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2.
Saudi Med J ; 42(4): 391-398, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1168263

ABSTRACT

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.


Subject(s)
COVID-19/physiopathology , Abdominal Pain/physiopathology , Adolescent , Asthma/epidemiology , Atrophy , Brain/pathology , Bronchiolitis Obliterans/epidemiology , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Child , Child, Preschool , Comorbidity , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Female , Fever/physiopathology , Heart Defects, Congenital/epidemiology , Hospital Mortality , Hospitalization , Humans , Hydrocephalus/epidemiology , Infant , Intensive Care Units, Pediatric , Male , Pharyngitis/physiopathology , Respiration, Artificial , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Retrospective Studies , Rhinorrhea/physiopathology , SARS-CoV-2 , Saudi Arabia/epidemiology , Severity of Illness Index , Vomiting/physiopathology
3.
Eur J Gastroenterol Hepatol ; 33(5): 691-694, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1159992

ABSTRACT

BACKGROUND: Infection due to severe acute respiratory syndrome coronavirus 2 is typically associated with a respiratory syndrome, but gastrointestinal symptoms have been described in early reports from China. However, data from European centres are scarce. OBJECTIVES: We aimed to characterise the gastrointestinal manifestations of patients with coronavirus disease 2019 (COVID-19) and their disease course. METHODS: Patients admitted at our centre between March and April 2020 with diagnosis of COVID-19 were included. Asymptomatic patients or those without symptom information were excluded. Clinical features, laboratory data and disease severity (mechanical ventilation, intensive care admission or death) were analysed. RESULTS: Two-hundred one patients were included (median age 71 years; 56.2% male). Digestive symptoms were reported by 60 (29.9%) patients during the disease course, being part of the disease presentation in 34 (16.9%). The most frequent were diarrhoea in 36 patients (17.9%). Patients with gastrointestinal symptoms were younger (P = 0.032), had higher haemoglobin levels (P = 0.002) and lower C-reactive protein (P = 0.045) and potassium levels (P = 0.004). Patients with digestive symptoms had less severe disease (28.3 vs. 44.0%; P = 0.038). Regarding liver damage, aspartate aminotransferase (AST) was elevated in 65.2% of patients and alanine aminotransferase (ALT) in 62.7%, but these patients did not present a more severe disease (elevated AST P = 0.062; elevated ALT P = 0.276). CONCLUSION: A significant portion of COVID-19 patients have digestive symptoms, mostly at presentation. This should be taken into account in order to keep a high level of suspicion to reach an early diagnosis and setup infection control measures to control the transmission rate. This subgroup of patients appears to have a less severe disease course.


Subject(s)
COVID-19/physiopathology , Diarrhea/physiopathology , Vomiting/physiopathology , Abdominal Pain/epidemiology , Abdominal Pain/metabolism , Abdominal Pain/physiopathology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/metabolism , Ageusia/physiopathology , Alanine Transaminase/metabolism , Aspartate Aminotransferases/metabolism , C-Reactive Protein/metabolism , COVID-19/metabolism , Diarrhea/epidemiology , Diarrhea/metabolism , Female , Hemoglobins/metabolism , Humans , Male , Middle Aged , Nausea/epidemiology , Nausea/metabolism , Nausea/physiopathology , Portugal/epidemiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Vomiting/epidemiology , Vomiting/metabolism , Young Adult
4.
J Med Case Rep ; 15(1): 171, 2021 Mar 26.
Article in English | MEDLINE | ID: covidwho-1154035

ABSTRACT

BACKGROUND: The pandemic of this century has overwhelmed the healthcare systems of affected countries, and all resources have been diverted to coronavirus disease 2019. At the onset, coronavirus disease 2019 can present as any other acute febrile undifferentiated illness. In tropical regions, clinicians are increasingly challenged to differentiate these febrile illnesses without the use of diagnostics. With this pandemic, many of these tropical diseases are neglected and go underreported. Dengue is holoendemic in the Maldives, and dengue viruses circulate throughout the year. Reports about coinfections with dengue virus and severe acute respiratory syndrome coronavirus 2 are scarce, and the outcome and the dynamics of the disease may be altered in the presence of coinfection. We have described the clinical manifestation and serial laboratory profile, and highlighted the atypical findings uncommon in dengue infection. CASE PRESENTATION: Case 1 was a 39-year old Asian male, presented on day 6 of dengue infection with warning signs. Reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 that was done as per hospital protocol was found to be positive. Case 2 was a 38-year old Asian male, was admitted on day 5 of illness with symptoms of acute respiratory infection with positive reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2. Evaluation of progressive leukopenia and thrombocytopenia showed positive dengue serology. CONCLUSION: Clinicians must be conscientious when working on the differential diagnosis of possible tropical diseases in cases of coronavirus disease 2019, specifically, when patients develop hemoconcentration, thrombocytopenia, and transaminitis with elevated expression of aspartate higher than alanine transaminase, which is frequently observed in dengue infection. Caution must be taken during the administration of intravenous fluids when treating patients with coronavirus disease 2019 and dengue coinfection, as coronavirus disease 2019 patients are more prone to develop pulmonary edema. Timely diagnosis and appropriate management are essential to avoid the devastating complications of severe forms of dengue infection. It is important to repeat and reconfirm the dengue serology in coronavirus disease 2019 patients to avoid false positivity. Diligence and care must be taken not to neglect other endemic tropical diseases in the region during the present pandemic.


Subject(s)
COVID-19/complications , Dengue/complications , Leukopenia/blood , Thrombocytopenia/blood , Abdominal Pain/physiopathology , Adult , Anosmia/physiopathology , COVID-19/blood , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Coinfection , Cough/physiopathology , Dengue/blood , Dengue/physiopathology , Dengue/therapy , Diarrhea/physiopathology , Dysgeusia/physiopathology , Fever/physiopathology , Fluid Therapy , Headache/physiopathology , Humans , Male , Myalgia/physiopathology , Pharyngitis/physiopathology , SARS-CoV-2 , Vomiting/physiopathology
5.
Pediatr Rheumatol Online J ; 19(1): 29, 2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1136233

ABSTRACT

BACKGROUND: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.


Subject(s)
COVID-19/physiopathology , Coronary Artery Disease/physiopathology , Hypotension/physiopathology , Lymphopenia/physiopathology , Mucocutaneous Lymph Node Syndrome/physiopathology , Myocarditis/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Age Distribution , Antirheumatic Agents/therapeutic use , Aspirin/therapeutic use , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/therapy , Child , Child, Preschool , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Female , Glucocorticoids/therapeutic use , Heart Failure/physiopathology , Humans , Hyperferritinemia/metabolism , Hyperferritinemia/physiopathology , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Infant , Intensive Care Units, Pediatric , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Italy/epidemiology , Male , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/metabolism , Mucocutaneous Lymph Node Syndrome/therapy , Platelet Aggregation Inhibitors/therapeutic use , SARS-CoV-2 , Shock/physiopathology , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/metabolism , Systemic Inflammatory Response Syndrome/therapy , Tachypnea/physiopathology , Troponin T/metabolism , Vomiting/physiopathology
6.
Cardiol Young ; 31(3): 485-487, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1131993

ABSTRACT

A four- and a half-month-old girl with severe dilated cardiomyopathy due to neonatal enterovirus myocarditis, treated with diuretics and milrinone for the past 4 months, was infected with SARS-CoV-2. The disease course was characterised by high fever and gastrointestinal symptoms. Cardiac function, as measured by echocardiography, remained stable. The treatment focused on maintaining a normal heart rate and a stable fluid balance. In children with severe underlying cardiac disease, even a mild SARS-CoV-2 infection can require close monitoring and compound treatment.


Subject(s)
COVID-19/physiopathology , Cardiomyopathy, Dilated/physiopathology , Diarrhea/physiopathology , Fever/physiopathology , Tachycardia/physiopathology , Tachypnea/physiopathology , Ventricular Dysfunction, Left/physiopathology , Vomiting/physiopathology , COVID-19/complications , Cardiomyopathy, Dilated/drug therapy , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Dilated/metabolism , Cardiotonic Agents/therapeutic use , Diuretics/therapeutic use , Echocardiography , Enterovirus Infections/complications , Female , Heart Rate , Heart Transplantation , Humans , Infant , Milrinone/therapeutic use , Myocarditis/complications , Natriuretic Peptide, Brain/metabolism , Peptide Fragments/metabolism , SARS-CoV-2 , Severity of Illness Index , Troponin T/metabolism , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/metabolism , Waiting Lists , Water-Electrolyte Balance
7.
Pediatr Rheumatol Online J ; 19(1): 21, 2021 Feb 24.
Article in English | MEDLINE | ID: covidwho-1102340

ABSTRACT

IMPORTANCE: Active pediatric COVID-19 pneumonia and MIS-C are two disease processes requiring rapid diagnosis and different treatment protocols. OBJECTIVE: To distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics, and laboratory values. DESIGN: Patients diagnosed and hospitalized with active COVID-19 pneumonia or MIS-C at Children's of Alabama Hospital in Birmingham, AL from April 1 through September 1, 2020 were identified retrospectively. Active COVID-19 and MIS-C cases were defined using diagnostic codes and verified for accuracy using current US Centers for Disease Control case definitions. All clinical notes were reviewed for documentation of COVID-19 pneumonia or MIS-C, and clinical notes and electronic medical records were reviewed for patient demographics, presenting signs and symptoms, prior exposure to or testing for the SARS-CoV-2 virus, laboratory data, imaging, treatment modalities and response to treatment. FINDINGS: 111 patients were identified, with 74 classified as mild COVID-19, 8 patients as moderate COVID-19, 8 patients as severe COVID-19, 10 as mild MIS-C and 11 as severe MIS-C. All groups had a male predominance, with Black and Hispanic patients overrepresented as compared to the demographics of Alabama. Most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis, and gastrointestinal symptoms were predominant in the MIS-C population whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients. CONCLUSIONS AND RELEVANCE: This study is one of the first to directly compare COVID-19 and MIS-C in the pediatric population. The significant differences found between symptoms at presentation, demographics, and laboratory findings will aide health-care providers in distinguishing the two disease entities.


Subject(s)
COVID-19/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Abdominal Pain/physiopathology , Adolescent , African Americans , Asthma/epidemiology , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/metabolism , Case-Control Studies , Child , Child, Preschool , Comorbidity , Conjunctivitis/physiopathology , Coronary Artery Disease , Diabetes Mellitus/epidemiology , Diarrhea/physiopathology , Dilatation, Pathologic , Echocardiography , Exanthema/physiopathology , Female , Fever/physiopathology , Heart Defects, Congenital/epidemiology , Humans , Hyponatremia/metabolism , Male , Nausea/physiopathology , Neoplasms/epidemiology , Neurodevelopmental Disorders/epidemiology , Obesity/epidemiology , SARS-CoV-2 , Severity of Illness Index , Sex Distribution , Stroke Volume , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/metabolism , Time Factors , Vomiting/physiopathology
8.
Nat Rev Gastroenterol Hepatol ; 18(4): 269-283, 2021 04.
Article in English | MEDLINE | ID: covidwho-1085424

ABSTRACT

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.


Subject(s)
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
9.
Pediatr Pulmonol ; 55(12): 3252-3267, 2020 12.
Article in English | MEDLINE | ID: covidwho-1064416

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. AIM: To assess the characteristics of COVID-19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. SEARCH STRATEGY: An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS-CoV-2, COVID-19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. RESULTS: The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. CONCLUSIONS: Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS-CoV-2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.


Subject(s)
Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Adolescent , Asymptomatic Infections , Betacoronavirus , COVID-19 , Child , Child, Preschool , Coronavirus Infections/blood , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/mortality , Cough/physiopathology , Diarrhea/physiopathology , Fever/physiopathology , Humans , Infant , Infant, Newborn , Lung/diagnostic imaging , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/mortality , SARS-CoV-2 , Severity of Illness Index , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/mortality , Vomiting/physiopathology
10.
Iran J Allergy Asthma Immunol ; 19(6): 570-588, 2020 Dec 19.
Article in English | MEDLINE | ID: covidwho-1068115

ABSTRACT

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.


Subject(s)
COVID-19/physiopathology , Conjunctivitis/physiopathology , Exanthema/physiopathology , Fever/physiopathology , Gastrointestinal Diseases/physiopathology , Shock/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Abdominal Pain/physiopathology , Acute Kidney Injury/physiopathology , COVID-19/epidemiology , COVID-19/therapy , Cheilitis/physiopathology , Cough/physiopathology , Diarrhea/physiopathology , Dyspnea/physiopathology , Headache/physiopathology , Humans , Meningism/physiopathology , Myalgia/epidemiology , Prognosis , Respiration, Artificial , Sex Distribution , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy , Vomiting/physiopathology
11.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066835

ABSTRACT

SARS-CoV-2 is the cause of COVID-19. Since the outbreak and rapid spread of COVID-19, it has been apparent that the disease is having multi-organ system involvement. Still its effect in the endocrine system is not fully clear and data on cortisol dynamics in patients with COVID-19 are not yet available. SARS-CoV-2 can knock down the host's cortisol stress response. Here we present a case of a 51-year-old man vomiting for 10 days after having confirmed COVID-19 infection. He had hypotension and significant hyponatraemia. Work-up was done including adrenocorticotropic hormone stimulation test. He was diagnosed as suffering from adrenal insufficiency and started on steroids with subsequent improvement in both blood pressure and sodium level. COVID-19 can cause adrenal insufficiency. Clinicians must be vigilant about the possibility of an underlying relative cortisol deficiency in patients with COVID-19.


Subject(s)
Adrenal Insufficiency/physiopathology , COVID-19/physiopathology , Hyponatremia/physiopathology , Hypotension/physiopathology , Acidosis/blood , Acidosis/physiopathology , Acidosis/therapy , Adrenal Insufficiency/blood , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , COVID-19/blood , Fluid Therapy , Glucocorticoids/therapeutic use , Humans , Hydrocortisone/blood , Hyponatremia/blood , Hyponatremia/therapy , Hypophosphatemia/blood , Hypophosphatemia/physiopathology , Hypophosphatemia/therapy , Hypotension/therapy , Male , Middle Aged , Pituitary-Adrenal Function Tests , Prednisolone/therapeutic use , SARS-CoV-2 , Vomiting/physiopathology , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/physiopathology , Water-Electrolyte Imbalance/therapy
12.
Eur J Obstet Gynecol Reprod Biol ; 256: 194-204, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1059877

ABSTRACT

Evidence concerning coronavirus disease-19 (covid-19) in pregnancy is still scarce and scattered. This meta-analysis aims to evaluate maternal and neonatal outcomes in covid-19 pregnancies and identify factors associated with perinatal viral transmission. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched to 3 June 2020. Overall, 16 observational studies and 44 case reports/series were included. Fever was the most frequent maternal symptom, followed by cough and shortness of breath, while about 15 % of infected were asymptomatic. Severe disease was estimated to occur in 11 % of women in case reports/series and in 7 % (95 % CI: 4 %-10 %) in observational studies. Two maternal deaths were reported. The rate of neonatal transmission did not differ between women with and without severe disease (OR: 1.94, 95 % CI: 0.50-7.60). Preterm birth occurred in 29.7 % and 16 % (95 % CI: 11 %-21 %) in data obtained from case series and observational studies, respectively. Stillbirth occurred in 3 cases and 2 neonatal deaths were observed. Vertical transmission was suspected in 4 cases. Fever was the most common neonatal symptom (40 %), followed by shortness of breath (28 %) and vomiting (24 %), while 20 % of neonates were totally asymptomatic. In conclusion, the maternal and neonatal clinical course the infection is typically mild, presenting low mortality rates. The risk of vertical transmission is suggested to be low and may not be affected by the severity of maternal disease. Further large-scale studies are needed to clarify the risk factors associated with viral transmission and severe infection in the neonatal population.


Subject(s)
COVID-19/epidemiology , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Infectious/epidemiology , Premature Birth/epidemiology , Asymptomatic Infections , COVID-19/physiopathology , COVID-19/transmission , Cesarean Section/statistics & numerical data , Cough/physiopathology , Dyspnea/physiopathology , Female , Fever/physiopathology , Humans , Infant, Newborn , Perinatal Mortality , Pregnancy , Pregnancy Complications, Infectious/physiopathology , SARS-CoV-2 , Severity of Illness Index , Stillbirth/epidemiology , Vomiting/physiopathology
13.
Diabetes Metab Syndr ; 14(6): 1841-1845, 2020.
Article in English | MEDLINE | ID: covidwho-1059536

ABSTRACT

BACKGROUND AND AIMS: To elucidate the clinical features of COVID-19 patients with type 1 diabetes (T1D) under hospitalization and home isolation conditions. METHOD: This retrospective study was conducted among 32 patients with COVID-19 and T1D, who sought treatment at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia between May 01, 2020 and July 30, 2020. Patients data were extracted from electronic medical records. RESULTS: Of the total of 32 COVID-19 patients with T1D, 21.9% required hospitalization, while 78.1% underwent home isolation. Among the study population, 9.4% (3/32) were reported to have hypertension, 21.9% (7/32) had chronic pulmonary disease (CPD), 18.8% (6/32) had thyroid disorders, and 18.8% (6/32) had the celiac disease. Of the 32 studied patients, 68.8% (22/32) of them were reported as normal, while 28.1% (9/32) had chronic kidney disease (CKD) II and 3.1% (1/32) had end-stage renal failure. The most common symptoms observed among the hospitalized patients were nausea and vomiting (71.4%; 5/7), followed by fever (57.1%; 4/7), cough (42.8%; 3/7), sore throat (42.8%; 3/7), abdominal pain (42.8%; 3/7) and dyspnea (42.%; 3/7). The most common reasons for hospitalization were diabetic ketoacidosis (71.4%; 5/7) followed by bacterial pneumonia (14.3%; 1/7), fever (14.3%; 1/7), sore throat (14.3%; 1/7), severe hyperglycemia (14.3%; 1/7) and COVID-19 pneumonia (14.3%; 1/7). Except the severity of COVID-19 (p = 0.0001), none of the demographic and clinical parameters indicated statistically significant differences between patients requiring hospitalization and home isolation. CONCLUSION: Majority of the COVID-19 patients with T1D recovered with conservative treatment at home. Diabetic ketoacidosis was the most common reason for hospitalization.


Subject(s)
COVID-19/physiopathology , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Hospitalization , Patient Isolation , Abdominal Pain/physiopathology , Age Factors , COVID-19/complications , COVID-19/epidemiology , Celiac Disease/epidemiology , Cough/physiopathology , Diabetes Mellitus, Type 1/epidemiology , Dyspnea/physiopathology , Female , Fever/physiopathology , Humans , Hypertension/epidemiology , Lung Diseases , Male , Nausea/physiopathology , Pharyngitis/physiopathology , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology , Severity of Illness Index , Thyroid Diseases/epidemiology , Vomiting/physiopathology , Young Adult
14.
Eur Rev Med Pharmacol Sci ; 24(22): 11971-11976, 2020 11.
Article in English | MEDLINE | ID: covidwho-962033

ABSTRACT

OBJECTIVE: This paper presents a newborn (G2P2, gestational age of 39+6 weeks, birth weight of 3,200 g, with normal fetal amniotic fluid) with suspected coronavirus disease 2019 (COVID-19) admitted to our hospital on February 10, 2020, at the birth age of 16 hours and 34 minutes. The Apgar scores at 1 and 5 min were 9 and 10 points, respectively. PATIENTS AND METHODS: The mother of the newborn was exposed to a patient with COVID-19 five days before delivery. The newborn had nausea and vomiting after birth, with feeding intolerance, and full enteral feeding was given on the 6th day after birth. The newborn was in good general condition during the period of hospitalization. RESULTS: The two 2019-nCoV nucleic acid tests of the newborn were negative on the 5th and 7th days after birth. On the 1st and 8th days after birth, typical pulmonary lesions were detected in the newborn by chest CT. Our study supports that chest imaging examination should be actively performed in the newborn even with a negative 2019-nCoV nucleic acid test in cases where a pregnant woman is exposed to a patient with COVID-19 or is confirmed with 2019-nCoV infection. CONCLUSIONS: For newborns with typical pulmonary lesions, strict quarantine measures are suggested if the possibility of COVID-19 cannot be excluded.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnostic imaging , Lung/diagnostic imaging , Maternal Exposure , Nausea/physiopathology , Pregnancy Complications, Infectious/diagnosis , Tomography, X-Ray Computed , Vomiting/physiopathology , Ambroxol , Anti-Bacterial Agents/therapeutic use , Ascorbic Acid/therapeutic use , Breast Feeding , C-Reactive Protein/metabolism , COVID-19/metabolism , COVID-19/physiopathology , COVID-19/therapy , Expectorants/therapeutic use , Female , Humans , Infant, Newborn , Male , Parenteral Nutrition , Pregnancy , Serum Amyloid A Protein/metabolism , Vitamins/therapeutic use
15.
Eur J Gastroenterol Hepatol ; 33(5): 610-612, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-900651

ABSTRACT

The main symptoms of coronavirus disease 2019 (COVID-19) are respiratory manifestations, while some confirmed patients developed gastrointestinal symptoms or even initially presented digestive symptoms. The link between pneumonia and gastrointestinal symptoms caused by severe acute respiratory symptoms coronavirus 2 focused our attention on the concept of 'gut-lung axis'. In this review, we discuss the inevitability and possible mechanisms of the occurrence of intestinal symptoms or intestinal dysfunction in COVID-19 from the perspective of the gut-lung axis, as well as the influence of the imbalance of intestinal homeostasis on the respiratory symptoms of COVID-19. The interaction between lung and intestine might lead to a vicious cycle of pulmonary and intestinal inflammation which may be a potential factor leading to the death of patients with COVID-19.


Subject(s)
Abdominal Pain/physiopathology , COVID-19/physiopathology , Diarrhea/physiopathology , Intestines/physiopathology , Lung/physiopathology , Vomiting/physiopathology , Feces/virology , Gastrointestinal Microbiome/immunology , Humans , Intestinal Mucosa/immunology , Intestines/immunology , Lung/immunology , Respiratory Mucosa/immunology , SARS-CoV-2
16.
Am J Gastroenterol ; 116(2): 306-310, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-809644

ABSTRACT

INTRODUCTION: The most typical presentation of COVID-19 is an acute respiratory syndrome whose most common symptoms include fever, cough, and dyspnea. However, gastrointestinal symptoms, such as diarrhea and nausea/vomiting, are increasingly reported in patients affected by COVID-19. This study aimed to describe the prevalence and time of onset of gastrointestinal symptoms in patients affected by COVID-19 and to find potential associations between gastrointestinal symptoms and clinical outcomes. METHODS: We performed a prospective single-center cohort study, enrolling patients who received diagnosis of COVID-19 at our institution between March 23, 2020, and April 5, 2020. We collected patient demographics and medical history, laboratory data, and clinical outcomes. Furthermore, we used a specifically designed questionnaire, administered to patients at time of diagnosis, to obtain data on the presence and time of onset of fever, typical respiratory symptoms, gastrointestinal symptoms, and other symptoms (fatigue, headache, myalgia/arthralgia, anosmia, ageusia/dysgeusia, sore throat, and ocular symptoms). RESULTS: In our cohort, 138 (69%) of 190 patients showed at least 1 gastrointestinal symptom at diagnosis; if excluding hyporexia/anorexia, 93 patients (48.9%) showed at least 1 gastrointestinal symptom. Gastrointestinal symptoms, in particular diarrhea, were associated with a lower mortality. At multivariate analysis, diarrhea was confirmed as independent predictive factor of lower mortality. DISCUSSION: Gastrointestinal symptoms are very frequent in patients with COVID-19 and may be associated with a better prognosis. These data suggest that, in some patients, the gastrointestinal tract may be more involved than the respiratory system in severe acute respiratory syndrome coronavirus 2 infection, and this could account for the less severe course of disease.


Subject(s)
COVID-19/diagnosis , Gastrointestinal Diseases/virology , Adult , Aged , Aged, 80 and over , COVID-19/physiopathology , COVID-19 Testing , Diarrhea/diagnosis , Diarrhea/epidemiology , Diarrhea/physiopathology , Diarrhea/virology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/physiopathology , Humans , Italy , Logistic Models , Male , Middle Aged , Nausea/diagnosis , Nausea/epidemiology , Nausea/physiopathology , Nausea/virology , Prevalence , Prognosis , Prospective Studies , Time Factors , Vomiting/diagnosis , Vomiting/epidemiology , Vomiting/physiopathology , Vomiting/virology
18.
Dig Liver Dis ; 52(10): 1076-1079, 2020 10.
Article in English | MEDLINE | ID: covidwho-803444

ABSTRACT

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.


Subject(s)
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
19.
Adv Biol Regul ; 77: 100745, 2020 08.
Article in English | MEDLINE | ID: covidwho-741319

ABSTRACT

Coronavirus disease 2019 caused by SARS-CoV-2 originated from China and spread across every corner of the world. The scientific interest on COVID-19 increased after WHO declared it a pandemic in the early February of 2020. In fact, this pandemic has had a worldwide impact on economy, health, and lifestyle like no other in the last 100 years. SARS-CoV-2 belongs to Coronaviridae family and causes the deadliest clinical manifestations when compared to other viruses in the family. COVID-19 is an emerging zoonotic disease that has resulted in over 383,000 deaths around the world. Scientists are scrambling for ideas to develop treatment and prevention strategies to thwart the disease condition. In this review, we have attempted to summarize the latest information on the virus, disease, prevention, and treatment strategies. The future looks promising.


Subject(s)
Betacoronavirus/pathogenicity , COVID-19/epidemiology , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Antiviral Agents/therapeutic use , Ataxia/diagnosis , Ataxia/physiopathology , Ataxia/virology , COVID-19/prevention & control , COVID-19/therapy , COVID-19/transmission , Communicable Disease Control/methods , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Humans , Hydroxychloroquine/therapeutic use , Nausea/diagnosis , Nausea/physiopathology , Nausea/virology , Pandemics/prevention & control , Personal Protective Equipment/supply & distribution , Physical Distancing , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Quarantine/methods , Quarantine/organization & administration , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Vomiting/diagnosis , Vomiting/physiopathology , Vomiting/virology
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