There remains a misperception that non-communicable diseases (NCDs) are predominantly an issue for developed countries and are not major public health problems in low-income countries. North Korea is also often considered as a country with a disease structure that is typical of a low-income country. Infectious diseases and nutritional problems, including tuberculosis and pneumonia, are still major sources of medical discussion. The authors challenge this misperception by reviewing empirical data on epidemiologic and demographic transitions of North Korea and show that the current NCD burden is the main public health issue in North Korea. In result, it can be said that epidemiologic transition and demographic transition of North Korea preceded prior to economic hardship. It is necessary for the international community, including South Korea, to advance in a new direction of medical support for North Korea.
Communicable Diseases ; Democratic People's Republic of Korea ; Developed Countries ; Korea ; Pneumonia ; Population Dynamics ; Public Health ; Tuberculosis

Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion “Reducing the readmission rate” is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

This study aimed to examine the relationship between hemoglobin A1c (HbA1c), one of the indicators of diabetes, and high sensitivity C-reactive protein (hs-CRP), one of the indicators of inflammation. Raw data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2015-2017) was analyzed. Among the patients diagnosed with diabetes, 1,479 adults were selected as subjects for our study, and their HbA1c levels, hs-CRP levels, sex, age, body mass index (BMI), waist circumference, level of triglycerides and high-density lipoprotein (HDL)-cholesterol, hypertension, receipt of diagnosis, monthly average income, education, and drinking and smoking habits were recorded. Multiple regression analysis of hs-CRP was performed by dividing hs-CRP into quartiles using HbA1c as the dependent variable. In Model 1, sex, age, and BMI were adjusted, and in Model 2, sex, age, BMI, waist circumference, level of triglycerides and HDL-cholesterol, hypertension, and receipt of diagnosis were adjusted. In Model 3, Model 2 parameters along with monthly average household income, education level, and drinking and smoking habits were adjusted. HbA1c levels increased as the hs-CRP quartile increased, that is, 2nd Quartile=0.307, p=0.003; 3rd Quartile=0.431, p=0.001; and 4 th Quartile=0.550, p=0.001. Of the various factors related to diabetes, this study examined the relationship between inflammation and diabetes.

Background: Little is known about the surgical discipline in North Korea from the perspective of the outside world. This study aimed to examine the disease entities covered by articles published in the major medical journal in North Korea, “Surgery.” Methods: Content and frequency analyses of 2,132 articles published in “Surgery” from 2006 to 2017 were conducted. Two medical doctors who majored in Surgery and anesthesiology perused the articles and compiled the diseases being elucidated in each article. The diseases described in each article were stratified into 13 surgical subspecialties. Results: Articles from “Surgery,” similar to articles from the Western surgical community, also covered a wide variety of surgical diseases from different subspecialties, and the number of publications continued to grow consistently. Moreover, a number of studies focused on the fields of orthopedics and general Surgery dealing with benign diseases. Some articles focused on minimally invasive surgeries using laparoscopy. Conclusion The studies published in the North Korean journal “Surgery” encompass various clinical areas, but their quality is unclear.

Background: Little is known about the surgical discipline in North Korea from the perspective of the outside world. This study aimed to examine the disease entities covered by articles published in the major medical journal in North Korea, “Surgery.” Methods: Content and frequency analyses of 2,132 articles published in “Surgery” from 2006 to 2017 were conducted. Two medical doctors who majored in Surgery and anesthesiology perused the articles and compiled the diseases being elucidated in each article. The diseases described in each article were stratified into 13 surgical subspecialties. Results: Articles from “Surgery,” similar to articles from the Western surgical community, also covered a wide variety of surgical diseases from different subspecialties, and the number of publications continued to grow consistently. Moreover, a number of studies focused on the fields of orthopedics and general Surgery dealing with benign diseases. Some articles focused on minimally invasive surgeries using laparoscopy. Conclusion The studies published in the North Korean journal “Surgery” encompass various clinical areas, but their quality is unclear.

Atypical hemolytic uremic syndrome (aHUS) is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury without any association with preceding diarrhea. Dysregulation of the complement system is the most common cause of aHUS, and monoclonal humanized anti-C5 antibodies are now recommended as the first-line treatment for aHUS. However, if the complement pathway is not the cause of aHUS, C5 inhibitors are ineffective. In this study, we report the second reported case of aHUS caused by DGKE mutations in Republic of Korea. The patient was an 11-month-old infant who presented with prodromal diarrhea similar to typical HUS, self-remitted with conservative management unlike complement-mediated aHUS but recurred with fever. While infantile aHUS often implies genetic dysregulation of the complement system, other rare genetic causes, such as DGKE mutation, need to be considered before deciding long-term treatment with C5 inhibitors.

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors

PURPOSE: The aim of this study was to investigate and compare the color stability of provisional restorative materials fabricated by 3D printing, dental milling, and conventional materials. MATERIALS AND METHODS: For the experimental groups, two commercially available 3D-printing provisional resins (E-Dent 100; EnvisionTEC GmbH, Germany & VeroGlaze TM ; Stratasys® , USA), two dental milling blocks (PMMA Disk; Yamahachi Dental Co., Japan & Telio® CAD; Ivoclar Vivadent AG, Liechtenstein), and two conventional materials (AlikeTM ; GC Co., Japan & Luxatemp automix plus; DMG, Germany) were used. The water sorption and solubility test were (n=10, respectively) carried out according to ISO4049:2000 (International Standards Organization, Geneva, Switzerland). For the color stability test (n=10), coffee and black tea were used as staining solutions, and the specimens were stored for 12 weeks. Data were analyzed by one-way ANOVA and Tukey’s HSD using SPSS version 22.0 (SPSS Inc. Chicago, IL, USA) (P<.05). RESULTS: Alike and Veroglaze showed the highest values and Luxatemp showed the lowest water sorption. In the color stability test, the ΔE of conventional materials varied depending on the staining solution. PMMA milling blocks showed a relatively low ΔE up to 4 weeks, and then significantly increased after 8 weeks (P<.05). 3D-printed materials exhibited a high ΔE or a significant increase over time (P<.05). CONCLUSION The degree of discoloration increased with time, and a visually perceptiblecolor difference value (ΔE) was shown regardless of the materials and solutions. PMMA milled and 3D-printed materials showed more rapid change in discoloration after 8 weeks.

The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.
Aged ; Bile Duct Neoplasms* ; Diagnosis ; Female ; Follow-Up Studies ; Gallstones* ; Humans ; Ileus* ; Incidence ; Intestines ; Jaundice, Obstructive* ; Liver Function Tests ; Tomography, X-Ray Computed