Cases of co-infection and secondary infection emerging during the current Coronavirus Disease-19 (COVID-19) pandemic are a major public health concern. Such cases may result from immunodysregulation induced by the SARS-CoV-2 virus. Pandemic preparedness must include identification of disease natural history and common secondary infections to implement clinical solutions.
Aim
Inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and celiac disease (CeD) more commonly affect women of reproductive age. The aim of our study is to evaluate the association between ectopic pregnancy (EP) in women with IBD, IBS, and CeD.
Methods
We searched MEDLINE, Web of Science, and CINAHL from the database inception date through December 31, 2020. Peer‐reviewed publications and abstracts written in English, regarding the association between EP and IBD, IBS, and CeD with controls were included. Quality assessment was conducted based on GRADE criteria. Analyses included odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity between studies was presented with I2.
Results
We included five population‐based cohort studies. The odds of EP significantly increased in Crohn's disease (CD), but not ulcerative colitis (UC) as compared to IBD‐free controls. The odds of EP significantly increased in IBS as compared to women without IBS. No significant difference was observed for odds of EP in women with and without CeD.
Conclusions
Possible evidence of associations between EP and CD as well as IBS were observed; however, not with UC and CeD. Pregnant women with chronic inflammatory bowel pathologies may warrant cautious monitoring.
Covid-19-induced coagulopathy and observed benefits with anticoagulationRecently, literature recognized an association between coronavirus disease-19 and coagulopathy [1]. COVID-19 illness severity is positively correlated with coagulopathy markers, including prolonged prothrombin time, increased fibrin degradation products, decreased platelet count, and elevated D-dimer [2-8]. However, the pathogenesis of COVID-19-induced coagulation and the role of anticoagulation treatment remain unclear.Presence of intravascular and extravascular fibrin is a prominent feature of sepsis-induced acute lung injury [9]. COVID-19 is identified as a sepsis-inducing pathogen, which may contribute to low PaO2 levels associated with decreased arterial blood perfusion secondary to sepsis and coagulopathy [10]. An observational study reported that many critically ill COVID-19 patients presented with clinical manifestations of shock, indicating vascular endothelial dysregulation [10]. Additionally, COVID-19 is characterized by an increase in pro-inflammatory markers, such as IL-6 and IL-Iβ, and induction of cytokine storms. Such events cause alveolar thickening, hyaline membrane formation, diffuse organ damage, and microthrombi via coagulation cascade activation which contributes to low SpO2 [11]. In fact, the pulse oximeter may inaccurately identify blood oxygen saturation (SpO2) in COVID-19 patients due to sepsis-induced vasodilation, formation of arteriovenous shunts, and culmination of venous blood containing carbon dioxide (CO2) [12].An observational study identified thrombotic event incidence in COVID-19 patients who received nadroparin 2850 IU or 5700 IU (if body weight was > 100 kg) subcutaneous per day as thromboprophylaxis [13]. Venous Thromboembolism (VTE) in 27 % of patients (95 % Confidence Interval (CI) 17-37 %) and arterial thrombotic events in 3.7 % of patients (95 % CI 0-8.2 %) were confirmed with computed tomography pulmonary angiography (CTPA) and/or ultrasonography. Of these events, pulmonary embolism (PE) was the most common complication (n = 25, 81 % of all thrombotic events) [13]. A subsequent Italian observational study reported 16.7 % (95 % CI 8.7-29.6 %) of a total of 48 intensive care unit (ICU) patients had at least one thromboembolic event, although all patients received thromboprophylaxis with weight adjusted low-molecular-weight heparin (LMWH). This study also found that 6.4 % of 314 ward patients (95 %CI 4.2 %-9.6 %) experienced at least one thromboembolic event. For the total patients, pulmonary embolism makes up 35.7 % of all reported complications. This study presented a higher incidence of thromboembolic events in patients admitted to ICU compared to general ward patients. In a recent case series, Negri et al, (2020) explored the effect of dose-titrated heparin on the PaO2/FiO2 level. During the first 72 h of heparin administration, all 27 patients experienced improved oxygen partial pressure (PaO2 in mmHg) to fraction of inspired oxygen (FiO2) ratio compared to pre-coagulation treatment(p = 0.013) [1...
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