OBJECTIVES: This study compared the demographic and clinical characteristics of police referrals with referrals from other sources to a psychiatric emergency department. METHODS: A retrospective cross-sectional study was conducted on the data from the psychiatric emergency department of Ulsan University Hospital from January 2014 to October 2017. The study sample consisted of 79 psychiatric patients who were referred by police, and the characteristics of this group were compared with those of 240 psychiatric patients who were referred by other sources. The collected data were analyzed using a chi-square, Fisher's exact test, and independent sample t-tests. RESULTS: Among the 1768 psychiatric emergency visits, 89 (5.0%) were referred by police, and among the 79 referrals by police chosen as the study group, there were 4(5.1%) cases of emergent psychiatric admission. These patients referred by police were more likely to be male and in a lower socio-economic status. Police referrals were more likely to exhibit violent behavior, be restrained, and more likely to visit after working hours. They were notified more rapidly to the psychiatric department, less notified to other departments, and visited the psychiatric outpatient clinics less after discharge from the emergency department. CONCLUSION: The study results highlight the importance of understanding the characteristics of psychiatric emergency patients referred by police and identifying the problems of the current psychiatric emergency services. Systems need to be developed that clarify the roles of police in psychiatric emergencies and facilitate collaboration between police and mental health institutions.
Ambulatory Care Facilities ; Cooperative Behavior ; Cross-Sectional Studies ; Emergencies ; Emergency Service, Hospital ; Emergency Services, Psychiatric ; Humans ; Male ; Mental Health ; Police ; Referral and Consultation ; Retrospective Studies ; Ulsan

BACKGROUND AND OBJECTIVES: There is a seasonal variation in the incidence of diabetes mellitus and cardiovascular disease. Insulin resistance is important in the development of both non-insulin dependent diabetes mellitus (Type II DM) and cardiovascular disease. Hyperinsulinemia, induced by an insulin resistant state, causes the development of a chronic inflammatory response in vascular structures, which is one of the main causes of cardiovascular disease. There have been several studies on seasonal variation in insulin resistance. Therefore, seasonal variation in insulin resistance were investigated to discover if any relationship existed. SUBJECTS AND METHODS: Korean people examined at a health care center were included. The subjects were divided into four groups, according to the season, and a homeostasis model assessment index (HOMA) calculated, as an indicator of insulin resistance, and compared between the groups. RESULTS: Using the homeostasis model assessment, the highest insulin resistance was observed during winter. Also, the body mass index and waist-hip ratio were highest during winter. CONCLUSION: Compensating for other metabolic factors (age, gender, body mass index, waist-hip ratio and season), insulin resistance was still found to be higher during winter. Seasonal variation in insulin resistance can be associated with the incidence of DM or cardiovascular disease. Therefore, a prospective study will be needed.
Body Mass Index ; Cardiovascular Diseases ; Delivery of Health Care ; Diabetes Mellitus ; Homeostasis ; Hyperinsulinism ; Incidence ; Insulin Resistance* ; Insulin* ; Seasons* ; Waist-Hip Ratio

BACKGROUND/AIMS: The nonspecific clinical presentation of acute hepatitis A (AHA) mandates the detection of anti-hepatitis A virus IgM antibodies (IgM anti-HAV) in the serum for obtaining a definitive diagnosis. However, IgM anti-HAV might not be present during the early phase of the disease. The aim of this study was to determine the optimal time for repeating the IgM anti-HAV test (HAV test) in AHA patients with a negative initial test. METHODS: In total, 261 patients hospitalized with AHA were enrolled for this retrospective study. AHA was diagnosed when the test for IgM anti-HAV was positive and the serum alanine aminotransferase (ALT) level was > or =400 IU/L. Repeat HAV test was conducted after 1-2 weeks if the initial HAV test was negative but AHA was still clinically suspected. RESULTS: The results of the initial HAV test were negative in 28 (10.7%) patients. The intervals from symptom onset to the initial-HAV-test day and from the peak-ALT day to the initial-HAV-test day were significantly shorter in the negative-initial-HAV-test group, but on multivariate analysis only the latter was significantly associated with negative results for the initial HAV test (beta=-0.978; odds ratio [95% confidence interval]=0.376 [0.189-0.747]; P=0.005). The HAV test was positive in all patients when it was performed at least 2 days after the peak-ALT day. CONCLUSIONS: The results of HAV tests were significantly associated with the interval from the peak-ALT day to the HAV-test day. The optimal time for repeating the HAV test in clinically suspicious AHA patients with a negative initial HAV test appears to be at least 2 days after the peak-ALT day.
Acute Disease ; Adult ; Alanine Transaminase/blood ; Female ; Hepatitis A/*diagnosis ; Hepatitis A Antibodies/*blood ; Hepatitis A virus/*immunology ; Humans ; Immunoglobulin M/*blood ; Male ; Odds Ratio ; Retrospective Studies ; Time Factors

BACKGROUND: Insulin resistance is a characteristic feature of uremia and recent studies suggested that it might be one of the causes of muscle wasting. Serum insulin-like growth factor 1 (IGF-1) has been known as one of marker of malnutrition in end-stage renal disease (ESRD) patients. However, there were few studies on the relationship between IGF-1 and insulin resistance. METHODS: We measured serum IGF-1, prealbumin, albumin, plasma insulin and glucose concentration and body composition by dual energy X-ray absorptiometry in 20 non-diabetic ESRD patients who admitted to start dialysis. Homeostasis model assessment method of insulin resistance (HOMA-IR) was used for insulin resistance. RESULTS: Patients with IGF-1 <200 ng/mL (n=6) had significantly lower body weight (BW), body mass index (BMI), prealbumin (29.8+/-7.0 vs. 39.7+/-9.3 mg/ dL, p=0.022), Fat mass, pFat (percent fat mass), pFat-limb and HOMA-IR (1.44+/-0.59 vs. 3.47+/-2.22, p=0.04) than those with >200 ng/mL (n=14). IGF-1 showed positive correlations with BMI (r=0.45), prealbumin (r=0.6), Fat-limb (r=0.51), and HOMA-IR (r=0.67). On WHO classification for weight status, IGF-1 seemed to be higher when weight status was increased from underweight (151.8+/-41.6 ng/mL) to overweight (371.8+/-109.8 ng/mL) and these trends were similar to those of HOMA-IR. On multivariate analysis, IGF-1 was independent variable for affecting HOMA-IR. CONCLUSION: Serum IGF-1 concentration seems to be associated with insulin resistance in ESRD patients and reflect body composition, especially fat mass.
Absorptiometry, Photon ; Body Composition ; Body Mass Index ; Body Weight ; Classification ; Dialysis ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Insulin-Like Growth Factor I ; Kidney Failure, Chronic* ; Malnutrition ; Multivariate Analysis ; Overweight ; Plasma ; Prealbumin ; Thinness ; Uremia

In August 2008, forty dogs out of 400 developed oral warts in a breeding farm in Korea. Canine oral papilloma infection is a common disease in dogs. However, there has been no report of an outbreak of canine oral papillomavirus (COPV) in a group of dogs or in dog breeding farms in Korea, and the genetic analysis of COPV in Korea has yet to be performed. This study diagnosed canine oral papilloma from the oral samples of these dogs based on histopathological examination and immunohistochemistry. Polymerase chain reaction was applied to amplify the corresponding products using pre-existing primer sets for COPV and a universal human papillomavirus targeting L1 gene. Further genetic analysis of the major viral capsid gene L1 confirms the sequences of Korean COPV, which shows a close relationship to previously reported COPV. This study describes the histopathological and immunohistochemical characteristics of canine oral papilloma in a group of breeding dogs in Korea and discloses the complete L1 gene sequences of Korean COPV.
Animals ; Base Sequence ; Capsid Proteins/chemistry/genetics ; DNA, Viral/chemistry/genetics ; Disease Outbreaks/*veterinary ; Dog Diseases/epidemiology/*virology ; Dogs ; Immunohistochemistry/veterinary ; Korea/epidemiology ; Lambdapapillomavirus/genetics/*isolation & purification ; Molecular Sequence Data ; Mouth Diseases/epidemiology/*veterinary/virology ; Papillomavirus Infections/epidemiology/*veterinary/virology ; Polymerase Chain Reaction/veterinary ; Sequence Analysis, DNA

The purpose of this prospective study was to verify and compare the strengths of various blood markers and fibrosis models in predicting significant liver fibrosis. One hundred fifty-eight patients with chronic liver disease who underwent liver biopsy were enrolled. The mean age was 41 yr and male patients accounted for 70.2%. The common causes of liver disease were hepatitis B (67.7%) and C (16.5%) and fatty liver (9.5%). Stages of liver fibrosis (F0-4) were assessed according to the Batts and Ludwig scoring system. Significant fibrosis was defined as > or =F2. Sixteen blood markers were measured along with liver biopsy, and estimates of hepatic fibrosis were calculated using various predictive models. Predictive accuracy was evaluated with a receiver-operating characteristics (ROC) curve. Liver biopsy revealed significant fibrosis in 106 cases (67.1%). On multivariate analysis, alpha2-macroglobulin, hyaluronic acid, and haptoglobin were found to be independently related to significant hepatic fibrosis. A new predictive model was constructed based on these variables, and its area under the ROC curve was 0.91 (95% confidence interval, 0.85-0.96). In conclusion, alpha2-macroglobulin, hyaluronic acid, and haptoglobin levels are independent predictors for significant hepatic fibrosis in chronic liver disease.
Adult ; Biological Markers/blood ; Chronic Disease ; Fatty Liver/complications ; Female ; Fibrosis ; Haptoglobins/analysis ; Hepatitis B/complications ; Hepatitis C/complications ; Humans ; Hyaluronic Acid/blood ; Liver Cirrhosis/complications/*diagnosis ; Liver Diseases/complications/*diagnosis ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; alpha-Macroglobulins/analysis

Porphyria cutanea tarda (PCT) is a metabolic disorder that results in a decrease in uroporphyrinogen decarboxylase activity. It is characterized by photosensitivity, bullae formation, and skin pigmentation. There are four types of PCT: acquired, familial, toxic, and hepatoerythropoietic. Uroporphyrin levels are elevated in the urine of PCT patients. PCT can be differentiated from other porphyrias by its clinical characteristics and the porphyrin levels in the serum, erythrocytes, urine, and feces. This metabolic disorder can lead to liver dysfunction as well as histological changes such as fatty infiltration or hepatic fibrosis. PCT rarely manifests as liver cirrhosis. We report herein a case of PCT-induced liver cirrhosis that progressed to hepatic failure.
Blister ; Erythrocytes ; Feces ; Fibrosis ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Failure ; Porphyria Cutanea Tarda ; Porphyrias ; Skin Pigmentation ; Uroporphyrinogen Decarboxylase

BACKGROUND/AIMS: Several studies suggested that serum cystatin C (CysC) is more useful than serum creatinine (Cr) for the assessment of renal function in patients with liver cirrhosis. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and normal Cr level. METHODS: We enrolled patients with cirrhotic ascites and a normal serum Cr level (<1.2 mg/dL). GFR was measured by 99mTc-DTPA renal scan. Serum Cr, CysC, and Cr clearance (CCr) were measured on the same day. Significant renal impairment and severe renal impairment were defined as GFR <60 mL/min and GFR <30 mL/min, respectively. RESULTS: Eighty-nine patients with cirrhotic ascites were enrolled in the study (63 men and 26 women; age, 55+/-11 years). Forty-seven (52.8%) and 42 (47.2%) patients were in Child-Pugh grade B and C, respectively. Serum Cr and CysC levels and GFR were 0.8+/-0.2 mg/dL, 1.1+/-0.3 mg/L, and 73.4+/-25.5 mL/min, respectively. Significant and severe renal impairment were noted in 28 (31.5%) and 2 (2.2%) patients, respectively. GFR was well correlated with serum Cr, CysC, and e-GFRMDRD, while it was not correlated with e-GFRC&G. In multivariate analysis, only CysC was significantly correlated with GFR (beta, 45.620; 95% CI, 23.042-68.198; P<0.001). Serum CysC level was the only independent predictor for significant renal impairment. CONCLUSIONS: Significant renal dysfunction was not rare in patients with cirrhotic ascites, even their serum Cr level is normal. Serum CysC is a useful marker for detecting significant renal dysfunction in these patients.
Adult ; Aged ; Area Under Curve ; Biological Markers/blood ; Creatinine/blood ; Cystatin C/*blood ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Diseases/complications/*diagnosis/metabolism ; Kidney Function Tests ; Liver Cirrhosis/*complications/metabolism ; Male ; Middle Aged ; Multivariate Analysis ; ROC Curve ; Severity of Illness Index ; Technetium Tc 99m Pentetate/diagnostic use

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is an important cause of various gastrointestinal diseases. H. pylori eradication is essential for the cure and prevention of associated diseases. Nowdays, proton pump inhibitor (PPI)-based triple therapy is the standard eradication regimen. The aims of this study were to compare the H. pylori eradication rate of different PPI-based triple therapies and to find out the factors influencing the eradication rate. METHODS: From May 2002 through Febraury 2004, H. pylori infected patients were treated with the eradication regimen based on one of the four PPIs (omeprazole, rabeprazole, esomeprazole and lansoprazole) for 1 or 2 weeks. After two weeks, drug compliance, adverse effects, and smoking history during the eradication therapy were obtained. The follow-up H. pylori test was performed 4 weeks after the completion of therapy. The data were analyzed by Chi-square test and multiple logistic regression analysis. RESULTS: Overall eradication rate was 83.5%. There was no significant difference in eradication rate among four PPIs (p=0.379). Odds ratio (OR) for omeprazole and rabeprazole was 1.15 (95% CI 0.50-2.68); for omeprazole and esomeprazole, OR 1.63 (95% CI 0.68-3.89); and for omeprazole and lansoprazole, OR 1.13 (95% CI 0.50-2.56). Smoking habit, site of ulcer, and the duration of therapy affected the eradication rate significantly. CONCLUSIONS: The efficacy of four different PPIs for H. pylori eradication is similar to each other. Smoking, site of ulcer, and the duration of treatment have significant effects on eradication rates.
Adult ; Anti-Infective Agents/*therapeutic use ; Anti-Ulcer Agents/*therapeutic use ; Comparative Study ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy/microbiology ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Proton Pumps/*antagonists & inhibitors

BACKGROUND/AIMS: We aimed to clarify the association of hepatitis B surface antigen (HBsAg)/hepatitis B core antigen (HBcAg) with the disease status and treatment response in patients with chronic hepatitis B (CHB). METHODS: We investigated 171 biopsy-proven entecavir-treated CHB patients (109 hepatitis B e antigen [HBeAg]-positive, 62 HBeAg-negative). HBcAg expression was positive when ≥10% of hepatocytes stained, and classified into nuclear, mixed, and cytoplasmic patterns. HBsAg expressions were intracytoplasmic (diffuse, globular, and submembranous) and membranous. The histologic activity index (HAI) and fibrosis stage followed Ishak system. RESULTS: In HBeAg-positive patients, older age, increased HAI score, advanced fibrosis, and reduced viral load were observed when HBcAg expression shifted from nucleus to cytoplasm in HBcAg-positive patients, and HBsAg expression from non-submembranous to submembranous in HBcAg-negative patients (all, p<0.05). In HBeAg-negative patients, only intracytoplasmic HBsAg expression patterns had clinical relevance with decreased ALT levels and viremia. In HBeAg-positive patients without favorable predictors of virologic response, negative HBcAg and membranous HBsAg expression predicted greater virologic response (both, p<0.05). The probability of HBeAg seroclearance was higher in patients with increased HAI or lacking HBcAg expression (both, p<0.05). Higher serum HBsAg levels and hepatocyte HBcAg positivity were associated with reduced serum HBsAg during first and post-first year treatment, respectively (both, p<0.05). CONCLUSIONS: Hepatocyte HBcAg/HBsAg expression is a good marker for disease status and predicting treatment response.
Cytoplasm ; Fibrosis ; Hepatitis B Core Antigens* ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis B, Chronic* ; Hepatitis* ; Hepatitis, Chronic* ; Hepatocytes* ; Humans ; Viral Load ; Viremia