Exercise Strategies for the Prevention and Treatment of Non-alcoholic Fatty Liver Disease

The prevalence of non-alcoholic fatty liver disease (NAFLD) is steadily increasing in conjunction with increases in obesity, type 2 diabetes, and physical inactivity. NAFLD encompasses a spectrum of conditions associated with lipid deposition in hepatocytes, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) and to advanced fibrosis and cirrhosis. A large proportion of patients with NAFLD have co-existing metabolic syndrome, which is also a major risk factor of cardiovascular disease. There is an urgency to recognize that NAFLD poses an additional risk for cardiovascular disease and should involve early aggressive risk factor modification. A lifestyle modification of diet and physical activity targeting substantial weight loss is considered as the first-line defense system against NAFLD. In this review, the roles of physical activity are discussed as an effective and safe means to combat NAFLD and its metabolic complications.

A Case of Severe HIV-Associated Psoriasis Successfully Treated with Acitretin Therapy

Psoriasis is a chronic inflammatory skin disease that involves immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. Psoriasis in patients with HIV responds poorly to treatment and has a high morbidity rate, thus posing a challenge to clinicians. Until now, there have been no documented cases of acitretin therapy for HIV-associated psoriasis in Korea. Here, we report a case of safe and successful therapy with acitretin in a 52-year-old man with HIV-associated psoriasis that responded poorly to previous treatments including steroids and ultraviolet B phototherapy. We also review the relevant literature.

Skin Graft Fixation with Histoacryl Tissue Adhesive in STSG of Burn Patients

PURPOSE: Comparing with suture and staple, skin graft fixation with Histoacryl (N-butyl-cyanoacrylate, B.Braun, Germany) has two advantages. Fixation is simple, painless and removal process is unnecessary. There are few reports that compare histoacryl with conventional methods for skin graft fixation in FTSG. However, there are no comparative studies in STSG. The purpose of this study is to show our experience of skin graft fixation with histoacryl in STSG of burn patients. METHODS: This study included those who was burned less than 10% of TBSA and needed STSG. The patients who had underlying disease (DM, hypertension, liver disease, lung disease) were excluded. 29 patients who visited Bestian burn center from January to July 2009 was enrolled in the study. In STSG, skin graft was fixed with histoacryl and authors marked the fixed points with pen. Fixation rate was checked in 7 days after STSG and take rate was checked in 14 days after STSG. RESULTS: The patient group consisted of 7 males and 22 females. The mean extent of burn area was 2.3%. The type of injury consisted of 18 contact, 8 scald, 1 flame, 2 friction. 31 STSG of 29 patients was done. STSG was done at 24th day after burn, the mean area of wound for STSG was 51 cm2. Mean numbers of fixation point with histoacryl per patients were 14.1. 430 of 436 fixation were stable and fixation rate was 98.6%. There was no infection case. Take rate was 99.1% in 14 days after STSG and it took 21 days for wound opening. CONCLUSION: Until now, suture and staple are common methods in skin graft fixation. However, it is disadvantageous that suture and staples should be removed. Histoacryl does not need those process. This study showed that take rate was 99.1% and fixation rate was 98.6% in fixation with histoacryl. In STSG, Skin graft fixation with histoacryl could be alternative methods for suture and staple.

Polymorphism of Haptoglobin in Patients with Premature Rupture of Membrane

PURPOSE: To investigate whether allelic polymorphism of haptoglobin (Hp) is associated with premature rupture of membrane (PROM), the Hp phenotypes of pregnant women with PROM were analyzed. PATIENTS AND METHODS: The Hp phenotypes of 221 pregnant Korean women (187 control and 34 PROM patients) were determined by benzidine/hydrogen peroxide staining, following native polyacrylamide gel electrophoresis of hemoglobin-mixed sera. The Hp allele frequencies were calculated from the data of Hp phenotypes, and overall association with PROM was evaluated using Pearson Chi-Square test. RESULTS: The polymorphic distribution of the patients cohort who underwent a normal delivery (control group) was similar to that of healthy Koreans. In contrast, however, patients with PROM showed significantly higher occurrence of the Hp 1-1 phenotype than control group (23.5% vs 8.0%). Hp 2-2 phenotype was lower in PROM cohort (38.2%) than in the control group (48.7%). The Hp1 allele frequency in PROM group was significantly higher than that in the control group (0.426 vs 0.297, p = 0.034) with odds ratio of 1.762 (95% CI: 1.038 - 2.991). CONCLUSION: These findings suggest that pregnant Korean women who possess Hp1 allele (expressed as Hp 1-1 phenotype) have higher incidence of PROM than women with Hp2 allele (expressed as Hp 2-2 phenotype). This is the first study that evaluated the significance of Hp polymorphism with respect to the development of PROM.

Reliability and Validity of the Modified Emergency Severity Index-2 as a Triage Tool

PURPOSE: We measured the inter-rater reliability and validity of the modified Emergency Severity Index-2 ((m)ESI-2) as a triage tool in the emergency department (ED). METHODS: We applied (m)ESI-2 to 2,724 patients who visited three EDs. In each ED, emergency medicine residents, interns, and nurses independently evaluated the severity of the patient with (m)ESI-2. Data on the triage result, the patient disposition, and the length of stay in the ED were collected prospectively. For patients who were admitted or who stayed more than 24 hours in the ED, the APACHE II score was calculated. RESULTS: The weighted kappa value was 0.602 between residents and interns, 0.541 between residents and nurses, and 0.451 between interns and nurses. Hospitalization (ED death, admission, transfer) rates were 100% in category 1 and 82.4%, 53.8%, 17.2%, 6.2% in categories 2 through 5, respectively. The mean length of stay was longest in category 3 (687 min) and shortest in category 5 (150 min). The mean APACHE II score was highest in category 1 (10.8) and 8.6, 6.2, 5.2, 2.9 in categories 2 through 5, respectively. CONCLUSION: The (m)ESI-2 demonstrated good to fair interrater reliability among residents, interns, and nurses, and the resultant categories were related with the hospitalization rates, the length of stay in the ED, and the APACHE II score. With further modification and refinement, (m)ESI-2 can be a reliable and a valid triage tool in the ED.

Psychiatric Follow-up after ED Discharge in Cases of Intentional Poisoning

PURPOSE: Many patients who intentionally poison themselves are reported to have underlying mental problems and to repeat the attempted suicidal poisoning. As a first step to prevent this regretful complication, we looked into the present status of psychiatric follow-up of the patients who intentionally poisoned themselves. METHODS: Using a chart review and telephone contact, we analyzed the psychiatric follow-up rate, the underlying psychiatric illness, the number of suicidal attempts, and the reasons for no follow-up for adult patients who intentionally poisoned themselves and who visited the Emergency Department of Severance Hospital from Mar. 2003 to Feb. 2004 with chart review, telephone contact. RESULTS: Forty-nine of 119 suicide patients (41.2%) chose poisoning as a means of suicide. The results of emergency treatment of those 119 patients were 4 deaths during treatment, 36 admissions (15 psychiatry, 21 others), and 79 discharges including 5 transfers. The most common underlying psychiatric problem based on 103 initial psychiatric interviews was depressive disorder in 52(50.5%) patients. Not counting the 19 deaths and psychiatry admissions, 26 patients received psychiatric follow-up during admission or after discharge, and the remaining 74 patients were subjected to telephone surveys. In the telephone surveys, only 53 patients were contacted; 25 patients declined to answer the questions and out of the 28 patients who answered them, 5 patients had received psychiatric follow-up at other hospitals. The most common reason given by the other 23 patients for no follow-up was that it was not necessary (39.1%, 9/23). The overall follow-up rate was 39.2% (31/79). Of the 48 patients who answered the question on repeated suicide attempts, 3 patients had repeatedly attempted suicide. CONCLUSION: To prevent further suicide attempts and resultant deaths in cases of patients who intentionally poisoned themselves, we urgently need an integrated psychiatric follow- up care program that is activated through a collaborative effort before discharge from the emergency department.

Korean Multicenter Study of Te tanus Antibody Titer (KoMUST)

PURPOSE: We determine the Korean antibody titer and positive rate of tetanus by using a with qualitative test (ELISA) and a quantitative test (TQS(R)). METHODS: This study was prospective collecting study with uncontolled patients who were admitted in 21 Emergency Departments during 3 months in South Korea. We measured TQS(R) and collected the serum with a centrifuge for 5 groups, which was classified with age: 2~10 years (I), 11~20 years (II), 21~30 years (III), 31~40 years (IV), 41~60 years (V), in each hospital. The freezed serum and the protocol with TQS(R) results were taken at the Soonchunhyang University Bucheon hospital to be analyzed. RESULTS: The number of enrolled patients was 1816 (male 58%). The positive rate of TQS(R) was 835 patients (46%), and there was no relation with region or sex. In sex and age, there was a definitive decline in the group III fort males and females. The results of ELISA was showed that 62.8% (> 0.15 IU/ml) and 52.2% (> 0.2 IU/ml) had protective levels of tetanus antibody. The proportion decreased to approximately 43% and 18% among persons 40~60 years of age at each level of antibody titers. By region and population, there was no statistical relationship with TQS(R) and ELISA, but previous military service was associated with a higher prevalence of protective antibodies to tetanus (p<0.001). CONCLUSIONS: A substantial portion of adults in South Korea do not have antibody levels that are protective against tetanus. Also, the mean level of tetanus antibody titers was definitively lower than those of other developed conturies and consistently decreased with aging. Therefore, an adult formulation diphteria and tetanus toxoid every 5 or 10 years is recommended for all adults between 20 and 60 years of age after being tested with TQS(R) in South Korea.

Lower Extremity Weakness and Back Pain from a Ruptured Iliac Artery Aneurysm: A Case Report

An isolated iliac artery aneurysm is a rare condition. Its prevalence is less than 0.01% of the general population and less than 1% of all vascular aneurysms. Metachronous occurrence of an iliac artery aneurysm is very rare, and its prevalence is unknown. Most iliac artery aneurysms do not have any clinical symptoms. If there are symptoms, they are due either to compression of adjacent organs, which depends on the anatomical position of the aneurysm, or to rupture. Aneurysmal rupture can present very variable clinical symptoms, which originate from the anatomical position, so diagnosis is often delayed. We report a case of a common iliac artery and an internal iliac artery aneurysm presenting as temporary lower extremity weakness and back pain, and we present a review of related literature.

Inter-rater Reliability of the Modified Emergency Severity Index as a Triage Tool

PURPOSE: Triage in the emergency departmen (ED) is the preliminary clinical sorting process before full disclosure of patients' problems so that patients with the highest acuity are treated first in the setting of resource constraints. To overcome the inter-rater variability of existing triage tools, the Emergency Severity Index (ESI) was developed and was shown to be both valid and reliable in practice. Because of the disparity in practice patterns and some inappropriate criteria in the original ESI, the authors have modified the ESI and determined its inter-rater reliability. METHODS: We applied the modified ESI to a convenient sample of adults who visited an urban academic ED between July 24, 2001, and August 5, 2001. After completion of a short, 4-hour training course on the modified ESI, an intern and emergency medicine resident pair triaged the patients independently. The inter-rater reliability was measured using a weighted kappa analysis and was categorized as excellent (>or=0.8), good (0.60-0.79), or fair (

Colon Perforation by an Ingested Toothpick

Foreign bodies in the gastrointestinal (GI) tract can be seen in all age groups and is not uncommon to see in the emergency department. Most are pediatric, edentulous, incarcerated and/or psychiatric patients. Since ingested objects are expected to pass spontaneously in 80% to 90% of patients with normal anatomy, direct foreign body removal using surgical intervention is rarely required. However, an ingested toothpick is of surgical interest as a cause of significant morbidity and even mortality. This is due to the difficulty in preoperative diagnosis resulting from a lack of history of ingestion of the toothpick and to the toothpick's radiolucent qualities. We report the case of a patient with peritonitis due to perforation of the sigmoid colon, a complication of accidental ingestion of a toothpick, that was diagnosed at the surgical field. Related literature is reviewed together.