Gastrointestinal Disease and COVID-19: A Review of Current Evidence

Assessing the impact of non-pharmaceutical interventions against COVID-19 on 64 notifiable infectious diseases in Australia: A Bayesian Structural Time Series model

BACKGROUND

Several studies have examined the effect of non-pharmaceutical interventions (NPIs) on COVID-19 and other infectious diseases in Australia and globally. However, to our knowledge none have sufficiently explored their impact on other infectious diseases with robust time series model. In this study, we aimed to use Bayesian Structural Time Series model (BSTS) to systematically assess the impact of NPIs on 64 National Notifiable Infectious Diseases (NNIDs) by conducting a comprehensive and comparative analysis across eight disease categories within each Australian state and territory, as well as nationally.

METHODS

Monthly data on 64 NNIDs from eight categories were obtained from the Australian National Notifiable Disease Surveillance System. The incidence rates for each infectious disease in 2020 were compared with the 2015-2019 average and then with the expected rates in 2020 using a BSTS model. The study investigated the causal effects of 2020 interventions and analysed the impact of government policy restrictions at the national level from January 2020 to December 2022.

RESULTS

During the COVID-19 pandemic interventions in Australia, there was a 38 % (95 % Credible Interval [CI] [9 %, 54 %]) overall relative reduction in incidence reported across all disease categories compared to the 2015-2019 average. Significant reductions were observed in bloodborne diseases: 20 % (95 % CI [10 %, 29 %]), respiratory diseases: 79 % (95 % CI [52 %, 91 %]), and zoonoses: 8 % (95 % CI [1 %, 17 %]). Conversely, vector-borne diseases increased by 9 % over the same period. Reductions and intervention effects varied by state and territory, with higher policy stringency linked to fewer cases for some diseases.

CONCLUSIONS

COVID-19 NPIs also impacted the transmission of other infectious diseases, with varying effects across regions reflecting diverse outcomes in response strategies throughout Australia. The findings could inform public health strategies and provide scientific evidence to support the development of early warning systems for future disease outbreaks.

Machine Learning Algorithm-Aided Determination of Predictors of Mortality from Diabetic Foot Sepsis at a Regional Hospital in South Africa During the COVID-19 Pandemic

Background and Objectives: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated factors associated with major amputation and mortality in patients admitted with DFS during the COVID-19 pandemic. Materials and Methods: Demographic information, COVID-19 and HIV status, clinical findings, laboratory results, treatment and outcome from records of patients with diabetic foot sepsis, were collected and analysed. Supervised machine learning algorithms were used to compare their ability to predict mortality due to diabetic foot sepsis. Results: Overall, 114 records were found and 57.9% (66/114) were of male patients. The mean age of the patients was 55.7 (14) years and 47.4% (54/114) and 36% (41/114) tested positive for COVID-19 and HIV, respectively. The median c-reactive protein was 168 mg/dl, urea 7.8 mmol/L and creatinine 92 µmol/L. The mean potassium level was 4.8 ± 0.9 mmol, and glycosylated haemoglobin 11.2 ± 3%. The main outcomes included major amputation in 69.3% (79/114) and mortality of 37.7% (43/114) died. AI. The levels of potassium, urea, creatinine and HbA1c were significantly higher in the deceased. Conclusions: The COVID-19 pandemic led to an increase in the rate of major amputation and mortality in patients with DFS. The in-hospital mortality was higher in patients above 60 years of age who tested positive for COVID-19. The Random Forest algorithm of ML can be highly effective in predicting major amputation and death in patients with DFS.

Incidence trends of gastric cancer in the United States over 2000-2020: A population-based analysis

BACKGROUND

Gastric cancer ranks among the top cancers in terms of both occurrence and death rates in the United States (US). Our objective was to provide the incidence trends of gastric cancer in the US from 2000 to 2020 by age, sex, histology, and race/ethnicity, and to evaluate the effects of the COVID-19 pandemic.

METHODS

We obtained data from the Surveillance, Epidemiology, and End Results 22 program. The morphologies of gastric cancer were classified as adenocarcinoma, gastrointestinal stromal tumor, signet ring cell carcinoma, and carcinoid tumor. We used average annual percent change (AAPC) and compared pairs using parallelism and coincidence. The numbers were displayed as both counts and age-standardized incidence rates (ASIRs) per 100000 individuals, along with their corresponding 95% confidence intervals (CIs).

RESULTS

Over 2000-2019, most gastric cancers were among those aged ≥55 years (81.82%), men (60.37%), and Non-Hispanic Whites (62.60%). By histology, adenocarcinoma had the highest incident cases. During the COVID-19 pandemic, there was a remarkable decline in ASIRs of gastric cancer in both sexes and all races (AAPC: -8.92; 95% CI: -11.18 to -6.67). The overall incidence trends of gastric cancer were not parallel, nor identical.

CONCLUSIONS

The incidence of gastric cancer shows notable variations by age, race, and sex, with a rising trend across ethnicities. While the overall incidence has declined, a noteworthy increase has been observed among younger adults, particularly young Hispanic women; however, rates decreased significantly in 2020.

A prospects tool in virus research: Analyzing the applications of organoids in virus studies

Organoids have emerged as a powerful tool for understanding the biology of the respiratory, digestive, nervous as well as urinary system, investigating infections, and developing new therapies. This article reviews recent progress in the development of organoid and advancements in virus research. The potential applications of these models in studying virul infections, pathogenesis, and antiviral drug discovery are discussed.

Determinants and outcomes of acute pancreatitis in patients hospitalized for COVID-19: Early pandemic experience

OBJECTIVES

To examine the predictors and outcomes associated with the development of acute pancreatitis (AP) in patients hospitalized with Coronavirus Disease 2019 (COVID-19).

METHODS

This is an observational analysis of the 2020 National Inpatient Sample Database. The study includes adult patients who were admitted with a confirmed diagnosis of COVID-19 and stratifies them based on the presence or absence of AP during their hospitalization. Predictors of AP development between the two groups and differences in outcomes are examined. Multivariate logistic regression analysis using Stata/BE 17.0 is conducted, with adjustments made for age, sex, race, and Charlson Comorbidity Index (CCI). Statistical significance is determined at a p-value of <0.05.

RESULTS

Significant factors associated with an increased risk of AP in COVID-19 patients include Hispanic ethnicity, higher Charlson Comorbidity Index (CCI) score, residence in states located in the southern region, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use. COVID-19 patients who developed AP were also found to be at higher risk of adverse outcomes, including mortality, acute coronary syndrome, acute kidney injury, sepsis, septic shock, in-hospital cardiac arrest, invasive mechanical ventilation, upper gastrointestinal bleeding, prolonged length of stay, and increased healthcare cost.

CONCLUSIONS

In hospitalized patients with COVID-19, the presence of AP is associated with increased mortality and morbidity. Risk factors for developing AP in this population include Hispanic ethnicity, residence in the southern region, higher Charlson Comorbidity Index (CCI) score, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use.

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample

Background

There is no uniformity in the available literature concerning the effects of coronavirus disease 2019 (COVID-19) viral illness on people with inflammatory bowel disease (IBD).

Methods

We conducted an analysis using the 2020 National Inpatient Sample (NIS) database to compare the outcomes of COVID-19 hospitalized patients with and without IBD.

Results

Of 1,050,040 patients admitted with COVID-19, 5,750 (0.5%) also had IBD. The group with COVID-19 and IBD had higher percentages of females and White individuals and a greater prevalence of chronic lung disease, peripheral vascular disease, and liver disease. However, after accounting for confounding variables, there was no significant difference in mortality rates, length of hospital stays, or hospitalization costs between the two groups.

Conclusion

According to our findings, the presence of IBD does not appear to elevate the risk of COVID-19 complications.

Relationship between hepatic and pancreatic steatosis and the COVID-19 pneumonia total severity score and prognosis with an emphasis on prognostic strength

PURPOSE

To investigate the relationship between hepatic steatosis (HS), pancreatic steatosis (PS), and coexisting HS and PS and the Coronavirus disease-2019 (COVID-19) pneumonia total severity score (TSS) and prognosis, assessed through computed tomography (CT), and to evaluate the degree of effectiveness of the three steatosis conditions on TSS and prognosis.

METHODS

This retrospective study involved 461 patients (255 male and 206 female, median age of 53 years) with COVID-19 who underwent unenhanced chest CT. HS, PS, and coexisting HS and PS, assessed through CT, were compared with patient demographics, comorbidities, TSS, hospitalization and intubation requirements, and mortality rates. The parameters were compared using Mann-Whitney U and chi-square tests. The parameters of three groups of patients with only HS, only PS, and both HS and PS were compared using the Kruskal-Wallis test.

RESULTS

Results revealed that TSS (P < 0.001 for all) and hospitalization rates (P < 0.001 for all except for HS [P = 0.004]) were higher in patients with HS, PS, and both than in those without. Intubation (P = 0.003) and mortality rates (P = 0.018) were significantly higher solely in patients with PS. However, TSS, hospitalization, and diabetes mellitus were significantly higher than in age-standardized analyses for PS. In a comparison between only HS, only PS, and coexisting HS and PS in 210 patients, the highest TSS was in the coexistence group (P < 0.001).

CONCLUSION

The TSS and hospitalization rates correlate with HS, PS, and coexisting HS and PS, whereas intubation and mortality rates only correlate with PS. However, TSS correlates with coexisting HS and PS at the highest rate.

Gastrointestinal tract and viral pathogens

Viral gastroenteritis is the most common viral illness that affects the gastrointestinal (GI) tract, causing inflammation and irritation of the lining of the stomach and intestines. Common signs and symptoms associated with this condition include abdominal pain, diarrhea, and dehydration. The infections commonly involved in viral gastroenteritis are rotavirus, norovirus, and adenovirus, which spread through the fecal-oral and contact routes and cause non-bloody diarrhea. These infections can affect both immunocompetent and immunocompromised individuals. Since the pandemic in 2019, coronavirus gastroenteritis has increased in incidence and prevalence. Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition, treatment with oral rehydration salts, and prompt vaccination. Improved sanitation measures have also played a key role in reducing the transmission of infection. In addition to viral hepatitis causing liver disease, herpes virus, and cytomegalovirus are responsible for ulcerative GI disease. They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals. Hepatitis viruses, Epstein-Barr virus, herpesvirus 8, and human papillomavirus have been involved in benign and malignant diseases. This mini review aims to list different viruses affecting the GI tract. It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management. This will help primary care physicians and hospitalists diagnose and treat patients more easily.

A Meta-Analysis on the Association between Peptic Ulcer Disease and COVID-19 Severity

The association between peptic ulcer disease and the severity of coronavirus disease 2019 (COVID-19) is inconclusive across individual studies. Thus, this study aimed to investigate whether there was a significant association between peptic ulcer disease and COVID-19 severity through a meta-analysis. The electronic databases (Web of Science, Wiley, Springer, EMBASE, Elsevier, Cochrane Library, Scopus and PubMed) were retrieved for all eligible studies. The Stata 11.2 software was used for all statistical analyses. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated by a random-effects meta-analysis model. The heterogeneity was evaluated by the inconsistency index (I²) and Cochran's Q test. Egger's analysis and Begg's analysis were conducted to evaluate the publication bias. Meta-regression analysis and subgroup analysis were done to explore the potential source of heterogeneity. Totally, our findings based on confounding variables-adjusted data indicated that there was no significant association between peptic ulcer disease and the higher risk for COVID-19 severity (pooled OR = 1.17, 95% CI: 0.97-1.41) based on 15 eligible studies with 4,533,426 participants. When the subgroup analysis was performed by age (mean or median), there was a significant association between peptic ulcer disease and a higher risk for COVID-19 severity among studies with age ≥ 60 years old (pooled OR = 1.15, 95% CI: 1.01-1.32), but not among studies with age < 60 years old (pooled OR = 1.16, 95% CI: 0.89-1.50). Our meta-analysis showed that there was a significant association between peptic ulcer disease and a higher risk for COVID-19 severity among older patients but not among younger patients.

Gastrointestinal Cancer and Vaccination Safety during COVID-19 Pandemic

BACKGROUND: During our past 18 months, we must be faced with the current COVID-19 pandemic era with much uncertainty in the continuation of multimodality treatment of the gastrointestinal cancer patients. Especially in this immunocompromised group with the history of previous chemotherapy treatment, these patients have an increased risk of COVID-19 transmission. Many studies have been reported about the current recommendation for gastrointestinal cancer patients during this pandemic, but there might be a lack of evidence about the safety of vaccination for the gastrointestinal cancer patients. AIM: Since the vaccination has been approved by our government medical support, we would evaluate the safety of the COVID-19 vaccination program in gastrointestinal cancer patients. METHODS: All gastrointestinal cancer patients who have been already diagnosed with cancer will be included in this study. The vaccine-related sign symptoms will be recorded and evaluated. The chemotherapy schedule was not been interrupted following the vaccination. The patient who refused to receive the second vaccination dose will be excluded from this study. RESULTS: Thirty-two patients were included in this study (our past 6-month evaluation from February till August 2021), colorectal adenocarcinoma was the most common gastrointestinal cancer according to organ-specific (25 patients), the others were gastric adenocarcinoma, pancreatic adenocarcinoma, and small bowel gastrointestinal stromal tumor. Both of them already received two doses of COVID-19 vaccine during this period, we reported there was no side effect related to these and the chemotherapy cycle has not been interrupted during vaccination. All of the patients could be tolerated it well and did not refuse to continue the treatment. CONCLUSION: There were no significant signs and symptoms of vaccine-related side effects on gastrointestinal cancer patients. COVID-19 vaccination during this pandemic and following the chemotherapy schedule on any kind of gastrointestinal cancer patients was safe and could be suggested as a routine protocol.