With the rapidly spreading coronavirus disease 2019 (COVID-19) pandemic over the past few months, the world is facing an unprecedented crisis. Innumerable lives have been lost to this novel infectious disease, the nature of which supersedes conventional medical understanding. People around the world are sacrificing their daily lives and enduring the crisis regardless of national boundaries and cultural backgrounds. The COVID-19 pandemic is not just a global health crisis, several aspects of life in the post-COVID-19 era are also being contemplated. Experts in unison are warning that the upcoming changes in all areas of life could potentially be far more drastic than ever experienced in the entire human civilization. The medical community is no exception, and therefore, personnel involved in forensic medicine also need to be adequately prepared for the future. Forensic medicine is a branch of medicine dedicated to one of the most important stages of the human lifecycle and has always been at the forefront in times of unprecedented social change. We present new autopsy guidelines in forensic medicine, formulated based on the various infectious diseases that we presently live with and may encounter in the future. In formulation of these guidelines several considerations have been taken into account, namely, the role forensic pathologists should play in the post-COVID-19 era and the necessary preparations as well as the support needed from society to fulfill that role. The present COVID-19 outbreak should be a starting point for formulating improvements in current practices in forensic science, including autopsy biosafety practices and the medicolegal death investigation system.

Objective: We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. Methods: The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. Results: Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. Conclusion There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

Objective: We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site. Methods: The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site. Results: Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups. Conclusion There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

With the rapidly spreading coronavirus disease 2019 (COVID-19) pandemic over the past few months, the world is facing an unprecedented crisis. Innumerable lives have been lost to this novel infectious disease, the nature of which supersedes conventional medical understanding. The COVID-19 pandemic is not just a global health crisis, several aspects of life in the post-COVID-19 era are also being contemplated. Experts in unison are warning that the upcoming changes in all areas of life could potentially be far more drastic than ever experienced in the entire human civilization. The medical community is no exception, and therefore, personnel involved in forensic medicine also need to be adequately prepared for the future. Forensic medicine is a branch of medicine dedicated to one of the most important stages of the human lifecycle and has always been at the forefront in times of unprecedented social change. The autopsy, one of the most important tools of forensic medicine, is also useful to infectious diseases because it identifies the causal relationship between death and infection, reveals medical and epidemiological knowledge, and provides objective evidence for legal disputes. We present new autopsy guidelines in forensic medicine, formulated based on the various infectious diseases that we presently live with and may encounter in the future. In formulation of these guidelines several considerations have been taken into account, namely, the role forensic pathologists should play in the post-COVID-19 era and the necessary preparations as well as the support needed from society to fulfill that role. The present COVID-19 outbreak should be a starting point for formulating improvements in current practices in forensic science, including autopsy biosafety practices and the medicolegal death investigation system.

Background: Non-suicidal self-injury (NSSI) and suicidality are common reasons for child and adolescent psychiatric emergencies. We aimed to investigate the incidence of pediatric emergency department (PED) utilization for psychiatric problems in children and adolescents and to identify demographic and clinical characteristics of youths who visited the PED for suicide attempt (SA) and/or NSSI. Methods: The medical records of children and adolescents who visited the PED for psychiatric problems from January 2015 to November 2019 were reviewed retrospectively.Demographic and clinical variables including psychiatric disorders were collected. We compared the characteristics of youths who presented to the PED for SA and/or NSSI with those of youths without SA or NSSI. Student's t-test, χ2 test, and multivariate logistic regression were used for statistical analysis. Results: During 59 months of observation, 194 youths visited the PED and the number of total PED visits was 336. Among them, 46 youths (23.7%) visited the PED for SA and/or NSSI at least once, and the number of visits was 91 (27.1% of PED visits). Youths with SA and/or NSSI were older (P = 0.001) and more likely to be a girl (P = 0.005) and to report parental absence (P = 0.023). Bipolar and related disorders (P = 0.032) and depressive disorders (P = 0.004) were more common in youths with SA and/or NSSI, while schizophrenia spectrum and other psychotic disorders (P = 0.030) and somatic symptom and related disorders (P = 0.007) were more common in those without SA and NSSI. After adjusting for age, sex, and parental marital status, bipolar and related disorders (odds ratio [OR], 6.72), depressive disorders (OR, 9.59), and somatic symptom and related disorders (OR, 0.12) were significantly associated with SA and/or NSSI. Youths with SA and/or NSSI also stayed longer in the PED (P = 0.007). Conclusion SA and NSSI are one of the main reasons for child and adolescent admittance to psychiatric services in the PED and are associated with psychiatric comorbidities. An appropriate risk assessment for suicidality and self-injury and proper management and referral to mental health services at the PED are of the utmost importance.

A 46-year-old man was found dead at the foot of a mountain, with a bloody knife aside of his neck. A horizontal throat cut wound with multiple vertebral incisions was observed, with damages of neck vessels and pharynx. There were also three stab wounds in the abdomen and a horizontal cut in the anterior side of left proximal arm. He had suffered from depression. Scene circumstances and autopsy findings pointed toward a suicidal etiology.
Abdomen ; Arm ; Autopsy ; Depression ; Foot ; Humans ; Middle Aged ; Neck ; Pharynx ; Suicide ; Wounds, Stab

Purpose: To evaluate the effect of the Active Sentry handpiece of the Centurion Vision System compared to the Centurion Ozil handpiece for phacoemulsification in cataract surgery. Methods: A retrospective study was conducted on 281 patients (449 eyes) who underwent cataract surgery between August 2020 and June 2021. Preoperative measurements, intraoperative parameters, complication rate, and postoperative outcomes were compared between the Active Sentry handpiece and the Centurion Ozil handpiece groups. Additionally, the parameters were compared in different cataract severity groups and multiple predictive factors for the number of active surge mitigation (ASM) actuations were assessed with the Active Sentry handpiece. Results: There were 198 eyes in the Active Sentry group and 251 eyes in the Centurion Ozil group. There were no statistically significant differences between the two groups, as the cumulative dissipated energy in the Active Sentry and Centurion Ozil groups were 8.32 ± 7.74 and 7.87 ± 9.25 μJ, respectively (p = 0.576). Total surgery time, ultrasound usage time, aspiration time, amount of fluid aspirated, postoperative corrected distant visual acuity, and postoperative decrease in corneal endothelial cell density were comparable between the two groups. The significant contributors to the number of ASM actuations were age, preoperative corrected distant visual acuity, axial length, and total ultrasound time. Conclusions There was no clear advantage of the Active Sentry handpiece compared to the Centurion Ozil handpiece. ASM actuation increases with age, poor visual acuity before surgery, short axial length, and prolonged ultrasound usage time. It is expected that in more severe and high-risk cataract surgery, the Active Sentry handpiece functions more effectively, possibly affecting the safety and prognosis.

The stercoral colitis is an inflammatory process involving the colonic wall related to fecal impaction. This rare condition usually has a poor prognosis. We experienced a death case where an 84 years old woman died of stercoral colitis complications after total knee arthroplasty surgery. The fatal complications were peritonitis with systemic inflammatory response syndrome, not accompanying bowel perforations. We would like to show the autopsy case of stercoral colitis and suggest the importance of early suspicion and treatment.
Arthroplasty ; Autopsy ; Colitis ; Colon ; Fecal Impaction ; Female ; Humans ; Knee ; Peritonitis ; Prognosis ; Systemic Inflammatory Response Syndrome

OBJECTIVES: The aim of this study was to examine the drug adherence and treatment effect of the paliperidone long acting injection (LAI) in patients with schizophrenia or other psychotic disorders. METHODS: We reviewed the medical charts of patients who were prescribed paliperidone LAI from January 2010 to April 2014. Date of each injection, last observation, and first admission after use of the drug were obtained. Kaplan-Meier survival analysis was used for calculation of drug adherence. The dose of paliperidone LAI, concurrent oral antipsychotics, and anticholinergic agent was also obtained. Antipsychotics dose was calculated as olanzapine equivalent dose. RESULTS: The drug adherence of the paliperidone LAI on day 365 was 65%. The reasons for all cause discontinuation were follow-up loss, no effect, poor insight, rejection, extrapyramidal symptom, pain, etc. A total dose of 9.1 mg of oral antipsychotics was decreased, while the dose of anticholinergic agent was increased. CONCLUSION: The drug adherence of the paliperidone LAI was 65%, which was concordant with previous studies. The dose of concurrent oral antipsychotics was increased, while the dose of anticholinergic agent was decreased.
Antipsychotic Agents ; Follow-Up Studies ; Humans ; Medication Adherence ; Psychotic Disorders ; Schizophrenia ; Treatment Outcome ; Paliperidone Palmitate

Objective: This study aimed to explore the mediating effects of cancer-related dysfunctional beliefs regarding sleep and intolerance of uncertainty on the effect of depression, insomnia, and anxiety on fear of progression (FoP). Methods: We retrospectively reviewed medical records of patients with cancer who visited the Sleep Clinic for cancer patients in Asan Medical Center for the first time between December 2021 and March 2022. Data collected included age, sex, types of cancer, staging, current treatment modalities, and history of surgical procedures. In addition, psychological symptoms were rated using the Insomnia Severity Scale (ISI), Patient Health Questionnaire–9 items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Short form of Fear of Progression Questionnaire, Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), single item of pain and fatigue, Connor Davidson Resilience Scale 2-item (CD-RISC2), and Intolerance of Uncertainty–12 (IUS-12). The predictive variables for FoP were determined by linear regression analysis. Results: The FoP was significantly correlated with age (r=-0.289), ISI (r=0.178), PHQ-9 (r=0.703), STAI-S (r=0.377), fatigue (r=0.452), CD-RISC2 (r=-0.270), IUS-12 (r=0.585), and C-DBS (r=0.427, all p<0.01). A mediation analysis showed that intolerance of uncertainty and dysfunctional beliefs about sleep mediated the relationship of FoP with insomnia, depression, or anxiety. Conclusion Psychological support for intolerance of uncertainty and cancer-related dysfunctional beliefs about sleep in patients with cancer may be beneficial to reduce their FoP.