Effects of SARS-CoV-2 infection on incidence and treatment strategies of hepatocellular carcinoma in people with chronic liver disease

BACKGROUND Chronic liver disease(CLD)was associated with adverse clinical outcomes among people with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.AIM To determine the effects of SARS-CoV-2 infection on the incidence and treatment strategy of hepatocellular carcinoma(HCC)among patients with CLD.METHODS A retrospective,territory-wide cohort of CLD patients was identified from an electronic health database in Hong Kong.Patients with confirmed SARS-CoV-2 infection[coronavirus disease 2019(COVID-19)+CLD]between January 1,2020 and October 25,2022 were identified and matched 1:1 by propensity-score with those without(COVID-19-CLD).Each patient was followed up until death,outcome event,or November 15,2022.Primary outcome was incidence of HCC.Secondary outcomes included all-cause mortality,adverse hepatic outcomes,and different treatment strategies to HCC(curative,non-curative treatment,and palliative care).Analyses were further stratified by acute(within 20 d)and post-acute(21 d or beyond)phases of SARS-CoV-2 infection.Incidence rate ratios(IRRs)were estimated by Poisson regression models.RESULTS Of 193589 CLD patients(>95%non-cirrhotic)in the cohort,55163 patients with COVID-19+CLD and 55163 patients with COVID-19-CLD were included after 1:1 propensity-score matching.Upon 249-d median follow-up,COVID-19+CLD was not associated with increased risk of incident HCC(IRR:1.19,95%CI:0.99-1.42,P=0.06),but higher risks of receiving palliative care for HCC(IRR:1.60,95%CI:1.46-1.75,P<0.001),compared to COVID-19-CLD.In both acute and post-acute phases of infection,COVID-19+CLD were associated with increased risks of allcause mortality(acute:IRR:7.06,95%CI:5.78-8.63,P<0.001;post-acute:IRR:1.24,95%CI:1.14-1.36,P<0.001)and adverse hepatic outcomes(acute:IRR:1.98,95%CI:1.79-2.18,P<0.001;post-acute:IRR:1.24,95%CI:1.13-1.35,P<0.001),compared to COVID-19-CLD.CONCLUSION Although CLD patients with SARS-CoV-2 infection were not associated with increased risk of HCC,they were more likely to receive palliative treatment than those without.The detrimental effects of SARS-CoV-2 infection persisted in post-acute phase.

Wastewater Surveillance Provides Spatiotemporal SARS-CoV-2 Infection Dynamics

Wastewater surveillance(WWS)can leverage its wide coverage,population-based sampling,and high monitoring frequency to capture citywide pandemic trends independent of clinical surveillance.Here we conducted a nine months daily WWS for severe acute respiratory syndrome coronavirus 2(SARSCoV-2)from 12 wastewater treatment plants(WWTPs),covering approximately 80%of the population,to monitor infection dynamics in Hong Kong,China.We found that the SARS-CoV-2 virus concentration in wastewater was correlated with the daily number of reported cases and reached two pandemic peaks three days earlier during the study period.In addition,two different methods were established to estimate the prevalence/incidence rates from wastewater measurements.The estimated results from wastewater were consistent with findings from two independent citywide clinical surveillance programmes(rapid antigen test(RAT)surveillance and serology surveillance),but higher than the cases number reported by the Centre for Health Protection(CHP)of Hong Kong,China.Moreover,the effective reproductive number(R_(t))was estimated from wastewater measurements to reflect both citywide and regional transmission dynamics.Our findings demonstrate that large-scale intensive WWS from WWTPs provides cost-effective and timely public health information,especially when the clinical surveillance is inadequate and costly.This approach also provides insights into pandemic dynamics at higher spatiotemporal resolutions,facilitating the formulation of effective control policies and targeted resource allocation.

Resolution of sperm quality impairment following SARS-CoV-2 infection:A prospective study

Objective:To investigate the length of time required to resolve COVID-19 effects on semen quality and DNA integrity.Methods:A prospective cohort study was conducted among 42 men who tested positive for SARS-CoV-2 and underwent semen analysis at baseline and four months’post-recovery.Semen samples were collected and evaluated for macroscopic and microscopic parameters,sperm chromatin maturation,and DNA fragmentation.Results:The mean age of participants was 37(±7)years,and 14%had normozoospermia at baseline.After a four-month recovery from COVID-19,48%of patients had normozoospermia.Sperm count,motility,and morphology increased significantly,while sperm DNA fragmentation and sperm chromatin maturation decreased significantly post-recovery from COVID-19.Conclusions:Sperm parameters improve after a four-month recovery from COVID-19.The findings indicate significant improvements in sperm count,motility,morphology,DNA fragmentation,and chromatin maturation after a four-month recovery period.

Hydroxychloroquine in SARS-CoV-2 infection:Understanding the misadventure

The widespread outbreak of SARS-CoV-2 was declared a public health emergency by the World Health Organization and various governments worldwide.This prompted the implementation of stringent infection control measures to curb the spread of the virus.Amidst this,the medical community faced the challenge of treating the virus without specific therapies or a vaccine,leading to reliance on empirical treatment approaches.In this context,hydroxychloroquine,an antimalarial and antirheumatic drug,gained attention as a potential treatment option.Despite its theoretical benefits,such as inhibiting viral entry,reducing inflammation,and modulating immune responses,empirical studies yielded inconsistent results.Some indicated a potential for symptom relief,while others showed no significant improvement in patient outcomes.The initial enthusiasm waned as the lack of substantial evidence led to revoking its Emergency Use Authorization,and several clinical trials were prematurely halted.The review in question critically examines the factors contributing to the ineffectiveness of hydroxychloroquine in treating SARS-CoV-2 infection,highlighting the complexities of drug repurposing during a rapidly evolving pandemic.

Prevalence and features of SARS-CoV-2 infection in prisons in Tuscany

BACKGROUND Prisons can be a reservoir for infectious diseases,including severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),due to the very intimate nature of the living spaces and the large number of people forced to share them.AIM To investigate the SARS-CoV-2 epidemiology in prisons,this study evaluated the infection incidence rate in prisoners who underwent nasopharyngeal swabs.METHODS This is an observational cohort study.Data collection included information on prisoners who underwent nasopharyngeal swab testing for SARS-CoV-2 and the results.Nasopharyngeal swab tests for SARS-CoV-2 were performed between 15 February 2021 and 31 May 2021 for prisoners with symptoms and all new arrivals to the facility.Another section included information on the diagnosis of the disease according to the International Classification of Diseases,Ninth Revision,and Clinical Modification.RESULTS Up until the 31 May 2021,79.2%of the prisoner cohort(n=1744)agreed to a nasopharyngeal swab test(n=1381).Of these,1288 were negative(93.3%)and 85 were positive(6.2%).A significant association[relative risk(RR)]was found only for the risk of SARS-CoV-2 infection among foreigners compared to Italians[RR=2.4,95%confidence interval(CI):1.2-4.8].A positive association with SARS-CoV-2 infection was also found for inmates with at least one nervous system disorder(RR=4,95%CI:1.8-9.1).The SARS-CoV-2 incidence rate among prisoners is significantly lower than in the general population in Tuscany(standardized incidence ratio 0.7,95%CI:0.6-0.9).CONCLUSION In the prisoner cohort,screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.

Myelin oligodendrocyte glycoprotein-associated transverse myelitis after SARS-CoV-2 infection:A case report

BACKGROUND Cases of myelin oligodendrocyte glycoprotein(MOG)antibody-related disease have a history of coronavirus disease 2019 infection or its vaccination before disease onset.Severe acute respiratory syndrome virus 2(SARS-CoV-2)infection has been considered to be a trigger of central nervous system autoimmune diseases.CASE SUMMARY Here we report a 20-year male with MOG-associated transverse myelitis after a SARS-CoV-2 infection.The patient received a near-complete recovery after standard immunological treatments.CONCLUSION Attention should be paid to the evaluation of typical or atypical neurological symptoms that may be triggered by SARS-CoV-2 infection.

Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection

AIM:To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy(AMN)lesions following severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.METHODS:Retrospective case series study.From December 18,2022 to February 14,2023,previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study.Totally 5 males and 9 females[mean age:29.93±10.32(16-49)y]were presented for reduced vision,with or without blurred vision.All patients underwent best corrected visual acuity(BCVA),intraocular pressure,slit lamp microscopy,indirect fundoscopy.Simultaneously,multimodal imagings fundus photography(45°or 200°field of view)was performed in 7 cases(14 eyes).Near infrared(NIR)fundus photography was performed in 9 cases(18 eyes),optical coherence tomography(OCT)in 5 cases(10 eyes),optical coherence tomography angiography(OCTA)in 9 cases(18 eyes),and fundus fluorescence angiography(FFA)in 3 cases(6 eyes).Visual field was performed in 1 case(2 eyes).RESULTS:Multimodal imaging findings data from 14 patients with AMN were reviewed.All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA.Fundus photography(45°or 200°field of view)showed irregular hypo-reflective lesion around the fovea in 7 cases(14 eyes).OCTA demonstrated that the superficial retinal capillary plexus(SCP)vascular density,deep capillary plexus(DCP)vascular density and choriocapillaris(CC)vascular density was reduced in 9 case(18 eyes).Among the follow-up cases(2 cases),vascular density increased in 1 case with elevated BCVA;another case has vascular density decrease in one eye and basically unchanged in other eye.En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance.NIR image mainly show the absence of the outer retinal interdigitation zone in AMN.No abnormal fluorescence was observed in FFA.Corresponding partial defect of the visual field were visualized via perimeter in one case.CONCLUSION:The morbidity of SARS-CoV-2 infection with AMN is increased.Ophthalmologists should be aware of the possible,albeit rare,AMN after SARS-CoV-2 infection and focus on multimodal imaging features.OCT,OCTA,and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.

Impact of chronic liver disease on SARS-CoV-2 infection outcomes:Roles of stage,etiology and vaccination

Since the first identification in December of 2019 and the fast spread of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection,it has represented a dramatic global public health concern.Though affecting mainly the respiratory system,SARS-CoV-2 disease,defined as coronavirus disease 2019(COVID-19),may have a systemic involvement leading to multiple organ dysfunction.Experimental evidence about the SARS-CoV-2 tropism for the liver and the increasing of hepatic cytolysis enzymes during infection support the presence of a pathophysiological relationship between liver and SARS-CoV-2.On the other side,patients with chronic liver disease have been demonstrated to have a poor prognosis with COVID-19.In particular,patients with liver cirrhosis appear extremely vulnerable to infection.Moreover,the etiology of liver disease and the vaccination status could affect the COVID-19 outcomes.This review analyzes the impact of the disease stage and the related causes on morbidity and mortality,clinical outcomes during SARS-CoV-2 infection,as well as the efficacy of vaccination in patients with chronic liver disease.

Case series in Indonesia:B.1.617.2(delta)variant of SARS-CoV-2 infection after a second dose of vaccine

BACKGROUND The B.1.617.2(delta)variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was first discovered in Maharashtra in late 2020 and has rapidly expanded across India and worldwide.It took only 2 mo for this variant to spread in Indonesia,making the country the new epicenter of the delta variant as of July 2021.Despite efforts made by accelerating massive rollouts of current vaccines to protect against infection,cases of fully-vaccinated people infected with the delta variant have been reported.AIM To describe the demographic statistics and clinical presentation of the delta variant infection after the second dose of vaccine in Indonesia.METHODS A retrospective,single-centre case series of the general consecutive population that worked or studied at Faculty of Medicine,Universitas Indonesia with confirmed Delta Variant Infection after a second dose of vaccine from 24 June and 25 June 2021.Cases were collected retrospectively based on a combination of author recall,reverse transcription-polymerase chain reaction(RT-PCR),and whole genome sequencing results from the Clinical Microbiology Laboratory,Faculty of Medicine,Universitas Indonesia.RESULTS Between 24 June and 25 June 2021,15 subjects were confirmed with the B.1.617.2(delta)variant infection after a second dose of the vaccine.Fourteen subjects were vaccinated with CoronaVac(Sinovac)and one subject with ChAdOx1 nCoV-19(Oxford-AstraZeneca).All of the subjects remained in home isolation,with fever being the most common symptom at the onset of illness(n=10,66.67%).The mean duration of symptoms was 7.73 d(±5.444).The mean time that elapsed from the first positive swab to a negative RT-PCR test for SARS-CoV-2 was 17.93 d(±6.3464).The median time that elapsed from the second dose of vaccine to the first positive swab was 87 d(interquartile range:86-128).CONCLUSION Although this case shows that after two doses of vaccine,subjects are still susceptible to the delta variant infection,currently available vaccines remain the most effective protection.They reduce clinical manifestations of COVID-19,decrease recovery time from the first positive swab to negative swab,and lower the probability of hospitalization and mortality rate compared to unvaccinated individuals.

COVID-19 (SARS-CoV-2 infection) in lymphoma patients: A review

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection now has a global resonance and represents a major threat for several patient populations.Observations from initial case series suggested that cancer patients in general might have an unfavorable outcome following coronavirus disease 2019(COVID-19),due to their underlying conditions and cytotoxic treatments.More recently,data regarding the incidence and clinical evolution of COVID-19 in lymphomas have been reported with the aim to identify those more frequently associated with severe complications and death.Patients with lymphoma appear particularly vulnerable to SARS-CoV-2 infection,only partly because of the detrimental effects of the anti-neoplastic regimens(chemotherapy,pathway inhibitors,monoclonal antibodies)on the immune system.Here,we systematically reviewed the current literature on COVID-19 in adult patients with lymphoma,with particular emphasis on disease course and prognostic factors.We also highlighted the potential differences in COVID-19 clinical picture according to lymphoma subtype,delivered treatment for the hematological disease and its relationship on how these patients have been managed thus far.

Portuguese Society of Intensive Care Score for Predicting SARS-CoV-2 Infection Applied to Inpatients with Pneumonia: A Reliable Tool?

Objectives: Early identification of patients with the novel coronavirus induced-disease 2019 (COVID-19) and pneumonia is currently challenging. Few data are available on validated scores predictive of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. The Portuguese Society of Intensive Care (PSIC) proposed a risk score whose main goals were to predict a higher probability of COVID-19 and optimize hospital resources, adjusting patients’ intervention. This study aimed to validate the PSIC risk score applied to inpatients with pneumonia. Methods: A retrospective analysis of 207 patients with pneumonia admitted to a suspected/confirmed SARS-CoV-2 infection specialized ward (20/03 to 20/05/2020) was performed. Score variables were analyzed to determine the significance of the independent predictive variables on the probability of a positive SARS-CoV-2 rRT-PCR test. The binary logistic regression modeling approach was selected. The best cut-off value was obtained with the Receiver Operating Characteristic (ROC) curve together with the evaluation of the discriminatory power through the Area Under the Curve (AUC). Results: The validation cohort included 145 patients. Typical chest computed-tomography features (OR, 12.16;95% CI, 3.32 - 44.50) and contact with a positive SARS-CoV-2 patient (OR, 6.56;95% CI, 1.33 - 32.30) were the most significant independent predictive variables. A score ≥ 10 increased suspicion for SARS-CoV-2 pneumonia. The AUC was 0.82 (95% CI, 0.73 - 0.91) demonstrating the good discriminating power for COVID-19 probability stratification in inpatients with pneumonia. Conclusions: The application of the PSIC score to inpatients with pneumonia may be of value in predicting the risk of COVID-19. Further studies from other centers are needed to validate this score widely.

Role of neutrophil chemoattractant CXCL5 in SARS-CoV-2 infection-induced lung inflammatory innate immune response in an in vivo hACE2 transfection mouse model

Understanding the pathogenesis of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and clarifying antiviral immunity in hosts are critical aspects for the development of vaccines and antivirals.Mice are frequently used to generate animal models of infectious diseases due to their convenience and ability to undergo genetic manipulation.However,normal adult mice are not susceptible to SARS-CoV-2.Here,we developed a viral receptor(human angiotensin-converting enzyme 2,hACE2)pulmonary transfection mouse model to establish SARS-CoV-2 infection rapidly in the mouse lung.Based on the model,the virus successfully infected the mouse lung 2 days after transfection.Viral RNA/protein,innate immune cell infiltration,inflammatory cytokine expression,and pathological changes in the infected lungs were observed after infection.Further studies indicated that neutrophils were the first and most abundant leukocytes to infiltrate the infected lungs after viral infection.In addition,using infected CXCL5-knockout mice,chemokine CXCL5 was responsible for neutrophil recruitment.CXCL5 knockout decreased lung inflammation without diminishing viral clearance,suggesting a potential target for controlling pneumonia.

Paediatric gastrointestinal disorders in SARS-CoV-2 infection:Epidemiological and clinical implications

The coronavirus disease 2019(COVID-19)pandemic is a threat worldwide for individuals of all ages,including children.Gastrointestinal manifestations could be the initial presenting manifestation in many patients,especially in children.These symptoms are more common in patients with severe disease than in patients with non-severe disease.Approximately 48.1%of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)viral RNA.Children typically form 1%-8%of all laboratoryconfirmed cases of SARS-CoV-2.Gastrointestinal manifestations of COVID-19 in children are not rare,with a prevalence between 0 and 88%,and a wide variety of presentations,including diarrhoea,vomiting,and abdominal pain,can develop before,with or after the development of respiratory symptoms.Atypical manifestations such as appendicitis or liver injury could also appear,especially in the presence of multisystem inflammatory disease.In this review,we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis,misdiagnosis,prognosis,and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome,child nutrition,and disease management.

Single-nucleus transcriptomic profiling of multiple organs in a rhesus macaque model of SARS-CoV-2 infection

Infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) causes diverse clinical manifestations and tissue injuries in multiple organs.However, cellular and molecular understanding of SARS-CoV-2 infection-associated pathology and immune defense features in different organs remains incomplete. Here, we profiled approximately 77 000single-nucleus transcriptomes of the lung, liver,kidney, and cerebral cortex in rhesus macaques(Macaca mulatta) infected with SARS-CoV-2 and healthy controls. Integrated analysis of the multiorgan dataset suggested that the liver harbored the strongest global transcriptional alterations. We observed prominent impairment in lung epithelial cells, especially in AT2 and ciliated cells, and evident signs of fibrosis in fibroblasts. These lung injury characteristics are similar to those reported in patients with coronavirus disease 2019(COVID-19).Furthermore, we found suppressed MHC class I/II molecular activity in the lung, inflammatory response in the liver, and activation of the kynurenine pathway,which induced the development of an immunosuppressive microenvironment. Analysis of the kidney dataset highlighted tropism of tubule cells to SARS-CoV-2, and we found membranous nephropathy(an autoimmune disease) caused by podocyte dysregulation. In addition, we identified the pathological states of astrocytes and oligodendrocytes in the cerebral cortex, providing molecular insights into COVID-19-related neurological implications. Overall, our multi-organ single-nucleus transcriptomic survey of SARS-CoV-2-infected rhesus macaques broadens our understanding of disease features and antiviral immune defects caused by SARS-CoV-2 infection,which may facilitate the development of therapeutic interventions for COVID-19.

Liver dysfunction and SARS-CoV-2 infection

Severe acute respiratory syndrome coronavirus 2 infection is the cause of coronavirus disease 2019(COVID-19),which predominantly affects the respiratory system;it also causes systemic and multi-organic disease.Liver damage is among the main extrapulmonary manifestations.COVID-19-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease,and occurs in approximately one in five patients.Abnormal liver test results have been associated with a more severe course of COVID-19 and other complications,including death.Mechanisms linking COVID-19 to liver injury are diverse.Particular consideration should be made for patients with pre-existing liver disease,such as metabolic dysfunction-associated fatty liver disease,chronic liver disease due to viral or autoimmune disease,liver transplant carriers,or cirrhosis,given the risk for more severe outcomes.This manuscript summarizes the current lines of evidence on COVID-19-associated liver injury regarding pathophysiology,clinical significance,and management in both patients with or without preexisting liver disease,to facilitate clinicians’access to updated information and patient care.Finally,we mention the ideas and recommendations to be considered for future research.

COVID-19 and the gastrointestinal tract:Source of infection or merely a target of the inflammatory process following SARS-CoV-2 infection?

Gastrointestinal(GI)symptoms have been described in a conspicuous percentage of coronavirus disease 2019(COVID-19)patients.This clinical evidence is supported by the detection of viral RNA in stool,which also supports the hypothesis of a possible fecal-oral transmission route.The involvement of GI tract in severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection is corroborated by the theoretical assumption that angiotensin converting enzyme 2,which is a SARS-CoV-2 target receptor,is present along the GI tract.Studies have pointed out that gut dysbiosis may occur in COVID-19 patients,with a possible correlation with disease severity and with complications such as multisystem inflammatory syndrome in children.However,the question to be addressed is whether dysbiosis is a consequence or a contributing cause of SARS-CoV-2 infection.In such a scenario,pharmacological therapies aimed at decreasing GI permeability may be beneficial for COVID-19 patients.Considering the possibility of a fecal-oral transmission route,water and environmental sanitation play a crucial role for COVID-19 containment,especially in developing countries.

Dysregulated liver function in SARS-CoV-2 infection:Current understanding and perspectives

Since it was first reported in December 2019,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has spread rapidly around the world to cause the ongoing pandemic.Although the clinical manifestations of SARS-CoV-2 infection are predominantly in the respiratory system,liver enzyme abnormalities exist in around half of the cases,which indicate liver injury,and raise clinical concern.At present,there is no consensus whether the liver injury is directly caused by viral replication in the liver tissue or indirectly by the systemic inflammatory response.This review aims to summarize the clinical manifestations and to explore the underlying mechanisms of liver dysfunction in patients with SARSCoV-2 infection.

Interaction between hepatitis B virus and SARS-CoV-2 infections

Coronavirus disease 2019(COVID-19)has become a global pandemic and garnered international attention.The causative pathogen of COVID-19 is severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),a novel,highly contagious coronavirus.Numerous studies have reported that liver injury is quite common in patients with COVID-19.Hepatitis B has a worldwide distribution as well as in China.At present,hepatitis B virus(HBV)remains a leading cause of cirrhosis,liver failure,and hepatocellular carcinoma.Because both viruses challenge liver physiology,it raises questions as to how coinfection with HBV and SARS-CoV-2 affect disease progression and mortality.Is there an increased risk of COVID-19 in patients with HBV infection?In this review,we summarize the current reports of SARS-CoV-2 and HBV coinfection and elaborate the interaction of the two diseases.The emphasis was placed on evaluating the impact of HBV infection on disease severity and clinical outcomes in patients with COVID-19 and discussing the potential mechanism behind this effect.

SARS-COV-2 infection(coronavirus disease 2019)for the gastrointestinal consultant

The current pandemic due to the severe acute respiratory syndrome coronavirus 2 has caused an extreme burden for health care systems globally,and the number of cases is expected to continue to increase,at least in the immediate future.The virus is estimated to have infected more than 1.5 million individuals.The available reports suggest that gastrointestinal(GI)involvement in coronavirus disease 2019(COVID-19)is common and in some cases the GI symptoms may precede the respiratory symptoms.In addition to direct effects of severe acute respiratory syndrome coronavirus 2,the infected patients remain at risk for the complications commonly managed by gastroenterology and hepatology consultants.The most commonly reported GI manifestation of COVID-19 is diarrhea,which is reported in a third to up to more than half of the patients.Mild to moderate elevation of the liver enzymes are also common,although no case of acute liver failure has been reported so far.Many of the medications used for treatment of COVID-19 can also be associated with GI symptoms or liver injury and can be included in the differential diagnosis in these patients.Although the diagnosis of the infection is currently based on RNA analysis in respiratory samples,the available literature on fecal shedding of this virus suggests that fecal RNA testing might prove to be a useful diagnostic test.It is reasonable to delay all non-urgent endoscopic procedures during the peak of the pandemic and use additional protective equipment such as N95 respirators during endoscopy while most patients can be considered high risk for having been exposed to the virus.

SARS-CoV-2 infection aggravates chronic comorbidities of cardiovascular diseases and diabetes in mice

Background:Cardiovascular diseases(CVDs)and diabetes mellitus(DM)are top two chronic comorbidities that increase the severity and mortality of COVID-19.However,how SARS-CoV-2 alters the progression of chronic diseases remain unclear.Methods:We used adenovirus to deliver h-ACE2 to lung to enable SARS-CoV-2 infection in mice.SARS-CoV-2’s impacts on pathogenesis of chronic diseases were studied through histopathological,virologic and molecular biology analysis.Results:Pre-existing CVDs resulted in viral invasion,ROS elevation and activation of apoptosis pathways contribute myocardial injury during SARS-CoV-2 infection.Viral infection increased fasting blood glucose and reduced insulin response in DM model.Bone mineral density decreased shortly after infection,which associated with impaired PI3K/AKT/mTOR signaling.Conclusion:We established mouse models mimicked the complex pathological symptoms of COVID-19 patients with chronic diseases.Pre-existing diseases could impair the inflammatory responses to SARS-CoV-2 infection,which further aggravated the pre-existing diseases.This work provided valuable information to better understand the interplay between the primary diseases and SARS-CoV-2 infection.