Gastrointestinal symptoms in COVID-19 could be associated with severe lung involvement and increased readmission rates

Introduction SARS-CoV-2 virus manifests itself with primary lung damage but also has intestinal involvement. In this study, we aimed to investigate the frequency of gastrointestinal symptoms (GIS) and the relationship of GIS with readmission to the hospital within 30 days in SARS-CoV-2 infected patients who were hospitalized in a specified pandemic hospital. Materials and Methods Symptomatic patients diagnosed with rapid antibody positivity with real-time polymerase chain reaction and typical thorax computed tomography findings were included in this retrospective cohort observational study. Demographic and clinical data were obtained from electronic medical records. Hospital-associated GIS were considered as experiencing at least one of the GIS such as gas, bloating, diarrhea, and constipation developing within72 h after hospital admission. Results The mean age of the patients was 58 ± 14.4 years and 60.7% were men. 82% of hospitalizations were a moderate and severe disease. 71.4% of patients without GIS had at least one of the GIS after hospitalization. As the severity of the disease increased, the frequency of the severity of gastrointestinal symptom increased. GIS bowel disorders were more prominent in patients with moderate and severe disease. Antibiotic and specific treatment (anti-Il-1, anti-Il-6) contributed to the occurrence of gastrointestinal symptom in SARS-CoV-2 inpatients. Conclusion According to our observations of the second wave of the pandemic, the presence, frequency, and severity of gastrointestinal symptom in inpatient is associated with severity of lung disease and increased readmission rate after discharge.

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Fabry Disease

10.5772/intechopen.99142 ◽

2021 ◽

Author(s):

Ida Kåks ◽

Peter Magnusson

Keyword(s):

Fabry Disease ◽

Severe Disease ◽

Gastrointestinal Symptoms ◽

Specific Treatment ◽

Skin Lesions ◽

Lysosomal Storage ◽

Pharmacological Chaperone ◽

Enzyme Replacement ◽

Related Quality ◽

Health Related

Fabry disease (FD) is a lysosomal storage disorder where deficient or completely absent activity of the enzyme α-galactosidas A leads to accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids in lysosomes. The condition is rare, approximately 1:50,000, although underdiagnosis seems frequent. The condition can affect multiple organ systems, including the skin, nervous system, kidneys, and heart. Early manifestations include skin lesions (angiokeratoma), neuropathic pain, and gastrointestinal symptoms. Later on, FD can result in cardiomyopathy, kidney failure, and stroke. Both lifespan and health-related quality of life are affected negatively by FD. Patients are divided into a classical or a non-classical phenotype based on presentation, where the diagnosis of classical FD requires that a set of specific criteria are met. Patients with non-classical FD often have a less severe disease course, sometimes limited to one organ. The hereditary pattern is X-linked. Thus, men are in general more severely affected than women, although there is an overlap in symptomatic burden. Two types of specific treatment options are available: enzyme replacement therapy and pharmacological chaperone therapy. In addition to this, management of each organ manifestation with usual treatment is indicated.

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Gastrointestinal Involvement in The Confirmed Covid-19 Patients

WMJ (Warmadewa Medical Journal) ◽

10.22225/wmj.6.1.2630.7-12 ◽

2021 ◽

Vol 6 (1) ◽

pp. 7-12

Author(s):

Rachma Greta Perdana Putri

Keyword(s):

Public Health ◽

Water Pollution ◽

Severe Disease ◽

Gastrointestinal Symptoms ◽

Public Health Emergency ◽

Gastrointestinal Involvement ◽

Oral Transmission ◽

Severity Of The Disease ◽

Keyword Searching ◽

Intestinal Enterocytes

The current pandemic of Coronavirus disease 2019, or known as COVID-19, has been claimed as Public Health Emergency of International Concern by WHO on 30 January 2020. According to WHO, there 47.362.304 confirmed cases and 1.211.986 deaths reported due to COVID-19 and still counting. This article investigates the involvement of gastrointestinal symptoms in COVID-19 related to the pathogenesis, transmission, and severity of the disease. The data was collected by keyword searching through EBSCO, PubMed, Google scholar, and additional references from retrieved articles. This article analyzes studies investigating gastrointestinal symptoms in Covid-19. The studies found gastrointestinal symptoms in COVID-19 confirmed patients such as abdominal pain, diarrhea, nausea, vomiting, constipation, and melena. Two studies showed that COVID-19 patients with gastrointestinal symptoms tended to have more severe disease. ACE2, as the receptor of S protein, was found abundantly in intestinal enterocytes besides in the respiratory system. Enterocyte abnormality induces decreased absorption of NA+, water, and mucosal disaccharides. It leads to increased undigested mono and disaccharides, carbohydrates, fats, and protein into the colon. As a result, the colon is unable to absorb sufficient water, leading to diarrhea. Gastrointestinal symptoms are commonly found in patients with COVID‐19, and the trend is increasing in the later stage of the epidemic. SARS‐CoV‐2 enters gastrointestinal epithelial cells and the feces of COVID‐19 patients are potentially infectious. The virus also found in wastewater system and may cause water pollution. Hence, further studies investigating gastrointestinal symptoms and possibility of fecal oral transmission should be conducted.

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Two recombinant human monoclonal antibodies that protect against lethal Andes hantavirus infection in vivo

Science Translational Medicine ◽

10.1126/scitranslmed.aat6420 ◽

2018 ◽

Vol 10 (468) ◽

pp. eaat6420 ◽

Cited By ~ 13

Author(s):

Jose L. Garrido ◽

Joseph Prescott ◽

Mario Calvo ◽

Felipe Bravo ◽

Raymond Alvarez ◽

...

Keyword(s):

Severe Disease ◽

Gastrointestinal Symptoms ◽

Specific Treatment ◽

Case Fatality ◽

Hantavirus Infection ◽

Lethal Challenge ◽

Hamster Model ◽

Post Exposure ◽

Andes Hantavirus

Andes hantavirus (ANDV) is an etiologic agent of hantavirus cardiopulmonary syndrome (HCPS), a severe disease characterized by fever, headache, and gastrointestinal symptoms that may progress to hypotension, pulmonary failure, and cardiac shock that results in a 25 to 40% case-fatality rate. Currently, there is no specific treatment or vaccine; however, several studies have shown that the generation of neutralizing antibody (Ab) responses strongly correlates with survival from HCPS in humans. In this study, we screened 27 ANDV convalescent HCPS patient sera for their capacity to bind and neutralize ANDV in vitro. One patient who showed high neutralizing titer was selected to isolate ANDV–glycoprotein (GP) Abs. ANDV-GP–specific memory B cells were single cell sorted, and recombinant immunoglobulin G antibodies were cloned and produced. Two monoclonal Abs (mAbs), JL16 and MIB22, potently recognized ANDV-GPs and neutralized ANDV. We examined the post-exposure efficacy of these two mAbs as a monotherapy or in combination therapy in a Syrian hamster model of ANDV-induced HCPS, and both mAbs protected 100% of animals from a lethal challenge dose. These data suggest that monotherapy with mAb JL16 or MIB22, or a cocktail of both, could be an effective post-exposure treatment for patients infected with ANDV-induced HCPS.

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Diabetes and COVID19: a bidirectional relationship

European Journal of Clinical Nutrition ◽

10.1038/s41430-021-00961-y ◽

2021 ◽

Author(s):

Ranjit Unnikrishnan ◽

Anoop Misra

Keyword(s):

Clinical Care ◽

Severe Disease ◽

Respiratory Involvement ◽

Pancreatic Damage ◽

Increased Risk ◽

Bidirectional Relationship ◽

Rapid Spread ◽

Relationship Of ◽

The Relationship ◽

New Onset

AbstractThe advent and rapid spread of the coronavirus disease-2019 (COVID19) pandemic across the world has focused attention on the relationship of commonly occurring comorbidities such as diabetes on the course and outcomes of this infection. While diabetes does not seem to be associated with an increased risk of COVID19 infection per se, it has been clearly demonstrated that the presence of hyperglycemia of any degree predisposes to worse outcomes, such as more severe respiratory involvement, ICU admissions, need for mechanical ventilation and mortality. Further, COVID19 infection has been associated with the development of new-onset hyperglycemia and diabetes, and worsening of glycemic control in pre-existing diabetes, due to direct pancreatic damage by the virus, body’s stress response to infection (including cytokine storm) and use of diabetogenic drugs such as corticosteroids in the treatment of severe COVID19. In addition, public health measures taken to flatten the pandemic curve (such as lockdowns) can also adversely impact persons with diabetes by limiting their access to clinical care, healthy diet, and opportunities to exercise. Most antidiabetic medications can continue to be used in patients with mild COVID19 but switching over to insulin is preferred in severe disease.

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Diabetes and COVID19: a bidirectional relationship

Nutrition and Diabetes ◽

10.1038/s41387-021-00163-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ranjit Unnikrishnan ◽

Anoop Misra

Keyword(s):

Clinical Care ◽

Severe Disease ◽

Respiratory Involvement ◽

Pancreatic Damage ◽

Increased Risk ◽

Bidirectional Relationship ◽

Rapid Spread ◽

Relationship Of ◽

The Relationship ◽

New Onset

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The impact of COVID-19 on emergency surgical presentations in a university teaching hospital

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02709-w ◽

2021 ◽

Author(s):

Ahmed M. Kamil ◽

Matthew G. Davey ◽

Fadi Marzouk ◽

Rish Sehgal ◽

Amy L. Fowler ◽

...

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Historical Data ◽

Severe Disease ◽

University Teaching ◽

Readmission Rates ◽

Descriptive Data ◽

Operative Complications ◽

Hospital Patients ◽

The Impact

Abstract Introduction The Coronavirus-19 (COVID-19) pandemic has led to a 50–70% reduction in acute non-COVID-19 presentations to emergency departments globally. Aim To determine the impact of COVID-19 on incidence, severity, and outcomes of acute surgical admissions in an Irish University teaching hospital. Methods Descriptive data concerning patients presenting with acute appendicitis, diverticulitis, and cholecystitis were analysed and compared from March–May 2020 to March–May 2019. Results Acute surgical admissions decreased in March from 191 (2020) to 55 (2019) (55%), before increasing by 28% in April (2019: 119, 2020: 153). Admissions due to acute cholecystitis reduced by 33% (2019: 33, 2020: 22), with increased severity at presentation (P = 0.079) and higher 30-day readmission rates (P = 0.056) reported. Acute appendicitis presentations decreased by 44% (2019: 78, 2020: 43, P = 0.019), with an increase in severity (P < 0.001), conservative management (P < 0.001), and post-operative complications (P = 0.029) in 2020 compared to the same period in 2019. Conclusion COVID-19 has potentiated a significant reduction in acute surgical presentations to our hospital. Patients presenting with acute appendicitis during the pandemic had more severe disease, were more likely to have complications, and were significantly more likely to be managed conservatively when compared to historical data.

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Alveolar macrophages: novel therapeutic targets for respiratory diseases

Expert Reviews in Molecular Medicine ◽

10.1017/erm.2021.21 ◽

2021 ◽

Vol 23 ◽

Author(s):

Pamelia N. Lim ◽

Maritza M. Cervantes ◽

Linh K. Pham ◽

Alissa C. Rothchild

Keyword(s):

Alveolar Macrophages ◽

Respiratory Diseases ◽

Severe Disease ◽

Pulmonary Inflammation ◽

Therapeutic Targets ◽

Therapeutic Strategies ◽

Lung Damage ◽

Respiratory Pathogens ◽

Inhaled Antibiotics ◽

Potential Risks

Abstract Alveolar macrophages (AMs) are lung-resident myeloid cells that sit at the interface of the airway and lung tissue. Under homeostatic conditions, their primary function is to clear debris, dead cells and excess surfactant from the airways. They also serve as innate pulmonary sentinels for respiratory pathogens and environmental airborne particles and as regulators of pulmonary inflammation. However, they have not typically been viewed as primary therapeutic targets for respiratory diseases. Here, we discuss the role of AMs in various lung diseases, explore the potential therapeutic strategies to target these innate cells and weigh the potential risks and challenges of such therapies. Additionally, in the context of the COVID-19 pandemic, we examine the role AMs play in severe disease and the therapeutic strategies that have been harnessed to modulate their function and protect against severe lung damage. There are many novel approaches in development to target AMs, such as inhaled antibiotics, liposomal and microparticle delivery systems, and host-directed therapies, which have the potential to provide critical treatment to patients suffering from severe respiratory diseases, yet there is still much work to be done to fully understand the possible benefits and risks of such approaches.

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Impact of length of stay in psychiatric intensive care on the episode trajectory

Journal of Psychiatric Intensive Care ◽

10.20299/jpi.2021.011 ◽

2021 ◽

Author(s):

H. Thomas de Burgh ◽

Jeremy McCabe ◽

Kamal Gupta

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Extended Period ◽

Post Discharge ◽

Readmission Rates ◽

Rapid Turnover ◽

Complex Patients ◽

Step Down ◽

The Uk ◽

Relationship Of

Background: Length of stay (LOS) on admission to psychiatric intensive care in the UK varies widely, with few studies examining the relationship of LOS to clinical outcomes. Data from two South London male PICUs delivering care with the contrasting philosophies of rapid turnover versus slower stepdown were investigated to determine if additional LOS correlated with clinical benefit.Method: Data on admissions to the PICUs were collected over six months and assessed for outliers and then for variance using Levene’s test. The variables were compared using independent samples t-tests. Pearson correlations were alsocalculated for the major variables.Results: Mean LOS was 8.4 days higher on PICU 1 (p = 0.026) and readmission rates to hospital 6 months post discharge were 27% higher on PICU 1 (p = 0.025). There were no strong correlations between LOS on either PICU and the other five variables examined.Conclusion: It was intuitive to expect better outcomes in the PICU with a slower turnover where complex patients could receive an extended period of re-evaluation of pharmacological treatments and engagement with services and could achieve a fuller recovery from the episode. However, this group had no reduction in LOS following step-down to the wards, readmission rates to PICU during in the index episode or re-hospitalisation six months following discharge. The PICU with a policy of rapid-turnover, concentrating on reducing acuity and risk and rapid step down, was equally effective on the measures evaluated.

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A machine learning approach for identification of gastrointestinal predictors for the risk of COVID-19 related hospitalization

10.1101/2021.08.27.21262728 ◽

2021 ◽

Author(s):

Peter Liptak ◽

Peter Banovcin ◽

Robert Rosolanka ◽

Michal Prokopic ◽

Ivan Kocan ◽

...

Keyword(s):

Machine Learning ◽

Emergency Department ◽

Random Forest ◽

Gastrointestinal Symptoms ◽

Machine Learning Algorithms ◽

Important Predictor ◽

University Hospital ◽

Home Based ◽

Severity Of The Disease ◽

The University

Background and aim: COVID-19 can be presented with various gastrointestinal symptoms. Shortly after the pandemic outbreak several machine learning algorithms have been implemented to assess new diagnostic and therapeutic methods for this disease. Aim of this study is to assess gas-trointestinal and liver related predictive factors for SARS-CoV-2 associated risk of hospitalization. Methods: Data collection was based on questionnaire from the COVID-19 outpatient test center and from the emergency department at the University hospital in combination with data from inter-nal hospital information system and from the mobile application used for telemedicine follow-up of patients. For statistical analysis SARS-CoV-2 negative patients were considered as controls to three different SARS-CoV-2 positive patient groups (divided based on severity of the disease). Results: Total of 710 patients were enrolled in the study. Presence of diarrhea and nausea was significantly higher in emergency department group than in the COVID-19 outpatient test center. Among liver enzymes only aspartate transaminase (AST) has been significantly elevated in the hospitalized group compared to patients discharged home. Based on random forest algorithm, AST has been identified as the most important predictor followed by age or diabetes mellitus. Diarrhea and bloating have also predictive importance although much lower than AST. Conclusion: SARS-CoV-2 positivity is connected with isolated AST elevation and the level is linked with the severity of the disease. Furthermore, using machine learning random forest algo-rithm, we have identified elevated AST as the most important predictor for COVID-19 related hos-pitalizations.

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Animais Venenosos em Território Português: Abordagem Clínica de Picadas e Mordeduras

Acta Médica Portuguesa ◽

10.20344/amp.15589 ◽

2021 ◽

Vol 34 (11) ◽

pp. 784

Author(s):

Sofia R. Valdoleiros ◽

Inês Correia Gonçalves ◽

Carolina Silva ◽

Diogo Guerra ◽

Lino André Silva ◽

...

Keyword(s):

Native Species ◽

Severe Disease ◽

Clinical Manifestations ◽

Specific Treatment ◽

Hospital Setting ◽

Marine Species ◽

Symptomatic Treatment ◽

Thaumetopoea Pityocampa ◽

Hermodice Carunculata ◽

Spider Bites

There are many native species of animals with the potential to cause severe disease in Portugal. Of the four clinically relevant snake species, the vipers (Vipera latastei and Vipera seoanei) are the most concerning. They can cause severe disease and require in-hospital management, monitoring and specific treatment, including the administration of anti-snake venom serum. The Malpolon monspessulanus and Macroprotodon brevis snakes cause mostly localized clinical manifestations, which do not require specific treatment. Only a minority of the spider species in Portugal possess chelicerae (mouthparts of the Chelicerata, shaped as either articulated fangs or pincers, which may contain venom or be connected to the venom glands and are used for predation or capture of food) long enough to perforate the human skin. Nevertheless, Latrodectus tredecimguttatus and Loxosceles rufescens spider bites may require specialized treatment in a hospital setting, as well as careful active symptom surveillance. Diversely, the treatment for Scolopendra cingulata and Scolopendra oraniensis centipedes’ bites is merely symptomatic. The only existing scorpion species in Portugal is the Buthus ibericus; its sting typically causes local symptoms with intense pain, and its treatment consists essentially of analgesia. The insects of the Hymenoptera order, such as bees and wasps, have the ability to inject venom into the skin. Most people present only with local or regional inflammatory response, and symptomatic treatment is usually effective. Even so, individuals with hypersensitivity to bee venom may develop anaphylaxis. Several marine species in the Portuguese coast are venomous to humans, including weeverfish (Trachinidae family), stingrays (Dasyatis pastinaca, Taeniura grabata, Myliobatis aquila), red scorpion fish (Scorpaena scrofa), cnidaria (Pelagia noctiluca, Chrysaora hysoscella, Physalia physalis) and bearded fireworm (Hermodice carunculata); treatment is symptomatic. Contact with the larvae or bristles (chitinous structures with locomotor or tactile functions) of Thaumetopoea pityocampa (pine processionary) can cause cutaneous, ocular and, rarely, respiratory reactions; its management is also symptomatic.

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