Estimation of the Outbreaks of Transfusion-Transmissible Emerging Infectious Diseases in Korean Blood Donors by Public Data / 대한수혈학회지

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.

Consideration of Appropriateness of Application of Immunoblot Assay as a Reentry Test for HCV or HIV Screening Reactive Donors / 대한수혈학회지

BACKGROUND: Currently, serological assay, immunoblotting, and nucleic acid amplification test (NAT) are required as reentry tests for deferred donors with hepatitis C virus (HCV) or human immunodeficiency virus (HIV) screening reactive result. However, immunoblotting must be performed even for serological nonreactive donors. In this study, the efficacy of immunoblot applications for serological nonreactive donors in donor reentry procedures was examined. METHODS: We analyzed non-qualified donors with immunoblot results from 2011 to 2015 in Korea and investigated reentry procedures related with HCV or HIV in other countries. RESULTS: Percentages of donors who could not be released due to immunoblot results even with serological nonreactive results were 54.2% (1,824/3,367) for HCV and 35.9% (4,300/11,964). In the case of 662 donors, their results were considered to be different using other assay kits or based on other criteria. In other countries, immunoblotting is not required as a donor reentry test. CONCLUSION: Indeterminate or reactive immunoblotting results in serological nonreactive donors were due to nonspecific reactions. It is not reasonable to apply immunoblotting to serological nonreactive donors. Therefore, we suggest that immunoblot assays be excluded from the reentry test.

Current Status of Irradiated Blood Components and Blood Irradiators in Korean Medical Institutes / 대한수혈학회지

BACKGROUND: Gamma or X-ray irradiation of blood components is used to prevent transfusion associated graft-versus-host disease (TA-GVHD). In this study, we assessed the current status of irradiated blood components and blood irradiators in Korean medical institutes. METHODS: We surveyed 306 medical institutes in Korea by a questionnaire, between August 2015 and October 2015. Institutions were asked to answer 9~16 questions, including whether they had facilities for irradiation of blood, type of irradiators used, dose of irradiation used, and if they did not have irradiation facilities, they were asked whether their blood components were irradiated. RESULTS: One-hundred and ninety-seven (64.4%) out of 306 questionnaires were returned and analyzed: 96 institutions provide irradiated blood, and 101 institutions do not use irradiated blood components. Forty-eight institutions have on site facilities with gamma blood irradiator for the irradiation of blood components and uses a dose of 20 to 50 Gy. Of the 48 institutions without facilities that use irradiated blood components, 38 (79.2%) have their blood components by referral to Korean Red Cross Blood Centers and 9 (18.8%) refer to other medical institutes for their irradiation needs. The survey showed that there is lot of regional variation in the supply and demand of irradiated blood components in Korea. CONCLUSION: Our survey does suggest that the establishment of the supply system for irradiated blood component by nation-wide blood establishments may provide national nuclear safety and stability of irradiated blood supply. It may also alleviate some regional disparity for the transfusion service of irradiated blood in Korea.

Severe Spastic Trismus without Generalized Spasticity after Unilateral Brain Stem Stroke

A 62-year-old female patient diagnosed with left brain stem stroke 2 months ago was admitted to our clinic for rehabilitation. She had no generalized spasticity on both extremities, but could open her mouth only approximately 2 mm between her upper and lower teeth due to severe trismus. On needle electromyography, the left masseter muscle showed paradoxically increased muscle activity during mouth opening. We injected 50 units of type A botulinum toxin (Botox(R)) into the left masseter muscle, and 20 units into the left temporalis muscle with guidance of ultrasonography. The interincisal distance increased to 8 mm on the 3rd day after injection, and 9 mm on the 4th day. One month later, the interincisal distance increased to 14 mm. The increased interincisal distance was maintained for 13 months after injection, and the quality of hygienic care and compliance of oral stimulation therapy also improved.

Usefulness of Videofluoroscopic Swallow Study with Mixed Consistency Food for Patients with Stroke or Other Brain Injuries

This study evaluated the feasibility of mixed consistency foods test in patients with dysphagia which developed after stroke or other brain injuries. The findings of a videofluoroscopic swallow study (VFSS) were compared using single versus mixed consistency foods. Forty-nine patients with stroke or other brain injuries who had no significant abnormal findings in the single consistency food VFSS and started regular hospital diet were recruited for this study. Twenty-five (51%) of the 49 patients showed normal findings whereas 24 (49%) patients showed abnormal findings in the mixed consistency food VFSS. Abnormal findings included posterior spillage of liquid prematurely to pyriform sinus (n = 23), laryngeal penetration (n = 6), subglottic aspiration in the oral preparatory phase of swallowing (chewing), solid components (n = 2), and significant (more than 10%) residue in valleculae or pyriform sinus (n = 2). There was an increased risk of abnormal findings in mixed consistency food VFSS such as aspiration and penetration when a patient showed delayed pharyngeal delay time in single consistency food using liquids. In conclusion, VFSS protocols using mixed consistency foods would be useful before starting regular diet for patients after stroke or other brain injuries.

Passive Knee Joint Proprioception Test in Normal Adults

OBJECTIVE: To establish appropriate test angle of passive knee proprioception test and to compare with active knee proprioception test. METHOD: Thirty one healthy volunteers were tested in seated position on isokinetic machine. For passive test, the knee joints were placed in starting angle of 0degrees, 30degrees in flexion test and 90degrees, 60degrees in extension test. To memorize target angle, they were passively positioned to the target angle and left hold for 10 seconds, and returned to starting position. After these processes, knee joints were passively moved toward flexion and extension target angle. The subjects were instructed to press stop button when the memorized angles were reproduced. The tests were performed 3 times for each 6 different test angle. The active test were performed with the same memorized process but the subjects moved actively to reproduce target angles. The absolute angular errors (AAE) between target angle and produced angle were measured and compared. RESULTS: In passive proprioception test, the AAEs were increased according to the test angle differences were increased from 30degrees to 60degrees. In the same target angle difference, there were no differences between starting positions. When the results of passive test were compared with active test, there were no significant differences in the flexion test, but larger angular error were measured in extension test. CONCLUSION: The passive knee proprioception test could be useful for patients with lower extremity weakness. Considering the possible error of large angular difference, the testing angular differences should be properly selected.