Analysis of pregnant women with critically severe COVID-19 in Republic of Korea from February 2020 and December 2021

Objectives@#This study aimed to describe the characteristics and risk factors for severe disease in pregnant women infected with coronavirus disease 2019 (COVID-19) from the early days of the COVID-19 epidemic in Korea to the predominant period of the Delta variant. @*Methods@#A retrospective cohort study was conducted among pregnant women diagnosed with COVID-19 between February 2020 and December 2021. Logistic regression analysis was performed to compare severe and mild cases after adjusting for pregnant women’s age, nationality, infection route, outbreak area, infection period, symptoms, underlying disease, smoking status, trimester, and COVID-19 vaccination status. @*Results@#In total, 2,233 pregnant women were diagnosed with COVID-19 by December 2021. Among these, 96.7% had mild symptoms, 3.3% had severe symptoms, and 0.04% died. The risk factors for severe disease in pregnant women with confirmed COVID-19 were being in the age group of 35 to 45 years, having hyperlipidemia, being in the second or third trimester of pregnancy at the time of COVID-19 diagnosis, being infected during the Delta-predominant period, and having a fever (≥38 °C) at diagnosis. Furthermore, 47.1% of patients in the mild group and 84.9% of patients in the severe group had 3 or more risk factors. @*Conclusion@#Pregnant women with COVID-19 mainly experienced mild symptoms, but those with risk factors were at a higher risk of developing severe symptoms. Therefore, treatment and follow-up management should be thoroughly implemented.

The effectiveness of Paxlovid treatment in long-term care facilities in South Korea during the outbreak of the Omicron variant of SARS-CoV-2

Objectives@#On November 5, 2021, Pfizer Inc. announced Paxlovid (nirmatrelvir+ritonavir) as a treatment method that could reduce the risk of hospitalization or death for patients with confirmed coronavirus disease 2019 (COVID-19). @*Methods@#From February 6, 2022 to April 2, 2022, the incidence of COVID-19 and the effects of treatment with Paxlovid were analyzed in 2,241 patients and workers at 5 long-term care facilities during the outbreak of the Omicron variant of severe acute respiratory syndrome coronavirus 2 in South Korea. @*Results@#The rate of severe illness or death in the group given Paxlovid was 51% lower than that of the non-Paxlovid group (adjusted risk ratio [aRR], 0.49; 95% confidence interval [CI], 0.24−0.98). Compared to unvaccinated patients, patients who had completed 3 doses of the vaccine had a 71% reduced rate of severe illness or death (aRR, 0.29; 95% CI, 0.13−0.64) and a 65% reduced death rate (aRR, 0.35; 95% CI, 0.15−0.79). @*Conclusion@#Patients given Paxlovid showed a lower rate of severe illness or death and a lower fatality rate than those who did not receive Paxlovid. Patients who received 3 doses of the vaccine had a lower rate of severe illness or death and a lower fatality rate than the unvaccinated group.

Associations of smoking with overall obesity, and central obesity: a cross-sectional study from the Korea National Health and Nutrition Examination Survey (2010-2013) / 한국역학회지

OBJECTIVES: The association between smoking and obesity is a significant public health concern. Both are preventable risk factors of cardiovascular disease and a range of other conditions. However, despite numerous previous studies, no consensus has emerged regarding the effect of smoking on obesity. We therefore carried out a novel study evaluating the relationship between smoking and obesity. METHODS: A total of 5,254 subjects aged 19 years or older drawn from the 2010-2013 Korea National Health and Nutrition Examination Survey were included in this cross-sectional study. Smoking was examined both in terms of smoking status and the quantity of cigarettes smoked by current smokers. Multiple logistic regression analysis was used to assess the association between smoking and obesity. Overall obesity was defined as a body mass index (BMI) ≥25 kg/m2, and central obesity was defined as a waist circumference ≥90 cm for males and ≥85 cm for females. We adjusted for the possible confounding effects of age, sex, physical activity, alcohol consumption, and the presence of hypertension or diabetes. RESULTS: A statistically significant difference in central obesity according to smoking status was identified. Current smokers were more likely to be centrally obese than never-smokers (adjusted odds ratio,1.30; 95% confidence interval, 1.02 to 1.67). However, no significant association was found between smoking and obesity defined by BMI. Moreover, among current smokers, no statistically significant association was found between the daily amount of smoking and obesity or central obesity. CONCLUSIONS: Smoking was positively associated with central obesity. Current smokers should be acquainted that they may be more prone to central obesity.

A Study Design to Evaluate Association between Smoking and Intracranial Atherosclerotic Stenosis / 신경중재치료의학

PURPOSE: Smoking is a well known risk factor for stroke. The cerebral arteries may be uniquely susceptible to the atherosclerotic effects of smoking, such that it has a different risk profile for stroke compared with other atherosclerosis risk factors. It remains uncertain whether smoking is associated specifically with intracranial (IC) or extracranial (EC) atherosclerotic cerebrovascular disease. The aim of this study design will be to evaluate the association between smoking and severe IC stenosis, adjusting for other atherosclerosis risk factors, particularly age distribution. STUDY DESIGN: This is a retrospective cohort study design. Participants are patients (n=1714) with severe atherosclerotic stenosis undergoing cerebral catheter angiography because of stroke or transient ischaemic attack. All atherosclerotic steno-occlusive lesions are described in terms of location (anterior versus posterior circulation, IC versus EC, or intradural versus extradural). The atherosclerotic or stroke risk factors for analysis include age, gender, smoking history, number of lesions (single versus multiple), cardiac disease, diabetes mellitus, hypertension, family history, dyslipidemia, history of previous stroke, alcohol intake, metabolic syndrome and body mass index. Statistical analysis includes univariate analysis followed by multivariate logistic regression. The relationship between IC atherosclerotic stenosis and smoking will be assessed. Differences in risk factor distribution is analysed according to age at intervals of 10 years. Significant risk factors associated with IC atherosclerotic stenosis will also be assessed by multivariate logistic regression analysis. SUMMARY: This is an analytical study design that intends to measure the association between IC or EC atherosclerotic stenosis and smoking and other risk factors. We anticipate that it will have the power to detect any relationship between smoking and IC atherosclerotic lesions especially in younger patients.

Genome-Wide Association Study of Orthostatic Hypotension and Supine-Standing Blood Pressure Changes in Two Korean Populations

Orthostatic hypotension (OH) is defined by a 20-mm Hg difference of systolic blood pressure (dtSBP) and/or a 10-mm Hg difference of diastolic blood pressure (dtDBP) between supine and standing, and OH is associated with a failure of the cardiovascular reflex to maintain blood pressure on standing from a supine position. To understand the underlying genetic factors for OH traits (OH, dtSBP, and dtDBP), genome-wide association studies (GWASs) using 333,651 single nucleotide polymorphisms (SNPs) were conducted separately for two population-based cohorts, Ansung (n = 3,173) and Ansan (n = 3,255). We identified 8 SNPs (5 SNPs for dtSBP and 3 SNPs for dtDBP) that were repeatedly associated in both the Ansung and Ansan cohorts and had p-values of <1 x 10(-5) in the meta-analysis. Unfortunately, the SNPs of the OH case control GWAS did not pass our p-value criteria. Four of 8 SNPs were located in the intergenic region of chromosome 2, and the nearest gene (CTNNA2) was located at 1 Mb of distance. CTNNA2 is a linker between cadherin adhesion receptors and the actin cytoskeleton and is essential for stabilizing dendritic spines in rodent hippocampal neurons. Although there is no report about the function in blood pressure regulation, hippocampal neurons interact primarily with the autonomic nervous system and might be related to OH. The remaining SNPs, rs7098785 of dtSBP trait and rs6892553, rs16887217, and rs4959677 of dtDBP trait were located in the PIK3AP1 intron, ACTBL2-3' flanking, STAR intron, and intergenic region, respectively, but there was no clear functional link to blood pressure regulation.

Current status and prospects of exchange of health officials from South and North Korea through non-governmental organizations

South Korea's health care non-governmental organizations (NGOs) have played a crucial role in South-North relations, for a formal intergovernmental relationship is difficult to establish and also easily breaks down. Humanitarian assistance by NGOs in the health care sector is an area that receives wide support from South Korean society for its urgency and for its appeal to humanity. This humanitarian assistance started in the late 1990's and continued to grow until the late 2000's. This assistance continued throughout the tension between the two administrations that resulted in a radical decrease in overall assistance from South Korea to North Korea. However, concerns remain about the transparency and efficiency of NGO activities. In this article, the NGOs and their major activities are delineated, and South Korean legislation is examined. A current act, the Law on the Development of South and North Korean Relations serves as a basis for governmental regulation and support of NGO's. Humanitarian assistance in the healthcare area is directly related to the health of the North Korean people, and it should not be influenced by political changes. Long-term planning and close discussions between NGOs, their North Korean counterparts, and the South Korean government are needed. NGOs need to overcome their shortcomings such as a lack of expertise and shortage of financial support. For this, NGOs must improve their administration transparency and professionalism.

Association of an Anti-inflammatory Cytokine Gene IL4 Polymorphism with the Risk of Type 2 Diabetes Mellitus in Korean Populations

Chronic inflammation has been implicated as one of the important etiological factors in insulin resistance and type 2 diabetes mellitus (T2DM). To investigate the role of anti-inflammatory cytokines in the development of T2DM, we conducted a case-control study to assess the association between IL4/IL4R polymorphisms and disease risk. We firstly identified single nucleotide polymorphisms (SNP) at IL4 and IL4RA loci by sequencing the loci in Korean participants. Case-control studies were conducted by genotyping the SNPs in 474 T2DM cases and 470 non-diabetic controls recruited from community-based cohorts. Replication of the associated signals was performed in 1,216 cases and 1,352 controls. We assessed effect of IL4-IL4RA interaction on T2DM using logistic regression method. The functional relevance of the SNP associated with disease risk was determined using a reporter expression assay. We identified a strong association between the IL4 promoter variant rs2243250 and T2DM risk (OR=0.77; 95% CI, 0.67~0.88; p=1.65x10-4 in the meta-analysis). The reporter gene expression assay demonstrated that the presence of rs2243250 might affect the gene expression level with ~1.5-fold allele difference. Our findings contribute to the identification of IL4 as a T2D susceptibility locus, further supporting the role of anti-inflammatory cytokines in T2DM disease development.