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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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Antidepressant might help prevent severe COVID-19

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The antidepressant drug fluvoxamine — best known by the brand name Luvox — may help prevent serious illness in COVID-19 patients who aren’t yet hospitalized, a new study finds.

The study included 152 patients infected with mild-to-moderate COVID-19. Of those, 80 took fluvoxamine and 72 took a placebo for 15 days.

By the end of that time, none of the patients who took the drug had seen their infection progress to serious illness, compared with six (8.3%) of the patients who took the placebo, according to researchers at Washington University School of Medicine in St. Louis.

“The patients who took fluvoxamine did not develop serious breathing difficulties or require hospitalization for problems with lung function,” said first author Dr. Eric Lenze, professor of psychiatry.

“Most investigational treatments for COVID-19 have been aimed at the very sickest patients, but it’s also important to find therapies that prevent patients from getting sick enough to require supplemental oxygen or to have to go to the hospital. Our study suggests fluvoxamine may help fill that niche,” Lenze noted in a university news release.

Fluvoxamine — widely used to treat depression, obsessive-compulsive disorder and social anxiety disorder — is a type of drug called a selective serotonin-reuptake inhibitor (SSRI). This class of drugs also includes medicines such as Prozac, Zoloft and Celexa.

But unlike other SSRIs, fluvoxamine has a strong interaction with a protein called the sigma-1 receptor, which helps regulate the body’s inflammatory response.

“There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules,” explained study senior author Dr. Angela Reiersen, associate professor of psychiatry.

“Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients,” she said in the release.

By reducing inflammation, fluvoxamine may prevent a hyperactive immune response in COVID-19 patients. That, in turn, may decrease their risk of serious illness and death, Reiersen said.

“Our goal is to help patients who are initially well enough to be at home and to prevent them from getting sick enough to be hospitalized,” Dr. Caline Mattar, assistant professor of medicine in the Division of Infectious Diseases, said in the release. “What we’ve seen so far suggests that fluvoxamine may be an important tool in achieving that goal.”

Dr. Amesh Adalja is a senior scholar at the Johns Hopkins Center for Health Security in Baltimore. He wasn’t involved in the study, but said the research is “notable not only because of its positive outcome — we desperately need a medication that keeps COVID patients out of the hospital — but also because of the manner in which it was conducted.”

But Adalja stressed that a larger trial is needed “to see if the promising findings hold up.”

The researchers said they plan to begin such a study in the next few weeks and it will include patients from across the United States.

The preliminary study was published online Nov. 12 in the Journal of the American Medical Association.

More information

For more on COVID-19, go to the U.S. Centers for Disease Control and Prevention.

SOURCES: Amesh Adalja, M.D., senior scholar, Johns Hopkins Center for Health Security, Baltimore; Washington University in St. Louis, news release, Nov. 12, 2020

Copyright 2020 HealthDay. All rights reserved.



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Survey: 40% in U.S. planning large gatherings for holidays despite COVID-19 warnings

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Nov. 12 (UPI) — Nearly 40% of U.S. residents plan to participate in gatherings of 10 or more people this holiday season despite concerns over the spread of COVID-19, according to the findings of a survey released Thursday by Ohio State University.

In addition, one-third of respondents said they wouldn’t ask attendees at holiday parties with family or friends to wear masks, and just over 25% indicated that they wouldn’t practice social distancing, the data showed.

“We’re going to look back at what happened during this holiday season and ask ourselves, ‘Were we part of the solution or were we part of the problem?'” Dr. Iahn Gonsenhauser, part of the team that conducted the survey, said in a statement.

“When you’re gathered together around the table, engaged in conversation, sitting less than 6 feet apart with your masks down, even in a small group, that’s when the spread of this virus can really happen,” said Gonsenhauser, chief quality and patient safety officer at Ohio State University Wexner Medical Center.

Researchers at Ohio State surveyed more than 2,000 U.S. residents on their holiday plans in the context of the COVID-19 pandemic.

As of Thursday afternoon, nearly 10.5 million people nationally have been sickened by the virus, and more than 240,000 have died, according to figures from Johns Hopkins University.

In recent weeks, federal, state and local public health officials have advised against traveling or partaking in large social gatherings as the holiday season approaches to limit the risk of spreading the new coronavirus to vulnerable loved ones.

At the very least, they’ve asked that gatherings not happen without wearing a mask and practicing social distancing, or staying 6 feet apart.

Those at risk for severe COVID-19 include the elderly, as well as those with diabetes, heart disease and high blood pressure, all of which are common across the United States, according to the Centers for Disease Control and Prevention.

Still, 38% of respondents to the Ohio State survey indicated they would host or attend a gathering with 10 or more people during the holidays and 33% would not ask others to wear masks, the researchers said.

However, 73% of respondents said they would practice social distancing during the holidays and 79% suggested that they would celebrate or gather only with people with whom they live, the data showed.

Just over 80% indicated that they would ask family and friends invited to events not to come if they had symptoms of COVID-19.

“If you have someone in your household who’s high risk and you’re in a low incidence area, you’re going to want to think twice about having a celebration where people are coming from an area where there’s a lot of virus in the community,” Gonsenhauser said.



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Healthy diet, exercise good for heart regardless of medication use

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No matter how many medications you take, eating a healthy diet, not smoking and getting plenty of exercise will help keep you alive, a new study finds.

“We’ve long known about the benefits of leading a healthy lifestyle. The results from our study underscore the importance of each person’s ability to improve their health through lifestyle changes even if they are dealing with multiple health issues and taking multiple prescription medications,” said researcher Neil Kelly. He’s a medical student at Weill Cornell Medicine of Cornell University in New York City.

For the study, Kelly’s team collected data on more than 20,000 people who took part in a study on racial differences in stroke.

At the start of the study, 44% of participants were taking four or fewer prescription medications, 39% were taking five to nine, and 17% were taking 10 or more medications.

After about 10 years, the researchers found that a healthy lifestyle reduced the risk of death during the study period regardless of the number of medications a person was taking, and the more healthy lifestyle habits one had, the lower the risk of death.

The findings were scheduled for presentation at the American Heart Association’s virtual annual meeting, Nov. 13 to 17. Such research should be considered preliminary until published in a peer-reviewed journal.

“It’s especially important for health care professionals to counsel patients and develop interventions that can maximize healthy lifestyle behaviors, even among patients with several prescription medications,” Kelly said in an AHA news release.

“It’s important for the public to understand that there is never a bad time to adopt healthy behaviors. These can range from eating a healthier diet to taking a daily walk in their neighborhood,” he added. “A healthier lifestyle buys more time.”

More information

For more on a healthy lifestyle, head to the American Heart Association.

Copyright 2020 HealthDay. All rights reserved.



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