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1.
Rev Gastroenterol Mex ; 85(3): 312-320, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32620315

RESUMO

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) virus. COVID-19 affected more than 6million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy.


Assuntos
Infecções por Coronavirus/complicações , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Hepatopatias/tratamento farmacológico , Pancreatopatias/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Humanos , Hepatopatias/complicações , Transplante de Fígado , Transplante de Pâncreas , Pancreatopatias/complicações
2.
Am Surg ; 86(6): 665-674, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683972

RESUMO

BACKGROUND: Mortality and complications are not well defined nationally for emergency general surgery (EGS) patients presenting with underlying all-cause liver disease (LD). STUDY DESIGN: We analyzed the 2012-2014 National Inpatient Sample for adults (aged ≥ 18 years) with a primary EGS diagnosis. Underlying LD included International Classification of Diseases, Ninth Revision, Clinical Modification codes for alcoholic and viral hepatitis, malignancy, congenital etiologies, and cirrhosis. The primary outcome was mortality; secondary outcomes included complications, operative intervention, and costs. RESULTS: Of the 6.8 million EGS patients, 358 766 (5.3%) had underlying LD. 59.1% had cirrhosis, 6.7% had portal hypertension, and 13.7% had ascites. Compared with other EGS patients, EGS-LD patients had higher mean costs ($12 847 vs $10 234, P < .001). EGS-LD patients were less likely to have surgery (26.1% vs 37.0%, P < .001) but for those who did, mortality was higher (4.8% vs 1.8%, P < .001). Risk factors for mortality included ascites (adjusted odds ratio [aOR] = 2.68, P < .001), dialysis (aOR = 3.44, P < .001), sepsis (aOR = 8.97, P < .001), and respiratory failure requiring intubation (aOR = 10.40, P < .001). Odds of death increased in both surgical (aOR = 4.93, P < .001) and non-surgical EGS-LD patients (aOR = 2.56, P < .001). CONCLUSIONS: Underlying all-cause LD among EGS patients is associated with increased in-hospital mortality, even in the absence of surgical intervention.


Assuntos
Serviço Hospitalar de Emergência , Tratamento de Emergência , Cirurgia Geral/estatística & dados numéricos , Hepatopatias/mortalidade , Adolescente , Adulto , Idoso , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/economia , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Hepatopatias/economia , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-32665398

RESUMO

OBJECTIVE: Severe liver damage is associated with worse outcome in COVID-19. Our aim was to explore the degree of liver damage, liver stiffness (LS) and severity of illness in patients with COVID-19. DESIGN: We investigated 32 patients with COVID-19 admitted to the University Hospital of Innsbruck in a prospective cross-sectional study. We performed laboratory testing, liver and spleen sonography and elastography to measure organ stiffness. RESULTS: 12 patients (38%) showed elevated aminotransferases and gamma-glutamyltransferase levels. LS was positively correlated with elevated aminotransferase levels in patients with COVID-19 compared with those without elevated enzymes. Even mild liver damage raised LS significantly in COVID-19 as it was in patients with gastrointestinal symptoms. Furthermore, higher LS measurements were significantly associated with illness severity like pneumonia, need for mechanical ventilation, and even death. CONCLUSION: Transient elastography is a useful and non-invasive tool to assess onset and severity of acute liver injury in patients with COVID-19 patients. Increased LS seems to be predictive for a more severe and complicated course of disease.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/complicações , Técnicas de Imagem por Elasticidade/métodos , Hepatopatias/diagnóstico , Fígado/diagnóstico por imagem , Pneumonia Viral/complicações , Idoso , Biópsia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , DNA Viral/análise , Feminino , Humanos , Hepatopatias/etiologia , Testes de Função Hepática , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
4.
Am J Gastroenterol ; 115(7): 1075-1083, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32618658

RESUMO

INTRODUCTION: Elevated liver enzyme levels are observed in patients with coronavirus disease 2019 (COVID-19); however, these features have not been characterized. METHODS: Hospitalized patients with COVID-19 in Zhejiang Province, China, from January 17 to February 12, 2020, were enrolled. Liver enzyme level elevation was defined as alanine aminotransferase level >35 U/L for men and 25 U/L for women at admission. Patients with normal alanine aminotransferase levels were included in the control group. Reverse transcription polymerase chain reaction was used to confirm severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and patients symptomatic with SARS-CoV-2 infection were defined as patients with COVID-19. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were collected and compared. RESULTS: Of 788 patients with COVID-19, 222 (28.2%) patients had elevated liver enzyme levels (median [interquartile range {IQR}] age, 47.0 [35.0-55.0] years; 40.5% women). Being male, overweight, and smoking increased the risk of liver enzyme level elevation. The liver enzyme level elevation group had lesser pharyngalgia and more diarrhea than the control group. The median time from illness onset to admission was 3 days for liver enzyme level elevation groups (IQR, 2-6), whereas the median hospitalization time for 86 (38.7%) discharged patients was 13 days (IQR, 11-16). No differences in disease severity and clinical outcomes were noted between the groups. DISCUSSION: We found that 28.2% of patients with COVID-19 presented with elevated liver enzyme levels on admission, which could partially be related to SARS-CoV-2 infection. Male patients had a higher risk of liver enzyme level elevation. With early medical intervention, liver enzyme level elevation did not worsen the outcomes of patients with COVID-19.


Assuntos
Infecções por Coronavirus , Hepatite Viral Humana/enzimologia , Testes de Função Hepática , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Estudos Transversais , Feminino , Hepatite Viral Humana/virologia , Humanos , Hepatopatias/enzimologia , Hepatopatias/virologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Estudos Retrospectivos , Fatores de Risco
5.
Zhonghua Gan Zang Bing Za Zhi ; 28(6): 523-527, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32660185

RESUMO

The highly contagious novel coronavirus pneumonia (COVID-19) that broke out in December 2019 has brought huge threats and losses to human society, so it has been the concern of every countries government. Presently, there are no specific drugs for COVID-19; however, a variety of potentially effective antiviral drugs, vaccines, cell therapies, traditional Chinese medicine and other methods are in clinical trials. Liver injury is a common complication of patients receiving COVID-19 treatment and its possible high incidence may affect the outcome of the disease. The pathogenesis of COVID-19 combined with liver injury in existing studies is still unclear, and relevant guidelines and expert consensuses are insufficient for clinical diagnosis and treatment. Therefore, the relevant progress and issues are now reviewed here.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Hepatopatias/etiologia , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Humanos , Fígado , Pneumonia Viral/complicações
6.
BMJ Open ; 10(7): e040517, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32641369

RESUMO

INTRODUCTION: COVID-19 has spread rapidly in China and around the world. Published studies have revealed that some patients with COVID-19 had abnormal liver function in laboratory tests. However, the results were inconsistent and the analysis of epidemiological data stratified by the severity of COVID-19 was not available in previous meta-analyses. Furthermore, these meta-analyses were suspected of overestimating the incidence of liver injury in patients with COVID-19 because some studies considered transaminase elevation as liver injury, which might partially result from cardiac and muscle injury. This systematic review aims to enrol published literatures related to COVID-19 without language restriction, analyse the data based on the severity of the COVID-19 and explore the impact of varied definitions of liver injury on the incidence of liver injury. METHODS AND ANALYSIS: We have conducted a preliminary search on PubMed and Excerpta Medica Database on 13 April 2020, for the studies published after December 2019 on the prevalence of acute liver injury and hypertransaminemia in patients with COVID-19. Two reviewers will independently screen studies, extract data and assess the risk of bias. We will estimate the pooled incidence of hypertransaminemia and acute liver injury in patients with COVID-19 by using the random-effects model. The I² test will be used to identify the extent of heterogeneity. Publication bias will be assessed by funnel plot and performing the Begg's and Egger's test if adequate studies are available. We will perform a risk of bias assessment using the Joanna Briggs Institute's critical appraisal checklist. ETHICS AND DISSEMINATION: Since this study will be based on the published data, it does not require ethical approval. The final results of this study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020179462.


Assuntos
Infecções por Coronavirus/epidemiologia , Hepatopatias/epidemiologia , Pneumonia Viral/epidemiologia , Doença Aguda , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Betacoronavirus , Bilirrubina/sangue , Humanos , Incidência , Hepatopatias/sangue , Pandemias , Prevalência
7.
World J Gastroenterol ; 26(19): 2286-2293, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32476793

RESUMO

In December 2019, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China causing coronavirus disease-2019 (COVID-19). Numerous studies have shown varying degrees of liver damage in patients infected with SARS-CoV-2. However, in previous case studies of COVID-19, the exact cause of liver injury has not been clearly elucidated, nor is there clear evidence of the interaction between liver injury and COVID-19. This study will analyze the causes of liver injury in COVID-19 and the influence of liver-related complications on the treatment and prognosis of COVID-19.


Assuntos
Infecções por Coronavirus/complicações , Hepatopatias/terapia , Hepatopatias/virologia , Pneumonia Viral/complicações , Adulto , Idoso , Betacoronavirus , Comorbidade , Infecções por Coronavirus/virologia , Feminino , Humanos , Fígado/virologia , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Prognóstico
8.
World J Gastroenterol ; 26(19): 2323-2332, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32476796

RESUMO

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that causes coronavirus disease-2019 (COVID-19) is a global pandemic, manifested by an infectious pneumonia. Although patients primarily present with fever, cough and dyspnea, some patients also develop gastrointestinal (GI) and hepatic manifestations. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Liver chemistry abnormalities are common and include elevation of aspartate transferase, alanine transferase, and total bilirubin. Studies have shown that SARS-CoV-2 infects the GI tract via its viral receptor angiotensin converting enzyme II, which is expressed on enterocytes of the ileum and colon. Viral RNA has also been isolated from stool specimens of COVID-19 patients, which raised the concern for fecal-oral transmission in addition to droplet transmission. Although indirect evidence has suggested possible fecal-oral transmission of SARS-CoV-2, more effort is needed to establish the role of the fecal-oral transmission route. Further research will help elucidate the association between patients with underlying GI diseases, such as chronic liver disease and inflammatory bowel disease, and severity of COVID-19. In this review, we summarize the data on GI involvement to date, as well as the impact of COVID-19 on underlying GI diseases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gastroenteropatias/virologia , Hepatopatias/virologia , Pneumonia Viral/complicações , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Transmissão de Doença Infecciosa , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Trato Gastrointestinal/virologia , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Fígado/virologia , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
9.
Indian Pediatr ; 57(6): 533-535, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32562397

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), though primarily a respiratory pathogen, also involves the gastrointestinal tract. Similar to the respiratory mucosa, angiotensin converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2) co-express in the gastrointestinal tract, which facilitates viral entry into the tissue. Less than 10% of children with infection develop diarrhea and vomiting. Prolonged RT PCR positivity in the stool has raised the possibility of feco-oral transmission. Elevated transaminases are common, especially in those with severe coronavirus disease (COVID-19). Children with inflammatory bowel disease and post liver transplant patients do not have an increased risk of disease, and should remain on medications they are already on. Children with chronic liver disease should continue their medications as usual. All elective procedures like endoscopy should be postponed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gastroenteropatias/complicações , Gastroenteropatias/virologia , Trato Gastrointestinal/virologia , Pneumonia Viral/complicações , Criança , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Gastroenteropatias/terapia , Trato Gastrointestinal/fisiopatologia , Humanos , Hepatopatias/complicações , Hepatopatias/terapia , Hepatopatias/virologia , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão
10.
Rev Gastroenterol Mex ; 85(3): 303-311, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32553772

RESUMO

The novel SARS-CoV-2 coronavirus is responsible for the infectious disease caused by coronavirus 19 (COVID-19). The current pandemic is growing worldwide and could affect 50-60% of the world population in the months to come. The most severe disease manifestations are atypical pneumonia and sepsis, but the gastrointestinal tract, particularly the liver, has recently been reported to be affected by SARS-CoV-2. Therefore, the aim of the present work was to review the literature available on the topic and provide information about COVID-19, in both healthy and diseased livers, and issue recommendations. The incidence of liver injury specifically associated with COVID-19 varies from 14.8-53%. The majority of case series have reported altered ALT and AST, elevated total bilirubin, and low serum albumin and liver compromise has been associated with the most severe cases of COVID-19. Cirrhosis of the liver has a recognized immune dysfunction status that includes immunodeficiency and systemic inflammation, making it reasonable for those patients to be more susceptible to SARS-CoV-2 infection. The recommendations for those patients, in addition to the general measures of physical distancing and handwashing for all persons, include social, medical, and psychologic support during the period of home quarantine to prevent lapses in treatment. Patients should be made aware that they need to keep abreast of changes in recommendations and social policies.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Cirrose Hepática/terapia , Hepatopatias/etiologia , Hepatopatias/fisiopatologia , Fígado/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Incidência , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Cirrose Hepática/fisiopatologia , Hepatopatias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia
11.
Medicine (Baltimore) ; 99(24): e20239, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541450

RESUMO

To evaluate the timing, feasibility, and necessity of early laparoscopic cholecystectomy (LC) in the management of patients with acute calculous cholecystitis complicated with hepatic dysfunction.The clinical data of 60 patients with acute calculous cholecystitis complicated with hepatic dysfunction treated from January 2016 to January 2018 were analyzed retrospectively. A total of 32 patients underwent LC within 72 hours of the cholecystitis attack, 28 patients after 72 hours. The results were compared with those from 28 patients with delayed LC.All the patients were operated by experienced surgeons, and no LC transfer to open operation. No significant differences were detected in the operation time, postoperative complications, intraoperative blood loss, white TBIL, ALT, GGT before and after the operation between the 2 groups (P > .05). Patients who underwent early LC had a short hospital stay and fewer hospital costs (P < .05). All the patients were cured.It is safe, feasible, and necessary to perform LC within 72 hours in patients with acute calculous cholecystitis complicated with hepatic dysfunction. Such patients show a high positive correlation between the inflammation of acute calculous cholecystitis and the damage of hepatic function.


Assuntos
Colecistite Aguda/cirurgia , Cálculos Biliares/complicações , Hepatopatias/etiologia , Hepatopatias/cirurgia , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Colecistectomia Laparoscópica/métodos , Estudos de Viabilidade , Feminino , Cálculos Biliares/patologia , Humanos , Tempo de Internação , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Prevenção Secundária/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento
12.
Eur J Intern Med ; 77: 18-24, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32507608

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19) starting last December in China placed emphasis on liver involvement during infection. This review discusses the underlying mechanisms linking COVID-19 to liver dysfunction, according to recent available information, while waiting further studies. The manifestations of liver damage are usually mild (moderately elevated serum aspartate aminotransferase activities), and generally asymptomatic. Few patients can still develop severe liver problems, and therapeutic options can be limited. Liver dysfunction may affect about one-third of the patients, with prevalence greater in men than women, and in elderly. Mechanisms of damage are complex and include direct cholangiocyte damage and other coexisting conditions such as the use of antiviral drugs, systemic inflammatory response, respiratory distress syndrome-induced hypoxia, sepsis, and multiple organ dysfunction. During new COVID-19 infections, liver injury may be observed. If liver involvement appears during COVID-19 infection, however, attention is required. This is particularly true if patients are older or have a pre-existing history of liver diseases. During COVID-19 infection, the onset of liver damage impairs the prognosis, and hospital stay is longer.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Hepatopatias/diagnóstico , Hepatopatias/virologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Infecções por Coronavirus/terapia , Humanos , Hepatopatias/terapia , Pandemias , Pneumonia Viral/terapia
14.
Lancet Gastroenterol Hepatol ; 5(8): 776-787, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32585136

RESUMO

The COVID-19 pandemic has spread rapidly worldwide. It is common to encounter patients with COVID-19 with abnormal liver function, either in the form of hepatitis, cholestasis, or both. The clinical implications of liver derangement might be variable in different clinical scenarios. With growing evidence of its clinical significance, it would be clinically helpful to provide practice recommendations for various common clinical scenarios of liver derangement during the COVID-19 pandemic. The Asia-Pacific Working Group for Liver Derangement during the COVID-19 Pandemic was formed to systematically review the literature with special focus on the clinical management of patients who have been or who are at risk of developing liver derangement during this pandemic. Clinical scenarios covering the use of pharmacological treatment for COVID-19 in the case of liver derangement, and assessment and management of patients with chronic hepatitis B or hepatitis C, non-alcoholic fatty liver disease, liver cirrhosis, and liver transplantation during the pandemic are discussed.


Assuntos
Infecções por Coronavirus/epidemiologia , Hepatopatias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Humanos , Hepatopatias/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Fatores de Risco
15.
Med Clin North Am ; 104(4): 681-694, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505260

RESUMO

Alcohol use is a common social and recreational activity in our society. Misuse of alcohol can lead to significant medical comorbidities that can affect essentially every organ system and lead to high health care costs and utilization. Heavy alcohol use across the spectrum from binge drinking and intoxication to chronic alcohol use disorder can lead to high morbidity and mortality both in the long and short term. Recognizing and treating common neurologic, gastrointestinal, and hematological manifestations of excess alcohol intake are essential for those who care for hospitalized patients. Withdrawal is among the most common and dangerous sequela associated with alcohol use disorder.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Hospitalização/economia , Hepatopatias/epidemiologia , Transtornos Relacionados ao Uso de Álcool/tratamento farmacológico , Transtornos Relacionados ao Uso de Álcool/economia , Benzodiazepinas/uso terapêutico , Comorbidade , Gabapentina/uso terapêutico , Humanos , Hepatopatias/etiologia , Estados Unidos/epidemiologia
16.
World J Gastroenterol ; 26(22): 2987-2999, 2020 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-32587443

RESUMO

Severe pulmonary disease caused by the novel coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], has devastated many countries around the world. It has overwhelmed the medical system. The priorities of many institutions have changed to manage critically ill corona virus infectious disease-2019 (COVID-19) patients, which affected the working style of many departments. Hepatologists and transplant surgeons look after a very sensitive patient group. Patients with liver disease need special attention and continuous follow-up. Similarly, transplant candidates also need special care. Healthcare professionals in the field of hepatology face the overwhelming task of taking care of COVID-19 patients with hepatic complications, liver disease or transplant patients who are SARS-CoV-2 positive, and the patients on routine surveillance who do not have COVID-19. This review will evaluate COVID-19 from the perspective of its effect on the liver and its possible effects on patients with liver disease. Furthermore, the level of care for liver transplant recipients during the pandemic will be discussed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Gastroenterologia/métodos , Hepatopatias/virologia , Transplante de Fígado , Pneumonia Viral/complicações , Infecções por Coronavirus/virologia , Humanos , Pandemias , Pneumonia Viral/virologia
17.
BMC Infect Dis ; 20(1): 394, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493232

RESUMO

BACKGROUND: Talaromyces marneffei is a highly pathogenic fungus that can cause life-threatening fatal systemic mycosis. Disseminated Talaromycosis marneffei affects multiple organs, including the lungs, skin, and reticuloendothelial system. However, T. marneffei infection has rarely been reported in human immunodeficiency virus (HIV)-negative infants with multiple intestinal perforations and diffuse hepatic granulomatous inflammation. CASE PRESENTATION: We present the case of an HIV-negative 37-month-old boy who has had recurrent pneumonia since infancy and was infected with disseminated Talaromycosis. Contrast-enhanced computed tomography of the whole abdomen showed hepatomegaly and intestinal wall thickening in the ascending colon and cecum with mesenteric lymphadenopathy. Colonoscopy showed a cobblestone pattern with erosion, ulcer, polypoid lesions, and lumen deformation ranging from the colon to the cecum. T. marneffei was isolated from the mucous membrane of the colon, liver, and bone marrow. After antifungal treatment and surgery, his clinical symptoms significantly improved. Whole-exome sequencing using the peripheral blood of the patient and his parents' revealed a heterozygous missense mutation in exon 17 of the STAT3 gene (c.1673G>A, p.G558D). CONCLUSIONS: In T. marneffei infection-endemic areas, endoscopic examination, culture, or histopathology from the intestine tissue should be performed in disseminated Talaromycosis patients with gastrointestinal symptoms. Timely and systemic antifungal therapy could improve the prognosis. Immunodeficiency typically should be considered in HIV-negative infants with opportunistic infections.


Assuntos
Hepatopatias/diagnóstico , Micoses/diagnóstico , Fator de Transcrição STAT3/genética , Talaromyces/isolamento & purificação , Antifúngicos/uso terapêutico , Pré-Escolar , Colonoscopia , Diagnóstico Diferencial , Humanos , Mucosa Intestinal/microbiologia , Perfuração Intestinal , Hepatopatias/tratamento farmacológico , Hepatopatias/microbiologia , Masculino , Mutação de Sentido Incorreto , Micoses/tratamento farmacológico , Micoses/microbiologia , Tomografia Computadorizada por Raios X
18.
Turk J Gastroenterol ; 31(5): 348-355, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32519953

RESUMO

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel acute infectious disease that has rapidly reached staggering pandemic proportions. This review addresses gastroenterologists, hepatologists, liver transplant (LT) specialists, and health-care professionals working in the field of liver diseases and liver transplantation. It has been written based on a limited number of publications, recommendations of national and international liver and organ transplantation societies, and experiences of patients with COVID-19 around the world. The purpose of this review is to provide information addressing questions and concerns about COVID-19, to reveal the effects of the novel disease on patients with chronic liver disease and LT recipients, and to share information about ways in which this pandemic will affect clinical practices. We, the Turkish Association for the Study of the Liver (TASL), would like to remind you that this text is actually not a practical guide. It is imperative to act according to the standards set by health-care institutions and the Ministry of Health, Republic of Turkey.


Assuntos
Infecções por Coronavirus/complicações , Gastroenterologia/normas , Gastroenteropatias/virologia , Transplante de Fígado/normas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Hepatopatias/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Turquia/epidemiologia
19.
Anticancer Res ; 40(6): 3361-3370, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487632

RESUMO

BACKGROUND/AIM: We evaluated whether splenic volume (SV) predicts sinusoidal obstruction syndrome (SOS) in colorectal cancer (CRC) patients receiving capecitabine plus oxaliplatin (CapeOX) therapy. PATIENTS AND METHODS: In this retrospective study, we measured SV in 41 patients receiving adjuvant CapeOX for CRC at five different time points. We compared the clinical data of the 18 patients who experienced ≥30% increases in SV immediately after vs. before CapeOX (group A) with data for the remaining 23 patients (group B). RESULTS: Platelet numbers decreased and the levels of hepatobiliary enzymes increased significantly 1 year after CapeOX compared with before CapeOX in group A. However, in group B, significantly decreased platelet numbers and significantly increased aspartate transaminase levels were confirmed only immediately after CapeOX, with no significant subsequent changes. CONCLUSION: SV was significantly associated with thrombocytopenia and liver dysfunction in CRC patients, and predicted SOS.


Assuntos
Antineoplásicos/uso terapêutico , Biomarcadores/metabolismo , Hepatopatias/etiologia , Oxaliplatina/efeitos adversos , Baço/patologia , Trombocitopenia/induzido quimicamente , Antineoplásicos/farmacologia , Feminino , Humanos , Masculino , Estudos Retrospectivos
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