BACKGROUND AND OBJECTIVE: The outcome of asthma treatment has traditionally been assessed by measuring the conventional clinical parameters such as symptoms, expiratory flow rates and needs for medications. But none of them tells us whether the patients are actually able to function properly in their lives. Only assessment of the quality of life (QOL) can reflect the parts of patients lives affected by the disease. However, there is no measure to assess the quality of life of patients with any chronic diseases in Korea yet. We developed the QOL Questionnaire for Korean Asthmatics and evaluated its measurement properties. METHOD: The questionnaire was composed of 18 items in four domains : i.e. activity limitation (6 items), symptoms (5 items), emotional function (3 items) and environmental stimuli (4 items). At our out-patient clinic, 32 adults with moderate to severe persistent bronchial asthma were enrolled. The study design consisted of 4 week unblinded single cohort with visits at 0 and 4 weeks, and the patients were asked to answer the questionnaire by self administration method at the two separate visits. Forced expiratory volume for 1 second (FEV1) and peak expiratory flow rate (PEFR) were recorded at each visit. According to the patients and physicians global assessment, the patients were divided into two groups, i.e. stable and changed (improved). The responsiveness, reproducibility and validity of the questionnaire were evaluated. RESULTS: The total QOL scores at the second visit in the changed group were significantly higher than those at the first visit. The score differences between the two visits in the changed group were higher than in the stable group. In the stable group, the responses to the questionnaire were reproducible. The QOL scores showed good longitudinal correlation with the expiratory flow rates, whereas FEV1 did not correlate with the QOL in cross-sectional analysis. CONCLUSION: The questionnaire proved to be reproducible, responsive and valid in the subjects. It could be recommended for the outcome evaluation of Korean asthmatics.
Adult ; Asthma ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Forced Expiratory Volume ; Humans ; Korea ; Outpatients ; Peak Expiratory Flow Rate ; Quality of Life* ; Self Administration ; Surveys and Questionnaires

Purpose: The study was aimed to examine components and provider’s characteristics of non-pharmacological intervention that affect delirium prevention in elderly inpatients. Additional effects on delirium prevention based on identified characteristics were explored. Methods: Studies were searched by using seven electronic databases and examined through Preferred Reporting Items Systematic Review and Meta-Analysis (PRISMA) flow diagram. The Risk of Bias (ROB) and the Risk of Bias Assessment tool for Non-randomized Study (RoBANS) were used to evaluate the quality of each included study. Results: Seven studies were selected for the systematic review. Most of the selected studies had a low risk of bias. Interventions of each study and delirium outcome were heterogeneous. Each multi-component non-pharmacological intervention consisted on average of five interventions. Giving orientation and promoting early mobilization were included in every study. Interventions that included giving orientation, promoting early mobilization, and supporting nutrition significantly decreased delirium incidence. Moreover, when health care providers who have an intimate relationship with patients provided non-pharmacological interventions, delirium incidence has significantly decreased. Conclusion Non-pharmacological intervention, such as giving orientation, promoting early mobilization, should be included to prevent delirium for elderly inpatients. It is important to include healthcare providers who have an intimate relationship or regular contact with patients in order to decrease delirium incidence.

A 42-year-old man presented with severe pancytopenia and uncontrolled epistaxis. The diagnosis of SLE was made and the pancytopenia was found to be due to myelofibrosis. The pulse therapy with methylprednisolone and maintenance therapy with prednisolone reversed both pancytopenia and myelofibrosis. Although myelofibrosis has been described in SLE, this coexistence must be very rare since there has been only 19 cases showing this combination. We report a case of SLE with myelofibrosis which was reversed by the treatment with glucocorticoid.
Adult ; Diagnosis ; Epistaxis ; Humans ; Lupus Erythematosus, Systemic* ; Methylprednisolone ; Pancytopenia ; Prednisolone ; Primary Myelofibrosis*

Hypersensitivity to mosquito bites is a disorder characterized by necrotic skin reactions and systemic generalized symptoms subsequent to mosquito bites. This disease has been reported mostly in Japanese patients in their first two decades of life. Recent studies have revealed that hypersensitivity to mosquito bites is frequently associated with chronic Epstein-Barr virus infection and natural killer cell leukemia/lymphoma. We describe here a Korean male adolescent who had hypersensitivity to mosquito bites accompanied by chronic Epstein-Barr virus infection and atypical lymphocytosis.
Adolescent ; Asian Continental Ancestry Group ; Culicidae* ; Herpesvirus 4, Human* ; Humans ; Hypersensitivity* ; Killer Cells, Natural ; Lymphocytosis* ; Skin

PURPOSE: Tibial internal torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Tibial internal torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The aim of this study is to evaluate the therapeutic effect of Tibial Counter Rotator (TCR) in patients with tibial internal torsion. Method:One hundred forty nine children (274 limbs) with tibial internal torsion participated in this study. Transmalleolar angle were measured with gravity goniometer. When tibial internal torsion was detected, TCR was applied at least for 3 hours a day during sleep. The patient's progress was followed monthly and transmalleolar angle was reevaluated by the same examiner. RESULTS: Transmalleolar angle was significantly increased in patients with tibial internal torsion during TCR application (P<0.001). CONCLUSION: TCR can be one of the effective methods for correcting tibial internal torsion in children under 12 years old of age.
Asian Continental Ancestry Group ; Child* ; Gravitation ; Humans ; Japan ; Korea ; Osteoarthritis ; Tibia*

BACKGROUND: This study was conducted to evaluate the survival benefit of the bronchial arterial embolization (BAE) for patients presenting with non-traumatic hemoptysis. METHODS: The clinical data were retrospectively collected from the medical records and the Order Communicating Systems (OCS). The information dealing with death was collected from national death certificates. After enrolled patients were divided with two group such as BAE group (patients who were managed with BAE) and non-BAE group (patients who were managed with conservative modality), the survival benefit of BAE was estimated during the observational period of 24 months through using the Kaplan-Meier survival graph and the Cox-proportional hazard regression analysis. RESULTS: The number of total cases was 272. Of these, BAE group involved 63 and non-BAE group involved 209. 69 cases had the malignant pulmonary lesions, 149 cases had non-malignant chronic lung lesion such as the mycobacteria infection, fungus ball, or bronchiectasis (BE), and 54 cases had the other pathologic conditions. For each sub-groups such as 'malignant lung lesion' group, 'non-malignant chronic lung lesion' group as well as about all cases, the adjusted hazard ratios (HRs) of BAE for death was not significantly different compared to the conservative management. But the adjusted HRs as to underlying causes such as 'malignant lung lesion' group and 'the other conditions' group increased significantly compared to 'non-malignant chronic lung lesion' group. CONCLUSION: There was no significant survival benefit by BAE procedure on survival in patients presenting with non-traumatic hemoptysis.
Bronchiectasis ; Death Certificates ; Embolization, Therapeutic ; Emergencies* ; Fungi ; Hemoptysis* ; Humans ; Lung ; Medical Records ; Retrospective Studies ; Survival Analysis

PURPOSE: Our previous study demonstrated the hypoglycemic effects of mulberry (Morus alba L.) leaf and the underlying mechanisms. Here we explored the potency of mulberry twigs (TW) and root barks (RB) in postprandial hypoglycemic effects in vitro and in vivo. METHODS: The major components of TW and RB were determined by high performance liquid chromatography (HPLC). Alpha-glucosidase inhibition and glucose/fructose uptake inhibition in Caco-2 cells were determined for TW, RB, and their major components, followed by an oral sugar tolerance test (OSTT) in streptozotocin-induced diabetic rats. Male Wistar rats were fed a high-fat diet for 2 weeks and then a single dose of streptozotocin (35 mg/kg B.W) was administered by intraperitoneal injection. Rats with fasting blood glucose levels above 126 mg/dL were randomly divided into 5 groups (n = 8/group) for the following treatments by gavage for 4 weeks: vehicle (normal control and diabetic control), 200 mg/kg B.W of TW or RB or 100 mg/kg B.W of oxyresveratrol (OXY). RESULTS: OXY and mulberroside A were identified as the major components of TW and OXY, mongolicin, and kuwanon H for RB. A significant inhibitory activity on alpha-glucosidase was found for TW, RB, and OXY (p = 0.0099). There was a dose-dependent inhibition of TW and RB on the intestinal sugar uptakes in Caco-2 cells, showing a greater impact on fructose compared to glucose. The OSTT showed that TW and RB significantly delayed time to maximal concentration (p = 0.0088) and decreased maximal concentration (p = 0.0043) compared to the control group. CONCLUSION: These results suggest that TW and RB may have a postprandial hypoglycemic effect, particularly in the case of high fructose or sucrose intake. OXY was suggested as a contributor to the hypoglycemic effect of TW and RB. Further studies are needed for the systemic effect of TW and RB in circulation.
alpha-Glucosidases ; Animals ; Blood Glucose ; Caco-2 Cells ; Chromatography, Liquid ; Diet, High-Fat ; Fasting ; Fructose ; Glucose ; Humans ; Hypoglycemic Agents* ; Injections, Intraperitoneal ; Male ; Morus* ; Rats ; Rats, Wistar ; Streptozocin ; Sucrose

PURPOSE: This study was designed to evaluate the effect of emergency department (ED) overcrowding on the outcome of patient care. METHODS: A retrospective review of medical records was obtained from Order Communicating System in the adult ED at a tertiary care teaching hospital from September 1, 2001 to November 30, 2001. For the overcrowding index, the length of stay in the ED and the time from registration to order were calculated. The outcome was defined as the result of care done in the ED or during hospitalization. The overcrowding effect on the outcome was tested by using a multivariate logistic regression analysis. Compared with the survival group, the odds ratio (OR) and 95% confidence interval (95% CI) of the death group was calculated with adjustments for gender, age, arrival time in the ED, arrival day of the week, clinical department, operation, hospitalization in the intensive care unit, and injury or disease. RESULTS: The number of total cases was 5,852. Of these, 3,046 was males and 2,806 females. Of these, the number of mortality cases in the ED was 106. A total of 2,025 patients were hospitalized. Of all the hospitalization cases, 161 died on the ward in spite of management. The length of stay in the ED, and adjusted OR were significantly increased in the total death cases and in the death cases on the ward compared to those of the survival cases. For time, from registration to order above 10 minute, compared to those below 10 minute, the adjusted OR for death in the ED was significantly increased. CONCLUSION: The overcrowding indices, such as the length of stay or the time from registration to order, were related with the outcome, that is, total death and death in the ED or on the ward.
Adult ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitalization ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Mortality ; Odds Ratio ; Patient Care* ; Pilot Projects* ; Retrospective Studies ; Tertiary Healthcare

Wernicke's encephalopathy is a neurological disorder that is caused by a thiamine deficiency, and characterized by acute confusion, ataxia, a change in the patient's state of mind and abnormal eye movement (op-thalmophlegia and nystag-mus). This encephalopathy can be found in patients with chronic alcoholism, anorexia nervosa, hemodialysis, AIDS and gastroplasty for morbid obesity. The diagnosis of this disease is difficult because not all cases display the typical symptoms. However, this disease can be confirmed not only by the clinical symptoms but also by the brain MRI findings, low thiamine level and clinical response to thiamine replacement therapy. We experienced two cases of Wer-nicke's encephalopathy in patients who underwent a gas-trec-tomy for gastric cancer. However, this condition was not diagnosed until the patients showed neurological symptoms and the typical MRI findings. These patients improved after vitamin B(1) (thiamine) replacement.
Alcoholism ; Anorexia Nervosa ; Ataxia ; Brain ; Diagnosis ; Eye Movements ; Gastrectomy* ; Gastroplasty ; Humans ; Magnetic Resonance Imaging ; Nervous System Diseases ; Obesity, Morbid ; Renal Dialysis ; Stomach Neoplasms* ; Thiamine ; Thiamine Deficiency ; Vitamins ; Wernicke Encephalopathy*

Background: This study investigated the trends of insulin use among Korean patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Changes in prescription of antidiabetic medications in T2DM patients taking insulin therapy were evaluated. Methods: We analyzed data from the National Health Insurance Service database in Korea to evaluate the prevalence of insulin users and trends of insulin use in T1DM and T2DM patients from January 2002 to December 2019. We also investigated numbers and types of antidiabetic medications in insulin users with T2DM. Results: The overall total number of insulin users increased from 2002 to 2019, reaching 348,254 for T2DM and 20,287 for T1DM in 2019 compared with 109,974 for T2DM and 34,972 for T1DM in 2002. The proportion of patients using basal analogs and short acting analogs have increased and those using human insulin, premixed insulin, or biphasic human insulin have decreased (rapid acting analogs: 71.85% and 24.12% in T1DM and T2DM, respectively, in 2019; basal analogs: 76.75% and 75.09% in T1DM and T2DM, respectively, in 2019). The use of other antidiabetic medication in addition to insulin increased for T2DM, especially in dual therapy, reaching up to 52.35% in 2019 compared with 16.72% in 2002. Conclusion The proportion of the patients using basal or rapid acting analogs increased among all insulin users in both T1DM and T2DM patients. Among patients with T2DM, the proportion of patients using antidiabetic medications in addition to insulin was significantly increased compared to those who used insulin alone.