The Severity of COVID-19 in Patients with Nonalcoholic Fatty Liver Disease in Korea / 보건행정학회지

Background@#Early identification of patients who are highly likely to develop severe illness among confirmed cases of coronavirus disease 19 (COVID-19) can be expected to lead to effective treatment. This study therefore aimed to determine whether the presence of nonalcoholic fatty liver disease (NAFLD) has an impact on the exacerbation of COVID-19 symptoms. @*Methods@#The study used the Korean National Health Insurance claim data for treatment of COVID-19 patients in 2020. NAFLD includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The outcome variables used were hospitalization and the use of medical devices. Hospitalization was defined by a length of stay exceeding one day and the use of medical devices was defined as one or more uses of a ventilator or extracorporeal membrane oxygenation. Multivariable logistic regression analysis was performed to determine if there was a difference in the hospitalization and use of medical devices of COVID-19 patients depending on the presence of NAFLD. @*Results@#The odds ratio of hospitalization was 1.059, indicating slightly higher odds of hospitalization for patients with NAFL or NASH compared to those without the conditions, but it was not statistically significant (0.969–1.156). On the other hand, the odds ratio of use of medical devices was high at 1.667 and was statistically significant (1.111–2.501). @*Conclusion@#The study results found NAFLD to be a risk factor that can exacerbate symptoms in COVID-19 patients. Accordingly, it is necessary to identify NAFLD patients through preemptive screening and provide them with appropriate treatments.

Health Behavior and Health Condition of Patients Exposed to Carbon Disulfide according to Exposure Level

Objective@#The purpose of this study is to garner useful information through a comparative analysis of health behaviors and health status between the low-dose carbon disulfide (CS2) exposure patients and the high-dose CS2 exposure patients. @*Methods@#Among 910 retired workers who were recognized for carbon disulfide poisoning, 702 survived at the research period. A total of 596 people were selected for the study, except 106 people who refused to participate or were unable to express their opinions. We define the low-dose exposure group as those under 5 ppm, and the high-dose exposure group as those over 5 ppm. @*Results@#Compared with the low-dose exposure patient, the high-dose exposure patient had a more frequent awakening during sleep and difficulty of dressing, toileting bathing, and food preparation. The high-dose exposure patient was vulnerable to anxiety and memory. In addition, the high-dose exposure patient felt hopeless more. The high-dose exposure patient lagged behind the low-dose exposure patient in sleep time and sleep quality. @*Conclusion@#The vulnerability of the high-dose exposure patient in terms of mental and sleep health needs to be acknowledged as the various characteristics of the CS2 exposure patient that appears according to an exposure group. A variety of disease prevention and health promotion programs that focus on the health behavior and status of the low-dose exposure and the high-dose exposure patients need to be developed and put into practice.

Health Behavior and Health Condition of Patients Exposed to Carbon Disulfide according to Exposure Level

Objective@#The purpose of this study is to garner useful information through a comparative analysis of health behaviors and health status between the low-dose carbon disulfide (CS2) exposure patients and the high-dose CS2 exposure patients. @*Methods@#Among 910 retired workers who were recognized for carbon disulfide poisoning, 702 survived at the research period. A total of 596 people were selected for the study, except 106 people who refused to participate or were unable to express their opinions. We define the low-dose exposure group as those under 5 ppm, and the high-dose exposure group as those over 5 ppm. @*Results@#Compared with the low-dose exposure patient, the high-dose exposure patient had a more frequent awakening during sleep and difficulty of dressing, toileting bathing, and food preparation. The high-dose exposure patient was vulnerable to anxiety and memory. In addition, the high-dose exposure patient felt hopeless more. The high-dose exposure patient lagged behind the low-dose exposure patient in sleep time and sleep quality. @*Conclusion@#The vulnerability of the high-dose exposure patient in terms of mental and sleep health needs to be acknowledged as the various characteristics of the CS2 exposure patient that appears according to an exposure group. A variety of disease prevention and health promotion programs that focus on the health behavior and status of the low-dose exposure and the high-dose exposure patients need to be developed and put into practice.

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.

Study on Mental Disorders in Abused Children / 신경정신의학

OBJECTIVES: Child abuse can affect mental and physical health of abused children. Accurate assessment of mental health of abused children is integral to providing proper treatment and preventing any further impact of childhood abuse on their future life. In this study, we investigated psychiatric illnesses among abused children. METHODS: Semi-structured interviews using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version were conducted for 61 abused children after obtaining consent from their guardians. We also assessed the relationship between the demographic data of these abused children and their diagnoses. RESULTS: Among the abused children, more than half had more than one psychiatric disorder. The most frequently diagnosed disorders were attention-deficit/hyperactivity disorder, posttraumatic stress disorder, depressive disorder, and oppositional defiant disorder. The incidence of posttraumatic stress disorder was higher in abused girls compared with abused boys. Abused children had a higher suicide risk than the general population. Among the parents of abused children, 50.8% had alcohol use disorders. CONCLUSION: Among the abused children, 50.8% had psychiatric disorders. Administration of intensive psychiatric treatment to abused children, and prevention of child abuse by education, treatment, and monitoring high-risk parents is imperative.

Early Cardiac Valvular Changes in Ankylosing Spondylitis: A Transesophageal Echocardiography Study

BACKGROUND: This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. METHODS: A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I ( or = 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. RESULTS: The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. CONCLUSION: Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution.

Early Cardiac Valvular Changes in Ankylosing Spondylitis: A Transesophageal Echocardiography Study

BACKGROUND: This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. METHODS: A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I ( or = 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. RESULTS: The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. CONCLUSION: Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution.

APACHE II Score, Rather Than Cardiac Function, May Predict Poor Prognosis in Patients With Stress-Induced Cardiomyopathy

While the disease course of stress-induced cardiomyopathy (SIC) is usually benign, it can be fatal. The prognostic factors to predict poorer outcome are not well established, however. We analyzed the Acute Physiology And Chronic Health Evaluation (APACHE) II score to assess its value for predicting poor prognosis in patients with SIC. Thirty-seven consecutive patients with SIC were followed prospectively during their hospitalization. Clinical factors, including APACHE II score, coronary angiogram, echocardiography and cardiac enzymes at presentation were analyzed. Of the 37 patients, 27 patients (73%) were women. The mean age was 66.1 +/- 15.6 yr, and the most common presentation was chest pain (38%). Initial echocardiographic left ventricular ejection fraction (EF) was 42.5% +/- 9.3%, and the wall motion score index (WMSI) was 1.9 +/- 0.3. Six patients (16%) expired during the follow-up period of hospitalization. Based on the analysis of characteristics and clinical factors, the only predictable variable in prognosis was APACHE II score. The patients with APACHE II score greater than 20 had tendency to expire than the others (P = 0.001). Based on present study, APACHE II score more than 20, rather than cardiac function, is associated with mortality in patients with SIC.

A Case of Aspergillosis of the Central Nervous System in an Immunocompetent Patient / 대한내과학회지

Invasive aspergillosis usually does not occur in immunocompetent patients. Recently, however, the incidence of invasive aspergillosis has been increasing in immunologically competent patients. It is difficult to diagnose neuroaspergillosis because of its varied radiological findings and clinical manifestations. We report a case of aspergillosis of the central nervous system, presenting as a mass-like lesion, in an immunocompetent patient. The patient was diagnosed after a surgical biopsy and treated with antifungal agents. The clinical outcome was good.

Lamotrigine Augmentation in Patients with Treatment-Resistant Major Depressive Disorder: A Naturalistic Study / 대한정신약물학회지

OBJECTIVE: Lamotrigine's possible efficacy in the treatment of depressive disorders has been suggested. This naturalistic study investigated clinical response to lamotrigine augmentation in patients with treatment-resistant depression. Characteristics of the lamotrigine-responders were also explored. METHODS: Clinical data from 40 lamotrigine- treated patients with treatment-resistant unipolar depression were analyzed. The subjects were diagnosed with DSM-IV major depressive disorder and resistant to at least 2 antidepressants. Efficacy of lamotrigine treatment was measured by the changes in mean scores of the Clinical Global Impression Severity subscale (CGI-S), which were extracted from the prospective mood chart and structured interviews. Response was defined as a decrease of at least 2 or more from baseline on the CGI-S. Untoward effects associated with lamotrigine treatment were also assessed through medical records. RESULTS: Significant reduction in the CGI-S mean score was observed from baseline through 8 week lamotrigine augmentation in 40 patients with treatment-resistant unipolar depression (t=5.7, df=39, p<.01), and the magnitude of treatment effect was large (r(effect size)=0.68). Drop-outs were mainly attributable to lamotrigine-associated rash (N=5). Greater rate of improvement was associated with responder group (N=14) compared to non-responder group (N=17) from week 3 onward. CONCLUSION: The results of current study lend support to the potential benefit of lamotrigine augmentation in a subpopulation of patients with treatmentresistant unipolar depression. Continuation of lamotrigine add-on for more than 3 weeks may be needed to assess clinical outcome. Lamotrigine augmentation was generally well-tolerated. Large scale, double-blind studies are necessary to confirm its use as an augmentation agent.

Low Dose Olanzapine Induced Tardive Dyskinesia: A Case Report / 대한정신약물학회지

Olanzapine is known to induce extrapyramydal symptom and tardive dysknesia less than typical antipsychotics. However, there are accumulating reports of tardive dyskinesia induced by olanzapine. We experienced a patient with schizophrenia who demonstrated tardive dyskinesia following treatment with low dose olanzapine. This case suggests that even patients with low dose olanzapine are exposed to the risk of tardive dyskinesia.

Alterations of the DPC4 Gene in Human Stomach Cancers / 대한암학회지

PURPOSE: Allelic loss on chromosome 18q is a hallmark of presence of a tummor represser gene. Recently, DPC4 (deleted in pancreatic carcinoma, locus 4), a candidate tumor suppressor gene, has been localized at 18q21. Inactivation of DPC4 gene was reported in pancreatic carcinomas, coloretal carcinomas, and prostatic carcinomas. The aim of the present study was to determine if it might be altered in stomach cancer. MATERIALS AND METHODS: We tested for DPC4 gene mutations and allelic status at 18q21 using a modified 'cold SSCP' method in 48 primary gastric carcinoma and correlated the findings with various clinicopathologic characteristics of the patients. RESULTS: The frequency of mutations in primary gastric cancer was 27.1% (13/48). Mutations of exon 1, 8, 10 were found in 2 (4.1%), 4 (8.2%) and 7 cases (14.6%), respectively. DNA sequencing of 13 cases with DPC4 mutations identified six cases (46.1%) with substitution, four cases with deletion (30.7%), and two cases (23.1%) with insertion. No significant difference was observed in the frequency of DPC4 mutations in terms of other various clinicopathologic characteristics. CONCLUSION: These findings suggest that DPC4 mutations may play a significant role in the establishment and progression of the primary gastric cancer.