Need for Awareness and Training in Women's Gastrointestinal Health: A Call to Action.

Women's gastrointestinal (GI) health is a topic that is not well understood nor taught in most training programs. In this article, we highlight the importance of proper training in women's GI health among gastroenterologists and fellows, and identify some common conditions to provide the best possible treatment for their female patients.

Spontaneous Intraparenchymal Hepatic Hemorrhage as a Sequela of COVID-19.

Patients with coronavirus disease 2019 (COVID-19) have been presenting with varying signs and symptoms. The medical community is being updated with new knowledge about this disease daily. We present a case of intrahepatic hemorrhage in a patient diagnosed with C0VID-19 which we believe was caused by endothelialitis, which is a characteristic feature of COVID-19. Nevertheless, further continued studies are required to validate this point. We aim to educate the medical community about the possible complications by COVID-19 in the liver and highlight that N-acetylcysteine (NAC) may be a useful option in these cases.

Acute Pancreatitis in Mild COVID-19 Infection.

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a global health crisis. This virus uses angiotensin converting enzyme 2 (ACE2) receptors to facilitate cellular entry. ACE2 receptors appear to be highly expressed in pancreatic exocrine glands and islet cells, more so than in lung tissues, suggesting that pancreatic injury can occur despite having only mild COVID-19 symptoms. We report a patient with COVID-19 who presented with only gastrointestinal symptoms and discuss the importance of identifying pancreatitis early to improve prognosis.

Acute Pulmonary Embolism in COVID-19: A Report of Two Cases.

Coronavirus disease 2019 (COVID-19), which is currently causing a global pandemic, is found to be associated with abnormal coagulation parameters and hyper-coagulable state with increased risk of venous thromboembolism (VTE). Here, we present two non-ICU cases of COVID-19, complicated with acute pulmonary embolism (PE). As of now, there are no proper guidelines established on anticoagulation in these patients. We discuss the pathophysiology and management strategy based on recently published studies on anticoagulation in COVID-19 patients.

Pseudocirrhosis in Chronic Budd Chiari Syndrome With Janus Tyrosine Kinase 2 (JAK2) Mutation.

Budd-Chiari syndrome (BCS) occurs when there is hepatic venous outflow obstruction. Chronic BCS may result in liver cirrhosis due to long-standing obstruction and tend to present late. We present the first case of BCS secondary to Janus tyrosine kinase 2 (JAK2) mutation resulting in "pseudocirrhosis" rather than cirrhosis of the liver. Pseudocirrhosis clinically and radiologically mimics cirrhosis without the classical histopathological changes, and it is usually associated with metastatic cancers.

Impact of Positive Airway Pressure on International Restless Legs Syndrome Score in Sleep Disordered Breathing.

STUDY OBJECTIVE: Studies have shown increased prevalence of restless legs syndrome (RLS) in sleep disordered breathing (SDB), however limited data have focused on the impact of SDB therapy on RLS. We hypothesize that positive airway pressure (PAP) will improve the International Restless Legs Syndrome (IRLS) score among SDB patients compared to patients without PAP. METHODS: Patients with AHI ≥ 5 who responded positively to a RLS qualifier question from January 2010 to May 2015 were included in this retrospective study. IRLS score was used to measure RLS symptom severity. Two-sample t-tests and one-way analysis of variance were used to compare changes in IRLS score and linear regression models were created to examine IRLS change with PAP use and PAP adherence (PAP usage ≥4 h nightly for ≥70% of nights), adjusting for potential confounders. RESULTS: In 434 patients (51.9 ± 13.4years, 50.5% female, 77.6% Caucasian; 325 PAP, 109 control), IRLS scores improved from baseline to follow-up, with the PAP group achieving significant improvement after adjustment for covariates (difference in IRLS: -1.8 (CI -3.6,0.00), p = 0.050). In self-reported PAP adherent patients, IRLS improvement was greater than controls (-5.3 ± 7.4 vs. -2.7 ± 7.6 respectively, p = 0.045), and comparable to non-adherent patients (-5.3 ± 7.4 vs. -3.0 ± 7.0, p = 0.091). CONCLUSIONS: Among SDB patients with a positive RLS qualifier, those who used PAP therapy achieved significantly greater improvement in IRLS scores than patients who did not use PAP, with more significant changes in the PAP adherent group. This is the first large clinical study to examine these relationships, providing a basis for future prospective interventional trials and informing clinicians of expected improvement in IRLS score in PAP treated SDB populations.

Impact of Drug Induced Long QT Syndrome: A Systematic Review.

BACKGROUND: Drug induced long QT syndrome is quite common in daily clinical practice but its impact is unknown. METHODS: PubMed and EMBASE databases (until May 2, 2017) were searched to identify studies reporting drug induced long QT syndrome and followed the PRISMA guidelines. The main outcomes measured in these studies were QTc prolongation, ventricular arrhythmias, torsade de pointes (TdP) and death. RESULTS: Out of 176 non-duplicate reports, 36 studies satisfied inclusion criteria and provided data on patients exposed to drugs that can potentially cause long QT. Totally, 14,756 patients were exposed and 930 patients (6.3%) were found to have QTc prolongation. The number of males was 6,400 and females were 5,723 patients. The mean age of the patients was 43.8 ± 9.36 years. Ventricular arrhythmias were found in 379 patients (2.6%), 26 patients were found to have premature atrial contractions (PACs) and premature ventricular contractions (PVCs). TdP was found in 49 patients (0.33 %), sudden cardiac death (SCD) was found in five patients and 586 patients were found to have all-cause mortality. CONCLUSIONS: Around 6% of patients have risk of QT prolongation when exposed but only 0.3% developed TdP and 2.6% developed ventricular arrhythmias. Risk of developing arrhythmias is higher with concomitant use of multiple QT prolonging drugs.