Evaluation of the mental health of COVID-19 patients discharged from the intensive care unit

In this editorial,I address the mental health status of patients who have been discharged from intensive care units(ICUs)after battling coronavirus disease 2019(COVID-19).An ICU admission is generally a stressful experience,and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences.These individuals may experience psychiatric distress,including symptoms such as insomnia,anxiety,depression,and even posttraumatic psychological issues.Research indicates that during the first 6 months to 1 year following an ICU stay,nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder.Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic,particularly for those who underwent an ICU stay.The ICU environment itself is inherently stressful,filled with the constant noise of various medical devices.Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.

Sleep Quality and Emotional Adaptation among Freshmen in Elite Chinese Universities during Prolonged COVID-19 Lockdown:The Mediating Role of Anxiety Symptoms

Under the effects of COVID-19 and a number of ongoing lockdown tactics,anxiety symptoms and poor sleep quality have become common mental health issues among college freshmen and are intimately related to their emotional adaptation.To explore this connection,this study gathered data from a sample of 256 freshmen enrolled in an elite university in China in September 2022.The association between sleep quality,anxiety symptoms,and emotional adaptation was clarified using correlation analysis.Additionally,the mediating function of anxiety symptoms between sleep quality and emotional adaptation was investigated using a structural equation model.The results reveal that:(1)Chinese elite university freshmen who were subjected to prolonged lockdown had poor sleep quality and mild anxiety symptoms;(2)a significant positive correlation between poor sleep quality and anxiety symptoms was identified;(3)anxiety symptoms were found to have a significant negative impact on emotional adaptation;(4)poor sleep quality had a negative impact on emotional adaptation through anxiety symptoms.This research makes a valuable contribution by offering insights into the intricate relationship between sleep quality and emotional adaptation among freshmen in elite Chinese universities during prolonged lockdown conditions,and it is beneficial for schools and educators to further improve school schedules and psychological health initiatives.

Physico-chemical characterization of acid base disorders in patients with COVID-19:A cohort study

BACKGROUND Acid-base imbalance has been poorly described in patients with coronavirus disease 2019(COVID-19).Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been over-looked using traditional acid-base analysis techniques.In a cohort of critically ill COVID-19 patients,we looked for an association between metabolic acidosis surrogates and worse clinical outcomes,such as mortality,renal dialysis,and length of hospital stay.AIM To describe the acid-base disorders of critically ill COVID-19 patients using Stewart’s approach,associating its variables with poor outcomes.METHODS This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan.Laboratory and clinical data were obtained from electronic records.Categorical variables were compared using Fisher’s exact test.Continuous data were presented as median and interquartile range.The Mann-Whitney U test was used for comparisons.RESULTS In total,211 patients were analyzed.The mortality rate was 13.7%.Overall,149 patients(70.6%)presented with alkalosis,28 patients(13.3%)had acidosis,and the remaining 34 patients(16.2%)had a normal arterial pondus hydrogenii.Of those presenting with acidosis,most had a low apparent strong ion difference(SID)(20 patients,9.5%).Within the group with alkalosis,128 patients(61.0%)had respiratory origin.The non-survivors were older,had more comorbidities,and had higher Charlson’s and simplified acute physiology score 3.We did not find severe acid-base imbalance in this population.The analyzed Stewart’s variables(effective SID,apparent SID,and strong ion gap and the effect of albumin,lactate,phosphorus,and chloride)were not different between the groups.CONCLUSION Alkalemia is prevalent in COVID-19 patients.Although we did not find an association between acid-base variables and mortality,the use of Stewart’s methodology may provide insights into this severe disease.

Nurses'attitude toward patients'safety climate during COVID-19 pandemic:a cross-sectional study

Objective:Patient safety is a fundamental factor in improving the quality of care provided in hospitals.Therefore,it is considered a significant parameter by all healthcare organizations around the world.The present study was conducted to investigate the attitude of nurses toward the patient safety climate during the Coronavirus Disease 2019(COVID-19)pandemic in the southeast of Iran.Methods:This is a cross-sectional descriptive study.Among all the nurses working in one of the hospitals in the southeast of Iran,171 nurses participated in the study through convenience sampling methods.The survey was conducted between June 1 and July 30,2020.A 2-part questionnaire including demographic information and an assessment of nurses'attitudes toward patients'safety climate was used for data collection in 2021.The content validity of the scale is(0.77)and reliability was re-calculated and confirmed by the present study with Cronbach's alpha(α=0.9).Data were analyzed by SPSS 20(IBM Corporation,Armonk,New York,United States)using descriptive and analytical statistical tests.Results:The mean score of safety climates was 3.2±5.20(out of 5 scores).The results showed that among all dimensions of the safety climate,only the education dimension was statistically significant between males and females(P<0.001).Also,there was a significant relationship between the overall average of the safety climate and its dimensions according to the people's position only in the dimension of supervisors'attitude(P<0.01)and burnout(P<0.01).Additionally,a significant correlation between the education level and the overall score of safety climate(P<0.01),as well as the supervisor's attitude dimension(P<0.01),was observed.Conclusions:The results showed that the safety climate was at a relatively favorable level.Considering the impact of nurses'attitudes on the safety climate of patients,its improvement seems necessary.It is recommended to design training courses and educate nurses in order to promote a patients safety climate in hospitals.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic:A multicenter cross-sectional study

BACKGROUND Healthcare workers(HCWs)are at increased risk of contracting coronavirus disease 2019(COVID-19)as well as worsening mental health problems and insomnia.These problems can persist for a long period,even after the pandemic.However,less is known about this topic.AIM To analyze mental health,insomnia problems,and their influencing factors in HCWs after the COVID-19 pandemic.METHODS This multicenter cross-sectional,hospital-based study was conducted from June 1,2023 to June 30,2023,which was a half-year after the end of the COVID-19 emergency.Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs.Symptoms such as anxiety,depression,and insomnia were evaluated by the Generalized Anxiety Disorder-7,Patient Health Questionnaire-9,and Insomnia Severity Index.Factors influencing the symptoms were identified by multivariable logistic regression.RESULTS A total of 2000 participants were invited,for a response rate of 70.6%.A total of 1412 HCWs[618(43.8%)doctors,583(41.3%)nurses and 211(14.9%)nonfrontline],254(18.0%),231(16.4%),and 289(20.5%)had symptoms of anxiety,depression,and insomnia,respectively;severe symptoms were found in 58(4.1%),49(3.5%),and 111(7.9%)of the participants.Nurses,female sex,and hospitalization for COVID-19 were risk factors for anxiety,depression,and insomnia symptoms;moreover,death from family or friends was a risk factor for insomnia symptoms.During the COVID-19 outbreak,most[1086(76.9%)]of the participating HCWs received psychological interventions,while nearly all[994(70.4%)]of them had received public psychological education.Only 102(7.2%)of the HCWs received individual counseling from COVID-19.CONCLUSION Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic,they still faced challenges and greater risks than did the general population.Identifying risk factors would help in providing targeted interventions.In addition,although a major proportion of HCWs have received public psychological education,individual interventions are still insufficient.

Cardiovascular risk factors affecting COVID-19 outcomes at a tertiary referral hospital in northwest Iran: A prospective cohort study

Objective:To investigate cardiovascular risk factors affecting COVID-19 outcomes in a tertiary referral hospital.Methods:This prospective cohort study analyzed 269 participants with COVID-19.The primary outcomes were ICU admission,prolonged hospital stay duration,and in-hospital death.The secondary outcomes included death,chronic symptoms,and NYHA functional class during follow-up periods.Results:A total of 412 patients with COVID-19 symptoms were enrolled in the study,and out of which 269 patients had complete medical records and positive SARS-CoV-2 PCR test results,fulfilling the study criteria were analyzed.The patients were divided into two groups,with cardiovascular comorbidities(group A,n=122),such as established cardiovascular disease,diabetes mellitus,and hypertension,and without cardiovascular comorbidities(group B,n=147).Binary logistic regression analysis showed that patients with underlying hypertension,diabetes,and established cardiovascular disease had a 1.55(95%CI:1.28-2.26),1.62(95%CI:1.34-2.13),and 1.63(95%CI:1.07-5.34)-fold risk of mortality,respectively in the adjusted model.Conclusions:Hospitalized COVID-19 patients with predisposing cardiovascular risk factors are more susceptible to develop worse outcomes.More attention should be paid to the management and follow-up of these patients.

Efficacy and safety of ivermectin in patients with mild and moderate COVID-19:A randomized controlled trial

Objective:To evaluate the effectiveness and safety of ivermectin in patients with mild and moderate COVID-19.Methods:This study was a single-center,randomized,open-label,controlled trial with a 2-arm parallel-group design on 68 patients with COVID-19.According to the 1:1 ratio between the study groups(ivermectin group and standard treatment group),patients were randomly admitted to each intervention arm.Results:The mean age of the participants in the ivermectin group was(48.37±13.32)years.Eighteen of them were males(54.5%)and the participants in the control group had a mean age of(46.28±14.47)years,with nineteen of them being males(59.4%).As a primary outcome,after 5 days of randomization,there was no significant difference between the ivermectin group and the control group in the length of stay in the hospital(P=0.168).ICU admission(P=0.764),length of stay in ICU(P=0.622),in-hospital mortality(P=0.427),adverse drug reactions,and changes in the mean difference of laboratory data had not any significant difference between the two groups(except for urea change).In addition,the radiologic findings of the two groups of patients were not significantly different.Linear regression analysis showed that for every 10 years increase of age,0.6 day of hospitalization duration was increased.There was no statistically significant association between other variables and clinical outcomes.Conclusions:Among adult hospitalized patients with moderate to severe COVID-19,there was no significant relationship between the administration of ivermectin single dose in a five-day course and clinical improvement,and mortality of the participants.

Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients:Case series and brief literature review

BACKGROUND Hospitalized and severely ill coronavirus disease 2019(COVID-19)patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites.Life-threatening bleeding complications include spontaneous iliopsoas hematoma,peritoneal bleeding,and extra-abdominal manifestations such as intracranial hemorrhage.CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding.In our case series of 9 patients,we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia.Contrast-enhanced computed tomography(CE-CT)is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach,whether interventional,surgical,or conservative management.CONCLUSION We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling.Finally,we provide a brief review of the literature.

Patient Experience at Endoscopy Centers in Three West African Countries during the COVID-19 Pandemic

Corona virus infection and the risk of contagiousness to medical personnel or patients during endoscopy necessitated further measures in the endoscopy rooms. The objective of this study was to assess the experience of patients in endoscopy rooms during the COVID-19 epidemic in West Africa. Patients and Methods: This was a multicenter cross-sectional study that took place over a period of 3 months (June to August 2020) in endoscopy centers in Burkina Faso, Benin and Niger. An online questionnaire was sent to patients who had performed upper digestive endoscopies, in 8 digestive endoscopy centers including private, public and religious structures. Depending on the choice of patients, questionnaires were either sent electronically or completed in the endoscopy room with the help of field investigators. The choice of centers was random from the list of centers and descriptive analyses were carried out. Results: A total of 294 patients responded to the online questionnaire. There were 37 lower and 257 upper gastrointestinal endoscopies. The female sex represented 52.1%. The wait times for obtaining an endoscopy appointment were considered satisfactory by 281 patients 95.6%. In the endoscopy departments, 112 patients, or 38.1%, were questioned about the risk factors for contamination of SARS-CoV-2. Among the risk factors found, 6 patients (2.0%) would have traveled abroad in the 2 weeks preceding the examination, 4 patients 1.4% had already been in contact with a subject at risk. The most frequent symptoms were chest pain (80 cases;27.2%), flu-like syndrome (29 cases;9.9%), cough (40 cases;13.6%), fever (46 cases;15.6%). In contrast, ageusia (7 cases;2.4%) and anosmia (5 cases;1.7%) were only found in very few patients. Twenty-two patients (7.5%) felt highly exposed to COVID-19 during the endoscopy examination and 144 patients (48.9%) rated the examination as satisfactory. Conclusion: Gastrointestinal symptoms initially described as rare are being reported with increasing frequency in studies and may motivate the request for endoscopy examinations. However, the risk associated with infection with SARS-CoV-2 does not seem to have been sufficiently taken into account in endoscopy centers in the 3 countries.

Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic posed new challenges in patient care worldwide.Vaccinations,which have proven efficacious in lowering the COVID-19 hospital burden,are still avoided by large populations.We,therefore,hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.AIM To evaluate whether patient vaccine hesitancy affected the hospital care team(HCT)perceptions.METHODS We performed a prospective clinical study using structured questionnaires.We approached physicians and nurses with previous experience caring for COVID-19patients from 11 medical centers across Israel during the fourth COVID-19 surge(September and October 2021).The participants completed a questionnaire with the following parts:(1)Sociodemographic characteristics;(2)Assessment of anger(STAXI instrument)and chronic workplace stress(Shirom-Melamed burnout measure);and(3)Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions(the difficult doctor-patient relation questionnaire,the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire).Results were evaluated according to each part of the questionnaire and the questionnaire as a whole.Associations between HCT perceptions and their baseline characteristics,anger or chronic workplace stress were assessed.RESULTS The HCT experienced their relationship with unvaccinated patients as more difficult(P<0.001,Cohen’s d=0.85),perceived unvaccinated patients as responsible for their medical condition(P<0.001,d=1.39)and perceived vaccinated patients as having a higher character value(P<0.001,d=1.03).Unvaccinated patients were considered selfish(P<0.001),less mature(P<0.001)and less satisfying to care for(P<0.001).The relationship with unvaccinated patients was more difficult among HCT with higher burnout(r=0.37,n=66,P=0.002).No correlations with baseline characteristics were found.All three study tools showed high internal consistency(αbetween 0.72 and 0.845).CONCLUSION Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients.In order to minimize the potential negative impact on patient care,designated departments should promote specific patient-centered preparations.Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.

COVID TCL:A Joint Metric Loss Function for Diagnosing COVID-19 Patient in the Early and Incubation Period

Convolution Neural Networks(CNN)can quickly diagnose COVID-19 patients by analyzing computed tomography(CT)images of the lung,thereby effectively preventing the spread of COVID-19.However,the existing CNN-based COVID-19 diagnosis models do consider the problem that the lung images of COVID-19 patients in the early stage and incubation period are extremely similar to those of the non-COVID-19 population.Which reduces the model’s classification sensitivity,resulting in a higher probability of the model misdiagnosing COVID-19 patients as non-COVID-19 people.To solve the problem,this paper first attempts to apply triplet loss and center loss to the field of COVID-19 image classification,combining softmax loss to design a jointly supervised metric loss function COVID Triplet-Center Loss(COVID-TCL).Triplet loss can increase inter-class discreteness,and center loss can improve intra-class compactness.Therefore,COVID-TCL can help the CNN-based model to extract more discriminative features and strengthen the diagnostic capacity of COVID-19 patients in the early stage and incubation period.Meanwhile,we use the extreme gradient boosting(XGBoost)as a classifier to design a COVID-19 images classification model of CNN-XGBoost architecture,to further improve the CNN-based model’s classification effect and operation efficiency.The experiment shows that the classification accuracy of the model proposed in this paper is 97.41%,and the sensitivity is 97.61%,which is higher than the other 7 reference models.The COVID-TCL can effectively improve the classification sensitivity of the CNN-based model,the CNN-XGBoost architecture can further improve the CNN-based model’s classification effect.

Characterization of oral and gut microbiome and plasma metabolomics in COVID-19 patients after 1-year follow-up

Background:Due to the outbreak and rapid spread of coronavirus disease 2019(COVID-19),more than 160 million patients have become convalescents worldwide to date.Significant alterations have occurred in the gut and oral microbiome and metabonomics of patients with COVID-19.However,it is unknown whether their characteristics return to normal after the 1-year recovery.Methods:We recruited 35 confirmed patients to provide specimens at discharge and 1 year later,as well as 160healthy controls.A total of 497 samples were prospectively collected,including 219 tongue-coating,129 stool and 149 plasma samples.Tongue-coating and stool samples were subjected to 16S rRNA sequencing,and plasma samples were subjected to untargeted metabolomics testing.Results:The oral and gut microbiome and metabolomics characteristics of the 1-year convalescents were restored to a large extent but did not completely return to normal.In the recovery process,the microbial diversity gradually increased.Butyric acid-producing microbes and Bifidobacterium gradually increased,whereas lipopolysaccharideproducing microbes gradually decreased.In addition,sphingosine-1-phosphate,which is closely related to the inflammatory factor storm of COVID-19,increased significantly during the recovery process.Moreover,the predictive models established based on the microbiome and metabolites of patients at the time of discharge reached high efficacy in predicting their neutralizing antibody levels one year later.Conclusions:This study is the first to characterize the oral and gut microbiome and metabonomics in 1-year convalescents of COVID-19.The key microbiome and metabolites in the process of recovery were identified,and provided new treatment ideas for accelerating recovery.And the predictive models based on the microbiome and metabolomics afford new insights for predicting the recovery situation which benefited affected individuals and healthcare.

Sociopsychological impact factors of depression patients during the COVID-19 epidemic period

Objective:To investigate the impact factors of the COVID-19 epidemic on the mental health of patients with depression.Methods:The relevant data of 242 residents aged 18-50 years in a certain area were collected,118 patients and 124 healthy people were analyzed by general information questionnaire,the PsychoSocial Index(PSI)questionnaire,Social Support Rating Scale(SSRS)and Symptom Checklist 90(SCL-90).Compare the differences in social and psychological factors between the two groups.Then use logistic regression to evaluate the social and psychological influencing factors of depression patients during the epidemic.Results:Two results of logistic regression analysis showed that marital status,occupational status,abnormal pathological behavior,and utilization of support were still significantly associated with depression.Compared to working,unemployed/unemployed/retired,students are closely related to depression,followed by abnormal pathological behavior and utilization of support.Conclusion:Under the epidemic,depression groups lacking social relationships should actively pay attention to their mental health status and comprehensively enhance their social and psychological support.To avoid the exacerbation of psychological and psychological symptoms caused by the epidemic.

Experiences of Social Isolation in Older Hospitalized Patients with COVID-19 and Their Close Relatives: A Qualitative Study

Background: Proximity between older patients and their close relatives is essential during hospitalisation. During the first wave of the pandemic, the Danish Patient Safety Authority restricted no hospital visitors. Aim: To explore how older patients with COVID-19 and their close relatives experienced physical separation during hospitalization. Method: A qualitative study using semi-structured interviews and thematic analysis was employed. Findings: Six interviews were conducted: three patients with a mean age of 81 years and three close relatives—two daughters and one spouse. The patients felt boredom, loneliness, and a sense of imprisonment, yet they felt safe and satisfied. Isolation was known beforehand from the media. Close relatives emphasised that information, involvement, and collaboration with hospital staff were crucial. Conclusion: Although older patients with COVID-19 and their close relatives widely accept their situation during hospitalization, they experience negative consequences from social isolation.

Evaluation of patient safety culture as perceived by nurses during the COVID-19 pandemic

Objectives:A good patient safety culture(PSC)is linked to a reduced risk of patient problems and minimal undesirable occurrences.This study investigated the PSC levels from nurses'perspectives during the COVID-19 pandemic.Methods:A descriptive cross-sectional design was applied.The Hospital Survey on Patient Safety Culture(HSOPSC)questionnaire was administered to 315 nurses working at 2 major hospitals in Jeddah,Saudi Arabia.The data were analyzed using descriptive statistics,a t-test,and a one-way ANOVA test.The statistical significance of the correlation was determined at the 0.05 level.Results:PSC was rated as medium overall according to the nurses,with a weighted mean of 2.88–0.76 and a relative weight of 57.57%.In addition,all PSC composites were rated from medium to high,except organizational learning,which was rated low.The correlation between sociodemographic variables as well as PSC levels was investigated using the t-test and one-way ANOVA test.The association is statistically significant when P≤0.05.The findings revealed a statistically significant correlation between nurse nationality(t=-4.399,P=0.000),age(F=7.917,P=0.000),experience in years(F=3.760,P=0.024),and hospital(t=-0.401,P=0.689).Conclusions:The nurses in this study had a medium overall PSC level,and all PSC composites ranged from a medium to a high level,except organizational learning,which had a low level.In addition,the findings showed that there is a significant relationship between PSC levels,nurses'nationalities,experience in years,and the hospital itself.

Effect of COVID-19 Pandemic on Patient Adherence to Chronic Medications in Sudan in 2021

Background: As the coronavirus spared accelerated, various sectors began to deteriorate since the early stages of the COVID-19 pandemic. The health sector as one of the major areas where the pandemic put a huge strain was also affected in different ways. Precisely, patient adherence to medication despite difficulties was a point of a question for health staff. Thus, this survey aims to distinguish and discuss the possibility of patients with chronic medications receiving their drugs and taking them regularly as prescribed. Method: Two online questionnaires were generated using Google forms and distributed among patients with chronic illnesses and pharmacists in the Khartoum locality. The survey was conducted during the period of the study to get the most recent data. Results: 81.4% of the population stated that they did encounter difficulties in obtaining their chronic medication during the pandemic. Pharmacists reported that drug availability decreased by 87% in pharmacies, but a considerable proportion of patients adhered to their medications (84%), and obtained their medications through a variety of means. More than half of the patients ordered their medication illegally, in addition to another approach discussed in the paper.

Clinical characteristics of patients with COVID-19 presenting with gastrointestinal symptoms as initial symptoms: Retrospective case series

BACKGROUND A large number of pneumonia cases due to coronavirus disease 2019(COVID-19)have been first reported in China.Meanwhile,the virus is sweeping all around the world and has infected millions of people.Fever and pulmonary symptoms have been noticed as major and early signs of infection,whereas gastrointestinal symptoms were also observed in a significant portion of patients.The clinical investigation of disease onset was underestimated,especially due to the neglection of cases presenting with gastrointestinal symptoms.AIM To characterize the clinical features of coronavirus-infected patients with gastrointestinal symptoms as initial symptoms.METHODS This is a retrospective,single-center case series of the general consecutive hospitalized patients with confirmed COVID-19 at Wuhan Union Hospital from February 2,2020 to February 13,2020.According to their initial symptoms,these patients were classified into two groups.Patients in group one presented with pulmonary symptoms(PS)as initial symptoms,and group two presented with gastrointestinal symptoms(GS).Epidemiological,demographic,clinical,laboratory,and treatment data were collected for analysis.RESULTS Among the 50 patients recruited,no patient has been admitted to intensive care units,and no patient died during the study.The duration of hospitalization was longer in the GS group than in the PS group(12.13±2.44 vs 10.00±2.13,P<0.01).All of the 50 patients exhibited decreased lymphocytes.However,lymphocytes in the GS group were significantly lower compared to those in the PS group(0.94±0.06 vs 1.04±0.15,P<0.01).Procalcitonin and hs-CRP were both significantly higher in the GS group than in the PS group.Accordingly,the duration of viral shedding was significantly longer in the GS group compared to the PS group(10.22±1.93 vs 8.15±1.87,P<0.01).CONCLUSION COVID-19 patients presenting with gastrointestinal symptoms as initial symptoms need more days of viral shedding and hospitalization than the patients presenting with pulmonary symptoms.

Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

Gastrointestinal(GI)symptoms,such as diarrhea,abdominal pain,vomiting,and anorexia,are frequently observed in patients with coronavirus disease 2019(COVID-19).However,the pathophysiological mechanisms connecting these GI symptoms to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infections remain elusive.Previous studies indicate that the entry of SARS-CoV-2 into intestinal cells leads to downregulation of angiotensin converting enzyme 2(ACE2)receptors resulting in impaired barrier function.While intestinal ACE2 functions as a chaperone for the amino acid transporter B0AT1,the B0AT1/ACE2 complex within the intestinal epithelium acts as a regulator of gut microbiota composition and function.Alternations to the B0AT1/ACE2 complex lead to microbial dysbiosis through increased local and systemic immune responses.Previous studies have also suggested that altered serotonin metabolism may be the underlying cause of GI disorders involving diarrhea.The findings of elevated plasma serotonin levels and high fecal calprotectin in COVID-19 patients with diarrhea indicate that the viral infection evokes a systemic inflammatory response that specifically involves the GI.Interestingly,the elevated proinflammatory cytokines correlate with elevated serotonin and fecal calprotectin levels further supporting the evidence of GI inflammation,a hallmark of functional GI disorders.Moreover,the finding that rectal swabs of COVID-19 patients remain positive for SARS-CoV-2 even after the nasopharynx clears the virus,suggests that viral replication and shedding from the GI tract may be more robust than that of the respiratory tract,further indicating fecal-oral transmission as another important route of viral spread.This review summarized the evidence for pathophysiological mechanisms(impaired barrier function,gut inflammation,altered serotonin metabolism and gut microbiota dysbiosis)underlying the GI symptoms in patients with COVID-19.

Gastrointestinal symptoms in patients with COVID-19: Is there a relationship with mortality and new variations of SARS-CoV-2?

Coronavirus disease 2019(COVID-19)is caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Although,respiratory symptoms are typical the digestive system is also a susceptible target with gastrointestinal symptoms present even in the absence of respiratory symptoms.The gastrointestinal symptoms of COVID-19 include diarrhea,abdominal pain,anorexia,and nausea among other symptoms.Some questions that remain to be answered include:Do patients with gastrointestinal symptoms have a higher mortality?SARS-CoV-2 variants are already a global reality:Do these variants present with a greater prevalence of gastrointestinal symptoms?Do patients with these symptoms warrant more intensive care unit care?