The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities / 대한내과학회지

BACKGROUND/AIMS: As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes. METHODS: Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups. RESULTS: The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR, 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis. CONCLUSIONS: Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor.

Response: Predictive Clinical Parameters for the Therapeutic Efficacy of Sitagliptin in Korean Type 2 Diabetes Mellitus (Diabetes Metab J 2011;35:159-65)

No abstract available.

Predictive Clinical Parameters for the Therapeutic Efficacy of Sitagliptin in Korean Type 2 Diabetes Mellitus

BACKGROUND: Sitagliptin is a highly selective dipeptidyl peptide-4 (DPP-4) inhibitor that increases blood levels of active glucagon-like peptide (GLP)-1 and glucose-dependent insulinotrophic polypeptide (GIP), resulting in increased insulin secretion. While studies conducted in other countries have indicated the efficacy and safety of using sitagliptin to treat type 2 diabetes mellitus (T2DM), its predictors of effects to sitagliptin are not well understood. Therefore, we evaluated the predictive clinical parameters for the therapeutic benefits of sitagliptin when added to an ongoing metformin or sulfonylurea therapy in Korean T2DM subjects. METHODS: We obtained data from 251 Korean T2DM subjects who had recently started taking sitagliptin as add-on therapy. Exclusion criteria included any insulin use. Changes in HbA1c (DeltaHbA1c) and fasting plasma glucose (DeltaFPG) were assessed by comparing baseline levels prior to sitagliptin administration to levels 12 and 24 weeks after treatment. Responders were defined as subjects who experienced decrease from baseline of >10% in DeltaHbA1c or >20% in DeltaFPG levels at 24 weeks. RESULTS: We classified 81% of the subjects (204 out of 251) as responders. The responder group had a lower mean body mass index (23.70+/-2.40 vs. 26.00+/-2.26, P< or =0.01) and were younger (58.83+/-11.57 years vs. 62.87+/-12.09 years, P=0.03) than the non-responder group. CONCLUSION: In Korean T2DM subjects, sitagliptin responders had lower body mass index and were younger compared to non-responders.

A case of angioimmunoblastic T cell lymphoma in a patient with ichthyosis / 대한내과학회지

Angioimmunoblastic T cell lymphoma (AITL), which accounts for only 1~2% of non-Hodgkin's lymphomas, is commonly accompanied by skin lesions. Those associated with AITL include erythematous plaques, nodules or rashes. Histological examination of most lesions shows infiltration by malignant lymphocytes. Ichthyosis is a generalized skin disease characterized by hyperkeratosis, in which the skin acquires an appearance resembling fish scales. Some cases may be acquired, but most have a genetic basis. We report a case of AITL with associated ichthyosis that is considered to be inherited.

Iatrogenic Esophageal Submucosal Dissection: A Case Report / 대한소화기내시경학회지

Nasogastric tube insertion is a routine clinical procedure for nutritional support, gastric aspiration and decompression. Although it is generally a safe procedure, complication rates range from 0.3~8%. Submucosal esophageal dissection is a rare disorder caused by mucosal tearing and bleeding between the mucosal and muscular layers of the esophagus, leading to their separation. We report a case of submucosal esophageal dissection secondary to the accidental iatrogenic intramural insertion of a nasogastric tube.

Clinical Outcomes of Lamivudine Therapy and HLA Alleles in Chronic Hepatitis B Patients / 대한소화기학회지

BACKGROUND/AIMS: The human leukocyte antigen (HLA) system is an integral component of immune response. Highly polymorphic HLA genes may play a pivotal role in the response of antiviral therapy. We investigated the effects of HLA gene polymorphism on the clinical outcome of chronic hepatitis B patients who received lamivudine treatment. METHODS: Depending on their clinical response to lamivudine therapy, a total of sixty one patients were divided into following groups; non-responders, viral breakthroughers, relapsers, and seroconverters. HLA-A, -B, -Cw, -DRB and HLA-DRB1 alleles typing was performed on each group through the polymerase chain reaction and the sequence-specific oligonucleotide hybridization method. The distribution patterns of HLA-A, HLA-B, HLA-Cw, HLA-DRB, and HLA-DRB1 were then analysed. RESULTS: When non-responders were compared to the other groups, high frequencies in HLA-Cw*1, HLA-DRB1*4 and HLA-DRB*4 (p=0.015, 0.033 and 0.004 respectively) were evident. When seroconverters were compared to viral breakthroughers, high frequencies in HLA-A*2 and HLA-DRB*4 (p=0.048, 0.025 respectively) were evident. CONCLUSIONS: Our data suggests that HLA-A*2, HLA-Cw*1, HLA-DRB1*4 genes are related to the clinical outcomes of lamivudine treatment in chronic hepatitis B patients. These genes may be used in the prediction of the clinical outcome of lamivudine therapy in chronic hepatitis B patients.