• Title/Summary/Keyword: family history

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A Research on Perception and Exposure to Hepatitis-B Virus of Dental Hygienists (치과위생사의 B형 간염에 대한 인지도와 노출에 대한 조사)

  • Kang, Eun-Ju;Kim, Jin;Choi, Mi-Hye
    • Journal of dental hygiene science
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    • v.7 no.1
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    • pp.13-20
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    • 2007
  • This study is aimed at providing basic data for measures to prevent dental hygienists who are highly exposed to hepatitis-B virus due to their characteristic working conditions from being infected of it. In order to determine their perception and the extent of their exposure to the risk of infection with hepatitis-B virus, a survey was conducted with questionnaires distributed to 354 dental hygienists who are working at dental offices in Seoul. Gyeongi and Jeolla provincial areas. From the survey, following conclusions could be drawn: 1. Sixty three point seven to 100 percent of them are found to have been vaccinated against hepatitis-B virus as is generally expected from their working environment. 2. Their general characters are found to be statistically significant in terms of vaccinating point of time among those who have been vaccinated. Most respondents are either vaccinated one year or 5 years ago. The completion of 3 requested vaccinations lies in the level of 64.3%~100% depending on the general characters. By age, the best result comes from the age group of 25~29, followed by the groups older than 30 and 20-24 in order (p < 0.05). Formation of antibody belongs to the level of 45%~100% generally. But statistically significant of them is the extremely unhealthy state with 100%, followed by normal, generally healthy, very healthy and not healthy in sequence (p < 0.05). 3. In terms of family's clinical history, it is known that the older (p < 0.01), the more unhealthy (p < 0.01) and the married (p < 0.01), the more possibility of having anamnesis of hepatitis-B virus infection. 4. The level of knowledge about Hepatitis-B virus is shown to be in the extent of 4.39~5.01 out of maximum 8 points in general terms. 5. It is revealed that there are high chances for dental hygienists to get spattered with body matters of patients like blood or sputum on their faces in general characters (87.%~100%). 6. A high rate (75%~100%) of respondents has experienced being shot by needles. The older(p < 0.05) and the longer(p < 0.05) their career, the higher the rate becomes.

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A Study on Home Economist Education with Refrence to the Business Activities in Korea (가정학교육과 취업방안연구)

  • 한상순
    • Journal of the Korean Home Economics Association
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    • v.27 no.2
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    • pp.163-185
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    • 1989
  • Korean home economics education has around 100 years history. The main aims of home economics education up 1950 had not been changed, they were mainly for the improvement of household-skill to raise both standard of living and life quality as well as womanhood. After 1960's the standard of living drastically improved and the industrialization of Korean society was quite rapidly proceeded from simple to complex one. Because of these changes, I considered that the aims and the contents of home economics education should be reexamined and reshaped. This study motivated me that especially home economics major should be trained to be competent enough to work in industrialized society as much as the input to her college education. As industialization was made progress, family member's diverse role differentiation also occurred from past simple role such as house wife or girl's high school teacher among by home economics major. In this current societal change, most of the home economics major have wish to have opportunities obtaining new kinds of employment rather than obtaining merely teaching work. With this in mind I made a study on college level home economics education of the new adjustment to current and future industrialized Korean society. (1) The full number of officially admissible home economics major in 169 Korean colleges, 70 junior colleges, and one open university were as follows, 7139, 6080, and 230 respectively. The percentages of employed of employed numbers of them for the college and junior college graduates were 26.5 and 39.0 respectively. (2) The certificate qualifications issued to college home economics major are nutritionist (1st grade and 2nd grade), clothes and textilist, home economics teacher (2nd grade for high school) and kindergartener (2nd grade), The qualifications are certified after majoring each field from major departments of college of home economics by Ministrys of Labour and Education of the Korean government. The percentages of their employment are low as mentioned earlier. (3) To find out new employment opportunity for home economics graduates in home economist in business (henceforce/HEIB) status quo of consumer division for mational enterprise was surveyed. According to govermment decree of general law of consumer protection (1980), enterprise should organize bureau (offics, subdivision) on liability to consumer's complaint. Of 89.6% of the enterprise established th subdivision in which 96.2% of employee was male (3.8% was female). Of the employee college graduate and high school graduate were 93.2% and 6.8% respectively. On the employee's major acadmic backgroud (%), economics and business administration, engineering and low-political science were 39.5, 26.2 and 11.2 respectively. (4) To study on the relation between home economics and home economist in business, the aspect of historical development of HEIB, group of HEIB employing enterprise and their nature of business were tried to find out as well as perception and evaluation by enterprise on HEIB. (a) In the united States of America employed home economics major to enterprise was organized autonomously HEIB subdivision within American Home Economics Association since 1920's and the membership of HEIB was 3,000 of the AHEA membership 50,000. (b) In Japan the Japanese founder HEIB had three times the bilateral congress with the U.S.HEIB and had 10th anniversary celebration in 1988. Japanese HEIB member are not necessary to be home economics graduates but should have certificate as consumer adviser effected by the Minister of Trade and Industry. Japanese subdivision of consumer affaire within Japanese enterprise employ the consumer adviser with the certificate. Because of this different system from the United Sates, Japanese HEIB call their title "HEEB" instead of HEIB. The Japanese consumer adviser certificate system had initiated since 1980 and it belongs to 2nd level national qualification certificate. Currently active membership of Japanese "HEEB" association had increased from 115 (in 1979) to 319 in 1988. (5) For the opening of the future new employment of home economics graduates to enterprise and qualification required for the HEIB by national enterprise in Korea, I studied on the courses which seem to be important and required by employee in the field of HEEB in the United States of America and preliminary curriculum for home economics related major student aimning to be the future "HEEB" by Japanese HEEB study group of Japanese Association of Home Economics. It is suggested that it is very important and urgent to realize as home economics educator to have common deep concern and endeavors on opening new employment for our home economics major student1), we should try to publicize strongly and let enterprise and consumer protection board realize that employee in the subdivision of consumer protection should be the one who well experienced home economics major graduates2), we, home economics educator, should try to develop actively new curriculum in line of the suggestion made earlier for our future home economics major student of open broadly their future employment opportunities3), we, home economics educators, should try to have consensus on whether we should have support from government in terms of receiving national qualification certificate on consumer pretection or not4), and I would appreciate if the Korean Home Economics Association and Korean Home Management Society paydeep and positive concern on this matter.

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Studies on the Construction Characteristics of Rear Garden Farmland at Joseon Palace (조선시대 궁궐 후원 농경지(農耕地) 조영의 특성)

  • Jung, Woo-Jin;Sim, Woo-Kyung
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.4
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    • pp.62-77
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    • 2012
  • This study aimed to investigate the Confucian-oriented agriculture phase of the Joseon Dynasty, which was reflected at the palaces, by analyzing constructional aspects and spatial characteristics of farmlands at the palace rear gardens. The objective sites were the rear gardens of Gyeongbok Palace, Changkyung Palace, and the outside of Sinmoomoon(神武門) This study was based on literature reviews. The farmlands at the palace rear garden were constructed to self-estimate the year's harvest condition within the palaces. It was a part of the agriculture encouragement policy on governing the group of Joseon like publishing the Nongsajiksul(農事直說) and establishing the Chingyeongnye(親耕禮: king's own cultivation ceremony) and Kikokje(祈穀祭: the rite of praying for grain). In addition, farmlands of the rear garden were operated from the beginning of the state almost until the Japanese colonial era. The results were summarized as follows: First, Gyeongbok Palace rear garden's farmland which begin at the reign of Sejong(世宗) existed at the present Hyangwonji(香遠池) area. It was constructed in order to check the advanced agricultural technologies. The rear garden's farmland in Changkyung Palace, which was executed during the reign of Seongjong(成宗), was constructed right after the initial Chingyeongnye of the Joseon Dynasty. Therefore, it might be understood as the context of the king's own cultivation of the Jeokjeonchinkyung(籍田親耕). Injo(仁祖) dug for farmland in the ground of the Gyemgdeok Palace(慶德宮) though there was some stay palace, when his stay dragged out for too long. This bespeaks that those farmlands at the palace rear gardens were of great importance in the Joseon political history. The farmland near Gyeongnongjae(耕農齋), which was made during the reign of Gojong(高宗), inherited predecessor's walks of the promoting agriculture and exhibited spatial compositions such as the rear garden's farmland at Changkyung Palace. Secondly, irrigation, its water systems, the name of observatory to study farming[觀耕臺] and location requirements for farmland had something in common. It was assumed as universal forms of physiocracy-space in the Joseon Dynasty. In this study, by considering aspects of operating about vegetable garden managed by eunuchs and of the orchard in palace to cultivate fruits for national ceremonies, it could be assumed that landscape architecture of royal palace in the Joseon Dynasty did not only focus on solemnity, orderliness and fanciness but also on the practical and productive which was helpful in life. In addition, the diverse activities of productive landscape architecture led by the royal family in palaces, and the initiatively tested advanced agricultural technologies by the king were considered as an aspect of the Korean traditional specific royal palace landscape architecture. That is considered sole landscape not only to love of the people but also the 'agriculture-first' principle which were absent from other nations.

ASSOCIATION BETWEEN TOURETTE DISORDER AND CATECHOL-O-METHYL TRANSFERASE(COMT) GENE IN KOREAN SUBJECTS (한국인에 있어서의 뚜렛 장애와 COMT유전자간의 상관 관계에 대한 연구)

  • Kim, Boong-Nyun;Lim, Jae-In;Cho, Soo-Churl
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.15 no.2
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    • pp.178-184
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    • 2004
  • Objectives : This study was conducted to investigate the association of the COMT polymorphism with the TD in Korean sample of families with TD probands. The relationship between risk alleles and specific clinical features (tic severity, comorbidity, drug response) was also explored. Method : Patients were recruited from the Tic Disorder clinic at the Child & Adolescent Psychiatric Division of Seoul National University Hospital and assessed through 2 stage evaluation. Firstly, all the patients and parents received semistructured interview using Korean version of K-SADS-PL. Secondly all the patients received clinical interview and tic severity assessment with Korean version of YGTSS. The subjects in control group were recruited from the health promotion center in out hospital and were evaluated by SCL-90 and SCID-IV. Through these process, total of 42 children and adolescents with TD, their 84 parents and 86 control subjects were finally recruited. Genotyping for The Val158Met polymorphism of the COMT gene was done by standardized method. After collection of genetic data of all the patients, parents and control subjects, case-control comparison and tranmission dysequilibrium test was executed by SPSS version 11. Result : From the case-control comparison, the frequency of L-allele and LL genotype was significantly higher in TD group. However, no differences were found from the TDT. No significant differences were found in in family history of tic, ADHD, OCD, drug response and comorbid conditions among the three different genotypes in patients with TD. Conclusion : Though this study results should be interpreted cautiously due to small sample size and negative finding in TDT test, this study is the first report that there is positive association between the functional polymorphism of COMT gene the TD.

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A Study on the Relationship between Sleep Duration and Suicidal Idea in an Urban Area of South Korea (일 도시지역 주민들의 수면시간과 자살사고의 연관성에 관한 연구)

  • Lee, Yu-Jin;Kim, Seog-Ju;Cho, In-Hee;Kim, Jong-Hoon;Bae, Seung-Min;Koh, Seung-Hee;Cho, Seong-Jin
    • Sleep Medicine and Psychophysiology
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    • v.16 no.2
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    • pp.85-90
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    • 2009
  • Introduction: There has been an increasing interest in the relationship between sleep and suicidality. In addition, suicidal patients habitually report their sleep problems. Although sleep-related complaints and electroencephalographic changes are generally encountered in psychiatric disorders, sleep complaints such as insomnia, hypersomnia and nightmares are more common in suicidal patients. In current study, we aimed at investigating the relationship between self-reported sleep duration and suicidality in general population. Methods: One thousand general population (male:female=500:500, mean age=$39.6{\pm}11.6$ years, ranged age=20-77 years) completed Center for Epidemiologic Study-Depression (CES-D), Beck Suicide Intent scale (BSI), Spielberger State-Trait Anger Expression Inventory (STAXI), Barratt Impulsiveness Scale (BIS), Morningness-Eveningness Scale (MES) and brief questionnaire of sleep habits. Results: After controlling for age and sex, score of BSI was correlated positively with the score of CES-D, STAXI and BIS on partial correlation analysis ($r_p$=0.251; p<0.001, $r_p$=0.352; p<0.001, and $r_p$=0.175; p<0.001, respectively). In addition, score of BSI was inversely correlated with the score of MES (rp=-0.066; p=0.037). However, score of BSI showed no significant correlation with sleep duration. However, regression analysis revealed that short (<6 hrs) or long (>10 hrs) sleep duration, the family history of psychiatric illness, the score of CES-D, and the score of STAXI predicted higher score of BSI significantly in total subjects (F=17.837, adjusted $R^2$=0.166; p=0.003, p=0.003, p<0.001, and p=0.003, respectively). This model was explained better in depressed subjects with 16 or higher score of CES-D (F=9.920, adjusted $R^2$=0.298). Conclusion: Current result suggested that not only short sleep duration (<6 hrs) but also long sleep duration (>10 hrs) might be related to suicidality.

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Clinical Experience of Long-term Home Oxygen Therapy (재택산소요법을 받고 있는 환자들에 대한 임상 관찰)

  • Lee, Young-Suk;Cha, Seung-Ick;Han, Chun-Duk;Kim, Chang-Ho;Kim, Yeun-Jae;Park, Jae-Yong;Jung, Tae-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.3
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    • pp.283-291
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    • 1993
  • Background: Long-term low flow oxygen therapy not only increases survival, but also improves the quality of life in patients with chronic obstructive pulmonary disease (COPD) with chronic hypoxemia. For the assessment and improvement of the status of home oxygen therapy, we analyzed clinical experience of 26 patients who have been administered low flow oxygen at home. Method: Twenty-six patients (18 men and 8 women) who have been received long-term oxygen therapy (LTOT) at home were examined. We reviewed physical characteristics, clinical history, pulmonary function test, ECG, arterial blood gas analysis, hemoglobin and hematocrit, types of oxygen devices, inhalation time per day, concentration of administered $O_2$, duration of $O_2$ therapy, and problems in the home oxygen therapy. Results: The underlying diseases of patients were COPD 14 cases, far advanced old pulmonary tuberculosis 9 cases, bronchiectasis 2 cases, and idiopathic pulmonary fibrosis 1 case. The reasons for LTOT at home were noted for cor pulmonale 21 cases, for dyspnea on exertion and severe ventilatory impairment 4 cases, and for oxygen desaturation during sleep 1 case. The mean values of aterial blood gas analysis before home oxygen therapy were $PaO_2$ 57.7 mmHg, $PaCO_2$ 48.2 mmHg, and $SaO_2$ 87.7%. And the mean values of each parameters in the pulmonary function test were VC 2.05 L, $FEV_1$ 0.92 L, and $FEV_1$/FVC% 51.9%. Nineteen patients have used oxygen tanks as oxygen devices, 1 patient oxygen concentrator, 2 patients oxygen tank and liquid oxygen, and other 4 patients oxygen tank together with portable oxygen. The duration of oxygen therapy was below 1 year in 3 cases, 1~2 years in 15 cases, 3~5 years in 6 cases, 9 years in 1 case, and 10 years in 1 case. All patients have inhalated oxygen with flow rate less than 2.5 L/min. And only 10 patients have inhalated oxygen more than 15 hours per day, but most of them short time per day. Conclusion: For the effective oxygen administration, it is necessary that education for long-term low flow oxygen therapy to patients, their family and neighbor should be done, and also the institutional backup for getting convenient oxygen devices is required.

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STUDY ON THE RELATIONSHIP BETWEEN THE ONTOGENETIC PROCESSES AND PSYCHOPATHOLOGY IN ATTENTION-DEFICIT HYPERACTIVITY DISORDER (주의력결핍 ${\cdot}$ 과잉운동장애의 Serotonin계의 개체발생적인 과정과 정신병리와의 상호관계에 관한 연구)

  • Jung, Yeoung;Shin, Sung-Woong;Whang, Joon-Won;Shin, Min-Sup;Cho, Soo-Churl
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.12 no.2
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    • pp.165-178
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    • 2001
  • In order to elucidate the biological etiology and the relationship between the ontogenesis of serotonin system and psychopathology in ADHD, plasma serotonin(5-hydroxytryptamine, 5-HT) and 5-hydroxyindoleacetic acid(5-HIAA) were measured and the correlation between the plasma levels of 5-HT and 5-HIAA and age were evaluated in 46 ADHD patients and 18 control subjects. The ADHD patients were composed of 16 combined type, 10 inattentive type, and 20 hyperactive-impulsive type and the control subjects were communication disorders. The results are summarized as follows:1) There was significant difference in plasma 5-HT levels among combined, inattentive and hyperactive-impulsive and control subjects(ANOVA F=4.33, df 3, 60, p<0.05), and post-hoc test using Scheffe method showed significant difference between the combined type and control group. But, post-hoc tests showed no significant differences between combined and inattentive, combined and hyperactive-impulsive, hyperactive-impulsive and inattentive, hyperactive-impulsive and control and inattentive and control groups. 2) There was no significant differences in plasma 5-HIAA levels among the combined, hyperactive- impulsive, inattentive and control groups(ANOVA F=2.08, df 3, 60, p>0.05). 3) Significant difference in 5-HT level was found between the whole ADHD group(N=46) and the control group(N=18)(T=3.10, df 62, p<0.05). But no significant difference in 5-HIAA level was found between the whole ADHD group and the control group(T=1.90, df 62, p>0.05). 4) Plasma 5-HT and 5-HIAA levels showed no significant correlation with TOVA findings(5-HT:omission pearson correlation 0.10, commision 0.23, reaction time 0.01, variability in attention 0.11, all p>0.05, 5-HIAA:omission 0.21, commision 0.15, reaction time 0.09, variability in attention 0.15, all p>0.05). 5) Plasma 5-HT and 5-HIAA levels showed no significant correlation with attention, hyperactivity and impulsivity based on DSM-IV criteria. 6) Plasma 5-HT and 5-HIAA levels showed no significant correlation with age both in ADHD and control group. These findings show that decreased plasma 5-HT level may play a role in the genesis of ADHD, but this finding has no significant correlation with the psychopathology of ADHD. And we could not find any significant differences in ontogenetic processes in 5-HT. Future studies should be focused on the drug effects, family history and prognosis based on the biochemical subtypes(high and low 5-HT group).

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Establishment of Reference Value of Insulin Using the Statistical Analysis (통계적 분석을 통한 Insulin의 정상 참고치 설정)

  • Kim, Whe-Jung;Yoon, Pil-Young;Shin, Young-Goon;Yoo, Seon-Hee;Cho, Shee-Man
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.143-146
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    • 2010
  • Purpose: Insulin is involved in carbohydrate metabolism and also it's very important because it increases storage of glycogen, synthesis of fatty acids, absorption of amino acid, synthesis of protein. Insulin is clinically useful when we evaluate fasting patients in hypoglycemia, classify and predict diabetes, assess the activity of ${\beta}$-cell, research insulin resistance. We are going to increase usability of insulin assay by establishing normal reference value according to statistical analysis. Material & Method: We selected 6,648 patients who visited asan health medical center from May to August in 2008. We set exclusion criteria as family of diabetes, diabetes medication, the past history of blood glucose rise, more than 100 mg/dL in normal fasting blood glucose, outside the scope of BMI 18.5~22.9 $kg/m^2$, and more than HbA1c 6.5%. We determine whether the subgroup is portioned as sex and age or not and establish normal reference value by conducting statistical analysis as Bayesian's method and Hoffman's method. Result: Portioning of subgroup as sex and age is not needed. By statistical analysis of Bayesian method, results 1.5-11.0 uIU/mL. By statistical analysis of Hoffman method, results 1.8~12.8 uIU/mL. Conclusion: We established 1.8~12.8 uIU/mL as Insulin normal reference value by Hoffman method. This is a similar value with reporting reference value 1.7~11.8 uIU/mL in kit. This will enhance the usability of insulin assay by establishing normal reference value.

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Legal and Regulatory Issues in Genetic Information Discrimination - Focusing on Overseas Regulatory Trends and Domestic Implications - (유전정보 차별금지의 법적문제 - 외국의 규율 동향과 그 시사점을 중심으로 -)

  • Yang, Ji Hyun;Kim, So Yoon
    • The Korean Society of Law and Medicine
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    • v.18 no.1
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    • pp.237-264
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    • 2017
  • With the onset of the Human Genome Project, social concerns about 'genetic information discrimination' have been raised, but the problem has not yet been highlighted in Korea. However, non-medical institutions' genetic testing which is related to disease prevention could be partially allowed under the revised "Bioethics and Safety Act" from June 30, 2016. In the case of one domestic insurance company, DTC genetic testing was provided for the new customer of cancer insurance as a complimentary service, which made the social changes related to the recognition of the genetic testing. At a time when precision medicine is becoming a new standard for medical care, discipline on genetic information discrimination has become a problem that can not be delayed anymore. Article 46 and 67 of the Bioethics Act stipulate the prohibition of discrimination on grounds of genetic information and penalties for its violation. However, these broad principles alone can not solve the problems in specific genetic information utilization areas such as insurance and employment. The United States, Canada, the United Kingdom, and Germany have different regulations that prohibit genetic information based discrimination. In the United States, Genetic Information Non-Discrimination Act takes a form that adds to the existing law about the prohibition of genetic information discrimination. In addition, the range of genetic information includes the results of genetic tests of individuals and their families, including "family history". Canada has recently enacted legislation in 2017, expanding coverage to general transactions of goods or services in addition to insurance and employment. The United Kingdom deals only with 'predictive genetic testing results of individuals'. In the case of insurance, the UK government and Association of British Insurers (ABI) agree to abide by a policy framework ('Concordat') for cooperation that provides that insurers' use of genetic information is transparent, fair and subject to regular reviews; and remain committed to the voluntary Moratorium on insurers' use of predictive genetic test results until 1 November 2019, and a review of the Concordat in 2016. In the case of employment, The ICO's 'Employment Practices Code (2011)' is used as a guideline. In Germany, Human Genetic Examination Act(Gesetz ${\ddot{u}}ber$ genetische Untersuchungen bei Menschen) stipulates a principle ban on the demand for genetic testing and the submission of results in employment and insurance. The evaluation of the effectiveness of regulatory framework, as well as the form and scope of the discipline is different from country to country. In light of this, it would be desirable for the issue of genetic information discrimination in Korea to be addressed based on the review of related regulations, the participation of experts, and the cooperation of stakeholders.

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Hemophagocytic Syndrome Presenting as Severe Acute Hepatitis (중증 급성 간염으로 발현한 혈구탐식증후군에 관한 연구)

  • Ryu, Jeong Min;Chang, Soo Hee;Kim, Joon Sung;Lee, Joo Hoon;Lee, Mi Jeong;Park, Kie Young;Kim, Kyung Mo;Seo, Jong Jin;Moon, Hyung Nam;Ghim, Thad;Chi, Hyun Sook
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.8 no.2
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    • pp.213-221
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    • 2005
  • Purpose: Hemophagocytic syndrome (HPS) is characterized by persistent high fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, and/or hypofibrinogenemia. Hepatic manifestations including overt hepatic failure and fulminant hepatitis are common in HPS. Liver transplantation (LT) should be considered in a case of fulminant hepatitis by other than HPS, but LT is contraindicated and complete cure is possible by chemotherapy in HPS. Therefore, we conducted this study to define the characteristics of HPS presenting as severe acute hepatitis. Methods: Among the total of 23 patients diagnosed as HPS by bone marrow examination between 1994 and 2005 in Asan Medical Center, 11 cases presented as severe acute hepatitis were enrolled in this study. We analyzed the clinical features, laboratory findings and outcome retrospectively. Results: Seven (64%) of the 11 children with HPS and hepatitis were referred to pediatric gastroenterologist at first. The mean age of onset was 50 months. There was no case with family history of primary HPS. Epstein-Barr virus was positive in 4, and herpes Simplex virus was positive simultaneously in 1 case. As the presenting symptoms and signs, fever was present in 10, hepatosplenomagaly was noted in all and jaundice in 10. Anemia was observed in 10, thrombocytopenia in 10, leukopenia in 8, hypertriglyceridemia in 9, hypofibrinogenemia in 8 and hyperferritinemia in 7 cases, respectively. Nine children received chemotherapy including etopside. The overall mortality rate was 72% (8/11). Conclusion: HPS, which needs chemotherapy, should be considered as a cause of severe acute hepatitis especially when accompanied with prolonged high fever and cytopenias.

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