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    Acute acalculous cholecystitis on a COVID-19 MESHD patient: a case report

    Authors: Edoardo Mattone; Maria Sofia; Elena Schembari; Valentina Palumbo; Rosario Bonaccorso; Valentina Randazzo; Gaetano La Greca; Carmelo Iacobello; Domenico Russello; Saverio Latteri

    doi:10.21203/rs.3.rs-42230/v1 Date: 2020-07-13 Source: ResearchSquare

    Background coronavirus disease-19 MESHD ( COVID-19 MESHD) has spread to several countries around the world and has become an unprecedented pandemic. We report an extremely rare case of acute acalculous cholecystitis MESHD on a COVID-19 MESHD patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 MESHD patient.Case presentation: a COVID-19 MESHD patient was diagnosed with acute acalculous cholecystitis MESHD and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient’s clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous MESHD, the severe inflammation MESHD made surgery difficult to perform.Conclusions acalculous cholecystitis MESHD was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous MESHD histopathology pattern and the gallbladder wall ischemia MESHD was probably caused by vascular insufficiency MESHD secondary to severe acute respiratory distress syndrome MESHD of COVID-19 pneumonia MESHD. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects MESHD small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia MESHD, nausea MESHD, vomiting MESHD, and diarrhea MESHD. Although the lack of evidence and guidelines about the management of patient with acute cholecystitis MESHD during COVID-19 pandemic MESHD, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis MESHD on COVID-19 MESHD patients.

    Exposure risk of patients with chronic infectious wounds during the COVID-19 MESHD outbreak and its countermeasures

    Authors: Haiying Zhou; Qianjun Jin; hui lu

    doi:10.21203/rs.3.rs-36407/v2 Date: 2020-06-18 Source: ResearchSquare

    BACKGROUND: A large number of cases of pneumonia MESHD caused by novel β-coronavirus emerged in Hubei Province, China, at the end of 2019 and demonstrated great potential for transmission. At present, known independent risk factors include age, diabetes MESHD and other chronic diseases MESHD, which may be similar to the patients with chronic wound, thus we try to explore the clinical characteristics, prognostic factors and management recommendation of patients with chronic infective wounds during the COVID-19 MESHD epidemic period. METHODS: In this single-center, retrospective observational study, we included all cases with chronic infective wounds that came to our hospital between the full outbreak of the COVID-19 MESHD in China (January 23, 2020) and the latest date prior to posting (20 April 2020). Demographic data, comorbidities, laboratory and imaging findings, consultation history and clinical outcomes (lesion cured, uncontrolled, amputated, etc. as of May 10, 2020) were collected for all individuals. Patients were subdivided into gangrene MESHD, traumatic infection MESHD and other types of soft tissue infection MESHD wound (including bedsores, gout ruptures MESHD, stab wounds and so on) according to the causes of wound and their disease-related information were compared group by group.RESULTS : Among the total 81 patients with chronic infective wounds, 60% were male, with a mean age of 60.8 years (SD 18.6), including 38 (47%) patients with traumatic infection MESHD, 29 (36%) gangrene MESHD cases, and 14 (17%) other soft tissue infection MESHD wounds. Common comorbidities are hypertension MESHD (32%), diabetes MESHD (32%), cardiovascular disease MESHD (24%), and kidney injury MESHD (12%), and the patients with gangrenes have the most comorbidities. As of May 10, 2020, there were 78 patients discharged and their average stay time is 15.8 days(SD 14.2), while people still at the hospital is 39.7days(SD 8.7)much longer than the discharged and also has more comorbidities. But there is no significant difference in the hospitalization time of three types of wounds. And fortunately, none of all the patients were infected by coronavirus.CONCLUSION: The majority of patients with chronic wounds are severely ill with high risk of infection and poor prognosis, therefore management of patients with chronic wounds should be improved.

    Severe colon ischemia in patients with severe COVID-2019 infection: a report of three cases

    Authors: Ana Almeida; Víctor Valentí Azcárate; Carlos Sánchez Justicia; Fernando Martínez Regueira; Pablo Martí-Cruchaga; Javier A. Cienfuegos; Fernando Rotellar

    doi:10.21203/rs.3.rs-31237/v1 Date: 2020-05-25 Source: ResearchSquare

    Severe disease MESHD caused by the SARS-CoV coronavirus MESHD is characterized by patients presenting with respiratory distress associated with a systemic inflammatory response syndrome (cytokine storm). Sixteen to thirty percent of COVID-19 MESHD patients also have gastrointestinal symptoms. Here we present three cases of COVID-19 MESHD who developed colonic ischemia MESHD. Three males aged 76, 68 and 56 with respiratory distress and receiving mechanical ventilation presented episodes of rectal bleeding MESHD, abdominal distension and signs of peritoneal irritation. Endoscopy (case 1) and computed tomography angiography revealed colonic ischemia MESHD and pneumoperitoneum MESHD.One patient (case 2) underwent surgery in which perforation of the gangrenous MESHD cecum and colonic ischemia MESHD was confirmed.In all three patients D-dimer levels were markedly increased (2170, 2100 and 7360 ng/mL). All three patients died shortly after diagnosis.In severe COVID-19 MESHD disease, the pathogenic cause has increasingly become attributed to the development of disseminated intravascular coagulation MESHD secondary to the systemic inflammatory response.

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MeSH Disease
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SARS-CoV-2 Proteins


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