BACKGROUND: Hypoglycemia is an important obstacle in the treatment of diabetes. When diabetic patients experience hypoglycemia, thorough glycemic control is more difficult. We evaluated the factors associated with risk of hypoglycemia and identified whether the demographic and clinical characteristics or the medication pattern changed during the study period. METHODS: This study was conducted retrospectively with 7 years of data from one university hospital emergency department. We evaluated the medical records of 396 diabetic patients who visited the emergency room with hypoglycemia between January 2008 and December 2014. Hypoglycemia was defined as a serum glucose level less than 70 mg/dL or an event requiring the assistance of another person to actively corrective action. RESULTS: The mean age, duration of diabetes, and hemoglobin A1c (HbA1c) of the study subjects were 71 ± 12.2 years, 12.7 ± 8.8 years, and 6.7 ± 1.39%, respectively. Among the subjects, 55% had a HbA1c level lower than 6.5%. Two-thirds of the study subjects received sulfonylurea, and one-third were treated with insulin. We observed a decreasing trend in the number of hypoglycemia cases during the study period. This trend might be partly explained by the decrease in sulfonylurea use and increase in dipeptidyl peptidase 4 inhibitor prescription during the study period. CONCLUSION: The clinical characteristics of subjects with hypoglycemia were old age, long duration of diabetes, relatively low HbA1c, and comorbidities. We found that hypoglycemia events in diabetic patients decreased in number in conjunction with the changing pattern of use of hypoglycemic agents.
Blood Glucose ; Comorbidity ; Diabetes Mellitus ; Dipeptidyl Peptidase 4 ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypoglycemia* ; Hypoglycemic Agents ; Insulin ; Medical Records ; Prescriptions ; Retrospective Studies

Purpose: Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia. Materials and Methods: A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture. Results: The initial white blood cell count of joint fluid was 71,472±51,667/mm3 (32,400–203,904/mm3 ), and polymorphic leukocytes were 91.1%±2.6% (86%–95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6–10 hours), and the irrigation period was 8.2±3.2 days (4–15 days). The average length of hospitalization was 20.8±8.7 days (9–37 days). There was no reoperation or recurrence. Smear and culture tests were not identified. Conclusion In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

It has been reported that theophylline clearance is lower in Korean infants than in Americans, suggesting that dose requirements for theophylline in Korean infants will be 1ower than those in Americans. Therefore, we reviwed patients charts retrospectively to formulate the new theophylline dosing equation appropiate to Korean infants. We reviewed patient charts of 111 asthmatic infants who received intravenous aminophy1line and oral theophylline in Wa1lace Memorial Baptist Hospital. We set the therapeutic serum concentration at 5-15microgram/ml in Korean infants based on response rate to theophylline therapy, which is supported by National Institute of Health Expert Panel Recommendations. Doses required to achieve a therapeutic serum concentration increased with age. The mean dose among the infants less than 4 months of age was 578+/-154mg/kg/day and increased to 10.12+/-1.78mg/kg/day after 8 months (p<0.0001). The relationship between age and dosage requirements can be expressed by the least squares determination of the linear regression :Dose (mg/kg/day) = 557 + 0.14 X (age in weeks). The coefficient of correlation for this relationship is 0.67(p<0.0001). Half-lives of elimination among the infants studied correspondingly decreased with age. In conclusion, this study showed that the relationship between age and dosage requirements in Korean infants may be different from those in Americans. Therefore, we strongly suggest that it is required to formulate a new theophylline dosing equation appropriate for Korean infants through well-designed prospective studies.
Asthma* ; Humans ; Infant* ; Least-Squares Analysis ; Linear Models ; Protestantism ; Retrospective Studies ; Theophylline*

BACKGROUND AND OBJECTIVES: The influence of anterior inferior cerebellar artery (AICA) loop on sudden sensorineural hearing loss (SSHL) remains controversial. The objective of this study was to evaluate the correlation between the anatomical type of AICA loop and SSHL. SUBJECTS AND METHOD: We reviewed the medical records of 69 ears from 60 patients with SSHL between January 2005 and April 2008, retrospectively. AICA loops were classified according to the Chavda classification method by magnetic resonance imaging. According to the extension depth of the loop in the internal auditory canal, it was classified as type I, II and III. The loop was classified as S (small diameter) and L (large diameter) by comparing the thickness of the loop with adjacent facial nerves. RESULTS: The predominant type of AICA loop was type I (68.1%) and type S (78.3%). There was no significant correlation between the pretreatment hearing level, extension depth and diameter. There was also no significant correlation between the rate of hearing recovery by Siegel's criteria and diameter. However, there was significant correlation between the rate of hearing recovery by Siegel's criteria and the types of the extension depth (p< 0.05). The ears with type II and III of AICA loop presented higher rates of hearing recovery by Siegel's criteria than those with type I. CONCLUSION: This study suggests that the type II and III of AICA loop may be considered a good prognostic factor in SSHL.
Arteries ; Ear ; Facial Nerve ; Hearing ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Retrospective Studies

The purpose of the present study was to determine the preventive effects of combined interventional trial of fish oil treatment and exercise training on insulin resistance of skeletal muscle in high-fat fed rats. Male Wistar rats were randomly divided into chow diet (CD), high-fat diet (HF), high-fat diet with fish oil (FO), high-fat diet with exercise training (EX), and FO+EX groups. The rats in control group were fed chow diet containing, as percents of calories, 58.9% carbohydrate, 12.4% fat, and 28.7% protein. High-fat diet provided 32% energy as lard, 18% as corn oil, 27% as carbohydrate and 23% as casein. The fish oil diet had the same composition as the high fat diet except that 100 g menhaden oil was substituted for corn oil. Insulin sensitivity was assessed by in vitro glucose transport in the soleus muscle after diet treatment and treadmill running for 4 weeks. While the FO or EX only partially prevented insulin resistance on glucose transport and visceral obesity induced by high-fat diet, these interventions completely corrected hyperinsulinemia and hyperglycemia from the high-fat diet. The rats in the FO+EX showed normalized insulin action on glucose transport, plasma chemicals and visceral fat mass. Insulin-mediated glucose transport was negatively associated with total visceral fat mass (r=-0.734; p<0.000), plasma triglyceride (r=-0.403; p<0.05) and lepin (r=-0.583; p<0.001) concentrations with significance. Multiple stepwise regression analysis showed that only total visceral fat mass was independently associated with insulin-mediated glucose transport (r=-0.668; p<0.000). In conclusion, combined interventional trial of FO+EX recovered insulin resistance on glucose transport of skeletal muscle induced by high-fat diet. Visceral fat mass might be more important factor than plasma TG and leptin to induce insulin resistance on glucose transport of skeletal muscle in high-fat fed rats.
Animals ; Caseins ; Corn Oil ; Diet ; Diet, High-Fat* ; Glucose* ; Humans ; Hyperglycemia ; Hyperinsulinism ; Insulin Resistance ; Insulin* ; Intra-Abdominal Fat ; Leptin ; Male ; Muscle, Skeletal* ; Obesity, Abdominal ; Plasma ; Rats* ; Rats, Wistar ; Running ; Triglycerides

BACKGROUND: Escherichia coli and Klebsiella pneumoniae are major Gram-negative pathogens causing bloodstream infection. Antibiotic-resistant mutant strains that produce extended-spectrum beta-lactamase (ESBL) have emerged among E. coli and K. pneumoniae and are increasingly being recognized. METHODS: The database at the Clinical Microbiology Department was retrospectively reviewed in order to identify the patients with E. coli and K. pneumoniae bacteremia. The archived blood isolates of E. coli and K. pneumoniae, isolated and stored from Jan 1998 to Dec 2002, were tested for ESBL production using the NCCLS guidelines and/or double-disk synergy test, and antimicrobial susceptibility by disk diffusion method using NSSCL guidelines. RESULTS: A total of 1045 strains of E. coli and 535 strains of K. pneumoniae were analyzed. The antimicrobial susceptibility of E. coli strains were as follows; cefotaxime 91%, ceftazidime 93%, imipenem 100%, amikacin 97%, gentamicin 75%, tobramycin 79%, and ciprofloxacin 75%. The antimicrobial susceptibility of K. pneumoniae strains were as follows; cefotaxime, 84%, ceftazidime, 87%, imipenem, 100%, amikacin, 94%, gentamicin, 87%, tobramycin, 84%, and ciprofloxacin, 87%. The overall prevalence of ESBL-producing organisms was 8.6% in E. coli and 14.2% in K. pneumoniae. In ESBL-producing organisms, all strains were susceptible to imipenem, whereas 40% of K. pneumoniae strains and 30% of E. coli strains were susceptible to ciprofloxacin. CONCLUSION: The overall prevalence of ESBL-producing organisms was 8.6% in E. coli blood isolates and 14.2% in K. pneumoniae blood isolates. Among the ESBL-producing strains, only 40% of K. pneumoniae strains and 30% of E. coli strains were susceptible to ciprofloxacin.
Amikacin ; Bacteremia ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Ciprofloxacin ; Diffusion ; Drug Resistance, Microbial ; Escherichia coli* ; Escherichia* ; Gentamicins ; Humans ; Imipenem ; Klebsiella pneumoniae* ; Klebsiella* ; Pneumonia ; Prevalence ; Retrospective Studies ; Tobramycin

BACKGROUND: Escherichia coli and Klebsiella pneumoniae are major Gram-negative pathogens causing bloodstream infection. Antibiotic-resistant mutant strains that produce extended-spectrum beta-lactamase (ESBL) have emerged among E. coli and K. pneumoniae and are increasingly being recognized. METHODS: The database at the Clinical Microbiology Department was retrospectively reviewed in order to identify the patients with E. coli and K. pneumoniae bacteremia. The archived blood isolates of E. coli and K. pneumoniae, isolated and stored from Jan 1998 to Dec 2002, were tested for ESBL production using the NCCLS guidelines and/or double-disk synergy test, and antimicrobial susceptibility by disk diffusion method using NSSCL guidelines. RESULTS: A total of 1045 strains of E. coli and 535 strains of K. pneumoniae were analyzed. The antimicrobial susceptibility of E. coli strains were as follows; cefotaxime 91%, ceftazidime 93%, imipenem 100%, amikacin 97%, gentamicin 75%, tobramycin 79%, and ciprofloxacin 75%. The antimicrobial susceptibility of K. pneumoniae strains were as follows; cefotaxime, 84%, ceftazidime, 87%, imipenem, 100%, amikacin, 94%, gentamicin, 87%, tobramycin, 84%, and ciprofloxacin, 87%. The overall prevalence of ESBL-producing organisms was 8.6% in E. coli and 14.2% in K. pneumoniae. In ESBL-producing organisms, all strains were susceptible to imipenem, whereas 40% of K. pneumoniae strains and 30% of E. coli strains were susceptible to ciprofloxacin. CONCLUSION: The overall prevalence of ESBL-producing organisms was 8.6% in E. coli blood isolates and 14.2% in K. pneumoniae blood isolates. Among the ESBL-producing strains, only 40% of K. pneumoniae strains and 30% of E. coli strains were susceptible to ciprofloxacin.
Amikacin ; Bacteremia ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Ciprofloxacin ; Diffusion ; Drug Resistance, Microbial ; Escherichia coli* ; Escherichia* ; Gentamicins ; Humans ; Imipenem ; Klebsiella pneumoniae* ; Klebsiella* ; Pneumonia ; Prevalence ; Retrospective Studies ; Tobramycin