• Neonatal Medicine
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• v.16 no.2
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• pp.190-196
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• 2009

Purpose: Candida infection has increased in neonatal intensive care units (NICU). However, recent reports on systemic candida infections in preterm newborns are rare in Korea. The aim of this study was to examine the epidemiological features of systemic candida infection in very low birth weight infants (VLBW) over the past five years. Methods: We retrospectively reviewed the medical records of 19 patients with systemic candida infections in VLBW that were admitted to the neonatal intensive care units of three hospitals affiliated with the College of Medicine, The Catholic University of Korea from January 2004 to December 2008. We analyzed the birth weight, gestational age, age at diagnosis, risk factors, co-morbidity, antifungal treatment, and mortality rates among the 19 patients. Results: Systemic candida infections occurred in 19 cases (4.7%) among the VLBW infants. The mean birth weight and gestational age were 959.0$\pm$255.9 g and 26.7$\pm$2.1 weeks. The isolated Candida species were C. albicans (4), C. parapsilosis (9), C. glabrata (2), C. famata (2), and unkown subspecies (2). Most patients had various associated risk factors, including a central venous catheter, broad spectrum antibiotics, parenteral nutrition, intravenous lipid emulsion, endotracheal intubation and $H_2$ blocker therapy. There was no significant difference in the risk factors between newborns that survived and those that died with regard to the systemic candida infection, except for gestational age. Nine (47.4%) out of 19 patients with a candida infection died and four cases (21.2%) were directly related to the candida infection. Conclusion: The prevalence of systemic candida infection is increasing in VLBW infants. The majority of Candida species has shifted to C. non-albicans, especially C. parapsilosis. Because of the high mortality associated with candida infection in the NICU, prophylaxis and early treatment based on epidemiological features is necessary.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.3
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• pp.155-162
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• 2006

Purpose: Diabetes mellitus (DM) is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is glowing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. Subjects and Methods: 203 diabetic patients (64 male, mean age $64.1{\pm}9.0$ years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was $36{\pm}18$ months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Results: Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the ocurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. Conclusion: Patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events.

• Korean Journal of Microbiology
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• v.40 no.4
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• pp.295-301
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• 2004

Recently, the rapid increase and global spread of extended-spectrum $\beta-lactamase$ producing clinical isolates has become a serious problem. The incidence of extended-spectrum $\beta-lactamase$ producing clinical isolates of Escherichia coli in Korea and susceptibility to antimicrobial agents were investigated. Total 233 isolates of E. coli were obtained from urine from hospitalized patients in Guro hospital, Korea University in 2001. One hun­dred and eighty four isolates $(78.9\%)$ were resistant to ampicillin, 80 isolates $(34.3\%)$ were resistant to ceph­alothin, 93 isolates $(39.9\%)$ were resistant to gentamicin, and 64 isolates $(27.5\%)$ were resistant to norfloxacin. Among 233 isolates, 17 isolates $(7.3\%)$ were positive as determined by the double disk synergy test. When min­imal inhibitory concentrations were assayed with additional 6 antimicrobial agents, 13 isolates $(76.5\%)$ were multi-drug resistant to at least four different class antimicrobial agents. Extended-spectrum $\beta-lactamase$ were characterized with isoelectric focusing gel electrophoresis and DNA sequencing. They were TEM-1 in 5 iso­lates, TEM-15 in 1 isolate, TEM-20 in 1 isolate, TEM-52 in 4 isolates, TEM-1 and AmpC in 2 isolates, TEM-1 and OXA-30 in 1 isolate, TEM-1 and OXA-33 in 1 isolate, TEM-1, CTX-M-3, and AmpC in 1 isolate, but SHV was not detected. Antimicrobial resistance genes were transferred to animal isolate of E. coli (CCARM No. 1203) by the filter mating method. Extended spectrum $\beta-lactamase$ producers studied in the current study have low correlation to each other as determined by random amplified polymorphic DNA and pulsed field gel elec­trophoresis. This is a contradictory result from the general hypothesis that extended-spectrum $\beta-lactamase$ pro­ducers in one hospital is a result from a clonal spread.

• Journal of Hospice and Palliative Care
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• v.10 no.2
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• pp.78-84
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• 2007

Purpose: The prevalence of lung cancer is increasing continuously these days. We studied clinical characters of the terminal lung cancer patients who had died in hospice units and our study is the basic report for efficient hospice and palliative care to the lung cancer patients. Methods: We retrospectively reviewed the medical records of 129 terminal lung cancer patients who had died in Sam Anyang Hospice Unit from March 2003 to December 2006. The survival days during the hospice and palliative care were analyzed using Kaplan-Meier method of SPSS 13.0. Results: There were 93 males (72%) and 36 females (28%), and median age of patients was 68 years (range $37{\sim}93$). Eighty two patients (64%) took analgesics, the others 47 (36%) not. The most prevalent reason for admission was dyspnea (47 patients, 36%) and it was different from the terminally ill cancer patients being hospitalized because of pain. And the most common symptom was general weakness (103 patients, 80%). One hundred twenty of the paitents (93%) were administered opioid analgesics, and IV morphine shots were mostly used (103 patients, 80%). Sedation was used in 87 patients (67%), and midazolam was mostly used (68 patients, 53%). The median survival in hospice and palliative care was 35 days and the median hospitalization was 24 days. Conclusion: It is very important to manage dyspnea in terminal lung cancer patients. The length of hospice and palliative care for the terminal lung cancer patients is still short. Therefore continuous education and promotion of hospice and palliative care is needed for an effective care for the patients, their families and doctors.

• Journal of Food Hygiene and Safety
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• v.35 no.1
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• pp.37-44
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• 2020

This study investigated the probability of foodborne illness caused by raw oyster consumption contaminated with high risk Vibrio species such as V. vulnificus and V. cholerae. Eighty-eight raw oyster samples were collected from the south coast, west coast and Seoul areas, and examined for the prevalence of high risk Vibrio species. The growth patterns of V. vulnificus and V. cholerae in raw oysters were evaluated, and consumption frequency and amounts for raw oyster were investigated from a Korean National Health and Nutrition Examination Survey. With the collected data, a risk assessment simulation was conducted to estimate the probability of foodborne illness caused by intake of raw oysters, using @RISK. Of 88 raw oysters, there were no V. vulnificus- or V. cholerae-positive samples. Thus, initial contamination levels of Vibrio species in raw oysters were estimated by the statistical methods developed by Vose and Sanaa, and the estimated value for the both Vibrio spp. was -3.6 Log CFU/g. In raw oyster, cell counts of V. vulnificus and V. cholerae remained unchanged. The incidence of raw oyster consumers was 0.35%, and the appropriate probabilistic distribution for the consumption amounts was the exponential distribution. A risk assessment simulation model was developed with the collected data, and the probability of the foodborne illness caused by the consumption of raw oyster was 9.08×10^-15 for V. vulnificus and 8.16×10^-13 for V. cholerae. Consumption frequency was the first factor, influencing the probability of foodborne illness.

• Journal of Food Hygiene and Safety
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• v.35 no.1
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• pp.51-59
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• 2020

This study evalutated the risk of foodborne illness from Vibrio spp. (Vibrio vulnificus and Vibrio cholerae) through sea squirt consumption. The prevalence of V. vulnificus and V. cholerae in sea squirt was evaluated, and the predictive models to describe the kinetic behavior of the Vibrio in sea squirt were developed. Distribution temperatures and times were collected, and they were fitted to probabilistic distributions to determine the appropriate distributions. The raw data from the Korea National Health and Nutrition Examination Survey 2016 were used to estimate the consumption rates and amount of sea squirt. In the hazard characterization, the Beta-Poisson model for V. vulnificus and V. cholerae infection was used. With the collected data, a simulation model was prepared and it was run with @RISK to estimate probabilities of foodborne illness by pathogenic Vibrio spp. through sea squirt consumption. Among 101 sea squirt samples, there were no V. vulnificus positive samples, but V. cholerae was detected in one sample. The developed predictive models described the fates of Vibrio spp. in sea squirt during distribution and storage, appropriately shown as 0.815-0.907 of R² and 0.28 of RMSE. The consumption rate of sea squirt was 0.26%, and the daily consumption amount was 68.84 g per person. The Beta-Poisson model [P=1-(1+Dose/β)^-α] was selected as a dose-response model. With these data, a simulation model was developed, and the risks of V. vulnificus and V. cholerae foodborne illness from sea squirt consumption were 2.66×10^-15, and 1.02×10^-12, respectively. These results suggest that the risk of pathogenic Vibrio spp. in sea squirt could be considered low in Korea.

• Sleep Medicine and Psychophysiology
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• v.20 no.2
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• pp.63-68
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• 2013

Objectives: Several evidence has been suggested that the circadian gene variants contribute to the pathogenesis of seasonal affective disorder. In this study, we aimed to investigate the polymorphism in RORA (Retinoid-related orphan receptor A) gene in relation to seasonal variations among healthy young adults in Seoul, Korea. Methods: A total of 507 young healthy adult subjects were recruited by advertisement. Seasonal variations were assessed by the Seasonality Pattern Assessment Questionnaire (SPAQ). Single-nucleotide polymorphism in the RORA rs11071547 gene was genotyped by PCR in 507 individuals. Considering summer type as confounding factor, we conducted analysis 478 subjects except 29 subjects of summer type. The Chi-square test was conducted to compare differences between groups of seasonals and non-seasonals. Association between genotypes and Global Seasonality Score (GSS) were tested using ANCOVA (Analysis of covariance). Results: In this sample, the prevalence of SAD was 12.1% (winter type 9.3%, summer type 2.8%). There is no significant difference in genotyping distribution of RORA rs11071547 between groups of seasonals and non-seasonals. Global seasonality score (GSS) and scores of all subscales except body weight and appetite were not significantly different between the group with C allele homozygote and the group with T allele homozygote and heterozygote (p-value 0.138). Scores of body weight and appetite were significantly higher in group with C allele homozygotes. Conclusion: These results suggest that RORA gene polymorphism play a role in seasonal variations in appetite and body weight and is associated with susceptibility to seasonal affective disorder in some degree in the population studied.

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.173-182
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• 2002

Background : Nontuberculous mycobacteria (NTM) have usually been considered to be contaminants of colonizers when isolated from respiratory specimens in Korea, where there is a high prevalence of tuberculosis and a low rate of HIV infections. Therefore, there has been few studies on the clinical significance of NTM species in immunocompetent patients were investigated. Methods : Thirty-five NTM isolates, for which species identification was requested by the treating physicians during 1999 at the Asan Medical Center, were retrospectively analyzed. They were identified to the species level by mycolic acid analysis using high-performance liquid chromatography. The medical records of the patients with the NTM isolates were reviewed to identify those patients who met the American Thoracic Society (ATS)'s criteria for mycobacterial pulmonary infection. Their antimicrobial susceptibility data were compared with the clinical outcomes. Results : The NTM were identified as M. intracellulare (6 isolates), M. avium (5), M. abscessus (5), M. gordonae (5), M. terrae complex (4), M. szulgai (2), M. kansasii (2), M. fortuitum (2), M. peregrinum (1), M. mucogenicum (1), M. celatum (1), and M. chelonae (1). All 35 patients showed clinical symptoms and signs of chronic lung disease, but none had a HIV infections; 16 (45.7%) patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria, 5 and 4 cases were affected with M. intracellulare and M. abscessus, respectively; 8 patients had a history of pulmonary tuberculosis. 13 patients received antimycobacterial therapy for an average of 21 months and 9 patients were treated with second-line drugs. Only 4 patients had improved radiologically. Conclusion : A NTM should be considered a potential pathogen of pulmonary infections in immunocompetent patients with chronic pulmonary diseases. Most NTM infections were left untreated for a prolonged period and showed a poor outcome as a result, M. intracellulare and M. abscessus were the two most frequent causes of NTM pulmonary infections in this study. Species identification and antimycobacterial susceptibility tests based on the species are needed for the optimum management of a NTM pulmonary infection in patients.

• Tuberculosis and Respiratory Diseases
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• v.54 no.4
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• pp.378-385
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• 2003

Background : Wheezing is an important clue in the diagnosis of asthma. Previously, a Korean National asthma survey used a written questionnaire, containing the question, "Have you ever experienced a breathing sound-like 'sack-sack' or a flute sound (the Korean description for wheezing) during the last 12 months?" The response to this question showed a large discrepancy between the prevalence of wheezing and physician diagnosed asthma. This might have resulted partly from a misunderstanding of the question, due to an inadequate description for wheezing. This study was aimed at finding how well the layman understands the term "wheezing" when described as a breathing sound-like 'sack-sack', a whistle or a flute. Subjects and method : Sixty subjects, without experience of wheezing(group I), and 45 subjects, with chronic cough alleging wheezing(group II), were recruited from the Hallym University's Sacred Heart Hospital, in Anyang, Korea. Four different breathing sounds; vesicular, wheezing, tracheobronchial and crackle, were played for the subjects, without any experience with wheezing, and they were asked "which sound is most like that you would imagine when asked about a breathing sound-like 'sack-sack', a whistle or a flute?" This was followed by replaying the true wheezing sound, and then a global assessment was requested for the concordance between the real wheezing sound and the imagined wheezing sound. The wheezing sound was played for those subjects alleging wheezing, and they were asked, "have you really experienced that sound". Results : Only 46.7% of group I answered correctly, with 13.3% choosing the vesicular sound, 16.7% the tracheobronchial sound, 5.0% the crackle and 18.3% failed to answer. The concordance between their imagined wheezing and the real sound was $69.3{\pm}22.4%(mean{\pm}S.D.)$. 77.8% of group II recognized the correct sound as the one they had experienced. Conclusions : Language is not sufficient to the layman for describing natural sounds, such as wheezing.

• Tuberculosis and Respiratory Diseases
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• v.63 no.6
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• pp.480-485
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• 2007

Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. COPD has systemic effects, such as skeletal muscle dysfunction and abnormal weight loss. It also has been suggested that COPD is related to other chronic disease, such as cardiovascular disease, osteoporosis, and anemia. The aim of this study was to evaluate a symptom questionnaire and laboratory findings in subjects with air flow limitation. Methods: We evaluated a symptom questionnaire and laboratory findings in subjects with airflow limitation detected by spirometry in conjunction with the Second Korean National Health and Nutrition Examination Survey. A total of 9,243 adults over the age of 18 were recruited. Among the adults, we finally analyzed 2,217 subjects who met the acceptability and repeatability criteria of spirometry, showed normal findings on chest radiography, and were older than 40 years of age. Results: There were 288 subjects with airflow limitation as determined by spirometry. The frequency of respiratory symptoms such as cough, sputum and wheezing were significantly higher in subjects with airflow limitation (p <0.01). Hemoglobin and hematocrit levels were higher in subjects with airflow limitation (hemoglobin level 13.98 mg/dL vs. 13.62 mg/dL, hematocrit 42.10% vs. 40.89%; p<0.01). The HDL cholesterol level was lower in subjects with airflow limitation (44.95 mg/dL vs. 45.60 mg/dL; p<0.01). There was no significant difference in the total cholesterol, triglyceride, blood urea nitrogen, creatinine, and fasting glucose levels. Conclusion: In subjects with airflow limitation, prevalence of respiratory symptoms was higher than in normal spirometry subjects and the levels of hemoglobin and the hematocrit were higher. The HDL cholesterol level was lower in subjects with airflow limitation.