Clinical Characteristics of Patients Who Contracted the SARS-CoV-2 Omicron Variant from an Outbreak in a Single Hospital

There are few studies on the severity and prognosis of patients infected with the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) omicron variant. From January 11, 2022 to January 25, 2022, 181 patients were infected with the SARS-CoV-2 omicron variant in a single hospital in Korea. The initial clinical characteristics were investigated through the COVID-19 basic investigation form. Outcomes were reviewed using medical records. The median age of the patients was 57 years (range 1–90), and 95 patients (52.5%) were male. None were re-infected with SARS-CoV-2, and 127 (70.2%) were fully vaccinated (boosted or within 6 months after second vaccination). Forty-two patients (23.2%) were asymptomatic. Among symptomatic patients, the frequency of symptoms was as follows: cough (37.0%), sore throat (33.7%), and fever (30.4%). In terms of disease severity, 168 (92.8%) patients did not require supplemental oxygen, 6 (3.3%) required low-flow oxygen, 5 (2.8%) required high-flow oxygen, and 2 (1.1%) died. Four of the five individuals who required high-flow oxygen and the two who died were not vaccinated. Most of the patients who contracted the SARS-CoV-2 omicron variant exhibited mild clinical features; however, severe clinical features including mortality were encountered among individuals who were not vaccinated.

Clinical Characteristics of COVID-19: Clinical Dynamics of Mild Severe Acute Respiratory Syndrome Coronavirus 2 Infection Detected by Early Active Surveillance

Background@#There is limited information describing the presenting characteristics and dynamic clinical changes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosed in the early phase of illness. This study is a case series of patients with coronavirus disease 2019 (COVID-19) admitted to 11 hospitals in Korea. @*Methods@#Patients with confirmed SARS-CoV-2 infection by positive polymerase chain reaction (PCR) testing of respiratory specimens by active surveillance that were finally discharged between February 20 and April 30, 2020 were included. Patients were classified into mild and non-mild groups on initial admission according to oxygen demand and Sequential Organ Failure Assessment score, and the mild group was followed up and subgrouped into non-aggravation and aggravation groups. @*Results@#A total of 161 patients with SARS-CoV2 infection were enrolled. Among the mild group of 136 patients, 11.7% of patients experienced clinical aggravation during hospitalization, but there was no initial clinical parameter on admission predicting their aggravation. Fever (odds ratio [OR], 4.56), thrombocytopenia (OR, 12.87), fever (OR, 27.22) and lactate dehydrogenase (LDH) > 300 U/L (OR, 18.35), and CRP > 1 mg/dL (OR, 11.31) significantly indicated aggravation in the 1st, 2nd, 3rd, and 4th 5-day periods, respectively.PCR positivity lasted for a median of 22 days and 32 days after the onset of illness in the nonaggravation and aggravation groups, respectively. @*Conclusion@#Old age was associated with early severe presentation. Clinical aggravation among asymptomatic or mild patients could not be predicted initially but was heralded by fever and several laboratory markers during the clinical course.

A Case of Lung with Jejunal Metastasis / 결핵

Primary lung cancer can metastasize by a direct local extension, hematogenous dessemination, and lymphatic spread. However, it less commonly metastasizes via a transbronchial invasion. A pproximately half of all patients with lung cancer have metastases at the initial presentation. Autopsy data showed that there are an average of 4.8 metastatic sites. The most common sites for metastases include the lymph nodes, liver, adrenal gland, bone, and brain. However, clinically significant metastases isolated in the small bowel seldom occur. Here we report a case of lung cancer with a small bowel metastasis.

Clinical Significance of Serum PDGF-BB and IGF-1 in Coal Workers' Pneumoconiosis / 결핵

BACKGROUND: Coal workers' pneumoconiosis(CWP) is a fibrotic lung disease resulting from the chronic inhalation of coal dust. Various cytokines and growth factors secreted from macrophages and monocytes play a key r ole in the pathogenesis of penumoconiosis. The platelet-derived growth factor (PDGF)-BB and the insulin-like growth factor(IGF)-1 secreted from the macrophages and monocytes are believed to stimulate the accumulation of mesenchymal cells and fibrosis of the lower respiratory tract that is observed in fibrotic lung disease. The serum concentration of PDGF-BB and IGF-1 in 30 CWP patients and 10 healthy controls were measured in order to determine if PDGF-BB and IGF-1 can be used as sensitive biomarkers in CWP. METHODS: Serum was collected from 30 patients with CWP (13 with simple CWP and 17 with complicated CWP) and 10 healthy controls. The serum concentrations of PDGF-BB and IGF-1 were measured using ELISA (RandD system, Minneapolis, MN). RESULTS: The serum PDGF-BB concentration in patients with complicated CWP (10083.76+/-639.07 pg/ml) was significantly higher than in the patients with simple CWP(8493.88+/-848.51 pg/ml) and the healthy controls (3726.17+/-292.20pg/ml)(p0.05). CONCLUSIONS: These results show the important role of the PDGF-BB mediated pathways in the pathogenesis of CWP. These data suggests that the PDGF-BB serum concentration is a useful biomarkers of the fibrotic extent in CWP patients.

Clinical Significance of Plasma TGF-β1 in Coal Workers' Pneumoconiosis / 결핵

BACKGROUND: Coal workers' pneumoconiosis is a fibrotic lung disease resulting from chronic inhalation of coal dust. The precise mechanism of lung fibrosis in coal workers' pneumoconiosis is uncertain. However, a relationship between the stimulation of fibroblast proliferation and collagen production by mediators released from inflammatory and resident lung cells is thought to be a major factor. The transforming growth factor-β(TGF-β), a multifunctional cytokine and growth factor, plays a key role in the scarring and fibrotic processes due to its ability to induce extracellular matrix proteins and modulate the growth and immune function of many cell types. To determine the involvement of TGF-βin the development of lung fibrosis in coal workers' pneumoconiosis, the TGF-β1 level in plasma was measured in patients with coal workers' pneumoconiosis. METHODS: Plasma was collected from 40 patients with coal workers' pneumoconiosis (20 with simple coal workers' pneumoconiosis and 20 with complicated coal workers' pneumoconiosis) and from 10 normal controls. The ELISA method was used to measure the plasma TGF-β1 concentration. RESULTS: Compared to the control group (0.63±0.18 ng/mL), there was no significant difference in the plasma TGF-β1 level in patients with simple coal workers' pneumoconiosis (0.64±0.17 ng/mL) (p>.05). However, in patients with complicated coal workers' pneumoconiosis the plasma TGF-β1 level (0.79±0.18 ng/mL) was significantly higher than in patients with simple coal workers' pneumoconiosis and control group (p<0.05). CONCLUSION: The data suggests that TGF-β1 has some influence in the development of lung fibrosis in coal workers' pneumoconiosis.

Two Cases of Acute Respiratory Distress Syndrome with Pulmonary Hemorrhage Induced by Injection of Silicone at Perineum / 결핵

Silicone fluid is a biomaterial widely used in modern cosmetic procedures because there are few side effects, considerable chemical stability and predictable physical properties. However, many local and systemic adverse reactions have reported. In particular some serious pulmonary complications have been reported such as pulmonary thromboembolism, acute respiratory distress syndrome with some cases leading to mortality. Most of the serious complicated cases were induced by an illegal silicone fluid injection. We experienced two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone fluid injection. The patients were 41 & 51 year old women, who complained of dyspnea. The chest X-ray and HRCT scan findings showed a bilateral ground glass attenuation on the bilateral dependent portion of the upper and middle lung zone. The patients clinical symptoms and the radiologic and other laboratory findings were compatible with acute respiratory distress syndrome induced by the silicon fluid injection. Here we report two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone injection with a review of the relevant literature.

Relationship Between Tumor Angiogenesis, sgtage and Prognosis in Non-Small Cell Lung Cancer / 결핵

BACKGROUND: Tumor angiogenesis is required for tumor growth and metastasis. In this study, we investigated the correlation between the intensity of angiogenesis and stage, nodal status, histologic type, metastasis and survival rate of non-small cell lung cancer. METHOD: Formalin fixed, paraffin embedded surgical specimens of 45 patients who had surgically resected primary non-small cell lung cancers without pre or post perative adjuvant chemotherapy or radiotherapy were examined. The microvessel count(MVC) was demonstrated by immunohistochemical staining for CD31(platelet ednothlial cell adhesion molecule, PECAM). RESULTS: Microvessel counts(MVCs)in stage IIIA and IIIB were higher than in stage I and II(p0.05). However, in adenocarcinoma, the MVC in patients with lymph node metastasis was significantly higher than that seen in patients without lymph node metastasis(p0.05). However, in stage IIIA and IIIB or N1~3 stage, the MVC in adenocarcinoma was higher than that in squamous cell carcinoma(p0.05). The survival rate in patients with high MVCs was lower than that in patients with low MVCs(P<0.05). CONCLUSION: In non-small cell lung cancer, MVC correlated relatively well with pathologic stage, nodal status (limited in patients with adenocarcinoma), histologic type, postoperative metastasis and survival rate. However, in the same histologic type and stage, MVC was not significantly related to the duration of survival. Therefore the assessment of the intensity of angiogenesis in non-small cell lung cancer may be helpful in predicting prognosis and in selecting patients for systemic adjuvant therapy of potential metastasis according to the results.

Clinical Features of Stroke in Patients Undergoing Maintenance Dialysis / 대한신장학회잡지

Cardiovascular and cerebrovascular diseases are important causes of death in patients receiving maintenance dialysis. Stroke occurred in high rate with the tendency to worsen prognosis. Also many patients with chronic renal failure(CRF) showed a high risk for stroke. From March 1985 to March 1999, at Wonju Christian Hospital, we investigated retrospectively risk factors, clinical appearance and prognosis for stroke in 20 patients with CRF who undergoing maintenance dialysis. The stroke occurred in nine male and eleven female with a mean age of 49.95+/-9.19 years. Seventeen patients underwent hemodialysis and three patients underwent peritoneal dialysis. Mean duration of dialysis was 50.05+/-34.68 months. Causes of CRF were as follows : 55% glomerulonephritis, 20% diabetes mellitus, 5% polycystic kidney and 20% unknown origin. At the time of stroke, serum protein level was 6.68+/-0.86mg/dL, albumin 3.38+/-0.87g/dL, cholesterol 160.25+/-43.34mg/dL, HDL-cholesterol 41.41+/-11.86mg/dL. All patients were on antihypertensive medication. Mean systolic blood pressure was 197+/-45mmHg, diastolic blood pressure 114+/-23mmHg. Systolic blood pressure of fourteen cases were more than 180mmHg. During hemodialysis, heparin dosage was an average 2425+/-371.48 IU. The types of stroke were intracerebral hemorrhage (ICH, 75%), subdural hematoma(10%), cerebral infarction(15%). One case developed both cerebral hemorrhage and subarachnoid hemorrhage. The sites of hematoma were basal ganglion-thalamus(60%), and subcortex(33.3%). Of these, nine cases had subsequent intraventricular hemorrhage(IVH). One case involved IVH only. The mean volume of hematoma was 66.42+/-29.92mL. Three cases of cerebral infarction developed in midcerebral arterial territory. Prognoses were as follows : Sixteen patients with cerebral hemorrhage died during hospitalization and one case has been monitored via outpatient department. One patient with cerebral infartion died during hospitalization and two have been discharged after symptom was improved. In conclusion, CRF patients undergoing maintenance dialysis showed higher incidence of ICH, unlike the recent studies which showed a higher rate of cerebral infarction to ICH in the general population. There was a higher incidence of stroke in patients whose blood pressure were poorly controlled. The most common site of ICH was basal ganglia and thalamus which was the same as in the general population. In many cases, it accompanied IVH and showed a higher mortality rate. Therefore, it is thought that aggressive blood pressure control is indicated to reduce mortality caused by stroke during maintenance dialysis.

A Study on the About Timing of Arteriovenous Fistula Formation for Maintenance Hemodialysis patients / 대한신장학회잡지

The number of patients and long-term survival rates of chronic renal failure have been increasing since the development of renal replacement therapy. Therefore, continuous follow-up observation on an outpatient basis, vascular access for dialysis and the determination of when to start dialysis have clinical significance associated with the prognosis of these patients. Presently, there is little clinical data about chronic renal failure patients such as, clinical features at initial dialysis, the presence or absence of neph-rologist follow-up, and the types and timing of vas-cular access. The goal of this study therefore was to investigate the clinical features at initial dialysis, presence or absence of follow-up, types and timing of vascular access in 80 patients retrospectively. The results are as below ; 1) The mean age of the patients was 47.8+/-14.0 years, and there were 47 male and 33 female patients. 2) Seventeen patients(21.3%) had DM as an underlying disease and 63 patients(78.79%) were non-diabetic patients. 3) At the initial dialysis, the diabetic patients had an average BUN of 79.2 +/- 29.6mg/dl, average Cr of 7.82.0mg/dl and an average Ccr of 10.0+/-7.0ml/min. The non-diabetic patients had the following averages ' BUN 118.7 +/- 37.9mg/dl, Cr 15.36.3mg/dl and Ccr 5.5 +/- 4.3ml/min. 4) The initial meeting with a nephrologist prior to dialysis occured as follows : in the diabetic group, 13 patients(76.596) met their nephrologist 12 months before, 3 patients(17.6%) 1 month before, one patient(5.9N) met the specialist one to 3 months before and no one had meeting 4 to 12 month before their dialysis. In the non-diabetic group, 36 patients(63.296) initially visited a nephrologist 12 months before, 16 patients (28.1M) one month before, 3 patients(5.3%) one to 3 months before and 2 patients(3.5%) had a meeting 4 to 12 months before the first dialysis. 5) The timing of native arteriovenous fistula for- mation was as follows; In the diabetic group, 10 patients(66.7%) had an A-V fistula constructed imme- diately upon admission, 2 patients(13.3%) had one constructed one to 3 months before, 2 patients(13.396) had one made 4 to 12 months before, one patient (6.7%) had a fistula created one week to one month before, and no one had a fistula formed 12 months before their initial dialysis. In the non-diabetic group, 36 patients(69.2%) had an A-V fistula constructed on admission ll patients(21.2%), one week to one month before 2 patients(3.8%), one to 3 rnonths before 2 patients(3.8%), 4 to 12 months before - one patient(1.9%) had the fistula created 12 months before initial dialysis. From these results, we learned that the time interval between either the patient's first meeting with his/her nephrologist or initial referral for renal replacement and vascular access preparation for hemodialysis was much longer than what is currently known. In conclusion, prompt referral to a nephro-logist early in the course of the disease and proper education of the patient by the nephrologist can lead to timely initiation of dialysis at a lower serum creatinine and higher Ccr levels which will reduce mortality, morbidity, and hospital care cost.

Multiple Arterial Aneurysms and Thrombosis in Behcet's Disease

Behcet's disease is characterized by recurrent orogenital ulcers and ocular and cutaneous inflammatory lesions. Cardiovascular involvement, which may be artrial or venous, is rare but carries a particularly poor prognosis. One of the known vascular complications of Behcet's disease is aneurysm formation or venous thrombosis. We recently experienced a Behect's disease with multiple arterial aneurysms and thrombosis and report this case with review of literatures.