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.

Changes in the Serum Level of High Density Lipoprotein-cholesterol after Smoking Cessation among Adult Men / 가정의학회지

BACKGROUND: Smoking and obesity are known risk factors for cardiovascular diseases, while low serum levels of high density lipoprotein-cholesterol is an independent risk factor for mortality from ischemic heart diseases. This study examines changes in the serum level of high density lipoprotein-cholesterol depending on changes in the state of smoking and body mass index. METHODS: A survey and blood check-up were conducted on medical examination, along with acts of smoking among male adults of 25 years or older who visited the health promotion center of Daegu Medical Center from 2007 to 2010, and the results were analyzed. The subjects were divided into two different groups, current smokers and abstainers, and body mass index, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, and triglycerides for three years were compared in both groups. Changes between the first and second visits in body mass index and lipid profiles of the two groups were compared to analyze changes after abstaining. RESULTS: The subject group which showed a significant increase in high density lipoprotein-cholesterol level was only abstainers whose body mass index had decreased by more than 0.5 kg/m2. CONCLUSION: Smoking cessation increases serum levels of high density lipoprotein-cholesterol. If reduction of body mass index and smoking cessation are combined, the risk of cardiovascular disease will be lower in proportion to the increase in serum high density lipoprotein.

Prepregnancy weight, maternal weight gain, and birth weight

BACKGROUND: Low birth weight and high birth weight are closely related to perinatal complications. The purpose of this study is to estimate the association of prepregnancy weight, maternal weight gain and infant birth weight. METHODS: The effect on birth weight in 724 live births after 38~42 weeks gestation was studied at Taegu Medical Center, between January, 1997, and August, 1998. Pregnant women with hypertension, diabetes mellitus, multiple pregnancy and drug abuse were excluded because of their possible influence on birth weight. To study the effect on infant birth weight, multiple regression analysis was carried out. RESULTS: We evaluated 724 pregnant women and their babies. Mean prepregnancy weight was 52.2+/-.9kg, mean maternal weight gain was 13.0+/-.6kg, and mean BMI(Body Mass Index) was 20.5+/-2.5kg/m(2). Mean gestational age was 278+/-7.3days and mean birth weight was 3,320.5+/-405.2gm. Correlation coefficient between birth weight and prepregnancy weight was 0.347(p<0.01), and maternal weight gain was 0.248(p<0.01), and BMI(Body Mass Index) was 0.261(p<0.01). Birth weight was significantly correlated with prepregnancy weight(p<0.01) and maternal weight gain(p<0.01), but prepregnancy weight was not significantly correlated with maternal weight gain(p<0.05). Prepregnancy weight had most apparent influence on birth weight. CONCLUSIONS: Prepregnancy weight and maternal weight gain was positively related to birth weight. These results suggest that there are good effects of properly controlling prepregnancy weight and maternal weight gain in pregnant women and their babies.

The influence of exercise to cardiovascular risk factors The in healthy adults

BACKGROUND: Diseases related with cardiovascular risk factors such as hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia and cerebrovascular disease are increasing according to the change of dietary patterns with economy growth and other causes such as low physical activity. Many studies showed the effects and benefits of exercise in people who had diseases related to cardiovascular risk factors, but there are few studies on the effects of exercise in healthy people. Therefore this study investigated the influence of exercise on cardiovascular risk factors in healthy adults. METHODS: 2,413 people who participated in periodic health examinations at Taegu medical center from May to July, in 1998 were assessed with respect to height, weight, blood pressure, fasting blood glucose, serum total cholesterol and subjects responded to the self-administered questionnaires. We reviewed 881 subjects. Subjects were classified as exereise group if they reported exercising for at least 30 minutes, 5 or more days of the week, and as control group if they reported exercising once a week or less. We observed the difference in Body Mass Index(BMI), fasting blood glucose, systolic and diastolic blood pressure, serum total cholesterol and the prevalence of overweight, hypertension, hypercholesterolemia, hyperglycemia between study groups. RESULTS: There were no differences in sex, age, education, economic status, occupation between the study groups. Serum total cholesterol, systolic and diastolic blood pressure, fasting blood glucose and BMI were significantly lower for the exercise group. The prevalence of overweight, hypertension, and hyperlipidemia were significantly lower for the exercise group. The prevalence of diabetes mellitus were lower for the exercise group, but were not statistically significant. CONCLUSIONS: In healthy peoples, they who were regularly exercise were significantly lowered in cardiovascular risk factors and diseases related with cardiovascular risk factors than nonexercising peopl

The influence of exercise to cardiovascular risk factors The in healthy adults

BACKGROUND: Diseases related with cardiovascular risk factors such as hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia and cerebrovascular disease are increasing according to the change of dietary patterns with economy growth and other causes such as low physical activity. Many studies showed the effects and benefits of exercise in people who had diseases related to cardiovascular risk factors, but there are few studies on the effects of exercise in healthy people. Therefore this study investigated the influence of exercise on cardiovascular risk factors in healthy adults. METHODS: 2,413 people who participated in periodic health examinations at Taegu medical center from May to July, in 1998 were assessed with respect to height, weight, blood pressure, fasting blood glucose, serum total cholesterol and subjects responded to the self-administered questionnaires. We reviewed 881 subjects. Subjects were classified as exereise group if they reported exercising for at least 30 minutes, 5 or more days of the week, and as control group if they reported exercising once a week or less. We observed the difference in Body Mass Index(BMI), fasting blood glucose, systolic and diastolic blood pressure, serum total cholesterol and the prevalence of overweight, hypertension, hypercholesterolemia, hyperglycemia between study groups. RESULTS: There were no differences in sex, age, education, economic status, occupation between the study groups. Serum total cholesterol, systolic and diastolic blood pressure, fasting blood glucose and BMI were significantly lower for the exercise group. The prevalence of overweight, hypertension, and hyperlipidemia were significantly lower for the exercise group. The prevalence of diabetes mellitus were lower for the exercise group, but were not statistically significant. CONCLUSIONS: In healthy peoples, they who were regularly exercise were significantly lowered in cardiovascular risk factors and diseases related with cardiovascular risk factors than nonexercising peopl

Accuracy of Automated Wrist Blood Pressure Meter

BACKGROUND: A reliable, well-validated home blood pressure(BP) self measurement device could have an important role in the management of hypertension. Rigorous assessment of such a device have not performed well, particularly in the hypertensive range. METHODS: We assessed the National EW274W device(oscillometric) for home messurem of BP according to the standards set out by the British Hypertension Society protocol and American Association for the Advancement of Medical Instrumentation(AAMI). The device was compared with sequential measurements using a standard mercury sphygmomanometer in the same arm in 105 patients aged 16-79 years. The BP of subjects was measured three times at least a week apart. These data were analysed using Pearson's correlation and paired t-test. RESULTS: The device was highly correlated to mercury sphygmomanometer in mean systolic BP(SBP) and mean diastolic BP(DBP) (r=0.93, r=0.93, P<0.05). The device was satisfactory over the whole BP range(SBP 106-182mmHg, DBP 56-116mmHg), with a B grade for SBP and a A grade for DBP(British Hypertension Society protocol) and a PASS for both SBP and DBP(AAMI). Sensitivity and specificity are 84.2%, 93.0%(mean SBP) and 100%, 96.9% (mean DBP). CONCLUSIONS: We concluded the wrist blood pressure meter(National EW274W) for home BP measurement is highly satisfactory and is suitable for clinical use.

The Relationship Between Nutritional Assessment and Obesity Index

BACKGROUND: Obesity has been accepted as the rusk factor of major chronic diseases in our society. And nutritional assessment is the important issue in respect to obesity evaluation. A self-administrated semiquantitative food frequency questionnaire of which validity is recognized is used in nutritional assessment. But the relationship between nutritional assessment resulted from the questionnaire and the obesity index has not been built until now, so we studied about this relationship. METHODS: Among 324 adults who had visited health screening center from June'95 to August '96, 270 adults were evaluated except who had any chronic disease such as diabetes mellitus, pulmonary tuberculosis, thyroid disease by screening data or low calorie diet for aimed weight loss or inadequate Questionnaire. Nutritional intake was assessed by the self-administrated semiquantitative food frequency questionnaire. We evaluated the activity grade, obesity indices such as body mass index(BMI), waist to hip ratio(WHR), percent body fat using bioelectrical impedance fatness analyzer and serum total cholesterol, HDL-cholesterol, triglyceride. Then we examined the correlation between obesity Indices and nutritional variables each other. We analyzed these results using Pearson's correlation coefficient. RESULTS: We evaluated for a group of 164 men and 106 women whose mean age was 43.9 years, mean BMI was 23.2kg/m2, mean WHR was 0.85 and mean percent body fat was 21.2%. Correlation coefficient between calorie intake to recommended calorie ratio(ICRCR) and BMI was 0.13(P OR =0.05), and percent body fat was 0.07(P> OR =0.05). Fats intake to recommended fats ratio(IFRFR) and obesity indices didn't show the significant correlation between them. We could not find the significant correlation between cholesterol intake and serum total cholesterol, triglyceride but the significant negative correlation between cholesterol intake and serum HDL-cholesterol(r=-0.14) was found. CONCLUSIONS: Only BMI among obesity indices and ICRCR showed low(r=0.13) correlation coefficient although it is significant. Our results shows that obesity is the complex syndrome influenced by genetic, social, psychological, medical variables besides nutritional impacts.

New Proposal for Adlt's Normal Sinus Heart Rates

BACKGROUND: The normal sinus heart rate standard of 60 to 100 beats per minute was set by the NYHA(New York Heart Association) in 1928. It has long been accepted to physicians, but clinical studies and experience suggest that both these limits are too high. Thus we reexamined to define operationally normal sinus heart rate that are scientifically and clinically acceptable. METHODS: Total 1,930 subjects(aged 20 to 92 years) were analyzed and evaluated for age, sex, body mass index(BMI), systolic blood pressure, diastolic blood pressure, and resting heart rates by electrocardiogram. We used Pearson's correlation test and t-test to analyze these data. RESULTS: Among 1930 subjects, 982 cases were male(51%) and 948 cases were female (49%), whose mean age was 48 years in male and 51 years in female. For the entire sample, mean heart rate and standard deviation was 68 +/- 11 beats/min. There was statistically significant difference between male(67+/-11 beats/min) and female(68+/-10 beats/min)(P<0,05). The prevalence of sinus tachycardia and bradycardia, calculated by current normal standard of 60 to 100 beats/min, was 22.0% (424 cases) and 0.9% (18 cases). Mean +/- two standard deviation yields rounded extremes of 46 to 89 beats/min for normal sinus heart rate. A positive correlations between resting heart rate and age(r=0.11), systolic blood pressure(r =0.17), diastolic blood pressure(r=0.12) were found(P<0.01). CONCLUSIONS: Two extremes of the normal sinus heart rate standard of 60 to 100 beats/min are set too high. They result in lower sensitivity for tachycardia and lower specificity for bradycardia. We propose that normal range for sinus heart rate should be 50 to 90 beats/min which is statistically justified, more realistic for clinical investigation.