Gastrointestinal Symptoms Are Associated with the Increased Risk of Progression from Non-Severe to Severe Illness in COVID-19 Patients: A Multicenter, Retrospective Study

Background. Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. Methods. Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. Results. 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. Conclusion. COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.

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An overview of COVID-19 induced gastrointestinal symptoms and liver dysfunction (Preprint)

10.2196/preprints.29648 ◽

2021 ◽

Author(s):

Obaid Rehman

Keyword(s):

Hepatic Injury ◽

Gastrointestinal Symptoms ◽

Prior History ◽

Rt Pcr ◽

Current Management ◽

Increased Risk ◽

Risk Of Progression ◽

History Of ◽

Polymerase Chain ◽

New Onset

UNSTRUCTURED The ongoing pandemic of COVID-19 beginning in December 2019 has caused widespread devastation to many individuals worldwide. Gastrointestinal manifestations and complications associated with SARS-CoV-2 are some of the less discussed implications of this virus. The initial gastrointestinal symptoms noted in COVID-19 patients are mainly diarrhea, nausea, poor appetite, anorexia, vomiting, diarrhea, and abdominal pain, as well as new onset of hepatic injury. Additionally, patients with a prior history of hepatic comorbidities have increased risk of progression to severe COVID-19. Presently, real-time reverse transcription polymerase chain reaction (RT-PCR), serological based tests, and imaging are used to achieve a definitive diagnosis. The current management of COVID-19 is supportive care along with antiviral, anti-inflammatory and analgesic therapy. The use of microbiota transplantation for COVID-19 management is also discussed. The importance of this article is to enlighten the overall understanding of COVID-19 induced gastrointestinal and liver pathophysiology, diagnosis, management, and prognosis.

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Semi-Quantitative Ultrasonographic Evaluation of NAFLD

Current Pharmaceutical Design ◽

10.2174/1381612826666200417142444 ◽

2020 ◽

Vol 26 (32) ◽

pp. 3915-3927 ◽

Cited By ~ 2

Author(s):

Stefano Ballestri ◽

Claudio Tana ◽

Maria Di Girolamo ◽

Maria Cristina Fontana ◽

Mariano Capitelli ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Imaging Techniques ◽

Metabolic Complications ◽

Nonalcoholic Fatty Liver ◽

Non Invasive ◽

Increased Risk ◽

Risk Of Progression ◽

Progressive Liver Disease

: Nonalcoholic fatty liver disease (NAFLD) embraces histopathological entities ranging from the relatively benign simple steatosis to the progressive form nonalcoholic steatohepatitis (NASH), which is associated with fibrosis and an increased risk of progression to cirrhosis and hepatocellular carcinoma. NAFLD is the most common liver disease and is associated with extrahepatic comorbidities including a major cardiovascular disease burden. : The non-invasive diagnosis of NAFLD and the identification of subjects at risk of progressive liver disease and cardio-metabolic complications are key in implementing personalized treatment schedules and follow-up strategies. : In this review, we highlight the potential role of ultrasound semiquantitative scores for detecting and assessing steatosis severity, progression of NAFLD, and cardio-metabolic risk. : Ultrasonographic scores of fatty liver severity act as sensors of cardio-metabolic health and may assist in selecting patients to submit to second-line non-invasive imaging techniques and/or liver biopsy.

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Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer

Nutrients ◽

10.3390/nu12020407 ◽

2020 ◽

Vol 12 (2) ◽

pp. 407

Author(s):

Reetta Holma ◽

Reijo Laatikainen ◽

Helena Orell ◽

Heikki Joensuu ◽

Katri Peuhkuri ◽

...

Keyword(s):

Colorectal Cancer ◽

Adjuvant Therapy ◽

Gastrointestinal Symptoms ◽

Mucosal Injury ◽

Dietary Carbohydrates ◽

Food Diary ◽

High Consumption ◽

Increased Risk ◽

Symptom Diary ◽

Low Consumption

Chemotherapy-induced mucosal injury of the small intestine may interfere with the enzymes and transporters responsible for the hydrolysis and absorption of dietary carbohydrates causing diarrhoea, abdominal discomfort and pain. The aim of this study was to investigate the association between the consumption of foods rich in FODMAPs (fermentable oligo-, di- and monosaccharides and polyols) and gastrointestinal symptoms in patients receiving adjuvant therapy for colorectal cancer. The patients (n = 52) filled in a 4-day food diary at baseline and during therapy and kept a symptom diary. The intakes of FODMAP-rich foods were calculated as portions and the intakes were divided into two consumption categories. Patients with high consumption of FODMAP-rich foods had diarrhoea more frequently than those with low consumption (for lactose-rich foods the odds ratio (OR) was 2.63, P = 0.03; and for other FODMAP-rich foods 1.82, P = 0.20). Patients with high consumption of both lactose-rich and other FODMAP-rich foods had an over 4-fold risk of developing diarrhoea as compared to those with low consumption of both (OR, 4.18; P = 0.02). These results were confirmed in multivariate models. Conclusion: Consumption of lactose-rich foods results in an increased risk of diarrhoea during adjuvant therapy for colorectal cancer, especially when the consumption of other FODMAP-rich foods is also high.

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Parasitic infections in Swiss children: Are we overtesting?

BMC Gastroenterology ◽

10.1186/s12876-021-01619-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Corinne Légeret ◽

Céline Rüttimann ◽

Hans Fankhauser ◽

Henrik Köhler

Keyword(s):

Retrospective Study ◽

Positive Result ◽

Pediatric Patients ◽

Intestinal Parasites ◽

Gastrointestinal Symptoms ◽

International Travel ◽

Parasitic Infections ◽

Stool Samples ◽

Stool Specimens

Abstract Background A wide variation of causes can lead to gastrointestinal symptoms in children- an infection with parasites is one of them. The expansion of international travel might lead to an increase in testing children for a correspondent infection. Currently there are no guidelines available, which patients should be tested for a possible parasitical infection. The aim of the study was to characterize Swiss children suffering from intestinal parasites, in order to provide more knowledge for the clinician who should be tested. Methods This is a retrospective study of Swiss pediatric patients, whose stools have been tested for parasites and helminths. Results A total of 1855 stool samples, belonging to 572 different children with an average age of 7.9 years, were tested within a 10-year period. The prevalence of a positive result was 4.2%, of which all were positive for Blastocystis, and 12.5% had a co-infection with Endolimax nana. Conclusion Immigrants, immune compromised children with diarrhea and pediatric patients with bloody or protracted diarrhea should have 2 different stool specimens examined for a possible parasitical infection.

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Hemoglobin A1c and preoperative glycemia as a decision tool to help minimise sternal wound complications: a retrospective study in OPCAB patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01580-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jef Van den Eynde ◽

Abel Van Vlasselaer ◽

Annoushka Laenen ◽

Delphine Szecel ◽

Bart Meuris ◽

...

Keyword(s):

Retrospective Study ◽

Hemoglobin A1c ◽

Clinical Decision Making ◽

Artery Bypass ◽

Clinical Decision ◽

Wound Complications ◽

Minimal Risk ◽

Off Pump ◽

Increased Risk ◽

Diabetes Patients

Abstract Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients (p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ratio, OR 1.24 per 1% increase, 95% confidence interval, CI 1.04;1.48, p = 0.016) as well as a higher grade of SWC (OR 1.25, 95% CI 1.06;1.48, p = 0.010). There was no association between glycemia and incidence (p = 0.539) nor grade (p = 0.607) of SWC. Significant modifiers of these effects were found: HbA1c was associated with SWC in diabetes patients younger than 70 years (OR 1.41, 95% CI 1.17;1.71, p < 0.001), whereas it was not in those older than 70 years. Glycemia was associated with SWC in patients who underwent non-urgent surgery (OR 2.48, 95% CI 1.26;4.88, p = 0.009), in diabetes patients who received skeletonised grafts (OR 4.83, 95% CI 1.28;18.17, p = 0.020), and in diabetes patients with a BMI < 30 (OR 2.19, 95% CI 1.01;4.76, p = 0.047), whereas it was not in the counterparts of these groups. Conclusions Under certain conditions, HbA1c and glycemia are associated SWC following OPCAB. These findings are helpful in planning the procedure with minimal risk of SWC.

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Considerations in the provision of teleconsultations for outpatient obstetric anaesthesia care during the Covid-19 pandemic

Proceedings of Singapore Healthcare ◽

10.1177/2010105821991170 ◽

2021 ◽

pp. 201010582199117

Author(s):

Leonard Wei Wen Loh ◽

Yingke He ◽

Hairil Rizal Abdullah ◽

Kai Lee Ng ◽

Un Sam Mok

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Severe Illness ◽

Continuing Care ◽

Short Report ◽

Obstetric Anaesthesia ◽

Increased Risk ◽

Process And Outcome ◽

Risk Of Exposure ◽

Anaesthesia Care

Evidence has emerged that pregnant women who contract coronavirus disease 2019 (Covid-19) are at increased risk of certain forms of severe illness as well as complications requiring intensive care unit admission and resultant mortality. Teleconsultations can facilitate continuing care for obstetric patients during the Covid-19 pandemic while reducing their risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this short report, we share our experience in the provision of teleconsultations for ambulatory obstetric anaesthesia patients in our high-risk obstetric anaesthesia clinic during the Covid-19 pandemic. Appropriate labour analgesia or anaesthesia plans were able to be formulated and communicated to the patients by teleconsultation, resulting in no delay or compromise in their peripartum care. Both patients and clinicians reported satisfaction with the teleconsultation process and outcome. The considerations and challenges in setting up a teleconsultation service as well as the factors in favour of teleconsultation are also explored.

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Serum BCMA levels predict outcomes in MGUS and smoldering myeloma patients

Blood Cancer Journal ◽

10.1038/s41408-021-00505-4 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

A. Visram ◽

C. Soof ◽

S. V. Rajkumar ◽

S. K. Kumar ◽

S. Bujarski ◽

...

Keyword(s):

Monoclonal Gammopathy ◽

Serum Samples ◽

Risk Models ◽

Independent Validation ◽

Increased Risk ◽

Risk Of Progression ◽

Paired Serum ◽

Smoldering Myeloma ◽

Undetermined Significance

AbstractSoluble BCMA (sBCMA) levels are elevated in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). However, the association between sBCMA levels and prognosis in MGUS and SMM has not been studied. We retrospectively analyzed sBCMA levels in stored samples from 99 MGUS and 184 SMM patients. Baseline sBCMA levels were significantly higher in MGUS and SMM patients progressing to MM during clinical follow up. When stratified according to the median baseline sBCMA level for each cohort, higher levels were associated with a shorter PFS for MGUS (HR 3.44 comparing sBCMA ≥77 vs <77 ng/mL [95% CI 2.07–5.73, p < 0.001] and SMM (HR 2.0 comparing sBCMA ≥128 vs <128 ng/mL, 95% 1.45–2.76, p < 0.001) patients. The effect of sBCMA on PFS was similar even after adjusting for the baseline MGUS or SMM risk stratification. We evaluated paired serum samples and found that sBCMA increased significantly in MGUS and SMM patients who eventually progressed to MM, whereas among MGUS non-progressors the sBCMA level remained stable. While our results require independent validation, they suggest that sBCMA may be a useful biomarker to identify MGUS and SMM patients at increased risk of progression to MM independent of the established risk models.

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Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility

Journal of Clinical Medicine ◽

10.3390/jcm10112355 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2355

Author(s):

Dean Decter ◽

Nissim Arbib ◽

Hila Markovitz ◽

Daniel S. Seidman ◽

Vered H. Eisenberg

Keyword(s):

Laparoscopic Surgery ◽

Retrospective Study ◽

Statistical Analysis ◽

Conservative Management ◽

Transvaginal Ultrasound ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Increased Risk ◽

And Control

We compared the prevalence of ultrasound signs of adenomyosis in women with endometriosis who underwent surgery to those who were managed conservatively. This was a retrospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demographics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was higher in the study group. Women in the study group with ≥ 5 sonographic signs of adenomyosis had more than twice the risk of experiencing infertility (OR = 2.31, p = 0.012, 95% CI; 1.20–4.45). Sonographic signs of adenomyosis are more prevalent in women with symptomatic endometriosis who underwent surgery compared with those who continued conservative management. Women with 5+ findings have a significantly increased risk of infertility. Adenomyosis on ultrasound should be considered in the management decisions regarding these patients.

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Factors associated with congenital syphilis: A retrospective study in Jiangxi Province, China

International Journal of STD & AIDS ◽

10.1177/09564624211052184 ◽

2021 ◽

pp. 095646242110521

Author(s):

Zhihua Wan ◽

Yuling Tao ◽

Huan Zhang ◽

Yang Hu ◽

Kuanyong Shu

Keyword(s):

Regression Analysis ◽

Retrospective Study ◽

Pregnant Women ◽

Congenital Syphilis ◽

Jiangxi Province ◽

Multivariable Logistic Regression Analysis ◽

Syphilis Infection ◽

Adequate Treatment ◽

Maternal Characteristics ◽

Increased Risk

Background There are a lack of studies about factors influencing congenital syphilis (CS) in economically underdeveloped areas, such as Jiangxi Province, China. Methods A retrospective study was conducted based on the information system of prevention of mother-to-child transmission of syphilis management in Jiangxi Province, China. Pregnant women with syphilis infection who delivered ≥28 gestational weeks and registered in this system from 1 January 2013 to 2030 June 2018 were enrolled. Maternal characteristics and treatment regimens associated with CS were evaluated using multivariable regression analysis. Results 1196 syphilis infected mothers and their 1207 infants were included in the analyses, and 116 infants were diagnosed with CS, providing an overall incidence of 9.61% (116/1207). Multivariable logistic regression analysis showed that increasing maternal age was barely associated with the risk of CS (adjusted odds ratio (aOR) = 0.97, 95% CI, 0.93–1.00, p = .047). Women with a high nontreponemal serum test titer (≥1:8) had a 126% increased risk of delivering an infant with CS than those with a low titer (<1:8) (aOR = 2.26, 95% CI, 1.51–3.39, p < .001). The risk for CS decreased significantly in infants born to mothers receiving adequate treatment than those receiving no treatment (aOR = 0.36, 95% CI, 0.21–0.61, p < .001). Conclusions Adequate treatment is critical for the prevention of CS. Further strategies focusing on early diagnosis and adequate treatment among syphilis infected pregnant women, particularly among those with younger age and high nontreponemal titer, should be strengthened to prevent CS.

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