Background: The interaction between calcium and magnesium as a risk modifier for insulin resistance may be largely overlooked because the strict regulatory system in blood has been thought to maintain such homeostatic interactions under tight control. This study aimed to investigate the relationship between the calcium-magnesium ratio in hair with the triglyceride glucose index (TyG index) and triglyceride/HDL-cholesterol ratio (TG/ HDL ratio) among overweight or obese Korean individuals. Methods: This cross-sectional study included 56 participants fulfilling the inclusion criterion of a body mass index of 23 kg/m2 or more. Intra-abdominal visceral adipose tissue (VAT) was measured by fat measurement computed tomography, while calcium and magnesium levels were measured by hair mineral analysis. A high TyG index and a high TG/HDL ratio were defined as >9.3 and >4.0, respectively (>75th percentile). Using multiple logistic regression analysis, we examined the associations between the TyG index, TG/HDL ratio, and calcium–magnesium ratio in hair. Results: The mean age, body mass index, and VAT were 45.3 years, 28.5 kg/cm2 , and 137.4 cm2 , respectively. Compared to the controls, the odds ratios (95% confidence intervals) for a high TyG index and a high TG/HDL ratio were 16.03 (1.32–194.23) and 9.98 (1.05–94.98) per one increment of log (calcium-magnesium ratio), respectively, after adjusting for age, sex, body mass index, visceral adipose tissue, white blood cell count, total cholesterol, hypertension medication, diabetes medication, and dyslipidemia medication. Conclusion We found that the calcium-magnesium ratio in hair was positively and independently associated with the TyG index and TG/HDL ratio.

IgG4-related disease (IgG4-RD) is characterized by a systemic involvement of tumor-like lesions with IgG4-positive plasmacytes. We experienced a case of IgG4-RD developed in a patient with bronchial asthma (BA) and chronic rhinosinusitis (CRS). A 55-yr-old female patient with BA and CRS complained of both eyes and neck swelling as well as a recurrent upper respiratory infection in recent 1 yr. The serum levels of IgG4, creatinine, and pancreatic enzymes were elevated. A biopsy of the submandibular gland showed an abundant infiltration of IgG4-positive plasmacytes. Her symptoms remarkably improved after the treatment of a systemic steroid that has been maintained without recurrence. We report a rare case of IgG4-RD developed in a patient with BA and CRS.
Asthma/complications/*diagnosis ; Chronic Disease ; Creatinine/blood ; Female ; Humans ; Immunoglobulin G/*blood ; Middle Aged ; Pancreas/enzymology ; Plasma Cells/physiology ; Prednisolone/therapeutic use ; Republic of Korea ; Rhinitis/complications/*diagnosis/drug therapy ; Sinusitis/complications/*diagnosis/drug therapy ; Submandibular Gland/pathology ; Tomography, X-Ray Computed

Many cutaneous adverse reactions including eczematoid dermatitis and lichenoid eruption have been reported with the increased usage of tumor necrosis factor-α inhibitors. However, there are very few reports of generalized pustular eruptions with adalimumab administration. A 44-year-old woman visited our clinic with multiple skin lesions scattered across her body. The patient developed these lesions three days after the initiation of adalimumab treatment. At the time of the patient’s visit, physical examination revealed multiple erythematous papules and pustules across the body. Histopathological findings revealed subcorneal neutrophilic microabscess formation with dense perivascular and perifollicular infiltration that was mainly composed of lymphocytes and neutrophils. We diagnosed the patient with cutaneous pustular eruptions due to adalimumab exposure and initiated treatment with prednisolone and discontinued adalimumab injections. After 1 month of treatment, the patient’s skin lesions improved. Herein, we report a case of generalized pustular eruptions, a rare cutaneous adverse reaction to adalimumab.

Many cutaneous adverse reactions including eczematoid dermatitis and lichenoid eruption have been reported with the increased usage of tumor necrosis factor-α inhibitors. However, there are very few reports of generalized pustular eruptions with adalimumab administration. A 44-year-old woman visited our clinic with multiple skin lesions scattered across her body. The patient developed these lesions three days after the initiation of adalimumab treatment. At the time of the patient’s visit, physical examination revealed multiple erythematous papules and pustules across the body. Histopathological findings revealed subcorneal neutrophilic microabscess formation with dense perivascular and perifollicular infiltration that was mainly composed of lymphocytes and neutrophils. We diagnosed the patient with cutaneous pustular eruptions due to adalimumab exposure and initiated treatment with prednisolone and discontinued adalimumab injections. After 1 month of treatment, the patient’s skin lesions improved. Herein, we report a case of generalized pustular eruptions, a rare cutaneous adverse reaction to adalimumab.

Background: Lipomas are the most common benign tumors and surgical removal is the treatment of choice. However, some deep-seated lipomas are technically challenging to surgically excise from a dermatologist’s perspective. This study was planned to help predict the depth of lipomas depending on their anatomical site of occurrence. Objective: To determine whether there is a relationship between the anatomical site and the depth of lipomas. Methods: We retrospectively reviewed the medical records of 459 patients with 459 lesions diagnosed as lipoma, surgically treated between June 2006 and June 2019. Histopathologic evaluation was performed to determine the relationship between the depth and the specific subtype of the lipoma. Results: The most common site of occurrence was the trunk (177; 38.6%). Most of the lipomas (388; 84.5%) were located in the subcutaneous fat layer. Some lipomas (71; 15.5%) were found in deeper tissues, such as the intramuscular, intermuscular, and submuscular layers. The forehead and flank had a higher incidence of deep-seated lipomas than other areas. Conclusion Our results revealed that lipomas in the forehead and flank are more likely to occur in deeper layers. In clinical practice, physicians often skip radiologic evaluation before surgery. However, we recommend preoperative radiologic evaluation before surgical excision of lipomas of the forehead and flank.

Purpose: The purpose of the study was to shorten the KPCS-1 (Korean Patient Classification System-1) for predicting nursing care need level and to explore whether the patients can be clustered by their acuity and dependency. Methods: The participants were inpatients in two surgical wards and two internal medicine wards at a teritory hospital during 14 days investigations. The KPCS-1 was evaluated once a day for all inpatients and 2,082 cases of data from a total of 411 patients were analyzed. Results: The items were reducted from 50 items to 26 items by partial least squares analysis and expert review. Through factor analysis, it was confirmed that hygiene, diet, elimination, and exercise were categorized as dependence factors. Patients were clustered with low acuity/low dependency (average score: 7.68±2.81/1.05±1.33), high acuity/low dependency (average score: 17.20±4.15/1.94±2.40), medium acuity/high dependency (average score: 13.56±5.30/9.66±2.64) through cluster analysis. The total score of the three groups for their nursing care needs was 8.73±3.36, 19.14±5.74, and 23.24±6.31 in order, and the results showed a statistically significant difference (F=1712.12, p<.001). Conclusion The shortening of the KPCS-1 and the new criteria for categorizing patients according to acuity and dependence will increase clinical utility and be useful for manpower assignment criteria in detail.

Dermatofibroma (DF) is one of the most common benign soft tissue tumors. Various histological variants of DF have been described, and it is important to discern the different variants to evaluate the prognosis. A 43-year-old female patient with no specific medical history presented with multiple brown-colored nodules on the right arm for 5 years. Biopsy specimens showed a predominance of collagen and fibroblasts in a whorled arrangement with moderate cellularity, findings that were consistent with fibrocollagenous DF. The patient underwent excision of the largest lesion and revisited our department 3 months after surgery with local recurrence at the excision site. We report a rare case of multiple fibrocollagenous DF with local recurrence at the excision site.

Chronic arsenic exposure causes varied dermatological sequelae, from arsenical keratosis to skin cancers. We report the successful treatment of palmoplantar arsenical keratosis with a combination of systemic alitretinoin and cryotherapy. A 49-year-old Korean man with a history of taking a traditional medicine formulation for 6 months in his early 30s was diagnosed with multiple cutaneous squamous carcinomas with metastasis to lymph node, squamous carcinoma in situ, and palmoplantar arsenical keratosis. Wide local excision followed by adjuvant radiotherapy was done for the malignancies, and palmoplantar arsenical keratosis was treated with systemic alitretinoin (30 mg/d) and cryotherapy. The patient tolerated the treatment well, and arsenical keratosis was nearly cleared after 18 months.