Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Background: Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM). Methods: From March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated. Results: In total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9± 14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, –1.1%±1.2%; P<0.001). The number of patients with HbA1c <7% increased significantly from 5 to 68 (P<0.005). In addition, lipid profiles and liver enzyme levels were also improved whereas no changes in body weight. There was no significant safety issue in patients treated with quadruple OHA therapy. Conclusion This study shows the therapeutic efficacy of the quadruple OHA regimen T2DM and demonstrates that it can be an option for the management of T2DM patients who cannot use insulin or reject injectable therapy.

Objective: We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up. Materials and Methods: Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The ‘positive conversion group’ was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the ‘initial pneumonia group.’ Patients with negative initial and follow-up chest radiographs were defined as the ‘non-pneumonia group.’ Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated. Results: Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the ‘initial pneumonia group’ and ‘positive conversion group’ were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the ‘non-pneumonia group’ (all p < 0.001). Among patients with negative initial chest radiographs, age ≥ 45 years (odds ratio [OR]: 3.93, 95% confidence interval [CI]: 1.76–8.75, p = 0.001), absolute lymphocyte count < 1500 cells/µL (OR: 2.25, 95% CI: 1.03–4.89,p = 0.041), and CRP > 0.5 mg/dL (OR: 3.91, 95% CI: 1.54–9.91, p = 0.004) were independent predictors for future development of pneumonia. Conclusion More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.

Background: The predictors of poor prognosis in patients with coronavirus disease 2019 (COVID-19) using computed tomography (CT) have not been investigated in a large cohort.Therefore, the purpose of this study was to investigate the adverse initial CT features to predict poor prognosis in COVID-19. Methods: From February to April 2020, 281 COVID-19 patients who underwent CT at the time of admission were included. We divided the patients into the severe and non-severe disease groups. The severe group included patients with severe pneumonia or critical events.Intensive care unit admission or death were the critical events in this study. We compared the clinical and CT findings between the severe and non-severe groups and investigated the prognostic factors and critical events of the severe group using the regression analysis. Results: Among the 281 patients, 36 (12.8%) patients were in the severe group and 245 (87.2%) patients were in the non-severe group. Critical events occurred in 10 patients (3.6%).In the severe group, patients showed significantly more pneumonia with consolidation, crazy-paving appearance, pleural effusion, and higher CT scores than those in the non-severe group (all, p < 0.05). In the multivariate regression, pleural effusion (odds ratio [OR], 8.96;95% confidence interval [CI], 1.81–44.42; p = 0.007), CT score > 5 (OR, 3.70; 95% CI, 1.44– 9.53; p = 0.007), old age (> 77 years, OR, 9.96; 95% CI, 3.78–26.28; p < 0.001), and elevated C-reactive protein (OR, 4.15; 95% CI, 1.62–10.6; p = 0.003) were significant prognostic factors of severe disease. CT score > 5 (OR, 7.29; 95% CI, 1.37–38.68; p = 0.020), pleural effusion (OR, 5.67; 95% CI, 1.04–30.8; p = 0.045) and old age (OR, 8.6; 95% CI, 1.80–41.0; p = 0.007) were also significant predictors of critical events. Conclusion Pleural effusion and the extent of pneumonia on initial CT scans are associated with poor prognosis in patients with COVID-19.

BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.
Cefotaxime ; Humans ; Immunization Programs ; Korea ; Levofloxacin ; Multiplex Polymerase Chain Reaction ; Penicillins ; Pneumococcal Vaccines ; Pneumonia ; Serogroup ; Streptococcus pneumoniae ; Streptococcus ; Vaccines

PURPOSE: The purpose of this study was to investigate relationships between the symptom of restless legs syndrome (RLS), somatic symptom, depression, and activities of daily living (ADL) among the elderly. METHODS: A descriptive approach was taken in this study. Data were collected from May 23 to July 5, 2019 and 140 elderly people replied to the questionnaire. The data were analyzed by descriptive statistics, t-test, One-way ANOVA, Pearson's correlation coefficient, and χ² test. RESULTS: 48.6% of the respondents had RLS symptom and the severity of RLS symptom was 9.57±11.55. RLS symptom had a positive correlation with depression (r=.538, p<.001), with somatic symptom (r=.528, p<.001), with ADL (r=.308, p<.001), and with IADL (r=.360, p<.001). Depression had the most significant correlation with RLS symptoms. There were significant differences in depression, somatization, ADL, and IADL according to the RLS severity. CONCLUSION The results of this study showed that many elders experienced mild to severe RLS symptom. Also, the elderly with RLS symptom had more severe depression, somatic symptom, ADL, and IADL than those without RLS symptom in this study. Depression, somatic symptom, and ADL could be deteriorated if the RLS symptom is not diagnosed early.

PURPOSE: This study was to explore the level of core nursing activities performed by long-term care hospital nurses and to investigate the frequency and educational needs of major nursing activities. METHODS: A cross-sectional descriptive research design was used. The subjects were 155 nurses working at seven long-term care hospitals in Korea. Data were collected in 2018 from September 15 to October 16 using a structured questionnaire. Data were analyzed using the SPSS program. RESULTS: The mean age of nurses was 45.19±10.99 years and the mean career of long-term care hospital was 49.84±40.52 months. Monitoring activity was shown as the highest score in the performance level and frequency, whereas infection control received the highest score in educational needs. A scatter plot revealed that physical examination, respiratory care, wound care, communication and education showed overall high scores in the performance level, frequency, and educational needs. Emergency care and infection control were the activities that were performed less frequently but had high performance level and educational needs. CONCLUSION: It is important to establish rules for requisite and delegable activities considering the performance level and frequency of nursing activities in long-term care hospitals in order to improve the quality of patient care.
Education ; Emergency Medical Services ; Infection Control ; Korea ; Long-Term Care* ; Nursing* ; Patient Care ; Physical Examination ; Research Design ; Wounds and Injuries

PURPOSE: The purpose of this study was to investigate relationships between the symptoms of Restless Legs Syndrome (RLS), sleep disturbance and depression among middle-aged women. METHODS: The study took a descriptive approach. A self-reported questionnaire was provided to women aged between 45 and 65 living in community area. The data were analyzed via SPSS program (version 25). RESULTS: 47.8% of the respondents showed moderate to severe RLS symptoms and the severity of RLS symptoms was 10.72. Depression score was 13.12 and sleep disturbance score was 4.97. There was a significant correlation between RLS symptoms and sleep disturbance (r=.423, p < .001), and RLS symptoms had a positive impact on sleep disturbance. There was also a significant correlation between RLS symptoms and depression (r=.494, p < .001) and RLS symptoms also had a positive impact on depression. CONCLUSION: Women with RLS symptoms had more severe sleep disturbance, depression and vasomotor syndrome than those without RLS symptoms. If RLS symptoms among middle-aged women is simply diagnosed as a menopausal symptom, this misdiagnosis can lead to sleep disorder and depression. Therefore, further empirical researches should be done to estimate the prevalence of RLS symptoms and to launch a program to detect RLS at the early stage.
Depression* ; Diagnostic Errors ; Empirical Research ; Female ; Humans ; Prevalence ; Restless Legs Syndrome* ; Sleep Wake Disorders ; Surveys and Questionnaires

BACKGROUND: As aging occurs, the skin develops more wrinkles and pigmentation, becomes drier, and loses its elasticity. In previous reports, light-emitting diode (LED) phototherapy was proven to stimulate collagen synthesis and accelerate fibroblast-myofibroblast transformation, which has a composite rejuvenation effect. OBJECTIVE: To evaluate the effectiveness and safety of LED phototherapy with 592 nm yellow light for photoaged skin. METHODS: Forty patients with photoaged skin (Korean photographic scale; grade 4approximately7) were enrolled and treated with an LED device producing 592+/-10 nm yellow light for 5 minutes twice a week for 4 weeks. The skin changes were assessed at 0, 2, 4, and 8 weeks by clinical photographs and the Cutometer(R) & Mexameter(R) (MPA 580, Courage+Khazaka Electronic GmbH, Koln, Germany). Measurements were made on the cheek, periorbital area, nasolabial fold, and glabella. RESULTS: At the final visit at 8 weeks, the Cutometer(R) parameters R4 and R6 decreased significantly compared to before treatment, from 0.118 to 0.099 for the periorbital (p=0.017) and 0.517 to 0.425 for the nasolabial fold (p=0.003). The average melanin index decreased significantly, from 133.65 to 124.55 (p<0.005). Fine improvement of wrinkles was shown grossly by reviewing follow-up clinical photographs. No adverse reactions occurred. LED phototherapy with 592+/-10 nm wavelength can be effective and safe in the treatment of photoaged skin. CONCLUSION: The findings suggest the LED with 592 nm yellow light might be an adjuvant therapeutic tool for photoaged skin.
Aging ; Cheek ; Collagen ; Elasticity ; Follow-Up Studies ; Humans ; Melanins ; Nasolabial Fold ; Phototherapy ; Pigmentation ; Rejuvenation ; Skin*