Characterization of Community-Associated Methicillin-Resistant Staphylococcus aureus in Gwangju, Korea

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens worldwide. This study was performed to investigate the characterization of MRSA isolated from healthy persons in Gwangju area. A total of 404 nasal swab samples was collected during October 2011 and May 2012 in Gwangu, Korea. A survey on MRSA was conducted with meat distributors (n=230), pre-school children (n=108), officers (n=66), respectively. To confirm the MRSA, polymerase chain reaction (PCR) for the S. aureus specific gene and mecA gene was performed. A total of 34 (8.4%) MRSA isolates was isolated from 404 nasal swab samples: 6.1% (14/230) from meat distributors, 16.7% (18/108) from pre-school children, and 3.0% (2/66) from officers samples, respectively. The most prevalent antimicrobial resistance observed in the MRSA isolates was to ampicillin 100% (34/34), followed by penicillin 97.1% (33/34), oxacillin 94.1% (32/34) and erythromycin 52.9% (18/34). All MRSA isolates were then characterized by panton-valentine leukocidin (pvl) gene detected by PCR, staphylococcal cassette chromosome mec (SCCmec) typing, and pulsed-field gel electrophoresis (PFGE) with Sma I digestion. 34 MRSA isolates from nasal carriage were pvl gene negative, SCCmec type IV; 73.5% (25/34), type II; 17.6% (6/34), type III; 2.9% (1/34), and untypable; 5.9% (2/34), respectively. 34 MRSA isolates showed 16 PFGE patterns. These results indicated that isolation rates of community-associated methicillin-resistant S. aureus (CA-MRSA) from healthy persons were low (8.4%), but continuous surveillance and monitoring should be performed to prevent the spread of MRSA in the community.

The Correlation between the Severity of Hypoxic Ischemic Encephalopathy and the Development of Acute Renal Failure in Asphyxiated Neonates

PURPOSE: We performed this study to determine the incidence of acute renal failure(ARF) in birth asphyxia and to correlate the severity of asphyxia and hypoxic-ischemic encephalopathy (HIE) and ARF in asphyxiated neonates. METHODS: Data was retrospectively collected from the medical records of 33 patients with neonatal asphyxia and of 33 neonates with no asphyxia. On the basis the 5-minute Apgar score, the asphyxiated neonates were further grouped into mild(6 or 7), moderate(4 or 5), and severe asphyxia(3 or less). Asphyxiated neonates with HIE were staged by the Sarnat and Sarnat scoring system. We compared serum creatinine, blood urea nitrogen, electrolytes, and urine output on day 3 of life and the incidence and severity of intraventricular hemorrhage(IVH) between each group. RESULTS: ARF occurred in 8(24.2%) asphyxiated neonates. Of these, 3(37.5%) were oliguric, while 1(10.0%) patient with mild asphyxia, 2(18.2%) of moderate asphyxia, and 5(41.7%) with of severe asphyxia had ARF(P>0.05). One(25%) patient with stage I HIE, 4(50%) with stage II HIE, and 3(75%) of HIE with stage III HIE developed ARF(P<0.01). There was no statistical correlation between the severity of asphyxia and HIE stage. One(7.7%) patient with grade 1 IVE, 0(0.0%) with grade 2 IVH, 2(66.7%) with grade 3 IVH, and 2(100.0%) with grade 4 IVH had ARF(P<0.01). Mortality was higher in asphyxiated neonates with ARF(P<0.05). There was no significant difference between the oliguric and non-oliguric renal failure. CONCLUSION: We found that the greater the degree of HIE, the higher was the incidence of ARF. Asphyxiated neonates with ARF had a poorer prognosis.

Measurements of Exhaled Nitric Oxide in Newborns

PURPOSE: Exhaled nitric oxide (eNO) is a reliable marker of eosinophilic airway inflammation in asthma. But few studies have measured endogenous nitric oxide exhaled from the respiratory system of newborns. The aim of this study was to measure the eNO of healthy newborns and attempted to provide reference ranges for healthy newborn infants. METHODS: The newborns included in this study were born from May through July, 2005 in Kyung Hee medical center. eNO was measured in healthy 41 newborns with online tidal breathing method using a chemiluminescence analyzer (CLD 88 sp, Eco Medics, Duernten, Switzerland). We divided the newborns into two groups, according to gestational age, sex and type of delivery. The comparisons between two groups were performed and a correation between eNO and birth weight was analyzed. RESULTS: The range for eNO in healthy newborns was 2.0-20.5 ppb. The mean value was 10.0 ppb and the upper limit (mean+2SD) of normal was 19.8 ppb. There was no significant difference in eNO concentration with regard to gestational age or gender. eNO measurements were not correlated with delivery type or birth weight. CONCLUSION: eNO measurement is safe, non-invasive method in newborns. The reference value of eNO in newborn was achieved and there was no evidence of eNO related to gestation age, gender, delivery type and birth weight. Although eNO analysis is currently a research tool in newborn infants, it can provide new values on the airway.

The Effect of Recombinant Human Growth Hormone on Growth in Children with Nephropathy Receiving Long-term Steroid Therapy

PURPOSE: Growth retardation is one of the serious problems in children with nephropathy requiring long-term steroid therapy. We observed the efficacy and safety of recombinant human growth hormone(rhGH) on the growth in children with long-term steroid therapy. METHODS: We studied 60 children(male 47, female 13) with nephropathy who received rhGH (1 U/kg/week) for more than 0.5 years(1.39+/-1.12). Their mean age was 11.0 years (11.17+/-2.62). They received steroid therapy from January 1987 through July 2005, and the mean duration of steroid therapy was 4.32+/-2.97 years. Among the patients, there were 32 nephrotic syndrome, 9 IgA nephropathy, 4 mesangial proliferative glomerulonephritis, 4 focal segmental glomerulosclerosis, 2 Henoch Schonlein nephritis, 2 Alport syndrome and 7 other cases. Data were gathered on the growth parameters, such as growth velocity, height standard deviation score(SDS), IGF-1, IGFBP-3, bone mass density(BMD) and general chemistry changes. RESULTS: Height velocity increased significantly with rhGH therapy from 3.29+/-1.95 to 8.66+/-3.75(cm/yr) and height SDS decreased from -0.72+/-0.93 to -1.04+/-0.86 at one year after steroid therapy but increased to -0.55+/-0.96 at one year after rhGH administration(P<0.05). BMD improved from 0.71+/-0.14 to 0.79+/-0.15 g/cm2(P<0.05). IGF-1 increased from 445.09+/-138.01 to 506.62+/-181.31 ng/mL(P<0.05). IGFBP-3 decreased from 4073.75+/-700.78 to 3933.61+/-789.25 ug/L numerically, but there was no statistically significant difference(P=0.533). CONCLUSION: The administration of rhGH in the short stature patients who received long- term steroid therapy showed improvement in growth parameters such as SDS, growth velocity, and BMD without significant side-effects or changes in the biochemical parameters.

Analysis of 1559 Kidney Biopsies: A Single Center Study

PURPOSE: To analyse the results of the renal biopsies and the clinical diagnoses of patients who had undergone percutaneous kidney biopsies in the department of pediatrics at Kyunghee University Hospital for 22 years from 1984 to 2005. METHODS: We retrospectively reviewed the medical records of 1559 patients and analyzed the chief complaints that led to a renal biopsy, age, sex, histopathologic findings and diagnosis. Routine kidney biopsies were performed by automated gun biopsy guided by real time ultrasonography. The diagnoses were made based on the specimen's light microscopy, immunofluorescence microscopy and electron microscopy findings and clinical symptoms and signs. RESULTS: The mean age of the patients was 10 years with the male to female ratio being 1.3:1. The chief complaints that led to a renal biopsy included hematuria only(753 cases, 48.3%), proteinuria only(125 cases, 8.0%) and hematuria combined with proteinuria(537 cases, 34.4%). The most frequent histopathological finding was primary glomerular disease(75.4%) which included IgA nephropathy(30.1%) and mesangial proliferative glomerulonephritis(27.6 %). Systemic disease comprised 11.4% which included Henoch-Shonlein nephritis(10.5%) and lupus nephritis(0.8%). Alport syndrome was found in 1.1% of cases which was attributed to hereditary causes. 628 children(40.3%) visited the clinic due to abnormal school urine screening abnormalities and among these, 237 children had mesangial proliferative glomerulonephritis and 234 children who had IgA nephropathy were managed thereafter. CONCLUSION: IgA nephropathy and mesangial proliferative glomerulonephritis were the two major forms of primary glomerulonephritis found in Korean children who had kidney biopsies from 1984 to 2005.

The Accuracy of the Assessment of Visceral Obesity by InBody 4.0 and Waist Circumference

BACKGROUND: InBody 4.0, a bioelectrical impedance analyser (BIA) has an automatic function of printing out the measurement data of visceral fat area. The purpose of this study was to assess the usefulness of the visceral obesity measured by the InBody 4.0 and the waist circumference METHODS: A total of 124 participants who visited an obesity clinic in a university hospital were measured their waist circumference, height, weight and the visceral fat area by the InBody 4.0 and CT scan. The mean difference and agreement between the two visceral fat areas by the two methods had been analyzed according to sex, age and BMI groups. The accuracy of the visceral obesity by the BIA and the waist circumference was respectively compared with the visceral obesity by the CT scan. RESULTS: There was no significant difference between visceral fat area measured by the CT and the BIA in women participants under 46 years of age and below BMI 30. When comparing visceral fat area obtained from the CT with those obtained from the BIA, the 95% confidence interval for the limit agreement was higher in male subjects than in females. The waist circumference was the more sensitive method to diagnose visceral obesity than the BIA (91.80% vs. 77.94%), but the BIA method showed a higher specificity than the waist circumference (76.79% vs 52.38%). CONCLUSION: Waist circumference turned out to be more useful than the BIA as a screening tool for visceral obesity. In the group of males, BMI of over 30, or the age over 46 years, it is recommended that the CT rather than the BIA for measurement of visceral fat area be utiliged.

Scores of SNAP and SNAP Variants Indices for Evaluation of Acute Severity in Newborn Infants

PURPOSE: The score for neonatal acute physiology (SNAP) based on physiologic derangements, is applied to variable fields including morbidity as well as mortality estimate. We evaluate the clinical usefulness of SNAP and SNAP variants for neonatal acute severity and mortality. METHODS: Twenty-one neonates were evaluated the SNAP, SNAP-PE, SNAP-II, and SNAPPE-II, who survived more than 24 hours in Neonatal Intensive Care Unit in Department of Pediatrics, Kyunghee University from July 2003 to December 2004. A study group included 21 neonates as death group and a control group matched for gestational age and birth weight. We analyzed the differences of clinical usefulness of SNAP and SNAP variants indices between the two groups. RESULTS: 1) SNAP:The scores were ranged 2-18 (median 6.5) in survival group and 9-31 (median 13.0) in death group. 2) SNAP-PE:The scores were ranged 2-48 (median 16.5) in survival group and 23-75 (median 32.0) in death group. 3) SNAP-II:The scores were ranged 0-16 (median 10.5) in survival group and 10-62 (median 21.0) in death group. 4) SNAPPE-II:The scores were ranged 0-45 (median 24.5) in survival group and 35-109 (median 44.0) in death group. The median values were higher in those who were died:SNAP<0.05 (P-value), SNAP-PE<0.01, SNAP-II<0.01, SNAPPE-II<0.01 showing the significant differences. CONCLUSION: The study shows that SNAP and SNAP variables are useful for the evaluation of acute severity and excellent predictors of neonatal survival. They would help the management of neonatal intensive care unit.

The Effect of School Based Smoking Prevention Program for College Freshmen / 성인간호학회지

PURPOSE: This study was conducted to investigate the effects of a school based smoking prevention program for college freshmen. METHOD: The nonequivalent control group, pretest-post-test design was used. Among 16 departments in a University located in S city, students in 8, randomly selected, departments received 6 sessions of smoking prevention program consisted of small group discussion led by smoking cessation leaders, video watching, and lectures from March 15 to June 9, 2004. Students in remaining 8 departments did not receive any education. Student's attitude, intention, stress, temptation, knowledge and self efficacy was measured. RESULT: The level of stress and smoking temptation was significantly decreased in the experimental group over that of the control group. CONCLUSION: It was proven that this school based smoking prevention program was effective for decreasing smoking temptation in college freshmen. In the future, more efforts should be given to college age students to prevent them becoming chronic smokers.