Background Gastrointestinal complications of COVID‐19 have been reported over the last year. One such manifestation is bowel ischaemia. This study thus aims to provide a more holistic review of our current understanding of COVID‐19‐induced bowel ischaemia. Method and Results A meticulous search was performed using different keywords in PubMed and Google Scholar. Fifty‐two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25 702 patients were included in our study after the completion of the qualitative assessment. Discussion The common symptoms of GIT in COVID‐19 patients are as diarrhoea, vomiting, nausea and abdominal pain. The mechanism of bowel ischaemia is associated with the formation of emboli which is related to COVID‐19’s high affinity for angiotensin‐converting enzyme‐2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients present with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute intestinal ischaemia (mesenteric). Management is usually initiated with gastric decompression, fluid resuscitation, and haemodynamic support. Surgical intervention is also sought. Conclusion Intestinal ischaemia presenting in patients with COVID‐19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to triage patients with COVID‐19 to suspect intestinal ischaemia and to help in diagnosis and management.
Normal gut flora plays various beneficial roles for the human body, including the protection against inflammatory states and mucosal viral infections. It also influences the immune system of the body. The metabolites produced by the gut bacteria control local and other systemic organs' immune functions like the lungs and brain, playing a role in their response to acute and chronic illnesses. Probiotics have shown beneficial effects on lung health. On the contrary, dysbiosis is associated with several diseases, including asthma, chronic bronchitis, emphysema, allergies, and other acute viral infections. By altering the diet of patients with respiratory diseases like patients with chronic obstructive pulmonary diseases (COPD), we may be able to mitigate their conditions. This literature review aims to discuss the mechanisms altering the gastrointestinal flora, the pathophysiology of gut and lung axis, the role of diet in gut microbe health, and the association of COPD with gut dysbiosis and peptic ulcer disease (PUD). We have extracted the data from PubMed and Google Scholar, consisting of review articles, case-control studies, and animal studies. The studies showed an association between gut microbes and different lung diseases. It is found that gut dysbiosis not only disrupts intestinal immunity but may also facilitate the development of COPD. Present studies also show an increased seroprevalence of Helicobacter pylori in patients with COPD. The strategies that can improve lung functions, especially in COPD patients, include prebiotics and probiotic supplementation to a diet more balanced than the current average American diet.
Obstructive sleep apnea (OSA) is a common condition, and if not treated can be a significant risk factor for multiple comorbidities like hypertension (HTN), coronary artery disease (CAD), and congestive heart failure (CHF). The underlying pathophysiology involves coagulation and inflammatory pathways, including an overactive sympathetic nervous system. This ultimately causes hemodynamic changes and subclinical myocardial injuries. We reviewed the published literature about the impact of continuous positive airway pressure (CPAP) when used as a mode of treatment to reduce the OSA effects on cardiomyocytes. We found that the results were mixed, including both ill and good effects. The cardiac markers like N-terminal pro-brain natriuretic peptide (NT-proBNP) and atrial natriuretic peptide (ANP) were reduced, implying the decrease in the incidence of heart failure with CPAP treatment in a few of the studies. They also proved a significant decrease in harmful cardiovascular (CV) outcomes, while others concluded that CPAP therapy might be stressful on the heart, causing an elevation in cardiac troponin T levels. However, the impact on inflammatory markers is still indeterminate and needs more research in future.
Background: Gastrointestinal complications of this COVID-19 have been reported over the last year. One such manifestation is bowel ischemia. This study thus aims to provide a more holistic review of our current understanding of COVID-19 induced bowel ischemia. Method and Results: A meticulous search was performed using different keywords in PubMed, EMBASE, and Google Scholar. Fifty-two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25,702 patients were included in our study after the completion of the qualitative assessment. Discussion: COVID-19 commonly presents in the GIT as diarrhea, vomiting, and nausea. The mechanism of bowel ischemia is associated with the formation of emboli which is related to COVID-19’s high affinity for angiotensin-converting enzyme-2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients presented with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute mesenteric ischemia. Management was usually initiated with gastric decompression, fluid resuscitation, and hemodynamic support. Surgical intervention was also sought. Conclusion: Mesenteric ischemia presenting in patients with COVID-19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to be able to triage patients with COVID-19 to suspect mesenteric ischemia and to help in diagnosis and management.
Recent advances in technology have led to significantly greater use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation with better outcomes. The novel ProtekDuo veno‐venous ECMO (CardiacAssist, Inc.) has gained significance as it facilitates effective decompression of the right heart in patients with acute decompensation, while also providing consistent and effective gas exchange by eliminating recirculation. Here, we report two cases of effectively using ProtekDuo veno‐venous ECMO: one case as a bridge to lung transplantation and another case as a bridge to heart‐lung transplantation.
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