Impact of Obesity on Outcomes Associated With Acute Alcoholic Pancreatitis.

The incidence and prevalence of obesity have been rising in the United States, negatively impacting the population's overall health. This study seeks to better understand the impact of obesity on patients presenting with acute alcoholic pancreatitis (AAP). Data collected using the National Inpatient Sample (NIS) from the fourth quarter of 2015 to 2019 with a principal diagnosis of AAP and secondary obesity were analyzed. Confounders were adjusted for multivariate regression analysis using a multitude of factors. A total of 229,510 patients were identified with a diagnosis of AAP, among which 14,150 were also identified as obese. A majority of the sample, both obese and non-obese patients with AAP, were middle-aged white females. The average comorbidity index (CCI) was lower in the non-obese cohort compared to the obese cohort. Compared to non-obese patients, patients with AAP who were obese had higher hospital charges and a longer LOS (p<0.05. Additionally, compared to non-obese patients, obese patients with AAP had higher odds of mortality and adverse events, such as acute renal failure and respiratory failure (p<0.05). Current research supports these complications, which have shown an association with increased visceral fat in or around the pancreas that can ultimately worsen acute pancreatitis outcomes and aggravate AAP by damaging the intestinal mucosal barrier. These findings should be considered when treating obese patients who develop AAP. Strategies to increase surveillance of such patients should be implemented to reduce complications and mortality in this population.

A Rare Presentation of a Duodenal Neuroendocrine Tumor.

Neuroendocrine tumors (NETs), which are a rare type of tumor, are defined as epithelial cells with predominantly neuroendocrine differentiation and consist of a spectrum of tumors emerging from stem cells throughout the body and can occur anywhere in the body. While they are rare, the incidence over the past few decades has increased. Here we present a case of a 64-year-old female who was incidentally found to have a duodenal neuroendocrine tumor. The patient initially presented to the emergency department secondary to syncope and collapse. During her trauma evaluation, an incidental lobulated soft tissue mass inferior to the distal stomach was seen on complete computed tomography (CT) scans. The surgery team was consulted for resection of the mass and an octreotide scan was performed prior to resection to further evaluate the mass and to check for any signs of metastatic disease. The octreotide scan demonstrated intense radiotracer accumulation within the duodenal mass consistent with a neuroendocrine tumor and no areas of abnormal radiotracer accumulation suspicious for metastatic disease. Pathology of the resected mass was positive for a well-differentiated neuroendocrine tumor with an organoid pattern and homogenous oval-round neoplastic cells with a salt-pepper nuclear and pseudo glandular arrangement that was well-circumscribed and partially encapsulated with negative margins. Immunohistochemistry was positive for AE ⅓, CD56, Synaptophysin, and chromogranin and negative for CD117, DOG-1, CD34, and CD45. The prevalence of NETs has increased over the years due to the improvement in diagnostic tools, such as upper gastrointestinal endoscopy. In addition to the fact that the duodenum is a rare location for such tumors, neuroendocrine tumors are also typically found in those under 50 years old. However, our patient was found to have both a duodenal mass and was over the age of 50 at the time of presentation and diagnosis. To date, a consensus on a conclusive treatment of duodenal NETs (D-NETs) has not been reached. This case brings to light the importance of further research in diagnosing and treating neuroendocrine tumors and also raises awareness for clinicians to have this in their differential.

Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease.

Background and Aim: Steroids have long been used in inducing remission of inflammatory bowel disease (IBD). Chronic use, defined as therapy greater than 3 months, has been implicated in complications including increased hospital length of stay (LOS), infections, and even death. In our retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD. Methods: The fourth quarter of 2015-2019 National Inpatient Sample (NIS) was used in this study. International Classification of Diseases (ICD-10) codes were used to identify patients with a diagnosis of IBD and chronic steroid use. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. Cohorts were weighted using an algorithm provided by the NIS allowing for accurate national estimates. Results: A total of 283 970 patients had a diagnosis of IBD. Of those, 18 030 patients had concurrent chronic steroid use. Racial disparities existed, with 77.4% White, 12.7% Black, and 6.0% Hispanic. Patients with a history of IBD and chronic steroid use were found to have higher odds of developing osteoporosis, opportunistic infections, and acute thromboembolic events but did not have higher odds of mortality. Conclusion: There is much controversy about whether IBD patients should be on chronic steroids for maintenance therapy and this study highlights the importance of this decision as patients on chronic steroid use had higher odds of developing adverse effects. These results stress the importance of monitoring patients on steroids and avoiding chronic use.

An Uncommon Cause of Urinary Tract Infections: A Case Report.

Urinary tract infections (UTI) in the elderly are common. UTI ranges in severity from mild disease to severe sepsis. Many organisms can cause UTIs yet many UTIs are caused by the same few organisms. An organism that has been increasingly gaining notoriety for infections is Aerococcus urinae. Aerococcus infections are constantly misdiagnosed due to their difficulty to identify. Here we present a case of an elderly male who was found to have a urinary tract infection with Aerococcus urinaethat progressed into bacteremia, severe sepsis and ultimately death.

A Mass in the Thorax: A Rare Presentation of Gastrointestinal Stromal Tumor.

Gastrointestinal stromal tumors (GIST) can occur anywhere in the gastrointestinal tract, with the primary site being the stomach. GISTs are often discovered incidentally on imaging due to the non-specific symptoms they present at the presentation. They can be distinguished from other mesenchymal tumors by immunohistochemistry staining. These tumors can range from benign to highly malignant, with surgical resection as the main treatment modality. Here, we present a case of a large GIST found not in the stomach, but in the mediastinum, incidentally on imaging, in a middle-aged male.

A Rare Case of Extramedullary Plasmacytosis.

Plasmacytosis is the abnormal proliferation of plasma cells in tissue, bone, blood, or exudates. Mucous membrane plasmacytosis is a rare form of plasmacytosis that is usually idiopathic in nature. A 68-year-old female underwent a diagnostic and therapeutic esophagogastroduodenoscopy, which revealed a friable antral erythematous gastric fold and a gastric polyp. Subsequent pathological testing was positive for diffuse polyclonal plasma cell proliferation, which was suggestive of a gastric plasmacytosis. In this article, we report a rare presentation of mucous membrane plasmacytosis.