|
1
|
Şirikçi V, Kiraç CO, Findikli HA. Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study. Medicine (Baltimore) 2024; 103:e40873. [PMID: 39654162 PMCID: PMC11631023 DOI: 10.1097/md.0000000000040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 11/14/2024] [Accepted: 11/20/2024] [Indexed: 12/12/2024] Open
Abstract
The impact of COVID-19 lockdown on glycemic control in patients with diabetes mellitus (DM) remains unclear. This study aimed to investigate the effects of lockdown measures on the metabolic parameters of patients with DM, with particular emphasis on geriatric populations. In this retrospective, longitudinal cohort study, 1224 patients were analyzed. Three periods were identified to examine the effects of the lockdown: pre-lockdown, lockdown, and post-lockdown. Each period spanned 1-year. Within each 1-year period, at least 2 measurements were taken at least 3 months apart, and their arithmetic mean was calculated. Only patients who presented to the hospital for DM management during all 3 periods were included in the study. While HbA1c levels significantly increased in patients over 65 years old during the lockdown period (P = .017), we observed a significant decrease in HbA1c levels in patients under 65 years old (P = .014). Upon further stratification of patients over 65 by age groups, HbA1c levels increased the most among those aged 75 to 85 years, with a significant rise also observed in those aged 65 to 75 years during the lockdown. However, there was no change in HbA1c levels for patients over 85 years old during the lockdown. These findings highlight the need for careful monitoring of elderly patients with DM during lockdown periods, facilitated via home care or telehealth services. Structured diet and exercise programs should also be provided for at home adherence.
Collapse
Affiliation(s)
- Vehbi Şirikçi
- Department of Internal Medicine, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Cem Onur Kiraç
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | | |
Collapse
|
|
2
|
Horvath A, Haller R, Feldbacher N, Habisch H, Žukauskaitė K, Madl T, Stadlbauer V. Probiotic Therapy of Gastrointestinal Symptoms During COVID-19 Infection: A Randomized, Double-Blind, Placebo-Controlled, Remote Study. Nutrients 2024; 16:3970. [PMID: 39599756 PMCID: PMC11597392 DOI: 10.3390/nu16223970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/02/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND The novel coronavirus (SARS-CoV-2) led to gastrointestinal manifestations in up to 50% of cases, with diarrhea being common, and probiotics have been suggested as a potential treatment. AIM This study aimed to assess changes in the microbiome and the effects of a multispecies probiotic in patients with COVID-19 in home quarantine through a fully remote telemedical approach. METHODS Thirty patients were randomized to receive either the Ecologic AAD probiotic (Winclove Probiotics, Amsterdam, The Netherlands), on the market as OMNi-BiOTiC 10 (Allergosan, Austria), or a placebo for 30 days in a 2:1 ratio. Respiratory and gastrointestinal symptoms were monitored in 2-10-day intervals via online surveys, and five stool samples were collected during the 30-day study period for microbiome and metabolomics analyses. Twenty-four healthy volunteers served as controls. RESULTS Of the 30 patients, 26 completed this study (10 placebo, 16 probiotic). Patients reported respiratory symptoms and a diminished gastrointestinal quality of life, both of which improved significantly during the study period, irrespective of the intervention. Compared to controls, infected patients showed significant alterations in the fecal microbiome (p = 0.002), including an increase in Bacteroidetes and decreases in Christensenellaceae, Ruminococcaceae, and Gammaproteobacteria, along with metabolomic changes. Probiotic treatment significantly modulated the patients' microbiome beta diversity (p = 0.001) and introduced the Enterococcus faecium W54 strain. Symptoms, COVID-19-related taxa, and the fecal metabolome were not affected by the intervention. CONCLUSIONS Patients with mild COVID-19 disease in home quarantine exhibited respiratory symptoms, a reduced gastrointestinal quality of life, and changes in the fecal microbiome and metabolome.
Collapse
Affiliation(s)
- Angela Horvath
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (A.H.)
- Center for Biomarker Research in Medicine (CBmed), Division Translational Precision Medicine, 8010 Graz, Austria
| | - Rosa Haller
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (A.H.)
- Center for Biomarker Research in Medicine (CBmed), Division Translational Precision Medicine, 8010 Graz, Austria
| | - Nicole Feldbacher
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (A.H.)
- Center for Biomarker Research in Medicine (CBmed), Division Translational Precision Medicine, 8010 Graz, Austria
| | - Hansjörg Habisch
- Otto Loewi Research Center, Medicinal Chemistry, Medical University of Graz, 8010 Graz, Austria
| | - Kristina Žukauskaitė
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (A.H.)
- Institute of Biosciences, Life Sciences Center, Vilnius University, 01513 Vilnius, Lithuania
| | - Tobias Madl
- Otto Loewi Research Center, Medicinal Chemistry, Medical University of Graz, 8010 Graz, Austria
- BioTechMed-Graz, 8010 Graz, Austria
| | - Vanessa Stadlbauer
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria; (A.H.)
- Center for Biomarker Research in Medicine (CBmed), Division Translational Precision Medicine, 8010 Graz, Austria
| |
Collapse
|
|
3
|
Donkers A, Seel W, Klümpen L, Simon MC. The Multiple Challenges of Nutritional Microbiome Research During COVID-19-A Perspective and Results of a Single-Case Study. Nutrients 2024; 16:3693. [PMID: 39519526 PMCID: PMC11547757 DOI: 10.3390/nu16213693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 10/25/2024] [Accepted: 10/27/2024] [Indexed: 11/16/2024] Open
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has affected multiple aspects of people's lives, which may also influence the results of studies conducted during this period across diverse research domains. This particularly includes the field of nutritional science, investigating the gut microbiota as a potential mediator in the association between dietary intake and health-related outcomes. This article identifies the challenges currently facing this area of research, points out potential solutions, and highlights the necessity to consider a range of issues when interpreting trials conducted during this period. Some of these issues have arisen specifically because of the measures implemented to interrupt the spread of small acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while others remain relevant beyond the pandemic.
Collapse
Affiliation(s)
| | | | | | - Marie-Christine Simon
- Nutrition and Microbiota, Institute of Nutrition and Food Science, University of Bonn, 53115 Bonn, Germany
| |
Collapse
|
|
4
|
Sasaki Y, Yano M, Umehara A, Tagashira Y. Implementation of multifaceted diagnostic stewardship for Clostridioides difficile infection during the COVID-19 pandemic at a small Japanese hospital. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e96. [PMID: 38836045 PMCID: PMC11149025 DOI: 10.1017/ash.2024.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
Objective Clostridioides difficile infection (CDI) is a common, healthcare-associated infection. However, in Japan, testing for CDI is infrequent, suggesting that its incidence may be underestimated. This study aimed to examine the implementation of a multifaceted, diagnostic stewardship (DS) for CDI in a small Japanese hospital during the coronavirus 2019 pandemic. Design Before-after study. Setting A small Japanese community hospital. Participants Healthcare workers including physicians, nurses, and pharmacists. Interventions A multifaceted intervention including (1) the addition of CD testing criteria to the hospital guidelines; (2) provision of a tutorial on CD testing to physicians, nurses, and pharmacists; (3) assessment by clinical pharmacists and nurses of the need for CD testing in patients with nosocomial diarrhea and issuance of recommendations for CD testing to physicians; (4) reporting of data on the CD testing rate and CDI incidence in the study center. Results The CD testing rate increased before the pandemic (+0.16/10,000 patient-days (PD); P = .28), decreased significantly during the pandemic (-0.79/10,000 PD; P = .02), and then increased significantly immediately after the implementation of the intervention (+29.6/10,000 PD; P < .01). Similarly, the CDI incidence increased significantly before the pandemic (+0.26/10,000 PD; P = .02) and decreased significantly during the pandemic (-0.49/10,000 PD; P = .01). Implementation of the intervention resulted in an immediate and significant increase in the CDI incidence (+6.2/10,000 PD; P < .01). Conclusion Multifaceted DS involving multidisciplinary specialists was effective in improving CD testing, suggesting that appropriate testing can contribute to diagnosing CDI accurately.
Collapse
Affiliation(s)
- Yasuhiro Sasaki
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | - Masataka Yano
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | - Ayumi Umehara
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
| | - Yasuaki Tagashira
- Department of Infection Control, Tama-Nambu Chiiki Hospital, Tokyo, Japan
- Department of Infectious Diseases, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| |
Collapse
|
|
5
|
Mehta D, Kelkar R, Patel N, Trivedi PD, Dawoodi S, Patel D, Solanki D, Hussain A, Nagaraj S, Khayat A, Samala Venkata V, Mansuri U, Patel UK, Sacks H, Atreja A. Gastrointestinal Manifestations and Outcomes of COVID-19: A Comprehensive Systematic Review and Meta-analysis. Cureus 2023; 15:e47028. [PMID: 37965386 PMCID: PMC10642711 DOI: 10.7759/cureus.47028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Deep Mehta
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Raveena Kelkar
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neel Patel
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Parth D Trivedi
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sameer Dawoodi
- Gastroenterology, State University of New York Downstate Medical Center, New York, USA
- Internal Medicine, Yale New Haven Hospital, New Haven, USA
| | - Dhruvan Patel
- Gastroenterology, Mercy Fitzgerald Hospital, Darby, USA
- Gastroenterology, University of Pennsylvania, Philadelphia, USA
| | | | - Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Hazard, USA
| | | | - Azadeh Khayat
- Pathology and Laboratory Medicine, Brown University, Providence, USA
| | | | - Uvesh Mansuri
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Henry Sacks
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ashish Atreja
- Internal Medicine (Division of Gastroenterology), Icahn School of Medicine at Mount Sinai, New York, USA
- Digital Health, University of California Davis Health, Sacramento, USA
| |
Collapse
|
|
6
|
Muzellina VN, Abdullah M, Kurniawan J, Rizka A. Relationship between anal swab PCR for SARS-CoV-2 with gastrointestinal clinical manifestations and severity of COVID-19 infection in Indonesia. F1000Res 2023; 12:358. [PMID: 37767018 PMCID: PMC10521035 DOI: 10.12688/f1000research.128821.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) cases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Indonesia remain high. The virus can bind with ACE2 receptor which is not only found in the lungs, but also in the digestive tract. Thus, it allows SARS-CoV-2 infection in the gastrointestinal tract, gastrointestinal manifestations, and detection of viral RNA on anal swab using polymerase chain reaction (PCR). There hasn't been similar study about the role of anal swab in Indonesia yet. Therefore, this study aims to determine the relationship between SARS-COV-2 anal swab PCR with gastrointestinal clinical manifestations, and the severity of COVID-19 in Indonesia. Methods: This is an analytical study with cross-sectional design. Samples were obtained from hospitalized COVID-19 patients from July 2020 to January 2021. Demographic data, clinical manifestations, severity, and SARS-CoV-2 anal swabs PCR were collected using case report form. Results: A total of136 patients were analyzed. 52 patients (38.2%) had positive SARS-CoV-2 anal swabs PCR and 84 patients (61.8%) had negative results. The most common gastrointestinal clinical manifestations were nausea and vomiting in 69 patients (50.7%), anorexia in 62 patients (45.6%), and abdominal pain in 31 patients (22.8%). There were 114 patients (83,8%) classified as mild-moderate symptoms and 22 patients (16,2%) classified as severe-critical symptoms. There was a statistically significant relationship between the gastrointestinal tract SARS-CoV-2 infection and gastrointestinal clinical manifestations (P=0.031). There was no statistically significant relationship between the gastrointestinal SARS-CoV-2 infection and the severity of COVID-19 infection (P = 0.844). Conclusions: This study showed there is a significant relationship between SARS-CoV-2 anal swab PCR with gastrointestinal clinical manifestations. There is no significant relationship between anal swab PCR with the severity of COVID-19 infection.
Collapse
Affiliation(s)
- Virly Nanda Muzellina
- Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Departement of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Pancreatobiliary, and Digestive Endoscopy, Departement of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Juferdy Kurniawan
- Division of Hepatobiliary, Department of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Aulia Rizka
- Division of Geriatric Medicine, Departement of Internal Medicine, Dr. Cipto Mangunkusumo National Central General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
|
7
|
Golla R, Vuyyuru SK, Kante B, Kedia S, Ahuja V. Disorders of gut-brain interaction in post-acute COVID-19 syndrome. Postgrad Med J 2023; 99:834-843. [PMID: 37130814 DOI: 10.1136/pmj-2022-141749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/18/2022] [Indexed: 11/03/2022]
Abstract
The novel coronavirus SARS-CoV-2 is responsible for the devastating pandemic which has caused more than 5 million deaths across the world until today. Apart from causing acute respiratory illness and multiorgan dysfunction, there can be long-term multiorgan sequalae after recovery, which is termed 'long COVID-19' or 'post-acute COVID-19 syndrome'. Little is known about long-term gastrointestinal (GI) consequences, occurrence of post-infection functional gastrointestinal disorders and impact the virus may have on overall intestinal health. In this review, we put forth the various mechanisms which may lead to this entity and possible ways to diagnose and manage this disorder. Hence, making physicians aware of this spectrum of disease is of utmost importance in the present pandemic and this review will help clinicians understand and suspect the occurrence of functional GI disease post recovery from COVID-19 and manage it accordingly, avoiding unnecessary misconceptions and delay in treatment.
Collapse
Affiliation(s)
- Rithvik Golla
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sudheer Kumar Vuyyuru
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Bhaskar Kante
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Saurabh Kedia
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vineet Ahuja
- Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India
| |
Collapse
|
|
8
|
Kuriki S, Nishida T, Chang LS, Hosokawa K, Fujii Y, Osugi N, Nakamatsu D, Matsumoto K, Yamamoto M, Morimura O, Abe K, Okauchi Y, Iwahashi H, Inada M. Gastrointestinal symptoms in 609 Japanese patients with COVID-19: a single-center retrospective study. Scand J Gastroenterol 2023; 58:1139-1144. [PMID: 37114496 DOI: 10.1080/00365521.2023.2204387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND GI symptoms are common in acute COVID-19 patients. This study aimed to characterize the GI symptoms occurring in Japanese COVID-19 patients. METHODS This retrospective single-center cohort study included 751 hospitalized acute COVID-19 patients. The primary outcomes were the frequency and severity of GI symptoms. The secondary outcomes included the association between COVID-19 severity and GI symptoms and the timing of GI symptom onset. RESULTS After exclusion, the data of 609 patients were analyzed. The median age was 62 years, and 55% were male. The median time from initial symptom onset to admission was five days. On admission, 92% of the patients had fever, 35.1% had fatigue, 75% had respiratory symptoms, and 75% had pneumonia. The sample included patients with mild (19%), moderate (59%), and severe COVID-19 (22%). A total of 218 patients (36%) had GI symptoms, of which 93% were classified as grade 1/2; 170 patients had both respiratory and GI symptoms. Diarrhea was the most frequent GI symptom, occurring in 170 patients, followed by anorexia in 73 patients and nausea/vomiting in 36 patients, and abdominal pain in 8 patients. There was no significant relationship between COVID-19 severity and GI symptoms. Among COVID-19 patients with both GI and respiratory symptoms, 48% had respiratory symptoms preceding GI symptoms, 25% had GI symptoms preceding respiratory symptoms and 27% had a simultaneous onset of respiratory and GI symptoms. CONCLUSION Thirty-six percent of the Japanese COVID-19 patients had GI symptoms; diarrhea was the most frequent GI symptom but did not predict severe COVID-19.
Collapse
Affiliation(s)
- Shinji Kuriki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Li-Sa Chang
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kana Hosokawa
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yoshifumi Fujii
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Naoto Osugi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Osamu Morimura
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kinya Abe
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yukiyoshi Okauchi
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan
- Diabetes Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Hiromi Iwahashi
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan
- Diabetes Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Masami Inada
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| |
Collapse
|
|
9
|
Karuna S, Gallardo-Cartagena JA, Theodore D, Hunidzarira P, Montenegro-Idrogo J, Hu J, Jones M, Kim V, De La Grecca R, Trahey M, Karg C, Takalani A, Polakowski L, Hutter J, Miner MD, Erdmann N, Goepfert P, Maboa R, Corey L, Gill K, Li SS, HVTN 405/HPTN 1901 Study Team. Post-COVID symptom profiles and duration in a global convalescent COVID-19 observational cohort: Correlations with demographics, medical history, acute COVID-19 severity and global region. J Glob Health 2023; 13:06020. [PMID: 37352144 PMCID: PMC10289480 DOI: 10.7189/jogh.13.06020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
Background Post-COVID conditions are characterised by persistent symptoms that negatively impact quality of life after SARS-CoV-2 diagnosis. While post-COVID risk factors and symptoms have been extensively described in localised regions, especially in the global north, post-COVID conditions remain poorly understood globally. The global, observational cohort study HVTN 405/HPTN 1901 characterises the convalescent course of SARS-CoV-2 infection among adults in North and South America and Africa. Methods We categorised the cohort by infection severity (asymptomatic, symptomatic, no oxygen requirement (NOR), non-invasive oxygen requirement (NIOR), invasive oxygen requirement (IOR)). We applied a regression model to assess correlations of demographics, co-morbidities, disease severity, and concomitant medications with COVID-19 symptom persistence and duration across global regions. Results We enrolled 759 participants from Botswana, Malawi, South Africa, Zambia, Zimbabwe, Peru, and the USA a median of 51 (interquartile range (IQR) = 35-66) days post-diagnosis, from May 2020 to March 2021. 53.8% were female, 69.8% were 18-55 years old (median (md) = 44 years old, IQR = 33-58). Comorbidities included obesity (42.8%), hypertension (24%), diabetes (14%), human immunodeficiency virus (HIV) infection (11.6%) and lung disease (7.5%). 76.2% were symptomatic (NOR = 47.4%; NIOR = 22.9%; IOR = 5.8%). Median COVID-19 duration among symptomatic participants was 20 days (IQR = 11-35); 43.4% reported symptoms after COVID-19 resolution, 33.6% reported symptoms ≥30 days, 9.9% reported symptoms ≥60 days. Symptom duration correlated with disease severity (P < 0.001, NIOR vs NOR; P = 0.003, IOR vs NOR), lung disease (P = 0.001), race (P < 0.05, non-Hispanic Black vs White), and global region (P < 0.001). Prolonged viral shedding correlated with persistent abdominal pain (odds ratio (OR) = 5.51, P < 0.05) and persistent diarrhoea (OR = 6.64, P < 0.01). Conclusions Post-COVID duration varied with infection severity, race, lung disease, and region. Better understanding post-COVID conditions, including regionally-diverse symptom profiles, may improve clinical assessment and management globally. Registration Clinicaltrials.gov (#NCT04403880).
Collapse
Affiliation(s)
- Shelly Karuna
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jorge A Gallardo-Cartagena
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Deborah Theodore
- Columbia University Physicians & Surgeons, New York, New York, USA
| | - Portia Hunidzarira
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Juan Montenegro-Idrogo
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Jiani Hu
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Megan Jones
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Vicky Kim
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Meg Trahey
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Carissa Karg
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Azwi Takalani
- Hutchinson Centre for Research in South Africa, Johannesburg, Republic of South Africa
| | | | | | | | | | | | - Rebone Maboa
- Ndlovu Research Centre, Elandsdoorn, Limpopo, Republic of South Africa
| | | | - Katherine Gill
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | | | - HVTN 405/HPTN 1901 Study Team
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Columbia University Physicians & Surgeons, New York, New York, USA
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Hutchinson Centre for Research in South Africa, Johannesburg, Republic of South Africa
- National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA University of Alabama at Birmingham, Birmingham, Alabama, USA
- Ndlovu Research Centre, Elandsdoorn, Limpopo, Republic of South Africa
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, Republic of South Africa
| |
Collapse
|
|
10
|
Cárdenas-Jaén K, Sánchez-Luna SA, Vaillo-Rocamora A, Castro-Zocchi MR, Guberna-Blanco L, Useros-Brañas D, Remes-Troche JM, Ramos-De la Medina A, Priego-Parra BA, Velarde-Ruiz Velasco JA, Martínez-Ayala P, Urzúa Á, Guiñez-Francois D, Pawlak KM, Kozłowska-Petriczko K, Gorroño-Zamalloa I, Urteaga-Casares C, Ortiz-Polo I, Del Val Antoñana A, Lozada-Hernández EE, Obregón-Moreno E, García-Rayado G, Domper-Arnal MJ, Casas-Deza D, Esteban-Cabello EI, Díaz LA, Riquelme A, Martínez-Lozano H, Navarro-Romero F, Olivas I, Iborra-Muñoz G, Calero-Amaro A, Caravaca-García I, Lacueva-Gómez FJ, Pastor-Mateu R, Lapeña-Muñoz B, Sastre-Lozano V, Pizarro-Vega NM, Melcarne L, Pedrosa-Aragón M, Mira JJ, MStat AM, Carrillo I, de-Madaria E. Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project). GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:425-438. [PMID: 36243249 PMCID: PMC9557114 DOI: 10.1016/j.gastrohep.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
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.
Collapse
Affiliation(s)
- Karina Cárdenas-Jaén
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sergio A Sánchez-Luna
- Basil I, Hirschowitz Endoscopic Center of Excellence, Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Alabama at Birmingham, Birmingham, United States
| | - Alicia Vaillo-Rocamora
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Micaela Riat Castro-Zocchi
- Gastroenterology Department, La Princesa University Hospital and IIS-Princesa & Biomedical Research Center on Liver and Digestive Diseases Network (CIBEREHD), Madrid, Spain
| | - Laura Guberna-Blanco
- Gastroenterology Department, La Princesa University Hospital and IIS-Princesa & Biomedical Research Center on Liver and Digestive Diseases Network (CIBEREHD), Madrid, Spain
| | - Daniel Useros-Brañas
- Internal Medicine Department, La Princesa University Hospital & IIS-Princesa, Madrid, Spain
| | - José M Remes-Troche
- Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
| | - Antonio Ramos-De la Medina
- Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
| | - Bryan A Priego-Parra
- Gastroenterology Department, Spanish Hospital of Veracruz & Medical Biological Research Institute, Veracruz University, Veracruz, Mexico
| | | | - Pedro Martínez-Ayala
- Gastroenterology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - Álvaro Urzúa
- Gastroenterology Section, Internal Medicine Department, Clinical Hospital University of Chile, Santiago, Chile
| | | | - Katarzyna M Pawlak
- Gastroenterology Department, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | | | | | | | - Inmaculada Ortiz-Polo
- Gastroenterology Unit, Digestive Diseases Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Adolfo Del Val Antoñana
- Gastroenterology Unit, Digestive Diseases Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Edgard E Lozada-Hernández
- General Surgery Service, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, León-Guanajuato, Mexico
| | - Enrique Obregón-Moreno
- General Surgery Service, Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, León-Guanajuato, Mexico
| | - Guillermo García-Rayado
- Gastroenterology Department, Lozano Blesa University Clinical Hospital & Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - María José Domper-Arnal
- Gastroenterology Department, Lozano Blesa University Clinical Hospital & Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Diego Casas-Deza
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital & Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | | | - Luis A Díaz
- Gastroenterology Department and Department of Health Sciences, AIRR Working Group, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Gastroenterology Department and Department of Health Sciences, AIRR Working Group, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Helena Martínez-Lozano
- Gastroenterology Department, Gregorio Marañón General University Hospital & Gregorio Marañón Institute of Health Research, Madrid, Spain
| | | | - Ignasi Olivas
- Gastroenterology Department, Hospital Clinic of Barcelona & Centre for Biomedical Research Network on Liver and Digestive Diseases (CIBEReHD) & August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | | | | | - Rubén Pastor-Mateu
- Gastroenterology Department, Valencia General University Hospital Consortium, Valencia, Spain
| | | | | | | | - Luigi Melcarne
- Gastroenterology Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Marc Pedrosa-Aragón
- Infectious Diseases Department, Parc Taulí University Hospital, Sabadell, Spain
| | - José J Mira
- ATENEA Research, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Alicante, Spain; Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Aurora Mula MStat
- ATENEA Research, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Alicante, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Enrique de-Madaria
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Spain.
| |
Collapse
|
|
11
|
Hagiwara J, Bunya N, Harada K, Nakase H, Narimatsu E. Fatal Gastrointestinal Disorders Due to COVID-19: A Case Series. Cureus 2023; 15:e40286. [PMID: 37448415 PMCID: PMC10336742 DOI: 10.7759/cureus.40286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19) primarily develop respiratory symptoms, which sometimes can be serious. Respiratory failure is the most common cause of death from COVID-19. This disease also causes gastrointestinal (GI) symptoms. However, there are limited reports that severe GI disorders caused by COVID-19 can be fatal. Herein, we report three cases of fatal GI disorders caused by COVID-19. All patients developed severe pneumonia requiring mechanical ventilation and venovenous extracorporeal membrane oxygenation (V-V ECMO) support. The respiratory status improved, and the patients could be weaned off support. However, severe watery diarrhea (over a few liters per day) developed after the onset of respiratory failure. The CT, endoscopic, and pathological findings were similar to those observed in GI graft-versus-host disease (GI-GVHD). Despite various efforts, the GI disorders did not improve, and all patients died of multiple organ failures associated with sepsis due to intestinal mucosal disruption. COVID-19 can cause fatal GI disorders and may have similar characteristics to GI-GVHD. Further investigation will contribute to a comprehensive understanding of fatal GI disorders due to COVID-19.
Collapse
Affiliation(s)
- Junya Hagiwara
- Intensive Care Unit, Sapporo Medical University, Sapporo, JPN
| | - Naofumi Bunya
- Intensive Care Unit, Sapporo Medical University, Sapporo, JPN
| | - Keisuke Harada
- Intensive Care Unit, Sapporo Medical University, Sapporo, JPN
| | - Hiroshi Nakase
- Gastroenterology and Hepatology, Sapporo Medical University, Sapporo, JPN
| | - Eichi Narimatsu
- Intensive Care Unit, Sapporo Medical University, Sapporo, JPN
| |
Collapse
|
|
12
|
Ivashkin V, Fomin V, Moiseev S, Brovko M, Maslennikov R, Ulyanin A, Sholomova V, Vasilyeva M, Trush E, Shifrin O, Poluektova E. Efficacy of a Probiotic Consisting of Lacticaseibacillus rhamnosus PDV 1705, Bifidobacterium bifidum PDV 0903, Bifidobacterium longum subsp. infantis PDV 1911, and Bifidobacterium longum subsp. longum PDV 2301 in the Treatment of Hospitalized Patients with COVID-19: a Randomized Controlled Trial. Probiotics Antimicrob Proteins 2023; 15:460-468. [PMID: 34643888 PMCID: PMC8512595 DOI: 10.1007/s12602-021-09858-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
The treatment of coronavirus disease (COVID-19) and COVID-19-associated diarrhea remains challenging. This study aimed to evaluate the efficacy of a multi-strain probiotic in the treatment of COVID-19. This was a randomized, controlled, single-center, open-label trial (NCT04854941). Inpatients with confirmed COVID-19 and pneumonia were randomly assigned to a group that received a multi-strain probiotic (PRO group) or to the control group (CON group). There were 99 and 101 patients in the PRO and CON groups, respectively. No significant differences in mortality, total duration of disease and hospital stay, incidence of intensive care unit admission, need for mechanical ventilation or oxygen support, liver injury development, and changes in inflammatory biomarker levels were observed between the PRO and CON groups among all included patients as well as among subgroups delineated based on age younger or older than 65 years, and subgroups with chronic cardiovascular diseases and diabetes. Diarrhea on admission was observed in 11.5% of patients; it resolved earlier in the PRO group than in the CON group (2 [1-4] vs. 4 [3-6] days; p = 0.049). Hospital-acquired diarrhea developed less frequently in the PRO group than in the CON group among patients who received a single antibiotic (0% vs. 12.5%; p = 0.023) unlike among those who received > 1 antibiotic (10.5% vs. 13.3%; p = 0.696). The studied probiotic had no significant effect on mortality and changes in most biomarkers in COVID-19. However, it was effective in treating diarrhea associated with COVID-19 and in preventing hospital-acquired diarrhea in patients who received a single antibiotic.
Collapse
Affiliation(s)
- Vladimir Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for Human Microbiome Research, Moscow, Russian Federation
| | - Victor Fomin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Sergey Moiseev
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Michail Brovko
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Roman Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation.
- Scientific Community for Human Microbiome Research, Moscow, Russian Federation.
| | - Anatoly Ulyanin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for Human Microbiome Research, Moscow, Russian Federation
| | - Victoria Sholomova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Maria Vasilyeva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Elizaveta Trush
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Oleg Shifrin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Elena Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for Human Microbiome Research, Moscow, Russian Federation
| |
Collapse
|
|
13
|
Duhan S, Keisham B, Salim A. Fulminant Clostridioides difficile Colitis With SARS-CoV-2 Infection. Cureus 2023; 15:e38401. [PMID: 37265903 PMCID: PMC10231867 DOI: 10.7759/cureus.38401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Clostridioides difficile (C. difficile)and coronavirus disease 2019 (COVID-19) infections can have overlapping symptoms. Recently, the association and outcomes of coinfection have been studied. We present the case of an 83-year-old lady with Parkinson's disease (PD) who was admitted with pneumonia secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. She was treated with empiric antibiotics ampicillin-sulbactam and azithromycin, along with antiviral therapy remdesivir and baricitinib, and dexamethasone. The patient developed severe C. difficile infection with a leukemoid reaction. She was treated with intravenous metronidazole and oral vancomycin without any improvement. Before she could receive a fecal microbiota transplant, her infection progressed to fulminant colitis, and she required emergent surgery. The patient developed several complications post-surgery and succumbed to the severe illness. Our patient's multiple comorbidities and an underlying COVID-19 infection predisposed her to severe illness. This case emphasizes the long-standing discussion on antibiotic stewardship and encourages a debate on the role of immunosuppressant antiviral medications and underlying PD in predisposing patients to a severe C. difficile infection.
Collapse
Affiliation(s)
- Sanchit Duhan
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Bijeta Keisham
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Ahlaa Salim
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| |
Collapse
|
|
14
|
Helou M, Nasr J, El Osta N, Jabbour E, Husni R. Liver manifestations in COVID-19 patients: A review article. World J Clin Cases 2023; 11:2189-2200. [PMID: 37122526 PMCID: PMC10131011 DOI: 10.12998/wjcc.v11.i10.2189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/09/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) initially presented as a disease that affected the lungs. Then, studies revealed that it intricately affected disparate organs in the human body, with the liver being one of the most affected organs. This review aimed to assess the association between COVID-19 and liver function, shedding light on its clinical implication. However, its exact pathophysiology remains unclear, involving many factors, such as active viral replication in the liver cells, direct cytotoxic effects of the virus on the liver or adverse reactions to viral antigens. Liver symptoms are mild-to-moderate transaminase elevation. In some patients, with underlying liver disease, more serious outcomes are observed. Thus, liver function should be meticulously considered in patients with COVID-19.
Collapse
Affiliation(s)
- Mariana Helou
- Division of Emergency Medicine, Department of Internal Medicine, Lebanese American University Medical Center, Lebanese American University School of Medicine, Beirut 1102-2801, Lebanon
| | - Janane Nasr
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut 1102-2801, Lebanon
| | - Nour El Osta
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut 1102-2801, Lebanon
| | - Elsy Jabbour
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut 1102-2801, Lebanon
| | - Rola Husni
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut 1102-2801, Lebanon
| |
Collapse
|
|
15
|
Al Oweidat K, Al-Amer R, Saleh MY, Albtoosh AS, Toubasi AA, Ribie MK, Hasuneh MM, Alfaqheri DL, Alshurafa AH, Ribie M, Ali AM, Obeidat N. Mortality, Intensive Care Unit Admission, and Intubation among Hospitalized Patients with COVID-19: A One-Year Retrospective Study in Jordan. J Clin Med 2023; 12:jcm12072651. [PMID: 37048734 PMCID: PMC10094820 DOI: 10.3390/jcm12072651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
COVID-19 is a public health crisis that has caused numerous deaths, necessitated an increased number of hospital admissions, and led to extended inpatient stays. This study aimed to identify the factors associated with COVID-19 mortality, intensive care unit admission, intubation, and length of hospital stay among Jordanian patients. This was a one-year retrospective study of 745 COVID-19 patients admitted to Jordan University Hospital. Data regarding the patients’ demographics, clinical and co-morbid conditions, imaging, laboratory parameters, mortality, intensive care unit admission (ICU), and intubation were collected from their medical records using a coding manual. The data revealed that the overall rates of COVID-19-related mortality, ICU admission, and invasive intubation were 23.0%, 28.3%, and 10.8%, respectively. Chronic kidney disease (CKD), troponin, lactate dehydrogenase (LDH), and O2 saturation <90% were significantly associated with the mortality rate. The variables that were significantly associated with ICU admission were heart failure and the use of remdesivir. However, O2 saturation <90% and gastrointestinal (GI) symptoms were the only variables associated with invasive intubation. The findings of this study suggest that study-related health outcomes can be used to predict the severity of COVID-19, and they can inform future research aiming to identify specific populations who are at a higher risk of COVID-19 complications.
Collapse
Affiliation(s)
- Khaled Al Oweidat
- Department of Respiratory and Sleep Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Rasmieh Al-Amer
- Faculty of Nursing, Isra University, Amman 11953, Jordan
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia
| | | | - Asma S. Albtoosh
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Ahmad A. Toubasi
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mona Khaled Ribie
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Manar M. Hasuneh
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Daniah L. Alfaqheri
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Abdullah H. Alshurafa
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Mohammad Ribie
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria 21527, Egypt
| | - Nathir Obeidat
- Department of Respiratory and Sleep Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
| |
Collapse
|
|
16
|
Bell MG, Ganesh R, Bonnes SL. COVID-19, the Gut, and Nutritional Implications. Curr Nutr Rep 2023:10.1007/s13668-023-00465-0. [PMID: 36894741 PMCID: PMC9998140 DOI: 10.1007/s13668-023-00465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE OF REVIEW Our goal is to provide the most recent and accurate scientific evidence available regarding COVID-19's interaction with the human gut and the role of nutrition/nutritional supplementation in the prevention and treatment of the disease. RECENT FINDINGS Gastrointestinal symptoms of COVID-19 are common and often persist even after classically defined illness resolution. Nutritional status and content have been shown to impact infection risk and severity. Well-balanced diets are associated with decreased infection risk/severity, and early nutrition is associated with better outcomes in the critically ill. No specific vitamin supplementation regimen has shown consistent benefit for infection treatment or prevention. The impact of COVID-19 extends far past the pulmonary system, and its impact on the gut should not be ignored. For those interested in adopting lifestyle modifications to prevent severe COVID-19 infection/side effects, consideration should be made for adoption of a well-balanced diet (e.g., Mediterranean style), utilization of probiotics, and addressing nutritional/vitamin deficiencies. Future, high-quality research is needed in this arena.
Collapse
Affiliation(s)
- Matthew G Bell
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
| |
Collapse
|
|
17
|
Clinical Significance of Gastrointestinal Symptoms in Hospitalized Patients With Covid-19 Infection. JOURNAL OF CONTEMPORARY MEDICINE 2023. [DOI: 10.16899/jcm.1119530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection.
Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated.
Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively.
Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.
Collapse
|
|
18
|
Mavragani A, Sanchez T, Ackerson BK, Hong V, Skarbinski J, Yau V, Qian L, Fischer H, Shaw SF, Caparosa S, Xie F. Natural Language Processing for Improved Characterization of COVID-19 Symptoms: Observational Study of 350,000 Patients in a Large Integrated Health Care System. JMIR Public Health Surveill 2022; 8:e41529. [PMID: 36446133 PMCID: PMC9822566 DOI: 10.2196/41529] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Natural language processing (NLP) of unstructured text from electronic medical records (EMR) can improve the characterization of COVID-19 signs and symptoms, but large-scale studies demonstrating the real-world application and validation of NLP for this purpose are limited. OBJECTIVE The aim of this paper is to assess the contribution of NLP when identifying COVID-19 signs and symptoms from EMR. METHODS This study was conducted in Kaiser Permanente Southern California, a large integrated health care system using data from all patients with positive SARS-CoV-2 laboratory tests from March 2020 to May 2021. An NLP algorithm was developed to extract free text from EMR on 12 established signs and symptoms of COVID-19, including fever, cough, headache, fatigue, dyspnea, chills, sore throat, myalgia, anosmia, diarrhea, vomiting or nausea, and abdominal pain. The proportion of patients reporting each symptom and the corresponding onset dates were described before and after supplementing structured EMR data with NLP-extracted signs and symptoms. A random sample of 100 chart-reviewed and adjudicated SARS-CoV-2-positive cases were used to validate the algorithm performance. RESULTS A total of 359,938 patients (mean age 40.4 [SD 19.2] years; 191,630/359,938, 53% female) with confirmed SARS-CoV-2 infection were identified over the study period. The most common signs and symptoms identified through NLP-supplemented analyses were cough (220,631/359,938, 61%), fever (185,618/359,938, 52%), myalgia (153,042/359,938, 43%), and headache (144,705/359,938, 40%). The NLP algorithm identified an additional 55,568 (15%) symptomatic cases that were previously defined as asymptomatic using structured data alone. The proportion of additional cases with each selected symptom identified in NLP-supplemented analysis varied across the selected symptoms, from 29% (63,742/220,631) of all records for cough to 64% (38,884/60,865) of all records with nausea or vomiting. Of the 295,305 symptomatic patients, the median time from symptom onset to testing was 3 days using structured data alone, whereas the NLP algorithm identified signs or symptoms approximately 1 day earlier. When validated against chart-reviewed cases, the NLP algorithm successfully identified signs and symptoms with consistently high sensitivity (ranging from 87% to 100%) and specificity (94% to 100%). CONCLUSIONS These findings demonstrate that NLP can identify and characterize a broad set of COVID-19 signs and symptoms from unstructured EMR data with enhanced detail and timeliness compared with structured data alone.
Collapse
Affiliation(s)
| | | | - Bradley K Ackerson
- Southern California Permanente Medical Group, Harbor City, CA, United States
| | - Vennis Hong
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Jacek Skarbinski
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, United States.,Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Vincent Yau
- Genentech, a Member of the Roche Group, San Francisco, CA, United States
| | - Lei Qian
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Heidi Fischer
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Sally F Shaw
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Susan Caparosa
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Fagen Xie
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| |
Collapse
|
|
19
|
Maslennikov R, Ivashkin V, Ufimtseva A, Poluektova E. A clinical variant of Coronavirus disease 2019 with diarrhea as the initial symptom compared with other variants. Minerva Gastroenterol (Torino) 2022; 68:487-489. [PMID: 33856143 DOI: 10.23736/s2724-5985.21.02827-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Roman Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russia -
- The Interregional Public Organization Scientific Community for the Promotion of the Clinical Study of the Human Microbiome, Moscow, Russia -
| | - Vladimir Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russia
| | - Anna Ufimtseva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russia
| | - Elena Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russia
- The Interregional Public Organization Scientific Community for the Promotion of the Clinical Study of the Human Microbiome, Moscow, Russia
| |
Collapse
|
|
20
|
Cuicchi D, Gabrielli L, Tardio ML, Rossini G, D’Errico A, Viale P, Lazzarotto T, Poggioli G. Virological and histological evaluation of intestinal samples in COVID-19 patients. World J Gastroenterol 2022; 28:6282-6293. [PMID: 36504555 PMCID: PMC9730443 DOI: 10.3748/wjg.v28.i44.6282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 11/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the pathogen responsible for pandemic coronavirus disease 2019 (COVID-19). It is a highly contagious virus which primarily affects the respiratory tract, nevertheless, the lungs are not the only target organs of the virus. The intestinal tract could represent an additional tropism site for SARS-CoV-2. Several observations have collectively suggested that enteric infections can occur in COVID-19 patients. However, the detection of viral RNA in gastrointestinal (GI) tissue samples has not been adequately investigated and results are conflicting.
AIM To detect the presence of SARS-CoV-2 RNA in intestinal mucosa samples and to evaluate histological features.
METHODS The COVID-19 patients hospitalized at an Italian tertiary hospital from April 2020 to March 2021 were evaluated for enrollment in an observational, monocentric trial. The study population was composed of two groups of adult patients. In the first group (biopsy group, 30 patients), patients were eligible for inclusion if they had mild to moderate disease and if they agreed to have a rectal biopsy; in the second group (surgical specimen group, 6 patients), patients were eligible for inclusion if they underwent intestinal resection during index hospitalization. Fifty-nine intestinal mucosal samples were analyzed.
RESULTS Viral RNA was not detectable in any of the rectal biopsies performed (0/53). Histological examination showed no enterocyte damage, but slight edema of the lamina propria with mild inflammatory lymphoplasmacytic infiltration. There was no difference in inflammatory infiltrates in patients with and without GI symptoms. SARS-CoV-2 RNA was detected in fecal samples in 6 cases out of 14 cases examined (42.9%). In the surgical specimen group, all patients underwent emergency intestinal resection. Viral RNA was detected in 2 surgical specimens of the 6 examined, both of which were from patients with active neoplastic disease. Histological examination also pointed out abundant macrophages, granulocytes and plasma cells infiltrating the muscular layer and adipose tissue, and focal vasculitis.
CONCLUSION Mild-moderate COVID-19 may not be associated with rectal infection by the virus. More comprehensive autopsies or surgical specimens are needed to provide histological evidence of intestinal infection.
Collapse
Affiliation(s)
- Dajana Cuicchi
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Liliana Gabrielli
- Department of Experimental, Diagnostic and Specialty Medicine, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Maria Lucia Tardio
- Department of Experimental, Diagnostic and Specialty Medicine, Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Giada Rossini
- Department of Experimental, Diagnostic and Specialty Medicine, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Antonietta D’Errico
- Department of Experimental, Diagnostic and Specialty Medicine, Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Pierluigi Viale
- Department for Integrated Infectious Risk Management, Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, University of Bologna, Bologna 40138, Italy
| | - Tiziana Lazzarotto
- Department of Experimental, Diagnostic and Specialty Medicine, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| |
Collapse
|
|
21
|
Filippatos F, Tatsi EB, Michos A. Post‑COVID‑19 syndrome in children (Review). Exp Ther Med 2022; 24:609. [PMID: 36160884 PMCID: PMC9468832 DOI: 10.3892/etm.2022.11547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
The persistence of symptoms for a long time after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is now familiar as post-COVID syndrome (PCS). To the best of our knowledge, the risk of long-term clinical outcomes in children after SARS-CoV-2 infection is still unclear. Unlike in adults, current evidence suggests a lower prevalence of persistent symptoms in children. However, since several studies are characterized by great heterogeneity, it is difficult to accurately estimate the exact incidence of PCS in children. The presence and course of recovery depend on risk factors that are more common in adults than children. Proposed pathophysiological mechanisms in PCS in children include age-dependent immune responses, angiotensin-converting enzyme 2 expression, blood-brain barrier development or social issues affecting children behavior, such as school closure and social isolation. However, further longitudinal studies are required for unanswered issues to be clarified. The aim of the present review is to describe the long-term symptoms per biological system in children, potential risk factors and the role of the immune system in the presence of PCS.
Collapse
Affiliation(s)
- Filippos Filippatos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
| | - Elizabeth-Barbara Tatsi
- University Research Institute for Maternal and Child Health and Precision Medicine, 11527 Athens, Greece
| | - Athanasios Michos
- First Department of Pediatrics, Infectious Diseases and Chemotherapy Research Laboratory, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children's Hospital, 11527 Athens, Greece
| |
Collapse
|
|
22
|
Rocchi G, Giovanetti M, Benedetti F, Borsetti A, Ceccarelli G, Zella D, Altomare A, Ciccozzi M, Guarino MPL. Gut Microbiota and COVID-19: Potential Implications for Disease Severity. Pathogens 2022; 11:1050. [PMID: 36145482 PMCID: PMC9503814 DOI: 10.3390/pathogens11091050] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 12/11/2022] Open
Abstract
The SARS-CoV-2 pandemic resulted in an unprecedented global crisis. SARS-CoV-2 primarily causes lung infection trough the binding of the virus with the ACE-2 cell receptor located on the surface of the alveolar epithelial cells. Notably, ACE-2 cell receptors are also expressed in the epithelial cells of the intestinal tract (GI). Recent data showed that the microbial communities of the GI might act as local and systematic inflammatory modulators. Gastrointestinal symptoms, including diarrhea, are frequently observed in infected individuals, and recent released data indicate that SARS-CoV-2 may also spread by fecal-oral transmission. Moreover, the gut microbiota's ecosystem can regulate and be regulated by invading pathogens, including viruses, facilitating an effective immune response, which in turn results in less severe diseases. In this regard, increased SARS-CoV-2 mortality and morbidities appear to be frequently observed in elderly immunocompromised patients and in people with essential health problems, such as diabetes, who, indeed, tend to have a less diverse gut microbiota (dysbiosis). Therefore, it is important to understand how the interaction between the gut microbiota and SARS-CoV-2 might shape the intensity of the infection and different clinical outcomes. Here, we provide insights into the current knowledge of dysbiosis during SARS-CoV-2 infection and methods that may be used to re-establish a more correct microbiota composition.
Collapse
Affiliation(s)
- Giulia Rocchi
- Department of Science and Engineering for Human and the Environment, University of Campus Bio-Medico, 00128 Rome, Italy
| | - Marta Giovanetti
- Laboratorio de Flavivirus, lnstituto Oswaldo Cruz/Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil
- Department of Science and Technology for Humans and the Environment, University of Campus Bio-Medico, 00128 Rome, Italy
| | - Francesca Benedetti
- Institute of Human Virology and Global Virus Network Center, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Alessandra Borsetti
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy
| | - Davide Zella
- Institute of Human Virology and Global Virus Network Center, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Annamaria Altomare
- Department of Science and Technology for Humans and the Environment, University of Campus Bio-Medico, 00128 Rome, Italy
- Unit of Digestive Disease, Campus Bio-Medico University, 00128 Rome, Italy
| | - Massimo Ciccozzi
- Medical Statistic and Molecular Epidemiology Unit, University of Biomedical Campus, 00128 Rome, Italy
| | | |
Collapse
|
|
23
|
Reveles KR, Frei AL, Strey KA, Young EH. Prevalence and Health Outcomes of Clostridioides difficile Infection during the COVID-19 Pandemic in a National Sample of United States Hospital Systems. Open Forum Infect Dis 2022; 9:ofac441. [PMID: 36092824 PMCID: PMC9452148 DOI: 10.1093/ofid/ofac441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented emphasis on infection control procedures; however, it is unknown whether the pandemic altered Clostridioides difficile infection (CDI) prevalence. This study investigated CDI prevalence before and during the COVID-19 pandemic in a national sample of United States (US) hospitals. Methods This was a retrospective cohort study using the Premier Healthcare Database. Patients with laboratory-confirmed CDI from April 2019 through March 2020 (pre–COVID-19 period) and April 2020 through March 2021 (COVID-19 period) were included. CDI prevalence (CDI encounters per 10 000 total encounters) and inpatient outcomes (eg, mortality, hospital length of stay) were compared between pre–COVID-19 and COVID-19 periods using bivariable analyses or interrupted time series analysis. Results A total of 25 992 CDI encounters were included representing 22 130 unique CDI patients. CDI prevalence decreased from the pre–COVID-19 to COVID-19 period (12.2 per 10 000 vs 8.9 per 10 000, P < .0001), driven by a reduction in inpatient CDI prevalence (57.8 per 10 000 vs 49.4 per 10 000, P < .0001); however, the rate ratio did not significantly change over time (RR, 1.04 [95% confidence interval, .90–1.20]). From the pre–COVID-19 to COVID-19 period, CDI patients experienced higher inpatient mortality (5.5% vs 7.4%, P < .0001) and higher median encounter cost ($10 832 vs $12 862, P < .0001). Conclusions CDI prevalence decreased during the COVID-19 pandemic in a national US sample, though at a rate similar to prior to the pandemic. CDI patients had higher inpatient mortality and encounter costs during the pandemic.
Collapse
Affiliation(s)
- Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin , Austin, TX , USA
- Pharmacotherapy Education and Research Center, University of Texas Health San Antonio , San Antonio, TX , USA
| | - Alexa L Frei
- College of Pharmacy, The University of Texas at Austin , Austin, TX , USA
- Pharmacotherapy Education and Research Center, University of Texas Health San Antonio , San Antonio, TX , USA
- College of Agriculture and Life Sciences, Texas A&M University , College Station, TX , USA
| | - Kelsey A Strey
- College of Pharmacy, The University of Texas at Austin , Austin, TX , USA
- Pharmacotherapy Education and Research Center, University of Texas Health San Antonio , San Antonio, TX , USA
| | - Eric H Young
- College of Pharmacy, The University of Texas at Austin , Austin, TX , USA
- Pharmacotherapy Education and Research Center, University of Texas Health San Antonio , San Antonio, TX , USA
| |
Collapse
|
|
24
|
Adriana DN, Sugihartono T, Nusi IA, Setiawan PB, Purbayu H, Maimunah U, Kholili U, Widodo B, Thamrin H, Vidyani A, Maulahela H, Yamaoka Y, Miftahussurur M. Role of fecal calprotectin as a hypoxic intestinal damage biomarker in COVID-19 patients. Gut Pathog 2022; 14:34. [PMID: 35945626 PMCID: PMC9360717 DOI: 10.1186/s13099-022-00507-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/19/2022] [Indexed: 12/15/2022] Open
Abstract
Background Gastrointestinal manifestations of coronavirus disease 2019 (COVID-19) appear to be substantial. Fecal calprotectin is a promising biomarker in COVID-19 associated gastrointestinal inflammation; however, its role in the severity of COVID-19 remains limited. We conducted a study to analyze the relationship between the severity of COVID-19 and hypoxic intestinal damage. Methods We assessed the severity of 44 hospitalized COVID-19 pneumonia patients based on the PaO2/FiO2 (P/F) ratio. Inflammatory markers were measured from blood samples, and fecal calprotectin was obtained from stool samples. Results Median levels of fecal calprotectin in COVID-19 patients involved in this study (n = 44) were found to be markedly elevated along with the severity of hypoxemia, as seen in the non-acute respiratory distress syndrome (ARDS) group 21.4 µg/g (5.2–120.9), mild ARDS 54.30 µg/g (5.2–1393.7), moderate ARDS 169.6 µg/g (43.4–640.5), and severe ARDS 451.6 µg/g (364.5–538.6). We also found significant differences in fecal calprotectin levels based on the severity of ARDS (P < 0.001), and although the patients were divided into ARDS and non-ARDS groups (P < 0.001). Furthermore, we found a strong negative correlation between the P/F ratio and fecal calprotectin levels (r = − 0.697, P < 0.001). Conclusion Our findings support the potential role of fecal calprotectin as a biomarker of intestinal inflammation in COVID-19 as a consequence of hypoxic intestinal damage and as suggested by the reduced P/F ratio.
Collapse
Affiliation(s)
- Deasy Natalia Adriana
- Department of Internal Medicine, Faculty of Medicine, Soetomo Teaching Hospital, Universitas Airlangga, Dr, Surabaya, 60286, Indonesia
| | - Titong Sugihartono
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia.
| | - Iswan Abbas Nusi
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Poernomo Boedi Setiawan
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Herry Purbayu
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Ummi Maimunah
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Ulfa Kholili
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Budi Widodo
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Husin Thamrin
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Amie Vidyani
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia
| | - Hasan Maulahela
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Yoshio Yamaoka
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia. .,Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, 60115, Indonesia. .,Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. .,Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA.
| | - Muhammad Miftahussurur
- Gastroenterology and Hepatology Division, Department of Internal Medicine, Faculty of Medicine, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60286, Indonesia.,Helicobacter Pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya, 60115, Indonesia
| |
Collapse
|
|
25
|
Shah SC, Canakis A, Halvorson AE, Dorn C, Wilson O, Denton J, Hauger R, Hunt C, Suzuki A, Matheny ME, Siew E, Hung A, Greevy RA, Roumie CL. Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score-Weighted Analysis of a Nationwide Cohort. GASTRO HEP ADVANCES 2022; 1:977-984. [PMID: 35966642 PMCID: PMC9357443 DOI: 10.1016/j.gastha.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Gastrointestinal (GI) symptoms are well-recognized manifestations of coronavirus disease 2019 (COVID-19). Our primary objective was to evaluate the association between GI symptoms and COVID-19 severity. METHODS In this nationwide cohort of US veterans, we evaluated GI symptoms (nausea/vomiting/diarrhea) reported 30 days before and including the date of positive SARS-CoV-2 testing (March 1, 2020, to February 20, 2021). All patients had ≥1 year of prior baseline data and ≥60 days follow-up relative to the test date. We used propensity score (PS)-weighting to balance covariates in patients with vs without GI symptoms. The primary composite outcome was severe COVID-19, defined as hospital admission, intensive care unit admission, mechanical ventilation, or death within 60 days of positive testing. RESULTS Of 218,045 SARS-CoV-2 positive patients, 29,257 (13.4%) had GI symptoms. After PS weighting, all covariates were balanced. In the PS-weighted cohort, patients with vs without GI symptoms had severe COVID-19 more often (29.0% vs 17.1%; P < .001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of intensive care unit admission and mechanical ventilation compared with patients without symptoms. There was a significant age interaction; among hospitalized patients aged ≥70 years, lower COVID-19-associated mortality was observed in patients with vs without GI symptoms, even after accounting for COVID-19-specific medical treatments. CONCLUSION In the largest integrated US health care system, SARS-CoV-2-positive patients with GI symptoms experienced severe COVID-19 outcomes more often than those without symptoms. Additional research on COVID-19-associated GI symptoms may inform preventive efforts and interventions to reduce severe COVID-19.
Collapse
Key Words
- BMI, body mass index
- CDW, Corporate Data Warehouse
- COVID-19
- COVID-19, coronavirus disease 2019
- Epidemiology
- GI, gastrointestinal
- ICD, International Classification of Diseases
- ICU, intensive care unit
- Infectious diseases
- OMOP, Observational Medical Outcomes Partnership
- OR, odds ratios
- Outcomes
- PCR, polymerase chain reaction
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitors
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SD, standard deviation
- SDR, Shared Data Resource
- SMD, standardized mean differences
- VHA, Veterans Health Administration
Collapse
Affiliation(s)
- Shailja C. Shah
- Gastroenterology Section, VA San Diego, San Diego, California
- Division of Gastroenterology, University of California, San Diego, San Diego, California
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alese E. Halvorson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Otis Wilson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason Denton
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard Hauger
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Center of Excellence for Stress and Mental Health, San Diego, California
| | - Christine Hunt
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- Gastroenterology Section, Durham VA Health Care System, Durham, North Carolina
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- Gastroenterology Section, Durham VA Health Care System, Durham, North Carolina
| | - Michael E. Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Siew
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adriana Hung
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee
| | - Christianne L. Roumie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee
- VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, Tennessee
| |
Collapse
|
|
26
|
Song J, Patel J, Khatri R, Nadpara N, Malik Z, Parkman HP. Gastrointestinal symptoms in patients hospitalized with COVID-19: Prevalence and outcomes. Medicine (Baltimore) 2022; 101:e29374. [PMID: 35758370 PMCID: PMC9276248 DOI: 10.1097/md.0000000000029374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/10/2022] [Indexed: 01/09/2023] Open
Abstract
To characterize outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19) who present with gastrointestinal (GI) symptoms.Clinical outcomes in patients with COVID-19 associated with GI symptoms have been inconsistent in the literature.The study design is a retrospective analysis of patients, age 18 years or older, admitted to the hospital after testing positive for COVID-19. Clinical outcomes included intensive care unit requirements, rates of discharges to home, rates of discharges to outside facilities, and mortality.Seven hundred fifty patients met the inclusion criteria. Three hundred seventy three (49.7%) patients presented with at least one GI symptom and 377 (50.3%) patients presented with solely non-GI symptoms. Patients who presented with at least one GI symptom had significantly lower ICU requirements (17.4% vs 20.2%), higher rates of discharges home (77.2% vs 67.4%), lower rates of discharges to other facilities (16.4% vs 22.8%), and decreased mortality (6.4% vs 9.8%) compared with patients with non-GI symptoms. However, patients who presented with solely GI symptoms had significantly higher ICU requirements (23.8% vs 17.0%), lower rates of discharges home (52.4% vs 78.7%), higher rates of discharges to facilities (28.6% vs 15.6%), and higher mortality (19.0% vs 5.7%) compared with those with mixed GI and non-GI symptoms.Although patients with COVID-19 requiring hospitalization with GI symptoms did better than those without GI symptoms, those with isolated GI symptoms without extra-GI symptoms had worse clinical outcomes. COVID-19 should be considered in patients who present with new onset or worsening diarrhea, nausea, vomiting, and abdominal pain even without pulmonary symptoms.
Collapse
Affiliation(s)
- Jun Song
- Temple University Hospital, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA
| | - Jay Patel
- Temple University Hospital, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA
| | - Rishabh Khatri
- Temple University Hospital, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA
| | - Neil Nadpara
- Temple University Hospital, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA
| | - Zubair Malik
- Temple University Hospital, Department of Medicine, Section of Gastroenterology and Hepatology, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA
| | - Henry P. Parkman
- Temple University Hospital, Department of Medicine, Section of Gastroenterology and Hepatology, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA
| |
Collapse
|
|
27
|
Maslennikov R, Ivashkin V, Ufimtseva A, Poluektova E, Ulyanin A. Clostridioides difficile co-infection in patients with COVID-19. Future Microbiol 2022; 17:653-663. [PMID: 35440149 PMCID: PMC9020461 DOI: 10.2217/fmb-2021-0145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
Aim: To assess the impact of Clostridioides difficile infection on the course of COVID-19. Methods: The authors included 809 patients with COVID-19 in this retrospective study: 55 had C. difficile infection, 23 had C. difficile-negative antibiotic-associated diarrhea and 731 had no diarrhea. C. difficile in feces was determined by immunochromatographic test for its toxins. Results:C. difficile infection was associated with increased risk of death (hazard ratio = 2.6; p = 0.021), especially after 20 days of disease (hazard ratio = 6.5; p < 0.001). C. difficile infection-associated diarrhea was longer and more severe than C. difficile-negative antibiotic-associated diarrhea. Unlike patients with C. difficile-negative antibiotic-associated diarrhea, patients with C. difficile infection were admitted to the intensive care unit and needed mechanical ventilation more often than those without diarrhea. Conclusion:C. difficile infection worsens the course and prognosis of COVID-19.
Collapse
Affiliation(s)
- Roman Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
- The Interregional Public Organization ‘Scientific Community for the Promotion of the Clinical Study of the Human Microbiome’, Pogodinskaya Street, 1, Building 1, Moscow, 119435, Russian Federation
| | - Vladimir Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
- The Interregional Public Organization ‘Scientific Community for the Promotion of the Clinical Study of the Human Microbiome’, Pogodinskaya Street, 1, Building 1, Moscow, 119435, Russian Federation
| | - Anna Ufimtseva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
| | - Elena Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
- The Interregional Public Organization ‘Scientific Community for the Promotion of the Clinical Study of the Human Microbiome’, Pogodinskaya Street, 1, Building 1, Moscow, 119435, Russian Federation
| | - Anatoly Ulyanin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
- The Interregional Public Organization ‘Scientific Community for the Promotion of the Clinical Study of the Human Microbiome’, Pogodinskaya Street, 1, Building 1, Moscow, 119435, Russian Federation
| |
Collapse
|
|
28
|
Zyoud SH, Al-Jabi SW, Shahwan MJ, Jairoun AA. Global research production pertaining to gastrointestinal involvement in COVID-19: A bibliometric and visualised study. World J Gastrointest Surg 2022; 14:494-505. [PMID: 35734615 PMCID: PMC9160685 DOI: 10.4240/wjgs.v14.i5.494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global pandemic that can cause diarrhoea, nausea/vomiting, and abdominal pain, among other gastrointestinal (GI) symptoms. AIM To perform a bibliometric analysis of the global research production pertaining to GI involvement in COVID-19. METHODS The Scopus database was used to search the global literature on GI involvement in COVID-19 during 2020. A bibliometric review of these publications was also performed using VOSviewer. RESULTS Scopus had published 95615 documents on COVID-19 in all areas of research at the time of data collection. In total, 1267 publications on the topic of GI and COVID-19 were identified. Research articles (n = 606; 47.83%), letters (293; 23.13%), and reviews (186; 14.68%) were the most popular types of documents. The most productive countries and institutions in this field were the United States and Huazhong University of Science and Technology. The most cited paper was Xiao et al, which was published in Gastroenterology as a brief communication, with 798 citations. This paper provides evidence for GI infection of COVID-19 and its possible faecal-oral transmission route. In the term cluster analysis, there were two frontiers in this field: GI manifestations among COVID-19 patients and the implications of COVID-19 for the gastroenterologist. CONCLUSION GI manifestations among COVID-19 patients and implications of COVID-19 for gastroenterologists were of interest, especially in the early stages of the pandemic.
Collapse
Affiliation(s)
- Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
- Poison Control and Drug Information Center, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine
| | - Moyad Jamal Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | | |
Collapse
|
|
29
|
Ebrahim Nakhli R, Shanker A, Sarosiek I, Boschman J, Espino K, Sigaroodi S, Al Bayati I, Elhanafi S, Sadeghi A, Sarosiek J, Zuckerman MJ, Rezaie A, McCallum RW, Schmulson MJ, Bashashati A, Bashashati M. Gastrointestinal symptoms and the severity of COVID-19: Disorders of gut-brain interaction are an outcome. Neurogastroenterol Motil 2022; 34:e14368. [PMID: 35383423 PMCID: PMC9115309 DOI: 10.1111/nmo.14368] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many of the studies on COVID-19 severity and its associated symptoms focus on hospitalized patients. The aim of this study was to investigate the relationship between acute GI symptoms and COVID-19 severity in a clustering-based approach and to determine the risks and epidemiological features of post-COVID-19 Disorders of Gut-Brain Interaction (DGBI) by including both hospitalized and ambulatory patients. METHODS The study utilized a two-phase Internet-based survey on: (1) COVID-19 patients' demographics, comorbidities, symptoms, complications, and hospitalizations and (2) post-COVID-19 DGBI diagnosed according to Rome IV criteria in association with anxiety (GAD-7) and depression (PHQ-9). Statistical analyses included univariate and multivariate tests. RESULTS Five distinct clusters of symptomatic subjects were identified based on the presence of GI symptoms, loss of smell, and chest pain, among 1114 participants who tested positive for SARS-CoV-2. GI symptoms were found to be independent risk factors for severe COVID-19; however, they did not always coincide with other severity-related factors such as age >65 years, diabetes mellitus, and Vitamin D deficiency. Of the 164 subjects with a positive test who participated in Phase-2, 108 (66%) fulfilled the criteria for at least one DGBI. The majority (n = 81; 75%) were new-onset DGBI post-COVID-19. Overall, 86% of subjects with one or more post-COVID-19 DGBI had at least one GI symptom during the acute phase of COVID-19, while 14% did not. Depression (65%), but not anxiety (48%), was significantly more common in those with post-COVID-19 DGBI. CONCLUSION GI symptoms are associated with a severe COVID-19 among survivors. Long-haulers may develop post-COVID-19 DGBI. Psychiatric disorders are common in post-COVID-19 DGBI.
Collapse
Affiliation(s)
- Ramin Ebrahim Nakhli
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Aaron Shanker
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Irene Sarosiek
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Jeffrey Boschman
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karina Espino
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Solmaz Sigaroodi
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Ihsan Al Bayati
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Sherif Elhanafi
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Amin Sadeghi
- Qatar Computing Research InstituteHamad bin Khalifa UniversityDohaQatar
| | - Jerzy Sarosiek
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Marc J. Zuckerman
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Ali Rezaie
- Division of GastroenterologyDepartment of MedicineGI Motility ProgramCedars‐SinaiLos AngelesCaliforniaUSA
| | - Richard W. McCallum
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Max J. Schmulson
- Laboratory of Liver, Pancreas and Motility (HIPAM)Unit of Research in Experimental MedicineFaculty of Medicine‐Universidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Ali Bashashati
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Department of Pathology and Laboratory Medicine, of the University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mohammad Bashashati
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| |
Collapse
|
|
30
|
Najmi N, Megantara I, Andriani L, Goenawan H, Lesmana R. Importance of gut microbiome regulation for the prevention and recovery process after SARS-CoV-2 respiratory viral infection (Review). Biomed Rep 2022; 16:25. [PMID: 35251612 PMCID: PMC8889546 DOI: 10.3892/br.2022.1508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported to affect organs other than the lungs, including the liver, brain, kidneys and intestine, and gastrointestinal symptoms, such as nausea, vomiting, diarrhea and abdominal discomfort, have also been reported. Thus, SARS-CoV-2 could potentially directly or indirectly regulate the gut microbiome profile and its homeostasis. The abundance of Coprobacillus, Clostridium ramosum and Clostridium are associated with the severity of COVID-19, and Firmicutes, Bacteriodetes, Proteobacteria and Actinobacteria are also related to COVID-19 infection. The four phyla are correlated with the severity of COVID-19 infection in patients. The modulation of factors that control the physiological growth of the gut microbiome will determine the proportionate ratio of microbiome types (profile). Taken together, gut microbiome profile alterations in COVID-19 patients may have a cross effect with the modulation of cytokine levels in COVID-19 infection. With these findings, several factors that regulate gut microbiome homeostasis may support the degree of the clinical symptoms and hasten the recovery process after COVID-19 infection.
Collapse
Affiliation(s)
- Nuroh Najmi
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
- Division of Biological Activty Central Laboratory, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
| | - Imam Megantara
- Division of Biological Activty Central Laboratory, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
| | - Lovita Andriani
- Faculty of Animal Husbandry, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
| | - Hanna Goenawan
- Division of Biological Activty Central Laboratory, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
- Department of Biomedical Sciences, Physiology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Bandung, West Java 45363, Indonesia
| | - Ronny Lesmana
- Division of Biological Activty Central Laboratory, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
- Department of Biomedical Sciences, Physiology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java 45363, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Bandung, West Java 45363, Indonesia
| |
Collapse
|
|
31
|
Pandey R, Rai D, Tahir MW, Wahab A, Bandyopadhyay D, Lesho E, Laguio-Vila M, Fentanes E, Tariq R, Naidu SS, Aronow WS. Prevalence of comorbidities and symptoms stratified by severity of illness amongst adult patients with COVID-19: a systematic review. Arch Med Sci Atheroscler Dis 2022; 7:e5-e23. [PMID: 35582712 PMCID: PMC9081912 DOI: 10.5114/amsad.2022.115008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction We performed a systematic review of comorbidities and symptoms of adult patients with coronavirus disease 2019 (COVID-19) to evaluate comorbidities, symptoms, and severity. Material and methods We searched databases and extracted comorbidities and symptoms from the included studies. We stratified the similar signs and symptoms in groups and on the basis of severity and compared them with stratified analysis. Individual case reports and case series with < 5 patients were excluded. Results A total of 163 studies with 43,187 patients were included. Mean age was 54.6 years. There were significantly fewer women in the study (43.9% vs. 56.1%, p < 0.0001). Prevalent cardiovascular comorbidities were hypertension (31.9%), obesity (27.9%), hyperlipidemia (26.4%), smoking (18.9%), diabetes mellitus (17.2%), atherosclerotic disease (9.2%) and arrhythmia (5.0%). The most frequently reported constitutional symptoms of COVID-19 were fever (73.9%), fatigue (33.4%), malaise (29.9%), myalgia and/or arthralgia (19.2%), generalized weakness (19.0%), and chills (11.3%). For the cardiovascular system, chest pain and/or tightness were most often reported (19.6%), followed by palpitations (5.2%). Hypertension and diabetes were common in severe disease. Obesity and congestive heart failure were not observed in any non-severe cases. Severe cases compared to non-severe cases more frequently had fever (87.8% vs. 58.5%, p < 0.001), shortness of breath (47.4% vs. 20.6%, p < 0.001), cough (66.8% vs. 62.9%, p < 0.001), sputum production (35.4% vs. 26.5%, p < 0.001) and rhinorrhea (32.2% vs. 7.3%, p < 0.001). Conclusions Hypertension, diabetes, and atherosclerotic diseases are common comorbidities across the world, with obesity as the second most common in the US and more common in men.
Collapse
Affiliation(s)
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, USA
| | | | - Abdul Wahab
- Department of Internal Medicine, University of Iowa, IA, USA
| | | | - Emil Lesho
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Maryrose Laguio-Vila
- Department of Infectious Disease, Rochester General Hospital, Rochester, NY, USA
| | - Emilio Fentanes
- Department of Cardiology, Brigham and Women’s Hospital, MA, USA
| | - Raseen Tariq
- Department of Internal Medicine, Rochester General Hospital, USA
| | - Srihari S. Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| |
Collapse
|
|
32
|
Assessment of Gastrointestinal Symptoms and Dyspnea in Patients Hospitalized due to COVID-19: Contribution to Clinical Course and Mortality. J Clin Med 2022; 11:jcm11071821. [PMID: 35407430 PMCID: PMC8999487 DOI: 10.3390/jcm11071821] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Gastrointestinal manifestations may accompany the respiratory symptoms of COVID-19. Abdominal pain (AP) without nausea and vomiting is one of the most common. To date, its role and prognostic value in patients with COVID-19 is still debated. Therefore, we performed a retrospective analysis of 2184 individuals admitted to hospital due to COVID-19. We divided the patients into four groups according to presented symptoms: dyspnea, n = 871 (39.9%); AP, n = 97 (4.4%); AP with dyspnea together, n = 50 (2.3%); and patients without dyspnea and AP, n = 1166 (53.4%). The patients with AP showed tendency to be younger than these with dyspnea, but without AP (63.0 [38.0−70.0] vs. 65.0 [52.0−74.0] years, p = 0.061), and they were more often females as compared to patients with dyspnea (57.7% vs. 44.6%, p = 0.013, for females). Patients with AP as a separate sign of COVID-19 significantly less often developed pneumonia as compared to individuals with dyspnea or with dyspnea and AP together (p < 0.0001). Patients with AP or AP with dyspnea were significantly less frequently intubated or transferred to the intensive care unit (p = 0.003 and p = 0.031, respectively). Individuals with AP alone or with dyspnea had significantly lower rate of mortality as compared to patients with dyspnea (p = 0.003). AP as a separate symptom and also as a coexisting sign with dyspnea does not predispose the patients with COVID-19 to the worse clinical course and higher mortality.
Collapse
|
|
33
|
Ilie OD, Bolos A, Nita IB, Cojocariu RO, Balmus IM, Ciobica A, Trus C, Doroftei B. Preliminary Data on Gastrointestinal Deficiencies Incidence and the Prevalence of Anxiety During the COVID-19 Pandemic Among the Medical Workers. J Nerv Ment Dis 2022; 210:98-103. [PMID: 34739008 DOI: 10.1097/nmd.0000000000001445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious new β-coronavirus that primarily affects the lungs. Because of its unprecedented spread, in a relatively short interval, it is declared a global pandemic. Binding to the angiotensin-converting enzyme 2 receptors, SARS-CoV-2 is easily disseminated through air. Apart from the established clinical panel, individuals exposed to prolonged chronic stress also manifest gastrointestinal (GI) symptoms similar to those exhibited by SARS-CoV-2-infected patients.The present study aims to assess the incidence of GI deficiencies and prevalence of anxiety among healthy medical staff by applying the Visual Analog Scale for Irritable Bowel Syndrome (VAS-IBS) and Hamilton Anxiety Rating Scale (HAM-A) during this global crisis.We found significant differences on several items of the VAS-IBS: regarding the incidence of diarrhea (p = 0.04), bloating/gases (p = 0.02), and nausea/vomiting (p = 0.01) from the physical spectrum. After stratification based on age of the participants and after we applied Kruskal-Wallis test because of heterogeneity between groups, we noted two situations in which the null hypothesis is rejected: nausea/vomiting in women between 20 and 30 years, and between 30 and 40, and between 40 and 50 years, respectively (p = 0.026/0.029). Anxiety was prevalent among young and middle-class people after the centralization of HAM-A data, where 40.4% of the participants had various forms of anxiety: mild (n = 13; 13.82%), severe (n = 13; 13.82%), and moderate (n = 12; 12.76%).This study demonstrates that VAS-IBS is a reliable tool for assessing the incidence of GI deficiencies, as well as HAM-A for anxiety.
Collapse
Affiliation(s)
| | - Alexandra Bolos
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa"
| | - Ilinca-Bianca Nita
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa"
| | | | - Ioana-Miruna Balmus
- Department of Exact and Natural Sciences, Institute of Interdisciplinary Research, "Alexandru Ioan Cuza" University, Iasi
| | | | - Constantin Trus
- Department of Morphological and Functional Sciences, Faculty of Medicine, "Dunarea de Jos" University, Galati
| | | |
Collapse
|
|
34
|
Li S, Kararigas G. Role of Biological Sex in the Cardiovascular-Gut Microbiome Axis. Front Cardiovasc Med 2022; 8:759735. [PMID: 35083297 PMCID: PMC8785253 DOI: 10.3389/fcvm.2021.759735] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022] Open
Abstract
There has been a recent, unprecedented interest in the role of gut microbiota in host health and disease. Technological advances have dramatically expanded our knowledge of the gut microbiome. Increasing evidence has indicated a strong link between gut microbiota and the development of cardiovascular diseases (CVD). In the present article, we discuss the contribution of gut microbiota in the development and progression of CVD. We further discuss how the gut microbiome may differ between the sexes and how it may be influenced by sex hormones. We put forward that regulation of microbial composition and function by sex might lead to sex-biased disease susceptibility, thereby offering a mechanistic insight into sex differences in CVD. A better understanding of this could identify novel targets, ultimately contributing to the development of innovative preventive, diagnostic and therapeutic strategies for men and women.
Collapse
Affiliation(s)
- Shuangyue Li
- State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Georgios Kararigas
- Department of Physiology, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| |
Collapse
|
|
35
|
Factors Associated with the Development of Gastrointestinal Symptoms in Patients Hospitalized with Covid-19. Dig Dis Sci 2022; 67:3860-3871. [PMID: 34751837 PMCID: PMC8575674 DOI: 10.1007/s10620-021-07286-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The most common symptoms of Covid-19 are respiratory; however, gastrointestinal symptoms are present in up to 50% of patients. We aimed to determine characteristics associated with the development of gastrointestinal symptoms in patients with Covid-19. METHODS A case-control study of adults hospitalized for Covid-19 was conducted across a geographically diverse alliance of 36 US and Canadian medical centers. Data were manually abstracted from electronic health records and analyzed using regression analyses to determine characteristics associated with any gastrointestinal symptoms and diarrhea specifically. RESULTS Of 1406 patients, 540 (38%) reported at least one gastrointestinal symptom and 346 (25%) reported diarrhea. Older patients (≥ 80 years) had significantly lower rates of any gastrointestinal symptoms and diarrhea (vs. patients 18-79 years, OR 0.41, p < 0.01 and OR 0.43 p = 0.01, respectively), while those with IBS (OR 7.70, p = 0.02 and OR 6.72, p < 0.01, respectively) and on immunosuppressive therapy (OR = 1.56, p = 0.02) had higher rates of any gastrointestinal symptom and diarrhea. Patients with constitutional symptoms exhibited significantly higher rates (OR 1.91, p < 0.01), while those with pulmonary disease alone had lower rates of gastrointestinal symptoms (OR 0.23, p = 0.01). A significant interaction between constitutional symptoms and pre-existing pulmonary conditions was observed. CONCLUSIONS Several patient- and disease-specific characteristics associate with gastrointestinal symptoms in patients with Covid-19. Knowledge of these may provide insights into associated pathophysiologic mechanisms, and help health care professionals provide targeted attention to reduce morbidity related to Covid-19.
Collapse
|
|
36
|
Spigaglia P. Clostridioides difficile infection (CDI) during the COVID-19 pandemic. Anaerobe 2022; 74:102518. [PMID: 35063599 PMCID: PMC8767936 DOI: 10.1016/j.anaerobe.2022.102518] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023]
Abstract
The ongoing coronavirus disease (COVID-19) pandemic has dramatically tested healthcare systems around the world, with serious repercussions on the measures of prevention and control of hospital-acquired infections (HAIs). Among HAIs, Clostridioides difficile infection (CDI) represents one of the most important global public health threats. Although the full impact of the COVID-19 pandemic on CDI remains undetermined, depending on the development of the pandemic in the coming months, in this review literature studies of the last three years have been considered in order to depict the current situation, and make some considerations about possible future developments. If on the one hand, a general reduction in CDI incidence has been reported in several settings, mainly due to the extraordinary reinforcement of infection prevention measures, on the other hand, the critical circumstances experienced in many hospitals have limited the effectiveness of these measures, particularly in the intensive care units (ICUs), increasing the possibility of the occurrence of hospital-acquired CDI (HA-CDI). New concerns have arisen from the decrease in C. difficile testing and the increased use of broad-spectrum antibiotics reported during the pandemic. In particular, overuse of antibiotics and disinfectants may lead to a selection of resistant C. difficile strains not only in hospitals but also in the community. Furthermore, patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and patients that have survived COVID-19 may represent a new group of frail patients potentially at a higher risk of CDI, a group that could potentially increase in size due to SARS-CoV-2 evolution. In the dramatic COVID-19 era, the multifactorial nature of CDI has emerged more clearly than before, highlighting the necessity of a strong refocus on efforts to improve prevention strategies and to integrate CDI surveillance in a One Health prospective in order to curtail the public health threat posed by this infection in the next future.
Collapse
|
|
37
|
Singh AK, Jena A, Kumar-M P, Jha DK, Sharma V. Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis. Intest Res 2022; 20:134-143. [PMID: 33440918 PMCID: PMC8831773 DOI: 10.5217/ir.2020.00108] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. METHODS We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. RESULTS Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38-83.88), cough: 59.58% (95% CI, 45.01-72.63), diarrhea: 27.26% (95% CI, 19.51-36.69), running nose: 27% (95% CI, 15.26-43.19) and dyspnea: 25.29% (95% CI, 18.52-33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24-18.19), 10.08% (95% CI, 5.84-16.85) and 8.80% (95% CI, 4.43-16.70) per 100 population, respectively. CONCLUSIONS The clinical presentation of COVID-19 in IBD patients is similar to the general population.
Collapse
Affiliation(s)
- Anupam K. Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daya Krishna Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
|
38
|
Maslennikov R, Ivashkin V, Ufimtseva A, Poluektova E. [Two consecutive attacks of diarrhea in 15 COVID-19 patients: An antibiotic-associated one following the viral one]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2022; 87:59-62. [PMID: 34754133 PMCID: PMC8570403 DOI: 10.1016/j.rgmx.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
Of the 971 patients admitted to our Clinic with suspected COVID-19, 15 (1.5%) presented with two consecutive attacks of diarrhea. One of those patients (a 47-year-old woman) required admission to the intensive care unit and mechanical ventilation. She died on the 11th day of hospitalization (18th day of illness). The first attack of diarrhea in those patients occurred on the 6 th (4th-7th) day of disease and lasted 3 (3-5) days. The second attack of diarrhea developed 11 (8-12) days after the initial onset of diarrhea. Despite the existing trend, the difference in the duration of the diarrhea and the maximum number of bowel movements per day between the first and second attacks was not statistically significant (p = 0.130; p = 0.328). There was no significant difference between the patients with a double attack of diarrhea and those with no diarrhea, regarding the results of the complete blood count, biochemical blood tests, and inflammation biomarkers.
Collapse
Affiliation(s)
- R Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for Clinical Study of the Human Microbiome Research, Moscow, Russian Federation
| | - V Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - A Ufimtseva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - E Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- Scientific Community for Clinical Study of the Human Microbiome Research, Moscow, Russian Federation
| |
Collapse
|
|
39
|
Bhurwal A, Minacapelli CD, Orosz E, Gupta K, Tait C, Dalal I, Zhang C, Zhao E, Rustgi VK. COVID-19 status quo: Emphasis on gastrointestinal and liver manifestations. World J Gastroenterol 2021; 27:7969-7981. [PMID: 35046624 PMCID: PMC8678824 DOI: 10.3748/wjg.v27.i46.7969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has caused one of the worst public health crises in modern history. Even though severe acute respiratory syndrome coronavirus 2 primarily affects the respiratory tract, gastrointestinal manifestations are well described in literature. This review will discuss the epidemiology, virology, manifestations, immunosuppressant states, and lessons learned from COVID-19. Observations: At the time of writing, COVID-19 had infected more than 111 million people and caused over 2.5 million deaths worldwide. Multiple medical comorbidities including obesity, pre-existing liver condition and the use of proton pump inhibitor have been described as risk factor for severe COVID-19. COVID-19 most frequently causes diarrhea (12.4%), nausea/vomiting (9%) and elevation in liver enzymes (15%-20%). The current data does not suggest that patients on immunomodulators have a significantly increased risk of mortality from COVID-19. The current guidelines from American Gastroenterological Association and American Association for the Study of Liver Diseases do not recommend pre-emptive changes in patients on immunosuppression if the patients have not been infected with COVID-19. Conclusions and relevance: The COVID-19 pandemic has prompted a change in structure and shape of gastroenterology departmental activities. Endoscopy should be performed only when necessary and with strict protective measures. Online consultations in the form of telehealth services and home drug deliveries have revolutionized the field.
Collapse
Affiliation(s)
- Abhishek Bhurwal
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | - Carlos D Minacapelli
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | - Evan Orosz
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | - Kapil Gupta
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | - Christopher Tait
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | - Ishita Dalal
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| | - Clark Zhang
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Eric Zhao
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Vinod K Rustgi
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
- Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
| |
Collapse
|
|
40
|
Maslennikov R, Ivashkin V, Ufimtseva A, Poluektova E. Two consecutive attacks of diarrhea in 15 COVID-19 patients: An antibiotic-associated one following the viral one. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:59-62. [PMID: 34896030 PMCID: PMC8639441 DOI: 10.1016/j.rgmxen.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
Of the 971 patients admitted to our Clinic with suspected COVID-19, 15 (1.5%) presented with two consecutive attacks of diarrhea. One of those patients (a 47-year-old woman) required admission to the intensive care unit and mechanical ventilation. She died on the 11th day of hospitalization (18th day of illness). The first attack of diarrhea in those patients occurred on the 6th (4th-7th) day of disease and lasted 3 (3-5) days. The second attack of diarrhea developed 11 (8-12) days after the initial onset of diarrhea. Despite the existing trend, the difference in the duration of the diarrhea and the maximum number of bowel movements per day between the first and second attacks was not statistically significant (p = 0.130; p = 0.328). There was no significant difference between the patients with a double attack of diarrhea and those with no diarrhea, regarding the results of the complete blood count, biochemical blood tests, and inflammation biomarkers.
Collapse
Affiliation(s)
- R Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation; Scientific Community for Clinical Study of the Human Microbiome Research, Moscow, Russian Federation.
| | - V Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - A Ufimtseva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - E Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation; Scientific Community for Clinical Study of the Human Microbiome Research, Moscow, Russian Federation
| |
Collapse
|
|
41
|
Zhang MM, Chen LN, Qian JM. Gastrointestinal manifestations and possible mechanisms of COVID-19 in different periods. J Dig Dis 2021; 22:683-694. [PMID: 34738727 PMCID: PMC8652439 DOI: 10.1111/1751-2980.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a pandemic worldwide. Although COVID-19 mainly affects the respiratory system, gastrointestinal (GI) manifestations have been frequently reported in such cases, even as initial symptoms. There have been several studies on different GI manifestations in patients with mild and severe disease or in remission. In this review article we summarized different GI manifestations of COVID-19 at various disease stages and the possible mechanisms based on published literatures, as well as the significance of GI manifestations in systemic inflammatory injury.
Collapse
Affiliation(s)
- Meng Meng Zhang
- Department of GastroenterologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lu Ni Chen
- Department of Microbiology and Tumor and Cell BiologyKarolinska InstituteSolnaSweden
| | - Jia Ming Qian
- Department of GastroenterologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
|
42
|
The Impact of Information Sources on COVID-19-Related Knowledge, Attitudes, and Practices (KAP) among University Students: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312462. [PMID: 34886184 PMCID: PMC8656615 DOI: 10.3390/ijerph182312462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
COVID-19 is an emerging respiratory disease caused by a novel coronavirus accompanied by a tsunami of misinformation and fake news. This can weaken the public health responses by affecting the COVID-19-related knowledge, attitudes, and practices (KAP) of the public. Therefore, this cross-sectional study was designed during the early stage of the pandemic to evaluate the KAP of Palestinian university students and their commonly used information sources. We found that the most trusted information source among students was the World Health Organization (WHO), followed by the Palestinian Ministry of Health (MoH) briefings and healthcare workers, whereas social media was the most frequently used source of information. The participants exhibited a high level of COVID-19-related knowledge, having an average score of 8.65 (range: 0–10). In total, 76% avoided going to crowded places, and only 33% wore a mask while being outdoors. The vast majority (93%) checked the accuracy of COVID-19-related information before publishing it, 56% used the WHO and MoH briefings for fact-checking, and only 8% relied on healthcare workers. This was particularly the case for those who lived in refugee camps. This study provides an insight into the information sources used by Palestinian university students, the sources they trust, and the information formats they prefer. These results may help public health authorities to locate the information sources through which university students should be targeted. Efforts should be made to recommend healthcare workers as credible information sources. In this way, they will be able to prevent the spread of misleading information and provide high-quality information, especially within unconventional settings such as refugee camps.
Collapse
|
|
43
|
Hussain S, Riad A, Singh A, Klugarová J, Antony B, Banna H, Klugar M. Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis. J Fungi (Basel) 2021; 7:jof7110985. [PMID: 34829271 PMCID: PMC8624337 DOI: 10.3390/jof7110985] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022] Open
Abstract
Mucormycosis, a secondary fungal infection, gained much attention in the ongoing COVID-19 pandemic. This deadly infection has a high all-cause mortality rate and imposes a significant economic, epidemiological, and humanistic burden on the patients and healthcare system. Evidence from the published epidemiological studies showed the varying prevalence of COVID-19-associated mucormycosis (CAM). This study aims to compute the pooled prevalence of CAM and other associated clinical outcomes. MEDLINE, Embase, Cochrane COVID-19 Study Register, and WHO COVID-19 databases were scanned to retrieve the relevant articles until August 2021. All studies reporting the prevalence of mucormycosis among COVID-19 patients were eligible for inclusion. Two investigators independently screened the articles against the selection criteria, extracted the data, and performed the quality assessment using the JBI tool. The pooled prevalence of CAM was the primary outcome, and the pooled prevalence of diabetes, steroid exposure, and the mortality rate were the secondary outcomes of interest. Comprehensive Meta-Analysis software version 2 was used for performing the meta-analysis. This meta-analysis comprised six studies with a pooled sample size of 52,916 COVID-19 patients with a mean age of 62.12 ± 9.69 years. The mean duration of mucormycosis onset was 14.59 ± 6.88 days after the COVID-19 diagnosis. The pooled prevalence of CAM (seven cases per 1000 patients) was 50 times higher than the highest recorded background of mucormycosis (0.14 cases per 1000 patients). A high mortality rate was found among CAM patients with a pooled prevalence rate of 29.6% (95% CI: 17.2-45.9%). Optimal glycemic control and the judicious use of steroids should be the approach for tackling rising CAM cases.
Collapse
Affiliation(s)
- Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (A.R.); (J.K.); (M.K.)
- Correspondence:
| | - Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (A.R.); (J.K.); (M.K.)
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia; (A.S.); (B.A.)
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (A.R.); (J.K.); (M.K.)
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia; (A.S.); (B.A.)
| | - Hasanul Banna
- International Clinical Research Center, Molecular Control of Cell Signaling Group, St. Anne’s University Hospital, 656 91 Brno, Czech Republic;
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (A.R.); (J.K.); (M.K.)
| |
Collapse
|
|
44
|
Rothschild N. Does Fecal-Oral Transmission of SARS-CoV-2 Due to Low Sanitation Conditions Contribute to Low Mortality Rates From COVID-19. Cureus 2021; 13:e18557. [PMID: 34754698 PMCID: PMC8571565 DOI: 10.7759/cureus.18557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The novel coronavirus disease 2019 (COVID-19) is a global pandemic generated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary infection site is mucosal surfaces, mainly the lungs and the intestine, where epithelial cells can be infected. COVID-19 has spread throughout the world, causing millions of deaths and hundreds of millions of confirmed infections. Despite the global spread of SARS-CoV-2, there are extreme differences between countries in mortality rates and confirmed infections. METHODS Pearson correlations and a t-test were performed on data from 137 countries in order to test the correlation between number of deaths from diarrheal diseases (pre-COVID-19 pandemic data) as a marker for countries' sanitation level, and the number of confirmed COVID-19 cases and deaths per million. RESULTS It was found that countries' prevalence of confirmed COVID-19 cases and deaths per million are statistically correlated with their sanitation level. CONCLUSIONS The hypothesis proposed in this article is that the low mortality rates from COVID-19 in countries where the level of sanitation is low are due to fecal-oral infection of the population by SARS-CoV-2, rather than infection of the respiratory system. This hypothesis is supported by the protective effect of the low sanitation level presented in this work and the fact that lung infection by SARS-CoV-2 can cause severe pathology, while infection in the intestine generally causes minor or no symptoms.
Collapse
|
|
45
|
Albaba I, Chopra A, Al-Tarbsheh AH, Feustel PJ, Mustafa M, Oweis J, Parimi SA, Santelises Robledo FM, Mehta S. Incidence, Risk Factors, and Outcomes of Rhabdomyolysis in Hospitalized Patients With COVID-19 Infection. Cureus 2021; 13:e19802. [PMID: 34956789 PMCID: PMC8693832 DOI: 10.7759/cureus.19802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION There is a paucity of studies examining the prevalence and clinical characteristics of rhabdomyolysis in hospitalized patients with COVID-19 infection. The purpose of this study is to examine the incidence, clinical characteristics, and outcome of hospitalized patients with COVID-19 infection who develop rhabdomyolysis. METHODOLOGY This is a single-center retrospective analysis of all hospitalized patients with COVID-19 admitted between March 8, 2020, and January 11, 2021. All patients with creatinine kinase (CK) levels available during the hospital admission were included. Rhabdomyolysis was defined as an elevation in CK level higher than five times the upper limit of normal (i.e., 1125 U/L). We compared clinical characteristics and outcomes of patients who developed rhabdomyolysis with patients who did not develop rhabdomyolysis. RESULTS The incidence of rhabdomyolysis in hospitalized patients with COVID-19 infection was 9.2%. There was no significant difference noted in comorbidities and clinical characteristics between the two groups. Moreover, there was no significant difference noted in the presence of severe COVID-19 infection (72.7% vs 54.6%, p = 0.1), mortality (27.3% vs 23.9%, p = 0.72), acute kidney injury (59.1% vs 42.7%, p = 0.14), or need for intensive care unit (ICU) care (72.7% vs 51.4%, p = 0.051). However, a higher percentage of patients in the rhabdomyolysis group required physical rehabilitation after discharge (40.9% vs 19.3%, p = 0.02). CONCLUSION The overall incidence of rhabdomyolysis in hospitalized patients with COVID-19 infection was high (9.2%). The presence of rhabdomyolysis was not associated with the increased severity of the disease. Patients with rhabdomyolysis more frequently required physical rehabilitation compared to those without rhabdomyolysis.
Collapse
Affiliation(s)
- Isam Albaba
- Internal Medicine, Albany Medical Center, Albany, USA
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, USA
| | | | - Paul J Feustel
- Department of Research, Albany Medical Center, Albany, USA
| | | | - Jozef Oweis
- Internal Medicine, Albany Medical Center, Albany, USA
| | | | | | - Swati Mehta
- Nephrology and Internal Medicine, Albany Medical Center, Albany, USA
| |
Collapse
|
|
46
|
Rahban M, Stanek A, Hooshmand A, Khamineh Y, Ahi S, Kazim SN, Ahmad F, Muronetz V, Samy Abousenna M, Zolghadri S, Saboury AA. Infection of Human Cells by SARS-CoV-2 and Molecular Overview of Gastrointestinal, Neurological, and Hepatic Problems in COVID-19 Patients. J Clin Med 2021; 10:4802. [PMID: 34768321 PMCID: PMC8584649 DOI: 10.3390/jcm10214802] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023] Open
Abstract
The gastrointestinal tract is the body's largest interface between the host and the external environment. People infected with SARS-CoV-2 are at higher risk of microbiome alterations and severe diseases. Recent evidence has suggested that the pathophysiological and molecular mechanisms associated with gastrointestinal complicity in SARS-CoV-2 infection could be explained by the role of angiotensin-converting enzyme-2 (ACE2) cell receptors. These receptors are overexpressed in the gut lining, leading to a high intestinal permeability to foreign pathogens. It is believed that SARS-CoV-2 has a lesser likelihood of causing liver infection because of the diminished expression of ACE2 in liver cells. Interestingly, an interconnection between the lungs, brain, and gastrointestinal tract during severe COVID-19 has been mentioned. We hope that this review on the molecular mechanisms related to the gastrointestinal disorders as well as neurological and hepatic manifestations experienced by COVID-19 patients will help scientists to find a convenient solution for this and other pandemic events.
Collapse
Affiliation(s)
- Mahdie Rahban
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran 1417614335, Iran;
| | - Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland;
| | - Amirreza Hooshmand
- Young Researchers and Elite Club, Jahrom Branch, Islamic Azad University, Jahrom 7414785318, Iran; (A.H.); (Y.K.)
| | - Yasaman Khamineh
- Young Researchers and Elite Club, Jahrom Branch, Islamic Azad University, Jahrom 7414785318, Iran; (A.H.); (Y.K.)
| | - Salma Ahi
- Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom 7414846199, Iran;
| | - Syed Naqui Kazim
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India; (S.N.K.); (F.A.)
| | - Faizan Ahmad
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India; (S.N.K.); (F.A.)
| | - Vladimir Muronetz
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119234 Moscow, Russia;
| | - Mohamed Samy Abousenna
- Central Laboratory for Evaluation of Veterinary Biologics, Agriculture Research Center, Cairo 11517, Egypt;
| | - Samaneh Zolghadri
- Department of Biology, Jahrom Branch, Islamic Azad University, Jahrom 7414785318, Iran
| | - Ali A. Saboury
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran 1417614335, Iran;
| |
Collapse
|
|
47
|
Maslennikov R, Svistunov A, Ivashkin V, Ufimtseva A, Poluektova E, Efremova I, Ulyanin A, Okhlobystin A, Kardasheva S, Kurbatova A, Levshina A, Grigoriadis D, Magomedov S, Dzhakhaya N, Shifrin O, Zharkova M, Yuryeva E, Kokina N, Shirtladze M, Kiseleva O. Early viral versus late antibiotic-associated diarrhea in novel coronavirus infection. Medicine (Baltimore) 2021; 100:e27528. [PMID: 34731146 PMCID: PMC8519250 DOI: 10.1097/md.0000000000027528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/22/2021] [Accepted: 09/29/2021] [Indexed: 02/07/2023] Open
Abstract
Diarrhea is one of the manifestations of the novel coronavirus disease (COVID-19), but it also develops as a complication of massive antibiotic therapy in this disease. This study aimed to compare these types of diarrhea.We included patients with COVID-19 in a cohort study and excluded patients with chronic diarrhea, laxative use, and those who died during the first day of hospitalization.There were 89 (9.3%), 161 (16.7%), and 731 (75.7%) patients with early viral, late antibiotic-associated, and without diarrhea, respectively. Late diarrhea lasted longer (6 [4-10] vs 5 [3-7] days, P < .001) and was more severe. Clostridioides difficile was found in 70.5% of tested patients with late diarrhea and in none with early diarrhea. Presence of late diarrhea was associated with an increased risk of death after 20 days of disease (P = .009; hazard ratio = 4.7). Patients with late diarrhea had a longer hospital stay and total disease duration, and a higher proportion of these patients required intensive care unit admission. Oral amoxicillin/clavulanate (odds ratio [OR] = 2.23), oral clarithromycin (OR = 3.79), and glucocorticoids (OR = 4.41) use was a risk factor for the development of late diarrhea, while ceftriaxone use (OR = 0.35) had a protective effect. Before the development of late diarrhea, decrease in C-reactive protein levels and increase in lymphocyte count stopped but the white blood cell and neutrophil count increased. An increase in neutrophils by >0.6 × 109 cells/L predicted the development of late diarrhea in the coming days (sensitivity 82.0%, specificity 70.8%, area under the curve = 0.791 [0.710-0.872]).Diarrhea in COVID-19 is heterogeneous, and different types of diarrhea require different management.
Collapse
Affiliation(s)
- Roman Maslennikov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- The Interregional Public Organization “Scientific Community for the Promotion of the Clinical Study of the Human Microbiome,” Moscow, Russian Federation
- Consultative and Diagnostic Center 2 of the Moscow City Health Department, Moscow, Russian Federation
| | - Andrey Svistunov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Vladimir Ivashkin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Anna Ufimtseva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Elena Poluektova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
- The Interregional Public Organization “Scientific Community for the Promotion of the Clinical Study of the Human Microbiome,” Moscow, Russian Federation
| | - Irina Efremova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Anatoly Ulyanin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Alexey Okhlobystin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Svetlana Kardasheva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Anastasia Kurbatova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Anna Levshina
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Diana Grigoriadis
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Shamil Magomedov
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Natiya Dzhakhaya
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Oleg Shifrin
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Maria Zharkova
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Elena Yuryeva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Nataliya Kokina
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Manana Shirtladze
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| | - Olga Kiseleva
- Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation
| |
Collapse
|
|
48
|
Clostridium Difficile and COVID-19: General Data, Ribotype, Clinical Form, Treatment-Our Experience from the Largest Infectious Diseases Hospital in Western Romania. ACTA ACUST UNITED AC 2021; 57:medicina57101099. [PMID: 34684136 PMCID: PMC8539017 DOI: 10.3390/medicina57101099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
Background and Objectives: In Coronavirus Disease 2019 (COVID-19), which is caused by the infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the clinical manifestations are primarily related to the pulmonary system. Under 10% of cases also develop gastrointestinal events such as diarrhea, nausea, vomiting and abdominal pain. Materials and Methods: We conducted an observational, retrospective study in the Infectious Diseases Clinic of "Victor Babes" Hospital, Timis County, in order to assess the incidence, outcome and risk factors for clostridium difficile infection (CDI) in COVID-19 patients. Results: Out of 2065 COVID-19 cases, hospitalized between 1st September 2020 and 30th April 2021, 40 cases of CDI were identified with 32 cases of hospital-onset of CDI and eight cases of community-onset and healthcare-associated CDI. By randomization, polymerase chain reaction ribotyping of Clostridium Difficile was performed in six cases. All the randomized cases tested positive for ribotype 027. The percentage of cases recovered with complications at discharge was higher among COVID-19 patients and CDI (p = 0.001). The in-hospital stay, 36 days versus 28 days, was longer among COVID-19 patients and CDI (p = 0.01). The presence of previous hospitalization (p = 0.004) and administration of antibiotics during the hospital stay, increased the risk of CDI among COVID-19 patients. The mean adjusted CCI at admission was lower among controls (p = 0.01). In two cases, exitus was strictly CDI-related, with one case positive for 027 ribotype. Conclusions: CDI has complicated the outcome of COVID-19 patients, especially for those with comorbidities or previously exposed to the healthcare system. In the face of the COVID-19 pandemic and the widespread, extensive use of antibiotics, clinicians should remain vigilant for possible CDI and SARS-CoV-2 co-infection.
Collapse
|
|
49
|
Chen H, Tong Z, Ma Z, Luo L, Tang Y, Teng Y, Yu H, Meng H, Peng C, Zhang Q, Zhu T, Zhao H, Chu G, Li H, Lu H, Qi X. Gastrointestinal Bleeding, but Not Other Gastrointestinal Symptoms, Is Associated With Worse Outcomes in COVID-19 Patients. Front Med (Lausanne) 2021; 8:759152. [PMID: 34722595 PMCID: PMC8548414 DOI: 10.3389/fmed.2021.759152] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Patients with coronavirus disease 2019 (COVID-19) can present with gastrointestinal (GI) symptoms. However, the prevalence of GI symptoms and their association with outcomes remain controversial in COVID-19 patients. Methods: All COVID-19 patients consecutively admitted to the Wuhan Huoshenshan hospital from February 2020 to April 2020 were collected. Disease severity and outcomes were compared between COVID-19 patients with and without GI symptoms. Logistic regression analyses were performed to evaluate the association of GI symptoms with the composite endpoint and death in COVID-19 patients. A composite endpoint was defined as transfer to intensive care unit, requirement of mechanical ventilation, and death. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 2,552 COVID-19 patients were included. The prevalence of GI symptoms was 21.0% (537/2,552). Diarrhea (8.9%, 226/2,552) was the most common GI symptom. Patients with GI symptoms had significantly higher proportions of severe COVID-19 and worse outcomes than those without. Univariate logistic regression analyses demonstrated that GI symptoms were significantly associated with the composite endpoint (OR = 2.426, 95% CI = 1.608-3.661; P < 0.001) and death (OR = 2.137, 95% CI = 1.209-3.778; P = 0.009). After adjusting for age, sex, and severe/critical COVID-19, GI symptoms were still independently associated with the composite endpoint (OR = 2.029, 95% CI = 1.294-3.182; P = 0.002), but not death (OR = 1.726, 95% CI = 0.946-3.150; P = 0.075). According to the type of GI symptoms, GI bleeding was an independent predictor of the composite endpoint (OR = 8.416, 95% CI = 3.465-20.438, P < 0.001) and death (OR = 6.640, 95% CI = 2.567-17.179, P < 0.001), but not other GI symptoms (i.e., diarrhea, abdominal discomfort, nausea and/or vomiting, constipation, acid reflux and/or heartburn, or abdominal pain). Conclusion: GI symptoms are common in COVID-19 patients and may be associated with their worse outcomes. Notably, such a negative impact of GI symptoms on the outcomes should be attributed to GI bleeding.
Collapse
Affiliation(s)
- Hongxin Chen
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Zhenhua Tong
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhuang Ma
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Li Luo
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
| | - Yufu Tang
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Yue Teng
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Hao Yu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Hao Meng
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Chengfei Peng
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Quanyu Zhang
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Tianyi Zhu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
- Department of Infectious Diseases, Wuhan Huoshenshan Hospital, Wuhan, China
| | - Haitao Zhao
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, China
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Guiyang Chu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Information Section of Medical Security Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Hongyu Li
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Hui Lu
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
| | - Xingshun Qi
- COVID-19 Study Group, General Hospital of Northern Theater Command, Shenyang, China
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| |
Collapse
|
|
50
|
Saleem S, Ishtiaq R, Inayat F, Aziz M, Bleibel W. Gastrointestinal and Liver Manifestations in COVID-19 Population. Middle East J Dig Dis 2021; 13:281-286. [PMID: 36606012 PMCID: PMC9489444 DOI: 10.34172/mejdd.2021.236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/29/2021] [Indexed: 01/09/2023] Open
Abstract
The coronavirus was first identified as the cause of pneumonia in Wuhan, a town in the Hubei Province of China, in December 2019. It usually has respiratory symptoms such as myalgia, headache, cough, and dyspnea. In the medical literature, digestive symptoms and liver disease have been reported in Coronavirus disease in 2019 (COVID-19) patients. In this review article, we summarized the recent studies of gastrointestinal and hepatic manifestations and management of COVID-19. The most common gastrointestinal symptoms were poor appetite/anorexia, nausea/vomiting, diarrhea, and abdominal pain. Elevated aminotransferase has been reported in patients with COVID-19. COVID-19 gastrointestinal and hepatic management is usually symptomatic except for high-risk populations such as patients with inflammatory bowel disease or autoimmune hepatitis, which require special attention.
Collapse
Affiliation(s)
- Saad Saleem
- Department of Internal Medicine, Sunrise Hospital and Medical Center, Las Vegas, NV, United States
,Corresponding Author: Saad Saleem, MD 3186 S Maryland Pkway, Las Vegas, NV 89109, United States Tel: + 1 702 9615000 Fax: + 1 702 9615010
| | - Rizwan Ishtiaq
- Department of Internal Medicine, St. Vincent Mercy Medical Center, Toledo, OH, United States
| | | | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, United States
| | - Wissam Bleibel
- Department of Internal Medicine, St. Vincent Mercy Medical Center, Toledo, OH, United States
| |
Collapse
|