Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.439
Y. Roh
Background: For elderly patients with many chronic and degenerative diseases (multiple comorbidities) and geriatric syndromes, chronic and complex problems should be comprehensively evaluated. The comprehensive geriatric assessment (CGA) is an evaluation of elderly patients in which clinical, medical, and functional evaluations are performed together.Current Concepts: Components of CGA include physical, psychological, and socioenvironmental content. In the physical aspect, the presence of various diseases, determination of the severity of each disease, multi-drug intake (polypharmacy), and vaccination records are evaluated. Geriatric syndromes should also be included in the evaluation. The functional evaluation comprises visual acuity, hearing, upper and lower extremity function, gait ability, balance, fall, urinary incontinence, weight change, oral health, nutritional status, and pain. In the psychological aspect, depression and cognitive function status are evaluated. The residential environment, degree of familial and social support, economic status, and advanced medical directives are evaluated in the socioenvironmental aspect.Discussion and Conclusion: Elderly patients with functional disabilities should be screened via the CGA for various problems and geriatric syndromes that the elderly are prone to developing. Problems found require further evaluation, treatment, and management. In this way, the health and quality of life of the elderly can be maintained and improved.
{"title":"Comprehensive geriatric assessment for the evaluation of the health statuses of elderly patients","authors":"Y. Roh","doi":"10.5124/jkma.2023.66.7.439","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.439","url":null,"abstract":"Background: For elderly patients with many chronic and degenerative diseases (multiple comorbidities) and geriatric syndromes, chronic and complex problems should be comprehensively evaluated. The comprehensive geriatric assessment (CGA) is an evaluation of elderly patients in which clinical, medical, and functional evaluations are performed together.Current Concepts: Components of CGA include physical, psychological, and socioenvironmental content. In the physical aspect, the presence of various diseases, determination of the severity of each disease, multi-drug intake (polypharmacy), and vaccination records are evaluated. Geriatric syndromes should also be included in the evaluation. The functional evaluation comprises visual acuity, hearing, upper and lower extremity function, gait ability, balance, fall, urinary incontinence, weight change, oral health, nutritional status, and pain. In the psychological aspect, depression and cognitive function status are evaluated. The residential environment, degree of familial and social support, economic status, and advanced medical directives are evaluated in the socioenvironmental aspect.Discussion and Conclusion: Elderly patients with functional disabilities should be screened via the CGA for various problems and geriatric syndromes that the elderly are prone to developing. Problems found require further evaluation, treatment, and management. In this way, the health and quality of life of the elderly can be maintained and improved.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"49 2-3 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89194036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.409
E. Rhee
Background: The diagnostic criteria for diabetes mellitus have evolved over time, taking into account new evidence. Here, the author would like to review the evolution of diagnostic criteria for diabetes mellitus, the current diagnostic criteria, and future perspectives.Current Concepts: For the first time, in 1965, the World Health Organization (WHO) recommended that a 2-hour plasma glucose concentration of 130 mg/dL or more after taking a 50-g or 100-g oral glucose bolus may be used to make the diagnosis in people younger than 45 years and that other clinical data might be used to make the diagnosis in people older than 45 years. The 2003 American Diabetes Association Diagnostic Criteria set the threshold for normal fasting glucose at 100 mg/dL. The International Expert Committee (IEC) in 2009, the American Diabetes Association in 2010, and the WHO in 2011 proposed new diagnostic criteria for diabetes: glycated hemoglobin (HbA1c) of 6.5% or higher. More recently, diabetes has been diagnosed via a fasting blood glucose of 126 mg/dL or higher after fasting for at least 8 hours, a 2-hour postprandial blood glucose of 200 mg/dL or higher, glycated hemoglobin of 6.5% or higher, or a random blood glucose of 200 mg/dL or higher with symptoms of hyperglycemia.Discussion and Conclusion: Further research is needed on the accuracy of other markers, such as HbA1c, fructosamine, and 1,5-anhydroglusitol, in the diagnosis of diabetes, and sufficient evidence is required to determine whether it is appropriate to use the same diagnostic criteria for diabetes in aged people and different ethnic groups.
{"title":"The evolution and future of diagnostic criteria for diabetes mellitus","authors":"E. Rhee","doi":"10.5124/jkma.2023.66.7.409","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.409","url":null,"abstract":"Background: The diagnostic criteria for diabetes mellitus have evolved over time, taking into account new evidence. Here, the author would like to review the evolution of diagnostic criteria for diabetes mellitus, the current diagnostic criteria, and future perspectives.Current Concepts: For the first time, in 1965, the World Health Organization (WHO) recommended that a 2-hour plasma glucose concentration of 130 mg/dL or more after taking a 50-g or 100-g oral glucose bolus may be used to make the diagnosis in people younger than 45 years and that other clinical data might be used to make the diagnosis in people older than 45 years. The 2003 American Diabetes Association Diagnostic Criteria set the threshold for normal fasting glucose at 100 mg/dL. The International Expert Committee (IEC) in 2009, the American Diabetes Association in 2010, and the WHO in 2011 proposed new diagnostic criteria for diabetes: glycated hemoglobin (HbA1c) of 6.5% or higher. More recently, diabetes has been diagnosed via a fasting blood glucose of 126 mg/dL or higher after fasting for at least 8 hours, a 2-hour postprandial blood glucose of 200 mg/dL or higher, glycated hemoglobin of 6.5% or higher, or a random blood glucose of 200 mg/dL or higher with symptoms of hyperglycemia.Discussion and Conclusion: Further research is needed on the accuracy of other markers, such as HbA1c, fructosamine, and 1,5-anhydroglusitol, in the diagnosis of diabetes, and sufficient evidence is required to determine whether it is appropriate to use the same diagnostic criteria for diabetes in aged people and different ethnic groups.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"15 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81896533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.427
C. Jeong, T. Sohn
Background: Exercise lowers blood glucose levels, improves insulin sensitivity, and helps prevent complications; therefore, it is highly effective for prevention and treatment of diabetes mellitus. However, many patients with diabetes do not meet the recommendations for the amount of exercise. In this study, we focus on the latest recommendations and discuss exercise therapies that are helpful for patients with diabetes.Current Concepts: Many studies have shown that exercise helps to improve blood glucose control, physical strength, and cardiorespiratory capacity in patients with type 1 or 2 diabetes. Patients with diabetes are advised to perform both aerobic and resistance exercises. Aerobic exercise is suitable for most patients and can rapidly lower blood glucose levels. Resistance exercise improves muscle strength and endurance and is useful for long-term stabilization of blood glucose levels. Combined aerobic and resistance exercise improves insulin resistance and additionally controls blood glucose levels. Patients with diabetes are recommended moderate intensity exercise for at least 150 min/week, at least thrice a week, without interruption in exercise for >2 consecutive days.Discussion and Conclusion: Exercise is an essential recommended lifestyle intervention for patients with diabetes, and regular exercise is important. Furthermore, patients with diabetes should avoid low-energy activities and minimize sitting time.
{"title":"Exercise therapy for diabetes mellitus","authors":"C. Jeong, T. Sohn","doi":"10.5124/jkma.2023.66.7.427","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.427","url":null,"abstract":"Background: Exercise lowers blood glucose levels, improves insulin sensitivity, and helps prevent complications; therefore, it is highly effective for prevention and treatment of diabetes mellitus. However, many patients with diabetes do not meet the recommendations for the amount of exercise. In this study, we focus on the latest recommendations and discuss exercise therapies that are helpful for patients with diabetes.Current Concepts: Many studies have shown that exercise helps to improve blood glucose control, physical strength, and cardiorespiratory capacity in patients with type 1 or 2 diabetes. Patients with diabetes are advised to perform both aerobic and resistance exercises. Aerobic exercise is suitable for most patients and can rapidly lower blood glucose levels. Resistance exercise improves muscle strength and endurance and is useful for long-term stabilization of blood glucose levels. Combined aerobic and resistance exercise improves insulin resistance and additionally controls blood glucose levels. Patients with diabetes are recommended moderate intensity exercise for at least 150 min/week, at least thrice a week, without interruption in exercise for >2 consecutive days.Discussion and Conclusion: Exercise is an essential recommended lifestyle intervention for patients with diabetes, and regular exercise is important. Furthermore, patients with diabetes should avoid low-energy activities and minimize sitting time.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"41 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77168328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.421
S. Chon
Background: Lifestyle modifications including medical nutrition, exercise, and behavioral psychological therapy play a pivotal role in the treatment of diabetes mellitus. In this study, we discuss the fundamental and essential aspects of medical nutrition therapy for treatment of diabetes mellitus based on the medical nutrition recommendations of the Korean Diabetes Association.Current Concepts: Patients with diabetes should receive education for individualized medical nutrition therapy from a qualified clinical dietitian. Overweight adults or those with obesity must lose at least 5% of their body weight. The percentages of carbohydrate, protein, and fat intake are individualized based on treatment goals and preferences. A Mediterranean, vegetarian, low-fat, low-carbohydrate, and Dietary Approaches to Stop Hypertension diet may be used based on individualized plans and priorities. Patients with diabetes are recommended to consume carbohydrates from fiber-rich whole grains, legumes, vegetables, raw fruits, and dairy products and to reduce intake of sweetened beverages. It is not necessary to limit protein intake. Patients with diabetes are recommended to replace foods high in saturated and trans fatty acids with foods rich in unsaturated fatty acids. Routine administration of unsaturated fatty acid supplements is not recommended. Sodium intake should not exceed 2,300 mg/day. Routine use of micronutrient supplements such as vitamins and minerals to improve blood glucose levels is not recommended. Patients using insulin or insulin secretagogues should be counseled to avoid hypoglycemia if they consume alcohol.Discussion and Conclusion: Medical nutrition therapy, which has been shown to treat diabetes and prevent a variety of cardiovascular risk factors and complications, should be utilized aggressively by all healthcare providers who treat patients with diabetes.
{"title":"Medical nutrition therapy for diabetes mellitus","authors":"S. Chon","doi":"10.5124/jkma.2023.66.7.421","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.421","url":null,"abstract":"Background: Lifestyle modifications including medical nutrition, exercise, and behavioral psychological therapy play a pivotal role in the treatment of diabetes mellitus. In this study, we discuss the fundamental and essential aspects of medical nutrition therapy for treatment of diabetes mellitus based on the medical nutrition recommendations of the Korean Diabetes Association.Current Concepts: Patients with diabetes should receive education for individualized medical nutrition therapy from a qualified clinical dietitian. Overweight adults or those with obesity must lose at least 5% of their body weight. The percentages of carbohydrate, protein, and fat intake are individualized based on treatment goals and preferences. A Mediterranean, vegetarian, low-fat, low-carbohydrate, and Dietary Approaches to Stop Hypertension diet may be used based on individualized plans and priorities. Patients with diabetes are recommended to consume carbohydrates from fiber-rich whole grains, legumes, vegetables, raw fruits, and dairy products and to reduce intake of sweetened beverages. It is not necessary to limit protein intake. Patients with diabetes are recommended to replace foods high in saturated and trans fatty acids with foods rich in unsaturated fatty acids. Routine administration of unsaturated fatty acid supplements is not recommended. Sodium intake should not exceed 2,300 mg/day. Routine use of micronutrient supplements such as vitamins and minerals to improve blood glucose levels is not recommended. Patients using insulin or insulin secretagogues should be counseled to avoid hypoglycemia if they consume alcohol.Discussion and Conclusion: Medical nutrition therapy, which has been shown to treat diabetes and prevent a variety of cardiovascular risk factors and complications, should be utilized aggressively by all healthcare providers who treat patients with diabetes.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87211165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.414
T. Oh
Background: Gestational diabetes mellitus (GDM) is a condition characterized by hyperglycemia that is first diagnosed during pregnancy. It increases both fetal and maternal risk and is related to future metabolic abnormalities in women and their offspring. Therefore, appropriate diagnosis and management of GDM are crucial.Current Concepts: There are two strategies to diagnose GDM—a one-step strategy comprising a 75 g oral glucose tolerance test (OGTT), and a two-step strategy involving a 50 g OGTT followed by a 100 g OGTT. The former can detect more glucose abnormality during pregnancy; however, either method is acceptable, considering the evidence regarding pregnancy outcomes. The mainstay of glucose management in GDM is medical nutrition therapy with appropriate physical activity and self-monitoring of glucose. Insulin therapy is required if hyperglycemia cannot be controlled by lifestyle interventions. Generally, insulin therapy is immediately discontinued after childbirth, and 75 g OGTT is recommended at 4 to 12 weeks in the postpartum period and every 1 to 3 years thereafter. Lifestyle intervention is important in women with a history of GDM to prevent future diabetes.Discussion and Conclusion: GDM prevalence is increasing because of higher maternal age and prevalent obesity. Healthcare providers and women of childbearing age need to be more careful with regard to the detection and management of GDM, and treatment strategies should be personalized.
背景:妊娠期糖尿病(GDM)是一种以高血糖为特征的疾病，在妊娠期间首次被诊断出来。它增加了胎儿和母亲的风险，并与妇女及其后代未来的代谢异常有关。因此，正确的诊断和治疗GDM是至关重要的。当前概念:诊断gdm有两种策略:一步策略包括75 g口服葡萄糖耐量试验(OGTT)，两步策略包括50 g OGTT和100 g OGTT。前者能检出更多孕期血糖异常;然而，考虑到有关妊娠结局的证据，任何一种方法都是可以接受的。糖尿病血糖管理的主要方法是药物营养治疗，适当的身体活动和自我血糖监测。如果生活方式干预不能控制高血糖，则需要胰岛素治疗。一般来说，分娩后立即停止胰岛素治疗，建议在产后4至12周及以后每1至3年使用75 g OGTT。生活方式干预对于有GDM病史的女性预防未来糖尿病很重要。讨论与结论:由于产妇年龄增高和普遍肥胖，GDM患病率正在上升。医疗保健提供者和育龄妇女在GDM的检测和管理方面需要更加小心，治疗策略应该个性化。
{"title":"Diagnosis and management of gestational diabetes mellitus","authors":"T. Oh","doi":"10.5124/jkma.2023.66.7.414","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.414","url":null,"abstract":"Background: Gestational diabetes mellitus (GDM) is a condition characterized by hyperglycemia that is first diagnosed during pregnancy. It increases both fetal and maternal risk and is related to future metabolic abnormalities in women and their offspring. Therefore, appropriate diagnosis and management of GDM are crucial.Current Concepts: There are two strategies to diagnose GDM—a one-step strategy comprising a 75 g oral glucose tolerance test (OGTT), and a two-step strategy involving a 50 g OGTT followed by a 100 g OGTT. The former can detect more glucose abnormality during pregnancy; however, either method is acceptable, considering the evidence regarding pregnancy outcomes. The mainstay of glucose management in GDM is medical nutrition therapy with appropriate physical activity and self-monitoring of glucose. Insulin therapy is required if hyperglycemia cannot be controlled by lifestyle interventions. Generally, insulin therapy is immediately discontinued after childbirth, and 75 g OGTT is recommended at 4 to 12 weeks in the postpartum period and every 1 to 3 years thereafter. Lifestyle intervention is important in women with a history of GDM to prevent future diabetes.Discussion and Conclusion: GDM prevalence is increasing because of higher maternal age and prevalent obesity. Healthcare providers and women of childbearing age need to be more careful with regard to the detection and management of GDM, and treatment strategies should be personalized.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"32 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89941381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-10DOI: 10.5124/jkma.2023.66.7.432
Sun Joon Moon, Won-Young Lee
Background: Emerging evidence suggests that controlling both glycemic variability and hemoglobin A1c is necessary to prevent complications associated with diabetes mellitus. Hence, continuous glucose monitoring (CGM) is crucial for effectively managing diabetes.Current Concepts: There are two primary types of CGM. Retrospective CGM only allows the reviewal of glycemic data after the monitoring period, whereas personal CGM allows real-time monitoring. Personal CGM can be further categorized into real-time CGM and intermittently scanned CGM. To interpret CGM data, time in range (TIR) is considered the standard parameter. A TIR of 70–180 mg/dL for more than 70% of the period has been established as a typical target for both type 1 and type 2 diabetes. Other parameters such as time below range, time above range, coefficient of variation, and glucose management indicator should also be reviewed. Importantly, numerous clinical studies have demonstrated the efficacy of CGM in both type 1 and type 2 diabetes.Discussion and Conclusion: A wealth of clinical evidence supports the application of CGM in diabetes, confirming its effectiveness across various treatment stages. CGM has emerged as a compelling therapeutic option in instances when other treatment choices remain limited. With a growing body of clinical evidence, the widespread adoption of CGM in diabetes management appears inevitable. However, challenges related to user comfort, cost, the need for extensive data interpretation, and necessary system improvements remain unaddressed. Further research is required to validate the appropriate usage and frequency of CGM through costeffectiveness analyses.
{"title":"Importance of continuous glucose monitoring in the treatment of diabetes mellitus","authors":"Sun Joon Moon, Won-Young Lee","doi":"10.5124/jkma.2023.66.7.432","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.7.432","url":null,"abstract":"Background: Emerging evidence suggests that controlling both glycemic variability and hemoglobin A1c is necessary to prevent complications associated with diabetes mellitus. Hence, continuous glucose monitoring (CGM) is crucial for effectively managing diabetes.Current Concepts: There are two primary types of CGM. Retrospective CGM only allows the reviewal of glycemic data after the monitoring period, whereas personal CGM allows real-time monitoring. Personal CGM can be further categorized into real-time CGM and intermittently scanned CGM. To interpret CGM data, time in range (TIR) is considered the standard parameter. A TIR of 70–180 mg/dL for more than 70% of the period has been established as a typical target for both type 1 and type 2 diabetes. Other parameters such as time below range, time above range, coefficient of variation, and glucose management indicator should also be reviewed. Importantly, numerous clinical studies have demonstrated the efficacy of CGM in both type 1 and type 2 diabetes.Discussion and Conclusion: A wealth of clinical evidence supports the application of CGM in diabetes, confirming its effectiveness across various treatment stages. CGM has emerged as a compelling therapeutic option in instances when other treatment choices remain limited. With a growing body of clinical evidence, the widespread adoption of CGM in diabetes management appears inevitable. However, challenges related to user comfort, cost, the need for extensive data interpretation, and necessary system improvements remain unaddressed. Further research is required to validate the appropriate usage and frequency of CGM through costeffectiveness analyses.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"79 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79074772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-10DOI: 10.5124/jkma.2023.66.6.336
S. Ahn, Seung Ju Lee, M. Oh
Background: Recurrent cystitis is a common condition affecting women, often causing discomfort and negatively impacting their quality of life. Despite the high level of morbidity, this condition is frequently overlooked due to relatively low fatality rate. This lack of adequate awareness about recurrent cystitis has led to increased healthcare costs, inappropriate utilization of medical resources, and growing antibiotic resistance. Therefore, there is an urgent need to raise awareness and improve the strategies employed for managing recurrent cystitis.Current Concepts: The socioeconomic burden imposed by recurrent cystitis is substantial, with billions of dollars spent worldwide every year on its diagnosis and treatment. Unnecessary emergency room visits and loss of labor due to illness further exacerbate the costs. Additionally, recurrent cystitis significantly diminishes patients’ quality of life, leading to psychological challenges such as anxiety and depression. Recent research has highlighted the importance of identifying underlying conditions and modifying lifestyle behaviors, in addition to actual treatment, to improve patients’ quality of life.Discussion and Conclusion: It is important to implement various strategies to raise awareness and foster interest in recurrent cystitis. These include patient education, public awareness campaigns, healthcare professional training, online resources, and research collaboration. By increasing awareness and adopting a proactive approach to managing recurrent cystitis, we can improve patient outcomes and enhance the overall efficiency of the healthcare system, ultimately benefiting patients, medical staff, and society as a whole.
{"title":"Raising awareness of recurrent cystitis among women","authors":"S. Ahn, Seung Ju Lee, M. Oh","doi":"10.5124/jkma.2023.66.6.336","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.6.336","url":null,"abstract":"Background: Recurrent cystitis is a common condition affecting women, often causing discomfort and negatively impacting their quality of life. Despite the high level of morbidity, this condition is frequently overlooked due to relatively low fatality rate. This lack of adequate awareness about recurrent cystitis has led to increased healthcare costs, inappropriate utilization of medical resources, and growing antibiotic resistance. Therefore, there is an urgent need to raise awareness and improve the strategies employed for managing recurrent cystitis.Current Concepts: The socioeconomic burden imposed by recurrent cystitis is substantial, with billions of dollars spent worldwide every year on its diagnosis and treatment. Unnecessary emergency room visits and loss of labor due to illness further exacerbate the costs. Additionally, recurrent cystitis significantly diminishes patients’ quality of life, leading to psychological challenges such as anxiety and depression. Recent research has highlighted the importance of identifying underlying conditions and modifying lifestyle behaviors, in addition to actual treatment, to improve patients’ quality of life.Discussion and Conclusion: It is important to implement various strategies to raise awareness and foster interest in recurrent cystitis. These include patient education, public awareness campaigns, healthcare professional training, online resources, and research collaboration. By increasing awareness and adopting a proactive approach to managing recurrent cystitis, we can improve patient outcomes and enhance the overall efficiency of the healthcare system, ultimately benefiting patients, medical staff, and society as a whole.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"34 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75635067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-10DOI: 10.5124/jkma.2023.66.6.343
Seung-hwan Jeong, J. Ku
Background: Hematuria is a common condition caused by various factors, including infections, inflammations, stone diseases, and anatomical abnormalities. While hematuria can be mistaken for other conditions, its significance should not be overlooked, as studies have shown that some patients with hematuria are diagnosed with urological cancers.Current Concepts: Experts agree on the need for specific diagnostic tests such as cystoscopy, upper urinary tract imaging, and urine cytology for visible hematuria. However, opinions differ when it comes to microscopic hematuria. Delays in diagnosing bladder cancer can significantly impact mortality rates. Therefore, objective diagnostic criteria, as well as guidelines to reduce excessive evaluations, costs, and side effects, are required. As of 2020, the American Urological Association has released new guidelines for the diagnosis and management of microscopic hematuria, that focus on assessing the risk of urological malignancies in individual patients and recommend tailored evaluations based on risk levels. This article provides an overview of these guidelines, discussing diagnostic criteria, initial evaluations, risk stratification, and recommended evaluations of the urinary tract.Discussion and Conclusion: Guidelines on hematuria aim to reduce unnecessary invasive procedures, provide appropriate follow-up strategies to patients with persistent or recurrent microscopic hematuria, and improve patient outcomes while minimizing unnecessary tests and procedures.
{"title":"Clinical guidelines for diagnosis of hematuria","authors":"Seung-hwan Jeong, J. Ku","doi":"10.5124/jkma.2023.66.6.343","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.6.343","url":null,"abstract":"Background: Hematuria is a common condition caused by various factors, including infections, inflammations, stone diseases, and anatomical abnormalities. While hematuria can be mistaken for other conditions, its significance should not be overlooked, as studies have shown that some patients with hematuria are diagnosed with urological cancers.Current Concepts: Experts agree on the need for specific diagnostic tests such as cystoscopy, upper urinary tract imaging, and urine cytology for visible hematuria. However, opinions differ when it comes to microscopic hematuria. Delays in diagnosing bladder cancer can significantly impact mortality rates. Therefore, objective diagnostic criteria, as well as guidelines to reduce excessive evaluations, costs, and side effects, are required. As of 2020, the American Urological Association has released new guidelines for the diagnosis and management of microscopic hematuria, that focus on assessing the risk of urological malignancies in individual patients and recommend tailored evaluations based on risk levels. This article provides an overview of these guidelines, discussing diagnostic criteria, initial evaluations, risk stratification, and recommended evaluations of the urinary tract.Discussion and Conclusion: Guidelines on hematuria aim to reduce unnecessary invasive procedures, provide appropriate follow-up strategies to patients with persistent or recurrent microscopic hematuria, and improve patient outcomes while minimizing unnecessary tests and procedures.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"35 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78915829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-10DOI: 10.5124/jkma.2023.66.6.355
B. Tae
Background: Hematuria is defined by the presence of red blood cells in the urine, usually treated by primary care physicians. Various urologic conditions cause this common finding. While malignancies are often considered in the differential diagnosis, benign urologic conditions also need to be recognized as potential causes of hematuria. A better understanding of these benign conditions can help avoid unnecessary diagnostic procedures and improve patient outcomes.Current Concepts: This review provides an overview of the current concepts regarding benign urologic conditions associated with hematuria. These include urinary tract infections, urolithiasis, benign prostatic hyperplasia, vascular conditions affecting the urinary tract, and hemorrhagic cystitis. Based on the latest literature, we discuss the epidemiology, clinical presentation, diagnostic evaluation, and management options for each benign condition.Discussion and Conclusion: Clinical presentation, diagnostic evaluation, and management of each condition are discussed. A comprehensive understanding of these benign urologic conditions is essential for accurately diagnosing and effectively managing hematuria.
{"title":"Benign urologic diseases that cause hematuria","authors":"B. Tae","doi":"10.5124/jkma.2023.66.6.355","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.6.355","url":null,"abstract":"Background: Hematuria is defined by the presence of red blood cells in the urine, usually treated by primary care physicians. Various urologic conditions cause this common finding. While malignancies are often considered in the differential diagnosis, benign urologic conditions also need to be recognized as potential causes of hematuria. A better understanding of these benign conditions can help avoid unnecessary diagnostic procedures and improve patient outcomes.Current Concepts: This review provides an overview of the current concepts regarding benign urologic conditions associated with hematuria. These include urinary tract infections, urolithiasis, benign prostatic hyperplasia, vascular conditions affecting the urinary tract, and hemorrhagic cystitis. Based on the latest literature, we discuss the epidemiology, clinical presentation, diagnostic evaluation, and management options for each benign condition.Discussion and Conclusion: Clinical presentation, diagnostic evaluation, and management of each condition are discussed. A comprehensive understanding of these benign urologic conditions is essential for accurately diagnosing and effectively managing hematuria.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"79 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73555945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-10DOI: 10.5124/jkma.2023.66.6.363
Sung Jin Kim, Myungchan Park, S. Yoo
Background: Hematuria, characterized by red blood cells in the urine, is a clinical symptom that demands an immediate investigation for potential urologic cancers, particularly in cases of gross hematuria. This study seeks to comprehensively review various urologic malignancies causing hematuria, such as urothelial carcinoma, renal cell carcinoma, and prostate ductal carcinoma. The review is anchored on the current urologic clinical guidelines and published literature.Current Concepts: Gross hematuria commonly signifies urologic cancer, with approximately 20% of gross hematuria cases and 5% of microscopic hematuria cases associated with a urologic cancer diagnosis. Cystoscopy and imaging studies of the upper urinary tract are recommended in patients presenting with gross hematuria, with urine cytology as a potential supplementary test. Conversely, in the presence of microscopic hematuria only, it is advisable to conduct appropriate tests while considering variables such as patient age. When hematuria occurs alongside antithrombotic drug administration, it is crucial not to forego appropriate testing due to the antithrombotic medication. Hematuria is a prevalent symptom of bladder cancer, renal cancer, and urothelial carcinoma; it can also be present in patients with prostate ductal carcinoma.Discussion and Conclusion: In instances of no urinary tract infection or other discernible cause of hematuria, a consultation with a urologist is recommended, irrespective of the patient’s age. When dealing with patients with urologic cancer, an early diagnosis is a critical factor influencing patient prognosis. Therefore, enhanced attention and a deeper understanding of urologic cancers that can precipitate hematuria are necessary.
{"title":"Urologic malignancies that cause hematuria","authors":"Sung Jin Kim, Myungchan Park, S. Yoo","doi":"10.5124/jkma.2023.66.6.363","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.6.363","url":null,"abstract":"Background: Hematuria, characterized by red blood cells in the urine, is a clinical symptom that demands an immediate investigation for potential urologic cancers, particularly in cases of gross hematuria. This study seeks to comprehensively review various urologic malignancies causing hematuria, such as urothelial carcinoma, renal cell carcinoma, and prostate ductal carcinoma. The review is anchored on the current urologic clinical guidelines and published literature.Current Concepts: Gross hematuria commonly signifies urologic cancer, with approximately 20% of gross hematuria cases and 5% of microscopic hematuria cases associated with a urologic cancer diagnosis. Cystoscopy and imaging studies of the upper urinary tract are recommended in patients presenting with gross hematuria, with urine cytology as a potential supplementary test. Conversely, in the presence of microscopic hematuria only, it is advisable to conduct appropriate tests while considering variables such as patient age. When hematuria occurs alongside antithrombotic drug administration, it is crucial not to forego appropriate testing due to the antithrombotic medication. Hematuria is a prevalent symptom of bladder cancer, renal cancer, and urothelial carcinoma; it can also be present in patients with prostate ductal carcinoma.Discussion and Conclusion: In instances of no urinary tract infection or other discernible cause of hematuria, a consultation with a urologist is recommended, irrespective of the patient’s age. When dealing with patients with urologic cancer, an early diagnosis is a critical factor influencing patient prognosis. Therefore, enhanced attention and a deeper understanding of urologic cancers that can precipitate hematuria are necessary.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"73 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76066024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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