BackgroundAcute pancreatitis is an acute inflammation of the pancreas that varies in severity from mild to life threatening usually requiring hospitalization. The true incidence of drug-induced pancreatitis (DIP) is indeterminate due to the inadequate documentation of case reports of DIP. Here we present the case of amoxicillin/clavulanic acid-induced pancreatitis in a previously healthy male after excluding all other causes of pancreatitis.Case presentationA 58-year-old Caucasian man presenting for acute sharp abdominal pain with associated nausea and heaves. Pain was non-radiating and worsening with movement. Patient had no constitutional symptoms. The only medication he received prior to presentation was amoxicillin/clavulanic acid as prophylaxis for a dental procedure with his symptoms starting on day 9th of therapy. Laboratory studies revealed mild leukocytosis, increased levels of serum lipase, amylase, and C-reactive protein (CRP). Abdominal computed tomography (CT) was notable for acute pancreatitis with no pseudocyst formation. Hence, patient was diagnosed with mild acute pancreatitis that was treated with aggressive intravenous (IV) hydration and pain management with bowel rest of 2 days duration and significant improvement being noticed within 72 h. On further questioning, patient recalled that several years ago he had similar abdominal pain that developed after taking amoxicillin/clavulanic acid but did not seek medical attention at that time and the pain resolved within few days while abstaining from food intake. All other causes of pancreatitis were ruled out in this patient who is non-alcoholic, non-smoker, and never had gallstones. Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) eliminated out the possibility of gallstones, biliary ductal dilatation, or choledocholithiasis. Patient had no hypertriglyceridemia nor hypercalcemia, never had endoscopic retrograde cholangiopancreatography (ERCP), never took steroids, has no known malignancy, infection, trauma, or exposure to scorpions.ConclusionThis case describes a patient with DIP after the intake of amoxicillin/clavulanic acid and when all other common causes of acute pancreatitis were excluded. Only two other case reports were available through literature review regarding amoxicillin/clavulanic acid- induced pancreatitis.We again stress on the importance of identifying and reporting cases of DIP to raise awareness among physicians and clinicians.
VERISHA KHANAM JURGENA TUSHA DANYAL TAHERI ABKOUH LAITH AL-JANABI VESNA TEGELTIJA AND SARWAN KUMAR PURPOSE: Throughout the years, several scoring systems have been established to measure disease severity in efforts to predict patient mortality and help guide management. In patients with sepsis, organ failure has been proven to worsen outcome, therefore utility of scores such as Sequential Organ Failure Assessment (SOFA) has helped determine the severity of disease and predict mortality. Patients infected with SARS COV-2 were observed to have varying disease progression with multiorgan involvement. Through this study, we intend to investigate the use of the SOFA score in predicting mortality in critically ill patients who tested positive for SARS COV-2. The aim of this study is to determine if the SOFA score is a strong predictor of mortality in critical care patients admitted with SARS-COV2 infection.
The rapid outbreak of coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to infection with variable clinical presentations and a wide clinical spectrum. The disease was first reported in Wuhan, China in 2019 and has rapidly spread worldwide. Despite reports of dynamic changes in disease progression, clinical predictors of disease severity have been difficult to identify. The following case describing identical twins with laboratory confirmed COVID-19 who had very different disease courses. These patients resided in the same home and shared many of the same comorbidities, including type 2 diabetes mellitus, hypertension and morbid obesity. Although twin 1 had higher inflammatory markers, white blood cell (WBC) and an arguably more complicated medical history in comparison to their identical twin, the patient experienced a milder and shorter disease course. This case highlights the need for identifying proper disease markers and predictors early in the clinical course in order to direct future management guidelines and timely treatment.
Colorectal neuroendocrine tumors are rare entities, with large cell neuroendocrine carcinomas occurring less frequently. We report a case of an 83-year-old male who presented with symptoms of intestinal obstruction. A computed tomography scan of the abdomen and pelvis revealed a high-grade large bowel obstruction secondary to an irregular exophytic soft tissue mass within the ascending colon, with extensive metastatic disease. He subsequently underwent a right hemicolectomy. Histologic evaluation revealed large cell neuroendocrine carcinoma of the colon. Standardized treatment modalities have not been established; however, chemotherapy is often used as the first-line or adjuvant therapy with surgery. Unfortunately, our patient succumbed to postoperative complications on day 30 of the hospital stay.
, a viral pneumonia associated with a new coronavirus SARS COV-2 emerged in Wuhan, China and quickly spread throughout the world causing high mortality rates. As of May 30th,2020, coronavirus disease 2019 (COVID-19) has been confirmed in 56,884 people in Michigan, with case fatality rate of 10%. Since very little is known regarding patients with COVID-19 disease, we aim to describe the clinical characteristics and outcomes of patients hospitalized in a Michigan community hospital. METHODS: A single centre, retrospective chart review of 163 hospitalized patients with confirmed cases of COVID-19 at a community hospital from March 15 to April 10, 2020. Cases were confirmed by real-time polymerase chain reaction testing of nasopharyngeal samples. Epidemiological, demographic, laboratory and overall outcomes were obtained from electronic medical record. Data collected was then analysed using SPSS software. RESULTS: A total of 163 patients were reviewed and included in the study. Median age of patient with confirmed SARS-COV2 infection was 70 years (mean 68, range, 30-101), of which 52.8% were female, 60.7% white and 33.7% African American. The most common comorbidities were hypertension (112, 68.7%), obesity (79, 48.6%), and hyperlipidemia (54, 33.1%). Patients presented with shortness of breath (109, 66.9%), cough (107, 65.6%) and fever (99, 60.7%). Gastrointestinal symptoms were found in 81 (49.6%) of patients with the most common symptom being diarrhea in 44 (27%) patients. There were 66 (40.5%) patients with fever >100.4F on admission. Multilobe infiltrates were found in chest x-ray of 115 (70.6%) patients. Within one-month, overall mortality was noted to be 29.5%. Mean length of stay of non-intensive care unit (ICU) patients was 6.46 days (range 1-19) when compared 15.5 days (range 3-46) for ICU patients. During hospitalization, 55 patients (33.7%) (median age 68 years, 54.5% female, 60.1% white) were treated in the ICU of which 43(78.2%) required mechanical ventilation and 28 (50.9%) died. For patients requiring mechanical ventilation, 27 (62.8%) died and 16 (37.2%) were discharged alive. CONCLUSIONS: This study provides insight into presenting characteristics, demographics and overall outcome of patients hospitalized with COVID-19 in a Michigan community hospital. CLINICAL IMPLICATIONS: In medical emergencies like the COVID pandemic, it is important to analyze patient demographics in order to help identify the population most at risk. Knowledge of the most vulnerable population not only allows us to come up with strategies to help control the spread of disease but also helps us risk stratify the patients for better resource allocation. It is crucial to learn from an outbreak like this so we can be better prepared for the future.
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