Background: Uncontrolled blood pressure (BP) is relatively common despite treatment with antihypertensive medication. This study aimed to investigate factors associated with uncontrolled systolic BP (SBP) and diastolic BP (DBP) separately in hypertensive patients with high medication adherence in Korea. Methods: This population-based cross-sectional study included 3,236 participants in the Korea National Health and Nutrition Examination Survey from 2013 to 2015. Hypertensive patients with high medication adherence were defined when they stated that they were taking antihypertensive medication daily. “Uncontrolled SBP and DBP” were defined as SBP ≥140 mm Hg and DBP ≥90 mm Hg, respectively. Data were analyzed using logistic regression to determine the association between uncontrolled SBP or DBP and various factors. Results: The prevalence of uncontrolled SBP and uncontrolled DBP was 23.3%, and 9.0%, respectively. In multivariate analysis, uncontrolled SBP was positively associated with older age, female sex, blue-collar occupation or no work (vs. white-collar), presence of a spouse, short sleep duration, frequent heavy alcohol drinking, longer hypertension duration, diabetes, stroke, and missing antihypertensive medication on the examination day, but negatively associated with high stress. Uncontrolled DBP was positively associated with frequent heavy alcohol drinking, but negatively associated with older age, blue-collar occupation or no work (vs. white-collar), and diabetes. Conclusion After excluding low medication adherence, we identified various factors associated with uncontrolled SBP or DBP in Korean adults with treated hypertension. There were differences between factors associated with uncontrolled SBP or DBP. Separate analysis of SBP and DBP may help understand the factors involved in BP control.

Background: This study was conducted to evaluate the effect of a weight loss method in individuals who successfully lost weight and determine the mental health problems that might have occurred while losing weight. Methods: Data were obtained from the Seventh Korea National Health and Nutrition Examination Survey in 2016. First, an independent sample t-test was used with continuous data to identify the relationship between successful weight loss and the general characteristics of all participants, and the chi-square test was applied to categorical data. Second, a logistic regression analysis was performed to determine the relevance of eight successful weight loss methods based on the variables that can affect weight change such as age and sex. Similarly, a multivariate logistic regression analysis aimed to determine the correlation between mental health problems and successful weight loss. Results: The results showed that adhering to an appropriate dietary regime and taking oriental medicines significantly influenced weight reduction.Other methods such as skipping a meal, taking prescribed medicines or health supplements, and following a mono-diet have no noticeable effect on weight loss. Moreover, the analysis of factors affecting mental health that could influence the environment and lifestyle of the dieter has indicated that there is no positive association between these factors and actual weight loss. Conclusion A controlled diet is recommended as an effective treatment for weight loss rather than skipping a meal or fasting and taking oriental medicine. The factors associated with weight loss may not cause mental health problems.

Purpose: Pediatric palliative care is a rapidly developing multidisciplinary approach that supports children with life-limiting conditions and their families. However, there is limited evidence on how to effectively support bereaved parents and siblings. The purpose of this study is to explore the therapeutic impact of art therapy for bereaved families, in accordance with John Bowlby’s four-stage theory of mourning. Methods: This single-case study employed the consensual qualitative research method. Art therapy records of bereaved families were reviewed individually, and records from one case were selected. Verbal statements made during the art therapy sessions and photocopies of the artworks were analyzed to understand the mourning process of the family. Results: A total of 113 statements and 12 artworks from 19 art therapy sessions were analyzed. As the art therapy progressed, each family member exhibited a pattern of engaging in more positive and healthy conversations in daily life, demonstrating the final stage of mourning: reorganization and recovery. The family dynamics also revealed that they reconstructed their inner world and redefined the meaning of loss, which is the final stage of mourning. The art therapy provided a safe environment for the family, allowing them to fulfill their wishes and regain the strength needed for recovery. Conclusion This study suggests that art therapy supports bereaved families in alleviating their psychological difficulties, engaging in a healthy mourning process, and functioning as members of society. Further research is needed to better understand the effect of art therapy as a bereavement support tool in pediatric palliative care.

BACKGROUND: Cadmium is a toxic element in cigarette smoke associated with ischemic vascular disease. Its association with cerebral aneurysm is unknown. METHODS: We retrospectively analyzed the medical records of patients with headache who underwent imaging studies between March 2014 and August 2016. An unruptured intracranial aneurysm (UIA) was confirmed by brain magnetic resonance angiography or computed tomography angiography. A control group included age- and sex-matched patients without an UIA. Whole blood and random urine tests were used for detection of cadmium and arsenic levels, respectively. Student t-test was used to compare subject characteristics, mean cadmium and arsenic levels between groups, and differences between groups with small (<4-mm) and large (≥4-mm) UIAs. Multivariate regression analysis was used to identify risk factors for aneurysm incidence. RESULTS: Of 238 patients, 25 had an UIA. Those with an UIA had more pack-years of smoking (19.5±3.8 vs. 12.5±6.8, P=0.044) and higher mean serum cadmium levels (1.77±0.19 vs. 0.87±0.21 µg/L, P=0.027). Arsenic levels showed no difference between groups. (67.4±23.5 vs. 62.2±18.3 µg/L, P=0.458). There were no significantly different demographic, clinical, or laboratory characteristics between small and large aneurysm groups. According to multivariate analysis, smoking (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.06–2.33; P=0.047) and serum cadmium >2.0 mcg/L (OR, 1.39; 95% CI, 1.15–1.84; P=0.043) were associated with aneurysm incidence. CONCLUSION: UIA incidence was associated with pack-years of smoking and serum cadmium level, but aneurysm size was not associated with serum cadmium level.
Aneurysm ; Angiography ; Arsenic ; Brain ; Cadmium ; Headache ; Humans ; Incidence ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Tobacco Products ; Vascular Diseases

Ventriculoperitoneal (VP) shunt insertion is the standard treatment for hydrocephalus; shunt-associated infection is the most common complication after surgery. However, fungal infections are unusual. We present a case of cryptococcal meningitis complicated by a brain abscess and an infected intra-abdominal pseudocyst that developed 14 weeks after VP shunt insertion to treat hydrocephalus in a 74-year-old patient. Cryptococcal central nervous system (CNS) infection has a high mortality rate; however, diagnosis is challenging. Therefore, prompt diagnosis and treatment are required when a cryptococcal CNS infection is suspected in patients with VP shunts.
Aged ; Brain Abscess ; Brain ; Central Nervous System ; Cryptococcus ; Diagnosis ; Humans ; Hydrocephalus ; Meningitis, Cryptococcal ; Mortality ; Ventriculoperitoneal Shunt

BACKGROUND: Mean platelet volume (MPV) increases when platelets are activated, and it is known to increase in migraine patients. The aim of this study is to investigate whether there is a difference in MPV or platelet count between migraine patients with (MA) and without aura (MO).METHODS: Migraine patients were recruited from the out-patient department of a hospital between January 2012 and June 2017. Patients were divided into MA and MO groups. Platelet count and MPV were compared between groups, and the frequency of comorbidities such as ischemic stroke and cardiovascular disease, was investigated in both groups.RESULTS: Of the 123 patients, 46 were classified as MA, and 77 were classified as MO. The MPV of the MA group was significantly higher than that of the MO group (8.92±0.17 fL, 6.32±0.28 fL, respectively) (P=0.034). However, platelet count showed no significant difference between groups. Cardiovascular disease and ischemic stroke incidences were significantly higher in the MA group than in the MO group (ischemic stroke: 15.2%, 7.8%, respectively, P=0.027; cardiovascular disease: 10.9%, 6.5%, respectively, P=0.018).CONCLUSION: Mean platelet volume was significantly greater in the MA group than in the MO group. This may be related to the pathophysiological differences between the two conditions.
Cardiovascular Diseases ; Comorbidity ; Epilepsy ; Humans ; Incidence ; Mean Platelet Volume ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Outpatients ; Platelet Activation ; Platelet Count ; Stroke

Ventriculoperitoneal (VP) shunt insertion is the standard treatment for hydrocephalus; shunt-associated infection is the most common complication after surgery. However, fungal infections are unusual. We present a case of cryptococcal meningitis complicated by a brain abscess and an infected intra-abdominal pseudocyst that developed 14 weeks after VP shunt insertion to treat hydrocephalus in a 74-year-old patient. Cryptococcal central nervous system (CNS) infection has a high mortality rate; however, diagnosis is challenging. Therefore, prompt diagnosis and treatment are required when a cryptococcal CNS infection is suspected in patients with VP shunts.

Oseltamivir has been used as a worldwide preparation for treatment of influenza A and B including H1N1. Gastrointestinal discomforts as like nausea, vomiting are commonly reported but acute hemorrhagic colitis is a very rare adverse effect. We report a case of a 17-year-old male who showed abdominal pain, diarrhea and hematochezia after the second administration of oseltamivir. Computed tomography revealed continuous, circumferential and edematous wall thickening involving ascending to descending colon with pericolic infiltration. Colonoscopic examination revealed diffuse mucosal edema, congestion and friability, suggesting hemorrhagic colitis. Histopathological examination showed ischemia and focal loss of the crypts. It also showed hyalinization and minimal inflammatory cell infiltration in the lamina propria, consistent with acute to subacute ischemic colitis. This report is the first case of oseltamivir-related ischemic colitis proved by both endoscopic examination and pathologic findings in the patient who had no risk factor of ischemic colitis in Korea.
Abdominal Pain ; Administration, Oral* ; Adolescent ; Colitis* ; Colitis, Ischemic ; Colon, Descending ; Diarrhea ; Edema ; Estrogens, Conjugated (USP) ; Gastrointestinal Hemorrhage ; Humans ; Hyalin ; Influenza, Human ; Ischemia ; Korea ; Male ; Mucous Membrane ; Nausea ; Oseltamivir* ; Risk Factors ; Vomiting

Reactive lymphoid hyperplasia (RLH) is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To date, only 43 cases have been reported in the English literature and 2 cases in the Korean literature. We report a case of hepatic RLH in a 36-year-old woman who had been diagnosed two years previously with an intrahepatic tumor that measured 0.6 x 1.0 cm on abdominal ultrasonography. Her medical history was otherwise unremarkable. On follow-up ultrasonography, the hepatic mass had increased in size. We biopsied the liver mass and the histopathologic findings confirmed reactive lymphoid hyperplasia. Radiofrequency ablation (RFA) was performed instead of surgical resection. The patient is currently doing well with no sign of relapse 1 year and 8 months after the RFA.
Adult ; Catheter Ablation* ; Female ; Follow-Up Studies ; Humans ; Liver ; Lymphocytes ; Pseudolymphoma* ; Recurrence ; Ultrasonography

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.
Aneurysm* ; Arteries ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Vessels ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction* ; Vasculitis ; Young Adult