Thromboembolic Rates Are Similar Between Intensive Care Unit and Nonintensive Care Unit Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Retrospective Cohort Study.

High rates of thromboembolic events have been described in intensive care unit (ICU) patients. Data regarding thromboembolic events in all hospitalized patients has been less frequently reported, raising concerns that thromboembolic events in non-ICU may be underrecognized. In addition, optimal anticoagulation type and dose is still unsettled at this time. This is a retrospective cohort study of 159 hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia during a 9-month period to determine an association between the frequency of thromboembolic rates and hospitalized patients with COVID-19. Secondary outcomes sought to investigate association of thromboembolic events with relation to place of admission, risk factors, anticoagulation, mortality, hospital length of stay, and discharge disposition. Among the cohort of 159 hospitalized patients who met criteria, 16 (10%) were diagnosed with a thromboembolic event. There were a total of 18 thromboembolic events with 12 venous and 6 arterial. Admission to the ICU was not associated with a higher frequency of thromboembolic events compared with non-ICU patients (37.5% vs 62.5%), p = .71. Patients with a thromboembolic event had a significantly higher mortality compared with those with no thromboembolic event (37.5% vs 13.3%), p = .012. Patients hospitalized with COVID-19 have increased rates of thromboembolic events, both venous and arterial, which contribute to a significant increase in mortality. However, the frequency of thromboembolism in patients admitted to the ICU was similar to events in non-ICU patients. We hope to increase awareness of the increased risk of hypercoagulability in all hospitalized patients with COVID-19 including non-ICU patients.

Hereditary Hyperferritinemia-Cataract Syndrome in 3 Generations of a Family in East Tennessee.

Hereditary hyperferritinemia and cataracts syndrome (HHCS) without iron overload is a syndrome first identified less than 3 decades ago. While investigators have dissected the gene where several responsible mutations reside, it remains a relatively unknown genetic disorder to clinicians. The result is often an expensive, invasive evaluation for iron overload, followed by a well-intended prescription for a series of phlebotomies that delivers morbidity instead of benefit. We present a father with an elevated ferritin and heterozygosity for H63D HFE mutation whose clinical course followed this path. His treatment rendered him symptomatic from iron deficiency with no reduction in his ferritin. On re-evaluation, a review of his past medical history clarified the cataract surgery noted in his record had occurred at a young age. Furthermore, one of his daughters required cataract surgery as a teenager. With this information, we strongly suspected HHCS. His phlebotomies were discontinued, and within weeks, his iatrogenic iron deficiency resolved and his health returned to normal.

Follicular lymphoma presenting as hyperleucocytosis.

Follicular lymphoma is the second most common subtype of non-Hodgkin's lymphoma affecting adults. Clinically, follicular lymphoma is generally indolent, most often presenting as a painless peripheral lymphadenopathy; however, a leucocytosis at presentation is exceedingly rare. We present the case of a 63-year-old woman with follicular lymphoma with a presenting hyperleucocytosis at diagnosis of 1 327 000/µL demonstrated on laboratory analysis work while hospitalised for progressive weakness. fluorescence in situ hybridization (FISH) panel was consistent with follicular lymphoma, which was positive for B-cell leukaemia/lymphoma 2 and negative for MYC Proto-Oncogene. Cytoreduction with rituximab-containing therapy was initiated, with the patient ultimately expiring. A leukaemic phase at presentation appears to be associated with poor outcome. The findings from our case, in addition to others, have potential implications in regard to prognostic utility. The current prognostic tool used to estimate overall survival for follicular lymphoma, Follicular Lymphoma International Prognostic Index, does not take leucocytosis into account.

Alcoholism: the keys to the CAGE.

PURPOSE: To compare the efficiency of screening for alcoholism using two different introductions to the CAGE questions. PATIENTS: Forty-three alcoholics on inpatient medical and surgical services were identified through random distribution of the Michigan Alcoholism Screening Test. METHODS: Participants were randomized to two groups receiving different introductions to the CAGE questions. Group I was introduced by a simple open-ended question. Group II patients were asked first to quantitate the volume and frequency of their drinking. The outcome measures were the scores on the four CAGE questions recorded by an independent observer. RESULTS: Eighteen of 21 (86%) patients in Group I admitted to prior attempts to cut back on their drinking as compared with 8 of 22 (36%) in Group II (p = 0.002). Likewise 10 of 21 (49%) patients in the first group admitted to annoyance compared with just 3 of 22 (14%) in Group II. The average scores per patient in the two groups were significantly different: Group I = 2.52 versus Group II = 1.23 (p = 0.0002). Using a screening CAGE score of two or more to identify an alcoholic patient, the open-ended introduction identified 95% of the alcoholics compared with only 32% when the closed-ended introduction was used (p < 0.0001). CONCLUSION: Our study demonstrates that the sensitivity of the CAGE questionnaire in screening for alcoholism is dramatically enhanced by an open-ended introduction. In contrast, the sensitivity of these questions is greatly reduced when preceded by inquiries that seek to define the quantity and frequency of drinking.