Analysis of Prevalence of Anemia according to Severity of Atopic Dermatitis

Background@#Inflammatory diseases can increase the prevalence of anemia. Recent studies confirmed that the prevalence of anemia is increased by atopic dermatitis (AD), a chronic inflammatory disease. Therefore, we aimed to elucidate the correlation between AD severity and prevalence of anemia. @*Methods@#We used data of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2016). We included pediatric patients (<18 years) with AD diagnosis who were prescribed medications for AD. We applied a propensity score method with inverse probability of treatment weighting (IPTW) adjusting for differences in prevalence of confounders and performed IPTW logistic regression to evaluate associations between the anemia and severity of AD. @*Results@#In total, 91,501 patients (mild AD: 47,054 patients; moderate-to-severe AD: 44,447 patients) <18 years who were prescribed drugs for AD were analyzed. Analysis of the probability of patients with mild AD and prevalence of anemia as a reference revealed an odds ratio (OR) of 1.159 (95% CI, 1.109-1.212; p<0.001) in moderate-to-severe AD patients, indicating a correlation between anemia prevalence and AD severity. Subgroup analysis according to gender, age group, and type of health insurance revealed there was an association between AD severity and anemia except in patients equal or older than 7 years. @*Conclusion@#The prevalence of anemia increased with AD severity despite adjusting for confounding factors. Our results support the hypothesis that AD can cause anemia, and anemia prevalence could be increased in severe AD patients. Further studies are needed to establish a pathological basis.

Analysis of Prevalence of Anemia according to Severity of Atopic Dermatitis

Background@#Inflammatory diseases can increase the prevalence of anemia. Recent studies confirmed that the prevalence of anemia is increased by atopic dermatitis (AD), a chronic inflammatory disease. Therefore, we aimed to elucidate the correlation between AD severity and prevalence of anemia. @*Methods@#We used data of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2016). We included pediatric patients (<18 years) with AD diagnosis who were prescribed medications for AD. We applied a propensity score method with inverse probability of treatment weighting (IPTW) adjusting for differences in prevalence of confounders and performed IPTW logistic regression to evaluate associations between the anemia and severity of AD. @*Results@#In total, 91,501 patients (mild AD: 47,054 patients; moderate-to-severe AD: 44,447 patients) <18 years who were prescribed drugs for AD were analyzed. Analysis of the probability of patients with mild AD and prevalence of anemia as a reference revealed an odds ratio (OR) of 1.159 (95% CI, 1.109-1.212; p<0.001) in moderate-to-severe AD patients, indicating a correlation between anemia prevalence and AD severity. Subgroup analysis according to gender, age group, and type of health insurance revealed there was an association between AD severity and anemia except in patients equal or older than 7 years. @*Conclusion@#The prevalence of anemia increased with AD severity despite adjusting for confounding factors. Our results support the hypothesis that AD can cause anemia, and anemia prevalence could be increased in severe AD patients. Further studies are needed to establish a pathological basis.

The Prescribing Patterns of Antipsychotic Drugs and Antiparkinsonian Drugs in Elderly Patients with Dementia

Background@#The number of patients with dementia continues to increase as the age of aging continues to grow. Psychiatric symptoms caused by senile dementia are controlled using antipsychotics. However, these antipsychotics can lead to Parkinson's disease, and abuse of dopamine derivatives such as levodopa among Parkinsonian drugs can lead to psychosis. Therefore, we evaluated the patterns of prescribed antipsychotics and antiparkinsonian drugs in patients with senile dementia. @*Methods@#We used data from the sample of elderly patients from the Health Insurance Review and Assessment Service (HIRA-APS-2016). We analyzed the patterns of prescribing antipsychotics and antiparkinsonian drugs including prescribed daily dosage, period of prescription, and number of patients with both antipsychotics and antiparkinsonian drugs for senile dementia. @*Results@#Among the 159,391 patients with dementia included in this analysis, 4,963 patients (3.1%) and 16,499 patients (10.4%) were prescribed typical and atypical antipsychotic drugs, respectively. The most frequently prescribed typical antipsychotic was haloperidol (4,351 patients with dementia), whereas the atypical agent was quetiapine (12,719 patients). The most frequently prescribed antiparkinsonian drugs were in the order of levodopa/carbidopa, benztropine, and ropinirole. In addition, 1,103 and 3,508 patients prescribed typical and atypical antipsychotics, respectively, were co-prescribed antiparkinsonian drugs. @*Conclusions@#Atypical antipsychotics were the preferred prescription in patients with senile dementia. The prescription dose was relatively low; however, the average treatment duration was mostly long-term. Selection of antipsychotics and/or antiparkinsonian drugs should be made carefully in senile dementia and the causal relationship of adverse drug reactions needs further study.

Multiple cardiovascular complications in a patient with Behcet's disease

Arterial and cardiac involvement of Behcet's disease is a rare but life threatening complication. The rupture of an arterial aneurysm might result in sudden death. We report a 54-year-old man with an established diagnosis of Behcet's disease who presented with multiple cardiovascular complications that eventually lead to his death. He presented with extensive venous occlusions, and sequentially developed right ventricular thrombosis with multiple pulmonary thromboembolisms, and a pulmonary artery aneurysm. We report this unusual sequence of cardiovascular complications in a patient with Behcet's disease.

A Case of Reactive Plasmacytosis Mimicking Multiple Myeloma in A Patient with Primary Sjogren's Syndrome

Primary Sjogren's syndrome (pSS) is a chronic autoimmune disease with welldocumented association of lymphoid malignancies during the progress of the disease. Although several types of malignancy and pseudomalignancy have been reported in pSS, low-grade non-Hodgkin's lymphomas are the most frequently observed. Reactive plasmacytosis mimicking myeloma is a very rare condition in association with pSS. We describe a 72-yr-old woman with pSS who presented with hypergammaglobulinemia, and extensive bone marrow and lymph node plasmacytosis, which mimicked multiple myeloma. In this patient, there was an abnormal differentiation of memory B cells to plasma cells in the peripheral blood suggesting underlying pathogenetic mechanism for this condition.

Changes in Homocysteine Levels During Low Dose Methotrexate Therapy for Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: To determine the effect of short term methotrexate (MTX) therapy and subsequent folic acid (FA) supplementation on plasma homocysteine (p-homocysteine) levels in patients with rheumatoid arthritis (RA). METHODS: Sixteen RA patients treated with low dose MTX (10 mg/week) were prospectively studied for 8 weeks. Sixteen age and sex matched healthy individuals were included for control. Serial p-homocysteine levels were determined before the initiation of MTX, 4 weeks after the MTX treatment, and further 4 weeks after FA supplementation. FA and vitamin B12 levels were determined before MTX treatment. RESULTS: Baseline p-homocysteine levels were not significantly different between the RA patients and the controls (7.63 vs 8.40micromol/L). However, in patients with RA, FA levels negatively correlated with the baseline p-homocysteine levels (p=0.009), whereas this negative correlation was not found in the controls. RA patients showed increased tendency in homocysteine levels after MTX treatment without folic acid supplementation but did not reach statistically significance (8.4 vs. 9.06micromol/L, p=0.57). With FA supplementation, the p-homocysteine levels significantly decreased to the level lower than the baseline value before treatment (8.40 vs. 7.05micromol/L, p=0.004). CONCLUSIONS: Folic acid nutriture is an important factor in determining baseline p-homocysteine levels. Folic acid supplementation during low dose MTX therapy result in decrease in p-homocysteine level, thereby, may be helpful to decrease the cardiovascular risk in patient with RA receiving MTX.

A Case of Systemic Lupus Erythematosus Presenting as Mononeuritis Multiplex / 대한류마티스학회지

Mononeuritis multiplex is a peripheral neuropathy characterized by degeneration of one or more named nerve trunks in association with the systemic vasculitides. Mononeuritis multiplex occurs rarely in systemic lupus erythematosus (SLE) patients and usually develops as a late complication of the disease. When mononeuritis multiplex occurs as a presenting feature of SLE, the diagnosis is often delayed causing considerable morbidity. We describe a patient who presented with mononeuritis multiplex as an initial manifestation of SLE.

Analysis of Immunoglobulin lambda Light Chain Repertoire in Systemic Lupus Erythematosus

BACKGROUND: Immunoglobulin (Ig) light chain repertoire has been implicated as a critical determinant in regulation of autoreactive B cells and production of pathogenic anti-DNA antibodies in systemic lupus erythematosus (SLE). We analyzed the impact of Ig lambda chain repertoire on development of autoimmunity in patients with SLE. METHODS: We obtained genomic DNA from individual peripheral CD19+ B cells of 3 untreated active SLE patients, and amplified Vlambda rearrangements from each single cell by polymerase chain reaction. RESULTS: A total number of 208 VlambdaJlambda rearrangements were analyzed. Analyzed sequences included 158 productive rearrangements and 50 nonproductive rearrangements. The differences in Vlambda gene usage in the productive and nonproductive repertoire of SLE patients were found compared to the non-autoimmune individuals. Vlambda gene, 9A was significantly overrepresented in nonproducative repertoire of SLE patients (P=0.016). In the productive repertoire, Vlambda genes, 3L and 1E were found more often in the SLE patients (P=0.001, P=0.043). When the productive and the nonproductive repertoires were compared, 9A was found significantly less in the productive repertoire in the SLE patients (P=0.000). There were no significant differences in the Jlambda gene usage between SLE patients and non-autoimmune individuals, but Jlambda2/3 gene was the most frequently used in SLE, whereas Jlambda7 gene was the most frequently used in the normal subjects. In the productive SLE Vlambda repertoire, 9.4% of the total sequences employed identical CDR3. It was particularly striking to find 7 identical versions of the 1G-Jlambda2/3 VlambdaJlambda rearrangements from one patient and 3 of the same sequence from another patient. Notably, identical Vlambda junctions in the SLE patients utilized significantly more homologous joining compared to Vlambda junctions of the normal adults (P=0.044). CONCLUSION: These data demonstrate regulation of lambda light chain expression in the SLE patients by selection of unique Vlambda genes. Also, biased selection and clonal expansion of particular Vlambda rearrangements are apparent in the SLE lambda repertoire.

Local Reactions after Intraarticular Hyaluronic Acid Injection for Osteoarthritis of the Knee / 대한류마티스학회지

OBJECTIVE: To describe the frequency and the nature of acute local reactions following intraarticular hyaluronate injection. METHODS: Retrospective review of patients with osteoarthirtis of the knee treated with intraarticular hyaluronate injection between June, 2001 and March, 2002. The frequency, symptoms and signs, and duration and treatment of the local reactions were analyzed. RESULTS: Nineteen patients received 124 hyaluronates injections to knees. Seven (36.8%) patients developed local reactions in 9 (7.3%) knees. Transient pain occurred in 3 patients. However, persistent pain accompanied by swelling developed in 4 patients. Patients who developed transient pain did not required treatment with self-limiting course, but patients with joint swelling required arthrocentesis and intraarticular corticosteroid injection. CONCLUSION: Intraarticular hyaluronate injection was associated with significant local reactions. Local reactions were more frequent and severe than previously described with occasional development of joint swelling requiring arthrocentesis.

Remission of Intractable Diarrhea in Secondary Amyloidosis Associated with Rheumatoid Arthritis / 대한류마티스학회지

Intractable diarrhea associated with secondary amyloidosis in rheumatoid arthritis (RA) is a serious clinical entity with poor prognosis. We describe a 39-year-old male RA patient who presented with intractable diarrhea. Biopsy findings of terminal ileum and colon revealed amyloidosis secondary to RA. Effective treatment of rheumatoid arthritis resulted in remission of intractable diarrhea caused by amyloid protein deposition.

A Case of a Huge Duodenal Brunner's Gland Hyperplasia / 대한소화기내시경학회지

So called Brunner's gland hyperplasia is characterized by a nodular proliferation of histologically normal Brunner's gland, accompanied by ducts and scattered stromal element. The clinical presentation vary from vague epigastric disomfort to obstruction and gastrointestinal bleeding. We experienced a case of huge Brunner's gland hyperplasia presented as a huge duodenal polyp. A 28-year-old woman was refered to our hospital because of suspicious ampulla of Vater cancer or duodenal cancer in abdominal CT scan. The patient complained of dizziness and intermittent melena. The side view duodenoscopic examination revealed a huge pedunculated mass originated from the posterior wall of the duodenal bulb. The head of the polyp was placed on the ampulla of Vater with several erosions suggesting recent bleeding. Resection of duodenal polyp was performed by laparoscopic duodenotomy and Brunner's gland hyperplasia was revealed on pathologic examination.

A Case of Behcet's Disease Complicated by Superficial Venous Thrombophlebitis and Thrombosis of the Abdomen / 대한류마티스학회지

Among the connective tissue diseases,Behcet's disease (BD)outrank systemic lupus erythematosus as a cause of venous occlusive disease.Deep vein thrombosis and superficial thrombophlebitis of the lower extremities are the most common venous lesions found in BD.We report a rare case of superficial venous thrombosis and thrombophlebitis of the abdomen,which was misdiagnosed as superficial mass in a previously undiagnosed BD patient.

A Case of Chronic Neutrophilic Leukemia Associated with Increased Respiratory Burst Activity of Neutrophils / 대한혈액학회지

Chronic neutrophilic leukemia is a rare myeloproliferative disorder. We have experienced a typical case of chronic neutrophilic leukemia in a 76-year-old man who complained abdominal distension due to hepatosplenomegaly. White blood cell count of peripheral blood was 50,500/nL with 90% segmented neutrophils. The underlying disease for a leukemoid reaction had not been detected. Leukocyte alkaline phosphatase score and the serum levels of vitamin B12 and uric acid were elevated. Chromosome study showed a normal karyotype without Philadelphia chromosome or bcr/abl rearrangement. Phorbol myristate acetate-activated respiratory burst activity of neutrophils measured with chemiluminescence showed increased activity.

Safety of transradial coronary intervention with early discharge in selected patients

BACKGROUND AND OBJECT: Transradial percutaneous coronary intervention enables early ambulation and caused less complications at the puncture site. This study was performed to evaluate the safety of transradial coronary intervention with early discharge in selected patients. MATERIALS AND METHOD: Thirty patients were studied retrospectively. Twenty five patients had transradial percutaneous coronary intervention with next morning discharge and 5 patients had transradial percutaneous coronary intervention on an outpatient basis. Each patient was checked for cardiovascular complication and any other problems at the puncture site immediately after, 2 weeks after and 1 month after the procedure. RESULTS: This study group consisted of 30 patients with a mean age of 60+/-10 years. The indication for intervention were unstable angina (63.3%), stable angina (20.0%), and restenosis at 6-month follow-up after intervention. A total of 21 stents were implanted at 40 lesions. No major cardiovascular complication nor puncture site complication was reported at 1 month follow-up. CONCLUSION: Early discharge is supposed to be safe for those with optimal angiographic results and no clinical problems for at least 5 hours after intervention.