Malaria is a parasitic infection caused by Plasmodium species. Most of the imported malaria in Korea are due to Plasmodium vivax and Plasmodium falciparum, and Plasmodium ovale infections are very rare. Here, we report a case of a 24-year-old American woman who acquired P. ovale while staying in Ghana, West Africa for 5 months in 2010. The patient was diagnosed with P. ovale malaria based on a Wright-Giemsa stained peripheral blood smear, Plasmodium genus-specific real-time PCR, Plasmodium species-specific nested PCR, and sequencing targeting 18S rRNA gene. The strain identified had a very long incubation period of 19-24 months. Blood donors who have malaria with a very long incubation period could be a potential danger for propagating malaria. Therefore, we should identify imported P. ovale infections not only by morphological findings but also by molecular methods for preventing propagation and appropriate treatment.
Blood/parasitology ; DNA, Protozoan/chemistry/genetics ; Female ; Ghana ; Humans ; Korea ; Malaria/*diagnosis/parasitology/*pathology ; Microscopy ; Plasmodium ovale/*isolation & purification ; Polymerase Chain Reaction ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA ; *Travel ; Young Adult

BACKGROUND: Qualitative hepatitis B surface antigen (HBsAg) assay kits are still commonly used in Korea where hepatitis B virus (HBV) infection is endemic. The accurate determination of HBsAg plays a crucial role in the diagnosis and prevention of HBV infection, especially in endemic areas. The aim of this study was to compare the detection sensitivities of 9 qualitative HBsAg assay kits. METHODS: Seven pooled sera with HBsAg concentration ranging from 0.14 IU/mL to 29.96 IU/mL were prepared. The HBsAg concentration of each pooled serum was determined by a quantitative HBsAg assay, Architect HBsAg (Abbott Laboratories, Ireland). The fully automated immunoassay kits included Elecsys HBsAg (Roche Diagnostics, Germany) and Immulite 2000 HBsAg (DPC, USA) and the rapid tests included 5 immunochromatographic assay (ICA) kits and 2 reverse passive hemagglutination assay (RPHA) kits. RESULTS: Elecsys HBsAg (Roche Diagnostics) showed positive result in pooled serum with HBsAg concentration of 0.14 IU/mL, but Immulite 2000 HBsAg (DPC) showed negative result in the same concentration. Although ICA kits showed variable results among different assay kits, all of them showed negative results in pooled sera with HBsAg concentration of < or =1.89 IU/mL. Two RPHA kits showed negative results in pooled sera with HBsAg concentration of < or =7.98 IU/mL. CONCLUSIONS: Although ICAs were more sensitive than RPHAs, they had variable sensitivities for HBsAg and were less sensitive than the automated immunoassay kits. Therefore, ICAs and RPHAs should be used with caution in the screening tests for HBsAg and their sensitivities need to be improved.
Chemiluminescent Measurements ; Electrochemical Techniques ; Enzyme-Linked Immunosorbent Assay ; Genotype ; Hemagglutination Tests ; Hepatitis B/*diagnosis ; Hepatitis B Surface Antigens/*blood ; Humans ; Reagent Kits, Diagnostic

Objective: Assault in the emergency room can lead to a decrease in the quality of the entire emergency medical system due to the functional deterioration and increased fatigue of the medical staff. This research tried to identify and analyze the characteristics of assault against emergency medical technicians (EMTs) working in the emergency room and establish the factors related to poor post-assault-exposure response. Methods: In this multicenter study, we conducted a survey of EMTs working in the emergency rooms. Response after assault was measured by Likert 5-point scale; the data of the participants were divided based on the median score. The demographic characteristics, hospital preparedness, and the characteristics of the assault were analyzed. Afterwards, the data of the risk factors for poor post-assault-exposure response were subjected to multivariable logistic analysis. Results: Of the 141 study participants, 84 (59.6%) were women. Most of them had experienced verbal violence (n=137, 97.2%) and physical threats (n=137, 92.2%), and 96 (68.0%) had experienced physical assault in the past year. The results of the multivariable logistic regression analysis revealed that female sex (adjusted odds ratio [aOR], 6.152; 95% confidence interval [CI], 2.687-14.120) and the increase in the number of physical assaults (aOR, 1.160; 95% CI, 1.036- 1.298) were associated with a poor response. Conclusion Considering the importance of the EMTs in the emergency medical system and the potential adverse effects on the status of their health and services, the provision of appropriate support to female EMTs and the active intervention for attenuation of physical assault escalation in case of aggressive situations is needed. Our present results can be used for the identification and resolution of the underlying causes of these problems.

This study aimed to establish and validate an HPLC method for the quantitative analysis of bioactive compounds in a mixture of the L. glauca leaves extract and water-soluble mastic gum (MLM). MLM has shown potential as an effective agent for preventing hair loss in the previous study. For the development of the quality evaluation of MLM, quercitrin (1), isoquercitrin (2), and oleanonic acid (3) were selected as analytical markers.The separation was achieved using a reverse-phase column with a gradient solvent system of 0.1% formic acid aqueous-0.1% formic acid acetonitrile at a flow rate of 1.0 mL/min. Detection was carried out at 210 nm and 254 nm. The calibration curves for all three markers exhibited good linearity (R 2 > 0.999). Recoveries of the three markers ranged from 100 ± 15%. The concentrations of compounds 1, 2, and 3 in MLM was determined to be 25.73 ± 1.38, 8.36 ± 0.05, and 212.24 ± 12.88 μg/mL, respectively. The validated method will facilitate further compositional investigations in MLM.

Recently, the number of Korean travelers and workers to malaria-endemic regions has increased, and the number of patients with imported malaria cases has increased as well. In Korea, most cases of imported malaria infections are caused by Plasmodium falciparum and P. vivax. Only one report of imported P. malariae infection has been published thus far. Here, we describe a case of imported P. malariae infection that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 53-yr-old man, who had stayed in the Republic of Guinea in tropical West Africa for about 40 days, experienced fever and headache for 3 days before admission. The results of rapid malaria test using the SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Wright-Giemsa stained peripheral blood smear revealed Plasmodium. To identify the Plasmodium species and to examine if the patient had a mixed infection, we performed nested PCR targeting the SSU rRNA gene. P. malariae single infection was confirmed by nested PCR. Sequence analysis of the SSU rRNA gene of P. malariae showed that the isolated P. malariae was P. malariae type 2. Thus, our findings suggest that when cases of imported malaria infection are suspected, infection with P. malariae as well as P. falciparum and P. vivax should be considered. For the accurate diagnosis and treatment of imported malaria cases, we should confirm infection with Plasmodium species by PCR as well as peripheral blood smear and rapid malaria antigen test.
Africa, Western ; Coinfection ; Diagnosis ; Fever ; Genes, rRNA ; Guinea* ; Headache ; Humans ; Korea ; Malaria ; Plasmodium ; Plasmodium falciparum ; Plasmodium malariae* ; Polymerase Chain Reaction ; RNA, Ribosomal ; Sequence Analysis

This case report concerns a young patient with an extremely rare combination of d-transposition of the great arteries (d-TGA) and anomalous origin of the right subclavian artery. In our patient, the right subclavian artery originated from the pulmonary artery, which is why he did not show reversed differential cyanosis. We conclude that the presence of an aortic arch anomaly should be considered in patients with d-TGA who do not present with reversed differential cyanosis. A further imaging work-up, including computed tomography or magnetic resonance imaging, might be helpful.
Aorta, Thoracic ; Arteries* ; Cyanosis ; Humans ; Magnetic Resonance Imaging ; Pulmonary Artery ; Subclavian Artery*

It is challenging to clinically distinguish between convulsive syncope and true seizure. We describe a 7-year-old girl presenting with generalized tonic seizure caused by acquired complete atrioventricular block related to acute myocarditis. After hospitalization following 6 episodes of new-onset fever with seizure, she had a short episode of abrupt complete atrioventricular block followed by another generalized tonic seizure. The concentrations of cardiac enzymes were elevated, and her echocardiogram showed a decreased left ventricular function. This case underlines the necessity of cardiac investigations in children with convulsive syncope.

It is challenging to clinically distinguish between convulsive syncope and true seizure. We describe a 7-year-old girl presenting with generalized tonic seizure caused by acquired complete atrioventricular block related to acute myocarditis. After hospitalization following 6 episodes of new-onset fever with seizure, she had a short episode of abrupt complete atrioventricular block followed by another generalized tonic seizure. The concentrations of cardiac enzymes were elevated, and her echocardiogram showed a decreased left ventricular function. This case underlines the necessity of cardiac investigations in children with convulsive syncope.

Objective: Previous studies focused primarily on drivers or front-seat passengers in motor vehicle accidents. Recent research has shown improvements in front-seat occupant protection. This study examined the risk factors contributing to severe injury in rear-seat occupants. Methods: This study was conducted retrospectively. The variables related to the crash data were acquired from the Emergency Department-based Injury In-depth Surveillance registry and electronic medical record of the authors’hospital between 2019 and 2020. Multivariate logistic regression analysis was used to identify the risk factors contributing to severe injury in rear-seat occupant. Results: One hundred and forty rear-seat occupants were analyzed. The occupants were categorized by the abbreviated injury scale into severe (n=39; 27.9%) and non-severe injury (n=101; 72.1%). The collision with a large-size vehicle (odds ratio [OR], 4.278; 95% confidence interval [CI], 1.617-18.000; P=0.015) and fixed objects (OR, 3.459; 95% CI, 1.347-8.883; P=0.049) was independently associated severe injury. Seatbelt use was also an independent risk factor of severe injury (OR, 2.649; 95% CI, 1.178-5.940; P=0.018). Common severe injuries encountered in rear seats were chest (12.1%), spine (9.3%), and abdomen (5.7%). Conclusion In contrast to the fact that seat belt use reduces the severity of injuries, seatbelt use was associated with severe injury in this study. Further research will be needed to assess the effects of seatbelt use. In addition, awareness should be raised about the relationship between the accident mechanism, seatbelt use, and the commonly injured body region.