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Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus causing acute respiratory distress with multisystem complications, including cardiac complications. Acute myocarditis is one possible complication of coronavirus disease 2019 (COVID-19). Previous studies revealed that mortality from COVID-19 was higher in patients with cardiac complications. Objectives We aim to identify if patients with COVID-19 develop myocarditis and if this condition is associated with an increased incidence of ventilatory support and mortality. We also aim to identify if preexisting cardiac conditions are associated with an increased incidence of ventilatory support and mortality in those who developed COVID-19. Methods This is a multicenter, retrospective study including patients aged 18 years and older. Statistical analysis was performed to compare the incidence of in-hospital mortality and ventilatory support in COVID-19-positive patients with and without myocarditis. In this study, we defined myocarditis using elevated troponin-T (TnT) and brain natriuretic peptide (BNP) levels as proxy. Results A total of 8,162 patients with a positive COVID-19 polymerase chain reaction (PCR) test were identified. Of those, 1,643 (20.1%) were found to have new-onset acute myocarditis. The risk of ventilation and mortality in these patients was significantly elevated (p<0.001) compared to patients without acute myocarditis. Underlying heart failure was associated with increased odds of in-hospital mortality, which was 1.6 times greater when compared to patients without heart failure. The odds of in-hospital mortality were 2.33 times as likely for those who had non-ischemic cardiomyopathy as opposed to those who did not. Conclusion Myocarditis is a serious and potentially fatal complication of COVID-19. The results of this study highlight the importance of routine testing of troponin-T and BNP levels to identify those at risk. Furthermore, underlying heart conditions are associated with a worse outcome, and those patients should be watched closely.
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Worldwide, gastric cancer is the fifth most common cancer and the third leading cause of cancer deaths, which carries a poor prognosis as only 28.3% are expected to survive after five years. The incidence varies depending on the geographical locations and dietary patterns. Here, we present a case of a 59-year-old Hispanic male with a 10-month history of recurrent bilateral pneumonia and dysphagia. Diagnostic workup revealed metastatic gastric adenocarcinoma.
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Acute pancreatitis is an acute inflammatory process of the pancreas that is associated with multiple etiologies. The two most common causes are gallstones and acute alcohol intoxication. However, medications are often overlooked when determining the cause. Empagliflozin is a type of sodium-glucose transport protein 2 (SGLT-2) inhibitor used for the treatment of type 2 diabetes mellitus. Given that this medication is new, the adverse effects have not been fully reported in the literature. Currently, the most commonly reported side effects are genitourinary infections such as cystitis or yeast infection although acute pancreatitis as a result of empagliflozin is very rare. Here, we discuss a case of a 64-year-old female who presented with severe pancreatitis after recently initiating the use of empagliflozin. Based on the timing of her presentation and her hospital workup to rule out many of the common etiologies, it was concluded that empagliflozin was the likely cause of her acute pancreatitis. With SGLT-2 inhibitors such as empagliflozin, becoming popular as first-line in the management of diabetes, this case may hope to raise awareness of the possible adverse effects related to it. Additionally, this case also emphasizes the importance of identifying iatrogenic related pancreatitis.