This study examined the safety of placing percutaneous endoscopic gastrostomy (PEG) tube in people with liver cirrhosis. The target population was further subdivided into people with ascites (case group) and people without ascites (control). We compare the morbidity and the mortality difference of PEG placement in cirrhotic patients with ascites vs cirrhotic patients without ascites. We then examined multiple factors including sex, race, chronic illness including hypertension, congestive heart failure, and others and their influence on the inpatient mortality of all cirrhotic patients who had PEG placement. A total of 38,175 inpatient PEG tube placements were identified. Only 583 patients out of 38,175 had a history of cirrhosis. One hundred seven had ascites and the rest did not. Mean age of the patients was 61.14 years. Patient demography included (65.2%) male and the rest were female, 359 were white (64.4%), 90 black (14.8%), 84 Hispanic (13.7%), 23 Asians (3.3%), 7 Native Americans (0.4%), and 20 others (3.5%). Complications from PEG procedure in cirrhosis with ascites vs non-ascites included bleeding of 4 (0.8%) vs 2 (1.9%) (P=0.35), surgical site infection 2 (0.4%) vs 1 (0.9%) (P=0.51), and urinary tract infection 105 (22.1%) vs 34 (23.8%) (P=0.34), respectively. There was no colonic injury in either group. The total inpatient mortality was 75 out of the 583. Fifty-six (11.8%) were in the ascites group and 19 (17.8%) in the non-ascites group (P=0.097). Factors including ascites, postsurgical bleeding, and surgical site infection did not have influence on the inpatient mortality and there were no statistical differences between the two groups.
inpatients for 17 months the prevalence of 0.56% is thought to accurately reflect the clinical situation.We also reveal that maculopapular lesions are common (75.0%) in Japan. The most common COVID-19-related skin rash was reported to be pseudo-chilblain lesions (40.9%) and 97% of these cases were from Europe or the USA. 4 The differences in cutaneous patterns may owe to a genetic/racial predisposition. The minor allele frequency of the IFIH1 gene which is common in Caucasians increases the production of type-1 interferons that can induce microangiopathy. 5 The patient age and the observation period might also explain the low frequency of pseudo-chilblains. The median age of pseudo-chilblains is reported to be 16.6-27.2 years and approximately 80% of cases were noticed at more than 2 weeks after onset whereas the figures for our study are median age of pseudo-chilblains of 68 years and mean duration of hospitalization of 14.0 days. 4,6,7
Rhodococcus is a rare zoonotic infection causing cavitary pneumonia in immunocompromised humans. There had been very few reported incidences of Rhodococcus osteomyelitis. Our patient is a 27 years old male with human immunodeficiency virus (HIV) infection who was diagnosed with Rhodococcus osteomyelitis and bacteremia. He initially presented with right hip pain and was diagnosed with osteomyelitis and abscess based on a CT scan. IR guided drainage of the abscess was done and culture yielded R. equi. He failed antibiotic treatment multiple times and later was managed with surgical intervention. Although it is a rare case, physicians should keep it in mind especially in immunocompromised patients while deciding on diagnosis and treatment plans.
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