Wormblevins9558

BACKGROUND Data on patients with inflammatory bowel diseases (IBD) who have had 2019 novel coronavirus (SARS-CoV-2) disease (COVID-19) are lacking. AIM To report the clinical characteristics, including gastrointestinal symptoms, of COVID-19 in IBD patients, and to assess the risk of COVID-19 in IBD. METHODS This case series included consecutive IBD patients with laboratory-confirmed COVID-19. Age-adjusted cumulative incidences were compared with the general population in the Madrid region. RESULTS Through April 8, 12 patients of 1918 IBD patients were diagnosed of COVID-19. The average age was 52 years, 75% of the patients were female, and 58.3% had Crohn's disease. Seven patients (58%) were on maintenance treatment with immunomodulators/biologics, of these 4 with combined therapy (33%). Eight patients (66%) required hospitalization (1 intensive care unit admission, and 2 deaths), and 4 patients were isolated at home. Nine patients had diarrhoea ranging between 4-10 loose stools per day (mean 5.4, SD 1.6). In 5 patients (42%) diarrhoea was a presenting symptom. In 2 patients, diarrhoea was the only symptom at debut. Cumulative incidence of COVID-19 was 6.1 per 1000 IBD patients. IBD patients had a lower adjusted incidence ratio of COVID-19 (OR 0.74, 95% CI 0.70-0.77; p less then 0.001), and a similar associated mortality ratio (OR 0.95, 95% CI 0.84-1.06; p=0.36), compared with the general population. CONCLUSIONS IBD patients do not have an increased risk of COVID-19 and associated mortality compared with the general population. In many IBD patients diarrhoea was a presenting symptom, and sometimes, was the only symptom at onset of COVID-19. This article is protected by copyright. All rights reserved.INTRODUCTION Re-operative pelvic surgery is rarely hostile and unsafe. Kraske's procedure has historically been used to approach the mid-rectum and to resect retrorectal tumors. However, it provides limited access to the pelvis and is best in the "virgin" pelvis. We have encountered a select group of patients who required completion proctectomy or resection of a disconnected ileoanal J-Pouch where trans-abdominal access to the pelvis was not possible, and access to the pelvis could only be safely gained by a prone en-bloc sacrectomy. TECHNIQUE We describe a prone approach that provides an alternative route of access to the hostile pelvis. After exposure of the sacrum and coccyx and transection of the sacrum, access to the mesorectal plane is achieved and a proctectomy (or resection of an ileoanal J-pouch) can be completed. The procedure is similar to the Kraske approach but requires a higher and wider exposure similar to the extent of an abdominal resection; however, the operation is performed in 'reverse'. RESULTS We found that this approach was feasible and safe in the previously operated, hostile pelvis. We employed it in one patient to excise a disconnected J-pouch with chronic sepsis and in another patient for a completion proctectomy. Both patients had an uneventful recovery and clear margins were obtained with no complications. CONCLUSION The en-bloc prone sacrectomy approach is a useful alternative in a very selected group of patients with difficult trans-abdominal access to the pelvis. Experience in pelvic surgery and identification of clear anatomical landmarks is paramount to avoid catastrophic uncontrollable bleeding. This article is protected by copyright. All rights reserved.BACKGROUND The emergence of SARS-CoV-2 has presented clinicians with a difficult therapeutic dilemma. With supportive care as the current mainstay of treatment, the fatality rate of COVID-19 is 6.9%. There are currently several trials assessing the efficacy of different antivirals as treatment. Of these, Chloroquine (CQ) and derivative, Hydroxychloroquine (HCQ), have garnered the most attention. METHODS In this study, the literature currently available on CQ and HCQ as treatment of COVID-19 was surveyed using EMBASE, PubMed, Cochrane Librar, MedRxiv and 1 clinical trial registry. Upon gathering published and preprint trials, risk of bias was assessed using Cochrane Risk of Bias Tool 2.0. RESULTS There are currently 7 completed clinical trials and 29 registered clinical trials focusing on HCQ or CQ as a therapeutic avenue for COVID-19. Of these, 5/7 trials have shown favorable outcomes for patients using CQ or HCQ and 2/7 have shown no change compared to control. However, all 7 trials carried varying degrees of bias and poor study design. CONCLUSION There is currently not enough data available to support the routine use of HCQ and CQ as therapies for COVID-19. Pending further results from more extensive studies with more stringent study parameters, clinicians should defer from routine use of HCQ and CQ. There are several clinical trials currently underway with results expected soon. selleck kinase inhibitor This article is protected by copyright. All rights reserved.In a preliminary study, Akiba and colleagues report novel observations about fetal limb soft tissue changes in Japanese women with gestational diabetes as compared to gravidas with normal glucose tolerance (BJOG 2020 xxxx). No significant differences in fractional arm volume (AVol) were found between groups until after 32 weeks gestation although corresponding differences did not occur with fractional thigh volume (TVol). This article is protected by copyright. All rights reserved.The natural history of COVID-19 caused by SARS-CoV-2 is extremely variable, ranging from asymptomatic or mild infection, mainly in children, to multi-organ failure, eventually fatal, mainly in the eldest. We propose here the first model, explaining how the outcome of first, crucial 10-15 days after infection, hangs on the balance between the cumulative dose of viral exposure and the efficacy of the local innate immune response (natural IgA and IgM antibodies, Mannose Binding Lectin ). If SARS-CoV-2 runs the blockade of this innate immunity and spreads from the upper airways to the alveoli in the early phases of the infections, it can replicate with no local resistance, causing pneumonia and releasing high amounts of antigens. The delayed and strong adaptive immune response (high affinity IgM and IgG antibodies) that follows, causes severe inflammation and triggers mediator cascades (complement, coagulation, and cytokine storm) leading to complications often requiring intensive therapy and being, in some patients, fatal.