Gastrointestinal, hepatobiliary, and pancreatic manifestations of COVID-19.

There is an increasing number of confirmed cases and deaths caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributing to the Coronavirus disease 2019 (COVID-19) pandemic. At this point, the need for further disease characterization is critical. COVID-19 is well established as a respiratory tract pathogen; however, recent studies have shown an increasing number of patients reporting gastrointestinal manifestations such as diarrhea, nausea, vomiting, and abdominal pain. The time from onset of gastrointestinal symptoms to hospital presentation is often delayed compared to that of respiratory symptoms. It has been noted that SARS-CoV-2 RNA can be detected in fecal matter for an extended period of time, even after respiratory samples have tested negative and patients are asymptomatic. In this article, SARS-CoV-2 and its disease COVID-19 will be reviewed with consideration of the latest literature about gastrointestinal symptomatology, the mechanisms by which the virus may inflict damage, and the possibility of viral replication contributing to a fecal-oral route of transmission.

[Prevention, screening and check-ups in gastroenterology]. / Vorsorgeuntersuchungen und Check-ups in der Gastroenterologie.

Diseases of the digestive tract are frequent and many gastroenterological tumors are characterized by a bad prognosis. Lifestyle changes such as normalization of body weight, physical activity, stop smoking or balanced diets can effectively prevent many gastroenterological tumors. Vaccination against hepatitis A and B, as well as eradication of Helicobacter pylori, are highly effective in avoiding liver infection and reducing the risk for gastric cancer respectively. Colorectal cancer screening using immunological stool tests (iFOBT) and colonoscopy has been proven to be the most efficacious tool in tumour screening at all. As compared to established screening tests, check-ups and their benefit are less well defined. In general, they yield to detect health risks, partially overlapping with the goals of prevention and screening. Gastroenterological check-ups include abdominal ultrasound and esophagogastroduodenoscopy offering a wide range of detecting diseases at potential risks like reflux esophagitis and their complications or aortal aneurysma.

Implementation of a Bowel Protocol to Improve Enteral Nutrition and Reduce Clostridium difficile Testing.

BACKGROUND: Underfeeding is common among adult patients receiving enteral nutrition. Constipation and diarrhea have been associated with low enteral nutrition volume in critically ill patients. In patients with diarrhea, Clostridium difficile is often suspected and tested for, although medications, illness, or enteral formulas are usually the cause. The use of bowel protocols to proactively address constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, thereby improving enteral nutrition, remains unclear. OBJECTIVE: To evaluate the efficacy of implementing protocols to decrease constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, and to deliver larger enteral nutrition volumes in a critical care unit. METHODS: A prospective convenience sample was used. The primary outcome was the proportion of patients receiving greater than or equal to 80% of their prescribed caloric volume 1 week (minimum 4 days) after initiating enteral nutrition. Rates of testing for hospital-onset C difficile infection were analyzed before and after the protocol was implemented. RESULTS: After the protocol was implemented, patients experienced significant increases in delivery of enteral nutrition volume-up to 78% of the goal volume (P = .048). The standardized infection ratio of hospital-onset C difficile infection decreased 43% (P = .04). CONCLUSIONS: The implementation of bowel protocols improved delivery of total enteral volumes and reduced inappropriate testing for hospital-onset infections with C difficile, and they may improve patient safety and facilitate positive patient outcomes.

Potential Adverse Drug Events and Nephrotoxicity Related to Prophylaxis With Omeprazole for Digestive Disorders: A Prospective Cohort Study.

PURPOSE: The purpose of this study was to assess whether prophylaxis for digestive disorders with omeprazole is a risk factor for adverse drug events (ADEs) and kidney impairment. METHODS: This was a 9-month, prospective, double-blinded cohort study performed in a Brazilian public hospital. All inpatients 18 years or older admitted during the period of data collection were divided into 2 cohorts. The first group comprised 200 patients receiving prophylaxis for digestive disorders with omeprazole. A total of 54 inpatients who received treatment with omeprazole and whose indication was not approved by the Brazilian Sanitary Agency and the US Food and Drug Administration were excluded. The second group comprised 219 inpatients without a prescription for omeprazole. Follow-up was performed until discharge and included assessment of medical records, medical prescriptions, laboratory data, and pharmaceutical anamnesis. The primary end point was kidney impairment. The variables monitored were kidney function (serum creatinine and urea levels as well as glomerular filtration rate), hepatic function (alanine aminotransferase and aspartate aminotransferase levels), pharmacotherapy, magnesium levels, and imputation of ADEs. With the aid of algorithms of World Health Organization and the National Coordinating Council for Medication Error Reporting and Prevention, we assessed the causality of adverse drug reactions (ADRs) and the seriousness of medication errors (ADEs), respectively. FINDINGS: Prophylaxis for digestive disorders with omeprazole (P = 0.019) and sex (P = 0.010) were considered risk factors for increased serum creatinine level via multivariate logistic regression even with concomitant use of nephrotoxic drugs (P = 0.252). Six ADEs related to omeprazole were identified: 2 ADRs (1 possible and 1 definite), 2 medication errors (nonserious), 1 therapeutic failure, and 1 drug-drug interaction. IMPLICATIONS: Prophylaxis for digestive disorders with omeprazole and male sex may contribute to the development of kidney impairment because both result in increased serum creatinine levels. Therefore, pharmacotherapeutic follow-up of male patients diagnosed with kidney disorders should be considered to identify potential drug-drug interactions early. This follow-up can prevent worsening clinical conditions and/or contraindicate prophylactic use of omeprazole. ClinicalTrials.gov identifier: NCT02278432.

GENERAL HEALTH STATUS AMONG FIREFIGHTERS AND RESCUE OPERATIONS WORKERS.

Research objective - to study the state of health of staff of service of fire extinguishing and accident rescue services department for definition of the priority directions of rendering the treatment-and-prophylactic help and rehabilitation of employees. By means of an information and analytical method the retrospective analysis of reports about the registered diseases, their result and the reasons of temporary disability of staff of service of fire extinguishing and accident rescue services department of Department on emergency situations of Almaty in 2011-2016 has been carried out. Statistical processing of the received results of research is carried out by means of Student's t-criterion. The conducted research showed that the high level of primary incidence is characteristic of the staff of service of fire extinguishing and accident rescue services department, at the same time the most significant are diseases of respiratory organs, traumas, poisoning and some other consequences of influence of the external reasons, diseases of bone and muscular system and connecting tissue, blood circulatory system illness. Studying of the state of health of staff of service of fire extinguishing and rescue services allowed to establish the priority directions of rendering the treatment-and-prophylactic help and rehabilitation. Their contents are defined by need of concentration of efforts on prevention, treatment and rehabilitation of the most widespread diseases causing the maximum damage to health.

Methods for Reducing Normal Tissue Complication Probabilities in Oropharyngeal Cancer: Dose Reduction or Planning Target Volume Elimination.

PURPOSE: Strategies to reduce the toxicities of head and neck radiation (ie, dysphagia [difficulty swallowing] and xerostomia [dry mouth]) are currently underway. However, the predicted benefit of dose and planning target volume (PTV) reduction strategies is unknown. The purpose of the present study was to compare the normal tissue complication probabilities (NTCP) for swallowing and salivary structures in standard plans (70 Gy [P70]), dose-reduced plans (60 Gy [P60]), and plans eliminating the PTV margin. METHODS AND MATERIALS: A total of 38 oropharyngeal cancer (OPC) plans were analyzed. Standard organ-sparing volumetric modulated arc therapy plans (P70) were created and then modified by eliminating the PTVs and treating the clinical tumor volumes (CTVs) only (C70) or maintaining the PTV but reducing the dose to 60 Gy (P60). NTCP dose models for the pharyngeal constrictors, glottis/supraglottic larynx, parotid glands (PGs), and submandibular glands (SMGs) were analyzed. The minimal clinically important benefit was defined as a mean change in NTCP of >5%. The P70 NTCP thresholds and overlap percentages of the organs at risk with the PTVs (56-59 Gy, vPTV56) were evaluated to identify the predictors for NTCP improvement. RESULTS: With the P60 plans, only the ipsilateral PG (iPG) benefited (23.9% vs 16.2%; P<.01). With the C70 plans, only the iPG (23.9% vs 17.5%; P<.01) and contralateral SMG (cSMG) (NTCP 32.1% vs 22.9%; P<.01) benefited. An iPG NTCP threshold of 20% and 30% predicted NTCP benefits for the P60 and C70 plans, respectively (P<.001). A cSMG NTCP threshold of 30% predicted for an NTCP benefit with the C70 plans (P<.001). Furthermore, for the iPG, a vPTV56 >13% predicted benefit with P60 (P<.001) and C70 (P=.002). For the cSMG, a vPTV56 >22% predicted benefit with C70 (P<.01). CONCLUSIONS: PTV elimination and dose-reduction lowered the NTCP of the iPG, and PTV elimination lowered the NTCP of the cSMG. NTCP thresholds and the percentage of overlap of the PTV with organs at risk can predict which patients will benefit and inform future clinical trial design.

[Main indicators of health status of the officers serving at the Armed Forces of the Russian Federation in 2005-2015].

Main indicators of health status of the officers serving at the Armed Forces of the Russian Federation in 2005-2015. Dynamic indicators of health status of officers in 2005-2015 were investigated and evaluated according to developed algorithm. Reliable increase of common morbidity indicators and labour losses and reduced discharge rate and mortality are defined. It is shown that the following diseases: traumas, circulatory diseases, respiratory disease, diseases of the digestive system, pathology of musculoskeletal system and neoplasm are 75,5% of the common health status indicator.

[Urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery on the Fallopian tube: Guidelines]. / Hystérectomies d'indication bénigne: complications viscérales et gestes associés sur les annexes: recommandations.

OBJECTIVES: To provide clinical practice guidelines from the French College of Obstetrics and Gynecology (CNGOF) based on the best evidence available, concerning the urinary, infectious and digestive adverse events related to benign hysterectomy and the associated surgery including opportunistic salpingectomy and adnexectomy. MATERIAL AND METHOD: Review of literature using following keywords: benign hysterectomy; urinary injury; bladder injury; ureteral injury; vesicovaginal fistula; infection; bowel injury; salpingectomy. RESULTS: Urinary catheter should be removed before 24h following uncomplicated hysterectomy (grade B). In case of urinary catheter during hysterectomy, immediate postoperative removal is possible (grade C). No hemostasis technics can be recommended to avoid urinary injury (grade C). There is not any evidence to recommend to perform a window in the broad ligament or an ureterolysis, to put ureteral stent or a uterine manipulator in order to avoid ureteral injury. An antibiotic prophylaxis by a cephalosporin is always recommended (grade B). Mechanical bowel preparation before hysterectomy is not recommended (grade B). If there is no ovarian cyst/disease and no familial or personal history of ovarian/breast cancer, ovarian conservation is recommended in premenopausal women (grade B). In postmenopausal women, informed consent and surgical approach should be taken in account to perform a salpingo-oophorectomy. Since the association salpingectomy and hysterectomy is not assessed in the prevention of ovarian cancer, systematic bilateral salpingectomy is not recommended (expert consensus). CONCLUSIONS: Practical application of these guidelines should decrease the prevalence of visceral complications associated with benign hysterectomy.

IgY antibodies in human nutrition for disease prevention.

Oral administration of preformed specific antibodies is an attractive approach against infections of the digestive system in humans and animals in times of increasing antibiotic resistances. Previous studies showed a positive effect of egg yolk IgY antibodies on bacterial intoxications in animals and humans. Immunization of chickens with specific antigens offers the possibility to create various forms of antibodies. Research shows that orally applied IgY's isolated from egg yolks can passively cure or prevent diseases of the digestive system. The use of these alternative therapeutic drugs provides further advantages: (1) The production of IgY's is a non-invasive alternative to current methods; (2) The keeping of chickens is inexpensive; (3) The animals are easy to handle; (4) It avoids repetitive bleeding of laboratory animals; (5) It is also very cost effective regarding the high IgY concentration within the egg yolk. Novel targets of these antigen specific antibodies are Helicobacter pylori and also molecules involved in signaling pathways in gastric cancer. Furthermore, also dental caries causing bacteria like Streptococcus mutans or opportunistic Pseudomonas aeruginosa in cystic fibrosis patients are possible targets. Therefore, IgY's included in food for human consumption may be able to prevent or cure human diseases.

[The disease and treatment of the frontline soldiers in Han dynasty].

This paper purports to identify and analyze the medical information of the frontline soldiers in the Northwest borderland provinces of Han Dynasty, especially Juyan and Dunhuang region, through an heuristic reading of the Juyan Bamboo Slips and the Dunhuang Bamboo Slips of the Han Dynasty. My findings are as follows. The most frequent disease found in the bamboo slips was the external injury. The injury of the frontline soldiers mainly occurred from the quarrels among armed soldiers using weapons. The bamboo slips also demonstrate that the quarrels usually arose due to the fierce tension caused by the frontier line service such as heavy guard activity and labour duty. Undernourishment and chronic stress the soldiers suffered might be another reasons. The second most common disease harassing the soldiers was exogenous febrile disease. In most cases reviewed in this paper, the exogenous febrile disease was usually concurrent with complex symptoms such as chills, fever, headache, etc. The bamboo slips show that the exogenous febrile disease was related to the harsh climate of the Northwest provinces, featuring extremely dry weather and the large magnitude of diurnal temperature fluctuations. In addition, the annual temperature range in the Northwest province was huge, fluctuating between very cold and dry winter and very hot and dry summer. The third most common disease this study identified was the disorder of the digestive system and respiratory system. However, these two types of disease were virtually indistinguishable in the bamboo slips, because the ancient Chinese chroniclers did not distinguish them, usually dubbing both diseases simply 'abdominal pain.' It should be mentioned that a few slips mention contagious disease such as dysentery and dermatolosis, and sudden death, as well. Overall, the bamboo slips demonstrate extremely poor status of the soldiers' heath condition and poor medical environment surrounding the soldiers stationing in the Northwest borderland military camps. The records also show that acupuncture, applying a plaster, drugs were the most common medical treatment. Drugs among them was the most frequently used. Whereas Acupuncture, applying a plaster were very rarely used. Medication has been used in three ways: powdered medicine, medicinal decoction and pill. Medicinal decoction was the most commonly used way.

Gut microbiome, gut function, and probiotics: Implications for health.

New insights from a rapidly developing field of research have ushered in a new era of understanding of the complexity of host-microbe interactions within the human body. The paradigm shift from culturing to metagenomics has provided an insight into the complex diversity of the microbial species that we harbor, revealing the fact that we are in fact more microbes than human cells. The largest consortium of these microbes resides in the gut and is called the gut microbiota. This new science has expanded the ability to document shifts in microbial populations to an unparalleled degree. It is now understood that signals from the microbiota provide trophic, nutritional, metabolic, and protective effects for the development and maintenance of the host digestive, immune, and neuroendocrine system. Evidence linking changes in the gut microbiota to gastrointestinal and extraintestinal disorders like irritable bowel syndrome, inflammatory bowel disease, obesity, diabetes, and celiac disease have begun to emerge recently. Probiotics act through diverse mechanisms positively affecting the composition and/or function of the commensal microbiota and alter host immunological responses. Well-controlled intervention trials, systematic reviews, and meta-analysis provide convincing evidence for the benefit of probiotics in prevention and treatment of gastrointestinal as well as extraintestinal disorders.

Ethnomedicinal plants used for digestive system disorders by the Karen of northern Thailand.

BACKGROUND: Digestive system disorders have a substantial effect on worldwide morbidity and mortality rates, including in Thailand, where the majority of the rural areas have a lack of proper sanitation and awareness about disease prevention. This has led to the prevalence of different types of digestive diseases. Karen people in Thailand still use medicinal plants as first aid remedies in treating these diseases. Therefore, this study aimed at documenting the plants used to cure and prevent different types of digestive system disorders by Karen people of Chiang Mai Province, northern Thailand. METHODS: Ethnomedicinal data were collected from six key informants and 172 non-specialist informants regarding their traditional knowledge of medicinal plants. Quantitative approaches were used to determine Use Value (UV), Informant Consensus Factor (ICF) and Fidelity Level (FL) values. RESULTS: The study revealed that 36 medicinal plant species belonging to 31 genera and 24 families were used to treat digestive system disorders. The most prevalent plant families were Zingiberaceae (6 species), Euphorbiaceae (4 species) and Fabaceae (4 species). Leaves were the most commonly used plant part accounting for 32.6% of the plants, followed by the bark (18.6%). About 60% of the administrations were given orally by potion (60%) and consumption as food was also indicated (14%). The highest ICF values were recorded for carminative disorders, stomachaches, geographic tongue, constipation, appetite stimulants and food poisoning (1.00 each) indicating the best agreement among the informants knowledge of medicinal plants that were used to treat aliments in these categories. The highest fidelity level values were recorded for Punica granatum (100.00), Psidium guajava (95.45), and Gymnopetalum integrifolium (90.91) showing conformity of knowledge on species with the best healing potential. CONCLUSION: Medicinal plants still play an important role among Karen culture. The present information on these medicinal plants, which have high UV and FL values, may serve as the baseline data to initiate further research for the discovery of new compounds and the biological activities of these potential plant remedies. Further research on these plants may provide some important clues for the development of new drugs for the treatment of digestive system diseases.