Gastrocolic Fistula Management in a Pregnant Patient.

We present a case of a pregnant woman admitted for malnutrition secondary to a large gastrocolic fistula (GCF). She has a history of perforated duodenal ulcer that required surgical pyloroplasty 6 years ago. This fistula was diagnosed on the gastrointestinal barium series showing direct transit of barium from the stomach to the colon. An upper endoscopy showed a large gastrocolonic fistula with stool leaking to the stomach. Her nutrition was optimized, then she underwent surgical repair. GCF is suspected in the patient presenting with malnutrition with a history of intra-abdominal surgery.

Acute ischemic stroke as initial manifestation of undiagnosed iron deficiency anemia: case-report and literature review.

Cerebrovascular disease is the second leading cause of death in the United States in adults aged 65 years and older and is most commonly caused by atherosclerosis. More so, cryptogenic strokes account for one-third of all ischemic strokes. At the same time, iron deficiency anemia is prevalent worldwide and mostly affects females of childbearing age. Here we report a case of a 42-year-old female who presented with symptoms of acute ischemic stroke and was found to have severe iron deficiency anemia. After prompt investigation of other secondary causes, it was determined that her stroke was likely secondary to her iron deficiency anemia. Upon review of the literature, a few case reports showed an association between iron deficiency anemia and strokes in the adult population, but little evidence exists supporting a direct relationship between the two entities. In this case, we aim to evaluate the complex relationship between iron deficiency anemia and stroke and to define a new potential cause of ischemic stroke, which would have been considered earlier as cryptogenic. However, further studies in the future are warranted to validate our observation.

A case of coronavirus disease 2019 in acquired immunodeficiency syndrome patient: a case report and review of the literature.

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that was identified in December 2019. The impact of COVID-19 virus on Acquired Immunodeficiency syndrome (AIDS) patients has been reported with variable outcome. We reported a patient that was immunosuppressed by AIDS disease and chemotherapy for cancer who contracted SARS-CoV-2 infection and had a mild disease. We did literature review for the cases published that had human immunodeficiency virus (HIV) infection and COVID-19 disease and analyzed the characteristics and outcomes of the reported cases. Our review yielded three case reports and four case series for patients with HIV infection and COVID-19 disease. The majority of patients had mild disease, and some had critical disease or death. Those who had severe disease usually had other comorbidities. The findings from the case reports and case series indicate that the risk of death or severe disease from COVID-19 in HIV positive patients was lower than observed in the general population, which may indicate a possible protective effect of uncontrolled HIV in preventing the complications associated with the massive inflammatory response.

Reversible bradycardia secondary to myxedema coma: case-report.

Myxedema coma occurs mostly in patients with long-standing untreated or undertreated hypothyroidism. Bradycardia is a well-known cardiac manifestation for myxedema coma; however, not all bradycardia with hypothyroidism are sinus bradycardia. Sick sinus syndrome is a group of arrhythmias caused by the malfunction of the natural pacemaker of the heart. Tachy-Brady syndrome is considered to be a type of sick sinus syndrome, where the heart alternates between tachycardia and bradycardia, and it is usually treated with pacemaker implantation along with rate slowing medical therapy. Here we report a case of an 83-year-old female who presented with myxedema coma and atrial fibrillation with tachycardia and intermittent slow ventricular response. We attempt to review the relationship between these two diseases and conclude that appropriate diagnosis of myxedema coma, may be beneficial in reducing the need for pacemaker implantation.

Early vs late cardiac surgery in patients with native valve endocarditis-United States Nationwide Inpatient database.

OBJECTIVE: Although the standard treatment of infective endocarditis (IE) is antimicrobial therapy, surgical intervention is required in some cases. However, the optimal timing of surgery remains unclear. Hence, we conducted a population-based analysis using the National Inpatient Sample (NIS) database to assess the outcomes of early versus late surgery in patients with native valve IE. METHODS: We queried the NIS database for all hospitalized patients between 2006 and 2016 with a primary diagnosis of IE who had cardiac surgery. We stratified surgery as early ≤7 or late >7 days of admission. Multivariable logistic regression models were used to assess in-hospital mortality and postoperative complications. Length of stay (LOS) and total hospital cost (HC) were evaluated using multivariable log-normal regression models. RESULTS: A total of 13 056 patients (57.6% in the early group and 42.4% in the late group) were included. The in-hospital mortality rate in the early group was 5.0% compared to 5.4% in the late intervention group (adjusted odds ratio, 1.20, 95% confidence interval [CI] 0.79-1.81). Overall median LOS was reduced in the early group by 48.2% (95% CI, 46.5%-49.9%, 12.4 days in the early group and 25.9 days in late group), as well as HC which was reduced in the early group by 28.3% (95% CI, 26.0%-30.6%). CONCLUSION: Among patients with native valve IE who needed cardiac surgery, the time of surgical intervention did not affect the in-hospital mortality. However, early surgery was associated with significantly shorter LOS and lower HC.

Hypolipidemia contributing to the severity of sepsis triggered by influenza a virus: A case report.

Hypolipidemia, an increasingly diagnosed disorder, is defined as a low-density lipoprotein serum level of <50 mg/dL. Hypolipidemia can be asymptomatic. However, the effect of hypolipidemia on sepsis survival and severity is still to be identified. Multiple studies show the physiologic effects of cholesterol on the immune system, and other studies linked hypolipidemia to increased mortality and morbidity. In this case, we present a young patient admitted for severe sepsis, and he developed multiorgan failure. Workup revealed hypolipidemia. The patient recovered from sepsis with residual renal and cardiac injury. We hypothesized that hypolipidemia could be contributing to the increased morbidity in the patient, although further studies are needed to approve this hypothesis. What is unique about this case is that it sheds light on a commonly overlooked metabolic abnormality that plays a role in the body's response to infections and sepsis. RELEVANCE FOR PATIENTS: This case report presents a previously healthy young patient admitted for pneumonia who had a complicated course. Workup revealed hypolipidemia that can be contributing to the severity of his disease. This observation may lead to more studies to evaluate the relationship between lipoprotein level and disease severity which may change the management for patients with hypolipidemia, especially with the familial type.