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2.
World J Pediatr ; 18(2): 83-90, 2022 02.
Article in English | MEDLINE | ID: covidwho-1603411

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that develops from and is linked to coronavirus disease 2019. MIS-C is considered a multi-organ dysfunction involving cardiac, renal, respiratory, hematologic, gastrointestinal and neurological symptoms and groups of signs and symptoms such as rash or bilateral non-purulent conjunctivitis, hypotension or shock and acute gastrointestinal problems, which require immediate therapeutic intervention to prevent the aggravation of the patient's health condition. MIS-C is relatively new in the field of evidence-based medicine; however, there are several clinical guidelines for good clinical practice. For every disorder, the guidelines have different suggestions. Hence, based on the current status of the evidence, recommendations have been combined to form a unified guideline for therapeutic management. METHODS: This paper compares and evaluates the current MIS-C-specific clinical practice guidelines (namely, American Academy of Pediatrics, American College of Rheumatology, Helen DeVos Children's Hospital Foundation, Children's Hospital of The King's Daughters, and the Infectious Diseases Society of America). The compiled literature was then assessed by the authors separately, and an algorithm was proposed for each disorder, taking into consideration the various guidelines proposed for the management of the disorder. RESULTS: The features of MIS-C patients are unified; this is very helpful in managing its symptoms and decreasing mortality rates. In addition, recommendations for pharmacological treatment for MIS-C symptoms are formulated after cross-comparison across five different guidelines. CONCLUSIONS: This study provides a general interpretation of the results in the context of other evidence and implications for future research. It proposes a unified guideline based on the current evidence, with the best potential to maintain suitable clinical standards in the Saudi Arabian Ministry of Health.


Subject(s)
COVID-19 , Systemic Inflammatory Response Syndrome/therapy , COVID-19/complications , Child , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/therapy , Humans , Practice Guidelines as Topic , SARS-CoV-2 , Saudi Arabia , Systemic Inflammatory Response Syndrome/etiology
3.
Arab J Gastroenterol ; 22(4): 305-309, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1588525

ABSTRACT

BACKGROUND AND STUDY AIMS: Gastrointestinal manifestations are common during coronavirus disease (COVID-19) infection. They can occur before respiratory symptoms, resulting in a diagnostic delay and an increased risk of disease transmission. The current study reports major gastrointestinal manifestations as initial symptoms of COVID-19. PATIENTS AND METHODS: This prospective, descriptive, cross-sectional, and single-center study of 713 cases was conducted in a field hospital in Morocco over a 5-week period from June 21 to July 25, 2020. RESULTS: The average age of our patients was 31.95 years. Clinically, on admission, anorexia was the main symptom, present in 32.3% of patients. Gastrointestinal manifestations were present in 14.9% of patients, including watery diarrhea in 8.6% of cases, nausea and/or vomiting in 4.6% of cases, and abdominal pain in 1.6% of cases. Six hundred thirty-two patients were treated in accordance with one of the two therapeutic protocols recommended by the National Ministry of Health. The treatment-related effects that occurred in 61.4% of patients were primarily digestive in 55.3% of cases. In multivariate analysis, following adjustment of the studied parameters, only the presence of gastrointestinal manifestations (odds ratio [OR]: 1.478 confidence interval [CI]: 1.286-1.698; p < 0.001) and treatment side effects (OR = 1.069, CI: 1.020-1.119, p = 0.005) altered the rate of negative polymerase chain reaction (PCR) tests on day 10. CONCLUSION: Gastrointestinal manifestations are common during COVID-19 and seem to be linked to a longer duration of disease. SARS-CoV-2 (the causative virus of COVID-19) can persist in the digestive tract, with the possibility of fecal-oral transmission. Therefore, hygiene is extremely important, especially handwashing and strict precautions when performing gastrointestinal endoscopy and handling stools from infected patients.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Adult , Cross-Sectional Studies , Delayed Diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Gastrointestinal Tract , Humans , Prospective Studies , SARS-CoV-2
5.
Eur Rev Med Pharmacol Sci ; 25(1 Suppl): 67-73, 2021 12.
Article in English | MEDLINE | ID: covidwho-1566965

ABSTRACT

A vast majority of COVID-19 patients experience fatigue, extreme tiredness and symptoms that persist beyond the active phase of the disease. This condition is called post-COVID syndrome. The mechanisms by which the virus causes prolonged illness are still unclear. The aim of this review is to gather information regarding post-COVID syndrome so as to highlight its etiological basis and the nutritional regimes and supplements that can mitigate, alleviate or relieve the associated chronic fatigue, gastrointestinal disorders and continuing inflammatory reactions. Naturally-occurring food supplements, such as acetyl L-carnitine, hydroxytyrosol and vitamins B, C and D hold significant promise in the management of post-COVID syndrome. In this pilot observational study, we evaluated the effect of a food supplement containing hydroxytyrosol, acetyl L-carnitine and vitamins B, C and D in improving perceived fatigue in patients who recovered from COVID-19 but had post-COVID syndrome characterized by chronic fatigue. The results suggest that the food supplement could proceed to clinical trials of its efficacy in aiding the recovery of patients with long COVID.


Subject(s)
COVID-19/complications , Dietary Supplements , Acetylcarnitine/administration & dosage , Adult , Aged , COVID-19/diet therapy , COVID-19/pathology , COVID-19/psychology , COVID-19/virology , Dietary Supplements/adverse effects , Fatigue/etiology , Female , Gastrointestinal Diseases/etiology , Humans , Male , Middle Aged , Phenylethyl Alcohol/administration & dosage , Phenylethyl Alcohol/analogs & derivatives , Pilot Projects , SARS-CoV-2/isolation & purification , Self Report , Surveys and Questionnaires , Vitamins/administration & dosage
7.
Eur Rev Med Pharmacol Sci ; 25(18): 5836-5842, 2021 09.
Article in English | MEDLINE | ID: covidwho-1451041

ABSTRACT

OBJECTIVE: Functional gastrointestinal disorders are common gastrointestinal diseases. The pathophysiology is multifactorial and psychosocial distress worsens symptoms severity. Since the end of 2019 the world has been facing COVID-19 pandemic. The associated control measures have affected the psychological health of people. The aim of the present study is to evaluate the impact of the COVID-19 pandemic on the prevalence of functional gastrointestinal disorders among Italian children and adolescents. PATIENTS AND METHODS: The study sample is composed of 407 patients (187 males, 220 females), aged from 10 to 17 years. The mean age is 14.27 ± 2.24 years. The study was conducted through the Italian version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version.  The prevalence of each disorder has been calculated as the ratio of affected subjects for each disease and the total number of effective cases for that specific disease. RESULTS: The study demonstrates that the prevalence of Functional Gastrointestinal Disorder in Italian children, during the COVD-19 pandemic, is higher, compared with the one reported in the previous studies. The most frequent disorders are Abdominal Migraine and Irritable Bowel Syndrome. CONCLUSIONS: Our study is the first one which provides data of the prevalence of Functional gastrointestinal disorders in sample of Italian adolescents, during the COVID-19 pandemic. The study underlines the need to focus on stress management, in order to reduce the effects of the lockdown on the psychological wellness of the youngest.


Subject(s)
COVID-19/psychology , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/psychology , Quarantine/psychology , Social Isolation/psychology , Stress, Psychological/complications , Abdominal Pain/epidemiology , Abdominal Pain/etiology , Abdominal Pain/psychology , Adolescent , Aerophagy/epidemiology , Aerophagy/etiology , Aerophagy/psychology , COVID-19/epidemiology , COVID-19/prevention & control , Child , Constipation/epidemiology , Constipation/etiology , Constipation/psychology , Dyspepsia/epidemiology , Dyspepsia/etiology , Dyspepsia/psychology , Fecal Incontinence/epidemiology , Fecal Incontinence/etiology , Fecal Incontinence/psychology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Humans , Irritable Bowel Syndrome/epidemiology , Irritable Bowel Syndrome/etiology , Irritable Bowel Syndrome/psychology , Italy , Male , Migraine Disorders/epidemiology , Migraine Disorders/etiology , Migraine Disorders/psychology , Prevalence , Rumination Syndrome/epidemiology , Rumination Syndrome/etiology , Rumination Syndrome/psychology , Stress, Psychological/diagnosis , Surveys and Questionnaires , Vomiting/epidemiology , Vomiting/etiology , Vomiting/psychology
8.
PLoS Med ; 18(9): e1003773, 2021 09.
Article in English | MEDLINE | ID: covidwho-1440981

ABSTRACT

BACKGROUND: Long-COVID refers to a variety of symptoms affecting different organs reported by people following Coronavirus Disease 2019 (COVID-19) infection. To date, there have been no robust estimates of the incidence and co-occurrence of long-COVID features, their relationship to age, sex, or severity of infection, and the extent to which they are specific to COVID-19. The aim of this study is to address these issues. METHODS AND FINDINGS: We conducted a retrospective cohort study based on linked electronic health records (EHRs) data from 81 million patients including 273,618 COVID-19 survivors. The incidence and co-occurrence within 6 months and in the 3 to 6 months after COVID-19 diagnosis were calculated for 9 core features of long-COVID (breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression). Their co-occurrence network was also analyzed. Comparison with a propensity score-matched cohort of patients diagnosed with influenza during the same time period was achieved using Kaplan-Meier analysis and the Cox proportional hazard model. The incidence of atopic dermatitis was used as a negative control. Among COVID-19 survivors (mean [SD] age: 46.3 [19.8], 55.6% female), 57.00% had one or more long-COVID feature recorded during the whole 6-month period (i.e., including the acute phase), and 36.55% between 3 and 6 months. The incidence of each feature was: abnormal breathing (18.71% in the 1- to 180-day period; 7.94% in the 90- to180-day period), fatigue/malaise (12.82%; 5.87%), chest/throat pain (12.60%; 5.71%), headache (8.67%; 4.63%), other pain (11.60%; 7.19%), abdominal symptoms (15.58%; 8.29%), myalgia (3.24%; 1.54%), cognitive symptoms (7.88%; 3.95%), and anxiety/depression (22.82%; 15.49%). All 9 features were more frequently reported after COVID-19 than after influenza (with an overall excess incidence of 16.60% and hazard ratios between 1.44 and 2.04, all p < 0.001), co-occurred more commonly, and formed a more interconnected network. Significant differences in incidence and co-occurrence were associated with sex, age, and illness severity. Besides the limitations inherent to EHR data, limitations of this study include that (i) the findings do not generalize to patients who have had COVID-19 but were not diagnosed, nor to patients who do not seek or receive medical attention when experiencing symptoms of long-COVID; (ii) the findings say nothing about the persistence of the clinical features; and (iii) the difference between cohorts might be affected by one cohort seeking or receiving more medical attention for their symptoms. CONCLUSIONS: Long-COVID clinical features occurred and co-occurred frequently and showed some specificity to COVID-19, though they were also observed after influenza. Different long-COVID clinical profiles were observed based on demographics and illness severity.


Subject(s)
COVID-19/complications , Survivors , Adult , Aged , COVID-19/epidemiology , Cohort Studies , Dyspnea/epidemiology , Dyspnea/etiology , Fatigue/epidemiology , Fatigue/etiology , Female , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , Incidence , Influenza, Human/complications , Influenza, Human/epidemiology , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Middle Aged , Pain/epidemiology , Pain/etiology , Proportional Hazards Models , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology , Young Adult
9.
Indian J Gastroenterol ; 40(5): 502-511, 2021 10.
Article in English | MEDLINE | ID: covidwho-1439767

ABSTRACT

OBJECTIVES: To characterize the frequency and association of gastrointestinal (GI) symptoms with outcomes in patients with corona virus disease 2019  (COVID-19) admitted to the hospital. METHODS: Records were retrospectively collected from patients admitted to a tertiary care center in Washington, D.C., with confirmed COVID-19 from March 15, 2020  to July 15, 2020. After adjusting for clinical demographics and comorbidities, multivariate logistic regression analysis was performed. RESULTS: The most common  presenting symptoms of COVID-19 in patients that were admitted to the hospital were cough (38.4%), shortness of breath (37.5%), and fever (34.3%), followed by GI symptoms in 25.9% of patients. The most common GI symptom was diarrhea (12.8%) followed by nausea or vomiting (10.5%), decreased appetite (9.3%), and abdominal pain (3.8%). Patients with diarrhea were more likely to die (odds ratio [OR] 2.750; p = 0.006; confidence interval [CI] 1.329-5.688), be admitted to the intensive care unit (ICU) (OR 2.242; p = 0.019; CI 1.139-4.413), and be intubated (OR 3.155; p = 0.002; CI 1.535-6.487). Additional outcomes analyzed were need for vasopressors, presence of shock, and acute kidney injury. Patients with  diarrhea  were 2.738 (p = 0.007; CI 1.325-5.658), 2.467 (p = 0.013; CI 1.209-5.035), and 2.694 (p = 0.007; CI 1.305-5.561) times more likely to experience these outcomes, respectively. CONCLUSIONS: Screening questions should be expanded to include common GI symptoms in patients with COVID-19. Health care providers should note whether their patient is presenting with diarrhea due to the potential implications on disease severity and outcomes.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Diarrhea/epidemiology , Diarrhea/etiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , Retrospective Studies , SARS-CoV-2
10.
Curr Opin Infect Dis ; 34(5): 471-476, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1408783

ABSTRACT

PURPOSE OF REVIEW: The ubiquitous expression of angiotensin-converting enzyme-2 receptors and its significance as the origin of viral entry have assisted in comprehending the pathophysiology of extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, we focus on the clinical significance of gastrointestinal manifestations. RECENT FINDINGS: The global pandemic, a result of the widespread implications of SARS-CoV-2, remains a significant burden to current healthcare systems. Fever, dyspnea, and tussive symptoms have primarily been recognized as the most common presenting signs/symptoms. During the past one year our scope of practice has transcended beyond the management of the respiratory system to incorporate other varying systemic manifestations such as anorexia, nausea, vomiting, diarrhea, and abdominal pain. The outcomes reported by recent studies suggest an association between the presence of gastrointestinal symptoms and important clinical factors such as delay in presentation, disease severity, and mortality. SUMMARY: We provide a summarization of the most recent in-depth investigations of coronavirus disease 2019 with gastrointestinal manifestations and their conclusions. Although the pathophysiology remains an area of evolving interest, a better understanding of this disease process may allow for early recognition, efficient triage, and improved prognostication for those presenting with gastrointestinal manifestations of SARS-CoV-2.


Subject(s)
COVID-19/complications , COVID-19/pathology , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/pathology , Gastrointestinal Tract/pathology , Gastrointestinal Diseases/virology , Gastrointestinal Tract/virology , Humans , Pandemics/prevention & control , SARS-CoV-2/pathogenicity
11.
Pediatr Allergy Immunol ; 31 Suppl 26: 92-95, 2020 11.
Article in English | MEDLINE | ID: covidwho-1388380

ABSTRACT

Gastrointestinal symptoms are common findings in children with SARS-CoV-2 infection. Diarrhea and vomiting have been reported in about 8%-9% of cases, reaching more than 20% in some studies. Children with gastrointestinal involvement appear to be younger than those without, but the severity of the disease seems to be similar between the two groups of subjects. Fecal shedding in children has been reported in 20%-30% of children and has been observed in both those with and those without overt gastrointestinal involvement. Moreover, prolonged fecal elimination, lasting several days after negativization of real-time polymerase chain reaction assay on respiratory swabs, has been reported with variable frequency in children with SARS-CoV-2 infection. These observations raise the question regarding the possibility of oral-fecal transmission and the possible role of children in spreading the infection, particularly when they appear asymptomatic or with gastrointestinal symptoms but with no respiratory involvement, as well as during their convalescent phase.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/etiology , SARS-CoV-2 , COVID-19/transmission , Child , Feces/virology , Humans , Virus Shedding
12.
Neurogastroenterol Motil ; 34(3): e14251, 2022 03.
Article in English | MEDLINE | ID: covidwho-1381134

ABSTRACT

BACKGROUND: COVID-19 frequently presents with acute gastrointestinal (GI) symptoms, but it is unclear how common these symptoms are after recovery. The purpose of this study was to estimate the prevalence and characteristics of GI symptoms after COVID-19. METHODS: The medical records of patients hospitalized with COVID-19 between March 1 and June 30, 2020, were reviewed for the presence of GI symptoms at primary care follow-up 1 to 6 months later. The prevalence of new GI symptoms was estimated, and risk factors were assessed. Additionally, an anonymous survey was used to determine the prevalence of new GI symptoms among online support groups for COVID-19 survivors. KEY RESULTS: Among 147 patients without pre-existing GI conditions, the most common GI symptoms at the time of hospitalization for COVID-19 were diarrhea (23%), nausea/vomiting (21%), and abdominal pain (6.1%), and at a median follow-up time of 106 days, the most common GI symptoms were abdominal pain (7.5%), constipation (6.8%), diarrhea (4.1%), and vomiting (4.1%), with 16% reporting at least one GI symptom at follow-up (95% confidence interval 11 to 23%). Among 285 respondents to an online survey for self-identified COVID-19 survivors without pre-existing GI symptoms, 113 (40%) reported new GI symptoms after COVID-19 (95% CI 33.9 to 45.6%). CONCLUSION AND INFERENCES: At a median of 106 days after discharge following hospitalization for COVID-19, 16% of unselected patients reported new GI symptoms at follow-up. 40% of patients from COVID survivor groups reported new GI symptoms. The ongoing GI effects of COVID-19 after recovery require further study.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Middle Aged , Patient Discharge , Prevalence , Primary Health Care , Risk Factors , Surveys and Questionnaires , Survivors , Young Adult
13.
J Pediatr Gastroenterol Nutr ; 73(3): 299-305, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1367080

ABSTRACT

ABSTRACT: Gastrointestinal symptoms are common findings in children with severe acute respiratory syndrome coronavirus 2 infection, including vomiting, diarrhoea, abdominal pain, and difficulty in feeding, although these symptoms tend to be mild. The hepato-biliary system and the pancreas may also be involved, usually with a mild elevation of transaminases and, rarely, pancreatitis. In contrast, a late hyper-inflammatory phenomenon, termed multisystem inflammatory syndrome (MIS-C), is characterized by more frequent gastrointestinal manifestations with greater severity, sometimes presenting as peritonitis. Gastrointestinal and hepato-biliary manifestations are probably related to a loss in enterocyte absorption capability and microscopic mucosal damage caused by a viral infection of intestinal epithelial cells, hepatocytes and other cells through the angiotensin conversion enzyme 2 receptor resulting in immune cells activation with subsequent release of inflammatory cytokines. Specific conditions such as inflammatory bowel disease (IBD) and liver transplantation may pose a risk for the more severe presentation of coronavirus disease 2019 (COVID-19) but as adult data accumulate, paediatric data is still limited. The aim of this review is to summarize the current evidence about the effect of COVID-19 on the gastrointestinal system in children, with emphasis on the emerging MIS-C and specific considerations such as patients with IBD and liver transplant recipients.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Diarrhea , Gastrointestinal Diseases/etiology , Humans , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
15.
Br J Radiol ; 94(1124): 20201220, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1309942

ABSTRACT

OBJECTIVES: With the increasing recognition of gastrointestinal (GI) manifestation of coronavirus disease-19 (COVID-19), various abdominal imaging findings are increasingly being noted. We scoped the existing literature on the abdominal imaging findings in COVID-19. METHODS: A systematic literature search was performed on PubMed, Embase, Google scholar and World Health Organization COVID-19 database. RESULTS: 35 studies were included in the final descriptive synthesis. Among the studies reporting positive abdominal imaging findings in patients with COVID-19, majority described imaging abnormalities of the GI tract (16 studies), of which bowel wall thickening was most frequently reported. Other findings noted were abdominal imaging manifestations of bowel ischemia with thrombosis of the splanchnic vasculature, and imaging features suggestive of pancreatitis. Imaging findings suggestive of solid organ infarction were reported in nine studies. An association between imaging evidence of hepatic steatosis and COVID-19 was noted in three studies. Incidental lung base findings on abdominal imaging were noted in 18 studies, where patients presented with predominant GI symptoms. The most common finding was bilateral ground glass opacities (90.7%) with predominant multilobar (91.1%) and peripheral (64.4%) distribution. CONCLUSION: This systematic review provides insight into the abdominal imaging findings in patients with COVID-19. Knowledge of these imaging manifestations will not only help in further research but also will aid in curtailing transmission of the SARS-CoV-2. Further prospective studies are needed to gain better insight into the pathophysiology of these imaging manifestations. ADVANCES IN KNOWLEDGE: This review highlights the abdominal imaging findings in patients with COVID-19, to gain insight into the disease pathophysiology and gear the abdominal radiologist through the pandemic.


Subject(s)
Abdomen/diagnostic imaging , COVID-19/complications , Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Diseases/etiology , Humans
16.
Dtsch Med Wochenschr ; 146(13-14): 891-893, 2021 Jul.
Article in German | MEDLINE | ID: covidwho-1307352

ABSTRACT

During COVID 19 pandemic patients typically present with respiratory symptoms. However, in a significant number of patients the gastrointestinal tract is also involved in the disease. Up to 20 % of patients suffering from gastrointestinal symptoms. New insights in pathophysiological aspects might open new therapeutic concepts. This up-date includes current data regarding epidemiology of gastrointestinal symptoms in COVID 19, its role for prognosis and specific risks in relation to immunosuppressive therapies and underlying diseases.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/etiology , Liver Diseases/virology , Pancreatic Diseases/virology , SARS-CoV-2/physiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/therapy , Humans , Prevalence , Prognosis , Risk Factors , SARS-CoV-2/pathogenicity
17.
United European Gastroenterol J ; 9(7): 750-765, 2021 09.
Article in English | MEDLINE | ID: covidwho-1287407

ABSTRACT

BACKGROUND: The COVID-19 pandemic has created unprecedented challenges in all fields of society with social, economic, and health-related consequences worldwide. In this context, gastroenterology patients and healthcare systems and professionals have seen their routines changed and were forced to adapt, adopting measures to minimize the risk of infection while guaranteeing continuous medical care to chronic patients. OBJECTIVE: At this point, it is important to evaluate the impact of the pandemic on this field to further improve the quality of the services provided in this context. METHODS/RESULTS/CONCLUSION: We performed a literature review that summarizes the main aspects to consider in gastroenterology, during the pandemic crisis, and includes a deep discussion on the main changes affecting gastroenterology patients and healthcare systems, anticipating the pandemic recovery scenario with future practices and policies.


Subject(s)
COVID-19/physiopathology , Delivery of Health Care , Gastroenterology , Immunosuppressive Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Liver Diseases/physiopathology , Biomarkers , COVID-19/complications , COVID-19/immunology , Disease Management , Endoscopy, Digestive System , Gastrointestinal Diseases/etiology , Gastrointestinal Diseases/physiopathology , Humans , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/metabolism , Liver Diseases/complications , Liver Diseases/surgery , Liver Transplantation , Pancreas/metabolism , Pancreas/physiopathology , Risk Factors , SARS-CoV-2 , Telemedicine
18.
Nutr Hosp ; 38(3): 622-630, 2021 Jun 10.
Article in English | MEDLINE | ID: covidwho-1264738

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Compared with adults, children with SARS-CoV-2 infection may have fewer and less severe symptoms. Gastrointestinal symptoms are commonly reported in children, sometimes as the only manifestation of the disease, and most often manifest as anorexia, diarrhea, nausea and vomiting, or abdominal pain. Although most children have asymptomatic or mild disease, 10 % of those infected may experience serious or critical disease, or even death. Multisystem inflammatory syndrome is a rare but serious condition recently reported in children with COVID-19. Studies indicate that children with obesity are at higher risk of developing severe COVID-19, and inflammation associated with obesity could be one of the factors that worsens COVID-19 symptoms due to an increased inflammatory response involving molecules such as interleukin 6, tumor necrosis factor alpha, and monocyte chemoattractant protein. On the other hand, evidence has been reported of a higher protein expression of ACE2 in the visceral adipose tissue of obese and malnourished humans, and this could be associated with complications and severity of COVID-19. Therefore, regulation of the intake of macronutrients or micronutrients could be used as a strategy to reduce the consequences of COVID-19. Diet in general and bioactive compounds could play an important role in the prevention of the inflammatory cascade. The micronutrients with the most evidence suggesting a role in immune support are vitamins C and D, zinc, and polyphenols.


INTRODUCCIÓN: La enfermedad por coronavirus 2019 (COVID-19) está causada por el virus "síndrome respiratorio agudo severo-coronavirus 2" (SARS-CoV-2). En comparación con los adultos, los niños con infección por SARS-CoV-2 pueden tener menos síntomas y estos pueden ser menos graves. Los síntomas gastrointestinales se informan comúnmente en los niños, a veces como única manifestación de la enfermedad. Los más comunes son anorexia, diarrea, náuseas y vómitos, y dolor abdominal. Aunque la mayoría de los niños tienen un cuadro leve o asintomático, el 10 % de los infectados pueden experimentar un cuadro grave o crítico, e incluso la muerte. El síndrome inflamatorio multisistémico es una afección poco común, pero grave, que se documentó recientemente en niños con COVID-19. Los estudios indican que los niños con obesidad tienen mayor riesgo de desarrollar COVID-19 grave, y la inflamación asociada con la obesidad podría ser uno de los factores que empeoran los síntomas de la COVID-19 debido a una respuesta inflamatoria aumentada en donde se ven involucradas moléculas como la interleucina 6, el factor de necrosis tumoral alfa y la proteína quimioatrayente de monocitos. Por otro lado, se ha encontrado evidencia de una mayor expresión proteica de ACE2 en el tejido adiposo visceral de los seres humanos obesos y desnutridos, y esto podría estar asociado a las complicaciones y la severidad de la COVID-19. Por tanto, la regulación de la ingesta de macronutrientes o micronutrientes podría utilizarse como estrategia para reducir las consecuencias de la enfermedad. La dieta en general y los compuestos bioactivos podrían desempeñar un papel importante en la prevención de la cascada inflamatoria. Los micronutrientes con mayor evidencia indicativa de que desempeñan un papel en el apoyo inmunológico son las vitaminas C y D, el zinc y los polifenoles.


Subject(s)
COVID-19/complications , Gastrointestinal Diseases/etiology , Pediatric Obesity/complications , Abdominal Pain/etiology , Angiotensin-Converting Enzyme 2/metabolism , Anorexia/etiology , Ascorbic Acid/administration & dosage , COVID-19/etiology , COVID-19/metabolism , Child , Diarrhea/etiology , Female , Humans , Inflammation/complications , Male , Nausea/etiology , Overweight/complications , Oxidative Stress , Pediatric Obesity/metabolism , Polyphenols/administration & dosage , Systemic Inflammatory Response Syndrome/etiology , Thinness/complications , Thinness/metabolism , Vitamin D/administration & dosage , Vitamins/administration & dosage , Vomiting/etiology , Zinc/administration & dosage , Zinc/deficiency
19.
Rev Neurol ; 72(11): 384-396, 2021 06 01.
Article in English, Spanish | MEDLINE | ID: covidwho-1248581

ABSTRACT

INTRODUCTION: Many patients with mild or severe COVID-19 do not make a full recovery and have a wide range of chronic symptoms for weeks or months after infection, often of a neurological, cognitive or psychiatric nature. The epidemiological evidence, diagnostic criteria and pathogenesis of post-COVID-19 syndrome are reviewed. DEVELOPMENT: Post-COVID-19 syndrome is defined by persistent clinical signs and symptoms that appear while or after suffering COVID-19, persist for more than 12 weeks and cannot be explained by an alternative diagnosis. The symptoms can fluctuate or cause relapses. It is a heterogeneous condition that includes post-viral chronic fatigue syndrome, sequelae in multiple organs and the effects of severe hospitalisation/post-intensive care syndrome. It has been reported in patients with mild or severe COVID-19 and irrespective of the severity of the symptoms in the acute phase. Between 10% and 65% of survivors who had mild/moderate COVID-19 present symptoms of post-COVID-19 syndrome for 12 weeks or more. At six months, subjects report an average of 14 persistent symptoms. The most common symptoms are fatigue, dyspnoea, anxiety, depression, and impaired attention, concentration, memory and sleep. The underlying biological mechanisms are unknown, although an abnormal or excessive autoimmune and inflammatory response may play an important role. CONCLUSIONS: Clinical manifestations are diverse, fluctuating and variable, although fatigue and neurocognitive complaints predominate. There is no defined consensus on post-COVID-19 syndrome and its diagnostic criteria have not been subjected to adequate psychometric evaluation.


TITLE: Síndrome post-COVID-19: epidemiología, criterios diagnósticos y mecanismos patogénicos implicados.Introducción. Numerosos pacientes con COVID-19 leve o grave no tienen una recuperación completa y presentan una gran variedad de síntomas crónicos durante semanas o meses tras la infección, con frecuencia de carácter neurológico, cognitivo o psiquiátrico. Se revisan las evidencias epidemiológicas, los criterios diagnósticos y la patogenia del síndrome post-COVID-19. Desarrollo. El síndrome post-COVID-19 se define por la persistencia de signos y síntomas clínicos que surgen durante o después de padecer la COVID-19, permanecen más de 12 semanas y no se explican por un diagnóstico alternativo. Los síntomas pueden fluctuar o causar brotes. Es una entidad heterogénea que incluye el síndrome de fatiga crónica posvírica, la secuela de múltiples órganos y los efectos de la hospitalización grave/síndrome poscuidados intensivos. Se ha descrito en pacientes con COVID-19 leve o grave y con independencia de la gravedad de los síntomas en la fase aguda. Un 10-65% de los supervivientes que padeció COVID-19 leve/moderada presenta síntomas de síndrome post-COVID-19 durante 12 semanas o más. A los seis meses, los sujetos relatan un promedio de 14 síntomas persistentes. Los síntomas más frecuentes son fatiga, disnea, alteración de la atención, de la concentración, de la memoria y del sueño, ansiedad y depresión. Se desconocen los mecanismos biológicos que subyacen, aunque una respuesta autoinmunitaria e inflamatoria anómala o excesiva puede tener un papel importante. Conclusiones. Las manifestaciones clínicas son diversas, fluctuantes y variables, aunque predominan la fatiga y las quejas neurocognitivas. No existe un consenso definido sobre el síndrome post-COVID-19 y sus criterios diagnósticos no se han sometido a una evaluación psicométrica adecuada.


Subject(s)
COVID-19/complications , SARS-CoV-2 , Autoimmunity , Brain/metabolism , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , Cardiovascular Diseases/etiology , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Coronavirus Infections/complications , Dyspnea/etiology , Fatigue Syndrome, Chronic/etiology , Gastrointestinal Diseases/etiology , Hospitalization , Host-Pathogen Interactions , Humans , Inflammation , Mental Disorders/etiology , Nervous System Diseases/etiology , Organ Specificity , Pandemics , Primary Dysautonomias/etiology , Risk Factors , Severe Acute Respiratory Syndrome/complications
20.
J Trop Pediatr ; 67(2)2021 05 17.
Article in English | MEDLINE | ID: covidwho-1246757

ABSTRACT

BACKGROUND: Data on the gastrointestinal (GI) manifestations of Pediatric Corona Virus Disease (COVID-19) are conflicting and the relationship between GI involvement and the severity of COVID-19 disease has not been evaluated. The objectives of this systematic review were to determine the GI manifestations of pediatric COVID-19 and to evaluate their role as risk factors for a severe clinical course. METHODS: : A systematic literature search was carried out in PubMed and Scopus for studies published before 31 December 2020 with information about the GI manifestations of pediatric COVID-19. Patients with a severe and nonsevere clinical course were compared using the inverse variance heterogeneity model and odds ratio (OR) as the effect size. A sensitivity analysis was performed if the heterogeneity was high among studies. RESULTS: A total of 811 studies were identified through a systematic search of which 55 studies (4369 patients) were included in this systematic review. The commonest GI symptoms were diarrhea-19.08% [95% confidence interval (CI) 10.6-28.2], nausea/vomiting 19.7% (95% CI 7.8-33.2) and abdominal pain 20.3% (95% CI 3.7-40.4). The presence of diarrhea was significantly associated with a severe clinical course with a pooled OR of 3.97 (95% CI 1.80-8.73; p < 0.01). Abdominal pain and nausea/vomiting were not associated with disease severity. CONCLUSIONS: Diarrhea, nausea/vomiting or abdominal pain are present in nearly one-fifth of all children with COVID-19. The presence of diarrhea portends a severe clinical course.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Child , Diarrhea/epidemiology , Diarrhea/etiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , SARS-CoV-2 , Vomiting/epidemiology , Vomiting/etiology
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