COVID-19 and acute biliary pancreatitis: comparative analysis between the normal period and COVID-19 pandemic.

BACKGROUND: The development of acute pancreatitis is multifactorial requiring predisposition and relevant injury.Viral acute pancreatitis has been described in other viral infections.However, pancreatic involvement in SARS-CoV-2 infection is still poorly defined.The present comparative study reports the patients with acute pancreatitis during the COVID-19 pandemic and last year covering the same period to appraise the link between COVID-19 and acute biliary pancreatitis. METHODS: The retrospective observational study was conducted in acute biliary pancreatitis patients from 13.03.19to13.09.19 and from 13.03.20to13.09.20 respectively. RESULTS: The study included 181patients(105patients in 2019;76 patients in 2020(during COVID-19 pandemic)).The patients were named as Group A(Normal period)and GroupB(Pandemic period),respectively.The groups were found to be comparable as there was no significant difference between the mean age, sex, comorbidities, cholecystectomized, and recurrency. There is no significant difference in the laboratory and radiological findings of GroupA and GroupB. However, there is a significant difference between the COVID-19 positive and negative patients in GroupB in terms of Glucose levels(p=0,025)and the presence of edema or necrosis in radiological images(p=0,046).There is a significant difference between the patients' number with abdominal pain of acute biliary pancreatitis in 2019and2020.(p=0)The length of stay was statistically significant in COVID-19 positive patients.(p= 0,013) CONCLUSIONS: Clinicians involved in the management of acute pancreatitis should be aware of its existence in the context of COVID-19.Understanding of the disease process and clinical manifestations of COVID-19 is still developing.Awareness of these issues and addressing them adequately will be crucial for the management. KEY WORDS: Acute Biliary Pancreatitis, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Coronary artery thrombus resulting in ST-elevation myocardial infarction in a patient with COVID-19.

COVID-19 is a prothrombotic condition that is also associated with raised troponin levels and myocardial damage. We present a case of a 54-year-old man who was admitted with respiratory failure due to COVID-19 and developed a ST-elevation myocardial infarction (STEMI) during his admission. His coronary angiogram did not show any significant coronary artery disease other than a heavily thrombosed right coronary artery. In view of heavy thrombus burden, the right coronary artery was treated with thrombus retrieval using a distal embolic protection device in addition to manual thrombectomy and direct (intracoronary) thrombolysis without the need for implantation of a coronary stent. After successful revascularisation, triple antithrombotic therapy was instituted with an oral anticoagulant in addition to dual antiplatelets. This case illustrates the association of COVID-19 with coronary artery thrombosis, which may require disparate management of a STEMI than that resulting from atherosclerotic coronary artery disease.

Comparative analysis of the management of acute appendicitis between the normal period and COVID-19 pandemic.

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period. METHODS: This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively. RESULTS: This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B. CONCLUSION: The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.