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GMS J Med Educ ; 37(7): Doc96, 2020.
Article in English | MEDLINE | ID: covidwho-1389116


Objectives: In undergraduate medical education and in the subject of child and adolescent psychiatry, examining young patients face-to-face is a key element of teaching. With the abrupt shutdown of face-to-face teaching caused by the SARS-CoV-2 pandemic, a case-based online training program integrating audio and video of real patients was developed. Methods: The blended learning platform CaseTrain guides medical students in their final year through real child-psychiatric patient cases, such as anorexia, autism, or attention deficit disorder, through presentation of video and audio of real patients and parents. The teaching format complements lectures on child psychiatric topics, comprising asynchronous elements (self-study using the digital material) as well as synchronous elements (web-conferences with a specialist). Learning objectives for students were set to develop knowledge of the spectra of psychiatric disorders that affect children and to recognize approaches how to assess and manage common psychiatric problems of childhood and adolescence. Results: The feedback from medical students through oral and written evaluation was positive. They appreciated getting to know 'real-world patients' in times of such a pandemic, to learn explorative techniques from role models, and to be in close contact with the supervising specialist. In consequence of critical feedback on the length of some video sequences, these training units will undergo revision. Conclusions: Case-based online training may continue to be a useful option in a post-pandemic future as integral part of medical education, complementing face-to-face lectures and training in (child) psychiatry.

Adolescent Psychiatry/education , COVID-19/epidemiology , Computer-Assisted Instruction/methods , Education, Distance/organization & administration , Education, Medical, Undergraduate/organization & administration , Anorexia/diagnosis , Anorexia/physiopathology , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/physiopathology , Autistic Disorder/diagnosis , Autistic Disorder/physiopathology , Health Knowledge, Attitudes, Practice , Humans , Pandemics , SARS-CoV-2
Nat Rev Gastroenterol Hepatol ; 18(4): 269-283, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085424


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to more than 200 countries and regions globally. SARS-CoV-2 is thought to spread mainly through respiratory droplets and close contact. However, reports have shown that a notable proportion of patients with coronavirus disease 2019 (COVID-19) develop gastrointestinal symptoms and nearly half of patients confirmed to have COVID-19 have shown detectable SARS-CoV-2 RNA in their faecal samples. Moreover, SARS-CoV-2 infection reportedly alters intestinal microbiota, which correlated with the expression of inflammatory factors. Furthermore, multiple in vitro and in vivo animal studies have provided direct evidence of intestinal infection by SARS-CoV-2. These lines of evidence highlight the nature of SARS-CoV-2 gastrointestinal infection and its potential faecal-oral transmission. Here, we summarize the current findings on the gastrointestinal manifestations of COVID-19 and its possible mechanisms. We also discuss how SARS-CoV-2 gastrointestinal infection might occur and the current evidence and future studies needed to establish the occurrence of faecal-oral transmission.

COVID-19/physiopathology , Diarrhea/physiopathology , Dysbiosis/physiopathology , Gastroenteritis/physiopathology , Gastrointestinal Microbiome , Nausea/physiopathology , Vomiting/physiopathology , Abdominal Pain/physiopathology , Angiotensin-Converting Enzyme 2/metabolism , Animals , Anorexia/physiopathology , COVID-19/transmission , Cell Line , Colon/metabolism , Cytokines/metabolism , Disease Models, Animal , Feces/chemistry , Gastroenteritis/virology , Humans , Intestinal Mucosa/metabolism , Intestine, Small/metabolism , Leukocyte L1 Antigen Complex/metabolism , Organoids , RNA, Viral , Receptors, Coronavirus/metabolism , SARS-CoV-2/metabolism , Serine Endopeptidases/metabolism , Viral Load , Virus Shedding
Dig Liver Dis ; 52(10): 1076-1079, 2020 10.
Article in English | MEDLINE | ID: covidwho-803444


Objective: To explore the clinical characteristics of Coronavirus Disease (COVID-19) patients with gastrointestinal symptoms. Methods: The clinical data of 164 COVID-19 patients with gastrointestinal symptoms were extracted and analysed retrospectively. Results: In total, 505 COVID-19 patients were divided into two groups: those with gastrointestinal symptoms (G group) and those without gastrointestinal symptoms (NG group). Common gastrointestinal symptoms included inappetence, diarrhoea, nausea, abdominal pain, and vomiting. Significantly higher proportions of patients with fever, dizziness, myalgia, and fatigue were noted in group G than in group NG. Compared with patients without fever, there was a significant difference between G group and NG group in moderate fever or above, while there was no significant difference between the two groups in low fever. The laboratory results showed that patients in the G group had significantly higher C-reactive protein, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase levels than those in the NG group. Moreover, the proportion of patients with severe pneumonia was significantly higher in the G group than in the NG group. Conclusion: In Wuhan, the proportion of COVID-19 patients who experience gastrointestinal symptoms is relatively high. Patients who experience gastrointestinal symptoms are more likely to suffer from severe pneumonia, which may help clinicians identify patients at high risk of COVID-19 and thus reduce the incidence of this condition.

Abdominal Pain/physiopathology , Anorexia/physiopathology , Coronavirus Infections/physiopathology , Diarrhea/physiopathology , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Vomiting/physiopathology , Abdominal Pain/etiology , Abdominal Pain/metabolism , Adult , Aged , Anorexia/etiology , Anorexia/metabolism , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Case-Control Studies , Coronavirus Infections/complications , Coronavirus Infections/metabolism , Diarrhea/etiology , Diarrhea/metabolism , Dizziness/etiology , Dizziness/physiopathology , Fatigue/etiology , Fatigue/physiopathology , Female , Fever/etiology , Fever/physiopathology , Humans , Hydroxybutyrate Dehydrogenase/metabolism , L-Lactate Dehydrogenase/metabolism , Male , Middle Aged , Myalgia/etiology , Myalgia/physiopathology , Nausea/etiology , Nausea/metabolism , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/metabolism , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Vomiting/etiology , Vomiting/metabolism
BMJ Case Rep ; 13(8)2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-733175


During the previous months, we have seen the rapid pandemic spread of SARS-CoV-2. Despite being considered a respiratory virus, it has become clear that other clinical presentations are possible and some of these are quite frequent. In this paper, a case of a man in his late 70s showing atypical symptoms in general practice is presented. Apart from fever, the patient complained of diarrhoea, borborygmus, loss of appetite and nausea. He developed no respiratory symptoms during his disease. Due to his symptoms, malignant disease was suspected, and he was referred for further testing which revealed typical COVID-19 findings on a chest CT scan. The occurrence of atypical symptoms is discussed, including the importance of recognising these in an ongoing pandemic.

Anorexia/physiopathology , Coronavirus Infections/physiopathology , Diarrhea/physiopathology , Hypoxia/physiopathology , Lung/diagnostic imaging , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Aged , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Coronavirus Infections/diagnosis , General Practice , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Tomography, X-Ray Computed
Am J Gastroenterol ; 115(8): 1153-1155, 2020 08.
Article in English | MEDLINE | ID: covidwho-525850

Coronavirus Infections/physiopathology , Digestive System Diseases/physiopathology , Pneumonia, Viral/physiopathology , Abdominal Pain/etiology , Abdominal Pain/metabolism , Abdominal Pain/physiopathology , Abdominal Pain/therapy , Ambulatory Care , Anorexia/etiology , Anorexia/metabolism , Anorexia/physiopathology , Anorexia/therapy , Anti-Bacterial Agents/adverse effects , Antipyretics/adverse effects , Antiviral Agents/adverse effects , Betacoronavirus , COVID-19 , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/metabolism , Chemical and Drug Induced Liver Injury/physiopathology , Chemical and Drug Induced Liver Injury/therapy , China , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Coronavirus Infections/complications , Coronavirus Infections/metabolism , Coronavirus Infections/therapy , Diarrhea/etiology , Diarrhea/metabolism , Diarrhea/physiopathology , Diarrhea/therapy , Digestive System Diseases/etiology , Digestive System Diseases/metabolism , Digestive System Diseases/therapy , Endoscopy, Digestive System , Gastroenterology , Humans , Liver Diseases/etiology , Liver Diseases/metabolism , Liver Diseases/physiopathology , Liver Diseases/therapy , Nausea/etiology , Nausea/metabolism , Nausea/physiopathology , Nausea/therapy , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/metabolism , Pneumonia, Viral/therapy , Probiotics/therapeutic use , SARS-CoV-2 , Societies, Medical , Vomiting/etiology
ACS Chem Neurosci ; 11(11): 1520-1522, 2020 06 03.
Article in English | MEDLINE | ID: covidwho-324525


Accumulating data have now shown strong evidence that COVID-19 infection leads to the occurrence of neurological signs with different injury severity. Anosmia and agueusia are now well documented and included in the criteria list for diagnosis, and specialists have stressed that doctors screen COVID-19 patients for these two signs. The eventual brainstem dysregulation, due to the invasion of SARS CoV-2, as a cause of respiratory problems linked to COVID-19, has also been extensively discussed. All these findings lead to an implication of the central nervous system in the pathophysiology of COVID-19. Here we provide additional elements that could explain other described signs like appetite loss, vomiting, and nausea. For this, we investigated the role of brainstem structures located in the medulla oblongata involved in food intake and vomiting control. We also discussed the possible pathways the virus uses to reach the brainstem, i.e., neurotropic and hematogenous (with its two variants) routes.

Anorexia/physiopathology , Appetite Regulation/physiology , Autonomic Nervous System/physiopathology , Coronavirus Infections/physiopathology , Eating/physiology , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Solitary Nucleus/physiopathology , Vomiting/physiopathology , Ageusia/etiology , Anorexia/etiology , Area Postrema/physiopathology , Blood-Brain Barrier , COVID-19 , Coronavirus Infections/complications , Humans , Hypothalamus/physiopathology , Medulla Oblongata/physiopathology , Nausea/etiology , Neural Pathways/physiopathology , Olfaction Disorders/etiology , Olfactory Nerve , Pandemics , Pneumonia, Viral/complications , Vagus Nerve , Vomiting/etiology