Objectives Identification of racial differences in characteristics and comorbidities in patients hospitalized for COVID-19 and the impact on outcomes. Study design Retrospective observational study. Methods Data for all patients admitted to seven community hospitals in Michigan, United States with polymerase chain reaction confirmed diagnosis of COVID-19 from March 10 to April 15, 2020 was analyzed. The primary outcomes of racial disparity in inpatient mortality and intubation were analyzed using descriptive statistics and multivariate regression models. Results The study included 336 black and 408 white patients . Black patients were younger (62.9 +/- 15.0 years vs 71.8 +/- 16.4, P <.001), had a higher mean body mass index (32.4 +/- 8.6 vs 28.8 +/- 7.5, P <.001), had higher prevalence of diabetes (136/336 vs 130/408, P =.02) and presented later (6.6 +/-5.3 days after symptom onset vs. 5.4 +/- 5.4, P =.006) compared to white patients. Younger black patients had a higher prevalence of obesity (age< 65, 69.9%) than older black patients (age>65, 39.2%) and younger white patients (age<65, 55.1%). Intubation did not reach statistical significance for racial difference (black patients 61/335 vs. 54/406, P =.08). Mortality was not higher in black patients (65/335 vs. 142/406 in white patients, Odds ratio 0.61, 95% CI 0.37 to 0.99, 2 sided P =.05) in multivariate analysis, accounting for other risk factors associated with mortality. Conclusions Higher prevalence of obesity and diabetes in young black populations may be the critical factor driving disproportionate COVID-19 hospitalizations in black populations. Hospitalized black patients do not have worse outcomes compared to white patients.

A straddling thrombus within a patent foramen ovale (PFO), also known as an impending paradoxical embolism, is an infrequent event that is rarely encountered in clinical practice. This should be considered whenever there is an arterial embolism in the presence of right-sided thromboembolic disease. Symptoms are widely variable depending on the severity of thrombus and obstructive embolic events. We present a patient who arrived at the hospital with signs and symptoms consistent with a cerebrovascular disease that was ultimately diagnosed with small foci of acute ischemic cerebral infarcts, bilateral pulmonary emboli, and a straddling thrombus traversing three cardiac chambers. Treatment included PFO closure, inferior vena cava filter placement, and surgical thrombectomy with a successful outcome. Consensus for treatment of an impending paradoxical embolism in the medical literature is a subject of controversy and is our reason behind contributing this case presentation with our treatment strategy.

Echocardiography is the most widely used noninvasive modality to evaluate the structure and function of the cardiac muscle in daily practice. However, up to 15–20% of echocardiograms are considered suboptimal. To enable accurate assessment of cardiac function and wall motion abnormality, the use of ultrasound microbubble contrast has shown substantial benefits in cases of salvaging nondiagnostic studies and enhancing the diagnostic accuracy in daily practice. DEFINITY® is a perflutren based, lipid shelled microbubble contrast agent, which is US FDA approved for left ventricular opacification. The basis of ultrasound microbubbles, its development, and the clinical role of DEFINITY (characteristics, indications and case examples, side effect profile and existing evidence) is the subject of discussion in this review.

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Introduction: The aim of the study was to evaluate the prognostic significance of histopathological differentiation in treatment outcome of locally advanced carcinoma cervix. Materials and Methods: This retrospective study includes 167 patients of locally advanced carcinoma cervix treated between January 2006 and December 2008 who have received definitive chemoradiation. Results: : The number of patients with well (85 [50.9%]) and moderately differentiated (76 [45.5%]) carcinoma was nearly equal with poorly differentiated variety having only 6 (3.6%) patients. On completion of treatment out of the 167 patients, 133 (79.6%) had a complete response and 34 (20.4%) had residual disease. On mean follow-up of 11 months, 19 (14.2%) patients had local and 5 (3.7%) had a distant relapse. Histopathological differentiation and age had no association with treatment outcome, whereas early-stage disease showed trend favoring better treatment response. Conclusion: Advanced stage along with poor histopathological differentiation influences the aggressiveness of the tumor responsible for distant relapse. However, histopathological differentiation has no correlation with local treatment response and overall survival. The main factor influencing the treatment outcome is the intrinsic radiosensitivity of the tumor and volume of the disease.