Differences In Presenting Symptoms Research Articles

Gastrointestinal Bleeding in Patients With Coronavirus Disease 2019: A Matched Case-Control Study.

INTRODUCTION:Although current literature has addressed gastrointestinal presentations including nausea, vomiting, diarrhea, abnormal liver chemistries, and hyperlipasemia as possible coronavirus disease 2019 (COVID-19) manifestations, the risk and type of gastrointestinal bleeding (GIB) in this population is not well characterized.METHODS:This is a matched case-control (1:2) study with 41 cases of GIB (31 upper and 10 lower) in patients with COVID-19 and 82 matched controls of patients with COVID-19 without GIB. The primary objective was to characterize bleeding etiologies, and our secondary aim was to discuss outcomes and therapeutic approaches.RESULTS:There was no difference in the presenting symptoms of the cases and controls, and no difference in severity of COVID-19 manifestations (P > 0.05) was observed. Ten (32%) patients with upper GIB underwent esophagogastroduodenoscopy and 5 (50%) patients with lower GIBs underwent flexible sigmoidoscopy or colonoscopy. The most common upper and lower GIB etiologies were gastric or duodenal ulcers (80%) and rectal ulcers related to rectal tubes (60%), respectively. Four of the esophagogastroduodenoscopies resulted in therapeutic interventions, and the 3 patients with rectal ulcers were referred to colorectal surgery for rectal packing. Successful hemostasis was achieved in all 7 cases that required interventions. Transfusion requirements between patients who underwent endoscopic therapy and those who were conservatively managed were not significantly different. Anticoagulation and rectal tube usage trended toward being a risk factor for GIB, although it did not reach statistical significance.DISCUSSION:In COVID-19 patients with GIB, compared with matched controls of COVID-19 patients without GIB, there seemed to be no difference in initial presenting symptoms. Of those with upper and lower GIB, the most common etiology was peptic ulcer disease and rectal ulcers from rectal tubes, respectively. Conservative management seems to be a reasonable initial approach in managing these complex cases, but larger studies are needed to guide management.

Differences in Presenting Symptoms of Acute Stroke Among Young and Older Adults (P2.3-002)

Differences in Presenting Symptoms of Acute Stroke Among Young and Older Adults (P2.3-002)

Abstract 145: Differences in Presenting Symptoms of Fibromuscular Dysplasia Patients With Family History of Fibromuscular Dysplasia, Arterial Aneurysm, Dissection, or Sudden Death: A Report from the United States Registry for Fibromuscular Dysplasia

Introduction: Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disorder which may lead to stenosis, tortuosity, dissection, or aneurysm in any arterial bed. Some affected patients have a family history of FMD, arterial aneurysm (AA), arterial dissection (AD) or sudden death (SD), supporting a genetic predisposition. The clinical characteristics of this patient population have not been described. We hypothesized that patients with a family history of FMD, AA, AD, or SD would present differently than those without. Methods: By July 2014, of 880 patients enrolled in the United States Registry for FMD, 295 had a family history of FMD, AA, AD, or SD. These patients were compared to those without family history, analyzing demographics, symptoms at time of diagnosis, and vascular bed involvement. Student’s t-tests and Fisher’s exact tests were used to analyze continuous and categorical variables, respectively. Results: Patients with a family history of FMD, AA, AD, or SD were younger at diagnosis and more likely to experience CNS symptoms (headache, tinnitus, neck pain), post-prandial abdominal pain, as well as stroke and TIA at time of diagnosis. They also exhibited a trend toward more frequent carotid dissection (Table 1). Conclusions: Patients with a family history of FMD, arterial aneurysm (AA), dissection (AD), or sudden death (SD) more commonly had extracranial arterial bed complications, and experienced symptoms related to this vascular territory at time of diagnosis. These results suggest that FMD may present differently in those with this family history.

Sex-specific Differences in Presenting Symptoms of Diabetic and Nondiabetic Patients with Acute Myocardial Infarction and Their Relationship to in-hospital Mortality

Sex-specific Differences in Presenting Symptoms of Diabetic and Nondiabetic Patients with Acute Myocardial Infarction and Their Relationship to in-hospital Mortality