Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that may trigger Guillain-Barre syndrome (GBS) in selected patients. We describe a case of GBS presenting as marked finger extensor weakness in a 73-year-old woman with COVID-19. Her clinical and electrophysiological findings were consistent with a diagnosis of acute motor axonal neuropathy subtype of GBS with prominent finger dropping. Treatment with intravenous immunoglobulin for 5 days completely resolved her finger extension weakness after 19 months, although other involved extremities recovered earlier at 3 months. This study highlights that COVID-19-associated GBS can present in various forms aside from the classic variant, even in patients without any COVID-19 symptoms. Therefore, it is important to always consider the diagnosis of GBS in patients with COVID-19.

Inclusion body myositis is a rare condition of idiopathic inflammatory myopathy. Prior criteria for the diagnosis of inclusion body myositis essentially required pathological features of rimmed vacuoles, tubulofilamentous inclusions, and amyloid deposits. However, recently developed new diagnostic criteria emphasize clinical characteristics including weakness of finger flexors and knee extensors. In addition, a serological evaluation of anti-cN1A antibody is helpful for the diagnosis. We report a case of inclusion body myositis with clinical, pathological, and serological consideration.

Background: and Purpose Advances in serological tests are transforming the classification of idiopathic inflammatory myopathy (IIM). The new criteria suggested by the 119th European Neuromuscular Center international workshop divide IIM cases into four main diseases according to clinical and pathological findings, adding immune-mediated necrotizing myositis and nonspecific myositis to the classic categories of polymyositis and dermatomyositis. Methods: Seventy one cases of IIM with sufficient available clinical and pathological data were reviewed to be reclassified according to the new criteria. Results: Most of the cases previously classified as polymyositis (77.8%, 35/45) were reclassified as immune-mediated necrotizing myopathy. The results of myositis-specific antibodies matched well with the new clinicopathological classification. Conclusions This new clinicopathological classification for IIM in combination with serological test results could be applied to our previous case series. Adoption of the new criteria will lead to a better understanding of the disease and hence new therapeutic insights.

OBJECTIVES: This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea. METHODS: To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis. RESULTS: An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals. CONCLUSIONS The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.

Deaths caused by grenades hardly occur except for during wartime, and can be seen as a particular incident that can be observed only within the military or by acts of terrorism. However, there has never been any data which tried to analyze the damage patterns through mock grenade explosions. So far, the processes leading to deaths were merely inferred by reconstructing the situation with limited intelligence after the incidents have already occurred. Therefore, the authors believe that having mock grenade explosions in order to compare and study the observances with those of the actual incident will be helpful for a more precise and objective medical jurisprudence, and thus have summarized the damage patterned obtained on 8 butchered pigs, that were 6~8 months old, about 100 cm in length and 70~100 kg in weight by photographing with radioactive rays and running autopsies after detonating grenades on them. In conclusion, if there was extensive loss of body parts, the grenade probably exploded when in contact with the lost body parts. If fractures were found the grenade is likely to have detonated contacting or within 25 cm of distance with the body, and if there were no lacerations or loss of body parts the grenade probably exploded at a distance of at least 50 cm. If soot was prevalent on the deceased's body, the grenade is likely to have exploded within a distance of 25 cm from the body at a free floating state, in which it was not in contact with the ground or the body. Lastly, if no soot was found, the grenade most probably detonated at a distance of 50 cm or more. The posture or the direction of the body cannot give precise clues of the victim's state before theexplosion, and a hasty presupposition could be very dangerous in case of contact explosions especially.
Autopsy ; Bombs ; Explosions ; Hand ; Homicide ; Human Body ; Humans ; Intelligence ; Jurisprudence ; Lacerations ; Military Personnel ; Posture ; Running ; Soot ; Suicide ; Swine ; Terrorism

The authors investigated the death days of 246 people who committed suicide and converted them into their respective days in lunar calendar in order to see if there are any correlations with the cycle of months. The cycle of the months was divided into the first quarter, full moon, last quarter, and the new moon. The death days were investigated by daily statistics each, and they were investigated in relation with the cycle of the months regarding the occurrence of suicide, holidays, and weekends. There were twice as many people committing suicide when the moon is dark than when it is full moon, but there weren't much significance when judging from the big context. There were three times as many people committing suicide in a short period of time when the moon is dark than when it is full moon, but there wasn't much significance when judging from the big context. There wasn't anything special about suicide in daily basis. There wasn't a big inclination in the number of people committing suicide over holidays or weekends despite common belief. If we find the correlation between the psychological factors and the actions of those who commit suicide in the military, we could contribute to adjusting to some extent the actions of those who have the potential of committing a suicide. Out of such expectation was proceeded this research.
Holidays ; Humans ; Military Personnel ; Moon ; Suicide

Fibromuscular dysplasia (FMD) of the coronary artery is a rare cause of sudden cardiac death; however, its prevalence and fatality may have been overlooked so far. A 47-year-old man complained of pain in his back and shoulder and became unconscious. Despite resuscitation, he died 3 hours after symptom onset. The heart weight was in the normal range; however, all three major coronary arteries showed intimal thickening without atherosclerosis or inflammatory cell infiltration. Fragmentations and duplications of the internal elastic lamina which are histologic features of intimal fibroplasia, a focal-type FMD, were observed. The prevalence of coronary FMD remains unknown, although it may be related to spontaneous coronary artery dissection and sudden death. The histopathologic confirmation of coronary FMD and exclusion of other possible coronary diseases through autopsy are essential to reveal the nature of the disease and therefore apply the information in dealing with legal problems after death.
Atherosclerosis ; Autopsy ; Cause of Death ; Coronary Disease ; Coronary Vessels ; Death, Sudden ; Death, Sudden, Cardiac ; Fibromuscular Dysplasia ; Heart ; Humans ; Middle Aged ; Prevalence ; Reference Values ; Resuscitation ; Shoulder ; Tunica Intima

Methylene-tetrahydrofolate reductase (MTHFR) is a homocysteine metabolism-related enzyme and defects of MTHFR is a risk factor for hyperhomocysteinemia and related various neurological disease. Among them, 665C>T polymorphism is the most common form. We report a 48 years old man presenting with progressive psychiatric problems along with severe demyelinating polyneuropathy due to homozygous c.665C>T homozygote polymorphism superimposed by compound heterozygous mutation (c.1417C>T, p.Arg473Trp) in the MTHFR gene, without thromboembolic changes.