Biomedical subjects

K P Hwang

Publications and source records attributed to K P Hwang.

At least 19 recordsLinked to original sources

PubMed2001

Molecular epidemiology of enterovirus 71 in Taiwan.

Taiwan suffered a severe and widespread outbreak of enterovirus infection in 1998. More than 400 children were hospitalized, with seventy-eight fatalities due to central nerve system (CNS) involvement and cardiopulmonary collapse. Enterovirus 71 (EV71) was incriminated as the causative agent for the fatal cases. To understand the viral molecular epidemiology in this outbreak, fragments of 207-bp length of the VP4 region in 23 Taiwanese EV 71 isolates were sequenced. Pair-wise comparison revealed a 17.5-24.4% difference between the isolates and the prototype BrCr. However, all the changes in the VP4 region of the isolated strains were synonymous substitutions. Phylogenetic analysis was performed on these 23 isolates and 21 others deposited in GenBank. In this study, forty-four EV71 isolates from the world were separated into three distinct genotypes: A, B and C. The EV71 prototype strain, BrCr/70, is the only strain of genotype A. Group B included strains from the United States, Japan and Taiwan. Most strains in genotype B were isolated prior to 1990. Group C consisted of strains from Japan and Taiwan. Most strains of genotype C were isolated after 1990, they were further divided into 3 clusters: i.e. C-1, C-2 and C-3. In Taiwan, two genotypes, B and C-3, were co-circulating during the outbreak in 1998, although a minor group of genotype B may have appeared in Taiwan before 1986. The majority of the isolates clustered in genotype C-3. Genotype C showed a higher evolutionary rate than genotype B (3.9 x 10(-3) vs. 1.4 x 10(-3)) in the VP4 region. There seems to be a worldwide trend with strains of genotype B appearing earlier than strains of genotype C which took over later in the dominance.

Base Sequence↗

PubMed2001

Antimicrobial resistance and serotype distribution of Streptococcus pneumoniae infections in Kaohsiung from 1996 through 1999.

A total of 89 isolates of Streptococcus pneumoniae were obtained from 86 patients during the period from November 1996 through September 1999 at the Kaohsiung Medical University Hospital. The purpose of this study was to determine the antimicrobial susceptibilities and the distribution of serotypes of these isolates, and to correlate these findings with the clinical characteristics of patients. Twenty-one (23.6%) isolates were obtained from patients aged below 5 years, and 38 (42.7%) from patients aged over 65 years. These 86 patients included 53 pneumonia, 13 bacteremia (including 6 with septic shock), 8 urinary tract infection, 8 soft tissue infections, 7 acute exacerbation of chronic bronchitis, 2 ophthalmic infection, and 2 cholecystitis cases. The most frequent serotypes were types 20 (10.1%), 6 (9%), 10 (9%), 11 (9%), and 23 (9%). All isolates were included in the serotypes represented in the 23-valent pneumococcal vaccine. Thirty-four (38.2%) isolates showed reduced penicillin susceptibility by the E-test. The predominant serotypes of penicillin-resistant S. pneumoniae were types 11 (17.6%), 7 (14.7%), 6 (8.8%), 8 (8.8%), and 23 (8.8%). All isolates were susceptible to vancomycin. Resistance rate to erythromycin was 49.4%, chloramphenicol, 20.2%; and trimethoprim/sulfamethoxazole, 61.8%. Multiple resistance (> or = 3 classes of antibiotics) was found in 28 (31.5%) isolates, of which the majority were serotypes 11 (14.3%), 7 (14.3%), 6 (10.7%), 8 (10.7%), and 23 (10.7%).

Adolescent↗

PubMed2000

Late diagnosis of Kawasaki disease is associated with haptoglobin phenotype.

BACKGROUND: Kawasaki disease (KD) is an acute febrile illness characterized by multiple clinical and biochemical features of inflammation and the most common complications of coronary artery abnormality (CAA). Haptoglobin (Hp) is an acute-phase protein whose phenotype is known to be involved in coronary artery diseases. In this paper, we report the investigation of the association of Hp phenotype with the formation of CAA in KD. PATIENTS AND METHODS: Forty-seven consecutive patients with clinically diagnosed KD were admitted. Sera were taken before therapy of intravenous immunoglobulins (IVIG) plus aspirin, and levels of serum proteins were measured by a rate immunonephelometer. The echocardiographic criteria for coronary artery abnormality were evaluated during acute or subacute stages. Hp phenotyping was performed by Western immunoblotting. RESULTS: Duration of fever at diagnosis of KD was significantly different between patients with Hp 2-2 (6.4 +/- 1.2 days, n = 25) and with Hp1 allele (Hp 2-1 plus Hp 1-1; 8.8 +/- 3.5 days, n = 22). In contrast, serum levels of Hp between KD patients with Hp2-2 and with Hp1 allele (297 +/- 121 mg dL-1 vs. 330 +/- 101 mg dL-1, respectively) was not significantly different. On the other hand, no patients with Hp 2-2 (0/25) were recognized as having KD in subacute stage. However, 5 out of 20 patients with Hp 2-1 were recognized in subacute stage, and their incidence of CAA was 80.0% (4/5). CONCLUSIONS: Patients with Hp 2-1 have patterns of delayed or incomplete presentation of clinical symptoms. Therefore, the late diagnosis of KD is associated with haptoglobin phenotype.

Acute Disease↗

PubMed2000

Pulse sequences for interventional magnetic resonance imaging.

Interventional magnetic resonance imaging (iMRI) is different from diagnostic magnetic resonance imaging (MRI) in its spatial, temporal, and contrast resolution requirements due to its specific clinical applications. As a result, the pulse sequences used in iMRI often are significantly different than those used in the more conventional diagnostic arena. The focus of this article is to summarize how iMRI is different from diagnostic MRI, to describe a variety of MRI pulse sequences and sequence strategies that have evolved because of these differences, and to describe some MRI sequence strategies that are in development and may be seen in future iMRI applications.

Body Temperature↗

PubMed1999

Improved device definition in interventional magnetic resonance imaging using a rotated stripes keyhole acquisition.

Keyhole acquisition techniques have been used to reduce image acquisition times primarily in contrast agent studies and via simulation in interventional MRI procedures. More recent simulations have suggested that improved definition of an interventional device [e.g., biopsy needles, radio frequency (RF) electrodes] could be achieved by rotating the keyhole pattern in k-space so that the read out direction lies perpendicular to the device orientation in real space. This study seeks to validate the earlier predictions of improved efficacy of a rotated stripes keyhole acquisition in actual in vitro and in vivo interventional MR imaging procedures. A true-FISP sequence was modified to perform central stripes keyhole (as known as conventional keyhole) acquisitions after a full initial reference data set was acquired. The gradients of this sequence were then modified to rotate the k-space definition and the keyhole stripes by 10 degrees, 20 degrees, 30 degrees, 45 degrees, and 60 degrees from their conventional k-space orientation. Acquisitions were performed during insertion of interventional devices in phantom and in vivo RF ablation procedures, using the modified sequence selected which placed the phase encoding axis at parallel and perpendicular orientations to the devices. Resulting images were compared between the two orientations for needle width and tip accuracy. Apparent needle width was thinner and tip position more accurately determined for placement of phase encoding parallel to the needle in all cases. Rotated keyhole imaging provides the required temporal advantage of conventional keyhole imaging along with a near optimal definition of an interventional device when the phase encoding is oriented parallel to the direction of the needle motion. Magn Reson Med 42:554-560, 1999.

Animals↗

PubMed1999

Epidemiological study of human salmonellosis during 1991-1996 in southern Taiwan.

Within a 6-year period from January 1991 to December 1996, 249 patients of salmonellosis admitted to Kaohsiung Medical College Hospital were enrolled for clinical and microbiological analysis. The number of patients increased by year from 1991 (14 patients) to 1996 (79 patients), especially in the case of nontyphoid salmonellosis. There were 57 different serotypes isolated during these period. Salmonella typhimurium was the most common clinical serotype of human origin in southern Taiwan, followed by S. choleraesuis, S. schwanzengrund, and S. derby. Fever (81.1%), diarrhea (68.9%), and anorexia (44.6%) were the most common manifestations of human salmonellosis. Relative bradycardia was a more important feature in S. typhi group (100%) than nontyphoid salmonellosis. Leukocytosis, especially lymphocytosis, was found especially in nontyphoid, but not in typhoid salmonellosis. Elevated liver function tests were found in the most severe patients, such as S. choleraesuis and S. typhi infections. Malignancy (8.8%), especially hematological malignancy (5.2%), gastrointestinal diseases (8.8%), and diabetes mellitus (6.4%) were the common underlying diseases. Case fatality rate of human salmonellosis was 8% (20/249), especially high in S. choleraesuis group. The severity of underlying diseases may be the major cause in S. choleraesuis group. There was no fatal case with typhoid fever. Very high resistance rate to commonly used antimicrobial agents in nontyphoid Salmonella was noted in southern Taiwan with overall rates of resistance to ampicillin, 67.9%, chloramphenicol, 66.7%, and TMP/SMZ, 42.2%. The emergence of ciprofloxacin-resistant and multiresistant strains was also a major therapeutic problem in this study.

Humans↗

PubMed1999

Salmonella choleraesuis bacteremia in southern Taiwan.

Within a 6-year period from January 1991 to December 1996, 19 patients with Salmonella choleraesuis bacteremia were enrolled for clinical and microbiological analysis. Young children, the elderly and patients with hematological malignancy (36.8%), liver cirrhosis (26.3%), systemic lupus erythematosus (10.5%), chronic renal impairment (10.5%), and peptic ulcer (10.5%) were at high risk of this infection. The ratio of male to female was 3:1. Three cases (15.8%) were nosocomially acquired. Fever (89.5%), chills (57.9%) and anorexia (52.6%) were the most common clinical manifestations. Seven patients (36.8%) presented no gastrointestinal manifestations. Normal white blood cell count was noted in seven patients (36.8%), and neutropenia caused by underlying diseases or severe infection was found in six cases (31.6%). Various types of metastatic focal infections were found, such as septic arthritis, cutaneous infection, spontaneous bacterial peritonitis, and pneumonia. The severe immunocompromised status of patients and the high virulence of this pathogen may contribute to the high case fatality rate (21%). Higher resistance rate to commonly used antimicrobial agents was noted in ampicillin (94.7%), chloramphenicol (89.5%), and TMP/SMZ (63.8%). All strains of S. choleraesuis were susceptible to third-generation cephalosporins and fluoroquinolones. Generally, S. choleraesuis bacteremia should be taken into account in the differential diagnosis of sepsis in immunocompromised patients, even without gastrointestinal manifestations. The third-generation cephalosporins and fluoroquinolones may be the first choice for treatment of this invasive infections.

Adolescent↗

PubMed1999

An indigenous melioidosis: a case report.

Melioidosis is a rare but potentially fatal infectious disease in Taiwan, although it has been endemic in Southeast Asia, especially northeast Thailand, and northern Australia. In this article, we report a male diabetes with fulminant pneumonia, and septicemia caused by Burkholderia pseudomallei without traveling abroad before this episode. Productive cough and intermittent chills, high fever for one week, followed by progressively deteriorating dyspnea, shock, disturbed consciousness status were the major presentations. Blood culture grew B. pseudomallei on the fifth admission day. Unfortunately, the patient died on the 9th admission day, despite intensive care and the broad-spectrum antimicrobial regimen used.

Adult↗

PubMed1998

Heat shock treatment decreases the mortality of sepsis in rats.

Sepsis is an increasingly common and lethal diagnosis in hospitalized patients. In spite of the advances in antibiotics and medical equipment, the mortality rate has not been improved in the last decade. Recently, heat shock proteins (Hsps) have been well documented to play a self-protective role in almost all living cells under various pathological and physiological stresses through a mechanism known as thermotolerance or cross tolerance. The present study was designed to investigate the expression of Hsp72 and the protective role of pre-induction of Hsps in the mortality during different phases of sepsis. Adult male Sprague-Dawley rats were employed in the study. Sepsis was induced by cecal ligation and puncture (CLP). Heat shock treatment was performed 16 hrs before sepsis induction by heating the rats whole-bodily with an electric heating pad under general anesthesia. The mortality rates with time in both control and preheated groups were monitored. Hsp72 was detected by SDS-PAGE, Western blotting and immunostaining in the brain, heart, liver, kidney, lung, adrenal gland, muscle and lymphocytes. The results show that both early (9 hrs post-CLP) and late (18 hrs post-CLP) sepsis failed to increase the synthesis of Hsp72. Previous induction of Hsps by heat shock treatment significantly decreased the mortality rate of late sepsis. Applying a sufficient inducer to lymphocytes of late sepsis reversed the synthesis of Hsp72 from inactive state into an over-expressive situation in vitro. These results suggest that Hsps are involved in the pathogenesis of sepsis and the involvement of Hsps during the progression of sepsis could add to a first line of host defense against invasive pathogens. Searching for an acceptable agent or less invasive method that leads to increased Hsps expression may provide a means for better treatment of severe infection.

Animals↗

PubMed1997

Discovery of encysted Paragonimus westermani eggs in the omentum of an asymptomatic elderly woman.

We report a case of asymptomatic chronic infiltrate of the omentum by eggs of Paragonimus westermani in an elderly woman who had immigrated to Taiwan from mainland China 46 years ago. The patient had a habit of eating raw freshwater crabs from the lakes of eastern China during her period of residence in that country. She stopped eating raw crabs after coming to Taiwan 20 years ago. During surgery for a peptic ulcer complicated by severe bleeding in 1995, her omentum was found to contain many small nodules approximately 2 x 2 x 1.5 cm in size. Biopsy of the nodules revealed eggs of P. westermani embedded in necrotic debris surrounded by capsules. A sputum examination result was negative and a chest radiograph was normal. The majority of the nodules in the omentum were removed during the surgery and praziquantel was given. At the present time, the patient remains asymptomatic.

Aged↗

PubMed1996

Silent transmission of the dengue virus in southern Taiwan.

Immunoglobulin M (IgM) antibody to dengue virus was examined from a total of 3,099 serum samples collected in southern Taiwan. Of 1,232 sera collected from a junior high school and four elementary schools in Liu-Chiu, 35 were IgM-positive, demonstrating that the dengue virus has been circulating on the island, despite the fact that no epidemic has been reported in the past 10 years. Sixteen of 925 sera collected from three elementary schools in Tung-Kang in 1991 were found to be IgM-positive and two of 192 sera from adults in the local community were positive. The IgM-positive subjects tended to be aggregated around a port. Fishing boats that had stopped in neighboring endemic countries were presumed to have introduced the virus periodically, causing a low level of inapparent infections. In the Kaohsiung area, two of 108 suspected clinical cases and four of 642 community-based sera were IgM-positive. Rapid urbanization has provided appropriate circumstances for vector breeding in this area and the high population density has also increased contact frequency between humans and mosquito vectors. This has, in turn, increased the possibility of silent transmission of the dengue virus via either intermittent reintroduction of the virus or continuation of inapparent infections or both. Establishment of a early warning system using the IgM antibody capture-enzyme-linked immunosorbent assay is suggested for effective monitoring of the disease.

Adolescent↗

PubMed1996

[Clinical manifestations and effects of IVGG in patients with Kawasaki disease].

From Jan 1984 till Dec 1992, 293 patients--180 males and 113 females (M:F = 1.5:1)--with Kawasaki disease visited the Pediatric Department of Kaohsiung Medical College Hospital. The mean age from the total cases were 28.5 months (2 months-10 years). Fever was the most common clinical symptom, followed by dry cracked lips (93.5%), pharyngeal injection (92.8%) and conjunctivitis (90.5%). Only 62.6% of the total cases had cervical lymph node swelling of which the prevalence was higher than the previous report of the National Taiwan University Hospital in 1985. Two hundred and ninety-three cases were divided randomly into 3 groups according to the different treatment regimens. The first group of 199 cases whose coronary artery change occurred in 85 cases (42.7%), were treated with aspirin alone. The second group of 80 cases were treated with aspirin and IVGG 400 mg/kg/day for 5 consecutive days. The prevalence of coronary artery abnormalities was 22.5% (18/80). The third group of 14 cases were treated with aspirin and single high dose IVGG (2 gm/kg) for 10-12 hours. Coronary artery abnormalities occurred in 3 cases (21.4%). IVGG, initiated within 10 days of the onset of fever, in conjunction with aspirin decreased the prevalence of coronary artery dilatation and aneurysms significantly in comparison with treatment by the aspirin alone (p < 0.05). However, there was no difference in the prevalence of coronary aneurysm between the groups of single high dose and multiple doses, though the single high dose of IVGG can improve the clinical symptoms quickly and shorten the duration of hospitalization.

Aspirin↗

PubMed1996

Pulmonary hyperinfection with Strongyloides stercoralis.

Strongyloides stercoralis is an intestinal parasite in humans. Infected patients may be asymptomatic or have mild to moderate abdominal symptoms. It may spread to the lungs and, finally, disseminate in the immunocompromised patient. S. stercoralis is an important cause of severe pulmonary infection and death in many areas of the world. Here we describe an 87-year-old man with S. stercoralis pulmonary hyperinfection. He had respiratory failure with severe abdominal distention. Chest x-ray showed infiltration over the right upper lung field. Papanicolaou stain of sputum demonstrated the rabditiform larvae of S. stercoralis. Stool examination revealed S. stercoralis larvae and eggs. He received two courses of albendazole treatment, but died 5 weeks after admission from Gram-negative bacteremia. This case is a classic presentation of the S. stercoralis pulmonary hyperinfection syndrome.

Aged↗

PubMed1995

A model to study cytokine profiles in primary and heterologously secondary Dengue-2 virus infections.

Roles of cytokines in primary and secondary Dengue virus (DV) infections are not completely understood. In this study, we challenged mononuclear leukocytes (MNLs) obtained from non-immune and DV-1-infected donors with DV-2 in vitro to mimic primary and heterologously secondary DV-2 infections, respectively. We found that MNLs in response to DV-2 could release a large amount of interleukin-1 (IL-1 beta) and tumor necrosis factor alpha (TNF alpha). However, IL-1 beta and TNF alpha released by MNLs with primary or heterologously secondary exposure to DV-2 were not significantly different. In contrast, MNLs with heterologously secondary DV-2 infections produced significantly higher amount of interferon gamma (IFN gamma) than those with primary DV-2 infections. These results suggest that IFN gamma, but not TNF alpha or IL-1 beta, may in part participate in the pathogenesis of Dengue shock syndrome (DSS) frequently found in heterologously secondary DV-2 infections.

Animals↗

PubMed1994

Anthelmintic effect of levamisole against Angiostrongylus cantonensis in mice.

Levamisole, in dosages of 2.5, 5, 10, and 25 mg/kg/day, was given orally by orogastric tube beginning 5, 10, 15, and 20 days after the infection of ICR mice with 50 third-stage larvae of Angiostrongylus cantonensis. Medication was given for 7, 14 or 21 consecutive days. The mice in each group were sacrificed 3 days after cessation of treatment and the brains were examined for parasites. Complete anthelmintic effects could be obtained when treatment was started 10 days post-infection with dosages as low as 2.5 mg/kg/day for 21 consecutive days. Over 90% worm reduction was achieved in the two-week treatment group with medication beginning 5 days after infection at diverse dosages. High dose were given in the treatment groups beginning 15 days post-infection. When the commencement of medication was delayed to 20 days post-infection, worm reduction rates were around 50% in spite of long periods and/or high dosages of medication.

Angiostrongylus cantonensis↗

PubMed1993

[Study on coronary artery lesions in patients with Kawasaki disease: recent 9 years' experience].

During a nine year period, two-dimensional echocardiography was used to evaluate the coronary artery lesions in 293 patients with Kawasaki disease. There were 170 males and 123 females (M: F = 1.4:1), with a mean age of 28.5 months (2 months-10 years). Patients were randomly divided into 3 groups according to different treatment regimens: group A, aspirin 60-80 mg/kg alone, 199 patient; group B, aspirin plus intravenous gamma globulin (IVGG) 400 mg/kg for 5 days, 80 patients; group C, aspirin plus a single dose of IVGG 2.0 gm/kg, 14 patients. A total of 106 patients (36.2%) had coronary artery lesions. The prevalence of coronary artery lesions in groups A, B, and C was 42.7%, 22.5% and 21.4% respectively. It was the highest in group A (P < 0.01). Coronary artery involvement occurred with equal frequency in males and females. There was a significantly greater incidence of coronary artery lessons in infants younger than 1 year of age than in older children (P < 0.05). From the serial echocardiographic studies, the coronary artery lesions occurred earliest on the 5th day of onset, with the prevalence of 23.6% in the acute stage, and 35.4% at the subacute stage. The prevalence of coronary artery abnormalities in group A was significantly higher than in group B and C at 2-3 weeks and 7-8 weeks after the onset of the fever (P < 0.01). Coronary artery lesions were further classified into 3 morphologic types: dilated form, fusiform and saccular aneurysm. The prevalence of saccular aneurysms was higher in group A than in group B and C (10.0% vs 1.2%, 0%, P < 0.01). Moreover, the regression rate was also higher in group A than the other groups (P < 0.01). Fifteen cineangiograms were performed on 14 patients and they confirmed the presence of coronary lesions in all cases. Better visualization of the lesions was achieved by cineangiography than by echocardiography, especially in the middle and distal portions of the coronary artery. In group A, a six months old boy expired, 25 days after suffering from fever, due to myocardial infarction and congestive heart failure, which was also confirmed by a postmortem examination. It appears that gamma globulin infusion especially a single high dose regimen, is more effective than the conventional aspirin therapy for Kawasaki disease. The IVGG groups are also associated with a lesser prevalence of coronary lesions, a lesser degree of severity and a greater chance of regression.

Age Factors↗

PubMed1993

Clinical study of Mycoplasma pneumoniae pneumonia.

From 1982 to 1991, we experienced 76 patients with Mycoplasma pneumoniae pneumonia which were confirmed by serologic tests. There were 32 (42%) male and 44 (58%) female patients. One patient had underlying disease of diabetes mellitus while the other patients were in good health. The age ranged from 9 months old to 72 years old. All the patients complained of fever and coughing; 63% had dry cough and 37% had sputum production. Upper respiratory tract complaints such as rhinorrhea, sore throat, or earache were noted in 57% of the patients. Fifty-five percent of the patients had GI symptoms of anorexia, nausea, vomiting, or diarrhea. Other complaints included myalgia/arthralgia (29%), headache (30%), and general malaise (32%). Dyspnea (17%) and chest pain (20%) were occasional complaints. Seventy-one percent of the patients had WBC counts < 10000/cu mm and 29% > 10000/cu mm. The mean value of C-reactive protein (CRP) was 53.1 micrograms/ml, while 16% of the patients had a CRP value above 100 micrograms/ml. Thirty-one percent of the patients were noted to have a transient elevation of serum transaminase. Four different patterns of infiltration were seen in chest radiographic manifestation: 1) peribronchial and perivascular interstitial infiltrates (18.4%), 2) nonhomogeneous patchy consolidations (22.4%), 3) homogeneous acinar consolidations (27.6%), and 4) mixed interstitial and alveolar infiltrates (27.6%). Interstitial infiltration was more commonly seen in pediatric than adult patients (46% vs 20%). Other features of the radiologic manifestation were as follows: unilateral lesions in 80% of patients, single lobe lesions in 77%, lower lobe predominant in 69%, pleural effusion in 7%, and radiographic deterioration in 10%. Mycoplasmal pneumonia should be considered in the differential diagnosis of community-acquired pneumonias.

Adolescent↗

PubMed1991

Detection of IgM antibodies from cerebrospinal fluid and sera of dengue fever patients.

During the dengue epidemic from late 1987 to 1989, 6 specimens of cerebrospinal fluid (CSF) and sera for IgM detection were collected from 4 cases virologically confirmed dengue patients who had neural symptoms. Another 20 serum specimens, which had been diagnosed as dengue infection either virologically or serologically, were sent to the laboratory from Kaohsiung Medical College Hospital. All these specimens were also taken to detect the existence of IgM. The results showed that IgM could be detected from 14 out of 20 serum specimens. One of the positive specimens showed IgM can last up to 252 days after onset of illness. In addition, IgM was detected from both CSF and sera of all four dengue patients with neural symptoms. The IgM titer in CSF (less than or equal to 1:20) was always lower than that in serum (greater than or equal to 1:80). Two cases with sequentially collected specimens showed the fading of IgM titer in CSF. As a matter of fact, it became undetectable about a month after onset of illness, which is apparently different from the situation in serum.

Dengue↗