Acanthamoeba keratitis (AK) is a rare sight-threatening corneal infection, often reporting from contact lens wearers. An asymptomatic human immunodeficiency virus (HIV)-infected Thai male without history of contact lens use complained foreign body sensation at his left eye during motorbike riding. He had neither specific keratitis symptoms nor common drugs responding, which contributed to delayed diagnosis. By corneal re-scraping, Acanthamoeba-like cysts were detected by calcofluor white staining and agar culture. The etiological agent obtained from the culture was molecularly confirmed by Acanthamoeba spp.-specific PCR, followed by DNA sequencing. The results from BLAST and phylogenetic analysis based on the DNA sequences, revealed that the pathogen was Acanthamoeba T4, the major genotype most frequently reported from clinical isolates. The infection was successfully treated with polyhexamethylene biguanide resulting in corneal scar. This appears the first reported AK case from a non-contact lens wearer with HIV infection in Thailand. Although AK is sporadic in developing countries, a role of free-living Acanthamoeba as an opportunistic pathogen should not be neglected. The report would increase awareness of AK, especially in the case presenting unspecific keratitis symptoms without clinical response to empirical antimicrobial therapy.
Acanthamoeba Keratitis ; Acanthamoeba ; Agar ; Asian Continental Ancestry Group ; Base Sequence ; Corneal Injuries ; Delayed Diagnosis ; Developing Countries ; Foreign Bodies ; Genotype ; HIV Infections ; HIV ; Humans ; Keratitis ; Male ; Off-Road Motor Vehicles ; Polymerase Chain Reaction ; Sensation ; Sequence Analysis, DNA ; Thailand

Road transport is the movement of passengers or goods on the road. To date, issues concerning the safety of students and school institutions have continued to attract public attention. The recent spate of incidents insideand outside the school compoundhas brought the issue of children safety into our attention. These include the escalating number of road casualties. This study was conducted to observe road hazard outside the school compound and analyse the safety risksfaced by school children by using the risk matrix. The risks are calculated to include likelihood and severity of hazard as identified in the Guideline of HIRARC 2008. The area selected was the East Coast state of Peninsular Malaysia, with over 111 schools randomly selected in Kelantan. Results werethen analysed and six highlighted hazards were discussed. The results show that the main road posed the highest risk due to speeding vehicles. These vehicles failed to slow down when approaching the school area. The school administrationmustenhance the safety of the staff, students, and public while in the school area. In conclusion, road safety awareness must be instilledamong teachers, students, parents and road users alike.
hazard ; road transport ; school ; children ; teacher ; safety ; hazard identification, risk analysis

Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and 43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and education program should berigorously introduced to public towards the implementation of the CRS law.
Child restraint system ; children passenger safety ; road traffic accident ; child injury

Road Safety remainsone the most important issuesaffecting educational institutions especiallythe school. The prevalence of road accidentsin recent news reportsunderlines the importance of this issue. Such accidents involving school pupils have further escalated this concern. As such,safety awareness among school teachersis crucial in order for them to identify the suitable methods to prevent more road accidents in future. This study was conducted to analyse teachers’ awareness of road safety in school to gauge the training requirementson road safety. Road safety education and training in school is just as important as improving safety for road users outside schools. For this study, a set of survey questionnaire wasdistributedto 400 school teachers from 111 schools randomly selected from the 10 District Education Offices in Kelantan. Results were then analysed using Statistical Package for the Social Sciences (SPSS). From the results, 40% of respondentswere male and 60% of them were female. Descriptive analysis showed that school teachers understood road safety as 90% of them possessed basic safety knowledge, while 10% of them lacked basicknowledge on road safety. However, they did not implement safety practice that may have contributed to unfortunate eventshappening outside of school including road accidents as reported in the news. This study suggests that school teachers must undergo road safety training to promote and improve road safety in school.With higher awareness and more information about the road safety, the teacherscould create a safer environment in their school. Undoubtedly, teachers have a vital roleto ensure safety of their pupils and their commitment will likely reduce the number of road accidents.
Road ; Safety ; Accident ; Awareness ; Teachers ; Training

PURPOSE: As the usage rate of all-terrain vehicles (ATV) the number of injuries caused by ATVs is also surging. This has led to an increase in social attention to the safety of ATVs and the law for ATV safety standards was revised in 2009 and 2011. The purpose of this study was to evaluate the characteristics of ATV injury compared with motorbike injury after implementation of the ATV safety policy. METHODS: A retrospective cross-sectional observation study was conducted using emergent department (ED)-based indepth injury surveillance system data from 2011 January to 2014 December. Demographics, injury-related characteristics, injury severity, and outcomes of patients related to ATV and motorbike injury visiting our ED were analyzed. Multivariate logistic regression was used for major adverse event (MAE), which was defined as any intensive care, emergent operation, or death between ATV and motorbike related injury adjusted for covariates. RESULTS: During the study period, there were 101 ATV- and 584 motorbike-related injuries. Females had more ATV-related injuries (63.4% vs 32.9%, p<0.001) during leisure activities (93.1%) with higher helmet usage (73.3% vs 62.0%, p=0.01) and lower usage in terms of emergency medical service (23.8% vs 46.4%, p<0.001), automobile insurance (10.9% vs 54.1%, p<0.001) compared with motorbike-related injuries. MAE in ATV-related injuries was less likely in a univariate logistic model (unadjusted odd ratios [ORs] 0.489, 95% confidential intervals [Cis] 0.282 to 0.848), but the multivariate logistic model showed no significant difference (adjusted ORs 1.018, 95% CIs 0.376 to 1.414). CONCLUSION: Results of this study showed no significant difference in occurrence of clinical major adverse events between motorbikes and ATVs-related injury on Jeju Island. However, considering the high injury prevalence in young age, female, and passengers during leisure activities, development of an education and injury prevention program will be needed for this vulnerable population.
Automobiles ; Demography ; Education ; Emergency Medical Services ; Female ; Head Protective Devices ; Humans ; Insurance ; Critical Care ; Jurisprudence ; Leisure Activities ; Logistic Models ; Motorcycles ; Off-Road Motor Vehicles* ; Prevalence ; Retrospective Studies ; Vulnerable Populations ; Wounds and Injuries

OBJECTIVE: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and region of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. METHODS: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (CT) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. RESULTS: The mean (SD) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient. The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. CONCLUSION: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.
Accidents, Traffic ; Axons ; Birth Injuries ; Brain Injuries ; Child ; Coma ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Motor Vehicles ; Off-Road Motor Vehicles ; Prognosis ; Retrospective Studies ; Skull ; Temporal Lobe

OBJECTIVE: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and region of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. METHODS: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (CT) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe extracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. RESULTS: The mean (SD) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient. The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. CONCLUSION: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.
Accidents, Traffic ; Axons ; Birth Injuries ; Brain Injuries ; Child ; Coma ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Motor Vehicles ; Off-Road Motor Vehicles ; Prognosis ; Retrospective Studies ; Skull ; Temporal Lobe

PURPOSE: All-terrain vehicle (ATV)-related injuries have increased since the introduction of ATVs to Korea. The purpose of this study is to compare patients with ATV-related injuries (PATV) to patients with motorcycle (MC)-related injuries (PMC). METHODS: We retrospectively analyzed the clinical records of PATV and PMC who visited an emergency center in 2008. The cases of PMC were 164, and those of PATV were 52. RESULTS: While PMC are seen evenly in the first half year and the second half year, PATV are seen mainly the first half year (from March to June: 73%). For PMC the most frequent injury mechanism was collision with another vehicle, while for PATV, it was side overturn/roll over. The injury severity score (ISS), the revised trauma score (RTS), the trauma score and the injury severity score (TRISS) were 5.6+/-5.6, 7.7+/-0.7, 5.0+/-2.1 for PMC and 7.1+/-7.5, 7.7+/-1.1, 5.5+/-1.5 for PATV, respectively. The most common injury sites were the lower extremities for PMC and the face for PATV. The rates of admission, surgery and the length of hospital stay were similar between PMC and PATV. CONCLUSION: This study shows that the risk of ATV accidents is similar to that of MC accidents. We recommend that the same safety standards and regulations that are applied to MCs should be used for ATVs. Safe and enjoyable paths have to be sought for drivers of ATVs.
Emergencies ; Humans ; Injury Severity Score ; Korea ; Length of Stay ; Lower Extremity ; Motorcycles ; Off-Road Motor Vehicles ; Retrospective Studies ; Social Control, Formal

PURPOSE: Recently, all-terrain vehicle (ATV)-related injuries have increased. The purpose of this study was to evaluate and analyze the ATV injuries in Korea. METHODS: We analyzed the patients who visited Chuncheon Sacred Heart Hospital emergency center with ATVrelated injuries, from 2004 January to 2008 December. The injury severity was evaluated according to the injury severity score (ISS), the revised trauma score (RTS), and the yrauma score and the injury severity score (TRISS). RESULTS: From 2004 to 2008, a total of 78 cases, 28 male and 50 female, of ATV-related injuries were reviewed. The annual incidence had increased 22.5-fold from 2004(2 cases) to 2008(45 cases). The age ranged from 8 to 68 years (median, 24 years). The most frequently injured site was the lower extremity(48.7%). The primary mechanism of injury was roll-over(35.9%), the next was falling down (33.3%). Eighty-two percent(82%) of accidents occurred on paved roads when ATVs are legislated for off-road use only. The average ISS was 6.8. In cases including both the driver and the passenger, the ISS of passengers was higher than that of drivers(7.4 vs. 4.7). Fifty percent (50%) of patients required an operation. The rate of admission was 62.8%. The average length of hospital stay was 25 days. Eighty-one percent (81%) of patients had no previous experience of operating an ATV. Sixty-seven percent (67%) of patients did not receive any formal training before operating an ATVs. CONCLUSION: Both the incidence and severity of ATV-related injuries are increasing in Korea. There is a lack of regulation enforcement and public awareness of the dangers of ATV use. The wearing of appropriate safety equipment and sufficient education about driving skills can reduce the ATVrelated injuries.
Emergencies ; Female ; Heart ; Hospitals, General ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Male ; Off-Road Motor Vehicles

Medicine, Kampo ; Century ; Road ; Maps