Depression and Self-care Behavior in Patients with Diabetes Mellitus / 당뇨병

BACKGROUND: Depression is known to be a risk factor for type 2 diabetes mellitus. Conversely, diabetes is also a risk factor for depression, and patients with diabetes have nearly twice the risk of comorbid depression as the general population. Depression in patients with diabetes may cause poor clinical outcomes through lower adherence to self-care activities such as exercise, diet control, and glucose monitoring. Furthermore, diabetic patients with depression are more likely to suffer from microvascular or macrovascular complications. We explored the prevalence of major depressive disorder in Korean diabetic patients and its impact on self-care activities and glucose control. METHODS: We surveyed depressive symptoms and self-care activities in 191 type 2 diabetic patients from the outpatient clinic of the St. Mary's hospital. Two questionnaires were used for assessment, the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Summary of Diabetes Self-Care Activities (SDSCA). RESULTS: Of the 191 respondents who completed questionnaires, 39 (20.4%) patients were categorized as having major depressive disorder. Among the depressed patients, only six (15.3%) had been previously evaluated and managed for their psychiatric problems. The incidence of depression was significantly higher in female diabetic patients compared to patients without depression (74.4% vs. 45.4%, P<0.001). Patients with depression showed significantly poorer diet control (18.5 vs. 15.9, P = 0.046) and less glucose monitoring (4.1 vs. 2.7, P = 0.047). However, there were no differences in exercise, foot care, or smoking status between the two groups. Additionally, metabolic parameters such as HbA1C and lipid profile were not significantly different between the two groups. CONCLUSION: Many diabetic patients are suffering from depression and exhibit poorer self-care activities than patients without depression. Identifying and managing depressed diabetic patients may help improve their self-care activities.

Toxic Hepatitis Associated with Carp Juice Ingestion / 대한간학회지

The potential hepatotoxicity of herbal remedies and/or health foods is usually ignored in daily life. There have been cases showing the toxic hepatitis and renal failure associated with the ingestion of raw carp bile. We experienced a case of toxic hepatitis without any evidence of renal failure that was associated with carp juice ingestion. The clinical manifestations were characterized by nausea and vomiting after the ingestion of carp juice for 3 months. The diagnosis of toxic hepatitis was made on the basis of the patient's history, laboratory data, RUCAM (Russel Uclaf Causality Assessment) and the results of ultrasonography guided liver biopsy. The patient showed rapid improvement after instituting supportive therapy.

Delayed Maturation of Arteriovenous Fistula due to Radial Artery Obstruction in a Patient Receiving Radiocephalic Arteriovenous Fistula / 대한신장학회잡지

Although radiocephalic arteriovenous fistula (AVF) is the method of choice for hemodialysis (HD) vascular access, it continues to have a high incidence of early failure due to delayed or failed venous maturation. Here we report an unusual case of delayed maturation of AVF due to radial artery obstruction in a patient receiving radiocephalic AVF. A 53-year-old woman had received radiocephalic AVF operation for hemodialysis. Venous maturation of the AVF did not occur 2 months after the operation. Fistulography via brachial artery approach demonstrated non- visualization of radial artery, anastomosis of radial side of palmar arch and cephalic vein and mild stenosis of the anastomosis site at left wrist area. We thought that we could not use the AVF for HD due to inadequate arterial blood flow and decided to make new vascular access. The patient received brachial-basilic AVF operation again. Adequate maturation of the AVF was successfully made 1 month after the operation. Therefore, we think that radial artery obstruction may be a possible cause of delayed maturation of AVF.

A Case of Pulmonary Cryptococcosis in an Immunocompetent Patient / 결핵및호흡기질환

We experienced a case of pulmonary cryptococcosis in an immunocompetent patient who presented with uncommon radiological findings. He complained of a dry cough for 3 weeks. The chest X-ray and CT showed multiple, variable sized, and irregular patch consolidations with cavities combined with some ground glass opacities in both lower lung fields. The diagnosis was made histologically via a thoracoscopic lung biopsy. The patient was administered oral fluconazole has since been well.