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1.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1114903

ABSTRACT

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Subject(s)
COVID-19 , Critical Care , Critical Illness , Symptom Assessment , Time-to-Treatment/statistics & numerical data , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , China/epidemiology , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness/mortality , Critical Illness/therapy , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Female , Healthcare-Associated Pneumonia/diagnosis , Healthcare-Associated Pneumonia/mortality , Heart Diseases/diagnosis , Humans , Hyperamylasemia/diagnosis , Hyperamylasemia/etiology , Hypernatremia/diagnosis , Hypernatremia/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prognosis , SARS-CoV-2/isolation & purification , Survival Analysis , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
2.
Food Chem Toxicol ; 146: 111769, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-803143

ABSTRACT

Common manifestations of COVID-19 are respiratory and can extend from mild symptoms to severe acute respiratory distress. The severity of the illness can also extend from mild disease to life-threatening acute respiratory distress syndrome (ARDS). SARS-CoV-2 infection can also affect the gastrointestinal tract, liver and pancreatic functions, leading to gastrointestinal symptoms. Moreover, SARS-CoV-2 can cause central and peripheral neurological manifestations, affect the cardiovascular system and promote renal dysfunction. Epidemiological data have indicated that cancer patients are at a higher risk of contracting the SARS-CoV-2 virus. Considering the multitude of clinical symptoms of COVID-19, the objective of the present review was to summarize their pathophysiology in previously healthy patients, as well as in those with comorbidities. The present review summarizes the current, though admittedly fluid knowledge on the pathophysiology and symptoms of COVID-19 infection. Although unclear issues still remain, the present study contributes to a more complete understanding of the disease, and may drive the direction of new research. The recognition of the severity of the clinical symptoms of COVID-19 is crucial for the specific therapeutic management of affected patients.


Subject(s)
COVID-19/complications , Cardiovascular Diseases/etiology , Digestive System Diseases/etiology , Kidney Diseases/etiology , Lung Diseases/etiology , Neoplasms/epidemiology , Nervous System Diseases/etiology , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/physiopathology , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/virology , Comorbidity , Digestive System Diseases/physiopathology , Digestive System Diseases/virology , Female , Humans , Kidney Diseases/physiopathology , Kidney Diseases/virology , Lung Diseases/physiopathology , Lung Diseases/virology , Male , Nervous System Diseases/physiopathology , Nervous System Diseases/virology , Pandemics , SARS-CoV-2
3.
Gastroenterol Hepatol ; 43(8): 464-471, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-733849

ABSTRACT

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Digestive System Diseases/etiology , Digestive System/virology , Pandemics , Pneumonia, Viral/complications , Aerosols , Angiotensin-Converting Enzyme 2 , Anorexia/etiology , Antiviral Agents/adverse effects , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , COVID-19 , Cohort Studies , Coronavirus Infections/drug therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Diarrhea/etiology , Digestive System Diseases/virology , Endoscopy, Digestive System/adverse effects , Feces/virology , Humans , Immunosuppressive Agents/adverse effects , Intestines/chemistry , Intestines/virology , Liver Diseases/etiology , Multicenter Studies as Topic , Pandemics/prevention & control , Peptidyl-Dipeptidase A/analysis , Peptidyl-Dipeptidase A/physiology , Personal Protective Equipment , Pneumonia, Viral/drug therapy , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Receptors, Virus/analysis , Receptors, Virus/physiology , Risk , SARS-CoV-2 , Universal Precautions
4.
J Natl Med Assoc ; 113(2): 142-146, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-713382

ABSTRACT

The novel coronavirus, SARS-CoV-2, has caused a global pandemic with high morbidity and mortality. It was first observed to cause a severe acute respiratory syndrome. However, gastrointestinal and hepatic manifestations have been increasingly recognized. Gastrointestinal symptoms include diarrhea, epigastric pain, nausea, and vomiting. Diarrhea is the most common GI manifestation of SARS-CoV-2 and can present without or without respiratory symptoms. Patients with GI symptoms have been associated with longer duration of illness and may be associated with more severe illness. Mechanism of diarrhea is thought to be related to direct viral cytotoxicity occurring when the SARS-CoV-3 enters GI cells via the ACE-2 receptor. Inflammatory response and cytokine release likely contributes to symptoms. SARS-CoV-2 can cause hepatic injury. Studies have shown mild to moderate elevation of liver enzymes. The pattern of liver abnormalities can be hepatocellular, cholestatic or mixed. Patients with severe infection have significantly higher rates of liver injury and worse outcomes. Proposed mechanisms for injury include immune mediated systemic inflammatory response, direct cytotoxicity from viral replication and hypoxia-reperfusion dysfunction. Recent data suggests that GI and hepatic injury may be under-recognized manifestation of SARS-CoV-2 infection. Patients with diarrhea and liver disease may have a worse prognosis. The rapidly evolving literature continues to reveal a growing body of information which enables updated guidance for management. More investigation is needed which focuses on vulnerable patients, including the elderly, those with underlying illness, as well as, racial and ethnic minorities.


Subject(s)
COVID-19 , Digestive System Diseases , COVID-19/epidemiology , COVID-19/immunology , COVID-19/physiopathology , Causality , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Humans , Prognosis , Risk Factors , SARS-CoV-2/pathogenicity
5.
Ann Palliat Med ; 9(4): 1851-1858, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-614414

ABSTRACT

BACKGROUND: The application of factor analysis in the study of the clinical symptoms of coronavirus disease 2019 (COVID-19) was investigated, to provide a reference for basic research on COVID-19 and its prevention and control. METHODS: The data of 60 patients with COVID-19 in Jingzhou Hospital of Traditional Chinese Medicine and the Second People's Hospital of Longgang District in Shenzhen were extracted using principal component analysis. Factor analysis was used to investigate the factors related to symptoms of COVID-19. Based on the combination of factors, the clinical types of the factors were defined according to our professional knowledge. Factor loadings were calculated, and pairwise correlation analysis of symptoms was performed. RESULTS: Factor analysis showed that the clinical symptoms of COVID-19 cases could be divided into respiratory-digestive, neurological, cough-wheezing, upper respiratory, and digestive symptoms. Pairwise correlation analysis showed that there were a total of eight pairs of symptoms: fever-palpitation, coughexpectoration, expectoration-wheezing, dry mouth-bitter taste in the mouth, poor appetite-fatigue, fatiguedizziness, diarrhea-palpitation, and dizziness-headache. CONCLUSIONS: The symptoms and syndromes of COVID-19 are complex. Respiratory symptoms dominate, and digestive symptoms are also present. Factor analysis is suitable for studying the characteristics of the clinical symptoms of COVID-19, providing a new idea for the comprehensive analysis of clinical symptoms.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/therapy , Digestive System Diseases/etiology , Factor Analysis, Statistical , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Respiratory Tract Diseases/etiology , Young Adult
6.
Am J Gastroenterol ; 115(8): 1153-1155, 2020 08.
Article in English | MEDLINE | ID: covidwho-525850

Subject(s)
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
7.
Am J Gastroenterol ; 115(7): 1129-1132, 2020 07.
Article in English | MEDLINE | ID: covidwho-618936

ABSTRACT

INTRODUCTION: High rates of concurrent gastrointestinal manifestations have been noted in patients with corona virus disease 2019 (COVID-19); however, the association between these digestive manifestations and need for hospitalization has not been established. METHODS: This is a retrospective review of consecutive patients diagnosed with COVID-19. A total of 207 patients were identified; 34.5% of patients noted concurrent gastrointestinal symptoms, with 90% of gastrointestinal symptoms being mild. RESULTS: In a multivariate regression model controlled for demographics and disease severity, an increased risk of hospitalization was noted in patients with any digestive symptom (adjusted odds ratio 4.84, 95% confidence interval: 1.68-13.94). DISCUSSION: The presence of digestive symptoms in COVID-19 is associated with a need for hospitalization.


Subject(s)
Coronavirus Infections/complications , Gastrointestinal Diseases/etiology , Pneumonia, Viral/complications , Adult , Aged , Betacoronavirus , COVID-19 , Digestive System Diseases/etiology , Digestive System Diseases/virology , Female , Gastrointestinal Diseases/virology , Hospitalization , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
8.
Clin Gastroenterol Hepatol ; 18(10): 2375-2377, 2020 09.
Article in English | MEDLINE | ID: covidwho-437178

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a major worldwide threat caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapidly spreading to a global pandemic. As of May 11, 2020, 4,176,346 cases have been reported worldwide, 219,814 in Italy, and of them, 81,871 occurred in the Lombardy region.1 Although the respiratory manifestations of COVID-19 have been widely described, the impact on the gastrointestinal (GI) system remains less clear. The reported prevalence of digestive symptoms ranges from 3% to 79%, depending on the setting,2-5 but data on GI endoscopic and histologic findings in COVID-19 patients are lacking. Therefore, the aim of this study is to describe the GI endoscopic and histologic findings in COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Digestive System Diseases/diagnosis , Endoscopy, Gastrointestinal/methods , Pneumonia, Viral/diagnosis , Aged , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Digestive System Diseases/etiology , Female , Humans , Italy/epidemiology , Male , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2
9.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-42091

ABSTRACT

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Subject(s)
Coronavirus Infections/transmission , Cross Infection/prevention & control , Digestive System Diseases , Endoscopy, Digestive System/standards , Gastroenterology/standards , Infection Control/standards , Pneumonia, Viral/transmission , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Cross Infection/etiology , Cross Infection/virology , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Digestive System Diseases/microbiology , Digestive System Diseases/virology , Hospital Units/standards , Humans , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2
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