ABSTRACT
Chronic diarrhea is a common disorder in tropical regions, affecting residents, visitors, and even expatriates. It may stem from a myriad of infectious, inflammatory, and even malignant causes. In patients in whom no etiology has been found, tropical sprue (TS) is an important diagnosis to consider. We report the case of a 60-year-old man originally from Guatemala, presenting with chronic diarrhea and megaloblastic anemia due to severe vitamin B12 deficiency. Biopsies of the small bowel revealed partial villous atrophy and inflammatory infiltrate with the participation of eosinophils. The diagnosis of TS was established after exclusion of other causes of malabsorption syndrome. This is a disease of unknown etiology with complex and multifactorial pathophysiology, with an important component of intestinal dysbiosis. Antibiotics and vitamin supplementation are the pillars of therapy. Awareness of this disorder is essential in preventing delayed diagnosis and subsequent morbidity.
ABSTRACT
BACKGROUND: Exercise-induced hypoxia (EIH) has been assessed at ED triage as part of an assessment of COVID-19; however, evidence supporting this practice is incomplete. We assessed the use of a 1-minute sit-to-stand exercise test among ED patients admitted for suspected COVID-19. METHODS: A case note review of all ED patients assessed for suspected COVID-19 between March and May 2020 at Monklands University Hospital was conducted. Demographic characteristics, clinical parameters, baseline blood tests and radiographic findings, hospital length of stay, intensive care and maximum oxygen requirement were obtained for those admitted. Using logistic regression, the association between EIH at admission triage and COVID-19 diagnosis was explored adjusting for confounding clinical parameters. RESULTS: Of 127 ED patients admitted for possible COVID-19, 37 were ultimately diagnosed with COVID-19. 36.4% of patients with COVID-19 and EIH had a normal admission chest radiograph. In multivariate analysis, EIH was an independent predictor of COVID-19 (adjusted OR 3.73 (95% CI (1.25 to 11.15)), as were lymphocyte count, self-reported exertional dyspnoea, C-reactive peptide and radiographic changes. CONCLUSIONS: This observational study demonstrates an association between EIH and a COVID-19 diagnosis. Over one-third of patients with COVID-19 and EIH exhibited no radiographic changes. EIH may represent an additional tool to help predict a COVID-19 diagnosis at initial presentation and may assist in triaging need for admission.
