Objective Coronavirus disease 2019 (COVID‐19) continues to spread, and younger patients are also being critically affected. This study analyzed obesity as an independent risk factor for mortality in hospitalized patients younger than 50. Methods This study retrospectively analyzed data of patients with COVID‐19 who were hospitalized to a large academic hospital system in New York City between March 1, 2020, and May 17, 2020. Data included demographics, comorbidities, BMI, and smoking status. Obesity groups included the following: BMI of 30 to < 40 kg/m2 and BMI ≥ 40 kg/m2. Multivariable logistic regression models identified variables independently associated with mortality in patients younger and older than 50. Results Overall, 3,406 patients were included; 572 (17.0%) patients were younger than 50. In the younger age group, 60 (10.5%) patients died. In the older age group, 1,076 (38.0%) patients died. For the younger population, BMI ≥ 40 was independently associated with mortality (adjusted odds ratio 5.1; 95% CI: 2.3‐11.1). For the older population, BMI ≥ 40 was also independently associated with mortality to a lesser extent (adjusted odds ratio 1.6; 95% CI: 1.2‐2.3). Conclusions This study demonstrates that hospitalized patients younger than 50 with severe obesity are more likely to die of COVID‐19. This is particularly relevant in the Western world, where obesity rates are high.

Coronavirus disease 2019 (COVID-19) is a global pandemic, and it is increasingly important that physicians recognize and understand its atypical presentations. Neurological symptoms such as anosmia, altered mental status, headache, and myalgias may arise due to direct injury to the nervous system or by indirectly precipitating coagulopathies. We present the first COVID-19 related cases of carotid artery thrombosis and acute PRES-like leukoencephalopathy with multifocal hemorrhage.

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Background Many patients with Crohn’s disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums. Methods We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up. Results From all the CD patients in the institutions’ databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer. Conclusions In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.

INTRODUCTION: Cytomegalovirus (CMV) is a common infection in immunocompromised patients including solid organ transplant patients. CMV infection of the GI tract can present in various ways. We present a case of chronic diarrhea of one-year duration associated with anemia. CASE DESCRIPTION/METHODS: A 56 year old female with a past medical history of hypertension, end stage renal disease with renal transplant in 2004 (maintained on cyclosporine, mycophenolate mofetil and prednisone) presented to the emergency room with generalized weakness of 4-days duration. The patient further endorsed significant weight loss and gradually progressive watery diarrhea that initially was postprandial and had been present for about one year. The symptoms persisted despite treatment with anti-diarrheal agents. The patient was also found to have anemia that began around a similar time as the diarrhea, and required multiple admissions for blood transfusions. She denied melena, hematochezia, fevers or chills. During prior admissions, fecal occult blood tests were negative and stool studies were unrevealing. On admission, the patient was found to have hemoglobin (Hgb) of 5.4 g/dL, acute kidney injury and metabolic acidosis. Fecal occult blood test was positive. Colonoscopy revealed diffuse pan colonic erythematous inflamed mucosa with rectal sparing and no evidence of punched-out ulcers (see Figures 1 and 2). Qualitative CMV polymerase chain reaction study was positive. Hematoxylin and Eosin stained biopsies were inconclusive for inclusion bodies. Immunohistochemical staining for CMV was positive for scattered reactive cells. CMV colitis was diagnosed. Patient was treated with oral valganciclovir leading to complete symptom resolution, improvement of anemia and weight gain. DISCUSSION: CMV colitis in immunocompromised patients typically presents with diarrhea associated with abdominal pain, fever, leukopenia and frank hematochezia. This case represents an unusual disease manifestation with an atypical timeline of disease duration, lack of aforementioned symptoms and non-characteristic endoscopic findings, making the diagnosis challenging. Furthermore, delayed CMV infection in organ transplant patients is quite unusual, as most typically, CMV infection presents shortly after initiation of immunosuppressive therapy.