mohammad abdehagh

Although COVID-19 patients typically present with respiratory symptoms such as cough, dyspnea, and bilateral pulmonary infiltration, there have been numerous reports of gastrointestinal manifestations such as diarrhea, nausea, vomiting, anorexia, and abdominal pain in these patients. The aim of this study was to review the gastrointestinal manifestations in COVID-19 patients.

In this systematic review, we searched the key-words in PubMed, Embase, Web of Science, and Google Scholar for studies published between 2019, and July 22, 2020. We selected the studies on epidemiological and clinical manifestations of COVID-19 including gastrointestinal symptoms, and excluded, duplicate publications, review articles, meta-analysis, guidelines, comment or editorials, case reports, studies with unavailable data, and studies in children. Finally, 35 articles were selected for our systematic review.

In our study, 6119 COVID-19 patients were evaluated for gastrointestinal manifestations. Four studies showed COVID-19 patients can merely present with gastrointestinal symptoms (highly variable, ranging from 10.1 to 100 percent). In these patients, the prevalence of gastrointestinal symptoms included anorexia (91.3%), nausea or/and vomiting (79.13%), diarrhea (41.73%), and abdominal pain (18.89%), respectively. Among 6119 patients, the most common gastrointestinal symptoms were nausea or/and vomiting (12.45%), diarrhea (11.47%), anorexia (9.56%), and abdominal pain (2.25%).

This review study showed that despite the preliminary opinions, SARS-CoV-2 does not always present with respiratory symptoms. Knowledge of pathophysiology, type, and prevalence of gastrointestinal manifestations can lead to early diagnosis (considering fecal viral RNA testing for diagnosis), timely treatment, and hence better prognosis for the patients. On the other hand, gastrointestinal manifestations can raise the possibility of oral-fecal transmission, which requires necessary recommendations to reduce the risk of transmission.

We used mixture cure mode to separately investigate the risk factors for long-term and short-term survival of colorectal cancer patients.

Colorectal cancer (CRC) is the second most common cancer worldwide. In cancer studies, patients’ survival is the most important indicator of patients’ status. Classical methods in analyzing the survival data usually apply Cox proportional hazard regression.

The study was performed on 1121 patients diagnosed with colorectal cancer. Mixture cure model with Weibull distribution and logit link function was fitted to data.

Odds of long-term survival for rectum cancer patients were lower than for colon cancer patients (OR=0.29(0.09, 0.9)). Also, patients with the advanced stage of the disease had lower odds of long-term survival compared to early-stage patients (OR=0.24(0.06, 0.86)).In the short-term, the hazard of death for people with normal BMI was lower than the underweight group (HR=0.4(0.21, 0.76)). The short-term hazard of death for rectum cancer was about half of the short-term hazard for colon cancer (HR=0.49(0.29, 0.81)). Further, people with moderately (HR=2.11(1.26, 3.55)) and poorly (HR=4.04(2.03, 8.03)) differentiated tumor grade had a higher short-term hazard of death compared to people with well-differentiated grade.

Predictive variables of colorectal cancer survival showed different effects in short- and long -terms. Site topography was a prognosis for both long-term and short-term survival; BMI and tumor grade were short-term predictors of survival while stage was a long-term predictor of survival.Keywords: Mixture cure model, Colorectal cancer, Survival.(Please cite as: Amanpour F, Akbari S, Azizmohammad Looha M, Abdehagh M, Pourhoseingholi MA. Mixture cure model for estimating short-term and long-term colorectal cancer survival. Gastroenterol Hepatol Bed Bench 2019;12(Suppl.1):S37-S43).

Neuropathy means nerve damage, which interferes with the functioning of the peripheral nervous system. It has been mentioned as one of the extra-intestinal manifestations of celiac disease. This study aimed to investigate the prevalence of celiac disease in patients presented with idiopathic neuropathy.
A cross-sectional study was done in patients with idiopathic neuropathy at Shariati Hospital, Tehran. Serological tests including endomysial IgA, tissue transglutaminase (TTG) IgA and IgG, and DGP (deamidated gliadin peptide) IgA, and genetic assessment for HLA DQ2 and DQ8 (human leukocyte antigen) were done for all patients and those who had positive celiac serology and HLA DQ2/DQ8 underwent endoscopy and adequate biopsy samples were taken. Diagnosis was made based on histopathological report of celiac disease.
101 patients with idiopathic neuropathy were enrolled. The mean age was 43.56 ± 10.66 years (range 70-18 years). The prevalence of HLA-DQ2 and HLA-DQ8 positivity in patients with idiopathic neuropathy was 36.6% and 9.9%, respectively. The most common neuropathy subtype in patients with positive HLA-DQ2 and DQ8 was demyelinating PN (Polyneuropathy). One patient (1%) was diagnosed as havine celiac disease.
Although the prevalence of celiac disease in patients with idiopathic neuropathy was similar to the general population, having considered the pravalence of celiac disease, treating this condition with gluten-free diet is of importance.