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Background@#As the coronavirus disease (COVID-19) pandemic continues, wearing masks has become a daily routine. As the mask-wearing time increased, the mask-covered skin was more likely to be influenced. @*Objective@#This study aimed to identify face mask-wearing behaviors and their effects on patients with facial skin diseases. @*Methods@#Patients with facial skin disease were surveyed at two institutions. The patterns of mask use, mask-associated skin problems, and the Dermatology Life Quality Index (DLQI) were investigated. @*Results@#A total of 174 participants were enrolled and the mean age was 42.2 years. Rosacea (35.6%) was the most common condition, followed by acne (25.3%) and contact dermatitis (17.2%). Ninety-four subjects (54.0%) reported that they wore masks for less than 6 hours a day, and 96 subjects (55.2%) wore masks to fit tightly against the face. Regarding the mask type, KF-99, 94, and 80 (62.6%) were the most common. Nearly three-quarters (n=128, 73.6%) of patients complained of mask-associated skin problems. Pimples were the most common symptom (59.4%), and the cheek was the most commonly affected area (67.2%). The mean DLQI score was 9.90. @*Conclusion@#We investigated the current patterns of mask use in patients with facial skin diseases. Moreover, it is necessary to recognize newly encountered relationships and seek strategies for relevant patients.
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Background@#Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. @*Objective@#This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. @*Methods@#Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. @*Results@#A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) (p<0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers (p=0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) (p=0.045). @*Conclusion@#This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.
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After anaplastic large-cell lymphoma (ALCL) was first described by Stain in 1985, there have been several histological variants of ALCL reported. There are classified histological subtypes of ALCL, such as lymphohistiocytic, small cell, Hodgkin-like, composite pattern, and other less common variants including neutrophil-rich ALCL. A 63-year-old male patient presented with erythematous exophytic mass on the left lower leg. In the past, his condition had been diagnosed as abdominal primary cutaneous ALCL (pcALCL), which recurred as systemic ALCL (sALCL) in the left bronchus. After treatment, he achieved complete remission. Histopathologic examination showed large-sized pleomorphic, anaplastic mitotic tumor cells, several neutrophils, and a few lymphocytes. Neutrophil-rich ALCL is a rare histological variant of ALCL. It is characterized by the presence of CD30-positive anaplastic tumor cells with numerous neutrophil infiltrations. Neutrophil-rich ALCL responds well to treatment but tends to recur. There were four cases reported to have recurrent neutrophilrich ALCL. All cases were diagnosed with neutrophil-rich pcALCL prior to recurrence.Three cases had local recurrence, and only one case relapsed as sALCL. Herein, we present the first case of neutrophil-rich ALCL recurring as sALCL twice.
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Background@#We explored the risk of death from pneumonia according to cumulative duration in low household income state (LHIS) among adults with type 2 diabetes mellitus (T2DM). @*Methods@#Using Korean National Health Insurance Service data (2002 to 2018), the hazards of mortality from pneumonia were analyzed according to duration in LHIS (being registered to Medical Aid) during the 5 years before baseline (0, 1–4, and 5 years) among adults with T2DM who underwent health examinations between 2009 and 2012 (n=2,503,581). Hazards of outcomes were also compared in six groups categorized by insulin use and duration in LHIS. @*Results@#During a median 7.18 years, 12,245 deaths from pneumonia occurred. Individuals who had been exposed to LHIS had higher hazards of death from pneumonia in a dose-response manner (hazard ratio [HR], 1.726; 95% confidence interval [CI], 1.568 to 1.899 and HR, 4.686; 95% CI, 3.948 to 5.562 in those exposed for 1–4 and 5 years, respectively) compared to the non-exposed reference. Insulin users exposed for 5 years to LHIS exhibited the highest outcome hazard among six groups categorized by insulin use and duration in LHIS. @*Conclusion@#Among adults with T2DM, cumulative duration in LHIS may predict increased risks of mortality from pneumonia in a graded dose-response manner. Insulin users with the longest duration in LHIS might be the group most vulnerable to death from pneumonia among adults with T2DM.
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The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population.
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Women undergo various physical changes because of hormonal changes occurring after menopause. Some representative changes caused by the reduction in estrogen levels in these women are dyslipidemia, abnormal lipoprotein levels, obesity, weight gain, and changes in body fat distribution. A characteristic of women approaching menopause is the shift of fat from their hips and thighs to their abdomen. Notably, fat accumulation is common in internal organs, resulting in male-pattern obesity among women approaching menopause; therefore, these women require more exercise therapy than premenopausal women to prevent and treat obesity. To the best of our knowledge, no effective exercise therapy guidelines have been established for postmenopausal women; therefore, I aimed to suggest more effective diet and exercise therapies for postmenopausal women with obesity. For this purpose, I organized the diet and exercise protocol by collaborating with an obstetrician and a researcher specializing in sports medicine; further, this protocol was actually applied to all participants. The results indicated that the protocol is effective in reducing weight; however, joint pain was commonly noted in participants who dropped out of the program. Based on the evaluation of joint pain, this study found that it is necessary to perform exercise therapy by avoiding weight-bearing activities and reinforcing personalized joint strengthening exercises because reduced estrogen level is an important factor exacerbating arthritis in postmenopausal women.
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Purpose@#This study aimed to evaluate the effects of e-health literacy, parenting stress, maternal role confidence on children’s health-promoting behaviors in mothers of infants and toddlers. @*Methods@#The participants were 175 mothers of infants and toddlers. Data were collected from August 30 to September 24, 2022. The effects of e-health literacy, parenting stress, and maternal role confidence on children’s health-promoting behaviors in mothers of infants and toddlers were analyzed using multiple regression using IBM SPSS Statistics ver. 27.0. @*Results@#Children’s health-promoting behaviors showed a significant positive relationship with e-health literacy and maternal role confidence, and negative relationship with children’s age and parenting stress. The factors affecting children’s health-promoting behaviors were e-health literacy, maternal role confidence, and children’s age, which explained 30.7% of the total variance in children’s health-promoting behaviors. @*Conclusion@#This study suggests including e-health literacy and maternal role confidence for improving children’s health-promoting behaviors in mothers of infants and toddlers.
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Background@#This study investigated the trends of insulin use among Korean patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Changes in prescription of antidiabetic medications in T2DM patients taking insulin therapy were evaluated. @*Methods@#We analyzed data from the National Health Insurance Service database in Korea to evaluate the prevalence of insulin users and trends of insulin use in T1DM and T2DM patients from January 2002 to December 2019. We also investigated numbers and types of antidiabetic medications in insulin users with T2DM. @*Results@#The overall total number of insulin users increased from 2002 to 2019, reaching 348,254 for T2DM and 20,287 for T1DM in 2019 compared with 109,974 for T2DM and 34,972 for T1DM in 2002. The proportion of patients using basal analogs and short acting analogs have increased and those using human insulin, premixed insulin, or biphasic human insulin have decreased (rapid acting analogs: 71.85% and 24.12% in T1DM and T2DM, respectively, in 2019; basal analogs: 76.75% and 75.09% in T1DM and T2DM, respectively, in 2019). The use of other antidiabetic medication in addition to insulin increased for T2DM, especially in dual therapy, reaching up to 52.35% in 2019 compared with 16.72% in 2002. @*Conclusion@#The proportion of the patients using basal or rapid acting analogs increased among all insulin users in both T1DM and T2DM patients. Among patients with T2DM, the proportion of patients using antidiabetic medications in addition to insulin was significantly increased compared to those who used insulin alone.
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Alzheimer’s disease (AD), one of the most representative neurodegenerative diseases, has diverse neurobiological and pathophysiological mechanisms. Treatment strategies targeting a single mechanism have repeated faced failures because the mechanism of neuronal cell death is very complex that is not fully understood yet. Since complex mechanisms exist to explain AD, a variety of diagnostic biomarkers for diagnosing AD are required.Moreover, standardized evaluations for comprehensive diagnosis using neuropsychological, imaging, and laboratory tools are needed. In this review, we summarize the latest clinical, neuropsychological, imaging, and laboratory evaluations to diagnose patients with AD based on our own experience in conducting a prospective study.
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Objectives@#Social withdrawal is emerging as a significant health issue in Korea. This study examines the prevalence of psychiatric disorders, including personality disorders, and the psychosocial characteristics of hikikomori individuals in Korea. @*Methods@#We recruited 30 hikikomori cases from the hikikomori family association, internet cafés, and psychiatric patients at the Samsung Medical Center. Hikikomori is defined as a prolonged withdrawal from social interactions, lasting at least three months. Psychiatric disorders were assessed using the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-5 Personality Disorders. Self-reported psychosocial characteristics, such as depression, anxiety, and life satisfaction, were measured using various scales. @*Results@#The hikikomori participants were predominantly young, unmarried males, with high unemployment rates and an average duration of social withdrawal of 38.7 months. The lifetime prevalence of psychiatric disorders was 76.6%, with depression and anxiety being the most common comorbid conditions. The prevalence rates in the current sample for major depressive disorders, social anxiety disorders, agoraphobia, and body dysmorphic disorders were 46.7%, 16.5%, 10.0%, and 10.0%, respectively. Personality disorders were diagnosed in 63.3% of the subjects. Additionally, 50.0% of the subjects scored above the cutoff point on the Korean version of the autism-spectrum quotient. The hikikomori group exhibited high levels of depressive anxiety, suicidality, poor subjective well-being, and compromised physical health. @*Conclusion@#This study highlights hikikomori as a severe syndrome associated with multiple psychiatric comorbidities, including personality disorders and the autism spectrum. Comprehensive psychiatric evaluation for hikikomori individuals is essential to facilitate appropriate therapeutic interventions and social rehabilitation.
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Purpose@#Globus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previous studies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Research has also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patients who had undergone unilateral DBS targeting the GPi and Vo. @*Materials and Methods@#Five patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwent DBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale. @*Results@#BFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. Disability Rating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 month after surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone. @*Conclusion@#Unilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target for dystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.
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A seated saline loading test (SLT) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) is one of the most accepted confirmatory tests of primary aldosteronism. However, LC-MS/MS is time-consuming and is not widely available in diagnostic laboratories compared to immunoassay. With immunoassay, it is unknown whether SLT in the seated position is more accurate than that of the supine position, and a cutoff value of post-seated SLT plasma aldosterone concentration (PAC) must be established in the Korean population. Ninety-eight patients underwent SLT in both positions, and post-SLT PAC was measured by LC-MS/MS and radioimmunoassay. We confirmed primary aldosteronism if post-seated SLT PAC by LC-MS/MS exceeded 5.8 ng/dL. The area under the receiver operating characteristic curve was greater for seated than supine SLT (0.928 vs. 0.834, P=0.003). The optimal cutoff value of post-seated SLT by radioimmunoassay was 6.6 ng/dL (sensitivity 83.3%, specificity 92.2%).
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Cyclosporine is one of the main therapeutic agents for psoriasis. It is known that psoriasis relapses 2∼3 months after discontinuation of cyclosporine, and exacerbation due to abrupt discontinuation of cyclosporine is uncommon. We report a case of psoriasis that was aggravated by cyclosporine cessation for guselkumab treatment, but improved with continuous administration of guselkumab. A 55-year-old man with a history of psoriasis presented with erythematous scaly plaques on the whole body. He had been treated with cyclosporine for 18 months and had received a subcutaneous injection of guselkumab 1 month previously. Two weeks after the first injection, the patient experienced exacerbation of the lesions. Considering the aggravation caused by abrupt discontinuation of cyclosporine, guselkumab administration was continued. The aggravated psoriatic lesions improved after additional guselkumab injections. At 16 weeks, the Psoriasis Area and Severity Index score was 0, which remained constant thereafter.
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Purpose@#A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. @*Materials and Methods@#We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. @*Results@#The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. @*Conclusion@#Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.
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Objective@#We investigated arthralgia and myalgia associated with the use of oral bisphosphonate (BP) by conducting a survey of patient. @*Methods@#The pharmacists conducted a survey between 1 Oct 2019 and 30 Sep 2020 among patients who were dispensed BP in community pharmacies to assess their demographic and medical characteristics, and their experiences with, and process for pain. Logistic regression analyses were performed to find the risk factors associated with the pain, and the odds ratios (OR) and 95% confidence intervals (CI) were determined. @*Results@#A total of 160 patients who used BP participated in the survey (74 [46.3%] used risedronate; 61 [38.1%] used alendronate; 23 [14.4%] used ibandronate), and 20 (12.5%) of them experienced pain. Significant statistical differences of the characteristics between patients who experienced pain or not were observed regarding menopause, and parity. Compared with women who had one or two parity, women who had more than three parity were associated with the decreased risk of pain (OR, 0.24; 95% CI, 0.04-0.98). Moreover, steady exercise was associated with the decreased risk of pain compared to less exercise (OR, 0.37; 95% CI, 0.14-0.98). @*Conclusion@#Our findings suggest that the risk of pain in BP-treated patients might be different regarding the different ingredients of BP, and dosing frequency. This survey highlights a need for a further safety research to understand the factors influencing the pain associated with the BP treatment.
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Background@#The skin barrier is made of the outermost layers of skin and is responsible for preventing cutaneous water loss. Skin barrier function is easily affected by external environmental factors, such as temperature and relative humidity, especially in areas with four distinct seasons, such as Busan, Korea. @*Objective@#This study was conducted to analyze the seasonal variation in skin barrier function on the face and to determine whether it is affected by thermo-hygrostat conditioning. @*Methods@#Ten healthy female volunteers aged 28 to 34 years were enrolled in this study. Each subject was put into a thermo-hygrostat–controlled room maintained at a temperature of 22.4°C to 23.8°C with a relative humidity of 50.2% to 52.0%. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were measured before and after a 20-minute session in the room. Measurements were taken once in the middle of each season. @*Results@#Regardless of thermo-hygrostat conditioning, TEWL and SCH values changed significantly between all four seasons (both p＜0.001). With thermo-hygrostat conditioning, 1 of 6 ΔTEWL and 4 of 6 ΔSCH values showed significant seasonal differences in post-hoc analysis. Difference of TEWL and SCH obtained before and after thermo-hygrostat conditioning was significant only in summer (TEWL, p=0.009; SCH, p=0.002). @*Conclusion@#Skin barrier function differed significantly between seasons, regardless of thermo-hygrostat conditioning. Thermo-hygrostat conditioning significantly affected TEWL and SCH only during summer. However, with Busan’s excessively humid summer, even a short period of thermo-hygrostat conditioning could increase the precision of skin barrier function measurement.
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A 49-year-old Chinese woman presented to Ilsan Paik Hospital emergency department with fever and general weakness. Chest computed tomography revealed cavity and peribronchial nodules and consolidation in the right upper lobe. A diagnosis of suspected active tuberculosis was made. A review of the patient’s medication prescribed at another hospital indicated that she had been taking antituberculosis medication for several months. Initially, the patient had anemia and mild thrombocytopenia. In addition, she developed leukopenia and her thrombocytopenia worsened. After discontinuing the antituberculosis medication, her pancytopenia initially improved, but was aggravated again after starting on antituberculosis drugs. Despite discontinuing the antituberculosis medication again, her pancytopenia progressed. As she had a high anti-nuclear antibody titer, another systemic disease was suspected. She was diagnosed with systemic lupus erythematosus and her leukopenia and thrombocytopenia improved after initiation of treatment with systemic steroids and antimalarial drugs
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Purpose@#A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. @*Materials and Methods@#We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. @*Results@#The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. @*Conclusion@#Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.
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Background@#Patients with rosacea usually suffer from skin irritations, such as itching, stinging, burning, and pain.These symptoms may be related to the skin barrier function disruption. @*Objective@#We investigated the skin barrier functions in patients with mild to moderate rosacea and the associated improvements based on the skin care habit modifications and treatment modalities. @*Methods@#We analyzed the data on transepidermal water loss (TEWL) and stratum corneum hydration (SCH) of skin lesions in 27 patients with rosacea and healthy skin of 29 control subjects. We compared the results of TEWL and SCH based on sex, age, type of rosacea, skin care habits, and the treatment modalities. @*Results@#The skin in the patients with rosacea exhibited increased TEWL and decreased SCH compared with that in control subjects. Male patients showed increased TEWL and decreased SCH compared to female patients. Combination therapy with systemic minocycline and topical metronidazole improved the skin barrier functions. Patients with better skin care habits presented better skin barrier functions and clinical improvement. @*Conclusion@#Patients with rosacea, especially those with poor skin care habits, showed reduced skin barrier functions. Appropriate skin care habits with cleansers and moisturizers are recommended for the management of rosacea.
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Background@#Oral alitretinoin is effective in the treatment of chronic hand eczema (CHE), and ≥12 weeks of alitretinoin treatment has been shown to be effective in Korean patients.However, in the real world, a considerable number of patients discontinue alitretinoin, which leads to treatment failure. @*Objective@#To evaluate the compliance rate of alitretinoin treatment and explore common reasons for poor compliance in patients with CHE in the real world. @*Methods@#We retrospectively reviewed the electronic medical records of CHE patients treated with alitretinoin. We defined ‘poor-compliance’ as subjects who were treated with alitretinoin for ＜12 weeks and ‘good-compliance’ as subjects who were treated with alitretinoin for ≥12 weeks. We reviewed the demographics, dose, and duration of alitretinoin usage, efficacy, and reasons for poor compliance. @*Results@#A total of 137 subjects were enrolled, and 77 (56.2%) did not complete the 12-week treatment with alitretinoin. Among them, the non-improvement rate was significantly higher in the poor-compliance group than in the good-compliance group (p＜0.01). The main reasons for the alitretinoin cessation in the poor-compliance group were insufficient response (40.8%), followed by high cost (34.7%), and adverse events (24.5%). @*Conclusion@#Alitretinoin appears the preferred longterm treatment option for CHE. Although there are complaints about late efficacy, cost, and side effects, following proper explanation, these should not justify discontinuation. Physicians need to recognize the reasons for poor compliance with alitretinoin for each patient and suggest continuing alitretinoin for the successful treatment of CHE.