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Diarrhea a key symptom in 1 of 4 COVID-19 patients, study finds

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March 18 (UPI) — Fever, cough and shortness of breath have been widely acclaimed as the hallmark symptoms of COVID-19, the disease caused by the new coronavirus, but a new analysis suggests diarrhea may be common as well.

While most patients with the virus present with respiratory symptoms and signs, early experience in China reveals that as many as one in four patients experiences digestive symptoms as their chief complain.

The finding comes from a descriptive, cross-sectional multicenter study in China by investigators at the Wuhan Medical Treatment Expert Group for COVID-19, published Wednesday in The American Journal of Gastroenterology.

“In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of mortality compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop,” Dr. Brennan M.R. Spiegel, co-editor-in-chief of the journal, said in a press release. “This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed.”

The findings are based on data from 204 patients with COVID-19 who were admitted to three hospitals in Hubei province between Jan. 18, 2020, and Feb. 28, 2020. Disease diagnosis was confirmed by real-time RT-PCR, the standard test used for COVID-19.

Although the U.S. Centers for Disease Control and Prevention includes diarrhea and vomiting on its list of symptoms for COVID-19, fever, cough and shortness of breath — or the catch-all phrase “flu-like symptoms” — are mentioned far more. A case report published earlier this month by the journal Gut, though, listed diarrhea is a key symptom in patients with COVID-19.

However, of the 204 patients included in the AJG study published Wednesday, 99 reported gastrointestinal symptoms as their chief complaint. Of these, 83 experienced anorexia — or weight loss — while 29 had diarrhea, eight had vomiting and four reported abdominal pain.

Notably, seven patients in the analysis with COVID-19 presented with digestive symptoms but no respiratory symptoms.

In general, as the disease progressed in severity, digestive symptoms became more pronounced. The authors found that those without digestive symptoms were nearly twice as likely to be cured and discharged than patients with digestive symptoms — 60 percent versus 34.3 percent.

For the study population overall, the average time from symptom onset to hospital admission was 8.1 days, but patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms — nine versus 7.3 days. The authors believe this indicates that those with digestive symptoms sought care later because they did not yet suspect COVID-19 due to the fact that they did not have respiratory symptoms.

“Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge,” the researchers wrote in the study.

“If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge,” researchers said.



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New veterans have 93% higher risk for suicide than general public, study finds

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Sept. 11 (UPI) — New military veterans are 93% more likely to die by suicide than the general public, an analysis published Friday by JAMA Network Open found.

The assessment, which focused on nearly 1.9 million service members that left the military between 2010 and 2017, found that more than 3,000 service of them died by suicide, with the vast majority of them — just over 94% — men.

The study found men were more than three times as likely to die by suicide after transitioning to civilian life than women, the researchers said.

Younger members, 17 to 19 years old, were 4.5 times as likely to die by suicide after leaving the service than older veterans — those 40 years old and older — according to the researchers.

“National leaders at the highest levels of the U.S. government have been concerned about suicide rates among service members transitioning to civilian life,” wrote the researchers, who are from the Veterans Affairs Puget Sound Health Care System in Washington.

“We believe this cohort study provides much-needed data to help inform prevention efforts among this veteran cohort,” they wrote.

More than 78,000 veterans died by suicide between 2005 and 2017, when a high 6,139 suicide deaths were reported, according to the Department of Veterans Affairs.

In addition, suicide rates across the United States have been increasing since at least 2000, and suicide has been the 10th leading cause of death in the country since 2008, the Centers for Disease Control and Prevention reported last month.

To address the issue, several branches of the service, including the Army and the National Guard, have stepped up suicide prevention initiatives, particularly since the start of the COVID-19 pandemic, when leaders became concerned that veterans isolating themselves to prevent infection would as a result stop accessing support services.

In the JAMA Network Open analysis, among those who left the military from the beginning of 2010 through the end of 2017, suicide rates were highest among American Indian and Alaska Native service members — 56 per 100,000 veterans — and White American service members — 46 per 100,000 veterans.

Marine Corps veterans were more than twice as likely to die by suicide than those of other branches of the military.

Veterans without a high school degree were 71% more likely to commit suicide, the data showed.

Those who were single or never married had a 21% higher risk for suicide, while those who were divorced, separated or widowed had a 43% higher risk, according to the researchers.

Suicide rates among service members peaked six to 12 months after separation from the military, the data showed.

“This pattern was true for service members who left the Army, Marine Corps or Air Force, [while] the rates for those who last served in the Navy peaked three to six months after their transition,” the researchers wrote.

“After transition, veterans can face challenges in a variety of areas, including employment, finances, mental health, access to health care and social support.”



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Common meds linked to faster mental decline in seniors

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A group of widely used medications might speed up older adults’ mental decline — especially if they are at increased risk of dementia, a new study hints.

The medications in question are called anticholinergics, and they are used to treat a diverse range of conditions — from allergies, motion sickness and overactive bladder to high blood pressure, depression and Parkinson’s disease.

The drugs are known to have short-term side effects such as confusion and fuzzy memory.

But studies in recent years have turned up a more troubling connection: a heightened risk of dementia among long-term users.

The new findings, published Sept. 2 in Neurology, add another layer: Healthy older adults on these medications had an increased risk of developing mild cognitive impairment. That refers to subtler problems with memory and thinking that may progress to dementia.

And the link, researchers found, was strongest among two groups of people already at heightened risk of Alzheimer’s disease: those who carry a gene variant that raises the odds of the disease, and people with certain biological “markers” of the disease in their spinal fluid.

The results do not prove anticholinergic drugs are to blame, cautioned Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association.

“This study shows an association in a very specific population, but it does not prove causation,” said Snyder, who was not involved in the research.

However, it is biologically plausible that the drugs could increase dementia risk, said Dr. Allison Reiss, an associate professor at NYU Long Island School of Medicine.

The medications, she said, block a chemical called acetylcholine, which transmits messages among nerve cells. Acetylcholine is involved in memory and learning, and is typically low in people with Alzheimer’s.

“The preponderance of evidence suggests it’s better to avoid these medications in older adults,” said Reiss, who is also an advisory board member at the Alzheimer’s Foundation of America.

That’s especially true, she added, when alternatives exist.

Many medications sold for allergies, colds and coughs have anticholinergic properties — and are available over-the-counter. So it’s important, Reiss said, that older adults be aware that non-prescription drugs are not automatically “safe.”

“You don’t want to add any medications that aren’t necessary,” said Reiss, who had no role in the study.

Meanwhile, certain prescription drugs for depression, high blood pressure, Parkinson’s disease and schizophrenia have anticholinergic properties, as do medications for overactive bladder and urinary incontinence.

Reiss said that people with questions about their prescriptions should talk to their doctor.

For the new study, researchers led by Lisa Delano-Wood, from the University of California, San Diego, followed 688 older adults who initially had no problems with memory or thinking skills. One-third said they’d been regularly taking anticholinergic drugs for more than six months — usually far more than one.

In fact, they were taking an average of almost five medications per person.

Over the next 10 years, people on anticholinergics were more likely to develop mild cognitive impairment, which was gauged through yearly tests. Over half — 51% — developed the condition, versus 42% of older adults not taking anticholinergics.

The researchers did consider other factors that affect dementia risk — such as people’s education levels and history of heart disease or stroke. And after adjusting for those factors, older adults on anticholinergics were still 47% more likely to develop mild impairment.

The link was even stronger among people who carried a gene variant that raises Alzheimer’s risk: Anticholinergic use more than doubled their risk of impairment. A similar pattern was seen among study participants with Alzheimer’s-linked proteins in their spinal fluid.

That, Reiss said, suggests the medications might have “accelerated a process that was already in place.”

Snyder said the results “illustrate that we need better treatments — not only for Alzheimer’s and other dementias, but for other common conditions associated with aging.”

More information

The University of British Columbia has more on anticholinergic drugs.

Copyright 2020 HealthDay. All rights reserved.



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Even ‘social smokers’ up their odds of death from lung disease

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Even light smokers are much more likely to die of lung disease or lung cancer than nonsmokers, a new study warns.

“Everyone knows that smoking is bad for you, but it’s easy to assume that if you only smoke a little, the risks won’t be too high,” said study co-leader Pallavi Balte, of Columbia University Irving Medical Center, in New York City.

The new study shows how wrong that thinking can be. It included nearly 19,000 people in the United States, average age 61, who were followed for an average of 17 years. During that time, nearly 650 died of lung disease (such as emphysema) and 560 died of lung cancer.

Among nonsmokers, less than 2% died from lung disease and less than 1% died from lung cancer. But among social smokers (fewer than 10 cigarettes a day), those numbers were over 3% and close to 5%, respectively.

Not surprisingly, heavy smokers (more than 20 cigarettes a day) fared worst, with more than 10% dying from lung disease and about 13% from lung cancer, the study found.

After accounting for other potential factors — such as age, sex, race, level of education and body weight — the researchers concluded that social smokers were 2.5 times more likely to die of lung disease and 8.6 times more likely to die of lung cancer than nonsmokers.

Social smokers had around half the rate of death from lung disease as heavy smokers, but their rate of lung cancer death was two-thirds that of heavy smokers, according to the study.

The results were scheduled for presentation at a virtual meeting of the European Respiratory Society. Data and conclusions presented at meetings should be considered preliminary until peer-reviewed.

The findings show that cutting down on smoking is no substitute for quitting, the researchers concluded.

“Previous research suggests that people are cutting down on smoking. For example, in the U.S.A., the proportion of smokers smoking less than 10 cigarettes per day has increased from 16% to 27%,” Balte said in a society news release.

“You might think that if you only smoke a few cigarettes a day you are avoiding most of the risk. But our findings suggest that social smoking is disproportionately harmful,” Balte said.

If you don’t want to die of lung cancer or respiratory disease, the best action is to quit completely, she added.

More information

The U.S. Centers for Disease Control and Prevention offers a guide for quitting smoking.

Copyright 2020 HealthDay. All rights reserved.



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