Post-Infection Irritable Bowel Syndrome in Sars-Cov-2 Patients: The Gi-Covid19 Study

Introduction: SARS-CoV-2 infection, known as COVID-19, may lead to persistent gastrointestinal dysfunction resembling aspects of post-infection disorders of gut-brain interaction (DGBI). However, the long-term consequences of COVID-19 on the gastrointestinal tract remain unclear. Aims & Methods: We aimed to evaluate the prevalence of gastrointestinal symptoms and post-infection disorders of gut-brain interaction (DGBI) up to 12 months after hospitalization and the factors associated with their presence. The GI-COVID19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were assessed at hospital admission and followed up after 1, 6, and 12 months to assess gastrointestinal symptoms using the Gastrointestinal Symptoms Rating Scale, the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults, and the hospital anxiety and depression scale. ClinicalTrials. gov number, NCT04691895. Result(s): The study included2183 hospitalized patients. After excluding patients with pre-existing gastrointestinal symptoms and/or surgery, a total of 883 patients (614 COVID-19 and 269 controls) were included in the primary analysis, of whom 435 COVID-19 and 188 controls completed 12 months of follow-up. At enrollment, gastrointestinal symptoms occurred more frequently in COVID-19 patients than in the control group (59.3% vs. 39.7%, P<0.001). Symptoms more frequently complained by COVID-19 patients at enrollment were nausea, diarrhea, loose stool, and urgency. At 1-month follow-up evaluation, nausea and acid regurgitation were significantly more prevalent in COVID-19 patients than in the control group (8.7% vs. 1.7%, P=0.015 and 8.4% vs. 2.1%, P=0.006, respectively). At 6 months, COVID-19 patients reported lower rates of flatus (17.6% vs. 19.1%, P=0.024), constipation (8.9% vs. 17.1%, P<0.001) and hard stools (9.6 vs. 17.2%, P=0.030) as compared with the control group. At 12 months, constipation and hard stools were significantly less prevalent in COVID-19 patients than in the control group (9.6% vs. 16%, P=0.019 and 10.9% vs. 17.7%, P=0.011, respectively). COVID-19 patients reported higher rates of DGBI during follow-up compared to controls (Table), although statistically significant differences were found only for irritable bowel syndrome (IBS) according to Rome III criteria (4.4% vs 1.1%, P=0.036) and Rome IV criteria (3.2% vs 0.5%, P=0.045). The rate of COVID-19 patients depressed at 6 months and with anxiety at 12 months was higher compared to controls (4.1% vs 2.7%, P=0.014 and 4.5% vs 1.1%, P=0.088, respectively). Factors significantly associated with IBS diagnosis were anamnestic allergies (OR 10.024, 95% CI 1.766-56.891, P=0.009), chronic intake of proton pump inhibitors (OR 4.816, 95% CI 1.447-16.025, P=0.010) and dyspnea (OR 4.157, 95% CI 1.336-12.934, P=0.014). Conclusion(s): Hospitalized COVID-19 patients complain less constipation and hard stools than control at 12 months after acute infection. COVID-19 patients are also more likely to develop IBS.

Updated Analysis Confirms Sustained Poor Prognosis of COVID-19 in Patients with Lymphoma in Latin America: A Cohort of 160 Patients from Gell

Updated analysis confirms sustained poor prognosis of COVID-19 in patients with lymphoma in Latin America: A cohort of 160 patients from GELL. Introduction: Ongoing SARS-COV-2 pandemic has impacted the management of cancer patients worldwide. Several reports have demonstrated inferior outcomes of patients with hematological malignancies, including higher rates of intensive care unit admission, need for mechanical ventilation and death. The impact of COVID-19 is profound in resource-restricted countries, including Latin America. Most cohorts reported have not included patients from Latin America, and there is paucity of data of the outcome of cancer patients with COVID-19 in low- and middle-income countries. Grupo de Estudio De Linfoproliferativos En Latino-America (GELL )is a collaborative network of hematological centers in 13 countries in Latin America. We report updated outcomes of lymphoma patients diagnosed with COVID-19 in Latin America. Methods: We conducted a retrospective study including patients with a diagnosis of lymphoma and COVID-19 infection. Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma were excluded from the analysis We defined active disease as follow: (1) patients with detectable disease either prior to initiating therapy or upon relapse, and/or (2) patients undergoing active cancer treatment. The primary outcome was overall survival at 100 days. Survival curves were estimated using the Kaplan Meier method. Uni and multivariable analysis were carried out with Cox model. Results: A total of 160 patients were available for analysis. Median age was 60 years old. Hypertension was the most common comorbidity (33%). Most patients had aggressive lymphomas (62%), including 43% of patients with diffuse large B-Cell lymphoma (DLBCL). Follicular lymphomas were observed in 13% of patients and Hodgkin lymphoma in 12.5% of patients. With a median follow-up of 37 days, the 100-day OS was 64% (95CI 56-74%, fig. 1). In univariate analysis, age (HR 1.03, p=0.0025), hypertension (HR 2.01, p=0.017), >1 number of prior lines (HR 2.78, p=0.011), patients currently on treatment (HR 1.83, p=0.043), ferritin >2000 ng/mL (HR 4.74 p=0.00047) were associated with inferior OS. In multivariate analysis, age (HR 1.03, p=0.0026) and patients currently on treatment (HR 1.82, p=0.04) had inferior OS. There was a trend towards inferior outcomes in patients receiving monoclonal antibodies in univariate analysis (HR 1.82, p=0.081) but not in multivariable analysis (HR=1.29, p=0.48). Use of steroids was not statistically related to mortality (HR 1.79, p=0.074). Finally, contrary to other cohorts, no improvement in OS was observed in patients diagnosed later on the pandemic (fig. 2). Conclusion: In this large cohort of Latin American patients with lymphoma malignancies, our updated analysis showed a maintained dismal prognosis with COVID-19 infection. With a median follow up of 37 days, the 100-day OS was 64%. Older age and ongoing active cancer treatment were significantly associated with mortality. The use of monoclonal antibodies and systemic corticosteroids were not statistically associated to poor survival. Current efforts are focused on improving immunization in the Latin American population. There is an unmet need for improving survival in patients with hematologic malignancies and COVID-19 infection. [Formula presented] Disclosures: Perini: Janssen: Honoraria, Speakers Bureau;Takeda: Honoraria, Speakers Bureau;Astra Zeneca: Honoraria, Speakers Bureau;MSD: Honoraria, Speakers Bureau. Otero: ASTRA ZENECA: Current Employment. Abello: Dr Reddy's: Research Funding;Amgen: Honoraria;Janssen: Honoraria. Castillo: Abbvie: Consultancy, Research Funding;BeiGene: Consultancy, Research Funding;Pharmacyclics: Consultancy, Research Funding;Janssen: Consultancy;Roche: Consultancy;TG Therapeutics: Research Funding.

Severe systemic thrombosis in a young COVID-19 patient with a rare homozygous prothrombin G20210A mutation

COVID-19 patients may experience a hypercoagulable condition, leading to thrombotic events. We describe a patient with COVID-19, carrying a rare homozygous mutation of the prothrombin gene, who developed a severe systemic vein thrombosis. In COVID-19 patients with hypercoagulability disorders the most common inherited and acquired risk factors should be investigated.

Two nasal swabs may not be enough to exclude SARS-CoV-2 infection in symptomatic patients.

Abstracts: The spread of COVID-19 (COronaVIrus Disease 2019), due to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2) has taken on dramatic pandemic proportions, affecting over 100 countries in a matter of weeks. Italy has had 237,828 confirmed cases according to the Istituto Superiore di Sanità as of May 13, and 34,448 deaths (1).