Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder Among Adults and Children/Adolescents in Korea

Objective@#This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. @*Methods@#This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. @*Results@#We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (＞ 18 years) during this period. Among adult and children/adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53− 78.91) had at least one psychiatric comorbidity, respectively. @*Conclusion@#Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.

The Diagnostic Rate and Drug Use Trend of Attention DeficitHyperactivity Disorder Among Children and Adults in Korea Using the National Health Insurance Database / 신경정신의학

Objectives@#Attention deficit/hyperactivity disorder (ADHD) is a condition characterized by inattention or hyperactivity and impulsivity that hinders function and development. The purpose of this study was twofold, that is, to check the diagnostic rate of ADHD, which is first diagnosed in adulthood as well as in childhood, and to compare drugs prescribed to children and adult patients. @*Methods@#This study utilized Health Insurance Review & Assessment Service data from 1 January 2009 to 31 December 2018. Only first entered International Classification of Diseases diagnostic codes were collected. We set the first year as a clearance period, checked changes in drug prescriptions over the years, and investigated differences found between pediatric and adult patients. @*Results@#The overall diagnostic rate of ADHD decreased from 71.9 to 69.7 per 100000 people between 2009 and 2012. This reducing trend was noticeable from 2012 and decreased to 43.7 by 2015, and then rose again to 65.4 in 2018. Extended-release formulation of the methylphenidate (ER-MPH) was found to be the most frequently used first drug. @*Conclusion@#Overall diagnostic rate decreased from 2009 to 2018, and the incidence of adult ADHD showed a steady increase. For children, ER-MPH was the most prescribed drug at all ages, while osmotic-release oral system formulation of the methylphenidate was most prescribed for adults.

Effects of Volatile Organic Compounds, and Formaldehyde on Heart Rate Variability among Elderly People in Seoul / 대한산업의학회지

OBJECTIVES: The purpose of the present study was to investigate the effects of volatile organic compounds, and formaldehyde on heart rate variability among elderly people who are vulnerable to ambient pollution. METHODS: From May to August of 2009, 57 subjects older than 60 years were recruited in this study. Indoor air pollutants (volatile organic compounds and formaldehyde) were measured by a personal passive sampler. Heart rate variability (HRV) was measured in the sitting position for five minutes and assessed by time-domain and frequency-domain. RESULTS: Multiple linear regression analysis showed significantly less low-frequency (LF) and high-frequency (HF) associated with elevated benzene levels. Exposure to toluene was associated with decreases in the Standard deviation of the NN intervals (SDNN) and LF. SDNN and LF were negatively associated with the increment of ethylbenzene levels. CONCLUSIONS: An adverse effect on cardiovascular function caused by volatile organic compounds was observed among the elderly people of Seoul even though indoor air pollutant levels were lower than the yearly average guideline for indoor air quality in Korea.

Relationship Between Urinary t, t-muconic Acid and Insulin Resistance in the Elderly / 대한산업의학회지

OBJECTIVES: To examine the associations between the urinary t, t-muconic acid (t, t-MA) concentration and three indices of insulin resistance; namely, the homeostasis assessment of insulin resistance (HOMA-IR) index, blood insulin level and fasting glucose level. METHODS: A panel study was performed on the elderly at a public health care center population in the northern area of Seoul between 2008 and 2010. The participants were 560 elderly, over 60 years of age whose urinary t, t-MA and insulin resistance indices had been measured; questionnaires were completed by these participants. A generalized linear mixed (GLM) analysis was adjusted for age, sex, drinking, urinary cotinine, exercise, vitamin intake and body mass index, at a significance level of p<0.05. RESULTS: A total of 411 participants were finally analyzed after excluding those with diabetes and only one visit to the public health care center. Higher urinary t, t-MA concentrations were linearly associated with the HOMA-IR index, blood insulin level and fasting glucose level in the simple and fully adjusted GLM models. Although there were few limitations, a portion of insulin resistance was proven to be explained by exposure to benzene using r-squared. A significant relationship was also observed between urinary t, t-MA and malondialdehyde (MDA) using the same GLM models. CONCLUSIONS: Urinary t, t-MA is related to the development of insulin resistance which is a key factor for development of diabetes and its complications induced by oxidative stress.

Herpes Zoster Ophthalmicus Complicated by Ophthalmoplegia in a Patient with Rheumatoid Arthritis / 대한류마티스학회지

There have been many reports about infections in patients with rheumatoid arthritis (RA) being more frequent than general population. Increased susceptability to infections in RA could be related to disease itself, comorbid conditions, and use of immunosuppressive drugs and steroid. Herpes zoster viral infections also have been reported to be more frequent in RA. We describe a case of 60-year-old woman with RA presented with ophthalmoplegia associated with herpes zoster ophthalmicus. Initially she complained of right orbital and periorbital pain. Six days later, she noted a cutaneous herpes zoster eruption involving the right 1st division of trigeminal nerve. Three days after developing skin eruption, she developed a right ptosis with external ophthalmoplegia and pupil dilatation resulting from the 3rd and 6th cranial nerve involvement. She was placed on intravenous acyclovir for 7days. Eight weeks after the onset of ophthalmoplegia, she recovered nearly completely.

Two Cases of Allergic Reactions to Mesna which Imitate Malar Rash / 대한류마티스학회지

Hemorrhagic cystitis is potentially life-threatening sequellae of chemotherapy using oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide). Mesna contains a sulfhydryl group that is believed to bind acrolein within the urinary collecting system and reduce the hemorrhagic cystitis without affecting the chemotherapeutic potential. To date, about thirty cases of hypersensitivity or allergic reactions of the delayed and urticarial type associated with mesna have been reported. We reported two patients with systemic lupus erythematosus who developed facial rash and flushing associated with mesna which imitate malar rash.

A Case of an Organoaxial Type of Chronic Gastric Volvulus / 대한소화기내시경학회지

Gastric volvulus is a rotation of the stomach of at least 180 associated with a closed loop obstruction. Pare described the first case of gastric volvulus m 1579. Laxity of the gastric ligament, a congenital or acquired diaphragmatic defect, increased abdominal pressure, and a genetic component contributing to gastric volvulus. Gastric volvulus has been classified clinically as acute and chronic gastric volvulus, and can be classified anatomically as organoaxial, mesenteroaxial or a mixed type. Gastric volvulus occurs in children usually before 1 year of age or elderly patients. In acute gastric volvulus, and be patients complain of sudden abdominal or chest pain. The chest pain, which can radiate to the arms and neck accompanied by dyspnea, may initially lead to consideration of ischemic heart disease. Chronic gastric volvulus is difficult to diagnose because it may be associated with mild and nonspecific symptoms such as epigastric discomfort, fullness or heartburn. We experienced a case of 83 year old male with an organoaxial type of chronic gastric volvulus, iagnosed by upper gastrointestinal series, and treated with conservative rnanagement.

Doppler Echocardiographic Findings of Mitral Valve Prolapse : Usefulness of the Apical Rotation Method of a Transducer for Assessment of Site of Prolapse

BACKGROUND: Color Doppler echocardiography is sensitive in detecting mitral regurgitation and useful in quantitating its severity. The presence of an eccentric regurgitant jet suggests that regurgitation is caused by prolapsing or flail leaflet of mitral valve. Until recently the direction of regurgitant jet in mitral valve prolapse has been examined in a single(parasternal short axis view) or orthogonal plane using color Doppler echocardiography, and few in the apical rotation method of a transducer. The purpose of this study was to clarify the usefullness of the apical rotation method of a transducer in detection of the direction of mitral regurgitant jet and diagnosis of the sites of mitral valve prolapse. METHODS: Twenty four patients(8 men and 16 women, mean age:47.3+/-18.8 years) with mitral valve prolapse with eccentric regurgitant jet were examined by two-dimensional and color Doppler echocardiograply using conventional parasternal long and short axis views, and four apical longitudinal planes(four chamber, vertical, two chamber and transverse views) obtained by the apical retation method of a transducer. RESULTS: Thirty one regurgitant jets were detected in twenty four patients, eighteen patients had anterior, nine patints posterior, and three patients bi-leaflet(anterior and posterior) prolapse. In eighteen patients with anterior leaflet prolapse, ten had medial, eight had middle, three had lateral, and three had two portions(two, medial and middle; one, middle and lateral) prolapse. In nine patients with posterior leaflet prolapse, five had medial, three had middle, two had lateral, and one had two(medial and middle) scallop prolapse. CONCLUSION: Color Doppler echocardiography by the apical rotation method of transducer is useful in assessment of the site of prolapse in patients with mitral valve prolapse with eccentric regurgitation.

A case of asymptomatic cor triatriatum

No abstract available.

Relation of hemodynamic load to left ventricular hypertrophy and performance in essential hypertension

BACKGROUND: Left ventricular function and left ventricular hypertrophy often show weak correlation with the degree of blood pressure in hypertensive patients. So we assessed correlation of hemodynamic load to left ventricular hypertrophy and left ventricular performance, and whether left ventricular wall stress is the major factor on the regulation of left ventricular function. METHODS: Relationships between echocardiographic hemodynamic parameters and indices of left ventricular hypertrophy and left ventricular function were evaluated in 40 patients with essential hypertension who have not been previously treated. RESULTS: Left ventricular mass index correlated weakly with blood pressure, cardiac index, and stroke volume. End-diastolic left ventricular relative wall thickness, as an index that assess the severity of concentric hypertrophy showed significantly negative correlation with cardiac index (r=-0.49, p<0.001),stroke index(r=-0.46, p<0.001) and a positive correlation with total peripheral resistance (r=0.55, p<0.001). Furthermore, patient with cardiac indices tend to have higher end-diastolic wall thickness at any given level of blood pressure. Fractional shortening suggesting left ventricular systolic function was not related with blood pressure. stroke volume, cardiac index, left ventricular mass index, and peak systolic wall stress. In contrast there were significant negative correlations between fractional shortening with mean wall stress index (r=-0.42, p<0.005) and with end-systolic wall stress (r=-0.72, p<0.001). CONCLUSIONS: These results suggest that anatomic and hemodynamic changes may be pathophysiologically interdependent and left ventricular function was regulated by the level of left ventricular wall stresses reflecting afterload (blood pressure).