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Pathophysiological mechanisms underlying gastrointestinal symptoms in patients with COVID-19

World Journal of Gastroenterology 2021年第19期27卷 2341-2352页

作者： Byungchang Jin Rajan Singh Se Eun Ha Hannah Zogg Paul J Park Seungil Ro Department of Physiology and Cell Biology University of Nevada School of MedicineRenoNV 89557United States Department of Medicine Renown HealthRenoNV 89557United States

Gastrointestinal(GI)symptoms,such as diarrhea,abdominal pain,vomiting,and anorexia,are frequently observed in patients with coronavirus disease 2019(COVID-19).However,the pathophysiological mechanisms connecting these GI symptoms to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infections remain *** studies indicate that the entry of SARS-CoV-2 into intestinal cells leads to downregulation of angiotensin converting enzyme 2(ACE2)receptors resulting in impaired barrier *** intestinal ACE2 functions as a chaperone for the amino acid transporter B0AT1,the B0AT1/ACE2 complex within the intestinal epithelium acts as a regulator of gut microbiota composition and *** to the B0AT1/ACE2 complex lead to microbial dysbiosis through increased local and systemic immune *** studies have also suggested that altered serotonin metabolism may be the underlying cause of GI disorders involving *** findings of elevated plasma serotonin levels and high fecal calprotectin in COVID-19 patients with diarrhea indicate that the viral infection evokes a systemic inflammatory response that specifically involves the ***,the elevated proinflammatory cytokines correlate with elevated serotonin and fecal calprotectin levels further supporting the evidence of GI inflammation,a hallmark of functional GI ***,the finding that rectal swabs of COVID-19 patients remain positive for SARS-CoV-2 even after the nasopharynx clears the virus,suggests that viral replication and shedding from the GI tract may be more robust than that of the respiratory tract,further indicating fecal-oral transmission as another important route of viral *** review summarized the evidence for pathophysiological mechanisms(impaired barrier function,gut inflammation,altered serotonin metabolism and gut microbiota dysbiosis)underlying the GI symptoms in patients with COVID-19.

关键词： COVID-19 Gastrointestinal symptoms Gut microbiota dysbiosis Impaired barrier function Serotonin Angiotensin converting enzyme 2 receptor

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Challenges confronting rural hospitals accentuated during COVID-19

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The Journal of Biomedical Research 2020年第6期34卷 397-409页

作者： Anthony D.Slonim Helen See Sheila Slonim renown health RenoNV 89503USA Medicine and Pediatrics University of NevadaReno School of MedicineRenoNV 89557USA Hospital Operations Carilion ClinicRoanokeVA 24017USA.

The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding ***-five years later,1350 CAHs serve approximately 18% of the US population and a systematic policy evaluation has yet to be *** policy analysis serves to define challenges faced by CAHs through a literature review addressing the four major categories of payment,quality,access to capital,and ***,this analysis describes how current challenges to maintain sustainability of CAHs over time are accentuated by gaps in public health infrastructure and variability in individual health care plans exhibited during the COVID-19 pandemic.

关键词： rural hospitals critical access hospitals COVID-19 coronavirus

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SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit

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World Journal of Cardiology 2022年第8期14卷 454-461页

作者： Daniel Antwi-Amoabeng Chanwit Roongsritong Moutaz Taha Bryce David Beutler Munadel Awad Ahmed Hanfy Jasmine Ghuman Nicholas T Manasewitsch Sahajpreet Singh Claire Quang Nageshwara Gullapalli Department of Internal Medicine Reno School of MedicineUniversity of NevadaRenoNV 89502United States Institute for Heart and Vascular health Renown Regional Medical CenterRenoNV 89502United States

BACKGROUND Timely and accurate identification of subgroup at risk for major adverse cardiovascular events among patients presenting with acute chest pain remains a *** available risk stratification scores are ***,a new scoring system called the Symptoms,history of Vascular disease,Electrocardiography,Age,and Troponin(SVEAT)score has been shown to outperform the History,Electrocardiography,Age,Risk factors and Troponin(HEART)score,one of the most used risk scores in the United *** To assess the potential usefulness of the SVEAT score as a risk stratification tool by comparing its performance to HEART score in chest pain patients with low suspicion for acute coronary syndrome and admitted for overnight *** We retrospectively reviewed medical records of 330 consecutive patients admitted to our clinical decision unit for acute chest pain between January 1st to April 17th,*** avoid potential biases,investigators assigned to calculate the SVEAT,and HEART scores were blinded to the results of 30-d combined endpoint of death,acute myocardial infarction or confirmed coronary artery disease requiring revascularization or medical therapy[30-d major adverse cardiovascular event(MACE)].An area under receiving-operator characteristic curve(AUC)for each score was then calculated.C-statistic and logistic model were used to compare RESULTS A 30-d MACE was observed in 11 patients(3.33%of the subjects).The AUC of SVEAT score(0.8876,95%CI:0.82-0.96)was significantly higher than the AUC of HEART score(0.7962,95%CI:0.71-0.88),P=*** logistic model,SVEAT score with cut-off of 4 or less significantly predicts 30-d MACE(odd ratio 1.52,95%CI:1.19-1.95,P=0.001)but not the HEART score(odd ratio 1.29,95%CI:0.78-2.14,P=0.32).CONCLUSION The SVEAT score is superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients.

关键词： Acute chest pain Risk stratification tool Symptoms,history of Vascular disease,Electrocardiography,Age,and Troponin score History,Electrocardiography,Age,Risk factors and Troponin score

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Management of hypertension in COVID-19

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World Journal of Cardiology 2020年第5期12卷 228-230页

作者： Daniel Antwi-Amoabeng Bryce D Beutler Alastair E Moody Zahara Kanji Nageshwara Gullapalli Christopher J Rowan Department of Internal Medicine Reno School of MedicineUniversity of NevadaRenoNV 89052United States Department of Anesthesiology University of UtahSalt Lake CityUT 84132United States renown Institute for Heart and Vascular health RenoNV 89512United States

The ACE2 receptor plays a central role in severe acute respiratory syndrome coronavirus 2 host cell entry and *** has therefore been postulated that angiotensin converting enzyme inhibitors and angiotensin receptor blockers may upregulate ACE2 expression and thus increase susceptibility to *** suggest that alternative anti-hypertensive agents should be preferred among individuals who may be exposed to this increasingly common and potentially lethal virus.

关键词： Angiotensin converting enzyme inhibitor Angiotensin receptor blocker Carvedilol Coronavirus disease-19 COVID-19 SARS-CoV-2 Verapamil

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女装业界对“洗涤剂、洗衣机、洗衣店”的期望

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中国洗涤用品工业 2017年第5期 54-62页

作者：神崎晃岳霄 renown

本文讨论了女装与洗涤剂、洗衣机、洗衣店的关系,通过具体事例指出了女装相关业界存在的问题,最后说明了各业界共享信息的重要性。

关键词：洗涤剂女装洗衣机洗衣店事故期望

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Randomized, double-blinded, placebo-controlled trial evaluating simethicone pretreatment with bowel preparation during colonoscopy

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World Journal of Gastrointestinal Endoscopy 2019年第6期11卷 413-423页

作者： Mohit Rishi Jaskarin Kaur Mark Ulanja Nicholas Manasewitsch Molly Svendsen Abubaker Abdalla Shashank Vemala Julie Kewanyama Karmjit Singh Nirmal Singh Nageshwara Gullapalli Eric Osgard Department of Internal Medicine University of NevadaReno School of MedicineRenown Regional Medical CenterRenoNV 89502 United States Gastroenterology Consultants LTDRenoNV 89502United States Aureus Univeristy School of Medicine Oranjestad 31CAruba American International Medical University Gross Islet 7610Saint Lucia

BACKGROUND The presence of small air bubbles and foam are an impediment to a successful colonoscopy. They impair an endoscopist’s view and diminish the diagnostic accuracy of the study. This has been particularly noted to be of concern with the switch to lower volume polyethylene glycol (PEG) and bisacodyl combination preparation. AIM To evaluate the effect of oral simethicone addition to bowel preparation on intraluminal bubbles reduction during colonoscopy. METHODS Described is a prospective, randomized, multi-center, double-blinded, placebocontrolled study to evaluate the use of premixed simethicone formulation with split-regimen, low-volume PEG-bisacodyl combination bowel preparation for 168 outpatients undergoing screening, surveillance, and diagnostic colonoscopies. Primary outcome includes evaluation of bubbles during colonoscopy graded using the Intraluminal Bubbles Scale. Secondary outcomes include evaluation of the Boston Bowel Preparation Scale (BBPS), total number of polyps, polyp size differentiation, polyp laterality, adenoma detection, mass detection, cecal insertion time, withdrawal time, and patient-reported adverse events. RESULTS Higher Intraluminal Bubbles grades III and IV (less than 75% of the mucosa cleared of bubbles/foam requiring intervention with simethicone infused wash) were detected in the placebo group [Simethicone n = 4/84 vs Placebo n = 20/84 (P = 0.007)]. BBPS total score was 7.42 [standard deviation (SD)=± 1.51] in the simethicone group and 7.28 (SD =± 1.44) in the placebo group (P = 0.542) from a total of 9. Significantly higher number of adenomas were detected in the simethicone group (P = 0.001). CONCLUSION The addition of simethicone to bowel preparation is well advised for its antifoaming properties. The results of this study suggest that addition of oral simethicone can improve bowel wall visibility.

关键词： Simethicone Intraluminal bubbles Colonoscopy Adenoma detection

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