BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States. METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission. RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified. CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

Malignant granular cell tumors (MGCTs) are rare and aggressive variants of granular cell tumors. They usually involve the head and neck region, skin and soft tissues. There are no standard therapeutic guidelines for management; however, surgical resection, whenever feasible, is considered to be first line. We report a patient with recurrent unresectable MGCT of lower lip who responded to pazopanib monotherapy. This drug has been recently approved for the treatment of advanced soft tissue sarcomas. It is a potent oral tyrosine kinase inhibitor and acts on multiple receptors, including vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), c-kit, platelet-derived growth factor receptor (PDGFR) and fibroblast growth factor receptor (FGFR). Due to the overexpression of multiple genes by the tumor and multiple targets of this drug, it is difficult to establish the mechanism of action responsible for disease response.

Synovial sarcoma (SS) is a rare soft tissue sarcoma usually arising in the deep soft tissues of the limbs, trunk, and head and neck region. Due to its rarity, diagnosis can be difficult to establish, especially when it involves an uncommon location like the breast. In this case report, we describe a young woman who was found to have primary SS of the breast. Initial immunohistochemistry staining was focally positive for cytokeratin and S100 and she was misdiagnosed with atypical spindle cell carcinoma. Due to the unusual presentation, further testing was performed which showed TLE1 and epithelial membrane antigen positivity, establishing the diagnosis of SS of the breast. A FISH was later sent out and was positive for SS18-SSX fusion transcript. This case highlights the importance of considering rare histopathology in breast lesions and using additional staining and cytogenetics to confirm diagnosis.

Introduction Patients with inflammatory bowel disease are at increased risk of infections due to the immunosuppressive drugs used for its treatment and by the virtue of the disease itself. The risk of infection is further exacerbated by decreased host response to vaccines. Objective The objective of this study is to determine the outcomes of sepsis in patients with Inflammatory bowel disease (IBD). Methods The 2016 National Inpatient Sample database was used to identify patients admitted with primary diagnosis of sepsis using ICD 10 code. The subgroup analysis was done to identify patients with IBD. IBD patients were further subdivided into Ulcerative colitis and Crohn’s disease. We analyzed inpatient demographics using chi-square. Predictors of inpatient mortality were calculated using univariate and multivariable regression models. Results 1,899,169 patients were admitted for sepsis in 2016. 10,485 UC and 13,879 CD patients with sepsis were identified. UC patients admitted with sepsis had a higher mortality (47.9%) compared to CD patients (37.8%). After adjusting for potential confounders, CD was associated lower odds of mortality as compared to UC (aOR 0.77, 95% CI 0.60–0.97, P=0.031). Independent predictors of mortality were Age (aOR 1.02, 95% CI 0.60–0.97, P=0.031) and increased Charlson comorbidity index (aOR 1.76, 95%CI 1.27–2.44 P=0.001). Acute renal failure patients requiring inpatient hemodialysis (aOR 2.8, 95% CI 1.9–4.1,P=0.000) and patients with septic shock requiring pressor support(aOR 1.6 95% CI 1.01–2.51, P=0.044) were also associated with higher odds of mortality. Severe malnourishment (aOR 0.005, 95% CI 1.18–2.62, P=0.005) and patients who developed obstruction (aOR 1.9, 95% CI 1.3–2.7, P=0.001) were also associated independent predictors of mortality on multivariate logistic regression. Conclusions Sepsis admissions in CD patients had better outcomes compared with UC patients. Age, Charlson comorbidity index, renal function and nutritional status of patient were useful tools to predict mortality. Further, research is needed to identify other predictors and to determine the mechanisms of underlying clinical differences.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme defect described in humans. Hemolysis in affected patients is usually triggered by circumstances involving free radical damage. While acute HIV infection is known to be a state of overwhelming oxidative stress, virus-induced hemolytic events in G6PD-deficient patients has rarely been reported. Despite an estimated overall prevalence of 6.8%–13% of this disorder in the HIV population, clinically significant hemolysis has been largely attributed to the use of offending medications rather than HIV infection itself. Here, we present a patient whose first episode of G6PD deficiency-associated hemolysis occurred as the main presentation of acute HIV infection.