Background: Migraine is a common neurological disorder that affects the quality of life and causes several health problems. Preventive migraine treatment can reduce migraine frequency, headache severity, and health care costs. This study aimed to estimate the utilization of migraine preventive therapy and associated factors in eligible patients. Methods: We studied 534 patients with migraine who were eligible for migraine preventive therapy using 2017 National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA). We estimated the migraine days by calculating the monthly average number of defined daily dose (DDD) of migraine-specific acute drug. Patients with a monthly average number of DDD of 4 or more were considered as subjects for preventive treatment. Chi-square test and multiple logistic regression analysis were used to determine the association between the preventive therapy and the influencing variables. Results Less than half of the eligible patients for prophylaxis (n=234, 43.8%) were prescribed preventive therapy. Multiple logistic regression results show that migraine preventive therapy was influenced by age, the type of migraine, and some comorbidities. Patients over the age of 50 tend to receive less prophylactic treatment than under the age of 40. On the other hand, migraine patients with epilepsy or depression were more likely to receive preventive therapy. Sumatriptan was the most preferred medication for acute treatment, and propranolol was the most commonly prescribed drug for prevention. Conclusions: More than half of the patients who were candidates for migraine prophylaxis were not receiving suitable preventive treatment. Positive factors affecting the use of migraine prevention were the presence of comorbidities such as epilepsy and depression.

Background: Migraine is a common neurological disorder that affects the quality of life and causes several health problems. Preventive migraine treatment can reduce migraine frequency, headache severity, and health care costs. This study aimed to estimate the utilization of migraine preventive therapy and associated factors in eligible patients. Methods: We studied 534 patients with migraine who were eligible for migraine preventive therapy using 2017 National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA). We estimated the migraine days by calculating the monthly average number of defined daily dose (DDD) of migraine-specific acute drug. Patients with a monthly average number of DDD of 4 or more were considered as subjects for preventive treatment. Chi-square test and multiple logistic regression analysis were used to determine the association between the preventive therapy and the influencing variables. Results Less than half of the eligible patients for prophylaxis (n=234, 43.8%) were prescribed preventive therapy. Multiple logistic regression results show that migraine preventive therapy was influenced by age, the type of migraine, and some comorbidities. Patients over the age of 50 tend to receive less prophylactic treatment than under the age of 40. On the other hand, migraine patients with epilepsy or depression were more likely to receive preventive therapy. Sumatriptan was the most preferred medication for acute treatment, and propranolol was the most commonly prescribed drug for prevention. Conclusions: More than half of the patients who were candidates for migraine prophylaxis were not receiving suitable preventive treatment. Positive factors affecting the use of migraine prevention were the presence of comorbidities such as epilepsy and depression.

Purpose: Eliglustat is an oral substrate reduction therapy (SRT) approved for adults with Gaucher disease type I (GD1) who are extensive, intermediate, or poor CYP2D6 metabolizers. Here we report one-year experience of eliglustat switch therapy from long-term enzyme replacement therapy (ERT) in three adult patients with GD1. Materials and Methods: Medical history, clinical (hemoglobin concentration, platelet count, and bone mineral density) and biochemical parameters (angiotensin converting enzyme, total acid phosphatase, and lyso-gb1) of the patients were collected and evaluated by retrospective review of medical records at every 3, 6, or 12 month after switch to SRT. Results: Patient 1 was a 43-year old female diagnosed GD1 and her clinical and biochemical parameters were stabilized for more than 20 years by ERT. Due to the burden of regular hospital visit, she switched to SRT. During one-year of SRT, clinical parameters and biomarkers were maintained stable. However, after suffering acute febrile illness during SRT, she decided to re-switch to ERT due to concerns about drug interaction. Patient 2 was 41-year old male, younger brother of patient 1 and Patient 3 was 31-year old male. They switched to SRT in clinically stable condition with long-term ERT. The one-year SRT was tolerable without specific safety issue and the clinical parameters were maintained stable. Conclusion One-year eliglustat therapy in three adult patients with GDI was generally tolerable and effective for maintaining the clinical parameters and biomarkers. However, the drug compliance, concurrent drug interactions, and long-term safety of eliglustat should be carefully monitored.

Like other substrates, plasma glucose is in a dynamic state of constant turnover (i.e., rates of glucose appearance [Ra glucose] into and disappearance [Rd glucose] from the plasma) while staying within a narrow range of normal concentrations, a physiological priority. Persistent imbalance of glucose turnover leads to elevations (i.e., hyperglycemia, Ra>Rd) or falls (i.e., hypoglycemia, Ra

Pyrazinamide (PZA) is an anti-tuberculosis drug and an essential component of the standard four-drug regimen for tuberculosis. Here, we report a case of immediate angioedema secondary to PZA administration intended for pulmonary tuberculosis treatment. A previously healthy 48-year-old woman was diagnosed with pulmonary tuberculosis and tuberculous lymphadenitis. Thirty minutes after taking the first dose of isoniazid, rifampicin, pyrazinamide, and ethambutol, the patient developed facial edema, generalized rash, and dizziness. An oral provocation test was performed on the four drugs, and 1,000 mg pyrazinamide showed a positive result characterized by 50 minutes of urticaria, angioedema, and hypotension. As the prevalence of tuberculosis increases, prescriptions for anti-tuberculosis drugs may increase as well. Clinicians should be aware of the possibility of immediate hypersensitivity as well as delayed hypersensitivity to anti-tuberculosis drugs.
Angioedema* ; Dizziness ; Drug Hypersensitivity ; Edema ; Ethambutol ; Exanthema ; Female ; Humans ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Hypotension ; Isoniazid ; Middle Aged ; Prescriptions ; Prevalence ; Pyrazinamide ; Rifampin ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; Urticaria*

Multiple symmetric lipomatosis (Madelung's disease) is an infrequent disease of unknown etiology. The typical characteristic of the disease is bulging, symmetric masses of fat tissue on the neck, upper extremities, and upper parts of the trunk. The disease strongly affects middle-aged men, people from Mediterranean regions and with alcohol abuse history. We report three cases of middle to old age males with long-standing multi-lobulated bulging of the neck, which gradually enlarged over many years. Of peculiar interest is one patient who presented with snoring and apnea together with typical findings of Madelung's disease. The case had involvement of the hypopharynx, which was successfully managed with microscopic laryngeal surgery with CO2 laser. The authors elucidate three cases of Madelung's disease found in the pharynx and neck, and report a review of the literature.
Alcoholism ; Apnea ; Humans ; Hypopharynx ; Lasers, Gas ; Lipomatosis, Multiple Symmetrical* ; Male ; Mediterranean Region ; Neck* ; Pharynx* ; Snoring ; Upper Extremity

BACKGROUND AND OBJECTIVES: The objective of this study was to determine whether the serum levels of zinc, vitamin B12, folic acid, iron, and fungus were correlated with symptoms of burning mouth syndrome (BMS) and to analyze the relationship between treatment responses and the results from serum examination. SUBJECTS AND METHOD: We analyzed data from 284 patients whose serum examination results recorded responses to treatment were available from June 2004 to November 2011. A total of 219 patients experienced burning sensation, while 65 patients experienced only globus symptoms or voice changes. RESULTS: Of the patients who experienced burning sensations, 5 (2.3%) had vitamin B12 deficiency, 23 (10.5%) had iron deficiency, 40 (24%) had zinc deficiency, but no patients had folic acid concentrations below the reference range. A total of 44 patients (25%) were fungus-positive. The comparison of the experimental and control treatment groups revealed that iron-deficient patients and fungal-positive patients were more frequently found in the experimental group (p=0.023 and p=0.010, respectively). Abnormalities in the serum or physical examinations were observed in 126 patients (57.5%). Symptomatic treatments were performed for both groups, which corrected abnormalities in serum examinations. CONCLUSION: The rates of fungus positivity and iron deficiency were higher in the BMS group. However, we did not identify a correlation between the response to treatment and serum examination of the analyzed elements or fungus examination. The total secondary oral burning rate was found to affect treatment modality.
Burning Mouth Syndrome ; Burns ; Folic Acid ; Fungi ; Humans ; Iron ; Physical Examination ; Reference Values ; Sensation ; Vitamin B 12 ; Vitamin B 12 Deficiency ; Voice ; Zinc

We used the nationwide claims database to calculate the incidence of thrombotic events and predict their overall 2-week incidence. From 2006 to 2020, the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) tended to increase. Unlike intracranial venous thrombosis (ICVT) and intracranial thrombophlebitis (ICTP), which showed no age difference, other venous embolism, and thrombosis (OVET), DIC, DVT, and PE were significantly more common in over 65 years.The overall 2-week incidence of ICVT was 0.21/1,000,000 (95% confidence interval [CI], 0.11–0.32). ICTP, OVET, DIC, DVT and PE were expected to occur in 0.08 (95% CI, 0.02– 0.14), 7.66 (95% CI, 6.08–9.23), 5.95 (95% CI, 4.88–7.03), 13.28 (95% CI, 11.92–14.64), 14.09 (95% CI, 12.80–15.37) per 1,000,000, respectively. To date, of 8,548,231 patients vaccinated with ChAdOx1 nCoV-19 in Korea, two had confirmed thrombosis with thrombocytopenia syndrome within 2 weeks. The observed incidence of ICVT after vaccination was 0.23/1,000,000.

We used the nationwide claims database to calculate the incidence of thrombotic events and predict their overall 2-week incidence. From 2006 to 2020, the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) tended to increase. Unlike intracranial venous thrombosis (ICVT) and intracranial thrombophlebitis (ICTP), which showed no age difference, other venous embolism, and thrombosis (OVET), DIC, DVT, and PE were significantly more common in over 65 years.The overall 2-week incidence of ICVT was 0.21/1,000,000 (95% confidence interval [CI], 0.11–0.32). ICTP, OVET, DIC, DVT and PE were expected to occur in 0.08 (95% CI, 0.02– 0.14), 7.66 (95% CI, 6.08–9.23), 5.95 (95% CI, 4.88–7.03), 13.28 (95% CI, 11.92–14.64), 14.09 (95% CI, 12.80–15.37) per 1,000,000, respectively. To date, of 8,548,231 patients vaccinated with ChAdOx1 nCoV-19 in Korea, two had confirmed thrombosis with thrombocytopenia syndrome within 2 weeks. The observed incidence of ICVT after vaccination was 0.23/1,000,000.

To analyze medical professors’ evaluation of their online education experiences in an attempt to support faculty members and indicate the future direction of medical education. Faculty members who taught online in the first semester of 2020 at Yonsei University College of Medicine in South Korea were surveyed. The results of the survey were analyzed in June 2020. There were 88 respondents (35.1% of 251): 59 professors (67.0%), 16 associate professors (18.2%), and 13 assistant professors (14.8%). Their specialties lay in basic medicine (25.0%), clinical medicine (65.9%), and research and special purposes (9.1%). Sixteen participants (18.2%) had previous experience in online lectures; 23 (26.1%) reported that preparation time for online lectures was the same as before; 65 (73.9%) reported that the preparation time had increased; 38 (43.2%) faced difficulties in preparation and lecturing online, and among them 16 (42.1%) indicated inadequate interaction with students; 11 (28.9%) needed extra preparation time; and 11 (28.9%) attributed their difficulties to technical issues with the online platform. Participants’ satisfaction with online lectures was low (p<0.001). In the free response question on overall experience with online education, 38.3% mentioned the need for an instructional design that allows students to actively participate and interact with professors, 29.5% mentioned the need for the establishment of an information & communications technology system, and 17.0% mentioned the necessity of faculty development. To prepare for the current pandemic and more in the long term, an appropriate educational support system must be constructed, and a learner-centered instructional design that enables wider interactions and active learning is needed.