Aim In addition to respiratory symptoms, COVID‐19 can present with gastrointestinal complaints suggesting possible faeco‐oral transmission. The primary aim of this review was to establish the incidence and timing of positive faecal samples for SARS‐CoV‐2 in patients with COVID‐19. Methods A systematic literature review identified studies describing COVID‐19 patients tested for faecal virus. Search terms for MEDLINE included ‘clinical’, ‘faeces’, ‘gastrointestinal secretions’, ‘stool’, ‘COVID‐19’, ‘SARS‐CoV‐2’ and ‘2019‐nCoV’. Additional searches were done in the American Journal of Gastroenterology, Gastroenterology, Gut, Lancet Gastroenterology and Hepatology, the World Health Organization Database, the Centre for Evidence‐Based Medicine, New England Journal of Medicine, social media and the National Institute for Health and Care Excellence, bioRxiv and medRxiv preprints. Data were extracted concerning the type of test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and evidence of viable faecal virus or faeco‐oral transmission of the virus. Results Twenty‐six relevant articles were identified. Combining study results demonstrated that 53.9% of those tested for faecal RNA were positive. The duration of faecal viral shedding ranged from 1 to 33 days after a negative nasopharyngeal swab with one result remaining positive 47 days after onset of symptoms. There is insufficient evidence to suggest that COVID‐19 is transmitted via faecally shed virus. Conclusion There is a high rate of positive polymerase chain reaction tests with persistence of SARS‐CoV‐2 in faecal samples of patients with COVID‐19. Further research is needed to confirm if this virus is viable and the degree of transmission through the faeco‐oral route. This may have important implications on isolation, recommended precautions and protective equipment for interventional procedures involving the gastrointestinal tract.
Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.
Both LVMR and RVMR are similar in terms of safety and efficacy. Although not randomized, this data may suggest a better functional outcome and quality of life in patients having RVMR for ERP.
AimIn addition to respiratory symptoms, patients with COVID-19 can present with gastrointestinal complaints suggesting a possible faeco-oral transmission route. The primary aim of this review is to establish the incidence and timing of positive faecal samples for the SARS-CoV-2 virus in patients with COVID-19. Methods A systematic literature review was performed to identify studies describing COVID-19 patients tested for the virus in their stool. Data were extracted concerning the nature of the test, number and timing of positive samples, incidence of positive faecal tests after negative nasopharyngeal swabs and any evidence of viable faecal virus or faeco-oral transmission of the virus. ResultsThere were 26 relevant articles identified. Combining these results demonstrated that 53·9% of those tested for faecal RNA in these studies were positive. Duration of faecal viral shedding ranged from 1 to 33 days after nasopharyngeal swab turned negative with one result remaining positive after 47 days of onset of symptoms. There was insufficient evidence to draw firm conclusions about the proportion of cases potentially transmitted through infection via faecally shed virus. ConclusionThere is a relatively high rate of positive tests and persistence of the SARS-CoV-2 virus in faecal samples of selected patients with COVID-19. Further research is needed to demonstrate how much these positive tests correlate with viable virus and transmission through the faeco-oral route. This may have important implications for duration of isolation, precautions recommended in individuals undertaking a period of isolation, protective equipment for health professionals and interventional procedures involving the gastrointestinal tract. What does this paper add to the existing literature?We synthesise all available evidence from multiple sources and clarify the uncertainty around faecal shedding of SARS-CoV-2 virus, its persistence and duration from onset of symptoms, and after negative nasopharyngeal swabs. Evidence for faeco-oral transmission is plausible and demonstrated in one study though its relative contribution to transmission remains unclear. Persistent viral shedding of SARS-CoV-2 in faeces -a rapid review
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