Short‑and Long‑Term Outcomes of Coronavirus Disease 2019 Patients Presenting with Diarrhea

Gastrointestinal (GI) manifestations of the coronavirus disease 2019 (COVID-19) pandemic are frequently observed in SARS-CoV-2-infected individuals at distinct time intervals after the initial diagnosis. Psychological distress in the form of anxiety, burnout, and depression is regarded as a common complication of COVID-19, but also as a risk factor for the development and exacerbation of irritable bowel syndrome (IBS), which is highly prevalent among COVID-19 patients and the general population. The pathophysiological mechanisms culminating in the diagnosis of IBS are yet to be fully understood, however, factors including gut–brain interaction, COVID-19-related intestinal damage, and other external influences might play a role in this process. While long-term GI complications of COVID-19 such as IBS are speculated to develop as a result of a multifaceted interaction between the virus itself with the host, in addition to the effects of psychological distress, further research on this topic is warranted. The purpose of this study was to explore possible factors correlating with the development of IBS and depression during the follow-up period post-COVID-19 infection. © 2023 Journal of Nature and Science of Medicine ;Published by Wolters Kluwer - Medknow.

Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study

Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Method(s): This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Result(s): Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 +/- 11.4. The average resting pressure decreased in response to treatment;however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion(s): Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.Copyright © 2023 The Author(s).

Copper Deficiency Mimicking Myelodysplastic Syndrome: Zinc Supplementation in the Setting of COVID-19

While copper deficiency is rare, it can have serious consequences, including pancytopenia and neuropathy. This treatable micronutrient deficiency can present very similarly to myelodysplastic syndrome (MDS), a group of myeloid neoplasms which can carry devastating prognoses. Copper deficiency is an essential differential diagnosis in suspected MDS, as it can present with similar laboratory findings, bone marrow biopsy, and clinical picture. While copper deficiency has multiple potential causes, it typically occurs in patients with a predisposing gastrointestinal pathology. One possible cause of copper deficiency is zinc overload. Interestingly, zinc over-supplementation has been prevalent during the COVID-19 pandemic, as some believe that zinc can help prevent COVID-19 infection. Multiple case reports have illustrated the similarities between copper deficiency and MDS. They have also highlighted zinc over-supplementation as a potential cause. The following case report is unique in that our patient lacked gastrointestinal pathology. He still presented with the clinical and laboratory findings of MDS in the setting of copper deficiency. These include anemia, leukopenia, fatigue, and neuropathy. Further, this deficiency was caused by zinc over-supplementation in efforts to prevent COVID-19. The deficiency and the accompanying symptoms were treated with copper supplementation and cessation of zinc intake.

Meta-analysis: Post-COVID-19 functional dyspepsia and irritable bowel syndrome.

INTRODUCTION: The burden of post-COVID-19 functional dyspepsia (FD) and irritable bowel syndrome (IBS) remains unclear. The aim of this meta-analysis was to estimate the rate of post-COVID-19 FD and IBS. METHODS: MEDLINE, Scopus and Embase were searched through 17 December 2022. Studies reporting the incidence of FD and/or IBS in COVID-19 survivors and controls (without COVID-19), when available, according to the Rome criteria, were included. Estimated incidence with 95% confidence intervals (CI) was pooled. The odds ratio (OR) with 95% confidence intervals (CI) was pooled; heterogeneity was expressed as I2 . RESULTS: Ten studies met the inclusion criteria and were included in the analysis. Overall, four studies including 1199 COVID-19 patients were considered for FD. Post-COVID-19 FD was reported by 72 patients (4%, 95% CI: 3%-5% and I2 0%). The pooled OR for FD development (three studies) in post-COVID-19 patients compared to controls was 8.07 (95% CI: 0.84-77.87, p = 0.071 and I2 = 67.9%). Overall, 10 studies including 2763 COVID-19 patients were considered for IBS. Post-COVID-19 IBS was reported by 195 patients (12%, 95% CI: 8%-16%, I2 95.6% and Egger's p = 0.002 test). The pooled OR for IBS development (four studies) in COVID-19 patients compared to controls was 6.27 (95% CI: 0.88-44.76, p = 0.067 and I2 = 81.4%); considering only studies with a prospective COVID-19 cohort (three studies), the pooled OR was 12.92 (95% CI: 3.58-46.60, p < 0.001 and I2 = 0%). CONCLUSIONS: COVID-19 survivors were found to be at risk for IBS development compared to controls. No definitive data are available for FD.

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Objective: Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods: Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results: One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean +or- SD, 55.9 +or- 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035);whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion: GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

Post-COVID-19 irritable bowel syndrome - importance of diet therapy and probiotic therapy

Introduction and Objective: The current challenge for medicine and the related disciplines is the development of methods and algorithms for dealing with the development of new diseases which undoubtedly include post-Covid-19 irritable bowel syndrome (P-IBS). This review is aimed at presentation of up-to-date scientific evidence on the impact of COVID-19 disease on development of post-Covid-19 irritable bowel syndrome. Review methods: The literature was reviewed using search engine data from PubMed, Google Scholar and the Medline databases. Brief description of the state of knowledge: At present, there are no guidelines or recommendations concerning therapeutic management of patients with post-Covid-19 irritable bowel syndrome. Therefore, the general standard of treatment for patients with irritable bowel syndrome (IBS) was reviewed. It is considered that the use of personalized low-FODMAP diet under the control of a clinical dietitian may be a good support in the treatment of IBS. Moreover, it seems advisable to supply personalized probiotic therapy based on the supplementation of strains with proven clinical effect. A new branch of probiotic therapy based on the use of psychobiotics in IBS patients as a form of support therapy also brings high hopes. Summary: The use of personalized low-FODMAP dietary supply and targeted probiotic therapy, including psychobiotherapy, could potentially be an effective method of supporting the treatment of patients suffering from post-Covid-19 irritable bowel syndrome. Currently, there are no guidelines for the routine use of the aforementioned methods. The need for further scientific research into the mechanisms of action and effectiveness of interventions in the context of P-IBS is indicated.

Early symptoms preceding post-infectious irritable bowel syndrome following COVID-19: a retrospective observational study incorporating daily gastrointestinal symptoms.

BACKGROUND: Intestinal microinflammation with immune dysfunction due to severe acute respiratory syndrome coronavirus 2 reportedly precipitates post-infectious irritable bowel syndrome. This study aimed to elucidate potential risk factors for subsequent development of irritable bowel syndrome, hypothesizing that it is associated with specific symptoms or patient backgrounds. METHODS: This single-center retrospective observational study (2020-2021) included adults with confirmed coronavirus disease requiring hospital admission and was conducted using real-world data retrieved from a hospital information system. Patient characteristics and detailed gastrointestinal symptoms were obtained and compared between patients with and without coronavirus disease-induced irritable bowel syndrome. Multivariate logistic models were used to validate the risk of developing irritable bowel syndrome. Moreover, daily gastrointestinal symptoms during hospitalization were examined in patients with irritable bowel syndrome. RESULTS: Among the 571 eligible patients, 12 (2.1%) were diagnosed with irritable bowel syndrome following coronavirus disease. While nausea and diarrhea during hospitalization, elevated white blood cell count on admission, and intensive care unit admission were associated with the development of irritable bowel syndrome, nausea and diarrhea were identified as risk factors for its development following coronavirus disease, as revealed by the adjusted analyses (odds ratio, 4.00 [1.01-15.84] and 5.64 [1.21-26.31], respectively). Half of the patients with irritable bowel syndrome had both diarrhea and constipation until discharge, and constipation was frequently followed by diarrhea. CONCLUSIONS: While irritable bowel syndrome was rarely diagnosed following coronavirus disease, nausea and diarrhea during hospitalization precede the early signs of irritable bowel syndrome following coronavirus disease.

The Prevalence of Irritable Bowel Syndrome after Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Their Association: A Systematic Review and Meta-Analysis of Observational Studies.

AIM: Investigate the prevalence of irritable bowel syndrome (IBS) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and assess the association between IBS and SARS-CoV-2 infection. METHODS: A systematic literature search for PubMed, Web of Science, Embase, Scopus, and the Cochrane Library was performed to identify all reports published before 31 December 2022. The confidence interval (CI), estimation effect (ES) of prevalence, and risk ratios (RR) were calculated to evaluate the prevalence of IBS after SARS-CoV-2 infection and their association. Individual results were pooled by the random-effects (RE) model. Subgroup analyses conducted a further investigation of the results. We employed funnel plots, Egger's test, and Begg's test to evaluate publication bias. Sensitivity analysis was performed for the assessment of the robustness of the result. RESULTS: The data on IBS prevalence after SARS-CoV-2 infection were extracted from two cross-sectional studies and ten longitudinal studies from nineteen countries with 3950 individuals. The IBS prevalence after SARS-CoV-2 infection ranges from 3% to 91% in different countries, and the overall pooled prevalence of IBS following SARS-CoV-2 infection is 15% (ES: 0.15; 95% CI, 0.11-0.20; p = 0.000). The data on the association between IBS and SARS-CoV-2 infection were extracted from six cohort studies from fifteen countries with 3595 individuals. The risk of IBS increased following SARS-CoV-2 infection but was not significant (RR: 1.82; 95% CI, 0.90-3.69; p = 0.096). CONCLUSIONS: In conclusion, the overall pooled prevalence of IBS following SARS-CoV-2 infection was 15%, and SARS-CoV-2 infection increased the overall risk of IBS but was not statistically significant. Further extra high-quality epidemiological evidence and studies to clarify the underlying mechanism of IBS following SARS-CoV-2 infection are needed.

Post-Covid-19 Gastro-Intestinal Disturbances.

BACKGROUND: Since the end of 2019, SARS-CoV-2 has been responsible for the multisystemic hyper-inflammatory disease, namely, COVID-19, as a majorly impactful pandemic. Gastrointestinal (GI) symptoms occurring during and after disease are gaining increasing attention among experts. METHODS: We briefly review and comment on preliminary and recent evidences on prevalence, pathophysiology, and perspective treatment options for GI disturbances during and after COVID-19. RESULTS: Several reports from the literature show a significant portion of COVID-19 patients suffering from GI symptoms both at the early stages of the disease and after the end of it, sometimes for several months, namely "long-COVID-19 " patients, irrespective of vaccination. An unsolved issue regarding COVID-19 is the association between GI symptoms and the outcome of COVID-19 patients. Several studies and metanalyses suggest a worse evolution of COVID-19 in patients presenting with GI symptoms. However, these data have not been agreed. Indeed, only one uniform observation can be found in the literature: patients with chronic liver disease have a worse outcome from COVID-19 infection. Upper and lower GI symptoms have similarities with postinfectious functional dyspepsia (FD) and irritable bowel syndrome (IBS). FD and IBS following infection are recognized as a pathophysiological factor, which is a gut microbial quali- and quantitative unbalance, namely dysbiosis. Furthermore, several preliminary reports and ongoing clinical trials have shown gut microbiota modulation by pre-, pro- and post-biotics to be effective in changing and preventing COVID-19 natural course. CONCLUSION: GI symptoms characterize both long- and non-long-COVID-19 with a potentially significant impact on its natural course. Gut microbiota modulation seems to be a sensible target for disease treatment and/or prevention.

Long-term Gastrointestinal Sequelae Following COVID-19: A Prospective Follow-up Cohort Study.

BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) is associated with long-term gastrointestinal sequelae; however, prospective longitudinal data are sparse. We prospectively studied the frequency, spectrum, and risk factors of post infection functional gastrointestinal disorders/disorders of gut-brain interaction (PI-FGID/DGBI) after COVID-19. METHODS: Three hundred twenty cases with COVID-19 and 2 control groups, group A, 320 healthy spouses/family controls, and group B, 280 healthy COVID serology-negative controls, were prospectively followed up at 1, 3, and 6 months by using validated Rome IV criteria to evaluate the frequency of PI-FGID/DGBI. RESULTS: Of 320 cases, at 1 month 36 (11.3%) developed FGID symptoms. Persistent symptoms were noted in 27 (8.4%) at 3 months and in 21 (6.6%) at 6 months. At 3 months, 8 (2.5%) had irritable bowel syndrome, 7 (2.2%) had functional diarrhea, 6 (1.9%) had functional dyspepsia, 3 (0.9%) had functional constipation, 2 (0.6%) had functional dyspepsia-IBS overlap, and 1 (0.3%) had functional abdominal bloating/distention. Among symptomatic individuals at 3 months, 8 (29.6%) were positive for isolated carbohydrate malabsorption, 1 (3.7%) was positive for post infection malabsorption syndrome, and 1 (3.7%) was positive for intestinal methanogen overgrowth. None of the healthy controls developed FGID up to 6 months of follow-up (P < .01). Predictive factors at 3 and 6 months were severity of infection (P < .01) and presence of gastrointestinal symptoms at the time of infection (P < .01). CONCLUSIONS: COVID-19 led to significantly higher number of new onset PI-FGID/DGBI compared with healthy controls at 3 and 6 months of follow-up. If further investigated, some patients can be diagnosed with underlying malabsorption.

Cannabinoids as Immune System Modulators: Cannabidiol Potential Therapeutic Approaches and Limitations.

Introduction: Cannabidiol (CBD) is the second most abundant Phytocannabinoid in Cannabis extracts. CBD has a binding affinity for several cannabinoid and cannabinoid-associated receptors. Epidiolex (oral CBD solution) has been lately licensed by the Food and Drug Administration (FDA) for the treatment of pediatric epileptic seizures. Methods: In this review, we discussed the most promising applications of CBD for chronic inflammatory conditions, namely CBD's anti-inflammatory effects during inflammatory bowel disease, coronavirus disease (antiviral effect), brain pathologies (neuroprotective and anti-inflammatory properties), as well as CBD immunomodulatory and antitumoral activities in the tumor microenvironment. Special focus was shed on the main therapeutic mechanisms of action of CBD, particularly in the control of the immune system and the endocannabinoid system. Results: Findings suggest that CBD is a potent immunomodulatory drug as it has manifested immunosuppressive properties in the context of sterile inflammation (e.g., inflammatory bowel disease, rheumatoid arthritis, and neurodegenerative diseases), and immunoprotective effects during viral infections (e.g. COVID-19) Similarly, CBD has exhibited a selective response toward cancer types by engaging different targets and signaling pathways. These results are in favor of the primary function of the endocannabinoid system which is homeostatic maintenance. Conclusion: The presented evidence suggests that the endocannabinoid system is a prominent target for the treatment of inflammatory and autoimmune diseases, rheumatoid diseases, viral infections, neurological and psychological pathologies, and cancer. Moreover, the antitumoral activities of CBD have been suggested to be potentially used in combination with chemo- or immunotherapy during cancer. However, clinical results are still lacking, which raises a challenge to apply translational cannabis research to the human immune system.

Post COVID-19 irritable bowel syndrome.

OBJECTIVES: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. DESIGN: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. RESULTS: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls. CONCLUSION: Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls. TRIAL REGISTRATION NUMBER: NCT04691895.

Application and development of fecal microbiota transplantation in the treatment of gastrointestinal and metabolic diseases: A review.

Fecal microbiota transplantation (FMT) restores a balanced intestinal flora, which helps to cure recurrent Clostridium difficile infections (RCDI). FMT has also been used to treat other gastrointestinal diseases, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and chronic constipation, as well as a variety of non-GI disorders. The purpose of this review is to discuss gut microbiota and FMT treatment of GI and non-GI diseases. An imbalanced gut microbiota is known to predispose one to Clostridium difficile infections (CDI), IBD, and IBS. However, the complex role of the gut microbiota in maintaining health is a newer concept that is being increasingly studied. The microbiome plays a major role in cellular immunity and metabolism and has been implicated in the pathogenesis of non-GI autoimmune diseases, chronic fatigue syndrome, obesity, and even some neuropsychiatric disorders. Many recent studies have reported that viral gastroenteritis can affect intestinal epithelial cells, and SARS-CoV-2 virus has been identified in the stool of infected patients. FMT is a highly effective cure for RCDI, but a better understanding of the gut microbiota in maintaining health and controlled studies of FMT in a variety of conditions are needed before FMT can be accepted and used clinically.

Functional Disorders of the Gastrointestinal Tract During the Pandemic of a New Coronavirus Infection

Aim. To analyze the literature data devoted to the study of the features of functional gastrointestinal diseases (FGID) during the pandemic of a new coronavirus infection. Key findings. Measures taken in connection with the pandemic of COVID-19 infection (introduction of lockdown, social isolation) leads to an increase in the level of depression and anxiety and, as a consequence, to an increase in the frequency and prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), as well as an increase in the severity of clinical symptoms of these diseases. In turn, the overcoming of COVID-19 infection contributes to an increase in the permeability of the mucous membrane of the gastrointestinal tract and the occurrence of its inflammatory changes, which lead to the development of postinfectious (postcovid) FD and postinfectious (postcovid) IBS. Conclusion. The problem of functional gastrointestinal diseases during the pandemic of a new coronavirus infection is very important and requires further research. © 2022 Russian Journal of Gastroenterology, Hepatology, Coloproctology

Prevalence of Small Intestinal Bacterial Overgrowth Syndrome in Patients with Irritable Bowel Syndrome who Have Suffered COVID-19

Aim. To study the prevalence of the small intestinal bacterial overgrowth syndrome in patients with irritable bowel syndrome with diarrhea who have had COVID-19 infection. Materials and methods. 60 patients with irritable bowel syndrome with diarrhea were examined. In 30 patients, irritable bowel syndrome was diagnosed after COVID-19 infection (main group). The comparison group consisted of 30 patients with classical stress-induced irritable bowel syndrome. The small intestinal bacterial overgrowth syndrome was diagnosed using a hydrogen breath test with lactulose loading in all patients. Results. In main group the small intestinal bacterial overgrowth syndrome was diagnosed in 93.3 % patients, which was statistically significantly higher (p < 0.01) relative to the comparison group - 60.0 % patients Conclusion. Irritable bowel syndrome in patients who have undergone COVID-19 occurs against the background of the small intestinal bacterial overgrowth syndrome development. © 2022 Russian Journal of Gastroenterology, Hepatology, Coloproctology

Patient satisfaction after remotely delivered gut-directed hypnotherapy for irritable bowel syndrome during the COVID-19 era: implications for future practice.

OBJECTIVE: Gut-directed hypnotherapy (GDH) is an evidence-based treatment for irritable bowel syndrome (IBS). Adoption of remote GDH has been accelerated by the COVID-19 pandemic. We aimed to evaluate patient experience and satisfaction following remote GDH. DESIGN: On completing 12 sessions of remote GDH via Skype using the Manchester protocol, patients with refractory IBS completed a feedback form on their experience. The proportion reporting positive outcomes (≥30% improvement in global IBS symptoms or abdominal pain, satisfaction, recommendation to family/friends) were compared by patient factors (age, gender, proximity, preferences). RESULTS: Of 52 patients completing the feedback form, 27 (52%) indicated that they would have opted for remote over face-to-face GDH, regardless of the pandemic situation. On a five-point scale (5=easy), patients rated the platform easy-to-use (mean 4.5±0.8) without impairment of communication (mean rating 4.6±0.8). Following remote GDH, 30/52 (58%) reported ≥30% global IBS symptom improvement, and 24/52 (46%) reported ≥30% pain reduction. 90% would recommend remote GDH to others. Only 39% felt they would have benefitted more from face to face. Those who would have chosen remote GDH regardless of the pandemic were more likely to be satisfied (p=0.01). Age, gender and proximity did not influence outcomes, satisfaction and likelihood of recommending remote GDH to others. Difficulties during remote sessions were infrequent in both those that were satisfied, and those that would have preferred face to face. CONCLUSION: These data support the need to continue developing remote GDH in the post-COVID era but suggest that there is still a role for face-to-face GDH, with patient choice being an important factor.

Health Coaching Across the Stages of Vaccine Readiness and Action: A Practical Guide for Public Health Nurses

Yet, lack of vaccine uptake puts in peril the goal of controlling the spread ofthe virus, particularly among communities that are at greatest risk of contracting and dying ofthe illness.8 The reasons for the lack of COVID-19 vaccine uptake among some communities in the United States are multifaceted, some of which include concerns about the safety or effectiveness ofthe vaccines, the speed in which the vaccines were developed, misinformation about the vaccines, and systemic barriers affecting community access (i.e., online appointment systems, inadequate transportation, and lack of child care).9,10 For many communities of color, including African American and Latinx individuals, COVID-19 vaccine reluctance is rooted in both historical and contemporary experiences of systemic racism, forced sterilization of Latinx women in California, the Tuskegee Study of Untreated Syphilis in the Negro Male (renamed as the US Public Health Service Syphilis Study at Tuskegee), marginalization, medical distrust, neglect from the scientific and medical communities, poor public health infrastructure, and institutional abandonment.2,3,10 In addition to those reasons, the politicization ofthe vaccine development process and efforts to increase vaccination after the 2020 US presidential election have deepened distrust among some communities. A 2021 Kaiser Family Foundation survey found that 79% of US adults who have not yet been vaccinated say they would likely turn to a trusted nurse, doctor, or other health care provider when deoiding wherher to ger a vaooination.11 As health oare professionals, nurses and other public health workers are often a patient's first clinical contact and are among the most trusted sources of information about the vaccines. Nurses are leading the nation's vaccine administration efforts and, to many, are the most accessible source of information for questions about safety, side effects, and benefits.11,12 To be effective, nurses and other public health workers require an understanding of the reasons that prevent people from getting vaccinated and have practical tools to support people with their decisions regarding if, when, and how they get vaccinated against COVID-19. The relationship between the stages in the framework are cyclical, and individuals can move in either direction at different points in time when exposed to new information tog., negative news reports) or negative experiences (e.g., a family member who had an adverse reaction).

COVID-19 Pandemic and Irritable Bowel Syndrome — is there a Relationship?

The aim: to reflect the features of the course of irritable bowel syndrome during the COVID-19 pandemic. Key points. It has been noted that the COVID-19 may contribute to the formation of post-infectious functional gastrointestinal diseases, given that angiotensin-converting enzyme-2 (ACE-2) receptors, the site of binding of the SARS-CoV-2 virus to human cells, are also present in epithelial intestinal cells;virus was found in feces in about half of patients, gastrointestinal symptoms, including diarrhea occur in about one fifth of patients, fecal calprotectin, a marker of GI inflammation is elevated in patients with COVID-19, macroscopically as well as histologically, patients show signs of damage mucous membrane of the gastrointestinal tract, and also, as noted above, they have a dysbiosis of the intestinal microbiota. Conclusion. It was shown that during the pandemic, more than 90 % of the interviewed patients with IBS had an exacerbation of IBS with an increase in symptoms such as bloating and cramps, and 75 % of them said that the exacerbation of symptoms was reflected in the activity of patients in everyday life. These factors dictate the need for an integrated approach in the management of such a group of patients with the use of modern multi-target drugs that affect the pathogenetic factors in the formation of functional gastrointestinal diseases, one of which is the Kolofort drug due to the triple multi-target mechanism of action on the pathogenesis of functional gastrointestinal diseases. © 2022 Russian Journal of Neurosurgery.