Stay (GI) Healthy: COVID-19 and Gastrointestinal Manifestations.

SARS-CoV-2 is the virus responsible for COVID-19, whose clinical spectrum ranges widely, both in terms of severity and multi-organicity. SARS-CoV-2 mainly involves the respiratory tract, causing from a flu-like syndrome to interstitial pneumonia and acute respiratory distress syndrome. Although its entry receptor, angiotensin-converting-enzyme 2, is typically expressed in epithelial cells of the airways, extra-pulmonary involvement has been consistently demonstrated since the beginning of the outbreak. Gastrointestinal manifestations in COVID-19 may be explained by the abundant expression of ACE2 in the digestive tract. Moreover, not only COVID-19 patients often present with GI symptoms (diarrhea, nausea/vomiting, abdominal pain) and liver tests abnormalities, but there are also data showing active viral replication in the GI tract and possible fecal-oral transmission. Aim of this review is to summarize the evidence regarding prevalence and clinical significance of GI involvement and liver abnormalities in patients with COVID-19, providing the reader with evidence-based recommendations on the management of these conditions.

Identifying medical professionals at risk for in-hospital COVID-19 infection: a snapshot during a "tsunami" highlighting unexpected risks.

The aim of this study was to profile healthcare professionals (HCPs) who infected with COVID-19 in hospital while working in a COVID-19 hub hospital during the pandemic. A questionnaire was sent to all HCPs from whom nasopharyngeal swabs (NPS) were collected. The type of work, work environment, individual characteristics, and modality of infection were analyzed. Working areas were categorized into COVID-free areas (wards and ICUs for patients without COVID-19, medical offices, and hospitality counters) and COVID+ areas (dedicated wards and the ICU for patients with COVID-19). From March 1 to 20, 2020, 302 HCPs were tested: 251 (83.1%) responded to the questionnaire, but 9 were excluded since infection occurred outside the hospital. The remaining 242 subjects included 53 (21.9%) with positive NPS and 189 (78.1%) with negative NPS, significant differences in NPS results were evident depending on the subject's role (p = 0.028). Pairwise post hoc analysis revealed that surgeons had a significantly increased rate of positive NPS (p = 0.001). Of the 189 subjects with negative NPS, 175 (92.6%) worked in COVID-free areas, and 14 (7.4%) in COVID+ areas. Of the 53 subjects with positive NPS, 44 (83.1%) worked in COVID-free areas and 9 (16.9%) worked in COVID+ areas. Medical offices featuring an open space with adjacent desks were identified as areas of higher risk. An apparent cause of infection could not be identified in 21 (39.6%) subjects with positive NPS. Among a total of 251 subjects, 80 (41.5%) of the 193 subjects with negative NPS and 16 (27.6%) of the 58 subjects with positive NPS had been vaccinated against the common flu. In conclusion, the vast majority of subjects with positive NPS came from COVID-free areas. The source of infection could not be identified in a significant portion of subjects with positive NPS. Personnel need better protection, more testing with NPS needs to be performed, and workplace layouts need to be re-thought. Vaccination against the flu seems to provide some protection.

COVID-19 Digestive System Involvement and Clinical Outcomes in a Large Academic Hospital in Milan, Italy.

Since February 2020, the COVID-19 pandemic has spread to Italy affecting more than 100,000 people. Several studies have reported a high prevalence of gastrointestinal (GI) symptoms, and investigated their potential association with clinical outcomes.1 The timing, clinical significance, and possible impact on viral spread of GI symptoms presentation have not been fully elucidated. Elevation of liver function tests and other laboratory values has also been reported; however, their prognostic significance has not been clearly established.2.

Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy.

We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802‒0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.