Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious acute complications of diabetes mellitus. In this study, we investigated the clinical characteristics of elderly diabetic patients in a hyperglycemic emergency state. Methods: We reviewed the medical records of elderly patients admitted with a diagnosis of DKA and HHS over the past 5 years at the National Medical Center in Korea. Patients were divided into 3 groups: those with only DKA, those with only HHS, and those with both DKA and HHS. We assessed the clinical characteristics, economic vulnerability, precipitating factors, and hospital mortality. Results: Twenty-seven patients (31 episodes) fulfilled the inclusion criteria. Nineteen episodes occurred in male patients. The mean age, blood glucose, and glycosylated hemoglobin (HbA1c) were 78.9 years, 700.7 mg/dL, and 10.6%, respectively. The mean mortality rate was 22.5%; the mortality rates of the DKA only group, the HHS only group, and the group with both DKA and HHS were 10%, 23%, and 37.5%, respectively. DKA was diagnosed in 10 patients (32%), HHS was diagnosed in 13 patients (42%), and both DKA and HHS were diagnosed in 8 patients (26%). There was no relationship between age, sex, economic vulnerability, HbA1c, insulin use, and mortality rate. However, the mortality rate was higher than that of a previous report. Self-discontinuation of diabetes medication and infections are the most common precipitating factors. Conclusion: Elderly patients with diabetes are prone to experience hyperglycemic emergency and have a high mortality rate. Therefore, more focused education and a social medical service system for those with diabetes should be instituted.
Objectives: To determine the effectiveness of an action plan that incorporates evidence-based community interventions in reducing alcohol-related harms in a community. Methods: The No More Alcohol to Drunken (NoMAD) project is a quasi-experimental study that aims to evaluate the impact of a community intervention for a district in reducing alcohol-related harms. The project incorporates evidence-based strategies, such as limiting alcohol in public areas, strengthening crackdown on drink-driving, responsible alcohol server program, screening and brief intervention for high-risk drinking at local clinics or pharmacies, mobile high-risk drinking management program, brain education at schools, and alcohol-free day campaign. The study will employ a difference-in-differences analysis to assess changes in alcohol-related harms 12 months after the implementation of the NoMAD project with non-intervention districts serving as a comparison group. Discussion: To our knowledge, this is the first trial in Korea to evaluate the effectiveness of evidence- and community-based interventions in reducing alcohol-related harms. Our study is expected to provide a prototype for community-environment strategies to prevent alcohol-related harms and establish scientific grounds for the efficacy of community interventions.
The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir.
Leptomeningeal carcinomatosis (LMC) is rare metastatic form of gastric cancer. Most cases are diagnosed in the final stage after multiple distant metastasis. An 84-year-old woman was admitted with melena, headache and vomiting. Esophagogastroduodenoscopy showed an ulceroinfiltrating lesion at the stomach (Borrmann class III), and biopsy revealed a signet ring cell carcinoma. The abdominal-pelvic CT showed no evidence of metastasis. A sudden decrease of consciousness was noted, but the brain CT showed no active lesion while the brain MRI revealed enhancement of leptomeninges. A lumbar puncture was performed and the cerebrospinal fluid study revealed malignant neoplastic cells. With family consent, no further evaluation and treatment were administered and she died six weeks after the diagnosis of gastric cancer. We report an extremely rare case of a patient who initially presented with neurologic symptoms, and was diagnosed LMC from advanced gastric cancer without any evidence of metastasis in abdomen and pelvis.
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