• Pediatric Infection and Vaccine
• /
• v.10 no.2
• /
• pp.159-166
• /
• 2003

Purpose : Streptococcus pneumoniae is part of the normal flora but is also responsible for causing many invasive diseases such as pneumonia, meningitis, and sepsis in addition to noninvasive diseases such as otitis in children. Multi-drug resistant strains has raised a lot of concern worldwide and thus the importance of prevention has been emphasized. We have analyzed the current serotypes and antibiotic sensitivity of each serotype as a baseline study to estimate the efficacy of the pneumococcal vaccine in Korean children. Methods : One hundred sixteen cases of pneumococcus cultured at Yonsei Medical Center from September 2001 to January 2003 were analyzed. The serotyping was done with the Quellung reaction and penicillin resistance was tested using the oxacillin disc diffusion method. Results : Pneumococcus were cultured from the sputum in 76 cases(65.5%), from the blood in 13 cases(11.2%), from the ear discharge in 12 cases(10.3%), from the throat in 7 cases(6.0%), from the nasal cavity in 2 cases(1.7%), and one case(0.9%) each from the cerebrospinal fluid, eye discharge, peritoneal fluid, post-operational wound, brain abscess, and catheter tip. Serotyping was possible with 98 cases and the following serotypes were found; 15 cases of type 19F(15.3%), 11 cases of 19A(11.2%), 8 cases of 11A(8.2%), 7 cases each of 6A, 14 and 3(7.1%), 6 cases each of 35, 6B and 23F(6.1%). Eighty two cases(70.7%) out of 116 cases were penicillin resistant and serotypes 19F, 19A, 11A, 23F, 6A, 9V constituted the majority, 48 cases(59.8%). These serotypes showed resistance to cotrimoxazole (74.4%), tetracycline(69.5%), and erythromycin(90.3%) as well. In the 22 cases cultured from children, 19A and 19F were found in 25.0%, 6A, 6B, and 23F in 10.0%, 11A, 14, 19, and 29 in 5.0%. Fifty percent(10/20) of the clinical isolates were represented in the current 7-valent pneumococcal protein conjugate vaccine, and 85%(17/20) when the cross-reacting serotypes were included. Penicillin resistance was found in 86.4%(19/22). Conclusion : The percentage of serotypes included in the 7 valent pneumococcal protein conjugate vaccine found in our study was 40.8% which was less than other prior studies. In anticipation of a change of pneumococcal serotypes, a nationwide multicenter study is needed before the initiation of pneumococcal vaccines in Korea.

• Microbiology and Biotechnology Letters
• /
• v.35 no.2
• /
• pp.158-162
• /
• 2007

Methicillin-resistant Staphylococcus aureus (MRSA) is one of a major nosocomial pathogen worldwide and the emergence of this strain has become a major clinical problem. This study was performed for 13 hospitals with more than 400 beds in the country by collecting samples including hands and nasal cavities of doctors, nurses, guardians and patients. Also, additional 320 samples of hands and nasal cavities of 160 community resident in different locations and regions were collected. In all of medical environments and community resident, 625 strains of S. aureus were detected. Among 625 strains of S. aureus, 585 strains(93.6%) showed the resistance to at least one kind of antimicrobial and 112 strains (17.9%) showed multi-drug resistance with the resistance to 4 different types of antimicrobial. Total 152 MRSA strains (24.3%) were isolated from medical environment and community resident. In nasal cavity and hand, 49 MRSA (19.4%) and 103 (27.6%) MRSA were isolated, respectively Minimum inhibitory concentration(MIC) test is used to measure for susceptibility of MRSA isolated to oxacillin. At a concentration $16{\mu}g/ml$ of oxacillin, 11 strains were inhibited. 32 strains at $32{\mu}g/ml$, 41 strains at $64{\mu}g/ml$, 3 strains at $128{\mu}g/ml$, 25 stains at $256{\mu}g/ml$ and 40 strains at over $256{\mu}g/ml$ were inhibited. It was considered that medical environment showed higher than livestock and marine environments in MRSA detection rate.

• Tuberculosis and Respiratory Diseases
• /
• v.49 no.2
• /
• pp.169-178
• /
• 2000

Background : Usually fever subsides within one week in over 90% of pulmonary tuberculosis (TBp) patients after the start of short-course anti-tuberculosis therapy, but occasionally it persists over two weeks after treatment. When the fever persists, drug resistance, combined infection, or drug fever, and so on, are considered as an etiology and, in some cases, drugs are changed. But inadvertent discontinuation of a short-course regimen inevitably will extend the duration of treatment, and the treatment completion may be delayed. This study was performed to investigate the causes of prolonged fever (PF) and to identify the predictors of PF in drug-susceptible TBp patients in Korea. Method : Five hundred-ninety-eight patients, who were admitted to Asan Medical Center from January 1996 to March 1999, diagnosed with TBp and prescribed short-course, anti-tuberculosis treatment, were reviewed. PF was defined as having fever over two weeks despite treatment. The causes of PF were analyzed. Drug-sus-ceptible TBp patients who presented no causes for PF, except turberculosis itself, were selected(n=22), and they were compared with those who had no fever at diagnosis (n=22) and those who had fever at diagnosis, which had subsided within two weeks after treatment (n=22). Clinical, laboratory, and radiological parameters were compared among the three groups. Results : Twenty-eight (4.8%) of 598 patients showed PF over two weeks despite short-course treatment. The causes of PF were drug fever (n=2), multi-drug resistant tuberculosis (n=3), disseminated Mycobacterium kansasii infection (n=1), and drug-susceptible tuberculosis itself (n=22). The patients with PF had more risk factors for tuberculosis, long duration of symptoms before treatment, night sweats, weight long, numerous acid fast bacilli on sputum smear, anemia, hyponatremia, hypoalbuminemia, over three lung cavity numbers and extensive infiltration, indicating that they had prolonged and extensive lung diseases. Conclusion : The main cause of PF in TBp despite short-course regimen seems to be drug-susceptible but extensive disease in Korea. Any changes to the drug regiment provided for TBp patients with prolonged fever despite treatment should be carefully considered.

• Restorative Dentistry and Endodontics
• /
• v.25 no.1
• /
• pp.46-55
• /
• 2000

During bonding procedure of composite resin, the prepared cavity can be contaminated by saliva. In this study, marginal microleakage and shear bond strength of a composite resin to primed enamel and dentin treated with artificial saliva(Taliva$^{(R)}$) were evaluated. For the marginal microleakage test, Class V cavities were prepared in the buccal surfaces of fifty molars. The samples were randomly assigned into 5 groups with 10 samples in each group. Control group was applied with a bonding system (Scotchbond$^{TM}$ Multi-Purpose plus) according to manufacture's directions without saliva contamination. Experimental groups were divided into 4 groups and contaminated with artificial saliva for 30 seconds after priming: Experimental 1 group ; artificial saliva was dried with compressed air only, Experimental 2 group ; artificial saliva was rinsed and dried. Experimental 3 group ; cavities were etched with 35% phosphoric acid for 15 seconds after rinsing and drying artificial saliva. Experimental 4 group ; cavities were etched with 35% phosphoric acid for 15 seconds and primer was reapplied after rinsing and drying artificial saliva. All the cavities were applied a bonding agent and filled with a composite resin (Z-100$^{TM}$). Specimens were immersed in 0.5% basic fuschin dye for 24 hours and embedded in transparent acrylic resin and sectioned buccolingually with diamond wheel saw. Four sections were obtained from one specimen. Degree of marginal leakage was scored under stereomicroscope and their scores were averaged from four sections. The data were analyzed by Kruscal-Wallis test and Fisher's LSD. For the shear bond strength test, the buccal or occlusal surfaces of one hundred molar teeth were ground to expose enamel(n=50) or dentin(n=50) using diamond wheel saw and its surface was smoothed with Lapping and Polishing Machine(South Bay Technology Co., U.S.A.). Samples were divided into 5 groups. Treatment of saliva-contaminated enamel and dentin surfaces was same as the marginal microleakage test and composite resin was bonded via a gelatin capsule. All specimens were stored in distilled water for 48 hours. The shear bond strengths were measured by universal testing machine (AGS-1000 4D, Shimaduzu Co., Japan) with a crosshead speed of 5 mm/minute. Failure mode of fracture sites was examined under stereomicroscope. The data were analyzed by ANOVA and Tukey's studentized range test. The results of this study were as follows : 1. Enamel marginal microleakage showed no significant difference among groups. 2. Dentinal marginal microleakages of control, experimental 2 and 4 groups were lower than those of experimental 1 and 3 groups (p<0.05). 3. The shear bond strength to enamel was the highest value in control group (20.03${\pm}$4.47MPa) and the lowest value in experimental 1 group (13.28${\pm}$6.52MPa). There were significant differences between experimental 1 group and other groups (p<0.05). 4. The shear bond strength to dentin was higher in control group (17.87${\pm}$4.02MPa) and experimental 4 group (16.38${\pm}$3.23MPa) than in other groups, its value was low in experimental 1 group (3.95${\pm}$2.51 MPa) and experimental 2 group (6.72${\pm}$2.26MPa)(p<0.05). 5. Failure mode of fractured site on the enamel showed mostly adhesive failures in experimental 1 and 3 groups. 6. Failure mode of fractured site on the dentin did not show adhesive failures in control group, but showed mostly adhesive failure in experimental groups. As a summary of above results, if the primed tooth surface was contaminated with artificial saliva, primer should be reapplied after re-etching it.

• Tuberculosis and Respiratory Diseases
• /
• v.45 no.6
• /
• pp.1143-1153
• /
• 1998

Background : Recent outbreaks of pulmonary disease due to drug-resistant strains of Mycobacterium Tuberculosis have resulted in significant morbidity and mortality in patients worldwide. We reviewed our experience to evaluate the effects of pulmonary resection on the management of multidrug-resistant tuberculosis. Method : A retrospective review was performed of 41 patients undergoing pulmonary resection for multidrug-resistant tuberculosis between January 1993 and December 1997. We divided these into 3 groups according to the radiologic findings : (1) patients who have reasonably localized lesion (Localized Lesion Group ; LLG) (2) patients who have cavitary lesions after pulmonary resection on chest roentgenogram (Remained Cavity Group : RCG) (3) patients who have Remained infiltrative lesions postoperatively (Remained infiltrative group : RIG). We evaluated the negative conversion rate after resection and overall response rate of the groups. Then they were compared with the results of the chemotherapy on the multi drug-resistant tuberculosis which has been outcome by Goble et al. Goble et al reported that negative conversion rate was 65% and overall response rate, 56% over a mean period of 5.1 months. Results : Seventy five point six percent were men and 24.4% women with a median age of 31 years (range, 16 to 60 years). Although the patients were treated preoperatively with multidrug regimens in an effort to reduce the mycobacterial burden, 22 of 41 were still sputum culture positive at the time of surgery. 20 of 22 patients(90.9%, p<0.01) responded which is defined as negative sputum cultures within 2 months postoperative. Of 26 patients with the sufficient follow up data, 19 have Remained sputum culture negative for a mean duration of 25.7 months (73.1%, p<0.05). The bulk of the disease was manifest in one lung, but lesser amounts of contralateral disease were demonstrated in 15, consisted of 8 in RIG and 7 in RCG, of 41. 12 of 12 patients (100%, p<0.01) who were sputum positive at the time of surgery in LLG converted successfully. 14 of 15 patients (93.3%, p<0.05) with the follow up have completed treatment and not relapsed for a mean period of 25. 7 months. The mean length of postoperative drug therapy of LLG was 12.2 months. In RIG, postoperative negative conversion rate was 83.3% which was not significant statistically. There was a statistical significance in overall response rate (100%, p<0.05) of RIG for a mean period of 24.4 months with a mean length of postoperative chemotherapy, 11.8 months. In RCG a statistically lower overall response rate (14.3%, p<0.01) has been revealed for a mean duration of follow up, 24.2 months. A negative conversion rate of RCG was 75% which was not significant statistically. Conclusion : Surgery plays an important role in the management of patients with multidrug-resistant Mycobacterium tuberculosis infection. Aggressive pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection to avoid treatment failure or relapse. Especially all cavitary lesions on preoperative chest roentgenogram should be resected completely. If all of them could not be resected perfectly, you should not open the thorax.