ABSTRACT
AIMS: The pandemic of coronavirus disease 2019 (COVID-19), has emerged as a dire health problem, causing a massive crisis for global health. BACKGROUND: Most commonly reported clinical manifestations are fever, fatigue and dry cough. Interestingly, a small percentage of patients experience GI symptoms with the most common being anorexia, diarrhea, nausea and vomiting. We aimed to investigate a comparable study of COVID-19 patients with or without gastrointestinal patients (GI). METHODS: Collective data of clinical manifestations and laboratory reports of patients admitted in Razi Hospital, Ahvaz, Khuzestan, Iran, during two weeks were analyzed. RESULTS: Our results showed that GI symptoms are not statistically significant criteria to be predictive or prognostic factors in the COVID-19 patients despite they are probably related to acute or non-acute phase of the disease. Moreover, non-specific GI symptoms seem to be as a result of cytokine storm occurred during the disease. CONCLUSION: Therefore, our results did not support GI tract involvement as a common route of COVID-19 infection. Maybe future research will shed light on why and how the gastrointestinal system became infected by COVID-19.
ABSTRACT
The renin-angiotensin-aldosterone system and its metabolites play an important role in homeostasis of body, especially the cardiovascular system. In this study, we discuss the imbalance of multiple systems during the infection and the importance of therapeutic choice, dosing, and laboratory monitoring of cardiac and anti-coagulant therapies in COVID-19 patients. The crosstalk between angiotensin, kinin-kallikrein system, as well as inflammatory and coagulation systems plays an essential role in COVID-19. Cardiac complications and coagulopathies imply the crosstalks between the mentioned systems. We believe that the blockage of bradykinin can be a good option in the management of COVID-19 and CVD in patients and that supportive treatment of respiratory and cardiologic complications is needed in COVID-19 patients. Ninety-one percent of COVID-19 patients who were admitted to hospital with a prolonged aPTT were positive for lupus anticoagulant, which increases the risk of thrombosis and prolonged aPTT. Therefore, the question that is posed at this juncture is whether it is safe to use the prophylactic dose of heparin particularly in those with elevated D-dimer levels. It should be noted that timing is of high importance in anti-coagulant therapy; therefore, we should consider the level of D-dimer, fibrinogen, drug-drug interactions, and risk factors during thromboprophylaxis administration. Fibrinogen is an independent predictor of resistance to heparin and should be considered before thromboprophylaxis. Alteplase and Futhan might be a good choice to assess the condition of heparin resistance. Finally, the treatment option, dosing, and laboratory monitoring of anticoagulant therapy are critical decisions in COVID-19 patients.