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Liu R, Song F, Sun L, Yan F, Jin Q, Yan F, Xia X, Wang X, Gao Y. Exploring the pathogenic and transmission characteristics of JN.1 in golden hamsters based on different attack methods. Virology 2025; 608:110548. [PMID: 40253975 DOI: 10.1016/j.virol.2025.110548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/30/2025] [Accepted: 04/15/2025] [Indexed: 04/22/2025]
Abstract
Since its emergence at the end of 2023, the JN.1 variant of COVID-19 has become the dominant strain globally. Currently, its characteristics in related animal models remain largely unknown. The results indicate that JN.1 can cause weight loss, viral load, viral titer, and histopathological changes in golden hamsters via intranasal and intragastric inoculation methods, with intranasal inoculation leading to faster viral replication. Interestingly, both viral load and viral titer of JN.1 are significantly lower than those of its parental strains BA.2 and XBB EG.5.1. A comparison of hematological data from the two inoculation methods was also consistent with previous findings. This highlights the importance of the infection route in studying the virus's progression and characteristics. In direct transmission studies of JN.1, the minimum time for virus transmission was 24 h, while XBB EG.5.1 could transmit the virus in as little as 6 h. Finally, the in vivo adaptability of JN.1 was investigated, with XBB EG.5.1 showing a more apparent adaptability advantage. Therefore, compared with EG.5.1, the pathogenicity and transmissibility of JN.1 are significantly weakened.
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Affiliation(s)
- Ruixue Liu
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong, China; Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Fang Song
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong, China; Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Li Sun
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong, China; Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Fang Yan
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Qiushi Jin
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Fang Yan
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong, China
| | - Xianzhu Xia
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China
| | - Xuefeng Wang
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China.
| | - Yuwei Gao
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong, China; Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun, China.
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Kitayama M, Unoki T, Liu K, Nakamura K. Enteral nutrition practice in the prone position in patients with coronavirus disease 2019: An international one-day point prevalence analysis. Clin Nutr ESPEN 2024; 59:257-263. [PMID: 38220384 DOI: 10.1016/j.clnesp.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Enteral nutrition (EN) in the prone position for severe respiratory failure is considered possible with care. However, the extent to which it is feasible, especially its association with the length of intensive care unit (ICU) stay, is unclear. Therefore, we investigated the relationship between the duration of prone position therapy and adequacy of EN delivery and explored factors associated with this relationship in an observational study of critically ill patients with coronavirus disease 2019 (COVID-19) who were actively treated in the prone position. METHODS This study was a secondary analysis of a worldwide one-day prevalence study in the COVID-19 era. We investigated the care and nutritional therapy provided to critically ill patients with COVID-19 admitted to ICU, along with ICU-related information. We targeted patients who received only tube feeding and analyzed the relationship between the duration of prone position, length of ICU stays, and nutrition delivery via EN. In addition, a multivariate analysis was performed to examine factors affecting the achievement of EN delivery of 20 kcal/kg/day or more in patients who were placed in the prone position for at least 6 h. RESULTS A total of 399 patients who received only EN, excluding parenteral nutrition and oral intake, were included, of whom 58 % received EN energy delivery of ≥20 kcal/kg/day; this rate increased with the length of ICU stay, regardless of the duration of prone position. In a multivariate analysis of 121 patients who were in the prone position for at least 6 h, the presence of dedicated dietitians in the ICU (OR = 6.91, 95 % CI = 1.98 to 24.1, p < 0.01) was associated with a higher energy delivery. Conversely, the use of muscle relaxants (OR = 0.32, 95 % CI = 0.11 to 0.98, p = 0.04) and presence of nutrition protocols (OR = 0.24, 95 % CI = 0.07 to 0.77, p = 0.02) was associated with a lower energy delivery. CONCLUSIONS Patients with COVID-19 received adequate nutrition by EN even during prone position. Target EN delivery would be achieved with the introduction of prone position.
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Affiliation(s)
- Mio Kitayama
- Nursing Department Heart Center, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan.
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Institute for Molecular Bioscience, The University of Queensland, Australia; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan.
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
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Daba TM, Mokonon M, Niguse E, Getahun M. The Potential Mechanisms Behind Adverse Effect of Coronavirus Disease-19 on Heart and Liver Damage: A Review. Ethiop J Health Sci 2024; 34:85-100. [PMID: 38957334 PMCID: PMC11217793 DOI: 10.4314/ejhs.v34i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/02/2023] [Indexed: 07/04/2024] Open
Abstract
Background Coronaviruses (CoVs) belong to the RNA viruses family. The viruses in this family are known to cause mild respiratory disease in humans. The origin of the novel SARS-COV2 virus that caused the coronavirus-19 disease (COVID-19) is the Wuhan city in China from where it disseminated to cause a global pandemic. Although lungs are the predominant target organ for Coronavirus Disease-19 (COVID-19), since its outbreak, the disease is known to affect heart, blood vessels, kidney, intestine, liver and brain. This review aimed to summarize the catastrophic impacts of Coronavirus disease-19 on heart and liver along with its mechanisms of pathogenesis. Methods The information used in this review was obtained from relevant articles published on PubMed, Google Scholar, Google, WHO website, CDC and other sources. Key searching statements and phrases related to COVID-19 were used to retrieve information. Original research articles, review papers, research letters and case reports were used as a source of information. Results Besides causing severe lung injury, COVID-19 has also been reported to affect and cause dysfunction of many other organs. COVID-19 infection can affect people by downregulating membrane-bound active angiotensin-converting enzyme (ACE). People who have deficient ACE2 expression are more vulnerable to COVID-19 infection. The patients' pre-existing co-morbidities are major risk factors that predispose individuals to severe COVID-19. Conclusion The disease severity and its broad spectrum phenotype is a result of combined direct and indirect pathogenic factors. Therefore, protocols that harmonize many therapeutic preferences should be the best alternatives to de-escalate the disease and obviate deaths caused as a result of multiple organ damage and dysfunction induced by the disease.
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Affiliation(s)
- Tolessa Muleta Daba
- Deparment of Biochemistry, Molecular Biology and Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye Campus, Rwanda
- Institute of Pharmaceutical Science, Adama Science and Technology University, Adama, Ethiopia
| | - Mulatu Mokonon
- Department of Biology, School of Applied Natural Sciences, Adama Science and Technology University, Adama, Ethiopia
| | - Elsa Niguse
- Department of Biology, School of Applied Natural Sciences, Adama Science and Technology University, Adama, Ethiopia
| | - Meron Getahun
- Department of Biology, School of Applied Natural Sciences, Adama Science and Technology University, Adama, Ethiopia
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Melchers M, Hubertine Hermans AJ, Hulsen SB, Kehinde Kouw IW, Hubert van Zanten AR. Individualised energy and protein targets achieved during intensive care admission are associated with lower mortality in mechanically ventilated COVID-19 patients: The COFEED-19 study. Clin Nutr 2023; 42:2486-2492. [PMID: 37918128 DOI: 10.1016/j.clnu.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND & AIMS Malnutrition is prevalent among COVID-19 patients admitted to the intensive care unit (ICU) and it is associated with poor survival. Customized nutrition plays a vital role in enhancing outcomes for this patient population. This study explores the association between energy and protein intake and 90-day mortality in invasively mechanically ventilated COVID-19 patients, utilizing fat-free mass (FFM) and actual body weight (ABW) for nutritional requirements. Furthermore, the study investigates the occurrence of gastrointestinal (GI) intolerance in critically ill COVID-19 patients in relation to their nutritional intake and survival. METHODS A retrospective study was undertaken at a university-affiliated teaching hospital, focusing on COVID-19 patients on invasive mechanical ventilation admitted to the ICU between March 2020 and December 2021. The study collected demographic and clinical data, along with cumulative energy and protein goals, and recorded cumulative intake on days 4, 7, and throughout the ICU stay. Univariate and multivariable Cox regression analyses were conducted to evaluate associations between energy and protein deficits and the 90-day all-cause mortality. RESULTS The study included 85 patients, of whom 67 (78 %) survived 90 days after ICU admission. There were no significant differences in body composition between survivors and non-survivors. Reaching ≥70 % of the energy goal based on both ABW and FFM during the ICU stay was associated with decreased 90-day mortality (HR 0.22, 95 % CI 0.08-0.60 and HR 0.28, 95 % CI 0.09-0.85, respectively). Similarly, achieving ≥80 % of the protein target based on FFM was associated with decreased 90-day mortality (HR 0.26, 95 % CI 0.07-0.94), whereas no significant association was found for reaching protein targets based on ABW (HR 0.03, 95 % CI 0.00-3.40). Patients who reached both their energy and protein goal based on FFM during ICU admission showed a lower risk of all-cause 90-day mortality compared to those who received <70 % of the energy goal and <80 % of protein based on FFM after adjusting for age (aHR 0.12, 95 % CI 0.03-0.50). No differences in GI intolerance related symptoms between COVID-19 survivors and non-survivors were observed. CONCLUSIONS This study underscores the significance of providing adequate nutritional therapy to COVID-19 ICU patients who require IMV. Meeting over 80 % of the protein goals based on BIA-derived FFM was associated with lower mortality rates, which emphasizes the need for further investigation into the role of FFM in establishing nutritional targets.
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Affiliation(s)
- Max Melchers
- Gelderse Vallei Hospital, Department of Intensive Care Medicine & Research, Willy Brandtlaan 10, 6716 RP Ede, Netherlands; Wageningen University and Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, Netherlands
| | - Anoek Jacqueline Hubertine Hermans
- Gelderse Vallei Hospital, Department of Intensive Care Medicine & Research, Willy Brandtlaan 10, 6716 RP Ede, Netherlands; Wageningen University and Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, Netherlands
| | - Suzanne Belia Hulsen
- Gelderse Vallei Hospital, Department of Intensive Care Medicine & Research, Willy Brandtlaan 10, 6716 RP Ede, Netherlands; University College Utrecht, Campusplein 1, 3584 ED Utrecht, Netherlands
| | - Imre Willemijn Kehinde Kouw
- Gelderse Vallei Hospital, Department of Intensive Care Medicine & Research, Willy Brandtlaan 10, 6716 RP Ede, Netherlands; Wageningen University and Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, Netherlands
| | - Arthur Raymond Hubert van Zanten
- Gelderse Vallei Hospital, Department of Intensive Care Medicine & Research, Willy Brandtlaan 10, 6716 RP Ede, Netherlands; Wageningen University and Research, Division of Human Nutrition and Health, Stippeneng 4, 6708 WE Wageningen, Netherlands.
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He T, Liu X, Lv R, Cheng G. Risk of bias in epidemiological studies regarding nutrition interventions for COVID-19. J Evid Based Med 2023; 16:417-419. [PMID: 37865965 DOI: 10.1111/jebm.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Tianyi He
- West China School of Medicine, Sichuan University
| | - Xueting Liu
- West China School of Public Health and West China Fourth Hospital and Healthy Food Evaluation Research Center, Sichuan University, Chengdu, China
| | - Ruiqi Lv
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Pediatrics, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Guo Cheng
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Department of Pediatrics, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Smyth JS, Truong JK, Rao A, Lin R, Foulke-Abel J, Adorini L, Donowitz M, Dawson PA, Keely SJ. Farnesoid X receptor enhances epithelial ACE2 expression and inhibits virally induced IL-6 secretion: implications for intestinal symptoms of SARS-CoV-2. Am J Physiol Gastrointest Liver Physiol 2023; 325:G446-G452. [PMID: 37697930 PMCID: PMC10887846 DOI: 10.1152/ajpgi.00099.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
Intestinal inflammation and diarrhea are often associated with SARS-CoV-2 infection. The angiotensin converting enzyme 2 (ACE2) receptor plays a key role in SARS-CoV-2 pathogenesis, facilitating entry of the virus into epithelial cells, while also regulating mucosal inflammatory responses. Here, we investigated roles for the nuclear bile acid receptor farnesoid X receptor (FXR) in regulating ACE2 expression and virally mediated inflammatory responses in intestinal epithelia. Human colonic or ileal enteroids and cultured T84 and Caco-2 monolayers were treated with the FXR agonists, obeticholic acid (OCA) or GW4064, or infected with live SARS-CoV-2 (2019-nCoV/USA_WA1/2020). Changes in mRNA, protein, or secreted cytokines were measured by qPCR, Western blotting, and ELISA. Treatment of undifferentiated colonic or ileal enteroids with OCA increased ACE2 mRNA by 2.1 ± 0.4-fold (n = 3; P = 0.08) and 2.3 ± 0.2-fold (n = 3; P < 0.05), respectively. In contrast, ACE2 expression in differentiated enteroids was not significantly altered. FXR activation in cultured epithelial monolayers also upregulated ACE2 mRNA, accompanied by increases in ACE2 expression and secretion. Further experiments revealed FXR activation to inhibit IL-6 release from both Caco-2 cells infected with SARS-CoV-2 and T84 cells treated with the viral mimic, polyinosinic:polycytidylic acid, by 46 ± 12% (n = 3, P < 0.05) and 35 ± 6% (n = 8; P < 0.01), respectively. By virtue of its ability to modulate epithelial ACE2 expression and inhibit virus-mediated proinflammatory cytokine release, FXR represents a promising target for the development of new approaches to prevent intestinal manifestations of SARS-CoV-2.NEW & NOTEWORTHY Activation of the nuclear bile acid receptor, farnesoid X receptor (FXR), specifically upregulates ACE2 expression in undifferentiated colonic epithelial cells and inhibits virus-induced proinflammatory cytokine release. By virtue of these actions FXR represents a promising target for the development of new approaches to prevent intestinal manifestations of SARS-CoV-2 infection.
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Affiliation(s)
- Jessica S Smyth
- School of Pharmacy and Biomolecular Sciences, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Jennifer K Truong
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Anuradha Rao
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Ruxian Lin
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Jennifer Foulke-Abel
- Gastroenterology Division, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Luciano Adorini
- Intercept Pharmaceuticals, San Diego, California, United States
| | - Mark Donowitz
- Gastroenterology Division, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Paul A Dawson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Stephen J Keely
- School of Pharmacy and Biomolecular Sciences, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Haines KL, Ohnuma T, Grisel B, Krishnamoorthy V, Raghunathan K, Sulo S, Kerr KW, Besecker B, Cassady BA, Wischmeyer PE. Early enteral nutrition is associated with improved outcomes in critically ill mechanically ventilated medical and surgical patients. Clin Nutr ESPEN 2023; 57:311-317. [PMID: 37739674 DOI: 10.1016/j.clnesp.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Data suggest that guidelines for enteral nutrition (EN) initiation are not closely followed in clinical practice. In addition, critically ill mechanically ventilated (MV) patients have varying metabolic needs, which often increase and persist over time, requiring personalized nutrition intervention. While both over- and under-nutrition can impact patient outcomes, recent data suggest that targeted early EN delivery may reduce mortality and improve clinical outcomes. This study examined if early EN improves clinical outcomes and decreases costs in critically ill patients on MV. METHODS Data from a nationwide administrative-financial database between 2018 and 2020 was utilized to identify eligible adult critical care patients. Patients who received EN within 3 days after intubation (early EN) were compared to patients who started EN after 3 days of intubation (late EN). Outcomes of interest included hospital mortality, discharge disposition, hospital and intensive care unit (ICU) length of stay (LOS), MV days, and total cost. After inverse-probability-of-treatment weighting, outcomes were modeled using a nominal logistic regression model for hospital mortality and discharge disposition, a linear regression model for cost, and Cox proportional-hazards model for MV days, hospital and ICU LOS. RESULTS A total of 27,887 adult patients with early MV were identified, of which 16,772 (60.1%) received early EN. Regression analyses showed that the early EN group had lower hospital mortality (OR = 0.88, 95% CI, 0.82 to 0.94), were more likely to be discharged home (OR = 1.47, 95% CI 1.38 to 1.56), had fewer MV days (HR = 1.23, 95% CI, 1.11 to 1.37), shorter hospital LOS (HR = 1.43, 95% CI, 1.33 to 1.54) and ICU LOS (HR = 1.36, 95% CI, 1.27 to 1.46), and lower cost (-$21,226; 95% CI, -$23,605 to -$18,848) compared to the late EN group. CONCLUSIONS Early EN within 3 days of MV initiation in real-world practice demonstrated improved clinical and economic outcomes. These data suggest that early EN is associated with decreased hospital mortality, increased discharge to home, and decreased hospital and ICU LOS, time on MV, and cost compared to delayed initiation of EN; highlighting the importance of early EN to optimize utcomes ando support the recovery of critically ill patients on MV.
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Affiliation(s)
- Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Tetsu Ohnuma
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Braylee Grisel
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Vijay Krishnamoorthy
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Karthik Raghunathan
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA; Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Suela Sulo
- The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
| | - Kirk W Kerr
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Beth Besecker
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Bridget A Cassady
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, USA.
| | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, USA.
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Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:387-394. [PMID: 37553014 DOI: 10.1016/j.redare.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 08/10/2023]
Abstract
INTRODUCTION The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. OBJECTIVE To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. MATERIAL AND METHODS Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. RESULTS Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n=6) were discharged and 25% died (n=2), compared to the group with «bad compliance» where 53% (n=8) were discharged and 47% (n=7) died (Chi square test, p-value=0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission=14, IQR=10-16 and median days of admission=22, IQR=13-39, p-value=0.025). CONCLUSIONS Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
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Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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9
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Alós Zaragozá L, Cobo Del Prado Ciurlizza I, Solis Albamonte P, Gandía Llopis J, Rosselló Chornet M, Romero García CS. [The clinical impact of implementation of a nutritional treatment protocol in critically ill adults with SARS-CoV-2 infection]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023:S0034-9356(23)00108-1. [PMID: 37363692 PMCID: PMC10208262 DOI: 10.1016/j.redar.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 11/27/2022] [Indexed: 06/28/2023]
Abstract
Introduction The critical patient affected by SARS-CoV-2 is at risk of malnutrition. The need to avoid volume overload and manoeuvres that delay reaching nutritional requirements such as pronation make the nutritional approach to these patients complex. To ensure adequate treatment, a nutritional support protocol was developed as a clinical practice guideline adapted to the COVID-19 patient. Objective To describe and analyse the results of introducing a nutritional support protocol aimed at SARS-CoV-2 patients admitted to the intensive care unit (ICU) of the Consorcio Hospital General Universitario de Valencia (CHGUV) from March to May 2020. Material and methods Observational, descriptive, retrospective and longitudinal design to evaluate compliance with a nutritional support protocol. Results Thirty-one consecutive patients were included but nutritional follow-up could not be performed in eight. Of the remaining 23 patients, only eight reached 80% of caloric requirements before the tenth day after starting treatment (good compliance group) and 15 after the eleventh day (poor compliance group). In the group with «good compliance» 75% (n = 6) were discharged and 25% died (n = 2), compared to the group with «bad compliance» where 53% (n = 8) were discharged and 47% (n = 7) died (Chi square test, p-value = 0.019). Those patients who reached 80% of caloric needs during ICU stay had a shorter length of stay compared to those who did not (median days of admission = 14, IQR = 10-16 and median days of admission = 22, IQR = 13-39, p-value = 0.025). Conclusions Introducing a nutritional protocol during the first weeks of the SARS-CoV-2 pandemic could improve clinical outcomes by promoting healing and reducing associated complications.
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Affiliation(s)
- L Alós Zaragozá
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - I Cobo Del Prado Ciurlizza
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - P Solis Albamonte
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Gandía Llopis
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Rosselló Chornet
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C S Romero García
- Departamento de Anestesiología y Cuidados Críticos, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Umbrello M, Marini JJ, Formenti P. Metabolic Support in Acute Respiratory Distress Syndrome: A Narrative Review. J Clin Med 2023; 12:jcm12093216. [PMID: 37176655 PMCID: PMC10179727 DOI: 10.3390/jcm12093216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic alterations due to the body's response to illness. In the present narrative review, after briefly summarizing the pathophysiology of critical illness stress response and patients' metabolic requirements, we focus on describing the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure. In patients with ARDS, several aspects of metabolism assume special importance. The physiological effects of substrate metabolism are described for this setting, particularly regarding energy consumption, diet-induced thermogenesis, and the price of their clearance, transformation, and storage. Moreover, we review the possible direct effects of macronutrients on lung tissue viability during ARDS. Finally, we summarize the noteworthy characteristics of metabolic control in critically ill patients with ARDS and offer a suggestion as to the ideal methods of metabolic support for this problem.
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Affiliation(s)
- Michele Umbrello
- Unità Operativa di Anestesia e Rianimazione II, Ospedaliera San Carlo, ASST Santi Paolo e Carlo, 20148 Milan, Italy
| | - John J Marini
- Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Paolo Formenti
- SC Anestesia, Rianimazione e Terapia Intensiva, ASST Nord Milano, Ospedale Bassini, 20097 Cinisello Balsamo, Italy
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11
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Muacevic A, Adler JR, Haq MA, Ahmad R, Sinha S, Adnan N, Haque M. Electrolyte Imbalance Among Bangladeshi Patients With COVID-19. Cureus 2023; 15:e35352. [PMID: 36860825 PMCID: PMC9970400 DOI: 10.7759/cureus.35352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Infection with SARS-CoV-2 begins in the lower respiratory tract, but COVID-19 often involves the renal system, resulting in serum electrolyte imbalance. Monitoring serum electrolyte levels and parameters of liver and kidney function is essential to understand disease prognosis. Objectives This study aimed to determine the effect of imbalances in serum electrolytes and other parameters on COVID-19 severity. Material and method This retrospective study comprised 241 patients, ages 14 years and older, including 186 patients who were moderately affected and 55 who were categorized as severely affected by COVID-19. Serum electrolytes (sodium (Na+), potassium (K+), and chloride (Cl-)) and biomarkers of kidney and liver function (creatinine and alanine aminotransferase (ALT)) were measured and correlated with disease severity. This research was conducted among admitted patients of Holy Family Red Crescent Medical College Hospital designated into two groups based on retrospective hospital records. Individuals with moderate illness had evidence of lower respiratory tract infection (cough, cold, breathless, etc.) during clinical assessment or imaging (chest X-ray and computed tomography (CT) scan of the lungs) and have an oxygen saturation by pulse oximetry (SpO2) ≥ 94% on room air at sea level. The severely ill group involved individuals with SpO2 ≤94% on room air at sea level and respiratory rate ≥ 30 breaths/minute, and critically ill patients are those who needed mechanical ventilation or required intensive care unit (ICU) care. This categorization was based on the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/). Results Average Na+ and creatinine increased by 2.30 parts (95% confidence interval (CI) = 0.20, 4.81, P = 0.041) and 0.35 units (95% CI = 0.03, 0.68, P = 0.043) in severe cases compared with moderate cases. Older participants had relatively Na+ lowered to -0.06 parts (95% CI = -0.12, -0.001, P = 0.045), significant Cl- reduction by 0.09 units (95% CI = -0.14, -0.04, P = 0.001), and ALT by 0.47 units (95% CI = -0.88, -0.06, P = 0.024), whereas serum creatinine was increased by 0.01 parts (95% CI = 0.001, 0.02, P = 0.024). The creatinine and ALT of COVID-19 participants were significantly higher in males by 0.34 units and 23.2 units, respectively, compared with females. In severe COVID-19 cases compared with moderate cases, the risks of hypernatremia, elevated chloride levels, and elevated serum creatinine levels were increased by 2.83-fold (95% CI = 1.26, 6.36, P = 0.012), 5.37-fold (95% CI = 1.90, 15.3, P = 0.002), and 2.00-fold (95% CI = 1.08, 4.31, P = 0.039), respectively. Conclusion Serum electrolyte and biomarker levels can serve as good indicators of the condition and disease prognosis of patients with COVID-19. Our purpose in this study was to determine the association between serum electrolyte imbalance and disease severity. We collected data from ex post facto hospital records and did not intend to assess the mortality rate. Consequently, this study expects that the prompt diagnosis of electrolyte disparity or disturbance possibly minimizes COVID-19-related morbidity and mortality.
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12
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Herron TJ, Farach SM, Russo RM. COVID, the Gut, and Nutritional Implications. CURRENT SURGERY REPORTS 2023; 11:30-38. [PMID: 36819787 PMCID: PMC9918822 DOI: 10.1007/s40137-022-00342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/13/2023]
Abstract
Purpose of Review The purpose of this review is to provide an overview of the current literature, recommendations, and practice guidelines on the nutritional management of and implications associated with COVID-19 infection. Recent Findings Particular attention should be paid to the screening, prevention, and treatment of malnutrition in critically ill individuals with COVID-19 infection given the significant risk for complications and poor outcomes. Extrapolation of existing literature for the nutritional support in the critically ill patient has demonstrated early enteral nutrition is safe and well-tolerated in patients with severe COVID-19 infection. Summary Futures studies should focus on the long-term nutritional outcomes for patients who have suffered COVID-19 infection, nutritional outcomes/recommendations for special populations with COVID-19, nutritional outcomes based on the current recommendations and guidelines for nutrition therapy, and the role for micronutrient supplementation in COVID-19 infection.
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Affiliation(s)
- Thomas J. Herron
- Division of Acute Care and Trauma Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606 USA
| | - Sandra M. Farach
- Division of Acute Care and Trauma Surgery, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606 USA
| | - Rocco M. Russo
- Department of Clinical Nutrition, Tampa General Hospital, Tampa, FL USA
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Taci Hoca N, Berktaş BM. Baseline electrolyte disorders predict disease severity and mortality in patients with COVID-19. Medicine (Baltimore) 2022; 101:e32397. [PMID: 36595788 PMCID: PMC9794216 DOI: 10.1097/md.0000000000032397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Distinguishing critical laboratory biomarkers for disease severity at the time of hospital presentation is important for early identification of patients who are most likely to have poor outcomes and effective use of health resources. This study aimed to evaluate whether electrolyte imbalances on hospital admission predict severe disease and mortality in patients with coronavirus disease 2019 (COVID-19). We retrospectively collected data on the blood electrolyte concentrations of 286 COVID-19 patients at admission. The correlations between electrolyte imbalances, inflammation, and thrombosis markers in COVID-19 patients were also evaluated. We assessed the predictive performance of baseline blood electrolyte concentrations for severe disease and death using receiver operating characteristic curve analysis and multivariate logistic regression methods. Abnormalities in serum sodium, calcium, and potassium levels at admission were found at 20.6%, 14%, and 4.2%, respectively in this study. In the receiver operating characteristic curve analyses, hypocalcemia and hyponatremia effectively predicted disease progression to hospitalization (area under the curve 0.82, P < .001 and 0.81, P < .001, respectively) and 30-day mortality (area under the curve 0.85, P < .001 and 0.91, P < .001, respectively). In the multivariate logistic regression analysis, baseline hypocalcemia was identified as an independent risk factor associated with the risk of hospitalization (β = 2.019, P = .01; odds ratio: 7.53). Baseline hypocalcemia and hyponatremia effectively predicted disease progression toward hospitalization and 30-day mortality in patients with COVID-19. Clinicians should closely follow up or reevaluate COVID-19 patients with baseline electrolyte disorders.
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Affiliation(s)
- Nevin Taci Hoca
- Department of Pulmonology, Faculty of Medicine, Gazi University, Emniyet Mah, Yenimahalle, Ankara, Turkey
- * Correspondence: Nevin Taci Hoca, Department of Pulmonology, Faculty of Medicine, Gazi University, Emniyet Mah, Mevlana Bulvari No: 29, Yenimahalle, Ankara 06560, Turkey (e-mail: )
| | - Bahadir M. Berktaş
- Department of Pulmonology, Faculty of Medicine, Health Sciences University, Atatürk Sanatorium Training and Research Hospital, Sanatorium Cad, Keçiören, Ankara, Turkey
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Pharmacological Mechanism of NRICM101 for COVID-19 Treatments by Combined Network Pharmacology and Pharmacodynamics. Int J Mol Sci 2022; 23:ijms232315385. [PMID: 36499711 PMCID: PMC9740625 DOI: 10.3390/ijms232315385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Symptom treatments for Coronavirus disease 2019 (COVID-19) infection and Long COVID are one of the most critical issues of the pandemic era. In light of the lack of standardized medications for treating COVID-19 symptoms, traditional Chinese medicine (TCM) has emerged as a potentially viable strategy based on numerous studies and clinical manifestations. Taiwan Chingguan Yihau (NRICM101), a TCM designed based on a medicinal formula with a long history of almost 500 years, has demonstrated its antiviral properties through clinical studies, yet the pharmacogenomic knowledge for this formula remains unclear. The molecular mechanism of NRICM101 was systematically analyzed by using exploratory bioinformatics and pharmacodynamics (PD) approaches. Results showed that there were 434 common interactions found between NRICM101 and COVID-19 related genes/proteins. For the network pharmacology of the NRICM101, the 434 common interacting genes/proteins had the highest associations with the interleukin (IL)-17 signaling pathway in the Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. Moreover, the tumor necrosis factor (TNF) was found to have the highest association with the 30 most frequently curated NRICM101 chemicals. Disease analyses also revealed that the most relevant diseases with COVID-19 infections were pathology, followed by cancer, digestive system disease, and cardiovascular disease. The 30 most frequently curated human genes and 2 microRNAs identified in this study could also be used as molecular biomarkers or therapeutic options for COVID-19 treatments. In addition, dose-response profiles of NRICM101 doses and IL-6 or TNF-α expressions in cell cultures of murine alveolar macrophages were constructed to provide pharmacodynamic (PD) information of NRICM101. The prevalent use of NRICM101 for standardized treatments to attenuate common residual syndromes or chronic sequelae of COVID-19 were also revealed for post-pandemic future.
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15
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Li S, Zhou Y, Yan D, Wan Y. An Update on the Mutual Impact between SARS-CoV-2 Infection and Gut Microbiota. Viruses 2022; 14:1774. [PMID: 36016396 PMCID: PMC9415881 DOI: 10.3390/v14081774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 12/15/2022] Open
Abstract
The gut microbiota is essential for good health. It has also been demonstrated that the gut microbiota can regulate immune responses against respiratory tract infections. Since the outbreak of the COVID-19 pandemic, accumulating evidence suggests that there is a link between the severity of COVID-19 and the alteration of one's gut microbiota. The composition of gut microbiota can be profoundly affected by COVID-19 and vice versa. Here, we summarize the observations of the mutual impact between SARS-CoV-2 infection and gut microbiota composition. We discuss the consequences and mechanisms of the bi-directional interaction. Moreover, we also discuss the immune cross-reactivity between SARS-CoV-2 and commensal bacteria, which represents a previously overlooked connection between COVID-19 and commensal gut bacteria. Finally, we summarize the progress in managing COVID-19 by utilizing microbial interventions.
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Affiliation(s)
- Shaoshuai Li
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- Shanghai Public Health Clinical Center, Department of Laboratory Medicine, Shanghai 201508, China
- Key Laboratory of Microecology-Immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi 154000, China
| | - Yang Zhou
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Dongmei Yan
- Key Laboratory of Microecology-Immune Regulatory Network and Related Diseases, School of Basic Medicine, Jiamusi University, Jiamusi 154000, China
| | - Yanmin Wan
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- Shanghai Public Health Clinical Center, Department of Radiology, Shanghai 201508, China
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S FA, Madhu M, Udaya Kumar V, Dhingra S, Kumar N, Singh S, Ravichandiran V, Murti K. Nutritional Aspects of People Living with HIV (PLHIV) Amidst COVID-19 Pandemic: an Insight. CURRENT PHARMACOLOGY REPORTS 2022; 8:350-364. [PMID: 35966952 PMCID: PMC9362559 DOI: 10.1007/s40495-022-00301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 04/16/2023]
Abstract
Purpose of Review This review elaborates the role of malnutrition in PLHIV (people living with HIV) in the context of COVID-19 and emphasis the need of supplementation, dietary intervention, and nutritional counselling in the post-COVID era. One of the most critical challenges among HIV/AIDS patients is malnutrition since it weakens the immune system and increases risk to opportunistic infections. In HIV (human immunodeficiency virus) infection, weight loss is prevalent due to reduced nutritional consumption, malabsorption, abnormal metabolism, and antiretroviral therapy. Sufficient nutrition is required for optimal immune function, as a result, food therapy is now considered an important adjuvant in the treatment of HIV patients. Recent Findings Nutritional intervention, such as the use of dietary supplements, can help to prevent nutrient deficiency, lowering the death risk among malnourished HIV population. Immunocompromised individuals are at very high risk for COVID-19 and malnutrition increases the risk of infection by multiple folds. Interventions, such as nutrition education and counselling are important, to improve the condition of HIV Patients by optimising their nutritional status. Summary A balanced diet should be one of the most important priorities in preventing PLHIV against the potentially deadly consequences of COVID-19. It is to be ensured that HIV-positive persons continue to get enough and appropriate assistance, such as nutrition and psychological counselling, in the context of COVID-19 infection. The use of telemedicine to maintain nutritional intervention can be beneficial. To meet their nutritional needs and minimise future difficulties, PLHIV infected with COVID-19 should get specialised nutritional education and counselling. Graphical abstract
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Affiliation(s)
- Fathima A. S
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - Maxima Madhu
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - V Udaya Kumar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - Nitesh Kumar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - Sanjiv Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - V. Ravichandiran
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar 844102 India
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Grecco BH, Araújo-Rossi PA, Nicoletti CF. Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review. JOURNAL OF INTENSIVE MEDICINE 2022; 2:249-256. [PMID: 36785649 PMCID: PMC9110372 DOI: 10.1016/j.jointm.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/07/2022]
Abstract
Hospitalized patients affected by coronavirus disease 19 (COVID-19) have a sustained pro-inflammatory state and recurrent gastrointestinal symptoms that correlate with a decline in the nutritional status, which is directly related to poor immune response and clinical evolution. Nutritional therapy has proven crucial in COVID-19 treatment through the provision of adequate amounts of nutrients. Since the beginning of the pandemic, medical societies have mobilized to provide practical nutritional guidelines to support decision-making; despite this, there are only a few studies dedicated to compiling the most relevant recommendations. In this narrative review, we aimed to summarize and stratify the current scientific literature on nutritional support for hospitalized COVID-19 patients. We carried out a literature review from three databases between January 2020 and July 2021, using nutrition therapy (or medical nutrition or enteral nutrition or parental nutrition or nutritional support) and COVID-19 (SARS-CoV-2 infection) as the search terms. Only those studies that evaluated adult hospitalized patients with admissions to wards, specific clinics, or intensive care units were included. The nutritional intervention considered was that of specific nutritional support via oral, enteral, or parenteral modes. A total of 37 articles were included. In general, the nutritional care provided to COVID-19 patients follows the same premises as for other patients, i.e., it opts for the most physiological route and meets nutritional demands based on the clinical condition. However, some protocols that minimize the risk of contamination exposure for the health team have to be considered. Energy requirements varied from 15 kcal/kg/day to 30 kcal/kg/day and protein goals from 1.2 g/kg/day to 2 g/kg/day. In both cases, the ramp protocol for increased supply should be considered. In cases of enteral therapy, ready-to-use diet and continuous mode are recommended. Attention to refeeding syndrome is essential when parenteral nutrition is used.
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Affiliation(s)
- Beatriz H. Grecco
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Paula A.O. Araújo-Rossi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Carolina F. Nicoletti
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, University of São Paulo, Av Dr Arnaldo 455, São Paulo, SP 01246-903, Brazil,Corresponding author: Carolina F. Nicoletti, Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, University of São Paulo, Av Dr Arnaldo 455, São Paulo, SP 01246-903, Brazil.
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Taherifard E, Movahed H, Kiani Salmi S, Taherifard A, Abdollahifard S, Taherifard E. Cytomegalovirus coinfection in patients with severe acute respiratory syndrome coronavirus 2 infection: a systematic review of reported cases. Infect Dis (Lond) 2022; 54:543-557. [PMID: 35522073 DOI: 10.1080/23744235.2022.2070273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dysfunction of both the innate and the adaptive immune systems is observed in severe coronavirus disease 2019 which, together with administration of immunosuppressive drugs, could lead to cytomegalovirus coinfection or reactivation associated with a poorer outcome. The current study aimed to systematically review the pattern, presentations, clinical course and outcome of patients with severe acute respiratory syndrome coronavirus 2 and cytomegalovirus coinfection. METHODS Three online databases, PubMed, Scopus and Web of Science, were searched, and after excluding duplicates and irrelevant reports, eligible articles were identified. Information about patients' age and gender, comorbidities, presentations of coronavirus disease 2019 and cytomegalovirus, treatment courses and outcomes were extracted. RESULTS A total of 34 reports with 59 patients with coinfection were considered to be eligible for data extraction. A majority of patients were middle-aged or elderly (84.5%). More than three-fourths (79.2%) had at least one comorbidity. Cytomegalovirus viremia was documented in 43 patients. The most common end organ involved was the gastrointestinal tract in 13 patients (48.1% of 27 patients with end organ involvement), mostly as cytomegalovirus colitis, followed by the respiratory tract in 12 patients. There was a significant association between intubation and fatal outcome (p = .011). CONCLUSION We comprehensively reviewed published cases with coronavirus disease 2019 and cytomegalovirus reactivation. The findings may assist in appraising signs and symptoms for early suspicion, detection and treatment in patients with unusual clinical courses or with severe, prolonged or unexplained deterioration of end organ function.
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Affiliation(s)
| | - Hamed Movahed
- Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Sima Kiani Salmi
- Radiology Department, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Ali Taherifard
- Radiology Department, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Saeed Abdollahifard
- Research Center for Neuromodulation and Pain, Shiraz, Fars, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
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Ojo O, Ojo OO, Feng Q, Boateng J, Wang X, Brooke J, Adegboye ARA. The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14051120. [PMID: 35268095 PMCID: PMC8912272 DOI: 10.3390/nu14051120] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients who are critically ill with COVID-19 could have impaired nutrient absorption due to disruption of the normal intestinal mucosa. They are often in a state of high inflammation, increased stress and catabolism as well as a significant increase in energy and protein requirements. Therefore, timely enteral nutrition support and the provision of optimal nutrients are essential in preventing malnutrition in these patients. Aim: This review aims to evaluate the effects of enteral nutrition in critically ill patients with COVID-19. Method: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic review and meta-Analysis framework and PICO. Searches were conducted in databases, including EMBASE, Health Research databases and Google Scholar. Searches were conducted from database inception until 3 February 2022. The reference lists of articles were also searched for relevant articles. Results: Seven articles were included in the systematic review, and four articles were included in the meta-analysis. Two distinct areas were identified from the results of the systematic review and meta-analysis: the impact of enteral nutrition and gastrointestinal intolerance associated with enteral nutrition. The impact of enteral nutrition was further sub-divided into early enteral nutrition versus delayed enteral nutrition and enteral nutrition versus parenteral nutrition. The results of the meta-analysis of the effects of enteral nutrition in critically ill patients with COVID-19 showed that, overall, enteral nutrition was effective in significantly reducing the risk of mortality in these patients compared with the control with a risk ratio of 0.89 (95% CI, 0.79, 0.99, p = 0.04). Following sub-group analysis, the early enteral nutrition group also showed a significant reduction in the risk of mortality with a risk ratio of 0.89 (95% CI, 0.79, 1.00, p = 0.05). The Relative Risk Reduction (RRR) of mortality in patients with COVID-19 by early enteral nutrition was 11%. There was a significant reduction in the Sequential Organ Failure Assessment (SOFA) score in the early enteral nutrition group compared with the delayed enteral nutrition group. There was no significant difference between enteral nutrition and parenteral nutrition in relation to mortality (RR = 0.87; 95% CI, 0.59, 1.28, p = 0.48). Concerning the length of hospital stay, length of ICU stay and days on mechanical ventilation, while there were reductions in the number of days in the enteral nutrition group compared to the control (delayed enteral nutrition or parenteral nutrition), the differences were not significant (p > 0.05). Conclusion: The results showed that early enteral nutrition significantly (p < 0.05) reduced the risk of mortality among critically ill patients with COVID-19. However, early enteral nutrition or enteral nutrition did not significantly (p > 0.05) reduce the length of hospital stay, length of ICU stay and days on mechanical ventilation compared to delayed enteral nutrition or parenteral nutrition. More studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education, School of Health Sciences, Health and Human Sciences, University of Greenwich, Avery Hill Campus, Avery Hill Road, London SE9 2UG, UK
- Correspondence:
| | - Osarhumwese Osaretin Ojo
- Smoking Cessation Department, University Hospital, South London and Maudsley NHS Foundation Trust, Lewisham High Street, London SE13 6LH, UK;
| | - Qianqian Feng
- The School of Nursing, Soochow University, Suzhou 215006, China; (Q.F.); (X.W.)
| | - Joshua Boateng
- School of Science, University of Greenwich, Medway Campus, Central Ave, Gillingham, Chatham Maritime, Kent ME4 4TB, UK;
| | - Xiaohua Wang
- The School of Nursing, Soochow University, Suzhou 215006, China; (Q.F.); (X.W.)
| | - Joanne Brooke
- Faculty of Health, Education and Life Sciences, Ravensbury House, Birmingham City University, City South Campus, Birmingham B15 3TN, UK;
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Healthcare Research, Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK;
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20
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Youssef N, Elbadry M, Al Shafie A, Abdalazeem A, Hasan S, Tahoon M, Omran D, El Kassas M. Nutritional status associated with clinical outcomes among patients hospitalized with COVID-19: A multicenter prospective study in Egypt. Nurs Health Sci 2022; 24:204-213. [PMID: 34918872 DOI: 10.1111/nhs.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/08/2023]
Abstract
Few studies have addressed the relationship between the nutritional status of patients with COVID-19 and their disease course. This multicenter prospective study aimed to evaluate the nutritional status of patients hospitalized with COVID-19 and its association with their clinical outcomes. Sociodemographic, physical, clinical, and nutritional data of 121 patients with confirmed COVID-19 were collected upon admission and at discharge from three COVID-19 quarantine hospitals in Egypt via a questionnaire and a standardized scale. The majority (73.6%) of the patients had a reduced dietary intake over the last week before admission, and 57% were severely ill. Overall, 14% had a high risk of malnutrition on admission, increasing to 26.3% at discharge. Malnutrition was present in most (85.7%) of the intensive care unit patients and deaths, compared with recovered patients (14%). We concluded that malnutrition might worsen the clinical outcomes and increase the morbidity and mortality of COVID-19 patients. A multidisciplinary approach is recommended to manage patients with COVID-19, considering their nutritional status before and during infection, with early detection of high-risk patients in order to design and provide the appropriate nutritional support.
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Affiliation(s)
- Naglaa Youssef
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
- Medical-Surgical Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed Elbadry
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmad Al Shafie
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Amr Abdalazeem
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Salwa Hasan
- Clinical Pharmacology Department, Aswan Specialized Hospital, Aswan, Egypt
| | - Marwa Tahoon
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia university, Menoufia, Egypt
| | - Dalia Omran
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Monroe I, Dale M, Schwabe M, Schenkel R, Schenarts PJ. The COVID-19 Patient in the Surgical Intensive Care Unit. Surg Clin North Am 2022; 102:1-21. [PMID: 34800379 PMCID: PMC8479422 DOI: 10.1016/j.suc.2021.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
COVID-19 continues to rampage around the world. Noncritical care-trained physicians may be deployed into the intensive care unit to manage these complex patients. Although COVID-19 is primarily a respiratory disease, it is also associated with significant pathology in the brain, heart, vasculature, lungs, gastrointestinal tract, and kidneys. This article provides an overview of COVID-19 using an organ-based, systematic approach.
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22
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Lewis SL, Chizmar LR, Liotta S. COVID-19 and Micronutrient Deficiency symptoms – is there some overlap? Clin Nutr ESPEN 2022; 48:275-281. [PMID: 35331502 PMCID: PMC8809666 DOI: 10.1016/j.clnesp.2022.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
Background & aims COVID-19 is highly inflammatory and when it affects the elderly who have multiple comorbidities, the risk of malnutrition is high. The aim of this review is to highlight the evidence for COVID-19 and risk for malnutrition (macro- and micro-nutrient deficiency) sharing two case reports. Methods We report two cases of patients with COVID-19. The first case includes a 75-year-old male with increasing confusion, delirium and malnutrition once he had clinically resolved from his COVID-19 diagnosis. The patient had a number of comorbidities and was treated with diuretics before and after his hospital admission. He was treated with intravenous thiamine and enteral nutrition. The second case includes a 77-year-old male with diabetes who presented with suspected vitamin C deficiency likely due to chronic aspirin use nearly two weeks prior to being diagnosed with pneumonia and COVID-19. The patient recovered from his COVID-19 diagnosis but continued to decline nutritionally and was readmitted sixty days later with failure to thrive. Results The first case had significant improvements in his appetite and neurological conditions following thiamine infusion and enteral nutrition and was discharged to home after a 19-day hospital stay. The second case presented with a vitamin C deficiency before testing positive for COVID-19. Although he did recover from COVID-19 he struggled to meet nutritional needs post-COVID and passed away 60 days after his COVID-19 diagnosis with pneumonia and failure to thrive. Conclusion Elderly patients with chronic diseases who use nutrient depleting medications are particularly high risk for micronutrient deficiency when they also experience the inflammatory insult of COVID-19. Patients who continue to have poor nutrition intake even after they appear to be clinically resolved from the virus should be closely monitored.
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23
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de Jesus RP, de Carvalho JF, de Oliveira LPM, Cunha CDM, Alves TCHS, Vieira STB, Figueiredo VM, Bueno AA. Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2. World J Hepatol 2022; 14:80-97. [PMID: 35126841 PMCID: PMC8790394 DOI: 10.4254/wjh.v14.i1.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/28/2021] [Accepted: 12/22/2022] [Indexed: 02/06/2023] Open
Abstract
Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.
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Affiliation(s)
- Rosangela Passos de Jesus
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | | | | | - Carla de Magalhães Cunha
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | - Thaisy Cristina Honorato Santos Alves
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | - Sandra Tavares Brito Vieira
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | - Virginia Maria Figueiredo
- Department of Gastroenterology, IPEMED, Ipemed Faculty of Medical Sciences, Salvador 40170-110, Bahia, Brazil
| | - Allain Amador Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester WR2 6AJ, United Kingdom
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24
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Whear R, Abbott RA, Bethel A, Richards DA, Garside R, Cockcroft E, Iles‐Smith H, Logan PA, Rafferty AM, Shepherd M, Sugg HVR, Russell AM, Cruickshank S, Tooze S, Melendez‐Torres GJ, Thompson Coon J. Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review. J Adv Nurs 2022; 78:78-108. [PMID: 34554585 PMCID: PMC8657334 DOI: 10.1111/jan.15047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 09/05/2021] [Indexed: 01/28/2023]
Abstract
AIM This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. DESIGN Systematic review. DATA SOURCES In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. REVIEW METHODS We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. RESULTS Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. CONCLUSION To prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future. IMPACT Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
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Affiliation(s)
- Rebecca Whear
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Rebecca A. Abbott
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Alison Bethel
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - David A. Richards
- College of Medicine and HealthUniversity of ExeterExeterUK
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Ruth Garside
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Emma Cockcroft
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Heather Iles‐Smith
- School of Health and SocietyUniversity of SalfordSalfordUK
- Northern Care Alliance NHS GroupSalfordUK
| | - Pip A. Logan
- School of MedicineUniversity of NottinghamQueens Medical CentreNottinghamUK
| | - Ann Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative CareKing’s College LondonLondonUK
| | - Maggie Shepherd
- NIHR Exeter Clinical Research FacilityRoyal Devon and Exeter NHS Foundation TrustExeterUK
- Institute of Biomedical and Clinical ScienceCollege of Medicine and HealthUniversity of ExeterExeterUK
| | | | | | | | - Susannah Tooze
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Jo Thompson Coon
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
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25
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Singh AK, Jena A, Kumar-M P, Jha DK, Sharma V. Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis. Intest Res 2022; 20:134-143. [PMID: 33440918 PMCID: PMC8831773 DOI: 10.5217/ir.2020.00108] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. METHODS We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. RESULTS Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38-83.88), cough: 59.58% (95% CI, 45.01-72.63), diarrhea: 27.26% (95% CI, 19.51-36.69), running nose: 27% (95% CI, 15.26-43.19) and dyspnea: 25.29% (95% CI, 18.52-33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24-18.19), 10.08% (95% CI, 5.84-16.85) and 8.80% (95% CI, 4.43-16.70) per 100 population, respectively. CONCLUSIONS The clinical presentation of COVID-19 in IBD patients is similar to the general population.
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Affiliation(s)
- Anupam K. Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daya Krishna Jha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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26
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Kariyawasam JC, Jayarajah U, Riza R, Abeysuriya V, Seneviratne SL. Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg 2021; 115:1362-1388. [PMID: 33728439 PMCID: PMC7989191 DOI: 10.1093/trstmh/trab042] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory viral infection, has affected more than 78 million individuals worldwide as of the end of December 2020. Previous studies reported that severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome-related coronavirus infections may affect the gastrointestinal (GI) system. In this review we outline the important GI manifestations of COVID-19 and discuss the possible underlying pathophysiological mechanisms and their diagnosis and management. GI manifestations are reported in 11.4-61.1% of individuals with COVID-19, with variable onset and severity. The majority of COVID-19-associated GI symptoms are mild and self-limiting and include anorexia, diarrhoea, nausea, vomiting and abdominal pain/discomfort. A minority of patients present with an acute abdomen with aetiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischaemia, haemoperitoneum or abdominal compartment syndrome. Severe acute respiratory syndrome coronavirus 2 RNA has been found in biopsies from all parts of the alimentary canal. Involvement of the GI tract may be due to direct viral injury and/or an inflammatory immune response and may lead to malabsorption, an imbalance in intestinal secretions and gut mucosal integrity and activation of the enteric nervous system. Supportive and symptomatic care is the mainstay of therapy. However, a minority may require surgical or endoscopic treatment for acute abdomen and GI bleeding.
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Affiliation(s)
- Jayani C Kariyawasam
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Rishdha Riza
- Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
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27
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Wang J, Zhu K, Xue Y, Wen G, Tao L. Research Progress in the Treatment of Complications and Sequelae of COVID-19. Front Med (Lausanne) 2021; 8:757605. [PMID: 34926504 PMCID: PMC8674502 DOI: 10.3389/fmed.2021.757605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022] Open
Abstract
With the improvement in the understanding of COVID-19 and the widespread vaccination of COVID-19 vaccines in various countries, the epidemic will be brought under control soon. However, multiple viruses could result in the post-viral syndrome, which is also common among patients with COVID-19. Therefore, the long-term consequences and the corresponding treatment of COVID-19 should be the focus in the post-epidemic era. In this review, we summarize the therapeutic strategies for the complications and sequelae of eight major systems caused by COVID-19, including respiratory system, cardiovascular system, neurological system, digestive system, urinary system, endocrine system, reproductive system and skeletal complication. In addition, we also sorted out the side effects reported in the vaccine trials. The purpose of this article is to remind people of possible complications and sequelae of COVID-19 and provide robust guidance on the treatment. It is extremely important to conduct long-term observational prognosis research on a larger scale, so as to have a comprehensive understanding of the impact of the SARS-CoV-2 on the human body and reduce complications to the greatest extent.
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Affiliation(s)
- Jinpeng Wang
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Kuoyun Zhu
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Yuchuan Xue
- The First Department of Clinical Medicine, China Medical University, Shenyang, China
| | - Guangfu Wen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lin Tao
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
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28
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Antwi J, Appiah B, Oluwakuse B, Abu BAZ. The Nutrition-COVID-19 Interplay: a Review. Curr Nutr Rep 2021; 10:364-374. [PMID: 34837637 PMCID: PMC8627159 DOI: 10.1007/s13668-021-00380-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 02/08/2023]
Abstract
Purpose of Review Nutritional status is affected by the COVID-19 pandemic, directly or indirectly. Even with the recent rollout of the coronavirus disease 2019 (COVID-19) vaccines and availability of medicines such as remdesivir, and monoclonal antibodies, host nutritional status is pivotal in the fight against the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and outcomes. The purpose of this review is to discuss the effects of COVID-19-related lockdown on lifestyle behaviors, and the nutritional consequences, and the direct sequelae of the infection on nutrition including potential nutritional interventions. Recent Findings The COVID-19-related lockdown imposed radical changes in lifestyle behaviors with considerable short-term and long-term health and nutritional consequences including weight gain and obesity and increased cardiometabolic risk, consistently linked to worsened prognosis. The extent of the impact was dependent on food insecurity, overall stress and disordered eating, physical inactivity, and exposure to COVID-19-related nutrition information sources. COVID-19 could directly induce inflammatory responses and poor nutrient intake and absorption leading to undernutrition with micronutrient deficiencies, which impairs immune system function with subsequent amplified risk of infection and disease severity. Nutrition interventions through nutrition support, dietary supplementation, and home remedies such as use of zinc, selenium, vitamin D, and omega-3 fatty acids showed the most significant promise to mitigate the course of COVID-19 infection and improve survival rates. Summary The nutrition-COVID-19 relationship and related dietary changes mimic a vicious cycle of the double burden of malnutrition, both obesity and undernutrition with micronutrient deficiencies, which promote infection, disease progression, and potential death.
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Affiliation(s)
- Janet Antwi
- Department of Agriculture, Nutrition and Human Ecology, Prairie View A&M University, Prairie View, TX, USA.
| | - Bernard Appiah
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| | - Busayo Oluwakuse
- Department of Agriculture, Nutrition and Human Ecology, Prairie View A&M University, Prairie View, TX, USA
| | - Brenda A Z Abu
- Wegmans School of Health and Nutrition, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA
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29
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Zeng Q, Cao H, Ma Q, Chen J, Shi H, Li J. Appetite loss, death anxiety and medical coping modes in COVID-19 patients: a cross-sectional study. Nurs Open 2021; 8:3242-3250. [PMID: 34463433 PMCID: PMC8510753 DOI: 10.1002/nop2.1037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/27/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022] Open
Abstract
AIM This study aims to explore the current level and associated factors of appetite and death anxiety amongst COVID-19 patients and also to identify correlation between the two variables. DESIGN A cross-sectional study. METHODS Demographic and characteristic questionnaires, templer death anxiety scale, council on nutrition of appetite questionnaire and medical coping modes questionnaire were utilized. RESULTS The average scores of appetite and death anxiety were 19.46 (4.09) and 6.58, (3.21) respectively. 76 patients (100%) suffered from appetite loss, whilst 27 (35.50%) patients suffered from severe death anxiety. Marital status, COVID-19 disease condition ranks, educational level and death anxiety were explained 55.20% of the total variance in the appetite regression model (F = 31.83, p < .001), whilst the gender, avoidance coping strategy and appetite level were explained 49.80% of the total variance in death anxiety model (F = 17.80, p < .001). A moderate negative correlation between appetite and death anxiety was also confirmed (r=-.55, p < .001).
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Affiliation(s)
- Qiuxuan Zeng
- Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Huangliang Cao
- Guangzhou Eighth People's Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Qing Ma
- School of NursingGuangzhou University of Chinese MedicineGuangzhouChina
| | - Jieya Chen
- Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Haixia Shi
- Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Jiaying Li
- School of Nursing, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
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30
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Shah MD, Sumeh AS, Sheraz M, Kavitha MS, Venmathi Maran BA, Rodrigues KF. A mini-review on the impact of COVID 19 on vital organs. Biomed Pharmacother 2021; 143:112158. [PMID: 34507116 PMCID: PMC8416601 DOI: 10.1016/j.biopha.2021.112158] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 02/09/2023] Open
Abstract
COVID-19 (Corona Virus Disease-2019) is an infectious disease caused by a novel coronavirus, known as the acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is a highly contagious disease that has already affected more than 220 countries globally, infecting more than 212 million people and resulting in the death of over 4.4 million people. This review aims to highlight the pertinent documentary evidence upon the adverse effects of the SARS-CoV-2 infection on several vital human organs. SARS-CoV-2 primarily targets the lung tissue by causing diffuse alveolar damage and may result in Acute Respiratory Distress Syndrome (ARDS). SARS-CoV-2 infects the cell via cell surface receptor, angiotensin-converting enzyme 2 (ACE2). Besides lungs, SARS-CoV-2 critically damage tissues in other vital human organs such as the heart, kidney, liver, brain, and gastrointestinal tract. The effect on the heart includes muscle dysfunction (acute or protracted heart failure), myocarditis, and cell necrosis. Within hepatic tissue, it alters serum aminotransferase, total bilirubin, and gamma-glutamyl transferase levels. It contributes to acute kidney injury (AKI). Localized infection of the brain can lead to loss or attenuation of olfaction, muscular pain, headaches, encephalopathy, dizziness, dysgeusia, psychomotor disorders, and stroke; while the gastrointestinal symptoms include the disruption of the normal intestinal mucosa, leading to diarrhea and abdominal pain. This review encompassed a topical streak of systemic malfunctions caused by the SARS-CoV-2 infection. As the pandemic is still in progress, more studies will enrich our understanding and analysis of this disease.
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Affiliation(s)
- Muhammad Dawood Shah
- Borneo Marine Research Institute, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia.
| | - Aini Simon Sumeh
- Penampang Health Clinic, Kampung Tuavon, 89500 Penampang, Sabah, Malaysia
| | - Muhammad Sheraz
- Arbutus Biopharma Inc, 701 Veterans Circle, Warminster, PA 18974, USA
| | - Muthu Subash Kavitha
- School of Information and Data Sciences, Nagasaki University, Bunkyo-machi 1-14, Nagasaki 852-8521, Japan.
| | - Balu Alagar Venmathi Maran
- Borneo Marine Research Institute, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia.
| | - Kenneth Francis Rodrigues
- Biotechnology Research Institute, Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia.
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31
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Alencar ESD, Muniz LSDS, Holanda JLG, Oliveira BDD, Carvalho MCFD, Leitão AMM, Cavalcante MIDA, Oliveira RCPD, Silva CABD, Carioca AAF. Enteral nutritional support for patients hospitalized with COVID-19: Results from the first wave in a public hospital. Nutrition 2021; 94:111512. [PMID: 34844158 PMCID: PMC8504071 DOI: 10.1016/j.nut.2021.111512] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 01/16/2023]
Abstract
Objectives Nutrition has become an important component in treating individuals during the coronavirus disease of 2019 (COVID-19) pandemic, which is increasingly affecting the world population and causing a collapse in health services. Prolonged hospitalization, including immobilization and catabolism, induces a decrease in body weight and muscle mass that may result in sarcopenia, a condition that impairs respiratory and cardiac function and worsens the prognosis. The present study aimed to analyze enteral nutritional support and the clinical evolution of patients admitted with COVID-19 in Brazil. Methods This was a retrospective study, conducted from March to May 2020, of patients admitted to a referral hospital in cardiology and pulmonology in Fortaleza-Ce/Brazil. Two hundred patients infected with COVID-19 were selected for the study. Sociodemographic, clinical, and nutritional data were collected from electronic medical records, and associations between outcomes and the use of the prone body position with nutritional variables were analyzed by linear regression. Odds ratio and 95% confidence interval estimates for the death outcome were analyzed by logistic regression. Results Of the 112 patients who were fed by enterally, the majority were male (n = 61; 54.5%), elderly (n = 88; 78.6%), and with no current smoking habit (n = 81; 72.3%). The median hospital stay was 14 d, mostly in intensive care units (median: 9 d). Prone body positioning impacted the nutritional therapy. In general, patients who maintained a prone body position tested lower for kcal/kg of body weight, protein/kg of body weight, percentage of diet adequacy, and total caloric value. In addition, patients who died had a lower mean maximum kcal/kg body weight, protein/kg body weight, percentage of diet adequacy, and total caloric value compared with surviving patients. Conclusions An association between inadequacies in protein and energy supply with mortality was confirmed, suggesting that nutritional support optimization should be prescribed in such situations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Carlos Antônio Bruno da Silva
- Postgraduate Program in Collective Health, Health Sciences Center, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
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Hawryłkowicz V, Lietz-Kijak D, Kaźmierczak-Siedlecka K, Sołek-Pastuszka J, Stachowska L, Folwarski M, Parczewski M, Stachowska E. Patient Nutrition and Probiotic Therapy in COVID-19: What Do We Know in 2021? Nutrients 2021; 13:3385. [PMID: 34684384 PMCID: PMC8538178 DOI: 10.3390/nu13103385] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The main nutritional consequences of COVID-19 include reduced food intake, hypercatabolism, and rapid muscle wasting. Some studies showed that malnutrition is a significant problem among patients hospitalized due to COVID-19 infection, and the outcome of patients with SARS-CoV-2 is strongly associated with their nutritional status. The purpose of this study was to collect useful information about the possible elements of nutritional and probiotic therapy in patients infected with the SARS-CoV-2 virus. METHODS A narrative review of the literature, including studies published up to 13 September 2021. RESULTS Probiotics may support patients by inhibiting the ACE2 receptor, i.e., the passage of the virus into the cell, and may also be effective in suppressing the immune response caused by the proinflammatory cytokine cascade. In patients' diet, it is crucial to ensure an adequate intake of micronutrients, such as omega-3 fatty acids (at 2-4 g/d), selenium (300-450 μg/d) and zinc (30-50 mg/d), and vitamins A (900-700 µg/d), E (135 mg/d), D (20,000-50,000 IU), C (1-2 g/d), B6, and B12. Moreover, the daily calorie intake should amount to ≥1500-2000 with 75-100 g of protein. CONCLUSION In conclusion, the treatment of gut dysbiosis involving an adequate intake of prebiotic dietary fiber and probiotics could turn out to be an immensely helpful instrument for immunomodulation, both in COVID-19 patients and prophylactically in individuals with no history of infection.
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Affiliation(s)
- Viktoria Hawryłkowicz
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (L.S.)
| | - Danuta Lietz-Kijak
- Department of Propedeutics, Physiodiagnostics and Dental Physiotherapy, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | | | - Joanna Sołek-Pastuszka
- Department of Anaesthesiology and Intensive Care, Pomeranian Medical University, 71-242 Szczecin, Poland;
| | - Laura Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (L.S.)
| | - Marcin Folwarski
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Miłosz Parczewski
- Department of Infectious, Tropical and Acquired Immunological Diseases, Pomeranian Medical University, 71-455 Szczecin, Poland;
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland; (V.H.); (L.S.)
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Vargas-Mendoza N, García-Machorro J, Angeles-Valencia M, Martínez-Archundia M, Madrigal-Santillán EO, Morales-González Á, Anguiano-Robledo L, Morales-González JA. Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals. World J Gastroenterol 2021; 27:5630-5665. [PMID: 34629792 PMCID: PMC8473593 DOI: 10.3748/wjg.v27.i34.5630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has affected millions of people globally. It was declared a pandemic by the World Health Organization in March 2020. The hyperinflammatory response to the entry of SARS-CoV-2 into the host through angiotensin-converting enzyme 2 is the result of a "cytokine storm" and the high oxidative stress responsible for the associated symptomatology. Not only respiratory symptoms are reported, but gastrointestinal symptoms (diarrhea, vomiting, and nausea) and liver abnormalities (high levels of aspartate aminotransferase, alanine aminotransferase transaminases, and bilirubin) are observed in at least 30% of patients. Reduced food intake and a delay in medical services may lead to malnutrition, which increases mortality and poor outcomes. This review provides some strategies to identify malnutrition and establishes nutritional approaches for the management of COVID-19 and liver injury, taking energy and nutrient requirements and their impact on the immune response into account. The roles of certain phytochemicals in the prevention of the disease or as promising target drugs in the treatment of this disease are also considered.
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Affiliation(s)
- Nancy Vargas-Mendoza
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | - Jazmín García-Machorro
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | | | - Marlet Martínez-Archundia
- Laboratorio de Diseño y Desarrollo de Nuevos Fármacos e Innovación Biotécnológica, Instituto Politécnico Nacional, México 11340, Mexico
| | | | | | | | - José A Morales-González
- Laboratorio Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México 11340, Mexico
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Abstract
Since its initial onset in 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread quickly across the globe, resulting in the potentially life-threatening respiratory coronavirus disease 2019 (COVID-19). Although less commonly reported, COVID-19 has also been associated with gastrointestinal and hepatic manifestations, which may occur more frequently in children. This has also led to concern about the susceptibility of children to the SARS-CoV-2 virus who have underlying chronic digestive disease and may be treated with immune suppression. As such, recommendations and expert consensus regarding the management of chronic gastrointestinal and hepatobiliary disease have been of great interest during the pandemic and international database reporting has informed our understanding. The impact of COVID-19 on the gastrointestinal tract and its influence on the management of pediatric digestive disease is reviewed in this article. [Pediatr Ann. 2021;50(8):e315-e319.].
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Levy E, Stintzi A, Cohen A, Desjardins Y, Marette A, Spahis S. Critical appraisal of the mechanisms of gastrointestinal and hepatobiliary infection by COVID-19. Am J Physiol Gastrointest Liver Physiol 2021; 321:G99-G112. [PMID: 34009033 PMCID: PMC8289353 DOI: 10.1152/ajpgi.00106.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
COVID-19 represents a novel infectious disease induced by SARS-CoV-2. It has to date affected 24,240,000 individuals and killed 2,735,805 people worldwide. The highly infectious virus attacks mainly the lung, causing fever, cough, and fatigue in symptomatic patients, but also pneumonia in severe cases. However, growing evidence highlights SARS-CoV-2-mediated extrarespiratory manifestations, namely, gastrointestinal (GI) and hepatic complications. The detection of 1) the virus in the GI system (duodenum, colon, rectum, anal region, and feces); 2) the high expression of additional candidate coreceptors/auxiliary proteins to facilitate the virus entry; 3) the abundant viral angiotensin-converting enzyme 2 receptor; 4) the substantial expression of host transmembrane serine protease 2, necessary to induce virus-cell fusion; 5) the viral replication in the intestinal epithelial cells; and 6) the primarily GI disorders in the absence of respiratory symptoms lead to increased awareness of the risk of disease transmission via the fecal-oral route. The objectives of this review are to provide a brief update of COVID-19 pathogenesis and prevalence, present a critical overview of its GI and liver complications that affect clinical COVID-19 outcomes, clarify associated mechanisms (notably microbiota-related), define whether gut/liver disorders occur more frequently among critically ill patients with COVID-19, determine the impact of COVID-19 on preexisting gut/liver complications and vice versa, and discuss the available strategies for prevention and treatment to improve prognosis of the patients. The novel SARS-CoV-2 can cause gastrointestinal and hepatobiliary manifestations. Metagenomics studies of virobiota in response to SARS-CoV-2 infection are necessary to highlight the contribution of bacterial microflora to COVID-19 phenotype, which is crucial for developing biomarkers and therapeutics.
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Affiliation(s)
- Emile Levy
- 1Research Centre, Sainte-Justine University Health Center, Université de Montréal, Quebec, Canada,2Department of Nutrition, Université de Montréal, Quebec, Canada,3Department of Pediatrics, Gastroenterology and Hepatology Unit, Université de Montréal, Quebec, Canada,4Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
| | - Alain Stintzi
- 5Department of Biochemistry, Microbiology and Immunology, Ottawa Institute of Systems Biology, University of Ottawa, Ontario, Canada
| | - Albert Cohen
- 6Division of Gastroenterology, Jewish General Hospital, Quebec, Canada
| | - Yves Desjardins
- 4Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
| | - André Marette
- 4Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
| | - Schohraya Spahis
- 1Research Centre, Sainte-Justine University Health Center, Université de Montréal, Quebec, Canada,2Department of Nutrition, Université de Montréal, Quebec, Canada,4Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
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Singer P. Nutritional and metabolic management of COVID-19 intensive care patients. JOURNAL OF INTENSIVE MEDICINE 2021; 1:31-34. [PMID: 36943801 PMCID: PMC7919505 DOI: 10.1016/j.jointm.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 04/15/2023]
Abstract
Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19 (COVID-19) patients. The aim of this review is to describe these disturbances during the progression of the disease, from the pre-intubation phase through the ventilated condition to the post extubation phase. The analysis of new data describing the prevalence of malnutrition, the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss. Rehabilitation may be extremely prolonged and therefore, nutrition is mandatory to decrease this recondition period. This review also comments on the European Society of Parenteral and Enteral Nutrition (ESPEN) nutritional statements.
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Ağagündüz D, Çelik MN, Çıtar Dazıroğlu ME, Capasso R. Emergent Drug and Nutrition Interactions in COVID-19: A Comprehensive Narrative Review. Nutrients 2021; 13:1550. [PMID: 34064534 PMCID: PMC8147951 DOI: 10.3390/nu13051550] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
Coronaviruses are a large family of viruses that are known to cause respiratory tract infections ranging from colds to more severe diseases, such as Middle East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS). New Coronavirus Disease 2019 (COVID-19), which led to deaths as well as social and economic disruptions, is an ongoing worldwide pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Currently, there is no approved treatment for COVID-19. Hence, only supportive care has been approved by the World Health Organization (WHO) for now. Pharmacological agents used for the adjunctive treatment of COVID-19 following the current literature and clinical experiences include antiviral, anti-inflammatory, and anti-malaria drugs, and other traditional or untraditional treatments. However, it has been reported that the use of these drugs may have some negative effects and comorbidities. Moreover, the current data have indicated that the risk of drug-drug interactions may also be high in polypharmacy cases, especially in elderly people, some comorbidity situations, and intensive care unit (ICU) patients. It is highly possible that these situations can not only increase the risk of drug-drug interactions but also increase the risk of food/nutrition-drug interactions and affect the nutritional status. However, this issue has not yet been entirely discussed in the literature. In this review, current information on the possible mechanisms as well as pharmacokinetic and pharmacodynamic effects of some pharmacological agents used in the treatment of COVID-19 and/or their secondary interactions with nutrition were evaluated and some future directions were given.
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Affiliation(s)
- Duygu Ağagündüz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Emek, Ankara 06490, Turkey; (M.N.Ç.); (M.E.Ç.D.)
| | - Menşure Nur Çelik
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Emek, Ankara 06490, Turkey; (M.N.Ç.); (M.E.Ç.D.)
| | - Merve Esra Çıtar Dazıroğlu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Emek, Ankara 06490, Turkey; (M.N.Ç.); (M.E.Ç.D.)
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, 80055 Naples, Italy
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Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y. Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications. World J Gastroenterol 2021; 27:1716-1727. [PMID: 33967552 PMCID: PMC8072196 DOI: 10.3748/wjg.v27.i16.1716] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
- Department of Microbiology, Royal College of Surgeons in Ireland - Bahrain, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
| | - Yasser El-Sawaf
- Department of Tropical Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Gastroenterology, University Medical Center, Arabian Gulf University, Manama 26671, Bahrain
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Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y. Paediatric gastrointestinal disorders in SARS-CoV-2 infection: Epidemiological and clinical implications. World J Gastroenterol 2021. [PMID: 33967552 DOI: 10.3748/wjg.v27.i16.1716.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
| | - Nermin Kamal Saeed
- Microbiology Section, Pathology Department, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Diseases, Tanta University, Tanta 31527, Algharbia, Egypt
| | - Yasser El-Sawaf
- Department of Tropical Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
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Deane K, Singh A, Sarfraz A, Sarfraz Z, Ciccone L, Zheng B, Afzal A, Khan G, Rodriguez G, Bahtiyar G. Correlation of Severity of COVID-19 Disease With Gastrointestinal Manifestations and Liver Injury - A North Brooklyn Community Hospital Experience: A Retrospective Cohort Study. Cureus 2021; 13:e14543. [PMID: 34017658 PMCID: PMC8130634 DOI: 10.7759/cureus.14543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction The primary receptor for SARS-CoV-2 infection, angiotensin-converting enzyme-2 (ACE-2), is expressed in the gastrointestinal tract and liver parenchyma. The involvement of the gastrointestinal tract with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has remained unclear. The following study retrospectively reviews gastrointestinal symptoms and liver function tests at the time of hospital admission to identify patient outcomes including prolonged hospital stay, the requirement for intensive care, and all-cause in-hospital 30-day mortality. Methods A retrospective review of patient charts at the Woodhull Medical and Mental Health Center (WMC) was conducted at the time of hospital admission, using a pre-determined selection criterion. All adult patients, both inpatient and outpatient, were included from March 2020 till May 2020. A 95% confidence interval was used to estimate the odds ratio (OR) for patient outcomes. Results Of the 520 patients, gastrointestinal symptoms including nausea (OR = 0.375, p = 0.015), and nausea and vomiting in combination (OR = 0.400, p = 0.016) had an inverse protective relationship with all-cause in-hospital 30-day mortality among COVID-19 patients. Gastrointestinal symptoms including diarrhea (OR = 1.008, p < 0.001), and nausea and vomiting (OR = 1.291, p = 0.043) had a mild impact on the length of hospital stay. Conclusion Elevated liver transaminases including alanine transaminase (ALT) and aspartate transaminase (AST) at the time of hospital admission can predict critical care requirement and all-cause 30-day hospital mortality in patients with COVID-19 infection. Presence of gastrointestinal symptoms is associated with worsened outcomes.
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Affiliation(s)
- Kitson Deane
- Internal Medicine, Woodhull Medical Center, Brooklyn, USA
| | - Ajay Singh
- Internal Medicine, Metropolitan Hospital, New York City, USA
| | | | - Zouina Sarfraz
- Research and Academic Affairs, Fatima Jinnah Medical University, Lahore, PAK
| | - Lyam Ciccone
- Internal Medicine, Woodhull Medical Center, Brooklyn, USA
| | - Beishi Zheng
- Internal Medicine, Woodhull Medical Center, Brooklyn, USA
| | - Arslan Afzal
- Internal Medicine, Woodhull Medical Center, Brooklyn, USA
| | - Gulam Khan
- Gastroenterology, Woodhull Medical Center, Brooklyn, USA
| | | | - Gul Bahtiyar
- Endocrinology, Woodhull Medical Center, Brooklyn, USA
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Pourfridoni M, Abbasnia SM, Shafaei F, Razaviyan J, Heidari-Soureshjani R. Fluid and Electrolyte Disturbances in COVID-19 and Their Complications. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6667047. [PMID: 33937408 PMCID: PMC8060100 DOI: 10.1155/2021/6667047] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/11/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) is the cause of an acute respiratory illness which has spread around the world. The virus infects the host by binding to the angiotensin-converting enzyme 2 (ACE2) receptors. Due to the presence of ACE2 receptors in the kidneys and gastrointestinal (GI) tract, kidneys and GI tract damage arising from the virus can be seen in patients and can cause acute conditions such as acute kidney injury (AKI) and digestive problems for the patient. One of the complications of kidneys and GI involvement in COVID-19 is fluid and electrolyte disturbances. The most common ones of these disorders are hyponatremia, hypernatremia, hypokalemia, hypocalcemia, hypochloremia, hypervolemia, and hypovolemia, which if left untreated, cause many problems for patients and even increase mortality. Fluid and electrolyte disturbances are more common in hospitalized and intensive care patients. Children are also at greater risk for fluid and electrolyte disturbances complications. Therefore, clinicians should pay special attention to the fluid and electrolyte status of patients. Changes in fluid and electrolyte levels can be a good indicator of disease progression.
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Affiliation(s)
| | | | - Fateme Shafaei
- Student Research Committee, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Javad Razaviyan
- Student Research Committee, Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Iran
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Rodriguez A, Arrizabalaga-Asenjo M, Fernandez-Baca V, Lainez MP, Al Nakeeb Z, Garcia JD, Payeras A. Seroprevalence of SARS-CoV-2 antibody among healthcare workers in a university hospital in Mallorca, Spain, during the first wave of the COVID-19 pandemic. Int J Infect Dis 2021; 105:482-486. [PMID: 33647507 PMCID: PMC7910131 DOI: 10.1016/j.ijid.2021.02.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To estimate the SARS-CoV-2 antibody seroprevalence in healthcare workers (HCWs) at a university hospital in Mallorca, Spain. METHODS All HCWs received an e-mail inviting them to take part in the study. Participants had a nasopharyngeal swab test performed for reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) and serological tests to detect SARS-CoV-2 antibodies (primary study). Additionally, they were invited to complete a questionnaire on their exposure to COVID-19 individuals and their COVID-19-related symptoms (secondary study). Prevalence of antibodies (IgG, IgM, or both) and 95% confidence intervals (CIs) were calculated. RESULTS Seventy-nine percent of the hospital's HCWs (N = 2210) took part in the primary study. Antibodies were detected in 61 participants, a prevalence of 2.8% (95% CI: 2.5-3.1). The prevalence was slightly higher in nurses (3.4%), registrars (3.9%), and wardens (3.4%). Thirty-nine percent of the primary study participants completed the secondary study questionnaire. Those with positive antibody test results had closer contact with COVID-19 individuals (60% vs. 92%; p < 0.001). CONCLUSION After the first wave of the COVID-19 pandemic in Spain, the seroprevalence of SARS-CoV-2 antibodies in our university hospital HCWs was around 2.8%, which is slightly higher than the seroprevalence in the general population in our region. We believe it would be advisable to perform additional seroprevalence studies during the second wave of the epidemic.
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Affiliation(s)
- Adrian Rodriguez
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain.
| | - Maria Arrizabalaga-Asenjo
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain; Research Group in Infectious Diseases and HIV, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Victoria Fernandez-Baca
- Microbiology Department, Son Llatzer University Hospital, Balearic Islands, Spain; Multidisciplinary Sepsis Group, Health Research Institute of the Balearic Islands (IdISBa), Spain
| | - Maria Pilar Lainez
- Department of Occupational Health, Son Llatzer University Hospital, Balearic Islands, Spain
| | - Zaid Al Nakeeb
- Medical Coordination, Son Llatzer University Hospital, Balearic Islands, Spain
| | - Jose Daniel Garcia
- Medical Coordination, Son Llatzer University Hospital, Balearic Islands, Spain
| | - Antoni Payeras
- Internal Medicine Department, Son Llatzer University Hospital, Balearic Islands, Spain; Research Group in Infectious Diseases and HIV, Health Research Institute of the Balearic Islands (IdISBa), Spain
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[COVID pandemic and clinical nutrition response in Spain: results of a national survey]. NUTR HOSP 2021; 38:207-212. [PMID: 33319580 DOI: 10.20960/nh.03370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.
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Osuna-Padilla I, Rodríguez-Moguel NC, Aguilar-Vargas A, Rodríguez-Llamazares S. Safety and tolerance of enteral nutrition in COVID-19 critically ill patients, a retrospective study. Clin Nutr ESPEN 2021; 43:495-500. [PMID: 34024561 PMCID: PMC7901378 DOI: 10.1016/j.clnesp.2021.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a lack of evidence about the tolerance of enteral nutrition (EN) in COVID-19 critically ill patients. However, several gastrointestinal manifestations related to COVID-19 have been described. The aims of this study were to analyze the incidence of gastrointestinal intolerance (GI) associated to EN (diarrhea, vomiting, gastroparesis and constipation) and to describe energy/protein provision along with biochemical alterations during the first week of EN. METHODS A retrospective cohort of COVID-19 critically ill patients under mechanical ventilation. We reported daily enteral nutrition infusion and gastrointestinal manifestations within the first week of intubation and enteral nutrition initiation. RESULTS Fifty-two patients were included; 40.3% were overweight and 46.2% were obese. During the first 7 days of EN, manifestations of GI intolerance such as vomiting, diarrhea and gastroparesis were present in 18 patients (32.4%). Hypernatremia (39%) was the most frequent electrolyte abnormality. Only Acute Kidney Injury (AKI) diagnosis was associated with a higher energy deficit on day 7. No associations between drug prescription and GI intolerance were observed. On day 4, 94.5% of patients were receiving more than 80% of energy requirements and 94.2% of protein requirements. Accumulated energy and protein deficits at day 3 were 2171.2 ± 945 kcal and 114.9 ± 49.2 g, respectively; and 2586.4 ± 1151 kcal, 133.3 ± 60.4 g at day 7. CONCLUSION Enteral nutrition is feasible and well-tolerated in COVID-19 patients with mechanical ventilation within the first week of enteral nutrition initiation. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.
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Affiliation(s)
- Iván Osuna-Padilla
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México City, Mexico
| | | | - Adriana Aguilar-Vargas
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México City, Mexico.
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Yu X. High-Fat Diet, Hypertriglyceridemia, Hyperlipidemic Acute Pancreatitis: Don't Forget Novel Coronavirus-Induced Acute Pancreatitis. Nutr Clin Pract 2021; 36:497. [PMID: 33624378 PMCID: PMC8014488 DOI: 10.1002/ncp.10627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Xianqiang Yu
- Surgery, Department of Medical School, Southeast University, Nanjing, China
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Aguila EJT, Cua IHY, Fontanilla JAC, Yabut VLM, Causing MFP. Response to "High-Fat Diet, Hypertriglyceridemia, Hyperlipidemic Acute Pancreatitis: Don't Forget Novel Coronavirus-Induced Acute Pancreatitis". Nutr Clin Pract 2021; 36:498-499. [PMID: 33580592 PMCID: PMC8013323 DOI: 10.1002/ncp.10630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Enrik John T Aguila
- Institute of Digestive and Liver Diseases, St Luke's Medical Center Global City, Manila, Philippines
| | - Ian Homer Y Cua
- Institute of Digestive and Liver Diseases, St Luke's Medical Center Global City, Manila, Philippines
| | - Joy Arabelle C Fontanilla
- Center for Weight Intervention and Nutrition Services, St Luke's Medical Center Global City, Manila, Philippines
| | - Vince Leenard M Yabut
- Clinical Nutrition Service, St Luke's Medical Center Quezon City, Manila, Philippines
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Matković Z, Đekić-Matković N. Ogilvie syndrome in a COVID-19 patient with pneumonia, absolute tachyarrhythmia and heart failure: A case report. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-31646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has recently spread worldwide presenting primarily in form of pneumonia. Gastrointestinal manifestations such as nausea, vomiting, diarrhoea and abdominal pain are less common than respiratory symptoms. However, critically ill patients may develop digestive complications including acute pseudo-obstruction of colon-Ogilvie syndrome. Gastrointestinal symptoms can manifest before the onset of typical respiratory symptoms. Common mucosal immune response underly both-pulmonary and gastrointestinal manifestations (high expression of angiotensin-converting enzyme 2 receptors). This article described a 75-year old female patient who arise Ogilvie syndrome during viral bilateral pneumonia induced by COVID-19. Patient also had an absolute tachyarrhythmia and hearth failure. Diameter of caecum, ascending and transverse colon was 12 to 14 cm. The walls of this segment of large bowel were deserosed, with threatening perforation. Right colectomy was performed. Nine days after the surgery, despite all therapeutic measures taken, there was a fatal outcome due to pulmonary thromboembolisation.
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Ilich JZ. Nutritional and Behavioral Approaches to Body Composition and Low-Grade Chronic Inflammation Management for Older Adults in the Ordinary and COVID-19 Times. Nutrients 2020; 12:E3898. [PMID: 33419325 PMCID: PMC7767148 DOI: 10.3390/nu12123898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
As more insight is gained into personalized health care, the importance of personalized nutritional and behavioral approaches is even more relevant in the COVID-19 era, in addition to the need for further elucidation regarding several diseases/conditions. One of these concerning body composition (in this context; bone, lean and adipose tissue) is osteosarcopenic adiposity (OSA) syndrome. OSA occurs most often with aging, but also in cases of some chronic diseases and is exacerbated with the presence of low-grade chronic inflammation (LGCI). OSA has been associated with poor nutrition, metabolic disorders and diminished functional abilities. This paper addresses various influences on OSA and LGCI, as well as their mutual action on each other, and provides nutritional and behavioral approaches which could be personalized to help with either preventing or managing OSA and LGCI in general, and specifically in the time of the COVID-19 pandemic. Addressed in more detail are nutritional recommendations for and roles of macro- and micronutrients and bioactive food components; the microbiome; and optimal physical activity regimens. Other issues, such as food insecurity and nutritional inadequacy, circadian misalignment and shift workers are addressed as well. Since there is still a lack of longer-term primary studies in COVID-19 patients (either acute or recovered) and interventions for OSA improvement, this discussion is based on the existing knowledge, scientific hypotheses and observations derived from similar conditions or studies just being published at the time of this writing.
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Affiliation(s)
- Jasminka Z Ilich
- Institute for Successful Longevity, Florida State University, Tallahassee, FL 32306, USA
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Gueiros LA, Neves MCS, Marques CDL. Chikungunya fever and COVID-19: Oral ulcers are a common feature. Oral Dis 2020; 28 Suppl 1:1008-1009. [PMID: 33179342 DOI: 10.1111/odi.13717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Luiz Alcino Gueiros
- Oral Medicine Unit, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Departmento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, Brazil
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50
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Haraj NE, El Aziz S, Chadli A, Dafir A, Mjabber A, Aissaoui O, Barrou L, El Kettani El Hamidi C, Nsiri A, Al Harrar R, Ezzouine H, Charra B, Abdallaoui MS, El Kebbaj N, Kamal N, Bennouna GM, El Filali KM, Ramdani B, El Mdaghri N, Gharbi MB, Afif MH. Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit. Clin Nutr ESPEN 2020; 41:423-428. [PMID: 33487301 PMCID: PMC7552965 DOI: 10.1016/j.clnesp.2020.09.214] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
Introduction The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. Tools and methods This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). Results Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m2 (17–42 kg/m2), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). Conclusion Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.
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Affiliation(s)
- Nassim Essabah Haraj
- Department of Endocrinology and Metabolic Diseases, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Siham El Aziz
- Department of Endocrinology and Metabolic Diseases, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Asma Chadli
- Department of Endocrinology and Metabolic Diseases, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco.
| | - Asma Dafir
- Surgical Intensive Care and Anaesthesia Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Amal Mjabber
- Department of Endocrinology and Metabolic Diseases, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Ouissal Aissaoui
- Surgical Intensive Care and Anaesthesia Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Lhoucine Barrou
- Surgical Intensive Care and Anaesthesia Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Chafik El Kettani El Hamidi
- Surgical Intensive Care and Anaesthesia Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Afak Nsiri
- Surgical Emergencies Intensive Care and Anaesthesia Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Rachid Al Harrar
- Surgical Emergencies Intensive Care and Anaesthesia Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Hanane Ezzouine
- Medical Intensive Care Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Boubaker Charra
- Medical Intensive Care Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Maha Soussi Abdallaoui
- Laboratory of Parasitology, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Nisrine El Kebbaj
- Department of Psychiatry, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Nabiha Kamal
- Laboratory of Biochemistry, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Ghali Mohamed Bennouna
- Cardiology Department, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Kamal Marhoum El Filali
- Department of Infectious Diseases, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Benyounes Ramdani
- Department of Nephrology, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Naima El Mdaghri
- Microbiology Laboratory, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Mohamed Benghanem Gharbi
- Department of Nephrology, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Moulay Hicham Afif
- Pneumology Department, 20 Août Hospital, CHU Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
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