Korean Journal of Family Medicine

Understanding the Mechanism of Action and Clinical Implications of Anti-Obesity Drugs Recently Approved in Korea: Kyoung Kon Kim; Korean J Fam Med 2019;40(2):63-71. Published online March 20, 2019; DOI: https://doi.org/10.4082/kjfm.19.0013

Abstract
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The Korean Ministry of Food and Drug Safety has approved three anti-obesity drugs for long-term management in the past decade. In addition, since 2019, bariatric surgery has been financially supported by National Health Insurance Service in Korea. In this review, the mechanisms of action and the clinical implications of the recently approved anti-obesity drugs, lorcaserin, naltrexone/bupropion, and liraglutide are explained. Lorcaserin stimulates proopiomelanocortin (POMC)/cocaine- and amphetamine-regulated transcript (CART) neurons and inhibits neuropeptide Y (NPY)/agouti-related peptide (AgRP) neurons, which results in the activation of melanocortin 3/4 receptors. Naltrexone/bupropion stimulates POMC neurons through bupropion; this stimulation is augmented by blocking the autoinhibitory mechanism of POMC with naltrexone. The hypophagic effect of liraglutide is mediated through the direct activation of POMC/CART neurons and the indirect suppression of NPY/AgRP neurons through γ-aminobutyric acid-dependent signaling, with adjunctive suppression of the mesolimbic dopamine reward system. In addition to liraglutide, another glucagon-like peptide-1 receptor agonist, semaglutide, is expected to be added to the list of anti-obesity drugs in the near future. In patients with obesity and high cardiovascular risk, lorcaserin was considered neutral and liraglutide was considered favorable, whereas inconclusive results were obtained for naltrexone/bupropion.

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A Possible Case of Statin-Induced Ichthyosis in an Elderly Woman: Ki Dong Ko, Kyoung Kon Kim, Jin-Ok Baek, Heuy Sun Suh, In Cheol Hwang; Korean J Fam Med 2018;39(1):51-53. Published online January 23, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.1.51

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Ichthyosis is a heterogeneous group of hereditary or acquired skin disorders, characterized by increased stratum corneum production. Several systemic diseases and many drugs can occasionally cause acquired ichthyosis. We report a case of statin-induced ichthyosis in which the causality between statin and ichthyosis was found possible by using the Naranjo scale. A 79-year-old woman presented with pruritic skin lesions on both legs that appeared erythematous, scaly, and cracked. A clinical diagnosis of acquired ichthyosis was made and the statin was suspected as the cause. The skin lesions improved after 6 weeks of dose reduction of the statin.

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Journal of the American Academy of Dermatology.2025;[Epub] CrossRef
Acquired ichthyosis, asteatotic dermatitis or xerosis? An update on pathoetiology and drug‐induced associations
Jason S. Park, Amir H. Saeidian, Leila Youssefian, Sylvia Hsu, Hassan Vahidnezhad, Jouni Uitto
Journal of the European Academy of Dermatology and Venereology.2023; 37(1): 47. CrossRef
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One Case of Malignant Mixed Mullerian Tumor Developed in a Postmenopausal Woman under Hormone Therapy.: In Cheol Hwang, Myoung Jin Kuk, Kyoung Kon Kim, Ki Bum Lee, Seo Young Na, Kyoung Sik Lee, Heuy Sun Suh; Korean J Fam Med 2009;30(9):723-727. Published online September 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.9.723

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Hormone therapy for peri- and postmenopausal women is widely used for relieving vasomotor symptoms or preventing osteoporosis. Even though exogenous hormone is the most common cause of vaginal bleeding in postmenopausal women under hormone therapy, in clinical practice, physicians must never exclude the possibility of endometrial disorders, such as endometrial hyperplasia or cancer. Taking thorough medical history and performing physical and pelvic examinations are essential for the evaluation of abnormal uterine bleeding in menopausal hormone therapy. Transvaginal ultrasonography, endometrial aspiration biopsy, dilatation and curettage, and hysteroscopy are the options which physicians may use. This case is about a woman with continuous combined hormone therapy for 5 years who had experienced rather sudden onset of vaginal spotting lasting for several months and was fi nally diagnosed as having malignant mixed Müllerian tumor. Our purpose is to inquire into the proper approaching steps for vaginal bleeding in menopausal hormone therapy.

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Clinical Implication of Plasma Uric Acid Level.: Young Tae Shin, Kyoung Kon Kim, In Cheol Hwang; Korean J Fam Med 2009;30(9):670-680. Published online September 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.9.670

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The debate over the clinical meaning of plasma uric acid level is still a very hot issue. As the interest in health grows larger in the general public, the number of having a regular health check-up is increasing rapidly. Most of the health care centers routinely check the plasma uric acid level but it is not simple to interpret and explain the appropriate meaning of that. Over the past decade, there have been several studies on clinical implication of plasma uric acid level but the question still remains. However the clinical signifi cance of the results might be different according to the severity of cardiovascular risk among subjects studied, and the fi ndings for correlation with the established risks have enough proof to be applied to clinical practice. Additionally, the uric acid-lowering agents should not be used in general population even though it has reason to be prescribed in a specifi c high risk patient. Thus, this review seeks to be helpful in clinical practice by examining the preexisting related studies in a different perspective.

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Aspirin Usage Based on Evidence for the Prevention of Cardio-Cerebrovascular Disease.: Young Sang Kim, Kyoung Kon Kim, In Cheol Hwang; Korean J Fam Med 2009;30(4):249-260. Published online April 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.4.249

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Aspirin is well known for its central role in preventing cardio cerebrovascular diseases as an antiplatelet agent. However besides its favorable effects, one must also be fully aware of its side effects such as gastrointestinal complications or cerebral hemorrhage. Particularly when prescribing to Koreans, one must be highly cautious, considering the higher prevalence of helicobacter pylori infection and the contribution of hemorrhagic stroke as a major part of cerebral disease in Korean. Currently the guideline for secondary prevention of cardio cerebrovascular diseases is relatively well established, while the consensus for primary prevention is still controversial. The purpose of this paper would be to summarize the evidence of aspirin usage in preventing cardio cerebrovascular diseases, examine the additional factors one must consider, and help primary physician prescribing aspirin appropriately.

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A Patient with Dyspnea, Chest Pain and Fatigue due to Angina Pectoris Treated with Saengmaeg-san-hap-Bojungikgi-tang-gami : A Case Report
Do-yeon Park, Hyang-ran Moon, Hui-jeong Noh
The Journal of Internal Korean Medicine.2024; 45(3): 478. CrossRef
Effect of Herbal Medicines on Preventing Restenosis After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Nayeon Hur, Subin Ahn, Hongjun Kim, Insoo Jang
The Journal of Internal Korean Medicine.2023; 44(3): 387. CrossRef

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Two Cases of Dengue Fever in Family Medicine.: Hyun Sik Park, Kyoung Kon Kim, Joong Yoon, Kyu Rae Lee, Heuy Sun Suh; J Korean Acad Fam Med 2008;29(1):48-51. Published online January 10, 2008

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Level of Understanding of Importance of Preventing and Treating Dermatophytoses in Diabetic Patients.: Bong Wu Wu, Sung Kyung Je, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2007;28(5):359-366. Published online May 10, 2007

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Background
Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. Methods: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. Results: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. Conclusion: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses. (J Korean Acad Fam Med 2007;28: 359-366)

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Factors Attributing to Increasing Attempts at Central Venous Catheterization.: Dong Hoon Suh, Dong Hee Oh, Hee Sun Seo, Kyung Hee Cho, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2006;27(4):288-293. Published online April 10, 2006

Abstract
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Background
: Central venous catheterization allows the measurement of hemodynamic variables, the delivery of medications and nutritional support. It also has been used as a means to treat sepsis, cardiogenic and hemodynamic shocks. Arterial puncture, hematoma, and pneumo-hemothorax are the most common mechanical complications during the insertion of central venous catheters. This study was done to find out the factors attributing to the increase of puncture attempts in subclavian venous catheter insertion.

Methods : We have conducted surveys in residents who had previous experience with insertion of subclavian venous catheterization in Ilsan hospital from 01/09/2003 to 30/11/2003. A total of 40 cases were marked as two groups, those with less than three puncture attempts and those with more than or equal to three attempts.

Results : The incidence of three or less insertion attempts were 23, whereas in 17 cases three or more attempts were required. The results of the comparison between these two groups proved that the patient's hemoglobin level, skeletal deformity, the level of experience (more than 20), puncture site marking and insertion in the mid-clavicular line were significant factors (P＜0.05).

Conclusion : It seemed necessary to try three or less puncture attempts in order to decrease the incidence of mechanical complications. The operator factors such as previous experience with the procedure, puncture site marking prior to insertion, and insertion in the mid-clavicular line had affected the number of puncture attempts.

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How Many Diabetes Patients Know the Name of Hypoglycemic Agents They Are Taking?.: Oh Byung Kwon, Jong Ho Yu, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2005;26(8):456-463. Published online August 10, 2005

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Background
: Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control.

Methods : A cross-sectional questionnaire survey was done from March to May 2004, targeting inpatients and outpatients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals.

Results : 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P＜0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P＜0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to take medicine (P＜0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P＜0.0001) were the independent related factors after adjustment.

Conclusion : The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.

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An Analysis of Attitudes on Euthanasia between Residents and Judicial Apprentices.: Jong Ho You, Oh Byung Kwon, Kyoung Kon Kim, Hee Cheol Kang, Myung Se Son, Kyoung Whan Lee; J Korean Acad Fam Med 2005;26(6):327-336. Published online June 10, 2005

Abstract
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Background
: Recently, the legal and ethical issues relative to euthanasia are becoming controversial in Korea. This study was designed to verify the differences of the attitudes on euthanasia between judicial apprentices and residents.

Methods : The questionnaire was conducted on the 35th-group of the judicial apprentices on March 24, 2004, and on the residents from April 2 to May 22, 2004. The respondents were 636 in total consisting of 460 judicial apprentices and 176 residents.

Results : Of the total 636 subjects, 373 (81.1%) of the judicial apprentices and 149 (84.7%) of residents agreed that allowing euthanasia is moral, without any significant difference (P＞0.05). The number of residents was greater (59 people, 33.5%) than that of judicial apprentices (112 people, 24.4%) who agreed with active euthanasia (P＜0.05). Among the total, 397 (86.3%) of the judicial apprentices and 160 (91.4%) of the residents answered that the law for euthanasia was necessary, without any significant difference (P＞0.05). But, among these supporters, the respondents who agreed on active euthanasia were significantly different in number between judicial apprentices (n=93, 23.4%) and residents (n=54, 33.8%) (P＜0.05).

Conclusion : This study did not find any significant differences between the two groups in the necessity of the law for euthanasia, but the rate of agreement on active euthanasia was higher in residents group than in judicial apprentices group.

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Predictors of High Peak Serum CK Levels in Doxylamine Intoxication.: Hea Jung Shin, Sung Kyung Lee, Kyoung Kon Kim, Kyung Hee Cho, Yong Joon Kang, Hee Chul Kang, Bang Bu Youn; J Korean Acad Fam Med 2004;25(3):216-223. Published online March 10, 2004

Abstract
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Background
: Because doxylamine succinate (DS) is an over-the-counter medicine, it can be obtained easily and is frequently used in suicidal attempts. Patients usually recover without serious complications, but occasionally rhabdomyolysis and even death can occur in DS intoxication. In this study, the authors tried to find out the independent predictors of high peak serum CK levels, i.e. probable rhabdomyolysis in DS intoxication.

Methods : The medical records of 41 patients who visited a hospital for DS intoxication from January 1, 2002 to April 30, 2003, were reviewed retrospectively.

Results : In the group of DS only, initial occult blood of urine (P=0.003), initial WBC count (P=0.003) and confusion (P= 0.007) were the best predictors of the peak serum CK level (r²=0.724). In the group of DS with other drugs intoxication, initial creatinine level (P=0.003) and initial occult blood of urine (P=0.007) were the best predictors of the peak serum CK level (r²=0.784). In the cases of rhabdomyolysis patients, the time taken for the CK level to be increased over 1,000 IU/L was 1.9±0.6 days.

Conclusion : In DS only intoxication, occult blood in initial urine analysis, initial high WBC count and confusion can be thought of as useful clinical predictors for high peak serum CK level case. In DS with other drugs intoxication, initial creatinine level and initial occult blood of urine can be considered as the best predictors. More than 2 days will be needed for the observation of serious complications in DS intoxication.

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Change of Body Composition in Obese Women with Short-term Low Calory Diets.: Hong Ki Lee, Young Gan Lee, Bok Gi Lee, Kyu Rae Lee, Kyoung Kon Kim, Hee Cheol Kang, Bang Bu Yun; J Korean Acad Fam Med 2004;25(1):21-27. Published online January 10, 2004

Abstract
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Background
: A reasonable weight reduction method is to reduce fat-body mass while preserving fat-free mass. Recently, many people in Korea have been trying reckless diet therapy for weight reduction by means of low calory and protein diets, which gave rise to many side effects consequently. For reasonable weight reduction, this study was undertaken to investigate the significant dietary factors that change body composition during short-term low calory diet.

Methods : Twenty six healthy obese women aged 23∼37 years, whose BMI was greater than 24, volunteered for the 6 week diet therapy from January to April in 2003. All subjects were instructed to eat approximately 1,200 kcal/day and keep a dietary diary. In the beginning the 3rd week and the 6th week of the study, subjects' body weight were measured and fat body weight were measured by BIA. In the 6th week, the analysis of the dietary diary was conducted.

Results : There was a significant positive correlation between the protein intake per ideal body weight in the first 3 weeks and the fat-free mass increase in the latter 3 weeks (P＜0.05). At the same time, the fat intake in the first 3 weeks had positive correlation with the fat-free mass in the latter 3 weeks, also (P＜0.05). But, we could not find any significant values that had effect on the fat-free mass increase in multiple regression analysis.

Conclusion : The protein intake in the first 3 weeks helped to preserve the fat-free mass in the latter 3 weeks, and had positive effects.

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A Study on Hair Mineral Concentrations in Diabetic Patients.: Soo Ick Jang, Kyoung Kon Kim, Bok Gi Lee, Hyung Joon Kim, Soo Hyun Lew, Hee Cheol Kang, Bang Bu Youn; J Korean Acad Fam Med 2002;23(9):1133-1140. Published online September 10, 2002

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A survey on change of perception and satisfaction of family medicine (From patients add in one general hospital in seoul).: Young Ju Kim, Kyu Ho Kim, Kyoung Kon Kim, Hyuk Jung Kweon, Bang Bu Youn; J Korean Acad Fam Med 2001;22(4):517-527.

Abstract

BACKGROUND
The author surveyed and analyzed the changes of perception and satisfaction about family medicine. So that the outcome may bring us a reference to advance family medicine more.
METHODS
247 in and out patients in one general hospital in Seoul were surveyed by the questionnaire from July 26, 2000 to June 20. The date was analyzed statistically by SAS program.
RESULTS
As for the knowledge of family medicine, 61.5% of the patients answered that they knew what it is, and the most of them, 54%, via medical institution. The office workers, married , and highly educated people tend to know more about family medicine (P<0.05). As for attitude, 68% of the group answered that family medicine is necessary, because "family medicine doctors give proper advice and consult through out all fields of medicine"(58.8%). As for the preference so prirate doctor, 56.7% of the group answered that they would register for family medicine clinic, and students and office workers are fond of family medicine(P<0.05). As for the satisfaction, 34.4% were ever been to family medicine clinic, and 35.5% out of them were dissatisfied, mainly due to the lack of knowledge of physicians about their diseases(70.1%).
CONCLUSION
The perception of family medicine are still scanty compared to the old studies.