Journal of Yeungnam Medical Science

Original articles

Medical Education
Stress and sleep quality among medical students in Bangladesh: a cross-sectional study: Tamal Kanti Kairi, Sanghamitra Dey, Rifat Jahan, Shahnewaz Fuad; J Yeungnam Med Sci. 2025;42:42. Published online August 5, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.42

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Background
Medical students experience high levels of stress owing to their demanding academic environment, which can significantly impact their sleep quality. This study aimed to assess the status of stress and sleep quality among medical students in Bangladesh and identify the factors influencing these conditions.
Methods
This cross-sectional study included 280 undergraduate medical students selected by stratified random sampling from four medical colleges in Bangladesh. Data were collected using a self-report questionnaire covering sociodemographic details, stress- and sleep-related factors, the Kessler Psychological Distress Scale, and the Pittsburgh Sleep Quality Index.
Results
The study revealed that 65.7% of students experienced stress, which was categorized as mild (27.5%), moderate (22.1%), or severe (16.1%). Poor sleep quality was prevalent in 72.1% of students, with 48.2% being moderately poor sleepers and 23.9% being very poor sleepers. Factors significantly associated with stress included female sex, higher academic year, lack of physical activity, high parental expectations, academic concerns, lack of a doctor in the family, and parental influence in choosing medical education. Poor sleep quality was significantly linked to stress, female sex, hostel residency, increased screen time before sleep, late dinner, daytime naps, coffee intake, and late-night snacks.
Conclusion
This study highlights the high prevalence of stress and poor sleep quality among medical students in Bangladesh. Stress significantly contributes to sleep disturbances, and various lifestyle and academic factors exacerbate these issues. Targeted interventions, including stress management programs and the promotion of healthier sleep, are essential for improving students’ well-being and academic performance.

Citations

Citations to this article as recorded by

The impact of social support on academic burnout among medical students: the mediating effects of anxiety and depression, and the role of urban-rural differences
Hualing Li, Min Liu, Mengxiao Yang, Enze Gao, Xiuyin Gao
Frontiers in Psychiatry.2026;[Epub] CrossRef
Sleep Quality, Sleep Hygiene Behaviors, and Psychosocial Determinants Among Undergraduate Students in South‐Eastern Bangladesh: A Cross‐Sectional Study
Md. Mayin Uddin Hasan, Intesar Mahmud Sayeed, Mohammed Zahidul Islam, Md. Shahin Rana, Md. Aminul Anowar, Shantu Ghosh, Abdullah Al Noman, Mohammed Abu Sayeed, Mohammad Injamul Hoq
Public Health Challenges.2026;[Epub] CrossRef
Impact of Perceived Stress on Work Engagement Among Intensive Care Unit Nurses: The Mediating Effects of Dispositional Mindfulness and Sleep Quality
Jiongjiong Lu, Yajie Song, Xue Li, Huijie Hu, Hongjuan Chang, Lina Wang
Nursing Open.2026;[Epub] CrossRef
Academic stress and online learning engagement in medical students: the parallel mediating roles of sleep quality and positive academic emotions
Li He, Wei Li, Yueyi Zhang, Jiacheng Wang, Ye Yu, Shudi Li, Bowen Liu, Jing Tian
BMC Medical Education.2025;[Epub] CrossRef

Psychiatry and Mental Health
Depression, sleep quality, and body image disturbances among pregnant women in India: a cross-sectional study: Kranti S. Kadam, Aditya R. Anvekar, Vishnu B. Unnithan; J Yeungnam Med Sci. 2023;40(4):394-401. Published online May 9, 2023; DOI: https://doi.org/10.12701/jyms.2023.00087

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Abstract PDF

Background
Pregnancy is associated with a number of physical, emotional, and biological changes that can exacerbate maternal psychological disturbances, such as body image concerns and depression. Sleep disturbances during pregnancy can also have adverse impacts. This study aimed to determine the prevalence of depression, sleep disturbances, and body image concerns among pregnant women. The study also examined the relationship between these factors and pregnancy-related variables, such as bad obstetric history and whether the pregnancies were unplanned.
Methods
A cross-sectional study of 146 pregnant patients was conducted at a tertiary care center over 15 months. The patients were administered the Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Body Image Concern Inventory questionnaires. Contingency tables, Fisher exact test, and Spearman correlation were used to identify underlying relationships.
Results
The prevalence of depression was 22.6%. Although body image disturbance was noted in only 2.7% of patients, 46.6% had poor sleep quality. Poor sleep was associated with primigravida status. Bad obstetric history and unplanned pregnancy were associated with depression. Depression was found to be significantly correlated with body image disturbances and poor sleep quality.
Conclusion
Psychiatric disorders were prevalent during pregnancy. This study highlights the importance of screening for depression in pregnant patients. Counselling and caregiver education can be useful for mitigating psychological disturbances. Management of pregnancies by multidisciplinary teams that include psychiatrists could be immensely useful in improving the pregnancy experiences of patients.

Citations

Citations to this article as recorded by

Sleep quality and its determinants among pregnant women in Northwest India: A cross-sectional study
Akshaya B. Raj, Naresh Nebhinani, Mukesh Kumar Swami, Tanu Gupta, Pratibha Gehlawat, Pratibha Singh, Meenakshi Gothwal
Indian Journal of Psychiatry.2026; 68(4): 367. CrossRef
Periconceptional maternal sleep disturbances and risk of congenital defects: A meta-analysis
Shadab Ahamad, Ashwitha H. Kotian, Prachi Kukshal
International Journal of Health Sciences.2026; 20: 131. CrossRef
Sleep quality and its associated factors among women of reproductive age in Ethiopia: a systematic review and meta-analysis
Diriba Dereje Olana, Tesema Etefa Birhanu, Adisu Ewunetu Desisa
Frontiers in Psychiatry.2026;[Epub] CrossRef
Prevalence and determinants of sleep disturbances among pregnant women: an Indian community-based cross-sectional study
Akashanand, Pracheth Raghuveer, Ravi Yadav, Ravi Girikematha Shankar, Deepika Sudha Reddy
Sleep and Biological Rhythms.2025; 23(2): 127. CrossRef
The association between body image and depressive symptoms in pregnant and postpartum women: a meta-analysis
Jingbo He, Xin Chen, Biru Luo
Frontiers in Public Health.2025;[Epub] CrossRef
Factors affecting body image in pregnancy: A path analysis
Derya Öztürk Özen, İlknur Münevver Gönenç
Women & Health.2025; 65(10): 834. CrossRef
Melatonin improves maternal sleep deprivation‐induced learning and memory impairment, inflammation, and synaptic dysfunction in murine male adult offspring
Yue‐Ming Zhang, Ru‐Meng Wei, Zong‐Yin Li, Xue‐Yan Li, Kai‐Xuan Zhang, Yi‐Jun Ge, Xiao‐Yi Kong, Xue‐Chun Liu, Gui‐Hai Chen
Brain and Behavior.2024;[Epub] CrossRef
Sleep quality disparities in different pregnancy trimesters in low- and middle-income countries: a systematic review and meta-analysis
Esuyawkal Mislu, Henok Kumsa, Shimelis Tadesse, Mulugeta Wodaje Arage, Belay Susu, Mulat Ayele, Fiker Chane
BMC Pregnancy and Childbirth.2024;[Epub] CrossRef

Alternative Medicine
Auricular acupuncture for sleep quality in participants with mental and behavioral disorders due to prior multiple drug use: a retrospective consecutive case series: Yuri Gimelfarb, Eran Goldstien; J Yeungnam Med Sci. 2023;40(1):78-85. Published online November 28, 2022; DOI: https://doi.org/10.12701/jyms.2022.00542

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Abstract PDF

Background
Poor sleep quality is associated with psychoactive substance abuse/addiction/withdrawal. Auricular acupuncture (AA) is a nonpharmacological method used for the treatment of sleep disturbances. This study aimed to examine the quality of sleep before and after AA in participants with mental and behavioral disorders due to prior multiple drug use in the therapeutic community.
Methods
This was a consecutive case series of 27 participants (25 male [92.6%]). The median age was 35.0 years (interquartile range [IQR], 29.0–37.2 years), methadone/buprenorphine were not used, and the participants were treated with AA (median number of treatments, 15.0 [IQR, 12.0–18.0]) during a median period of 51.0 days (IQR, 49.0–51.0 days) according to the National Acupuncture Detoxification Association (NADA)-Acudetox protocol. Sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire that assesses sleep quality and disturbances over a 1-month interval.
Results
The global PSQI score dropped (indicating better sleep quality) by a median of 3.0 points (IQR, 0.0–8.0 points) after treatment. In the multivariate logistic regression analysis, with an increase in global PSQI score during AA by 1 point, there was a 0.73-fold reduction in the risk of poor sleep quality post-AA (adjusted odds ratio, 0.73; 95% confidence interval, 0.52–1.01; p<0.055; Nagelkerke's R2=0.66).
Conclusion
The results revealed a positive effect of AA (by the NADA-Acudetox protocol) on sleep quality (as measured by PSQI) among participants in a treatment center with mental and behavioral disorders due to multiple drug use.

Citations

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Feasibility of Auricular Acupressure Therapy for Neuropathic Pain in Cancer Patients
Eunhea You, William Holzemer, Xiaomei Cong, Hermine Poghosyan, Heon Joon Lee, Jeffrey Paul Aleski
Pain Management Nursing.2026; 27(4): e540. CrossRef
Auricular Acupuncture for Stress and Anxiety in Correctional Staff: A Pilot Feasibility Study in a High-Security Psychiatric Unit
Konstantinos Georgiadis, Giorgos Tzigkounakis, Vasileios Giannakidis, Athanasios Douzenis
Medical Acupuncture.2026;[Epub] CrossRef

Focused Review articles

Psychiatry and Mental Health
Understanding insomnia as systemic disease: Seokho Yun, Sohye Jo; Yeungnam Univ J Med. 2021;38(4):267-274. Published online September 13, 2021; DOI: https://doi.org/10.12701/yujm.2021.01424

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Abstract PDF

Sleep plays a critical role in homeostasis of the body and mind. Insomnia is a disease that causes disturbances in the initiation and maintenance of sleep. Insomnia is known to affect not only the sleep process itself but also an individual’s cognitive function and emotional regulation during the daytime. It increases the risk of various neuropsychiatric diseases such as depression, anxiety disorder, and dementia. Although it might appear that insomnia only affects the nervous system, it is also a systemic disease that affects several aspects of the body, such as the cardiovascular, endocrine, and immune systems; therefore, it increases the risk of various diseases such as hypertension, diabetes mellitus, and infection. Insomnia has a wide range of effects on our bodies because sleep is a complex and active process. However, a high proportion of patients with insomnia do not seek treatment, which results in high direct and indirect costs. This is attributed to the disregard of many of the negative effects of insomnia. Therefore, we expect that understanding insomnia as a systemic disease will provide an opportunity to understand the condition better and help prevent secondary impairment due to insomnia.

Citations

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ZnO Nanoparticle-Based Electrochemical Immunosensor for One-Step Quantification of Cortisol in Saliva
M. P. Divyamani, Sachin N. Hegde, S. K. Naveen Kumar, M. P. Dharma Guru Prasad
ACS Omega.2025; 10(33): 38303. CrossRef
Insomnia and Cardiometabolic Health: Bridging the Gap Between Sleep Deficit and Disease Prevention
James W. Kim, Akshay B. Jain, Atul Khullar
Canadian Journal of Diabetes.2025; 49(5-6): 342. CrossRef
Medical service utilization patterns among adults with insomnia: A retrospective cohort study
Min Kyung Hyun, Jang Won Lee
European Journal of Integrative Medicine.2024; 67: 102325. CrossRef
Exploring Health Promotion Behaviors, Occupational Burnout, and Sleep Disturbances in Traditional Industry Workers
Ying-Fen Yu, Yi-Ya Chang, Shu-Hung Chang
Healthcare.2024; 13(1): 51. CrossRef
Socio-Ecological Context of Sleep: Gender Differences and Couples’ Relationships as Exemplars
Andrea N. Decker, Alexandra R. Fischer, Heather E. Gunn
Current Psychiatry Reports.2022; 24(12): 831. CrossRef
Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective
Yun-Jo Lo, Viraj Krishna Mishra, Hung-Yao Lo, Navneet Kumar Dubey, Wen-Cheng Lo
Aging and disease.2022;[Epub] CrossRef
Understanding sleep and sleep disturbances in autism spectrum disorder, and management of insomnia: an update
Hye-Geum Kim
Yeungnam University Journal of Medicine.2021; 38(4): 265. CrossRef

Psychiatry and Mental Health
An update on the cause and treatment of sleep disturbance in children and adolescents with autism spectrum disorder: Wan Seok Seo; Yeungnam Univ J Med. 2021;38(4):275-281. Published online September 13, 2021; DOI: https://doi.org/10.12701/yujm.2021.01410

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Abstract PDF

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by abnormalities in social communication/interaction and restrictive, repetitive patterns of behavior. ASD is a relatively common psychiatric disorder, with a prevalence of approximately 1.7% in children. Although many children and adolescents with ASD visit the hospital for medical help for emotional and behavioral problems such as mood instability and self-harming behavior, there are also many visits for sleep disturbances such as insomnia and sleep resistance. Sleep disturbances are likely to increase fatigue and daytime sleepiness, impaired concentration, negatively impact on daytime functioning, and pose challenges in controlling anger and aggressive behavior. Sleep disturbance in children and adolescents with ASD negatively affects the quality of life, nothing to say the quality of life of their families and school members. In this review, sleep disturbances that are common in children and adolescents with ASD and adolescents are presented. The developmental and behavioral impacts of sleep disturbances in ASD were also considered. Finally, non-pharmacological and pharmacological treatments for sleep disturbances in children and adolescents with ASD and adolescents are reviewed.

Citations

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Molecular Psychiatry.2026; 31(7): 4124. CrossRef
Sleep and Psychiatric Comorbidities
Davis C. Thomas, Anu Priya Guruswamy Pandian, Simran Gupta, Jonathan Betlinski
Medical Clinics of North America.2026; 110(5): 835. CrossRef
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Occupational Therapy International.2026;[Epub] CrossRef
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Paediatrics & Child Health.2026; 31(5): 459. CrossRef
From restless nights to peaceful sleep: mothers’ lived experiences in dealing with sleep problems among children with autism spectrum disorder
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Mishthi Ratwani, Shradha Bisht, Swati Prakash
Biochemical and Biophysical Research Communications.2025; 770: 151978. CrossRef
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Hatice Altun, Semiha Cömertoğlu Arslan
European Journal of Therapeutics.2024; 30(2): 227. CrossRef
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Muhammed Emin Boylu, İlker Taşdemir, Mehmet Doğan, Tuba Özcanlı
Journal of Forensic Sciences.2024; 69(6): 2091. CrossRef
Pattern of sleep disorders among children with autism spectrum disorder
Muaath Ahmed Mohammed, Elham Mohammed Abdalkhalig, Ibrahim Abdelrhim Ali, Salma Shakir Hassan, Hayat Osman
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Review of Sleep Disorders and Therapeutic Approaches in Patients With Autism Spectrum Disorder and Rett Syndrome
Katelyn Bricker, Bradley V. Vaughn
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Sleep and Autism Spectrum Disorder: A Comprehensive Review of Diagnosis, Markers, Interventions, and Treatments
Deepa Burman, Karthikeyan Ramanujam, Dilshad Manzar, Vijay Kumar Chattu, David Warren Spence, Nevin F. W. Zaki, Haitham Jahrami, Seithikurippu R. Pandi-Perumal
Sleep and Vigilance.2023; 7(1): 9. CrossRef
Efficacy of Melatonin for Insomnia in Children with Autism Spectrum Disorder: A Meta-analysis
Mei Xiong, Fang Li, Zhaohua Liu, Xin Xie, Hongli Shen, Weiteng Li, Liping Wei, Rongfang He
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Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay
Irene Favole, Chiara Davico, Daniele Marcotulli, Roberta Sodero, Barbara Svevi, Federico Amianto, Federica S. Ricci, G. Maurizio Arduino, Benedetto Vitiello
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Sleep Disturbances in Children Affected by Autism Spectrum Disorder
Jessica Galli, Erika Loi, Lucrezia Maria Visconti, Paola Mattei, Anna Eusebi, Stefano Calza, Elisa Fazzi
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Analysis of sleep problem in children aged 1–3 years with autism spectrum disorder in Zhejiang province, China
Dan Yao, Shasha Wang, Fangfang Li, Minjie Gao, Jie Shao
Frontiers in Psychiatry.2022;[Epub] CrossRef
Understanding sleep and sleep disturbances in autism spectrum disorder, and management of insomnia: an update
Hye-Geum Kim
Yeungnam University Journal of Medicine.2021; 38(4): 265. CrossRef

Case report

Hematology
Adrenal insufficiency development during chemotherapy plus anti-programmed death receptor-1 monoclonal antibody (tislelizumab) therapy in patients with advanced gastric cancer: two case reports: Jin Ho Baek; J Yeungnam Med Sci. 2022;39(1):62-66. Published online April 19, 2021; DOI: https://doi.org/10.12701/yujm.2021.00934

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Abstract PDF

Immune checkpoint inhibitor (ICI)-associated adrenal insufficiency is rare but may become a serious adverse event in patients treated with ICIs. The present case report documents two cases of adrenal insufficiency developed during chemotherapy plus tislelizumab (百泽安, Baize’an; BeiGene Ltd.) therapy in patients with advanced gastric cancer. Adrenal insufficiency developed after 6 and 13 cycles of treatment and was well controlled with hydrocortisone. The patients also developed hypothyroidism, which was managed with levothyroxine. Two patients showed a partial response, and one patient out of two achieved a near-complete response, sustaining over 11 months. Increased awareness of ICI-related adrenal insufficiency is crucial for early detection and prompt management of patients treated with ICIs.

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Immune checkpoint inhibitor-related adrenal hypofunction and Psoriasisby induced by tislelizumab: A case report and review of literature
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Severe thyrotoxicosis induced by tislelizumab: a case report and literature review
Liman Huo, Chao Wang, Haixia Ding, Xuelian Shi, Bin Shan, Ruoying Zhou, Ping Liang, Juan Hou
Frontiers in Oncology.2023;[Epub] CrossRef
Immune-related adverse events with severe pain and ureteral expansion as the main manifestations: a case report of tislelizumab-induced ureteritis/cystitis and review of the literature
Qihao Zhou, Zhiquan Qin, Peiyuan Yan, Qunjiang Wang, Jing Qu, Yun Chen
Frontiers in Immunology.2023;[Epub] CrossRef
Isolated Renal Calyceal Urothelial Carcinoma Effectively Treated With PD-1 Inhibitor Alone: A Case Report And Literature Review
Shihao Li, Yi Zhu, Zhijian Xu, Jianjun Liu, Hongwei Liu
Frontiers in Oncology.2022;[Epub] CrossRef

Focused Review article

Psychiatry and Mental Health
Effects and mechanisms of a mindfulness-based intervention on insomnia: Hye-Geum Kim; Yeungnam Univ J Med. 2021;38(4):282-288. Published online January 14, 2021; DOI: https://doi.org/10.12701/yujm.2020.00850

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Abstract PDF

Medication alone is not sufficient to treat insomnia. In addition, the side effects of sleep medications themselves cannot be ignored during treatment. Insomnia begins with poor sleep quality and discomfort, but as it continues, patients fall into a vicious circle of insomnia with negative thoughts and dysfunctional and distorted perceptions related to sleep. Mindfulness-based intervention for insomnia corrects these sequential cognitive and behavioral processes. The mindfulness technique basically recognizes all the thoughts, feelings, and experiences that occur to us as they are, nonjudgmentally, and then trains them to return to the senses of our body. In this way, while noticing all the processes of the sequential vicious cycle and training them to return to our bodies (e.g., breathing), mindfulness determines whether we are really sleepy or just fatigued. This mindfulness-based intervention can be a useful nonpharmaceutical intervention for insomnia, and its stability and efficacy has been proven by many studies.

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Suicidal risk, insomnia symptoms, and interoceptive sensitivity: Network analysis in a university student population
Julie Faccini, Sophie Bayard, Clarisse Madiouni, Jonathan Del-Monte
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Mariel Emrich, Crystal L. Park, Adam B. David, Lucy Finkelstein-Fox
Mindfulness.2023; 14(12): 2932. CrossRef
THE DEVELOPMENT AND VALIDITY OF MINDFULNESS DHIKR BREATHING THERAPY FOR INSOMNIA
Setiyo Purwanto, Mahadir Ahmad, Zaini Said, Nisa Rachmah Nur Anganthi, Mutalazimah, Siti Zulaekah
The Indonesian Journal of Public Health.2023; 18(3): 382. CrossRef
Effectiveness of a 4-Day Mindfulness-Based Intervention in a 2-Month Follow-Up for Chinese Incarcerated People
Jieting Zhang, Zening Zheng, Lina Wang, Christina M. Luberto, Man (Sophie) Zhang, Yuhua Wen, Qi Su, Can Jiao
Behavior Therapy.2022; 53(5): 981. CrossRef
Understanding sleep and sleep disturbances in autism spectrum disorder, and management of insomnia: an update
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Effects of mindful breathing combined with sleep-inducing exercises in patients with insomnia
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Original Article

Neurology
Effect of Sleep on Epileptiform Discharges in Epileptic Patients with Structural Lesion: Based on Routine EEG.: Se Jin Lee, Jeong Sang Hah; Yeungnam Univ J Med. 2007;24(2):107-118. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.107

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Abstract PDF: BACKGROUND
It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. MATERIALS AND METHODS: We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. RESULTS: In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were 0.058+/-0.121 and 0.148+/-0.187, and it was 0.081+/-0.150 and 0.174 +/-0.226 in patients without organic brain lesions. There were significant increases in the spike index (P<0.05) during NREM sleep in both groups (n=36), but no significant difference in the percent increase of spike index (P>0.05). CONCLUSION: The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.

Case Reports

Pediatrics, Perinatology, and Child Health
One Case of Lupus Nephritis Flare in Child During Tapering the Steroid: Jung Youn Choi, Yong Hoon Park; Yeungnam Univ J Med. 2007;24(2 Suppl):S755-760. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S755

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Abstract PDF: Systemic lupus erythematosus (SLE) is a chronic multisystemic inflammatory autoimmune disease. Hematologic abnormality is more frequent and the frequency of using high dose steroid and immunosuppressant as treatment is higher in children, because the number of involved major organ is numerous and the disease progress is often rapid in the SLE of children. We reported an experience of lupus nephritis flare after tapering the steroid in 9 years old boy who was diagnosed focal proliferative glomerulonephritis.

Rheumatology
A Case of Protein-losing Enteropathy Treated with High Dose Intravenous Glucocorticoid Therapy in Systemic Lupus Erythematosus.: Kyu Hyung Lee, Chang Mo Kwon, Hyun Do Kim, Dae Young Yun, Jae Yoong Lee, Yeong Hoon Hong, Choong Ki Lee; Yeungnam Univ J Med. 2005;22(2):253-258. Published online December 31, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.2.253

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Abstract PDF

Generalized edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include: Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to our hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.

Citations

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A Case of Protein Losing Enteropathy as Only Clinical manifestation of Systemic Lupus Erythematosus
Tae Hyun Kim, Yu Hee Choi, Lae Hyung Kang, Hyeong Jin Kim, Jin Ho Jang, Min Wook So
Kosin Medical Journal.2017; 32(1): 84. CrossRef

Rheumatology
Symptomatic Sacroiliitis in Female Systemic Lupus Erythematosus.: Ki Do Park, Young Hun Hong, Sung Dong Kim, Dong Hwan Ryu, Coong Ki Lee; Yeungnam Univ J Med. 2000;17(2):161-164. Published online December 31, 2000; DOI: https://doi.org/10.12701/yujm.2000.17.2.161

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Abstract PDF: We report a case of 17-year-old female with juvenile onset systemic lupus erythematosus Who developed symptomatic unilateral sacroiliitis. She had neither HLA-DR3 nir B27 antigens. Though sacroiliitis have been reported in mail SLE patient. it has been rarely reported in female patients. The rare coexistence of SLE and sacroiliitis. described in this case. may not be determined soley by genetic factors; sacroiliitis may be just an infrequent manifestation of SLE.

Rheumatology
Two Cases of Systemic Lupus Erythematosus with Cerebrovascular Involvement.: Bong Jun Kim, Eun Young Lee, Young Hoon Hong, Ki Do Park, Young Doo Song, Choong Ki Lee, Young Ran Shim; Yeungnam Univ J Med. 1998;15(2):371-380. Published online December 31, 1998; DOI: https://doi.org/10.12701/yujm.1998.15.2.371

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Abstract PDF: Systemic lupus erythematosus(SLE) is an autoimmune disease which may affect many different organs and disclose various clinical manifestations. Recently central nervous system(CNS) involvement has been recognized as an increasingly significant contributor to morbidity and mortality of SLE. The clinical manifestations of CNS-lupus are highly variable and range from mild cognitive dysfunction, movement disorder, headache, psychosis to life-threatening stroke and coma. Among the neuropsychiatric disorders encountered in patients with SLE, cerebrovascular disease has been a relatively rare complication. The diagnosis and management of CNS-lupus is difficult because of the lack of useful diagnostic methods. If, cerebrovascular involvement is suspected, then aggressive treatment such as high dose steroid, immunosuppressive therapy, plasma exchange, may be required to reduce high mortality rate. We experienced 2 cases cerebrovascular disease occurring in SLE patients which presented with various neuropsychiatric manifestations. They were diagnosed as CNS-lupus by neuropsychiatric symptoms, brain MRI, and EEG, and showed good response to high dose steroid pulse therapy.

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