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Objectives: This study aimed to compare the demographic characteristics, responses to negative emotions, and difficulties in emotion regulation between self-harming adolescents and control individuals aged 12-14 years from the community. Methods: Data were collected from adolescents in Chungcheong Province, South Korea, between September 2021 and November 2022. Demographic characteristics and responses to the Depressed Mood Questionnaire and Difficulties in Emotion Regulation Scale-16 (DERS-16) were compared between the self-harm and control groups. Results: The self-harm group exhibited a higher prevalence of child abuse (odds ratio [OR]=4.787, 95% confidence interval [CI]=1.591-14.409, p=0.005) and school bullying victimization (OR=4.495, 95% CI=2.353-8.588, p<0.001) than those in the control group. The selfharm group displayed higher levels of rumination (t=7.88, p<0.001) and reduced distraction responses (reverse score t=2.25, p=0.025) than those of the control group. Additionally, the self-harm group scored higher on all subscales and the total DERS-16 score (t=7.61, p<0.001). Conclusion: Interventions for self-harming adolescents should address child abuse and bullying victimization. Prevention programs for self-harming adolescents should focus on reducing rumination responses, increasing distractive responses, and addressing difficulties in emotion regulation using dialectical behavior therapy-skill training.
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Heat-related illnesses (HRIs) are characterized by hyperthermia, neurological dysfunction, and multiorgan damage. Cardiac dysfunction has been reported, but ST-elevation with a rise in cardiac markers suggesting acute coronary syndrome has been infrequently reported. Data from the middle east in particular is lacking. This is a case of a 43-year-old male patient from the United Arab Emirates diagnosed with acute inferior ST-elevation myocardial infarction necessitating cath lab activation revealing normal coronary arteries. Echocardiography did not show evidence of wall motion abnormalities. After reviewing his clinical presentation, he was diagnosed with heat exhaustion complicated by rhabdomyolysis and acute kidney injury. The patient fully recovered with intensive medical care. This case showed that the electrocardiographic changes and elevation of cardiac markers do not reflect true cardiac ischemia but rather a pathophysiological response to HRI. Previously published reports were scarce and showed conflicting results due to the heterogenicity of cases and methods as well as the lack of angiographic documentation of coronary pathology. This case report demonstrates the importance of early recognition and timely management of HRI cases with an unusual presentation that mimics myocardial infarction, especially in countries with high ambient temperatures during the summer seasons.
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BACKGROUND: Increased left ventricular (LV) mass is associated with adverse cardiovascular outcomes, and its accurate assessment is important. The aim of this study was to analyze the degree of difference among various methods of LV mass calculation based on transthoracic echocardiographic (TTE) measurements and cardiovascular magnetic resonance (CMR) measurements, especially in patients with aortic stenosis with varying degrees of LV hypertrophy (LVH). The mechanism underlying this disagreement was also investigated. METHODS: Ninety-nine patients with moderate to severe aortic stenosis and 33 control subjects matched for age, sex, body weight, and height were enrolled in this prospective observational cohort study. All patients underwent TTE and CMR imaging. LV mass index (LVMI) was calculated using three formulas on the basis of TTE measurements (the Penn-cube, American Society of Echocardiography [ASE], and Teichholz methods) and compared with measurements obtained using CMR, the reference method. RESULTS: Although all methods calculated using TTE measurements showed good correlations with CMR measurements, LVMI measured using the Penn-cube and ASE methods tended to be larger than LVMI measured using CMR (difference in LVMI by the Penn-cube and ASE methods, 59.3 ± 29.7 and 30.6 ± 22.3 g/m², respectively). This tendency decreased with the Teichholz method (difference in LVMI by the Teichholz method, 22.9 ± 19.1 g/m²). The degree of LVMI overestimation was significantly different among the three methods (P < .001 by one-way analysis of variance), which was more significant in patients with LVH, especially with the Penn-cube method (differences between CMR and TTE measurements in patients with aortic stenosis and LVH, 66.3 ± 34.8 vs 31.2 ± 26.6 vs 15.5 ± 20.9 g/m² for the Penn-cube, ASE, and Teichholz methods, respectively; P < .001 with post hoc Tukey analysis). There was a good correlation between LVMI and LV diameter-to-length ratio (r = 0.468, P < .001), which suggested that the left ventricle takes on a more globular shape with the increase of LVMI, resulting in a significant deviation from the basic assumptions on which the Penn-cube and ASE methods were built. CONCLUSIONS: Current methods of calculating LVMI from echocardiographic measurements carry a tendency to measure LVMI larger than methods based on CMR measurements, which was more significant in patients with LVH. The change of the left ventricle's shape with LVH may be a plausible explanation for this, and a correction method may be needed when calculating LVMI from echocardiographic measurements, especially in patients with LVH and smaller body size.