Gastrointestinal Manifestations and Outcomes of COVID-19: A Comprehensive Systematic Review and Meta-analysis.

Introduction Pulmonary symptoms are the most prominent manifestations of Coronavirus disease 2019 (COVID-19). However, gastrointestinal (GI) symptoms have been reported widely as well. Literature describing the relation of these symptoms with outcomes of COVID-19 patients is limited in terms of sample size, geographic diversity, and the spectrum of GI symptoms included. We aim to evaluate the association of GI symptoms with outcomes of hospitalized COVID-19 patients. Methods A systematic review and meta-analysis of observational studies assessing GI symptoms and outcomes in COVID-19 patients were undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Details on outcomes included ICU vs. non-ICU admission, severe vs. non-severe disease, invasive mechanical ventilation (IMV) vs. no-IMV use, oxygen saturation <90% vs. >90%, in-hospital mortality vs. discharged alive and survivors. We obtained the odds ratio (OR), 95% confidence interval (95%CI), and forest plots. Sensitivity analysis was used to analyze publication bias and heterogeneity. Results In 35 studies with 7931 confirmed COVID-19 patients, we found that anorexia (pooled OR:2.05; 95%CI: 1.36-3.09, p=0.0006) and abdominal pain (OR 2.80; 95%CI: 1.41-5.54, p=0.003) were associated with a higher risk of poor outcomes and no such association was found for diarrhea (OR 1.04; 95%CI: 0.85-1.26, p=0.71), nausea (OR 0.73; 95%CI: 0.38-1.39, p=0.34) and vomiting (OR 1.24; 95%CI 0.86-1.79, p=0.25). Conclusion The meta-analysis concludes that anorexia and abdominal pain are associated with poor outcomes in hospitalized COVID-19 patients, while diarrhea, nausea, and vomiting have no association. Future research should focus on whether detecting GI invasion in conjunction with fecal polymerase chain reaction (PCR) testing can aid in the early triage of high-risk individuals and improve outcomes.

Gastrointestinal problem among Indian adults: Evidence from longitudinal aging study in India 2017-18.

Introduction: Diseases and illnesses of the gastrointestinal system (GIS) have grown in the last decade due to considerable lifestyle changes. People with gastrointestinal (GI) diseases have a high prevalence of depression, stress, anxiety, and impaired central nervous system functioning. Therefore, this study aims to explore the factors associated with the self-reported gastrointestinal problems among the Indian elderly and to explore the relationship between non-communicable diseases (NCDs), such as hypertension, heart diseases, diabetes, and neurological or psychiatric and gastrointestinal disorder. Methods: This study uses data from the Longitudinal Aging Study in India (LASI), a population-based national survey, conducted during 2017-2018 with a representative sample of 72,250 individuals. Descriptive statistics were used to provide the frequency distribution of sociodemographic and economic profiles of adults. Bivariate analysis was used to understand the percentage distribution of adults suffering from gastrointestinal problems by their background characteristics. Binary logistic regression was used to determine the factors associated with gastrointestinal problems. In the binary logistic regression analysis, a systematic model building procedure was adopted. Results: The overall prevalence of self-reported gastrointestinal problems was 18%, with significant variations among regions, and it substantially increased with the increasing age of men. Hypertension and neurological problems have significant individual effects on gastrointestinal problems. Prevalence was higher in those who suffered from neurological or psychiatric problems (27%) than in those who suffered from hypertension (22%) and heart disease (23%). Adults from the age group 45-54 (1.11, p < 0.01) and 55-64 (1.09, p < 0.01) years were significantly more likely to have gastrointestinal problems compared with the <44 years age group. Former and current smokers and adults with the habits of chewing tobacco were significantly more likely to report gastrointestinal problems than their counterparts. Moreover, the increasing economic status significantly and positively increased the likelihood of having self-reported gastrointestinal problems among adults. Conclusion: Aging-related gastrointestinal problems are physiological or pathological and more prevalent in the elderly population aged 64 years and above. Hence, policies and interventions have to be made age-specific. Gastrointestinal problems among older adults are acquiring greater importance in clinical practices to plan effective treatment, administration of gastrointestinal drugs, the early screening of gastrointestinal diseases. Given the policy focus through Health and Wellness centers for accessible NCD care, it is important that gastro-intestinal illnesses receive more focus and systemic support.

Association of Smoking and E-Cigarette in Chronic Liver Disease: An NHANES Study.

Background: There is an increased trend of e-cigarette but the toxic effects of e-cigarette metabolites are not widely studied especially in liver disease. Hence, we aimed to evaluate the prevalence and patterns of recent e-cigarette use in a nationally representative sample of US adults and adolescents and its association amongst respondents with liver disease. Methods: We conducted a retrospective cross-sectional study using National Health and Nutrition Examination Survey (NHANES) database from 2015 to 2018. The self-reported NHANES questionnaire was used to assess liver disease (MCQ160L, MCQ170L and MCQ 510 (a-e)), e-cigarette use (SMQ900) and traditional smoking status (SMQ020 or SMQ040). We conducted univariate analysis and multivariable logistic regression models to predict the association of e-cigarette use, traditional smoking and dual smoking amongst the population with liver disease. Results: Out of total 178,300 respondents, 7,756 (4.35%) were e-cigarette users, 48,625 (27.27%) traditional smoking, 23,444 (13.15%) dual smoking and 98,475 (55.23%) non-smokers. Females had a higher frequency of e-cigarette use (49.3%) compared to dual (43%) and traditional smoking (40.8%) (P < 0.0001). Respondents with a past history of any liver disease have lower frequency of e-cigarette use compared to dual and traditional smoking, respectively (2.4% vs. 6.4% vs. 7.2%; P < 0.0001). In multivariate logistic regression models, we found that e-cigarette users (odds ratio (OR): 1.06; 95% confidence interval (CI): 1.05 - 1.06; P < 0.0001) and dual smoking (OR: 1.50; 95% CI: 1.50 - 1.51; P < 0.0001) were associated with higher odds of having history of liver disease compared to non-smokers. Conclusion: Our study found that despite the low frequency of e-cigarette use in respondents with liver disease, there was higher odds of e-cigarette use amongst patients with liver disease. This warrants the need for more future prospective studies to evaluate the long-term effects and precise mechanisms of e-cigarette toxicants on the liver.

Case Report: Unprovoked venous thromboembolism in a young adult male.

A 24-year-old male was presented to us with sudden onset of chest pain and dyspnea for the past one hour. There was no history of calf pain, trauma, surgery, prolonged immobilization, long-haul air travel, bleeding diathesis or any other co-morbidity. The patient denied any addiction history. The heart rate was 114 beats/min, and blood pressure was 106/90 mmHg. Electrocardiogram showed tachycardia with S 1Q 3T 3 pattern. The left arterio-venous Doppler study was suggestive of a thrombus in popliteal vein and sapheno-popliteal junction. The CT-Pulmonary Angiogram scan was suggestive of a massive pulmonary thromboembolism. The patient was thrombolysed with Intravenous Alteplase immediately and was put on tab Rivaroxaban for maintenance. He was later discharged after being stable. Unprovoked venous thromboembolism (VTE) is very rare and has the potential to lead to pulmonary embolism which could be disastrous, especially in young adults. We present such a case where unprovoked VTE was diagnosed and treated. This case suggests that high clinical suspicion is the key for the diagnosis of acute pulmonary embolism, especially in the absence of history suggestive of deep vein thrombosis.

Changing Antimicrobial Resistance Pattern of Isolates from an ICU Over a 3 Year period.

OBJECTIVE: To study the changing patterns of antimicrobial resistance in gram negative bacilli esp. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa species and Gram positive Staphylococcus aureus isolates from a 37 bedded ICU of a private hospital. METHODS: Antibiotic susceptibilities were determined by using disk diffusion and Vitek-2 system. RESULTS: A total of 13410 clinical samples were screened over a period of 3 years, among which 16.77 percent (2250 isolates) were culture positive. In recent years there has been an increased incidence of extended-spectrum ß- lactamase (ESBL). The ESBL producing Escherichia coli and Klebsiella pneumonia has shown an increase in resistance to the tune of 80-90% from 2011 to 2013. The prevalence of resistant strains of Acinetobacter species and Pseudomonas aeruginosa has shown an increase in Imipenem and Meropenem resistance at the rate of 75-80%. CONCLUSIONS: Antibiotic resistance has shown an increase in gram negative pathogens and thereby has created a significant problem in choosing the right antibiotic for empirical usage. Rise in resistance has left little choice for the clinicians to select antibiotics. Klebsiella pneumonia ESBL and Escherichia coli ESBL have become dominant organisms in the ICU. Piperacillin + Tazobactum, Imipenem and Amikacin have decreased sensitivity against Enterobacter. A number of old antibiotic compounds such as Polymyxins, Fosfomycin, and Aminoglycosides are re-emerging as valuable alternatives for the treatment of ESBL producing bacteria. Cases of MDR Escherichia coli and Klebsiella pneumonia bacteria have increased in recent years and are now the most frequent cause of hospital acquired infections.