ABSTRACT
Aim: This study aimed to assess the demographic details of coronavirus disease-2019 (COVID-19) patients, their comorbid conditions, preexisting illnesses such as tuberculosis (TB), the prevalence of gastrointestinal (GI) symptoms, duration of GI symptoms, gender-wise distribution of GI symptoms, age-wise distribution of GI symptoms, lab investigation, and computed tomography (CT) scanning was done to record the grading. Materials and methods: In total, 956 COVID-19 patients admitted to an isolation ward of a tertiary care center were screened for 3 months. Patients were confirmed positive for SARS-CoV-2 virus by real-time polymerase chain reaction (RT-PCR) test with a throat swab. Patient's age, demographic details, preexisting illness, and GI symptoms such as fever, impairment of appetite, loss of taste, loss of smell, hiccups, nausea, vomiting, diarrhea, abdominal pain, symptom's duration, history of chronic drug intake, biological markers, CT scanning, and comorbidities were recorded. Based on the provided protocol, standard care management was given to the admitted COVID-19 patients.Statistical analysis was performed using SPSS version 20.0. Frequencies with percentages, median (min, max), Chi-square test, and Mann-Whitney U test were used to test the statistical significance, and a p-value of <0.05 was considered statistically significant. Results: In our prospective study of 956 COVID-19 hospitalized patients, details were analyzed and the results are: the median age was 45 years, 70% of male, 60% were above 35 years, comorbidities like diabetes present in 42%, hypertension in 36%, asthma in 8%, cardiovascular diseases (CVD) in 5%, and history of chronic drug intake in 21%.Among 956 COVID-19 patients, GI symptoms were loss of smell (29.2%), loss of taste (26.4%) for 3 days; nausea (10%), vomiting (7.1%), abdominal pain (12.7%), and fever (42.5%) were observed for 2 days among the 36-45 years of age-group; and the loss of appetite (19%) for 3 days among the age-group of 46-55 years.The loss of appetite (23.7 vs 16.9%) (p= 0.014), taste (32.4 vs 23.8%) (p = 0.005), nausea (14.6 vs 8.2%) (p = 0.003), and vomiting (10.8 vs 5.5%) (p = 0.004) were higher in females than in males. No gender difference was observed in loss of smell (p = 0.057), abdominal pain (12 vs 14.3%) (p = 0.491), hiccups (4 vs 2.1%) (p = 0.132), and fever (41.3 vs 45.3%) (p = 0.329).Females had significantly higher levels of C-reactive protein (CRP) than males (6.1 vs 3.8) (p = 0.002). No gender difference was observed in neutrophil/lymphocyte ratio (NLR) (p = 0.772), ferritin, and lactate dehydrogenase (LDH). CT-grade IV was higher in males than in females (1.7 vs 1.5%), but the rest of the CT grades were higher in females than in males. Conclusion: In conclusion, GI symptoms are the onset of symptoms that are first expressed after being infected with the SARS-CoV-2 virus. Several studies showed the GI symptoms but did not analyze the age and gender that are risk factors for any disease, but our study showed all GI symptoms and their association with age and gender, which will shed light for our clinicians for early symptom identification, diagnosis, and appropriate treatment. How to cite this article: Murugesan M, Govindarajan R, Prakash L, et al. In COVID-19 Patients, the Identified Gastrointestinal Symptoms in Tertiary Care Center of India. Euroasian J Hepato-Gastroenterol 2022;12(1):24-30.
ABSTRACT
BACKGROUND AND AIM: Though rodenticidal hepatotoxicity is reported from India, there is no systematic study to assess its magnitude. This study aimed to assess exposure to rodenticide as a risk factor for acute hepatotoxicity in Tamil Nadu, India. METHODS: We retrospectively analyzed acute hepatotoxicity caused by ingestion of hepatotoxin or potentially hepatotoxic drug overdose across 15 hospitals in 6 districts of Tamil Nadu from 1 January 2019 to 30 June 2019. Study exclusion criteria were idiosyncratic drug-induced liver injury and chronic liver diseases. RESULTS: Of the 702 patients, 685 gave history of consuming rodenticide; hepatotoxicity in the other patients resulted from paracetamol overdose (n=10) and due to other drugs (n=7); 97% patients had a suicidal intent. Of 671 patients with complete data, ratio of number of patients with hepatotoxicity due to rodenticide to paracetamol overdose was 450:6 (i.e. 75:1). The 451 rodenticidal hepatotoxicity patients (255 males, 75% were 15-34 years old) underwent conservative management (n=396), plasma exchange (n=54) and plasma exchange followed by liver transplant (n=1); 159 patients (35%) had poor outcome (131 died, 28 discharged in moribund state). Based on our observations, we estimate a case burden of 1584 rodenticidal hepatotoxicity patients (95% CI: 265-6119) with poor outcome in 554 patients in Tamil Nadu from January 2019 to June 2019. Population attributable risk for rodenticide as cause of hepatotoxicity was 22.7%. CONCLUSION: Rodenticide ingestion was an important cause of acute hepatotoxicity in Tamil Nadu. Most patients were young and one-third had poor outcome. Public health interventions are needed to address this.
