Sun Huh

A Recombinant 10-kDa Protein of Taenia solium Metacestodes Specific to Active Neurocysticercosis

Neurocysticercosis (NCC) is an important cause of neurological disease worldwide. A 10-kDa antigen of Taenia solium metacestodes (TsMs) has been shown to be specific for immunodiagnosis of NCC. Screening of a TsM complementary DNA (cDNA) library isolated a cDNA encoding this protein. The cloned cDNA contained a 258-bp complete open-reading frame that encodes an 86-amino acid polypeptide with a calculated molecular weight of 9582 Da. It showed 73% homology with a 10-kDa antigen of T. crassiceps. The recombinant protein was expressed bacterially as a fusion protein at a high level. In immunoblot with recombinant protein, 97% (184/190) of sera from patients with active NCC showed strong reactivity, whereas 14% (4/29) of those from patients with chronic calcified NCC reacted weakly. In 180 sera from other patients with parasitic infections and from normal controls, it showed 98% specificity. A single recombinant TsM antigen has a high potential for serological differentiation of active NCC.

A Nationwide Survey on the Prevalence of Intestinal Parasitic Infections in the Republic of Korea, 2004

National surveys on the prevalence of intestinal parasitic infections have been carried out every 5-7 years since 1971 in the Republic of Korea in order to establish control measures. The present nationwide survey was conducted from June to December 2004. The 10% population sampling data of Population and Housing Census by the Korean government in 2000 was used as the survey population. One sample was selected randomly from each of the 22,858 registered subjects, and a total of 20,541 people were ultimately included in this survey. Fecal examinations were performed by the cellophane thick smear and saturated brine flotation techniques. Pinworm infection was examined by cello-tape anal swab method. This survey also included a questionnaire study for a socioeconomic analysis. The total helminth egg positive rate was 3.7%, and the estimated total positive number among nationwide people was 1,780,000. The rates in urban and rural areas were 3.1% and 6.8%, respectively. As the total egg positive rate in the 6th survey in 1997 was 2.4%, the present survey showed that there was a considerable degree of increase in the prevalence rate of intestinal parasitic infections over the 7-year period following the 6th survey. The largest increases occurred in the egg positive rates of Clonorchis sinensis and heterophyids including Metagonimus yokogawai.

Transmission of Toxocara canis via Ingestion of Raw Cow Liver: A Cross-Sectional Study in Healthy Adults

The aim of this study is to ascertain the relationship between ingestion of raw cow liver and Toxocara canis infection. A total of 150 apparently healthy adults were divided into 2 groups; 1 group consisted of 86 adults with positive results of Toxocara ELISA, and the other group of 64 adults with negative results. One researcher collected the history of ingestion of raw cow liver within 1 year and recent history of keeping dogs. Among 86 seropositive adults for T. canis, 68 (79.1%) had a recent history of ingestion of raw cow liver. Multivariate statistical analysis showed that a recent ingestion of raw cow liver and keeping dogs were related to an increased risk of toxocariasis (odds ratios, 4.4 and 3.7; and 95% confidence intervals, 1.9-10.2 and 1.2-11.6, respectively). A recent history of ingestion of raw cow liver and keeping dogs was significantly associated with toxocariasis.

Toxocariasis and Ingestion of Raw Cow Liver in Patients with Eosinophilia

Ingestion of raw animal liver has been suggested as a possible mode of infection of human toxocariasis. We evaluated the relationship between toxocariasis and the ingestion of raw meat in patients with eosinophilia of unknown etiology. The study population consisted of 120 patients presenting with peripheral blood eosinophilia (>500 cells/microliter or >10% of the white blood cell count). They were divided into 2 groups: 104 seropositive patients based on a Toxocara excretory-secretory IgG ELISA and 16 seronegative patients. While 25.0% of seronegative patients had a recent history of eating raw cow liver, 87.5% of seropositive patients had this history. Multivariate statistical analysis showed that a recent history of eating raw cow liver was related to an increased risk of toxocariasis. Collectively, it is proposed that raw cow liver is a significant infection source of toxocariasis in the patients with eosinophilia of unknown etiology.

Serodiagnosis of Toxocariasis by ELISA Using Crude Antigen of Toxocara canis Larvae

Toxocariasis is a worldwide zoonosis caused by larvae of ascarid nematodes of dogs or cats, Toxocara canis or T. cati. Diagnosis of human toxocariasis currently relies on serology that uses T. canis excretory-secretory antigen to detect specific IgG antibodies by ELISA. We investigated the serodiagnostic efficacy of ELISA using crude antigen of T. canis larvae (TCLA). Serum specimens of 64 clinically confirmed toxocariasis, 115 healthy controls, and 119 other tissue-invading helminthiases were screened by ELISA using TCLA. The ELISA using TCLA showed 92.2% (59/64 patient samples) sensitivity and 86.6% (103/119) specificity. Its positive diagnostic predictivity was 78.7% and negative predictivity was 97.8%. No serum of healthy controls reacted but that of anisakiasis (45.5%), gnathostomiasis (19.2%), clonorchiasis (15.8%), sparganosis (11.1%), and cysticercosis (6.3%) cross-reacted. Immunoblot analysis on TCLA recognized antigenic proteins of 28- and 30-kDa bands in their dominant protein quantity and strong blotting reactivity. The present results indicate that the ELISA using our TCLA antigen is acceptable by the sensitivity and specificity for serodiagnosis of human toxocariasis. ELISA with TCLA is recommended to make differential diagnosis for patients with any sign of organ infiltration and eosinophilia.

Seroprevalence of Toxocariasis among Healthy People with Eosinophilia

The aim of this study is to determine the Toxocara seropositive rate among healthy people with eosinophilia. A total of 97 people residing in Seoul who were healthy and whose blood eosinophilia was over 10%, as shown by regular health check-ups in 2004, were subjected to this study. Their sera were tested by immunoblotting and ELISA with the antigen of larval Toxocara canis excretory-secretory (ES) protein. Sixty-five sera were band-positive (67.0%). The seropositve control sera were positive to band sizes of 66 kDa, 56 kDa, 32 kDa, and 13 kDa. In ELISA, 63 sera (65.0%) were positive to T. canis ES protein. There was no significant correlation between the IgG ELISA titer and the level of eosinophilia (r = 0.156, P = 0.156). As there were insufficient data to determine whether there were cross-reactions with other helminthic infections, or whether atopy occurred, further studies are required to verify the cause of the seropositive reactions against T. canis ES antigen. Toxocariasis seropositivity is suggested to be the major cause of eosinophilia, since the Toxocara seroprevalence among Korean rural adults was shown to be approximately 5%.

Ocular toxocariasis in Korea

PurposeTo analyze the characteristics and clinical manifestations of clinically diagnosed and serologically confirmed ocular toxocariasis in patients.MethodsThirty-three eyes of 33 patients diagnosed as having ocular toxocariasis at the Hallym University Medical Center between January 1999 and December 2008 were included in the study. The diagnosis of ocular toxocariasis was based on clinical features and confirmed serologically by enzyme-linked immunosorbent assay and immunoblotting. All patients were interviewed by using a structured questionnaire that included risk factors that might account for the introduction of Toxocara larvae. Demographics, social characteristics determined from the questionnaire, and clinical features were evaluated.ResultsA total of 33 eyes of 33 patients were enrolled in this study: 24 (73%) patients were men, and mean patient age was 41.6 ± 11.0 years. Ten of 28 patients (36%) who responded to the questionnaire had a history of contact with pets, and 23 (82%) had a history of consuming raw food. The most common symptoms were blurred vision in 22 eyes (67%) and floaters in six eyes (18%). The toxocariasis was unilateral in all patients, and the inflammation was acute in two-thirds of the patients. In 17 eyes (52%), Toxocara granuloma was found in the peripheral retina. Nineteen eyes (58%) had visual acuity of 20/40 or better at presentation and improved significantly after treatment. Final visual acuity was 20/40 or better in 26 eyes (79%).ConclusionsOcular toxocariasis in Korea usually affects young adults to middle-aged men. The clinical manifestation is unilateral and presents as acute inflammation with a peripheral inflammatory mass. Visual prognosis with appropriate treatment is good.

Seven cases of Diphyllobothrium latum infection

Seven cases of Diphyllobothrium latum infection were proved by collection of worms after praziquantel treatment between October, 1986 and July, 1987. The patients were all males aged 20-44 years residing in Seoul or Ulungdo, Kyungpook Province. All of them had the history of eating several kinds of raw marine fishes, and they had never been to abroad. One of them experienced abdominal pain and 6 experienced natural discharge of a chain of worm segments, but none revealed any sign of anemia. Total 12 worms (1-3/patient) were collected after praziquantel treatment. The worms were 85-423 cm in length, and revealed the characteristic rosette-shape uterus in their gravid proglottides. The average egg size varied 61.0-65.3 x 41.7-46.1 microns. The eggs were yellowish-brown, and ovoid to elliptical. Including the present 7 cases, the total number of human D. latum infections proven by worms in Korea becomes 28 cases.

Revision of the instructions to authors to require a structured abstract, digital object identifier of each reference, and author’s voice recording may increase journal access

In February 2013, I received a message from a database that the Journal of Educational Evaluation for Health Professions (JEEHP) was reviewed for its inclusion in the database. The following are representative of the comments received: Citedness is below expectations; There is no international diversity among authors; Only one issue is published per year; Author instructions need to be described in greater detail. Among our responses to these comments, revised instructions to authors will take effect on May 1, 2013 so that the papers beginning in May 2013 conform to the revised instructions. JEEHP follows Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication (http://www.icmje.org/) if otherwise not described in the instructions to authors; however, instead of simply following the Uniform Requirements, there are several stipulations that would be worth explicitly specifying in the instructions to authors. The three most important changes to the instructions to authors are moving from a non-structured to a structured abstract, requiring a digital object identifier (DOI) at the end of each reference, and requiring the authors’ explanation of their paper in an audio recording of the author speaking or video recording in their mother tongue or in English. A structured abstract has gradually become the rule rather than the exception in medical journals. Structuring an abstract with sections such as Purpose, Methods, Results, and Conclusion, not only provides more systematic information to readers, but assists authors in determining the most important content to include in the abstract. Since most researchers are too busy to read the full text of papers, they usually read only abstracts. A concise and lucid purpose and conclusion in the abstract will lead readers to move to the full text when they find it particularly relevant. Audio or video descriptions of the contents will also increase access to the content for those with disabilities, who share the author’s mother tongue, or who simply enjoy learning in a different modality. Making the audio or video streaming of the authors available on the homepage will promote the content of the papers to internet visitors. Although JEEHP is an international journal indexed in PubMed, PubMed Central, and CINAHL, the number of submissions has remained rather small. In 2012, I received 33 unsolicited manuscripts, and the acceptance rate was 36.4%. The published paper’s authors were from Korea, Nepal, Malaysia, United Arab Emirates, Turkey, Fiji, New Zealand, the United States, and the United Kingdom. The 2012 SCIE impact factor manually calculated from Web of Science was 1.222 when only citable papers such as reviews, research articles (original articles), and brief reports were considered. This value is expected to increase year by year. It has been possible by the help of worldwide good reviewers. JEEHP is an online only journal with volume (year) and article number but no issue number. It is not yet possible to publish this journal with multiple issues that can be easily seen in print journals, since the papers are published as soon as possible after acceptance. Beginning in 2013, social network services such as Facebook or Twitter links, QR codes, Pubreader, and an app for the iPad were added. A mobile web version of JEEHP will appear soon. This year, CrossMark, Fundref, and ORCID provided by CrossRef will be introduced to JEEHP. I will do my best to solicit more manuscripts from a variety of countries to provide invaluable information to medical health professionals worldwide. JEEHP has the merits of gold open access according to the Creative Commons Attribution License and no article processing charge on the author side, two significant incentives to researchers to select JEEHP as a journal for submission. Being indexed in a variety of international databases might be an even greater incentive. This year, JEEHP reached its tenth year of publication. The most recent revision of the instructions to authors is just one more step in a decade-long effort to reach the goal of becoming an outstanding journal focused on disseminating the latest knowledge on educational evaluation across the health professions and around the world.

Malignancy in renal transplant recipients.

With improved management of infectious and cardiovascular complications of renal transplant recipients, prolonged survival with long-term follow up duration, and increasing age of patients, cancer became an increasingly important cause of morbidity and mortality in transplant patients. Literatures indicate three to fivefold incidence of malignancy in solid organ transplant recipients compared with that of general population. Certain types of malignancy, such as skin cancer, Kaposis sarcoma, lymphoma, cervical, oral and anogenital cancer, hepatocelluar and renal cell carcinoma are particularly reported to be high in incidence. Reduction of immunosuppressive medication is the first step to be considered for the management, especially for virus-associated cancer. The inhibitor of mammalian target of rapamycin(mTORi) suppresses the growth and proliferation of tumors in various animal models, cured Kaposis sarcoma and seems to reduce the incidence of de novo malignancies of renal transplant recipients, and is therefore a valuable option for the management of cancer of these patients without increment of the risk of graft rejection.