Death and Venous Thromboembolism Analyses among Hospitalized COVID-19-Positive Patients: A Multicenter Study.

BACKGROUND: Coagulation disorders are frequently encountered among patients infected with coronavirus disease 2019 (COVID-19), especially among admitted patients with more severe symptoms. This study aims to determine the mortality rate and incidence and risk factors for venous thromboembolism (VTE) in hospitalized patients with COVID-19. METHODS: This retrospective observational cohort study was conducted from March to July 2020 using a hospital database. All adult patients (>18 years old) with laboratory-confirmed COVID-19 were included. Laboratory data and the real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) for SARS-CoV-2 were obtained from medical records. The mortality rate and the incidence of VTE were established as study results. A multivariate logistic regression analysis was performed to identify predictors of thrombotic events. RESULTS: rA total of 1024 confirmed COVID-19 patients were treated, of whom 110 (10.7%) were deceased and 58 patients (5.7%) developed VTE. Death occurred more frequently in patients older than 50 years and those admitted to the intensive care unit (ICU, 95%) and who received mechanical ventilation (62.7%). Multivariate analysis revealed that cancer patients were two times more likely to have VTE (adjusted odds ratio = 2.614; 95% CI = (1.048-6.519); p = 0.039). Other chronic diseases, such as diabetes, hypertension, and chronic kidney disease, were not associated with an increased risk of VTE. CONCLUSIONS: One-tenth of hospitalized COVID-19 patients were deceased, and VTE was prevalent among patients with chronic conditions, such as cancer, despite anticoagulation therapy. Healthcare professionals should closely monitor individuals with a high risk of developing VTE to prevent unwanted complications.

Hepatobiliary manifestations of COVID-19 and their impact on severity and outcomes in a single center in Saudi Arabia.

Recognizing hepatic manifestations of COVID-19 and their impact on the severity and outcome is crucial in managing this emerging pandemic. However, we lack such reported data in Saudi Arabia regarding this clinical entity. This is a retrospective observational study conducted on 387 patients with COVID-19 disease who were hospitalized at King Fahad Hospital of the University from March-September 2020. The total cohort was divided into two groups: liver and non-liver involvement. Then, the frequency of hepatic manifestations was determined, followed by comparing severity and outcome among the two study groups. A total of 387 patients were included, of which 72.87% had hepatic manifestations. The most prevalent abnormalities were high LDH in 308 (79.58%) followed by AST 205 (52.97%), GGTP 124 (31.26%), ALT 74 (19.12%), PT/INR 66 (17.05%), direct bilirubin 51 (12.40%), total bilirubin 46 (11.88%), and low albumin 48 (12.4%). Univariate analyses showed that liver involvement was significantly associated with severe (31.91%) and critical (34.75%) presentation (P<0.001). Multivariate regression analysis showed that the presence of liver involvement was an independent risk factor for severe or critical COVID-19 disease (OR 2.44; P<0.001), longer hospitalization (OR 2.27; P=0.001), and ICU admission (OR 2.27; P=0.006). The current study showed that liver involvement is common in the setting of COVID-19 disease. Such patients had a higher disease severity and a worse clinical outcome.

Early Determinants of Mortality in Hospitalized COVID-19 Patients in the Eastern Province of Saudi Arabia.

PURPOSE: This study investigated the clinical determinants of mortality in hospitalized patients infected with COVID-19. PATIENTS AND METHODS: A retrospective multicenter large cohort of COVID-19 patients hospitalized between March 2020 and February 2021. We included patients admitted with a confirmed COVID-19 infection with positive COVID-19 through real-time polymerase chain reaction (RT-PCR). SPSS version 25.0 (Armonk, NY: IBM Corp.) was used to analyze the data. RESULTS: Among the study participants (n = 1444), the mean age of the population was 49.22±17.69 years, of which 63.9% were males (n = 924). Overall, the mean age for non-survivors was 55.65 ±16.41 years and the length of ICU stay was 13.95 ±12.4 years. The most common comorbidity among the study subjects was hypertension (HTN) (32.7%), followed by cardiovascular disease (CVD) (10.7%). Patients who were mechanically ventilated (MV) had higher mortality than those who did not require MV (p < 0.001). CONCLUSION: Our study concluded that old age, the presence of underlying cardiovascular conditions, an abnormal WBC count (leukopenia or leukocytosis), and abnormal blood urea nitrogen (BUN) levels are among the independent predictors of mortality in the Saudi population. These findings may guide health care providers to manage COVID-19 patients more effectively with better outcomes.

Predictors of Illness Severity in COVID-19 Cases in Saudi Arabia.

PURPOSE: Multiple studies worldwide have reported the clinical and epidemiological features of coronavirus disease 2019 (COVID-19), with limited reports from the Middle East. This study describes the clinical and epidemiological features of COVID-19 cases in the Eastern Province of Saudi Arabia and identified factors associated with the severity of illness. PATIENTS AND METHODS: This was an observational study of 341 COVID-19 cases. These cases were reported in the first three months after the first case in the country was identified. Clinical and demographic data were analyzed and described to identify the effects of age, sex, and ethnicity on illness severity. In addition, the duration of viral shedding and cycle threshold (Ct) values of real-time PCR were evaluated as predictors of severity. RESULTS: The median age was 45 years. Males were twice as likely to be infected than females (p <0.0001). The duration of viral shedding ranged from 9 to 36 days. The most common clinical presentations include fever, shortness of breath, cough, myalgia, sore throat, vomiting, and headache. Critical cases were significantly higher in men (23% vs 8.7%), senior adults (>65 years), individuals of Bengali ethnicity, and in patients with comorbidities including diabetes, hypertension, and dyslipidemia (p =0.001). The case fatality rate was found to be 10%. The fatality was significantly higher in males than females (13.8% vs 2.6%), and in Asians (17.9%) than Arabs (6%) and Africans (0) (p =0.002). No association was found between viral load, represented by the RT-PCR cycle threshold (Ct) values, and severity of illness. CONCLUSION: Age, sex, and ethnicity are important predictors of COVID-19 severity. The cycle threshold (Ct) of the SARS-CoV-2 RT-PCR test cannot be used as a predictor of the criticality of illness.

Infective Endocarditis Caused by Pseudomonas stutzeri: A Case Report and Literature Review.

Pseudomonas bacteria are widespread pathogens that account for considerable infections with significant morbidity and mortality, especially in hospitalized patients. The Pseudomonas genus contains a large number of species; however, the majority of infections are caused by Pseudomonas aeruginosa, infections by other Pseudomonas species are less reported. Pseudomonas stutzeri is a ubiquitous Gram-negative bacterium that has been reported as a causative agent of some infections, particularly in immunocompromised patients but has rarely been reported as a cause of infective endocarditis. Here, we report a case of a 55-year-old female with no significant medical history who presented with exertional dyspnea, productive cough, and fever. She was diagnosed as a case of acute anterior ST myocardial infarction, underwent double valve replacement surgery, and was found to have infective endocarditis caused by Pseudomonas stutzeri.

Unusual Presentation of Aspergillus Pericarditis: A Case Report.

Cardiac aspergillosis is a rare fungal infection that affects the heart and/or pericardium of immunocompromised patients. Here, the authors report a rare case of a 36-year-old female with aspergillus pericarditis. The patient was diagnosed with infective endocarditis and splenic infarction and treated with emergency splenectomy and double-valve replacement surgery. During the surgery, a fibropurulent pericardial tissue was found and excised. The culture report of the tissue confirmed the diagnosis of aspergillus pericarditis. The patient was successfully managed with intravenous voriconazole. Aspergillus do not usually infect the pericardium and such infections are rarely detected premortem, especially during a cardiac surgery. In this report, the infection was accidentally detected during the double-valve surgery. The authors conclude that because of its nonspecific clinical manifestations, a high degree of clinical suspicion is required for the early diagnosis and treatment of aspergillus pericarditis.

Challenges in the management of adenocarcinoma of ampulla of Vater in pregnancy: A case report and review of literature.

INTRODUCTION: Ampullary adenocarcinoma is a rare entity during pregnancy. It accounts for 0.5% of all gastrointestinal malignancies. The best treatment modality for resectable tumors with the best reported outcome is surgical resection in the form of pancreaticoduodenectomy (Whipple procedure). In this case report, we discuss the challenges in the management of ampullary adenocarcinoma in a pregnant patient. CASE PRESENTATION: We report a case of 22 years old pregnant women who presented with vague abdominal pain and jaundice at the 28th week of gestation. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture around the ampulla and distal common bile duct (CBD). The CBD was stented and a biopsy was taken. Histopathology revealed: an invasive adenocarcinoma. The patient was managed by elective pancreaticoduodenectomy after induction of vaginal delivery at the 34th week of gestation. CONCLUSION: Diagnosing and managing ampullary adenocarcinoma in pregnant patients in their 3rd trimester is challenging. Yet, a delayed viable delivery followed by a definitive surgery in the form of pancreaticoduodenectomy offers the best outcomes for both the mother & fetus in case of early stage disease.

Thoracic Complications of Bariatric Surgeries: Overlooked Entities.

INTRODUCTION: Bariatric surgeries are increasingly performed to treat obesity worldwide. The currently available literature on these surgeries mainly focuses on their abdominal complications, giving less attention to their thoracic ones. Hence, the present work aimed to highlight the thoracic complications associated with bariatric surgeries. METHODS: A retrospective descriptive study was performed and involved the review of the medical charts of 390 patients who underwent different bariatric surgeries between January 2014 and January 2017 in our hospital or who were referred to us from other centers after their specific operations. The data of patients who developed thoracic complications and who required further intervention were identified and categorized by the modality of diagnosis, outcome, duration of hospital and ICU stays, and management. Patients with a history of a preexisting pulmonary disease were excluded. RESULTS: Twenty-six patients were observed to have thoracic complications secondary to their bariatric surgeries. Twenty-two patients (84.6%) received post-laparoscopic sleeve gastrectomy (LASG). Nine patients (34.6%) required ICU stays. Twenty patients (76.9) had incidences of pleural effusion in the postoperative period. The mean duration of hospital and ICU stays were 4.4 ± 11.67 days and 15 ± 19.36 days, respectively. Other reported thoracic complications included esophageal perforations, thoracic empyema, septic pericardial effusion, and pancreaticopleural fistula. CONCLUSION: Bariatric surgeries are safe procedures in selected patients. There is a significant amount of literature describing abdominal, nutritional, neurological, and even ophthalmic complications after bariatric surgeries. Being that they are relatively rare, thoracic complications are underreported in the literature. The management of thoracic complications after bariatric surgery requires awareness and a high index of suspicion to prevent further morbidities and mortalities.

Aortic Valve Myxoma Presenting with a Stroke: A case report and review of the literature.

Myxomas originating from the aortic valve are rare. We report a 40-year-old male patient who presented to the King Fahd Hospital of the University, Khobar, Saudi Arabia, in 2017 with a stroke. Transoesophageal echocardiography indicated a mobile mass measuring 6 × 2 mm attached to the right coronary cusp of the aortic valve and a mobile interatrial septum with a small patent foramen ovale (PFO). The patient underwent surgical excision of the mass and direct closure of the PFO. Histopathology confirmed the mass to be a myxoma. Despite their rarity, the recognition and treatment of valvular myxomas is very important; moreover, clinicians should be aware that affected patients may present with an embolic stroke.