Is it worth to perform initial non-operative treatment for patients with acute ACL injury?: a prospective cohort prognostic study.

PURPOSE: To evaluate the result of implementing an initial non-operative treatment program for an acute ACL injury and to find if the timing of initiating the non-operative treatment is significant. METHODS: This study included a prospective cohort of 85 consecutive patients with acute ACL injury who were treated according to the above strategy for the initial 3 months with 1-year follow-up. Clinical evaluations were made by Lysholm score, Tegner activity score, Lachman test (LT), pivot-shit test (PST), and the side to side difference (SSD) by KT-2000 arthrometer. The results were analyzed according to the timing of initiating the non-operative treatment. RESULTS: Initially, 84% of the patients showed LT and PST ≤ grade 1, and 16% with ≥grade 2. At 1-year follow-up, 77 patients (91%) with LT and PST ≤ grade 1 did not receive reconstruction as copers and 8 patients with LT or PST ≥ grade 2 required reconstruction (six patients received the operation and two refused). The patients with LT and PST ≤ grade 1 showed average Lysholm score 91.2, average SSD 2.5 mm, and mean Tegner score decreased from 6.9 (pre-injury) to 6.2. Patients who started the non-operative treatment within 2 weeks after injury revealed superior rates of grade 0 or 1 instability than those who commenced the treatment later than 2 weeks after injury (P = 0.043). CONCLUSIONS: Implementing a non-operative treatment with brace in acute phase of ACL injury appears to be an effective and viable option to achieve a reasonable clinical outcome. We recommend earlier initiation of the non-operative treatment to obtain a better result in patients with acute ACL injury.

Pharmacokinetics of hydroxychloroquine and its clinical implications in chemoprophylaxis against malaria caused by Plasmodium vivax.

Hydroxychloroquine (HCQ) is an antimalarial drug used as chemoprophylaxis against malaria caused by Plasmodium vivax in the Republic of Korea Army (ROKA). In this study, we evaluated the pharmacokinetics (PK) of HCQ and its metabolites and the relationship between the PK of HCQ and the effect of treatment of HCQ on vivax malaria in South Koreans. Three PK studies of HCQ were conducted with 91 healthy subjects and patients with vivax malaria. Plasma concentrations were analyzed by noncompartmental and mixed-effect modeling approaches. A two-compartment model with first-order absorption best described the data. The clearance and the central and peripheral volumes of distribution were 15.5 liters/h, 733 liters, and 1,630 liters, respectively. We measured the plasma concentrations of HCQ in patients with prophylactic failure of HCQ and compared them with the prediction intervals of the simulated concentrations for HCQ from the final PK model built in this study. In 71% of the patients with prophylactic failure, the plasma concentrations of HCQ were below the lower bounds of the 95% prediction interval, while only 8% of them showed higher levels than the upper bounds of the 95% prediction interval. We report that a significant cause of prophylactic failure among the individuals in ROKA was ascribed to plasma concentrations of HCQ lower than those predicted by the PK model. However, prophylactic failure despite sufficient plasma concentrations of HCQ was confirmed in several individuals, warranting continued surveillance to monitor changes in the HCQ susceptibility of Plasmodium vivax in the Republic of Korea.

Status of Plasmodium vivax malaria in the Republic of Korea during 2001-2003.

The Republic of Korea experienced a re-emergence of Plasmodium vivax malaria in 1993. The incidence of this disease increased rapidly through 2000 with its geographic distribution expanding from the vicinity near the Demilitarized Zone to the adjacent outlying areas. However, the number of cases of P. vivax malaria since that time period has decreased. A total of 2,538 cases occurred in 2001, and this decreased to 1,761 cases and 1,164 cases in the two subsequent years. A total of 5,463 cases of P. vivax malaria were reported from 2001 through 2003; 25.26% (1,380) were reported among Republic of Korea military personnel, 27.48% (1,501) were among veterans who had been discharged from the military within two years, and 47.26% (2,582) were among the civilian population. Mosquito control activities by the North Korean and South Korean governments, chemoprophylaxis of Republic of Korea Army personnel, and the low level of Anopheles mosquitoes in 2001 may have been factors responsible for the decreasing number of malaria cases. However, local transmission might have taken place in urban regions of the malaria-risk areas that are within 30 km south of the Demilitarized Zone. Extensive intervention and continued surveillance are warranted to prevent the epidemic from re-expanding and to eliminate this disease in the Republic of Korea.