Lessons from a COVID-19 hospital, Republic of Korea.

OBJECTIVE: To document the experiences of converting a general hospital to a coronavirus disease 2019 (COVID-19) designated hospital during an outbreak in Daegu, Republic of Korea. METHODS: The hospital management formed an emergency task force team, whose role was to organize the COVID-19 hospital. The task force used different collaborative channels to redistribute resources and expertise to the hospital. Leading doctors from the departments of infectious diseases, critical care and pulmonology developed standardized guidelines for treatment coherence. Nurses from the infection control team provided regular training on donning and doffing of personal protective equipment and basic safety measures. FINDINGS: Keimyung University Daegu Dongsan hospital became a red zone hospital for COVID-19 patients on 21 February 2020. As of 29 June 2020, 1048 COVID-19 patients had been admitted to the hospital, of which 22 patients died and five patients were still being treated in the recovery ward. A total of 906 health-care personnel worked in the designated hospital, of whom 402 were regular hospital staff and 504 were dispatched health-care workers. Of these health-care workers, only one dispatched nurse acquired COVID-19. On June 15, the hospital management and Daegu city government decided to reconvert the main building to a general hospital for non-COVID-19 patients, while keeping the additional negative pressure rooms available, in case of resurgence of the disease. CONCLUSION: Centralized coordination in frontline hospital operation, staff management, and patient treatment and placement allowed for successful pooling and utilization of medical resources and manpower during the COVID-19 outbreak.

Epidemiological and clinical characteristics of coronavirus disease 2019 in Daegu, South Korea.

OBJECTIVES: Two Coronavirus Disease 2019 (COVID-19) outbreaks simultaneously occurred at a church and a long-term care facility in Daegu, South Korea. This study aimed to investigate the epidemiological characteristics of COVID-19 and factors related to severe outcomes. METHODS: We enrolled all inpatients diagnosed with COVID-19 between February 21 and April 2, 2020, in Daegu Dongsan Hospital. We analyzed their clinical and demographic data, laboratory parameters, radiological findings, symptoms, and treatment outcomes. RESULTS: Of 694 patients, severe cases accounted for 19.7% (137 patients). No severe case was observed among patients aged ≤19 years. Hypertension was the most common comorbidity (27%), and cough was the most common symptom (59%). Asymptomatic patients accounted for 14.4% of cases. Lymphopenia, lactate dehydrogenase, C-reactive protein, and albumin were associated with severe outcomes. The first outbreak was mostly associated with younger age groups, and asymptomatic patients mostly showed mild progression. In the second outbreak involving a long-term care facility, both the number of severe patients and the mortality rate were higher. CONCLUSIONS: The overall mortality in Daegu was low, which might have resulted from large scale mass screening to detect patients and starting appropriate treatment, including hospitalization for severe cases, and quarantine for asymptomatic patients.

Relationship between serum adiponectin and leptin concentrations and body fat distribution.

The aim of this study was to investigate the relationship between adiponectin and leptin and body fat distribution. One hundred and ninety-seven women participated in this study. Subjects were grouped based on their visceral adipose tissue area (VAT). Body fat distribution was determined by computed tomography. The numbers in the subcutaneous fat dominant group (SFDG) and visceral fat dominant group (VFDG) were 79 and 118, respectively. The VFDG showed lower adiponectin levels than the SFDG (8.9+/-0.4 microg/ml versus 11.4+/-0.7 microg/ml, P=0.006), but leptin levels did not differ significantly between groups (18.8+/-1.1 ng/ml versus 17.7+/-1.8 ng/ml, P=0.111). Adiponectin levels were inversely correlated with fasting insulin, HOMA-IR, triglyceride, SBP and DBP, subcutaneous adipose tissue area (SAT) and VAT, and waist-to-hip ratio (WHR). Leptin levels were positively correlated with fasting glucose and insulin, HOMA-IR, triglyceride, SBP and DBP, VAT and SAT, and WHR (all values of P<0.05). VAT and HDL-cholesterol were independent variables of adiponectin concentrations (R(2)=0.207, P<0.0001), and SAT, fasting insulin, and HOMA-IR were independent variables of leptin concentrations (R(2)=0.498, P<0.0001) In conclusion, adiponectin and leptin concentrations, although associated with metabolic parameters, were more strongly influenced by VAT in the case of adiponectin, and by SAT in the case of leptin.

Usefulness of lumbar AP spine DXA for measuring the percentage of perilumbar regional fat and predicting visceral fat in obese postmenopausal women.

We investigated whether measurement of the perilumbar regional fat amount by lumbar spine DXA is as good a predictor of visceral fat in obese postmenopausal women. Twenty-two obese (BMI 30-383 kg/m(2)) and 18 nonobese (BMI 20.1-24.7 kg/m(2)) postmenopausal women with similar age were recruited. Lumbar AP spine DXA for measuring the percentage of perilumbar regional fat and CT scanning for estimation of the abdominal visceral fat areas were performed. In obese subjects, visceral fat areas as measured by CT were significantly correlated with BMI, waist circumference, WHR, and DXA-measured perilumbar regional fat percentage. In nonobese subjects, visceral fat areas measured with CT were correlated with BMI, waist circumference, WHR, and DXA-measured perilumbar regional fat percentage. The results of multiple regression analysis were that the perilumbar regional fat percent by DXA was the best predictor of visceral fat amount in obese postmenopausal women (R(2) = 0.750) and BMI predicted visceral fat amount in nonobese postmenopausal women (R(2) = 0.343). This study suggests that lumbar regional fat percentage, as measured by DXA, is a better predictor of abdominal visceral fat amount than waist circumference, WHR, or BMI in obese postmenopausal women.

Relationship between Family Meals and Depressive Symptoms in Children.

BACKGROUND: Recently, importance of family meals has been emphasized at home and abroad, and several journals reported that family meals had a big impact on children's development. In this paper, we would like to report the relationship between family meals and depressive symptoms in children. METHODS: This study was based on questionnaires distributed to 162 5th and 6th graders of one elementary school in the area of Daegu, Korea, in July, 2010. The questionnaire was about general characteristics, family characteristics, and quantity/quality of family meals. Family functions and depressive symptoms in children were evaluated with Smilkstein's family APGAR (adaptability, partnership, growth, affection, and resolve) score (FAS) and Kovac's Children's Depression Inventory (CDI). RESULTS: In one-way analyses of variance, there was no significant difference in FAS and CDI according to general and family characteristics (P > 0.05). CDI was significantly lower in the group having more frequent family meals (P < 0.05). Higher FAS and lower CDI was seen in the group having more conversation and better atmosphere during meals (P < 0.05). There were no significant differences in FAS and CDI according to the number of participants, duration, and watching television during meals (P > 0.05). CONCLUSION: The frequency of family meals, having more conversation and better atmosphere during family meals predicted less depressive symptoms in children.

A model for estimating body shape biological age based on clinical parameters associated with body composition.

BACKGROUND: To date, no studies have attempted to estimate body shape biological age using clinical parameters associated with body composition for the purposes of examining a person's body shape based on their age. OBJECTIVE: We examined the relations between clinical parameters associated with body composition and chronological age, and proposed a model for estimating the body shape biological age. METHODS: The study was conducted in 243,778 subjects aged between 20 and 90 years who received a general medical checkup at health promotion centers at university and community hospitals in Korea from 2004 to 2011. RESULTS: In men, the clinical parameters with the highest correlation to age included the waist- to-hip ratio (r = 0.786, P < 0.001), hip circumference (r = -0.448, P < 0.001), and height (r = -0.377, P < 0.001). In women, the clinical parameters with the highest correlation to age include the waist-to-hip ratio (r = 0.859, P < 0.001), waist circumference (r = 0.580, P < 0.001), and hip circumference (r = 0.520, P < 0.001). To estimate the optimal body shape biological age based on clinical parameters associated with body composition, we performed a multiple regression analysis. In a model estimating the body shape biological age, the coefficient of determination (R(2)) was 0.71 in men and 0.76 in women. CONCLUSION: Our model for estimating body shape biological age might be a novel approach to variation in body shape that is due to aging. We assume that our estimation model would be used as an adjunctive measure in easily predicting differences in body shape with the use of clinical parameters that are commonly used to assess the status of obesity in a clinical setting.

Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report.

Thoracolumbar junction syndrome is characterized by referred pain which may originate at the thoracolumbar junction, which extends from 12th thoracic vertebra to 2nd lumbar vertebra, due to functional abnormalities. Clinical manifestations include back pain, pseudo-visceral pain and pseudo-pain on the posterior iliac crest, as well as irritable bowel symptoms. During clinical examination, pain can be demonstrated by applying pressure on the facet joints or to the sides of the spinous processes. Radiological studies show only mild and insignificant degenerative changes in most cases. We report a 42-year-old female patient with osteogenesis imperfecta who suffered from chronic low back pain. Under the diagnosis of thoracolumbar junction syndrome, she was treated with an epidural block and a sympathetic nerve block, which improved her symptoms.

Perception and performance of preventive behaviors for the pandemic influenza in hospital employees and outpatients.

PURPOSE: A new strain of the H1N1 subtype of influenza A virus resulted in a pandemic outbreak. In South Korea, cases of pandemic influenza have increased. Therefore, we explored perception or preventive behaviors for this virus in hospital employees and outpatients. MATERIALS AND METHODS: Data was collected from hospital employees and outpatients at three university hospitals located in Daegu, Gyeongju in South Korea between the 21st and 30th of September, 2009 using a self-administrated questionnaire. We estimated perception by components of The Health Belief Model (HBM), preventive behaviors consisted of avoidance behaviors, and the recommended behaviors by the Korea Center of Disease Control and Prevention (KCDC). Desire for vaccination was identified. RESULTS: The 1,837 participants comprised hospital employees (n = 880, 47.9%) and outpatients (n = 957, 52.1%). Of all hospital employees, 491 (55.8%) and 708 (80.5%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Among all outpatients, 490 (51.2%) and 651 (68.0%) perceived susceptibility of the pandemic influenza and benefits of the preventive behaviors, respectively. Recommended preventative behaviors were adopted by 674 (76.6%) of hospital employees and 631 (65.9%) of outpatients. Vaccination was desired by 479 (54.4%) of hospital employees and 484 (50.6%) of outpatients. Factors influencing preventative behaviors included gender, economic status (for hospital employees) and educational level (for outpatients). All HBM components except perception of barriers were associated with the preventive behaviors in both groups. CONCLUSION: The majority of the surveyed hospital employees and outpatients perceived the benefits of preventive behaviors for pandemic influenza and performed them.

Comparison of Patient-Physician Interaction (PPI) Evaluation between Different Grade Medical Students.

PURPOSE: A proper patient-physician interaction (PPI) creates rapport between doctors and patients and improves medical outcomes. The importance of PPI evaluation items was evaluated in each medical student in grades 3 and 4, before and after their clinical clerkship. METHODS: Six PPI evaluation guidelines (SEGUE, Kalamazoo Consensus, Calgary-Cambridge Guide, Macy guideline, 2 Korean Consortium guidelines) were selected and importance of each guideline was evaluated through the structured questionnaire in 73 pre-clinical clerkship (3rd-grade) and 78 post-clinical clerkship (4th-grade) medical students. RESULTS: The importance of medical communication items among total clinical performance, students-rated PPI portion was 21+/-9.7%. In SEGUE recommendations, 'Elicit information' was evaluated to be most important items before (58.3%) and after (65.8%) clinical clerkship. In Kalamazoo Consensus, 'Gathering information' was evaluated to be most important (49.3%/42.3%), same as in Calgary-Cambridge Guide (52.1%/56.4%) and Daegu Gyeongbuk Consortium (47.9%/43.6%). In the Macy guideline, 'Listening' was evaluated to be most important (28.8%/33.3%). In the Seoul Gyeonggi Consortium, 'Buidling relationships' was evaluated to be most important (23.3%/28.2%). CONCLUSION: In the 4th-grade post-clerkship medical students after clinical clerkship, importance of 'Gathering information' was evaluated to be less important, however, 'Giving information' and 'Understanding the patient perspective' was evaluated to be more important, compared to pre-clerkship students 3rd-grade students.

Role of (-)-epigallocatechin-3-gallate in cell viability, lipogenesis, and retinol-binding protein 4 expression in adipocytes.

(-)-Epigallocatechin-3-gallate (EGCG), a bioactive compound of green tea, is known to combat obesity by reducing the viability and lipid accumulation of adipocytes. In this study, we evaluated the mechanism and clinical relevance on those actions of EGCG. We measured the viability of 3T3-L1 preadipocytes and adipocytes by the 3-(4, 5-dimethylthiazol-2yl)-2, 5-diphenyltetrazolium bromide assay. Lipid accumulation was measured by Oil Red O staining. Intracellular accumulation of reactive oxygen species (ROS) was determined using a flow cytometer. Cellular glucose uptake was determined with 2-deoxy-[(3)H]-glucose. The protein levels of peroxisome proliferator-activated receptor (PPAR)-γ and adiponectin in 3T3-L1 adipocytes, as well as the protein level and secretion of plasma retinol-binding protein (RBP4) in human adipocytes, were measured by western blot. EGCG at concentrations higher than 10 µM induced ROS generation and decreased the viability and lipid accumulation of adipocytes. It also decreased the expression of PPAR-γ and adiponectin. At concentrations readily achievable in human plasma via green tea intake (≤10 µM), EGCG inhibited cellular glucose uptake and enhanced the expression and secretion of RBP4 in adipocytes. Pharmacological doses of EGCG showed cytotoxic effects in preadipocytes and adipocytes. EGCG-mediated glucose uptake inhibition in adipocytes may be clinically relevant and is probably linked to the increase in the expression and secretion of RBP4. Because secreted RBP4 from adipocytes inhibits muscular glucose uptake and enhance hepatic glucose output, the systemic effect of EGCG associated with its effect on RBP4 secretion should be further determined, as it may negatively regulate whole-body insulin sensitivity, contrary to general belief.

Tissue levels of malondialdehyde after passive smoke exposure of rats for a 24-week period.

The present study was to evaluate the effects of chronic cigarette smoke exposure on lipid peroxidation in various organ tissues. Sprague-Dawley rats were exposed to passive smoking 2 hr per day, 6 days per week (Monday-Saturday), for 24 weeks. Malondialdehyde levels, as an index of lipid peroxidation, were measured by the thiobarbituric acid assay. Levels were significantly higher in tissues of passive-smoke-exposed groups (n=10) compared with normal-bred control groups (n=6), for red blood cells (2.17+/-0.22 vs. 1.80+/-0.39 nmol/mg), lung (1.39+/-0.32 vs. 1.03+/-0.35 nmol/mg), and spleen (1.75+/-0.33 vs. 1.42+/-0.15 nmol/mg); p<.05. No differences in malondialdehyde levels were found in plasma, heart, liver, stomach, and renal tissues. The results suggest that chronic environmental tobacco smoke exposure can increase lipid peroxidation in red blood cells and in lung and spleen tissue. This finding brings further investigative attention to the public health issue of the injurious effects of chronic passive smoke exposure.