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Carlton McDermott posted an update 3 weeks ago
Background Type 2 diabetes mellitus (DM) is prevalent in developing countries and is associated with many comorbidities, including diabetic peripheral neuropathy (DPN) and cardiovascular disease (CVD). In this study, we assessed and evaluated the association between DPN and CVD. Methods The study is a cross-sectional study that included DM patients who are attending DM primary care clinics. We evaluated each patient and collected epidemiological data, the physical examination findings, including cardiovascular status, and the presence of DPN. DPN was assessed with the neuropathic disability score (NDS), and it was considered present if the score was 5 or higher. The age and the levels of blood glucose, HbA1C, and plasma total cholesterol were recorded. Results The study included 116 DM, the mean age was 64.5±15 years (19 to 84 years) and the majority (61.2%) of the sample were male. The sample was divided into two groups patients with DM only and patients with DM and CVD. The CVD group had a higher NDS score compared to the non-CVD group (P=0.006). The result indicated that for the CVD group, the prevalence of DPN was higher (50.8%) as compared to the non-CVD group (30.2%) (P=0.041). DPN was also associated with the acute coronary syndrome (ACS) (P = 0.013) but not heart failure (HF) (P=0.427). In addition, the HbA1C was significantly higher in patients with DPN (P=0.0345). Conclusion Our findings indicate that DPN was more prevalent in the CVD group and, in particular, in the group with ACS. The evidence provides support for the association between DPN and CVD.Gastrointestinal stromal tumours (GISTs) are considered the most common mesenchymal neoplasms of the alimentary tract, yet they account for only 0.2% of all gastrointestinal neoplasms. We are presenting a case of a 68-year-old gentleman who was diagnosed with a 250 mm jejunal GIST only when he presented with abdominal pain and fullness in the upper abdomen. We believe that detailed medical history, followed by prompt investigations, will help in early diagnosis of small GISTs with less malignant potential, which in turn will lead to better outcomes.In nearly a year since the first reported cases of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a lot has been established about the virus. Correlates in regards to the biology and cellular effects of SARS-CoV-2 have brought a lot of explanations to the clinical manifestations of the disease and possible therapeutic modalities. However, despite the discoveries made, the tropism of SARS-CoV-2 has not yet been fully established, nor have all the clinical aspects of COVID-19. Herein we report the gross and histological findings in two diseased patients. Apart from the already established pulmonary and vascular changes caused by SARS-CoV-2, we report the presence of histological changes of the olfactory bulbs and frontal lobes of the brain, which may present as a correlate for COVID-19 related anosmia. The olfactory bulbs histologically showed necrotizing olfactory bulbitis. As both the olfactory bulb and frontal lobe of the cerebrum are key areas of olfaction, we believe that this tropism of SARS-CoV-2 may be key to the development of anosmia and not changes within the nasal cavity.Background Viral pneumonia is an important cause of respiratory morbidity and mortality. Cases of viral pneumonia are becoming increasingly more common as at-risk populations increase globally. We sought to highlight the racial distribution of hospitalized patients with viral pneumonia and compare their outcomes. Materials and methods Data were obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study involved adults who had a principal discharge diagnosis of viral pneumonia. The primary outcome analyzed was inpatient mortality. Secondary outcomes included the development of sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, need for mechanical ventilation, and use of vasopressors as well as mean length of hospitalization and mean total hospital charges. Results Blacks and Hispanics had lower inpatient mortality adjusted odds (aOR 0.39, 95% CI = 0.229 – 0.662, p less then 0.001 and aOR 0.55, 95% CI = 0.347 – 0.858, p=0.009, respectively) compared to Whites. Black and Hispanic patients were also found to have lower adjusted odds ratio of having acute respiratory failure (aOR 0.54, 95% CI = 0.471 – 0.614, p less then 0.001, and 0.66, 95% CI = 0.576 – 0.753, p less then 0.001, respectively). Conclusion Black and Hispanic patients are at lower risk of adverse outcomes when compared to White patients with viral pneumonia.Hepatoid adenocarcinoma of the stomach (HAS), a rare and unique histological subtype of gastric cancer, accounts for less than 1.5% of all gastric cancers. Historically, this subtype is found to have a poor prognosis in comparison to other types of gastric cancer. While the diagnosis is made based on pathological findings, most cases described in the literature are associated with elevated alpha-fetoprotein (AFP) levels. We present a case of AFP-negative HAS with additional unique pathologic findings of signet ring cells which has been reported only once in the literature. Given the rare and late presentation of the disease, AFP-negative HAS should be included in the differential diagnosis in patients with suspicion for gastric cancer.This report reviews the indications and complications of resuscitative thoracotomy in the trauma patient as seen with the clinical course of a 19-year-old male who experienced postoperative pericardial tamponade after a bilateral resuscitative thoracotomy with pericardiotomy. This patient presented to the hospital in critical condition with 31 gunshot wounds (GSWs) distributed over the chest, abdomen, and extremities. After undergoing an initially successful resuscitative thoracotomy, the patient continued to bleed into his chest at a greater rate than the chest tubes were able to adequately evacuate. BID1870 Despite the presence of a large pericardial window, clotted blood led to cardiac tamponade. Subsequent bedside reopening of thoracotomy under conscious sedation (ketamine, fentanyl, and midazolam) was required to evacuate the clots and stabilize the patient. This case provides the opportunity to discuss several interesting points for managing the traumatized patient, including indications for resuscitative thoracotomy, use of conscious sedation for bedside major surgery, and complications of clamshell thoracotomy, and ethics of resource allocation.