The Influence of Obesity on Acute Pancreatitis Hospitalizations: Does Body Mass Index Matter?

OBJECTIVE: To identify the influence of body mass index (BMI) on Acute Pancreatitis (AP) hospitalizations in the United States (US). METHODS: The National Inpatient Sample was utilized to identify normal weight, overweight and obese AP hospitalizations in the US from 2016-2019 based on BMI. Hospitalization characteristics and outcomes were compared. RESULTS: Between 2016-2019, there were 314,215 (74.7%) obese, 27,005 (6.4%) overweight and 79,380 (18.9%) normal weight AP hospitalizations. Obese AP hospitalizations were younger (51.5 vs 56.5 years, p < 0.0001) compared to the normal weight cohort. However, normal weight AP hospitalizations had a higher proportion of Blacks and Asians compared to the obese subgroup. We also noted a higher all-cause inpatient mortality for normal weight AP hospitalizations (3.4% vs 2.8% vs 1.8%, p < 0.0001) compared to the overweight and obese cohorts, respectively. Furthermore, normal weight AP hospitalizations had a higher proportion of patients with pancreatic pseudocyst formation and pancreatic necrosis compared to the overweight and obese cohorts. The mean length of stay (5.8 vs 8.2 days, p < 0.0001) and mean total healthcare costs ($66,742 vs $82,319, p < 0.0001) were lower for obese compared to normal weight AP hospitalizations. CONCLUSIONS: Normal weight AP hospitalizations had higher inpatient mortality and complications compared to obese hospitalizations.

A Rare Cause and Alternative Algorithm for the Treatment of Gastrointestinal (GI) Bleed: Complications of a Failed Pancreatic Transplant.

A 39-year-old woman with no known risk factors presented for a recurrent upper gastrointestinal (GI) bleed. She had a prior history of failed kidney and pancreatic transplants secondary to childhood diabetes mellitus type I. After an extensive workup, she was found to have active hemorrhage into an area of the small bowel from an artery supplying her failed pancreatic transplant. Here, we discuss the importance of a systematic approach to evaluation, a high index of suspicion, and a known but not entirely common method of treatment for this condition.

Pregnancy and Metabolic-associated Fatty Liver Disease: A Clinical Update.

The intricate relationship between metabolic-associated fatty liver disease (MAFLD) and maternal complications has rapidly become a significant health threat in pregnant women. The presence of MAFLD in pregnancy increases the maternal risk of metabolic complications and comorbidities for both mother and baby. The preexistence or development of MAFLD in pregnancy is a complex multifactorial disorder that can lead to further complications for mother and baby. Therefore, as pregnant women are severely underrepresented in clinical research, there is a great need for a fair inclusion of this group in clinical trials. This review aims to explore the effects of MAFLD during pregnancy in the context of maternal complications and outcomes and explore the effects of pregnancy on the development and progression of MAFLD within the context of maternal obesity, altered metabolic profiles, gestational diabetes and altered hormonal profiles. We also addressed potential implications for the presence of MAFLD during pregnancy and its management in the clinical setting.

Increasing thirty-day readmissions of Crohn's disease and ulcerative colitis in the United States: A national dilemma.

BACKGROUND: The prevalence of Crohn's disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization. AIM: To identify trends and adverse outcomes for 30 d readmissions for CD and UC. METHODS: This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients < 18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. Stata® Version 16 software (StataCorp, TX, United States) was used for statistical analysis and P value ≤ 0.05 were considered statistically significant. RESULTS: Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (P-trend < 0.001), CD specific readmission rate from 7.1% in 2010 to 8.2% in 2018 (P-trend < 0.001), 30-day all-cause readmission rate of UC from 14.1% in 2010 to 15.7% in 2018 (P-trend = 0.003), and UC specific readmission rate from 5.2% in 2010 to 5.6% in 2018 (P-trend = 0.029). There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions. However, we found an increasing trend of mean THC for UC readmissions. After comparison, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions. CONCLUSION: There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.

Tumor Lysis Syndrome in a Patient With Gastric Adenocarcinoma.

Tumor lysis syndrome (TLS) is a severe metabolic complication that usually occurs in patients with aggressive tumors who undergo treatment with chemotherapy. Traditionally, it was mainly associated with hematologic malignancies. However, over the past 4 decades, there have been increasing reports of TLS in solid tumors. We report a case of TLS in a patient with gastric cancer, as a complication of FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy. Our patient was a 48-year-old man with metastatic gastric adenocarcinoma who presented with altered mental status and slurred speech. On examination, he was confused and disoriented, but the rest of his examination, including vitals, was unremarkable. Laboratory findings on admission were significant for an elevated uric acid of 14.5 mg/dL, creatinine of 4.1 mg/dL, and phosphorus of 6.9 mg/dL. He had received his first cycle of FOLFOX chemotherapy 4 days prior to admission. The constellation of electrolyte abnormalities and the temporal relationship to chemotherapy led to the diagnosis of chemotherapy-induced TLS. He was treated with aggressive fluid repletion and rasburicase, following which the electrolyte derangements resolved, and he improved clinically. This case highlights the importance of early recognition of TLS in patients with gastric cancer. Initiation of early treatment can reduce the high morbidity and mortality associated with this oncologic emergency.