Usefulness of the Alcohol Use Disorders Identification Test–Korean Revised Version in Screening for Diagnostic and Statistical Manual of Mental Disorders 5th Edition Alcohol Use Disorder among College Students / 가정의학회지

BACKGROUND: There is a distinction in alcohol consumption behavior between adults and college students. This study aims to verify the usability and the optimal cutoff point of Alcohol Use Disorders Identification Test–Korean revised version (AUDIT-KR) for screening alcohol use disorder in college students when the diagnostic and statistical manual of mental disorders (DSM), 5th edition diagnostic criteria is applied. METHODS: A total of 922 college students living in Daejeon were enrolled and divided into two groups based on how many items they corresponded to among DSM-5 alcohol use disorder diagnostic criteria: those who corresponded to ≥2 of the 11 items were classified into the patient group (107 males, 89 females) while the others into the control group (311 males, 415 females). The participants were evaluated using AUDIT-KR to find the optimal cutoff point for screening alcohol use disorder, sensitivity, and specificity. RESULTS: The mean±standard deviation scores in the AUDIT-KR were 12.76±7.27, 10.72±4.62 for males and females, respectively, in the patient group. In contrast, in the control group the scores were 6.26±5.23 and 3.95±3.59 in males and females, respectively. The area under the receiver operating characteristic curve (95% confidence interval) regarding alcohol use disorder screening by AUDIT-KR was 0.768 (0.715–0.821) and 0.883 (0.848–0.919) for males and females, respectively. The optimal cutoff point of alcohol use disorder for males was >9, sensitivity 64.49%, and specificity 76.85%. The optimal cutoff point for females was >6, sensitivity 82.02%, and specificity 80.48%. CONCLUSION: This study suggested that AUDIT-KR can be used as a screening tool for alcohol use disorder in groups of college students when DSM-5 diagnosis criteria are applied.

Association between Alcohol Drinking and the Ratio of Aspartate Aminotransferase to Alanine Aminotransferase in Korean Adult Male

BACKGROUND: The aspartate transaminase (AST)/alanine transferase (ALT) ratio increases with alcohol consumption. This study investigated AST/ALT ratio according to alcohol drinking and predictive power of AST/ALT ratio for heavy drinking in Korean men. METHODS: In 2015, 830 men with no history of disease or medication affecting liver function values were selected. Using 14 g of alcohol as the standard glass, odd ratios (ORs) of AST/ALT ratio over 1 among the drinking group were compared with the non-drinking group by multiple logistic analyses. Screening of heavy drinkers was conducted according to both NIAAA and Korean guidelines. Using AST/ALT ratio >1, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios, negative likelihood ratios and odds ratios were investigated. RESULTS: After correcting for age, body mass index, exercising, and smoking history, ORs (95% confidence interval) of AST/ALT >1 were 1.607 (1.048-2.464) in 14 glasses group. When AST/ALT >1 in the drinking group, sensitivity, specificity, positive predictive values, negative predictive values, likelihood ratios (LR)+, LR- and OR according to NIAAA guidelines, were 57.2%, 52.7%, 23.2%, 76.8%, 1.21 (1.04-1.41), 0.81 (0.67-0.98), and 1.49 (1.05-2.01), respectively. By Korean guidelines, these values were 55.2%, 55.3%, 33.7%, 66.3%, 1.24 (1.03-1.36), 0.84 (0.72-0.98), and 1.40 (1.04-1.89), respectively. CONCLUSIONS: Healthy male adults showed a positive correlation between risk of AST/ALT >1 and drinking amount compared to the non-drinking group. Use of the AST/ALT >1 in combination with other blood markers to predict excessive drinking is advisable.

Analysis of Natural History of Upper Gastrointestinal Subepithelial Tumors and Factors Related to Tumor Growth Demonstrated by Endoscopic Ultrasonography

BACKGROUND/AIMS: Small subepithelial tumors (SETs) are often found incidentally during esophagoduodenoscopy, and EUS is a useful tool for assessing SETs. This study aimed to evaluate the natural history of SETs and to clarify the predictive factors of growth using EUS. MATERIALS AND METHODS: We retrospectively investigated SETs less than 30 mm and identified the EUS features. A significant increase in SET size was defined as a lengthening of more than 25% of the longest diameter in the last follow-up EUS features compared with the initial study. RESULTS: A total of 99 patients with 105 upper gastrointestinal SETs were enrolled. The mean follow-up period for SETs was 22.8 months. Among the 105 SETs, 12 (11.4%) were significantly larger at follow-up. Univariate analysis revealed that the presence of hypoechoic areas was associated with significant SET growth (P=0.021). In multivariate analysis, the presence of hypoechoic areas (OR, 8.96; 95% CI, 1.89~42.54) and anechoic areas (OR, 7.85; 95% CI, 1.09~56.37) were related with significant growth of SETs. Six of the 12 SETs showing significant growth were removed, and identified as gastrointestinal stromal tumors. CONCLUSIONS: Majority of small SETs showed no significant increase during follow-up. Presence of hypoechoic areas and anechoic areas were associated with SET growth. Therefore, small SETs with hypoechoic area or anechoic area may be considered for regular follow-up in the clinical field.

Relationship among Alcohol Consumption, Facial Flushing Response and Dyslipidemia in Male

BACKGROUND: Facial flushing response to drinking is observed in East Asians with deficient activity of the variant aldehyde dehydrogenase 2 genotype. This study examined the role of flushing response in the relationship between alcohol consumption and dyslipidemia. METHODS: This cross-sectional study included 1,443 Korean men, including 261 non-drinkers, 470 flushers and 712 non-flushers. Based on a questionnaire, weekly alcohol consumption was assessed and categorized into 4 groups. Dyslipidemia was defined by the National Cholesterol Education Program-Adult Treatment Panel III criteria. After adjusting for confounding factors, we evaluated the relationship between weekly alcoholic drinks and dyslipidemia in flushers and non-flushers by comparing with non-drinkers, using a multi-variable logistic regression analysis. RESULTS: Non-flushers had a significant relationship between hypertriglyceridemia and alcohol consumption in two groups (4-8 drinks: adjusted odds ratio [aOR] 1.937, 95% confidence interval [CI] 1.029-3.644; ≥16 drinks: aOR 2.118, 95% CI 1.272-3.527) in contrast to flushers, who showed no significant relationship between hypertriglyceridemia and alcohol consumption. Non-flushers had a significant relationship to low serum high density lipoprotein (HDL) cholesterol levels in four groups (<4 drinks: aOR 0.428, 95% CI 0.277-0.662; 4-8 drinks: aOR 0.409, 95% CI 0.216-0.774; 8-16 drinks: aOR 0.285, 95% CI 0.152-0.536; ≥16 drinks: aOR 0.343, 95% CI 0.207-0.568), and flushers had a significant relationship in two groups (8-16 drinks: aOR 0.234, 95% CI 0.102-0.536; ≥16 drinks: aOR 0.342, 95% CI 0.166-0.705). CONCLUSIONS: Our results suggest that drinking alcohol increases the risk of hypertriglyceridemia in non-flushers and the risk of low HDL cholesterol flushers.

The Influence of Iron Deficiency on Helicobacter pylori Eradication

BACKGROUND/AIMS: Helicobacter pylori is a distinctive pathogen that lives in the gastric mucosa and is a well known risk factor of gastric adenocarcinoma. Iron deficiency aggravates the development of H. pylori-induced premalignant and malignant lesions in a cagA-dependent manner, enhancing H. pylori virulence. The aim of this study was to identify the relationship between iron deficiency and H. pylori eradication rates. MATERIALS AND METHODS: Participants who received 7 days of first-line triple therapy with serum iron level measured in parallel were retrospectively investigated between 2005 and 2014. H. pylori eradication was confirmed by the rapid urease test or 13C-urea breath test at least 4 weeks after completion of triple therapy. Iron deficiency was defined as either a serum iron level less than 50 µg/dL or a serum ferritin level less than 12 ng/mL. RESULTS: A total of 194 patients received 7 days of first-line triple therapy along with parallel serum iron level measurements over the 10-year period. The mean average age was 53.3 years (range, 21~86 years), and 135 patients (69.6%) were male. The overall H. pylori eradication rate was 83.5%. Proportions of eradication success with ferritin level less than 12 ng/mL and iron less than 50 µg/dL were 90.5% and 88.6%, respectively. However, there was no statistical difference in eradication rates according to iron deficiency. CONCLUSIONS: Iron deficiency might not be related with H. pylori eradication rates in this study. Further large-scale studies are needed to confirm this result.

A Cases of Adult Onset Still's Disease with Hemolytic Anemia

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.

A Cases of Adult Onset Still's Disease with Hemolytic Anemia

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.

The Current Status of Multidrug-Resistant Tuberculosis in One Tertiary Hospital in Busan, 2005~2009 / 결핵및호흡기질환

BACKGROUND: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. METHODS: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. RESULTS: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. CONCLUSION: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.

Comparison of the Diagnostic Usefulness of Two Whole-Blood Interferon-Gamma Assays for Extrapulmonary Tuberculosis / 대한내과학회지

BACKGROUND/AIMS: The QuantiFERON-TB Gold (QFT-G) and QuantiFERON-TB Gold in tube (QFT-IT) assays have been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. The clinical usefulness of these assays for the detection of active extrapulmonary (EP) TB has not been fully defined. The aim of this study was to compare the diagnostic value of these two interferon-gamma assays for EP-TB. METHODS: From June 2007 to August 2010, we evaluated the usefulness of QFT-G (n = 56) and QFT-IT (n = 48) in patients (n = 104) with suspected EP-TB. The diagnostic sensitivity, specificity, postive predictive value (PPV), and negative predictive value (NPV) of QFT-G and QFT-IT, and the cut-off value of QFT-IT were analyzed. RESULTS: EP-TB was diagnosed in 55 (53%) patients. The overall sensitivity, specificity, PPV, and NPV of the QFT-IT assay were 96%, 42%, 62%, and 91%, respectively, and those of the QFT-G test were 81%, 52%, 68%, and 68%, respectively. In subgroup analyses according to infection site, the sensitivity and NPV of QFT-IT were higher than those of QFT-G. Analysis confirmed that the manufacturer's recommended test cut-off value fell within our cut-off value range (0.30-0.45 IU/mL; 95.8% sensitivity, 41.7% specificity). CONCLUSIONS: The QFT-IT assay showed superior sensitivity and NPV, and equivalent specificity, as comparison with the QFT-G test for the detection of Mycobacterium tuberculosis infection. The logistic benefits of the QFT-IT test format should facilitate the diagnosis of EP-TB.

The Stress of Traditional Biggest Holidays among Korean Married Women / 가정의학회지

BACKGROUND: The Korean traditional national holidays commonly produce several physical symptoms related to stress. This study was performed to evaluate the degree of the stress from the married women during their Korean traditional biggest holidays. METHODS: The subjects were 99 married women who had visited the Health Promotion Center at a university hospital. For evaluating the stress of the Korean traditional biggest holidays, subjects were allowed to write in subjective stress score based on the Social Readjustment Rating Scale. The factors associated with the stress were investigated. RESULTS: The mean (+/- SD) score of the married women's stress of the Korean traditional biggest holidays was 38.7 (+/- 21.9). The score was widely distributed from the 0 to 100. The cases with hobbies to cope with stress showed significantly (P < 0.05) lower stress score than those without hobby. The stress score was inversely correlated with family APGAR score (r = -0.346, P < 0.01). In stepwise multiple regression model, the stress score was related to family APGAR score and hobby to cope with stress (overall R2 = 0.171, P < 0.001). CONCLUSION: The stress score of the Korean traditional biggest holidays was widely distributed from 0 to 100 in Korean married women. These results suggest that traditional biggest holidays act as a stressor for individual with a range of variable extent.

A Case of Rituximab Treatment for Interstitial Lung Disease in a Patient with Antisynthetase Syndrome / 대한류마티스학회지

The clinical manifestations of antisynthetase syndrome are severe interstitial pneumonitis, mild polyarthritis, and myositis. This disease is accompanied by anti-Jo-1 antibodies and anti-Ro/SSA antibodies and occasionally by the concurrence of anti-Jo-1 and anti-Ro/SSA antibodies, which leads to a more severe form of interstitial lung disease. In this case, the patient was transferred to our hospital because of pulmonary fibrosis with myositis and diagnosed with antisynthetase syndrome and the concurrence of anti-Jo-1 with anti-Ro/SSA antibodies. He was refractory to glucocorticoids, and developed leucopenia and thrombocytopenia. He was treated with rituximab infusions, but the interstitial pneumonitis progressed very rapidly and he died.

Prognostic Factors Affecting Survival Rate in Inflammatory Myositis / 대한류마티스학회지

OBJECTIVE: To assess the 10-year cumulative survival outcome of polymyositis (PM) and dermatomyositis (DM) as well as the factors associated with the the outcome. METHODS: Eighty five patients with PM and twenty one patients with DM were diagnosed at our university medical center between 1997 and 2007. Thirty six patients with PM and 13 patients with DM were followed up until death or until the end of January, 2008. Gender, age, AST, ALT, CPK, LDH, ESR, CRP, aldolase, drugs of therapy, combined ILD, and cancer, and duration of remission after therapy were assessed as prognostic factors of death by the Kaplan-Meier curve and Cox regression model. RESULTS: The respective 10-year survival rate for PM and DM was 80.8% (95% confidence interval (CI): 73.3~87.2) and 55.9% (95% CI: 40.7~71.1), respectively. The median survival for PM and DM was 11.3 years (95% CI: 9.8~12.9) and 7.0 years (95% CI: 3.6~10.5), respectively. Compared to DM patients, the subjects with PM had a 167.26 fold (95% CI: 7.59~3683.19) combined ILD adjusted risk of mortality (p<0.05) and no other individual factor reached significance as a predictor of death. However, cancer had a hazard ratio (HR) of 17.00 (95% CI: 1.06~281.79) and 2.45 (95% CI: 0.78~12.45) for death in the PM and DM group, respectively. CONCLUSION: According to an analysis of the survival and its prognostic factors in patients with PM and DM, ILD is a risk factor for mortality in PM and cancer was risk factor for mortality in both PM and DM.

Can Carbohydrate-Deficient Transferrin (CDT) Reflect Alcohol Consumption in Korean Male Drinkers?

BACKGROUND: It has been suggested that CDT is a potential biological marker in the Western countries to reflect the degree of past alcohol consumption. This study was performed to compare CDT, AST (aspartate transaminase), ALT (alanine transaminase), and GGT (gamma- glutamyl transferase) as a biological marker reflecting drinking amounts in Korean patients. METHODS: The 25 males with moderate drinking(21 drinks/week) were studied for the relationships between their weekly drinking amount and the blood levels of CDT, AST, ALT, and GGT. RESULTS: Only CDT was significantly correlated (P=0.001) with weekly drinking amount among heavy drinkers, while both CDT (P=0.029) and GGT (P=0.000) were significantly correlated in moderate drinkers. Stepwise multiple regression revealed that GGT had R2 of 49.1% in moderate drinkers and CDT had R2 of 38.9% in heavy drinkers for the weekly drinking amount. CONCLUSION: The results described above suggested that CDT can be a potential biological marker for the purpose of quantitative monitoring the drinking behavior of heavy drinkers in Korea.