ABSTRACT
Duodenal lipomas (DLs) are rare benign nonepithelial tumors that account for 4% of all gastrointestinal (GI) lipomas. DLs can occur in any part of the duodenum but most commonly arise in the second part of the duodenum. They are usually asymptomatic and discovered incidentally but may present with GI hemorrhage, bowel obstruction, or abdominal pain and discomfort. The diagnostic modalities can be based on radiological studies and endoscopy with the aid of endoscopic ultrasound (EUS). DLs can be managed either endoscopically or surgically. We report a case of symptomatic DL presenting with upper GI hemorrhage along with a review of the literature. We report a case of a 49-year-old female patient who presented with a one-week history of abdominal pain and melena. Upper endoscopy revealed a single, large pedunculated polyp with an ulcerated tip in the first part of the duodenum. EUS confirmed features suggestive of a lipoma, including an intense homogeneous hyperechoic mass originating from the submucosa. The patient underwent endoscopic resection, with excellent recovery. The rare occurrence of DLs requires a high index of suspicion and radiological endoscopic assessment to rule out invasion into the deeper layers. Endoscopic management is associated with good outcomes and a decreased risk of surgical complications.
ABSTRACT
OBJECTIVES: To describe the effect of diabetes mellitus (DM) on clinical outcomes of patients admitted with COVID-19 infection. METHODS: We carried out a single center, observational, retrospective study. We included adult patients with laboratory-confirmed diagnosis of COVID-19 admitted to a tertiary hospital in Jeddah, Saudi Arabia, from April 2020 to December 2020. Electronic medical records were reviewed for demographics, clinical status, hospital course, and outcome; and they were compared between the patients with or without DM. RESULTS: Out of 198 patients included in the study, 86 (43.4%) were diabetic and 112 (56.5%) were non-diabetic. Majority of the patients were males 139 (70.2%) with a mean age of 54.14±14.89 years. In-hospital mortality rate was higher in diabetic patients than in non-diabetic patients (40 vs. 32; p=0.011). The most common comorbidity was hypertension (n=95, 48%) followed by ischemic heart disease (n=35, 17.7%), chronic kidney disease (n=17, 9.6%), and bronchial asthma (n=10, 5.1%). CONCLUSION: The risk of SARS-CoV-2 infection is higher among diabetic patients; particularly, those with preexisting co-morbidities or geriatric patients. Diabetic patients are prone to a severe clinical course of COVID-19 and a significantly higher mortality rate.
