Comparison between Natives and Foreigners who Visited an Emergency Center due to Suicidal Attempt

PURPOSE: In an effort to determine the characteristics of foreign suicides who visit an emergency center, this study analyzed suicidal attempt between natives and foreigners. METHODS: We conducted a retrospective analysis of 1,218 Korean and 149 foreign suicidal attempters who visited a regional emergency center from January 1, 2009 to December 31, 2013. We compared two groups according to age, sex, selected suicidal methods, past psychiatric history, medical examination and treatment acceptance, elapsed time to visit an emergency center after suicidal attempt, emergency center residence time, and hospitalization period. RESULTS: No difference in medical exam acceptance and tetanus vaccination was observed between the two groups. However, we found a difference in hospitalization acceptance. The prevalence rate of psychiatric disorders was lower in foreign suicides, and the refusal rate of psychiatric treatment was higher in foreign patients. CONCLUSION: In foreign suicides, social support including finance is required for easy access to health care service. In addition, more active interdisciplinary cooperation with the department of psychiatry and close observation is needed.

A Telephone Method for Helping Lay Rescuers Perform High Quality Cardiopulmonary Resuscitation

PURPOSE: Dispatcher-assisted telephone instruction during cardiopulmonary resuscitation (CPR) improves the quality of CPR performed by laypersons. However, in Korea, CPR instruction guidelines for bystanders have not made. We therefore studied the effects of verbal instruction on the quality of chest compression. METHODS: Data from two randomized, double-blinded, controlled trials using identical methodology were combined to obtain 175 records for analysis. Subjects were randomized into either a "push as hard as you can and fast" (n=87) or "push down 5~6 cm, 100~120 rate/min" (n=88), verbal instructions in the 2011 Korea Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Data were recorded via a Resusci(R) Anne SkillReporter(TM), Laerdal Medical mannequin. Primary outcome measures included chest compression depth and chest compression rate per minute. RESULTS: The average compression depth and speed of chest compressions did not significantly differ between the two verbal instructions. CONCLUSION: The verbal istructions provided by telephone based on the 2011 Korean Guidelines for CPR and ECC are not effective. The instructions for high quality CPR of layperson should therefore be studied.

Corrected QT Interval Differences from Intoxication by Over The Counter Versus Prescription Hypnotics

PURPOSE: This study analyzed QTc prolongation in patients intoxicated from over the counter (OTC) hypnotics compared with prescription hypnotics. METHODS: The medical records of intoxicated patients presented to four emergency centers from January 1, 2010 to December 31, 2010 were retrospectively reviewed. The records of hypnotics overdose patients were selected and investigated for several features: general characteristics, vital signs, past history, ECG findings, treatment methods, ED stay time, drug category and amount, and final results. RESULTS: There were 134 patient cases of OTC hypnotic intoxication (36.9+/-15.1yrs, M:F=37:97), and 270 patient cases of prescription hypnotic intoxication (47.9+/-18.1yrs, M:F=58:212). The ECG QTc upon emergency center admission was 468.4+/-34.8 msec in the OTC hypnotic intoxication group and 449.48+/-26.2 msec in the prescription hypnotic intoxication group (p<0.05). QTc prolongation was noted in 81.3% of patients in the OTC hypnotic intoxication group and 64.1% of patients in the prescription hypnotic intoxication group (p<0.05). CONCLUSION: ECG QTc prolongation was more common from OTC hypnotic intoxication than prescription hypnotics. Close monitoring is therefore recommended for patients who have ingested and overdosed from OTC hypnotics to prevent potentially lethal cardiac toxicity.

1alpha,25-Dihydroxyvitamin D3 Protects Dopaminergic Neurons in Rodent Models of Parkinson's Disease through Inhibition of Microglial Activation

BACKGROUND: Recent studies have demonstrated the molecular basis of the immunomodulatory and anti-inflammatory activities of 1,25-dihydroxyvitamin D3(1,25-(OH)2D3). This hormone improves behavioral deficits and normalizes the nigral dopamine levels in animal models of Parkinson's disease (PD). METHODS: We studied whether the administration of 1,25-(OH)2D3 would protect against 6-hydroxydopa (6-OHDA)- and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neuronal injury, and its potential regulatory effect on microglia activation. RESULTS: We found that 1,25-(OH)2D3 pretreatment significantly decreased 6-OHDA- and MPTP-induced dopaminergic neuronal loss in the substantia nigra pars compacta by preventing the activation of microglia. This observed neuroprotective effect in MPTP-treated mice that were given 1,25-(OH)2D3 may be attributable to inhibition of proinflammatory cytokine expression. CONCLUSION: These results suggest that 1,25-(OH)2D3 is a potentially valuable neuroprotective agent; it may therefore be considered for the treatment of pathologic conditions of the central nervous system, such as PD, where inflammation-induced neurodegeneration occurs.

Changes of Regional Cerebral Blood Flow in Left Anterior Thalamic Infarction: Analysis of 99mTc-Ethyl Cysteinate Dimer (ECD) SPECT by using Statistical Parametric Mapping

BACKGROUND: The thalamus has multiple connections with areas of the cerebral cortex involved in arousal and cognition. Thalamic damage has been reported to be associated with variable neuropsychological dysfunctions and dementia. This study investigates the changes of regional cerebral blood flow (rCBF) by using SPM analysis of 99mTc-ECD SPECT and examining the neuropsychological abnormalities of 4 patients with anterior thalamic infarctions. METHODS: Four patients with left anterior thalamic infarctions and eleven normal controls were evaluated. K-MMSE and the Seoul Neuropsychological Screening Battery were performed within 2 days after stroke. The normalized SPECT data of 4 patients were compared to those of 11 controls for the detection of areas with decreased rCBF by SPM analysis. RESULTS: All 4 patients showed anterograde amnesia in their verbal memory, which was not improved by recognition. Dysexecutive features were occasionally present, such as decreased word fluency and impaired Stroop test results. SPM analysis revealed decreased rCBF in the left supramarginal gyrus, the superior temporal gyrus, the middle and inferior frontal gyrus, the medial dorsal and anterior nucleus of the left thalamus. CONCLUSIONS: The changes of rCBF in patients with left anterior thalamic infarctions may be due to the remote suppression on metabolism by the interruption of the cortico-subcortial circuit, which connects the anterior thalamic nucleus and various cortical areas. The executive dysfunction and dysnomia may be caused by the left dorsolateral frontal dysfunction of the thalamocortical circuit. Anterograde amnesia with storage deficit may be caused by the disruption of mamillothalamic tract.