Ketosis-prone diabetes includes heterogeneous disease groups characterized by provoked or unprovoked ketoacidosis (ketosis), with a typical phenotype of autoimmune type 1 diabetes. As the incidence of obesity and type 2 diabetes is universally increasing, the rate of type 2 diabetes in diabetic ketoacidosis in children and adolescents is exptected to increase rapidly. The clinical presentation of atypical ketoacidosis with type 2 diabetes has been reported mostly in adults. We recently experienced a case of a 10-year-old obese girl with new-onset type 2 diabetes who initially presented with severe diabetic ketoacidosis, and introduce it with literature reviews.
Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Incidence ; Ketosis ; Obesity ; Phenotype

Ketosis-prone diabetes includes heterogeneous disease groups characterized by provoked or unprovoked ketoacidosis (ketosis), with a typical phenotype of autoimmune type 1 diabetes. As the incidence of obesity and type 2 diabetes is universally increasing, the rate of type 2 diabetes in diabetic ketoacidosis in children and adolescents is exptected to increase rapidly. The clinical presentation of atypical ketoacidosis with type 2 diabetes has been reported mostly in adults. We recently experienced a case of a 10-year-old obese girl with new-onset type 2 diabetes who initially presented with severe diabetic ketoacidosis, and introduce it with literature reviews.
Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Incidence ; Ketosis ; Obesity ; Phenotype

In this article, on page 218, Fig. 2B and D have errors.

BACKGROUND AND OBJECTIVES: Transcatheter device closure becomes the first option for treating secundum atrial septal defect (ASD), but the conventional method is sometimes unsuccessful even when the defect size indicates the closure to be feasible. To increase the success rate, modified methods have been introduced and used. This study aimed to find predictors for using the modified methods in the device closure of secundum ASDs. SUBJECTS AND METHODS: Between October 2010 and December 2012, 92 patients with ASDs underwent the transcatheter device closure. We analyzed the sizes of the defect, the surrounding rims, and the ratios of the left atrium (LA) dimensions to the device size in the patients who underwent the procedure either using the conventional or modified methods. RESULTS: Among the 88 successful cases (95.7%), 22 patients (25%) required modified methods (12 using pulmonary vein and 10 using balloon). The modified method group had the larger size of ASDs and smaller posterosuperior rim. The mean ratios of the LA anteroposterior diameter, width, and length to the device size were all significantly smaller in the modified methods group than in the conventional group (1.20 vs. 1.56, 1.32 vs. 1.71, and 1.61 vs. 2.07, respectively). We found that the risk factors for the modified methods were smaller retroaortic rim, larger ASD, and smaller LA dimension/device size. CONCLUSION: In addition to larger defects and smaller retroaortic rim, the smaller ratios of the LA dimensions to the device size influenced the need for the application of modified methods in the transcatheter device closure of ASDs.
Cardiac Catheterization ; Heart Atria ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Pulmonary Veins ; Risk Factors ; Septal Occluder Device

BACKGROUND AND OBJECTIVES: This study was intended to test how the inflammation at the Bacille Calmette-Guerin (BCG) inoculation site (BCGitis) can be a useful a diagnostic feature of Kawasaki disease (KD). SUBJECTS AND METHODS: All subjects were infants at the time of admission, and had received BCG vaccination during their neonatal period. There were 54 patients with complete KD (group 1) and 29 patients with incomplete KD (group 2). All 83 patients had BCGitis during the acute phase of illness. Data regarding the coronary artery diameters in 31 age-matched controls were used for comparison. RESULTS: The 2 patient groups did not differ in clinical and laboratory variables. During the acute phase, the median z scores of the left anterior descending coronary artery (LAD) diameter were 0.20, 0.42, and -0.48 in groups 1, 2, and control respectively, and that of right coronary artery (RCA) diameters were -0.15, -0.16, and -1.17 respectively. The z scores in both patient groups were greater than those in controls (p=0.0014 in LAD and p<0.0001 in RCA between group 1 and controls; p=0.0023 in LAD and p<0.0001 in RCA between group 2 and controls). A similar pattern was observed during the subacute and convalescent phases. CONCLUSION: BCGitis is a useful feature in the diagnosis of incomplete KD in infants who received BCG vaccine during neonatal period.
BCG Vaccine ; Coronary Vessels ; Humans ; Infant ; Inflammation ; Mucocutaneous Lymph Node Syndrome ; Mycobacterium bovis ; Vaccination

NAG activity has been measured in the urine of hypertension, diabetes mellitus and renal disease subjects. Results have shown significantly higher levels of Urinary NAG in hypertension, diaetes and renal disease subjects compared to normal control Subjects group(P<0.001). Urinary NAG measurement is simple and accurate and it provides a valuable information in the early detection of renal dysfunction in hypertension and diabetes subjects and also in the follow up of these patients.
Acetylglucosaminidase* ; Diabetes Mellitus* ; Follow-Up Studies ; Humans ; Hypertension*

PURPOSE: To correlate SOhographic and pathologic findings of gallbladder adenoma, and to evaluate the clinical significance of sonographic findings. MATERIALS AND METHODS: Ultrasound findings of twenty gallbladder adenomas were retrospectively reviewed to evaluate the size, shape and echogenicity of the adenoma, and was correlated with the pathological finding. RESULTS: Among 14 patients, 11 patients had single lesion and 3 patients had multiple lesions. Three patients showed 2, 3 and 4 adenomas, respectively. Nine of 20 lesions showed focal dysplasia pathologically. Among the nine adenomas with dysplasia, two adenomas showed focal cancerous change. The nine adenomas showing focal dysplasia measured 25.6mm (14-35mm) in mean diameter, while the mean diameter of adenomas without dysplasia was 8.7 mm (3-13mm). The echogenicity of adenoma with focal dysplasia were hyperechoic in 8, isoechoic in 1. The echogenicity of adenomas without dysplasia were hyperechoic in 7, isoechoic in 4. Sessile(7/9) and papillary shape(6/9) were predominant in adenoma with dysplasia, but smooth shape(8/11) and stalked type(9/11) were predominant in adenoma without dysplasia. Two adenomas with focal cancerous change showed histological transition from cancer to dysplasia and to adenomatous tissue. In adenoma with dysplasia, the diameter more than 14 mm on sonography was statistically significant (p<0. 005). Also age of patient was significantly different between the two groups (p<0.01), while echogenicity and associated stone were not statistically significant. CONCLUSION: As gallbladder adenoma more than 14ram in diameter on US is suggestive of dysplasia on pathology, so, close follow up US or surgery is recommended.
Adenoma* ; Follow-Up Studies ; Gallbladder* ; Humans ; Pathology ; Retrospective Studies ; Ultrasonography

PURPOSE: The purpose of this study was to examine the effect of patient perception of the switching cost and negative word of mouth on revisit intention of patients in out-patient departments (OPDs) of general hospitals. METHODS: The participants were 306 patients in general hospital, selected through convenience sampling. Data were collected using a structured questionnaire and analyzed using descriptive statistics, Spearman correlation coefficient, and logistic regression with SPSS Win. RESULTS: Relational switching cost was positively correlated with revisit intention (r=.58, p=<.001), but not financial switching cost or procedural switching cost. Negative word of mouth was negatively correlated with revisit intention (r=-.22, p=<.001). The significant predictors influencing revisit intention in patients was relational switching cost. CONCLUSION: The findings of this study suggest that hospital and nursing managers should seek to bolster perceptions of switching costs and negative word of mouth, which subsequently increases revisit intentions in small hospitals located in the country as well as urban large hospitals.
Hospitals, General ; Humans ; Intention ; Logistic Models ; Mouth ; Outpatients ; Surveys and Questionnaires

No abstract available.
Cataract* ; Nephrotic Syndrome*

Pyruvate dehydrogenase complex deficiency (PDCD) is one of the most common neurodegenerative disorders associated with abnormal mitochondrial metabolism. Pyruvate dehydrogenase complex plays an important role in glucose metabolism and generation of energy from carbohydrates. Potential therapies for PDCD, include thiamine and ketogenic diet (KD), have been used with varying degrees of success. However, the KD is too restrictive, and its serious complications, particularly in early age of neonate or infancy are important drawbacks. Recently, the modified Atkins diet (MAD) for intractable epilepsy has provided balanced nutrients. The complications can be expected to be less frequent and well controlled. In this report, we describe an infant with PDCD confirmed by PDHA1 gene mutation through high-throughput sequencing technique of whole exome sequencing, who failed to continue the KD, but made good progress on MAD.