Acute intestinal ischemia in patients with COVID-19: single-centre experience and literature review.

OBJECTIVE: Acute Intestinal ischemia (AII) may involve the small and/or large bowel after any process affecting intestinal blood flow. COVID-19-related gastrointestinal manifestations, including AII, have been attributed to pharmacologic effects, metabolic disorders in ICU patients and other opportunistic colonic pathogens. AII in COVID-19 patients may be due also to "viral enteropathy" and  SARS-CoV-2-induced small vessel thrombosis. A critical appraisal of personal experience regarding COVID-19 and AII was carried out comparing this with a systematic literature review of published series. PATIENTS AND METHODS:   A retrospective observational clinical cohort study and a systematic literature review including only COVID-19 positive patients with acute arterial or venous intestinal ischemia were performed. The primary endpoint of the study was the mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay. RESULTS: Patient mean age was 62.9±14.9, with a prevalence of male gender (23 male, 72% vs. 9 female, 28%). The mean Charlson Comorbidity Index was 3.1±2.7. Surgery was performed in 24/32 patients (75.0%), with a mean delay time from admission to surgery of 6.0 ±5.6 days. Small bowel ischemia was confirmed to be the most common finding at surgical exploration (22/24, 91.7%). Acute abdomen at admission to the ED (Group 1) was observed in 10 (31.2%) cases, while 16 (50%) patients developed an acute abdomen condition during hospitalization (Group 2) for SARS-CoV-2 infection. CONCLUSIONS: Our literature review showed how intestinal ischemia in patients with SARS-CoV-2 has been reported all over the world. The majority of the patients have a high CCI with multiple comorbidities, above all hypertension and cardiovascular disease. GI symptoms were not always present at the admission. A high level of suspicion for intestinal ischemia should be maintained in COVID-19 patients presenting with GI symptoms or with incremental abdominal pain. Nevertheless, a prompt thromboelastogram and laboratory test may confirm the need of improving and fastening the use of anticoagulants and trigger an extended indication for early abdominal CECT in patients with suggestive symptoms or biochemical markers of intestinal ischemia.

COVID-19 IN LIVER TRANSPLANT RECIPIENTS: AN ITALIAN CASE-CONTROL DOUBLE-CENTER STUDY

Background and aim: Liver transplant (LT) recipients are clinically vulnerable to SARS-CoV-2 infection, due to immunosuppression and comorbidities. Aim of this study was to evaluate the impact of COVID-19 on LT recipients compared to general population in Southern Italy (Campania region). Materials and methods: In this case-control double-center study, we enrolled all consecutive adult liver recipients with confirmed SARS-CoV-2 infection. Data were collected at diagnosis of COVID-19 and during follow-up and compared with the Campania regional population (extracted by National Health System COVID-19 database – https://covid-19.iss.it). Results: A total of 30 LT patients developed Sars-CoV-2 infection (76.6% male, median age 62.6yrs). Sixteen (53.3%) were symptomatic;no differences in LT indications, immunosuppression and comorbidities were found between asymptomatic and symptomatic patients. Common COVID-19 symptoms were fever (46.6%), cough (36.6%), fatigue (36.6%) and anosmia (36.6%). Twenty-five (83.4%) patients were managed at home, while 5 (16.6%) required hospitalization (2 were admitted to ICU, 2 developed ARDS and 2 died). Immunosuppressors were modified only in hospitalized patients incidence rate of Sars-CoV-2 infection was similar between LT patients and general population (3.28% vs 4.37%, p=0.1) while symptomaticity rate was higher in LT patients (46.67% vs 15.87%, p<0.00). Hospitalization rate was higher in LT patients than in general population (16.67% vs 4.54%, p=0.001), with similar median length of stay (11 vs 20 days, p=0.32). Lethality rate was higher in LT patients than in general population (6.67% vs 1.76%, p=0.041). According to the multivariable logistic regression analysis, age (fully adjusted-OR 1.02 [95% CI 1.00-1.04], p=0.005) and female sex (fully adjusted-OR 0.31 [95% CI 0.13-0.73], p=0.007) showed positive and negative association, Sars-CoV-2 infection in LT patients. In fully adjusted model, LT patients are more frequently symptomatic (OR 5.44 [95% CI 2.44-12.17], p<0.00), while hospitalization and death for COVID-19 are not significatively associated with liver transplant and p=0.46, respectively). Conclusions: Our study showed that the vulnerability of the LT patients is not a risk factor for acquiring SARS-CoV-2 infection. Nonetheless, LT patients are more frequently symptomatic, although they are comparable to the general population in terms of hospitalization and lethality.

Review of global influenza circulation, late 2019 to 2020, and the impact of the COVID-19 pandemic on influenza circulation

This report summarizes the chronology, epidemiology and virology of influenza seasons between the end of 2019 and the end of 2020 in the temperate regions of the northern and southern hemispheres and the tropical and equatorial regions. Data on influenza activity during this period were derived primarily from reports published by national ministries of health and other official bodies and data reported to WHO through FluNet1 or FluID.2 Transmission characteristics, illness and mortality are presented by influenza transmission zone 3 in each temperate hemisphere and in the tropical zone. A small literature review was conducted on possible interactions between respiratory viruses to make hypotheses on the impact of COVID-19 on influenza circulation in 2020.

Surgical emergencies during SARS-CoV-2 pandemic lockdown: what happened?

OBJECTIVE: The pandemic from SARS-CoV-2 is having a profound impact on daily life of a large part of world population. Italy was the first Western country to impose a general lockdown to its citizens. Implications of these measures on several aspects of public health remain unknown. The aim of this study was to investigate the effects of the lockdown on surgical emergencies volumes and care in a large, tertiary referral center. MATERIALS AND METHODS: Electronic medical records of all patients visited in our Emergency Department (ED) and admitted in a surgical ward from February 21st 2020 to May 3rd 2020 were collected, analyzed and compared with the same periods of 2019 and 2018 and a cross-sectional study was performed. RESULTS: Number of surgical admissions dropped significantly in 2020 with respect to the same periods of 2019 and 2018, by almost 50%. The percentage distribution of admissions in different surgical wards did not change over the three years. Time from triage to operating room significantly reduced in 2020 respect to 2019 and 2018 (p<0.001). CONCLUSIONS: The lockdown in Italy due to SARS-CoV-2 pandemic arguably represents the largest social experiment in modern times. Data provided by our study provide useful information to health authorities and policymakers about the effects of activity restriction on surgical accesses and changing epidemiology due to an exceptional external event.