• Journal of Chest Surgery
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• 제54권2호
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• pp.137-142
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• 2021

Background: Refractory empyemas with collapsed lung and persistent bronchopleural fistulas pose significant problems to thoracic surgeons and impose a substantial burden in terms of morbidity and mortality. The modified Eloesser flap procedure is a useful palliative option for clearing infections. Herein, we present our experiences with the modified Eloesser flap procedure in mixed suppurative lung pathologies with a new technique of irrigation for persistent infection. Methods: A retrospective review was carried out of 56 patients who underwent the modified Eloesser flap with continuous irrigation at Katurba Medical College. These patients had severe morbidities and were not suitable for major thoracic resection surgery, and electively underwent modified Eloesser flap surgery. Regular follow-up was done at 1, 3, 6, and 12 months. Patients with persistent infections were treated with our continuous irrigation technique. Results: The most important finding was that all patients with active sputum acid-fast bacilli-positive findings became sputum smear-negative during the first month of follow-up. Half (50%) of the patients had a patent stoma. Eleven patients had persistent infections, necessitating continuous irrigation. The infection was fully cleared after 1 month in 9 patients, while 2 patients required second irrigation and continued to receive follow-up. In the remaining 50% of the patients, the stoma closed completely, and the lung expanded fully. Conclusion: The modified Eloesser flap is a simple procedure. In suppurative pathologies, infections were well controlled and the general condition of the patients improved. Our continuous irrigation method showed promising results in patients with persistent purulent discharge.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.88-99
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• 2021

Objective : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4-8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4-8 weeks of antibiotic treatment is sufficient. Methods : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4-8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.

• 대한임상검사과학회지
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• 제53권1호
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• pp.11-18
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• 2021

호흡기 바이러스는 감염된 방문자와의 직접적인 접촉을 통해 병원 환경에서 감염된다. 감염관리 분야에서 호흡기 바이러스에 의한 병원내 획득 감염의 주요한 문제를 유발한다. 임상 검사실에서 파생된 감시 데이터는 또한 의료 서비스를 제공하는 기관과 공중 보건 분야에서 치료, 소모품 및 진단 제품 구매를 위해 병원과 지역 사회에 의료자원을 적절하게 배분하기 위해 종종 사용된다. 호흡기바이러스의 감염에서 조기 진단은 필수적이며 호흡기 검체를 사용하는 진단법에 활용될 수 있는 방법에는 바이러스 배양, 분자 진단 및 분석 등이 포함된다. 랩온어칩(LoC)/마이크로칩은 보다 다양하고 강력한 기술인 차세대 현장검사 시험법을 개발할 수 있는 새로운 전략으로 제공한다. 호흡기계의 중요성은 의료관련 종사자의 직업적 건강과 안전을 보장하기 위해 감염 관리 지침에 엄격히 적용되어야 한다. 이 연구를 포함하여 점점 더 많은 임상적 효능 증거가 감염 전파에 대한 오랜 패러다임에 도전하고 있다. 바이러스의 감염 가능성을 의심하는 새로운 호흡기 증상이 시작된 입원 환자로부터 호흡기 바이러스를 탐지하기 위한 빈번한 검사에 대해 추가 지원이 요구되고 감염통제의 노력에 집중적으로 도움이 이루어져야 할 것이다.

• Journal of Medicine and Life Science
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• 제20권2호
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• pp.67-72
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• 2023

Carbapenem-resistant Enterobacteriaceae (CRE) infections have increased rapidly over the past decade and are recognized as a severe health threat in Korea and worldwide. This study aimed to identify the status and characteristics of CRE infection in Jeju province and provide important basic data for the prevention and management of CRE infection. A descriptive epidemiological analysis was performed on reported cases of CRE infection in Jeju Province between 2018 and 2021 using the integrated management system for disease, an infectious disease reporting system from the Korea Disease Control and Prevention Agency. The annual difference and distribution trends of CRE infection were analyzed using CRE isolates, carbapenemase-producing CREs (CP-CRE) and their genotypes, and the type of medical institution in Jeju Province. CRE infections steadily increased in Jeju from 2018 to 2021, and the proportion of CP-CRE among the CREs also showed a statistically significant increase each year. Among the CRE isolates, Klebsiella pneumoniae (KPC, 62.13%) was the most common, and among the CP-CRE genotypes, KPC (81.62%) showed the highest distribution and increased each year. As the distribution of CP-CRE in have increased over the past 4 years, measures to prevent the spread and outbreak of CRE infections are warranted. The results of this study are expected to be used as basic data for prevention and management of CRE infections in the province.

• Parasites, Hosts and Diseases
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• 제61권4호
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• pp.449-454
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• 2023

Free-living amoebae (FLA) rarely cause human infections but can invoke fatal infections in the central nervous system (CNS). No consensus treatment has been established for FLA infections of the CNS, emphasizing the urgent need to discover or develop safe and effective drugs. Flavonoids, natural compounds from plants and plant-derived products, are known to have antiprotozoan activities against several pathogenic protozoa parasites. The anti-FLA activity of flavonoids has also been proposed, while their antiamoebic activity for FLA needs to be emperically determined. We herein evaluated the antiamoebic activities of 18 flavonoids against Naegleria fowleri and Acanthamoeba species which included A. castellanii and A. polyphaga. These flavonoids showed different profiles of antiamoebic activity against N. fowleri and Acanthamoeba species. Demethoxycurcumin, kaempferol, resveratrol, and silybin (A+B) showed in vitro antiamoebic activity against both N. fowleri and Acanthamoeba species. Apigenin, costunolide, (-)-epicatechin, (-)-epigallocatechin, rosmarinic acid, and (-)-trans-caryophyllene showed selective antiamoebic activity for Acanthamoeba species. Luteolin was more effective for N. fowleri. However, afzelin, berberine, (±)-catechin, chelerythrine, genistein, (+)-pinostrobin, and quercetin did not exhibit antiamoebic activity against the amoeba species. They neither showed selective antiamoebic activity with significant cytotoxicity to C6 glial cells. Our results provide a basis for the anti-FLA activity of flavonoids, which can be applied to develope alternative or supplemental therapeutic agents for FLA infections of the CNS.

• Childhood Kidney Diseases
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• 제28권1호
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• pp.35-43
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• 2024

Purpose: Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods: We retrospectively reviewed the medical records of 147 patients <24 months of age with UTIs who were hospitalized between August 2018 and October 2021. The patients were divided into recurrent and single UTI episode groups. Clinical findings and anthropometric and laboratory data were compared between the two groups. Results: In the recurrent UTI group, the weight-for-length (WFL) percentile at the first UTI diagnosis was lower compared to the single UTI episode group, and the weight-for-age percentile at 3-month and 6-month follow-ups after the first UTI decreased (all P<0.05). In univariable logistic regression analysis, higher birth weight, lower WFL percentile, the presence of hydronephrosis, acute pyelonephritis or vesicoureteral reflux, the use of prophylactic antibiotics, and non-Escherichia coli infections were associated with the development of recurrent UTIs (all P<0.05). However, in the multivariable analysis, only the presence of hydronephrosis and prophylactic antibiotic use were independently related to UTI recurrence (P<0.05). Conclusions: The presence of hydronephrosis at the first UTI can be helpful for predicting UTI recurrence in young children aged <24 months. Antibiotic prophylaxis may be associated with UTI recurrence. Potential growth delay should be carefully monitored in infants with recurrent UTI.

• Clinical and Experimental Pediatrics
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• 제49권12호
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• pp.1287-1295
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• 2006

목 적 : 신생아 중환자실에서 포도알균 감염이 증가하고 있어서 감염시 사망률과 유병율이 높기 때문에 신생아 중환자실에서 포도알균 감염의 임상적인 특징과 위험인자에 대하여 조사하였고 최근 늘어가고 있는 Methicilline 저항성 포도알균과 관련하여 항생제에 대한 감수성을 조사하였다. 방 법 : 2000년 1월부터 2004년 12월까지 한일병원과 경희의 대부속병원 신생아 중환자실에 입원한 세균 배양 검사상 포도알균에 양성을 보인 환아 240명을 대상으로 하여 의무 기록을 후 향적으로 조사하였다. 포도알균을 MRSA, MSSA, S.epidermidis, S.epidermidis 외 CNS로 나누어 감염에 대한 임상적 특징과 여러요인과 발생빈도에 있어서의 연관성에 대한 조사를 시행하였다. 포도알균에 양성을 보인 240명의 환아중 MRSA는 88명, MSSA는 41명, S.epidermidis는 63명, S.epidermidis 외 CNS는 48명이었다. 결 과 : 5년동안 신생아실에 입원한 3,593명 중에 배양검사를 시행한 환아수는 7,481명이었으며 배양검사상 양성 환아수는 2000년도에 23명, 2001년도에 109명, 2002년도에 53명, 2003년도에 35명, 2004년도에 20명이었다. 포도알균 감염의 위험요인은 제태연령 37주 미만, 5분 아프가 점수가 7점 미만, 입원후 총정맥영양 시행, 입원후 인공호흡기의 사용, 제대정맥관 또는 제대동맥관 삽입, 입원후 비강 또는 구강용 영양튜브의 사용 등이었다. 항생제 감수성에 있어서는 모두 vancomycin에 감수성이 100%였으며 teicoplanin, trimethoprim-sulfamethoxazole, chloramphenicol, clindamycin에 감수성이 높았으며 gentamycin과 erythromycin에는 감수성이 낮았다. 결 론 : 포도알균 감염의 빈도를 줄이기 위해서는 철저한 산전 관리 등을 통해 미숙아 출생을 낮춰야 하며 신생아실에 입원하는 환아에게 총정맥영양의 시행, 인공호흡기 사용, 중심정맥도관의 삽입, 비강 또는 구강용 영양튜브의 사용을 최소한도로 해야 하겠으며 최근 신생아실에서 증가하고 있는 methicillin 저항성 포도알균에 대해서는 조기에 적절한 항생제를 사용하는 것이 MRSA 감염으로 인한 유병률과 사망률을 낮출수 있을 것으로 사료된다.

• Pediatric Infection and Vaccine
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• 제21권2호
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• pp.129-138
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• 2014

목적: A군 연쇄구균은 소아에서 인두염, 연조직염을 일으키며 드물게 침습성 질환을 일으키는 중요한 원인균이다. 그리하여 본 연구에서는 한국 소아에서 A군 연쇄구균 침습성 감염증의 임상 양상 및 예후에 대해 조사하고자 하였다. 방법: 1992년 3월부터 2012년 12월까지 서울대학교 어린이병원 및 2003년 3월부터 2012년 12월까지 분당 서울대학교병원에 입원한 환자 중 A군 연쇄구균 침습성 감염증으로 치료받은 18세 이하의 소아를 대상으로 하였다. 의무기록을 후향적으로 분석하여 대상환자들의 임상양상, 검사결과, 치료방법 및 예후와 합병증에 대해 조사하였다. 결과: A군 연쇄구균 침습성 감염증으로 진단 받은 총 36명의 환자 중 30명에 대해 의무기록을 확인할 수 있었다. 남자가 많았으며(남:여=2.75:1) 환자들의 중앙연령은 4년 2개월(생후 12일부터 15세까지)로 그 중 53.3%가 5세 미만이었다. 질환은 피부 및 연조직감염증(9/30, 30.0%), 국소 감염부위가 없는 균혈증(4/30, 13.3%) 그리고 관절염 및 골수염(6/30, 20.0%)가 가장 많은 것으로 확인되었다. 연쇄구균 독소쇼크증후군(3/30, 10.0%), 호흡기, 복부 및 중추신경계 감염증도 확인되었다. 전체기간 중 2012년에 환자발생이 가장 많았으며(9/30, 30.0%), 사망한 사례는 없었다. Erythromycin 및 clindamycin에 대한 항생제 내성률은 각각 3.8% 및 7.5%로 확인되었다. 결론: 본 연구를 통해 소아에서 A군 연쇄구균 침습성 감염증으로 입원치료 받은 환자들의 임상양상을 확인할 수 있었으며 주로 5세 미만의 어린 연령층에서 발생하는 것을 알 수 있었다. 지난 20년 동안 한국 소아에서 발생한 A군 연쇄구균 침습성 감염증의 임상적 특성 및 예후를 조사함으로써 향후 임상에서 환자를 빠르게 인지하고 적절하게 치료하는데 본 연구결과가 도움이 될 수 있을 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제48권3호
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• pp.251-259
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• 2005

Atopy is a highly prevalent and serious health problem. The prevalence and severity of asthma and allergic diseases have increased over recent decades, particularly in industrialized nations. Early life infections may protect against the development of atopy and allergic diseases like asthma. The inverse relationship between the incidence of atopy and childhood infections has led to the 'hygiene hypothesis', which suggests that diminished exposure to childhood infections in modern society has led to decreased Th1-type responses. Th1 and Th2 responses are counter-regulatory. Reduced Th1 may lead to enhanced Th2-type inflammation, which is important in promoting asthma and allergic disease via up-regulation of IL-4, IL-5, and IL-13. It is now widely accepted that altered regulation of Th2 responses(and possibly the balance between Th1 and Th2 responses) is an important factor in the development of atopy. CpG DNA represent a novel class of drugs with substantial immunomodulatory properties. CpG DNA contain unmethylated motifs centered on the CpG dinucleotides, like bacterial DNA. These CpG DNA promote Th1 and regulatory type immune responses and suppress Th2 responses. In murine studies, CpG DNA are effective in prevention and treatment of asthma and allergic diseases. CpG DNA are just beginning to be tested in human asthma. While its precise mechanisms continue to be fully studied, CpG DNA offers considerable promise as a novel treatment for atopic inflammation. It may prove to be an important disease modifying therapy, or even curative therapeutic agent for asthma and allergic diseases.

• The Journal of Asian Finance, Economics and Business
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• 제7권12호
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• pp.115-121
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• 2020

This study aims to investigate the effects of restrictions in economic activity on the spread of COVID-19 in the Philippines. This research employs daily time-series data of confirmed new COVID-19 cases, Apple mobility trends (i.e., use of public transport to destinations, volume of people driving, and amount of walking to destinations) and Google community mobility (i.e., visits to transit stations, visits to workplaces, and staying-at-home) indicators covering the period February 17 to September 11, 2020. The analysis starts by establishing the correlation pattern of new confirmed COVID-19 daily infections to each independent variable. The results show negative linear correlation of the number of new COVID-19 daily infections with less visit to transit station, increase stay-at-home, less use of public transport, and less amount of walking to destinations. Interestingly, the number of new COVID-19 daily infections indicates some form of positive linear correlation with visits to workplaces and volume of people driving. Moreover, employing robust least square regression via the method of MM-estimation, major findings reveal that across mobility measures, staying-at-home has the highest impact on reducing the spread of COVID-19, followed by visiting transit stations less, less use of public transport, less amount of walking, and less workplace visits.