Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up

Background@#There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms. @*Methods@#We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at Ulsan University Hospital, Ulsan, Korea.The final follow-up date was May 19, 2020. All COVID-19 cases in Ulsan were included.Demographic and epidemiological information, comorbidities, clinical signs and symptoms, laboratory and radiologic findings, medications, treatments, outcomes, and main durations of patients with COVID-19 were compared according to supplemental oxygen requirement. @*Results@#Forty patients were included (median age, 30 years; interquartile range [IQR], 25–57 years; 58% female). Six (15%) patients required supplemental oxygen. The prevalence of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was 5% and that of presymptomatic infection was 13%. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea were the screening criteria for diagnosing symptomatic and presymptomatic SARS-CoV-2 infections. Sputum production, chest discomfort, a large number of symptoms, abnormal procalcitonin and C-reactive protein levels, and abnormal chest X-ray or chest computed tomography findings were more common in patients requiring supplemental oxygen than in those not requiring supplemental oxygen. Overall mortality rate was 3% (1/40). Four patients (10%) were readmitted after testing positive by reversetranscription polymerase chain reaction again. Incubation period was 5 days (IQR, 4–6 days), and the duration of viral shedding was 21 days (IQR, 14–28 days; maximum, 51 days). @*Conclusion@#The prevalence of asymptomatic SARS-CoV-2 infection was 5%, which is much lower than that previously reported. This finding suggests that careful interviews and follow-ups should be performed to identify SARS-CoV-2 infections. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea are adequate screening criteria for covering all symptoms of SARS-CoV-2 infection. Further evaluation is required to create representative screening criteria for COVID-19.

Lifestyle in Relation to Increase in Weight in Korean Middle-aged Men

BACKGROUND: The relationship of lifestyle and socioeconomic factors with weight change over 4 years in Korean middle-aged group was assessed. METHODS: A total of 1,167 men, aged 40~59 years, were selected from the Health Promotion Center of Ulsan University Hospital during the period of Jan. 2000 through Mar. 2000. Including anthropometric measures, designed questionnaires were administered concern lifestyle behavior topics with cigarette smoking, exercise, alcohol consumption, dairy product consumption and socioeconomic factors of monthly income and education. The subjects were divided into three groups by body mass index (BMI: kg/m(2)); normal ( or =25 kg/m(2)). After 4 years of follow-up, the men were classified into weight change categories; 1) stable weight group (from normal to normal, from overweight to overweight) and 2) weight gain group (from normal to overweight/obesity, from overweight to obesity). RESULTS: The weight gain group were 18.4% (n=215) and the stable overweight group were 81.6% (n=952). Adjusted for age, the frequency of dairy product consumption, the frequency of alcohol drinking, the regularity of exercise, education and monthly income, the smokers (> or =10/day) had significantly high incidence rates of increase in weight (odds ratio=1.77, 95% CI 1.07~2.90). The increased dairy consumers (> or =4/week) had significantly low incidence rates of increase in weight (odds ratio=0.43, 95% CI 0.20~0.93). Otherwise, there were no significant relationships in weight change. CONCLUSION: Smoking and decreased dairy product consumption were related to the increase in weight.

The Association between Distal Colon Adenoma and the Metabolic Syndrome and Lifestyle Factors in Male Examinees in a University Hospital

BACKGROUND: According to previous epidemiologic studies, the metabolic syndrome, dietary and lifestyle factors were associated with colon polyps. The aim of this cross-sectional study was to assess the relationship between the risk of the colorectal adenoma incidence and the individual components of the metabolic syndrome with lifestyle factors such as drinking, cigarette smoking and physical activity. METHODS: Sigmoidoscopic examination for colon cancer screening was performed from January 2002 to December 2003 at the Health Promotion Center of Ulsan University Hospital in Ulsan, Korea. A total of 1,565 subjects underwent satisfactory sigmoidoscopy. The subjects with a history of colon cancer or polyps or inflammatory bowel disease were excluded from the study. Alcohol consumption, cigarette smoking and other confounding factors were included as covariates in the models. RESULTS: After adjusting for age, physical activity,smoking and alcohol intake, the subjects of metabolic syndrome (> or =3 vs. 0 components) combined with cigarette smoking had a positive association with colorectal adenoma incidence (OR 3.63, 95% CI 1.49~8.89). Physical activity was negatively associated the risk of the colorectal adenoma incidence (OR 0.60 95% CI 0.44~0.81). CONCLUSION: These results suggest that clustering of components of the metabolic syndrome combined with cigarette smoking significantly increased the colorectal adenoma risk, but physical activity reduced the risk of colorectal adenoma incidence in Korean adult males after multivariate adjustment.

Prevalence and Risk Factors for Adenomatous Polyp in Koreans (A Cross-sectional Study)

BACKGROUND: According to previous epidemiologic studies, dietary and life style factors were associated with colon polyps. Despite the high prevalence of colon polyps, little is known about its risk factors in Korean adults. The aim of this cross-sectional study was to assess the relationship between alcohol consumption, smoking, obesity, physical activity and the presence of colorectal polyps. METHODS: Sigmoidoscopic examinations for colon cancer screening were performed from January 2002 to December 2003 at the Health Promotion Center of Ulsan University Hospital. Alcohol consumption, smoking and other confounding factors were assessed by self-administered questionnaire. RESULTS: After adjusting for age, physical activity, obesity, total fat and total energy intake, current smokers who had smoked more than 21 pack-years were at significantly higher risk of adenomatous polyps compared to non-smokers (OR 2.56, 95% CI 1.30~5.01). Alcohol consumption was positively associated with risk of adenomatous polyps compared to non-drinkers (OR 1.48, 95% CI 1.03~2.13). Physical activity was negatively associated withs risk of distal colon polyps. CONCLUSION: These results suggest that alcohol consumption, cigarette smoking, and obesity were positively associated with risk of colorectal polyps and physical activity was negatively associated in Korean adult males.

Relationship between Abdominal Obesity and Electrocardiographic QTc Interval Prolongation

BACKGROUND: Electrocardiographic QTc interval prolongation can cause serious arrhythmias such as ventricular tachycardia, ventricular fibrillation, torsade de pointes, and even sudden death. Many studies have been performed to clarify whether QTc interval prolongation is related to increasing body mass index (BMI) and abdominal obesity. However, there is no study about the relationship between abdominal obesity and QTc interval prolongation in Korea. We, therefore, studied the relationship between QTc interval prolongation and abdominal obesity among Korean adults. METHODS: The measurement of height, weight, and waist circumference, and standard 12-lead ECG was performed on 3,086 subjects at a health promotion center of a university hospital from March to April, 2003. We excluded: 37 subjects whose ECG or body measurement was not performed, 17 with a past history of cardiac disease or current cardiac medications which can influence QTc interval, 9 taking neuropsychiatric medications, 25 with abnormal serum concentration of potassium or calcium, 1 foreigner and 59 with underweight. First, we studied the correlation between BMI and waist circumference. Then, we analyzed the relationship between QTc interval prolongation and the index of obesity. RESULTS: A total of 2,938 subjects consisted of 2,411 men and 527 women. BMI and waist circumference were shown to have a significant correlation with QTc interval after age was adjusted in men (P<0.01, P<0.01). The odds ratio between QTc interval prolongation and the subjects of normal, overweight, and obesity by BMI were not significant in both men and women. In men with abdominal obesity, the odds ratio between QTc interval prolongation and abdominal obesity by waist circumference was 1.33 (0.99~1.79). CONCLUSION: In men, abdominal obesity was shown a positive correlation with QTc interval prolongation. But these results were not statistically significant.

The Effect of Physical Activity on Colorectal Polyps

BACKGROUND: The results of previous epidemiologic studies showed that dietary and life style factors are associated with colon polyps. Despite the high prevalence of colon polyps, little is known about its risk factors in Korean adults. The aim of this study was to assess the relationship between physical activity and the presence of colorectal polyps. METHODS: In 859 subjects, rectosigmoidoscopy was performed at Ulsan University Hospital Health Promotion Center from January 2002 to October 2002. Drinking, smoking and other confounding factors were assessed by self-administered questionnaire in 161 subjects with colon polyps and 698 controls. RESULTS: Among the total of 859 cases the prevalence of colorectal adenomatous polyps was 18.7%. After adjusting for age, sex, physical activity, obesity, calcium and total energy intake,using multiple logistic regression, decreasing risk of colorectal polyps were observed with increasing level of physical activities. The odds ratio for 3 to 4 hours per week exercise group was 0.460 (CI=0.262~0.089). The frequency and intensity of exercise also had an inverse association with colon polyps (4~5 times/ week group: OR=0.428, CI=0.220~0.832. vigorous exercise group: OR=0.454, CI=0.298~0.693). CONCLUSION: Physical activities were inversely associated with colorectal polyps in Korean adults.

Relationship of Biological Indices of Manganese with Pallidal Index on MRI in Liver Cirrhotics / 대한산업의학회지

OBJECTIVES: The objectives of this study were to clarify which biological manganese exposure indices reflect the pallidal signal intensities in magnetic resonance imaging (MRI) in liver cirrhotics. METHODS: We examined whole blood, plasma, RBC and urinary manganese concentrations, as well as, brain MRI in 22 cirrhotic patients and 10 healthy controls. From MRI scans we calculated the signal intensity of the globus pallidus using the pallidal index (PI), the ratio of the globus pallidus to subcortical frontal white-matter signal intensity in axial T1-weighted MRI planes multiplied by 100. In addition, we studied the relationships between PI and other measurements. RESULTS: The high signal intensity in the globus pallidus on T1-weighted MRI was observed in 18 (81.8%) patients. There was a significant correlation between whole blood and RBC manganese concentration, and PI on MRI. According to multiple linear regression, whole blood and RBC manganese concentration reflected PI on MRI better the other indices did. CONCLUSIONS: Whole blood and RBC manganese concentrations could be useful as biological manganese exposure indices that reflect PI on MRI.

The Effect of Hormone Replacement Therapy and Related Factors on the Change of Bone Mineral Density in Early Postmenopausal Women in Ulsan-si, Korea

BACKGROUND: Hormone replacement therapy (HRT) has been used as a effective therapeutic strategy of postmenopausal osteoporosis. However, the studies on HRT are insufficient, particularly in early postmenopausal women in Korea. This study was designed as a community based clinical trial and was conducted for 1 year. METHODS: One hundred and forty early postmenopausal women aged 49 to 54 years who resided in Ulsan in Korea were enrolled in this study. The osteoporosis prone life style and general characteristics of the participants and their measured BMD were investigated. The therapy groups included 45 women who were assigned to one of the following regimens in 28 day cycles for 1 year: (1) conjugate equine estrogen (CEE), 0.625 mg/d daily, medroxyprogesterone acetate (MPA) 2.5 mg/d daily and calcium 500 mg/d daily (2) CEE 0.625 mg/d daily, MPA 10 mg/d for days 1 through 12 and calcium 500 mg/d daily. RESULTS: The women in the therapy groups had an average gain of 5.4%, 4.2%, 2.1%, 4.9% in BMD in the lumbar spine, femur total, femur neck and ward's area, respectively. HRT has significantly influenced the BMD after controlling age, month since menopause, alcohol intake, smoking, calcium intake, exercise, body mass index and baseline BMD. The baseline BMD and the BMI were factors that influenced the effect of HRT in BMD. CONCLUSION: HRT had positively influenced the BMD in Korean women. The baseline BMD and the BMI were predictors of the effect of HRT in BMD change.

Factors Associated with Distorted Self-perception of Body Weight in Korean Adults

BACKGROUND: This study was done to examine the relationship between distorted self-perception of body weight and some sociodemographic factors in Korean adults. METHODS: This study was conducted among 14,621 adults (men 10,833, women 3,788), who visited Ulsan University Hospital Health Promotion Center to take a routine health examination. The objective body weight status was classified as underweight, normal, overweight, and obesity by body mass index. We compared the self- perception of body weight with in objective body weight status. We used multiple logistic regression to assess the odds ratio for distorted self-perception of body weight by age, marital status, monthly income, and level of education. RESULTS: Among the total 72.8% of obese men had a distorted self-perception of being slightly excess, 48% of overweight men considered themselves as just about right, and 39.5% of men with normal body weight as underweight. In women, 36.5% with normal body weight had a distorted self-perception of being slightly excess or very excess. In both men and women who were overweight or obesity, the distorted self-perception of being just about right was increased with higher age and lower education. The odds ratio of distorted self-perception in normal as being slightly excess or very excess was higher in women with higher income and higher education. CONCLUSION: In both men and women, many people had a distorted self-perception of Body weight. Some sociodemographic factors were found to be related to the self- perception of body weight.

Eradication rate of one-week triple therapy for peptic ulcer with Helicobacter pylori and clinical characteristics of patients with failed eradication

BACKGROUND: The decisive factors influencing the eradication of H. pylori still remain unclear. It was our aim to assess H.pylori eradication rate with proton pump inhibitor based triple therapy and investigate the clinical characteristics and endoscopic factors. METHODS: We investigated 106 male patients with H.pylori- positive peptic ulcer. The patients were treated with a 1-week regimen composed of omeprazole, amoxicillin and clarithromycin. THe success of the treatment was evaluated by histology at least 4 weeks after completion of therapy. Endoscopic factor and clinical factors influencing H.pylori eradication were assessed. RESULTS: The overall eradication of H.pylori was successful in 87 of 106 patients (82%). The eradication rate was higher in those who drink or smoke, with gastric ulcer, less than 50 years old but these factors did not significantly influence the outcome of treatment. CONCLUSIONS: H.pylori eradication rate with omeprazole, amoxicillin, and clarithromycin did not differ from other studies. These results suggest that factors such as smoking, drinking, age and ulcer site did not influence the eradication rate of H.pylpori.

Risk Factors of Colorectal Polyps in Korean Adults

BACKGROUND: Although several epidemiologic studies have revealed that our dietary factors, obesity and alcohol are associated with an increased incidence of colon cancer, association of these factors with colorectal polyps is unclear. In this study, we tried to investigate the association between colorectal polyps and lifestyle factors in Korean adults. METHODS: Rectosigmoidoscopy was performed on all subjects from January 2001 to December 2001 at Ulsan University Hospital Health Promotion Center. Self-administered questionnaire for drinking and other life style factors was done. RESULTS: Among the 1,102 cases in which sigmoidoscopy examination was performed by a family physician, the prevalence of colorectal polyps was 17.6%. Smoking and drinking were significant risk factors for colon polyps. After adjusting for age and sex, using multiple logistic regression, the odds ratio of subjects with 20 pack years or more of smoking compared with the non-smoking subjects was 2.503 (95% CI: 1.277-3.299). Compared with non-drinking subjects, adjusted odds ratio in group with 3 or more times of drinking per week group was 2.833 (95% CI: 1.623-4.945). The odds ratio for the highest exercise group, compared with the lowest group was 0.539 (95% CI: 0.336-0.867). Exercise was associated inversely with colon polyps. Obesity was statistically insignificant in this study. CONCLUSION: These results showed that drinking and smoking were positively associated with colorectal polyps, but it was associated inversely with exercise.

Prevalence and risk factors of the osteoporosis of perimenopausal women in the community population / 대한내과학회지

BACKGROUND: Osteoporotic fractures pose a major public problem, not only in Western populations but also of increasing significance in Asian populations. However, most previous studies for the prevalence of osteoporosis in Korea were carried out from the data of hospitalized or out-patient based subjects, hospital staff, healthy volunteers and so forth. The purpose of present study was to evaluate the normative data of bone mineral density (BMD) in Korean young and perimenopausal women and to determine the prevalence and risk factors of low bone mass, including osteoporosis and osteopenia in a community-based population. METHODS: In 1999, a baseline survey was carried out in the Dong-gu of Ulsan city, a urban area but located in seashore of southeastern Korea. The selected community sample of 3,822 inhabitants (all were women aged 49~54 years) were chosen. We studied 1,629 women among them and 127 healthy women aged 20~35 years. BMD of lumbar spine and femur was measured using dual-energy X-ray absorptiometry. For analysis of risk factors, those were excluded who was the current or recent user of estrogen and who had osteoporosis related disease or unknown menopause due to previous hysterectomy. Thus, 1,020 subjects were analysed for the association of low BMD and risk factors. Significant determinants of BMD were investigated using univariate and multiple regression analysis. RESULTS: When our young normal data were used, 9.8% for the lumbar spine and 1.4% for the femoral neck of our study population (n=1,629) were classified as osteoporosis. Among them, the menopausal status of above 1,020 subjects had independent association with low BMD (T-score<-1.0) of both lumbar spine (odds ratio=4.71 in postmenopause, p<0.001) and femoral neck (odds ratio=2.86 in postmenopause, p<0.001). In premenopausal women (n=507), weight and age of menarche were associated independently with low bone mass, including osteoporosis and osteopenia of both lumbar spine and femoral neck. In postmenopausal women (n=513), weight and duration since menopause were associated independently with low bone mass of both lumbar spine and femoral neck. Also, daily amount of calcium intake had significant association (regression coefficient=0.047; p<0.05) independently with BMD of femoral neck. CONCLUSION: The results of this population-based study suggest that it is important to prevent bone loss and screen the BMD in women aged 49~54 years with menopause, low body weight, late menarche, prolonged duration since menopause, low calcium intake.

Relation of physical activity and calcium intake to bone mineral density in perimenopausal women

BACKGROUND: Physical activity and calcium nutriture with reproductive endocrine status are primary controller of bone remodelling activity. There are differences in impact of exercise on early menopausal bone ; late menopausal bone. There are possibility of different effect of calcium intake on bone mass among different life stage. The aim of this study was to elucidate whether the relation between lifestyle and bone mineral density varied with life stages. METHODS: We examined bone mineral density and took questionnaires related to lifestyle of 1,698 women aged 49~54 years old who lived in ulsan from July 1999 to Dec. 1999. We selected 731 healthy subjects without medical conditions or lifestyle factors known to affect bone metabolism. RESULTS: In 6~10 years postmenopausal women, those with calcium intake of more than 600 or 800mg /day showed significantly greater BMD. In postmenopausal women , those daily consumption of milk showed greater BMD. But it is not significantly. In premenopausal women with regular menstruation, those who took regular exercise showed significantly greater BMD than those who did not. Working hours is not related with BMD. CONCLUSIONS: Our study showed that the relation between calcium intake or physical activity and BMD differed with life stages. It was suggested that life stages should be taken into consideration to perform lifestyle modifications for the prevention and management of osteoporosis.

Prevalence of polyps found during sigmoidoscopy by family physician

BACKGROUND: Sigmoidoscopy reduce colorectal cancer mortality by identifying both cancer and adenomatous polyp for treatment. However, this screening technique, sigmoidoscopy is extremely limited to family physician. We performed sigmoidoscopy and attemped to analyze colon polyps. METHODS: The authors performed rectosigmoidoscopy from January 2000 to January 2001 at ulsan university hospital health promotion center. We reviewed and analyzed all subjects at which time all polyps were biopsied. RESULTS: In total, 1107 case sigmidoscopy examination were performed without complication. Polyps were found in 11.5%. 44.5% were neoplastic adenoma and 33.6% were hyperplastic polyps. Cancer was detected in 2 subjects. All case of neoplastic polyps were refered to colonoscopist. The difference of polyp incidence rate was significant in age and sex group. (p<0.01) CONCLUSION: The prevalence of colon polyps was 11.5%. This data is simillar to colonoscopist's data. These results suggest that screening sigmoidoscopy can be performed usefully by family physicians.

The effect of audiovisual instruction that influences hormone replacement therapy uptake and changes of lifestyle behaviors related to osteoporosis in perimenopausal women

No Abstract Available.

Smoking Behavior and its Related Factors in Male Students of One Senior High School in Taegu

BACKGROUND: The increase of smoking prevalence in adolescents Is serious problem because of physical and psychological influences furthermore, fixation of smoking habit. This study is aimed at providing applicable basic information to setting up the education programs and strategies to prevent smoking among high school students by analysing smoking behavior and its related factors. METHODS: 835 students from one senior high school in Taegu completed a self administerd questionnaire during school hours in May, 1996. 813 questionnaires with adequate responses were analyzed using SPSS/PC program. All students were asked class years, school satisfaction, school performance score, number of their three best friends who smoke, smoking status of their fathers, religion, allowance, alcoholic drinks, addicting drug use, Zung's self-rating depression scale(SDS) and Zung's self-rating anxiety scale(SAS), Smokers were asked amount of smoking, motives for smoking, when they started smoking, Fagerstrom score. RESULTS: Of the 813 students in the sample 135(16.6%) were current smokers. About the amount of smoking, 59.3% smoked less than 5 cigarettes/day. About the motives of smoking, 34.8% started smoking through the solicitation by friends or for making friends. About when they started smoking, 52.6% started smoking before entrance into senior high school. The related factor with smoking Included class years, school satisfaction, school performance score, numbers of three best friends who smoke, allowance, alcoholic drinking, addicting drug use, SDS. Predictor of smoking were number of three best friends who smoke, number of alcoholic drinking, and allowance. The related factors of nicotine dependency were amount of smoking, allowance, when they started smoking. Predictor of nicotine dependency were amount of smoking, number of three best friends who smoke. CONCLUSIONS: The related factors with smoking included class years, school satisfaction, school performance score, number of three best friends who smoke, allowance, alcoholic drinking, addicting drug use, and SDS. Predictors of smoking were number of three best friends who smoke, number of alcoholic drinking, and allowance.

PCR Prevalence and Risk Factors of Hepatitis C Virus Infection in the Adult Population of Ulsan

BACKGROUND: Liver disease is an important public health problem in Korea. The aim of this study was to estimate the prevalence of hepatitis C virus antibody(anti-HCV) in the adult population of Ulsan and to identify risk factors for HCV infection by case centre study. METHODS: The anti-HCV test was performed in 10,140 adults older than 20 years of age who underwent a general medical checkup in Ulsan University Hospital, Health Promotior Center from January 1997 to November 1997. 33 cases and 99 controls matched for age and sex with a 1: 3 ratio of cases to controls were enrolled. The cases were defined as positive anti-HCV and positive HCV-RNA whereas the controls were negative anti-HCV negative HBsAg and ALT < OR = 40. Exposure data were obtained by self-administered questionnaire. RESULTS: The overall prevalence of anti-HCV was 1.3%(95% CI : 1.1-1.5) and the positive predictive value of 3rd generation anti-HCV ELISA was 34%. Thus, true prevalence of HCV infection was 0.45%. Only history of transfusion was significantly associated with anti-HCV infection. CONCLUSIONS: The overall prevalence of anti-HCV was 1.3% and true prevalence of HCV infection was 0.45% in the adult population of Ulsan. Transfusion was the major route of transmission of HCV but the risk will likely reduce.