We investigated the frequency of sleep disturbances and the association between sleep disturbances and glucoregulation in type 2 diabetic patients. The frequency of sleep disturbances in 614 type 2 diabetic patients was investigated using validated sleep questionnaires. There were 381 male and 233 female patients. The mean age was 59.7 +/- 11.1 yr; the mean body mass index was 24.9 +/- 4.4 kg/m2; the mean HbA1c was 7.8% +/- 1.5%; and the mean duration of diabetes was 10.3 +/- 8.4 yr. The questionnaires revealed insomnia in 48.2% of the patients while 8.5% reported excessive daytime sleepiness. A total of 49% of the patients was poor sleepers, while 28.5% had depression. Multivariate logistic regression analysis showed that there was no significant association between HbA1c and other sleep disturbances, such as poor sleep, insomnia, and short duration of sleep. Sleep disturbances were very common in patients with type 2 diabetes mellitus, whereas there was no association between poor or short sleep and glucoregulation. Awareness and identifying sleep complaints in such patients are necessary to improve their quality of daily life.
Adult ; Aged ; Body Mass Index ; Depression/epidemiology ; Diabetes Mellitus, Type 2/complications/*diagnosis/drug therapy ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hypoglycemic Agents/therapeutic use ; Logistic Models ; Male ; Middle Aged ; Quality of Life ; Questionnaires ; Sleep Disorders/*complications ; Sleep Initiation and Maintenance Disorders/epidemiology

This study aimed to assess the effects of sarcopenia and A Body Shape Index (ABSI) on cardiovascular disease (CVD) risk according to obesity phenotypes.

This study aimed to assess the effects of sarcopenia and A Body Shape Index (ABSI) on cardiovascular disease (CVD) risk according to obesity phenotypes.

Background: This study aimed to assess the effects of sarcopenia and A Body Shape Index (ABSI) on cardiovascular disease (CVD) risk according to obesity phenotypes. Methods: We used data from the National Health and Nutrition Examination Survey 1999 to 2012. A total of 25,270 adults were included and classified into the following groups: metabolically healthy normal weight (MHNW), metabolically healthy overweight/obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight/obese (MUO). Sarcopenia was defined as the appendicular skeletal mass index <7 kg/m2 in men and <5.5 kg/m2 in women. A multivariate logistic regression analysis was performed to evaluate the odds ratio (OR) of sarcopenia and ABSI for CVD events according to the obesity phenotype. Results: The MHNW participants with sarcopenia had higher risk for CVD than those without sarcopenia (OR, 2.69; 95% confidence interval [CI], 1.56 to 4.64). In the analysis with MHNW participants without sarcopenia as a reference, the participants with sarcopenia showed a higher OR for CVD than those without sarcopenia in both MHO (OR in participants without sarcopenia, 3.31; 95% CI, 1.94 to 5.64) (OR in participants with sarcopenia, 8.59; 95% CI, 2.63 to 28.04) and MUO participants (OR in participants without sarcopenia, 5.11; 95% CI, 3.21 to 8.15) (OR in participants with sarcopenia, 8.12; 95% CI, 4.04 to 16.32). Participants within the second and third tertiles of ABSI had higher ORs for CVDs than the counterpart of obesity phenotypes within the first tertile. Conclusion These results suggest that clinical approaches that consider muscle and body shape are required.

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

This study provides an application of datamining approach to CQJ using the discharge summary. First, we found a process variation in hospital infection rate by SPC (Statistical Process Control) technique. Second, importance of factors influencing hospital infection was inferred through the decision tree analysis which is a classification method in data -mining approach. The most important factor was surgery followed by comorbidity and length of operation. Comorbidity was further divided into age and principal diagnosis and the length of operation was further divided into age and chief complaint. 24 rules of hospital infection were generated by the decision tree analysis. Of these, 9 rules with predictive prover greater than 50% were suggested as guidelines for hospital infection control. The optimum range of target group in hospital infection control were identified through the information gain summary.Association rule, which is another kind of datamining method, was performed to analyze the relationship between principal diagnosis and comorbidity. The confidence score, which measures the degree of association, between urinary tract infection and causal bacillus was the highest, followed by the score between postoperative wound disruption and postoperative wound infection.This study demonstrated how datamining approach could be used to provide information to support prospective surveillance of hospital infection. The datamining technique can also be applied to various areas for CQI using other hospital databases.
Bacillus ; Classification ; Comorbidity ; Cross Infection ; Data Mining* ; Decision Trees ; Diagnosis ; Urinary Tract Infections ; Wounds and Injuries

Percutaneous needle aspiration biopsy is a relatively simple and safe procedure for the diagnosis of lung and mediastinal lesions. Systemic air embolism during and after percutaneous needle aspiration biopsy of the lung is very rare; however, it is still a complication that can cause fatal outcomes, such as cerebral infarction and myocardial infarction. Here, we report a 72-year-old woman who suffered a change in consciousness immediately after receiving a percutaneous needle aspiration biopsy for the pathologic examination of pulmonary nodules found during a routine health medical examination. She had left side weakness and ST segment elevation on an electrocardiogram. After a high concentration of oxygen, she recovered from neurological symptoms and electrocardiographic abnormalities. The authors report a case of air embolism occurring simultaneously in the brain and coronary arteries after percutaneous needle aspiration biopsy.
Aged ; Biopsy ; Biopsy, Needle* ; Brain ; Cerebral Infarction ; Consciousness ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Embolism ; Embolism, Air* ; Fatal Outcome ; Female ; Humans ; Intracranial Embolism ; Lung* ; Myocardial Infarction ; Needles* ; Oxygen

An aortoesophageal fistula is one of the very few causes of upper gastrointestinal bleeding but can be fatal if the diagnosis is delayed. This usually occurs secondary to esophageal or aortic surgery. A primary aortoesophageal fistula is rare and less likely to be suspected. Here, we present a case of a primary aortoesophageal fistula that presented as massive upper gastrointestinal bleeding. An 81-year-old man with a history of aortic aneurysm had syncope and bright color hematemesis. The aortoesophageal fistula was not diagnosed early enough and the patient died. Therefore, emergency physicians should consider aortoesophageal fistula as a potential cause when encountering upper gastrointestinal bleeding.
Aged, 80 and over ; Aortic Aneurysm ; Diagnosis ; Emergencies ; Esophageal Fistula ; Fistula* ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Humans ; Syncope

Patients with ankylosing spondylitis (AS) are at high risk for spinal fracture even after a minor injury. Most spinal fractures with ankylosing spondylitis occur in the cervical spine, whereas spinal fractures in thoracic or lumbar spine are rare. These fractures are often difficult to detect on standard radiographs, because the normal anatomical landmarks are lacking and the abnormal spinal stiffness precludes optimal exposure of the spine. We report on a case of a 12th thoracic spine fracture in ankylosing spondylitis with bamboo spine after a minor injury. In this case, anteroposterior and lateral radiographs of the thoracolumbar spine showed a bamboo spine typical for ankylosing spondylitis with no evidence of fracture. However, computed tomography showed a 12th thoracic fracture with burst. Therefore, this fracture, in a patient with AS involved all three spinal columns, was considered unstable.
Humans ; Spinal Fractures ; Spine* ; Spondylitis, Ankylosing*

BACKGROUND/AIMS: Recent epidemiological studies revealed a striking inverse relationship between vitamin D levels, glucose intolerance/insulin resistance (IR), and cardiovascular disease. However, few interventional studies have evaluated the effect of vitamin D supplementation on cardiovascular risk, such as IR and arterial stiffness, in diabetes. We investigated the role of vitamin D supplementation on cardiovascular risk in type 2 diabetes patients, including metabolic parameters, IR, and arterial stiffness. METHODS: We enrolled patients who were taking antidiabetic medications or managed their diabetes using lifestyle changes. We excluded patients who were taking vitamin D or calcium supplements. We randomized participants into the vitamin D group (cholecalciferol 2,000 IU/day + calcium 200 mg/day, n = 40) or the placebo group (calcium 200 mg/day, n = 41). We compared their IR (homeostasis model of assessment [HOMA]-IR) and arterial stiffness (brachial-ankle pulse wave velocity and radial augmentation index) before and after 24 weeks of intervention. RESULTS: The baseline characteristics of the two groups were similar. A total of 62 participants (placebo, 30; vitamin D, 32) completed the study protocol. At the end of the study period, the 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in the vitamin D group than in the placebo group (35.4 +/- 8.5 ng/mL vs. 18.4 +/- 7.3 ng/mL, p < 0.001). There was no difference in HOMA-IR or changes in arterial stiffness (placebo, 21, vitamin D, 24) between the groups. CONCLUSIONS: Our data suggest that high-dose vitamin D supplementation might be effective in terms of elevating 25(OH)D levels. However, we identified no beneficial effects on cardiovascular risk in type 2 diabetes, including IR and arterial stiffness.
Calcium, Dietary/administration & dosage ; Cholecalciferol/*administration & dosage ; Diabetes Mellitus, Type 2/complications/*drug therapy/physiopathology ; Double-Blind Method ; Female ; Humans ; *Insulin Resistance ; Male ; Middle Aged ; Prospective Studies ; Vascular Stiffness/*drug effects ; Vitamin D/analogs & derivatives/blood ; Vitamin D Deficiency/blood/complications/drug therapy