Background and Aim COVID‐19 is a new pandemic disease recognized by the World Health Organization. It mainly affects the respiratory system, but it can also affect other systems. The gastrointestinal system has been found to be affected in many patients. This study investigated the COVID‐19‐related gastrointestinal manifestations and the effect of gastrointestinal involvement on the course and outcome of the disease. Methods This was a retrospective descriptive study conducted on 140 COVID‐19 polymerase chain reaction‐positive symptomatic individuals admitted to Al‐Shafa Hospital – Medical City Complex in Baghdad, Iraq during the period 2 March 2020 to 12 May 2020. Demographic data and clinical presentation and laboratory data were extracted from the case sheets of the patients and were also obtained from direct communication with the patients, their families, and medical staff. Results Gastrointestinal (GI) symptoms alone were detected in 23.6% of the patients; 44.3% of the patients presented with only respiratory symptoms, and 32.1% presented with both respiratory and GI symptoms. Patients with only GI symptoms had less severe disease compared with those who had both GI and respiratory symptoms, who had more severe disease with higher mortality. Overall mortality was 8.6%, with no mortality in the GI symptoms alone group. The highest severity and mortality were in patients with both GI and respiratory symptoms (48.39 and 13.33%, respectively). Conclusions COVID‐19‐related gastrointestinal symptoms are common, and their presence alone carries a better prognosis, but their presence with respiratory symptoms is associated with higher morbidity and mortality.
The introduction of a SEAT in the ED is associated with earlier recognition of severe sepsis and improvements in quality of care.
Purpose: To examine the feasibility of snuffbox arteriovenous fistula as a first option for haemodialysis Background: Snuffbox arteriovenous fistula is the most distal native anastomosis possible for haemodialysis access. It was described by Rassat et al. This systematic review evaluates all literature investigating the feasibility and efficiency of performing snuffbox arteriovenous fistula. Methods: PubMed, Cochrane Library and Google Scholar were systematically searched for all English articles related to snuffbox arteriovenous fistula. Included studies were appraised using relevant appraisal tools. Results: Eleven papers were included, one prospective trial and the remaining being retrospective. Two trials compared snuffbox arteriovenous fistula to the standard Cimino-Brescia wrist fistula. Factors predicting success included vessel diameter, diabetes, age <70 years, male gender, palpable radial artery, central venous system patency and surgical technique. Patency rates ranged from 61% to 87% at 1-year follow-up and decreased to 36.3%–87% on longer duration follow-up. Ipsilateral radiocephalic fistula was successfully formed in 45%–100% of snuffbox arteriovenous fistula that failed (average of 73.5%). Conclusion: This is a systematic review investigating snuffbox arteriovenous fistula’s efficacy. The current literature is scarce and of poor quality; however, it does reflect that, in the well-selected patient, snuffbox arteriovenous fistula is a good and valid option for first-line haemodialysis. It provides a long segment of vessel for needling and also spares the proximal vessels for future use. Ability to effectively convert to wrist fistula in the event of snuffbox arteriovenous fistula failure provides longevity to native haemodialysis access before prosthetic adjuncts are required. This review provides recommendation for well-constructed randomised controlled trials to help delineate snuffbox arteriovenous fistula efficacy and investigate factors that affect success of these fistulas.
The evidence supporting or opposing serial lipase as a prognostic factor for pancreatitis is weak and consists mainly of retrospective analyses. The only prospective data identified suggested benefits to serial lipase in prognosis. Further prospective studies evaluating the prognostic value of serial lipase in the adult population with both traumatic and non-traumatic pancreatitis are required given the paucity of available evidence.
Background: Recent guidelines from the British Society of Gastroenterology published in April 2018, recommended performing random colonic biopsies (RCB) in endoscopically normal colonic mucosa when investigating chronic diarrhoea in adults to rule out microscopic colitis; however, cost effectiveness was not accounted for due to poor evidence base. There is now more evidence that RCBs are of low yield and of significant cost. Methods: A two-centre audit of current practice was conducted at Rockingham General Hospital and Fremantle Hospital in Western Australia, aiming to determine the yield of RCB in macroscopically normal mucosa for microscopic colitis, from 1 January 2009 to 30 June 2018, with comparisons of practice and results between gastroenterologists and general surgeons. Variability in the indications (diarrhoea and non-diarrhoea indications) for RCBs was determined and the cost of consumables, additional endoscopy time and histopathology analysis were calculated. Results: A total of 872 normal colonoscopies with RCBs were included; 48.7% of colonoscopies with RCB were for diarrhoea. Only 1.5% of RCBs were positive for microscopic colitis; 3.1% of patients with diarrhoea had microscopic colitis. Only one patient received pharmacologial treatment as a result of the test. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42. Conclusion: RCBs from normal colonic mucosa have poor yield and are costly. Local guidelines should be updated, so RCBs are performed only in patients with a high degree of suspicion of an organic cause of chronic diarrhoea.
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