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1.
Front Cardiovasc Med ; 7: 598846, 2020.
Article in English | MEDLINE | ID: covidwho-1067650

ABSTRACT

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation. Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I 2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I 2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I 2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I 2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I 2 0%]. Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

2.
Eur J Case Rep Intern Med ; 7(10): 001905, 2020.
Article in English | MEDLINE | ID: covidwho-884060

ABSTRACT

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019. The disease is caused by severe acute respiratory syndrome virus coronavirus 2 (SARS-CoV-2). A few published cases have linked COVID-19 and hyponatremia. The mechanism of hyponatremia in these cases is related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Here we present a unique case of urinary retention and SIADH as unusual presenting features of SARS-CoV-2 infection. LEARNING POINTS: Urine retention could be an unusual presenting symptom of severe hyponatremia of COVID-19.Hyponatremia and SIADH could be unusual presenting features of SARS-CoV-2 infection.Careful correction of hyponatremia related to COVID-19 is necessary to avoid osmotic demyelination syndrome.

3.
Am J Trop Med Hyg ; 103(4): 1600-1603, 2020 10.
Article in English | MEDLINE | ID: covidwho-740526

ABSTRACT

The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Intestinal Perforation/virology , Intestinal Pseudo-Obstruction/virology , Pancreatitis/virology , Pneumonia, Viral/virology , Renal Insufficiency/virology , Adult , Biomarkers/metabolism , COVID-19 , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Intestinal Perforation/diagnostic imaging , Intestinal Perforation/physiopathology , Intestinal Perforation/therapy , Intestinal Pseudo-Obstruction/diagnostic imaging , Intestinal Pseudo-Obstruction/physiopathology , Intestinal Pseudo-Obstruction/therapy , Liver/enzymology , Liver/pathology , Liver/virology , Male , Pancreatitis/diagnostic imaging , Pancreatitis/physiopathology , Pancreatitis/therapy , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Positive-Pressure Respiration/methods , Renal Dialysis , Renal Insufficiency/diagnostic imaging , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy , SARS-CoV-2 , Tomography, X-Ray Computed , Transaminases/metabolism
4.
Am J Trop Med Hyg ; 103(3): 1166-1169, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-646100

ABSTRACT

COVID-19 is a recent outbreak in China and rapidly spread worldwide. Lung consolidation is the most common radiologic finding of COVID-19 pneumonia. Pneumothorax has been rarely reported as a complication of severe COVID-19 pneumonia. Early recognition and management are detrimental to the outcome. We here report three cases of SARS-CoV-2 infection complicated by pneumothorax. In addition, we present a brief literature review.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Pneumothorax/etiology , Adult , COVID-19 , Coronavirus Infections/diagnostic imaging , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumothorax/diagnosis , Pneumothorax/therapy , SARS-CoV-2
5.
IDCases ; 21: e00895, 2020.
Article in English | MEDLINE | ID: covidwho-621608

ABSTRACT

As the cases of COVID-19 are flooding around the world, atypical presentations are being recognized, making the diagnosis challenging. Gastrointestinal symptoms and mild abdominal pain are common. However, severe abdominal pain associated with COVID-19 warranting surgical evaluation has been rarely described; recognizing such presentations and differentiating them from a surgical abdomen is critical to effectively and safely manage COVID-19 patients. Here we present a case of a middle-aged gentleman who developed features resembling secondary peritonitis. Eventually, he was found to have COVID-19 and was managed conservatively. In this report, we discuss his management course, and we explore pertinent relevant literature.

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