Eosinophilic gastroenteritis (EGE) is known to have a low incidence among the pediatric population, but it can result in serious complications, such as gastric outlet obstruction. In previously published EGE cases with the obstruction in adults, surgeries were often performed. In this report, we present a 14-year-old girl who came to our facility with severe abdominal pain and vomiting. On the initial abdominal physical examination, diffuse tenderness and severe epigastric pain were noted. Computed tomography scan of the abdomen showed the findings of superior mesenteric artery (SMA) syndrome. However, she had no history of recent weight loss, and the medical history was inconsistent with SMA syndrome. We planned upper gastrointestinal series with barium, and then verified gastric outlet obstruction. We performed esophagogastroduodenoscopy and obtained a final diagnosis of EGE through mucosal biopsy specimen. Corticosteroids and anti-inflammatory medications were administered. Dietary modification and education were done as well. The symptoms resolved, and the follow-up esophagogastroduodenoscopy and ultrasonography showed improvements in the obstruction. Our case emphasizes that gastric outlet obstruction due to EGE must be carefully differentiated from SMA syndrome because of their similarities in clinical features and radiologic images. In doing so, we can avoid surgical intervention and perform medical/dietary treatment for gastric outlet obstruction.

Pleural paragonimiasis is uncommon in the pediatric population and therefore can be challenging to diagnose. This is a case of a 6-year-old girl with pleural effusion who had been having intermittent persistent epigastric pain and erythematous rash on the face, hands, and arms for 6 months. Exudative pleural effusion with prominent eosinophils and serum eosinophilia were observed. As patient showed high immunoglobulin M (IgM) titers against Mycoplasma pneumoniae , she was treated with antibiotics; however, the pleural effusion did not improve during hospitalization. Despite showing negative stool ova and cyst results, patient's serum and pleural effusion were positive for Paragonimus westermani-specific IgGs on enzyme-linked immunosorbent assay. Respiratory symptoms, pleural effusion, and skin symptoms improved after praziquantel treatment.
Abdominal Pain ; Anti-Bacterial Agents ; Arm ; Child ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Exanthema ; Female ; Hand ; Hospitalization ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Mycoplasma pneumoniae ; Ovum ; Paragonimiasis ; Paragonimus ; Pleural Effusion ; Pneumonia, Mycoplasma ; Praziquantel ; Skin

BACKGROUND AND PURPOSE: Middle East respiratory syndrome (MERS) has a high mortality rate and pandemic potential. However, the neurological manifestations of MERS have rarely been reported since it first emerged in 2012. METHODS: We evaluated four patients with laboratory-confirmed MERS coronavirus (CoV) infections who showed neurological complications during MERS treatment. These 4 patients were from a cohort of 23 patients who were treated at a single designated hospital during the 2015 outbreak in the Republic of Korea. The clinical presentations, laboratory findings, and prognoses are described. RESULTS: Four of the 23 admitted MERS patients reported neurological symptoms during or after MERS-CoV treatment. The potential diagnoses in these four cases included Bickerstaff's encephalitis overlapping with Guillain-Barré syndrome, intensive-care-unit-acquired weakness, or other toxic or infectious neuropathies. Neurological complications did not appear concomitantly with respiratory symptoms, instead being delayed by 2–3 weeks. CONCLUSIONS: Neuromuscular complications are not rare during MERS treatment, and they may have previously been underdiagnosed. Understanding the neurological manifestations is important in an infectious disease such as MERS, because these symptoms are rarely evaluated thoroughly during treatment, and they may interfere with the prognosis or require treatment modification.
Cohort Studies ; Communicable Diseases ; Coronavirus ; Coronavirus Infections* ; Diagnosis ; Encephalitis ; Guillain-Barre Syndrome ; Humans ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Mortality ; Neurologic Manifestations ; Pandemics ; Peripheral Nervous System Diseases ; Prognosis ; Republic of Korea

PURPOSE: This study aimed to investigate the relationships between body mass index (BMI) and prostate-specific antigen (PSA) levels, international prostate symptom score (IPSS), quality of life (QoL), and prostate volume (PV). MATERIALS AND METHODS: Height, weight, PSA levels, PV, and IPSS were analyzed in 15,435 patients who underwent a prostate examination between 2001 and 2014. Patients aged <50 years or with a PSA level ≥10 ng/mL were excluded. The relationships between BMI and PSA, IPSS, QoL, and PV were analyzed by a scatter plot, one-way analysis of variance, and the Pearson correlation coefficient. RESULTS: The mean age was 71.95±7.63 years, the mean BMI was 23.59±3.08 kg/m2, the mean PSA level was 1.45±1.45 ng/mL, the mean IPSS was 15.53±8.31, the mean QoL score was 3.48±1.25, and the mean PV was 29.72±14.02 mL. PSA, IPSS, and QoL showed a tendency to decrease with increasing BMI, and there were statistically significant differences for each parameter (p≤0.001). PV showed a significant tendency to increase with BMI (p < 0.001). In the correlation analysis, BMI showed a statistically significant correlation (p < 0.001) with PSA, IPSS, and QoL, although the correlations were very weak. In contrast, BMI showed a significant correlation with PV (p < 0.001), with a meaningful Pearson correlation coefficient of 0.124. CONCLUSIONS: Higher BMI was associated with lower PSA levels and higher IPSS and QoL scores. Meanwhile, PV increased with BMI. Although obese individuals had a greater PV, obesity did not aggravate lower urinary tract symptoms.
Body Mass Index* ; Humans ; Lower Urinary Tract Symptoms ; Male ; Obesity ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Quality of Life

Dietary fiber improves hyperglycemia in patients with type 2 diabetes through its physicochemical properties and possible modulation of gut hormone secretion, such as glucagon-like peptide 1 (GLP-1). We assessed the effect of dietary fiber-enriched cereal flakes (DC) on postprandial hyperglycemia and gut hormone secretion in patients with type 2 diabetes. Thirteen participants ate isocaloric meals based on either DC or conventional cereal flakes (CC) in a crossover design. DC or CC was provided for dinner, night snack on day 1 and breakfast on day 2, followed by a high-fat lunch. On day 2, the levels of plasma glucose, GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and insulin were measured. Compared to CC, DC intake exhibited a lower post-breakfast 2-hours glucose level (198.5±12.8 vs. 245.9±15.2 mg/dL, P<0.05) and a lower incremental peak of glucose from baseline (101.8±9.1 vs. 140.3±14.3 mg/dL, P<0.001). The incremental area under the curve (iAUC) of glucose after breakfast was lower with DC than with CC (P<0.001). However, there were no differences in the plasma insulin, glucagon, GLP-1, and GIP levels. In conclusion, acute administration of DC attenuates postprandial hyperglycemia without any significant change in the representative glucose-regulating hormones in patients with type 2 diabetes (ClinicalTrials.gov. NCT 01997281).
Adult ; Aged ; Area Under Curve ; Blood Glucose/*analysis ; Cross-Over Studies ; Diabetes Mellitus, Type 2/complications/diagnosis/*diet therapy ; Dietary Fiber/*therapeutic use ; Female ; Gastric Inhibitory Polypeptide/blood ; Glucagon/blood ; Glucagon-Like Peptide 1/*blood ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hyperglycemia/complications/diagnosis ; Insulin/blood ; Intestines/metabolism ; Male ; Middle Aged ; ROC Curve

BACKGROUND: We developed a patient-centered, smartphone-based, diabetes care system (PSDCS). This study aims to test the feasibility of glycosylated hemoglobin (HbA1c) reduction with the PSDCS. METHODS: This study was a single-arm pilot study. The participants with type 2 diabetes mellitus were instructed to use the PSDCS, which integrates a Bluetooth-connected glucometer, digital food diary, and wearable physical activity monitoring device. The primary end point was the change in HbA1c from baseline after a 12-week intervention. RESULTS: Twenty-nine patients aged 53.9±9.1 years completed the study. HbA1c and fasting plasma glucose levels decreased significantly from baseline (7.7%±0.7% to 7.1%±0.6%, P<0.0001; 140.9±39.1 to 120.1±31.0 mg/dL, P=0.0088, respectively). The frequency of glucose monitoring correlated with the magnitude of HbA1c reduction (r=-0.57, P=0.0013). The components of the diabetes self-care activities, including diet, exercise, and glucose monitoring, were significantly improved, particularly in the upper tertile of HbA1c reduction. There were no severe adverse events during the intervention. CONCLUSION: A 12-week application of the PSDCS to patients with inadequately controlled type 2 diabetes resulted in a significant HbA1c reduction with tolerable safety profiles; these findings require confirmation in a future randomized controlled trial.
Blood Glucose ; Delivery of Health Care ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diet ; Diet Records ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Motor Activity ; Pilot Projects* ; Self Care ; Smartphone

No abstract available.
Blood Glucose* ; Glucose*

No abstract available.
Biopsy ; Blood Glucose/metabolism ; C-Peptide/blood ; Calcium Gluconate/administration & dosage/*diagnostic use ; Female ; Humans ; Immunohistochemistry ; Injections, Intra-Arterial ; Insulin/blood ; Insulinoma/blood/*blood supply/pathology/surgery ; Middle Aged ; Pancreatic Neoplasms/blood/*blood supply/pathology/surgery ; Pancreaticoduodenectomy ; Splenic Artery/*radiography ; *Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/blood

BACKGROUND: Subjects with normal glucose tolerance (NGT) who have a high 1-hour postload plasma glucose level (> or =155 mg/dL; NGT 1 hour-high) have been shown to be at higher risk for type 2 diabetes than subjects with NGT 1 hour-low postload plasma glucose level (<155 mg/dL). We compared beta-cell function in subjects with NGT 1 hour-high, NGT 1 hour-low, and impaired glucose tolerance (IGT). METHODS: We classified subjects into NGT 1 hour-low (n=149), NGT 1 hour-high (n=43), and IGT (n=52). The beta-cell function was assessed based on insulinogenic index (IGI), oral disposition index (DI), and insulin secretion-sensitivity index-2 (ISSI-2). RESULTS: Insulin sensitivity was comparable between the subjects with NGT 1 hour-high and NGT 1 hour-low. The beta-cell function with/without adjusting insulin sensitivity was significantly different among the three groups. The IGI (pmol/mmol) was 116.8+/-107.3 vs. 64.8+/-47.8 vs. 65.8+/-80.6 (P=0.141), oral DI was 3.5+/-4.2 vs. 1.8+/-1.4 vs. 1.8+/-3.1 (P<0.001), and ISSI-2 was 301.2+/-113.7 vs. 213.2+/-67.3 vs. 172.5+/-87.5 (P<0.001) in NGT 1 hour-low, NGT 1 hour-high, and IGT, respectively. Post hoc analyses revealed that oral DI and ISSI-2 were significantly different between NGT 1 hour-low and NGT 1 hour-high but comparable between NGT 1 hour-high and IGT. CONCLUSION: Among Korean subjects with NGT, those who have a higher 1-hour postload glucose level have a compromised insulin-sensitivity adjusted beta-cell function to a similar degree as IGT subjects.
Blood Glucose* ; Glucose Tolerance Test ; Glucose* ; Insulin ; Insulin Resistance

Graves' ophthalmopathy occurs in 25-50% of patients with Graves' disease. Although patients with Graves' ophthalmopathy mostly present with hyperthyroidism, a minority of patients have euthyroid or hypothyroid characteristics, which may delay a correct diagnosis. Here, we report a case of euthyroid Graves' ophthalmopathy that was initially negative for thyroid autoantibodies, but later changed to positivity.
Autoantibodies* ; Diagnosis ; Graves Disease ; Humans ; Hyperthyroidism ; Thyroid Gland