Background: It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior. Methods: A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and prepandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death. Results: There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs.2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic. Conclusion During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.

Osteoporosis is a known major health problem and a serious disease of the bone, there has been a great need to develop more and newer animal models for this disease. Among animal models used for testing drug efficacy, the minipig model has become useful and effective due to its close similarity with humans (validity), particularly with the pharmacokinetics of compounds via subcutaneous administration, the structure and function of the organs, the morphology of bone and the overall metabolic nature. Based on these advantages, we sought to develop a new animal model of osteoporosis using micropig, which differs from other miniature pigs in the genetic background. Female micropigs were used for the induction of a moderate osteoporosis model by bilateral ovariectomy (OVX) and compared with shamoperated animals. For osteoporosis evaluation, clinical biomarkers such as blood osteocalcin (OSC) and parathyroid hormone (PTH) levels were measured, as well as bone mineral density (BMD) using micro-computed tomography (micro-CT). Compared to sham, OVX animals have decreased blood OSC level, while the blood PTH level increased in blood sera. In addition, we observed the significantly decreased BMDs of tibia region in OVX animals. Based on these results, we report that the micropig model developed in this study can be used to develop a new and effective medical method for diagnosis and treatment of osteoporosis.
Animals ; Biomarkers ; Bone Density ; Female ; Humans ; Models, Animal ; Osteocalcin ; Osteoporosis ; Ovariectomy ; Parathyroid Hormone ; Salicylamides ; Swine ; Swine, Miniature ; Tibia

OBJECTIVES: The purpose of this study was to examine the association of exposures to heavy metals with positive diagnosis for attention-deficit hyperactivity disorder (ADHD) and Tourette's syndrome (TS). METHODS: Study participants included 27 children diagnosed with ADHD (9.9+/-2.9 years of age), 21 diagnosed with Tourette's disorder (10.7+/-2.2 years of age), and 45 normal control children (9.6+/-0.5 years of age). A Perkin-Elmer mass spectrometer was used to measure the concentrations of 5 heavy metals (Pb, Cd, U, Be, Hg) in hair samples obtained from each participant. Each heavy metal concentration was compared among the groups by use of a Kruskal-Wallis test. RESULTS: The levels of lead (p=.006) and cadmium (p=.037) observed in the hair of children diagnosed with ADHD were significantly higher than those found in the control subjects. There were no significant differences observed for heavy metal levels when comparing TS and control subjects. CONCLUSION: We confirmed that lead exposure is a risk factor for ADHD. We also identified that cadmium may be a new candidate risk factor for manifestation of ADHD. We did not find an association between heavy metals and manifestation of TS.
Cadmium ; Child ; Hair ; Humans ; Metals, Heavy ; Risk Factors ; Tourette Syndrome

Diabetes, which has shown an explosive increase in terms of its incidence, is regarded as a serious disease that must be overcome for the sake of human life. Among animal models used for testing of drug efficacy, the mini-pig model has shown a rapid upload due to its many similarities with human, particularly concerning the pharmacokinetics of compounds after subcutaneous administration, the structure and function of the gastrointestinal tract, the morphology of the pancreas, and overall metabolic status. Based on these various advantages, we sought to develop an animal model of type II diabetic mellitus using the Micro-pig, which differs from other miniature pigs. We used six male Micro-pigs for induction of a moderate insulin deficient model with nicotinamide (NIA)/streptozotocin (STZ) treatment and three animals for control. For evaluation of incidence of type II diabetes, we measured blood glucose level, and performed oral glucose tolerance test and immunohistochemistry on pancreatic tissue using insulin antibody. Compared to control animals, all animals treated with NIA/STZ showed high levels of glucose and low levels of insulin. In addition, we observed the partially destroyed beta cell population from tissue of the pancreas in treated animals. Based on these results, we report that the Micro-pig model developed in this study can be used for testing of the efficacy of therapeutic agents for treatment of Type 2 diabetic mellitus.
Animals ; Blood Glucose ; Gastrointestinal Tract ; Glucose ; Glucose Tolerance Test ; Humans ; Immunohistochemistry ; Incidence ; Insulin ; Male ; Models, Animal ; Niacinamide ; Pancreas ; Swine

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.
Anemia ; Angiotensin Receptor Antagonists ; Angiotensins ; Female ; Heart ; Heart Failure ; Hospitalization ; Humans ; Hyponatremia ; Korea ; Multivariate Analysis ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Registries ; Risk Factors ; Stroke Volume

There has been little data on the prevalence of supplement use and the characteristics of the dietary supplement users in the Republic of Korea. This study presents the prevalence and the details of any dietary supplement use and the characteristics of the adults who use dietary supplements in the Republic of Korea. Between May 18 and June 16, 2006, nationwide and population-weighted personal interviews with 6,201 adult aged from 30 to 69 years were conducted and the final sample consisted of 3,000 people with a 49.8% response rate. We examined the prevalence and details of the use of dietary supplements and the characteristics of those who use the dietary supplement among adults. About sixty two percent of adults had taken any dietary supplement during the previous 12-month period in 2006. The most commonly reported dietary supplement was ginseng, followed by multivitamins, glucosamine, probiotics, and vitamin C. Female (versus male), an older age group, a higher family income, those living in metropolitan cities, those with marital experience, those with a higher level of education, and those having medical problems had a greater likelihood of reporting the use of any dietary supplements. The particular relationships differed depending on the type of supplement. The most Korean adults took one more dietary supplement and the dietary supplement users had different demographic and health characteristics compared to those of the nonusers. Research on diet supplements by the medical community is needed in the future.
Adult ; Aged ; Ascorbic Acid ; Complementary Therapies ; Demography ; Diet ; Dietary Supplements ; Female ; Glucosamine ; Humans ; Morinda ; Panax ; Prevalence ; Probiotics ; Republic of Korea

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.
Adolescent ; Anxiety ; Delusions ; Depression ; Dysarthria ; Dystonia ; Gait Disorders, Neurologic ; Hallucinations ; Humans ; Neuroimaging ; Pantothenate Kinase-Associated Neurodegeneration ; Psychotic Disorders ; Rare Diseases ; Siblings ; Substance Withdrawal Syndrome ; Tics

No abstract available.
Attention Deficit Disorder with Hyperactivity

PURPOSE: Surgeons are confronted frequently with the diagnostic and therapeutic challenges in the cases of acute appendicitis in the elderly. Despite the improvements in management, the morbidity and mortality remain high. In order to verify contributing factors of high morbidity and mortality and establish more proper diagnostic and therapeutic strategies, we compared the clinical characteristics and outcomes of acute appendicitis in the elderly with those of younger people. METHODS: We retrospectively reviewed medical records of 30 elderly and 248 younger people who were pathologically diagnosed as appendicitis after an appendectomy. RESULTS: There was no difference in the rates of occurrence of right lower abdominal pain and tenderness between the two people. The rate of appendiceal perforation was significantly higher in the elderly. Prehospital delay was significantly longer in the elderly. Concomitant diseases were more prevalent in the elderly. The hospital stay was significantly longer and the rate of complication was relatively higher in the elderly also. CONCLUSIONS: When a vague and unexplained abdominal discomfort occurs in the elderly, we should suspect and rule out acute appendicitis as the cause of the discomfort. Early aggressive diagnostic and therapeutic interventions are essential components in managing acute appendicitis in the elderly. In addition, perioperative evaluation and prophylactic measures for concomitant diseases are needed to decrease morbidity and mortality in the elderly.
Abdomen, Acute ; Abdominal Pain ; Aged* ; Appendectomy ; Appendicitis* ; Humans ; Length of Stay ; Medical Records ; Mortality ; Retrospective Studies

Neuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for semi-automated fuzzy tissue segmentation. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semiautomated Talairach atlas-based parcellation method. Boys with TS had smaller total brain volumes than control subjects. In the gray matter, although the smaller brain volume was taken into account, TS boys had a smaller right frontal lobe and a larger left frontal lobe and increased normal asymmetry (left>right). In addition, TS boys had more frontal lobe white matter. There were no significant differences in regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. These findings suggest that boys with TS may have neuropathological abnormalities in the gray and the white matter of the frontal lobe.
Adolescent ; Analysis of Variance ; Case-Control Studies ; Cerebellum/*pathology ; Child ; Frontal Lobe/*pathology ; Humans ; Intelligence ; Korea ; Magnetic Resonance Imaging ; Male ; Regression Analysis ; Tourette Syndrome/*pathology/physiopathology