Résumé
Althowgh intensive insulin regimen is the main treatment in people with type 1 diabetes, glucose variability and weight gain remain as challenges for this treatment. Sodium-glucose cotransporter (SGLT) inhibitors (including the SGLT1/2 inhibitors) have emerged as an add-on therapy for insulin treatment in peoples with type 1 diabetes due to their insulin-independent mechanism. Recent clinical trials have consistently reported that SGLT inhibition provides additive benefits in glycemic control, including lower insulin dose and weight loss. However, there is concern that an increase in ketone-related adverse events such as diabetic ketoacidosis is higher in SGLT1/2, as well as SGLT2 inhibitors. Despite safety issues that require further evaluation, SGLT2 inhibitors used with caution may provide an adjunctive therapy in people with type 1 diabetes.
Sujets)
Diabète , Acidocétose diabétique , Glucose , Insuline , Prise de poids , Perte de poidsRésumé
BACKGROUND: This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team. METHODS: In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched. RESULTS: Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased. CONCLUSION: Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.
Sujets)
Humains , Amputation chirurgicale , Pied diabétique , Diagnostic , Dossiers médicaux électroniques , Membres , Hémoglobine glyquée , Corée , Durée du séjour , Membre inférieur , Étude d'observation , Équipe soignante , Études rétrospectives , Centres de soins tertiaires , UlcèreRésumé
Comprehensive education is the cornerstone of diabetes management. However, in Korea, diabetes education is constrained by short office visits. This article intends to introduce various educational strategies, particularly regarding diet style modification, that can be employed in the time-limited outpatient setting to improve diabetes management. Instructing patients to reduce their intake of carbohydrates, the predominant nutrient consumed in a traditional Korean diet, may be beneficial. The use of novel educational technologies or the introduction of new healthy diet plans may also help.
Sujets)
Humains , Glucides , Diabète , Régime alimentaire , Régime pour diabétique , Éducation , Technologie de l'éducation , Corée , Thérapie nutritionnelle , Consultation médicale , Patients en consultation externeRésumé
Two cases of urachal anomaly (1 urachal cyst and 1 patent urachus) are reported in a neonate and an eleven-year old boy, respectively. In case 1, the patient was born after an uncomplicated pregnancy to a mother who had taken progesterone during the first trimester. Because of breech presentation, cesarian section was elected to deliver a male baby weighing 2.3 kg who showed abdominal distension. The patient died of respiratory difficulty several minutes after birth. At autopsy, there was a large cyst in the midpoint of the abdominal and pelvic cavity. This round cyst was composed of two components, urachus and urinary bladder. No area of umbilicocystic fistula was present. The lining epithelium was chiefly of transitional type. Assocaited anomalies were segmental stenosis of posterior urethra, absence of abdominal musculature, bilateral polycystic kidney of Potter type IV, hydroureter, and hypoplasia of lungs. Low set ears, micrognathia and club foot were also present. In case 2 the patient was 11-year old boy. He had suffered from intermittent urinary dribbling from umbilicus since early infancy, whenever the abdominal pressure was increased. The patency of urachus was confirmed by fistulography. And the urachal anomaly was surgically removed. Histopathologically the resected patent urachus consisted of pseudostratified columnar to transitional epithelium resting on fibrous stroma mixed with well formed smooth muscle bundles.
Sujets)
Grossesse , Femelle , Mâle , Nouveau-né , Humains , KystesRésumé
No abstract available.
Sujets)
Humains , Nourrisson , Nouveau-né , Préparation pour nourrissons , Nourrisson à faible poids de naissanceRésumé
In 8218 newborns who were born in Ewha Womans University Hospital during the period from January, 1974 to December, 1978, the authors investigated the mortality rate within 7 days after birth and studied the factors associated with it. The results are as follows; 1. The early neonatal mortality rate was, in average, 15.5 among 1000 live newborns. 2. The mortality rate was 1.5 times greater in males than in females. 3. According to the birth weight, marked increase of mortality rate was found in those under 2500 gm and all under 1000 gm were expired during the first week of life. 4. The gestational age under 37 weeks was associated with higher mortality rate and all under 27 weeks were expired. 5. The lower the both birth weight and gestational age were, the higher the mortality rate was. The lower gestational age in the same birth weight group or the lower birth weight in the same gestational age group was associated with higher mortality rate. The mortality rate was also higher in those with lower Apgar score. 6. 69.8% of neonatal death occurred within 24 hours after birth and the rate decreased during the succeeding days. 7. The most common cause of death was abnormal pulmonary ventilation (30.1%), which was followed by congenital anomalies, prematurity, birth trauma and infection in the order of frequency. 10 of 11 autopsied cases were found to have anomalies or diseases of the lung.
Sujets)
Femelle , Humains , Nourrisson , Nouveau-né , Mâle , Score d'Apgar , Poids de naissance , Cause de décès , Âge gestationnel , Mortalité infantile , Poumon , Mortalité , Parturition , Ventilation pulmonaireRésumé
Clinical study on meconium-stained babies among 6190 newborn's delivered at EWHA Womans University Hospital in 5-year period from January 1973 to December 1977 was. The results are summarized as follows: 1) The incidence of meconium staining was 10.87% in total 6190 newborns. 2) There was a tendency of increasing incidence of meconium staining in babies with higher birth weights and longer gestational periods. 3) The highest rate of meconium staining was in the group of 21~25 year of maternal age and the primipara group. The mortality rate of meconium stained baby was higher in mother's age groups of 35 years and older, and primipara groups. 4) The rate of meconium staining increased if the durations of labor or rupture of membrane was longer than 24 hours. 5) Perinatal mortality rate was higher in groups of meconium stained baby compared to non-stained groups and the incidence of aspiration pneumonia and congenital anomaly was higher in meconium stained baby, also, but that of prematurity and idiopathic respiration distress syndrome was higher in non-stained group. 6) 24.38% of mothers of meconium stained baby was found to have medical problems during the pregnancy e.g. toxemia, diabetes mellitus, syphilis etc.
Sujets)
Femelle , Humains , Nouveau-né , Grossesse , Poids de naissance , Diabète , Incidence , Âge maternel , Méconium , Membranes , Mortalité , Mères , Mortalité périnatale , Pneumopathie de déglutition , Respiration , Rupture , Syphilis , ToxémieRésumé
The patient was presented characteristic clinical, histopathological and X-ray findings, in cluding generalized edema, petechial rash, lymphadenopathy, bone lesions, pulmonary infiltration and hepatomegaly with anemia. Most of these signs developed soon after birth. Diagnosis was confirmed by microscopic examin ation of lymph node biopsy and clinical X-ray findings. The patient was received antibiotics, corticosteroid and vinblastine and discharged against doctors order without improvement.