Erratum to "A large unruptured ectopic pregnancy" [Radiology Case Reports 16 (2021) 1204-1206].

[This corrects the article DOI: 10.1016/j.radcr.2021.02.048.].

COVID-19 Presenting As Miller Fisher Syndrome in a Patient With a History of Guillain-Barré Syndrome: A Case Report.

Coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, primarily affects the respiratory system. While coronaviruses are not a common cause of neurological disease, they have been reported to cause direct central nervous system infection, as well as presumed para-infectious disorders. Here we report a very rare case of SARS-CoV-2 infection presenting as Miller Fisher syndrome with positive anti-GQ1b antibodies in a patient with a history of Guillain-Barré syndrome, which was treated with IV immunoglobulin resulting in marked improvement in her symptoms. Thus, a high index of suspicion and meticulous observation are the cornerstones to identifying possible uncommon presentations of COVID-19.

Ruptured Sinus of Valsalva Aneurysm in Apert Syndrome: Case report.

Background: Sinus of Valsalva aneurysm (SOVA) is a rare anomaly of the aorta that can be congenital or acquired. It can be associated with syndromes such as Marfan syndrome and Ehlers-Danlos syndrome. However, to our knowledge, it has never been described in a patient with Apert syndrome. Although it often presents as an incidental finding on imaging, SOVA is associated with the risk of serious complications, including rupture. A possible connection between the conditions might be the FGFR2 gene mutation in Apert syndrome and the influence of a mutation in fibroblast growth factor 2 (FGF2) on heart development. Here we report a case of acute heart failure secondary to rupture of SOVA into the right atrium in a patient with Apert syndrome. Case presentation: A 47-year-old Caucasian woman with a history of Apert syndrome and rheumatoid arthritis presented with shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and progressive bilateral lower extremity edema for 2 weeks. She was diagnosed with acute right heart failure due to ruptured SOVA. The patient underwent surgical repair of the ruptured SOVA. Unfortunately, her postoperative course was complicated by a stroke leading to brain death. Conclusion: Ruptured SOVA is a quite rare but serious condition that can cause life-threatening complications. In this case, SOVA occurred in a patient with Apert syndrome. The case may suggest that these two conditions may be related through the FGFR2 gene mutation associated with Apert syndrome and the related growth factor FGF2 involved in heart development.

Clinical Characteristics and Outcomes of Decompensated Cirrhosis Patients Admitted to Hospitals With Acute Pulmonary Embolisms: A Nationwide Analysis.

INTRODUCTION: Cirrhosis is a significant cause of mortality and morbidity worldwide. Recent studies suggested that cirrhosis is associated with an increased risk of venous thromboembolism (VTE), which disproves the old belief that chronic liver disease coagulopathy is considered protective against VTE. We conducted a retrospective study which is to our knowledge the first of its kind to assess clinical characteristics and outcomes of decompensated cirrhosis (DC) patients admitted with acute pulmonary embolism (APE). METHODOLOGY: We used the National Inpatient Sample database for the years 2016-2019. All adults admitted to the hospitals with a primary diagnosis of APE were included. Patients less than 18 years old, missing race, gender, or age were excluded. Patients were divided into two groups, either having DC or not. A multivariate logistic regression model was built by using only variables associated with the outcome of interest on univariable regression analysis at P < 0.05. RESULTS: 142 million discharges were included in the NIS database between the years 2016 and 2019, of which 1,294,039 met the study inclusion criteria, 6,200 patients (0.5%) had DC. For adult patients admitted to the hospitals with APE, odds of inpatient all-cause mortality were higher in the DC group than in patients without DC; OR of 1.996 (95% CI, 1.691-2.356, P-value < 0.000). Also, vasopressor use, mechanical ventilation, and cardiac arrest were more likely to occur in the DC group, OR of 1.506 (95% CI, 1.254-1.809, P-value < 0.000), OR of 1.479 (95% CI, 1.026-2.132, P-value 0.036), OR of 1.362 (95% CI, 1.050-1.767, P-value 0.020), respectively. In addition, DC patients tend to have higher total hospital charges and longer hospital length of stay, coefficient of 14521 (95% CI, 6752-22289, P-value < 0.000), and a coefficient of 1.399 (95% CI, 0.848-1.950, P-value < 0.000), respectively. CONCLUSION: This study demonstrates that DC is a powerful predictor of worse hospital outcomes in patients admitted with APE. An imbalance between clotting factors and natural anticoagulants produced by the liver is believed to be the primary etiology of thrombosis in patients with DC. The burden of APE can be much more catastrophic in cirrhotic than in non-cirrhotic patients; therefore, those patients require closer monitoring and more aggressive treatment.

Health care workers attitudes toward COVID-19 vaccination and the effect on personal and professional life.

INTRODUCTION: While the discovery of the Coronavirus disease 2019 (COVID-19) vaccine renewed the hope to restore normal life, the attitude of Health Care Workers (HCWs) towards vaccination and its impact on their life are yet to be evaluated. METHODS: We conducted a cross-sectional study from late January to mid-February at the MedStar Health Hospitals in Baltimore, Maryland. Eligible HCWs completed the questionnaires anonymously. The primary outcomes were attitudes of HCWs towards vaccination and the impact on HCWs' comfort and anxiety in caring for patients, sleep, mood, attendance of social gatherings, and utilization of health clubs, before and after vaccination. RESULT: A total of 300 respondents completed the questionnaires. The mean age was 37.2 years with 37.7% physicians and 45.7% registered nurses. Of the respondents only, 15.7% refused vaccination. The most common reason for refusal was concerns for long-term adverse effects, cited by 59.5%. Following vaccination, comfort level in caring for patients with COVID-19 and other illnesses improved (6.3 (2.8) to 8.2 (2.0), p < 0.005, and 8.4 (2.4) to 9.1 (1.0), p < 0.005, respectively). Additionally, a significant decrease in anxiety was noted in HCWs caring for patients with COVID-19 and other illnesses (5.0 (3.3) vs. 3.5 (3.2), p < 0.005 and 2.7 (3.3) vs. 2.3 (3.4), p = 0.001, respectively). Significant improvement in mood scores (6.9 (2.4) vs. 7.7 (2.1), p < 0.005) and comfort level at social gatherings (4.3 (3.2) vs. 6.3 (3.0), p < 0.005) were also noted. CONCLUSION: Vaccination against COVID-19 resulted in overall improvement in HCWs physical and mental wellbeing.

Shock in the Setting of Diamond-Blackfan Anemia Relapse.

Adult intensivists have increasing exposure to individuals with congenital diseases surviving into adulthood. Solid knowledge bases and early recognition of the possible sequelae of congenital disorders are crucial in caring for these patients. We present a challenging case of shock and relapse of Diamond-Blackfan anemia in a 42-year-old man lost to follow-up for 18 years and highlighted the importance of healthcare transitions into adulthood and the challenges faced by health care systems to develop new strategies successfully transitioning complex pediatric patients to adult care.

A large unruptured ectopic pregnancy.

Ectopic pregnancy carries a significant mortality risk in the first trimester given the increased likelihood of rupture of large embryos. In this report, an otherwise asymptomatic woman presented with amenorrhea and a positive urine pregnancy test. Results included an elevated beta-human chorionic gonadotropin (B-hCG) of 39,947 IU/L and Transvaginal ultrasound suggestive of a 3.9 cm unruptured fallopian tube ectopic pregnancy. She underwent emergent salpingectomy without complications, confirming a 10 week, 6 days gestational age pregnancy. This exceptional case of an unruptured ectopic with crown rump length (CRL) above 2 cm illustrates the importance of early diagnosis due to the often unremarkable presentation.

Cholestatic Hepatitis in Graves' Disease: A Diagnostic Challenge.

Cholestatic hepatitis is a rare presentation of thyrotoxicosis potentially confused as an adverse effect of antithyroid therapy. We report a 37-year-old man with cholestatic hepatitis as an initial presentation of Graves' disease. Diagnostic evaluation demonstrated (i) elevated transaminases and alkaline phosphatase (R-factor value: 2.6), and marked cholestasis (total bilirubin: 17.3 mg/dL, direct bilirubin: 9.4 mg/dL); (ii) negative hepatitis, viral, and autoimmune serologies; (iii) normal magnetic resonance cholangiopancreatography; (iv) liver biopsy with marked cholestasis and no fibrosis; (v) thyroid-stimulating hormone <0.01, fT4 (free thyroxine): 1.5, fT4 (free triiodothyronine): 4.3 and positive thyroid-stimulating immunoglobulins. Radioiodine uptake scan confirmed Graves' disease. Clinical resolution was achieved with propranolol, prednisone, methimazole, and thyroidectomy.