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1.
Cureus ; 15(7): e41444, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37426399

RESUMO

Introduction Initially regarded as primarily a respiratory illness, coronavirus disease 2019 (COVID-19) has since been recognized as a complex disease affecting multiple systems. A COVID-19 infection can cause a hypercoagulable state leading to thrombotic complications in various systems. Acute mesenteric ischemia (AMI) has been reported as a rare complication of COVID-19, carrying a significant mortality rate. Although some risk factors for AMI in COVID-19 patients have been identified, there is a lack of large-scale studies examining outcomes and predictors of mortality. This study aims to assess the outcomes and identify predictors of mortality in a larger cohort of hospitalized COVID-19 patients with AMI, utilizing a retrospective analysis of the National Inpatient Sample (NIS) database. Methods Data from the 2020 NIS database were retrospectively analyzed. Patients aged 18 years and older, with a principal diagnosis of mesenteric ischemia were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes. The population was divided into mesenteric ischemia with COVID-19 and mesenteric ischemia without COVID-19. Patient demographics, comorbidities, hospital characteristics, and outcomes such as mortality, length of stay, and costs were analyzed. Multivariable logistic regression was performed to identify predictors of mortality. Results Among the 18,185 patients with acute mesenteric ischemia in 2020, 2.1% (n=370) had AMI with COVID-19 while 97.9% (n=17,810) had AMI only. In comparison to those without COVID-19, patients with AMI and COVID-19 had significantly higher in-hospital mortality. They also had higher odds of acute kidney injury, coronary artery disease, and ICU admission. Increasing age and white race were identified as predictors of mortality. Patients with COVID-19 had longer hospital stays and higher total costs compared to those without COVID-19. Discussion In this retrospective analysis of the NIS database, COVID-19 infection was associated with higher mortality in patients with AMI. Additionally, COVID-19 patients with AMI experienced increased odds of complications and higher resource utilization. Advanced age and white race were identified as predictors of mortality. These findings emphasize the importance of early recognition and management of AMI in COVID-19 patients, especially in high-risk populations.

2.
Cureus ; 14(5): e24783, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35673305

RESUMO

We are reporting a case of massively enlarged left inguinal hernia containing the stomach and presenting with coffee ground emesis. Esophagogastroduodenoscopy (EGD) identified a non-ischemic stomach with three small gastric ulcers. The patient opted for non-surgical management.

3.
Artigo em Inglês | MEDLINE | ID: mdl-35711859

RESUMO

We are presenting a rare case of pyloric stenosis due to Crohn's disease. A 53-year-old woman with prior history of colonic Crohn's disease was admitted to the hospital with gastric outlet obstruction. Esophagogastroduodenoscopy demonstrated pyloric stenosis and biopsy was consistent with Crohn's disease. She was treated with corticosteroids and her condition improved.

4.
J Investig Med High Impact Case Rep ; 10: 23247096211065625, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35343847

RESUMO

Following the first report of COVID-19 infection in December 2019 as a respiratory illness, it has proven to be a multisystem disease. There are few reported cases of ischemic colitis with COVID-19 infection in the medical literature to date and we have limited understanding of its pathophysiology. We report 2 cases of ischemic colitis as the only manifestation of COVID-19. In addition, we review the current limited literature regarding COVID-19-associated ischemic colitis.


Assuntos
COVID-19 , Colite Isquêmica , Colite Isquêmica/etiologia , Humanos
5.
Artigo em Inglês | MEDLINE | ID: mdl-34805580

RESUMO

BACKGROUND: Post-cholecystectomy syndrome (PCS) is a group of heterogeneous signs and symptoms, predominately consisting of right upper quadrant abdominal pain, dyspepsia, and/or jaundice, manifesting after undergoing a cholecystectomy. According to some studies, as many as 40% of post-cholecystectomy patients are in fact, affected by this syndrome. This study aims to determine the demographics, aetiology, average length of hospital stay, and health care burden associated with PCS. METHODS: We queried the National Inpatient Sample (NIS) database to determine inpatient admissions of PCS between 2011 and 2014 using the ICD-9 primary diagnosis code 576.0. RESULTS: From 2011 to 2014, the number of inpatient admissions with a principal diagnosis of PCS totally 275. The average length of hospital stay was 4.28±4.28, 3.42±2.73, 3.74±1.84, and 3.79±2.78 days in 2011, 2012, 2013, and 2014, respectively. The total yearly charges were $32,079±$24,697, $27,019±$22,633, $34,898.21±$24,408, and $35,204±$32,951 in 2011, 2012, 2013, and 2014, respectively. Notably, the primary cause of PCS in our patient sample between the year 2011 and 2014, was biliary duct dysfunction, followed by Peptic ulcer disease. CONCLUSIONS: In conclusion, there is a strong need to examine for and treat the underlying aetiology when approaching a post-cholecystectomy patient. We found that longer hospital stays, were associated with a greater health care burden, and visa versa. Furthermore, our findings help identify at-risk populations which can contribute to improving surveillance of this costly disease.

6.
Case Rep Gastrointest Med ; 2021: 6306149, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34471551

RESUMO

Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used for the treatment of type 2 diabetes mellitus. We are reporting the second case of liraglutide-induced liver injury, with complete resolution of liver injury after discontinuation of the drug.

7.
World J Oncol ; 12(4): 127-131, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34349858

RESUMO

Gastric cancer is one of the most common and deadly cancers worldwide, especially amongst older males. Current data suggest gastric cancer is the fifth most common neoplasm and the third most deadly cancer, with an estimated 783,000 deaths in 2018. Risk factors associated with the development of gastric cancer include obesity, gastroesophageal reflux disease, Helicobacter pylori infection, and low socioeconomic status. Diagnosis of gastric cancer can be accomplished by endoscopy, which allows the clinician to obtain a biopsy specimen. Endoscopic ultrasound is also an important modality that is helpful in assessing tumor invasion. The most common sites of metastatic gastric cancer in descending order are the liver, peritoneum, lung and bone. Rarely will gastric cancer metastasize to the colon. Here we present a rare case of colonic metastasis of a primary gastric adenocarcinoma.

8.
Curr HIV Res ; 19(5): 411-419, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34053428

RESUMO

BACKGROUND: The "remission theory" is an emerging concept that suggests the presence of human immunodeficiency virus (HIV) results in decreased disease severity in patients with inflammatory bowel disease. This theory is based upon evidence that implicates CD4 T-lymphocytes in the pathogenesis of both Crohn's disease and ulcerative colitis. This study sought to elucidate the legitimacy of this theory. METHODS: A retrospective cohort analysis of all adult inpatient hospitalizations for inflammatory bowel disease (IBD) using the 2016 National Inpatient Sample (NIS) was conducted. Our study population included patients admitted with IBD who were infected with HIV. We compared our study group to patients who also had IBD but were not infected with HIV. Baseline demographic characteristics, resource utilization, and in-hospital mortality rates were extracted for both groups. RESULTS: A total of 58,979 patients were admitted for IBD in 2016. Of those patients, we identified 145 who also had the presence of HIV. We found that patients with ulcerative colitis and HIV had a shorter length of hospital stay (4.1 vs. 5.9 days, p-value < 0.01), lower hospital charge ($35,716 vs $52,893, p-value < 0.01), and lower hospital cost ($7,814 vs. $13,395, p-value < 0.01) than those who did not have HIV. In patients with Crohn's disease, the presence of HIV resulted in decreased colonoscopy rates (0% vs. 17.4%, p-value < 0.01); however, the rate of esophagogastroduodenoscopies was not statistically significant (7.1% vs. 14.7%, p-value 0.106). CONCLUSION: In this retrospective population-based study, we found that patients with ulcerative colitis and concurrent HIV had a milder course of the disease when compared to ulcerative colitis patients that were not infected with HIV. These findings support the remission theory in that HIV may play a role in inflammatory bowel disease.


Assuntos
Colite Ulcerativa , Doença de Crohn , Infecções por HIV , Doenças Inflamatórias Intestinais , Adulto , Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Estudos Retrospectivos
9.
Int J Colorectal Dis ; 36(11): 2455-2461, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33987734

RESUMO

BACKGROUND: Ischemic colitis (IC) occurs when the blood supply of the large intestine becomes compromised. Several cardiovascular conditions, such as coronary artery disease, congestive heart failure, and atrial fibrillation, are well-established risk factors for the development of IC. The effects of pulmonary conditions, namely chronic obstructive pulmonary disease (COPD), on IC have not been well studied. AIMS: Our aim was to elucidate if the presence of COPD worsened outcomes in patients with IC. METHODS: Retrospective analysis of patients hospitalized with IC in 2016 was evaluated using the National Inpatient Sample database. Baseline demographic data, length of hospital stay (LOS), total hospital cost/charge, rates of colectomy, and in-hospital mortality were extracted from the database. Categorical variables were compared using the chi-square test and continuous variables were compared using the t-test. RESULTS: A total of 25,035 patients with IC were identified while 4482 of these patients also had COPD. We found that IC patients with COPD had a longer LOS (5.8 days vs 4.4 days; P<0.01), higher total hospital charge ($56,682 vs $42,365; P<0.01), higher total hospital cost ($13,603 vs $10,238; P<0.01), higher mortality rate (6.5% vs 3.1%; P<0.01), and higher colectomy rate (5.1% vs 3.7%; P<0.01). CONCLUSIONS: The presence of COPD portends poor outcomes in patients with IC. This was evidenced by increased risk of death and increased risk of undergoing colectomy. Given these findings, patients with COPD warrant closer observation. We advocate that COPD be considered as part of the risk assessment of patients with acute IC who need surgical intervention.


Assuntos
Colite Isquêmica , Doença Pulmonar Obstrutiva Crônica , Colite Isquêmica/complicações , Mortalidade Hospitalar , Humanos , Tempo de Internação , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Fatores de Risco
10.
J Investig Med High Impact Case Rep ; 9: 23247096211013206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33969720

RESUMO

Rectal bleeding is a known complication of transrectal ultrasound-guided prostate biopsy. It is usually mild and resolves spontaneously. However, massive life-threatening hemorrhage can also rarely occur in this setting, potentially presenting a therapeutic conundrum. We hereby delineate the case of a patient who experienced severe intermittent lower gastrointestinal bleeding following a transrectal ultrasound-guided prostate biopsy. Traditional tamponade methods failed to control the hemorrhage. Subsequently, an urgent flexible sigmoidoscopy revealed an anterior rectal wall prominence with biopsy punctures as the possible source of bleeding. Endoclip was successfully applied at the bleeding site, achieving permanent hemostasis. The patient had an uneventful recovery and was discharged from the hospital. While the use of endoclipping has been widely reported in gastrointestinal endoscopy, its application remains exceedingly rare in this group of patients. To our knowledge, this case represents only the third report of endoclipping alone to treat massive rectal bleeding follwing a prostate biopsy procedure. In addition, we systematically review published medical literature to evaluate endoscopic techniques aimed at managing this important complication. This article illustrates that endoscopic therapy may present an efficient, noninvasive method to deal with severe post-biopsy rectal hemorrhage. Therefore, prompt consultation with the gastroenterology service should be advocated.


Assuntos
Biópsia , Hemorragia Gastrointestinal , Próstata , Reto , Biópsia/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Próstata/diagnóstico por imagem , Ultrassonografia de Intervenção
11.
Clin Pract ; 11(2): 185-189, 2021 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-33805260

RESUMO

Esophagitis dissecans superficialis (EDS) is a rare and underdiagnosed esophageal lesion characterized by sloughing of the esophageal mucosa that has been associated with medications, various autoimmune disorders, and exposure to some chemical irritants. Anatomically, EDS is most commonly seen in the middle and distal thirds of the esophagus. When present, EDS is best treated by discontinuing the offending agent and initiating pharmacologic therapy with proton pump inhibitors. Steroids may also be effective if the etiology is autoimmune in nature. Our case highlights a 65-year-old female diagnosed with EDS after incidental ingestion of hair dye containing resorcinol and para-phenylenediamine (PPD).

12.
JGH Open ; 5(3): 350-355, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33732881

RESUMO

BACKGROUND AND AIM: To determine the United States-based in-hospital gastroparesis mortality rate and independent predictors associated with it. METHODS: A retrospective study was conducted using the deidentified National Inpatient Sample and Healthcare Cost and Utilization Project database between the years 2012 and 2014. The in-hospital gastroparesis mortality rate was calculated. Patients' demographics, including age, gender, race, comorbid conditions, and hospital characteristics, were examined as potential predictors of mortality. RESULTS: The gastroparesis mortality rate was 3.19 per 1000 gastroparesis patients for the years 2012-2014. Caucasians had the highest mortality rate, with odds ratio (OR) = 2.27; 95% confidence interval (CI) 1.52-3.38, and P = 0.0001. Rural hospitals had higher mortality, with OR = 1.51, 95% CI 1.10-2.10, and P = 0.01, whereas urban nonteaching and teaching hospitals showed no statistically significant mortality difference, with OR = 0.83, 95% CI 0.6-1.15, and P = 0.27 and OR = 0.82, 95% CI 0.59-1.15, and P = 0.25, respectively. In hospitals in the south region, mortality was the highest at 65.6%, with OR = 2.05, 95% CI 1.48-2.84, and P < 0.0001. Patients with diabetes mellitus had 39% lower probability in the mortality group. CONCLUSION: Being of advanced age; being White; and being in a rural, southern U.S. hospital were predictors of in-hospital mortality in gastroparesis patients.

13.
J Clin Gastroenterol ; 55(5): e37-e45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33470608

RESUMO

GOALS/BACKGROUND: Hemospray is a new hemostatic powder recently approved for endoscopic hemostasis in gastrointestinal (GI) bleeding. Data are limited in terms of its clinical outcomes, and its role in the treatment algorithm of GI bleeds. We conducted a systematic review and meta-analysis to study the clinical performance of Hemospray in the management of GI bleeding. STUDY: We searched multiple databases from inception through March 2019 to identify studies that reported on the clinical outcomes of Hemospray in GI bleeding. The primary outcome was pooled rates of clinical success after the application of Hemospray in GI bleeding. The secondary outcomes were pooled rebleeding rates and adverse events after use of Hemospray. RESULTS: A total of 19 studies, 814 patients, of which 212 patients were treated with Hemospray as monotherapy, and 602 patients were treated with Hemospray with conventional hemostatic techniques. Overall pooled clinical success after the application of Hemospray was 92% [95% confidence interval (95% CI), 87%-96%; I2=70.4%]. Overall pooled early rebleeding rates after application of Hemospray was 20% (95% CI, 16%-26%; I2=54%). Overall pooled delayed rebleeding rates after the application of Hemospray was 23% (95% CI, 16%-31%; I2=34.9%). There was no statistical difference in clinical success (RR, 1.02; 95% CI, 0.96-1.08; P=0.34) and early rebleeding (RR, 0.89; 95% CI, 0.75-1.07; P=0.214) in studies that compared the use of Hemospray as monotherapy versus combination therapy with conventional therapy. CONCLUSIONS: Hemospray is highly effective in achieving immediate hemostasis in gastrointestinal bleeding. However, due to significantly high rebleeding rates, Hemospray is not suited for definitive long-term therapy.


Assuntos
Hemostase Endoscópica , Hemostáticos , Hemorragia Gastrointestinal/terapia , Hemostáticos/efeitos adversos , Humanos , Minerais , Resultado do Tratamento
15.
Clin J Gastroenterol ; 13(6): 1010-1021, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32965635

RESUMO

Esophageal cancer is the eighth most common type of cancer worldwide and constitutes the sixth leading cause of cancer deaths. It is characterized by its high mortality rate, poor prognosis at time of diagnosis and variability based on geographic location. Present day, the prevalence of esophageal cancer is in transition. Although esophageal squamous cell carcinoma continues to be the most prevalent type worldwide, esophageal adenocarcinoma is quickly becoming the most prevalent type in developed countries. Risk factors for the development of esophageal squamous cell carcinoma include low socioeconomic status, consumption of tobacco, alcohol, hot beverages, and nitrosamines. Additionally, micronutrient deficiencies have also been linked to the development of esophageal squamous cell cancer. These include vitamin C, vitamin E, and folate. With respect to esophageal adenocarcinoma, risk factors include Barrett's esophagus, gastroesophageal reflux disease, obesity, and tobacco consumption. Screening for esophageal cancer will likely play an essential role in prevention, and consequently, mortality in the future. Present day, there are no established guidelines for esophageal squamous cell cancer screening. Guidelines for esophageal adenocarcinoma are more well established but lack concrete evidence in the form of randomized controlled trials. This review will discuss the epidemiology, risk factors, and current prevention strategies for esophageal cancer in depth. It is our aim to raise awareness on the aforementioned topics to increase public health efforts in eradicating this disease.


Assuntos
Adenocarcinoma , Esôfago de Barrett , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Adenocarcinoma/epidemiologia , Adenocarcinoma/etiologia , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/etiologia , Humanos , Fatores de Risco
16.
J Investig Med High Impact Case Rep ; 8: 2324709620950121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32787452

RESUMO

Malignant mesothelioma is an aggressive cancer associated with asbestos exposure with median survival time of 8 to 14 months following diagnosis. Given that mesothelial cells also line the peritoneum and pericardium, malignant mesothelioma can present in unusual sites and in patients with nonrespiratory complaints. A 73-year-old male presented to the emergency department for worsening intermittent diffuse abdominal pain for the past 3 months with associated unintentional 40-pound weight loss, early satiety, and diarrhea. He denied exposure to asbestos. Computed tomography imaging revealed multiple masses concerning for malignancy including the primary retroperitoneal mass, a mass involving the terminal ileum, and a mass in the right upper lung. Esophagogastroduodenoscopy demonstrated significant mass effect within the stomach without signs of endoluminal infiltration. Computed tomography-guided biopsy of the retroperitoneal abdominal and intramuscular paraspinal masses was performed. Stage IV epithelioid mesothelioma was confirmed when hematoxylin and eosin staining revealed pleomorphic malignancy nuclei containing a vesicular chromatin pattern and prominent nucleoli and immunohistochemical staining was positive for CK Oscar, cytokeratin 7, GATA3, calretinin, EMA, and CK5/6. He was started on cisplatin, pemetrexed, and bevacizumab but developed severe abdominal pain with pneumoperitoneum and bowel perforation 1 month later and expired shortly thereafter. To our knowledge, this represents a highly atypical presentation of malignant mesothelioma considering the involvement of the retroperitoneum with diffuse lesions in the abdominopelvic cavity and thorax (sparing the lung pleurae). This case also calls attention to the occurrence of malignant mesothelioma in patients without known asbestos exposure and the crucial role of pathology in diagnosing atypical presentations.


Assuntos
Amianto/efeitos adversos , Mesotelioma Maligno/induzido quimicamente , Mesotelioma Maligno/patologia , Neoplasias Retroperitoneais/induzido quimicamente , Neoplasias Retroperitoneais/patologia , Dor Abdominal/etiologia , Idoso , Diagnóstico Diferencial , Evolução Fatal , Humanos , Imuno-Histoquímica , Masculino
17.
Cureus ; 12(7): e8941, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32637290

RESUMO

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare type of thrombophilia and hematopoietic stem cell disorder characterized by mutation of the X-linked PIG-A gene. Patients with PNH present either with clinical features of intravascular hemolysis or thrombosis. Visceral vein thrombosis is associated with increased mortality risk. Here, we present an extremely rare case of a young man presenting with extensive thrombosis of multiple visceral veins from PNH.

18.
Ann Gastroenterol ; 33(4): 374-378, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32624657

RESUMO

BACKGROUND: Colonoscopy is the gold standard for colon cancer screening. Adenoma detection rate and a withdrawal time of 6 min are quality metrics to measure the efficacy of colonoscopy in colon cancer screening. The aim of our study was to exploit the Hawthorne effect in an effort to ensure adherence to a minimum 6-min withdrawal time and subsequently increase adenoma detection rate. METHODS: This was a retrospective single-center study where we reviewed the records of patients who underwent screening colonoscopy in 2015 and 2017. We divided our patient population into 2 groups. The first group of patients from 2015 underwent screening colonoscopy with no visual cues on the colonoscopy monitor. The second group of patients from 2017 had visual cues indicating withdrawal time on the colonoscopy monitor. RESULTS: Screening colonoscopy had a statistically significantly higher adenoma detection rate when performed with visual cues compared to without visual cues (25.3% vs. 19.45, P=0.04). Polyp detection rate was also higher in the group where visual cueing was used (52.9% vs. 22.9%, P<0.001). There were no statistically significant differences in actual withdrawal time or cecal intubation rates. CONCLUSIONS: Visual cues indicating withdrawal time are a useful intervention that results in an increased adenoma detection rate. Given its practicality and cost effectiveness, we recommend universally implementing visual cues to ensure adherence to a minimum 6-min withdrawal time.

20.
World J Oncol ; 11(2): 55-64, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32284773

RESUMO

BACKGROUND: Esophageal cancer is the sixth leading cause of cancer-related deaths and the eighth most common cancer worldwide with a 5-year survival rate of less than 25%. Here we report the incidence, risk factors and treatment options that are available currently, and moving into the future. METHODS: We retrospectively analyzed the Surveillance Epidemiology and End Results (SEER) database made available by the National Cancer Institute in the USA. Specifically we extracted data from the years 2004 - 2015. RESULTS: In total we identified 23,804 patients with esophageal adenocarcinoma and 13,919 patients with esophageal squamous cell carcinoma. Males were at an increased risk of developing both types of esophageal cancer when compared to females. Most cases of adenocarcinoma were diagnosed as poorly differentiated grade III (42%), and most cases of squamous cell carcinoma were diagnosed as moderately differentiated grade II (39.5%). The most common stage of presentation for both adenocarcinoma (36.9%) and squamous cell (26.8%) carcinoma was stage IV. The worst outcomes for adenocarcinoma were noted with grade III tumors (hazard ratio (HR): 1.56, 95% confidence interval (CI): 1.44 - 1.68, P value: < 0.01), stage IV tumors (HR: 3.58, 95% CI: 3.33 - 3.85, P value: < 0.01) and those not treated with surgery (HR: 2.54, 95% CI: 2.44 - 2.65, P value: < 0.01). For squamous cell carcinoma, the worst outcomes were noted with grade III tumors (HR: 1.35, 95% CI: 1.23 - 1.49, P value: < 0.01), stage IV tumors (HR: 2.12, 95% CI: 1.94 - 2.32, P value: <0.01). CONCLUSIONS: The incidence of esophageal adenocarcinoma in the USA is steadily on the rise. Conversely, the incidence of squamous cell carcinoma has been continually declining. While white males had an increased incidence of both types of esophageal cancer, a higher proportion of African Americans suffered from squamous cell carcinoma. Despite the wide spread use of proton pump inhibitors, adenocarcinoma continues to be a major public health concern.

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