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Currently, there are no approved therapies for COVID-19 other than supportive care, enrollment in clinical trials, and the use of off-label therapies such as vitamin C and hydroxychloroquine without supportive, randomized clinical trials to support their efficacy. Laboratory results were as follows: white blood cell count 3.71 G/L, platelets 140 G/L, serum bilirubin 0.6 mg/dL (N: < 25), AST 1230 IU/L (N: < 50), ALT 697 IU/L (N: < 50), alkaline phosphatase 141 IU/L (N: < 125), serum albumin 3.1 g/dL (N: > 3.5), INR 1.08, and ferritin 6,606 ng/mL (N: <150). Because all other causes of acute nonicteric hepatitis were ruled out, it seems highly likely that her acute hepatitis was caused by COVID-19 infection.

BackgroundBariatric surgery is endorsed by multiple societies as the most effective treatment for obesity. Psychosocial functioning has also been noted to improve for most patients after bariatric surgery. However, some studies have shown an increase in post-operative suicide risk. The aim of this study was to review the published literature and evaluate the association of bariatric surgery with suicide events and suicide/self-harm attempts in patients who have undergone weight loss surgery.MethodsMEDLINE and Embase were searched from inception through January 2018 for retrospective or prospective studies reporting mortality outcomes and self-harm or suicide rates after bariatric procedures. The primary outcome was the pooled event rate with 95% confidence interval (95% CI) for suicide. Secondary outcomes were suicide/self-harm attempts after bariatric surgery compared to same population prior to surgery and to matched control subjects, with the respective calculated odds ratios (OR) and 95% CI.ResultsFrom 227 citations, 32 studies with 148,643 subjects were eligible for inclusion. The patients were predominantly females (76.9%). Roux-en-Y gastric bypass (RYGB) was the most commonly performed procedure (58.9%). The post-bariatric suicide event rate was 2.7/1000 patients (95% CI 0.0019–0.0038), while the suicide/self-harm attempt event rate was 17/1000 patients (95% CI 0.01–0.03). The self-harm/suicide attempt risk was higher after bariatric surgery within the same population with OR of 1.9 (95% CI 1.23–2.95), and compared to matched control subjects, OR 3.8 (95% CI, 2.19–6.59).ConclusionsPost-bariatric surgery patients had higher self-harm/suicide attempt risk compared to age-, sex-, and BMI-matched controls. Various pre- and post-surgical psychosocial, pharmacokinetic, physiologic, and medical factors may be involved.