Nonalcoholic Fatty Liver Disease Association with Intubation and Severity of Covid-19

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) and its hepatic manifestation, metabolic-associated fatty liver disease (MAFLD) have a rising prevalence worldwide in the background of the ongoing global pandemic. It is imperative to explore the relationship with COVID-19 to improve patient care and treatment protocols for better outcomes. This metaanalysis aims to investigate the association between NAFLD and MAFLD with the severity of COVID-19 infection and the need for mechanical ventilation. METHOD(S): A systematic review of literature across 5 databases was conducted from January 2019 to June 2022. Observational studies or clinical trials were included. Studies that evaluated NAFLD/ MAFLD using laboratory methods, non-invasive imaging, or liver biopsy were included. The study protocol was registered in Prospero and Prisma guidelines were followed (Figure 1). Meta-analysis was performed on studies with mechanical ventilation and severity of COVID-19 infection outcomes using Revman software. The Mantel- Haenszel odds ratio was generated to describe the overall effect size using random effect models. RESULT(S): Mechanical Ventilation A total of 36,817 patients from twelve studies were included in the qualitative analysis. There were 5615 patients in the NAFLD group and 31,202 patients in the Non-NAFLD group. A total of 3148 patients with COVID-19 required mechanical ventilation;778 (13.8%) in the NAFLD group and 782 (2.5%) in the Non-NAFLD group with high odds of need for mechanical ventilation (OR 2.03, 95%CI 1.06-3.88, p-value=0.03, I2=95%) (Figure 2). COVID-19 Severity A total of 5286 patients from fourteen studies were included in the qualitative analysis. 2716 patients were in the NAFLD group, while 2570 patients were in the Non-NAFLD group. A total of 1,623 patients had increased severity of COVID-19;901 (33.1%) in the NAFLD group and 722 (28.9%) in the Non-NAFLD group. COVID-19 patients with NAFLD had worse COVID-19 infection outcomes compared to those without NAFLD (OR 1.59, 95%CI 1.12-2.26, p-value=0.01, I2=81%) (Figure 4). CONCLUSION(S): Our meta-analysis suggests that NAFLD patients had higher odds of needing mechanical ventilation or ICU admission and developing more severe forms of COVID-19 than Non-NAFLD patients.

Nonalcoholic Fatty Liver Disease Association with Hospital and Icu Admission in Covid-19

INTRODUCTION: Association between non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) with COVID-19 is still an ongoing debate. We aimed to conduct a systematic review and meta-analysis investigating the impact of NAFLD/ MAFLD on the duration of ICU and hospital stay in COVID-19 patients. METHOD(S): A systematic review of literature from January 2019- to June 2022 on databases PubMed, Cochrane, Embase, Science Direct, and Web of science was conducted. Observational studies or clinical trials were included. Studies that assessed NAFLD/ MAFLD using lab assessment, non-invasive imaging, or liver biopsy were included. The protocol of the study was registered in Prospero and Prisma guidelines were followed (Figure 1). The meta-analysis was performed using Revman software. Mantel- Haenszel odds ratio was generated to describe the overall effect size using random effect models. RESULT(S): ICU Admission A total of 37,109 patients from fifteen studies were included in the qualitative analysis. A total of 5624 patients were in the NAFLD group and 31,485 patients were in the Non-NAFLD group, where 3148 patients with COVID-19 required ICU admission. Out of these, 1098 (19.5%) were in the NAFLD group and 2050 (6.5%) in the Non-NAFLD group. We observed a significantly increased ICU admission among COVID-19 patients with NAFLD compared to those without NAFLD (OR 1.67, 95%CI 1.02- 2.72, p-value= 0.04). (Figure 2). Hospital Admission A total of 27,683 patients from three studies were included in the qualitative analysis. A total of 1128 patients in the NAFLD group and 26,555 patients in the Non-NAFLD group, where 4019 patients with COVID-19 required hospital admission. Out of these, 518 (45.9%) were in the NAFLD group and 3501(13.1%) in the Non-NAFLD group. We observed a significant increase in hospital admissions among COVID-19 patients with NAFLD compared to those without NAFLD (OR 2.71, 95%CI 1.10-6.70, p-Value=0.03). CONCLUSION(S): The NAFLD patients may have increased ICU and hospital admission compared to Non-NAFLD Patients. Fatty liver disease has an association with increased healthcare admission and critical care service utilization among COVID-19 patients.

Atypical presentation of newly diagnosed diffuse large b cell lymphoma

Introduction: Acute pancreatitis is caused by inflammation of the pancreas due to the obstruction of pancreatic secretory transport ducts and sequential activation of inflammatory pancreatic enzymes. Both alcohol use and gallstones remain among the leading risks. Pancreatic involvement is frequently report but diffuse large B cell lymphoma presenting as pancreatitis is rare. Case Description/Methods: A 69 y/o male with no PMH presented to the Emergency room complaining of a 3-week history of worsening sharp epigastric pain associated with dysphagia and odynophagia to solid foods. He denied fever, weight loss, night sweats, nausea, vomiting, diarrhea, melena, smoking, alcohol use, recent steroid use, surgery, trauma or autoimmune disease. Physical exam was notable for tenderness in the epigastric region, lower abdomen and hypoactive bowel sounds. Laboratory analysis is appreciated in figure A. Lipid panel was unremarkable and Covid was negative. CT abdomen/pelvis showed peripancreatic inflammatory changes with trace fluid along both anterior parietal fasciae. A 21 x 14 mm right sided distal esophageal mass, and an ill-defined 40 x 26 mm bilobed necrotic mass at the inferior margin of gastric pylorus. Also multiple ill-defined enlarged periportal and retroperitoneal lymph nodes, appreciated mainly in periportal and infrarenal retrocaval lymph nodes. Esophagogastroduodenoscopy was performed with findings of large fungating ulcerating mass that was oozing blood in the cardia, which can be appreciated in figure B. Biopsy revealed diffuse proliferation of lymphoid cells strongly positive for CD 45, CD20, CD79a, BCL 6 which suggested diffuse large B cell lymphoma. CEA, CA 19-9 were within normal limits. Patient was treated with Lactate Ringer's solution on day 1 with resolution of pancreatitis within 1 week. He was discharged and lost to follow up for management of DLBCL. Discussion: Although he had no signs of pancreatic metastasis, he presented with features that fulfill diagnostic criteria for pancreatitis. This case report provided key information into the various possibilities that could initially present with abdominal pain, and why it is essential to keep various diagnoses in mind, even when there is one already established.Due to the proximity and small space of the abdominal compartment, many of these can present with overlapping symptoms. A key takeaway from this review is to follow up with each symptom individually and explore all needed diagnosis tests, in order to rule in or out other possible causes..

A cohort study of association in mortality rates between proton pump inhibitor usage and h2 blocker usage among COVID-19 patients

Introduction: Mortality rates among patients who were hospitalized for COVID- 19 and were on Proton pump Inhibitors are compared to mortality rates among hospitalized COVID-19 patients and were on H2 blockers. Methods: Patients at two major urban hospitals in New Jersey were identified for the study. Patients who were COVID-19 positive and hospitalized and were put on either famotidine or Pantoprazole were enrolled for the study. Mortality rates were studied between these two cohort of patients and results are analyzed using chi-square method. Results: A total of 1243 patients who got admitted were identified. Of them 613 patients were tested COVID-19 negative and 630 patients were tested COVID-19 positive. Of the 630 patients who were COVID positive, patients were on either famotidine or pantoprazole, remaining 223 patients were not on either pantoprazole or famotidine. The patients were put on either pantoprazole or famotidine depending on their severity of illness and they were observed for mortality rates. A total of 262 patients were put on PPI and 145 patients were put on H2 blocker. A total of 147 patients expired and 260 patients were stabilized. Among PPI usage patients 106 patients expired and 156 were stabilized. Among H2 blocker users 41 patients expired and 104 patients were stabilized. A chi-square analysis of the results was done. The chi-square statistic is 6.0037, p-value is 0.014276. The result was significant as the p value was less than 0.05. Conclusion: The study shows that there is a significant association between PPI use and mortality among hospitalized COVID-19 patients. Patients who were on PPI usage during admission are associated with more mortality than the patients who put on H2 blockers..