BACKGROUND: Organic solvent-induced chronic toxic encephalopathy (CTE) is known as a non-progressive disorder that does not progress after diagnosis. The authors present a case those symptoms worsened after continued exposure to organic solvent after returning to work. Because such a case has not been reported in South Korea to the best of our knowledge, we intend to report this case along with literature review. CASE PRESENTATION: A 59-year-old man, who performed painting job at a large shipyard for 20 years, was receiving hospital treatment mainly for depression. During the inpatient treatment, severe cognitive impairment was identified, and he visited the occupational and environmental medicine outpatient clinic for assessing work relatedness. In 1984, at the age of 27, he began performing touch-up and spray painting as a shipyard painter. Before that he had not been exposure to any neurotoxic substances. In 2001, at the age of 44, after 15 years of exposure to mixed solvents including toluene, xylene and others, he was diagnosed with CTE International Solvent Workshop (ISW) type 2A. After 7 years of sick leave, he returned to work in 2006. And he repeated return-to-work and sick leave in the same job due to worsening of depressive symptoms. He had worked four times (2006–2010, 2011–2011, 2011–2011, 2016–2017) for a total of 5 years as a shipyard painter after first compensation. During the return-to-work period, the mean values of the mixed solvent index ranged from 0.57 to 2.15, and except for a one semiannual period, all mean values were above the standard value of 1. We excluded other diseases that can cause cognitive impairment like central nervous system diseases, brain injury, psychological diseases and metabolic diseases with physical examinations, laboratory tests, and brain image analysis. And finally, throughout neuropsychological tests, an overall deterioration in cognitive function was identified compared to 2002, and the deterioration types was similar to that often shown in the case of CTE; thus a diagnosis of CTE (ISW) type 3 was made. CONCLUSION: This case is showing that CTE can go on with continued exposure to mixed solvents. Appropriate “fitness to work” should be taken to prevent disease deterioration especially for the sick leave workers.
Ambulatory Care Facilities ; Brain ; Brain Injuries ; Central Nervous System Diseases ; Cognition ; Cognition Disorders ; Compensation and Redress ; Depression ; Diagnosis ; Education ; Environmental Medicine ; Humans ; Inpatients ; Korea ; Metabolic Diseases ; Middle Aged ; Neuropsychological Tests ; Neurotoxicity Syndromes ; Occupational Diseases ; Paint ; Paintings ; Physical Examination ; Return to Work ; Sick Leave ; Solvents ; Toluene ; Xylenes

OBJECTIVES: This study investigated the implementation of training courses and the overall outlook for occupational and environmental medicine (OEM) in Korea. We described the problems facing OEM residency programs in Korea, and reviewed studies dealing with the specialty of occupational health in developed countries in order to suggest directions of improvement for the OEM training courses. METHODS: We surveyed 125 OEM residents using a questionnaire in August 2012. A total of 23 questions about the training environment, residency programs, preferred institutions for post-licensure employment, and the outlook for OEM specialists were included in the questionnaire and analyzed according to the type of training institution and residency year. Responses from 88 residents (70.4 %) were analyzed. RESULTS: The major responsibilities of OEM residents were found to vary depending on whether they were trained in research institutes or in hospitals. OEM residents had a lower level of satisfaction with the following training programs: toxicology practice (measurements of biological markers, metabolites, and working environments), and OEM practice (environmental diseases and clinical training involving surgery). When asked about their eventual place of employment, OEM residents preferred institutions providing special health examinations or health management services. OEM residents reported a positive outlook for OEM over the next 5 years, but a negative outlook for the next 10 years. CONCLUSIONS: Although a standardized training curriculum for OEM residents exists, this study found differences in the actual training courses depending on the training institution. We plan to standardize OEM training by holding a regional conference and introducing open training methods, such as an open hospital system. Use of Korean-language OEM textbook may also reduce differences in the educational programs of each training institution. Toxicology practice, environmental diseases, and clinical training in surgery are areas that particularly need improvement in OEM residency training programs.
Academies and Institutes ; Biological Markers ; Curriculum ; Developed Countries ; Education ; Employment ; Environmental Medicine* ; Internship and Residency* ; Korea* ; Occupational Health ; Specialization ; Toxicology

HBV core antibody and surface antibody test are currently conducted for those donors showing non-discriminated reactive (NDR) results on a nucleic acid amplification test (NAT) as a blood donor screening assay. It is necessary to investigate the relationship with HCV or HIV in the donors showing NDR results. From June 12th, 2012 to December 31st, 2018, 0.05% (9,020/17,798,461) donors showed NDR results on a NAT. Among the donors showing NDR results, 17 and 18 donors showed positive results on serological assay of HCV and HIV, respectively. 23 donors with NDR results showed positive results on the serological assay or NAT for HCV or HIV on the following donation. Further study and more accumulated data are required because it may be difficult to find the cause of NDR results by the current serological assay that is used for screening blood donors.
Blood Donors ; HIV ; Humans ; Mass Screening ; Nucleic Acid Amplification Techniques ; Tissue Donors

BACKGROUND: For donor samples showing reactive results in a human T-cell lymphotropic virus (HTLV) antibody test along with indeterminate results in Western blot assay, HTLV nucleic acid amplification test using laboratory-developed polymerase chain reaction (PCR) was performed. It is necessary to construct an adequate internal control (IC) to evaluate the accuracy of the results since we did not use an IC in the laboratory-developed PCR. METHODS: As a competitive IC, plasmid DNA containing the primer recognition sequence for amplification of the HTLV pX region was constructed. We determined the adequate concentration of the IC, which was added to the samples to evaluate the accuracy of the test results. RESULTS: When the plasmid DNA was added to the HTLV-positive samples, the amplified product of IC (400 bp) was detected with the HTLV gene (230 bp). The adequate concentration of plasmid DNA added as an IC was 1 pg. CONCLUSION: The construction of plasmid DNA as a competitive IC is an efficient method to evaluate accuracy of the test results. However, the production process for the competitive IC must be further developed. Therefore, it is necessary to compare with the performance of a non-competitive IC.
Blotting, Western ; DNA ; Humans ; Methods ; Nucleic Acid Amplification Techniques ; Plasmids ; Polymerase Chain Reaction* ; T-Lymphocytes ; Tissue Donors

BACKGROUND: The objective of this study is to suggest revised recognition standards for occupational disease due to chromium (VI) by reflecting recent domestic and international research works and considering domestic exposure status with respect to target organs, exposure period, and cumulative exposure dose in relation to the chromium (VI)-induced occupational disease compensation. METHODS: In this study, the reports published by major international institutions such as World Health Organization (WHO) International Agency for Research on Cancer (IARC) (2012), Occupational Safety and Health Administration (OSHA) (2006), National Institute for Occupational Safety and Health (NIOSH) (2013), American Conference of Governmental Industrial Hygienists (ACGIH) (2004), National Toxicology Program (NTP) (2014), and Agency for Toxic Substances and Disease Registry (ASTDR) (2012) were reviewed and the recent research works searched by PubMed were summarized. RESULTS: Considering the recent research works and the domestic situation, only lung cancer is conserved in the legislative bill in relation to chromium (VI), and the exposure period is not included in the bill. Nasal and paranasal sinus cancer was excluded from the list of cancers that are compensated as the chromium (VI)- induced occupational disease, while lung cancer remains in the list. In the view of legislative unity, considering the fact that only the cancers having sufficient evidence are included in the conventional list of cancers compensated as occupational disease, nasal and paranasal sinus cancer having limited evidence were excluded from the list. The exposure period was also removed from the legislative bill due to the insufficient evidence. Recent advices in connection with cumulative exposure dose were proposed, and other considerable points were provided with respect to individual occupational relevance. CONCLUSIONS: It is suggested that the current recognition standard which is “Lung cancer or nasal and paranasal sinus cancer caused by exposure to chromium (VI) or compounds thereof (exposure for two years or longer), or nickel compounds” should be changed to “Lung cancer caused by exposure to chromium (VI) or compounds thereof, and lung cancer or nasal and paranasal sinus cancer caused by exposure to nickel compounds”.
Chromium ; Compensation and Redress ; International Agencies ; Korea ; Lung Neoplasms ; National Institute for Occupational Safety and Health (U.S.) ; Nickel ; Occupational Diseases ; Occupational Exposure ; Paranasal Sinus Neoplasms ; Toxicology ; United States Occupational Safety and Health Administration ; World Health Organization

BACKGROUND: Transfusion transmissible emerging infectious diseases (EIDs) is a potential risk to the safety of blood transfusions due to the lack of donor screening assays. To prevent the spread of EIDs through blood transfusions, we attempted to predict the possibility of blood donations from people with EIDs using a public database. METHODS: We used the Disease Web Statistics System of the Korean Centers for Disease Control and Prevention and Korean Statistical Information Service. We estimated the possibility of blood donations from people with EIDs using the public database combined with the database made available by the Blood Information Management System of the Korean Red Cross. RESULTS: Among the transfusion transmissible EIDs, Babesiosis, Leishmaniasis, West Nile fever, Chikungunya, and Dengue fever were reported in Korea. All of them were cases imported from abroad. Although the number of reported cases of Babesiosis, Leishmaniasis, West Nile fever, and Chikungunya were less than 10 per year until 2016, the reported cases of Dengue fever gradually increased from 2001, and there were 318 cases of Dengue fever in 2016. CONCLUSION: The possibility of blood donation from people with transfusion-transmissible EIDs was low because all reported transfusion-transmissible EIDs in Korea were from foreigners and blood donation from Koreans who returned from abroad was restricted for a period of a month. Nonetheless, preventive strategy for donation from people is necessary given the recent increase in Dengue fever.
Animals ; Babesiosis ; Blood Donors* ; Blood Transfusion ; Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases, Emerging* ; Dengue ; Disease Outbreaks* ; Donor Selection ; Emigrants and Immigrants ; Humans ; Information Management ; Information Services ; Korea ; Leishmaniasis ; Red Cross ; West Nile Fever

Pulmonary alveolar proteinosis (PAP) is a rare condition that is treated using whole lung lavage. A recent study suggested that granulocyte-macrophage colony stimulating factor (GM-CSF) plays roles in both the pathogenesis and treatment of PAP. We present a 69-year-old man with PAP who deteriorated despite bilateral whole lung lavage; that said, his symptoms, chest X-ray findings, and pulmonary function test improved after GM-CSF inhalation therapy over 12 months. GM-CSF therapy is an effective treatment modality for PAP.
Aged ; Bronchoalveolar Lavage ; Colony-Stimulating Factors ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Inhalation ; Lung ; Pulmonary Alveolar Proteinosis ; Respiratory Function Tests ; Respiratory Therapy ; Thorax

BACKGROUND: Since December 15 2017, donors showing a non-discriminated reactive (NDR) result in the nucleic acid amplification test (NAT) have been temporarily deferred and anti-HBc and anti-HBs assays as additional tests were performed. Donors with an anti-HBc reactive result and less than 100 IU/L of anti-HBs could not be released and can request a reentry test after more than six months. This study considered the effects of additional tests for NDR donors by analyzing the reentry test results in donors not released in the additional test. METHODS: This study examined the results of the additional test for NDR donors from January 2017 to September 2018 and the reentry test of the donors not released in the additional test. RESULTS: NAT was conducted on 4,706,051 blood donors over the period and 2,545 (0.05%) of them showed NDR. A total of 656 (25.8%) of the NDR donors were not released in the additional test. Among them, 246 donors requested a reentry test; 222 (90.2%) donors were not reentered, and 23 (10.4%) showed HBV NAT reactive results in the reentry test. Among the remaining 24 reentered donors, 2 donors (8.3%) showed anti-HBc nonreactive results in the reentry test and 22 donors (91.7%) showed higher than 100 IU/L of anti-HBs. CONCLUSION: The follow-up of NDR donors may be significant because some donors showed different results between screening test and reentry test. In addition the effectiveness of the introduction of additional tests for the NDR donors has been proved to be effective.
Blood Donors ; Follow-Up Studies ; Humans ; Mass Screening ; Nucleic Acid Amplification Techniques ; Tissue Donors

BACKGROUND: The risk of transfusion-transmissible infections (TTIs) of HBV, HCV, and HIV in Korea has been reduced significantly by strengthening the blood safety policies. On the other hand, the risk of TTI still exists due to the diagnostic window period or viral variants. METHODS: The residual risks of TTI of HBV, HCV, and HIV were calculated from July 1, 2012 to June 30, 2018 by dividing the data into two year sets. The residual risk was conducted by separating the donors who donated only once and those who donated more than once during each period. RESULTS: In the first two years, the residual risks of HBV, HCV, and HIV were calculated to be 17.54/106, 0.42/106, and 0.30/106 respectively. The residual risk of HBV and HCV over the last two years was calculated to be 9.41/106 and 0.27/106, showing a tendency to decrease with time. On the other hand, the residual risk of HIV over the last two years was calculated to be 0.29/106, showing no significant difference. The residual risk in the donors who donated only once was higher than that in the donors who donated more than once during each period. CONCLUSION: The real transfusion-transmitted infection can be different from the estimated residual risk in this study because this study was based on the thesis that all NAT-reactive blood components cause infection. Because the residual risk of HBV is higher than HCV and HIV, it was considered that the safety measures for the HBV need to be improved continuously.
Blood Safety ; Hand ; HIV ; Humans ; Korea ; Tissue Donors

BACKGROUND: If donors who were deferred due to the reactivity or grey zone in HBV surface antigen (HBsAg) assay want to donate blood again, they need to pass reentry tests. On the other hand, approximately half of the donors who are subject to the reentry tests cannot be reentered. This study examined the association between the sample to cutoff (S/Co) value of the HBsAg assay and the final results of the reentry test. METHODS: This study analyzed the S/Co values of the HBsAg assay and the final results of the reentry tests for the 3,947 donors from January 2008 to December 2017 using the database of Blood Information Management System of the Korean Red Cross. RESULTS: 1,767 donors (44.8%) were not reentered among 3,947 deferred donors. Among 1,585 donors showing ≥10 of the S/Co value in the HBsAg screening test, 1,542 donors (97.3%) were not reentered. The additional reentry tests were performed on 120 donors who were not reentered in the first reentry test; 98 donors (81.7%) were still not reentered. Overall, 4.6% of the donors showing a grey zone in the HBsAg assay were not reentered. CONCLUSION: The reentry test needs to be restricted for the deferred donors showing a more than 10 S/Co value. The application of the grey zone of current HBsAg assay will need to be continued to enhance the HBV-related blood safety.
Antigens, Surface* ; Blood Safety ; Hand ; Hepatitis B Surface Antigens ; Humans ; Immunoassay* ; Information Management ; Mass Screening ; Red Cross ; Tissue Donors*