자매에서 발생한 한국 토착형 소아 말라리아 2례

곽영호,최승은,나송이,이환종,채종일,Kwak, Young Ho,Choi, Seong Eun,Na, Song Yi,Lee, Hoan Jong,Chae, Chong Il 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.2

Malaria is a febrile disease caused by protozoan parasites, genus Plasmodium. In Korea., indigenous malaria has been believed to be eradicated by 1984, and, thereafter, all of the reported cases were imported malaria. But since the first case report of re-emerging indigenous malaria in 1993, increasing number of cases were reported reaching more than 350 cases in 1996. However, indigenous malaria in children has not been reported yet. We experienced two cases of indigenous malaria in sisters who were 7 and 5 years old, respectively. Elder sister was presented with periodic fever, splenomegaly and mild headache. She had been to Guam before 4 months of the onset of symptoms. Younger sister was suffered from fever and splenomegaly and has not been abroad. They were diagnosed by examination of peripheral blood smear to be infected with Plasmodium vivax and were treated with hydroxychloroquine and primaquine successfully. These cases are believed to be first re-emerging cases of indigenous malaria in children, and malaria should be included in the differential diagnosis of unexplained febrile children.

재난관련 감염병의 관리와 자연재난의 젠더 영향에 대한 고찰

곽영호(Young-Ho Kwak) 이화여자대학교 젠더법학연구소 2020 이화젠더법학 Vol.12 No.3

갑작스럽게 발생하여 사람과 자연, 인공물에 손상을 초래하는 재난과 재난관련 감염병은 최근 코로나19 바이러스 범유행과 관련하여 많은 관심을 받고 있다. 우리나라에서도 태풍, 호우와 같은 풍수해를 비롯한 자연재난이 끊이지 않고 있어 현재 질병관리청을 중심으로 재난과 재난관련 감염병에 대한 대비를 하고 있다. 그러나 아직도 재난, 특히 재난관련 감염병의 감시체계는 미흡한 것이 현실이다. 또한 다양한 분야와의 협력연구가 필요한 재난의학 분야에서 재난의 젠더 영향에 대한 연구는 아직 걸음마 단계라고 할 수 있다. 이 글에서는 첫째, 우리나라 재난관련 감염병 감시체계의 개선을 위한 방안을 제시하고자 하였으며, 둘째, 재난에 의한 젠더 영향에 대한 고찰을 시도하였다. 우리나라 재난관련 감시체계의 개선 방안으로는 1) 기존의 보건소 기반 감시 체계의 개선과 활성화, 2) 이재민 대피소에서의 새로운 감염병 감시 체계 제안, 그리고 3) 재난 피해 지역에 대한 보건응급조사의 활성화와 함께, 4) 국가응급진료정보망(NEDIS)의 적극적인 활용 방안을 그 대안으로 제시하였다. 또한 재난과 재난관련 감염병에 의한 젠더 영향을 살펴본 결과, 사망률과 사회적 불평등을 다룬 대다수의 연구들에서 여성의 취약성과 불평등은 분명한 사실로 보인다. 그러나 일부 문헌에서 논란을 초래하는 결과들이 존재하며 이들의 유형을 분류하면 남성의 생물학적 취약성, 사회경제적 요소와 문화적 요소의 영향, 성 역할의 영향과 함께 주요 결과의 설정에 따른 결론 해석의 문제 등으로 요약할 수 있다. 향후 우리나라에서 재난과 재난 관련 감염병, 젠더 영향에 대한 깊은 성찰과 노력, 이를 위한 다학제적 협력과 제도, 정책의 개선이 필요할 것으로 사료된다. Recently with COVID-19 pandemic, disaster and disaster-associated infectious diseases (DAID) gather lots of attention and concern of people. In Korea, Center for Disease Control and Prevention (KCDC) has already set up the preparedness plan against various types of disasters since its inauguration, however, surveillance system for DAID is not well prepared in Korea. Moreover, the concept or study of impact on gender of DAID is very rare. The aim of this study was twofold: The first aim was to develop advanced surveillance system for DAID in Korea. Second objective was to explore the impact on gender of disasters and DAID. For improvement of the surveillance system for DAID in Korea, we proposed the four practical systems: 1) Improvement of surveillance system based on already present public health center, 2) development of individual and shelter reporting forms in shelter clinic for short-term living centers for disaster victims, 3) adaptation of PHASER (Public Health Assessment for Emergency Response) programs for disaster, and 4) augmented modification and utilization of NEDIS (National Emergency Department Information System). Gender impact by natural disasters has been clearly reported in terms of mortality rate by Dr. Neumayer’s study. In this study adverse effect of natural disasters on female’s life expectancy was proved. In accordance with this study, many other studies also showed similar unequal impact of disaster or DAID on female. However, through the literature review, many mixed, even contradictory results are found. The types can be summarized as follows. By biologic or physiologic vulnerability of male, or by socioeconomic factor, or by cultural background or conventional role model of each community/country, the interpretation of gender impact can be changed or conditioned in some studies. Furthermore, by changing the primary outcome of the study the implication of the result of gender impact can be differed. For better preparedness of disaster and DAID, we need to establish advanced infection surveillance system in Korea in near future. Furthermore, we also need to make inter-science collaboration and to improve legal and social system to mitigate the aftermath of disaster and DAID.

북한강 지류 상천천에 서식하는 대륙종개 Barbatula nuda (Pisces: Nemacheilidae)의 난발생 및 자치어 형태 발달

곽영호 ( Yeong-ho Kwak ),송미영 ( Mi-young Song ),송하윤 ( Ha-yoon Song ) 한국어류학회 2022 韓國魚類學會誌 Vol.34 No.1

대륙종개의 난발생 및 초기생활사 연구를 위해 2020년 4월 26일 북한강 지류인 상천천에서 대륙종개를 채집하였다. 성숙한 암컷과 수컷의 복강에 HCG 10 IU/g를 주사하였고 15시간 후에 건식법으로 인공수정하였다. 대륙종개 암컷 전장 70.64~79.24 mm (n=3)의 포란수는 1,308±293개였고, 성숙란은 황회색의 침성점착란이었다. 수정란의 난경은 1.13±0.01 mm (n=10)였고 수정 후 104시간 만에 부화하였다. 난발생 시 수온 15℃ 그룹의 부화율은 평균 80.1±1.2%로 나타났고, 수온 20℃ 그룹은 61.5±6.8%로 나타나 발생 수온은 15℃에서 적합하였다 (p<0.05). 부화 직후의 자어는 전장 3.12±0.06 mm (n=10)였으며 몸은 투명하였다. 부화 후 4일에는 전장 4.89±0.09 mm (n=10)로 입과 항문이 열리면서 먹이활동을 시작하였고 난황이 모두 흡수되면서 전기자어기로 이행하였다. 부화 후 14일에는 전장 8.66±0.14mm(n=10)로 척색말단이 위로 휘어지기 시작해 중기자어기로 이행하였고 부화 후 21일에는 전장 10.98±0.40mm(n=10)로 척색말단이 45°로 완전히 휘어졌다. 부화 후 26일에는 전장 13.47±0.37 mm (n=10)로 모든 지느러미 기조가 정수가 되어 치어기로 이행하였다. We investigated to elucidate the early life history of siberian stone loach, Barbatula nuda (Pisces: Nemacheilidae). Adult fish were collected using net in the Sangcheoncheon Stream, Cheongpyeong-myeon, Gapyeong-gun, Gyeonggi-do, Korea, 26th April 2020. HCG 10 IU/g was injected to female and male fish and fertilized by dry method in the laboratory. The number of eggs of B. nuda was 1,308±293 (TL: 70.64~79.24 mm), and the egg color was yellowish grey. Fertilized eggs measured 1.13±0.01 mm (n=10) in diameter and showed adhesion. The fertilized eggs started hatching after 104 hours. At the time of egg development, the 15°C group showed an average hatching rate of 80.1±1.2% and the 20°C group showed 61.5±6.8%, so the 15°C group was suitable (p<0.05). Newly hatched larva an average were 3.12±0.06 mm (n=10) in total length. At 4 days after hatching, the total length was 4.89±0.09 mm (n=10), and feeding began with the mouth and anus opened, and entered to preflexion larvae stage. At 21 days after hatching, the total length was 10.98±0.40 mm (n=10), and the distal part of the notochord was bent to 45°, and entered to postflexion larvae stage At 26 days after hatching, the total length was 13.47±0.37 mm (n=10), and entered the juvenile stage.

Group B β-hemolytic Streptococcus에 의한 소아 감염증의 임상상

김윤경,곽영호,김예진,정혜선,홍정연,이환종,Kim, Yun Kyung,Kwak, Young Ho,Kim, Yae Jean,Jung, Hye Sun,Hong, Jung Yeon,Lee, Hoan Jong 대한소아감염학회 1999 Pediatric Infection and Vaccine Vol.6 No.2

목 적 : 이전까지는 국내에서 발생 증례가 적었던 GBS 감염증이 최근에는 자주 접하게 되었다. 이에 최근 수년간의 발생 증례에 대한 고찰을 하여 그 임상적, 역학적 특성을 고찰하고자 하였다. 방 법 : 1985년 6월부터 1999년 6월까지 서울대학교 병원 소아과에서 균이 증명된 GBS 감염증 환아들을 대상으로 하였다. 이들의 의무 기록을 후향적으로 검토하였고, 분려된 일부 균주의 혈청형과 항균제 감수성을 경시하였다. 결 과 : 기간 별 증례 수를 비교해 보면, 1990년대 후반에 그 이전보다 증례가 많았다. 총 27례중 25례가 신생아 감염증이었고, 지발형이면서 뇌막염인 증례가 많았다. 혈청형은 III(6균주), Ib(6), Ia(1)와 II(1)였다. 검사된 10개의 항균제에 대하여 모든 균주가 감수성을 보였다. 결 론 : 국내에서 신생아 GBS 감염증은 증가하고 있는 추세이므로, 신생아 패혈증 또는 뇌막염의 원인균으로서 GBS의 가능성을 고려하여야 하며, 향후 빈도가 더욱 증가하면 산모에게 산전 검사와 예방적 항생제 요법 등을 고려해야 할 것으로 사료된다. Background : Group B ${\beta}$-hemolytic Streptococcus(GBS) has been the major pathogen of neonatal sepsis in western country. In contrast, GBS has played little role in neonatal sepsis in Korea. But recently, neonatal GBS infections are encountered more frequently. It is important to characterize the clinical and epidemiological features of GBS infection in Korean children. Methods: We reviewed retrospectively the medical records of twenty-seven infants and children with GBS infection experienced at the Seoul National University Children's Hospital during 14 year-period from June, 1985 to June, 1999. Fourteen strains isolated from blood and cerebrospinal fluid were serotyped. Minimum inhibitory concentrations of 10 strains were determined by agar dilution method for penicillin, ampicillin, ampicillin with sulbactam, cefarolin, cefuroxime, and cefuiaxone. Results: The numbers of cases with GBS infection increased in 1990s. Among twenty seven cases, twenty-five cases were under three months of age and both of two cases with underlying disease occurred at three years of age. All neonatal infections were late-onset type and meningitis predominated. Serotypes were III(6 strain), Ib(4), Ia(l) and V(2). All of the strain were susceptible to all of the antibiotics tested. Conclusion: GBS infections in infants were increasingly recognized. GBS should be considered as an etiological agent of neonatal sepsis or meningitis in Korea. Maternal screening and prophylactic antibiotic therapy may be considered.

건강보험심사평가원 환자표본자료를 이용한 국내 두부손상의 역학 및 뇌 CT 시행 분석

박소영 ( So Young Park ),정재윤 ( Jae Yun Jung ),곽영호 ( Young Ho Kwak ),김도균 ( Do Kyun Kim ),서동범 ( Dong Bum Suh ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: To understand the epidemiology of head trauma and the utilization of brain CT in Korea, we analyzed a national sampling data set, the National Patient Sample obtained from the Health Insurance Review and Assessment Service. Methods: We retrospectively collected and analyzed demographic and clinical data on enrolled patients from the National Patient Sample based on medical claims data for 2009. The data included patient`s age, sex, treatment date, diagnosis codes, procedure codes related with CT, holiday or night consultation fee, and fee for emergency management services. Results: In 2009, the estimated population with head trauma was 819,059(1.8%), and the rate of brain CT utilization was 22.4%. Children ages 5 to 15 were the most commonly injured group(22.8%), but had the lowest brain CT utilization(16.5%). The mean age of the estimated population with head trauma was 34.9±0.5 years old, and male patients accounted for 60.5% of that population. Intracranial injury was found in 8.6% of all head traumas, and the rate of intracranial injury in children was lower than it was in adults(4.1% vs. 10.9%, p<0.001). Twenty- three percent of patients with head trauma visited the emergency department (ED). More patients with head trauma visited medical facilities in the daytime on weekdays(66.5% vs. 33.5%, p<0.001), but head CT was performed more frequently at night or on weekends/holidays(16.1% vs. 34.7%, p<0.001) There is low incidence of head trauma in the winter in children (p<0.001). In the multivariate logistic regression analysis, patients who were adults, female, or ED visitors were more likely to undergo brain CT (odds ratio (OR): 1.65, 95% confidence interval (CI): 1.47-1.84; OR: 1.40, 95% CI: 1.27-1.54; OR: 7.80, 95% CI: 6.91-8.80, respectively). Conclusion: In this study, we analyzed the national epidemiologic trend for head trauma, and the pattern of utilization of brain CT. (J Trauma Inj 2012;25:152-158)

신성요붕증 가계에서 바소프레신 V2 수용체(AVPR2) 유전자 분석 : AVPR2 유전자 R202C 돌연변이의 발견

박준동,김호성,김희주,이윤경,곽영호,하일수,정해일,최용,박혜원,Park June-Dong,Kim Ho-Sung,Kim Hee-Joo,Lee Yoon-Kyung,Kwak Young-Ho,Ha Il-Soo,Cheong Hae-Il,Choi Yong,Park Hye-Won 대한소아신장학회 1999 Childhood kidney diseases Vol.3 No.2

목적 : 신성 요붕증(Nephrogenic diabetes insipidus, NDI)은 바소프레신(arginine vasoporessin, AVP)에 대한 신세뇨관의 저항성으로 인하여 요농축의 장애를 특징으로 하는 드문 유전성 질환이다. 반성유전형 신성 요붕증은 바소프레신 V2수용체(AVPR2)의 장애에 기인하며, NDI 환자에서 지금까지 다양한 AVPR2의 돌연변이가 보고되었다. 저자들은 임상적으로 반성 유전형 신성 요붕증으로 진단된 가계에서 AVPR2 유전자의 돌연변이를 발견하기 위하여 분자유전학적 검사를 실시하였다. 방법 : 대상환자의 백혈구에서 추출한 DNA로 AVPR2유전자를 polymerase chain reaction-single strand conformational polymorphism(PCR-SSCP)분석하여 이상이 발견된 부분은 클론닝하여 염기서열을 분석하였다. 같은 PCR 산물을 Hae III로 처리하여 PCR-RFLP(restriction fragement length polymorphism) 분석을 하였다. 결과 : AVPR2 유전자를 PCR-SSCP 분석하였을 때 PCR 산물의 정상인과 이동거리의 차이가 발견되어 환아에서 돌연변이가 있고 환아의 어머니는 보인자임을 예측하였고, 염기서열을 분석하여 675번째 염기 A가 G로 치환됨으로 tryptophan이 cysteine으로 바뀌는 R202C 점돌연변이를 발견하였다. 같은 PCR 산물을 PCR-RFLP 분석을 하였을 때 돌연변이로 인한 Hae III의 인지부위의 상실을 확인하였고 환아의 어머니가 이종접합보유자 (heterozygote)임을 확인하였다. 결론 : 저자들은 임상적으로 신성 요붕증으로 확인된 환아와 어머니의 V2 수용체 유전자를 분석하여 R202C 돌연변이를 확인하였다. 신성 요붕증은 진단이 지연되면 성장장애, 정신박약과 사망을 초래할 수 있는 심각한 질환이나, 태생기 또는 신생아기에 진단하면 후유증을 예방할 수 있으므로 조기진단 및 보인자 발견에 분자유전학적 진단 방법을 적극 활용하여야 하겠다. Purpose : Nephrogenic diabetes insipidus (NDI) is a rare X-linked disorder associated with renal tubule resistance to arginine vasopressin (AVP). The hypothesis that the defect underlying NDI might be a dysfunctional renal AVPR2 has recently been proven by the identification of mutations in the AVPR2 gene in NDT patients. To investigate the association of mutations in th AVPR2 gene with NDI, we analyzed the AVPR2 gene located on the X chromosome. Methods : We have analyzed the AVPR2 gene in a kindred with X-linked NDI. The proband and proband's mother were analyzed by polymerase chain reaction-single strand conformational polymorphism(PCR-SSCP) and DNA sequencing of the AVPR2 gene. We also have used restriction enzyme analysis of genomic PCR product to evaluate the AVPR2 gene. Results : C to T transition at codon 202, predictive of an exchange of tryptophan 202 by cysteine(R202C) in the third extracellular domain was identified. This mutation causes a loss of Hae III site within the gene. Conclusion : We found a R202C missense mutation in the AVPR2 gene causing X-linked NDI, and now direct mutational analysis is available for carrier screening and early diagnosis.

권역 응급의료센터에 내원한 비외상성 객혈 환자에서 기관지 동맥 색전술의 장기 생존 효과

천성빈 ( Song Bin Chon ),정성구 ( Sung Koo Jung ),곽영호 ( Young Ho Kwak ),서길준 ( Gil Joon Suh ),유은영 ( Eun Young You ),신상도 ( Sang Do Shin ) 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.2

요골두아탈구 환자에서 방사선 검사 시행과 연관된 인자 분석

장익완 ( Ik Wan Chang ),김도균 ( Do Kyun Kim ),박소영 ( So Young Park ),서동범 ( Dong Bum Suh ),정재윤 ( Jae Yun Jung ),곽영호 ( Young Ho Kwak ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.2

Purpose: In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow. Methods: Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed. Results: A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher`s exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004). Conclusion: One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination weremechanism of injury and consultation with an orthopedic surgeon.

학교 손상과 관련된 병원 전단계 응급 의료 실태 및 위해 환경 요인

송경준 ( Kyoung Jun Song ),정성구 ( Sung Goo Jeong ),곽영호 ( Young Ho Kwak ),서길준 ( Gil Joon Suh ),권운용 ( Woon Yong Kwon ),신상도 ( Sang Do Shin ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Purpose: This study was designed to evaluate the risk factors of injury and pre-hospital emergency service system in school. Methods: A designed questionnaire was made up by nurse-teachers. We described the frequency and the distribution by types of school, gaining method of information about emergency care, education programs and concerns about injury prevention, transportation methods, and number of injured victim. After all school were divided with two groups such as high and low injury group based on median points of injury count, the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of each risk factor were measured using the multivariate logistic regression analysis. Results: 246 female nurse-teachers were responded. Of them, 143 worked at primary school, 50 at middle school, 29 at high school, and 18 at special school, respectively. Injury was the second common cause visiting to nursing room. 43.67% of victims were directly transported by nurse-teacher. Degree of attention about injury prevention was relatively high (63.0%) but education program was not sufficient (83.0%). There were no oxygen devices, ventilatory devices, airway maintenance devices, electrocardiography equipments, and critical drugs except immobilization devices, stretchers, oral antibiotics, and fluids in most schools. Mean number of victim visiting to nursing room due to injury was 2.6 per a day per 1,000 students. Adjusting for related factors, ``disordered shopping and parking area to near school`` (adjusted OR 1.840; 95% CI 1.077~3.143), ``risky window without safety equipment`` (adjusted OR 1.786; 95% CI 1.019~3.131), and ``when number of involved indoor condition was increased by one`` (adjusted OR 1.255 95% CI 1.004~1.568) were significant risk factors on high injury incidence. Conclusion: Injury was one of the most common health problems in school but there was no equipped for emergency care. ``Disordered street near to school`` and ``risky indoor conditions`` were significant risk factors on school injury.

응급의료센터로 내원한 급성 A형 간염 환자의 임상적 고찰

곽영호,신중호,정성구,이중의,서길준,윤여규,이창현 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: We conducted this study to evaluate the clinical manifestations of acute hepatities A in an emergency center. Methods: All hepatitis A patients who visited the emergency center of Seoul National University Hospital from October 1999 to March 2002 were analyzed using a retrospective medical record review. Variables included in the data analysis were age, sex, clinical symptoms and signs, and laboratory findings on initial presentation and their peak values. Results: A total of 31 patients showed positive for the anti-HAV lgM antibody, and 29 patients had apparent hepatitis A. The number of hepatitis A cases per month in 1999, 2000, 2001, and 2002 were 1.33, 0.25, 0.92, and 4.3, respectively. Among the 29 patients, 15 were brought to the emergency center and constituted the study group. The mean age were 22.3 years old. The most common symptoms were nausea and vomiting (100%), followed by fever (86.7%), anorexia (66.7%). Common signs were jaundice (53.3%) and hepatomegaly (46.7%). Seven patients admitted via the outpatient department were older and had a longer duration of symptoms from onset to diagnosis than the study group. The mean values of the initial laboratory tests were serum aspartate aminotransferase (AST) of 3,044 IU/L, alanine aminotransferase (ALT) of 3,521 IU/L, and a total bilirubin of 4.15 mg/dL. The peak mean values of those variables were 4,067 IU/L, 4,662 IU/L, and 7.35 mg/dL, respectively. All patients recovered without complications. Conclusion: Patients with hepatitis A showed benign clinical features. This study revealed a trend of increasing incidence of hepatitis A in adults and suggested the possibility of an outbreak. Further effort to prevent the propagation of the disease is warranted.