The Relation of High-Sensitivity C-Reactive Protein with Hyperuricemia: Using Health Examination Data at One Medical Institution’s Health Examination Center (2016–2017)

Background@#Several studies have shown that elevated serum uric acid levels are associated with cardiovascular disease. High sensitivity C-reactive protein (hs-CRP) has been shown to be a measure of the severity and prognosis of cardiovascular disease. The aim of this study was to investigate the association of hs-CRP with hyperuricemia. @*Methods@#From March 2016 to November 2017, a total of 26,987 patients who received a health check-up at a Soonchunhyang University Cheonan Hospital, Korea, were enrolled. Foreigners, patients who had hs-CRP score greater than 10 or white blood cell score greater than 10,000, those who did not respond sincerely, those who had previously been diagnosed with gout and cerebrovascular disease, and females were excluded. Data were collected from 2,808 patients. @*Results@#The subjects were divided into four sections by 25th percentile, 50th percentile, 75th percentile, and 100th percentile based on the distribution of hs-CRP. Serum hs-CRP levels were 1.85 (1.34–2.56), 2.59 (1.90–3.54), and 3.64 (2.70–4.93) respectively in the second, third, and fourth quartiles based on the first quartile. The odds ratios were 1.46 (1.05–2.03), 1.76 (1.27–2.45), and 2.27 (1.64–3.14) after adjusting the disturbance variables of age, body mass index, smoking status, and regular exercise. @*Conclusion@#In this study, we evaluated the relationship between serum hs-CRP and hyperuricemia, which are the risk factors for cardiovascular disease, and found statistically significant correlations. These results were still significant after adjusting for age, smoking, exercise, and body mass index.

The Change of Metabolic Syndrome Prevalence and Its Risk Factors in Korean Adults for Decade: Korea National Health and Nutrition Examination Survey for 2008–2017

Background@#Metabolic syndrome is a nationwide health problem, which is associated with the development of cardiovascular diseases, diabetes, and chronic renal failure. The prevalence of metabolic syndrome in Korea significantly increased from 1998 to 2007. After that, the prevalence was stable in female but still increasing in male. The objective of this study was to evaluate how the prevalence and risk factors for metabolic syndrome changed in Korean adults through the last decade. @*Methods@#Data from the Korea National Health and Nutrition Examination Survey 2008 to 2017 was used. National Cholesterol Education Program Adult Treatment Panel III were used to define metabolic syndrome. We compared how each metabolic syndrome component and the risk factors changed through the years. @*Results@#A total of 51,177 (30,092 female and 21,085 male) people were included in this study. The prevalence of metabolic syndrome in male increased from 24.5% in 2008 to 28.1% in 2017, whereas that in female was stable at 20.5% in 2008 from 18.7% in 2017. Waist circumference measurements and fasting glucose levels increased through the decade in male, whereas only fasting glucose levels increased in female. @*Conclusion@#Since the last decade, the prevalence of metabolic syndrome in Korean adults has increased in male but remained stable in female. Lifestyle intervention in male, namely ceasing smoking and drinking could prevent increasing metabolic syndrome prevalence in Korean adults.

Association between Glycated Hemoglobin A1c and Intraocular Pressure in Nondiabetic Subjects

BACKGROUND: Diabetic patients are known to have unusually high mean intraocular pressure (IOP); attributable to autonomic dysfunction and genetic factors. A recent study reported that diabetic complications occur in not only diabetes but also prediabetes. We performed this study to analyze the relationship between glycated hemoglobin A1c (HbA1c) levels and IOP in non-diabetics using electronic medical records at the health screening center of Soon Chun Hyang University Seoul Hospital.METHODS: We considered 16,643 individuals who visited the health screening center of Soon Chun Hyang University Seoul Hospital between November 2015 and September 2017. In total, 3,029 subjects were included in the study. Exclusion criteria included a history of hypertension, diabetes, stroke, cardiovascular disease, hepatitis (A-C), cancer, other disease, fasting blood glucose of 126 mg/dL or higher, HbA1c of 6.5% or higher, and individuals whose binocular IOP could not be measured. We categorized subjects into two groups; those with HbA1c less than or equal to 5.6%, and those with HbA1c greater than 5.6% and less than 6.5%. The mean IOP of each group was compared by gender.RESULTS: After adjusting for factors affecting IOP, analysis of variance was performed to analyze the relationship between HbA1c and IOP. There was no statistically significant difference between the HbA1c groups in males. However, there was a significant difference in IOP between females in the the higher and lower HbA1c groups.CONCLUSION: There was a statistically significant relationship between mean IOP and HbA1c in females without diabetes. Further research is needed with prospective and extensive data collection.

The factors associated with Vitamin D deficiency in community dwelling elderly in Korea

BACKGROUND/OBJECTIVES: Recent studies showed vitamin D deficiency is linked to chronic diseases in addition to skeletal metabolism which could threaten the elderly. We analyzed health conditions and socio-demographic factors associated with vitamin D deficiency in community dwelling people aged 65 years and older. SUBJECTS/METHOD: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 to 2012 were obtained. A total of 2,687 subjects aged 65 years and older were participated. The cutoff value of the Vitamin D deficiency was considered as serum 25-hydroxyvitamin D [25(OH)D] ≤ 20 ng/mL (50 nmol/L). RESULTS: The overall prevalence rate of vitamin D deficiency in the elderly was 62.1%. The factors such as female, obesity, metabolic syndrome, current smoker, and skipping breakfast were positively associated with vitamin D deficiency, but high intensity of physical activity and more than 9 hours of sleep duration were negatively associated with vitamin D deficiency (all P < 0.05). CONCLUSIONS: It is important that health professions know that the factors proved in this study are connected to vitamin D deficiency thus provide information and intervention strategies of vitamin D deficiency to old aged people.

Accuracy of Capillary Blood Glucose Test When Fasting in Diabetes Patients or General Population: Performance Evaluation of G300 Based on ISO 15197:2013 Standards

BACKGROUND: Self-monitoring of blood glucose plays an important role in management of diabetes mellitus. Blood glucose measurement is based on using plasma glucose separated from whole blood, but many people with diabetes and health care providers use a portable glucose meter for convenience. The aim of this study was to evaluate the accuracy and agreement of G300 portable glucose monitoring system against standard venous glucose testing methods, based on ISO 15197:2013 standards. METHODS: This study was the evaluation of G300 system accuracy following ISO 15197:2013 standards. We estimated precision, system accuracy, hematocrit interference, interfering substances, and user performance. RESULTS: In repeatability precision evaluation of those glucometers, standard deviation was 2.9–3.7 mg/dL at glucose levels under 100 mg/dL and coefficient of variation was 1.7–3.2% at glucose levels over 100 mg/dL, respectively. In accuracy evaluation, 99.5% of difference values between results of G300 portable glucose monitoring system and clinical laboratory were within 95%. Consensus Error grid analysis showed that all values (100%) are within zone A. Hematocrit range between 20% and 60% did not cause interference. These results were acceptable for the ISO15197:2013 criteria in all glucose concentrations. CONCLUSIONS: This study showed that G300 can provide reliable blood glucose results for patients and health care providers to manage diabetes mellitus, satisfying the ISO 15197:2013 criteria.

The Analysis of Risk Factors of Gall Stone Associated with Metabolic Syndrome

OBJECTIVE: Recently, the prevalence of gall stone related with metabolic syndrome is increasing in Korea. The aim of this study was to reveal a relationship between components of metabolic syndrome and the development of gall bladder stones. METHODS: Among the subjects who visited a health promotion center of Soonchunhyang University Hospital from March 2009 to March 2010, a total of 5,201 adults were examined. Among them, the final 5,052 (male 3,403, female 1,649) adults were included. Sex, age, body mass index, waist circumference, blood pressure, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol levels, and the presence of gall stones were measured. Metabolic syndrome was defined by criteria of 2004 American Heart Association/Updated National Cholesterol Education Program Adult Treatment Panel III. Analyses were adjusted by age and sex. RESULTS: This study showed that the prevalence of gall stone was 1.6% and metabolic syndrome was 19.3%. The results didn't show an association between gall stone risk and components of metabolic syndrome. But gall stone risk was increased according to aging, high total cholesterol in the abnormal body mass index group. In normal body mass index group, waist circumference was related with the development of gall stone. Total cholesterol level was related with the development of gall stone in overweight group. CONCLUSION: This study showed total cholesterol levels and waist circumference related with prevalence of gall stone in specific body mass index group.

A Case Report of Fitz-Hugh-Curtis Syndrome due to Chlamydia in 19-year-old Woman

Fitz-Hugh-Curtis syndrome (FHCS)-inflammation of the liver capsule (Perihepatitis) associated with genital tract infection-occurs in 4~14% of patients with pelvic inflammatory disease (PID). Generally presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis. It needs differential diagnosis such as cholecystitis, pyelonephritis. The pathogenesis of FHCS is incompletely understood. But Neisseria gonorrhoeae and Chlamydia trachomatis are thought to be the primary causative germs of FHCS. We make a report about FHCS in 19-year-old woman who had been sexual history recently.

Comparing Various Short-Form Geriatric Depression Scales in Elderly Patients

BACKGROUND: A 15-item GDS form is now widely used to screen for depressive symptoms in elderly patients, but even the 15-item version seems fairly long for routine use in busy outpatient settings. This study was conducted to determine which of the three short-form GDS tools with four or five questions extracted from the 15-item GDS tool could be a valid alternative to the 15-item GDS. METHODS: This study was performed using a questionnaire survey of 102 elderly patients over sixty-five, who had either visited or had been admitted in either one of the two universities hospitals in Seoul or ChungCheong district from October 1999 to June 2004. Questionnaire contained demographic and statistical characteristics, items related to health behavior, 15-item GDS, Mini-Mental State Examination Korean (MMSE-K) and activities of daily living. Three scales, namely, D'Ath GDS-4, Van Marwijk GDS-4, and Hoyl GDS-5 were compared to the 15-item GDS. Sensitivity, specificity, positive predictive value and the area under the ROC curves were calculated for each short-form GDS scales. RESULTS: The mean 15-item GDS score was 7.4+/-3.3 and 69.6% of the subjects were to have suggested depression. Hoyl GDS-5 instrument had the highest sensitivity of 87.3%, specificity of 80.6%, and positive predictive value of 91.1% among the three short-form alternatives. The 5-item Hoyl GDS version had the highest area under the curve (0.84), compared to 0.76 for the 4-item Van Marwijk and 0.66 for the 4-item D'Ath GDS version. CONCLUSION: The 5-item Hoyl GDS had superior validity over the D'Ath GDS-4 and Van Marwijk GDS-4. The GDS5/15 may be an effective alternative screening tool.

COX-2 and iNOS Expression and Microvessel Density by Microsatellite Instability in Colorectal Cancer

PURPOSE: We tried to identify the overall incidence of microsatellite instability (MSI) and the utility of mismatch repair (MMR) protein expression in sporadic colorectal cancers in Korean. We also investigate the role of angiogenesis in colorectal cancers by MSI status. METHODS: A total 85 resected colorectal cancers were submitted for MSI study using PCR methods with 5 markers and immunohistochemistry (IHS) for hMLH1 and hMSH2. Expression of COX-2 and iNOS and microvessel density by IHS were correlated with various clinicopathologic prognostic factors. RESULTS: Among 85 cases of sporadic colorectal cancers, MSI was observed in 11 cases (12.9%) including 10 MSI-H and 1 MSI-L cases. Patients with MSI (+) showed female prevalence (1.75 : 1), low Dukes stage, mucinous histologic type, and Crohn-like lymphoid reaction than those with MSS. Overall sensitivity of hMLH1 and/or hMSH2 expression was 98.6% and specificity was 72.7%. iNOS expression was significantly correlated with COX-2 expression in tumor cells (P=0.006), however, they were not correlated with MSI status. High microvessel density was correlated with hMLH1 expression (P=0.025), COX-2 expression (P= 0.05), and Crohn-like lymphoid reaction (P=0.041). CONCLUSIONS: IHS for MMR proteins is a valuable substitute of MSI status and COX-2 related neoangiogenesis is thought to be related to inhibition of microsatellite unstable colorectal cancer progression via decreased microvessel density.

The Relation of Nonalcoholic Fatty Liver Disease to Metabolic Syndrome

BACKGROUND: The aim of this study was to elucidate the relationship between nonalcoholic fatty liver disease diagnosed by ultrasonography and the metabolic syndrome defined by NCEP-ATP III criteria. METHODS: Sixty-nine adult male subjects with negligible alcohol consumption underwent an anthropometric and laboratory investigation. The ultrasound scan of the liver was performed to determine the presence and the severity of nonalcoholic fatty liver disease. RESULTS: Nonalcoholic fatty liver disease was diagnosed in 36 cases by ultrasound scan. According to the severity of nonalcoholic fatty liver, triglyceride, HDL- cholesterol, alanine aminotransferase, aspartate aminotrasnferase, fasting insulin level, HOMA-IR, and obesity related variables (body mass index, percent body fat, waist circumference) showed a significant difference. The independent variables which account for the severity of nonalcoholic fatty liver disease was waist circumference, and alanine aminotransferase which is a predictor of nonalcoholic steatohepatitis. The prevalence of metabolic syndrome was 41% vs 6.1% in nonalcoholic fatty liver group vs control group, respectively, and the odds ratio was 11.1 (95% CI 2.29~53.6). The prevalence of nonalcoholic fatty liver was increased with increasing the number of features of metabolic syndrome. CONCLUSION: Nonalcoholic fatty liver disease was closely related to the metabolic syndrome and the severity classification of nonalcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance, and the risk of nonalcoholic steatohepatitis.

Factors Related to Cognitive Impairment of Elderly Patients in Kyongin District

BACKGROUND: With the rapid increase in elderly population arousing from development of medical technology and in standards of living, mental disorders as well as organic disorders according to aging constitute a serious social problem. This study aimed to find a factor related closely to cognitive impairment by analyzing the risk factors influencing cognitive impairment, which is one of the typical geriatric neuropsychiatric conditions. METHODS: This study was conducted using a questionnaire survey and history taking and physical examination was done in 200 elderly patients over sixty-five, who had visited either of the four universities hospitals in the Kyongin district from July 1997 to June 2002. A variety of factors being widely known to be related to cognitive impairment by was investigated using the existing comprehensive geriatric assessment. By using MMSE-K (Korea version of Mini- Mental State Examination), the relation between cognitive impairment and each variable was analyzed by using chi-square test and logistic regression analysis with SPSS 10.0k/PC statistical program. RESULTS: The number of males and females was 73 (36.5%) and 127 (63.5%), respectively, among the total number of 200 examinees. Males and females having symptoms of cognitive impairment was 25 (34.2%) and 49 (38.6%) among the total number of 74 (37%), respectively. Total mean point of MMSE-K was 24 5.4, 24 5.3 in males and 23.9 5.5 in females. According to the results of multi-variable quantities analysis, it was shown that the cognitive impairment had positive relation to age (P= 0.004), but negative relation to regular exercising (P= 0.016), instrumental activities of daily living (P=0.039) and social support (P=0.003). CONCLUSIONS: The factors having a close relation to cognitive impairment of elderly people were social support, age, regular exercising and instrumental activities of daily living.

An Analysis of Outpatient Prescription before and after the Implementation of the Medical Reform in an University Hospital

BACKGROUND: In Korea before the enforcement of the medical reform in July 2000, it was generally difficult to analyze the conditions of prescriptions in hospitals and clinics. It was true that the circulation process of prescribed medicine was unclear and that there was no support between medical and pharmaceutical industries with the government. Also with the reality of high rate of pharmaceutical expenses among medical costs in Korea, it was necessary to enforce reform of medical and pharmaceutical industries and for our citizens to follow the new reform as well in order to prevent drug abuse and reduce medical costs. This research was to provide basis for future studies on prescription conditions and related factors through compared analysis of before and after the medical reform by analyzing university hospital prescriptions. METHODS: A comparison and analysis of patients, who visited a university hospital for medical treatment, was dpme. There were 23,974 patients in March 2000, and 22,550 patients in March 2001. During these periods 16,870, 12,919 prescriptions were each issued, respectively. RESULTS: There was a total of 46,524 outpatients with 29,789 prescription issued. There were 23,974 outpatients in March 2000 and 22,550 in March 2001 with 16,870 and 12,919 prescriptions, respectively. Among the outpatients, there were 20,769 men (44.6%) and 24,471 women (52.6%) with 13,527 and 16,209 prescriptions, respectively. In comparing the outpatients and prescription issued patients in March 2000 and in March 2001, both men and women showed decrease in the number of prescriptions (P <.001). Also in the ages between 0-15, 16-40 and 41-65, there was a clear evidence of decrease in the number of both outpatients and prescription issued patients (P<0.001). However in the age group of 65 and over there was an increase of 4,453 patients from 3,956 outpatients. The patient analysis in March 2000 and March 2001 excluding the outpatients in emergency, urology, dentistry and radiology shows a decrease in the number of patients in medical departments in general. Also except for the increase of prescription authorized patients in dentistry, urology and family health, it showed a decrease. In general, there was a decrease in the number of cases in the issuance of prescriptions excluding few item changes in the upper 1st to 10th medicine categories in prescribed frequencies. For prescribed medicine categories no vast difference existed. In total medicine categories, there was a decrease in injections from 24.5% to 12.3% and increase of oral medications from 64.5% to 73.8%. Also there was a significant decrease of prescriptions in injections for antibiotics and significant increase of prescription for anti-hypertensive agents such as Angiotensin Converting Enzyme inhibitors. CONCLUSION: This study involved before and after the reform of prescription conditions and obtained related factor information. The results may differ depending on the type of a hospital, patient distribution and local area, but has provided valuable basic research information which did not exist in previous university hospital unit. Hence in relation to the before and after the medical reform, future studies on diseases and on significant changes in elderly patient care, antibiotic usage and in categories of anti-hypertensive agents may be necessary.

Determinants of Self-assessed Health among Elderly Adults

BACKGROUND: Self-assessed health is a crude and simple measure which was used as a summary of an individual's general state of health. In this study, we examined the relationship between comprehensive variables and self-assessed health and identified the major determinants of self-assessed health among community dwelling elderly. METHODS: We performed a study on variables using comprehensive geriatric assessment in 308 elderly people who visited the department of family medicine or the department physical medicine and rehabilitation of 11 university hospitals or general hospitals in Korea from July 1, 1999 through October 31, 1999. The association of self-assessed health and variables was examined by X2-test and multiple linear regression analysis. For dependent variable a question "How would you describe your health now?" was used and the subjects responded from these categories: very good, good, fair, poor, and very poor. The independent variables were sociodemographic characters, health behavior, diseases, physical and social function, family and social support. RESULTS: In the X2-test, self-assessed health was significantly associated with income, exercise, nutrition, number of disease, cardiac disease, cerebrovascular disease, fall, ADLs, IADLs, depression and social support. In the multiple linear regression analysis, majority of the explained variance in self-assessed health was nutrition, cardiac disease and depression. CONCLUSION: Self-assessed health among older adults was influenced by various factors. Based on the results, multidimensional approach needs to be developed to improve health.

The multi-center study of the comprehensive geriatric assessment in the Korean elderly

BACKGROUND: Comprehensive geriatric assessment is identified as a dynamic process responsive to the changes on health status that occurs over time in the context of extremely increasing trend in the numbers of the elderly people, their office visit, and the medical cost universally. We completed the comprehensive geriatric assessment and applied it to the Korean elderly through the multi-center trials. METHODS: We performed studies variables using questionnaires, with interviewing, physical examination to the number of total 312 elderly people who visited the department of family medicine or physical medicine and rehabilitation of the 11 university hospital or general hospital in Korea from July 1, 1999 through October 31, 1999. We, the geriatrician, met and discussed 3 times to complete the comprehensive geriatric assessment through the consensus panel. RESULTS: We found the sex ratio of 312 subjects was 1 to 2 (104 males and 208 females) and the average age was 73.2 years old. The orders of more frequency of self-reported health status of the respondents were hypertension, arthritis, cataract, gastrointestinal disturbance, diabetes mellitus, urinary/fecal incontinence, depression, cerebrovascular accident, anemia, and heart disease. Nearly 15% of those showed depression, 41.6% of those were in the status of socially isolation. We found 43.1% of those showed hypertension, 3.7% isolated systolic hypertension, and 20.2% orthostatic hypotension. Of those, cognitive impairment were measured in 37.1%, gait disturbance 13.0%, and the risk of malnutrition 39.6%. Geriatrician spent 21.1 minutes per person during the process of comprehensive geriatric assessment. CONCLUSION: We realized we could diagnose and intervene effectively certain hidden conditions/diseases, particularly urinary incontinence, falls, visual impairment, hearing impairment, pain, depression, social isolation, cognitive impairment, and orthostatic hypotension, with using the comprehensive geriatric assessment. These results reflected the fact that the comprehensive geriatric assessment might be necessary for the care of the elderly.

Geriatrics Clinic in the primary care practice

No abstract available.

Clinical Yield from Preventive In-Home Comprehensive Geriatric Assessment Program Among Elderly People

OBJECTIVES: To evaluate the consequences of care of a program of preventive in-home comprehensive geriatric assessment(CGA) and determine: 1) if there are major findings in all domains of CGA(medical, functional, mental health and social/environmental), 2) if there is a continued clinical yield when CGA is repeated annually, and 3) factors which affect patient adherence with recommendations from CGA. METHODS: Descriptive prospective study of subjects allocated to the intervention group of a randomized trial of preventive in-home CGA was applied to 202 persons aged 75 years or older and living at home who received the intervention of annual and quarterly home visits by gerontologic nurse practitioners(GNPs) for three years at participants' homes in an urban setting. Detailed data were collected prospectively on clinical problems detected by CGA, specific recommendations made of these problems, and subject adherence with these recommendations. RESULTS: Participants were 80.8 years, 70% of them were female, 95% white, and 64% living alone.4 mean of 17.5 active problems per subject were identified in all domains of CGA, although the most common problems were medical.4 constant number of therapeutic and preventive recommendations was made each year(8.5 per subject annually). Subject adherence varied by type of recommendation(ANOVA, p=.0001); adherence was better for referrals to a physician than for referrals to a non-physician professional or community service or for recommendations involving self-care activities. CONCLUSION: In these community-dwelling older people, there was a continued yield of problems identified and recommendations made when preventive in-home CGA was repeated annually for three years, supporting the practice of repeat CGA in community elders. Subject adherence with recommendations from CGA varied by type of recommendation, but further work is needed to determine additional factors which affect this adherence and to determine the association, if any, between the yield of CGA(i.e., problems identified and recommendations given) and important clinical consequences.

Comparison of the Epidemiology and Clinical Characteristics of Primary Hepatocellular Carcinoma Between HBsAg and Anti-HCV Positive Group

BACKGROUND: Primary hepatocellular carcinoma(HCC) is the second cause of cancer death in our country. Hepatitis B virus(HBV) and hepatitis C virus(HCV) are important risk factors for hepatocellular carcinoma. The mechanism of HCC development and the epidemiology in HCV infected individuals are still unclear. In this study, we investigated the epidemiolgical and clinical features of HCC in relation to viral infection. METHODS: We reviewed the medical records of 160 HCC patients retrspectively who had been admitted to one University Hospital located in Seoul between January 1991 and December 1995. Among these patients, 113 patients were positive for HBsAg(B group), 24 for anti-HCV(C group). We compared epidemiological and clinical data between B group and C guoup. RESULTS: Anti-HCV positivity was significantly higher in HBsAg negative patients than in HBsAg positive patients(53.3:1.7%, p<0.01). The mean age of patients in B group was significantly lower than that in C group(52:62yr, p<0.01). In C group, the proportion of Child-Pugh class B and C was significantly larger than that of B group(35.4: 75.0%, p<0.01). In C group, the proportion of transfusion history was significantly larger than that in B group(4.4: 16.7%, p<0.05), and the proportion of drug abuse hestory was significantly larger than that in B group (31.0:62.5%, p<0.01). In C group, the albumin, cholesterol, Gamma-glutamyl transferase leves were significantly lower than those in B group. In B group, the proportion of metastasis was significantly larger than that in C group(31.9:4.2%, p<0.01). Alpha fetoprotein levels greater than 400ng/ml are much more prevalent in group B significantly(67:39.1%, p<0.05). No significant differences in cumulative survival rate(1yr, 2yr) and median survival time were observed between the two groups. CONCLUSIONS: We ascertain that the HBV and HCV are inportant factors in HCC. In epidemiology and clinical features of HCC, there were some difference between the HBsAg and anti HCV positive group. Therefore, on primary health care settings, it is necessary to test for hepatitis C as well as hepatitis B in order to prevent and manage HCC and chronic liver desease.

An inclination for medical students' career choice and A cognitive degree on family medicine

No abstract available.

Demographic characteristics and family function among shift-workers

No abstract available.

Clinical analysis of low back pain

No abstract available.