Unusual Large And Multiple Liver Abscesses in Patient Recovered From COVID-19 - The Daily Guardian
Connect with us

Medically Speaking

Unusual Large And Multiple Liver Abscesses in Patient Recovered From COVID-19



During the second wave of the COVID-19, in April-May 2021, a number of COVID-19 patients presented with some unusual manifestations. We saw for the first time in last two months unusually large and multiple liver abscesses in fourteen patients after recovery from COVID-19 infection. Liver abscess (Pus formation in Liver) is commonly caused by a parasite known as Entamoeba histolytica (Picture attached) which is transmitted by contaminated food and water.

According to Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, “What we found unusual was that after recovery from Covid within 22 days in patients who were otherwise immunocompetent had large areas of both lobes of liver filled with pus at multiple locations requiring drainage and hospitalization.”

Prof. Anil Arora, further added “These patients were of age group between 28-74 yrs, ten were males and four females. All patients had fever and upper abdominal pain and 3 patients also had associated lower GI bleeding with black coloured stools. Eight of these patients received steroids for the management of COVID-19 symptoms. Six patients had multiple large abscesses in both lobes of liver of which 5 patients had unusually large abscess (>8cm) the largest being 19 cm size (Figures attached). Three patients who had blood in stools showed ulcers in large intestine which were detected by colonoscopy (large intestine were seen through a camera). Median duration between COVID-19 symptoms and diagnosis of liver abscess was 22 days. Thirteen out of Fourteen patients were successfully treated with antibiotics, Metronidazole medications and drainage of pus from the liver. While one patient with large multiple abscesses died due to massive bleeding in abdomen after rupture of abscess in the abdominal cavity. Rest are stable and have been discharged.”

Prof. Anil Arora also said that “In our patients we found multiple and large abscesses which is very unusual for an immunocompetent person. We believe that suppression of immunity by COVID-19 infection along with use of steroids to treat Covid infection per se, low index of suspicion for liver abscess and delay in treatment in patients recuperating from Covid in this pandemic probably led to development of multiple and large abscesses in Liver.”

Entamoeba histolytica is a common parasite in countries with poor sanitation services. This parasite causes amoebiasis, an intestinal infection that is also called amoebic dysentery. After an infection has occurred, the parasite may be carried by the bloodstream from the intestines to the liver and causes liver abscess. Normally these abscesses are single and not very large and picked up early on routine ultrasonography of the abdomen as a part of workup for fever and associated symptoms in immunocompetent patients. Poor nutrition, immunocompromised status (like in HIV and cancer patients) and steroid use predisposes patients to these infections by amoeba causing liver abscesses.

In this present pandemic, a high index of suspicion of such infections in the form of fever and pain in right abdomen merits a timely intervention in the form of an early diagnosis and effective medical therapy can effectively save uncalled misery and avoidable hospitalization in these patients, said Dr. Praveen Sharma, Senior Consultant Gastroenterology, Sir Ganga Ram hospital.

The Daily Guardian is now on Telegram. Click here to join our channel (@thedailyguardian) and stay updated with the latest headlines.

For the latest news Download The Daily Guardian App.

Medically Speaking

Love Nature To Lessen Covid Anxiety



Young but fragile Himalaya is blessed with rich Biodiversity.Its valuable resources have traditionally served as the foundation for economic and cultural life of vast & vibrant population.

A few attitudinal differences and climate change developments coupled with variation in soil conservation create striking changes in the terrain having fabulous flora and fauna.Such a unique bio diversity not only encompasses ecological, scientific or economic values,it is a capital of inheritance,passed down generations, stressing the need for Sustainable Development.


2) Developments of past and present indicate ,however, extremes of biotic interference.Making wise use of bio diversity inheritance should not be tutored.It has to be felt ,imbibed and carried forward when one is confronted with the tentacles of Corona Auntie And whims & fancies of the Covid Uncle.Without entering into realm of discussion on the origin of the virus,one should believe that SARS II virus is an off shoot of the prevailing environment.An environment throttled by one and all..

Fauna Such As Elephants Need Fresh Look

3) Coming to judicious utilisation rather than exploitation of floral & faunal wealth, there may be a need for a fresh approach.Not only farming communities near forests have to be sensitized to extract forest and non forest timber products properly but they also have to be briefed to leave ENOUGH scope for growth and sustenance of grass,shrubs,water bodies etc, vital for life of animals,such as,Lions,Elephants,Tigers, Deer etc.While saying so,one is not aiming to touch upon the crucial Food Chain,
rather the purpose is to prick our mind specifically about the plight of gentle Elephants,who,being vegetarian,show full loyalty towards their masters.
Of 27,000 Asian Elephants in India,21% reside in Assam.Due to loss of forest habitat, they are increasingly coming face to face with humans.Every year,around 100 of them, unfortunately, get killed.They are also misused in the Tourism industry.The Wildlife Protection Act,1972 bans the sale of captive & unregistered elephants.
The mere fact that they live,eat and move in groups or clusters,goes on to show their strong family instincts,something reflected glaringly in:

A) Episode of 18 elephants in Nagaon,Assam in May,2021 crushed by lightening And
B) Freak,directionless walk of over 500 kms by 15 elephants in Kunming area of Yunan province of China in June,2021.

Sympathy Is Necessary

4) Despite the inherent friendly attitude of the elephants and many other animals often the reports of Entry into the human habitations, hit the head lines.There has to be some reason for such an entry.What they get in return is hectic,irrational and merciless action.The facial expression of the fauna in such a situation shows their State of helplessness. The onlookers, never the less ,get sarcastic pleasure in having an exciting glimpse.Whether it is a case of entry by the loveable Monkeys.,Leopards,Tigers or the Elephants into towns of different states, these should not be considered as an intrusion by the animals.

Assertion of Rights

5) It is felt that such a behavior has to be viewed as a valiant act of ASSERTION of rights by certain species to counter the actual intrusion into their bonafide habitat by the shrewd human beings.There should be no justification to suppress or subjugate the innocent animals either by mechanical or muscle power.
Will our Forest Service friends wake up and take requisite action especially during the current wave of Covid,when almost two dozen “positive” tigers and couple of similar infected lions have already left the world ?
.Lingering threat to pets & domestic animals who soothen our feelings when we are tired & exhausted, also fill the atmosphere,time and again.

5) Having stated so,I may humbly submit :
“When the animal instinct among the humans crosses conceivable limits,the actual and bonafide sons and daughters of mother earth are left with no alternative but to react vehemently or justifiably”.

Unhealthy Tussle

6) It is not only the competition or tussle factor for a habitat between the animals and human beings, But it is a question of displaying adequate love and care for the natural endowments,indiscriminately gifted by the Almighty.

Saviour Duty

7) It may not be out of context to remind ourselves about the basic Hindu philosophy of emphasizing reverence to the flora and fauna right from childhood.For generations, plants, such as,Peepal,Banyan,Tulsi,Banana,Mango, etc.and the animals,namely,Cow,Bull,Lion,Tiger,Elephant,Monkey,Rat,Cobra snakes etc were being worshipped. Also the morning ritual of offering water to Sun God, Tulsi plant and Peepal tree not only has given the requisite faith & confidence to the worshippers but it can also teach us again the forgotten lesson to do everything possible to Preserve Flora & Fauna.

8) To Sum Up:

If we are mandated to avoid Social Interaction due to Corona virus and more lethal Third Wave, how can we afford to undermine similar “social” instinct among the animals?
Their state of hunger and helpless facial expressios during last two rounds of Lock Downs, calls for improving our overall attitude towards them. Timely food intake and sound health of fauna not only can improve their internal social behavior but it may also ensure a refined attitude towards their human handlers, caretakers or masters.
Even if we get rid of COVIDITY clinically, the love and affection displayed by the pets may prove much more valuable if not decisive in reducing our anxiety and depression. It may Ultimately Facilitate Satisfactory Healing of the Community.

Continue Reading

Medically Speaking




A new study from the University of Sheffield has revealed that Vitamin D supplements are not an effective treatment for easing painful symptoms of Irritable Bowel Syndrome (IBS).

The findings of the study appeared in the European Journal of Nutrition. Scientists from the University’s Department of Oncology and Metabolism – in conjunction with a health supplement company, BetterYou – carried out trials on participants who suffer from the chronic condition of the digestive system to assess whether vitamin D reduced the severity of their symptoms and whether it could improve their quality of life.

Results of the study found that despite an improvement in vitamin D status in the participants in response to a vitamin D3 oral spray supplementation over a 12-week trial, there was no difference to their IBS symptom severity over the same period, nor a reported change in the participants’ quality of life.IBS is a common functional bowel disorder, characterized by chronically relapsing perturbed bowel habits. It causes symptoms such as stomach cramps, bloating, diarrhea and constipation.

For some, symptoms will come and go, but for others, it can severely affect their quality of life, often causing embarrassment leading to many living with the condition undiagnosed, affecting both mental health and wellbeing.

Continue Reading

Medically Speaking




A new study found that people who eat a diet that includes at least half a serving per day of foods high in flavonoids like strawberries, oranges, peppers and apples may have a 20 per cent lower risk of cognitive decline.The findings of the study were published in the online issue of ‘Neurology’, the medical journal of the American Academy of Neurology. The study looked at several types of flavonoids and found that flavones and anthocyanins may have the most protective effect.

Flavonoids are naturally occurring compounds found in plants and are considered powerful antioxidants. It is thought that having too few antioxidants may play a role in cognitive decline as you age. “There is mounting evidence suggesting flavonoids are powerhouses when it comes to preventing your thinking skills from declining as you get older,” said study author Walter Willett, MD, DrPH, of Harvard University in Boston, Mass.“Our results are exciting because they show that making simple changes to your diet could help prevent cognitive decline,” added Willett.The study looked at 49,493 women with an average age of 48 and 27,842 men with an average age of 51 at the start of the study. Over 20 years of follow up, people completed several questionnaires about how often they ate various foods. Their intake of different types of flavonoids was calculated by multiplying the flavonoid content of each food by its frequency.Study participants evaluated their own cognitive abilities twice during the study, using questions like, “Do you have more trouble than usual remembering recent events?” and “Do you have more trouble than usual remembering a short list of items?”

This assessment captured early memory problems when people’s memory has worsened enough for them to notice, but not necessarily enough to be detected on a screening test. The people in the group that represented the highest 20 per cent of flavonoid consumers, on average, had about 600 milligrams (mg) in their diets each day, compared to the people in the lowest 20 per cent of flavonoid consumers, who had about 150 mg in their diets each day. Strawberries, for example, have about 180 mg of flavonoids per 100 gram serving, while apples have about 113.

Continue Reading

Medically Speaking




According to a new study, people with type 2 diabetes diagnosed during youth have a high risk of developing complications at early ages and have a greater chance of multiple complications within 15 years after diagnosis. The findings of the study were published in the New England Journal of Medicine. The results of the study are the culmination of a first-of-its-kind trial funded largely by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health.

Within 15 years of a type 2 diabetes diagnosis, 60 per cent of participants had at least one diabetes-related complication, and nearly a third of participants had two or more complications, according to results of the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) follow-up study, called TODAY2.

“The original TODAY study showed that youth-onset type 2 diabetes is distinct from adult-onset diabetes – it is both more aggressive and more difficult to control,” said Dr Barbara Linder, NIDDK project scientist for TODAY.“By following this unique disease course, TODAY2 shows the devastating complications that can develop in what should be the prime of these young people’s lives,” added Dr Linder.

TODAY2 involved 500 original participants from the TODAY study, which began in 2004. TODAY was the first major comparative effectiveness trial for the treatment of type 2 diabetes in youth. The study compared three treatments for managing blood glucose: metformin alone, metformin plus rosiglitazone, and metformin plus intensive lifestyle intervention. Metformin is the only oral medication approved by the US Food and Drug Administration to treat type 2 diabetes in youth.

At the time of enrollment, participants were between the ages of 10-17, had been diagnosed with type 2 diabetes for fewer than two years, and were overweight or had obesity. The average age of participants after the TODAY2 follow-up was 26 years.

Participants in TODAY2 were monitored annually for signs of diabetes complications, including heart disease, kidney disease, diabetic foot complications, and to report other health events. Diabetic eye disease was assessed once during the study, at the seven-year study visit.Overall, researchers saw a steady decline in blood glucose control over 15 years. In addition:

1. 67 per cent of participants had high blood pressure

2. Nearly 52 per cent had dyslipidemia or high-fat levels in the blood

3. Around 55 per cent had kidney disease

Rates did not differ based on the original TODAY study treatment group assignment. In addition, certain participants had a higher likelihood to develop multiple complications over time, with 28 per cent developing two or more over the follow-up period. Participants who belonged to a minority racial or ethnic group, or who had high blood glucose, high blood pressure, and dyslipidemia were at higher risk for developing a complication.“Compared to what we see in adults with type 2 diabetes, the participants in TODAY2 developed complications much earlier in their disease course and at a much faster pace over time,” said TODAY2 study chair Dr Philip Zeitler, professor of paediatrics-endocrinology at the University of Colorado School of Medicine.

“This study shows the importance of treating youth-onset type 2 diabetes intensively from beginning and using all available approaches to control blood glucose and aggressively treat developing complications,” added Dr Zeitler.

Continue Reading

Medically Speaking

Psychological consequences of Covid-19 on healthcare discovered by researchers



A recent study has discussed the psychological consequences of COVID-19 on healthcare and also highlighted the protective factors that can help people cope with the severe strain caused by the pandemic.

The study conducted by the University of Bonn is based on a large joint online survey at the University Hospitals Bonn, Erlangen, Ulm, Dresden, and Cologne, which also involves many other hospitals in Germany. The results have been published in the journal PLOS ONE. Perceived coherence was found to be particularly important – in simple terms: the feeling that life has meaning and challenges can be classified in an understandable way.

The researchers invited employees in health care to take part in an online survey from April to July last year, i.e. during the first wave of the pandemic. “Alongside physicians and nursing staff, this also included two groups who have so far been overlooked in the discussion,” explained Professor Dr Franziska Geiser, Director of the Clinic for Psychosomatic Medicine and Psychotherapy at University Hospital Bonn.

Geiser added, “Firstly, the comparatively small number of pastoral workers in the hospitals. Secondly, the many medical and technical employees – the medical technical assistants within the examination, radiology, and the laboratories.”

More than 4,300 completed questionnaires were evaluated during the current study. A good 80 per cent of the participants worked in hospitals at the time of the survey, 11 per cent at University Hospital Bonn. They were asked to state, among other things, how stressed they felt by their work at present and before the survey and how often they suffered from symptoms of depression and anxiety.

Information was also collected on three possible “resilience factors”, which are assumed to protect against mental consequences of stress: social support, religiosity, and sense of coherence.

More than 20 per cent of the respondents in each case stated that they had symptoms of depression or anxiety to an extent requiring treatment. “We do not know exactly what the situation was like for this sample before the pandemic,” explained Geiser.

He continued, “However, the values found are higher than in earlier studies among physicians and nursing staff, so we can assume there has been an increase during the pandemic. While, during normal times, physicians and nurses display higher mental strain than the rest of the population, they actually had lower anxiety values during the pandemic in our survey. This naturally makes us curious about possible protective factors.”All the more so as Geiser is part of an interdisciplinary DFG research group at the University of Bonn, which is dedicated to researching resilience.Sense of coherence particularly stands out among the potential resilience factors. The term comes from salutogenesis, a concept developed by medical expert Aaron Antonovsky in the 1980s, which focuses on searching for health-promoting factors and attitudes.

“Sense of coherence refers to the extent to which we perceive our life as understandable, meaningful, and manageable,” explained Jonas Schmuck from Geiser’s working group, who is the lead author of the study together with Dr Nina Hiebel.

The more pronounced the sense of coherence among employees, the less often they suffered from mental symptoms. “However, a causal relationship cannot necessarily be derived from this,” said Geiser as a warning against drawing premature conclusions. “It may also be the case that anxiety or depression themselves minimize perceived coherence.”

Nevertheless, she believes that this factor actually makes us more resilient to stress and particular challenges.

In her view, the study thus brings to light important conclusions on how people should handle crises like the COVID-19 pandemic in the future. “The more complex the situation, the better we need to communicate,” she stressed.

“Uncertainties and also contradictions, such as with regard to protective measures or treatment processes, are unavoidable in a new situation like the pandemic. The better it is explained to employees why this is the case and the more personal meaning they experience in their work, the better they can handle it. Timely information is therefore essential.” This information should not only flow in one direction, according to Geiser. “It is important to enter into a dialogue that also allows for questions and responses to concerns,” she said.

Continue Reading

Medically Speaking




The findings of a new study suggest that symptoms for early COVID-19 infection differ among age groups and between men and women.These differences are most notable between younger age groups (16-59 years) compared to older age groups (60->80 years), and men have different symptoms compared to women in the early stages of COVID-19 infection. The paper, published today in the Lancet Digital Health and led by researchers from King’s College London analyses data from the ZOE COVID Symptom Study app between April 20th to 15th October 2020.

App contributors are invited to get tested as soon as they report any new symptoms, thanks to a joint initiative with the Department of Health and Social Care. The researchers modeled the early signs of COVID-19 infection and successfully detected 80 per cent of cases when using three days of self-reported symptoms.

Researchers compared the ability to predict early signs of COVID-19 infection using current National Health Service UK diagnostic criteria and a Hierarchical Gaussian Process model, a type of machine learning.This machine learning model was able to incorporate some characteristics about the person affected, such as age, sex, and health conditions, and showed that symptoms of early COVID-19 infection are different among various groups.

18 symptoms were examined, which had different relevance for early detection in different groups. The most important symptoms for the earliest detection of COVID-19 overall included loss of smell, chest pain, persistent cough, abdominal pain, blisters on the feet, eye soreness, and unusual muscle pain.

However, loss of smell lost significance in people over 60 years of age and was not relevant for subjects over 80. Other early symptoms such as diarrhea were key in older age groups (60-79 and >80). Fever, while a known symptom of disease, was not an early feature of the disease in any age group.Men were more likely to report shortness of breath, fatigue, chills and shivers, whereas women were more likely to report loss of smell, chest pain and a persistent cough.

While these models were generated in the COVID Symptom study app, models were replicated across time suggesting they would also apply to non-app contributors. Although the models were used on the first strain of the virus and Alpha variants, the key findings suggest the symptoms of the Delta variant and subsequent variants will also differ across population groups.Lead author, Claire Steves, Reader at King’s College London said, “Its important people know the earliest symptoms are wide-ranging and may look different for each member of a family or household. Testing guidance could be updated to enable cases to be picked up earlier, especially in the face of new variants which are highly transmissible. This could include using widely available lateral flow tests for people with any of these non-core symptoms.”

Dr Liane dos Santos Canas, the first author from King’s College London, said, “Currently, in the UK, only a few symptoms are used to recommend self-isolation and further testing. Using a larger number of symptoms and only after a few days of being unwell, using AI, we can better detect COVID-19 positive cases. We hope such a method is used to encourage more people to get tested as early as possible to minimise the risk of spread.”Dr Marc Modat, Senior Lecturer at King’s College London, said, “As part of our study, we have been able to identify that the profile of symptoms due to COVID-19 differs from one group to another. This suggests that the criteria to encourage people to get tested should be personalised using individuals’ information such as age. Alternatively, a larger set of symptoms could be considered, so the different manifestations of the disease across different groups are taken into account.”

Continue Reading