Introduction: Calcium metabolism plays an important role in the pathophysiology of acute pancreatitis. Hyperparathyroidism may adversely affect the clinical course of acute pancreatitis (AP) due to persistent hypercalcemia; however, there is no inpatient, population-based studies assessing the impact of hypercalcemia on acute pancreatitis related outcomes. We sought to evaluate the impact of hyperparathyroidism on acute pancreatitis clinical outcomes and health-care utilization. Methods: The Nationwide Inpatient Sample (2008-2014) was reviewed to identify all adult inpatients (≥18 years) with a principal diagnosis of AP with a secondary diagnosis of hyperparathyroidism. The primary clinical outcomes (mortality, renal failure, and respiratory failure, intubation, sepsis with organ failure) and secondary resource outcomes (length of stay) were analyzed using univariate and multivariate comparisons. Results: Hyperparathyroidism was associated with only 0.67% (12,009/1,779,587) of acute pancreatitis admissions. These patients were more often older patients (mean age 57 years as compared to 52; p On univariate patients acute pancreatitis and hyperparathyroidism had a significantly higher mortality, and proportion of acute kidney injury, sepsis and length of stay compared with patients without hyperparathyroidism. However, on multivariate analysis, after adjusting for confounders, there was no difference in mortality (odds ratio (OR) 1.06; 95% confidence interval (CI) 0.72-1.56; p value 0.74). Further analysis demonstrated that the complications in acute pancreatitis such as acute kidney failure (11.9% vs. 8.7%; P 0.001); acute respiratory failure, intubation, sepsis with organ failure was significantly higher in patients with hyperparathyroidism. The length of stay was also slightly higher in patients with hyperparathyroidism (5.32 days as compared to 4.3 days; p<0.001). Conclusion: Hyperparathyroidism was associated with less than 1% of all acute pancreatitis admissions during the 7-year cohort. Even though hyperparathyroidism is associated with higher frequency of pancreatitis related complications such as acute kidney injury, acute respiratory failure, intubation and sepsis with organ failure, in-patient mortality is not significantly different compared with patients without hyperpara on multivariate analysis. These observations with inherent bias of retrospective data suggest further studies to understand the impact of hyperparathyroidism on acute pancreatitis.9_A Figure 1. Demographics of the populaiton9_B Figure 2. Factors associated with mortality
Short bowel syndrome (SBS) hospitalizations are often complicated with sepsis. There is a significant paucity of data on adult SBS hospitalizations in the United States and across the globe.
: Venous thromboembolism (VTE) occurs frequently in acute myeloid leukemia (AML) patients. There are no population-based studies from the United States (U.S.) analyzing this association. The study aims to analyze the trends, predictors of mortality, and outcomes of VTE in AML patients.
Gastrointestinal tuberculosis (TB) is rare and can occur in the context of active pulmonary disease or as a primary infection with no pulmonary symptoms. It typically presents with vague abdominal symptoms making it difficult to discern from alternative infectious, autoimmune and neoplastic processes. To demonstrate the importance of maintaining a high clinical suspicion for the disease, we present a case of gastrointestinal TB presenting as with abdominal pain, diarrhea, weight loss found to have severe malnutrition and evidence of segmental colitis of the left colon. A 36 year-old woman, originally from the Dominican Republic, presented to the emergency department with a one year history of intermittent abdominal pain, diarrhea and a 70 pound weight loss. She had no reported medical history, recent travel outside of the US or known sick contacts. She was cachectic with diffuse muscle wasting and a body mass index (BMI) of 14. Computed tomography (CT) of the chest and abdomen showed several right-sided pulmonary nodules, a large left-sided pleural effusion and diffuse small and large bowel wall thickening with enlarged mesenteric lymph nodes. Clinical suspicion remained high for malignancy, inflammatory bowel disease or infection such as TB. EGD revealed friable tissue along the esophagus and atrophic mucosa throughout the stomach and proximal duodenum. Colonoscopy showed circumferential friable ulcerated mucosa in the descending colon. Biopsies only showed necrotic tissue that was AFB negative. Extensive autoimmune and infectious workup was unrevealing. Quantiferon gold and Mycobacterium Tuberculosis (MTB) PCR from an induced sputum sample came back positive. She was started on anti-tuberculin therapy. She subsequently developed a large bowel obstruction at the splenic and hepatic flexures. She underwent a subtotal colectomy with endileostomy. Pathology of the resected colon showed confluent necrotizing granulomatous inflammation with transmural colonic wall involvement as well as necrotizing granulomas of the surrounding lymph nodes, consistent with tuberculosis. The ileocecal region is the most commonly involved site of gastrointestinal TB, accounting for almost 64% of cases. Involvement of the splenic flexure with segmental colitis, as in the above reported case, is unusual. Antimicrobial therapy remains the mainstay of the treatment for gastrointestinal TB however surgical or endoscopic intervention is often required in cases complicated by perforation or obstruction.Figure: Circumferential friable ulcerated mucosa in the descending colon just distal to the splenic flexure.
Gastrointestinal (GI) tuberculosis (TB) is rare and can occur in the context of active pulmonary disease or as a primary infection with no pulmonary symptoms. It typically presents with vague abdominal symptoms, making it difficult to discern from alternative disease processes. Although the ileocecal region is the most commonly affected site, tuberculous enteritis can involve any aspect of the GI tract. To demonstrate the importance of maintaining a high clinical suspicion for the disease, we present a case of GI TB presenting as severe malnutrition and segmental colitis of the left colon.
Phnom Penh, the capital of Cambodia, as with many other world megacities, is exposed to multiple major ecological and environmental hazards. Without a proper wastewater treatment facility, it is difficult for local residents to obtain a health-compliant water supply. In this study, a hybrid aggregation method using principal component analysis (PCA) and weighted means was used to calculate a water quality index (WQI) to map the water quality of the entire Boeung Cheung Ek (BCE) wetland region. We used Universal Kriging to map eight water quality parameters: DO, pH, TDS, F, Cl, NO3−, PO43−, and NH4+. The restricted maximum likelihood method was used for model fitting. Data were collected from groundwater and surface water for different rainfall seasons between March 2017 and February 2018. The principal component analysis (PCA) used to compute a water quality index (WQI) is based on the resulting dimensions of the highest variation among all water quality parameters. The results show that the northern part of the study area has a worse water quality than the southern region, which is caused by the discharge of municipal wastewater directly into the BCE wetland area. The results for different rainfall seasons also show that groundwater has a relatively better quality than surface water. The results of this analysis can serve as a supplementary study to support sustainable development goals because they might confirm the need for a wastewater treatment facility being under construction at the time of writing this article with funding from the Japan International Cooperation Agency (JICA).
Acquired ectopic splenic tissue is called splenosis, which is common after the history of trauma or surgical exploration. We present a rare case of intrahepatic splenosis in 36-year-old male patient mimicking a liver neoplasm on imaging however presented with left flank pain for 5 months and had remote history of splenectomy after splenic rupture from trauma. We discuss various imaging modalities and the role of various magnetic resonance imaging sequences and nuclear medicine examination. We also discuss the differentiating features to be kept to make the correct diagnosis along with a brief review of literature. We mentioned signal intensities of splenic lesions and normal signal intensity of spleen in different magnetic resonance imaging sequences and with high suspicion how we can diagnose splenosis and avoid unnecessary biopsy and its result related stress.
