Background: The coronavirus disease 2019 (COVID-19) pandemic has led to socio-economic issues, highlighting the importance of strengthening health systems for future infectious diseases. This study aims to analyze the relationship between health system preparedness, response levels, and COVID-19 fatality rates across 194 countries. Methods: This study examined various indicators of national health system preparedness and response, including health service delivery, health workforce, health information systems, essential medicines and health products, health financing, and leadership and governance. Results: A correlation was found between the health system and the COVID-19 case fatality rate (CFR). Further examination of specific indicators within health service delivery, health workforce, health information systems, health financing, and leadership/governance showed significant correlations with the CFR. Multiple regression analysis, considering aging and urbanization rates, identified reproductive/maternalewborn and child health, infectious diseases, nursing and midwifery personnel density, birth registration coverage, and out-of-pocket health expenditure as significant factors affecting the CFR. Conclusion Countries with strong health system indicators experience lower case fatality rate from COVID-19. Strengthening access to essential health services, increasing healthcare personnel and resources, ensuring reliable health information, and bolstering overall health systems are crucial for preparedness against future infectious diseases.

Elsberg syndrome is a rare disease of lumbosacral myeloradiculitis, mostly caused by herpes simplex virus type 2 (HSV-2). It frequently has concomitant myelitis, and immunocompromised patients can be fatal with ascending myelitis. Since anti-viral agents might lead to good recovery, clinicians need to be suspicious for conditions of cauda equina syndrome. Detection of viral DNA from cerebrospinal fluid ensures the diagnosis. We report a case of Elsberg syndrome caused by HSV-2 and are to delineate the clinical and radiologic spectrum.

The objective of this study was to investigate the effect of occasional mid-morning snacks (MMS) on dietary behaviors and school life among elementary students. The students, mothers, and teachers from two elementary schools in Seoul were selected. The schools have been provided a steamed sweet-potato or potato, or a piece of ricecake or cake with a pack of milk as MMS 3-4 times a month for more than 3 years. Most students were satisfied with the MMS. Mothers and teachers reported that their children or students were happier, more active, and more energetic in school with MMS. Furthermore, the students answered that they could drink milk better on the day when the school provided MMS. Many students felt that it was relevant to serve a simple menu at lunch time if they were served MMS. Also, students became more interested in school meals or foods with MMS. In addition, mothers who had jobs wanted more frequent MMS. The degree of satisfaction about MMS of the teachers was higher than that of students or mothers. Many teachers thought that their students drank milk better with MMS and further, that it made students to drink more milk on other days. In conclusion, MMS had positive effects on the dietary behavior and school life of elementary students. Therefore, it can be a good option for eliminating skipping breakfast because it provides more nutrition, makes students drink more milk, and allows students to enjoy school activities more.
Breakfast ; Child ; Humans ; Lunch ; Meals ; Milk ; Mothers ; Snacks ; Solanum tuberosum ; Steam

OBJECTIVES: The aim of this study was to reveal how collagenases (matrix metalloproteinase [MMP]-1, 8, 13) and tissue inhibitor of metalloproteinase 1 (TIMP-1) are expressed in immunohistochemistry of retrodiscal tissue in temporomandibular joint disorder patients. MATERIALS AND METHODS: This study was conducted on 39 patients who underwent discoplasty or discectomy. Immunohistochemical staining was undertaken and expression levels of MMP-1, 8, 13, and TIMP-1 were evaluated. The status of internal derangement of disc, osteoarthritis, and joint effusion were analyzed using magnetic resonance imaging (MRI). Disc status observed during operation was also categorized. RESULTS: The more severe disc derangement was observed on MRI, the more increased expression of MMPs and TIMP-1 appeared. Regarding MMP-13 expression, 86.7% of late-stage disc displacement patients showed grade II or III. Expression level of MMPs or TIMP was not statistically significant associated with joint effusion level. In perforation and/or adhesion groups, all patients showed grade II or III expression of MMP-13. Once perforation occurred, MMP-13 showed increased expression with statistical significance. CONCLUSION: MMP-1 and MMP-13 expression seem to be related to progression of osteoarthritis whereas MMP-8 does not seem to have a specific role with regard to temporomandibular joint disorders. TIMP-1 is considered to be partly related to internal derangement rather than osteoarthritis, but it is not significant.
Collagenases* ; Diskectomy ; Humans ; Immunohistochemistry ; Joints ; Magnetic Resonance Imaging ; Matrix Metalloproteinases ; Osteoarthritis ; Temporomandibular Joint Disorders* ; Temporomandibular Joint* ; Tissue Inhibitor of Metalloproteinase-1*

Purpose: A systematic review of the literature on diagnostic and therapeutic indications, techniques, and complications of dacryoendoscopy (DE) was performed. Methods: The authors performed a PubMed search of articles published in English on DE. Data were collected and classified according to the categories of the disease. The clinical outcomes and limitations were particularly analyzed. Results: The lacrimal drainage system from the canaliculus to the inferior meatus could be examined based on the specific anatomical features by DE. The canalicular mucosa is smooth and brightly colored, the lacrimal sac shows covering mucosa with good vascularization and the nasolacrimal duct is lined with bright tubular mucosal folds. DE allows direct visualization of the detailed internal condition of the lacrimal disorders, to directly diagnose the site of obstruction with accuracy and address the causes and recanalize the lacrimal drainage system using assisted micro lacrimal surgical instruments in the tearing patients. Conclusions Better visualization of the lacrimal canal with DE improves the understanding of physiology and precise identification of the obstructing lesions, both of which are the key to a comprehensive management for the tearing patients.

The prognosis of patients with advanced hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) is extremely poor. Herein, we present a rare case of advanced HCC that was treated with sorafenib and radiotherapy, leading to complete remission. This patient had a 9 cm infiltrative HCC occupying almost the entire left lobe with a tumor thrombus extending through the hepatic vein, IVC, and left portal vein. The patient received 400 mg sorafenib twice daily. One year after the start of sorafenib, intensity-modulated radiation therapy for viable HCC and tumor thrombus was performed with a dose of 5,500 cGy. Twenty-seven months after the starting date of sorafenib, there was no intratumoral arterial enhancement, which suggested a complete response according to the modified RECIST criteria. This case suggests that the combination of sorafenib and radiotherapy might provide clinical benefits in patients with advanced HCC with IVC tumor thrombus.

Hepatocellular carcinoma (HCC) is highly prevalent and the third most common cause of cancer-related death in Asia. In contrast to the West, the main etiology of HCC in many Asian countries except Japan is chronic hepatitis B virus infection. Differences in the major causes of HCC lead to significant clinical and treatment differences. This review summarizes and compares guidelines on managing HCC from China, Hong Kong, Taiwan, Japan, and South Korea. From oncology and socio-economic perspectives, factors such as underlying diseases, staging methods, government policies, insurance coverage, and medical resources contribute to varying treatment strategies among countries. Furthermore, the differences in each guideline are fundamentally caused by the lack of incontrovertible medical evidence, and even existing results of clinical trials can be interpreted differently. This review will provide a complete overview of the current Asian guidelines for HCC in recommendations and in practice.

Purpose: The aim of this study was to identify factors related to the vaccination intentions of nursing students before clinical practice. Methods: A descriptive correlational study design was used. The participants were 129 nursing students who were enrolled in one college of nursing in Seoul and were scheduled for clinical training. Data collection was conducted from February 28 to March 7, 2022. The data were analyzed using descriptive statistics, a t-test, ANOVA, Pearson’s correlation coefficient, and a latitudinal regression analysis using the IBM SPSS statistics version 26.0 program. Results: The intention to vaccinate showed a significant correlation with vaccination attitude (r=.72, p<.001), subjective norms (r=.68, p<.001), and perceived behavioral control (r=.63, p<.001). The influencing factors on three intent to vaccinate were vaccination attitude (β=.36 p<.001), subjective norms (β=.31, p<.001), and perceived behavioral control (β=.36, p<.001). The explanatory power of these variables was 69.6%. Conclusion The vaccination rate before the clinical training of nursing students was related to economic burden, a lack of time, and transportation problems that nursing college students experienced during the vaccination process. Therefore, administrative and financial support is needed for improving the vaccination rates of nursing students.

Objectives: ：To describe the differences in long-term outcomes in Alzheimer’s disease (AD) patients according to initial dementia severity. Methods: ：A retrospective chart review of AD patients from a dementia clinic at the University Hospital in Korea was conducted from April 2010 to March 2017. There were 168 patients enrolled, who were divided into three groups based on initial Clinical Dementing Rating (CDR). There were 55 in the very mild group (CDR=0.5 ; mean age 80.64±6.57), 93 in the mild group (CDR=1 ; mean age 80.57±7.28) and 20 in the moderate group (CDR=2 ; mean age 83.00±9.07). Participants were treated with donepezil±memantine. The observation period was 2.44±0.50 years. Cognitive function and severity of dementia were initially assessed by the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery (CERAD-NP) and were annually assessed by Mini-Mental State Exam (MMSE), CDR and CDR-Sum of boxes (CDR-SB). Results: ：The annual decline rate of MMSE score was -0.82 and those of very mild, mild, moderate groups were -0.63, -0.80, -1.96 respectively, while the annual change in CDR-SB score was 0.98, very mild group 0.86, mild group 1.03, moderate group 1.26. Education level, male, initial CDR were found to be significant potential factors in the annual change in MMSE, while initial CDR was a significant potential factor in the annual change in CDR-SB. Conclusion ：It is meaningful that we studied long-term outcomes of anti-dementia medications in real-world clinical setting. The higher the initial severity of AD, the higher the cognitive decline rate.