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Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.
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Objectives We aimed to investigate risk factors predicting oxygen demand in COVID-19 patients. Methods Patients admitted to Shizuoka General Hospital with COVID-19 from August 2020 to August 2021 were included. First, we divided patients into groups with and without oxygen demand. Then, we compared patients' clinical characteristics and laboratory and radiological findings to determine factors predicting oxygen demand. Results One hundred seventy patients with COVID-19 (aged 58 ± 15 years,57 females) were enrolled. Common comorbidities were cardiovascular diseases (47.6%), diabetes mellitus (28.8%), and dyslipidemia (26.5%). Elder age, higher body mass index, cardiovascular diseases, diabetes mellitus, lower lymphocyte count, albumin, hepatic attenuation value, and the liver-to-spleen ratio (L/S), higher D-dimer, aspartate aminotransferase, lactate dehydrogenase, troponin-T, C-reactive protein, KL-6, chest and abdominal circumference, and visceral fat were found in patients with oxygen demand. According to the multivariate logistic regression analysis, L/S, lymphocyte count, D-dimer, and abdominal circumference under the diaphragm were independent risk factors predicting oxygen demand in COVID-19 patients. Conclusions On admission, L/S, lymphocyte count, D-dimer, and abdominal circumference were predictive factors for oxygen demand. These factors may help in the appropriate triage of COVID-19 patients in the decision to admit them to the hospital.
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Background: The Coronavirus disease 2019 (COVID-19) pandemic is a significant challenge for public health and clinical medicine. COVID-19 mainly impairs the respiratory tract. However, gastrointestinal manifestations of COVID-19 are increasingly being recognized. Although acute viral pancreatitis has been described in other viral infections, pancreatic involvement in SARS-CoV-2 disease is still poorly defined. We reported a case of acute maternal pancreatitis in an early postpartum period woman with confirmed COVID-19. Case Presentation: A 31-year-old woman in term pregnancy had a caesarean section due to acute respiratory distress syndrome (ARDS) caused by COVID-19 pneumonia. One day after surgery, her stomach appeared bloated, bowel sounds were weak, and her abdominal circumference increased. Ultrasound examination did not reveal any suspicion of bleeding or hematoma. Her abdominal contrast-enhanced computerized tomography (CT) scan showed small bowel obstruction and oedematous pancreas. Amylase levels increased to 382 units/litre and lipase levels to 724 units/litre. C-reactive protein and procalcitonin were also increased. The diagnosis of sepsis was made, and she received broad-spectrum antibiotics and treatment for the COVID-19 infection. Recovery was characterized by a gradual resolution of abdominal and pulmonary signs and symptoms. A decline of amylase and lipase was observed by the tenth day. On the 13th day, she was extubated and gradually recovered from respiratory symptoms, with a negative result for COVID-19 RT-PCR. Based on this case, we consider that pregnancy and COVID-19 support each other as the cause of acute pancreatitis. Conclusion(s): Early diagnosis and severity classification are essential steps for successful management because late recognition and treatment may allow a greater prevalence of associated complications.Copyright © 2022, Philippine College of Physicians. All rights reserved.
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Objective. Whilst most cases of COVID-19 in pregnancy evolve uneventfully, some others have a poor outcome, such as preterm birth and HDP. The effect of COVID-19 on fetal growth still has to be addressed and appears controversial. Our study aims to focus on fetal growth velocity across the trimesters in pregnancy affected with COVID-19. Materials and Methods. This is a multicentric prospective observational study on data from COVID-19 pregnancies referred to the centers of Careggi University Hospital and S. Stefano Hospital in Prato from 2020 to 2022, included in the local branch of ItOSS surveillance. Fetal growth was evaluated across the three trimesters of pregnancy by abdominal circumference (AC) and expected fetal weight (EFW). Both AC, and EFW plus birthweight were used to calculate growth velocity (Vannuccini et al., 2017). Results. Data from a cohort of 211 cases was collected. The majority (80%) of COVID-19 cases occurred in the third trimester. Of note, the percentage of gestational diabetes (12.3%) and preterm births (7.1%) was comparable to the general population. Mean birthweight was 3259 +/- 509 g. The percentage of cesarean sections was acceptable (13.7%). Concerning the velocity of growth, AC decreased from the second to third trimester to reach values < 10th centile in 24% of cases and < 5th percentile in 17% of cases, even in presence of 2% of hypertensive disorders (HDP). Fetal growth restriction according to Gordjin et al. (2015) was antenatally identified in 4.7% of cases. Fetal growth > 95th centile occurred in 5.7% of cases. At birth, the cumulative percentage of small for gestational age newborns defined as birth weight < 2500 g resulted 5.2%. A significant percentage of newborns required NICU assistance (7.8%). Conclusions. Regardless of the association and prevalence of preterm birth, SGA and HDP in pregnant women, fetal growth appears to be affected by COVID-19 with a higher incidence of impaired growth velocity compared to the general population.
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Background and Aims : Cardiovascular disease (CVD) affects approximately one third of type 2 diabetes mellitus (T2DM) patients. We aimed to evaluate treatment targets of T2DM patients with CVD. Method(s): This retrospective study included 469 T2DM patients attending a Diabetes Center before COVID-19 (08.2016-12.2019). Data regarding diabetes history, complications and comorbidities, anthropometric parameters, metabolic profile were collected from medical records. Result(s): The patients' mean age was 62.27+/-9.98 and 48.8% were men. The mean diabetes duration was 6.81+/-7.04 years and the metabolic parameters were: BMI 31.78+/-5.32 kg/m2, HbA1c 7.5+/-1.47%, glycaemia 159.96+/-49.31 mg/dl, LDL-cholesterol 99.60+/-42.68 mg/dl, triglycerides 200.33+/-143.37 mg/dl. 203 patients had atherosclerotic CVD (angina, cardiac ischemic disease, peripheral arterial disease). A comparative analysis revealed higher values in CVD patients for age, diabetes duration, abdominal circumference, glycaemia, urinary albumin to creatinine ratio (ACR), p <0.05. Diabetes duration and ACR seemed to be predictive factors for CVD (AUC=0.579, p <0.01, CI=0.52 - 0.63, respectively AUC=0.607, p <0.01, CI=0.52 - 0.68). Regarding treatment targets of CVD patients, 45.5% had systolic blood pressure <130 mmHg, 14.8% had LDL-cholesterol <55 mg/dl, and 26.6% had HbA1c <7%. Conclusion(s): In clinical practice, some T2DM patients fail to achieve cardio-metabolic control even if managed according to the latest ESC recommendations. Copyright © 2022
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Background: The COVID-19 pandemic has spread worldwide, forcing governments to implement quarantines as a preventive measure against the spread of the virus. Quarantine causes changes in lifestyle and anthropometry status among communities. Objective: To describe the lifestyle and anthropometric status of medical students batch 2018 FM UA during the pandemic. Methods: This was a descriptive study using online questionnaires from September 2020 to February 2021. Results: There were variations in students’ anthropometry. Students’ average height is 161.110 cm, the average weight is 60.308 cm, the average body mass index is 23.193 cm, the average upper arm circumference is 27.846 cm, and the average abdominal circumference is 79.621 cm. Furthermore, 145 respondents (81.9%) stated that they experienced changes in their lifestyle during the pandemic. A total of 89 respondents (50.3%) continued to exercise and the other 88 respondents (49.7%) did not. Regarding the sleep pattern, 108 respondents (61%) had quite good sleep quality and 50 respondents (28.2%) had quite poor sleep quality. For the food consumption pattern, 46 respondents (26%) ate more sweet foods. Furthermore, 156 respondents (88.1%) did sedentary activities, with 77 respondents (43.5%) doing sedentary behavior for more than 6 hours a day. Conclusion: During the COVID-19 pandemic, the anthropometric status of medical students batch 2018 FMUA varied;and tend to maintain their physical activity, have quite good sleep quality, prefer eating sweet foods, and do a sedentary behavior for a longer duration
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Background and Aims: In order to reduce the spread of COVID-19, a lockdown was imposed in Tunisia with movement restrictions, social distancing and home confinement, which has affected routine healthcare activities and everyday life. The aim of this study was to examine the impact of the COVID-19 lockdown on glycemic control in patients with type 2 diabetes (T2D). Methods: Seventy-eight patients were evaluated in the period of three months after lockdown ending . Clinical metabolic profile, glycemic and metabolic control ( fasting glucose, Hba1c, lipid parameters) were evaluated in patients with type 2 diabetes Results: A total of seventy-eight participants took part in the study, of which 32 (41%) were men and 46(59%) women. Clinical characteristics were shown a weight gain (+ 3,2 kg), an increase in abdominal circumference by 2,7 cm but not change in hypertension profile. Biological parameters found a worsening in diabetes control: meaning fasting glucose was increased by 1,9 mmol/l and HbA1C increased by 1,1% ( 36 have not attend their glycemic targets , compared to 23 in the period before lockdown). six patients report to be hospitalized during this period for major hyperglycemia. Conclusions: A short-term variation of daily habits induced by the COVID-19 lockdown significantly worsened metabolic control in a relevant number of patients with type 2 diabetes. The recent increase in covid 19 spread suggests serious intervention to anticipate such deleterious effect.
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Purpose/Background: Although GI melanoma is commonly a metastatic disease, it is very unusual to see the mesenteric mass of the cecum and terminal ileum as the primary origin of melanoma. Hypothesis/Aim: This is a case report and presentation showing a rare occasion of primary melanoma in the cecum and the terminal ileum mesentery along the ileocolic pedicle causing cecal complete bowel obstruction. Methods/Interventions: The reported case is a rare occasion of large bowel obstruction near the cecum resulted from primary mesenteric melanoma invading into the wall of the descending colon. Primary melanoma of the GI tract is still controversial and only a limited of cases have been reported in the literature. We added a review of the other published case reports to this case report using Endnote. Results/Outcome(s): This is a 68-year-old female who was seen in the outpatient setting with increasing abdominal girth in addition to nausea and vomiting and obstipation. The patient had alternating bowel habits for over 2 months which she felt this was related to Covid as she was tested Covid positive and diagnosed with Covid pneumonia at the same time. She was directly admitted from the office to the inpatient and she had a CAT scan of the abdomen pelvis that demonstrated cecal obstruction related to possibly cecal mass/mesenteric mass with multiple liver metastatic diseases. She underwent exploratory laparotomy which resulted in Right extended hemicolectomy en bloc with a loop of jejunum and part of the terminal ileum. We tested later serum S100 the protein and it was elevated to 18,000, she had serum negative alpha-fetoprotein and negative CEA. This is a 68-year-old female who was seen in the outpatient setting with increasing abdominal girth in addition to nausea and vomiting and obstipation. The patient had alternating bowel habits for over 2 months which she felt was related to Covid as she was tested Covid positive and diagnosed with Covid pneumonia at the same time. She was directly admitted from the office to the inpatient service and she had a CAT scan of the abdomen pelvis that demonstrated cecal obstruction related to possibly cecal mass/ mesenteric mass with multiple liver metastatic diseases. She underwent exploratory laparotomy which resulted in Right extended hemicolectomy en bloc with a loop of jejunum and part of the terminal ileum. She had also intraoperative liver biopsy that demonstrated metastasis of the melanoma to the liver. We tested later serum S100 the protein and it was elevated to 18,000, she had serum negative alpha-fetoprotein and negative CEA. Limitations: Case report study with reported cases reviewed. Conclusions/Discussion: Large bowel obstruction could be related to unusual diagnoses like melanoma of the bowel mesentery. Although, primary GI melanoma is rare this showed the possibility of such diagnosis. (Figure Presented).
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Objective: Prior studies have shown maternal viral infections are associated with fetal growth restriction (FGR);however, the relationship between FGR and Sars-CoV-2 (SCOV2) infection during pregnancy remains unclear. In this study, we investigate the association between FGR & parental SCOV2 infection at a county hospital in Atlanta, Georgia. Study Design: A prospective cohort study was created by matching patients who had positive SCOV2 (PSCOV2) and negative SCOV2 (NSCOV2) PCR tests between 1/2020-4/2021 utilizing an institutional database. Cohorts were drawn from patients who received a 3rd trimester ultrasound (3TUS) & were matched by gestational age & month SCVO2 testing was performed. FGR was present when estimated fetal weight (EFW) was ≤10% or abdominal circumference (AC) ≤10% at time of either late 2nd or 3rd trimester ultrasound. Sample size calculations were performed to investigate a 15% difference in FGR rate requiring 74 subjects per group. Univariate analyses, chi-square tests and logistic regression were performed. Regression models were adjusted for comorbidities including preeclampsia, gestational diabetes, chronic hypertension, gestational hypertension, and maternal race. Results: 157 subjects were in the analyses (n=78 PSCOV2 and n=79 NSCVO2). 83.4% (n =131) self-identified as African American. FGR rates were 15.3% and 16.4% among PSCOV2 and NSCOV2 respectively. After adjusting for confounders, no difference in FGR was observed between the groups (adjusted OR: 1.12, 95% CI 0.46-2.73). Absolute EFW at time of FGR diagnosis was lower in PSCOV2 vs NSCOV2 (1,250 grams vs.1,337 grams, p= 0.015), a relationship that remained after adjusting for confounders (p=0.015). Conclusion: Our data suggest that despite a high background FGR rate (15.2%), there was no significant association between FGR and SCOV2. Also, EFW was lower in PSCOV2 cohort vs NSCOV2 cohort. Therefore, unlike other viral illnesses, while SCOV2 may not clinically drive FGR, further studies are necessary to investigate the effects of maternal SCVO2 on fetal growth & examine whether growth exams improve outcomes in this setting.