Effect of rifampicin on anticoagulation of warfarin:A case report

BACKGROUND The drug interaction between warfarin and rifampicin is widely known,but there are still some difficulties in managing the combination of the two drugs.CASE SUMMARY A patient with brucellosis received strict monitoring from a Chinese pharmacist team during combination of warfarin and rifampicin.The dose of warfarin was increased to 350%in 3 mo before reaching the lower international normalized ratio treatment window.No obvious adverse reaction occurred during the drugadjustment period.This is the first case report of long-term combined use of rifampicin and warfarin in patients with brucellosis and valve replacement in China based on the Chinese lower warfarin dose and international normalized ratio range.CONCLUSION Anticoagulation for valve replacement in Chinese patients differs from that in other races.Establishment of a pharmacist clinic provides vital assistance in warfarin dose adjustment.

COVID-19 in gastroenterology and hepatology:Lessons learned and questions to be answered

BACKGROUND Although coronavirus disease 2019(COVID-19)presents primarily as a lower respiratory tract infection,increasing data suggests multiorgan,including the gastrointestinal(GI)tract and liver,involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).AIM To provide a comprehensive overview of COVID-19 in gastroenterology and hepatology.METHODS Relevant studies on COVID-19 related to the study aim were undertaken through a literature search to synthesize the extracted data.RESULTS We found that digestive symptoms and liver injury are not uncommon in patients with COVID-19 and varies in different individuals.The most common GI symptoms reported are diarrhea,nausea,vomiting,and abdominal discomfort.Other atypical GI symptoms,such as loss of smell and taste and GI bleeding,have also been reported along with the evolvement of COVID-19.Liver chemistry abnormalities mainly include elevation of aspartate transferase,alanine transferase,and total bilirubin.It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus to the angiotensin converting enzyme-2 receptor located on several different human cells.CONCLUSION Standardized criteria should be established for diagnosis and grading of the severity of GI symptoms in COVID-19 patients.Gastroenterology and hepatology in special populations,such as children and elderly,should be the focus of further research.Future long-term data regarding GI symptoms should not be overlooked.