Unusual gastrointestinal manifestations of COVID-19: two case reports.

As of December 2019, a new strain of coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was discovered in Wuhan, China, following an epidemic of a fast-spreading viral respiratory disease, later called Coronavirus Disease 2019 (COVID-19), which then lead to the present pandemic the world has come to know. Patients who tested positive for COVID-19 are mostly asymptomatic or present with mild self-limiting symptoms. While GI symptoms occur with less prevalence, they are increasingly being reported. A diagnosis of Covid-19 has increased dramatically in patients presenting with gastrointestinal symptoms suggesting that GI symptoms should be taken into serious consideration with patient diagnosis. Case 1: A 65-year-old man presented to the hospital emergency room with abdominal pain, Murphy's sign and chills without fever, subsequently diagnosed as acute acalculous cholecystitis with a positive COVID-19 rRT-PCR. Case 2: A 78-year-old woman presented to the hospital emergency room complaining of severe positional epigastric pain precipitated by lying supine, chills with no fever, being later diagnosed as acute pancreatitis and a positive COVID-19 rRT-PCR. It has become evident that the ACE2 receptor plays a significant role as the entry site into human cells for the virus. This receptor is generally expressed in respiratory cells, as well as the gastrointestinal tract, corresponding with extrapulmonary manifestations of COVID-19. Studies concluded that the origin of gastrointestinal symptoms could be caused by the interaction of the SARS-CoV-2 virus with cells through the ACE2 receptor. The findings of the present study support this theory, as both patients presented with symptoms regarding tissues with high ACE2 expression.

A Randomized Clinical Trial of the Effect of Pentoxifylline on C-Reactive Protein Level and Dialysis Adequacy in End-stage Renal Disease Patients on Maintenance Hemodialysis.

INTRODUCTION:  C-reactive protein (CRP) is increased among patients on maintenance hemodialysis. Such inflammatory markers can result in protein-energy deficit syndromes and low adequacy of dialysis in these patients. This study evaluated the effect of pentoxifylline on serum CRP level and KT/V in end-stage renal disease patients on maintenance hemodialysis. MATERIAL AND METHODS: This 1-month randomized, double-blind, placebo-controlled clinical trial involving 73 patients with end-stage renal disease on maintenance hemodialysis assessed the effectiveness of 400 mg/d of pentoxifylline on serum CRP level decrease and improvement of dialysis adequacy. RESULTS: The difference in mean serum CRP levels of the pentoxifylline and placebo groups was not significant before study. While CRP showed showed a significant increase in the placebo group after completing the interventions (P = .01), the difference was nonsignificant in the pentoxifylline group (P = .53). The difference in the mean adequacy of dialysis was not significant before the interventions between the two groups, while there was a significant increase in the pentoxifylline group (P = .01) and a nonsignificant increase in the placebo group (P = .31) after the interventions. CONCLUSIONS: Among patients on maintenance hemodialysis, a 1-month trial of pentoxifylline was associated with a substantial improvement of adequacy of dialysis and a significant prevention from serum CRP level increase, but not a significant reduction in the mean serum CRP level.