Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests

Acute generalized exanthematous pustulosis (AGEP) is rarely caused by radiocontrast media (RCM). The role of skin tests for the diagnosis and evaluation of cross-reactivity in a delayed type of RCM-induced hypersensitivity have yet to be determined. Here, we report a case of iodixanol-induced AGEP where we safely administered alternative RCM using patch tests. A 44-year-old woman had coronary artery angiography (CAG) for the evaluation of ischemic heart disease. She was on regular hemodialysis because of end-stage renal disease. She was given iodixanol (Visipaque) during CAG. Approximately 1 day after CAG, she developed AGEP. The patient was rehospitalized for CAG again after 1 year. We performed skin tests to choose safe alternative RCM. Intradermal tests with iodixanol, iohexol (Bonorex) and Iopamidol (Pamiray) showed negative responses. Patch tests showed a positive response to iodixanol, equivocal to iohexol, and negative to Iopamidol. We finally chose Iopamidol and performed CAG successfully without any adverse reaction. Patch tests may be a useful tool for the diagnosis and choice of safe alternatives in RCM-induced delayed-type hypersensitivity reactions such as AGEP.

Impact of Socioeconomic Status on Health Behaviors, Metabolic Control, and Chronic Complications in Type 2 Diabetes Mellitus

BACKGROUND: The aim of the study was to assess the impact of socioeconomic status (SES) on health behaviors, metabolic control, and chronic complications in people with type 2 diabetes mellitus (T2DM) from South Korea, a country with universal health insurance coverage and that has experienced rapid economic and social transition. METHODS: A total of 3,294 Korean men and women with T2DM aged 30 to 65 years, participating in the Korean National Diabetes Program (KNDP) cohort who reported their SES and had baseline clinical evaluation were included in the current cross-sectional analysis. SES included the level of education and monthly household income. RESULTS: Lower education level and lower income level were closely related, and both were associated with older age in men and women. Women and men with lower income and education level had higher carbohydrate and lower fat intake. After adjustment for possible confounding factors, higher education in men significantly lowered the odds of having uncontrolled hyperglycemia (glycosylated hemoglobin ≥7.5%) (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43 to 0.91 for highest education; P(trend)=0.048), while higher household income in men significantly lowered the odds of having diabetic retinopathy (OR, 0.59; 95% CI, 0.37 to 0.95 for highest income level; P(trend)=0.048). In women, lower income was associated with a higher stress level. CONCLUSION: Men with lower SES had higher odds of having diabetic retinopathy and uncontrolled hyperglycemia, showing the need to improve care targeted to this population.

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Hypereosinophilic Syndrome Presenting as Eosinophilic Cholangiopathy and Cystitis / 대한췌담도학회지

Eosinophilic cholangiopathy is a rare disease characterized by dense transmural eosinophilic infiltration of the gallbladder and bile duct. It's clinical and laboratory manifestations are not different from those of other causes of cholangiopathy, and the diagnosis is usually made based on pathologic findings after cholecystectomy. Moreover, the occurrence of eosinophilic cystitis accompanied by cholangiopathy is extremely rare. We report a rare case of hypereosinophilic syndrome manifested as eosinophilic cholangiopathy accompanied with eosinophilic cystitis, for the first time in Korea, in a 49-year-old woman who presented with persistent right upper quadrant pain. After performing imaging study to validate the diagnosis of acute acalculous cholecystitis and cholangitis, an urgent cholecystectomy was performed. Pathologic examination of the excised gallbladder was consistent with eosinophilic cholecystitis. The patient underwent bladder biopsy because there was persistant irritative voiding symptoms combined with constant mild peripheral eosinophilia even after cholecystectomy, and the pathologic findings revealed eosinophilic cystitis. Symptoms and peripheral eosinophilia were improved after steroid therapy for an indicated period.

Relationship between Bone Mineral Density, Erythropoiesis, and Calcium-Phosphorus-Parathyroid Hormone Status in End-stage Renal Disease Patients

OBJECTIVES: Abnormal bone turnover and mineralization is the characteristic of the end-stage renal disease (ESRD) patients receiving dialysis treatment. Reduced bone mineral density (BMD) has been reported in ESRD patients in many recent studies. Recent study has demonstrated hypoxia increases the loss of bone mass whereas the use of erythropoietin (EPO) increases bone marrow mesenchymal stem cell in vitro, which is the commonly found in ESRD patients. The objective of the present study is to analyze the relationship between erythropoiesis and calcium, phosphorus, parathyroid hormone (PTH) status in ESRD patients. METHODS: This study was a cross-sectional analysis of 183 ESRD patients (78 males, 105 females) on dialysis with mean age of 52 +/- 13 years and mean dialysis duration of 3.4 +/- 3.0 years. Duration and dose of EPO administration, hemoglobin, serum ferritin, and iron were checked in all subjects. BMD was evaluated by DXA. RESULTS: Age was negatively, and body weight and c-calcium positively associated with spine and femur neck and total hip BMD. Hemoglobin was positively correlated with femur neck and total hip BMD. Total dose of EPO, iPTH, and alkaline phosphatase had no significant association with BMD. However, according to tertile of serum PTH concentration, BMD were worst in third tertile group. In multivariate linear regression analysis, age, weight, and serum PTH affect BMD. CONCLUSIONS: BMD was independently related with age and weight. Hemoglobin correlated positively with femur neck and total hip BMD. However, treatment with EPO had no association with BMD. Increased PTH was related with reduced BMD.

A case of Sheehan's syndrome with central diabetes insipidus showing hemorrhagic pituitary apoplexy / 대한내과학회지

Ischemic necrosis of the pituitary gland, known as Sheehan's syndrome, can develop after massive postpartum bleeding. This condition is rarely accompanied by diabetes insipidus. An empty sella is a constant feature of Sheehan's syndrome in the later phase, but very few observations of magnetic resonance imaging (MRI) features in the acute phase are available. We report a case of Sheehan's syndrome presenting with diabetes insipidus leading to severe hypernatremia, showing hemorrhagic postpartum pituitary apoplexy on acute MRI.

Development and Validation of a Semi-Quantitative Food Frequency Questionnaire to Assess Diets of Korean Type 2 Diabetic Patients / 당뇨병

BACKGROUND: Our aim was to assess the validity of a semi-quantitative food frequency questionnaire (FFQ) by comparison with the 3-day diet record (DR) in patients with type 2 diabetes. METHODS: Eighty five type 2 diabetic patients (aged 33 to 70 years) from the Korean National Diabetes Program (KNDP) completed 3-day DR and FFQ. The FFQ was designed to reflect the eating pattern of Korean type 2 diabetic patients, and was based on the 2003 Korean National Health and Nutrition Examination Survey. The FFQ consists of 85 food items and 12 food groups. The validity of FFQ was assessed by comparison with the 3-day DR. RESULTS: The mean age was 49 +/- 10 years. Clinical characteristic including body weight, diabetic duration, and HbA1c were not different from the total cohort subjects (n = 1,478). There were no significant differences in the mean intake of protein, fat and calcium estimated by the FFQ and the 3-day DR. Energy and carbohydrate estimated by the FFQ were higher than those estimated by the 3-day DR. The correlation coefficient was highest for energy (r = 0.740; P < 0.00) and lowest for iron (r = 0.269; P < 0.05). The Kappa values for energy, carbohydrate, protein, fat and calcium were 0.54, 0.37, 0.36, 0.46, and 0.19, respectively. CONCLUSION: The FFQ is a reasonable instrument for assessing the intake of most macronutrients in Korean type 2 diabetes, although careful consideration is required for the food groups and nutrients for which the FFQ had low validity.

Development and Validation of a Semi-Quantitative Food Frequency Questionnaire to Assess Diets of Korean Type 2 Diabetic Patients / 당뇨병

BACKGROUND: Our aim was to assess the validity of a semi-quantitative food frequency questionnaire (FFQ) by comparison with the 3-day diet record (DR) in patients with type 2 diabetes. METHODS: Eighty five type 2 diabetic patients (aged 33 to 70 years) from the Korean National Diabetes Program (KNDP) completed 3-day DR and FFQ. The FFQ was designed to reflect the eating pattern of Korean type 2 diabetic patients, and was based on the 2003 Korean National Health and Nutrition Examination Survey. The FFQ consists of 85 food items and 12 food groups. The validity of FFQ was assessed by comparison with the 3-day DR. RESULTS: The mean age was 49 +/- 10 years. Clinical characteristic including body weight, diabetic duration, and HbA1c were not different from the total cohort subjects (n = 1,478). There were no significant differences in the mean intake of protein, fat and calcium estimated by the FFQ and the 3-day DR. Energy and carbohydrate estimated by the FFQ were higher than those estimated by the 3-day DR. The correlation coefficient was highest for energy (r = 0.740; P < 0.00) and lowest for iron (r = 0.269; P < 0.05). The Kappa values for energy, carbohydrate, protein, fat and calcium were 0.54, 0.37, 0.36, 0.46, and 0.19, respectively. CONCLUSION: The FFQ is a reasonable instrument for assessing the intake of most macronutrients in Korean type 2 diabetes, although careful consideration is required for the food groups and nutrients for which the FFQ had low validity.

R1467H Variants of Rho Guanine Nucleotide Exchange Factor 11 (ARHGEF11) are Associated with Type 2 Diabetes Mellitus in Koreans / 당뇨병

BACKGROUND: The human Rho guanine nucleotide exchange factor 11 (ARHGEF11) functions as an activator of Rho GTPases and is thought to influence insulin signaling. The R1467H variant of ARHGEF11 has been reported to be associated with susceptibility to type 2 diabetes mellitus (T2DM) in Western populations. METHODS: We investigated the effects of the R1467H variant on susceptibility to T2DM as well as related traits in a Korean population. We genotyped the R1467H (rs945508) of ARHGEF11 in 689 unrelated T2DM patients and 249 non-diabetic individuals and compared the clinical and biochemical characteristics according to different alleles. RESULTS: The H allele was significantly more frequent in T2DM cases than in controls (P = 0.037, 17.1% and 13.1%; respectively). H homozygocity was associated with a higher risk of T2DM compared to those with R/R or R/H genotype (odds ratio, 5.24; 95% confidence interval, 1.06 to 25.83; P = 0.042). The fasting plasma glucose, HbA1c, fasting insulin, HOMA2-IR and HOMA2-%beta levels did not differ significantly between different genotypes. CONCLUSION: Our study replicated associations of the ARHGEF11 polymorphism with increased risk of T2DM in a Korean population and thus supports previous data implicating a potential role of ARHGEF11 in the etiology of T2DM. Further studies revealing the underlying mechanism for this association are needed.

Acute Pyelonephritis Complicated by Renal Vein Thrombosis and Pulmonary Embolism in Patient without any Thrombotic Risks / 감염과화학요법

Renal vein thrombosis (RVT) is not an uncommon condition amongst patients with nephrotic syndrome or malignancy. Septic pulmonary embolism (SPE) is associated with risk factors such as intravenous drug use, pelvic thrombophlebitis, and suppurative processes in the head and neck. However, acute pyelonephritis is a rare cause of RVT and SPE. Case reports on RVT and SPE due to acute pyelonephritis are rare. In most of the earlier cases, patients had underlying conditions such as diabetes mellitus, renal carcinoma, calyceal stones, and hyperhomocysteinemia. We report a case of acute pyelonephritis complicated by RVT and SPE that occurred in a patient without any predisposing risk factors for thromboembolism. RVT and SPE were diagnosed using computed tomography and ventilation/perfusion scan. The patient recovered with antibiotics and anticoagulation therapy without any surgical interventions.

Influenza Vaccine Coverage Rate and Related Factors on Pregnant Women / 감염과화학요법

BACKGROUND: During seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related to influenza infection. Although influenza vaccination has been widely recommended to pregnant women and immunocompromised hosts, the vaccination rate is presumed to be low in pregnant women. This study was aimed to evaluate the vaccination rate and factors associated with Influenza vaccination among pregnant women, who are at high risk for developing complications from the influenza. MATERIALS AND METHODS: This study was carried out by telephone survey from April, 2007 to August, 2007. Women who were in their second trimester of pregnancy or above,- during October, 2006 and February, 2007, the recommended vaccination period, and had given birth at Inha University Hospital were selected as the study population. Immunization status, general understanding, and factors associated with vaccination were evaluated. RESULTS: Among a total of 506 eligible pregnant women, 227 (44.8%) responded to the questionnaires. The influenza vaccination rate among the pregnant women was only 4% (9/227). Major reasons for not receiving vaccination were first, not awaring the necessity of immunization during pregnancy (48.5%, 110/227) and second, misunderstanding that it is prohibited during pregnancy (36.1%, 82/227). The major factors that influenced the compliance of vaccination were correct understanding and doctor's recommendation on the influenza immunization during pregnancy. CONCLUSIONS: The influenza vaccine coverage on pregnant women was very low and the awareness of influenza vaccination during pregnancy in general was inaccurate. Shift in perception is required and this can be achieved by educating the pregnant women on the safety and efficacy of vaccination. In addition, doctors' active encouragement to vaccination is highly recommended.

Acute Pyelonephritis Complicated by Renal Vein Thrombosis and Pulmonary Embolism in Patient without any Thrombotic Risks / 감염과화학요법

Renal vein thrombosis (RVT) is not an uncommon condition amongst patients with nephrotic syndrome or malignancy. Septic pulmonary embolism (SPE) is associated with risk factors such as intravenous drug use, pelvic thrombophlebitis, and suppurative processes in the head and neck. However, acute pyelonephritis is a rare cause of RVT and SPE. Case reports on RVT and SPE due to acute pyelonephritis are rare. In most of the earlier cases, patients had underlying conditions such as diabetes mellitus, renal carcinoma, calyceal stones, and hyperhomocysteinemia. We report a case of acute pyelonephritis complicated by RVT and SPE that occurred in a patient without any predisposing risk factors for thromboembolism. RVT and SPE were diagnosed using computed tomography and ventilation/perfusion scan. The patient recovered with antibiotics and anticoagulation therapy without any surgical interventions.

Influenza Vaccine Coverage Rate and Related Factors on Pregnant Women / 감염과화학요법

BACKGROUND: During seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related to influenza infection. Although influenza vaccination has been widely recommended to pregnant women and immunocompromised hosts, the vaccination rate is presumed to be low in pregnant women. This study was aimed to evaluate the vaccination rate and factors associated with Influenza vaccination among pregnant women, who are at high risk for developing complications from the influenza. MATERIALS AND METHODS: This study was carried out by telephone survey from April, 2007 to August, 2007. Women who were in their second trimester of pregnancy or above,- during October, 2006 and February, 2007, the recommended vaccination period, and had given birth at Inha University Hospital were selected as the study population. Immunization status, general understanding, and factors associated with vaccination were evaluated. RESULTS: Among a total of 506 eligible pregnant women, 227 (44.8%) responded to the questionnaires. The influenza vaccination rate among the pregnant women was only 4% (9/227). Major reasons for not receiving vaccination were first, not awaring the necessity of immunization during pregnancy (48.5%, 110/227) and second, misunderstanding that it is prohibited during pregnancy (36.1%, 82/227). The major factors that influenced the compliance of vaccination were correct understanding and doctor's recommendation on the influenza immunization during pregnancy. CONCLUSIONS: The influenza vaccine coverage on pregnant women was very low and the awareness of influenza vaccination during pregnancy in general was inaccurate. Shift in perception is required and this can be achieved by educating the pregnant women on the safety and efficacy of vaccination. In addition, doctors' active encouragement to vaccination is highly recommended.

Comparative Study of Serum Brain-Derived Neurotrophic Factor in Acute and Chronic Depression / 대한정신약물학회지

OBJECTIVE: The aim of this study was to compare the serum brain-derived neurotrophic factor (BDNF) in acute depression with that in chronic depression. METHODS: Eighty subjects who met criteria for major depressive disorder (MDD) were recruited. Patients experiencing at least their fourth episode or an episode of at least 24 months in duration were defined as chronically depressed (n=21). Other patients were classified as acutely depressed (n=59). Antidepressant medications were administered for 6 weeks. Serum BDNF and Hamilton rating scale for depression (HAM-D) scores were measure before and after the administration of medication. RESULTS: We found significant differences in serum BDNF between the two groups. Serum BDNF was significantly higher among those with chronic depression than among those with acute depression both at baseline and after medication. CONCLUSION: This study suggested that serum BDNF might constitute a potential biological marker for chronic depression.

The Effect of Rutin on the Melanogenesis and Nitric Oxide in UVB-irradiated HM3KO Human Melanoma / 대한해부학회지

Ultraviolet (UV) radiation is the main physiological stimulus for human skin pigmentation. Recently, nitric oxide (NO) have been involved in mediation of skin pigmentation induced by UVB. Rutin, a flavonoid of vegetables and fruits, has antiviral and antioxidant properties. Therefore, we investigated the effect of rutin on UVB-induced melano-genesis and NO production in HM3KO cells. In this study, we demonstrated that UVB-irradiation stimulated melanin content and tyrosinase activity in HM3KO cells. Rutin suppressed UVB-stimulated total melanin content and tyrosinase activity in a dose-dependent manner. Additionally, we showed that UVB-irradiation stimulated NO production in HM3KO cells. Rutin also suppressed UVB-induced NO production and repaired reduction of cell proliferation by UVB. UVB stimulation of melanogenesis was mimicked by exogenous NO donor (sodium nitroprusside, SNP), and rutin effectively suppressed it. Therefore, we concluded that rutin suppressed UVB-stimulated melanogenesis and that it is involved in melanogenesis regulation partially through the suppression of UVB-induced NO production.