Case Report: COVID-19 Infection With Gastrointestinal Symptoms and Mood Disorder: Criticalities in Differential Diagnosis, Therapy and Management of Complications

During this pandemic Italy was deeply hit by the burden of the COVID-19. Current studies reveal that respiratory symptoms of COVID-19 represent the most common manifestations at presentation. The incidence of less common gastrointestinal symptoms varies significantly among different study populations. Liver injury is also described at different degree. We describe the case of a 20-year-old woman confirmed as SARS-CoV-2 positive by nasopharyngeal swab-PCR test, admitted to the COVID-only—Psychiatric Ward, set up in Niguarda Hospital in Milan on March 2020, for a depressive episode characterized by depressed mood and anorexia. In comorbidity we report a previous avoidant/restrictive food intake disorder present since childhood and a Border Personality Disorder according to the DSM V. On the admission to the ward we administered the Hamilton Depression Rating Scale with a total score of 29 suggesting severe depression. During the hospitalization she developed a clinical picture with increasing vomiting and diarrhea, nausea, abdominal pain along with fever and no respiratory symptoms. She also showed abnormalities in liver function indices. At the same time she showed clinophilia and persistent food avoidance that, initially, led to attribute all the symptoms to her psychiatric disorders. We prescribed the already ongoing therapy with lithium carbonate and SSRI. On the second day of hospitalization, along with the worsening of the gastrointestinal symptoms, we started therapy with hydroxychloroquine with a no significant remission of nausea and vomiting but with a further increase in liver function indices suggesting liver damage. This led us to suspend the treatment with hydroxychloroquine for the suspect of a drug induced injury. The depressive symptoms improved rapidly as opposed to the patient's overall condition. The gastrointestinal symptoms resolved with the evidence of the recovery from infection. In this report we underline the importance of investigating the physical symptoms in a patient with a history of mental disorder especially during an undergoing pandemic. During this pandemic, specialists from various fields were called upon to support teams working with COVID patients and to acquire new skills out of necessity, fostering a multidisciplinary approach and cooperation.

Download Full-text

Clinical Course of a Covid-19 Patient with Gastrointestinal Symptoms- A Case Report

International Journal of Medical Students ◽

10.5195/ijms.2020.617 ◽

2020 ◽

Vol 8 (2) ◽

pp. 148-151

Author(s):

Sidra Agarwal ◽

Hemanshi Mistry

Keyword(s):

New York ◽

Case Report ◽

Gastrointestinal Tract ◽

Respiratory Symptoms ◽

Clinical Course ◽

Gastrointestinal Symptoms ◽

Oral Route ◽

Nasopharyngeal Swab ◽

Virus Shedding ◽

Angiotensin Converting Enzyme 2

Background: COVID-19 most commonly presents with respiratory symptoms. However, it can involve the gastrointestinal tract causing symptoms like diarrhea and the resultant shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. This is due to the virus adhering to angiotensin-converting enzyme 2 receptors largely present in the gastrointestinal tract. This case report recommends routine stool Real-Time Reverse Polymerase Chain Reaction (rRT-PCR) testing for patients presenting with gastrointestinal symptoms. The Case: A healthy 36-year-old male healthcare worker in New York who tested positive for SARS-CoV-2 infection through rRT-PCR of the nasopharyngeal swab. After 7 days of convalescence, he recovered from influenza like symptoms after which he predominantly developed diarrhea, nausea, vomiting and extreme fatigue. Cough was the only lower respiratory symptom during the 3rd week of the clinical course. Anosmia or ageusia preceding the onset of respiratory symptoms was also reported. Due to the outbreak of the pandemic and New York being the epicenter at the time, the patient was recommended to self-isolate with supportive management through antipyretics and electrolyte replacement. Conclusion: This case highlights a SARS-CoV-2 PCR positive patient with predominant gastrointestinal symptoms. The reports regarding virus shedding in feces suggest that SARS-CoV-2 could be transmitted via fecal-oral route and thus routine stool rRT-PCR testing can aid in transmission-based precautions. Furthermore, reports of viral ribonucleic acid present in the stool, suggests direct infectivity of the virus on the intestinal tract. Therefore, screening in patients with only gastrointestinal symptoms can potentially help to contain the virus spread.

Download Full-text

Gastrointestinal symptoms as Covid-19 onset in hospitalized Italian patients

10.1101/2020.04.20.20064873 ◽

2020 ◽

Author(s):

Elisabetta Buscarini ◽

Guido Manfredi ◽

Gianfranco Brambilla ◽

Fernanda Menozzi ◽

Claudio Londoni ◽

...

Keyword(s):

Respiratory Symptoms ◽

Ventilatory Support ◽

Gastrointestinal Symptoms ◽

Benign Disease ◽

Nasopharyngeal Swab ◽

Disease Course ◽

X Ray ◽

Non Invasive ◽

Gi Symptoms ◽

Chest X Ray

ABSTRACTObjectiveTo assess the prevalence of gastrointestinal symptoms and their correlation with need of non-invasive ventilatory support, intensive care unit admission and death in hospitalized SARS-CoV-2 patients.DesignSince February 21th 2020, all individuals referred to our emergency department for suspected SARS-CoV-2 underwent a standardized assessment of body temperature and pulse oximetry, hematological screening, chest X-ray and/or computed tomography (CT), and SARS-CoV-2 assay on nasopharyngeal swab. Medical history and GI symptoms including nausea, vomit, diarrhea, and abdominal pain were recorded. were recorded.ResultsGI symptoms were the main presentation in 42 (10.2%) of 411 patients, with a mean onset 4.9 +/-… days before admission. In 5 (1.2%) patients GI symptoms have not been associated with respiratory symptoms or fever. We found an inverse trend for ICU admission and death as compared with patients without GI symptoms.ConclusionsGI symptoms can be an early and not negligible feature of Covid-19, and might be correlated with a more benign disease course.

Download Full-text

Risk of idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia

International Psychogeriatrics ◽

10.1017/s1041610215001763 ◽

2015 ◽

Vol 28 (5) ◽

pp. 863-868 ◽

Cited By ~ 2

Author(s):

Yuta Yoshino ◽

Taku Yoshida ◽

Takaaki Mori ◽

Shigeru Hirota ◽

Junichi Iga ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Older Patients ◽

Rating Scale ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Psychiatric Ward ◽

Drug Induced ◽

Timed Up And Go ◽

Older Inpatients ◽

Psychiatric Rating Scale

ABSTRACTBackground:The mean age of inpatients with schizophrenia has gradually increased in Japan and the risk of fracture in older schizophrenia patients is elevated. One possible cause may be idiopathic normal pressure hydrocephalus (iNPH). The present study aimed to evaluate the prevalence and symptoms of iNPH in older inpatients with schizophrenia.Methods:We prospectively examined older inpatients with schizophrenia (N = 21, mean age = 70.5 ± 5.9) in a psychiatric ward. We evaluated iNPH symptoms using the idiopathic Normal-Pressure Hydrocephalus Grading Scale (iNPHGS), Timed Up-and-Go test (TUG), Gait Status Scale (GSS), Mini-Mental State Examination (MMSE), and Neuropsychiatric Inventory (NPI). We also evaluated symptoms of schizophrenia using the Brief Psychiatric Rating Scale (BPRS) and Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). We conducted cerebrospinal fluid (CSF) tap tests for patients with possible-iNPH.Results:In total, three (14.3%) patients were diagnosed with possible iNPH: age, GS-Gait, GS-Cognition, TUG, 10-meter walking test, GSS, and DIEPSS were significantly increased in these compared to patients without iNPH; however, GS-Urine, MMSE, NPI, and BPRS did not differ significantly. Probable iNPH was diagnosed for two (9.5%) patients because of positive CSF tap tests.Conclusion:The prevalence of possible and probable iNPH in older patients with schizophrenia was much higher than that reported for older people without mental illness. Of the symptoms evaluated with the tests employed, only gait disturbances, particularly walking speed, distinguished schizophrenia patients with iNPH. These findings suggest that we should pay more attention to the possibility of iNPH in older patients with schizophrenia.

Download Full-text

Acetaminophen: Macula densa hypersecretory activity by induced hepatotoxicity

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010012895x ◽

1987 ◽

Vol 45 ◽

pp. 934-935

Author(s):

S.S. Poolsawat ◽

C.A. Huerta ◽

S.TY. Lae ◽

G.A. Miranda

Keyword(s):

Cell Proliferation ◽

Liver Function ◽

Chronic Inflammation ◽

Foam Cell ◽

Term Effect ◽

Short Term ◽

Drug Induced ◽

Experimental Induction ◽

Tissue Alterations ◽

Toxic Responses

Introduction. Experimental induction of altered histology by chemical toxins is of particular importance if its outcome resembles histopathological phenomena. Hepatotoxic drugs and chemicals are agents that can be converted by the liver into various metabolites which consequently evoke toxic responses. Very often, these drugs are intentionally administered to resolve an illness unrelated to liver function. Because of hepatic detoxification, the resulting metabolites are suggested to be integrated into the macromolecular processes of liver function and cause an array of cellular and tissue alterations, such as increased cytoplasmic lysis, centrilobular and localized necroses, chronic inflammation and “foam cell” proliferation of the hepatic sinusoids (1-4).Most experimentally drug-induced toxicity studies have concentrated primarily on the hepatic response, frequently overlooking other physiological phenomena which are directly related to liver function. Categorically, many studies have been short-term effect investigations which seldom have followed up the complications to other tissues and organs when the liver has failed to function normally.

Download Full-text

Predictors of Suicidal Ideation and Attempt among Patients with Major Depressive Disorder at a Tertiary Care Hospital, Puducherry

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1721558 ◽

2021 ◽

Vol 12 (01) ◽

pp. 122-128

Author(s):

Ralte Lalthankimi ◽

Padmavathi Nagarajan ◽

Vikas Menon ◽

Jeby Jose Olickal

Keyword(s):

Major Depressive Disorder ◽

Suicidal Ideation ◽

Depressive Disorder ◽

Rating Scale ◽

Tertiary Care ◽

Severe Depression ◽

Care Hospital ◽

Suicidal Behaviors ◽

Major Depressive ◽

Severity Of Depression

Abstract Objectives Mental disorders have a large impact on death by suicide. Hence, this study aims to determine the prevalence of suicidal behaviors among major depressive disorder (MDD) patients and the associated factors. Materials and Methods This cross-sectional analytical study was conducted among individuals aged 18 to 65 years, diagnosed with MDD in the Psychiatry Outpatient Department of a Tertiary Care Center, Puducherry during March to October 2019. Severity of depression was assessed using Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale was used to find the suicidal behaviors. Results For 166 participants in the study, mean (standard deviation) age was 40 (11) years and majority were females (76%). More than one-third (37%) had severe or very severe depression, and the prevalence of suicidal ideation, plan, and attempts were 83, 24, and 35%, respectively. After adjusting the covariates, the severity of depression and unemployment were significantly associated with suicidal attempts (adjusted prevalence ratios [aPR] = 11.4 and 1.9), and very severe depression was associated with suicidal ideation (aPR = 1.6). Among 140 individuals with suicidal ideation, 45 (32%) had an ideation frequency of 2 to 3 times/week, 69 (50%) had ideation for 1 hour, 36 (26%) could control ideation with little difficulty, and 12% had suicidal ideation mostly to end or stop their pain. Conclusion Suicidal ideation and attempts were significantly high in MDD patients, and the severity of depression was significantly associated with it. Early identification of high-risk suicidal behavior and implementation of effective preventive interventions are necessary to reduce death by suicide in these groups.

Download Full-text

COVID-19 in CKD Patients: Lessons from 553 CKD Patients with Biopsy-Proven Kidney Disease

Kidney & Blood Pressure Research ◽

10.1159/000515714 ◽

2021 ◽

pp. 1-8

Author(s):

Juan León Román ◽

Clara García-Carro ◽

Irene Agraz ◽

Nestor Toapanta ◽

Ander Vergara ◽

...

Keyword(s):

Cardiovascular Disease ◽

Kidney Disease ◽

Kidney Biopsy ◽

Cox Regression ◽

Gastrointestinal Symptoms ◽

Bivariate Analysis ◽

Chronic Obstructive ◽

Nasopharyngeal Swab ◽

Obstructive Pulmonary Disease ◽

Immunosuppressed Patients

Introduction: Chronic kidney disease (CKD) patients infected with COVID-19 are at risk of serious complications such as hospitalization and death. The prognosis and lethality of COVID-19 infection in patients with established kidney disease has not been widely studied. Methods: Data included patients who underwent kidney biopsy at the Vall d’Hebron Hospital between January 2013 and February 2020 with COVID-19 diagnosis during the period from March 1 to May 15, 2020. Results: Thirty-nine (7%) patients were diagnosed with COVID-19 infection. Mean age was 63 ± 15 years and 48.7% were male. Hypertension was present in 79.5%, CKD without renal replacement therapy in 76.9%, and cardiovascular disease in 64.1%. Nasopharyngeal swab was performed in 26 patients; older (p = 0.01), hypertensive (p = 0.005), and immunosuppressed (p = 0.01) patients, those using RAS-blocking drugs (p = 0.04), and those with gastrointestinal symptoms (p = 0.02) were more likely to be tested for COVID-19. Twenty-two patients required hospitalization and 15.4% died. In bivariate analysis, mortality was associated with older age (p = 0.03), cardiovascular disease (p = 0.05), chronic obstructive pulmonary disease (p = 0.05), and low hemoglobin levels (p = 0.006). Adjusted Cox regression showed that low hemoglobin levels at admission had 1.81 greater risk of mortality. Conclusions: Patients with COVID-19 infection and kidney disease confirmed by kidney biopsy presented a mortality of 15.4%. Swab test for COVID-19 was more likely to be performed in older, hypertensive, and immunosuppressed patients, those using RAS-blocking drugs, and those with gastrointestinal symptoms. Low hemoglobin is a risk factor for mortality.

Download Full-text

Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand

SAGE Open Medicine ◽

10.1177/2050312121989631 ◽

2021 ◽

Vol 9 ◽

pp. 205031212198963

Author(s):

Artit Sangkakam ◽

Pasin Hemachudha ◽

Abhinbhen W Saraya ◽

Benjamard Thaweethee-Sukjai ◽

Thaniwan Cheun-Arom ◽

...

Keyword(s):

Influenza Virus ◽

Gastrointestinal Tract ◽

Hospital Stay ◽

Rectal Swab ◽

Average Length ◽

Gastrointestinal Symptoms ◽

Virus Detection ◽

Length Of Hospital Stay ◽

Nasopharyngeal Swab ◽

Influenza Virus Detection

Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and replication, and it is transmitted mainly via respiratory secretions. Nasopharyngeal swab is the gold standard specimen type for influenza detection, but several studies have also suggested that the virus replicates in the human gastrointestinal tract. Methods: A retrospective study was conducted on all patients positive for influenza virus and initially recruited as part of the PREDICT project from 2017 to 2018. The objectives of the study were to investigate whether rectal swab could aid in improving influenza detection, and if there was any correlation between gastrointestinal disturbances and severity of infection, using length of hospital stay as an indicator of severity. Results: Of the 51 influenza-positive patients, 12 had detectable influenza virus in their rectal swab. Among these 12 rectal swab positive patients, influenza virus was not detected in the nasopharyngeal swab of three of them. Gastrointestinal symptoms were observed for 28.2% patients with a negative rectal swab negative and 25.0% patients with a positive rectal swab. Average length of hospital stay was 4.2 days for rectal swab positive group and 3.7 days for rectal swab negative group. This difference was not statistically significant (p = 0.288). Conclusions: There is no correlation between influenza virus detection in rectal swab and gastrointestinal disturbances or disease severity, and there is currently insufficient evidence to support replicative ability in the gastrointestinal tract.

Download Full-text

Gastrointestinal Physiology Before and After Duodenal Switch with Comparisons to Unoperated Lean Controls: Novel Use of the SmartPill Wireless Motility Capsule

Obesity Surgery ◽

10.1007/s11695-021-05452-4 ◽

2021 ◽

Author(s):

Khalid Elias ◽

Per M. Hellström ◽

Dominic-Luc Webb ◽

Magnus Sundbom

Keyword(s):

Small Bowel ◽

Transit Time ◽

Duodenal Switch ◽

Rating Scale ◽

Gastrointestinal Symptoms ◽

Small Bowel Transit ◽

Gastrointestinal Physiology ◽

Time Points ◽

Small Bowel Transit Time ◽

Wireless Motility Capsule

Abstract Purpose Bariatric surgery alters gastrointestinal anatomy. In this exploratory study, the SmartPill® wireless motility capsule (WMC) was used to study changes in gastrointestinal physiology following biliopancreatic diversion with duodenal switch (BPD/DS). Material and Methods Twenty-eight BPD/DS patients (35 ± 11 years, 50% females, body mass index [BMI] 56 ± 5) were to be examined preoperatively and postoperatively. In addition to transit time, appetite control and gastrointestinal symptoms were studied by patient-scored questionnaires (visual analogue scale and Gastrointestinal Symptom Rating Scale (GSRS)). Data was compared to 41 lean unoperated controls. Results About 1.8 years postoperatively, 18 patients (BMI 35.8 ± 8.3) returned for a second WMC test. As expected, small bowel transit time was reduced, from 3.9 ± 1.6 h to 2.8 ± 2.0, p = 0.02, and at both these time points, it was shorter than in lean controls (5.4 ± 1.9 h, p = 0.001). Postoperatively, a trend towards reduced colon and whole gut transit times was seen in BPD/DS-patients, thus approaching those of lean controls. Surprisingly, BPD/DS patients scored higher satiety than controls preoperatively as well as increased hunger and desire to eat postoperatively. Compared to lean, BPD/DS patients reported a higher total GSRS score at both time points (1.2 ± 0.2 vs 1.7 ± 0.6 and 2.3 ± 0.5, p < 0.001). Postoperatively, the scores for diarrhea and indigestion increased. Conclusions The novel use of the SmartPill system in BPD/DS patients gave the expected readouts. Although small bowel transit time was further shortened after BPD/DS, whole gut transit time did not differ from controls. Typical gastrointestinal symptoms were reported postoperatively. Graphical abstract

Download Full-text

Profile and outcomes of critically ill children in a lower middle-income country

Emergency Medicine Journal ◽

10.1136/emermed-2016-205720 ◽

2017 ◽

Vol 35 (1) ◽

pp. 52-55 ◽

Cited By ~ 3

Author(s):

Muhammad Irfan Habib ◽

Khalid Mehmood A Khan

Keyword(s):

Critically Ill ◽

Respiratory Symptoms ◽

Gastrointestinal Symptoms ◽

Middle Income Country ◽

Income Country ◽

Critically Ill Children ◽

Age Group ◽

Middle Income ◽

Lower Middle Income Country ◽

Level 1

ObjectiveTo determine the clinical profile and outcome of critically ill children presenting to a paediatric ED in a lower middle-income country.MethodsWe performed a retrospective analysis of children (<14 years) presenting to the ED of the National Institute of Child Health, Karachi, between January and December 2014 who were assigned to acuity 1 (requiring immediate life-saving interventions) according to the Emergency Severity Index. Data included demographic variables, presenting complaints, interventions and outcomes in the ED.ResultsThere were 172 162 visits during the year. Of these, 13 551 (8%) were level 1. 64% of level 1 patients were transported to the ED without ambulance service. Neonates (0–28 days) constituted 48% of level 1 children; their most frequent presenting complaints were respiratory symptoms, followed by fever and reluctance to feed. Above the neonatal age group, the most common presenting complaints were gastrointestinal symptoms (with signs of hypoperfusion), followed by seizures, reluctance to feed and respiratory symptoms. 64% of children of >28 days presenting were malnourished. Interventions included cardiopulmonary resuscitation, application of bubble continuous positive airway pressure and endotracheal intubation. Overall mortality was 13%; 63% of all deaths were in the neonatal age group.ConclusionChildren with the highest triage acuity represent 8% of all visits to a paediatric ED. In this group, neonates account for nearly half of all the children, and more than half of all the deaths among critically ill children came in ED. A large proportion of high-acuity children are malnourished.

Download Full-text

Exploring Clinical Characteristics of Bipolar Depression: Internal Structure of the Bipolar Depression Rating Scale

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670903107666 ◽

2009 ◽

Vol 43 (9) ◽

pp. 830-837 ◽

Cited By ~ 11

Author(s):

Jae Seung Chang ◽

Yong Min Ahn ◽

Han Young Yu ◽

Hye Jean Park ◽

Kyu Young Lee ◽

...

Keyword(s):

Internal Structure ◽

Rating Scales ◽

Rating Scale ◽

Bipolar Depression ◽

Cluster Structure ◽

Hierarchical Cluster ◽

Symptom Cluster ◽

Extrapyramidal Symptoms ◽

Young Mania ◽

Drug Induced

Objective: Due to its pleomorphic phenomenology, the clinical features of bipolar depression are difficult to assess. The objective of the present study was therefore to explore the internal structure of the Bipolar Depression Rating Scale (BDRS) in terms of the phenomenological characteristics of bipolar depression. Methods: Sixty patients with DSM-IV bipolar depression completed the BDRS, depression and excitement subscales of the Positive and Negative Syndrome Scale (PANSS-D and PANSS-E), 17-item Hamilton Depression Rating Scale, Montgomery–Äsberg Depression Rating Scale, Young Mania Rating Scale (YMRS), and the Drug-Induced Extrapyramidal Symptoms Scale. The internal structure of the BDRS was explored through hierarchical cluster analysis (HCA) using Ward's method and multidimensional scaling (MDS). Results: From 20-item BDRS data, the HCA yielded two symptom clusters. The first cluster included 12 items of conventional depressive symptoms. The second cluster included eight items of mixed symptoms. The MDS identified a depressive–mixed dimension. The depressive symptom cluster showed a more cohesive and conglomerate cluster structure on the MDS map compared to the mixed symptom cluster. After controlling for the effects of treatment-emergent extrapyramidal symptoms, strong positive correlations were observed between the BDRS and other depression rating scales, and the BDRS also weakly correlated with the YMRS and the PANSS-E. Conclusions: The internal structure of BDRS appears to be sensitive to complex features of bipolar depression. Hence, the BDRS may have an advantage in evaluating clinical changes in patients with bipolar depression within the therapeutic process.

Download Full-text