Adverse Drug Reactions to Dapsone: A Retrospective Study during the Last 15 Years / 대한피부과학회지

Background@#Dapsone has been used for a long time to treat skin diseases. Although various drug-related side effects and adverse reactions to dapsone have been reported, most studies have addressed only one or two specific reactions to dapsone. @*Objective@#This study aimed to investigate the overall adverse reactions to dapsone in Koreans and their relationship with patient demographics. @*Methods@#A retrospective analysis was conducted by reviewing the electronic medical records from 2005 to 2020. The association between adverse drug reactions and dapsone use was assessed using the Naranjo scale. Correlations between variables and adverse reactions were analyzed using univariate and logistic regression analyses. @*Results@#The overall incidence of adverse drug reactions to dapsone was 7.7% (41 of 533 patients). The incidence was significantly higher in female than in male, and predictable adverse reactions were significantly higher (6.8%, 36 of 533 patients) than in unpredictable cases (0.9%, 5 of 533 patients). The most common adverse event was methemoglobinemia/anemia (3.0%, 16 of 533 patients), and the least common was hypersensitivity syndrome, which occurred in only one case (0.2%, 1 of 533 patients). With the exception of hypersensitivity syndrome, which is a severe drug-related side effects and adverse reactions, most patients recovered after drug discontinuation. @*Conclusion@#Dapsone can be used relatively safely for various chronic diseases if medical personnel are aware of its adverse reactions.

A Review on Community Care for Chronic Disease Management Based on Digital Health Care: For Elderly Living Alone / 임상당뇨병

In the face of aging, it can be difficult for the elderly to accept and cope with changes. During the coronavirus disease 2019 (COVID-19) pandemic, changes in the medical service market for health care such as non-face-to-face treatment implementation, education and counseling, seminars, and camps have accelerated. Changes in medical use through mobile phones, tablet PCs, wearable devices, etc. were inevitable. It is important to study how the current early elderly population maintains change in daily life and the extent to which elderly people living alone can participate in such change. This review aims to answer the question, “What should we consider when treating and consulting patients regarding use of the vastly changing medical environment?” In particular, the study focuses on digital healthcare and community care and related health and welfare policies with consideration of aging and increasing chronic diseases.

Management of Obesity and Diabetes Mellitus in Children and Adolescents: Staged Intervention / 임상당뇨병

Obesity is becoming a social issue as well as a medical problem, and childhood obesity, which affects healthy longevity, can lead to psychological, emotional, and social problems along with the transition to other diseases such as high blood pressure and diabetes. Active management at the social and government level is required. Nevertheless, there are few advanced general hospitals that systematically provide education for obese patients, and it is a reality that interventions for obese patients with diabetes, especially children and adolescents, are rare. As the number of children and adolescents with obesity and diabetes increases, attention should be paid to the approach, including individuals, families, and schools in the community that take into account characteristics and surrounding individuals. In addition, if education is being prepared in the field, changes in each system, including individual patients, take time, and a step-by-step approach is required. In this review, I would like to look at a step-by-step approach for educators on the juvenile obesity.

Management of Obesity and Diabetes Mellitus in Children and Adolescents: Staged Intervention / 임상당뇨병

Obesity is becoming a social issue as well as a medical problem, and childhood obesity, which affects healthy longevity, can lead to psychological, emotional, and social problems along with the transition to other diseases such as high blood pressure and diabetes. Active management at the social and government level is required. Nevertheless, there are few advanced general hospitals that systematically provide education for obese patients, and it is a reality that interventions for obese patients with diabetes, especially children and adolescents, are rare. As the number of children and adolescents with obesity and diabetes increases, attention should be paid to the approach, including individuals, families, and schools in the community that take into account characteristics and surrounding individuals. In addition, if education is being prepared in the field, changes in each system, including individual patients, take time, and a step-by-step approach is required. In this review, I would like to look at a step-by-step approach for educators on the juvenile obesity.

The Effect of Tumor Necrosis Factor-Alpha Inhibitors on Uveitis in Patients with Ankylosing Spondylitis

BACKGROUND: Tumor necrosis factor-alpha (TNF-α) inhibitors (TNFis), which are the main treatment for ankylosing spondylitis (AS), have been reported not only to reduce the incidence of anterior uveitis (AU) but also to induce it, and these effects differ among the various types of TNFis in clinical use. The present study investigated the effect of TNFis on uveitis by analyzing the long-term clinical course of AU in AS patients treated with TNFi therapy. METHODS: Patients treated with at least one TNFi between January 2007 and July 2017 were reviewed, and 54 patients with at least one episode of AU were included in this study. The TNFis included anti-TNF-α antibodies (adalimumab, infliximab, and golimumab), and a soluble TNF receptor molecule (etanercept). The effect of prevention of AU, the likelihood of new-onset uveitis after the initiation of TNFi therapy, and the effects of drug switching and dose escalation were assessed. RESULTS: The first uveitis flare was observed before TNFi therapy in 39 patients and after TNFi therapy in 15 patients. Anti-TNF-α antibodies were more efficacious in decreasing the recurrence of AU than etanercept. Among patients in which uveitis first occurred after beginning TNFi therapy, patients on etanercept tended to first develop AU less than 1 year after starting the drug, and their AS tended to be well-controlled at the time of uveitis flares. Patients with a uveitis flare before their medication was switched did not recur afterwards, and five of eight patients showed no relapse after dose escalation. CONCLUSION: TNFis have various effects on AU. TNFis, particularly anti-TNF-α antibodies, should be considered in patients with AS and frequent AU relapse. Additionally, clinicians should consider whether AU is due to an absence of a therapeutic response of AS to TNFi treatment or to TNFi treatment itself, and appropriate treatment changes should be made accordingly.

A Case of Leber Hereditary Optic Neuropathy Showing Optic Disc Hyperfluorescence

PURPOSE: We report an unusual case of Leber hereditary optic neuropathy presenting with optic disc hyperfluorescence. CASE SUMMARY: A 17-year-old male with sequential painless visual loss 3 weeks apart affecting first the left and then the right eye presented to our neuro-ophthalmology clinic. His best-corrected visual acuity was counting fingers in the right eye and 0.32 in the left eye. Fundus examination showed mild optic disc edema and hyperemia in both eyes, which were worse in the right eye. Fluorescein angiography revealed dye leakage from the right optic disc in the late phase. The results of magnetic resonance imaging of the brain and spinal cord were normal, and lumbar puncture study was unremarkable. Mitochondrial DNA sequencing revealed a pathognomonic 11778 mutation for Leber hereditary optic neuropathy. His vision deteriorated to 0.03 in both eyes 6 months later, but slowly started to improve 11 months after onset. At 2 years, his corrected visual acuity was 0.2 in both eyes. CONCLUSIONS: To our knowledge, this is the first report of optic disc hyperfluorescence in Leber hereditary optic neuropathy. This finding suggests that this mitochondrial optic neuropathy can masquerade as optic neuritis.

The Mentors, The Social Support and Patients with Diabetes Mellitus / 임상당뇨병

In countries with advanced health practices, it is important to note the importance of social capital and social support as social determinants in patient health as early as possible, while minimizing the constraints on self-management and reducing health inequalities. Beyond the individual, we offer mentoring and a social support system for individuals using community resources. We examined the growth of mentors and mentees through mentoring effectiveness and mentoring, and discussed the issues to be considered when applying such in the field. Ultimately, educators who are accustomed to 1:1 education or communicative group education should have the opportunity for recognition reconstruction.

Diabetes, Returning to Work, and Your Rights for Health / 임상당뇨병

Diabetes sufferers in their 30s to 50s are at an age must maintain their income-producing activities while also managing their health; however, maintaining this balance is not always easy due to their disease. Patients in their 30s to 50s who are actively engaged in work life may not experience workplace difficulties when their diagnosis is known and can be addressed with health-promoting behaviors or passive management. Patients have limitations in implementing the active self-management required by the educational scene in-house. The reason is because the working environment in Korea has not yet established a proper perception of diabetes and feels that allowing diabetes to manage diseases against fairness. The educators proudly reveal themselves as diabetes and cannot take into consideration or take responsibility the disadvantages they can experience when returning to work, we must consider what the patient “has to do to get back to work.” In addition, patients should think about how to manage their disease effectively through more than just a passive response. Moreover the Korean Diabetes Association should establish guidelines for the areas that need to be protected legally and on the defensive aspects that need to be better perceived.

Intravitreal Anti-vascular Endothelial Growth Factor Injections to Treat Neovascular Age-related Macular Degeneration: Long-term Treatment Outcomes

PURPOSE: We assessed the visual and anatomical outcomes, and the safety profile of long-term intravitreal anti-vascular endothelial growth factor (VEGF) injections (aflibercept, ranibizumab, and bevacizumab) given to treat neovascular age-related macular degeneration (NAMD). METHODS: We analyzed medical records collected over 7 years of treatment-naive NAMD patients who received outpatient clinic-based intravitreal anti-VEGF injections. All were treated employing either “treat-and-extend” or “as needed” protocols at the discretion of the retinal specialist. The number of injections, adverse events associated with injection, and measures of visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP) were recorded. RESULTS: Overall, we assessed 196 eyes of 196 patients (average age 68.6 ± 9.6 years; 77 females). Patients received an average of 17.3 ± 13.5 injections over 78.0 ± 16.5 months of clinical follow-up. The initial mean VA (logMAR) was 0.75 ± 0.58 and the CFT was 349.7 ± 152.6 µm. Both parameters exhibited maximal improvements at the 6-month visit (p < 0.05). However, the clinical outcomes worsened over the 7-year clinical course; the best-corrected visual acuity (BCVA) was 0.91 ± 0.78 and the CFT was 284.5 ± 105.8 µm at 7 years. The BCVA at 7 years was significantly correlated with the initial BCVA. IOP-related events increased 11-fold and anterior chamber reactions increased 3-fold over the years, but no significant complications such as endophthalmitis were recorded. CONCLUSIONS: The use of intravitreal anti-VEGF agents was associated with initial visual improvements over 6 months but did not prevent the worsening of NAMD over 5 years. The BCVA at the initial visit was a strong predictor of the final BCVA. A more intensive injection schedule might improve long-term outcomes.

Understanding and Approaching Low Motivation in Young Adults with Diabetes Mellitus / 임상당뇨병

Young Adults with diabetes mellitus suffer from low blood sugar levels due to the influences of their personal and social environments. In addition, they experience a constantly declining motivation, causing them to experience burn-out and eventually lose their quality of life. Considering this, diabetic education should be able to understand and take into account the characteristics of young adult patients while implementing various different approaches.

The Current Strategic Direction of Diabetes Education: American Association of Diabetes Educators Yearly Strategic Plan 2016~2018 / 임상당뇨병

The burden of diabetes mellitus (DM) has increased rapidly, affecting both individuals and society. Recent data suggest that multiple DM conditions impose an even larger burden on society and individuals. The effective self-management and prevention of DM has been one of the major agendas of health policy around the world. This is a time of sweeping change in health care regarding DM. To prepare for these changes, the American Association of Diabetes Educators (AADE) completed a thorough assessment of the current environment and trends affecting people with diabetes and diabetes education professionals. This paper explains the AADE 2016~2018 Strategic Plan, including ideas for empowering diabetes educators to expand the horizon of innovative education, management, and support. The roles and competencies of educators are evolving as various education delivery models advance and diversify.

Development of Menu Labeling System (MLS) Using Nutri-API (Nutrition Analysis Application Programming Interface)

Now a days, people eat outside of the home more and more frequently. Menu labeling can help people make more informed decisions about the foods they eat and help them maintain a healthy diet. This study was conducted to develop menu labeling system using Nutri-API (Nutrition Analysis Application Programming Interface). This system offers convenient user interface and menu labeling information with printout format. This system provide useful functions such as new food/menu nutrients information, retrieval food semantic service, menu plan with subgroup and nutrient analysis informations and print format. This system provide nutritive values with nutrient information and ratio of 3 major energy nutrients. MLS system can analyze nutrients for menu and each subgroup. And MLS system can display nutrient comparisons with DRIs and % Daily Nutrient Values. And also this system provide 6 different menu labeling formate with nutrient information. Therefore it can be used by not only usual people but also dietitians and restaurant managers who take charge of making a menu and experts in the field of food and nutrition. It is expected that Menu Labeling System (MLS) can be useful of menu planning and nutrition education, nutrition counseling and expert meal management.

NutriSyn: Knowledge Based Synonym Retrieval Service for Food and Dishes on the Web

Studies based on food analysis or food databases use the national standard food database. Although Internet information services are increasing gradually, users are only able to get definitive and profitable information using standard food terms. Until now, it has been uncommon to find food retrieval services that include users' regional or historical characteristics. Thus, this study introduces a prototype for Food and Dish Synonym Retrieval (NutriSyn) that includes synonyms and related words. The environments which NutriSyn was implemented were Linux for the server operating system, the Microsoft Windows series for the users' operating system and Apache for a web server. The development languages used are PHP, JavaScript and HTLM with a MySQL database. Users can access NutriSyn using Internet browsers. The main menu items are (1) Food Synonym DB, (2) Dish Synonym DB, (3) Food Information DB, (4) Dish Information DB, and (5) Food and Menu Synonym Retrieval. This system is expected to be a useful tool for food experts and inter- disciplinary research.

A Case of Acromegaly with Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis / 대한내분비학회지

Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 mg/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70~110 mg/dL, 13~100 U/L and 13~190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 mg/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 cm sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis

A Case of Multiple Endocrine Neoplasia Type I Presenting with a Watery Diarrhea / 대한내분비학회지

MEN1 is characterized by the combined occurrence of tumors of the parathyroids, pancreatic islet cells and the anterior pituitary. Pancreatic islet cell tumors occur in 40% of MEN1 patients. Pancreatic polypeptidomas occur most commonly but they are asymptomatic. Gastrinomas are the second most common type. VIPomas are rare and there has been no report of a case in Korea so far. We encountered a case of pancreatic VIPoma in MEN Type I. A 49 year old man was referred from his local hospital presenting with a sudden onset of an explosive watery diarrhea of 3 months duration. Abnormal findings in his blood chemistry were hypercalcemia and hypokalemia. The 99mTc-sestamibi sintigraphy showed an increased uptake in right lower parathyroid gland. Abdominal CT demonstrated a mass of 6x4 cm in tail of the pancreas and multiple lesions in both hepatic lobes. Serum levels of VIP hormones were elevated. Subtotal parathyroidectomy and subtotal pancreatectomy were done. Postoperatively his symptoms were improved transiently, however the patient showed repetitive attacks of watery diarrhea. So in order to palliate his symptoms, an RF ablation of the metastatic liver masses was performed. After that therapy his clinical symptoms were reduced dramatically. Unfortunately, the patients condition worsened again. Despite of continuous octreotide therapy, interferon and two courses of combination chemotherapy, the hepatic metastases failed to regress and the patient died 10 months after the diagnosis of a metastatic VIPoma. This is the first report of pancreatic VIPoma in MEN type I in Korea.

2 Cases of Ectopic ACTH Syndrome due to Thymic Neuroendocrine Carcinoma Associated with Different Clinical Manifestations / 대한내분비학회지

Primary neuroendocrine carcinoma of the thymus (formerly known as thymic carcinoids) are unusual tumors that account for 5% of all anterior mediastinal neoplasms. Thymic neuroendocrine carcinomas exhibit a much more aggressive behavior than those originating from other foregut locations and are associated with the ectopic ACTH syndrome in 38% of cases. Patients having a thymic neuroendocrine carcinoma usually present with symptoms such as chest tightness, dyspnea, a palpable neck mass and sometimes a weight gain. We report on 2 patients with thymic neuroendocrine carcinoma who showed different clinical manifestations each other. One presented with a typical. Cushingoid appearance and the other had symptoms of fatigue and weight loss which is a common symptom of malignant tumors.