Infectivity of Coronavirus Disease 2019: A Prospective Cohort Study in the Korean Metropolitan Area

Background@#Although several characteristics of coronavirus disease 2019 (COVID-19), an ongoing pandemic disease, have been identified, data on the infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are limited. @*Methods@#This prospective cohort study was conducted to analyze the infectivity of SARSCoV-2 based on data of all patients diagnosed with COVID-19 confirmed using real-time polymerase chain reaction test from January to April 2020 in Gyeonggi-do, the largest province in Korea. @*Results@#Of the 502 patients, 298 consisting of 106 clusters with 5,909 contacts were included. Of these, 277 (93.0%) were symptomatic, and the most common symptoms were cough, fever, sputum, sore throat, and headache. A total of 94 patients (31.5%) had pneumonia, while 8 (2.7%) died during the follow-up period. The secondary attack rate (SAR) in the study population was 3.5% (204/5,909). In exposure settings, the SAR was higher in religious gathering (13.5% [95% confidence interval, 10.7–16.8%]), workplaces (8.49% [95% CI, 6.08–11.74%]), and schools (6.38% [95% CI, 3.39–11.69%]) than in health care facilities (1.92% [95% CI, 1.45–2.55%]). Sore throat at any period, dyspnea at diagnosis or any period, lower cycle threshold value in the lower respiratory tract samples, leukocytosis, and higher bilirubin levels were associated with higher infectivity of COVID-19. The presence of symptoms was not related to the infectivity. @*Conclusion@#In establishing the infection control strategies for COVID-19, the variables associated with high infectivity may be considered.

Clinical and Laboratory Factors Associated with Symptom Development in Asymptomatic COVID-19 Patients at the Time of Diagnosis

In preparation for the surge of coronavirus disease 2019 (COVID-19), it is crucial to allocate medical resources efficiently for distinguishing people who remain asymptomatic until the end of the disease. Between January 27, 2020, and April 21, 2020, 517 COVID-19 cases from 13 healthcare facilities in Gyeonggi province, Korea, were identified out of which the epidemiologic and clinical information of 66 asymptomatic patients at the time of diagnosis were analyzed retrospectively. An exposure-diagnosis interval within 7 days and abnormal aspartate aminotransferase levels were identified as characteristic symptom development in asymptomatic COVID-19 patients. If asymptomatic patients without these characteristics at the time of diagnosis could be differentiated early, more medical resources could be secured for mild or moderate cases in this COVID-19 surge.

Rapidly Progressive Small Bowel Necrosis in a Previously Healthy Child without Proven Mechanical Obstruction / 대한소아소화기영양학회지

Bowel ischemia is a life-threatening surgical emergency. We report a case of rapidly progressive bowel necrosis in a previously healthy child without proven mechanical small bowel obstruction. The definite diagnosis was established at the time of an exploratory operation. Of note, imaging studies and even a laparotomy did not reveal any evidence of acute appendicitis or mechanical obstruction such as intussusception or Meckel's diverticulum. During hospitalization, since we could not rule out surgical abdomen after inconclusive image findings, we closely followed the patient and repeated physical examinations carefully. Eventually surgical exploration was performed based on changes in clinical condition, which proved to be the right decision for the patient. We propose that in children with suspected strangulation of small bowel obstruction, especially when imaging findings do not provide a conclusive diagnosis, the timely exploratory surgical approach ought to be chosen based on carefully observed clinical findings and other evaluations.

Evaluation of Bio-Rad D-10 HbA1c Autoanalyzer / 임상검사와정도관리

BACKGROUND: Hemoglobin A1c (HbA1c) is a useful marker for the diagnosis and monitoring of diabetes, which has resulted in an increasing dependency on HbA1c levels for diagnosing diabetes in small- and medium-sized hospitals. We evaluated a high performance liquid chromatography (HPLC) based HbA1c autoanalyzer Bio-Rad D-10 (Bio-Rad Laboratories, USA) by comparing the analysis results with that by Tosoh HLC-723 G7 (Tosoh Corporation, Japan). METHODS: The Bio-Rad D-10 autoanalyzer was evaluated for its precision, linearity, and carryover. The analysis time and correlation were evaluated and compared with those by Tosoh HLC-723 G7 autoanalyzer. RESULTS: Bio-Rad D-10 showed within-run, between-day, and total precision of less than 1.3% coefficient of variation (CV) and excellent linearity between HbA1c in the range of 3.2%-21% (coefficient of determination, R 2 = 0.998). The sampleto-sample carryover was 0.57%. The results obtained by using Bio-Rad D-10 showed good correlation (r = 0.997; P < 0.001) with those by Tosoh HLC-723 G7; however, the analysis time using Bio-Rad D-10 was about 2.3 times per 10 samples and 2.5 times per 20 samples than those using Tosoh HLC-723 G7. CONCLUSIONS: Bio-Rad D-10 showed good performance in assaying HbA1c. Bio-Rad D-10 autoanalyzer would be suitable for use in laboratories with small to medium amount of samples to be analyzed, but its initial analyzing time was longer than that by Tosoh HLC-723 G7.

Efficacy and Safety of Propiverine Hydrochloride 40mg in Treatment of Overactive Bladder : Prospective, Multicenter, Observational study

PURPOSE: This study aims to compare the efficacy and safety of propiverine hydrochloride (propiverine) 40mg for the treatment of overactive bladder (OAB). MATERIAL AND METHODS: Total of 284 patients (male:86, female:198) with OAB were included in this study. The patients were treated with propiverine 20mg twice daily or 40mg once daily for 8 weeks. The initial evaluation included with history taking, physical examination, International Prostatic Symptom Score (IPSS), IPSS QoL and consecutive voiding diaries for 3 days. After a 8-week treatment, IPSS, IPSS QoL, patients perception of treatment benefit, global assessment of efficacy by physicain and safety were evaluated. RESULTS: Two hundred eighteen patients were treated with propiverine 20mg twice daily and 66 patients treated with 40mg once daily. The 59 patients had been treated previously with anticholinergics. After a 8-week treatment, IPSS score (total, voiding and storage subscore) and IPSS QoL were improved in all patients (p<0.05). After a 8-week with propiverine 40mg once daily, improvement of IPSS score was noted in the patients non-responsive to anticholinergics previously (p<0.05). The patients treated with propiverine 40mg once daily showed much more symptomatic improvements assessed by physicians than 20mg twice daily (p<0.05). The overall side effect was noted in the 13.4% patients and the most common side effect was dry mouth. CONCLUSION: Propiverine 40mg once daily is considered to reduce the symptom of OAB effectively and can be used safely in the patients with OAB. Treatment with propiverine 40mg is seemed to show more improvement in the unsatisfactory patients with previous anticholinergics.

The Factors that Influence the Clinical Outcomes after Trial without Catheter for Acute Urinary Retention due to Benign Prostatic Hyperplasia: a Multicenter Trial / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) is a common problem that's experienced by aging men, and it can lead to serious outcomes, including acute urinary retention (AUR). We studied the factors that influence the clinical outcomes after trial without catheter (TWOC) for AUR due to BPH. MATERIALS AND METHODS: The medical records of all 455 BPH patients who visited the emergency room for the first time with AUR from March 2001 through February 2005 were retrospectively reviewed. The patients were divided into two groups: the success group (group I) or failure group (group II) that underwent trial without catheter. The patient's characteristics were compared between the two groups using logistic regression analysis and the chi-square test. RESULTS: From the 292 cases of group I and the 163 cases of group II, the multivariate analysis revealed statistically significant differences in the retention volume (p<0.01), the prostate volume (p<0.01) and the previous use of alpha-blockers before AUR (p<0.01). CONCLUSIONS: The prostate volume, retention volume and previous use of alpha-blockers before AUR were thought to influence the clinical outcomes of TWOC for the BPH patients with AUR, and these factors should be considered in future treatment planning.

Idiopathic Hypereosinophilic Syndrome Presenting As a Single Mass in the Liver / 대한소화기학회지

Hypereosinophilic syndrome is characterized by persistent blood eosinophilia of 1,500/mm3 or more in the absence of known causes and multiorgan dysfunction by eosinophil-related tissue damage. In Korea, some cases of hypereosinophilic syndrome with hepatic involvement have been described with prolonged benign clinical courses. Most of them were diffuse or multifocal lesions in imaging studies, and any case presenting as a large single mass lesion has not been described. Herein we report a case of hypereosinophilic syndrome with hepatic involvement in a 48-year-old woman who presented with a giant single mass. By abdominal CT scan, a lobulated well-margined heterogenous mass lesion was detected in the left lateral segment of the liver. Liver biopsy revealed severe eosinophilic infiltration and centrilobular necrosis of hepatocytes. The lesion completely disappeared after steroid administration for eleven months.

A Case of Auto-immune Hepatitis Associated with Primary Sjogren's Syndrome / 대한간학회지

Auto-immune hepatitis is a chronic necroinflammatory liver disorder that is characterized by hypergammaglobulinemia, auto-antibodies in serum, and, on histological examination, the presence of periportal hepatitis. Although it can be associated with a number of other auto-immune diseases, Sjogren's syndrome is rarely associated with auto-immune hepatitis. We herein report an unusual case of auto-immune hepatitis associated with primary Sjogren's syndrome. A 39-year-old woman was admitted to our hospital due to jaundice. Laboratory data showed negative viral hepatitis marker, increased serum IgG level, positive anti- nuclear antibody, and an increased rheumatoid factor titer. The patient had no history of taking medications and alcohol. Based on characteristic clinical features, liver biopsy findings, positive Schirmer's test, and salivary scintigraph, she was diagnosed as having auto-immune hepatitis and Sjogren's syndrome. The patient achieved complete remission with steroid monotherapy.

An Analysis of Extravariceal Collaterals of Gastric Varices Using Magnetic Resonance Angiography in Portal Hypertensive Patients / 대한소화기학회지

BACKGROUND/AIMS: This study was aimed to analyze the relationship between gastric varices and its collaterals using magnetic resonance angiography (MRA) and to assess the usefulness of MRA in studies of portosystemic circulation. METHODS: Eighty-one patients who had portal hypertension with gastric varices took MRA before the therapy for gastric varices. RESULTS: The types of collaterals observed by MRA were left gastric vein in 67 patients (83%), short gastric vein in 28 (35%), gastrorenal shunt in 25 (31%), and splenorenal shunt in 14 (17%). In most of patients with advanced gastric varices, the size of left gastric vein was larger than others. In most cases of large gastric varices, the short gastric vein ranged between 5 to 10 mm. Gastrorenal shunt was also correlated with the size of gastric varices. The types of more prominent esophageal varices showed a right type (left gastric vein predominance), but the types of more prominent gastric varices or only the gastric varices showed a left type (posterior or short gastric vein predominance) (p<0.05). CONCLUSIONS: Gadolinium enhanced 3D-MRA can contribute to the study of the hemodynamic relationships between gastric vein and the collateral circulations by presenting more clear images for patients with portal hypertension.

A Case of Metastatic Gastric Synovial Sarcoma / 대한소화기내시경학회지

Synovial sarcomas are malignant soft tissue neoplasms that develop from tendon and bursa near the large joints and frequently occur in the lower extremities of young male adults. They usually recur within 2 years after surgical treatment. The lung is a common metastatic site and rarely reported as the primary site of synovial sarcoma. The stomach is a very rare primary site of synovial sarcoma and recently only two cases of primary gastric synovial sarcoma were reported. We report a case of metastatic gastric synovial sarcoma in a 53-year-old male 4 years after surgical treatment of primary lung synovial sarcoma. The tumor had histologic, immunohistochemical and ultrastructural features of biphasic synovial sarcoma of the soft tissue.

Changes in portosystemic collaterals after endoscopic injection sclerotherapy: focused on magnetic resonance angiography / 대한내과학회지

BACKGROUND: This study was aimed at evaluating the changes of collateral circulation, using MR angiography (MRA), which is a non-invasive and a useful tool for viewing the porto-systemic circulation as a whole, following endoscopic injection sclerotherapy (EIS). METHODS: 30 patients who have portal hypertension with esophageal varices have taken MRA before the sclerotherapy and followed up 1 month after the eradication. RESULTS: The collaterals observed before EIS are as follows: left gastric vein 30 patients (100%), short gastric vein 2 patients (7%), gastro-renal shunt 2 patients (7%) and spleno-renal shunt 6 patients (20%). After the sclerotherapy, left gastric vein was obliterated in 12 patients (40%), decreased to 25% and 50% in 9 patients (30%) but, no change in 6 patients (20%), increased in 3 patients (10%). For short gastric vein, 25% and 50% size reduction was found in 2 patients. For gastro-renal shunt, no change in size was observed in 1 patient, increased to 25% in 1 patient. For spleno-renal shunt, it disappeared in 1 patients (17%) and decreased to 25% in 1 patient but, no change in 3 patients (50%), increased to 25% in 1 patients. CONCLUSION: Obliteration of left gastric vein was observed in many cases after the sclerotherapy and further evaluation is needed.

Two Cases of Autoimmnune Hepatitis Associated with Systemic Lupus Erythematosus / 대한간학회지

Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disease of unknown cause associated with circulating autoantibodies and high serum globulin level. Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complex, affecting multiple organs including the liver, kidney, and CNS. The difference between the hepatic involvement of SLE and autoimmune hepatitis has not been clearly defined in the past due to similarities in clinical and biochemical features. A scoring system for the diagnosis of AIH has been established, and AIH and SLE-associated hepatitis have been defined as two different entities, although both have the same autoimmune features such as polyarthralgia, hypergammaglobulinemia and circulating autoantibodies. AIH has been considered to occur infrequently in SLE. We report two cases of AIH which simultaneously satisfied the criteria of SLE.

Expression of CD44, p53 and p21 in Uterine Cervical Intraepithelial Neoplasia and Squamous Cell Carcinoma with Respect to HPV Status / 대한산부인과학회잡지

OBJECTIVE: To clarify the possible role of CD44, p53 and p21 in the development or progression of uterine cervical tumors, an immunohistochemical investigation was carried out on 99 cases of cervical intraepithelial neoplasia (CIN) III and stage Ib squamous cell carcinoma. Abnormal expression of CD44, p53 and p21 has been observed in a variety of human tumor, but little is known about its expression during cervical carcinogenesis. METHODS: The author examined the expression pattern of CD44, p53, and p21 in CIN III and invasive carcinoma groups with respect to high risk HPV positivity and tumor invasion. RESULTS: CD44s was expressed in CIN III and invasive carcinoma groups, and the positivities of expression were 75.0% and 52.7%, respectively. The positivities of CD44-v5 and CD44-v6 expression were 81.8%, 63.6% and 43.2%, 36.4%, respectively. The positivities of p53 and p21 expression in CIN III and invasive carcinoma groups were 18.2, 40.0% and 54.5%, 36.4%, respectively. This study revealed that neither CD44s nor CD44v appears to have independent prognostic relevance. No association between p53 immunostaining and p21 expression was found. Expression of CD44 and p21 was independent of the high risk HPV status, but expression of p53 is higher in the high risk HPV negative cases. CONCLUSION: The author demonstrated reduced expression of CD44 and increased expression of p53 with progression from CIN III to invasive squamous cell carcinoma. CD44 may have an important role in early tumorigenesis. Immunohistochemically detected CD44, p53 and p21 appeared to be of no predictive value with regard to clinical outcome.

Endoscopic variceal ligation-injection sclerotherapy (EVLIS) for gastric varices: Analysis of 10 years' experience / 대한내과학회지

BACKGROUND: The aim of this study is to evaluate the long-term clinical outcome, rebleeding rate, and recurrence rate of endoscopic variceal ligation injection sclerotherapy (EVLIS) for gastric varices. METHODS: 302 cases were chosen from patients treated with EVLIS for gastric varices from September 1992 to August 2002. The follow-up period ranged from 6 to 12 months with average being 35 months. RESULTS: The number of patients with gastric varices F1, F2, F3 were 105 (43.8%), 127 (42%), 70 (23.2%) and Lg-c, Lg-f, Lg-cf were 82 (26.9%), 67 (22.2%), 153 (50.9%). The average sessions of therapy needed for the initial hemostasis was 2.34 times. Initial hemostasis in 117 patients who needed emergency treatment was successfully done in all cases. Early rebleeding was observed in 36 (12%) patients in whom most of the bleeding occurred from the secondary ulcer. Late rebleeding was observed in 37 (12.2%) patients in whom secondary ulcer and gastric variceal bleeding accounted for rebleeding in 14 (4.6%) patients and 23 (7.6%) patients respectively. Within the follow-up period, recurrence of gastric varices was observed in 104 (34.3%) patients with the average time to recurrence being 18.8+/-16 months. CONCLUSION: Since our method shows similar results with that of long-studied esophageal variceal therapy, it is thought of as an excellent treatment modality for gastric varices.

Neurofibroma of the Esophagus / 대한소화기내시경학회지

Neurofibroma in gastrointestinal tract are presented as localized forms or in associated with neurofibromatosis. Previous reported cases were presented as relatively large sized esophageal mass and treated by surgical resection. However, a neurofibroma was found incidentally during endoscopy in this case. It was presented as palisade like solitary nodules with or without connecting mucosal bridges in lower esophagus. It was treated by mucosectomy and followed up without recurrence.

Pyoderma Gangrenosum on the Sternal Area in Ulcerative Colitis / 대한소화기내시경학회지

Pyoderma gangrenosum is a painful, chronic, ulcerative skin disease of unknown cause. It commences as an erythematous papulopustule and rapidly evolves to form an area of frank ulceration with undermined, violaceous edges and a bright outer halo of erythema. An underlying systemic illness is present in more than 75 per cent of patients. Inflammatory bowel disease, either ulcerative colitis or Crohn's disease, is the most frequent. Pyoderma gangrenosum generally appears during the course of active bowel disease and frequently concur with exacerbations of colitis. However, they also occur in inactive colitis. Nor is there general agreement regarding the relationship between the duration, activity, and extent of bowel disease and the incidence and severity of the skin lesions. We experienced a case of pyoderma gangrenosum developed on the sternum with inactive ulcerative colitis and improved with corticosteroid, antimicrobial agents and topical dressing but recurred another site with active colitis.

An Immunohistochemical study of the origin and differentiation of gastric stromal tumor / 대한내과학회지

BACKGROUND: Gastrointestinal stromal tumors (GISTs) have the subject of debate and controversy regarding their histogenesis, criteria on malignancy, prognostic features, site-specificity and their nomenclature. These tumors have various phenotypical features and are generally divided into (1) tumors showing differentiation toward smooth muscle cells (2) tumors showing apparent differentiation toward neural elements (3) tumors showing dual differentiation toward smooth muscle and neural elements (4) tumors lacking differentiation toward either cell type (uncommitted type). This study was performed to identify the possible origin and differentiation of gastric stromal tumor. METHODS: This study was performed on 38 patients who had gastric stromal tumors on endoscopy or endoscopic ultrasonography and confirmed by endoscopic or surgical resection between January 1994 and June 1999 at Department of Internal Medicine, Korea University College of Medicine. Formalin-fixed, paraffin-embedded tissues were studied by immunohistochemical method for detecting the presence of CD 34, CD 117, Vimentin, SMA, Desmin, S-100, PGP 9.5 and NSE. RESULTS: The patients' age ranged from 26 to 81 years old, with an average age of 53.8 years. The male to female ratio was 1:1.2. Endoscopic resections were performed on 22 patients and surgical operations on 16 patients. The average tumor size was 25.3 mm in diameter. On immunohistochemical staining method, the uncommitted type was found in 18 patients (47.4%), of which 17 patients (94.4%) were CD117 (+), CD34 (+), Vimentin (+), 12 patients (31.6%) had muscular differentiation, 7 patients (18.4%) showed neural differentiation and 1 patient (2.6%) showed differentiation toward both neural and muscular immunohistochemical pattern. CONCLUSION : Gastric stromal tumors showed phenotypical diversity in immunohistochemical staining suggesting different histogenesis. Most uncommitted type had a phenotype of intersititial cells of Cajal (ICC) and this evidence supports the hypothesis that uncommitted type has the origin of ICC.

Electron Microscopic Evaluation of Adhesion of Helicobacter pylori to the Gastric Epithelial Cells in Chronic Gastritis

BACKGROUND: The adhesion of H. pylori to the gastric epithelial cells may be an essential step for the pathophysiology of various H. pylori-induced gastrointestinal diseases. The purpose of this study was to investigate the ultrastructural relation of H. pylori and gastric epithelial cells in their adhesion. METHODS: Endoscopic biopsy of gastric antrum and body was performed from 15 patients (9 men, 6 women) with chronic gastritis and H. pylori infection. The specimens were processed for electron microscopy and observed with a transmission electron microscope (Hitachi H-600). RESULTS: On the basis of morphological appearances, the adhesions of H. pylori to the gastric epithelial cells were categorized into three types; filamentous connection, adhesion pedestals and membrane fusion. Coccoid and undetermined forms adhered mainly by the filamentous connection, whereas the bacillary forms adhered primarily by the adhesion pedestals and membrane fusion. CONCLUSION: Various types of adhesion were associated with H. pylori and gastric epithelium. Further studies are needed to evaluate the influence of different types of adhesion to the pathophysiology of H. pylori.

Clinical Significance of Total Colonoscopy in Patients with Active Pulmonary Tuberculosis without Gastrointestinal Symptoms / 대한소화기내시경학회지

BACKGROUND/AIMS: Pulmonary tuberculosis may coexist with intestinal tuberculosis even in the absence of gastrointestinal symptoms. The aim of this prospective study was to define the colonoscopic findings of early lesions of intestinal tuberculosis, incidence of asymptomatic intestinal tuberculosis in patients with active pulmonary tuberculosis and to evaluate the clinical response after standard anti- tuberculosis chemotherapy. METHODS: We examined 59 Korean patients with active pulmonary tuberculosis, who had no gastrointestinal symptoms. Patients underwent diagnostic total colonoscopy up to terminal ileum for evaluation of intestinal tuberculosis. Follow-up total colonoscopy was also done in 1~3 months after start of treatment. RESULTS: Intestinal tuberculous lesions were found in 54% of patients. The common locations of lesion were terminal ileum (84%) and cecum (69%). The combination of circumferential ulceration, hyperemic mucosa and erosions of the colon was the most common finding (37.5%), the combination of hyperemia and ulceration occurred in 34.4% of patients and hyperemia with/without erosion in 12.5%. The direction of ulceration was transevere in relation to long axis of the colon but occasionally longitudinal. Although most ulcers were multiple in number and various in size but some paitents had isolated single ulcer with erosion. All of the lesions regressed within 1~3 months of treatment. CONCLUSIONS: During screening total colonoscopy, if there are nonspecific hyperemia, erosion or shallow ulcer on colon or terminal ileum, it is necessary to check up chest X-ray for rule out tuberculous lesion, especially in countries with a high prevalence of tuberculosis.

Analysis of Eradication Rate of Helicobacter pylori According to Treatment Duration by Using 13C-Urea Breath Test Comparison of OAC 7, 10 or 14 days regimen / 대한소화기내시경학회지

BACKGROUND/AIMS: Efficacy of triple therapy with omeprazole, amoxicillin, and clarithromycin (OAC) for Helicobacter pylori (H. pylori) varies among different geographic regions and patient populations. And, there is no full consensus on how long this treatment should be maintained. We assessed the efficacy of the OAC regimen according to the treatment duration (7, 10 or 14 days) using 13C-urea breath test (13C-UBT). METHODS: Two hundred fifty five H. pylori positive patients with peptic ulcer were randomly assigned to a OAC (omeprazole 20 mg b.d., amoxicillin 1.0 g b.d. and clarithromycin 500 mg b.d.) 7, 10 or 14 days regimen. Eradication of H. pylori was assessed by 13C-UBT 4 weeks after the completion of therapy. RESULTS: 140 male and 115 female (mean age, 51.3) patients were enrolled. The overall eradication rate of H. pylori in each group was significantly higher in OAC 14 days regimen than OAC 7 and 10 days regimen (91.9% in OAC 14 days, 74.4% in OAC 7 days, and 80.2% in OAC 10 days, respectively, p<0.05). CONCLUSIONS: The overall eradication rate of H. pylori was highest in OAC 14 days regimen in our study. We have found significant differences in eradication rates with previous reports, using CLO and histology, in Korea. Thus, further studies focusing on the treatment period may be warranted.