[Two consecutive attacks of diarrhea in 15 COVID-19 patients: An antibiotic-associated one following the viral one]

Of the 971 patients admitted to our Clinic with suspected COVID-19, 15 (1.5%) presented with two consecutive attacks of diarrhea. One of those patients (a 47-year-old woman) required admission to the intensive care unit and mechanical ventilation. She died on the 11th day of hospitalization (18th day of illness). The first attack of diarrhea in those patients occurred on the 6 th (4th-7th) day of disease and lasted 3 (3-5) days. The second attack of diarrhea developed 11 (8-12) days after the initial onset of diarrhea. Despite the existing trend, the difference in the duration of the diarrhea and the maximum number of bowel movements per day between the first and second attacks was not statistically significant (p = 0.130; p = 0.328). There was no significant difference between the patients with a double attack of diarrhea and those with no diarrhea, regarding the results of the complete blood count, biochemical blood tests, and inflammation biomarkers.

Two consecutive attacks of diarrhea in 15 COVID-19 patients: An antibiotic-associated one following the viral one

Of the 971 patients admitted to our Clinic with suspected COVID-19, 15 (1.5%) presented with two consecutive attacks of diarrhea. One of those patients (a 47-year-old woman) required admission to the intensive care unit and mechanical ventilation. She died on the 11th day of hospitalization (18th day of illness). The first attack of diarrhea in those patients occurred on the 6th (4th-7th) day of disease and lasted 3 (3-5) days. The second attack of diarrhea developed 11 (8-12) days after the initial onset of diarrhea. Despite the existing trend, the difference in the duration of the diarrhea and the maximum number of bowel movements per day between the first and second attacks was not statistically significant (p = 0.130; p = 0.328). There was no significant difference between the patients with a double attack of diarrhea and those with no diarrhea, regarding the results of the complete blood count, biochemical blood tests, and inflammation biomarkers.

Disruption of the pro-inflammatory, anti-inflammatory cytokines and tight junction proteins expression, associated with changes of the composition of the gut microbiota in patients with irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a pathologic condition characterized by changes in gut microbiome composition, low-grade inflammation, and disruption of intestinal wall permeability. The interaction between the gut microbiome and the disease manifestation remains unclear. The changing of tight junction proteins and cytokines expression throughout the gastrointestinal tract in IBS patients has not been studied yet.

AIM OF THE STUDY

To assess the changes of gut microbiome composition, tight junction proteins, and cytokines expression of intestinal mucosa from the duodenum to the distal part of the colon in IBS patients and healthy volunteers.

METHODS

In 31 IBS patients (16 patients with IBS-D; 15 patients with IBS-C) and 10 healthy volunteers the expression of CLD-2, CLD-3, CLD-5, IL-2, IL-10, and TNF-α in mucosal biopsy specimens was determined by morphological and immune-histochemical methods. The qualitative and quantitative composition of the intestinal microbiota was assessed based on 16S rRNA gene sequencing in both groups of patients.

RESULTS

The expression of IL-2 and TNF-α was significantly increased in IBS patients compared with the controls (p<0.001), with a gradual increase from the duodenum to the sigmoid colon. The expression of IL-10, CLD-3, and CLD-5 in mucosal biopsy specimens of these patients was lower than in the control group (p<0.001). Increased ratios of Bacteroidetes and decreased ratios of Firmicutes were noted in IBS patients compared to healthy volunteers (p<0.05).

CONCLUSION

IBS patients have impaired gut permeability and persisting low-grade inflammation throughout the gastrointestinal tract. Changes in the gut microbiota may support or exacerbate these changes.

Characteristics of vessels wall, myocardium and epicardial fat in patients with heart failure with preserved ejection fraction with and without metabolic syndrome

BACKGROUND

The structure of the vessels wall and myocardium is an independent predictor of cardiovascular events among patients with heart failure (HF). There is a data that metabolic syndrome (MS) accelerates the progression of structural and functional disorders of the vessel wall and myocardium. Epicardial fat thickness was shown to correlates with visceral fat thickness and to be an independent predictor of cardiovascular diseases.

OBJECTIVES

To investigate the characteristics of vessels wall, myocardium and epicardial fat in patients with HF with preserved ejection fraction (HF-PEF) with and without MS.

MATERIALS AND METHODS

A total of 59 patients with HF-PEF were included. First group - patients without MS (n = 29), second group - patients with MS (n = 30). Following characteristics were evaluated: Arterial stiffness (stiffness index [SI]), reflection index (RI), augmentation index (Alp). The function of big vessels was evaluated by phase shift (PS), of the small vessels - by the occlusion index (OI). Investigations were performed by the device "angioscan." Sizes of the heart chambers and the thickness of the myocardium wall and epicardial fat thickness were evaluated echocardiographically.

RESULTS

Among the patients from both groups significant changes of the vessels wall and myocardial structure were found. SI at the first group was 8.26 ± 1.72 m/s, at the second group - 9.62 ± 5.61 m/s (non-significant, P = 0.25). RI at the first group was 39.79 ± 18.12%, at the second - 31.43 ± 17.23% (non-significant, P = 0.086). Alp at the first group was 23.47 ± 14.69%, at the second - 11.16 ± 17.14% (significant, P = 0.011). PS at the first group was 8.05 ± 7.72 ms, at the second - 5.34 ± 4.4 ms (non-significant, P = 0.36). OI at the first group was 1.34 ± 0.58%, at the second - 1.46 ± 0.54% (non-significant, P = 0.46). Significant intergroup differences were found in the interventricular septum thickness: 10.3 ± 1.2 mm at the first group and 11.3 ± 1.6 mm at the second (P = 0.01); left ventricle wall thickness: 10.1 ± 1.1 mm at the first group and 11.3 ± 1.6 mm - at the second (P = 0.001); left ventricle myocardium mass: 157.75 ± 46.11 g at the first group and 201.19 ± 58.82 g - at the second (P = 0.005). The epicardial fat thickness was 14.8 ± 1.8 mm at the first group and 36.7 ± 1.7 mm - at the second group (significant, P = 0.001).

CONCLUSION

Among patients with hypertension and HF-PEF with and without MS significant changes in the structure of the vessel wall and myocardium were found. The presence of MS lead to more pronounced myocardial remodeling. The epicardial fat thickness is significantly higher among patients MS.