia, blind PSB were performed, and the results compared with blood and EA cultures. A protected specimen brush was introduced through the endotracheal tube, and settled at the affected large bronchus. A specimen brush was introduced to the expected region using the blind method. The tip of the brush was introduced with an aseptic technique after vigorously mixed for 1 minute in $1cm^3$ of Ringer's lactate solution. The specimens were submitted for quantitative culture within 15 minutes, with a culture being regarded as positive if the colony forming units were above $10^3/ml$. Results : Of the 51 patients, 15 (29.4%) had community-acquired pneumonia (CAP), 27 (52.9%) hospital-acquired pneumonia (HAP) and 9 (17.6%) non-infectious diseases. The sensitivity and specificity of the quantitative PSB culture for the diagnosis of pneumonia were 52.4 and 88.9%, respectively. The sensitivity and specificity of EA were 78.6 and 77.8%, respectively. The blind PSB was superior to the EA for the identification of true etiologic agents. Of 53 episodes of 27 HAP patients, MRSA (Methicillin-resistant staphylococcus aureus) (41.5%) was the most common causative agent followed by Pseudomonas aeruginosa (15.1%), Klebsiella sp. (7.5%) and Acinetobacter sp. (7.5%). Conclusions : As a simple, non-invasive diagnostic modality, the blind PSB is a useful method for the differentiation of a pulmonary infection from non-infectious diseases and to identify the etiologic agents in intubated patients. A blind PSB can be performed without bronchoscopy, so is safer, more convenient and cost-effectiveness for patients where bronchoscopy can not be performed.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.781-784
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• 2007

Foreign body aspiration (FBA) is a common accident in young children. Undiagnosed and retained foreign bodies may result in severe early and late complications such as asphyxia, pneumonia, atelectasis and bronchiectasis. Moreover, because it can mimic bronchiolitis, croup or asthma, an accurate history and a high index of suspicion are of paramount importance for early diagnosis. With our experience on bronchial FBA initially misdiagnosed as acute bronchiolitis, we emphasize that a minute radiological finding should not be neglected and a repeat chest radiograph may be helpful when the initial study shows normal findings. Multidetector computed tomography is a very useful noninvasive diagnostic modality for FBA.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.116-121
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• 2008

Purpose: Cricopharyngeal incoordination is a rare cause of swallowing difficulties in newborns and infants; it is characterized by delayed pharyngeal contractions related to cricopharyngeal relaxation. Dysphagia and repeated aspiration are common findings despite normal sucking. We conducted this study to assess the clinical features of cricopharyngeal incoordination in newborns and infants. Methods: An analysis of the clinical data from 17 patients with cricopharyngeal incoordination who were admitted to the Department of Pediatrics, Pusan National University Hospital, between 2000 and 2006 was conducted retrospectively. The diagnosis of cricopharyngeal incoordination was established by the clinical characteristics and the videofluoroscopic swallowing studies. Results: The male to female ratio was 1:1.1 (males 8, females 9) the age range 1 to 60 days. The body weight of 11 patients (64.7%) was less than the $10^{th}$ percentile at diagnosis. Six patients (35.3%) were born prematurely. The associated anomalies or diseases were chromosomal anomaly (2 cases), congenital heart disease (3 cases), and laryngomalacia, hypoxic brain damage or neonatal seizures (1 case each). The chief complaints of patients were recurrent aspiration pneumonia (10 cases), feeding difficulty (9 cases), dyspnea (4 cases), and chocking (4 cases). The severity of aspiration on the videoesophagogram or esophagogram was mild in 12 cases. The correlation between the severity of aspiration and the duration of tube feeding after the diagnosis was significant (p<0.05). Conclusion: Cricopharyngeal incoordination should be considered in the differential diagnosis of newborns and infants, without known risk factors associated with swallowing dysfunction, when they present with unexplained respiratory problems. Although the prognosis of cricopharyngeal incoordination is good, early diagnosis and tube feeding are recommended to prevent the complications associated with this disorder.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1996.04a
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• pp.81-81
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• 1996

선천성 후두열은 매우 드문 선천성 기형으로 신생아에게 심각한 호흡곤란 및 수유장애를 초래할 수 있다. 해부학적 결손정도와 관련된 기형에 따라 다양한 증상이 나타난다. 가장 흔한 특징적 증상으로는 흡기시 천명, 간헐적으로 나타나는 수유시 호홉곤란을 들 수 있다. 이 증상들은 후두연화증, 성대마비, 후비공폐색 둥과 같은 다른 선천성 기형에서도 나타나기 때문에 미리 의심하지 못하면 진단이 어렵다. 따라서 진단을 위해서는 세심한 주의와 정확한 내시경 검사가 필요하다. 저자들은 선천성 후두열 2례를 경험하였다. 첫 증례는 제 II형이었고 두번째는 III형이었으며, 두 증례 모두 전방 후두열 접근법으로 치료하였다. 제 III형 환아는 술전 흡기시 천명을 동반한 호흡곤란과 여러번의 흡인성 폐렴을 겪었으며 술후 캐놀라발거는 가능하였으나 경구를 통한 수유시 흡인을 동반하여 현재까지 위루술을 통해 음식을 섭취하고 있는 상태이다. 저자들은 최근 경험한 선천성 후두열 2례를 video presentation과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.329-332
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• 1993

Breakdown of the normal protective function of the larynx, either through primary or neurologic cause, leads to chronic aspiration, recurrent pneumonitis and possibly death. Lindemann`s tracheoesophageal diversion has three main advantages; first, it eliminates intractable aspiration in all patients who underwent the procedure, second, it preserves larynx, and third, if the underlying neurologic condition is recorved, the procedure can be reversed. We had performed tracheoesophageal diversion in two cases of intractable aspiration pneumonia patients. The postoperative courses were uneventful and they were receiving oral alimentation on the 22th and 9th postoperative days respectively, and could be discharged on 43th and 20th postoperative days respectively.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.356-361
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• 2008

Background: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope. Methods: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope. Results: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications. Conclusion: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.207-213
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• 2014

Purpose: This study aimed to investigate the association between respiratory virus infection and pneumococcal colonization in children. Methods: From May 2009 to June 2010, nasopharyngeal (NP) aspirates were obtained from patients under 18 years old who visited Seoul National University Children's Hospital for respiratory symptoms. NP samples were used to detect respiratory viruses (influenza virus A and B, parainfluenza virus 1, 2 and 3, respiratory syncytial virus A and B, adenovirus, rhinovirus A/B, human metapneumovirus, human coronavirus 229E/NL63 and OC43/HKU1) by RT-PCR and pneumococcus by culture. Results: Median age of the patients was 27 months old. A total of 1,367 NP aspirates were tested for respiratory viruses and pneumococcus. Pneumococcus was isolated from 228 (16.7%) of samples and respiratory viruses were detected from 731 (53.5%). Common viruses were rhinovirus (18.4%), respiratory syncytial virus (RSV) A (10.6%), adenovirus (6.9%), influenza virus A (6.8%). Pneumococcal isolation rate was significantly higher in the cases of positive virus detection than negative detection [21.3% (156/731) vs. 11.3% (72/636), P <0.001]. For individual viruses, pneumococcal isolation rate was positively associated with detection of influenza virus A [24.7% (23/93) vs 16.1% (205/1274), P=0.001], RSV A [28.3% (41/145) vs 15.3% (187/1222), P=0.001], RSV B [31.3% (10/32) vs 16.3% (218/1335), P=0.042], rhinovirus A/B [22.6% (57/252) vs 15.3% (171/1115), P=0.010]. Conclusion: The study revealed that pneumococcal isolation from NP aspirates is related with respiratory virus detection. The result of this study could be used to investigate how respiratory viruses and pneumococcus cause clinical diseases.

• Journal of Korean Academy of Nursing
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• v.50 no.3
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• pp.474-486
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• 2020

Purpose: The purpose of this study was to develop and validate a Korean version of the Self-Care for Aspiration Pneumonia Prevention (SCAPP-K) scale in older adults at risk of dysphasia. Methods: The Hertz and Baas model of scale development and validation was used. In the development stage, items were generated via literature review and interviews with medical experts, older adults, and caregivers. Ten experts assessed the items for content validity. Subsequently, 12 older adults participated in a pilot test to determine the comprehensibility and appropriateness of the SCAPP-K scale. The validation stage involved a cross-sectional survey with 203 older adults for exploratory factor analysis (EFA) and 200 older adults for confirmatory factor analysis (CFA) and to determine convergent and discriminant validity. To test the validity and reliability of the scale, EFA using principal component analysis with varimax rotation and CFA were conducted, and convergent and discriminant validity as well as internal consistency reliability were determined. Results: As a result of EFA, three self-care factors (knowledge, resources, behaviors) with 21 items were validated. The CFA and convergent and discriminant validity indicated the applicability of the three-factor self-care scale. The reliability of the SCAPP-K scale was acceptable, with Cronbach's α=.87~.91. Conclusion: The SCAPP-K scale has acceptable validity and reliability and can contribute to clinical practice, research, and education to improve self-care for the prevention of aspiration pneumonia in older adults at risk of dysphasia.

• The Journal of the Korean dental association
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• v.53 no.10
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• pp.678-687
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• 2015

In order to prevent aspiration pneumonia, oral hygiene care is important; thus proper tips for oral hygiene care should be distributed among hospitals and care facilities for elderly. Malpractice of oral hygiene itself may cause aspiration pneumonia. For efficient and effective oral hygiene care, engagement of professionals such as dentists or dental hygienists is essential. At the point where necessity of systemized dental $professionals^{\circ}{\phi}$ involvement at care facilities for elderly is being emerged, it is important to determine less risky approaches for oral health care tailored to elderly. Among many approaches, oral health care practice without usage of water is considered safe, reducing risk of possibility of aspiration. Since this practice is quite easy to implement, many dental professionals may utilize it when practiced at care facilities for elderly.