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COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission

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COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission

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... Probiotics SARS-CoV-2 RNA has been detected in the stool of patients with COVID-19 (Gu et al., 2020;Holshue et al., 2020). Furthermore, the presence of the viral host receptor ACE2 was demonstrated in the cytoplasm of gastrointestinal epithelial cells, whereas the viral nucleocapsid protein was visualized in the cytoplasm of rectum, duodenal, and gastric epithelial cells (Xiao et al., 2020). ...
... Viral infections, including those sustained by influenza viruses, are known to alter the commensal microbiota in both the gastrointestinal and the airway tracts of the host (Edouard et al., 2018) through the altered delivery of cytokines and the induction of a Th17-mediated immune response (Wang et al., 2014). Even if very little is known regarding the association between COVID-19 and microbial dysbiosis in both the gut and the respiratory tract, the possible occurrence of diarrhea, nausea, vomiting, and abdominal discomfort with this disease, as well as the determined tropism of SARS-CoV-2 for enterocytes (Gu et al., 2020;Wu et al., 2020), suggests a possible interaction between this new coronavirus and the gut microbiota. ...
Article
A healthy diet and dietary supplements have gained attention as potential co-adjuvants in managing and preventing coronavirus disease 2019 (COVID-19). This paper critically reviews the current evidence regarding the impact of diet and supplements on the prevention and progression of COVID-19. According to available data, a healthy diet and normal weight are considered protective factors. Regarding dietary supplementation, the most robust results from human studies are for vitamin C, which appears to decrease inflammatory markers and suppress cytokine storm. A small, random-ized trial showed that a high dose of vitamin D significantly reduced the need for intensive care unit treatment of patients requiring hospitalization for COVID-19. According to retrospective human studies, there is limited evidence for vitamin E and selenium supplements. Animal studies have investigated the effects of green tea and curcumin. Xanthohumol and probiotics, interesting for their antiviral, anti-inflammatory, and immunoregulatory properties, need formal clinical study. In summary, there is promising evidence supporting the role of diet and supplements as co-adjuvants in the treatment of COVID-19. Further studies and properly designed clinical trials are necessary to draw more robust conclusions; however, it is not unreasonable to take a pragmatic approach and promote the use of appropriate diet and supplements to counter the effects of COVID-19, ideally with a mechanism to assess outcomes.
... COVID-19 was first identified in China in December 2019 and quickly spread to many countries (1). From the first days of this epidemic, respiratory symptoms were reported as the main symptoms of the disease, but with the spread of COVID-19, new manifestations such as gastrointestinal involvement (2), cardiac involvement (3), nervous system complications, and loss of smell and taste (4) were gradually observed in some patients and reported in studies. Preliminary studies also found probable evidence suggesting the presence of some electrolyte imbalances in these patients (5,6), but no consistent and specific report on electrolyte imbalances in these patients is available. ...
... However, few studies have specifically examined electrolyte imbalances seen in the course of this disease. The following four factors further demonstrate the importance of discussing electrolyte imbalances in COVID-19: (1) closer attention to electrolyte imbalances in the course of this disease and their timely correction can contribute to the better management of these patients; (2) there still is no specific treatment available for this disease, and in some centers, drugs such as hydroxychloroquine, lopinavir/ritonavir (Kaletra), and steroids are used in the treatment, which can have side effects similar to those of electrolyte imbalances (such as long QT in the case of hypocalcemia and hydroxychloroquine), or cause electrolyte imbalances (in the case of steroids); (3) identification of the more prevalent electrolyte imbalances in this disease and confirmation of the findings in multiple studies may help elucidate the pathophysiology of COVID-19; (4) electrolyte imbalances can be associated with disease severity and help establish disease prognosis. ...
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: Since the identification of COVID-19, its various manifestations have been reported in numerous studies. However, few studies have specifically examined the electrolyte imbalances seen in this disease. Patients with a definitive diagnosis of COVID-19 admitted to our hospital entered this retrospective cross-sectional study. Upon admission of the patients, a blood sample was sent for the analysis of the electrolytes. The relationship between electrolyte imbalances and disease severity, ICU admission, and mortality was also stated. Of 1072 hospitalized patients studied, 657 were men, and 415 were women. The prevalence of hypocalcemia (47.7%), hypophosphatemia (21.1%), hypomagnesemia (15.8%), and hyponatremia (13%) was higher compared to other electrolyte imbalances in these patients. Lower levels of sodium, calcium, and magnesium were seen in severe cases, while higher serum levels of potassium and phosphorus were detected in severe cases and ICU hospitalized patients. Causes such as albumin decrease in inflammation, the role of PTH, and the effect of vitamin D can play a role in hypocalcemia in these patients. In addition, electrolyte loss from the digestive tract can contribute to electrolyte imbalances. Because of the high prevalence of electrolyte imbalance in these patients, electrolyte monitoring is recommended in COVID-19 patients to ensure better care.
... Rotaviruses and coronaviruses are both RNA viruses with common elements in their outer coat, with similar infectious processes that create similar conditions. 9,13,14,17,18 Reasons to expect a reduction in the impact of COVID-19 infection in adult humans previously vaccinated against rotavirus include: Support of the intestinal and respiratory microbiota, their physiological barrier functions (mucosa) and the reactions associated with the innate cellular and humoral immune system. ...
... Furthermore, it should be noted that the SARS-CoV-2 genome and virus have been detected in faeces of sick people even during the convalescent phase, which means that both rotaviruses and coronaviruses affect, and can be found, in the respiratory system and in the intestinal system, being shed in faeces, and seem to use similar transmission routes (respiratory, anus-mouth, fomites), which supports that both viruses have common manifestations. 9,13 On the other hand, no references have been found in the literature to cases of repeated rotavirus infection involving an abnormal immune response with abnormal exaggerated inflammatory response. The terminology that sometimes appears in the literature indicating an intensification of the immune response does not necessarily imply an exaggerated response, but rather "activation". ...
Preprint
This proposal was prepared in the very first weeks of 2020 because of the outbreak of COVID-19.There is good reason to suppose that rotavirus vaccine can be used as protection tool to effectively and safely fight and mitigate SARS-CoV-2 infection and the impact caused by COVID-19 in adult humans, due to the development of cross and trained immunity following rotavirus vaccination. Up-to-date, some rotavirus vaccines are available and approved, two of them have a large experience in results and safety. Little experience has been achieved in the use of rotavirus vaccine in adults. However, it can be expected that it would be safe and effective in adults and in the elderly as well. This proposal explains the background.
... In contrast, Alphacoronaviruses and Gammacoronaviruses are reported in these animals [21,22]. SARS-CoV-2 might be shed for lengthy periods in feces of COVID-19 patients, [23][24][25][26][27]. Hence, SARS-CoV-2 is detected in wastewater management facilities [28] and could be introduced to aquatic habitats through sewage outfalls. ...
Article
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health threat. This virus is the causative agent for coronavirus disease 2019 (COVID-19). Pandemic prevention is best addressed through an integrated One Health (OH) approach. Understanding zoonotic pathogen fatality and spillover from wildlife to humans are effective for controlling and preventing zoonotic outbreaks. The OH concept depends on the interface of humans, animals, and their environment. Collaboration among veterinary medicine, public health workers and clinicians, and veterinary public health is necessary for rapid response to emerging zoonotic pathogens. SARS-CoV-2 affects aquatic environments, primarily through untreated sewage. Patients with COVID-19 discharge the virus in urine and feces into residential wastewater. Thus, marine organisms may be infected with SARS-CoV-2 by the subsequent discharge of partially treated or untreated wastewater to marine waters. Viral loads can be monitored in sewage and surface waters. Furthermore, shellfish are vulnerable to SARS-CoV-2 infection. Filter-feeding organisms might be monitored to protect consumers. Finally, the stability of SARS-CoV-2 to various environmental factors aids in viral studies. This article highlights the presence and survival of SARS-CoV-2 in the marine environment and its potential to enter marine ecosystems through wastewater. Furthermore, the OH approach is discussed for improving readiness for successive outbreaks. This review analyzes information from public health and epidemiological monitoring tools to control COVID-19 transmission.
... Viral pancreatitis is also possible to develop [87]. Symptoms of gastrointestinal infection such as diarrhea, abdominal pain, nausea, and vomiting may manifest as gastroenteritis, suggesting the possibility of viral transmission fecal-orally [88]. ...
Article
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The SARS-CoV-2 infection causes COVID-19, which has affected approximately six hundred million people globally as of August 2022. Organs and cells harboring angiotensin-converting enzyme 2 (ACE2) surface receptors are the primary targets of the virus. However, once it enters the body through the respiratory system, the virus can spread hematogenously to infect other body organs. Therefore, COVID-19 affects many organs, causing severe and long-term complications, even after the disease has ended, thus worsening the quality of life. Although it is known that the respiratory system is most affected by the SARS-CoV-2 infection, many organs/systems are affected in the short and long term. Since the COVID-19 disease simultaneously affects many organs, redesigning diagnostic and therapy policies to fit the damaged organs is strongly recommended. Even though the pathophysiology of many problems the infection causes is unknown, the frequency of COVID-19 cases rises with age and the existence of preexisting symptoms. This study aims to update our knowledge of SARS-CoV-2 infection and multi-organ dysfunction interaction based on clinical and theoretical evidence. For this purpose, the study comprehensively elucidates the most recent studies on the effects of SARS-CoV-2 infection on multiple organs and systems, including respiratory, cardiovascular, gastrointestinal, renal, nervous, endocrine, reproductive, immune, and parts of the integumentary system. Understanding the range of atypical COVID-19 symptoms could improve disease surveillance, limit transmission, and avoid additional multi-organ-system problems.
... Therefore COVID-19 causes serious damage to lungs [62]. Together with the lungs, gastrointestinal tract is also targeted by SARS-CoV-2 due to the abundant expression of ACE2 receptors is in the enterocytes, glandular cells, and endothelial cells of the gastrointestinal tract [63,64]. ...
Chapter
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There is a deep-rooted belief in mankind that for every illness, somewhere in the world, there exists a botanical-based healing agent in nature in the form of a natural product. Natural products are better equipped to become successful drugs because of their million years of coevolution in a biological milieu. Generally, most herbal formulations and natural products obtained from traditionally used medicinal plants are nontoxic and have rarely shown any adverse side effects on humans. Plants synthesize secondary metabolites primarily for their defense against microbes and herbivores, and because of this, these metabolites have good specificity and potency against harmful pathogens. Nowadays, mankind is facing the contagion effect of SARS-CoV-2 that has caused the ongoing pandemic of COVID-19, which has no specific and effective treatment. Hence this is the time to explore nature for effective, safe, and affordable remedies against this disease. This chapter includes an overview of coronaviruses, their therapeutic targets, and the progress made in identifying lead natural products against the coronaviruses. Additionally, molecular docking and pharmacokinetics analysis of anticoronaviral natural products have been performed to narrow down the possible lead molecules.
... Tüm bunlara dayanarak SARS-CoV-2'nin neden olduğu diyarenin COVID-19 hastalarında erken bir belirti olabileceği öne sürülmektedir (13). Virolojik değerlendirme yapılan çalışmalarda COVID-19'lu bireylerin yaklaşık %50'sinin anal sürüntü ve fekal örneklerinde SARS-CoV-2 virüsü tespit edilmiştir, bu da sindirim sisteminin virüs replikasyonu ve aktivitesi için ekstrapulmoner bir bölge olabileceğini düşündürmektedir (14)(15)(16). SARS-CoV-2 ile enfekte 73 hastanın dahil edildiği bir çalışmada hastaların %53'ünün fekal örneklerinde viral nükleik asit saptanmıştır (17). Böylece SARS-CoV-2'nin gastrointestinal enfeksiyona ve olası fekal-oral bulaşma yoluna dair kanıt elde edilmiştir. ...
... In the context of COVID-19, several studies have found altered microbiomes following SARS-CoV-2 infection. [32][33][34][35][36] However, due to the high variability of the human microbiomes, which may have been influenced by the infection and medications in COVID-19 patients, controlled animal studies might help define the role of the gut microbiome in host response to SARS-CoV-2 infection. Interferon signaling is efficiently suppressed by at least 13 components of the SARS-CoV-2 genome, including spike protein, the nucleocapsid proteins nsp1 and nsp6, and accessory proteins ORF3b and ORF6. ...
Article
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The gut microbiome is intricately coupled with immune regulation and metabolism, but its role in Coronavirus Disease 2019 (COVID-19) is not fully understood. Severe and fatal COVID-19 is characterized by poor anti-viral immunity and hypercoagulation, particularly in males. Here, we define multiple pathways by which the gut microbiome protects mammalian hosts from SARS-CoV-2 intranasal infection, both locally and systemically, via production of short-chain fatty acids (SCFAs). SCFAs reduced viral burdens in the airways and intestines by downregulating the SARS-CoV-2 entry receptor, angiotensin-converting enzyme 2 (ACE2), and enhancing adaptive immunity via GPR41 and 43 in male animals. We further identify a novel role for the gut microbiome in regulating systemic coagulation response by limiting megakaryocyte proliferation and platelet turnover via the Sh2b3-Mpl axis. Taken together, our findings have unraveled novel functions of SCFAs and fiber-fermenting gut bacteria to dampen viral entry and hypercoagulation and promote adaptive antiviral immunity.
... Studies showed that cardiopulmonary disease might be associated with ACE2 through changes in the gut or lung microbiomes [5] and GIT symptoms are prevalent in about 3.34 to 11.4% of COVID-19 patients, including, vomiting and diarrhea, and are more predominating in critically ill patients [6]. There is a suggestion that the digestive tract might be a site of viral replication and activity, supported by the presence of viral RNA and living viruses in stool samples [7]. ...
Article
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Background: SARS-CoV-2 is considered one of the most widely spread viral infections globally. The relation between diminished gut microbiota and susceptibility to Corona virus 2019 infection is well correlated. We aimed to investigate of the correlation between gut microbiota imbalance and the development of several diseases including COVID-19 with suggestion of routes for restoring this imbalance in affected patients especially geriatric ones. Discussion: Resulting immune disruption from COVID-19 infection can alter gut microbiota leading to dysbiosis and increases gut permeability leading to progression of secondary bacterial infections and bacterial pneumonia. Besides, dysbiosis may lead to development of inflammatory bowel diseases, cardiovascular diseases, and autoimmune diseases. Diet changes and supplementation can positively affect dysbiosis state. Conclusion: Diets like cereals, fruits, vegetables, and whole grain cereal are main contributor in restoring gut microbiota balance, on the other hand, diets containing high fat content are unfavorable due to their negative effect on microbiota diversity. Moreover, massive use of antibiotics is not recommended and was proven to affect gut microbiota abundance and balance leading to several inflammatory diseases. Finally, probiotics and prebiotics are proven to regulate bacterial balance and reduce probability of bacterial and viral infections. Keywords: COVID-19; Gut Microbiota; Antibiotics; Probiotics; Prebiotics; Crohn’s Disease
... Year 16, Issue 4 (July-August 2022) Iranian Journal of Medical Microbiology (17)(18)(19)(20). Previous studies have shown that the angiotensin-converting enzyme 2 (ACE2) receptor acts as a SARS-CoV entry point in the small intestine epithelial cells (21). ...
... Severe symptoms include shortness of breath, loss of appetite, confusion, persistent pain or pressure in the chest, high temperature. 11 Complications leading to mortality include respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock, thromboembolism, multiorgan failure, including injury of the heart, kidneys or liver. 12 At the beginning of the pandemic, it was presumed that paucity of oral involvement is a differentiating attribute of COVID-19 from other viral diseases. ...
Article
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Since the inception of COVID-19 pandemic in November 2019, caused by SARS-CoV-2 virus, relationship between corona virus disease and oral effects caused due to viral enanthema have been studied with great interest. Owing to the existence of many ACE2 receptors (which permit entry of virus in the host cell) in the oral cavity, a multitude of oral manifestations have been described. Among various oral symptoms, dysgeusia is the most prevalent. Other oral lesions included ulcer, erosion, vesicle, bulla, depapillated tongue, macule, papule, plaque, pigmentation, whitish areas, petechiae and erythema. Aphthous stomatitis, mucositis were also diagnosed among COVID-19 affected patients. Kawasaki-like disease and atypical Sweet syndrome was also noted in some patients. People with severe disease state and older individuals had significantly more oral lesions. Many oral symptoms were seen in patients post the corona virus disease recovery as well. This may be due to the diverse treatment given to the patients which may have ill-effects. Older age group, underlying diseases, opportunistic infections, poor oral hygiene and stress are the important factors for the development of oral manifestations in COVID-19 patients. Health care workers should be vigilant to identify the various oral manifestations and provide extensive treatment with an intent to improve general status as well as oral health of COVID affected individuals.
... Coronavirus disease 2019 (COVID- 19) was first reported in December 2019 and continues to cause a worldwide pandemic in 2022. COVID-19 patients often experience gastrointestinal symptoms, such as diarrhea, nausea and vomiting, anorexia, and abdominal pain (1). Our institution reported that abdominal pain is a risk factor for severe disease outcomes in COVID-19 (2). ...
Article
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Introduction Coronavirus disease 2019 (COVID-19) is still causing a global pandemic. But the mechanism of COVID-19 severity is not well elucidated. Materials and methods We conducted two single-center observational studies of patients with COVID-19. In the first study, the enrolled patients were distinguished based on critical vs. non-critical COVID-19. We collected blood samples from the patients at admission to measure markers related to inflammation and thrombosis and stool samples to analyze the fecal microbiome, metabolome, and calprotectin level. In the second study, we collected ileum and colon tissue samples from patients with critical COVID-19 who required colonoscopy due to severe gastrointestinal symptoms and analyzed mucosal gene expression. Results A total of 19 blood samples and 10 stool samples were collected. Interleukin (IL)-6 was the only serum inflammatory marker with significantly higher levels in the critical group than in the non-critical group. The fecal calprotectin level in the critical group was significantly higher than that in the non-critical group ( P = 0.03), regardless of the presence of gastrointestinal symptoms. Stool metabolomic analysis showed that the level of indole-3-propionic acid, a ligand for aryl hydrocarbon receptor (AhR), was markedly decreased in the critical group compared to that in the non-critical group ( P = 0.01). The expression of genes involved in tryptophan metabolism, including ACE2 , AHR , CARD9 , and IL22 , was downregulated in the ileum of critical COVID-19 patients who required a colonoscopy. Discussion Critical COVID-19 patients have gastrointestinal inflammation potentially caused by impaired tryptophan metabolism in the small intestine due to decreased expression of genes involved in tryptophan metabolism.
... Covid-19 infected patients with GI symptoms have a poor prognosis. Patients with covid-19 positive with truly GI symptoms have delayed diagnosis [5] [6] [7]. For this reason, GI symptoms have special significance in the corona virus patients. ...
... Based on the analysis of the confirmed cases, fever, cough, fatigue, and dyspnea were identified as predominant symptoms of COVID-19 (7,8). Thus, these also became important keywords when searching for information related to . ...
... It is a type of virus identified in 13 January 2020 as a result of the investigation of respiratory disease symptoms, such as fever, cough, and difficulty of breathing in a group of patients. 1 According to authorities in China, the epidemic started by transmitting the virus from animals sold in the seafood and wild animal market to humans. Later, the epidemic spread to other cities in China and worldwide through international travels. ...
Article
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The coronavirus disease 2019 (COVID-19) which began in Wuhan in December 2019 has permeated all over the world in such a short time and was declared as a pandemic by World Health Organization (WHO). The pandemic that is erupting all of a sudden attracts the researchers to examine the spread and effects of the disease as well as the possible treatments and vaccine developments. In addition to the analytical models, such as compartmental modeling, Markov decision process, and so on, simulation and system dynamics (SD) are also widely applied in this field. In this study, we adopt the compartmental modeling stages to build an SD approach for the spread of the disease. A dynamic control measure decision support system (DSS) that varies depending on the number of daily cases is incorporated to the model. Furthermore, the economic loss in the gross domestic product (GDP) and workforce due to hospital stay and death caused by the COVID-19 are also investigated. The model is tested with various numerical parameters and the results are presented. The results on the spread of the disease and the associated economic loss provide meaningful insights into when control measures need to be imposed at which level. We also provide some policy insights, including some alternative policies, such as increasing awareness of people and vaccination in addition to control measures. The results reveal that the total number of cases and deaths is approximately 37% higher in the absence of dynamic DSS. However, everything comes at a price and applying such control measures brings about an increase in the economic loss about 47%.
... 78 The probability of SARS-CoV-2 fecal-oral transmission in the current global outbreak is supported by these findings. 78,79 Furthermore, live SARS-CoV-2 was found in blood samples and anal swabs, while oral swabs were negative for the same patients in a few cases. As a result, although posing a risk to others through fecal-oral transmission, those individuals were found to be COVID-19 negative during routine surveillance ( Figure 2). ...
Article
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New infectious agents pose a global threat to the healthcare system, and studies are conducted to estimate their health and epidemiological outcomes in the long run. The SARS-CoV-2 virus, which has caused the COVID-19 disease, was formerly assumed to be a respiratory virus; however, it can have serious systemic effects, affecting organs such as the gastrointestinal tract (GIT). Viral RNA was reported in the stool in a subset of patients, indicating another mode of transmission and diagnosis. In COVID-19, prolonged GIT symptoms, especially diarrhea, were associated with reduced diversity and richness of gut microbiota, immunological dysregulation, and delayed viral clearance. Intestinal coccidian parasites are intracellular protozoa that are most typically transmitted to humans by oocysts found in fecally contaminated food and water. Their epidemiological relevance is coupled to opportunistic infections, which cause high morbidity and mortality among immunocompromised individuals. Among immunocompetent people, intestinal coccidia is also involved in acute diarrhea, which is usually self-limiting. Evaluating the available evidence provided an opportunity to carefully consider that; the COVID-19 virus and coccidian protozoan parasites: namely, Cryptosporidium spp., Cyclospora cayetanensis, and Isospora belli, could mutually influence each other from the microbiological, clinical, diagnostic, and elimination aspects. We further systemically highlighted the possible shared pathogenesis mechanisms, transmission routes, clinical manifestations, parasite-driven immune regulation, and intestinal microbiota alteration. Finally, we showed how this might impact developing and developed countries prevention and vaccination strategies. To the best of our knowledge, there is no review that has discussed the reciprocal effect between coccidian parasites and COVID-19 coinfection.
... Probiotics have analgesic and anti-inflammatory properties and can reduce gut inflammation. A mix of three probiotic strains (Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201; Lactibiane Iki ® , Biocure (PiLeJe Groupe), Milan, Italy/PiLeJe Laboratoire, Orée-d'Anjou, France) had significant beneficial effects on inflammation and symptoms of acute uncomplicated diverticulitis [12]. ...
Article
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Background: COVID-19 disease, which typically presents with respiratory symptoms, can trigger intestinal inflammation through SARS-CoV-2 replication in the gastrointestinal tract. Supplementation with probiotics may have beneficial effects on gut inflammation due to their analgesic and anti-inflammatory properties. The primary objective of our study was to evaluate the efficacy of a mix of three probiotic strains (Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201; Lactibiane Iki®) in the reduction in fecal calprotectin in patients with COVID-19 pneumonia, compared to a control group. The secondary aim was to evaluate the reduction in oxygen support and length of hospital stay in patients taking the probiotic mix. Patients and Methods: We conducted a prospective randomized controlled trial at Fondazione Policlinico Gemelli, Rome. We enrolled patients with COVID-19 interstitial pneumonia. One group received the probiotic mix twice a day for 10 days in addition to the standard COVID-19 therapy, and a second group received standard COVID-19 therapy without probiotics. We administered oxygen support (through Ventimask or Optiflow®) on days (D) 1, 3, 5, 7 and 10, and the level of fecal calprotectin between D3–D5 and D7–D10. Results: A total of 80 patients (44 M/36 F; mean age: 59.8 ± 17.3) were enrolled with a mean value of calprotectin at enrollment of 140 mg/dl. At D7–10, the probiotic group showed a 35% decrease in fecal calprotectin compared to 16% in the control group, a decrease in C-reactive protein (CRP) of 72.7% compared to 62%, and a slight but not significant decrease in oxygen support compared to the control group. Conclusion: Supplementation with a mix of probiotics for 10 days in patients with COVID-19 interstitial pneumonia significantly reduces inflammatory markers.
... Indeed, the presence of the virus within the gut epithelia has been demonstrated in some studies. Extended viral shedding in the faeces of infected patients has also been reported [5,9]. In addition, GIT involvement may also be due to CD4+ T cell-mediated inflammation. ...
Article
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Coronavirus disease 2019 (COVID-19) is primarily considered to be a respiratory ailment. Hitherto, abdominal symptoms have been reported with variable frequency in acute COVID-19. The purpose of this study was to estimate the frequency of abdominal symptoms at presentation among patients hospitalised with COVID-19 infection, and to determine their association with disease severity. This was a single-centre cross-sectional observational study conducted at a COVID-19 tertiary care hospital (CTRI/2021/10/037195, registered on 08/10/2021). Consecutive patients hospitalised with acute COVID-19 illness during the study period were included in the study. Their demographic information, abdominal symptoms, comorbidities and category of COVID-19 illness were elicited. All patients had serum inflammatory markers tested on the day of hospitalisation. Among the 685 participants, 214 patients had mild-to-moderate category illness whereas the rest 471 had severe COVID-19 illness. Abdominal complaints were present among 132/685 (18.3%) patients with distension of abdomen (8.03%) being the most common symptom, followed by vomiting (6.72%) and abdominal pain (3.94%). At admission to the hospital, abdominal complaints were commoner among patients with severe disease than in those with mild-to-moderate disease (101/471 vs. 31/214; p=0.029). Abdominal symptoms were associated with a higher neutrophil to lymphocyte ratio (p=0.029). The mortality among COVID-19 patients with abdominal symptoms was higher (9.09 vs. 3.25%; p = 0.007). This study demonstrates the spectrum of abdominal symptoms that can be a part of acute COVID-19 at hospitalisation and also highlights their prognostic potential in acute COVID-19 infection.
... 11 Furthermore, In the current COVID-19 clinical trials, mild to moderate liver injury has been recorded, including increased aminotransferases, hypoproteinaemia, and prothrombin time lengthening. 12 Regarding liver injury, Acute liver failure occurs when significant complications arise soon after the initial signs of liver disease (such as jaundice) and suggests that the liver has been severely damaged (80-90 percent of liver cells have lost function). ...
Article
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Background: The respiratory system is most affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). However, COVID-19 can appear in a variety of ways. It has found a link between higher liver enzymes and COVID-19 infection, implying that the virus can induce liver damage through direct hepatotoxic injury, medication toxicity, or an immune-mediated response. Materials and Methods: In the southern Iraqi province of Basra, a cross-sectional observational study is being conducted in a single center (Basra teaching hospital) to estimate the prevalence of liver damage among hospitalized patients and identify those at risk. Results: The study found that most of the patients have a normal liver function test at the time of diagnosis and or admission, but after hospitalization, there is a statistically significant increase in the liver enzymes that is positively related to the disease severity and cytokine storm and also lead to more extended hospital staying and further mortality. Fortunately, the degree of liver damage is of mild severity in the majority of patients. Still, the severe form of liver damage was also noticed in some patients, especially those with a higher degree of lung involvement and severely desaturates with raised inflammatory markers. Conclusions: Elevated liver enzymes are prevalent, but the majority is mild with COVID-19 disease. Liver function abnormalities, particularly increased levels of AST and ALT, are not only common in COVID-19, but they are also linked to poor outcomes, mainly if severe liver damage has occurred.
... Though the understanding of this novel coronavirus is still somewhat limited, there is some postulation that it shares many similarities with the SARS-CoV. Previously, the angiotensin converting enzyme 2 (ACE2) receptor was identified as the specific receptor used by SARS-CoV to infect the ciliated bronchial epithelial cells and the type 2 pneumocytes [5][6][7][8] . The same receptor is implicated in the pathogenesis of SARS-Cov-2. ...
... The presence of the virus in the faeces leads to the presence of the virus in the wastewater. Although less studied, the faecal-oral route of transmission has also been investigated [14][15][16]. ...
Article
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Water is a risk factor for epidemics of waterborne diseases with effects on human health. In 2019, new viral pneumonia cases occurred in China and spread worldwide. The aim of this study was to assess the feasibility and accuracy of a wastewater-based epidemiological (WBE) monitoring tool in a SARS-CoV-2 hot spot (Sibiu City metropolitan area), namely to highlight the correlation between the number of infections on the days of sampling and the amount of viral RNA detected in wastewater. Wastewater samples were collected once a week, and viral RNA was extracted and quantified. In parallel, the daily number of SARS-CoV-2 infections was obtained from the local council. The correlation between the number of infections and viruses detected in sewage was measured by Pearson correlation coefficients. The results show the amount of viral RNA in the wastewater is directly correlated with the number of infections reported in the week up to the sampling day and also the number of infections reported for the sampling day. Moreover, correlation coefficients show the amount of viral RNA in wastewater increases in advance of the increase in reported infection cases. Therefore, WBE can be used as a tool for monitoring virus spread trends in human communities and can help anticipate the trend of this type of viral infection.
... For example, researchers report the need for further research to understand how gastrointestinal symptoms are associated with COVID-19 and possible fecal-oral transmission. [70] Notably, a limitation of this study was the limited access to research regarding COVID-19 and health conditions. The limited research is because COVID-19 is a novel disease, and research is gradually building over time. ...
... 4 The risk of exposure to infectious agents is not limited to upper endoscopy procedures; considering the reports on the detection of SARS-CoV-2 in biopsy specimens and stools, a possible fecal-oral transmission is suggested. 5 Preventive measures in an endoscopy center start by minimizing the chance of an infected person visiting the center. To achieve this, it is necessary to first determine whether there is any risk of infection by asking structured questions. ...
... 2022;70:e20220033 They did not present preventive measures against COVID-19 by professionals or organizations/institutions (5) Martelli-Júnior et al. [15] Farooq & Ali [16] Gu et. al. [19] Sabino-Silva et al. [20] Guo et al. [21] They analyzed another type of coronavirus, which was not 2019 (1) Gaffar et al. [22] Six reviews, 1 letter of recommendation to the editor, 2 case studies referring to hospital units, and 2 cross-sectional studies were included in this integrative review. A total of 368 dentists and 50 hospital units were evaluated. ...
Article
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Objective The study and enactment of dental preventive measures, in response to the COVID-19 pandemic, are necessary to prevent cross-infections between professionals and patients. The objective of this integrative review was to identify the COVID-19 preventive practices in dentistry. Methods The electronic search was conducted on these databases: Pubmed / Medline, Web of Science, Cochrane Library, Scopus, LILACS and Scielo, using the following descriptors and / or words: “Coronavirus disease 2019”; “Coronavirus 2019”; “Covid-19”; “2019-ncov”; “Sars-cov2”; “Dental practice”; “Dental care”; “Dentistry”; “Dental medicine” and “Oral medicine”. PRISMA was used as a reference for designing it. Results A total of 11 articles were included and the preventive measures against COVID-19 were based on guidelines from health agencies and consisted of: perform only emergency treatments; reschedule patients with suspected disease; hand washing; disinfection of surfaces with 70% alcohol; testing dental professionals for the disease; use the N95 mask; disposable lab coats, and face shields. Children, in addition to the measures mentioned above, should routinely drink a lot of water and be provided with healthy diets. No study has evaluated the efficacy and effectiveness of these measures. There is a lack of scientific evidence on the preventive protocols adopted against COVID-19 in dentistry since preventive measures are recommended by health agencies. Conclusion Consequently, professionals are recommended to follow the guidelines by these organizations until effective and efficient preventive protocols tailored to dentistry are established. Indexing terms Community dentistry; Infection control; Dental education
... Apparently, this is caused by a central dysfunction [99,100]. However, gastrointestinal problems and hyposmia are the common non-motor symptoms in PD individuals during the prodromal stage; this is when neurodegeneration has been initiated [101]. Based on Braak's hypothesis, these indications suggest that it is the beginning phase of PD progression, which entails α-synuclein deposition in the anterior olfactory nucleus region and dorsal motor region. ...
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... True asymptomatic or less symptomatic cases, severe pneumonia, and fatal acute respiratory distress syndrome are all on the disease's shockingly wide range [20]. Although the upper and lower respiratory tracts are the most common organs and tissues affected by SARS-CoV-2, other tissues and organs, including the central and peripheral nervous system, gastrointestinal tract, cardiovascular system, liver, kidneys, spleen, and even the eyes, may also be affected [21][22][23][24][25]. ...
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The coronavirus disease 2019 (COVID-19) pandemic determined the use of different research methods and investigations in the management of this novel infectious disease. The impact and development of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at cellular level is still a challenge and many directions of investigation have been opened, a complex topic that has been explored is the bidirectional interaction between host micro-ribonucleic acids (miRNAs) and viral miRNA. The main point of this study is to analyze the transcriptional modifications induced by the viral infection at ocular level, mediated by miRNAs. It is known that the ocular transmission is a route of infection, and it can cause multiple neuro-ophthalmological manifestations, such as optic nerve dysfunction, eye movement abnormalities, oscillopsia and intracranial hypertension. We have managed to identify more than six miRNAs specifically involved in eye disorders that are strongly dysregulated by the SARS-CoV-2. These miRNAs regulate different pathways, such as the nuclear factor-kappa B (NF-κB) pathway, the expression of complement factor H (CFH) gene, the expression of transforming growth factor-beta (TGF-β), fibroblast growth factor (FGF) and platelet-derived growth factor (PDGF) genes. In the context of SARS-CoV-2 infection, many more molecular changes at ocular level need to be elucidated to better understanding the COVID-19.
... 12,13,18,19 Furthermore, the mechanism of diarrhea in COVID-19 infection is explained by previous evidence that suggested SARS-CoV-2 alters the permeability of the gastrointestinal tract causing malabsorption within the enterocytes. 20 There is also evidence demonstrating ACE2 involvement in the gastrointestinal linings directly disrupts the homeostasis of gut microbes. 21 Nevertheless, the pathophysiology of diarrhea in severe cases of COVID-19 has not been fully understood. ...
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... e virus has also recently been found in feces [98] and urine [99]. Evidence suggests that COVID-19 is less likely to be transmitted through the feces of an infected person, and that gastrointestinal infections and diarrhea occur in approximately 2 to 10% of cases [100]. Several studies have reported the presence of the virus in fecal samples. ...
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... The most common symptom of COVID-19 (SARS-CoV-2) is respiratory symptoms [1,2]. On the other hand, non-respiratory symptoms reported, such as digestive symptoms (nausea, vomiting, and diarrhea), have been reported [3]. An increase in voiding frequency and lower urinary tract symptoms (LUTS) have been reported [4]. ...
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Since the International Health Regulations National Focal Point for the United Kingdom alerted the WHO of ten cases of acute severe hepatitis of unknown etiology in children on April 5, 2022, relevant cases have been reported worldwide. These patients had acute hepatitis (negative for hepatitis viruses A–E) and elevated aminotransferase (AST) or alanine aminase (ALT) exceeding 500 U/L. Furthermore, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and/or adenovirus type F41 have been detected in some cases. This unknown hepatitis has been hypothesized to be induced by a viral reservoir of novel coronavirus superantigen, which repeatedly stimulates the intestines and leads to a multisystem inflammatory syndrome in children (MIS-C), which causes immune abnormalities in the presence of human adenovirus. Although this hypothesis has not been confirmed by any in vivo experimental or clinical studies, it may provide ideas for possible intervention strategies.
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Introducción: el virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), que produce una patolo-gía llamada COVID-19 (Coronavirus Disease 2019), presenta cuadros diversos, desde los completamente asin-tomáticos hasta neumonías fatales. Debido, además, a su alta tasa de transmisión ha provocado una pande-mia de consecuencias históricas. Objetivo: analizar los aportes derivados de la Biotecnología que resultaron en productos terapéuticos, diversas estrategias/técnicas disponibles actualmente para el diagnóstico y vacunas profilácticas destinadas a esta patología. Materiales y Métodos: se realizó una búsqueda en MEDLINE/Pubmed y otros buscadores, usando como palabras clave: COVID 19, SARS-CoV-2, coronavirus, vaccines, biopharmaceu-ticals, biotherapies, microbiota, y biomarkers. Resultados: en el trabajo se presentan y describen el desarrollo de tests diagnósticos, biofármacos, bioterapias con células madre distintas tecnologías y plataformas vacuna-les para COVID 19. Conclusiones: La biotecnología bioquímico-farmacéutica tiene una activa e importante parti-cipación en la Covid-19, a través de desarrollos que pueden prevenir, diagnosticar, tratar síntomas y disminuir la mortalidad de los pacientes.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to a severe respiratory illness and alters the gut microbiota, which dynamically interacts with the human immune system. Microbiota alterations include decreased levels of beneficial bacteria and augmentation of opportunistic pathogens. Here, we describe critical factors affecting the microbiota in coronavirus disease 2019 (COVID-19) patients. These include, such as gut microbiota imbalance and gastrointestinal symptoms, the pattern of altered gut microbiota composition in COVID-19 patients, and crosstalk between the microbiome and the gut-lung axis/gut-brain-lung axis. Moreover, we have illustrated the hypoxia state in COVID-19 associated gut microbiota alteration. The role of ACE2 in the digestive system, and control of its expression using the gut microbiota is discussed, highlighting the interactions between the lungs, the gut, and the brain during COVID-19 infection. Similarly, we address the gut microbiota in elderly or co-morbid patients as well as gut microbiota dysbiosis of in severe COVID-19. Several clinical trials to understand the role of probiotics in COVID-19 patients are listed in this review. Augmented inflammation is one of the major driving forces for COVID-19 symptoms and gut microbiome disruption and is associated with disease severity. However, understanding the role of the gut microbiota in immune modulation during SARS-CoV-2 infection may help improve therapeutic strategies for COVID-19 treatment. © 2022 Baishideng Publishing Group Co., Limited. All rights reserved.
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Background: The COVID-19 pandemic has raised concerns on whether colonoscopies (CS) carry a transmission risk. The aim was to determine whether colonoscopies are an aerosol-generating procedures. Methods: This was a prospective observational trial including all patients undergoing CS in Prince of Wales Hospital from 1st June to 31st July 2020. Three particle counters were placed 10cm from the patients' anus, near endoscopists' and nurses' mouth. The particle counter recorded the number of particles of size 0.3μm, 0.5μm, 0.7μm, 1μm, 5μm, and 10μm. Patient demographics, seniority of endoscopists, use of CO2 and water immersion technique and air particle count (particles/cubic feet, dCF) were recorded. Multilevel modelling was used to test all the hypotheses with a post-hoc analysis. Results: 117 patients were recruited. During CS, the level of 5μm and 10μm were significantly higher than the baseline period (p=.002). Procedures performed by trainees had a higher level of aerosols when compared to specialists (0.3μm: p <.001; 0.5μm and 0.7μm: p<0.001). The use of CO2 and water immersion techniques had significantly lower aerosol generated when compared to air (CO2: 0.3μm, 0.5μm and 0.7μm: p<0.001; water immersion: 0.3μm: p=0.048; 0.7μm: p=0.03). There were no significant increases in any particle sizes during the procedure at the endoscopists' and nurses' mouth. However, 8/117 (6.83%) particle count tracings showed a simultaneous surge of all particle sizes at the patient's anus, endoscopists' and nurses' level during rectal extubation. Conclusion: CS generates droplet nuclei especially during rectal extubation. The use of CO2 and water immersion techniques may mitigate these risks.
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The Covid-19 that has hit the world since the end of 2019 has had a considerable impact on the Indonesian economy, especially on business people. This paper considers how businesses in Indonesia could benefit from implementing a Retail Direct Order (RDO) process to respond to social changes, particularly restrictions on movement, brought about by the pandemic. The paper first reviews the literature on supply chain management and logistics and the effects on them due to greater digitization of businesses, operational automation and globalization. It then proposes how RDO can assist businesses in Indonesia-especially department stores, supermarkets, convenience stores, and non-store retailers-to adapt to the new business environment. One benefit of properly managed RDO is to reduce panic buying by supporting a more dependable supply of goods.
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Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, the capital of China’s Hubei province and has rapidly spread all over the world. Until August 2020, >25 million cases of SARS-CoV-2 infection had been confirmed worldwide, causing >800,000 deaths. This disease was named by the World Health Organization (WHO) as COVID-19. Similar to SARS and Middle East Respiratory Syndrome, which are also caused by corona virus infections, COVID-19 mainly causes severe respiratory system damage; however, it also causes damage to multiple organs, including the gastrointestinal tract, the cardiovascular system and the nervous system. According to the WHO, common signs of infection include fever, cough, and respiratory difficulties like shortness of breath. Serious cases can lead to pneumonia, kidney failure, and even death. The main aim of the present review article was to summarize the current knowledge of COVID-19, such as the transmission process, diagnostic methods, clinical feature pathological characteristics, and treatment measures.
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The aim. To investigate the clinical peculiarities of adult patients with diarrheal syndrome, associated with coronavirus infection COVID-19. The materials and methods. There has been carried out the analysis of 56 patients aged 26-81 years, hospitalized with acute enteric infection at the Municipal Infectious Diseases Hospital №8 (not reprofiled as hospital for the treatment of coronavirus infection COVID-19 patients) in the course of August 2020 – February 2021 and the patients with cause-effect relationship with COVID-19. There have been used the routine diagnostic methods, the analysis of feces for causative agents of diarrhea was tested by the methods of bacteriological and immunoenzymatic analysis, the analysis of feces for toxins A and B Clostridium difficile was tested method of immunochromatographic assay; the blood serum was tested by method of immunoenzymatic analysis and the analysis of nasopharyngeal swabs was tested by immunochromatographic assay and PCR test for markers SARS-COV-2. The statistical material treatment has been done using Statistical Package of IBM SPSS Statistics-22. The results. There have been registered 51,8% of cases – diarrhea as one of the clinical manifestations of COVID-19 in adult patients (the first group of patients), in 48,2% of cases – diarrhea as a result of recently treated COVID-19 and a massive course of antibiotics (the second group of patients). In the second group 12 patients have been diagnosed with clostridial infection, 15 patients – with antibiotic-associated diarrhea. There has been registered the main severity of clinical manifestations in patients with clostridial infection. The disease being characterized by severity of colitis syndrome, the blood sedimentation rate increasing, hyperleukocytosis in haemogram, hypoproteinemia and hypoalbuminemia. The aggravating factors are combined comorbidity and patients aged over 55 years. The conclusion. There should be used the differential approach for diarrheal syndrome in patients with coronavirus infection. Taking into account the massive course antibiotics’ side effects, the analysis of feces for pathogenic flora must be included into the medical examinations such as Clostridium difficile and the course of probiotic and anticlostridial medicines should be done.
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Spontaneous intestinal perforation is a rare extrapulmonary manifestations of critical COVID-19 case. The pathogenesis of viral etiology is still unclear and association to some essential therapeutic treatment such as steroid or interleukin-9 antagonist is also inconclusive. Surgery is not mandatory If source control and sepsis can be accomplished with available interventions reported in current literatures. This uncommon complication develops either at time of presentation or after hospital admission, both upper and lower gastrointestinal tract1 We reported an ARDS patient experienced cardiac thrombus without valvular defect or arrhythmia who was diagnosed of spontaneous intestinal perforation from acute necrotizing ileitis necessitated damage control surgery.
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Coronavirus disease 2019 (COVID-19) had caused pandemia with a high rate of mortality and morbidity. Lung involvement is the main cause of mortality, but central nervous system and cardiac disease, and thromboemboli may participate in increasing mortality. A wide spectrum of organs involvement and complication has been reported as data gathering during the pandemia has progressed. We report a 69-year-old man who was admitted to Imam Khomeini hospital in Tehran and complained of severe abdominal pain and fever. He had been admitted 10 days earlier because of dyspnea and fever. At the first admission, based on the findings in the lung computed tomography (CT) and a positive nasopharyngeal polymerase chain reaction (PCR) test for COVID-19, he was treated with intravenous remdesivir for 5 days and prophylactic anti-coagulant heparin during hospital admission. Two days before the new admission, he was discharged with relative recovery. During the new admission, because of the absence of hypoxemia and leukocytosis diagnostic approach to abdominal pain was planned. In abdominal imaging, evidence of bowel perforation appeared. In laparotomy, suppurative peritonitis and proximal jejunal perforation without definite etiology were seen, and bowel resection and primary anastomosis were done. After 5 days, the patient was discharged in good condition. This case is reported to inform that bowel perforation due to ischemia or vasculitis may complicate the course of COVID-19 and, in cases of gastrointestinal symptoms, should be considered.
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The turnover of gastrointestinal carcinoma is high and mostly undergoes surgery / excision. Coronavirus disease, shortly named as COVID-19, as it started during 2019. It was declared as a pandemic by the World Health Organization in March, 2020. During this period, there are many patients who had delay in surgeries due to the high risk of contamination of patient of surgeon with COVID-19 and this would increase the risk of complications. Objective: To find the frequency of gastrointestinal cancer surgery in Pir Abdul Qadir Shah Gelani (GIMS), Hospital, Gambat. Methods: This descriptive cross sectional study was conducted from 14th March 2020 to 31 December 2021 in the surgery department of Pir Abdul Qadur Shah Gelani (GIMS) Hospital, Gambat. Total patients with both genders presenting with age 35 to 75 years and histopathological diagnosed with gastric cancer disease were included in this study. Meanwhile patients with age less than 35 years or more than 75 years those with renal failure and liver failure were excluded from study. Data were entered in SPSS version 21.0. Age, were presented ad mean and standard deviation. Categorical data like gender, upper GI, lower GI, operated cases were presented as frequencies & percentage, with histopathological findings were presented in diagram. Results: In our study, total 63 patients enrolled. The tumor was upper GI diagnosed in 38 patients and the lower GI diagnosed in 25 patients, 30 cases operated successfully and 17 cases in upper GI and 13 cases in lower GI. In 38 upper GI tumors, 11 were located in esophagus, 15 were in stomach, 8 were in pancreas, 2 were in per ampula and 2 were duodenum. Conclusion: It has been concluded that during COVID-19 pandemic, there is a need for clear guidelines in every surgical unit to ensure both patient and staff safety.
Article
The wide range of manifestations and clinical symptoms of COVID-19 has made it a unique disease. Investigating the epidemiology of different clinical manifestations of this disease in patients referred to medical centers is one of the most effective steps in adopting a suitable diagnostic and treatment approach. These findings also provide a basis for comparing the evolution of the virus and its clinical manifestations over time and at different peaks of the disease. Therefore, the present study was aimed at investigating common clinical findings at the time of referral in patients with COVID-19 in Afzalipour Hospital, Kerman, during the first peak of the disease. This descriptive-analytical cross-sectional study was performed on hospitalized patients diagnosed with COVID-19, between March 2020 and June 2020. The patients were included in the study by census method, and the research variables related to demographic indicators, disease course and clinical symptoms were extracted from the patients' medical records, and then subjected to statistical analysis. In this study, a total of 210 patients were examined, consisted mainly of male patients (59.5%). The mean age was found to be 53.95 ± 19.55 years. Also, 20.3% of patients needed admission in the intensive care unit. In addition, 1% of patients were infected in February 2020, 24% in March 2020, 47.4% in April 2020 and 27.4% in May 2020. The mean onset of symptoms until hospitalization was also found as 6.51 days. The most common clinical symptoms included shortness of breath (75.7%), dry cough (52.9%), fever (50.5%), myalgia (45.7%) and fatigue (41.9%). Fever at admission time was significantly more common in ages less than 50 years (p=0.034). Our study showed that the most common clinical symptoms were shortness of breath, dry cough, fever, myalgia and fatigue. No statistically significant difference was found in common symptoms between men and women. Among the common clinical symptoms, only fever at admission time was observed to be significantly higher in those under 50 years of age.
Article
Since the COVID-19 outbreak has started in late 2019, SARS-CoV-2 has been widely detected in human stools and in urban wastewater. No infectious SARS-CoV-2 particles have been detected in raw wastewater until now, but it has been reported occasionally in human stools. This has raised questions on the fate of SARS-CoV-2 during wastewater treatment and notably in its end-product, wastewater treatment sludge, which is classically valorized by land spreading for agricultural amendment. In the present work, we focused on SARS-CoV-2 stability in wastewater treatment sludge, either during storage (4 °C, room temperature) or thermophilic anaerobic digestion (50 °C). Anaerobic digestion is one of the possible processes for sludge valorization. Experiments were conducted in laboratory pilots; SARS-CoV-2 detection was based on RT-quantitative PCR or RT-digital droplet PCR. In addition to SARS-CoV-2, Bovine Coronavirus (BCoV) particles were used as surrogate virus. The RNA from SARS-CoV-2 particles, inactivated or not, was close to the detection limit but stable in wastewater treatment sludge, over the whole duration of the assays at 4 °C (55 days) and at ambient temperature (∼20 °C, 25 days). By contrast, the RNA levels of BCoV and inactivated SARS-CoV-2 particles decreased rapidly during the thermophilic anaerobic digestion of wastewater treatment sludge lasting for 5 days, with final levels that were close to the detection limit. Although the particles’ infectivity was not assessed, these results suggest that thermophilic anaerobic digestion is a suitable process for sludge sanitation, consistent with previous knowledge on other coronaviruses.
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Introduction: During the COVID-19 pandemic, elective endoscopic retrograde cholangiopancreatography (ERCP) procedures have been postponed as recommended by international guidelines. In this study, the results of biliary and pancreatic ERCP procedures that had to be postponed during the pandemic process were investigated. Materials and methods: Forty-seven patients whose stent exchange procedures with ERCP were postponed between March 2020 and June 2020 due to the COVID-19 pandemic were included in the study. Patients were evaluated in 2 groups as delayed biliary procedures (n: 32) and delayed pancreatic procedures (n: 15). Clinical problems (biliary or pancreatic pain, itching, cholangitis, etc.) and technical problems encountered during the procedure (stent migration, abundant stone sludge in the bile ducts, etc.) were compared with 46 patients who could be treated without delay (39 interventions for the biliary system and seven interventions for the pancreas). Findings: Considering the procedures for the biliary system, there was no difference in age and sex between the groups. Although clinical problems in biliary procedures were more common in the group with delay than in those without delay, this difference was not significant (34% vs. 20%; P: 0.14). The technical problems encountered during the procedures in the group with delay were significantly higher than those without delay (21% vs. 2.5%; P: 0.019), with stent migration being the most common problem (n: 5). Age and sex did not differ in the patients who had pancreatic interventions with and without delay. The clinical problems that developed in the patients did not differ between the groups with and without delay (26% vs. 28%; P: 0.8). Although technical problems were encountered in 1 out of 15 patients in the group with delay, no technical problem was experienced in the group without delay (P: 0.68). Conclusion: Postponing elective ERCP procedures for the biliary system not for the pancreatic system during the COVID-19 pandemic brings technical problems.
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COVID-19 is the major problem in the whole world since last two years that completely shrink the human health as well as world's economy. It is a contagious viral disease caused by SARS-CoV-2 and its first case was found in China in December, 2019. In the last two years this disease spread in nearly all parts of the world and till today more than 30 million cases are recorded overall. Countries like USA, India and Brazil are major impacted by this disease due to high spreading nature which results in lockdown in all corners of the world. It is transmitted from one person to other person through air via sneezing, coughing etc. which accounts for its high spread nature. Therefore, to control the spread of this disease, not only medical treatment but social awareness is also important among the people. So along with the use of mask and sanitizers, it is also advised to maintain the maximum physical distance from one another so that its transmission can be control. But this creates a problem in a dense city like Delhi, Mumbai and California where people have don't enough space to maintain proper physical distance. Apart from its impact on health and economy, it also affects the psychological thinking of people. During the initial days of lockdown, it helps the people to get some psychological stability because people get some time for their family and loving one, which they can't afford in normal busy schedule, but after some time it starts to affects the people's psychological behavior because they can't go outside and live their normal lives. They have to spend the time inside the house which feels like a bird captured in a cage. Longer lockdown creates frustration, anxiety and tiredness among the people which starts to affects their mental health as well as their social behavior. Student and adult society are most affected by this psychological disturbance because they continue to their normal social life. People start to spend their lot of time at online sites which is also a major reason for their stress.
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Covid care and COVID 19
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Antecedentes y objetivo: La endoscopía digestiva se considera un procedimiento de alto riesgo para COVID-19 por lo que se han hecho recomendaciones para su práctica durante la pandemia. Se realizó una encuesta para conocer el apego a las recomendaciones para la práctica de la endoscopía durante la pandemia por COVID-19 en México y Latinoamérica. Material y métodos: Encuesta electrónica en médicos endoscopistas de México y Latinoamérica consistente en 43 preguntas para la evaluación de 4 rubros: aspectos generales y sociodemográficos, aspectos pre, intra y pos- procedimiento. Resultados: Se obtuvo respuesta por parte de 338 endoscopistas de 15 países en Latinoamérica. La valoración telefónica previa, el lavado de manos y uso de cubrebocas se hizo en menos del 60% de los pacientes. El 63% contaban con área de triaje respiratorio. El 65% había recibido entrenamiento para la colocación/retiro del equipo de protección personal (EPP) y 49% tenían un área específica para retiro/colocación de este. El 78% de los endoscopistas solo realizaban urgencias o procedimientos sensibles al tiempo. El 83% de los endoscopistas que había hecho un procedimiento en las últimas 4 semanas había tenido EPP completo. El seguimiento telefónico posprocedimiento frecuente se realizaba solo en el 31% de los centros. El 72% había reutilizado EPP. La descontaminación de la sala fue realizada >75% de las ocasiones solo por el 47%. Conclusión: El apego a las recomendaciones para la práctica de la endoscopia durante la pandemia por COVID-19 es adecuado en la parte intraprocedimiento. Sin embargo, es deficiente en los aspectos pre y post procedimiento.
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Importance In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited. Objective To describe the epidemiological and clinical characteristics of NCIP. Design, Setting, and Participants Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020. Exposures Documented NCIP. Main Outcomes and Measures Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked. Results Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men. Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]). Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 10⁹/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%). Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0). Conclusions and Relevance In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
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An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient's initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.
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Background: In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. Methods: We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus. Findings: The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues. Interpretation: 2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. Funding: National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.
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Liver impairment is commonly reported in up to 60% of patients who suffer from severe acute respiratory syndrome (SARS). Here we report the clinical course and liver pathology in three SARS patients with liver impairment. Three patients who fulfilled the World Health Organization case definition of probable SARS and developed marked elevation of alanine aminotransferase were included. Percutaneous liver biopsies were performed. Liver specimens were examined by light and electron microscopy, and immunohistochemistry. Reverse-transcriptase polymerase chain reaction (RT-PCR) using enhanced real-time PCR was applied to look for evidence of SARS-associated coronavirus infection. Marked accumulation of cells in mitosis was observed in two patients and apoptosis was observed in all three patients. Other common pathologic features included ballooning of hepatocytes and mild to moderate lobular lymphocytic infiltration. No eosinophilic infiltration, granuloma, cholestasis, fibrosis, or fibrin deposition was noted. Immunohistochemical studies revealed 0.5% to 11.4% of nuclei were positive for proliferative antigen Ki-67. RT-PCR showed evidence of SARS-associated coronavirus in the liver tissues, but not in the sera of all 3 patients. However, electron microscopy could not identify viral particles. No giant mitochondria, micro- or macro-vesicular steatosis was observed. In conclusion, hepatic impairment in patients with SARS is due to SARS-associated coronavirus infection of the liver. The prominence of mitotic activity of hepatocytes is unique and may be due to a hyperproliferative state with or without disruption of cell cycle by the coronavirus. With better knowledge of pathogenesis, specific therapy may be targeted to reduce viral replication and modify the disease course.
Clinical Characteristics of 138 Hospitalized Patients with
  • D Wang
  • B Hu
  • C Hu
Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019
Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection
  • Leung