BACKGROUND & AIMS: Q6Although coronavirus disease 2019 (COVID-19) is characterized by fever and respiratory symptoms, some patients have no or mild symptoms. Severe acute respiratory syndromecoronavirus (SARS-CoV-2) has been detected in feces of patients. We investigated gastrointestinal symptoms and shedding of virus into feces of patients with asymptomatic or mild COVID-19. METHODS:We collected data from 46 patients (median age, 26 y; 46% men) with asymptomatic or mild COVID-19 (without fever and pneumonia) and prolonged respiratory shedding of SARS-CoV-2, quarantined from April 4, 2020, through April 24, 2020, in Korea. Respiratory specimens included upper respiratory specimens (nasopharyngeal and oropharyngeal swabs) and lower respiratory specimens (sputum), and were collected twice per week. The median interval between COVID-19 diagnosis to the start of fecal sample collection was 37 days (range, 29-41 d); 213 stool specimens were collected from 46 patients. We used real-time reverse-transcription polymerase chain reaction to detect SARS-CoV-2 in the respiratory and fecal specimens. RESULTS:Gastrointestinal manifestations were observed in 16 of the 46 patients (35%); diarrhea was the most common (15%), followed by abdominal pain (11%), dyspepsia (11%), and nausea (2%).Virus RNA was detected in feces from 2 patients without gastrointestinal symptoms (4%). Mean cycle threshold values from the time of quarantine to the time of fecal collection tended to be lower in patients with virus detected in fecal samples than in patients without virus in fecal samples (29.91 vs 33.67 in the first week, 29.47 vs 35.71 in the fifth week, respectively). Shedding of virus into feces persisted until day 50 after diagnosis; fecal samples began to test negative before or at approximately the time that respiratory specimens also began to test negative. CONCLUSIONS:In an analysis of fecal and respiratory specimens from patients with COVID-19 in quarantine in Korea, we found that the gastrointestinal tract could be a route of transmission of SARS-CoV-2 even in patients with asymptomatic or mild disease, with no gastrointestinal symptoms. The viral load of the respiratory specimens appears be related to shedding of the virus into feces in this group of patients.

There have been several reports about the clinical association between type 2 diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). However, most of the studies were about the unilateral effects of type 2 DM on NAFLD, and studies on the reverse relation are rare. Thus, this study was designed to investigate the effect of NAFLD on type 2 DM. We conducted a prospective cohort study on 25,232 Korean men without type 2 DM for 5 years. We serially checked the various metabolic factors including fasting glucose and hemoglobin A1c (HbA1c), and monitored the development of type 2 DM. The incidence rate of type 2 DM was compared according to the degree of NAFLD (normal, mild, and moderate to severe), and a Cox proportional hazards model was used to measure the hazard ratios (HRs) of NAFLD on type 2 DM. The incidence rate of type 2 DM increased according to the degree of NAFLD (normal: 7.0%, mild: 9.8%, moderate to severe: 17.8%, P < 0.001). Even after adjusting for other multiple covariates, the HRs (95% confidence interval [CI]) for type 2 DM development was higher in the mild group (1.09; 0.81-1.48) and moderate to severe group (1.73; 1.00-3.01) compared to the normal group, respectively (P for trend <0.001). Conclusion: The development of type 2 DM is potentially more associated with more progressive NAFLD than a normal or milder state. In addition, NAFLD was an independent risk factor for the future development of type 2 DM. These results suggest the potential availability of NAFLD as an early predictor of type 2 DM. (HEPATOLOGY 2013;57:1378-1383

Objective: The aim of this study was to validate the Korean version of the Brief Pain Inventory (BPI-K), a pain assessment tool that has been validated in several languages. Methods: The sample consisted of 132 patients in Seoul who had recurrent or metastatic cancer and who expressed pain. The Korean version of the Beck Depression Inventory (BDI-K), the Eastern Cooperative Oncology Group (ECOG) performance status score, the Pain Management Index (PMI), and the PMI-Revised (PMI-R) were used to further validate the BPI-K. Results: Cronbach alphas, computed for the pain interference and pain severity item, were 0.93 and 0.85, respectively. Confirmatory factor analysis of the BPI-K items showed a two-common-factor solution for the BPI-K, consistently demonstrated in other language versions of the BPI. The mean pain interference score was more correlated with the BDI-K scale (r = 0.44) and ECOG (r = 0.39) than the mean pain severity score. Seventy-four percent of the patients in the Seoul sample had inadequate analgesia using the PMI. Conclusion: The BPI-K is a valid and useful instrument for assessing cancer pain and pain impact in Korea.