Factors Associated with the Development of Gastrointestinal Symptoms in Patients Hospitalized with Covid-19.

BACKGROUND AND AIMS: The most common symptoms of Covid-19 are respiratory; however, gastrointestinal symptoms are present in up to 50% of patients. We aimed to determine characteristics associated with the development of gastrointestinal symptoms in patients with Covid-19. METHODS: A case-control study of adults hospitalized for Covid-19 was conducted across a geographically diverse alliance of 36 US and Canadian medical centers. Data were manually abstracted from electronic health records and analyzed using regression analyses to determine characteristics associated with any gastrointestinal symptoms and diarrhea specifically. RESULTS: Of 1406 patients, 540 (38%) reported at least one gastrointestinal symptom and 346 (25%) reported diarrhea. Older patients (≥ 80 years) had significantly lower rates of any gastrointestinal symptoms and diarrhea (vs. patients 18-79 years, OR 0.41, p < 0.01 and OR 0.43 p = 0.01, respectively), while those with IBS (OR 7.70, p = 0.02 and OR 6.72, p < 0.01, respectively) and on immunosuppressive therapy (OR = 1.56, p = 0.02) had higher rates of any gastrointestinal symptom and diarrhea. Patients with constitutional symptoms exhibited significantly higher rates (OR 1.91, p < 0.01), while those with pulmonary disease alone had lower rates of gastrointestinal symptoms (OR 0.23, p = 0.01). A significant interaction between constitutional symptoms and pre-existing pulmonary conditions was observed. CONCLUSIONS: Several patient- and disease-specific characteristics associate with gastrointestinal symptoms in patients with Covid-19. Knowledge of these may provide insights into associated pathophysiologic mechanisms, and help health care professionals provide targeted attention to reduce morbidity related to Covid-19.

Computed tomography based scoring system in a prospectively ascertained cohort of patients with chronic pancreatitis.

OBJECTIVE: No standardized system is currently used to report the presence or severity of parenchymal and ductal features of chronic pancreatitis (CP) on CT scan. We report a modification to the previously proposed Cambridge classification to serve this purpose. METHODS: Contrast-enhanced CT scans of 158 well-phenotyped patients with CP enrolled in the North American Pancreatitis Studies (NAPS2) during 2000-2014 from the University of Pittsburgh were retrospectively reviewed by a subspecialty trained abdominal radiologist. Presence and severity (score scale 0-4) of pancreatic duct (PD) dilation, obstruction and contour irregularity, pancreatic calcifications, atrophy and extent of pancreatic involvement were recorded to grade the morphological severity of CP and stratify patients into distinct morphologic patterns. Findings were also correlated with clinical features. RESULTS: Pancreatic atrophy, calcifications, PD dilation and PD irregularity were observed in 80%, 68%, 65%, 58% cases, respectively. An obstructive stone or PD stricture was present in 63%, and 86% had diffuse pancreatic involvement. Using these features, CP was noted to be moderate or severe in 61%, and classified morphologically as obstructive with/without calcifications, calcific but non-obstructive and non-calcific/non-obstructive in 65%, 20%, 15%, respectively. Functional abnormalities but not the presence of pain generally correlated with imaging findings. CONCLUSION: A structured scoring system can provide qualitative and quantitative assessment of imaging findings in CP and an opportunity for adoption into clinical practice and research for initial evaluation and longitudinal follow-up. Our findings need validation in a prospective cohort before widespread adoption.

[Risk factors for the kidney stones: a hospital-based case-control study in a distric hospital in Beijing].

OBJECTIVE: To explore the risk and protective factors of kidney calculi in order to put forward theoretical basis for preventive and control measures. METHODS: A 1:1 matched case-control study was performed using data from a hospital in Beijing. The case group included 100 inpatients who were diagnosed kidney calculi using B ultrasonic, X-ray and intravenous pyelography during the survey while other 100 urolithiasis and endocrine disease excluded inpatients who shared the same sex, within five years gap to the case group inpatients were for the control group. A face-to-face survey was conducted with self-made questionnaires which covered demographic characteristics, water issues, dietary habits, genetic and medical history. Epidata 3.0 was used to build the database and SPSS 19.0 for the statistical analysis. RESULTS: In the univariate Logistic regression analysis, ten variables were found showing statistical significance. For the multivariate Logistic regression analysis, variables left in the model were labor intensity (OR=0.622, 95%CI: 0.435-0.889), preferring to drink after dinner (OR=0.316, 95%CI: 0.122-0.815), loving drinking (OR=0.232, 95%CI: 0.084-0.642), drinking tea regularly (OR=1.463, 95%CI: 1.033-2.071), eating more vegetables (OR=0.571, 95%CI: 0.328-0.993), the history of the urolithiasis (OR=2.127, 95%CI: 1.065-90.145). CONCLUSION: Drinking tea regularly, urolithiasis history and brain work are the risk factors of kidney calculi while loving drinking and eating more vegetables for the protection.

Immune protective effect of donor spleen perfusion on the renal allografts in specific sensitized canine recipients / 中华器官移植杂志

Objective To assess the immune protective effect of donor spleen perfusion on the renal allografts in specific sensitized canine recipients.Methods Male dogs were operated as donors and recipients for kidney transplantation.Eighteen dogs were previously sensitized by a method of multi-infusion of small number of lymphocytes from a paired donor and were then randomly divided into 3 groups equally.In donor specific spleen perfusion group,the artery and vein of the excised do- nor canine spleen were connected to the abdominal aortic artery and inferior vena cava of the recipient with processed fistula tubes,perfused at a speed of 18-25 ml/min for 40 min and then kidney from the same donor was transplanted to the recipient;In non-specific spleen perfusion group,the methods of excised spleen perfusion and kidney transplantation were indifferent to the above group except for the organs which removed from a non-specific donor;In control group,kidney transplantations were per- formed after an exclusion time of 40 min in the open abdominal surgery.Cross-match between paired dogs monitored by means of complement dependent cytotoxicity(CDC)and mixed lymphocyte culture (MLC)test before and after donor spleen perfusion was investigated.Rejection episodes and serum creatinine level in each group were assessed after kidney transplantation.Results Immune sensitization was successfully induced in all 3 groups after 3 to 4 times of donor lymphocyte stimulations.CDC as well as lymphocytes proliferation in MLC and CH50 of recipients was significantly declined after spe- cific spleen perfusion,and white blood cell count in peripheral blood also decreased transiently.After kidney transplantation between the paired sensitized dogs,the advanced rate of renal allograft function deterioration was slower in specific spleen perfusion group than in other two groups.The pathologic investigation suggested that severity of rejection in spleen perfusion group was milder than in other two groups.Conclusions Donor spleen perfusion can present a specific absorption efficacy for pre- formed antibodies and activated lymphocytes in sensitized recipients,as well as simultaneously deplete part of platelets in peripheral blood.So donor spleen perfusion may delay the presenting time of rejec- tion in early phase after kidney transplantation between the paired sensitized dogs,ameliorate the se- verity of rejection so as to improve the renal allograft function.