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1.
Nat Med ; 27(6): 1012-1024, 2021 06.
Article in English | MEDLINE | ID: covidwho-1472229

ABSTRACT

Age is the dominant risk factor for infectious diseases, but the mechanisms linking age to infectious disease risk are incompletely understood. Age-related mosaic chromosomal alterations (mCAs) detected from genotyping of blood-derived DNA, are structural somatic variants indicative of clonal hematopoiesis, and are associated with aberrant leukocyte cell counts, hematological malignancy, and mortality. Here, we show that mCAs predispose to diverse types of infections. We analyzed mCAs from 768,762 individuals without hematological cancer at the time of DNA acquisition across five biobanks. Expanded autosomal mCAs were associated with diverse incident infections (hazard ratio (HR) 1.25; 95% confidence interval (CI) = 1.15-1.36; P = 1.8 × 10-7), including sepsis (HR 2.68; 95% CI = 2.25-3.19; P = 3.1 × 10-28), pneumonia (HR 1.76; 95% CI = 1.53-2.03; P = 2.3 × 10-15), digestive system infections (HR 1.51; 95% CI = 1.32-1.73; P = 2.2 × 10-9) and genitourinary infections (HR 1.25; 95% CI = 1.11-1.41; P = 3.7 × 10-4). A genome-wide association study of expanded mCAs identified 63 loci, which were enriched at transcriptional regulatory sites for immune cells. These results suggest that mCAs are a marker of impaired immunity and confer increased predisposition to infections.


Subject(s)
Aging/genetics , Communicable Diseases/genetics , Pneumonia/genetics , Sepsis/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Aging/pathology , Biological Specimen Banks , Chromosome Aberrations , Communicable Diseases/complications , Communicable Diseases/microbiology , Digestive System Diseases/epidemiology , Digestive System Diseases/genetics , Digestive System Diseases/microbiology , Female , Genetic Predisposition to Disease , Genome-Wide Association Study , Genotype , Hematologic Neoplasms/complications , Hematologic Neoplasms/genetics , Hematologic Neoplasms/microbiology , Humans , Male , Middle Aged , Mosaicism , Pneumonia/epidemiology , Pneumonia/microbiology , Risk Factors , Sepsis/epidemiology , Sepsis/microbiology , Urogenital Abnormalities/epidemiology , Urogenital Abnormalities/genetics , Urogenital Abnormalities/microbiology , Young Adult
2.
Ann Palliat Med ; 10(4): 4858-4867, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1175843

ABSTRACT

Coronavirus disease 2019 (COVID-19) was initially reported in December 2019, and since then it has become a pandemic with newly confirmed cases and deaths increasing continuously. The COVID-19 pandemic has dramatically impacted the organization and execution of activities in the clinical sector. Asymptomatic infections are increasingly being identified when patients seek medical advice for non-respiratory system illnesses, particularly digestive system symptoms. This has posed a significant challenge for clinical diagnosis and treatment. Based on the clinical symptoms of patients with COVID-19 reported to date, patients with typical clinical symptoms of COVID-19 may also present with symptoms associated with the digestive system. Digestive illness symptoms in patients with COVID-19 are underscored by a bidirectional relationship between respiratory and digestive systems. Because the clinical diagnosis and treatment of digestive illnesses caused by COVID-19 have been challenging so far, we hypothesized that investigating the pathogenesis of digestive system diseases in patients with COVID-19 will provide potential novel targets for its prevention and treatment, and concurrently reduce COVID-19 virulence and socio-sanitary burden. This review summarizes the relationship between the digestive and respiratory systems in patients with COVID-19 from the perspective of the "gut-lung" axis. We discuss extant literature on the pathogenesis of COVID-19-related digestive symptoms, which may facilitate differential diagnosis and treatment of this condition.


Subject(s)
COVID-19 , Digestive System Diseases , Digestive System Diseases/epidemiology , Humans , Lung , Pandemics , SARS-CoV-2
3.
Medicine (Baltimore) ; 100(11): e24897, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1138016

ABSTRACT

ABSTRACT: The prevalence of children exhibiting coronavirus disease 2019 (COVID-19) with digestive system involvement remains unknown. Therefore, we aimed to quantify the impact of COVID-19 on the digestive system of children.In this meta-analysis, we searched PubMed, Embase, and Web of Science from January 1, 2020, to June 31, 2020. We also searched for COVID-19 publications in specific journals for more comprehensive results. We included studies that reported the epidemiological and clinical characteristics of COVID-19, and we excluded duplicate publications, reviews, animal studies, case reports, publications without the full text, studies with incomplete information, and studies from which data extraction was impossible.We conducted a meta-analysis of the incidence of gastrointestinal symptoms and changes in liver function involving 19 studies. The pooled prevalence of diarrhea was 10% (95% CI: 7-14; I2  = 84%), that of nausea or vomiting was 7% (95% CI: 5-11; I2  = 77%), and that of abdominal pain was 4% (95% CI: 2-9; I2  = 79%). In addition, the pooled incidence of increased alanine aminotransferase was 8% (95% CI: 5-15; I2  = 46%), and the pooled incidence of increased AST was 15% (95% CI: 9-26; I2  = 66%). The pooled rate of recovery was 97% (95% CI: 94-100; I2  = 86%), and the pooled rate of death, which was 1% (95% CI: 1-4; I2  = 48%), was much smaller than the recovery rate.Our research shows that digestive system symptoms and function in children with COVID-19 are not uncommon. More attention should be paid to this unique group of patients.


Subject(s)
COVID-19/epidemiology , Digestive System Diseases/epidemiology , Abdominal Pain/epidemiology , Adolescent , Child , Child, Preschool , Diarrhea/epidemiology , Digestive System/physiopathology , Female , Gastrointestinal Diseases/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Liver Diseases/epidemiology , Male , Nausea/epidemiology , Prevalence , SARS-CoV-2 , Vomiting/epidemiology
4.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1125185

ABSTRACT

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Subject(s)
COVID-19 , Digestive System Diseases , Digestive System Surgical Procedures , Emergency Treatment , Infection Control , Postoperative Complications , Time-to-Treatment , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Digestive System Diseases/diagnosis , Digestive System Diseases/epidemiology , Digestive System Diseases/mortality , Digestive System Diseases/surgery , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/mortality , Emergencies/epidemiology , Emergency Treatment/adverse effects , Emergency Treatment/methods , Emergency Treatment/mortality , Female , Humans , Incidence , Infection Control/methods , Infection Control/statistics & numerical data , Male , Mortality , Multicenter Studies as Topic , Observational Studies as Topic , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Research Design , Risk Assessment/methods
5.
Medicine (Baltimore) ; 100(5): e24409, 2021 Feb 05.
Article in English | MEDLINE | ID: covidwho-1062940

ABSTRACT

ABSTRACT: Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the "pandemic" cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the "control" cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).


Subject(s)
COVID-19 , Digestive System Diseases , Digestive System Surgical Procedures , Emergency Treatment , Infection Control , Postoperative Complications , Time-to-Treatment , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Digestive System Diseases/diagnosis , Digestive System Diseases/epidemiology , Digestive System Diseases/mortality , Digestive System Diseases/surgery , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/mortality , Emergencies/epidemiology , Emergency Treatment/adverse effects , Emergency Treatment/methods , Emergency Treatment/mortality , Female , Humans , Incidence , Infection Control/methods , Infection Control/statistics & numerical data , Male , Mortality , Multicenter Studies as Topic , Observational Studies as Topic , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Research Design , Risk Assessment/methods
6.
J Laparoendosc Adv Surg Tech A ; 31(3): 261-265, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-978578

ABSTRACT

Background: During the Health Emergency due to coronavirus disease 2019 (COVID-19) in Peru, elective surgeries were suspended and only emergency surgeries were allowed. Conservative management was considered as an alternative and laparoscopic surgery was indicated following safety recommendations. Surgically operated patients were at higher risk of becoming infected with COVID-19 due to hospital exposure, being more susceptible to complications. Methods: Retrospective cohort-type analytical study that includes patients who were admitted to a private center due to an emergency and who underwent laparoscopic gastrointestinal surgery during the National Health Emergency (group exposed to the COVID-19 pandemic) from March 11, 2020 to June 8, 2020 and were compared with those patients operated between March 11, 2019 and June 8, 2019 (group not exposed to the COVID-19 pandemic). Results: A total of 104 patients were identified, 59 patients operated during the COVID-19 pandemic. All were operated by laparoscopy, both groups with a similar degree of disease severity. There was no mortality or surgical reintervention. No surgeon at the institution was infected with the virus during the study period. Conclusions: The degree of severity of abdominal surgical pathologies in this time of pandemic has not increased compared with the previous year. Likewise, the laparoscopic approach to emergency surgery was safe and effective during the pandemic.


Subject(s)
COVID-19/epidemiology , Digestive System Diseases/surgery , Emergencies , Emergency Service, Hospital/statistics & numerical data , Laparoscopy/statistics & numerical data , Pandemics , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Comorbidity , Digestive System Diseases/epidemiology , Elective Surgical Procedures/statistics & numerical data , Female , Humans , Incidence , Male , Middle Aged , Peru/epidemiology , Retrospective Studies , SARS-CoV-2 , Young Adult
7.
Medicine (Baltimore) ; 99(48): e23353, 2020 Nov 25.
Article in English | MEDLINE | ID: covidwho-944498

ABSTRACT

BACKGROUND: Digestive diseases have been often reported in COVID-19 patients, but whether COVID-19 patients with existing digestive comorbidities are at an increased risk of serious disease and death remains unclear. This study aims to evaluate the association between digestive diseases and COVID-19 severity and mortality. METHODS: PubMed, Embase.com, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed will be searched to identify relevant studies up to October 1, 2020. We will use the Newcastle-Ottawa quality assessment scale to assess the quality of included studies. We will use Stata to perform pairwise meta-analyses using the random-effects model with the inverse variance method to estimate the association between digestive diseases and the mortality and severity of COVID-19. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity. We will create a "Summary of findings' table presenting our primary and secondary outcomes using the GRADEpro Guideline Development Tool software. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSIONS: This study will comprehensively evaluate the association between digestive diseases and the severity and mortality of patients with COVID-19. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.


Subject(s)
COVID-19/epidemiology , Digestive System Diseases/epidemiology , COVID-19/mortality , Humans , Pandemics , Research Design , SARS-CoV-2 , Severity of Illness Index
8.
Cir Esp (Engl Ed) ; 98(10): 618-624, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: covidwho-715275

ABSTRACT

INTRODUCTION: Since the appearance of SARS-CoV-2 in December 2019 in the Chinese city of Wuhan, we have experienced a reduction in admissions in our Service and a decrease in urgent surgical activity. Therefore, this study aimed to assess the incidence of potentially surgical abdominal emergency in our center during the epidemic of COVID-19. METHODS: A retrospective study was designed. It included all patients admitted for urgent abdominal pathology with potential surgical treatment in our General and Digestive Surgery Department from February 24, 2020 to April 19, 2020. RESULTS: Eighty-nine patients with a mean age of 58.85±22.2 were included. The median time from symptom onset to the Emergency Department (ED) visit was 48 (P25-P75 = 24-96) hours. On arrival at the ED, 18 (20%) patients presented with systemic inflammatory response syndrome criteria. Fifty-one (57%) surgical procedures were performed. The rate of post-surgical complications at 30 days was 31% and the mortality rate was 2%. Concerning the same period from 2017 to 2019, the mean number of admissions from the ED to our Department decreased by 14% during the epidemic period. CONCLUSION: There has been a decrease in the number of patients admitted for urgent, potentially surgical, abdominal pathology during the period of the COVID-19 epidemic in our center.


Subject(s)
Abdomen/surgery , COVID-19/epidemiology , Digestive System Diseases/epidemiology , Digestive System Diseases/surgery , Emergency Service, Hospital , Female , Humans , Incidence , Male , Middle Aged , Pandemics , Patient Admission/trends , Patient Readmission/statistics & numerical data , Postoperative Complications , Retrospective Studies , SARS-CoV-2 , Spain/epidemiology , Systemic Inflammatory Response Syndrome/epidemiology
12.
J Clin Virol ; 128: 104386, 2020 07.
Article in English | MEDLINE | ID: covidwho-227004

ABSTRACT

There is an increasing number of confirmed cases and deaths caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributing to the Coronavirus disease 2019 (COVID-19) pandemic. At this point, the need for further disease characterization is critical. COVID-19 is well established as a respiratory tract pathogen; however, recent studies have shown an increasing number of patients reporting gastrointestinal manifestations such as diarrhea, nausea, vomiting, and abdominal pain. The time from onset of gastrointestinal symptoms to hospital presentation is often delayed compared to that of respiratory symptoms. It has been noted that SARS-CoV-2 RNA can be detected in fecal matter for an extended period of time, even after respiratory samples have tested negative and patients are asymptomatic. In this article, SARS-CoV-2 and its disease COVID-19 will be reviewed with consideration of the latest literature about gastrointestinal symptomatology, the mechanisms by which the virus may inflict damage, and the possibility of viral replication contributing to a fecal-oral route of transmission.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/epidemiology , Diarrhea/virology , Digestive System Diseases/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Coronavirus Infections/virology , Digestive System Diseases/prevention & control , Digestive System Diseases/virology , Feces/virology , Gastrointestinal Tract/virology , Humans , Liver/virology , Oxygen/administration & dosage , Pancreas/virology , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Respiration, Artificial , SARS-CoV-2 , Virus Replication , Vomiting/virology
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