Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

Acquired dermal melanocytosis, characterized by the presence of melanocytes in the dermis, varies in the timing and location of occurrence. While congenital cases, such as Mongolian spots, nevus of Ota, nevus of Ito, and blue nevus, are common, acquired cases also occur. Acquired bilateral nevus of Ota-like macules is relatively common in Asians;however, extrafacial cases, particularly those involving both the face and extremities, are extremely rare. We report the case of a 66-year-old man with symmetric pigmented patches on the scalp, face, shoulders, and dorsa of the hands for 9 months, following the onset of spots on the forehead and nose that progressively spread. Notably, nasal ala pigmentation was confirmed. Histopathological examination revealed scattered melanin-containing dendritic cells in the upper dermis. Based on the clinicopathological findings, he was diagnosed with acquired dermal melanocytosis of the face and extremities, representing a rare case.

The coronavirus disease 2019 (COVID-19) has been a major public health emergency worldwide. Vaccines were rapidly developed and approved to prevent the spread of viral infection. However, various side effects of the COVID-19 messenger RNA (mRNA) vaccines have been reported after their commercialization. A 24-year-old man visited our emergency department with polyuria and polydipsia that occurred after he received a COVID-19 mRNA vaccine 10 days beforehand. The initial laboratory findings showed very low urine osmolality with hyperosmolar hypernatremia. Based on these findings, diabetes insipidus was suspected, and sella magnetic resonance imaging showed an enlarged pituitary gland and the absence of posterior pituitary higher intensity. After 12 hours of using oral desmopressin acetate, urine volume decreased, and after 5 days of administration, serum electrolyte and serum osmolality improved. This case report of diabetes insipidus occurring after vaccination with the BNT162b2 mRNA COVID-19 vaccine is presented as a reminder that close monitoring is necessary for patients with polyuria and polydipsia after vaccination.

We compared the glycemic efficacy of treatment intensification between quadruple oral antidiabetic drug therapy and once-weekly glucagon-like peptide-1 receptor agonist (GLP-1RA)-based triple therapy in patients with poorly controlled type 2 diabetes mellitus refractory to triple oral therapy. For 24 weeks, changes in glycosylated hemoglobin (HbA1c) from baseline were compared between the two treatment groups. Of all 96 patients, 50 patients were treated with quadruple therapy, and 46 were treated with GLP-1RA therapy. Reductions in HbA1c for 24 weeks were comparable (in both, 1.1% reduction from baseline; P=0.59). Meanwhile, lower C-peptide level was associated with a lower glucose-lowering response of GLP-1RA therapy (R=0.3, P=0.04) but not with quadruple therapy (R=–0.13, P=0.40). HbA1c reduction by GLP-1RA therapy was inferior to that by quadruple therapy in the low C-peptide subgroup (mean, –0.1% vs. –1.3%; P=0.04). Treatment intensification by switching to quadruple oral therapy showed similar glucose-lowering efficacy to weekly GLP-1RA-based triple therapy. Meanwhile, the therapeutic response was affected by C-peptide levels in the GLP-1RA therapy group but not in the quadruple therapy group.

Background: To examine whether glycated hemoglobin (HbA1c) test would be a suitable screening tool for detecting high-risk subjects for diabetes compared to oral glucose tolerance test (OGTT) according to accompanied central obesity. Methods: In this prospective population-based cohort study, both OGTT and HbA1c tests were performed and continued every 2 years up to 12 years among individuals with non-diabetic state at baseline (aged 40 to 69 years, n=7,512). Incident diabetes was established by a doctor, HbA1c ≥6.5%, and/or fasting plasma glucose (FPG) ≥126 mg/dL, and/or 2-hour postprandial glucose (2hPG) level based on OGTT ≥200 mg/dL. Discriminative capacities of high HbA1c (≥5.7%) versus high 2hPG (≥140 mg/dL) for predicting incident diabetes were compared using Cox-proportional hazard regression and C-index. Results: During the median 11.5 years of follow-up period, 1,341 (17.6%) developed diabetes corresponding to an incidence of 22.1 per 1,000 person-years. Isolated high 2hPG was associated with higher risk for incident diabetes (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.56 to 5.17) than isolated high HbA1c (HR, 2.79; 95% CI, 2.40 to 3.26; P<0.05). In addition, high 2hPG provided better discriminatory capacity than high HbA1c (C-index 0.79 vs. 0.75, P<0.05). Meanwhile, in subjects with central obesity, the HR (3.95 [95% CI, 3.01 to 5.18] vs. 2.82 [95% CI, 2.30 to 3.46]) and discriminatory capacity of incident diabetes (C-index 0.75 vs. 0.75) between two subgroups became comparable. Conclusion Even though the overall inferior predictive capacity of HbA1c test than OGTT, HbA1c test might plays a complementary role in identifying high risk for diabetes especially in subjects with central obesity with increased sensitivity.

Diabetic neuropathy is a common complication that can negatively influence balance and is a major cause of falls. We evaluated the association between postural sway and diabetic autonomic neuropathy (DAN) among patients with diabetic peripheral neuropathy (DPN). Patients with DPN documented by typical symptoms with abnormal results of nerve conduction study were included and postural stability was assessed using dynamic posturography. Composite autonomic scoring scale (CASS) score was calculated by evaluating sudomotor, cardiovagal, and adrenergic functions. CASS score ≥2 indicated DAN and the severity of DAN was indicated by the CASS scores divided into three subscales of 10-point total CASS: none or mild autonomic failure (0-3), moderate failure (4-6), and severe failure (7-10). A total of 34 patients comprised the DAN group (n=19) and non-DAN group (n=15). Patients with DAN had higher prevalence of diabetic retinopathy(p=0.011), higher urine albumin-creatinine ratio (p = 0.009), and lower HbA1c levels (p<0.001) than those with non-DAN. With regard to dynamic postural instability, the presence (p=0.025) as well as the severity of DAN (p<0.05) was associated with postural instability in the eyes-opencondition. Interestingly, the poorer dynamic postural instability in moderate/severe DAN compared to mild DAN was observed only in medio-lateral direction and this association remained significant after adjusting for age, sex, and glycemic control state (HbA1c). In patients with DAN accompanied by DPN, the dynamic postural instability was affected by visual feedback and medio-lateral directional instability was closely associated with the severity of DAN.

BACKGROUND: Despite the necessity of job retention in achieving return-to-work (RTW) goals, many workers leave their jobs after returning to work. The objective of this study was to examine the impacts of RTW type and period on job retention in Korean workers with occupational injuries and diseases. METHODS: Data were derived from the Panel Study of Worker's Compensation Insurance, including data from 2,000 systemically sampled workers who had finished recuperation in 2012; three waves of survey data were included in the analyses. Workers who returned to work (n = 1,610) were included in the analysis of the relationship between RTW type and job retention, and 664 workers who returned to their original workplaces were included in the analysis of the relationship between RTW period and job retention. The participants completed a questionnaire, and administrative data were provided by workers' compensation insurance. RESULTS: A Cox proportional-hazards regression analysis showed an increased hazard ratio (HR) for non-retention of 2.66 (95% confidence interval, 2.11–3.35) in reemployed workers compared to that in workers returning to their original workplaces. Among workers returning to their original workplaces, HRs for non-retention were increased in workers with a RTW period of 13–24 months (3.03 [1.52–6.04]) and > 24 months (5.33 [2.14–13.25]) compared to workers with a RTW period of ≤ 3 months. CONCLUSION: RTW type and period were significantly related to job retention, suggesting that policies for promoting job retention rate should be implemented.
Insurance ; Occupational Diseases ; Occupational Health ; Occupational Injuries ; Return to Work ; Workers' Compensation