The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.
The central location, the size, and instability of saddle pulmonary embolism (PE) have raised considerable concerns regarding its hemodynamic consequences and the optimal management approach. Sparse and conflicting reports have addressed these concerns in the past. We aimed to evaluate the clinical presentation, hemodynamic and echocardiographic effects, as well as the outcomes of saddle PE, and compare the results with those of non-saddle type. This was a retrospective study of 432 adult patients with saddle and non-saddle PE. Overall, 432 patients were diagnosed with PE by computed tomography pulmonary angiography (CTPA). Seventy-three (16.9%) had saddle PE, and 359 had non-saddle PE. Compared to those with non-saddle PE, patients with saddle PE presented more frequently with tachycardia (68.5% vs. 46.2%, P = .001), and tachypnea (58.9% vs. 42.1%, P = .009) on admission, required more frequent intensive care unit (ICU) admissions (45.8% vs. 26.6%, P = .001) and thrombolysis/thrombectomy use (19.1% vs. 6.7%, P = .001), and were at more risk of developing decompensation and cardiac arrest after their initial admission (15.3% vs. 5.9%, P = .006). On echocardiography, right ventricular (RV) enlargement (60% vs. 31.1%, P = .000), RV dysfunction (45.8% vs. 22%, P = .000), and RV systolic pressure (RVSP) of greater than 40 mmHg (61.5% vs. 39.2%, P = .003) were significantly more observed with saddle PE. The two groups did not differ concerning the rates of hypotension (17.8% vs. 18.7%, P = .864) and hypoxemia (41.1% vs. 34.3%, P = .336) on admission and mortality rates. A logistic regression model indicated that the use of oral contraceptive pills (OCP), RVSP > 40 mmHg, and development of hypotension and decompensation following admission were associated with an increased likelihood of having saddle embolus. Saddle PE accounts for a higher proportion among all PE cases than previously reported. Patients with saddle PE tend to present more frequently with adverse hemodynamic and echocardiographic changes and decompensate after their initial presentation. OCP use, development of hypotension, and decompensation following admission and RVSP > 40 mmHg are significant predictors of saddle PE. These characteristics should not be overlooked when managing patients with saddle PE.
Background: Type 2 diabetes mellitus has been found to be associated with 25(OH)D (vitamin D) deficiency. The aim of this study was to the prevalence of vitamin D deficiency in T2DM patients in Qatar and the correlation between vitamin D deficiency and other variables such as dyslipidemia and glycemic control and microalbuminuria. Methods: This retrospective cross-sectional analytical study was carried out at the Hamad General Hospital medical outpatient clinic, in which adult patients (? 18 years) with type 2 DM were involved, between January 1, 2018, and July 31, 2018. Ethical approval was obtained from medical research committee. Results: We recruited 400 subjects with type 2 diabetes mellitus. Their mean age was 58.97±10.32 years and the majority were women (52.0%) and Arabs (69.5%). The mean duration of type 2 diabetes diagnosis was 14.94±8.99 years and mean. The prevalence of vitamin D deficiency was 29.5%. A comparison between vitamin D deficiency and non-vitamin D deficiency groups, showed a statistically significant difference in terms of fasting blood sugar (P<0.001), random blood sugar (P<0.001), HBA1c (P<0.001), total cholesterol (P=0.001), LDL (C) (P=0.004), HDL (C) (P<0.001), triglyceride (P<0.001), and Urinary Albumin Excretion Rate (P=0.007). Data analysis showed that a significant negative correlation was found between vitamin D level and fasting blood sugar (r= -0.208, P<0.001), random blood sugar (r= -0.20, P<0.001), HBA1c (r= -0.260, P<0.001), total cholesterol (r= -0.218, P<0.001), LDL (C) (r= -0.176, P=0.004), triglyceride (r= -0.342, P<0.001), and Urinary Albumin Excretion Rate (r= -0.184, P=0.007). Conclusion: Our study showed a significant correlation between vitamin D deficiency and the poor control of T2DM, dyslipidemia, and microalbuminuria. The results emphasize the importance of monitoring vitamin D status in high-risk populations.
Background: Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla or from paravertebral ganglia of the sympathetic chain(1). The tumours commonly produce one or more catecholamines: epinephrine, norepinephrine, and dopamine leading to a classic triad of presentation with pounding headache, profuse sweating, and palpitations occurs in spells; However, one in 10 patients may be completely asymptomatic and the diagnosis of PPGL is frequently missed(2). Care Report: A 29 years old African female presented with one-month history of throbbing headache, palpitations, profuse sweating, and unintentional weight loss. Her previous medical history and family history was unremarkable. She was found to have accelerated hypertension and a small lacunar infarct and some suspected subarachnoid hemorrhage on MRI head but was clinically silent. Investigation for secondary causes of hypertension revealed high metanephrine in urine and her imaging showed giant adrenal mass suggestive of pheochromocytoma. CT Abdomen of large left adrenal necrotic solid mass lesion with heterogenous enhancement of its solid components measuring 6.5 x 6.1 x 7 cm in maximum AP, TR and CC dimensions respectively. She was scheduled for open resection and left adrenalectomy after approximatly10 day and was treated with high-sodium diet, alpha blockers, and beta blockers perioperatively. Histopathology examination revealed Pheochromocytoma measuring 8 x 7 x 5 cm with diffuse growth >10% of tumor volume with central necrosis; PASS =4, which has malignant potential. She recovered well post operatively and required no further antihypertensive therapy or hormonal replacement, follow up hormonal profile and imaging with Iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy were negative for remnants or metastasis, further evaluation with gallium DOTATATE PET CT and molecular genetic testing was considered, but it was not available. Conclusion: Pheochromocytoma is a rare cause of secondary hypertension with a variable clinical presentation. Episodes of tumoral catecholamine release, are thought to be responsible for the high prevalence of cardiovascular emergencies, such as myocardial infarction, heart failure, and stroke as a complication of hypertensive crisis. Timely diagnosis and treatment are crucial to prevent life-threatening complications.
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