Gestational diabetes mellitus (GDM) is a frequent medical problem during pregnancy. It is associated with an increased risk of complications for GDM mother and the offspring. There is increasing evidence that GDM may increase the risk of future type 2 diabetes and cardiovascular disease in mothers, and may also increase the risk of obesity and diabetes in children. Therefore GDM affects health for a lifetime. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed a new screening approach for pre-diagnosed diabetes at the first prenatal visit and diagnostic criteria for GDM in accordance with perinatal outcomes. Nonetheless, controversies still exist about these issues. There is a positive linear association between increasing maternal glucose at oral glucose tolerance testing and risk of important perinatal outcomes. In managing the GDM patients, an individualized medical approach is essential. If maternal glucose levels have increased, insulin can be used to achieve glycemic targets. Postpartum screening for diagnosing of diabetes is essential for women with previous GDM.
Cardiovascular Diseases ; Child ; Diabetes, Gestational* ; Diagnosis ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin ; Mass Screening ; Mothers ; Obesity ; Postpartum Period ; Pregnancy

The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.
Cholestasis ; Fluconazole ; Hepatic Encephalopathy ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Hepatocytes ; Humans ; Incidence ; Korea ; Liver ; Liver Transplantation ; Massive Hepatic Necrosis ; Necrosis ; Portal Vein ; Sepsis ; Serologic Tests ; Veins

No abstract available.
Abscess* ; Bacteria, Aerobic* ; Quinolones* ; Virulence*

Tight control of dyslipidemia and hypertension in elderly diabetic patients aged 65 years or older are considered to be very important for the secondary prevention of cardiovascular disease and control of severe diseases associated with macrovascular complications. In addition, in elderly diabetes with risk factors for cardiovascular disease, it is important to control all of the accompanying risk factors together to accomplish the primary prevention of cardiovascular disease. In elderly diabetic patients, thorough control of blood glucose level by itself prevents macrovascular complications. However, it is recommended to perform tight blood glucose control along with other risk factors in consideration of the function and life of the patient. In particular, insulin resistance progresses before the onset of diabetes mellitus and other risk factors for cardiovascular disease. It is important to suppress and prevent the progression of macrovascular complications.
Aged ; Blood Glucose ; Cardiovascular Diseases ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Insulin Resistance ; Primary Prevention ; Risk Factors ; Secondary Prevention

No abstract available.
Mass Screening* ; Prospective Studies*

Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation for facial laceration in pediatric patients. The major benefits are its rapid onset of effects, relatively short half-life, and lack of respiratory depression. The known side effects of ketamine are hallucinations, dizziness, nausea, and vomiting. Seizure is not a known side effect of ketamine in patients without a seizure history. Here, we present the case of a patient in whom ketamine likely induced a generalized tonic-clonic seizure when used as a single agent in procedural sedation for facial laceration repair. The aim of this article is to report a rare and unexpected side effect of ketamine used at the regular dose for procedural sedation. This novel case should be of interest to not only emergency physicians but also plastic surgeons.