Background: Dipeptidyl peptidase-4 (DPP4) inhibitors are frequently prescribed for patients with type 2 diabetes; however, their cost can pose a significant barrier for those with impaired kidney function. This study aimed to estimate the economic benefits of substituting non-renal dose-adjusted (NRDA) DPP4 inhibitors with renal dose-adjusted (RDA) DPP4 inhibitors in patients with both impaired kidney function and type 2 diabetes. Methods: This retrospective cohort study was conducted from January 1, 2012 to December 31, 2018, using data obtained from common data models of five medical centers in Korea. Model 1 applied the prescription pattern of participants with preserved kidney function to those with impaired kidney function. In contrast, model 2 replaced all NRDA DPP4 inhibitors with RDA DPP4 inhibitors, adjusting the doses of RDA DPP4 inhibitors based on individual kidney function. The primary outcome was the cost difference between the two models. Results: In total, 67,964,996 prescription records were analyzed. NRDA DPP4 inhibitors were more frequently prescribed to patients with impaired kidney function than in those with preserved kidney function (25.7%, 51.3%, 64.3%, and 71.6% in patients with estimated glomerular filtration rates [eGFRs] of ≥60, <60, <45, and <30 mL/min/1.73 m2, respectively). When model 1 was applied, the cost savings per year were 7.6% for eGFR <60 mL/min/1.73 m2 and 30.4% for eGFR <30 mL/min/1.73 m2. According to model 2, 15.4% to 51.2% per year could be saved depending on kidney impairment severity. Conclusion Adjusting the doses of RDA DPP4 inhibitors based on individual kidney function could alleviate the economic burden associated with medical expenses.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.

Background and Objectives: The clinical implications of the BRAF V600E mutation in papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm of tumor size, remain controversial. We investigated the association between the BRAFV600E mutation and PTMC recurrence in a retrospective cohort of patients with thyroid cancer. Materials and Methods: This study included 2319 patients with PTMC (median age, 50 years [interquartile range (IQR), 41-57 years]) who underwent thyroid surgery from 2010 to 2019 at a single tertiary medical center. The median follow-up time was 75 months (IQR, 30-98 months). Tumor recurrence was confirmed by histological, cytological, radiographic, and biochemical criteria, combined with persistent and recurrent disease. Results: A total of 60.2% (1395/2319) patients with PTMC had the BRAF V600E mutation. The tumor recurrence rate was 2.1% (19/924) in BRAF mutation-negative patients and 2.9% (41/1395) in BRAF mutation-positive patients, with a hazard ratio (HR) of 1.05 (95% confidence interval [CI], 0.61-1.84) after adjusting for clinicopathological risk factors. Similar results were found in patients with high-risk PTMC (adjusted HR, 1.09; 95% CI, 0.56-2.11) who had lymph node metastasis (LNM), extrathyroidal extension (ETE), or distant metastasis (DM) at diagnosis and in patients with low-risk PTMC (adjusted HR, 1.00; 95% CI, 0.35-2.83) who had no LNM, ETE, or DM. Conclusion The finding that the BRAF V600E mutation was not associated with tumor recurrence in our cohort of Korean patients with PTMC, especially in patients with low-risk PTMC, suggests that its value in the prediction of disease progression is limited.

Purpose: Pneumococcal vaccination (13-valent pneumococcal conjugate vaccine [PCV13]) is recommended to cancer patients undergoing systemic chemotherapy. However, the optimal time interval between vaccine administration and initiation of chemotherapy has been little studied in adult patients with solid malignancies. Materials and Methods: We conducted a prospective randomized controlled trial to evaluate whether administering PCV13 on the first day of chemotherapy is non-inferior to vaccinating 2 weeks prior to chemotherapy initiation. Patients were randomly assigned to two study arms, and serum samples were collected at baseline and 4 weeks after vaccination to analyze the serologic response against Streptococcus pneumoniae using a multiplexed opsonophagocytic killingassay. Results: Of the 92 patients who underwent randomization, 43 patients in arm A (vaccination 2 weeks before chemotherapy) and 44 patients in arm B (vaccination on the first day of chemotherapy) were analyzed. Immunogenicity was assessed by geometric mean and fold-increase of post-vaccination titers, seroprotection rates (percentage of patients with post-vaccination titers > 1:64), and seroconversion rates (percentage of patients with > 4-fold increase in post-vaccination titers). Serologic responses to PCV13 did not differ significantly between the two study arms according to all three types of assessments. Conclusion The overall antibody response to PCV13 is adequate in patients with gastric and colorectal cancer during adjuvant chemotherapy, and no significant difference was found when patients were vaccinated two weeks before or on the day of chemotherapy initiation.

BACKGROUND AND OBJECTIVES: Although systemic steroid is widely used, there is no established standard treatment for patients with sensorineural olfactory disorder. The aim of this study was to prospectively investigate the effect of stellate ganglion block (SGB) in patients with sensorineural olfactory disorders unresponsive to systemic steroids. SUBJECTS AND METHOD: Twenty patients with anosmia or hyposmia following upper respiratory tract infection (URI) that was unresponsive to systemic steroid treatments were included in this study from February 2009 through December 2009. Nine patients were treated with SGB (the treatment group) and compared with the 11 untreated patients (the control group). Except for SGB, both groups were treated the same otherwise (with topical steroids, vitamins, peripheral vasodilators) during the treatment period. We evaluated the olfactory function using Korean Version of Sniffin' Sticks test II (KVSS II) and the subjective symptom questionnaire (SSQ). RESULTS: The KVSS II scores improved significantly only in the treatment group, showing a significant difference between the two groups, whreas the SSQ scores were improved in both groups and did not show significant differences. KVSS II and SSQ scores showed a significant correlation. CONCLUSION: These results suggest that SGB may be effective in the treatment for patients with sensorineural olfactory disorder following URI unresponsiveness to systemic steroid treatments.
Humans ; Olfaction Disorders ; Prospective Studies ; Surveys and Questionnaires ; Respiratory System ; Respiratory Tract Infections ; Smell ; Stellate Ganglion ; Steroids ; Vitamins

Metronidazole may produce a number of neurologic side effects including peripheral neuropathy, seizure, encephalopathy. We experienced neurological side effects of metronidazole. The 32-year-old female patient with spinal cord injury was diagnosed as encephalophathy and peripheral polyneuropathy resulting from complication of metronidazole. It was difficult to diagnose at first glance using clinical findings because of paraplegia due to spinal cord injury. But through magnetic resonance imaging with diffusion weighted imaging and electrophysiologic study, the patient showed to have characteristic abnormalities that of a person suffering from metronidazole-induced encephalopathy and peripheral polyneuropathy. Whether the symptoms were caused by a peripheral nerve lesion or MIE, the patient's paraplegia prevented to appear other symptoms, such as ataxic gait and seizure, from manifesting. In such case as this, an active differentiated diagnosis is crucial.
Adult ; Diffusion ; Female ; Gait ; Humans ; Magnetic Resonance Imaging ; Metronidazole ; Paraplegia ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Polyneuropathies ; Seizures ; Spinal Cord ; Spinal Cord Injuries ; Stress, Psychological

Metronidazole may produce a number of neurologic side effects including peripheral neuropathy, seizure, encephalopathy. We experienced neurological side effects of metronidazole. The 32-year-old female patient with spinal cord injury was diagnosed as encephalophathy and peripheral polyneuropathy resulting from complication of metronidazole. It was difficult to diagnose at first glance using clinical findings because of paraplegia due to spinal cord injury. But through magnetic resonance imaging with diffusion weighted imaging and electrophysiologic study, the patient showed to have characteristic abnormalities that of a person suffering from metronidazole-induced encephalopathy and peripheral polyneuropathy. Whether the symptoms were caused by a peripheral nerve lesion or MIE, the patient's paraplegia prevented to appear other symptoms, such as ataxic gait and seizure, from manifesting. In such case as this, an active differentiated diagnosis is crucial.
Adult ; Diffusion ; Female ; Gait ; Humans ; Magnetic Resonance Imaging ; Metronidazole ; Paraplegia ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Polyneuropathies ; Seizures ; Spinal Cord ; Spinal Cord Injuries ; Stress, Psychological

BACKGROUND AND OBJECTIVES: The presence of ectopic tooth in the sinonasal cavity is an unusual phenomenon and the underlying etiology remains unclear. Because of its rarity, clinical observation studies about sinonasal ectopic tooth are very rare. The aim of this study was to analyze the clinical characteristics of ectopic tooth occurring in the sinonasal cavity. SUBJECTS AND METHOD: Medical records and radiologic studies of 11 patients, who were treated between January 2006 and June 2012 for ectopic nasal teeth were reviewed retrospectively, with regard to sex, age, location, symptoms and treatment methods. RESULTS: Among 11 patients, 8 patients were male and 3 patients were female. The average age was 24.2 years. Among 7 patients who had symptoms, nasal obstruction was the most common followed by rhinorrhea, postnasal drip, facial swelling or pain, headache. The nasal cavity was the most frequently affected site. Among 14 ectopic teeth from eleven patients, 7 were removed by intrasnasal endoscopy and 2 by external premaxillary approach. Five teeth which were unerupted within the hard palate or maxillary sinus were offered conservative treatment with periodic follow-up. CONCLUSION: Removal of ectopic nasal tooth is generally advocated to alleviate the symptoms and prevent complications; if conservative treatment is decided, periodic monitoring of the patient is recommended. We suggest that treatment be carefully planned based on the symptoms of patients, location of the ectopic tooth, and whether the tooth is erupted or not.
Endoscopy ; Female ; Headache ; Humans ; Male ; Maxillary Sinus ; Medical Records ; Nasal Cavity ; Nasal Obstruction ; Palate, Hard ; Paranasal Sinuses ; Retrospective Studies ; Tooth ; Tooth, Supernumerary

BACKGROUND AND OBJECTIVES: Nausea and vomiting in early pregnancy are well-known phenomena. It has been suggested that the mechanism that triggers nausea and vomiting in pregnancy may be related to olfactory changes. We planned to investigate olfactory function changes and the relationship between olfaction changes and nausea and vomiting in early pregnancy. SUBJECTS AND METHODS: Two groups of participants with the total of 75 women (35 pregnant women; 40 non-pregnant women) were analyzed prospectively. Objective olfactory function was tested using Korean Version of Sniffin' Sticks-II test (KVSS-II test). In addition, pregnant subjects were investigated using the questionnaire to evaluate the severity of nausea and vomiting, and whether the changes were due to olfactory sensitivity. RESULTS: Subjective olfactory sensitivity was increased in pregnant subjects. However, there was no significant difference in the objective olfactory function between the two groups. CONCLUSION: Based on this study, we concluded that pregnancy is accompanied by changes in subjective olfactory sensitivity and higher subjective olfactory discomfort. But these findings do not support the hypothesis that nausea and vomiting is dependent of the changes in the objective olfactory function during early pregnancy.
Female ; Humans ; Hypersensitivity ; Morning Sickness ; Nausea ; Pregnancy ; Prospective Studies ; Surveys and Questionnaires ; Smell ; Vomiting

BACKGROUND: The incidence pattern of malignancy after kidney transplantation is different from that of the general population. Because increased exposure to immunosuppressants results in an increased incidence of malignancy, institutional reports that do not consider duration of immunosuppression have limited value for providing future kidney recipients with the actual risk for malignancy or for developing a kidney allograft recipient surveillance program. Thus, we retrospectively analyzed our institutional data with regard to the duration of exposure to immunosuppressants. METHODS: A total of 757 patients who had kidney transplantation and were followed-up for at least 6 months at our hospital were reviewed retrospectively. The crude incidence rate (CI) was calculated by counting the days of exposure to immunosuppressants. RESULTS: Most malignancies after kidney transplantation were solid tumors (85.3%). The CI of malignancies was 641.1 in allograft recipients and 329.6 in the general population per 100,000 persons per year. Solid tumor cancers of the stomach, liver, lung, breast, cervix, and pancreas showed an increased CI in the allograft recipient group than the general population but cancers of the thyroid and colon did not. Based on the type of immunosuppressive agent, the CI was highest in the cyclosporine group (866/12 months/100,000 persons) than the other groups. CONCLUSIONS: We have provided the CIs of cancers after kidney transplantation at our institute. The pattern of post-transplant malignancy is different from that of western countries. Nationwide registration is needed to provide a more rational approach to post-transplant cancer surveillance in Korea.
Breast ; Cervix Uteri ; Colon ; Cyclosporine ; Female ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Liver ; Lung ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Stomach ; Thyroid Gland ; Transplantation, Homologous