Antimicrobial-resistant Staphylococcus aureus and MRSA prevalence among Korean families and household items.

One-hundred-and-seventy-nine Staphylococcus aureus strains, collected from a total of 825 resident and household item samples in Korean homes nationwide, were tested, to survey the spread of antimicrobial-resistant S. aureus including the methicillin-resistant S. aureus (MRSA) strain. Antimicrobial resistance to sulfamethoxazole-trimethoprim (0.0%), teicoplanin (0.0%), tetracycline, vancomycin (0.0%,) chloramphenicol (0.0%), ciprofloxacin (1.1%), clindamycin (1.1%), amikacin (2.2%), gentamicin (8.4%), oxacillin (17.9%), erythromycin (21.8%), ampicillin (96.6%) and penicillin (96.6%), was detected by disk diffusion method and 7.3% (13/179) of the antimicrobial-resistant isolates, were multi-drug resistant (resistant to ≥3 antimicrobial classes). Nine of 32 oxacillin-resistant strains, were positive for the mecA gene and identified as MRSA, in 4 residents and 4 loofah samples, by polymerase chain reaction. These findings provide public health information and contribute to preventing circulation of antimicrobial-resistant strains in community settings including healthy homes.

Analysis of ethyl carbamate in plum wines produced in Korea.

Ethyl carbamate is naturally occurring compound, commonly found in many fermented foods and alcoholic beverages. During the process of plum wine production, ethyl carbamate can be formed. To this date, limited studies were conducted to monitor the ethyl carbamate in the plum wine brewed in-house. The objective of this study was to analyze the ethyl carbamates in plum wine, that were produced in differently: in-house and commercial production. A total of 33 plum wines were analyzed. The levels of ethyl carbamate ranged from N.D to 352.7 µg/kg in plum wines available in Korea. The current level of ethyl carbamate in plum wine was below the governmental regulation. However, continuous monitoring and further develop a strategy to reduce the level of ethyl carbamate in plum wine is in need, as the highest level of ethyl carbamate in plum wine is near the governmental standard (400 µg/kg).

Maximal pericoronary adipose tissue thickness is associated with hypertension in nonobese patients with acute or chronic illness.

BACKGROUND/AIMS: Recent studies have shown an association of epicardial fat thickness with diabetes and hypertension (HTN) in asymptomatic populations. However, there is lack of information as to whether there is similar association between pericoronary adipose tissue (PAT) and HTN in the patients who have acute or chronic illness. METHODS: This study included 214 nonobese patients hospitalized with acute or chronic noncardiogenic illness. PAT thicknesses were measured from fat tissues surrounding left and right coronary arteries in enhanced, chest computed tomography scans, yielding the maximal PAT value from left and right coronary arteries was used for analysis. Baseline data from hypertensive (n = 81) and normotensive (n = 133) patients were collected and compared. RESULTS: PAT is positively correlated with age (r = 0.377, p <0.001), body mass index (BMI; r = 0.305, p < 0.001), systolic blood pressure (r = 0.216, p = 0.001), and total cholesterol (r = 0.200, p = 0.006). The hypertensive group was older (69.58 ± 11.69 years vs. 60.29 ± 14.98 years), and had higher PAT content (16.30 ± 5.37 mm vs. 13.06 ± 5.58 mm) and BMI (23.14 ± 3.32 kg/m2 vs. 20.96 ± 3.28 kg/m) than the normotensive group (all p < 0.001). Multivariate analysis showed that age (odds ratio [OR], 2.193; p = 0.016), PAT thickness (OR, 1.065; p = 0.041), and BMI (25 ≤ BMI < 30 kg/m2 ; OR, 6.077; p = 0.001) were independent risk factors for HTN. CONCLUSIONS: In nonobese patients with noncardiogenic acute or chronic illness, PAT thickness is independently correlated with HTN, age, and BMI.

Helicobacter pylori: A Possible Risk Factor for Bone Health.

BACKGROUND: Helicobacter pylori (H. pylori) infection may cause systemic inflammation and increase the production of tumor necrosis factor-α, interleukin-1, and interleukin-6. Unfortunately, bone mineral density also may be affected by these cytokines. This study aimed to evaluate the association between bone mineral density and H. pylori infection. METHODS: A cross-sectional study evaluated 1,126 men undergoing a comprehensive health screening in a private Korean screening center. Subjects' sera were tested for H. pylori antibodies (immunoglobulin G) using an enzyme-linked immunosorbent assay, and bone mineral densities (g/cm(2)) of the lumbar spine, femoral neck, and total femur were obtained using dual-energy X-ray absorptiometry. To evaluate the difference in bone mineral density according to H. pylori infection status, the adjusted mean bone mineral densities at each site were compared after adjusting for potential confounders, including age, sex, body mass index, smoking, alcohol consumption, and exercise. RESULTS: H. pylori infection was associated with a significant decrease in mean lumbar bone mineral density (H. pylori-positive, 1.190 g/cm(2); H. pylori-negative, 1.219 g/cm(2); P=0.006), which was greatest among men who were ≥50 years old (H. pylori-positive, 1.193 g/cm(2); H. pylori-negative, 1.233 g/cm(2); P=0.006). However, no significant association was observed in the bone mineral densities of the total femur and femoral neck. CONCLUSION: In men, H. pylori infection was negatively associated with lumbar bone mineral density. This association may be useful in the early detection, prevention, and management of male osteoporosis.

The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study.

In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.

A comparison of bilateral stenting methods for malignant hilar biliary obstruction.

BACKGROUND/AIMS: Despite common use of stent-instent methods for endoscopic bilateral metal stenting in malignant hilar obstruction, the longevity of these stents and clinical outcomes of patients who receive them are less well known than for the side-by-side method. We aimed to compare treatment outcomes according to bilateral stenting method. METHODOLOGY: A total of 41 patients were divided into two groups: a bilateral side-by-side metal stenting group (side-by-side group, n=19) and a bilateral stent-in-stent metal stenting group (stent-in-stent group, n=22). RESULTS: During the study period, successful drainage was achieved in 15 of 19 patients (78.9%) with the side-by-side placement, which did not differ significantly from the proportion with the stent-in-stent placement (18 of 22 patients, 81.8%). The two groups did not differ significantly in rates of early complications (31.6% vs. 22.7%, p=0.725), late complications (36.8% vs. 50.0%, p=0.531) or death (47.4% vs. 54.5%, p=0.647). Comparing stent patency and survival curves according to bilateral stenting type, patients with stent-in-stent placement and those with side-by-side placement did not differ significantly (p=0.771 and p=0.769). CONCLUSIONS: Our results show no significant difference in clinical outcomes, including stent patency and overall survival, between side-by-side and stent-in-stent bilateral metal stenting in patients with malignant hilar obstruction.

Can percutaneous cholecystostomy be a definitive management for acute acalculous cholecystitis?

GOALS: To evaluate the safety, efficacy, and long-term outcome of percutaneous cholecystostomy without additional cholecystectomy as a definitive treatment for acute acalculous cholecystitis (AAC). BACKGROUND: AAC mainly occurs in seriously ill patients, and for those considered to be at high-risk for cholecystectomy, immediate percutaneous cholecystostomy can be a simple alternative interim treatment. However, no consensus has been reached on the issue of additional cholecystectomy. STUDY: The medical records of 57 patients that underwent percutaneous cholecystostomy for AAC at a single institution between 1995 and 2010 were retrospectively analyzed. RESULTS: Percutaneous cholecystostomy was technically successful in all patients, and no major complications relating to the procedure were encountered. Symptoms resolved within 4 days in 53 of the 57 (93%) patients. The in-hospital mortality rate was 21% (11/57) and elective cholecystectomy was performed in 18/57 (31%). Twenty-eight patients were managed non-operatively and cholecystostomy tubes were subsequently removed. These 28 patients were follow-up over a median 32 months and recurrent cholecystitis occurred in 2 (7%). CONCLUSION: Percutaneous cholecystostomy is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or an underlying comorbidity. After patients with AAC have recovered from percutaneous cholecystostomy, further treatment such as cholecystectomy might not be needed.

A prospective comparison of liquid-based cytology and traditional smear cytology in pancreatic endoscopic ultrasound-guided fine needle aspiration.

OBJECTIVE: To compare results of liquid-based cytology (LBC) and the conventional smear method (SMEAR) when performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for lesions of suspected pancreatic malignancy without an on-site cytopathologist. STUDY DESIGN: Fifty-eight patients were prospectively enrolled between July and December 2009. Aspirates obtained from the first needle pass were randomized either to SMEAR or LBC. Another sample from the second needle pass was allocated to the other method. The rest of the aspirates from the third or later needle passes were used for SMEAR. Diagnostic accuracy was compared and related factors were pursued. RESULTS: Although both methods were 100% specific, LBC was inferior to SMEAR in terms of sensitivity, negative predictive value, and accuracy. However, LBC provided correct diagnoses in 2 out of 3 cases of false negatives for malignancy by SMEAR in which blood was highly contaminated. Although no factor was identified for LBC, low blood contamination and more than 3 needle passes were related with accurate diagnosis in SMEAR. CONCLUSION: LBC was less accurate than SMEAR when performing pancreatic EUS-FNA without an on-site cytopathologist. However, LBC might serve as a good complement to SMEAR if blood contamination is profound.

Preoperative evaluation of the longitudinal extent of borderline resectable hilar cholangiocarcinoma by intraductal ultrasonography.

BACKGROUND AND AIM: In patients with hilar cholangiocarcinoma (HC), longitudinal tumor extent is important for curative resection. The purpose of this study was to evaluate the longitudinal extents of HC using transpapillary intraductal ultrasonography (IDUS) for optimal surgical planning. METHODS: From July 2006 to April 2010, a total of 42 patients with borderline resectable HC were enrolled at Samsung Medical Center, a tertiary referral hospital in Seoul, Korea. All patients were evaluated using multi-detector computed tomography (MDCT), endoscopic retrograde cholangiopancreatography (ERCP) and IDUS. The new modified Bismuth Type (MBT) classification, in which the traditional Bismuth type IV stage is divided into stages IVa and IVb, was used to determine whether the tumor invaded the left lateral section. Among the subtypes of HC, the periductal infiltrative type (PDI) and intraductal papillary neoplasm of the bile duct (IPN-B) were compared. The accuracies of CT, ERCP, and IDUS were assessed through comparison with the postoperative histology findings. RESULTS: A total of 42 patients were prospectively enrolled, and the tumor extent could be assessed histologically in 30 patients. The accuracies of CT, ERCP, and IDUS were 66.6%, 60%, and 90%, respectively. The accuracy of IDUS was 85.7% in 21 patients with PDI and 100% in nine patients with IPN-B. CONCLUSIONS: Hilar cholangiocarcinoma staging based on IDUS findings was highly accurate. We therefore highly recommend using IDUS for optimal surgical planning in patients with borderline resectable HC.

Antimicrobial susceptibilities and epidemiological analysis of Salmonella enteritidis isolates in Korea by phage typing and pulsed-field gel electrophoresis.

A total of 81 isolates of Salmonella Enteritidis were analyzed by antibiotic susceptibility, phage typing, and pulsed-field gel electrophoresis (PFGE). Thirty-two isolates came from broiler carcasses and pig feces, and 49 isolates were from humans in Seoul and suburbs of Seoul, Korea. Antibiotic resistance was most prevalent among human isolates. Of human isolates, 89.8% were resistant to more than two antibiotics, while 64.7% of poultry isolates and 13.3% of pig isolates showed multiple resistance to more than two antibiotics. The most common phage type (PT) was PT1, followed by PT30 or 33, PT21 and PT20a. The isolates showed six PFGE patterns with XbaI or SpeI digestion, and five PFGE patterns with NotI digestion. But a single pattern, PFGE X1, S1, or N1, was predominant and the rest of the PFGE patterns differed by only one or two bands. Results indicated the spread of a genetically related clone of Salmonella Enteritidis in foods and humans in Korea and that phage typing as well as PFGE may offer an improved level of discrimination for the epidemiological investigation of Salmonella Enteritidis.