Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including bleeding. The prevalence of bleeding in these patients remains unclear. The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients and its association with mortality. MEDLINE and Embase were searched through December 20, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled; heterogeneity was expressed as I2. Metaregression analysis was performed to assess the impact of confounding covariates. Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, resp.)]. The overall pooled gastrointestinal bleeding rate was 5% [95% CI 2–8], with high heterogeneity (I2 99.2%); “small study effect” was observed using the Egger test ( p = 0.049 ). After removing two outlier studies, the pooled bleeding rate was 2% [95% CI 0–4], with high heterogeneity (I2 99.2%), and no “small study effect” ( p = 0.257 ). The pooled UGIB rate was 1% (95% CI 0–3, I2 98.6%, p = 0.214 ), whereas the pooled LGIB rate was 1% (95% CI 0–2, I2 64.7%, p = 0.919 ). Metaregression analysis showed that overall estimates on gastrointestinal bleeding were affected by studies reporting different sources of bleeding. No significant association between gastrointestinal bleeding and mortality was found. In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.

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A meta-analysis of the impact of COVID-19 on liver dysfunction

European Journal of Medical Research ◽

10.1186/s40001-020-00454-x ◽

2020 ◽

Vol 25 (1) ◽

Cited By ~ 1

Author(s):

Zeng-hong Wu ◽

Dong‑liang Yang

Keyword(s):

Liver Dysfunction ◽

Meta Analysis ◽

Elevated Serum ◽

Clinical Severity ◽

The Novel ◽

Significant Difference ◽

Novel Coronavirus ◽

The Impact ◽

Review Manager ◽

Different Levels

Abstract Background The novel coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is leading to a worldwide pandemic. Except representative manifestation of pneumonia and acute respiratory symptoms, COVID-19 patients have also shown different levels of liver injury or liver dysfunction. The aim of our study was to explore the probable clinical severity and mortality of COVID-19 patients and their liver dysfunction. Method A combination of computer and manual retrieval was used to search in Medline through PubMed, EMBASE and Web of Science. Review Manager 5.3 software was used to examine the heterogeneity among the studies and to calculate the combined effect value (OR, 95CI). Subgroup analysis, sensitivity analysis, and publication bias test were also performed. Results We found a significant connection between liver dysfunction and mortality of COVID-19 patients with a pooled OR of 1.98 (95% CI 1.39–2.82; P = 0.0002). There was a significant association between AST and severity of COVID-19 with a pooled OR of 4.48 (95% CI 3.24–7.21; P < 0.001), and a pooled WMD of 3.35 (95% CI, 2.07 to 4.64; P < 0.001). In addition, there was a significant difference between TBIL and severity of COVID-19, with a pooled OR of 1.91 (95% CI 1.40–2.60; P < 0.001), and with a pooled WMD of 1.18 (95% CI, 0.78 to 1.58; P < 0.001). Conclusion The mortality and severity of COVID-19 patients are significantly associated with liver dysfunction. The non-survivors and severe COVID-19 patients have elevated serum AST levels than the survivors and non-severe COVID-19 patients. The results of this study form a basis for better clinical liver management of patients with COVID-19.

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Association and treatment of diabetes in patients affected by Covid-19

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.3591 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1198-1201

Author(s):

Syed Yasir Afaque

Keyword(s):

Diabetes Mellitus ◽

Prognostic Value ◽

Heart Diseases ◽

The Novel ◽

The World ◽

Treatment Of Diabetes ◽

Coronavirus Infection ◽

Composite Outcomes ◽

Novel Coronavirus ◽

The Impact

In December 2019, a unique coronavirus infection, SARS-CoV-2, was first identified in the province of Wuhan in China. Since then, it spread rapidly all over the world and has been responsible for a large number of morbidity and mortality among humans. According to a latest study, Diabetes mellitus, heart diseases, Hypertension etc. are being considered important risk factors for the development of this infection and is also associated with unfavorable outcomes in these patients. There is little evidence concerning the trail back of these patients possibly because of a small number of participants and people who experienced primary composite outcomes (such as admission in the ICU, usage of machine-driven ventilation or even fatality of these patients). Until now, there are no academic findings that have proven independent prognostic value of diabetes on death in the novel Coronavirus patients. However, there are several conjectures linking Diabetes with the impact as well as progression of COVID-19 in these patients. The aim of this review is to acknowledge about the association amongst Diabetes and the novel Coronavirus and the result of the infection in such patients.

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SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

BMC Infectious Diseases ◽

10.1186/s12879-021-06456-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Heidi Luise Schulte ◽

José Diego Brito-Sousa ◽

Marcus Vinicius Guimarães Lacerda ◽

Luciana Ansaneli Naves ◽

Eliana Teles de Gois ◽

...

Keyword(s):

Clinical Signs ◽

Federal District ◽

Therapeutic Interventions ◽

Diagnostic Process ◽

The Novel ◽

Prevention Measures ◽

Laboratory Findings ◽

Novel Coronavirus ◽

The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

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Pediatric Endocrinology in the Time of COVID-19: Considerations for the Rapid Implementation of Telemedicine and Management of Pediatric Endocrine Conditions

Hormone Research in Paediatrics ◽

10.1159/000513060 ◽

2020 ◽

Vol 93 (6) ◽

pp. 343-350

Author(s):

Molly O. Regelmann ◽

Rushika Conroy ◽

Evgenia Gourgari ◽

Anshu Gupta ◽

Ines Guttmann-Bauman ◽

...

Keyword(s):

Patient Care ◽

Care Patient ◽

The Novel ◽

Patient Privacy ◽

Pediatric Endocrinology ◽

Quality Of Patient Care ◽

Care Outcomes ◽

Novel Coronavirus ◽

The Impact

Background: Pediatric endocrine practices had to rapidly transition to telemedicine care at the onset of the novel coronavirus disease 2019 (COVID-19) pandemic. For many, it was an abrupt introduction to providing virtual healthcare, with concerns related to quality of patient care, patient privacy, productivity, and compensation, as workflows had to change. Summary: The review summarizes the common adaptations for telemedicine during the pandemic with respect to the practice of pediatric endocrinology and discusses the benefits and potential barriers to telemedicine. Key Messages: With adjustments to practice, telemedicine has allowed providers to deliver care to their patients during the COVID-19 pandemic. The broader implementation of telemedicine in pediatric endocrinology practice has the potential for expanding patient access. Research assessing the impact of telemedicine on patient care outcomes in those with pediatric endocrinology conditions will be necessary to justify its continued use beyond the COVID-19 pandemic.

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Coronavirus, the great toilet paper panic and civilisation

Thesis Eleven ◽

10.1177/07255136211033167 ◽

2021 ◽

pp. 072551362110331

Author(s):

Jon Stratton

Keyword(s):

General Population ◽

Federal Government ◽

Perceived Threat ◽

The Novel ◽

Social Breakdown ◽

Toilet Paper ◽

Western Civilisation ◽

Novel Coronavirus ◽

Key Aspects ◽

The Impact

Panic buying of toilet rolls in Australia began in early March 2020. This was related to the realisation that the novel coronavirus was spreading across the country. To the general population the impact of the virus was unknown. Gradually the federal government started closing the country’s borders. The panic buying of toilet rolls was not unique to Australia. It happened across all societies that used toilet paper rather than water to clean after defecation and urination. However, research suggests that the panic buying was most extreme in Australia. This article argues that the panic buying was closely linked to everyday notions of Western civilisation. Pedestal toilets and toilet paper are key aspects of civilisation and the fear of the loss of toilet paper is connected to anxiety about social breakdown, the loss of civilisation. This is the fear manifested in the perceived threat posed by the virus.

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