Evaluation of Stress in Korean Patients with Diabetes Mellitus Using the Problem Areas in Diabetes-Korea Questionnaire

BACKGROUND: It is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility. METHODS: This study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky's Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress. RESULTS: Cronbach's alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05). CONCLUSION: We developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea.

Rarity of TLR4 Asp299Gly and Thr399Ile Polymorphisms in the Korean Population

PURPOSE: Activation of the innate immune system and chronic low-grade inflammation are thought to be involved in the pathogenesis of atherosclerosis and also thought to be associated with type 2 diabetes and its complications. As a receptor for bacterial lipopolysaccharide and heat-shock proteins, Toll-like receptor 4 (TLR4) is one of the central regulators of the immune response. Recent studies have reported an association between TLR4 polymorphisms and diabetes and its complications in Caucasian populations. MATERIALS AND METHODS: In this study, we analyzed the association between TLR4 gene polymorphisms in patients with features of type 2 diabetes and healthy controls in Korea. Two polymorphisms of the TLR4 gene (Asp299Gly and Thr399Ile) were examined in 225 diabetic patients and 153 healthy controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and single-strand conformation polymorphism (SSCP). RESULTS: No Asp299Gly or Thr399Ile mutations were detected in any of the 378 subjects. Seven subjects from each group who had slightly different SSCP patterns were selected for sequencing, but we found no TLR4 polymorphisms on Exon3. The Asp299Gly and Thr399Ile TLR4 gene polymorphisms were absent in both groups, which was similar to the results for Japanese and Chinese Han subjects. CONCLUSION: Our data and other Asian data suggest that a racial difference can be found in the frequency of the TLR4 polymorphism.

Association of Educational Level and Socioeconomic Status with Glucose Metabolism / 당뇨병

BACKGROUND: The objective of the present study was to examine the association of educational level and socioeconomic status with glucose metabolism including prediabetes. METHODS: This cross-sectional study subjects were 882 (mean age: 51.0 +/- 13.4 years, M:F = 241:641) without diabetes, aged more than 20 years and residing in Whasu 2 dong in Incheon. We classified them into three levels according to their educational level: primary (illiterate or up to elementary school), secondary (middle school or high school) and tertiary (university), and into three levels according to their socioeconomic status by self reported questionnaire: low, middle and high. Subjects were diagnosed as three groups (normal, prediabetes and diabetes) by American Diabetes Association criteria using 75 g oral glucose tolerance test. The association of educational level and socioeconomic status with glucose metabolism was analyzed. RESULTS: The number of normal group was 300 (34.0%), that of prediabetes was 470 (53.3%) and that of diabetes was 112 (12.7%). In women, the proportion of primary educational group was larger than that of secondary educational group in diabetes (Odds ratio [OR] = 1.88; 95% confidence interval [CI]: 1.01-3.51) and larger than that of tertiary educational group in prediabetes ([OR] = 2.00; [CI]: 1.06-3.78). But socioeconomic status did not have the statistical association with glucose metabolism in women. Also both educational level and socioeconomic status had no statistical association with glucose metabolism in men. CONCLUSIONS: The proportion of low educational level is larger in prediabetes and diabetes compared with normal group in women.

Dystrophic Endocardial Calcification Associated with Prior Myocardial Infarction

Myocardial calcification is usually classified as either dystrophic or metastatic. Dystrophic calcification is more common and usually occurs in the area of prior myocardial infarction. It is found in 8% of patients who have been survived longer than 6 years after myocardial infarction. The most common site of calcification is in the anterior wall of the left ventricle or apical and anterolateral aspect in the aneurysm of the left ventricle. We report the case of a 50-years old man with a typical dystrophic calcification of the endocardium in area of myocardial necrosis.

Two Cases of Double-Chambered Right Ventricle without Other Congenital Cardiac Anomalies

Double-chambered right ventricle (DCRV) is a congenital cardiac anomaly in which the right ventricle is divided into two chambers by anomalous hypertrophied muscle bundles that cross the right ventricular cavity. DCRV may be associated with other congenital cardiac anomalies, most commonly with ventricular septal defect. We report two cases of DCRV without other congenital cardiac anomalies with review of literatures. We performed echocardiography, cardiac catheterization and right ventricular angiogram to confirm the diagnosis.

Heparin-Induced Thrombocytopenia (HIT) in Patients with Acute Coronary Syndrome: Incidence and Clinical Feature, Retrospective Study

BACKGROUND: The aims of this study were to find the incidence and clinical features of Heparin-induced thrombocytopenia (HIT) in acute coronary syndrome patients treated with unfractionated heparin. METHODS: The medical records of 554 patients treated with unfractionated heparin (UFH) for their coronary artery diseases at the Gachon Medical School Gil Heart Center during 2002~2003. were retrospectively reviewed. The gourp eligible group inclusion in this study was comprised of 338 patients with acute coronary syndrome. RESULTS: The median duration of UFH administration was 6 days, ranging from 1 to 22 days. Among the eligible patients, 40 (11.8%) received UFH for > 96 hours, and developed thrombocytopenia, which involved a platelet count decrease to less than 100,000 per cubic millimeter or a 50% or greater decrease in the platelet count. CONCLUSION: Despith the limitations of retrospective analyses, the present study shows that thrombocytopenia is relatively common in acute coronary syndrome patients treated with UFH, but did not account for HIT associated complication, such as thrombosis. When clinicians recognize the development of HIT without a thrombocytopenia related disease, many will stop the use of heparin for its management.