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.

Clinical Course and Outcomes of 3,060 Patients with Coronavirus Disease 2019 in Korea, January–May 2020

Background@#The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea. @*Methods@#Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. @*Results@#The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3–4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5–7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50–59, 60–69, 70–79, and ≥ 80 years of age, respectively. @*Conclusion@#In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.

A Longitudinal Study on the Effects of Negative Rearing Experiences on Adolescents' Social Withdrawal and Aggression / 가정의학회지

BACKGROUND: Children who have experienced negative rearing behaviors show a lack of self-confidence due to emotional instability and are reserved in interpersonal relationships. This can lead to failure in social adaptation and a high risk of depression, suicide, criminal acts, and anti-social behaviors. Therefore, this study aims to analyze the effects of experiencing negative parental rearing behaviors, such as neglect and abuse, on adolescents' social withdrawal and aggression, by utilizing multivariate latent growth models. METHODS: Data from the Korean Children and Youth Panel Study (KCYPS), a survey conducted by the National Youth Policy Institute targeting a cohort of three different age groups (grade 1, grade 4, and grade 7), from 2010 to 2016 was used. Multi-stage stratified sampling methods were used in the KCYPS, which surveyed the students and parents of the selected grade levels. This study analyzed the data for grade 7, from second year (grade 8) to fourth year (grade 10). RESULTS: Negative rearing experiences had a significant effect on social withdrawal and aggression, and this influence was shown to persist over the long term. CONCLUSION: This study examined the long-term developmental trajectory in the relationship between risk factors for adolescent development. Furthermore, the relationship between risk factors was shown to have not only short term but long-term effects as well, which reinforces the limitations of previous studies.

Complex Anterior Skullbase Fracture Caused by a Bottle Cap: A Case Report and Review of the Literature

We report a case of foreign body presence in the ethmoid sinus cavity with anterior skull base fracture and visual loss. A 42-year-old male had an uncertain history of trauma and a penetrating wound near the left medial canthus. Computed tomography imaging showed a 3.0-cm bottle cap penetrating into the anterior skull base. He underwent foreign body removal, canalicular repair, ethmoidectomy, and cerebrospinal fluid leakage repair using packing material. Six months after the initial surgery, a second-stage operation for blow-out fracture repair was performed. At the 18-month postoperative follow-up from the initial surgery, the patient had no complaints except anosmia. This is a very rare case of a large, blunt, foreign body penetrating into the anterior skull base without long-term complications after successful removal and skull base repair. Simultaneous repair of cerebrospinal fluid leakage, management of canaliculi injury, and traumatic optic nerve neuropathy should be considered in such cases.

In Reply: Bringing Retracted Papers Into Focus

No abstract available.

Bilateral Occurrence and Morphologic Analysis of Complete Discoid Lateral Meniscus

PURPOSE: The aim of the study was to investigate and analyze bilateral incidence and morphology of complete discoid lateral meniscus (DLM) with possible relation to tears and symptoms in knee joints. MATERIALS AND METHODS: Thirty-eight consecutive patients with symptomatic or already-torn complete DLM on magnetic resonance imaging in a unilateral knee underwent diagnostic arthroscopy on both knee joints upon agreement. The presence and shape of complete DLM as well as presence and pattern of tear were recorded accordingly. RESULTS: In total, 89.5% (34 of 38 patients) showed bilateral complete DLM, and 84.2% yielded bilateralism with identical shape. Cape-slab was the most frequent shape, comprising 68.8% of patients with identically-shaped bilateral DLM overall. Tear patterns were more frequent, in the order of longitudinal, simple horizontal, radial, and degenerative; however, the morphological shape of complete DLM was not significantly related to tear incidence or pattern. Meniscus tears and knee symptoms occurred in the contralateral knee with incidences of 32.4% and 26.5% in patients with bilateral complete DLM, respectively. CONCLUSION: Based on these findings, more aggressive warning on the presence of discoid pathology and the need for evaluation on the contralateral knee should be considered during consultation with patients with symptomatic complete DLM in a unilateral knee in the outpatient clinic.

Balloon Sinuplasty / 대한이비인후과학회지

Balloon sinuplasty (BSP) is a newly developed catheter-based technique for dilating sinus ostia to improve sinus ventilation and drainage. BSP has been in clinical use since 2005, but there has been many debates and criticism between early movers and mainstream doctors. But, recently, many evidences strongly support its safety, efficacy, and growing popularity among patients and physicians. The objective of this clinical review is to present its theoretical background, technical considerations, and treatment outcomes. BSP will be an additional tool for treating sinusitis, either alone or with conventional sinus surgery technique.

Endoscopic Endonasal Marsupialization of Extensive Nasopalatine Duct Cysts Protruding into the Nasal Cavity

BACKGROUND: Nasopalatine duct cysts (NPDCs) are considered the most common non odontogenic cysts of the maxilla. Although the recommended treatment is complete removal of the lesion, complications, such as hematoma or fistula, can occur, especially in extensive cases. The aim of the present paper was to introduce transnasal endoscopic marsupialization as an efficient and useful treatment for NPDC. MATERIALS AND METHODS: A retrospective review of 5 patients with extensive NPDCs (>2 cm) protruding into their nasal cavities was performed. All patients underwent endoscopic endonasal marsupialization. In order to survey the long-term, subjective outcomes, telephone interviews were conducted. RESULTS: The mean age of the included patients with NPDC was 32 years and all were male. Most of the patients had facial pain (100%) and nasal obstruction (80%), and somepatients complained of palate swelling (60%). There were no perioperative complications. The mean OPD follow-up duration was 3.7 months and a telephone survey was conducted with 4 patients at a mean of 27.5 postoperative months. Patients complained of some crust formation in the nasal cavity, but no cyst relapse or other significant complications were reported. CONCLUSIONS: A large NPDC protruding into the nasal cavity can be easily and efficiently managed with endoscopic endonasal marsupialization as a substitute for complete enucleation.

The Efficacy of Preemptive Analgesia With Pregabalin in Septoplasty

OBJECTIVES: Pregabalin is used to treat neuropathic pain and has shown analgesic properties in postoperative pain. The aim of this study was to investigate the effectiveness and safety of pregabalin in reducing postoperative pain in patients after septoplasty. METHODS: Forty-seven patients scheduled for elective septoplasty were randomly assigned to groups that received either pregabalin (150 mg) or placebo, both one hour before surgery and 12 hours after the initial dose. Pain (verbal numerical rating scale, VNRS) and side effect assessments were performed at 6, 12, 12 to 24, and 24 to 48 hours postoperatively. RESULTS: From 1 to 12 hours postoperatively, VNRS scores for pain were lower in the pregabalin group (n=24) than in the placebo group (n=23; P<0.05). The number of patients who needed rescue analgesics was lower in the pregabalin group (P=0.042). The incidence of nausea and vomiting did not differ between groups (P=0.666), and the incidence of sedation was higher in the placebo groups (P=0.022). CONCLUSION: The perioperative administration of oral pregabalin (150 mg twice) is an effective and safe way to reduce early postoperative pain in patients undergoing septoplasty.

Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing

OBJECTIVES: We wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality. METHODS: Polysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed. RESULTS: Significant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index, the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction. CONCLUSION: The severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.

Reliable Early Prediction for Different Types of Post-Thyroidectomy Hypocalcemia

OBJECTIVES: High incidence of hypocalcemia after thyroidectomy is a major determinant in delay of discharge. Even though many studies have focused on the search for reliable early predictors of postoperative hypocalcemia, definitions of hypocalcemia are diverse; therefore, interpretation and application of previously reported findings may not be easy. We aimed to elucidate diverse patterns of post-thyroidectomy hypocalcemia and to provide reliable early predictors for these different types of hypocalcemia. METHODS: Retrospective chart review was performed and eligible 112 patients of thyroidectomy were categorized into four groups according to symptomatic and/or biochemical hypocalcemic criteria. A mismatch of occurrence and the timing of symptomatic or biochemical abnormalities were evaluated. Predictive values of commonly used biomarkers were compared in each group; levels of serum total calcium and ionized calcium, and intact parathyroid hormone (PTH). RESULTS: Among 62 hypocalcemic patients, 45 patients (72.5%) experienced both symptomatic and biochemical abnormalities during hospitalization. A mismatch on the timing of initial detection of symptomatic and biochemical hypocalcemia was observed in 21 patients (46.6%). Intact PTH level measured at 1 hour was a useful indicator in prediction of symptomatic hypocalcemia with 79.7-87.4% of diagnostic accuracy. Serum ionized calcium measured next morning after surgery was a reliable predictor of biochemical hypocalcemia with 77.9-94.8% of diagnostic accuracy. CONCLUSION: For the safety of patients, the possibility of both symptomatic and biochemical hypocalcemia should be considered together before deciding early discharge. Using intact PTH for symptomatic hypocalcemia and day-1 ionized serum calcium level for biochemical hypocalcemia will be helpful for the reliable prediction of heterogeneous nature of postoperative hypocalcemia.

A Case of Basal Cell Nevus Syndrome with Odontogenic Keratocyst / 대한이비인후과학회지

Nevoid basal cell carcinoma syndrome (Gorlin syndrome) is a cancer predisposition syndrome characterized by multiple basal cell carcinomas and diverse developmental defects. Recently, we experienced a case of odontogenic keratocysts in a 13-year-old boy who was finally diagnosed as having nevoid basal cell carcinoma syndrome by genetic study. The purpose of this paper is to report odontogenic keratocyst as the first manifestation of nevoid basal cell carcinoma syndrome and to emphasize that one must consider this syndrome as a possible diagnosis in all cases of odontogenic keratocysts.

Clinical Characteristics of Dizziness in Children

BACKGROUND AND OBJECTIVES: The children who are complaining of dizziness are difficult to manage. Because the incidence is quite low and the diagnostic spectrum is different from the adult. The purpose of this study is to analyze the clinical characteristics and vestibular function test in dizzy children, leading to provide a proper diagnostic approach. MATERIALS AND METHOD: A total of 57 children with dizziness who underwent vestibular function test were included in this study. Theses patients were retrospectively reviewed based on clinical charts. The average age of the patients was 11.1 years (range: 4-15). Caloric and rotation chair tests were performed in 57 and 31 patients respectively. Imaging study such as computed tomography and magnetic resonance imaging was performed in selective cases. RESULTS: Recurrent vertigo (49.1%) is the most common symptoms in dizzy children. Most common diagnostic entity in dizzy children is benign positional vertigo (BPV) (31.6%). Compared to adults, BPPV is relatively uncommon. Uncertain diagnosis is also common in dizzy children. Caloric test suggested that 19.3% of dizzy patients showed unilateral weakness. However, among normal caloric responders who underwent rotation chair test simultaneously, 11 out of 23 (47.8%) showed abnormal VOR gain and oculomotor abnormality. CONCLUSION: Most common diagnosis of dizzy children is BPV, although many patients were remained uncertain. Abnormality of oculomotor test and VOR is relatively common, that suggests abnormal visual vestibular interaction is related with dizzy symptoms in children. The evaluation of vertigo in children should include a complete history and vestibular function test related with visual vestibular interaction.

Parathyroid Hormone as an Early Predictor of Post-thyroidectomy Hypocalcemia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Parathyroid dysfunction following a total or completion thyroidectomy is not uncommon and it may be associated with significant patient morbidity. If there is a simple test with proven high predictability for identifying which patients will develop hypocalcemia, it would be very useful to determine the necessities of careful monitoring and calcium replacement. The purpose of this study is to determine which test would be the most valuable predictor of post-thyroidectomy hypocalcemia. SUBJECTS AND METHOD: Prospective series of 63 consecutive patients undergoing total or completion thyroidectomy were enrolled for this study. Calcium and ionized calcium were measured before and immediately after surgery, and daily during hospitalization. Parathyroid hormone (PTH) was measured immediately after surgery and early in the morning of the next day. Slopes of serum calcium, ionized calcium and PTH level change were calculated. Sensitivity, specificity and predictive values of each test for the symptomatic and biochemical hypocalcemia were compared. RESULTS: With the cut-off value of 10 pg/ml of spot PTH, sensitivity, specificity, positive and negative predictive values of hypocalcemia were 97%, 64%, 77% and 95% respectively. By combining the spot PTH and the slope of ionized calcium change, the above values became 94%, 82%, 87% and 92%. CONCLUSION: Immediate postoperative spot PTH level was the most valuable single test for predicting post-thyroidectomy hypocalcemia. Combination of a spot PTH and the slope of ionized calcium change resulted in improved specificity and positive predictability.

Characteristics of Computed Tomography in Chronic Rhinosinusitis with Asthma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate differences of the extents of disease between chronic rhinosinusitis patients with and without asthma. MATERIALS AND METHOD: Medical records and CT scans of consecutive 48 asthmatic and 523 non-asthmatic chronic rhinosinusitis patients between 1995 and 2001 were reviewed retrospectively. Each sinus in the ostiomeatal complex (OMC) CT scans was assigned scores of 0 to 2 according to the extent of the disease using the Lund scoring system, and the ratio of the score of each sinus to the total score was analyzed for the difference between the asthmatic and non-asthamatic groups. RESULTS: The ratio of ethmoid sinus score to total score was higher in asthmatic patients than in non-asthmatic patients (p<0.05), and the ratio of the score of maxillary sinus to the total score was lower in asthmatic patients than in non-asthmatic patients (p<0.05). CONCLUSION: Our study shows that the ethmoid sinus is the preferred site of chronic rhinosinusitis in patients with coexisting asthma.

Effect of Remifentanil and Fentanyl on Bispectral Index and Hemodynamics during Propofol TCI / 대한마취과학회지

BACKGROUND: Remifentanil appears to have a pharmacologic profile similar to other potent mu agonists, but with exceptionally short lasting pharmacokinetics. It is likely to make it a very useful opioid for clinical practice. The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. The purpose of this study is to compare sedative and cardiovascular effects of remifentanil and fentanyl during target controlled infusion (TCI) of propofol by monitoring BIS and hemodynamics. METHODS: Fifty-two patients undergoing total abdominal hysterectomy were randomly assigned to remifentanil group and fentanyl group with 26 cases in each group. Anesthesia was induced with propofol (4microgram/ml) and either remifentanil (0.5microgram/kg) or fentanyl (1.5microgram/kg) and was maintained with inhalation of 50% nitrous oxide and 50% oxygen mixture and a continuous infusion of either remifentanil (0.2microgram/kg/min) or fentanyl (0.03microgram/kg/min). Depth of anesthesia, hemodynamic changes and adverse reactions were observed. RESULTS: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly lesser than that in the fentanyl group (P<0.05). During intubation, skin incision, maintenance of anesthesia and extubation, remifentanil group shows lesser fluctuation of hemodynamic value than those in the fentanyl group (P<0.05). BIS was significantly decreased both groups during infusion of propofol, but no difference was found between the two groups. There was no significant difference between the two groups in the aspect of adverse reactions. CONCLUSIONS: Remifentanil with propofol TCI based anesthetic can prevent the fluctuation of heart rate and mean arterial pressure during the operation especially, during intubation.

Management of Calculi in the Hilum of Submandibular Gland: Intraoral Removal with Marsupialization of the Duct / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The excision of submandibular gland (SMG) has been commonly used for the treatment of calculi in the hilum of SMG, since intraoral removal of the hilar stone has the potential risk of lingual nerve injury and the poor surgical field. However, it would leave loss of remained gland function and external scars after the excision. Therefore, the authors modified the intraoral retrieval techniques as the marsupialization of the Wharton's duct up to the calculi in the hilum. This study reports our clinical experience with the modified intraoral retrieval technique and the advantages of this modality for calculi in the hilum of SMG. SUBJECTS AND METHOD: SMG excision and intraoral removal with marsupialization (IRM) were used from 1994 through 2003 to treat 9 and 16 cases of calculi in the hilum of SMG, respectively. We analyzed the characteristic findings of calculi, surgical morbidities and complications by comparing two different treatment groups. RESULTS: The mean diameter of the calculi was 6.1 mm in patients with SMG excision and 7.8 mm in patients with IRM. The success rate of extraction by IRM of calculi in the hilum were 86.7%. The surgical complications were similar in both groups. The proportion of palpable calculi were significantly increased in the IRM group (92.9% vs 22.2%). We failed to remove the stone by IRM from patients, and stones were impalpable intraorally preoperatively. CONCLUSION: IRM is an excellent alternative method for the removal of palpable calculi located in the hilum of SMG. Furthermore, it would preserve the salivary gland function without external scars and with acceptable surgical complications and morbidities.

A Survey II for Satisfaction for Stoma on Ostomates

PURPOSE: This survey was designed to acknowledge that it is necessary to rehabilitate ostomates. METHODS: This medical survey attempted to make an analysis of the types and causes of stoma, the problems stemming from the stoma, the degree to which ostomates are satisfied with their life quality, and the extent to which they are affected in doing their jobs, on the basis of the examinations conducted for eighty eight ostomates, who responded to the questionnaire at the 3rd Workshop for Stoma Rehabilitation for Ostomates on August 29, 1998 by the Department of Surgery, Kyung-Hee University Hospital, or who replied back to the questionnaire that was sent by mail. RESULTS: On examination, it was found that the ratio of male to female was nearly 1.5:1 (53:35); by age distribution, the ostomates in their 50 and 60's constituted 65.9%; by stoma pattern, colostomy was made up of 81 cases (92%), ileostomy 4 cases (4.5%), urostomy 2 cases (2.3%); by duration, permanent stoma was 81 cases (92%), temporary stoma 6 cases (6.8%); by the cause of stoma operation, malignancy consisted of 78 cases (88.6%), IBD 4 cases (4.5%), congenital anomaly 1 case, car accident 1 case, benign bladder disease 1 case, intestinal obstruction after radiation therapy 1 case, but 2 cases were not identified. Besides, it was also examined that, regarding the degree of post-operation satisfaction for stoma, dissatisfaction amounted to 58 cases (65.9%); as for the problems stemming from the stoma, skin irritation or injury reached 30 cases (34.1%), discomfort for stoma location 17 cases (19.35%), parastomal hernia 8 cases (9.1%), stoma retraction 4 cases (4.5%) and disease recurrence 3 cases (3.4%); as for the degree of the satisfaction of ostomates for their life quality, dissatisfaction revealed 70 cases (79.5%); regarding the extent to which the ostomates are affected in doing their jobs, fifty four out of eighty eight ostomates (62.0%) had a disturbance. CONCLUSIONS: This medical survey clearly shows that most of ostomates suffered from stoma in their daily lives and doing their occupations, thus they need helps from the experts such as colorectal surgeons and enterostomal therapists, or the ostomy association. In addition, it is also necessary to pay a more deliberate attention to determining the location of stoma.

A Case of Perianal Adenocarcinoma Developing in Chronic Tuberculous Anal Fistula

Mucinous adenocarcinomas of the anal region constitute only 2% of anal cancer and adenocarcinoma developing in a chronic tuberculous anal fistula is extremely rare. In most cases, its origin is difficult to ascertain because the primary sites have already been destroyed before any diagnosis of malignancy is made. We experienced a case of perianal adcnocarcinoma developing in chronic tuberculous anal fistula, which was treated by abdominoperineal resection with preoperative chemo-irradiation. We reported a case and reviewed the related literatures.