Clinical Characteristics and Risk Factors for Severe Disease of Coronavirus Disease 2019 in a Low Case Fatality Rate Region in Korea

Background@#Jeju island had the seventh highest incidence rate of coronavirus disease 2019 (COVID-19) but showed the lowest case fatality rate among 17 provinces of Korea, which may be associated with comorbidities and geographic differences. This study aimed to analyze the epidemiological and clinical characteristics of patients with COVID-19 and evaluate the risk factors for severe COVID-19 in Jeju island, Korea. @*Materials and Methods@#All patients with COVID-19 admitted between February 20, 2020, and June 19, 2021, at a single center were retrospectively enrolled in this study. The severity of illness was defined using five categories (asymptomatic, mild, moderate, severe, and critical) according to the National Institute of Health criteria. Then, patients with severe and critical illness were grouped into a severe group, whereas patients with asymptomatic, mild, and moderate illness were grouped into a non-severe group. Multivariate logistic regression analysis was performed using risk factors that were found to be significantly associated with the severe group. @*Results@#This study included 348 patients with a median age was 57 years, and 37.5% were aged 60 or older. Among them, 43.4% were male and 10.9% were asymptomatic, whereas 41.4%, 33.9%, 12.9%, and 1.1% had mild, moderate, severe, and critical illness. The all-cause mortality of patients with COVID-19 was 0.28% (1/348). Among confirmed patients with COVID-19, exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was mainly within Jeju island (75.9%). The mean body mass index was 24.09 ± 4.04 kg/m 2 , the median comorbidity index score was low in each group (0 in asymptomatic; 1 in mild; 1 in moderate; 1 in severe; and 2 in critical group, P <0.548). In the multivariable analysis, male sex [odds ratio (OR), 6.37; 95% confidence interval (CI), 2.69 – 15.13; P <0.001], ≥65 years of age (OR, 2.68; 95% CI, 1.18 – 6.10; P <0.019), chronic pulmonary disease (OR, 6.10; 95% CI, 1.40 – 26.61; P = 0.016), and length of fever duration (OR, 1.33; 95% CI, 1.19 – 1.49; P <0.001) were independently associated with severe COVID-19. @*Conclusion@#The most relevant risk factors of COVID-19 severity were male sex, older age, underlying chronic lung diseases, and duration of fever during hospitalization. The risk factors for severe COVID-19 were not significantly different from those reported in other studies. However, a lower proportion of the older population among confirmed SARS-CoV-2 cases might contribute to the lower fatality rate than the national rate.

Comparison of serum cystatin C and creatinine as a marker for early detection of decreasing glomerular filtration rate in renal transplants / 대한외과학회지

PURPOSE: We wished to compare the clinical effectiveness of cystatin C (CyC) and serum creatinine (sCr) to assess renal function in renal transplantation patients. METHODS: We compared the clinical effectiveness of CyC with that of the sCr to estimate 24-hour urine creatinine clearance (CrCl) in 72 adult recipients who underwent renal transplantation from January 2001 to December 2008. We analyzed the data in terms of accuracy, bias, precision and sensitivity as a function of length of time posttransplantation and CrCl value. RESULTS: The patients were divided into four groups according to CrCl value or =90 mL/min/1.73 m2. The corresponding Cr-based glomerular filtration rate (GFR) estimates had accuracies of 0.71, 0.906, 0.963, and 1.00 within 50% of the reference, with biases (mean percentage errors) of 4.7, 5.32, -5.79, -31.33 mL/min/1.73 m2, and precisions (mean absolute percentage errors) of 7.57, 10.03, 14.52, and 31.33 mL/min/1.73 m2, respectively. The CyC-based GFR estimates had accuracies of 0.35, 0.79, 0.93, and 0.67 within 50% of the reference, respectively, with biases of 15.03, 13.37, -5.58, and -34.79 mL/min/1.73 m2 and precisions of 15.03, 14.80, 17.91, and 34.79 mL/min/1.73 m2. The sensitivity for detecting GFR below 60 mL/min/1.73 m2 was higher for CyC (0.96, 1, and 0.95) than for Cr (0.77, 0.75, and 0.82). CONCLUSION: CyC is a more sensitive indicator of low GFR (CrCl <60 mL/min/1.73 m2) than sCr. However, CyC-based GFR estimates are restrictive data, and are neither accurate nor specific. Therefore, to evaluate renal function, we may need a revised CyC-based GFR formula and close monitoring of sCr.

Impact on Prognosis of Lymph Node Micrometastasis and Isolated Tumor Cells in Stage II Colorectal Cancer

PURPOSE: Even though the importance of micrometastases (MMS) and isolated tumor cells (ITC) has been brought up by many physicians, its impact on the prognosis in stage II colorectal cancer is uncertain. In this research, we tried to investigate the clinical features of MMS and ITC and to prove any correlation with prognosis. METHODS: The research pool was 124 colorectal cancer patients who underwent a curative resection from April 2005 to November 2009. A total of 2,379 lymph nodes (LNs) were examined, and all retrieved LNs were evaluated by immunohistochemical staining with anti-cytokeratin antibody panel. Clinicopathologic parameters and survival rates were compared based on the presence of MMS or ITC and on the micrometastatic lymph node ratio (mmLNR), which is defined as the number of micrometastatic LNs divided by the number of retrieved LNs. RESULTS: Out of 124 patients (26.6%) 33 were found to have MMS or ITC. There were no significant differences in clinicopathologic features, such as gender, tumor location and size, depth of invasion, histologic grade, except for age (P = 0.04). The three-year disease-free survival rate for the MMS or ITC positive group was 85.7%, and that for MMS and ITC negative group was 92.8% (P = 0.209). The three-year disease-free survival rate for the mmLNR > 0.25 group was 73.3%, and that for the mmLNR < or = 0.25 group was 92.9% (P = 0.03). CONCLUSION: The presence of MMS or ITC was not closely correlated to the prognosis. However, mmLNR is thought to be a valuable marker of prognosis in cases of stage II colorectal cancer.

Effect of Biofeedback Treatment in Patients with Fecal Incontinence

PURPOSE: We aimed to assess the efficacy of biofeedback therapy for patients with fecal incontinence (FI) according to the etiology. METHODS: Twenty-nine patients with fecal incontinence were treated with biofeedback therapy using a EMG-based system. The efficacy was assessed by using changes in the FI score (Cleveland Clinic, Florida: 0~20) and satisfaction based on a subjective evaluation score from 0 to 100. The median follow up duration was 12 (3~25) months. RESULTS: Ten patients had idiopathic fecal incontinence. Fourteen patients had fecal incontinence due to a sphincter saving operation for rectal cancer. Four cases had spinal cord injury and one patient had a major external sphincter tearing due to trauma. The mean age was 52 (16~78) years. The median number of biofeedback sessions was 10 (3~15) overall. The mean efficacy was 42.8%, and the mean satisfaction score was 56.6. Improvements in the FI score and in the patients' satisfaction varied according to the etiology, 69.5% and 71.5 in the idiopathic group, 28.5% and 49.3 in the postoperative group, and 35% and 24 in the spinal cord injury group. In the idiopathic group, 50% of the patients showed an improvement in the FI score of more than 75%, and 90% of the patients showed an improvement of more than 50%. The number of liquid incontinence episodes was improved 78.3% later in the biofeedback group, and this result was much better than in the postoperative incontinence group (31.8%, p=0.03). CONCLUSIONS: The success rate of the biofeedback therapy for fecal incontinence is acceptable. Subjective satisfaction is relatively higher than the improvement in the ecal incontinence score. Idiopathic fecal incontinence may be the best indication for biofeedback therapy.