Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Purpose: The study was aimed at assessing the prevalence of depression in individuals with fecal incontinence (FI) and the relationship between the symptoms of depression and the severity of objective test parameters. Methods: Patients with FI for over 3 months were included in the study. The exclusion criteria were (1) diagnosis or treatment of the pelvic organ prolapse syndrome, (2) previous anorectal surgery, (3) inflammatory bowel disease, (4) previous diagnosis of psychiatric disorder, and (5) inability to read or understand the questionnaire themselves. The questionnaire included the Beck Depression Inventory-II (BDI-II) for measuring depression, and 142 patients were included for analysis. Results: Of the 142 patients, 34 were males and 108 were females, with a mean age of 67.8 years. The mean duration of FI symptoms was 38.36 months (range, 3–600 months). The mean Cleveland Clinic Incontinence Score and BDI-II were 11.96 ± 4.76 and 12.46 ± 9.84, respectively. The Cleveland Clinic Incontinence Score showed a positive correlation with the BDI-II score (P = 0.005). Of the 142 patients, 99 showed minimal to mild BDI-II scores, and 43 showed moderate-to-severe BDI-II scores. The multivariable logistic regression analysis showed that health insurance status was related to the depression in FI patients. Conclusion Mood disorders related to FI are more affected by the severity of the subjective symptoms or the surrounding environment than the objective indicators derived from the test.

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Background: This study aimed to analyze the correlation between bone mineral density (BMD) and the type of 5th metatarsal fracture, as well as to demonstrate whether there is a difference in radiological findings (heel alignment angle [HAA], heel moment arm [HMA], and metatarsus angle) between fracture types. Methods: A total of 87 patients were enrolled in the study and allocated into 3 groups: the Zone 1 group (N=36), the Zone 2 group (N=33), and the Zone 3 group (N=18). The participants’ demographic data, T-scores, existing fracture or osteoporosis medications, and radiologic parameters including HAA, HMA, and metatarsus adductus angle were analyzed and compared. Results: There was a significant difference between the mean age of the participants, with the highest age in the Zone 1 group and the lowest in the Zone 3 group. Regarding the history of concurrent fracture or osteoporosis medications, there was no significant difference between the 3 groups. Similarly, no significant difference was observed between the 3 groups about the BMD values. In contrast, the HAA was statistically significant in all groups with a positive correlation of -8.9 in the Zone 1 group, a negative correlation of 3.55 in the Zone 2 group, and an inverse relationship of 6.1 in the Zone 3 group. The metatarsus adductus angle was significantly higher in the Zone 3 group than the Zone 1 and Zone 2 groups. Conclusions The location of a 5th metatarsal bone fracture is not significantly associated with BMD. However, mechanical influences, such as hindfoot varus or forefoot adductus, have a significant correlation with fracture types.

Purpose: The study was aimed at assessing the prevalence of depression in individuals with fecal incontinence (FI) and the relationship between the symptoms of depression and the severity of objective test parameters. Methods: Patients with FI for over 3 months were included in the study. The exclusion criteria were (1) diagnosis or treatment of the pelvic organ prolapse syndrome, (2) previous anorectal surgery, (3) inflammatory bowel disease, (4) previous diagnosis of psychiatric disorder, and (5) inability to read or understand the questionnaire themselves. The questionnaire included the Beck Depression Inventory-II (BDI-II) for measuring depression, and 142 patients were included for analysis. Results: Of the 142 patients, 34 were males and 108 were females, with a mean age of 67.8 years. The mean duration of FI symptoms was 38.36 months (range, 3–600 months). The mean Cleveland Clinic Incontinence Score and BDI-II were 11.96 ± 4.76 and 12.46 ± 9.84, respectively. The Cleveland Clinic Incontinence Score showed a positive correlation with the BDI-II score (P = 0.005). Of the 142 patients, 99 showed minimal to mild BDI-II scores, and 43 showed moderate-to-severe BDI-II scores. The multivariable logistic regression analysis showed that health insurance status was related to the depression in FI patients. Conclusion Mood disorders related to FI are more affected by the severity of the subjective symptoms or the surrounding environment than the objective indicators derived from the test.

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Background: This study aimed to analyze the correlation between bone mineral density (BMD) and the type of 5th metatarsal fracture, as well as to demonstrate whether there is a difference in radiological findings (heel alignment angle [HAA], heel moment arm [HMA], and metatarsus angle) between fracture types. Methods: A total of 87 patients were enrolled in the study and allocated into 3 groups: the Zone 1 group (N=36), the Zone 2 group (N=33), and the Zone 3 group (N=18). The participants’ demographic data, T-scores, existing fracture or osteoporosis medications, and radiologic parameters including HAA, HMA, and metatarsus adductus angle were analyzed and compared. Results: There was a significant difference between the mean age of the participants, with the highest age in the Zone 1 group and the lowest in the Zone 3 group. Regarding the history of concurrent fracture or osteoporosis medications, there was no significant difference between the 3 groups. Similarly, no significant difference was observed between the 3 groups about the BMD values. In contrast, the HAA was statistically significant in all groups with a positive correlation of -8.9 in the Zone 1 group, a negative correlation of 3.55 in the Zone 2 group, and an inverse relationship of 6.1 in the Zone 3 group. The metatarsus adductus angle was significantly higher in the Zone 3 group than the Zone 1 and Zone 2 groups. Conclusions The location of a 5th metatarsal bone fracture is not significantly associated with BMD. However, mechanical influences, such as hindfoot varus or forefoot adductus, have a significant correlation with fracture types.

Background: Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM). Methods: From March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated. Results: In total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9± 14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, –1.1%±1.2%; P<0.001). The number of patients with HbA1c <7% increased significantly from 5 to 68 (P<0.005). In addition, lipid profiles and liver enzyme levels were also improved whereas no changes in body weight. There was no significant safety issue in patients treated with quadruple OHA therapy. Conclusion This study shows the therapeutic efficacy of the quadruple OHA regimen T2DM and demonstrates that it can be an option for the management of T2DM patients who cannot use insulin or reject injectable therapy.

There has been a worldwide pandemic infection of influenza A (H1N1) since June 2009. A 23-year-old female presented with fever and sore throat and was diagnosed as having influenza A (H1N1) infection. After 2 days of illness, she had headache, nausea, and neck stiffness. Cerebrospinal-fluid findings were consistent with viral infection, and brain MRI revealed intense signals in both frontotemporal cortices. During her illness she developed repetitive seizures, which were considered to be status epilepticus.
Brain ; Encephalitis ; Encephalitis, Viral ; Female ; Fever ; Headache ; Humans ; Influenza, Human ; Nausea ; Neck ; Pandemics ; Pharyngitis ; Seizures ; Status Epilepticus ; Young Adult

PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using porous hydroxyapatite for intraarticular calcaneal fracture of joint depression type. MATERIALS AND METHODS: Twenty patients with intraarticular calcaneal fracture were followed up for more than 1 year. The period to union was calculated to evaluate the osteoconductivity of porous hydroxyapatite used as bone graft substitute. The measurement of Bohler angle, Gissane angle and the degree of articular surface depression was performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 10.4degrees, 117.8degrees to average 22.6degrees, 113.5degrees immediate postoperatively, and had maintained to average 21.2degrees and 114.4degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 4.8 mm to 1.5 mm at the last follow-up. All cases achieved bone union, and the interval to union was average 12.8 weeks. AOFAS score was average 85.2 points at last follow-up. There were 7 excellent, 10 good, and 3 fair results according to the CNHF scale. Therefore, 17 cases (85%) achieved satisfactory results. CONCLUSION: Plate fixation using porous hydroxyapatite seems to be one of effective treatment methods for intraarticular calcaneal fracture of joint depression type, because of supporting the reduction of subtalar articulation by augmenting bony defect and facilitating bone formation. Further evaluation about long-term radiological changes and histological analysis on hydroxyapatite implantation site should be required.
Animals ; Ankle ; Depression ; Durapatite ; Follow-Up Studies ; Foot ; Humans ; Joints ; Osteogenesis ; Transplants