Fecal impaction (FI) is a potentially fatal condition characterized by the accumulation of large, hardened fecal masses in the large intestine, resulting in mechanical obstruction. This condition is commonly observed in older adults but can also affect younger populations, particularly patients with psychiatric conditions who face increased risk due to medication side effects, autonomic dysfunction, and inadequate bowel management. This report describes two forensic autopsy cases of fatal FI in patients with neuropsychiatric disorders. The first case involved a 52-year-old man with mild intellectual disability who had received long-term psychiatric treatment. Autopsy findings included marked colonic dilation (maximum diameter >10 cm), ischemic mucosal changes, and a large fecal mass (~2,200 g) obstructing the sigmoid and descending colon. The second case involved a 25-year-old man with severe intellectual disability. Autopsy revealed severe colonic dilation (maximum diameter of 12 cm), extensive FI along rectum and descending colon, and no evidence of alternative causes of death. In both cases, death was attributed to mechanical intestinal obstruction secondary to FI. These cases highlight the forensic significance of FI as a cause of sudden death in patients with neuropsychiatric disorders. Symptoms such as paradoxical diarrhea may be misinterpreted, and the inadvertent use of contraindicated medications (e.g., antidiarrheals) can worsen the condition, contributing to fatal outcomes. Furthermore, forensic evaluation must assess whether inadequate medical intervention or neglect played a role in the progression of FI. Early recognition, proactive bowel management, and interdisciplinary collaboration are critical to preventing fatal events in high-risk patients with neuropsychiatric disorders.

Fecal impaction (FI) is a potentially fatal condition characterized by the accumulation of large, hardened fecal masses in the large intestine, resulting in mechanical obstruction. This condition is commonly observed in older adults but can also affect younger populations, particularly patients with psychiatric conditions who face increased risk due to medication side effects, autonomic dysfunction, and inadequate bowel management. This report describes two forensic autopsy cases of fatal FI in patients with neuropsychiatric disorders. The first case involved a 52-year-old man with mild intellectual disability who had received long-term psychiatric treatment. Autopsy findings included marked colonic dilation (maximum diameter >10 cm), ischemic mucosal changes, and a large fecal mass (~2,200 g) obstructing the sigmoid and descending colon. The second case involved a 25-year-old man with severe intellectual disability. Autopsy revealed severe colonic dilation (maximum diameter of 12 cm), extensive FI along rectum and descending colon, and no evidence of alternative causes of death. In both cases, death was attributed to mechanical intestinal obstruction secondary to FI. These cases highlight the forensic significance of FI as a cause of sudden death in patients with neuropsychiatric disorders. Symptoms such as paradoxical diarrhea may be misinterpreted, and the inadvertent use of contraindicated medications (e.g., antidiarrheals) can worsen the condition, contributing to fatal outcomes. Furthermore, forensic evaluation must assess whether inadequate medical intervention or neglect played a role in the progression of FI. Early recognition, proactive bowel management, and interdisciplinary collaboration are critical to preventing fatal events in high-risk patients with neuropsychiatric disorders.

Fecal impaction (FI) is a potentially fatal condition characterized by the accumulation of large, hardened fecal masses in the large intestine, resulting in mechanical obstruction. This condition is commonly observed in older adults but can also affect younger populations, particularly patients with psychiatric conditions who face increased risk due to medication side effects, autonomic dysfunction, and inadequate bowel management. This report describes two forensic autopsy cases of fatal FI in patients with neuropsychiatric disorders. The first case involved a 52-year-old man with mild intellectual disability who had received long-term psychiatric treatment. Autopsy findings included marked colonic dilation (maximum diameter >10 cm), ischemic mucosal changes, and a large fecal mass (~2,200 g) obstructing the sigmoid and descending colon. The second case involved a 25-year-old man with severe intellectual disability. Autopsy revealed severe colonic dilation (maximum diameter of 12 cm), extensive FI along rectum and descending colon, and no evidence of alternative causes of death. In both cases, death was attributed to mechanical intestinal obstruction secondary to FI. These cases highlight the forensic significance of FI as a cause of sudden death in patients with neuropsychiatric disorders. Symptoms such as paradoxical diarrhea may be misinterpreted, and the inadvertent use of contraindicated medications (e.g., antidiarrheals) can worsen the condition, contributing to fatal outcomes. Furthermore, forensic evaluation must assess whether inadequate medical intervention or neglect played a role in the progression of FI. Early recognition, proactive bowel management, and interdisciplinary collaboration are critical to preventing fatal events in high-risk patients with neuropsychiatric disorders.

Fecal impaction (FI) is a potentially fatal condition characterized by the accumulation of large, hardened fecal masses in the large intestine, resulting in mechanical obstruction. This condition is commonly observed in older adults but can also affect younger populations, particularly patients with psychiatric conditions who face increased risk due to medication side effects, autonomic dysfunction, and inadequate bowel management. This report describes two forensic autopsy cases of fatal FI in patients with neuropsychiatric disorders. The first case involved a 52-year-old man with mild intellectual disability who had received long-term psychiatric treatment. Autopsy findings included marked colonic dilation (maximum diameter >10 cm), ischemic mucosal changes, and a large fecal mass (~2,200 g) obstructing the sigmoid and descending colon. The second case involved a 25-year-old man with severe intellectual disability. Autopsy revealed severe colonic dilation (maximum diameter of 12 cm), extensive FI along rectum and descending colon, and no evidence of alternative causes of death. In both cases, death was attributed to mechanical intestinal obstruction secondary to FI. These cases highlight the forensic significance of FI as a cause of sudden death in patients with neuropsychiatric disorders. Symptoms such as paradoxical diarrhea may be misinterpreted, and the inadvertent use of contraindicated medications (e.g., antidiarrheals) can worsen the condition, contributing to fatal outcomes. Furthermore, forensic evaluation must assess whether inadequate medical intervention or neglect played a role in the progression of FI. Early recognition, proactive bowel management, and interdisciplinary collaboration are critical to preventing fatal events in high-risk patients with neuropsychiatric disorders.

Objective: The purpose of this study is to evaluate the impact of tumor necrosis factor (TNF)-α blocker therapy on the Assessment of SpondyloArthritis international Society Health Index (ASAS-HI) among patients who have failed conventional nonsteroidal anti-inflammatory drugs. Methods: A comparative study was conducted involving axial spondyloarthritis (axSpA) patients treated with either TNF-α blocker or conventional therapy. Patient data, including demographics, disease characteristics, and ASAS-HI scores, were collected before and after treatment. Statistical analysis was performed to compare changes in ASAS-HI scores between the TNF-α blocker and the conventional therapy group. Results: The study population consisted of patients with axSpA, with a mean age of 38.3 years in conventional treatment group and 29.3 years in TNF-α blocker group. Most variables, including C-reactive protein levels, other comorbidities, and disease assessment scores showed no significant difference between groups. Longitudinal analysis within each treatment group from Week 0 to 12 showed no significant change in the conventional treatment group, whereas the TNF-α blocker group experienced a significant reduction in ASAS-HI scores, demonstrating the effectiveness of the treatment. The TNF-α blocker group exhibited a significantly greater improvement in ASAS-HI scores compared to the conventional therapy group. The Bath Ankylosing Spondylitis Functional Index and the Bath Ankylosing Spondylitis Disease Activity Index demonstrated strong positive correlations with ASAS-HI scores, indicating higher disease activity and functional limitation are associated with worse health outcomes in patients. Conclusion The research demonstrates that ASAS-HI scores significantly improve with TNF-α blocker therapy in axSpA patients, underscoring ASAS-HI's effectiveness as a tool for evaluating drug responses.

OBJECTIVES: We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea. METHODS: In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022. RESULTS: In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%. CONCLUSIONS The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Fat embolism syndrome (FES) is a rare but serious complication that primarily occurs in patients with long bone fractures. Herein, we report a case of sudden death due to FES, which was later confirmed by autopsy. The clinical course and pathological findings of the case are also presented. A 79-year-old male pedestrian was struck by a car while crossing a crosswalk, and due to the impact, he flew 4.5 meters away. He was admitted to the emergency room and diagnosed with an intertrochanteric fracture of the right femur. Upon admission, he had clear consciousness and normal vital signs. The patient died 27 hours after trauma during surgery for a right femur fracture. Histological examination revealed fat droplets in lung tissue. The diagnosis of FES was confirmed based on clinical and histological findings.

Ascending aortic aneurysm of the thorax is a condition characterized by an increase in the diameter of the ascending aorta between the aortic valve and the brachiocephalic artery. Most patients with ascending aortic aneurysm are asymptomatic and do not require treatment; the rates of dissection, rupture, and mortality are also low. In this report, we describe the autopsy findings in a case of sudden death due to acute myocardial infarction secondary to the previously asymptomatic, unruptured, and undissected aortic aneurysm of the thoracic ascending aorta extending to the sinus of Valsalva. The findings in this case emphasize the importance of preventive management of asymptomatic ascending aortic aneurysms, and possible mechanisms of sudden cardiac death in patients with uncomplicated ascending aortic aneurysm is also discussed.

We examined the anticancer effects of a novel sirtuin inhibitor, MHY2256, on HCT116 human colorectal cancer cells to investigate its underlying molecular mechanisms. MHY2256 significantly suppressed the activity of sirtuin 1 and expression levels of sirtuin 1/2 and stimulated acetylation of forkhead box O1, which is a target protein of sirtuin 1. Treatment with MHY2256 inhibited the growth of the HCT116 (TP53 wild-type), HT-29 (TP53 mutant), and DLD-1 (TP53 mutant) human colorectal cancer cell lines. In addition, MHY2256 induced G0/G1 phase arrest of the cell cycle progression, which was accompanied by the reduction of cyclin D1 and cyclin E and the decrease of cyclin-dependent kinase 2, cyclin-dependent kinase 4, cyclin-dependent kinase 6, phosphorylated retinoblastoma protein, and E2F transcription factor 1. Apoptosis induction was shown by DNA fragmentation and increase in late apoptosis, which were detected using flow cytometric analysis. MHY2256 downregulated expression levels of procaspase-8, -9, and -3 and led to subsequent poly(ADP-ribose) polymerase cleavage. MHY2256-induced apoptosis was involved in the activation of caspase-8, -9, and -3 and was prevented by pretreatment with Z-VAD-FMK, a pan-caspase inhibitor. Furthermore, the autophagic effects of MHY2256 were observed as cytoplasmic vacuolation, green fluorescent protein-light-chain 3 punctate dots, accumulation of acidic vesicular organelles, and upregulated expression level of light-chain 3-II. Taken together, these results suggest that MHY2256 could be a potential novel sirtuin inhibitor for the chemoprevention or treatment of colorectal cancer or both.

Endogenous endophthalmitis secondary to group B Streptococcus (GBS) is extremely rare, particularly in healthy adults. However, the visual prognosis is poor. We report the first South Korean case of GBS infective endocarditis presenting as endogenous endophthalmitis and skin and soft tissue infection. Cultures of blood, vitreous humor, and pus from skin aspirates yielded a penicillin-susceptible serotype V strain of Streptococcus agalactiae. After 6 weeks, the patient completely recovered from GBS infective endocarditis. However, despite early antibiotic treatment and early surgical intervention, the patient's right eye developed phthisis bulbi and was a candidate for evisceration.
Adult* ; Endocarditis* ; Endophthalmitis* ; Humans ; Patient Rights ; Prognosis ; Serogroup ; Skin ; Soft Tissue Infections ; Streptococcus agalactiae* ; Streptococcus* ; Suppuration ; Vitreous Body