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 reverse-transcription 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.

[The association of obesity and left colonic adenomatous polyps in Korean adult men].

OBJECTIVES: We wanted to evaluate the relationship between obesity and left colonic adenomatous polyps in Korean adult men. METHODS: This study was conducted among 575 adults men (aged between 40 and 69), who had colonoscopy done from January to December 2002 during a routine health examination at Health Promotion Center, Ulsan University Hospital. The patients' colons were examined up to splenic flexure by using fiberoptic colonoscopy. A questionnaire survey on behavioral factors and physical measurements were also done. The body mass index (BMI) and waist-hip ratio (WHR) were used as the indices of obesity. The BMI was categorized into three levels: normal (BMI < or = 22.9), overweight (23 < or = BMI < or = 24.9), and obese (BMI > or = 25.0). The WHR was categorized into four levels with cut-off points at the 30th, 60th, and 90th percentile of the control group. Age, education, smoking, alcohol use and exercise were controlled for by performing multiple logistic regression analysis. RESULTS: There were 99 cases of colonic adenomatous polyps. Four hundred seventy six subjects with normal colonoscopy findings served as the control. The BMI and WHR were associated with the adenomatous polyps (odds ratio, 1.81 [95% CI=1.02-3.19] for a BMI > or = 25.0 as compared with a BMI < or = 22.9, odds ratio, 3.94 [95% CI = 1.77-8.77] for a WHR > or = 0.95 as compared with a WHR < or = 0.86). The BMI was not associated with the risk of adenomatous polyps after additional adjustment was made for the WHR, but the association between the WHR and adenomatous polyps was still positive and independent of the BMI (odds ratio, 4.15 [95% CI=1.63-10.59]). CONCLUSIONS: The results support that obesity, and particularly abdominal obesity, can be associated with an increased risk of incurring colonic adenomatous polyps.

Blood manganese concentration is elevated in iron deficiency anemia patients, whereas globus pallidus signal intensity is minimally affected.

OBJECTIVES: To determine whether blood manganese (Mn) concentration is elevated in patients with iron deficiency anemia (IDA), and whether this affects signal intensities in the globus pallidus. METHODS: Twenty-seven patients with IDA and 10 control subjects were tested for blood Mn, and brain magnetic resonance images (MRI) were also examined. Seventeen of the 27 patients were followed-up after iron therapy. RESULTS: IDA patients had a mean blood Mn concentration of 2.05 +/- 0.44 microg/dl, which was higher than controls. The mean pallidal index (PI) of anemic patients was not different from that of controls. There was a correlation between log blood Mn and PI (rho = 0.384, P = 0.048; n = 27) in IDA patients. None of the patients showed increased signals in the globus pallidus in T1-weighted MRI. Blood Mn levels decreased and hemoglobin levels increased after iron therapy (P < 0.05). CONCLUSION: Although blood Mn is elevated in IDA patients, there is no increase in globus pallidus MRI signal intensity. These findings stand in contrast to those of our other studies showing patients with chronic liver disease or occupational Mn exposure have elevated signal intensities remarkably.

Whole blood manganese correlates with high signal intensities on T1-weighted MRI in patients with liver cirrhosis.

We examined whole blood (MnB), plasma (MnP) and urinary Mn (MnU) concentrations in 33 cirrhotics and 11 healthy controls to clarify: (1) whether, in chronic liver diseases, MnB or MnP reflects pallidal signal intensities in magnetic resonance imaging (MRI); and (2) which factors in chronic liver diseases correlate with pallidal signal intensities in T1-weighted MRI. Increased signal intensity in the pallidum was observed in 27 (81.8%) of 33 patients with liver cirrhosis in T1-weighted MRI. There was a significant correlation between MnB and pallidal index (PI) (gamma = 0.559, P < 0.01) in the patients. However, no significant correlation was observed between MnP and PI (gamma = 0.353, P > 0.05). According to a multiple linear regression, MnB reflected the signal intensities of T1-weighted MRI better than MnP or MnU. Child/Pugh score and total bilirubin level also correlated with PI. However, the hemoglobin level did not correlate with PI significantly.