The pandemic of coronavirus disease 2019 has emerged in late 2019 infecting millions of people worldwide. Diabetes mellitus (DM) has been associated with severe illness and mortality mainly due to acute respiratory distress syndrome. We report a case of a middle-aged man with DM and COVID-19 who developed seizure and altered mental status, found to have diabetic ketoacidosis (DKA), acute kidney injury, hypovolemic shock, and hyperammonemia all contributing to metabolic encephalopathy. He was admitted to the ICU and subsequently intubated for airway protection; with appropriate management his condition improved and was successfully extubated. The patient had no lung involvement throughout the illness. We report this case to highlight that COVID-19 can lead to multi-organ failure in patients with DM even in the absence of lung involvement which all physicians should be mindful of.
Deep vein thrombosis (DVT) is a relatively common clinical entity with significant morbidity and mortality. Acute pulmonary embolism (PE) is the most significant complication of DVT and warrants immediate attention. The location of the DVT has a substantial impact on its ability to break off and travel to the pulmonary vasculature, causing a PE. Proximal DVT is more likely to cause a PE than a distal DVT. The widely accepted management for proximal DVT is anticoagulation. However, the management of distal DVT is unclear. This review article discusses factors that increase the risk of PE in patients with distal DVT, guidance on how to categorize patients into high and low-risk categories, and the recommended management for each category.
Patients with primary and metastatic brain tumors are predisposed to thromboembolism. This review of the literature explores the high prevalence of venous thromboembolism and its negative impact on patients with brain cancer. It outlines the recommended prophylactic strategies to prevent venous thrombosis and analyzes the benefit versus risk of anticoagulation in this population, with a focus on the risk of intracranial bleeding associated with it. Additionally, it explores the exceedingly high prevalence of venous thromboembolism in the setting of brain cancer surgeries and provides guidance on the best methods used for prophylaxis in this setting and discusses the safety of each method perioperatively. Lastly, this review article provides guidance on how to manage venous thromboembolism in patients with brain cancer and discusses the use of vena cava filters in this population.
Malnutrition is extremely common in hospitalized patients. It can lead to various complications and increase mortality. However, it remains poorly recognized and many health care systems do not require nutritional assessment during the hospital stay. This most likely due to lack of awareness and inadequate coordination between health care workers. Physicians can utilize many different methods when performing malnutrition screening, and there is also a lack of global clear-cut recommendations on criteria used to diagnose malnutrition. This article aims to increase malnutrition awareness among health care providers, and provide a guide on screening, diagnosis, and management of malnutrition.
Neuroendocrine tumors (NETs) are epithelial neoplasms with predominant neuroendocrine differentiation and the ability to synthesize and secrete variable hormones and monoamines. They are relatively rare, accounting for 2% of all malignancy cases in the United States. The most common system affected by NETs is the gastrointestinal tract. Clinical presentation depends on the organ being involved and the hormone being secreted. It can be variable from asymptomatic incidental findings on imaging to intestinal obstruction, or carcinoid syndrome (CS). Several biochemical testings are developed to help with the diagnosis of NETs including 5-hydroxyindoleacetic acid (5-HIAA) and chromogranin A (CgA). Computerized tomography (CT) scans and magnetic resonance imaging (MRI) are the most commonly used modalities to localize the primary tumor and evaluate for metastasis. However, radionuclide imaging using somatostatin receptor-based imaging techniques has improved accuracy to detect smaller neoplasm. Surgical removal is the mainstay of treatment for locoregional tumors. Several medical managements are available for non-respectable NETs which include SSAs, peptide receptor radionuclide therapy (PRRT), and platinum-based chemotherapy agents.
Hyperleukocytosis is a rare form of paraneoplastic syndrome that has been reported in adenocarcinomas, particularly pancreatic cancer. We present an elderly man with chronic abdominal pain and weight loss for six months. On examination, he had diffuse tenderness and marked ascites. A workup with a CT scan revealed a pancreatic mass, which was confirmed to be pancreatic adenocarcinoma on biopsy. His lab work showed a significant leukocytosis. An extensive infectious workup was negative. He was not on any medications known to cause a leukocytosis; therefore, his leukocytosis was attributed to his cancer. Unfortunately, he died just a few days later. This case highlights hyperleukocytosis as a paraneoplastic syndrome that is a poor prognostic sign, and can be used as a marker for disease progression.
Acute myeloid leukemia (AML) is a hematologic malignancy that can affect all blood cell lineages, the presentation varies, and infection is a common complication. This case involves a patient initially presenting with a necrotic foot ulcer and leukocytosis, ultimately leading to a diagnosis of osteomyelitis. After establishing adequate source control with serial debridements and intravenous antibiotics, the patient developed some knee swelling. On repeat assessment, he was discovered to have lymphadenopathy, and workup revealed AML. As indicated by this case, though it appeared a clear-cut diagnosis of osteomyelitis, there was an underlying malignancy that would have potentially gone unnoticed due to incomplete clinical examination.
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