Obesity and Insulin Resistance According to Age in Newly Diagnosed Type 2 Diabetes Patients in Korea / 고신대학교의과대학학술지

OBJECTIVES: With the rapid increase in the prevalence of diabetes, the age groups of diabetic patients are becoming diversified. This study will examine the degree of obesity, insulin resistance, and insulin secretion ability among patients first diagnosed with diabetes according to age and gender. METHODS: The subjects of this study included 616 patients who were first diagnosed with diabetes during a routine physical examination. This sample was obtained from a total of 28,075 adults aged 19 years and older who received the examination among 33,829 participants in the Korea National Health & Nutrition Examination Survey (KNHANES) from 2007–2010. The subjects were categorized by age into young age (age: 19 – 39 years), middle age (age: 40 – 59 years), and old age (age: 60 years and older). The degree of obesity was categorized according to body mass index (BMI) into normal weight (BMI: 18.5 ~ 22.9), overweight (BMI: 23 ~ 24.9), and obesity (BMI: 25 or above). Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: It was found that 14.1% (n = 87) of a total of 616 subjects (324 men, 292 women) were in the young age group, 43.8% (n = 270) were in the middle age group, and 42.1% (n = 259) were in the old age group. In addition, 83.3% of men that were overweight or obesity were in the young age group, while 79.2% and 60.5% were in the middle age and old age groups, respectively. A total of 82.2% of women that were overweight or obesity were in the young age group, while 79.5% and 77% were in the middle age and old age groups, respectively. For men, the more obesity they were in all age groups, the higher their HOMA-IR. For women, the more obesity they were in the young age and middle age groups, the higher their HOMA-IR; however, women in the old age group showed the highest HOMA-IR when they were of normal weight. CONCLUSION: Among diabetic patients first diagnosed with the disease in Korea, the youth population had the highest obesity rate. Insulin resistance increases as an individual's weight increases among those patients who are first diagnosed with diabetes; the only exception noted is for elderly women.

A Case of Multiple Sialolithiasis in the Parotid Gland with Sjogren's Syndrome / 대한이비인후과학회지

Multiple calcification in the major salivary glands is very rare. Sjogren's syndrome is characterized by tissue damage due to chronic lymphocyte infiltration of exocrine glands, and the involvement of the major salivary glands is followed by typical symptoms such as multiple formation of sialolith, blockage of salivary duct, and edema of the parenchyme. When multiple calcification is found in the parenchyme of parotid gland on the computed tomography imaging, Sjogren syndrome should be considered, where the primary solution is conservative treatment and preventing recurrent inflammation.

Prevalence and Risk Factors for Depression in Korean Adult Patients with Asthma: Is There a Difference between Elderly and Non-Elderly Patients?

Depression is an important comorbidity of asthma. However, little information is available about depression and its potential impact on asthma control in Korean adult asthma patients. We aimed to estimate the prevalence and risk factors for depression in Korean adults with persistent asthma. The 127 non-elderly (20-64 yr) and 75 elderly (> or =65 yr) patients with asthma were recruited. Demographic and clinical data were extracted, and the patients completed the Asthma Specific Quality of Life (AQOL) questionnaire and asthma control test (ACT). Depression status was defined using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Depression was more prevalent in non-elderly (18.9%) than in elderly patients with asthma (13.3%). Patients with depression were significantly younger, had lower economic status, shorter disease duration, poorer asthma control, and worse AQOL scores (P<0.05). Within the non-elderly group, younger age and shorter disease duration were significantly associated with depression (P<0.05). Within the elderly group, a higher body mass index and current smoking status were significantly associated with depression (P<0.05). The PHQ-9 score was significantly correlated with worse ACT and AQOL scores in both groups. In conclusion, depression is strongly associated with poor asthma control and quality of life in Korean adult asthma patients. Our results provide important clues that used to target modifiable factors which contribute to development of depression in asthma patients.

Association between Vitamin D Deficiency and Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis

OBJECTIVE: The present study determined if vitamin D deficiency is a potential risk factor for increased carotid intima-media thickness (CIMT) in patients with rheumatoid arthritis (RA). METHODS: This cross-sectional study analyzed 50 consecutive female RA patients without cardiovascular disease history at the Pusan National University Hospital between September and December of 2013. CIMT was measured using a high-resolution ultrasonography. Serum 25-hydroxy vitamin D (25-OHD) levels were assessed by radioimmunoassay, and vitamin D deficiency was defined as serum 25-OHD levels <20 ng/mL. Stepwise multivariable linear regression analyses were performed to evaluate the association between vitamin D deficiency and increased CIMT. RESULTS: The median 25-OHD level (inter-quartile range) was 14.0 (11.0~20.7) ng/mL, and 74% of patients had vitamin D deficiency. The mean+/-standard deviation of CIMT was 0.58+/-0.08 mm. RA patients with vitamin D deficiency had significantly higher CIMT than those without this feature (0.59+/-0.07 vs 0.54+/-0.05, p=0.028). In univariable linear regression models, vitamin D deficiency (beta(SE)=0.047 (0.021), p=0.028), older age (beta(SE)=0.003 (7.2(-4)), p<0.001) and higher disease activity score 28-erythrocyte sedimentation rate (beta(SE)=0.021 (0.010), p=0.034) and Korean version of health assessment questionnaire score (beta(SE)=0.051 (0.015), p=0.002) were significantly associated with increased CIMT. Vitamin D deficiency remained statistically significant in multivariable regression models after adjusting for confounders. CONCLUSION: Vitamin D deficiency was associated with increased CIMT in female RA patients. Our finding suggests that hypovitaminosis D can be a risk factor for atherosclerosis in RA patients.

Impact of Pheochromocytoma on Left Ventricular Hypertrophy and QTc Prolongation: Comparison with Takotsubo Cardiomyopathy

BACKGROUND AND OBJECTIVES: Excessive catecholamine causes the alteration of cardiac structure and function. This study evaluated if there is any difference in left ventricular hypertrophy (LVH) and QTc prolongation in conditions with pheochromocytoma and Takotsubo cardiomyopathy (TC). SUBJECTS AND METHODS: We reviewed the medical records of 20 pheochromocytoma patients for cardiovascular events prior to diagnosis. The patient's clinical history and electrocardiographic and echocardiographic findings were compared to those of 20 patients diagnosed with TC. RESULTS: Left ventricular (LV) mass index (133.3+/-37.8 vs. 113.3+/-17.3, p=0.031), relative wall thickness (0.55+/-0.15 vs. 0.47+/-0.07, p=032) and elevated blood pressure (BP) were more prominent in pheochromocytoma compared to TC. The mean creatinine kinase-MB elevation, reduced LV systolic function and ST segment changes were more prominent in the TC group compared to the pheochromocytoma groups (all p<0.05). The prevalence of QTc prolongation was high in patients with pheochromocytoma (45%) and TC (55%), and TC male patients appeared to have a more prolonged QTc interval. Urine epinephrine (r=0.844, p=0.004) and norepinephrine level (r=0.782, p=0.013) were significantly correlated with LV mass index, and the predictors for the QTc prolongation were male gender and the presence of LVH. CONCLUSION: A prolonged QTc was prominent in pheochromocytoma and TC regardless of BP and systolic LV function, and LVH was more prominent in pheochromocytoma than TC.

Long-term Follow-up of a Case of Cowden Syndrome / 대한소아소화기영양학회지

Cowden syndrome is very rare clinical condition with characteristic mucocutaneous lesions associated with abnormalities of the breast, thyroid, and gastrointestinal tract. Here, the case of a 16-year-old girl with diverse gastrointestinal polyposis with breast and thyroid lesions is reported as a definite case of Cowden syndrome. During follow up for 4 years, changes in the characteristic lesions were observed; Esophageal acanthosis and oropharyngeal polyps were newly developed. Gastric, duodenal, rectal and ileal polyps were noted at the first visit when she was 12 years of age and revealed histologically hyperplastic polyps. Mucocutaneous lesions, the pathognomonic finding of Cowden syndrome, were not noted at the first visit or during the follow up period. Breast and thyroid masses were noted at the first visit. Breast aspiration showed highly cellular ductal epithelial fragments and fibroblastic stromal cell fragments, and a thyroid biopsy shows proliferation of irregular sized follicles, with variable colloid contents. Macrocephaly was also noted at the first visit. The characteristic lesions of Cowden syndrome change with the patient's age, and the long-term follow up is recommended in cases suspected with this syndrome.