As malaria remains a major health problem worldwide, various diagnostic tests have been developed, including microscopy-based and rapid diagnostic tests. LabChip real-time PCR (LRP) is a small and portable device used to diagnose malaria using lab-on-a-chip technology. This study aimed to evaluate the diagnostic performance of LRP for detecting malaria parasites. Two hundred thirteen patients and 150 healthy individuals were enrolled from May 2009 to October 2015. A diagnostic detectability of LRP for malaria parasites was compared to that of conventional RT-PCR. Sensitivity of LRP for Plasmodium vivax, P. falciparum, P. malariae, and P. ovale was 95.5%, 96.0%, 100%, and 100%, respectively. Specificity of LRP for P. vivax, P. falciparum, P. malariae, and P. ovale was 100%, 99.3%, 100%, and 100%, respectively. Cohen’s Kappa coefficients between LRP and CFX96 for detecting P. vivax, P. falciparum, P. malariae, and P. ovale were 0.96, 0.98, 1.00, and 1.00, respectively. Significant difference was not observed between the results of LRP and conventional RT-PCR and microscopic examination. A time required to amplify DNAs using LRP and conventional RT-PCR was 27 min and 86 min, respectively. LRP amplified DNAs 2 times more fast than conventional RT-PCR due to the faster heat transfer. Therefore, LRP could be employed as a useful tool for detecting malaria parasites in clinical laboratories.

Objective: We aimed to investigate diagnostic accuracy of the STONE score and the modified STONE score by external validation in a large-scale cohort. Methods: We retrospectively reviewed the medical records of patients with suspected urinary stones who underwent computed tomography in the emergency center of a single tertiary hospital from 2014 to 2015. We compared and analyzed our cohort and two original studies with each other. Patients were categorized into three risk groups (low, moderate, and high) according to both scoring systems. The prevalence of urinary stones and alternative diagnoses was evaluated in each group. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with our data for each score performance. Results: Eight hundred fifty-six patients out of a total of 1,013 were diagnosed with urinary stones. The prevalence of urinary stones in the high-risk group of the STONE and the modified STONE scores were 91.1% and 91.2%, respectively. The areas under the receiver operating characteristic curve of both scores were 0.71 and 0.73, respectively. The optimal cutoff value for predicting urinary stones using the STONE score was 9, with 87.9% sensitivity, 45.9% specificity, 89.8% PPV, and 40.9% NPV. In the case of the modified STONE score, the optimal cutoff value was 10, which was the same as that of the original study with 85.9% sensitivity, 54.8% specificity, 91.2% PPV, and 41.6% NPV. Conclusion The STONE and the modified STONE scores showed good diagnostic accuracy in high-risk groups of patients with suspected urinary stones. These scoring systems would be helpful to physicians in their diagnoses and in reducing radiation exposure.

Objective: During cardiac arrest and after cardiopulmonary resuscitation, a lack of pulsatile blood flow promotes rapid clot formation. After the return of spontaneous circulation, the clot burden dissipates throughout the vasculature and vital organs. Recently, the D-dimer to fibrinogen ratio (DFR) has been under consideration as a useful marker for the diagnosis and prognosis of pulmonary embolism and cardiovascular disease. This study aimed to describe the relationship between DFR and anoxic time and to evaluate the DFR and clinical outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM). Methods: A retrospective study was performed on patients treated with TTM. Patients were divided into two groups according to their calculated DFR (DFR <4 and DFR ≥4). The primary outcome was poor neurological outcomes at six months, as defined by a Cerebral Performance Category (CPC) between 3 and 5. Results: A total of 345 subjects were included in the study and of these, 239 subjects had poor neurological outcomes at 6 months. There was a positive correlation between DFR and the duration of cardiac arrest in 229 witnessed cardiac arrest (CA) patients (r=0.449, P<0.001). The multivariate logistic regression analysis showed that DFR ≥4 was an independent predictor for poor neurologic outcomes at 6 months after CA (odds ratio of 3.549; 95% confidence interval 1.082-11.642). Conclusion The D-dimer to fibrinogen ratio showed a correlation with the duration of cardiac arrest in witnessed OHCA patients and DFR ≥4 was associated with poor neurological outcomes at 6 months after CA treated with TTM.

Objective: Criminal proceedings of medical accidents are increasing gradually, and convictions are also on the rise. This study examined the precedents to determine how to prevent medical lawsuits from the perspective of criminal law. Methods: This study collected the criminal precedents of emergency treatment from January 2012 to December 2021. The emergency care in the Integrated Search and Access Service for Judgement was searched online. Results: In 2,371 cases, 22 precedents of professional negligence resulting in death or injury were extracted. These 22 cases were analyzed to understand the legal perspective of the judgment. Of those 22 cases, there were convictions in 10 cases of criminal precedents of emergency treatment and 12 acquittals within the last 10 years. There were four cases where the accused were guilty in the first trial but acquitted in the second. On the other hand, there was one case in which the accused was acquitted in the first trial but convicted in the second. Conclusion Having basic legal knowledge and concepts to prevent medical accidents is helpful. In an inevitable medical accident, it is necessary to actively deal with it from the beginning to prevent significant damage. In addition, it is important to review recent medical trials and to update procedures where possible.

Objective: During cardiac arrest and after cardiopulmonary resuscitation, a lack of pulsatile blood flow promotes rapid clot formation. After the return of spontaneous circulation, the clot burden dissipates throughout the vasculature and vital organs. Recently, the D-dimer to fibrinogen ratio (DFR) has been under consideration as a useful marker for the diagnosis and prognosis of pulmonary embolism and cardiovascular disease. This study aimed to describe the relationship between DFR and anoxic time and to evaluate the DFR and clinical outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM). Methods: A retrospective study was performed on patients treated with TTM. Patients were divided into two groups according to their calculated DFR (DFR <4 and DFR ≥4). The primary outcome was poor neurological outcomes at six months, as defined by a Cerebral Performance Category (CPC) between 3 and 5. Results: A total of 345 subjects were included in the study and of these, 239 subjects had poor neurological outcomes at 6 months. There was a positive correlation between DFR and the duration of cardiac arrest in 229 witnessed cardiac arrest (CA) patients (r=0.449, P<0.001). The multivariate logistic regression analysis showed that DFR ≥4 was an independent predictor for poor neurologic outcomes at 6 months after CA (odds ratio of 3.549; 95% confidence interval 1.082-11.642). Conclusion The D-dimer to fibrinogen ratio showed a correlation with the duration of cardiac arrest in witnessed OHCA patients and DFR ≥4 was associated with poor neurological outcomes at 6 months after CA treated with TTM.

Objective: During cardiac arrest and after cardiopulmonary resuscitation, a lack of pulsatile blood flow promotes rapid clot formation. After the return of spontaneous circulation, the clot burden dissipates throughout the vasculature and vital organs. Recently, the D-dimer to fibrinogen ratio (DFR) has been under consideration as a useful marker for the diagnosis and prognosis of pulmonary embolism and cardiovascular disease. This study aimed to describe the relationship between DFR and anoxic time and to evaluate the DFR and clinical outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM). Methods: A retrospective study was performed on patients treated with TTM. Patients were divided into two groups according to their calculated DFR (DFR <4 and DFR ≥4). The primary outcome was poor neurological outcomes at six months, as defined by a Cerebral Performance Category (CPC) between 3 and 5. Results: A total of 345 subjects were included in the study and of these, 239 subjects had poor neurological outcomes at 6 months. There was a positive correlation between DFR and the duration of cardiac arrest in 229 witnessed cardiac arrest (CA) patients (r=0.449, P<0.001). The multivariate logistic regression analysis showed that DFR ≥4 was an independent predictor for poor neurologic outcomes at 6 months after CA (odds ratio of 3.549; 95% confidence interval 1.082-11.642). Conclusion The D-dimer to fibrinogen ratio showed a correlation with the duration of cardiac arrest in witnessed OHCA patients and DFR ≥4 was associated with poor neurological outcomes at 6 months after CA treated with TTM.

Objective: During cardiac arrest and after cardiopulmonary resuscitation, a lack of pulsatile blood flow promotes rapid clot formation. After the return of spontaneous circulation, the clot burden dissipates throughout the vasculature and vital organs. Recently, the D-dimer to fibrinogen ratio (DFR) has been under consideration as a useful marker for the diagnosis and prognosis of pulmonary embolism and cardiovascular disease. This study aimed to describe the relationship between DFR and anoxic time and to evaluate the DFR and clinical outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing targeted temperature management (TTM). Methods: A retrospective study was performed on patients treated with TTM. Patients were divided into two groups according to their calculated DFR (DFR <4 and DFR ≥4). The primary outcome was poor neurological outcomes at six months, as defined by a Cerebral Performance Category (CPC) between 3 and 5. Results: A total of 345 subjects were included in the study and of these, 239 subjects had poor neurological outcomes at 6 months. There was a positive correlation between DFR and the duration of cardiac arrest in 229 witnessed cardiac arrest (CA) patients (r=0.449, P<0.001). The multivariate logistic regression analysis showed that DFR ≥4 was an independent predictor for poor neurologic outcomes at 6 months after CA (odds ratio of 3.549; 95% confidence interval 1.082-11.642). Conclusion The D-dimer to fibrinogen ratio showed a correlation with the duration of cardiac arrest in witnessed OHCA patients and DFR ≥4 was associated with poor neurological outcomes at 6 months after CA treated with TTM.

BACKGROUND: The aim of the study was to establish a new syphilis test algorithm using Architect Syphilis TP (Abbott Japan, Japan: AST), a fully automated treponemal antibody test, as a screening test in a university hospital laboratory. We evaluated performance characteristics of AST in various patient groups. METHODS: A total of 1,357 serum samples obtained from patients at a university hospital from June to August, 2008 were categorized into checkup, preoperative, other diseases, diagnosis (clinically suspected of syphilis), and follow up groups. We compared the results of AST with those of RPR (N=1,276) or Treponema pallidum hemagglutination assay (TPHA, N=81). Samples with discrepant results between RPR or TPHA and AST were retested by fluorescent treponemal antibody absorption test (FTA-ABS) and all patients' clinical records were thoroughly reviewed. RESULTS: The positive rate of AST was significantly higher than that of RPR in preoperative and other diseases groups and was the same as that of RPR in diagnosis group. There were no significant differences in check up and follow up groups. The results of AST showed 97.4% (1,243/1,276) and 97.5% (79/81) concordance rates with those of RPR and TPHA, respectively. Among 26 RPR-AST discrepant and FTA-ABS confirmed cases, there were 20 RPR false-negatives, 4 RPR false-positives, 1 AST false-negative, and 1 AST false-positive. CONCLUSIONS: Based on the results and literature review, we established a new syphilis test algorithm using AST as a screening test, which would be helpful for detection of more syphilis patients including latent infections.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Autoanalysis ; Child ; Child, Preschool ; False Positive Reactions ; Female ; Fluorescent Treponemal Antibody-Absorption Test/methods ; Hemagglutination Tests/methods ; Humans ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; Syphilis/*diagnosis ; Syphilis Serodiagnosis/*methods

Scedosporium prolificans is a saprophytic fungus widespread in the environment. It has become an emerging pathogen in recent years causing disseminated infections, especially in profoundly neutropenic immunocompromised patients. We report a case of fatal Scedosporium fungemia in a 45 year old female with acute myeloid leukemia in relapse. She received salvage chemotherapy and antibiotic treatment, and was neutropenic with relapsing fever. S. prolificans was isolated repeatedly from the aerobic bottles on the second day of two successive blood cultures. Amphotercin B was started; however, the patient expired the next day.
Drug Therapy ; Female ; Fungemia* ; Fungi ; Humans ; Immunocompromised Host ; Leukemia, Myeloid, Acute* ; Middle Aged ; Recurrence ; Relapsing Fever ; Scedosporium*

Histoplasmosis is a very rare disease in Korea. Clinical manifestations are very similar to those of tuberculosis. This is the first case report of combined disseminated histoplasmosis and tuberculosis in a patient with HIV infection in Korea. A 42-year-old Korean with Acquired Immunodeficiency Syndrome (AIDS) was diagnosed with tuberculosis. He had lived in Guatemala for the past five years. Upon diagnosis of disseminated tuberculosis with HIV infection, he was treated with anti-tuberculosis medications and anti-retroviral agents. Fever, weakness, hepatosplenomegaly and pancytopenia were persistent despite treatment. The patient's history of living in Guatemala caused us to seek opportunistic infectious organisms other than tuberculosis. Bone marrow aspiration and biopsy were performed and the result revealed numerous intracellular organisms consistent with Histoplasma capsulatum; therefore, the diagnosis of disseminated histoplasmosis was made.
AIDS-Related Opportunistic Infections/microbiology ; Acquired Immunodeficiency Syndrome/complications/pathology ; Adult ; Bone Marrow/microbiology/pathology ; HIV Infections/*complications/drug therapy ; Histoplasma/isolation & purification ; Histoplasmosis/complications/*diagnosis/microbiology ; Humans ; Male ; Thorax/microbiology/pathology/radionuclide imaging ; Tuberculosis/complications/*diagnosis