Eun Sil Lee

Comparison of adverse event profile of intravenous iron sucrose and iron sucrose similar in postpartum and gynecologic operative patients

Abstract Objective Severe iron deficiency resulting in anemia is a common problem during pregnancy and in menstruating women. Several choices for IV iron replacement therapies exist and increased pressures on budgets may require cheaper ‘iron sucrose similar’ (ISS) to be used. In our practice, an iron sucrose similar (Ferex; ISSFRX) was introduced to reduce costs in the treatment of pregnant women or those planned for surgery. Post several months of use we observed increased rates of adverse events from patients and hence performed this analysis to confirm these findings. Methods Data on adverse events was retrospectively collected from 658 patients treated between September 2004 and December 2011. Patients were analyzed in three cohorts, iron sucrose originator (ISORIG), ISSFRX diluted in 100 mL saline and ISSFRX diluted in 200 mL saline. Results The mean age was 38.5 years and included patients having normal delivery, Cesarean section, myomectomy, hysterectomy, cystectomy and adnexectomy. There were 169 patients in the ISORG group and 210 and 279 in the ISSFRX-100 and ISSFRX-200 groups respectively. Adverse drug reactions were more frequent in the ISSFRX groups vs. ISORIG (11.0 vs. 14.3 vs. 1.8%; p < 0.02). Events were mild-to-moderate in nature and were predominately injection site reactions and phlebitis. Results may be impacted by imbalance in baseline characteristics and cumulative iron dose received, however events were mostly acute and all patients received 200 mg iron as single administration. Conclusion This is the first large analysis suggesting increased adverse events due to an ISS. For our practice, the use of ISSFRX was discontinued owing to safety concerns outweighing the theoretical cost benefit. This study raises the question on the appropriate approval process for complex drugs and if these can be substituted without appropriate clinical testing, both for efficacy and most importantly safety, in routine clinical practice.

Awareness and Experience of Menopausal Symptom and Hormone Therapy in Korean Postmenopausal Women

Objectives To investigate awareness and experience of menopausal symptom and hormone therapy in Korean postmenopausal women. Methods A total of 570 postmenopausal women were accepted our survey. The women filled out the questionnaires composed of medical and surgical history, menopausal age and symptom, demand of treatment on menopausal symptom, and personal method for overcoming the symptom. Also, we make inquiries about experience of hormone therapy, concern about hormone therapy, improvement of menopausal symptom after therapy, adverse effect, and cause of cease the therapy. Results According to the survey, 80% (456/570) of the women experienced menopausal symptom. When they felt the symptom at first, 47% (213/570) of women was 46-50 years old. The most common menopausal symptom was hot flushes (141/570). A number of Korean women regarded that menopause was a natural process of ageing (69%). Eighty two % of women thought to need to have treatment on menopausal symptom. However, only half (43%) visited doctor. The most concerned disease after menopause they had answered was osteoporosis (60%) but only 22% of women were taken regular check-up of bone mineral density. The common causes were unwilling to do treatment were concern about adverse effect (51%) and indefinite fear of cancer (32%). Moreover, many women got diverse information about menopause from the mass media than professional advice. Conclusion Only a minority of Korean postmenopausal women with menopausal symptoms had taken a hormone therapy. We should provide appropriate education and counsel to Korean peri-menopause women.

Prevalence of Sarcopenia in Healthy Korean Elderly Women

Background We evaluated the prevalence of sarcopenia, presarcopenia, and severe sarcopenia in healthy Korean elderly women. Methods We measured the muscle mass and muscle function of 196 ambulatory women over the age of 65 years who visited the University Hospital Menopause Clinic. Appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry to measure skeletal muscle mass index (SMI). Assessment of hand grip strength (HGS) of the dominant hand was performed to measure the muscle strength, and 4-m straight on-way path was used to measure gait speed for physical performance. The values used to define the presarcopenia, sarcopenia, and severe sarcopenia were based on the cutoff values proposed by the Asian Working Group for Sarcopenia (AWGS). Results The mean age of women was 71.2 years, and the mean SMI in 196 women was 5.94 kg/m2. The average HGS was 20.3 kg, and the mean gait speed was 1.08 m/sec. In 41 out of the 196 women (20.9%), the SMI was reduced to less than 5.4 kg/m2. Fifty-nine women (30.1%) had HGS of less than 18 kg, and gait speed was less than 0.8 m/sec in 12 women (6.1%). Twenty-six women (13.3%) were classified into the presarcopenia stage, and 15 women (7.6%) were classified into the sarcopenia stage. There was no case of severe sarcopenia. Conclusions One out of five relatively healthy women aged more than 65 years showed a decrease in muscle mass, and 7.6% of women showed a decrease in muscle mass and strength. The sarcopenia stage was also intensified with aging.

A new compound heterozygous mutation in the CYP17A1 gene in a female with 17α-hydroxylase/17,20-lyase deficiency.

Abstract Background: Congenital adrenal hyperplasia due to 17α-hydroxylase/17,20-lyase deficiency (OMIM #202110) is a rare autosomal recessive disorder, which is caused by mutations of the CYP17A1 gene located on chromosome 10q24.3. It has been reported that the type of mutation of the CYP17A1 gene was associated with the extent of 17α-hydroxylase/17,20-lyase deficiency, and the prevalence of common mutation was different among ethnic groups. Case: A 21-year-old Korean female presented with primary amenorrhea and sexual infantilism, and intermittent hypokalemic episodes. Laboratory test was consistent with hypergonadotropic hypogonadism. The karyotype was 46,XX[20]. Genomic DNA was extracted from peripheral blood leukocytes. All the eight exons of the CYP17A1 gene including flanking regions of introns were amplified by PCR. The mutations of the CYP17A1 gene were detected by direct sequencing. A compound heterozygous mutation was identified; one allele had a missense mutation of c.1118A>T (p.His373Leu), which was reported previously and induced the complete loss of both 17α-hydroxylase/17,20-lyase activity. This mutation has been known to be one of the common mutation types in East Asia. The other allele had a novel 1-bp deletion c.1148delA causing frameshift, premature termination codon (p.Glu383fs) and induced truncated enzymes. Conclusion: Our experience for stepwise clinical, laboratory and molecular approach would be helpful to diagnose these patients accurately and understand the genetic events in 17α-hydroxylase/17,20-lyase deficiency patients.

A Flood of Health Functional Foods: What Is to Be Recommended?

Health functional food is referred to a food prepared or processed from specific components or ingredients for functionality beneficial to the body through extraction, concentration, purification, blending and other methods. The demand for health functional foods is steadily increasing, and red ginseng is the most demanded food among women in the 50s, followed by multivitamin, omega-3, glucosamine and aloe. To date, there is insufficient evidence on the effect of red ginseng on exercise capacity, somatic symptom and cognitive performance in healthy individuals. Moreover, evidence is insufficient that a nutritional dose of vitamin or mineral reduces the incidence of cardiovascular disease and cancer, or mortality rate. A steady intake of oily fish is recommended to prevent the incidence of cardiovascular disease for postmenopausal women. Consumption of omega-3 fatty acids is expected to prevent cardiovascular disease in postmenopausal women with almost no intake of oily fish and those not taking statins. It still remains controversial whether glucosamine is effective in the treatment of osteoarthritis. Hence, physicians should fully inform patients with all controversial information about the effectiveness of glucosamine when prescribing glucosamine for patients with osteoarthritis.

Bone Density in Patients with Cervical Cancer or Endometrial Cancer in comparison with Healthy Control; According to the stages.

Objective: To evaluate the bone mineral density (BMD) in the lumbar spine and femur in postmenopausal women with cervical cancer and endometrial cancer without bone metastasis in comparison with that in healthy control postmenopausal women, and to assess the loss of BMD according to the cancer stage. Materials and methods: We analyzed the BMD of the lumbar spine and femur using dual-energy X-ray absorptiometry (DXA) in 218 patients with cervical cancer, 85 patients with endometrial cancer, and 259 healthy controls. The serum levels of calcium (Ca), phosphorus (P), osteocalcin (OSC), and total alkaline phosphatase (ALP), and urine deoxypyridinoline(DPL) were measured in all participants. Results: Age, body mass index, parity, and time since menopause were not significantly different between the three groups. Serum Ca level was higher in the cervical cancer group (p = 0.000), however, urine DPL was lower in endometrial cancer group (p = 0.000). The T-scores of basal BMD at the second and fourth lumbar vertebra (L2, L4) were significantly lower in patients with cervical cancer (p = 0.038, 0.000, respectively) compared to those in the healthy control groups. Additionally, the incidence of osteoporosis and osteopenia basal status of bone mass was significantly higher in patients with cervical cancer compared to that in controls (p = 0.016). No differences in basal BMD of the lumbar spine and femur were observed between patients with cervical cancer according to their stages. Conclusion: Our results suggest that postmenopausal women with cervical cancer have a lower BMD and are at increased risk of osteoporosis in the lumbar spine before receiving anticancer treatment compared with postmenopausal women with endometrial cancer.

Avoiding unnecessary blood transfusions in women with profound anaemia

Blood transfusions may be associated with risks and the risk: benefit ratio is not always clear, even in the setting of haemorrhage.

A national survey of gynecologists on current practice patterns for management of abnormal uterine bleeding in South Korea

To evaluate practice patterns of gynecologists in the management of abnormal uterine bleeding (AUB) in South Korea.

Undifferentiated sarcoma arising in a mature cystic teratoma of the ovary

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