De Novo Crohn's Disease Diagnosed in the Setting of Acute SARS-Cov-2 Infection Requiring Escalation of Infliximab Therapy Guided by Personalized Pharmacokinetics.

Here, we describe a 7-year-old girl who was diagnosed with an early-onset Crohn's disease in the setting of COVID-19 illness. Her disease process responded poorly to standard infliximab dosing, necessitating repeat hospitalizations and red blood cell transfusions. Remission was subsequently induced using a personalized infliximab pharmacokinetic profile based on therapeutic drug monitoring. While the initial data does not support a link, several case reports suggest an association between COVID-19 illness and de-novo development of IBD, especially in young female patients. We report, to our knowledge, the youngest patient who developed early-onset Crohn's disease in the setting of concomitant SARS-CoV-2 infection.

"Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis".

BACKGROUND: Pulmonary artery catheterization (PAC) has been widely used in critically ill patients, yielding mixed results. Prior studies on cardiogenic shock (CS) predominantly included patients with acute myocardial infarction. This study aims to examine the effect of PAC use in patients with non-ischemic CS. METHODS: This retrospective cohort study employed data from the National Inpatient Sample (NIS) database, including weighted hospitalizations of adult patients with non-ischemic CS during 2017 to 2019. In-hospital outcomes were compared between groups using inverse probability of treatment weighting. RESULTS: A total of 303,970 patients with non-ischemic CS were included, of whom 17.5% received a PAC during their hospitalization. The median age was 67 years (interquartile range: 57 - 77) and 61% were male. After inverse probability of treatment weighting, patients in the PAC group had significantly lower in-hospital mortality (24.8% vs. 35.3%, p < 0.001), renal replacement therapy (10.7% vs. 12.4%, p = 0.002), in-hospital cardiac arrest (7.1% vs. 9.6%, p < 0.001), and mechanical ventilation (44.6% vs. 50.4%, p < 0.001) compared to non-PAC group. In contrast, the PAC group had higher use of intra-aortic balloon pump (15.4% vs. 3.4%, p < 0.001), percutaneous ventricular assist devices (12.6% vs. 2.6%, p < 0.001), extracorporeal membrane oxygenation (3.9% vs. 2.5%, p < 0.001), and heart transplantation (2.1% vs. 0.4%, p < 0.001). CONCLUSION: In the real-world setting, invasive hemodynamic monitoring with PAC in patients with non-ischemic CS is associated with survival benefits and a reduction in adverse events, including reduced need for renal replacement therapy, mechanical ventilation and risk of in-hospital cardiac arrest.

[Massive neonatal hemorrhage of the adrenal glands]. / Hemorragia suprarrenal neonatal masiva.

We report the case of a three week old newborn who developed bilateral adrenal hemorrhage. This is an extraordinary case because of the late presentation of the hemorrhage as well as the excessive amount of blood involved. The newborn was the product of a normally evolved to full-term pregnancy, with a prolonged and traumatic delivery. The child had severe neonatal hypoxia and encephalopathy which required intensive care. The child was discharged in good conditions a week later. A week after that, the child is readmitted due to circulatory collapse, extreme paleness and a hemoglobin count of 3 g/dL. The newborn was treated for hypovolemic shock and improved substantially. The bilateral intraabdominal mass was detected and using an intravenous pyelography, ultrasonography and a CAT scan, a severe bilateral adrenal hemorrhage was seen. Adrenal failure was excluded and the child's care allowed for him to be discharged a week later in excellent conditions an followed as an outpatient until the hematomas subsided. This problem should be suspected in hypoxic newborns for which they should be submitted to abdominal ultrasonography before being discharged.