Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project).

BACKGROUND: Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. METHODS: This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p<0.05 was considered significant. RESULTS: Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. CONCLUSION: GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

Topical use of hyperoxygenated fatty acids decreases surgical site infection in patients following laparoscopic cholecystectomy. A randomized controlled trial.

BACKGROUND: To date, the topically effect of hyperoxygenated fatty acids (HOFA) on the control of surgical site infection (SSI) is still unclear. OBJECTIVE: To assess the effect of topical application of a HOFA solution on the umbilical trocar site after laparoscopic cholecystectomy on SSI. The occurrence of trocar site incisional hernia (TSIH) was also analyzed. METHODS: A prospective, double-blind, randomized trial was conducted in patients undergoing laparoscopic cholecystectomy, who also presented at least one of the following associated risk factors for SSI and TSIH such as Body Mass Index (BMI) above 30 kg/m2, Diabetes Mellitus (DM), age over 65 years and Chronic Obstructive Pulmonary Disease (COPD). Patients were randomly allocated to topical application of a HOFA solution (HOFA arm) or saline physiological solution (non-HOFA arm) during closure of the umbilical trocar site with a polypropylene mesh. SSI was the primary outcome. TSIH was also assessed as a secondary outcome. RESULTS: 103 patients were included, 51 (49.5%) in the HOFA group and 52 (50.5%) in the non-HOFA group. SSI rate was significantly lower in the HOFA group in comparison with the non-HOFA group (19.6% vs. 3.8%; p = 0.028). TSIH rates were similar in both groups (3.8% vs. 2%). Multivariate analyses showed that only HOFA decreased significantly SSI rate. CONCLUSION: Topical application of a HOFA solution at the umbilical trocar site after laparoscopy cholecystectomy decreased SSI rate.

Evidence of influenza infection in dogs and cats in central Chile.

As companion animals, dogs and cats live in close contact with humans, generating the possibility of interspecies pathogen transmission events. Equine origin H3N8 and avian origin H5N1 influenza virus have been reported in dogs and cats respectively since 2004 with outbreaks associated with different strains recorded for both species in Asia and North America. To date, there have been no reports of influenza viruses from companion animals in South America. To fill this gap in knowledge, we performed active epidemiological surveillance in shelters that received abandoned animals, backyard production systems and veterinary clinics between May 2017 and January 2019 to estimate the burden of influenza infection in cats and dogs in the central region of Chile. Blood samples, oropharyngeal swabs or both were collected for influenza A virus detection by RT-qPCR, NP-ELISA, and hemagglutination inhibition assay. Logistic regression models were performed to assess the association between NP-ELISA-positivity and variables including sex and animal origin. The percentage of ELISA-positive samples was 43.5 % (95 % CI: 37.0-50.1) and 23.3 % (95 % CI: 10.6-42.7) for dogs and cats, respectively. No association was found between NP-ELISA results and sex or animal origin for either dogs or cats. Two ELISA positive samples showed hemagglutination inhibition titers against pandemic H1N1 influenza. One dog sample tested positive by RT-qPCR, indicating an overall RT-qPCR positivity in dogs of 1.1 % (95 % CI: 0.05-6.7). None of the tested cat samples were positive by this assay.

[Littré hernia: an unusual cause of intestinal obstruction.

BACKGROUND: Littre's hernia is the presence of a Meckel diverticulum within an orifice in the abdominal wall. There are few cases published in the literature and its frequency is not well described. CLINICAL CASE: We present the case of a 74-year-old patient who arrived at the emergency service with clinical signs of intestinal obstruction caused by an incarcerated right inguinal hernia. Emergency surgery was performed using a preperitoneal approach. Within the hernia, 5 cm of small bowel containing a Meckel diverticulum was found. Therefore, we decided to extirpate the diverticulum and repair the hernia placing a polypropylene mesh. CONCLUSIONS: Meckel diverticulum is the persistence of the omphalomesenteric duct. It is usually asymptomatic, producing bleeding, infection or intestinal obstruction as the main symptoms.

Colecistitis agudas: ¿está justificado hoy en día diferir la cirugía? / Acute cholecystitis: is it still justified to delay surgery?

Introducción: El tratamiento de la colecistitis aguda puede ser inicialmente quirúrgico o conservador con cirugía posterior, revisamos los casos encontrados en nuestro centro, cómo fueron tratados y la evolución de los mismos. Material y métodos: Realizamos un estudio retrospectivo del tratamiento realizado en 178 pacientes con colecistitis aguda durante un año. Se evalúan variables relacionadas con las características de los pacientes, clínica y exploración, técnicas diagnósticas, tratamiento realizado y evolución. Resultados: El 70,2% es tratado de forma conservadora (grupo A) y el 29,8% es intervenido en las primeras 72h (grupo B). En el grupo A se trataron 96 casos con antibioterapia, 15 con antibioterapia y colecistostomía y 12 con antibioterapia y CPRE. En el grupo B se realizó colecistectomía urgente laparoscópica en el 60,4% de los casos y abierta en el 35,8%. En el grupo A el tiempo de ingreso fue de 11 días, con evolución satisfactoria en el 79,2%, tasa de mortalidad del 5,6% y tasa de reingresos del 10,7%. En el grupo B el tiempo quirúrgico fue de 111+/−43, una media de 8,7 días de ingreso, no precisaron tratamiento además de la cirugía el 68% de los casos. La evolución fue satisfactoria en todos los casos menos en 7, no hubo mortalidad en este grupo. Tuvimos una tasa de reingreso del 2%. Conclusiones: Continuamos realizando una proporción importante de tratamiento conservador en detrimento de la cirugía urgente, en números absolutos este parece tener mayor tasa de complicaciones, de mortalidad y de tiempo de ingreso hospitalario (AU)

Introduction: Acute cholecystitis treatment may initially be surgical or conservative with subsequent surgery; we reviewed the cases found in our centre, including their treatment and outcome. Material and methods: We conducted a retrospective study of treatment in 178 patients with acute cholecystitis during one year. We evaluated variables associated with patient characteristics, as well as clinical data, diagnostic tests, treatment and outcome. Results: The majority (70.2%) was treated conservatively (group A), and 29.8% were operated on in the first 72h (group B). In group A, 96 patients were treated with antibiotics, 15 with antibiotic therapy and cholecystectomy, and 12 with antibiotics and ERCP. In group B urgent laparoscopic cholecystectomy was performed in 60.4%, and 35.8% had open cholecystectomy. In group A, admission time was 11 days, with satisfactory progress in 79.2%, mortality rate of 5.6% and 10.7% of readmissions. In group B, operation time was 111 +/− 43min, a mean of 8.7 days hospital stay, and 68% of cases did not require further treatment after surgery. Outcome was satisfactory in all but 7, there was no mortality in this group. We had a return rate of 2%. Conclusions: A significant proportion of conservative treatment was carried out at the expense of emergency surgery, although in absolute numbers conservative treatment seems to have a higher rate of complications, mortality and hospitalisation time(AU)

[Acute cholecystitis: is it still justified to delay surgery?]. / Colecistitis agudas: ¿está justificado hoy en día diferir la cirugía?

INTRODUCTION: Acute cholecystitis treatment may initially be surgical or conservative with subsequent surgery; we reviewed the cases found in our centre, including their treatment and outcome. MATERIAL AND METHODS: We conducted a retrospective study of treatment in 178 patients with acute cholecystitis during one year. We evaluated variables associated with patient characteristics, as well as clinical data, diagnostic tests, treatment and outcome. RESULTS: The majority (70.2%) was treated conservatively (group A), and 29.8% were operated on in the first 72 h (group B). In group A, 96 patients were treated with antibiotics, 15 with antibiotic therapy and cholecystectomy, and 12 with antibiotics and ERCP. In group B urgent laparoscopic cholecystectomy was performed in 60.4%, and 35.8% had open cholecystectomy. In group A, admission time was 11 days, with satisfactory progress in 79.2%, mortality rate of 5.6% and 10.7% of readmissions. In group B, operation time was 111 +/- 43 min, a mean of 8.7 days hospital stay, and 68% of cases did not require further treatment after surgery. Outcome was satisfactory in all but 7, there was no mortality in this group. We had a return rate of 2%. CONCLUSIONS: A significant proportion of conservative treatment was carried out at the expense of emergency surgery, although in absolute numbers conservative treatment seems to have a higher rate of complications, mortality and hospitalisation time.