Gastrointestinal Manifestations of COVID-19: A Review of What We Know.

Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Methods: We outline the evidence of the pathophysiology of COVID-19 in the GI tract, the effects of the virus on the gut and liver, the presence of the virus in stool samples, and the potential for fecal-oral transmission of COVID-19. Most of the literature sources used in this paper are case studies from China following the surge of COVID-19 infection. Results: In patients with COVID-19, GI symptoms such as anorexia, nausea, vomiting, diarrhea, and abdominal pain have presented in conjunction with respiratory symptoms such as fever, shortness of breath, and cough. Evidence also shows acute hepatocellular injury, indicated by elevated liver enzymes such as alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. Fecal-oral transmission of COVID-19 is suspected because of the presence of COVID-19 RNA in stool samples of COVID-19-positive patients. Conclusion: Even without the presence of respiratory symptoms, several GI symptoms are associated with COVID-19 infection, as well as possible fecal-oral transmission. Therefore, COVID-19 infection should be considered for patients presenting with primarily GI symptoms.

Approach to critical illness myopathy and polyneuropathy in the older SARS-CoV-2 patients.

One of the major concerns of the health care community and the public surrounding the SARS-CoV-2 pandemic is the availability and use of ventilators. Unprecedented surges of patients presented to intensive care units across the country, with older adults making up a large proportion of the patient population. This paper illustrates contemporary approaches to critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) in older patients, including incidence, risk factors, mechanisms for pathology, diagnosis, contemporary treatment approaches, and outcomes. We hope that the following analysis may help educate clinicians and ultimately decrease the duration of the mechanical ventilation required by these patients, resulting in improved clinical outcomes and an increase in ventilator availability for other patients in need.