Cryptic Disseminated Tuberculosis: a Secondary Analysis of Previous Hospital-...fahmi khan
The main purpose of this study was to describe the demographic and clinical features of cryptic disseminated TB; it was also aimed to shed light on diagnostic test, procedure results, organ involvement, and outcomes of cryptic disseminated TB in patients with confirmed disseminated TB.
NON-STEROIDAL ANTI INFLAMMATORY DRUGS AND GASTROINTESTINAL TOXICITYApollo Hospitals
Non-steroidal anti inflammatory drugs (NSAIDs) because of their high efficacy as both anti-inflammatory and analgesic agents, are one of the most commonly prescribed drugs world-wide. They are used in treatment of many commonly occurring disorders such as chronic arthropathies, headache and low back pain. Their widespread and uncontrolled use is promoted by their over the counter availability. This acts as a double edge sword. One of the most common adverse effects that add largely to its morbidity and mortality
is the gastrointestinal tract damage.
Cryptic Disseminated Tuberculosis: a Secondary Analysis of Previous Hospital-...fahmi khan
The main purpose of this study was to describe the demographic and clinical features of cryptic disseminated TB; it was also aimed to shed light on diagnostic test, procedure results, organ involvement, and outcomes of cryptic disseminated TB in patients with confirmed disseminated TB.
NON-STEROIDAL ANTI INFLAMMATORY DRUGS AND GASTROINTESTINAL TOXICITYApollo Hospitals
Non-steroidal anti inflammatory drugs (NSAIDs) because of their high efficacy as both anti-inflammatory and analgesic agents, are one of the most commonly prescribed drugs world-wide. They are used in treatment of many commonly occurring disorders such as chronic arthropathies, headache and low back pain. Their widespread and uncontrolled use is promoted by their over the counter availability. This acts as a double edge sword. One of the most common adverse effects that add largely to its morbidity and mortality
is the gastrointestinal tract damage.
frequency of hepatitis C virus infection in patients with type 2 diabetes mel...Dr Tarique Ahmed Maka
ABSTRACT
Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics. Study Design: Descriptive cross sectional study design. Place and Duration of Study: Department of Medicine, Combined Military Hospital (CMH) Kharian, from Jan 2015 to Jun 2015. Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized. Results: The mean age of patients was 48.82 ± 10.14 with 60.7% female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 (32.1%) of patients with 41-50 years of age group most commonly affected age group (34.7%) and female (57.8%) commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 (46.7%) had history of surgery in the past, 13 (28.9%) had history of blood transfusion in the past, 7 (15.55%) had history of hemodialysis while only 4 (8.9%) had history of tattooing in the past. Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated. Keywords: Blood transfusion, Diabetes Mellitus, Haemodialysis, Hepatitis C virus infection, Risk Factors, Surgery, Tattooing.
Risk factors of chronic liver disease amongst patients receiving care in a Ga...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract—Hydatid cyst disease is a zoonotic disease caused by the larval stage of Echinococcus granulosus and Echinococcus Multilocularis. In human beings, apart from involving the liver and lungs commonly, it also affects other organs like brain, kidney and spleen. Rupture of Hydatid cyst into abdominal cavity causes disseminated abdominal hydatidosis which is a rare complication. Here this rare case was presenting as a 48 years old female patient of disseminated intra-abdominal hydatidosis. Disseminated abdominal hydatidosis occurs secondary to traumatic or surgical rupture of a hepatic cyst. Ultrasonography or Computed Tomography findings are helpful in making a definitive diagnosis. For localized hydatid cysts in liver or lungs, the management of choice is preferably surgical while the treatment for disseminated intra-abdominal hydatidosis remains medical. Albendazole is the treatment of choice for disseminated abdominal hydatidosis.
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
frequency of hepatitis C virus infection in patients with type 2 diabetes mel...Dr Tarique Ahmed Maka
ABSTRACT
Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics. Study Design: Descriptive cross sectional study design. Place and Duration of Study: Department of Medicine, Combined Military Hospital (CMH) Kharian, from Jan 2015 to Jun 2015. Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized. Results: The mean age of patients was 48.82 ± 10.14 with 60.7% female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 (32.1%) of patients with 41-50 years of age group most commonly affected age group (34.7%) and female (57.8%) commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 (46.7%) had history of surgery in the past, 13 (28.9%) had history of blood transfusion in the past, 7 (15.55%) had history of hemodialysis while only 4 (8.9%) had history of tattooing in the past. Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated. Keywords: Blood transfusion, Diabetes Mellitus, Haemodialysis, Hepatitis C virus infection, Risk Factors, Surgery, Tattooing.
Risk factors of chronic liver disease amongst patients receiving care in a Ga...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract—Hydatid cyst disease is a zoonotic disease caused by the larval stage of Echinococcus granulosus and Echinococcus Multilocularis. In human beings, apart from involving the liver and lungs commonly, it also affects other organs like brain, kidney and spleen. Rupture of Hydatid cyst into abdominal cavity causes disseminated abdominal hydatidosis which is a rare complication. Here this rare case was presenting as a 48 years old female patient of disseminated intra-abdominal hydatidosis. Disseminated abdominal hydatidosis occurs secondary to traumatic or surgical rupture of a hepatic cyst. Ultrasonography or Computed Tomography findings are helpful in making a definitive diagnosis. For localized hydatid cysts in liver or lungs, the management of choice is preferably surgical while the treatment for disseminated intra-abdominal hydatidosis remains medical. Albendazole is the treatment of choice for disseminated abdominal hydatidosis.
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
ABSTRACT- Background: Viral hepatitis B and C can lead to the end stage liver disease and diabetes mellitus is also
a life-long chronic disease. Simultaneous presences of both of these conditions lead to synergistic detrimental outcome.
So identification of diabetes mellitus at the initial evaluation of a patient having chronic hepatitis B and C is essential.
Materials and methods: This study was designed as a retrospective single center cross-sectional study. The association
of viral hepatitis B and C with diabetes mellitus was investigated at the Liver Centre Dhaka, Bangladesh for a period of
12 years. HBsAg was tested for hepatitis B virus infection and anti-HCV for hepatitis C virus infection. Demographic
profile and biochemical data were retrieved from records.
Results: A total of 29425 cases were analyzed in the study [median age 31(19–95) years, 24615(84%) males]. HBsAg
positive were 27475 and hepatitis C were 1950. Patients with hepatitis C were older than hepatitis B (p<0.001).
Although previous history of jaundice was similar in both infections but history of blood transfusion was more common
among hepatitis C patients (p<0.001). Analyzing different conditions of liver disease, it was observed that hepatitis B
virus infection was highly responsible for acute hepatitis than hepatitis C (10.7% vs 1.1%) (p<0.001). Chronic hepatitis
was similar in rate (73.3% vs 59.9%). But in both conditions of cirrhosis of liver like compensated and decompensated
states, hepatitis C virus was significantly responsible than the hepatitis B virus 24.7% vs 9.6% (p<0.001) and 14.3% vs
6.4% (p<0.001) respectively. The most significant finding was very higher rate of diabetes among hepatitis C which
was 22.6% while only 1.8% among hepatitis B virus infection (p<0.001).
Conclusion: Hepatitis C virus was highly related with the presence of diabetes than hepatitis B.
Key-words- Diabetes mellitus, Prevalence, Hepatitis B virus, Hepatitis C virus
Digestive Manifestations During Infection with COVID-19: Experience of A Moro...semualkaira
COVID-19 due by the new SARS-CoV-2 coronavirus, is responsible for the current pandemic. If respiratory symptoms are in the foreground and condition the prognosis of the disease, the gastrointestinal symptoms initially described as rare are reported more and more frequently in the latest studies. Those studies suggest that they are a sign of a favorable environment for an aggravation of the disease, probably in connection with the development of inflammation. Inevitably, the influence of the gut microbiota is suspected.
Digestive Manifestations During Infection with COVID-19: Experience of A Moro...semualkaira
COVID-19 due by the new SARS-CoV-2 coronavirus, is responsible for the current pandemic. If respiratory symptoms are in the foreground and condition the prognosis of the disease, the gastrointestinal symptoms initially described as rare are reported more and more frequently in the latest studies. Those studies suggest that they are a sign of a favorable environment for an aggravation of the disease, probably in connection with the development of inflammation. Inevitably, the influence of the gut microbiota is suspected.
Evolution and Revolution: Current Issues in HIV and HCV Co-infection
Chapter 1 – HIV-Hepatitis C Virus Co-infection: An evolving epidemic
Chapter 2 - Management of HIV infection in HIV/HCV co-infected patients
Chapter 3 - Management of HCV in co-infected patients
Chapter 4 - HCV Therapy: Direct acting antiviral agents in co-infected individuals
Chapter 5 - Drug interactions with directly acting antivirals for HCV: Overview & challenges in HIV/HCV Co-infection
Chapter 6 - Complicated cases
Chapter 7 - Future trials of Hepatitis C therapy in the HIV co-infected
Chapter 8 - HCV infection in marginalized populations
Chapter 9 - HIV/HCV Co-infection: Through the eyes of a co-infected hemophiliac
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common
cancers of the world and surgery is an effective treatment for that.
However, long-term complications, such as diarrhea, are the focus
on the postoperative quality of life. Until now, the etiologies of
diarrhea after esophagectomy are still ill-defined.
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common cancers of the world and surgery is an effective treatment for that. However, long-term complications, such as diarrhea, are the focus on the postoperative quality of life. Until now, the etiologies of diarrhea after esophagectomy are still ill-defined.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. Correspondence
www.thelancet.com/gastrohep Published online April 15, 2020 https://doi.org/10.1016/S2468-1253(20)30118-7 1
Enteric involvement in
hospitalised patients
with COVID-19 outside
Wuhan
Early studies1,2
of coronavirus disease
2019 (COVID-19) reported that the
proportion of patients presenting
with gastrointestinal symptoms was
low. However, evidence for enteric
involvement is emerging.3–6
Recently,
a multicentre study7
in Hubei province
(China) indicated that gastrointestinal
symptoms were common in patients
with COVID-19. We examined the
intestinal symptoms of patients with
COVID-19 from multiple medical
centres located in and outside of Hubei
province.
We retrospectively analysed data
from 232 patients who were positive
for severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) RNA
admitted to 14 hospitals (two
hospitals in Guangdong province, two
in Hubei province, and ten in Jiangxi
province) between Jan 19, 2020, and
March 6, 2020. Most patients were
admitted because of fever, cough,
dyspnoea, and chest CT findings
consistent withCOVID-19 pneumonia.
Diagnosis of COVID-19 was based on
positive SARS-CoV-2 RNA tests. Two
patients with pre-existing digestive
diseases were excluded from our
analysis. The analysis was approved
by the institutional review boards
of Sun Yat-sen University and the
participating hospitals. Full details of
the methods used are in the appendix
(p 1).
The clinical and demographic
characteristics of the 230 patients
analysed are shown in the appendix
(p 2). There were 129 men and
101 women; median age was
47·5 years (range 7–90). The most
common symptoms at onset of illness
were fever (193 [84%] patients), cough
(159 [69%] patients), and sputum
production (98 [43%] patients).
Diarrhoea was observed in 49 (21%)
patients. Patients with diarrhoea were
older and were more likely to have
comorbidities than patients without
diarrhoea (table). A greater proportion
of patients admitted to hospital had
diarrhoea as the outbreak progressed:
nine (43%) of 21 patients admitted
between Feb 12 and March 6, 2020,
had diarrhoea versus 40 (19%) of 209
patients admitted between Jan 19 and
Feb 11, 2020.
More patients with diarrhoea
showed severe symptoms of
pneumonia than those without
diarrhoea, with an adjusted (for age,
sex, and comorbidities) odds ratio
(OR) of 4·95 (95% CI 2·14–11·70,
p=0·0002). Although there was no
correlation between diarrhoea and
oxygen supplementation, a greater
proportion of patients with diarrhoea
required ventilator support (adjusted
OR 6·52 [95% CI 1·44–35·86],
p=0·018) and required admission
to intensive care (3·19 [1·25–8·16],
p=0·015). Most laboratory test results
did not differ significantly between
patients with and without diarrhoea
(table).
A similar proportion of patients with
and without diarrhoea were given
antibiotics and antiviral medications
(table). Less frequent gastrointestinal
symptoms included bloody stool
(ten [4%] of 230 patients) and
abdominal pain (three [1%] of
230 patients). No patients presented
with gastrointestinal symptoms
alone, which might reflect the
With
diarrhoea
(n=49)
Without
diarrhoea
(n=181)
p value
Age, years 55 (40–65) 46 (36–57) 0·017
Sex ·· ·· 0·87
Male 27 (55%) 102 (56%) ··
Female 22 (45%) 79 (44%) ··
Any comorbidity 19 (39%) 39 (22%) 0·017
Date of admission to hospital ·· ·· 0·022
Jan 19–Feb 11, 2020 40 (82%) 169 (93%) ··
Feb 12–March 6, 2020 9 (18%) 12 (7%) ··
Severe COVID-19 disease 26 (53%) 35 (19%) <0·0001
Oxygen supplementation 44 (90%) 143 (79%) 0·10
Ventilatory support 6 (12%) 3 (2%) 0·0036
Intensive care 15 (31%) 20 (11%) 0·0015
Died 4 (8%) 2 (1%) 0·020
White blood cell count, ×10⁹ cells per L 5·6 (2·0) 5·6 (3·0) 1·0
Lymphocyte count, ×10⁹ cells per L 1·0 (0·6) 1·1 (0·5) 0·28
Neutrophil count, ×10⁹ cells per L 3·4 (1·8) 3·9 (2·9) 0·34
Alanine aminotransferase, U/L 37·9 (27·4) 34·0 (24·4) 0·36
Aspartate aminotransferase, U/L 39·3 (27·0) 34·7 (17·9) 0·19
Total bilirubin, μmol/L 12·5 (7·3) 11·5 (5·9) 0·36
Activated partial thromboplastin time, s 30·5 (9·5) 31·0 (7·8) 0·74
D-dimer, mg/L 1·0 (1·8) 1·6 (5·4) 0·48
Procalcitonin, ng/mL 0·29 (0·69) 0·19 (0·36) 0·25
Erythrocyte sedimentation rate, mm/h 40·7 (30·0) 23·8 (18·7) 0·0002
C-reactive protein, mg/L 40·5 (52·0) 30·0 (38·3) 0·16
Antibiotics 36 (73%) 138 (76%) 0·71
Antiviral treatment 49 (100%) 180 (99%) 1·0
Data are median (IQR), n (%), or mean (SD). p values comparing patients with and without diarrhoea were
calculated by use of Fisher’s exact test, Mann–Whitney U test, or Student’s t test. COVID-19=coronavirus
disease 2019.
Table 1: Demographic and clinical characteristics of patients with COVID-19 with and without
diarrhoea
See Online for appendix
Lancet Gastroenterol Hepatol
2020
Published Online
April 15, 2020
https://doi.org/10.1016/
S2468-1253(20)30118-7
2. Correspondence
2 www.thelancet.com/gastrohep Published online April 15, 2020 https://doi.org/10.1016/S2468-1253(20)30118-7
recommendation for patients with
mild symptoms to stay at home.
Our observations of patients with
COVID-19 from medical centres
within and outside of Hubei province
(appendix pp 3–5) are consistent
with other reports3–9
showing
gastrointestinal involvement in
COVID-19. Many of these studies3–9
reported patients with COVID-19 who
only had gastrointestinal symptoms
during the course of the illness, and
another study2
reported patients
with COVID-19 who presented
with diarrhoea 1–2 days before the
development of fever and dyspnoea.
We noted correlations between the
presence of diarrhoea and the severity
of respiratory symptoms, and found
that more patients with diarrhoea
required ventilator support and were
admitted to intensive care than those
without diarrhoea. Similarly, during
the SARS outbreak in 2003, more
patients with SARS who had diarrhoea
required ventilator support and
were admitted to intensive care than
those who did not have diarrhoea.10
Understanding the mechanism
underlying these correlations could
help to identify novel intervention
strategies to reduce or prevent severe
outcomes of COVID-19.
The proportion of patients with
COVID-19 who had gastrointestinal
symptoms in our analysis (21%
with diarrhoea) is higher than that
observed in earlier reports (2–3%
with diarrhoea1,11
). Similarly, a greater
proportion of patients admitted to
hospital had diarrhoea as the outbreak
progressed. This difference could
be due to a heightened awareness
of the gastrointestinal symptoms
of COVID-19 among clinicians.
Additionally, the passing of time
could have allowed the virus to
accumulate mutations that might
have affected its tropism for the
intestines. The difference could also
reflect geographic differences between
populations studied (ie, early studies
from Wuhan vs our patients from four
other cities). The increasing number
of patients with COVID-19 who have
gastrointestinal symptoms warrants
further study.
A potential limitation of our
analysis is the absence of data on
the prevalence of asymptomatic
COVID-19. It is likely that more
asymptomatic patients existed,
leading to an overestimation of
the proportion of patients with
gastrointestinal symptoms. Another
possible confounding factor is that the
antivirals, lopinavir and ritonavir, are
known to cause diarrhoea. However,
we did not observe a correlation
between diarrhoea and use of antiviral
medicine or antibiotics.
All authors declare no competing interests. This
work was partially supported by National Natural
Science Foundation of China 81770571 (to LZ),
81970452 (to PL), 81774152 (to RZ), the
Guangzhou Science andTechnology Plan Projects
201803040019 (to PL), and the Key Projects of
Dongguan City Social Science andTechnology
Development Plan 201750715001464 (to LS).YW,
JL, LS,YZ, LH, and LZ contributed equally; LZ, GY, RZ,
and PL are joint senior authors.
YunleWan, Jie Li, Lihan Shen,
Yifeng Zou, Linlin Hou, *Lixin Zhu,
Howard S Faden, ZhipengTang,
Mang Shi, Na Jiao,Yichen Li,
Sijing Cheng,Yibo Huang,
DingfengWu, Zhifeng Xu, Linnuo Pan,
Jun Zhu, GuangjunYan, Ruixin Zhu,
Ping Lan
zhulx6@mail.sysu.edu.cn
Department of Hepato-Biliary Surgery, Sixth
Affiliated Hosptial (YW), and Department of
Colorectal Surgery, Guangdong Provincial Key
Laboratory of Colorectal and Pelvic Floor Diseases,
Sixth Affiliated Hospital, Guangdong Institute of
Gastroenterology (YZ, LZ, NJ,YL, SC,YH, PL),
SunYat-sen University, Guangzhou, China; School
of Medicine, SunYat-sen University, Guangzhou
and Shenzhen, China (LH, MS, PL); Jingzhou
Hospital ofTraditional Chinese Medicine, Jingzhou,
China (JL, GY); Dongguan People’s Hospital,
Dongguan, China (LS); Department of Pediatrics,
Division of Infectious Diseases, Jacobs School of
Medicine and Biological Sciences, University at
Buffalo, Buffalo, NY, USA (HSF); Institute of
Digestive Disease, Longhua Hospital, Shanghai
University ofTraditional Chinese Medicine,
Shanghai, China (ZT); and Department of
Bioinformatics, Putuo People’s Hospital,Tongji
University, Shanghai, China (DW, ZX, LP, JZ, RZ)
1 Chen N, Zhou M, Dong X, et al.
Epidemiological and clinical characteristics of
99 cases of 2019 novel coronavirus
pneumonia inWuhan, China: a descriptive
study. Lancet 2020; 395: 507–13.
2 Wang D, Hu B, Hu C, et al. Clinical
characteristics of 138 hospitalized patients
with 2019 novel coronavirus-infected
pneumonia inWuhan, China. JAMA 2020;
published online Feb 7. DOI:10.1001/
jama.2020.1585.
3 Holshue ML, DeBolt C, Lindquist S, et al. First
case of 2019 novel coronavirus in the United
States. N Engl J Med 2020; 382: 929–36.
4 ZhangW, Du RH, Li B, et al. Molecular and
serological investigation of 2019-nCoV
infected patients: implication of multiple
shedding routes. Emerg Microbes Infect 2020;
9: 386–89.
5 WangW, XuY, Gao R, et al. Detection of
SARS-CoV-2 in different types of clinical
specimens. JAMA 2020; published online
March 11. DOI:10.1001/jama.2020.3786.
6 Xiao F,Tang M, Zheng X, LiuY, Li X, Shan H.
Evidence for gastrointestinal infection of
SARS-CoV-2. Gastroenterology 2020; published
online March 3. DOI:10.1053/
j.gastro.2020.02.055.
7 Pan L, Mu M,Yang P, et al. Clinical
characteristics of COVID-19 patients with
digestive symptoms in Hubei, China:
a descriptive, cross-sectional, multicenter
study. Am J Gastroenterol 2020; published
online March 18, 2020. https://journals.lww.
com/ajg/Documents/COVID_Digestive_
Symptoms_AJG_Preproof.pdf?PRID=AJG_
PR_031820 (preprint).
8 Luo S, Zhang X, Xu H. Don’t overlook digestive
symptoms in patients with 2019 novel
coronavirus disease (COVID-19).
Clin Gastroenterol Hepatol 2020; published
online March 20. doi:10.1016/
j.cgh.2020.03.043.
9 Fang D, Ma J, Guan J, et al. Manifestations of
digestive system in hospitalized patients with
novel coronavirus pneumonia inWuhan,
China: a single-center, descriptive study.
Chin J Dig 2020; published online Feb 23.
DOI:10.3760/cma.j.issn.0254-1432.
2020.0005.
10 LeungWK,To KF, Chan PK, et al.
Enteric involvement of severe acute
respiratory syndrome-associated coronavirus
infection. Gastroenterology 2003; 125: 1011–17.
11 Huang C,WangY, Li X, et al. Clinical features of
patients infected with 2019 novel coronavirus
inWuhan, China. Lancet 2020; 395: 497–506.