Gastrointestinal manifestations and dynamics of liver enzymes in children and adolescents with COVID-19 infection: A systematic review and meta-analysis

Objectives: To improve the knowledge on Coronavirus Disease (COVID-19) infection, we aimed to study the prevalence of gastrointestinal symptoms and the dynamics of liver enzymes in children infected with COVID-19. Methods: We performed a systematic search of all the articles published up to May 2020 in the following databases: PubMed-MEDLINE, Scopus, and Cochrane. We chose the fixed-or random-effect model for analysis based on the I2 statistic. The included data were analyzed to identify the prevalence of gastrointestinal symptoms (diarrhea, vomiting or nausea) and to identify the dynamics of liver enzymes in children and adolescents diagnosed with COVID-19. Results: We detected an overall prevalence of all gastrointestinal symptoms of 26 (95 CI: 0.18-0.35). The pooled prevalence of diarrhea and nausea/vomiting was 12 (95 CI: 0.08-0.16) with no heterogeneity (P = 0.19; I2 = 23.53) and 11 (95 CI: 0.05-0.17), respectively. The pooled prevalence of elevated ALT and AST and LDH was 12 (95 CI: 0.07-0.17), 14 (95 CI: 0.10-0.18) and 33 (95 CI: 0.12-0.54), respectively among the included studies. Conclusions: According to our systematic review and meta-analysis, 26 of the children and adolescents diagnosed with COVID-19 present gastrointestinal symptoms. This paper has provided a comprehensive overview of the prevalence of digestive symptoms of COVID-19 and of the liver enzymes dynamics in children and adolescents. © 2020, Author(s)

Sequelae of COVID-19 at long-term follow-up after hospitalization

Aim. To assess long-term sequelae of COVID-19 in hospitalized patients at 3 to 7 months after discharge.Material and Methods. The whole of 700 patients hospitalized to the temporary COVID-19 treatment center hosted by the FSBI “National Medical Research Center of Cardiology” of the Ministry of Health of Russia from April to June 2020 were invited to participate in a follow-up study. At 3-7 months after the index hospitalization, patients or their proxies were contacted via telephone in order to obtain information on their vital status, cardiovascular and other conditions or their complications, and new hospitalizations. In addition, patients were invited to an outpatient visit under the "COVID-19-follow-up" program, encompassing physical examination and a comprehensive battery of laboratory and instrumental tests, including spirometry, chest computed tomography (CT) and the six minute walk test (6MWT). Further, dyspnea was assessed using the mMRC (Modified Medical Research Council) Dyspnea Scale. Results: We were able to contact 87.4% (612/700) of patients or their proxies. At follow-up, 4.4% (27) patients died, of which 96.3% (26) had cardiovascular diseases (CVD). A total of 213 patients aged 19 to 94 years old (mean age 56.8±12.5, median 57 years [49.0; 64.0]; men, 55.4%) agreed come for an outpatient visit and to participate in the “COVID-19-follow-up” program. Since discharge, 8% (17) of patients required new hospitalizations, and more than a half of these patients (58.8%; 10/17) had CVD-related hospitalizations. A total of 8.4% (18) patients experienced worsening of hypertension, 9 (4.2%) patients had newly diagnosed hypertension, 2 (0.9%) – coronary artery disease patients experienced new/recurrent angina symptoms. 4 (1.9%) patients had newly diagnosed coronary artery disease, and one patient had an ischemic stroke. At the outpatient visit, 114 (53.5%) patients had some symptoms, most frequently, shortness of breath (33%), fatigue (27.4%), chest pain (11.3%), and abnormal heartbeats (8.5%). Based on the mMRC Scale, 59% of patients had dyspnea of varying severity. Most patients had a normal vital capacity (VC), which was moderately reduced in 3.3% and severely reduced in 0.5% of patients. Chest CT scans were obtained in 78 (36.6%) patients, whose worst lung damage scores during hospitalization were CT3 or CT4. One in ten patients (10.8%) with severe lung damage during acute infection had persisting ground glass opacities, 35.9% developed fibrotic changes, 79.6% of patients had linear or fine focal opacities. According to the 6MWT data, 12.3% of patients walked less than 70% of the predicted distance, 67% walked 71 to 99% of the predicted distance, and 20.7% of patients were able to walk 100% of their predicted distance.Conclusion. These data suggest long-term negative sequelae of COVID-19 in more than half of hospitalized patients

СОПОСТАВЛЕНИЕ РЕЗУЛЬТАТОВ КОМПЬЮТЕРНОЙ ТОМОГРАФИИ И ВНУТРИСОСУДИСТОГО УЛЬТРАЗВУКОВОГО ИССЛЕДОВАНИЯ В ОЦЕНКЕ ПАРАМЕТРОВ АТЕРОСКЛЕРОТИЧЕСКИХ БЛЯШЕК КОРОНАРНЫХ АРТЕРИЙ

Purpose. To determine the possibilities of coronary CT-angiography (CTA) in evaluation of qualitative and qualitative parameters of coronary plaques in comparison with intravascular ultrasound (IVUS).Matherials and methods. 37 patients (29 men, 8 women) with symptoms of acute coronary syndrome (ACS) were included in the study. Unstable angina was detected in 24 patients, acute myocardial infarction (AMI) – in 13 patients. Averageage was 58 [44; 65] years. CTA had been performed as the first method of beam diagnostics in all cases if it was not necessary to use the emergency selective coronary angiography (CAG). IVUS was performed in one, two or three coronary arteries of every patient. Total, 60 coronary lesionsin 55 arteries were examined with IVUS. IVUS data was compared with CTA data.Results. Methods well correlated in detection of plaque burden (r = 0.823; p < 0.0001), plaque length (r = 0.932, p < 0.0001), remodeling index(RI) (r = 0.906; p < 0.0001). Sensitivity and specificity of CTA in detection of irregular contour was 96.1% and 88.9% (area under ROC-curve 0.925), positive remodeling – 100% and 97.4% (area under ROC-curve 0.974). CTA and IVUS in evaluation of spotty calcinates was not coincide in 9 plaques, sensitivity and specificity of CTA in detection of 71% and 100% (area under ROC-curve 0.855).Discussion. Comparison of CTA and IVUS was performed in evaluation of plaques features in patients with ACS. This analysis showed high comparability of methods for evaluation of coronary stenosis degree, RI, plaque burden, length and contour. Thus, the characteristics of plaques according to CTA data can be used to stratify the risk of development of ACS.Conclusion. CTA – fast non-invasive method of coronary plaques evaluation. CTA correlates well with IVUS.Цель исследования: определить возможности КТ-ангиографии (КТА) в оценке количественных и качественных характеристик атеросклеротических бляшек (АСБ) в коронарных артериях по сравнению с данными внутрисосудистого ультразвукового исследования (ВСУЗИ).Материал и методы. В исследование было включено 37 пациентов (29 мужчин, 8 женщин), поступивших в отделение неотложной кардиологии с клинической картиной острого коронарного синдрома (ОКС), из которых у 24 диагностирована нестабильная стенокардия, у 13 – острый инфаркт миокарда. Средний возраст больных составил 58 [44; 65] лет. Всем пациентам первым из лучевых методов исследования была выполнена КТА коронарных артерий при отсутствии необходимости экстренного проведения инвазивной коронарной ангиографии. Каждому из 37 пациентов ВСУЗИ было выполнено в одной, двух или трех коронарных артериях. Всего с помощью ВСУЗИ обследовано 60 измененных участков в 55 коронарных артериях. Данные ВСУЗИ сравнивались с результатами КТА.Результаты. Корреляционный анализ показал высокую сопоставимость методов в определении бремени бляшки (r = 0,823; p < 0,0001), протяженности бляшки (r = 0,932; p < 0,0001), индекса ремоделирования (ИР) (r = 0,906; p < 0,0001). Чувствительность и специфичность метода в выявлении неровности контура составили 96,1 и 88,9% (площадь под кривой 0,925), положительного ремоделирования – 100 и 97,4% (площадь под кривой 0,974) соответственно. При оценке точечных кальцинатов в 9 мягких бляшках данные КТА не совпадали с данными ВСУЗИ. а чувствительность и специфичность метода составили 71 и 100% (площадь под кривой 0,855) соответственно.Обсуждение. В представленной работе впервые в нашей стране проведен сравнительный анализ состояния бляшек в коронарных артериях по данным КТА и ВСУЗИ у больных с ОКС, который показал высокую сопоставимость методов для определения степени стенозирования просвета коронарных артерий, ИР, бремени, протяженности и контуров бляшки. Таким образом, характеристики АСБ по данным КТА можно использовать для стратификации риска развития ОКС.Заключение. КТА является быстрым неинвазивным методом оценки состояния АСБ. Результаты КТА хорошо коррелируют с данными ВСУЗИ

Delayed ct scan of the lungs in patients with covid-19 pneumonia

Purpose. Assessment the state of the lungs using CT in the dynamic follow-up of pa-tients who have suffered from viral COVID-19 pneumonia in the delayed period af-ter 6-10 months, and to identify the relationship of residual lung changes with the clinical condition and results of external respiratory function (ERF). Materials and methods. We examined 78 patients who had suffered from bilateral polysegmental viral COVID-19 pneumonia in April-May 2020, using multi-spiral computed tomography (CT) of the lungs. All patients had a medical history, performed CT scans of the lungs in the acute and delayed (6-10 months after hospitalization) phases, and a study of FVD in the delayed phase. The analysis of a series of tomograms of the lungs in dynamics was carried out. We developed an severity score of the lung condition (LungSS), expressed in the total score, which was calculated based on the score of typical patterns characteristic of viral Covid19-pneumonia, as well as residual changes and areas of fibrosis. LungSS was calculated for each patient in the acute and delayed follow-up periods. Results. The present study shows the dynamics of lung changes in the delayed peri-od 6-10 months after the viral Covid19-pneumonia. Residual lung changes were detected in 66 people (84,6%). Of these, 35,9% of patients have areas of fibrosis, but most of the residu-al changes are linear and small-nodular seals (76,9%). The frequency of detection of residual reticular changes and consolidation was low (15,3%, 1,3%, respectively). Attention is drawn to the relatively frequent detection of areas of "Ground-glass opacity "(10,8%). In patients with severe and critical course of viral Covid19-pneumonia (CT3 and CT4), LungSS in the delayed follow-up period did not significantly differ from that in patients with mild and mod-erate course (CT1 and CT2) of the disease (4,5 [0,22], 2,5 [0,16], accordingly, p=0,61). There was no significant correlation between the detected residual lung changes in the delayed period and ERF. Conclusion. In a significant part of patients (84,6%) who have suffered from COVID-19 viral pneumonia, residual changes in the lung parenchyma persist, mainly in the form of linear seals and to a lesser extent fibrosis. These changes did not have a reliable relation-ship with the results of the FVD. LungSS proposed in this study reflects the dynamic picture of lung changes in the acute and delayed period, and can be a good indicator for monitoring patients who have suffered from COVID-19 viral pneumonia

Dynamics of MSCT-patterns of lung damage in severe viral COVID19-pneumonia on the background of intensive therapy

Purpose. To demonstrate the value of chest computed tomography (CT) in patient with severe COVID-19 viral pneumonia in choosing the optimal treatment strategy. Materials and methods. Chest CT dynamic studies of a patient with severe bilateral polysegmental viral COVID-19 pneumonia were performed. The analysis of CT scans images series is provided. Results. The presented clinical case demonstrates the influence of the lung CT results in choosing the optimal therapy, including the cytokine storm prevention using the interleukin-6 (IL6) receptor inhibitors. The dynamic observation of the lungs in monitoring of the intensive therapy results was performed. The changes of CT patterns depending on the disease stage and results of treatment was studied. Conclusion. The paper shows that CT diagnostics for coronavirus COVID-19 infection helps not only in making an accurate diagnosis, but also is necessary in dynamics for monitoring the course of the disease, including helping to determine treatment tactics to prevent the development of a cytokine storm