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.

Objective: To develop an integrated and comprehensive community-based mental healthcare model, opinions were collected on various issues from practitioners in mental health service institutions currently offering mental healthcare services in Seoul through a focus group interview, qualitative research method, and Delphi survey. Methods: The focus group interview was conducted with six practitioners from mental health welfare centers and six hospital-based psychiatrists. A questionnaire of opinions on the mental healthcare model was filled by these practitioners and psychiatrists. A Delphi survey was additionally conducted with a panel of 20 experts from a community mental health welfare center and hospital-based psychiatrists. Results: The focus group interview results showed the need for integrated community-based mental healthcare service and the need to establish a system for managing mental and physical health in an integrated manner. Based on the survey results, the current status of community-based mental healthcare services was investigated, and the direction of the revised model was established. The Delphi survey was then conducted to refine the revised model. Conclusion The present study presents the Seoul-type community-based mental healthcare model with integrated services between a psychiatric hospital with a mental health welfare center as well as combined mental and physical health services. This is ultimately expected to help people with mental illnesses live healthy lives by meeting their needs as community members.

Thoracic foreign bodies (FBs) are serious and relatively frequent in emergency departments. Thoracic FBs may occur in association with aspiration, ingestion, trauma, or iatrogenic causes. Imaging plays an important role in the identification of FBs and their dimensions, structures, and locations, before the initiation of interventional treatment. To guide proper clinical management, radiologists should be aware of the radiologic presentations and the consequences of thoracic FBs. In this pictorial essay, we reviewed the optimal imaging settings to identify FBs in the thorax, classified thoracic FBs into four types according to their etiology, and reviewed the characteristic imaging features and the possible complications.

Background: The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea. Methods: Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. Results: The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3–4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5–7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50–59, 60–69, 70–79, and ≥ 80 years of age, respectively. Conclusion In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.

No abstract available.
Carcinoma, Squamous Cell ; Cyclic AMP Response Element-Binding Protein ; Epithelial Cells

Behcet's disease is an inflammatory disorder of unknown etiology with multi-organ involvement. Although it rarely involves the heart, once the heart is involved the results can be devastating. However, since cardiac involvement has various manifestations, diagnosis is challenging. The clinical features and echocardiographic findings of cardiac Behcet's may mimic culture-negative infective endocarditis. A correct diagnosis is usually made postoperatively. Here, we report the case of a 55-year-old male who was initially diagnosed with infective endocarditis that caused metastatic vertebral osteomyelitis. He underwent immediate cardiac surgery and received empirical antibiotics, but all culture findings were negative; however, he had a sustained fever and elevated inflammatory marker levels. After reviewing the results of pathologic and imaging studies, a final diagnosis of cardiac Behcet's disease was made. He was successfully treated with a high dose of corticosteroids. This report demonstrates a rare case of cardiac Behcet's disease mimicking culture-negative infective endocarditis.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Behcet Syndrome ; Diagnosis ; Echocardiography ; Endocarditis* ; Fever ; Heart ; Humans ; Male ; Middle Aged ; Osteomyelitis ; Spondylitis ; Thoracic Surgery

BACKGROUND: A1chieve(R) was a noninterventional study evaluating the clinical safety and efficacy of biphasic insulin aspart 30, insulin detemir, and insulin aspart. METHODS: Korean type 2 diabetes patients who have not been treated with the study insulin or have started it within 4 weeks before enrollment were eligible for the study. The patient selection and the choice of regimen were at the discretion of the physician. The safety and efficacy information was collected from the subjects at baseline, week 12, and week 24. The number of serious adverse drug reactions (SADRs) was the primary endpoint. The changes of clinical diabetic markers at week 12 and/or at week 24 compared to baseline were the secondary endpoints. RESULTS: Out of 4,058 exposed patients, 3,003 completed the study. During the study period, three SADRs were reported in three patients (0.1%). No major hypoglycemic episodes were observed and the rate of minor hypoglycemic episodes marginally decreased during 24 weeks (from 2.77 to 2.42 events per patient-year). The overall quality of life score improved (from 66.7+/-15.9 to 72.5+/-13.5) while the mean body weight was slightly increased (0.6+/-3.0 kg). The 24-week reductions in glycated hemoglobin, fasting plasma glucose and postprandial plasma glucose were 1.6%+/-2.2%, 2.5+/-4.7 mmol/L, and 4.0+/-6.4 mmol/L, respectively. CONCLUSION: The studied regimens showed improvements in glycemic control with low incidence of SADRs, including no incidence of major hypoglycemic episodes in Korean patients with type 2 diabetes.
Biphasic Insulins ; Body Weight ; Diabetes Mellitus, Type 2 ; Drug Toxicity ; Fasting ; Glucose ; Hemoglobins ; Humans ; Incidence ; Insulin ; Insulin Aspart ; Insulin, Isophane ; Insulin, Long-Acting ; Patient Selection ; Plasma ; Quality of Life ; Republic of Korea ; Treatment Outcome ; Insulin Detemir

A 28-year-old Asian male was referred for dermatologic evaluation of diffuse bluish-red maculopapules in the lower trunk and genital regions. There was no family history, and with the exception of dispersed skin lesions and hypohidrosis, no other complaints or symptoms were present. Histological evaluation of the skin lesions revealed angiokeratomas. When this combination of clinical and histological findings is observed, Fabry disease is suspected. Biochemical examination performed for definitive diagnosis did not show any activity of the alpha-galactosidase A enzyme. Through identification of a c.182_183ins(GA) mutation of the GLA gene, Fabry disease was diagnosed. However, there was no particular abnormal finding with regard to the evaluation of non-cutaneous manifestations, a symptom that can occur in the progress of this disease. We reported a case of Fabry disease, restricted to the dermatologic presentation, involving a novel frameshift mutation in the GLA gene.
alpha-Galactosidase ; Angiokeratoma ; Asian Continental Ancestry Group ; Fabry Disease ; Frameshift Mutation ; Humans ; Hypohidrosis ; Male ; Skin ; Skin Manifestations

A 28-year-old Asian male was referred for dermatologic evaluation of diffuse bluish-red maculopapules in the lower trunk and genital regions. There was no family history, and with the exception of dispersed skin lesions and hypohidrosis, no other complaints or symptoms were present. Histological evaluation of the skin lesions revealed angiokeratomas. When this combination of clinical and histological findings is observed, Fabry disease is suspected. Biochemical examination performed for definitive diagnosis did not show any activity of the alpha-galactosidase A enzyme. Through identification of a c.182_183ins(GA) mutation of the GLA gene, Fabry disease was diagnosed. However, there was no particular abnormal finding with regard to the evaluation of non-cutaneous manifestations, a symptom that can occur in the progress of this disease. We reported a case of Fabry disease, restricted to the dermatologic presentation, involving a novel frameshift mutation in the GLA gene.
alpha-Galactosidase ; Angiokeratoma ; Asian Continental Ancestry Group ; Fabry Disease ; Frameshift Mutation ; Humans ; Hypohidrosis ; Male ; Skin ; Skin Manifestations