GASTROINTESTINAL COMPLICATIONS OF CORONAVIRUS DISEASE (COVID-19).

BACKGROUND: It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. Accordingly, tissues with high expression levels of ACE2 are more susceptible to infection, including pulmonary alveolar epithelial cells, small intestine enterocytes, cholangiocytes, and vascular endothelial cells. Considering the atypical manifestations of COVID-19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease. METHOD: The phrase "Gastrointestinal complication of COVID" was searched in the PubMed, Medline, and SciELO databases. Due to the heterogeneity of the studies included in the present review, a narrative synthesis of the available qualitative data was performed. RESULT: The literature search retrieved 28 articles, primarily case reports and case series, for the qualitative analysis of gastrointestinal complications of COVID-19, in addition to two retrospective cohort and one case-control. The studies focused on hemorrhagic, thrombotic, ischemic, and perforation complications, in addition to acute pancreatitis and pneumatosis intestinalis. CONCLUSION: There is a straight relationship between high expression levels of ACE2 in the gastrointestinal tract and its greater susceptibility to direct infection by SARS-CoV-2. So, it is important to consider the gastrointestinal infection manifestations for early diagnosis and treatment trying to avoid more serious complications and death.

THE ROLE OF FISTULOCLYSIS IN THE TREATMENT OF PATIENTS WITH ENTEROATMOSPHERIC FISTULAS.

BACKGROUND: Enterocutaneous fistulas represent a connection between the gastrointestinal tract and adjacent tissues. Among them, there is a subdivision - the enteroatmospheric fistulas, in which the origin is the gastrointestinal tract in connection with the external environment through an open wound in the abdomen. Due to the high output in enterocutaneous fistulas, the loss of fluids, electrolytes, minerals and proteins leads to complications such as sepsis, malnutrition and electrolyte derangements. The parenteral nutrition has its secondary risks, and the fistuloclysis, that consist in the infusion of enteral feeding and also the chyme through the distal fistula, represents an alternative to the management of these patients until the definitive surgical approach. AIM: To evaluate the current evidence on the fistuloclysis technique, its applicability, advantages and disadvantages for patients with high output fistulas. METHOD: A systematic literature search was conducted in May 2020 with the headings "fistuloclysis", "chyme reinfusion" and "succus entericus reinfusion", in the PubMed, Medline and SciELO databases. Results: There were 29 articles selected for the development of this narrative synthesis, from 2003 to 2020, including reviews and case reports. CONCLUSION: Fistuloclysis is a safe method which optimizes the clinical, nutritional, and immunological conditions of patients with enteroatmospheric fistulas, increasing the chances of success of the reconstructive procedure. In cases where the definitive repair is not possible, chances of reducing or even stopping the use of nutrition through the parental route are increased, thus representing a promising modality for the management of most challenging cases.

Impact of COVID-19 on the number of transplants performed in Brazil during the pandemic. Current situation.

The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.

Current state of trauma and violence in São Paulo - Brazil during the COVID-19 pandemic.

The coronavirus pandemic led society to adopt measures to contain its spread that generate impacts in the social, economic and psychological spheres, mainly due to social isolation. Some authors point out that social changes have generated changes in the various forms of trauma and violence. For this study, data collection for the years 2019 and 2020 was carried out on DATASUS - TABNET and on the website of the Secretariat of Public Security - SSP, considering various types of trauma and violence, with subsequent correlation analysis using the Kendall coefficient and correlation test. There was statistical significance, allowing a correlation with the negative pandemic for the rates of body injury due to traffic accidents, gunshot injuries, stab wounds, sexual violence, bodily injuries and interpersonal violence. As factors possibly associated with a reduction in the incidence of these variables, the literature presents some changes resulting from the pandemic, such as adherence to isolation, with a reduction in the flow of people on the street, and a decrease in reports of violence. The present study indicates that the findings may serve as a warning for future changes and for the adoption of preventive measures, however they represent the initial situation of the pandemic in São Paulo and, therefore, further investigations must be carried out with the course of the pandemic, which still remains.

Impact of COVID-19 on the number of transplants performed in Brazil during the pandemic. Current situation / Impacto do COVID-19 no número de transplantes no Brasil durante a pandemia. Situação atual

ABSTRACT The intense use of resources to combat COVID-19 causes concern in the entire transplant community because, in addition to physical limitations such as ICU beds, lack of homogeneous treatment protocols and uncertainties about the effects of immunosuppression on viral progression have significant impact on transplant surgeries. The aim of the present study is to comparatively assess the number of solid organ transplants performed in 2019 and 2020, as well as the impact of the COVID-19 pandemic on organ donation and transplant surgeries in Brazil. The last 10 years have shown increasing trend in the number of solid organ transplants, which have significantly decreased in 2020. Lung transplantations were mostly affected by the pandemic; these surgeries have been carried out only in Rio Grande do Sul and São Paulo states. Liver transplantations were the least affected ones, since the number of surgeries have only decreased by 10.8% in the first three quarters of 2020, in comparison to 2019. The number of active patients on the waiting list for heart and kidney transplantation has increased in 2020. Therefore, it is necessary developing strategies to keep the structure necessary for organ transplantation processes active and, consequently, to reduce the impacts of the pandemic on these patients.

RESUMO A utilização intensa dos recursos para o combate da COVID-19 causa preocupação em toda comunidade de transplantes, pois além das limitações físicas, como leitos de UTI, a falta de protocolos homogêneos para tratamentos e as incertezas dos efeitos da imunossupressão na progressão do vírus, resultam em um impacto significativo nas cirurgias de transplantes. O objetivo do presente estudo é avaliar comparativamente o número de transplantes de órgãos sólidos realizados nos anos de 2019 e 2020, e o impacto da pandemia na doação e transplantes de órgãos no Brasil. Considerando os últimos 10 anos, é possível observar uma tendência de aumento no número de transplantes de órgãos sólidos, com queda expressiva no ano de 2020. O transplante pulmonar foi o mais atingido pela pandemia, sendo realizado apenas nos estados do Rio Grande do Sul e São Paulo. O transplante hepático foi o menos afetado, apresentando uma diminuição de apenas 10,8% nos três primeiros trimestres de 2020, quando comparados com 2019. Sobre os pacientes ativos em lista de espera, houve um aumento em 2020 para transplante de coração e rim. Portanto, estratégias devem ser desenvolvidas para que a estrutura necessária ao processo de transplantes de órgãos se mantenha ativa, reduzindo assim os impactos da pandemia sobre estes pacientes.

Gastrointestinal complications of coronavirus disease (covid-19) / Complicações gastrointestinais causadas pelo coronavírus (covid-19)

ABSTRACT Background: It is currently understood that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly enters target cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. Accordingly, tissues with high expression levels of ACE2 are more susceptible to infection, including pulmonary alveolar epithelial cells, small intestine enterocytes, cholangiocytes, and vascular endothelial cells. Considering the atypical manifestations of COVID-19 and the challenges of early diagnosis, this review addresses the possible gastrointestinal complications of the disease. Method: The phrase "Gastrointestinal complication of COVID" was searched in the PubMed, Medline, and SciELO databases. Due to the heterogeneity of the studies included in the present review, a narrative synthesis of the available qualitative data was performed. Result: The literature search retrieved 28 articles, primarily case reports and case series, for the qualitative analysis of gastrointestinal complications of COVID-19, in addition to two retrospective cohort and one case-control. The studies focused on hemorrhagic, thrombotic, ischemic, and perforation complications, in addition to acute pancreatitis and pneumatosis intestinalis. Conclusion: There is a straight relationship between high expression levels of ACE2 in the gastrointestinal tract and its greater susceptibility to direct infection by SARS-CoV-2. So, it is important to consider the gastrointestinal infection manifestations for early diagnosis and treatment trying to avoid more serious complications and death.

RESUMO Racional: Atualmente, entende-se que o vírus SARS-CoV-2 é capaz de infectar diretamente células-alvo por acoplamento ao receptor da enzima conversora de angiotensina 2 (ECA 2), por isso tecidos que contêm altos níveis de ECA 2 estão mais suscetíveis a infecção, como as células epiteliais dos alvéolos pulmonares, os enterócitos do intestino delgado, os colangiócitos e o endotélio vascular. Objetivo: Levando em consideração as manifestações atípicas da COVID-19 e a dificuldade na suspeita diagnósticaprecoce, esta revisão busca apresentar aspossíveis complicações gastrointestinais da doença. Método: A busca foi realizada com o descritor"Gastrointestinal complication of COVID" nas bases de dados PubMed, Medline e SciELO e dada à natureza heterogênea dos textos adicionados a esta revisão, optou-se pela realização uma síntese qualitativa narrativa dos dados disponíveis.Foram selecionados 28 artigos para análise qualitativa sobre o tema, sendo principalmente relatos e séries de casos, além de duas coortes retrospectivas e um caso-controle.Os estudos tratavam de complicações hemorrágicas, trombóticas, isquêmicas, perfurativas, além de pancreatite aguda e pneumatose intestinal. Resultados: Diversos autores sugerem que o vírus tenha um papel direto no dano às células da mucosa gastrointestinal. Os estudos relatam casos de hemorragia gastrointestinal, assim como fenômenos trombóticos e isquêmicos, reforçando o papel do SARS-CoV-2 nos distúrbios de coagulação. Casos de perfuração intestinal e pancreatite também foram associados à COVID-19. Conclusão: Uma vez que a relação entre altos níveis de ECA 2 no trato gastrointestinal e a sua maior suscetibilidade a infecção direta pelo vírus SARS-CoV-2 esteja estabelecida, é importante estar atento para as diferentes manifestações e complicações gastrointestinais e serem elas diagnosticadas e tratadas precocemente.

The role of fistuloclysis in the treatment of patients with enteroatmospheric fistulas / O papel da fistuloclise no tratamento de pacientes com fístulas enteroatmosféricas

ABSTRACT Background: Enterocutaneous fistulas represent a connection between the gastrointestinal tract and adjacent tissues. Among them, there is a subdivision - the enteroatmospheric fistulas, in which the origin is the gastrointestinal tract in connection with the external environment through an open wound in the abdomen. Due to the high output in enterocutaneous fistulas, the loss of fluids, electrolytes, minerals and proteins leads to complications such as sepsis, malnutrition and electrolyte derangements. The parenteral nutrition has its secondary risks, and the fistuloclysis, that consist in the infusion of enteral feeding and also the chyme through the distal fistula, represents an alternative to the management of these patients until the definitive surgical approach. Aim: To evaluate the current evidence on the fistuloclysis technique, its applicability, advantages and disadvantages for patients with high output fistulas. Method: A systematic literature search was conducted in May 2020 with the headings "fistuloclysis", "chyme reinfusion" and "succus entericus reinfusion", in the PubMed, Medline and SciELO databases. Results: There were 29 articles selected for the development of this narrative synthesis, from 2003 to 2020, including reviews and case reports. Conclusion: Fistuloclysis is a safe method which optimizes the clinical, nutritional, and immunological conditions of patients with enteroatmospheric fistulas, increasing the chances of success of the reconstructive procedure. In cases where the definitive repair is not possible, chances of reducing or even stopping the use of nutrition through the parental route are increased, thus representing a promising modality for the management of most challenging cases.

RESUMO Racional: As fístulas enterocutâneas representam uma conexão entre o trato gastrointestinal e os tecidos adjacentes. Dentre elas, há uma subdivisão - as fístulas enteroatmosféricas, em que a origem é o trato gastrointestinal em conexão com o meio externo por meio de uma ferida aberta no abdômen. Devido ao alto débito nas fístulas enterocutâneas, a perda de fluidos, eletrólitos, minerais e proteínas levam a complicações como sepse, desnutrição e desequilíbrios eletrolíticos. A nutrição parenteral tem seus riscos secundários, e a fistuloclise, que consiste na infusão de nutrição enteral e também do quimo pela fístula distal, representa uma alternativa no manejo desses pacientes até a abordagem cirúrgica definitiva. Objetivo: Avaliar as evidências atuais sobre a técnica de fistuloclise, sua aplicabilidade, vantagens e desvantagens para pacientes com fístulas de alto débito. Método: Foi realizada uma busca sistemática da literatura em maio de 2020 com os títulos "fistuloclysis", "chyme reinfusion" e "succus entericus reinfusion", nas bases de dados PubMed, Medline e SciELO. Resultados: Foram selecionados 29 artigos para o desenvolvimento desta síntese narrativa, no período de 2003 a 2020, incluindo revisões e relatos de caso. Conclusão: A fistuloclise é um método seguro que otimiza as condições clínicas, nutricionais e imunológicas dos pacientes com fístulas enteroatmosféricas, aumentando as chances de sucesso do procedimento de reconstrução. Nos casos em que o reparo definitivo não é possível, aumentam as chances de reduzir ou mesmo interromper o uso da nutrição pela via parental, representando uma modalidade promissora para o manejo dos casos mais desafiadores.

Current state of trauma and violence in São Paulo - Brazil during the COVID-19 pandemic / Estado atual do trauma e violência em São Paulo - Brasil durante a pandemia de COVID-19

ABSTRACT The coronavirus pandemic led society to adopt measures to contain its spread that generate impacts in the social, economic and psychological spheres, mainly due to social isolation. Some authors point out that social changes have generated changes in the various forms of trauma and violence. For this study, data collection for the years 2019 and 2020 was carried out on DATASUS - TABNET and on the website of the Secretariat of Public Security - SSP, considering various types of trauma and violence, with subsequent correlation analysis using the Kendall coefficient and correlation test. There was statistical significance, allowing a correlation with the negative pandemic for the rates of body injury due to traffic accidents, gunshot injuries, stab wounds, sexual violence, bodily injuries and interpersonal violence. As factors possibly associated with a reduction in the incidence of these variables, the literature presents some changes resulting from the pandemic, such as adherence to isolation, with a reduction in the flow of people on the street, and a decrease in reports of violence. The present study indicates that the findings may serve as a warning for future changes and for the adoption of preventive measures, however they represent the initial situation of the pandemic in São Paulo and, therefore, further investigations must be carried out with the course of the pandemic, which still remains.

RESUMO A pandemia do coronavírus levou a sociedade a adotar medidas de contenção de sua disseminação que geram impactos em âmbito social, econômico e psicológico, principalmente pelo isolamento social. Alguns autores apontam que as mudanças sociais geraram mudanças sobre as variadas formas de trauma e violência. Para este estudo, foi realizada coleta de dados referente aos anos de 2019 e 2020 no DATASUS - TABNET e no site da Secretaria de Segurança Pública- SSP, considerando diversos tipos de trauma e violência, com posterior análise de correlação pelo teste de coeficiente e correlação de Kendall. Houve significância estatística, permitindo realizar correlação com a pandemia de caráter negativo para as taxas de lesão corporal por acidente de trânsito, ferimento por arma de fogo, ferimento por arma branca, violência sexual, lesão corporal e violência interpessoal. Como fatores possivelmente associados a redução na incidência destas variáveis, a literatura apresenta algumas mudanças provenientes da pandemia, como adesão ao isolamento, com redução do fluxo de pessoas na rua, e diminuição de denúncias de violência. O presente estudo indica que os achados podem servir de alerta para mudanças futuras e para adoção de medidas preventivas, porém representam o quadro inicial da pandemia em São Paulo e, portanto, mais investigações devem ser elaboradas com o decorrer da pandemia, que ainda se mantém.