RESUMO
Upper gastrointestinal bleeding results in significant morbidity, mortality, and healthcare burden. This study aimed to evaluate inpatient outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) during the year 2020 of the COVID-19 pandemic. The National Inpatient Sample databases were used to identify NVUGIB-related hospitalizations. Outcomes of interest for the year 2019 were compared to 2020 and included inpatient mortality, length of stay, mean inpatient cost, odds of getting esophagogastroduodenoscopy (EGD), mean time to EGD, early EGD (within 1 day of hospitalization), endoscopic intervention for hemostasis, and the odds of developing complications. NVUGIB-related hospitalizations increased by 8.1% in 2020. NVUGIB-related hospitalizations in 2020 were also associated with an 11.1% higher mortality (adjusted odds ratio [aOR] = 1.11, confidence interval [CI] = 1.06-1.17, P < 0.01), 0.15-day longer mean time to EGD (aOR = 0.15, CI = 0.08-0.24, P < 0.01), 4% lower odds of getting an EGD (aOR = 0.96, CI = 0.93-0.99, P = 0.02), 8% lower odds of getting an early EGD (aOR = 0.92, CI = 0.89-0.96, P < 0.01), and $6340 higher mean inpatient cost (aOR = 6340, CI = 1762-10919, P = 0.01) compared to 2019. We conclude that there was an increase in NVUGIB-related hospitalizations and mortality in 2020 when the COVID-19 pandemic started.
RESUMO
Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edema that leads to acute respiratory distress. It remains one of the major diagnoses requiring ICU admission and mechanical ventilation. We present a case of a 25-year-old gravida 3 para 2 female who was admitted for uncomplicated 38-week pregnancy and delivered a healthy male infant but developed acute onset dyspnea six hours after vaginal delivery. She required mechanical ventilation four hours after the onset of respiratory distress and had to be transferred to a higher level facility for extracorporeal membrane oxygenation (ECMO) within 24 hours of the symptom onset. She was diagnosed with severe ARDS. Even though she missed the other typical feature of amniotic fluid embolism, atypical amniotic fluid embolism remained the most likely explanation for her symptoms after the other causes of ARDS were excluded.
RESUMO
Background Chorionic bump is a rare condition defined as a bulge or protrusion from the choriodecidual surface into the gestational sac. The limited literature on this infrequent entity suggests that the pregnancies with multiple chorionic bumps mostly result in fetal demise. Aims To review the available literature and the patients from our institute having sonographic findings of chorionic bump and making the sonographers and radiologists aware of this known cause of first-trimester pregnancy loss. Study design A retrospective review of the cases diagnosed at our institute during the last four years. Methods and materials Single-center institutional data for four years (January 2016-December 2019) was accessed using ICD codes. IRB approval was waived owing to the anonymized use of patient data. Results Six female patients diagnosed with chorionic bump were included, with a mean age of 29.83±12 years. The average gestational age at the time of diagnosis was 8.16±3 weeks. The most common sonographic findings were a protrusion from the chorionic wall into the gestational sac cavity, having a central hypoechoic region with peripheral hyperechoic rim (isoechoic to the chorion) and having no vascularity (n=5), and the less common finding was a hyperechoic protrusion with no vascularity (n=1). n=5 had a single lesion, and n=1 had two lesions. The average diameter of the lesion in the largest dimension was 18±11 mm. n=3 pregnancies resulted in a first-trimester miscarriage, and n=3 pregnancies delivered healthy babies at term. Conclusions A chorionic bump significantly increases the risk of a first-trimester miscarriage.
