Background: Although insulin resistance is common, its significance in kidney transplant recipients remains unclear. We explored clinical implications of the triglyceride-glucose (TyG) index as a marker for unfavorable allograft outcomes in kidney transplant recipients. Methods: A total of 6,354 kidney transplant recipients were enrolled in a multicenter prospective cohort study between May 2014 and December 2022. The TyG index was assessed between 6 and 12 months after transplantation. We evaluated the association between the TyG index and the risk of adverse kidney outcomes. Results: The cumulative rates of ≥50% decline in estimated glomerular filtration rate (eGFR), death-censored graft survival, and major adverse kidney events differed across TyG index quartiles, with the highest rate observed in quartile 4 (p < 0.001). TyG index quartile 4 was associated with the highest risk of death-censored graft loss after multivariable adjustment (adjusted hazard ratio, 2.13; 95% confidence interval [CI], 1.28–3.55). The risk of ≥30% decline in eGFR was 1.46 times higher (95% CI, 1.17–1.82) in quartile 4 compared with quartile 1, and the risk of ≥50% decline was 1.78 times higher (95% CI, 1.30–2.44). Quartile 4 also showed a significantly steeper decline in renal function, with an adjusted mean difference in eGFR slope of –4.72 mL/min/1.73 m2 (95% CI, –7.39 to –2.04). Conclusion Kidney transplant recipients with high TyG index were at increased risk of eGFR decline and graft loss, and also exhibited a more rapid deterioration in renal function. The TyG index is a useful marker for identifying individuals at high risk for adverse graft outcomes.

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

There have been ongoing social discussions on revision of the abortion law since the Constitutional Court ruled it nonconformity to the constitution on April 11, 2019. Thus, Korean Society of Obstetrics and Gynecology, Korean Society of Maternal Fetal Medicine, Korean College of Obstetricians and Gynecologists, and Korean Association of Obstetricians and Gynecologists organized 'special committee for abortion law' to support social discussion on the revision of the abortion law, and they prepared official opinions of obstetrics for medical issues including doctors' right to refuse abortion. In the future, the committee will continue to adapt to changes of medical environment especially after the revision of the abortion law by collecting its members' feedbacks.

Mycoplasma pneumoniae (MP) is the most common causative agent of community-acquired pneumonia in school-aged children. An 8-year-old boy who had been diagnosed with autism looked severely ill when he presented to our hospital due to dyspnea and lethargy. He had fever and cough 7 days prior to hospitalization. He had signs and symptoms of severe respiratory distress. The percutaneous oxygen saturation was 88% at high oxygen supply. Chest radiography showed diffusely increased opacity with moderate pleural effusion. He was intubated immediately and admitted to the intensive care unit. Under the clinical impression of mycoplasmal pneumonia, intravenous clarithromycin was started. Laboratory findings showed leukocytosis, hepatitis, decreased renal function, and presence of serum MP immunoglobulin (Ig) M (+) IgG (+) and sputum MP polymerase chain reaction (+). On hospital day 2, the patient developed multiple organ failure with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (ECMO) was performed with continuous renal replacement therapy (CRRT) and was weaned successfully. This is the first reported case of an ARDS due to MP infection complicated by multiple organ failure that was successfully treated with ECMO and CRRT in South Korea.
Autistic Disorder ; Child ; Clarithromycin ; Cough ; Dyspnea ; Extracorporeal Membrane Oxygenation ; Fever ; Hepatitis ; Hospitalization ; Humans ; Immunoglobulin G ; Immunoglobulins ; Intensive Care Units ; Korea ; Lethargy ; Leukocytosis ; Male ; Multiple Organ Failure ; Mycoplasma pneumoniae ; Mycoplasma ; Oxygen ; Pleural Effusion ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Radiography ; Renal Replacement Therapy ; Respiratory Distress Syndrome, Adult ; Sputum ; Thorax

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008–2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 μm [PM₁₀], ozone [O₃], nitrogen dioxide [NO₂], and sulfur dioxide levels [SO₂]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM₁₀ after adjusting for covariates (odds ratio [OR] 1.23; [per 5 μg/m³ PM₁₀ increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.
Adult ; Aging ; Air Pollutants ; Air Pollution* ; Education ; Humans ; Korea* ; Logistic Models ; Male ; Myopia ; Nitrogen Dioxide ; Nutrition Surveys ; Ozone ; Particulate Matter ; Pterygium* ; Recurrence ; Slit Lamp ; Solar System ; Sulfur Dioxide

Peritoneal dialysis (PD) is associated with the development of various complications, such as exit site infection or peritonitis, and rarely, intestinal obstruction in prolonged PD patients with recurrent peritonitis. However, post-colonoscopy acute intestinal obstruction has not been reported in PD patients to date. Herein, we report a case of severe ileus after a colonoscopy without previous episodes of peritonitis in a PD patient. A 51-year-old man undergoing PD for 7 years visited our emergency department due to severe abdominal pain and vomiting after colonoscopic polypectomy. A simple abdominal radiography and abdominal computed tomography showed ileus with collapsed distal ileal loop. A peritoneal dialysate study revealed no evidence of peritonitis. The patient was treated with decompression therapy, and ileus was successfully treated without complications. This case suggests that it is not only necessary to prevent peritonitis, but also important to monitor the development of ileus after colonoscopy in PD patients.
Abdominal Pain ; Colonoscopy* ; Decompression ; Emergency Service, Hospital ; Humans ; Ileus* ; Intestinal Obstruction ; Middle Aged ; Peritoneal Dialysis* ; Peritonitis ; Radiography, Abdominal ; Vomiting

Adenocorticotropic hormone-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. It is characterized by multinodular enlargement of the adrenal glands and hypercortisolism. Although bilateral adrenalectomy is the standard therapy, unilateral adrenalectomy is an effective alternative. Here we present a case of a 71-year-old female referred to the Endocrinology Department for further evaluation of bilateral adrenal macronodular hyperplasia. Based on dynamic hormone tests and imaging studies, she was diagnosed with AIMAH. Due to persistent hypercortisolism, she underwent completion contralateral surgery after unilateral adrenalectomy. This case demonstrates that unilateral adrenalectomy should be considered in a patient presenting with obvious symptoms of hypercotisolism and relatively asymmetric adrenal enlargement.
Adrenal Glands ; Adrenalectomy ; Aged ; Cushing Syndrome* ; Endocrinology ; Female ; Humans ; Hyperplasia*

Peritoneal dialysis (PD) is associated with the development of various complications, such as exit site infection or peritonitis, and rarely, intestinal obstruction in prolonged PD patients with recurrent peritonitis. However, post-colonoscopy acute intestinal obstruction has not been reported in PD patients to date. Herein, we report a case of severe ileus after a colonoscopy without previous episodes of peritonitis in a PD patient. A 51-year-old man undergoing PD for 7 years visited our emergency department due to severe abdominal pain and vomiting after colonoscopic polypectomy. A simple abdominal radiography and abdominal computed tomography showed ileus with collapsed distal ileal loop. A peritoneal dialysate study revealed no evidence of peritonitis. The patient was treated with decompression therapy, and ileus was successfully treated without complications. This case suggests that it is not only necessary to prevent peritonitis, but also important to monitor the development of ileus after colonoscopy in PD patients.
Abdominal Pain ; Colonoscopy ; Decompression ; Emergency Service, Hospital ; Humans ; Ileus ; Intestinal Obstruction ; Middle Aged ; Peritoneal Dialysis ; Peritonitis ; Radiography, Abdominal ; Vomiting

This study was performed to measure early changes in the serotype distribution of pneumococci isolated from children with invasive disease during the 3-year period following the introduction of 10- and 13-valent pneumococcal conjugate vaccines (PCVs) in Korea. From January 2011 to December 2013 at 25 hospitals located throughout Korea, pneumococci were isolated among children who had invasive pneumococcal disease (IPD). Serotypes were determined using the Quellung reaction, and the change in serotype distribution was analyzed. Seventy-five cases of IPD were included. Eighty percent of patients were aged 3-59 months, and 32% had a comorbidity that increased the risk of pneumococcal infection. The most common serotypes were 19A (32.0%), 10A (8.0%), and 15C (6.7%). The PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F, and 6A) accounted for 14.7% of the total isolates and the PCV13 minus PCV7 types (1, 3, 5, 7F and 19A) accounted for 32.0% of the total isolates. Serotype 19A was the only serotype in the PCV13 minus PCV7 group. The proportion of serotype 19A showed decreasing tendency from 37.5% in 2011 to 22.2% in 2013 (P = 0.309), while the proportion of non-PCV13 types showed increasing tendency from 45.8% in 2011 to 72.2% in 2013 (P = 0.108). Shortly after the introduction of extended-valent PCVs in Korea, serotype 19A continued to be the most common serotype causing IPD in children. Subsequently, the proportion of 19A decreased, and non-vaccine serotypes emerged as an important cause of IPD. The impact of extended-valent vaccines must be continuously monitored.
Adolescent ; Bacteremia/complications/diagnosis ; Child ; Child, Preschool ; Female ; Hospitals ; Humans ; Infant ; Male ; Pneumococcal Infections/microbiology/*prevention & control ; Pneumococcal Vaccines/*immunology ; Republic of Korea ; Serotyping ; Streptococcus pneumoniae/*classification/isolation & purification ; Vaccines, Conjugate/*immunology

BACKGROUND: This study investigated the association between the frequency of growth hormone receptor (GHR) exon 3 polymorphism (exon 3 deletion; d3-GHR) and metabolic factors in patients with acromegaly in Korea. METHODS: DNA was extracted from the peripheral blood of 30 unrelated patients with acromegaly. GHR genotypes were evaluated by polymerase chain reaction and correlated with demographic data and laboratory parameters. RESULTS: No patient had the d3/d3 genotype, while four (13.3%) had the d3/fl genotype, and 26 (86.7%) had the fl/fl genotype. Body mass index (BMI) in patients with the d3/fl genotype was significantly higher than in those with the fl/fl genotype (P=0.001). Age, gender, blood pressure, insulin-like growth factor-1, growth hormone, fasting plasma glucose, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol levels showed no significant differences between the two genotypes. CONCLUSION: The d3-GHR polymorphism may be associated with high BMI but not with other demographic characteristics or laboratory parameters.
Acromegaly* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol, HDL ; Cholesterol, LDL ; DNA ; Exons ; Fasting ; Genotype ; Growth Hormone* ; Humans ; Korea ; Polymerase Chain Reaction ; Receptors, Somatotropin* ; Triglycerides