Background: Left ventricular hypertrophy (LVH) is an independent predictor of fatal and non-fatal cardiovascular events in hypertensive patients. Current guidelines for the management of hypertension are based on cardiovascular risk stratification. This study evaluated the possibility that an inexpensive, simple random, single-void urinary protein-to-creatinine ratio (UPCR) would be associated to left ventricular (LV) mass in a black African setting, and therefore direct appropriate management of these patients. Methods: We measured echocardiographic LV mass and a random spot UPCR in 34 untreated newly diagnosed hypertensive patients attending the cardiology consultation unit at the Yaoundé General Hospital. LV mass was indexed to height (in m^2.7) to obtain the LV mass index (LVMI). A regression model was used to verify the independent association between UPCR and LVMI. Results: The mean age of our patients was 52.65 years, and the mean systolic and diastolic blood pressures were 152.44 and 92.84 mm Hg, respectively. The prevalence of LVH was 41.2%. UPCR was higher in patients with LVH compared to those without (p = 0.043). There was a significant correlation between UPCR and LVMI (r = 0.581, p < 0.001). In the multiple linear regression model, UPCR was associated with LVMI independent of systolic blood pressure (p < 0.001). Conclusion: Random spot UPCR is associated with an increased LV mass and may be very useful in screening and guiding appropriate management of high-risk untreated hypertensive patients.

Leiomyomas in the colon are uncommon accounting for a few cases of gastrointestinal smooth muscle tumors. These tumors are usually benign and asymptomatic. They may present with abdominal pain, intestinal obstruction, perforation, and rarely hemorrhagic, especially when the tumor is large. We present the case of a sigmoid leiomyoma in a 60-year-old patient consulting for a positive fecal occult blood test. Colonic leiomyomas should be considered in the differential diagnosis when a polyp is found during routine endoscopic evaluations. This case also highlights the limitations of diagnosing the nature of polyps using endoscopy alone.

172 Background: Gastric cancer (GC) remains a pervasive condition in the US with high morbidity and mortality. Race/ethnicity, lack of insurance, and poverty may all be contributing to this burden, especially in select populations. We evaluated the impact of these sociodemographic factors on GC outcomes at a hospital with high immigrant-patient populations. Methods: We conducted a retrospective study to identify patients diagnosed with GC between year 2010 and 2019. Data obtained from our institution database regarding patients' sociodemographic factors, including age, gender, race/ethnicity, insurance status and type, and neighborhood socioeconomic status. Likewise, information on tumor histology, anatomic location, and stage were also obtained. Kaplan-Meier analysis was used to plot survival curves and analyze the impact of insurance on survival outcome. Results: One hundred eleven patients were analyzed in this study, with a male-to-female ratio of 1.26:1. The median age at the time of GC diagnosis was 52.9 (range 27-87) years, with median survival time (±SD, range) of 12.7 (±17.7, 0.25-84) months. Most patients (69.4%) were uninsured—out of which 76.7% presented with advanced-stage disease. Among those, the majority (70.3%) were Hispanic, and 60.4% were non-U.S. citizens. The most common tumor histology was diffuse-type adenocarcinoma in 55% of patients. Patients insured were on public coverage (Medicaid), private insurance, and Medicare at 11.7%, 9.9%, and 9.0%, respectively. In terms of survival, lack of insurance (p = 0.012) and Medicaid insurance (p = 0.046) were associated with the worst survival outcomes in GC patients. Conclusions: Our study reflects the trends in GC outcomes distinctly linked to significant sociodemographic disparities. Patients who lack insurance coverage had the worst survival outcomes. Therefore, efforts such as increasing healthcare access for this population-type at risk of sociodemographic incongruities may enhance outcomes and are crucial in fighting GC.

In this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevation myocardial infarction on repeat electrocardiograms, and a negative coronary angiogram ruling out a coronary artery thrombosis or occlusion. With worsening diffuse ST-segment elevation on electrocardiograms and reduced ejection fraction on echocardiography in the setting of systemic inflammation, fulminant myocarditis was highly suspected. Despite optimal medical treatment, the patient’s condition deteriorated and was complicated by cardiac arrest that failed resuscitation. Although myocarditis was initially suspected, the autopsy revealed no evidence of myocarditis or pericarditis but did demonstrate multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature. Additionally, scattered microscopic cardiomyocyte necrosis with pathological diagnosis of small vessel micro-thrombotic occlusions. These findings are potentially exacerbated by inflammation-induced coagulopathy, hypoxia, hypotension, and stress, that is, a multifactorial etiology. Further research and an improved understanding are needed to define the precise pathophysiology of the coagulopathic state causing widespread micro-thrombosis with subsequent myocardial and pulmonary injury.