Chest x-ray resolution after SARS-CoV-2 infection

Aim To analyse the resolution of chest X-ray findings in relation to laboratory parameters in patients infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a two- month followup. Analysis of chest X-ray findings in the first few months after the disease is the main goal of our work. Methods Out of the total of 343 patients chest X-ray findings were followed in 269 patients. Patients were divided into groups according to the severity of findings. D-dimer, inflammatory markers, blood cell count, neutrophil lymphocyte ratio (NLR) were analysed. Chest X-ray was analysed during the hospitalization on the day of admission, on the third, the seventh and the fourteenth day (scoring method was used). After discharge chest X-ray was performed in a two-week follow-up, then after one and two months, and after three months if necessary. Results Incomplete chest X-ray resolution was identified in 24 (39.34%) patients with severe, 27 (22.31 %) patients with moderate and in three (3.91%) patients with mild findings. Statistical significance was established in overall score by comparison between all groups (p<0.001), and in the moderate compared to the mild group (p=0.0051). The difference of NLR in the severe compared to the moderate group was observed (p=0.0021) and in the severe group compared to the mild group (p=0.00013). Conclusion Chest X-ray findings persisted mostly in the severe group followed by the moderate and mild ones. Long-term followup is necessary for the appropriate treatment and prevention of fibrosis, and reduction of symptoms

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Recurrent Lower Gastrointestinal Bleeding Due to Angiodysplasia in the Rectum: Endoscopic Treatment with Heater Probe

Lower gastrointestinal bleeding due to vascular abnormalities is commonly found in the elderly and on the right side of the colon. Such lesions are still difficult to diagnose and manage. We report a case with recurrent and massive lower gastrointestinal bleeding due to angiodysplasia at an unusual age and localization, which was diagnosed and treated endoscopically

Protective effect of probiotics on the healing of colon anastomosis after ischemia and reperfusion injury in rats

Introduction: Intestinal transplantation (IT) is one of the important cause of intestinal ischemia and reperfusion injury. It is well known that anastomotic problems seen after IT are mainly related to reperfusion injury. Probiotics are non-pathogenic live microorganisms that are used for various bowel diseases due to their beneficial effects on bowel functions. Wound healing is an important bowel function and impaired healing is a series trouble after IT and ischemic bowel. In this study, we aimed to investigate the effect of probiotics on the intestinal anastomosis healing process. Methods: Forty male SD rats were divided into four groups: Group I(n:10) colonic anastomosis only; Group II (n:10) colonic anastomosis after IR injury; Group III (n:10) probiotic and colonic anastomosis; Group IV (n:10) probiotic and colonic anastomosis after IR injury. Probiotics are given 250 million/day, po. The left colon was cut and anastomotised with continuous 6/0 nylon suture after 60 minutes of reperfusion. Animals were monitored for 7 days, then sacrificed. Macroscopic findings, anastomotic bursting pressures and histopathologic findings were evaluated. Results: Probiotics were well tolerated in the treatment groups (Groups III and IV). Macroscopically, there were no anastomotic leaks or abscess formation in either of the probiotic groups (Groups III and IV). Anastomotic bursting pressures of probiotics groups tended to be highly compared with the ischemic control group (Group II), although the difference was not statistically significant. The histologic scores of probiotic groups were very similar to the control groups. Conclusion: The probiotic groups had less adhesions according to the macroscopic findings; anastomotic bursting pressures tended to be high and histologically, they had equivalent healing scores compared with the control groups. We conclude that probiotics have some beneficial effect to impaired anastomotic healing processes , without any side effects on the colon in the colon. Therefore they might be considered as a supportive treatment in IT patients