Management of patients with digestive diseases during the COVID-19 pandemic. Clinical practice guidelines by the Russian scientific medical society of internal medicine (RSMSIM) and the Gastroenterological Scientific Society of Russia (2nd edition)
22 May 2021-Vol. 187, Iss: 3, pp 5-82
TL;DR: The presented clinical practice guidelines of the Gastroenterological Scientific Society of Russia (GSSR), diagnostic, and therapeutic approaches for patients with digestive diseases during the COVID-19 pandemic were approved by the XXIII Congress of the GSSR and the 22nd International Slavonic-Baltic Scienti fi c Forum “St. Petersburg - Gastro-2020 ON-LINE”.
Abstract: The presented clinical practice guidelines of the Gastroenterological Scientific Society of Russia (GSSR), diagnostic, and therapeutic approaches for patients with digestive diseases during the COVID-19 pandemic. The guidelines were approved by the XXIII Congress of the GSSR and the 22nd International Slavonic-Baltic Scientifi c Forum “St. Petersburg - Gastro-2020 ON-LINE” (St. Petersburg, June 11, 2020). The presented clinical practice guidelines of the Russian Scientific Medical Society of Internal Medicine (RSMSIM) and the Gastroenterological Scientific Society of Russia (GSSR), diagnostic, and therapeutic approaches for patients with digestive diseases during the COVID-19 pandemic. The recommendations were approved at the XV National Congress of Internal Medicine, XXIII Congress of NOGR on the basis of the 1st edition, adopted at the 22nd International Slavic- Baltic Scientific Forum “St. Petersburg - Gastro-2020 ON-LINE”.
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TL;DR: The results of this case series suggest that high-dose oral famotidine is well tolerated and associated with improved patient-reported outcomes in non-hospitalised patients with COVID-19.
Abstract: Objective: Treatment options for nonhospitalized patients with coronavirus disease 2019 (COVID-19) to reducemorbidity, mortality, and spread of the disease are an urgent global need The over-the-counter histamine-2 receptorantagonist famotidine is a putative therapy for COVID-19 We quantitively assessed longitudinal changes in patient-reported outcome measures in nonhospitalized patients with COVID-19 who self-administered high-dose famotidineorally Design: Patients were enrolled consecutively after signing written informed consent Data on demographics, COVID-19 diagnosis, famotidine use, drug related side-effects, temperature measurements, oxygen saturations, and symptom scores were obtained using questionnaires and telephone interviews Based on an NIH-endorsedProtocol to research Patient Experience of COVID-19, we collected longitudinal severity scores of five symptoms(cough, shortness of breath, fatigue, headaches, and anosmia) and general unwellness on a 4-point ordinal scalemodeled on performance status scoring All data are reported at the patient level Longitudinal combined normalizedsymptom scores were statistically compared Results: Ten consecutive patients with COVID-19 who self-administered high-dose oral famotidine were identified The most frequently used famotidine regimen was 80mg three times daily (n=6) for a median of 11 days (range: 5 to21 days) Famotidine was well tolerated All patients reported marked improvements of disease-related symptomsafter starting famotidine The combined symptom score improved significantly within 24 hours of starting famotidineand peripheral oxygen saturation (n=2), and device recorded activity (n=1) increased Conclusions: The results of this case series suggest that high-dose oral famotidine is well tolerated and associated with improved patient reported outcomes in nonhospitalized patients with COVID-19 A blinded outpatient trial isplanned The findings may be transferable and relevant to the treatment of patients with cancer and COVID-19
27 citations
01 Jan 2010
TL;DR: Research of the etiological structure of acute hepatitis of unknown origin has allowed verifying the hepatitis E at 5,6% cases, DNA EBV was found out at 2,8% cases and 2,4% of patients had RNA HGV in blood.
Abstract: Research of the etiological structure of acute hepatitis of unknown origin has allowed verifying the hepatitis E at 5,6% cases, DNA EBV was found out at 2,8% cases and 2,8% of patients had RNA HGV in blood. The data of the anamnesis and a clinical and laboratory picture does not allow excluding at 31% of patients a drug-induced liver injury.
11 citations
14 Aug 2021
TL;DR: Therapy for patients with COVID-19 should include therapeutic approaches aimed at correcting disorders of the intestinal microbiota, intestinal barrier permeability, and relief of gastroenterological manifestations.
Abstract: With a new coronavirus infection (COVID-19), gastroenterological symptoms are often detected, which is due to both the damage to the digestive organs by the SARS-CoV-2 coronavirus and the exacerbation of chronic diseases, as well as aggressive multicomponent therapy. The severity of gastroenterological manifestations, primarily impaired liver function, is associated with a more severe and complicated course of COVID-19 infection. Numerous mechanisms of damage to the digestive organs in COVID-19 have been identified: direct damage by the virus due to resuscitation and multicomponent therapy, impaired central and peripheral nervous regulation, immunothrombotic syndrome, virus persistence in the gastrointestinal tract, induction of autoimmune reactions by the virus, humoral disorders (changes in serotonin levels, bradykinin, activation of mast cells). Violation of the microbial-tissue complex of the intestine and the permeability of the intestinal barrier, induced by the SARS-CoV-2 virus, ensures the formation and progression of chronic systemic inflammation, cytokine aggression, insulin resistance, endothelial dysfunction, which affect the severity of the infection. Therapy for patients with COVID-19 should include therapeutic approaches aimed at correcting disorders of the intestinal microbiota, intestinal barrier permeability, and relief of gastroenterological manifestations
3 citations
02 Sep 2021
TL;DR: Treatment of patients with diffuse liver diseases includes lifestyle and nutritional modification, the use of hepatoprotective drugs, and means of correcting the intestinal barrier.
Abstract: Liver dysfunction is common with COVID-19 infection, and the prevalence is higher in men as well as in the elderly. Manifestations of liver damage such as high aspartate aminotransferase and alanine aminotransferase activity, increased bilirubin levels, low albumin levels, and prolonged prothrombin time are associated with severe COVID-19 infection. Mortality in patients with diffuse liver diseases without cirrhosis with COVID-19 infection was 12 %, in the presence of liver cirrhosis up to 40%, decompensated liver cirrhosis up to 4363%. The mechanisms of liver damage in COVID-19 include direct hepatotoxicity and indirect liver damage (due to systemic inflammation with impaired immunity, sepsis, hypoxia, ischemia, coagulopathy, endotheliitis, right ventricular failure, worsening of the course of existing liver diseases, drug liver damage). Treatment of patients with diffuse liver diseases includes lifestyle and nutritional modification, the use of hepatoprotective drugs, and means of correcting the intestinal barrier (bibliography: 30 refs).
2 citations
TL;DR: In this article , the authors discuss clinical case of a new coronavirus infection in a patient with a severe course of Crohn's disease (CD) in a long anamnesis.
Abstract: The article discusses clinical case of a new coronavirus infection in a patient with a severe course of Crohn's disease (CD) in a long anamnesis. The issues of the complexity of diagnosing Crohn's disease in an atypical course (gastroduodenal form), the algorithm for selecting basic therapy for a severe course of the disease are considered. The second problem in the article is the tactics of managing patients with COVID-19 against the background of combined basic immunosuppressive therapy for autoimmune diseases. © 2022 Global Media Technologies. All rights reserved.
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TL;DR: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness, and patients often presented without fever, and many did not have abnormal radiologic findings.
Abstract: Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of...
22,622 citations
TL;DR: The epidemiological and clinical characteristics of novel coronavirus (2019-nCoV)-infected pneumonia in Wuhan, China, and hospital-associated transmission as the presumed mechanism of infection for affected health professionals and hospitalized patients are described.
Abstract: 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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TL;DR: Characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia, and further investigation is needed to explore the applicability of the Mu LBSTA scores in predicting the risk of mortality in 2019-nCoV infection.
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