Stable Vital Signs Research Articles

S1798 Silent Perforated Diverticulitis in a Kidney Transplant Patient With Autosomal Dominant Form of Polycystic Kidney Disease

Introduction: Large bowel and colonic diverticulosis are among the common extrarenal manifestations of the autosomal dominant form of polycystic kidney disease (ADPKD), notably, with a prevalence of 4.1% for diverticulosis and 1.2% for diverticulitis. Additionally, those patients with kidney transplant and on immunosuppressive therapy are at an increased risk of bowel perforation. Case Description/Methods: Our patient is a 64-year-old man with a past medical history of ADPKD treated with nephrectomy and kidney transplant on tacrolimus, mycophenolate mofetil, and prednisone. He presented to our hospital for total knee arthroplasty. The procedure was performed successfully with no complications and with minimal blood loss. On day two, he complained of mild lower abdominal pain after a bowel movement. Physical exam showed stable vital signs and mild lower abdominal tenderness with negative peritoneal signs. Moreover, laboratory work was unremarkable. The patient was placed on nothing by mouth, and conservative measures were initiated. An urgent computerized tomography (CT) scan of the abdomen and pelvic with oral contrast revealed perforated sigmoid and diverticulitis with moderate pneumoperitoneum (Figure 1). Intravenous antibiotics were started. Furthermore, laparotomy, sigmoidectomy, and colostomy were urgently performed. He had a complete recovery and was discharged home. Discussion: The ADPKD is the most common life-threatening monogenic disease, affecting 12 million people worldwide. ADPKD is commonly associated with colonic diverticulosis, most commonly in the sigmoid. Interestingly, colonic perforation is facilitated by immunotherapy's suppressive influence on collagen formation. Also, it suppresses inflammatory cells and pain-inducing prostaglandins, thereby concealing the natural inflammatory response. Adults with perforated sigmoid treated with primary resection have a high mortality rate, occurring in up to 45% of patients. This case demonstrates that a high index of suspicion is required in this population of patients as typical symptoms may not appear in immunocompromised individuals. Nevertheless, early detection and treatment can prevent life-threatening outcomes.Figure 1.: CT scan of the abdomen and pelvis with oral contrast.

The role of internal jugular vein Doppler ultrasonography in predicting hypovolemic shock in polytrauma patients.

PurposeThe aim of this study was to evaluate the accuracy of internal jugular vein (IJV) Doppler ultrasonography in predicting hypovolemic shock in polytrauma patients.MethodsThis prospective observational study was conducted on 75 multiple trauma patients (injury severity score >15) with a mean age of 33.00±9.57 years. IJV Doppler ultrasonography was performed in all patients with stable vital signs and a negative extended focused assessment with sonography for trauma. Jugular pulsatility index (JPI) values were calculated using the equation (Vmax-Vmin)/Vmax. Clinical and laboratory indices of hypovolemic shock were recorded at the time of admission. Patients were subsequently divided into those with hemorrhagic shock (n=36) and those without (n=39) based on the occurrence of hemorrhagic shock within 6 hours after admission. The results were compared between these groups.ResultsIJV Doppler ultrasound parameters (JPI, Vmin, and Vmax-Vmin) showed significant differences between the two groups. The JPI values of patients with hemorrhagic shock were significantly lower than those in the control group (0.43±0.21 vs. 0.78±0.24, P<0.001). The sensitivity, specificity, and discriminant ability (area under the curve) of JPI with a cutoff of 0.58 in detecting hemorrhagic shock were 86.11%, 82.05%, and 0.853 (P<0.001), respectively.ConclusionIJV Doppler ultrasonography can reliably predict hemorrhagic shock in polytrauma patients with stable vital signs. Ultrasonography can be used in combination with clinical signs and laboratory findings to diagnose patients at risk of hypovolemic shock.

A Baffling Bump: A Case Report of an Unusual Chest Wall Mass in a Pediatric Patient.

IntroductionChest wall masses are rare in children, but the differential diagnosis is broad and can include traumatic injury, neoplasm, and inflammatory or infectious causes. We report a novel case of an eight-year-old, previously healthy female who presented to the emergency department (ED) with one month of cough, fevers, weight loss, and an anterior chest wall mass.Case ReportThe patient’s ultimate diagnosis was necrotizing pneumonia with pneumatocele extending into the chest wall. This case is notable for the severity of the patient’s pulmonary disease given its extension through the chest wall, and for the unique speciation of her infection.ConclusionAlthough necrotizing pneumonia is a rare complication of community-acquired pneumonia, it is important for the emergency physician to recognize it promptly as it indicates severe progression of pulmonary disease even in children with normal and stable vital signs, as in this case. The emergency physician should consider complications of pneumonia including pneumatocele and empyema necessitans when presented with an anterior chest wall mass in a pediatric patient. Additionally, point-of-care ultrasound was used in the ED to facilitate the diagnosis of this illness and was particularly useful in determining the continuity of the patient’s lung infection with her extrathoracic chest wall mass.

Revenge on Social Psychology

Some time ago, a man in Anning City, Anhui Province wounded someone with a knife in a commercial pedestrian street. According to reports, as of 12:00 on June 6, 6 of the 20 injured were killed and the other 14 injured are under active treatment (1 is critically ill and 13 had stable vital signs). Later, with the cooperation of the masses, the public security personnel quickly identified the suspects and quickly captured the suspects. Although the perpetrators have been arrested, many people around them still can't help but ask: Why do people do such terrible things? Why hurt those innocent strangers? Recently, I read Fromm's books and related criminology theories, and wanted to put forward my views on the nature and reasons of the evil of human nature and the social psychology of revenge.

Endovascular aortic repair for abdominal aortic injury complicated with bowel injury due to blunt abdominal trauma: A case report.

Introduction and importanceBlunt abdominal aortic injury (BAAI) resulting from blunt abdominal trauma is rare; therefore, there are no standard guidelines for its treatment. Herein, we report the successful treatment of BAAI via endovascular aortic repair (EVAR) performed immediately after emergency laparotomy to repair a bowel injury.Case presentationA 78-year-old man was injured after being caught between a shovel car and the bumper of his own car for approximately 15 s. Upon arrival at the hospital, the patient was conscious and had stable vital signs, abdominal and low back pain, and numbness in the right lower limb. Computed tomography revealed contrast medium leakage into the mesentery, as well as aortic dissection and rupture. Hemostasis and intestinal resection were completed, and EVAR was performed immediately after abdominal closure. The patient was discharged from the hospital at 35 days after surgery.Clinical discussionIn this case, there existed a risk of artificial blood vessel infection if reconstruction was simultaneously performed with intestinal resection. Symptoms of lower limb ischemia that were observed prior to surgery resolved. After open surgery, bleeding was controlled, and the patient's vital signs were stable. EVAR was performed as treatment for aortic injury, thereby reducing the risk of direct implant infection and enabling minimally invasive treatment.ConclusionEVAR may be useful for the treatment of BAAI in the presence of intestinal injuries, reduce the risk of implant infection, and allow for a one-time, minimally invasive treatment.

Effectiveness of lavender inhalation aromatherapy on pain level and vital signs in children with burns: a randomized controlled trial

BackgroundBurns are a source of pain, which cannot be fully treated with medications. ObjectivesThis study aims is to test the effectiveness of lavender oil inhalation aromatherapy applied before dressing change on vital signs and pain levels of children with burns. DesignThis randomized controlled study was held between May 2018 and May 2019. A total of 108 children who met the inclusion criteria were studied in three groups: Lavender-15 Group inhaled lavender oil for 15 min before dressing (n:36), Lavender-60 Group inhaled lavender oil for 60 min before dressing (n:36), and Control Group inhaled jojoba (placebo) oil for 15 min before dressing (n:36). Baseline pain levels and vital signs of the children were measured before inhalation. Pain levels and vital signs of the children were re-measured at the 1st and 30th minutes after dressing. ResultsThere was no significant difference between the groups in terms of pain levels (p = 0.750) and vital signs before dressing. In post-dressing measurements, the number of respiration (after 1 min p = 0.000, after 30 min p = 0.000), heart rate (after 1 min p = 0.000, after 30 min p = 0.000), mean arterial blood pressure (after 1 min p = 0.010, after 30 min p = 0.000) and pain levels (after 1 min p = 0.000, after 30 min p = 0.000) were lower in the Lavender groups compared to the placebo group. DiscussionThe result of this research reveals that inhalation aromatherapy which applied before dressing in children with burns affects the reduction of pain levels and stabilization of vital signs.

Delayed death after chlorfenapyr poisoning

Chlorfenapyr is a widely used insecticide, that is very lethal if ingested. It exhibits delayed toxicity in which there are few symptoms at first which suddenly worsen after a few days. A 66-year-old female patient ingested about 90 mL of chlorfenapyr liquid hydrating agent (Chlofenapyr 10%) and showed stable vital signs with no specific symptoms and findings other than a mild fever, vomiting, and nausea. From the 3rd day of ingestion, creatine kinase was high, and rhabdomyolysis was suspected. From the 4th day of ingestion, pancreatic enzymes began to gradually increase. A diffusion-weighted image showed a multifocal high signal intensity in the white matter and corpus callosum area. On the 8th day after ingestion, she suffered a high fever and a heart attack and died. Thus, if a patient is suspected of taking chlorfenapyr, he/she needs active treatment and monitoring even if he/she does not exhibit any symptoms.

Single-Center Clinical Analysis of Traumatic Thoracic Aortic Injuries: A Retrospective Observational Study

Purpose This study investigated the clinical outcomes of trauma patients with blunt thoracic aortic injuries at a single institution. Methods During the study period, 9,501 patients with traumatic aortic injuries presented to Trauma Center of Gil Medical Center. Among them, 1,594 patients had severe trauma, with an Injury Severity Score (ISS) of >15. Demographics, physiological data, injury mechanism, hemodynamic parameters associated with the thoracic injury according to chest computed tomography (CT) findings, the timing of the intervention, and clinical outcomes were reviewed. Results Twenty-eight patients had blunt aortic injuries (75% male, mean age, 45.9±16.3 years). The majority (82.1%, n=23/28) of these patients were involved in traffic accidents. The median ISS was 35.0 (interquartile range 21.0–41.0). The injuries were found in the ascending aorta (n=1, 3.6%) aortic arch (n=8, 28.6%) aortic isthmus (n=18, 64.3%), and descending aorta (n=1, 3.6%). The severity of aortic injuries on chest CT was categorized as intramural hematoma (n=1, 3.6%), dissection (n=3, 10.7%), transection (n=9, 32.2%), pseudoaneurysm (n=12, 42.8%), and rupture (n=3, 10.7%). Endovascular repair was performed in 71.4% of patients (45% within 24 hours), and two patients received surgical management. The mortality rate was 25% (n=7). Conclusions Traumatic thoracic aortic injuries are life-threatening. In our experience, however, if there is no rupture and extravasation from an aortic injury, resuscitation and stabilization of vital signs are more important than an intervention for an aortic injury in patients with multiple traumas. Further study is required to optimize the timing of the intervention and explore management strategies for blunt thoracic aortic injuries in severe trauma patients needing resuscitation. Keywords: Aorta, thoracic; Aneurysm, false; Traumatic; Multiple trauma

Epidural catheter migration during cesarean

BackgroundEarly detection and vigilance of high spinal anesthesia post epidural catheter migration in cesarean section leads to safe conduct of anesthesia. Our case describes the migration of a previously functioning epidural catheter in the subarachnoid space.This migration can be explained by patient posture changes and movements.Case presentationA 32 year – old G2P0 medically free female parturient (height 160cm, weight 65 kg), admitted to the labor ward with a 4 cm cervical dilatation, an epidural catheter was inserted in the L3-4 space, and an aspiration test was negative for CSF/blood through epidural catheter.Epidural catheter was fixed on her back using sterile dressings. Epidural mixture of 0.1% bupivacaine and fentanyl 2 mcg/ml started. Due to fetal distress, cesarean section was urgently planned. She was given a bolus dose through the epidural catheter,10 minutes after skin incision, the patient suddenly started to complain of difficulty of breathing and drowsiness. Moreover, her oxygen saturation suddenly started to drop so rapid sequence induction with cricoid pressure applied and was performed till she was intubated. Her pupils were reactive and dilated. She had stable vital signs. She was reversed with neostigmine and atropine after the use of nerve stimulator.Aspiration from the epidural catheter was performed. A clear 10mls fluid was aspirated. The fluid was sent to the lab for analysis and found to be CSF. Upon extubation, the patient was conscious and obeying commands. She completely recovered the motor power of her upper and lower limbs while she was admitted to ICU for observation and she was discharged the next day without any residual anesthesia.ConclusionAspiration test and epinephrine test dose is always recommend to be performed prior to local epidural anesthetic for cesarean section even if the function of the epidural catheter was previously established. Careful observation of neurologic signs is also important.

Felty syndrome: a case report

BackgroundFelty syndrome is a rare manifestation of chronic rheumatoid arthritis in which patients develop extraarticular features of hepatosplenomegaly and neutropenia. The typical presentation of Felty syndrome is in Caucasians, females, and patients with long-standing rheumatoid arthritis of 10 or more years. This case report presents a patient with an early-onset and atypical demographic for Felty syndrome.Case presentationOur patient is a 28-year-old African American woman with past medical history of rheumatoid arthritis diagnosed in 2017, asthma, pneumonia, anemia, and mild intellectual disability who was admitted to inpatient care with fever, chills, and right ear pain for 7 days. The patient’s mother, also her caregiver, brought the patient to the hospital after symptoms of fever and ear pain failed to improve. Our patient was diagnosed with sepsis secondary to pneumonia and urinary tract infection. She had been admitted twice in the past year, both times with a diagnosis of pneumonia. During this visit in September 2019, it was discovered that the patient had leukopenia and neutropenia. Bone marrow biopsy revealed increased immature mononuclear cells with left shift and rare mature neutrophils. During the hospital course, the patient was provisionally diagnosed with Felty syndrome and treated with adalimumab and hydroxychloroquine for her rheumatoid arthritis. Her sepsis secondary to pneumonia and urinary tract infection was treated with ceftriaxone and doxycycline, which was later switched to cefepime because of positive blood and urine cultures for Pseudomonas aeruginosa. She was discharged with stable vital signs and is continuing to control her rheumatoid arthritis with adalimumab.ConclusionThis case report details the clinical course of sepsis secondary to pneumonia and urinary tract infection in the setting of Felty syndrome. Our patient does not fit the conventional profile for presentation given her race, age, and the length of time following diagnosis of rheumatoid arthritis.

Ovarian vein and IVC thrombosis due to normal vaginal delivery; a case report and literature review.

Introduction and importanceOvarian vein thrombosis (OVT) is exceedingly rare, which commonly occurs in postpartum patients and can result in serious complication such as pulmonary emboli. With a presentation often mimicking that of acute abdomen, it can be often misdiagnosed and mistreated.Case presentationA 30-year-old woman referred with right lower quadrant abdominal pain, nausea and anorexia, one week after normal vaginal delivery. Physical examination demonstrated tenderness and rebound tenderness at the right side of the abdomen, with a stable vital sign except 38 °C fever. She had no history of coagulation problems or thrombotic disorders. Patient was admitted on a suspicion of appendicitis and was prescribed antibiotics followed by pelvic and abdominal ultrasonography that indicated an 8 to 10-centimeter hypoechoic tubular structure on the right side, next to the IVC. CT scan with contrast showed clear dilatation and thrombosis of the right ovarian vein with spread to the IVC. Anticoagulant treatment was started with 1000 intravenous units of heparin per hour, along with aPTT control, with a disappearance of the symptoms after 72 h.ConclusionSuspicion of OVT should be high in cases where patients refer with abdominal pain after childbirth, this diagnosis should be taken into account. In the absence of proper and timely diagnosis, it may lead to serious complications or mortality of the mother. CT scan with contrast and at least 3- months anticoagulant therapy (in case of thrombosis spreading to the IVC, this period should be extended) is recommended in diagnosing and treatment of OVT.

Incidence and Causes of Reintubation Other Than Reopening of the Chest in Post-Cardiac Surgical Patients in a Tertiary Care Hospital.

ObjectiveTo determine the incidence of endotracheal reintubation, excluding surgical reopening, in post-cardiac surgical patients in a tertiary care hospital.Material and methodsA retrospective descriptive analysis of 408 patients who underwent different cardiac surgeries during this period. Post-operative extubation was performed when patients fulfilled the preset criteria for extubation, which include consciousness (awake and aware), stable vital signs, acceptable arterial blood gases, acceptable respiratory mechanics, a maximum inspiratory force greater than 20-25 cm H2O, chest tube drainage less than 100 ml per hour, normal temperature and electrolytes. The total number of patients who were reintubated within 72 hours of extubation was noted. The criteria for reintubation included altered conscious level with Glasgow Coma Score (GCS) of less than 8, respiratory failure, unstable hemodynamics, and arrhythmias such as ventricular tachycardia (VT) and fibrillation. All of the information was collected retrospectively on a specifically prepared form. Data was entered and evaluated in Statistical Package for the Social Sciences.The research was piloted in the Cardiac Intensive Care Unit (CICU) of Northwest General Hospital and Research Center, Hayatabad, Peshawar from December 2018 to March 2020.ResultsOut of 408 patients who had cardiac surgeries, only nine (2.2%) were reintubated after initial extubation. The average time for which patients remained on the ventilator was 8 ± 2 hours. The reasons for reintubation were recorded. Among those reintubated, eight patients (88.88%) had undergone coronary artery bypass grafting (CABG) whereas one patient (11.11%) had undergone mitral valve replacement (MVR). In three (33.33%) patients, stroke (hemiplegia in two and global brain ischemia in one) with low GCS was the primary cause of reintubation. Arrhythmias - which included VT, ventricular fibrillation (VF), and supraventricular tachyarrhythmias (SVT) - were responsible for three (33.33%) cases of reintubation. Respiratory failure - with a partial pressure of oxygen in arterial blood less than 60 mmHg, along with tachypnea - was responsible for reintubation in two (22.22%) patients. In one (11.11%) patient who had MVR, cardiac arrest was the underlying reason; the cause of arrest could not be retrieved from the retrospective data. Notably, as a common variable, five (62.5%) out of the eight reintubated CABG patients had a poor left ventricular function. ConclusionCauses of reintubation were primarily cardiac (arrhythmias) and neurological, followed by respiratory causes in our center. Patients with poor left ventricular function and diffuse coronary artery disease appear to have a higher incidence of reintubation which can lead to extended CICU and hospital stay, elevated mortality, and higher costs.

Acute Kidney Injury in a Previously Healthy 15-Year-Old Patient: A Subtle Presentation of Addison’s Disease

Introduction: Primary adrenal insufficiency (PAI), also known as Addison’s disease, is a disorder of the adrenal glands characterized by decreased levels of glucocorticoids and mineralocorticoids. It is a rare condition with a prevalence of 120 cases per million and is less frequently seen in the pediatric population. Here, we report a previously healthy 15-year-old patient with acute kidney injury (AKI) and PAI. Case Presentation: The patient was admitted to the hospital after findings of abnormal laboratory studies, which included an elevated BUN (53 mg/dL), creatinine (1.39 mg/dL), calcium (11.3 mg/dL), potassium (5.6 mmol/L), and hyponatremia (126 mmol/L). These were performed at an outpatient visit due to three-week history of back pain, fatigue and emesis. On admission, he had stable vital signs. Physical examination revealed generalized darkening of skin, more noticeable on the knuckles and palmar creases, with hyperpigmented patches in oral mucosa and both upper extremities. Although his renal function, serum potassium and calcium levels normalized after intravenous hydration with normal saline, hyponatremia (128 mmol/L) continued. His urine analysis and renal ultrasound were normal. Due to his hyperpigmentation and persistent hyponatremia, PAI was suspected. An ACTH stimulation test revealed that basal and stimulated serum cortisol levels were low, 2.6 mcg/dL and 2.9 mcg/dL, respectively. His plasma ACTH level was elevated at 1,625 pg/mL and serum aldosterone level was low at <4.0 ng/dL. These results were consistent with PAI. The patient’s hyponatremia resolved after receiving stress dose hydrocortisone. He was discharged home on hydrocortisone and fludrocortisone with endocrinology follow up. Discussion: PAI is well described in the literature, though reports in pediatrics vary. Patients may present with nonspecific symptoms such as unexplained weight loss, fatigue, diffuse abdominal pain, nausea, vomiting and muscular weakness. These symptoms may be of insidious onset, which often leads to delayed diagnosis. Physical signs include hypotension and hyperpigmentation. Characteristic biochemical findings are hyponatremia, hyperkalemia and hypoglycemia. Despite the electrolyte derangements, AKI is not a common presentation of PAI. There are only a few case reports associating these two diseases. In this case, his symptoms and abnormal electrolytes were initially considered to be the result of AKI of unknown origin. PAI only became a suspicion after a careful physical exam and persistent hyponatremia despite improvement of his AKI with fluid resuscitation. His low serum cortisol and aldosterone levels with elevated plasma ACTH confirmed the diagnosis of PAI. Conclusion: This case highlights a unique presentation of PAI in an adolescent. A timely diagnosis reduces the risk of unwanted and potentially life-threatening complications such as an Addisonian crisis.

Premature Babies Delivered by Assisted Reproductive Technology and Their Family Care Experience

Currently, the majority of couples who choose assisted reproductive technology (ART) have waited for and experienced the disappointment of natural conception. With the assistance of ART, they are finally able to “carry a baby to term.” This is wonderful for first-time parents. This case report involves a woman who delivered a premature baby weighing 1,520 g at 30+5 weeks using ART and her family care experience. During the period of care from October 23, 2016 to December 9, 2016, data were collected on this case through systemic assessment, clinical observation, and parental interview. Problems including gas exchange disorder, caregiver role tension, and the potential risk of parent-child attachment disorder were identified. In addition to providing appropriate medical care to maintain stable vital signs, we hoped to reduce the occurrence of comorbidities through a complete nursing assessment and comprehensive developmental care. We also attempted to build trust and to reduce parental anxiety and stress by providing relevant medical information and psychological support through active and proactive nursing care. The performance of “kangaroo care” with stable vital signs enhances parent-child attachment and a sense of involvement in the ongoing care of the infant. This strengthens the mother’s motivation and self-confidence in her caregiving role, enhances her sense of accomplishment as a mother, and promotes the growth and development of the infant after returning home. The weight of the infant reached 2,430 g before discharge. Before discharge, the mother was able to cite at least two caregiving skills and her eyes were no longer red from sobbing. We hoped that the parent-child attachment was well developed and that “kangaroo care” will assist the mother to face the future with a positive attitude after returning home. This article can be used as reference for nursing practitioners to improve the quality of care for premature babies.

Exploring the value of cesarean section diverticulum area to predict the safety of hysteroscopic management for cesarean scar pregnancy patients.

To study indicators predicting the safety of hysteroscopic management for cesarean scar pregnancy (CSP) patients. This was a retrospective study, starting from June 1, 2020. The study included 141 CSP patients who underwent hysteroscopic surgery and met the requirements of gestational age ≤12weeks, stable vital signs, and preoperative magnetic resonance imaging. Patients were divided into control group and testing group according to surgical outcomes. Preoperative indicators were compared between the two groups, including a novel indicator, cesarean section diverticulum (CSD) area. Univariate analysis identified five statistically significant (P<0.05) factors associated with hysteroscopy failure including a large CSD area. Multifactor logistic regression analysis showed that the only statistically significant indicator of all five factors was the CSD area. The area under the receiver operating characteristics curve of CSD area was 0.848. Next, we determined three cut-off values for CSD area that can be used to predict the outcome of surgery: 138, 189, and 300mm2 . For the first time, we found that CSD area could predict the safety of hysteroscopic management for CSP patients and might be helpful for clinical decision making. The findings need to be verified by further research.

Literature Review; Stabilitas Tanda-tanda Vital Neonatus Segera Mandi dengan Tunda Mandi

Introduction: Bathing of neonate is a part of the birth process by cleaning the baby's body, watering or soaking. However, neonates may experience heat loss more rapidly and show signs of vital instability. Objectives: The purpose of this study was to compare the stability of the vital signs of neonates who immediately took a bath and who delayed bathing. Methods: the research method as a comprehensive search strategy, namely articles in the database of research journals through the Scopus database, Proquest, Clinical Key, and Science Direct with full text criteria and published in years. 2016-2020. Results: The results obtained in this study indicate that it is advisable to delayed bathing in newborns so that the stability of vital signs is better

Interferon gamma in the treatment of patients with moderate COVID-19

Interferons are produced in response to the presence of pathogens in cells and are responsible for the proper formation of immune reaction. Preliminary data obtained in studies of properties of recombinant interferon gamma (IFN-γ) that involved patients with community-acquired pneumonia (including bacterial), acute respiratory viral infection (ARVI), influenza and new coronavirus infection have shown promising results.The purpose of the study was to assess the effect of subcutaneous administration of IFN-γ in patients with viral pneumonia on the changes of vital signs and the duration of hospital stay. An open-label, randomized, low-interventional study included patients with moderate new coronavirus infection COVID-19 over 18 years of age of both sexes. IFN-γ 500,000 IU was administered s/c, daily, once a day, during 5 days. IFN-y in addition to complex therapy of the disease resulted in more favorable changes in the stabilization of vital signs, as well as in reduced length of fever and hospital stay by 2 days what allows suggesting a positive effect of this substance on the recovery processes in patients with moderate COVID-19. Special emphasis should be made to the fact that patients who received recombinant IFN- γ experienced no progression of respiratory failure and required no transfer to intensive care unit. This study confirms earlier obtained data on the positive effect of IFN-y on the rate of clinical stabilization and recovery of patients with community-acquired pneumonia and viral infections. Presented results are limited to a small number of patients; further study of drug properties in post-marketing studies is required. Progress in the treatment of patients with moderate COVID-19 by adding recombinant IFN-γ to the complex therapy may reasonably expand the range of existing treatment options for this infection.

A126 GIST – GLUE IN STROMAL TUMOR

Abstract Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and typically located in the stomach. Gastrointestinal bleeding is a frequent complication of GISTs with surgery being the treatment of choice. Managing GIST bleeding endoscopically can be challenging by an underlying friable neovascularization. The use of cyanoacrylate basis glue has well-established utility in the endoscopic management of variceal bleeding. However, the role of cyanoacrylate basis glue in the management of GIST bleeding is exceptionally rare. Aims We present a case of a bleeding GIST that was successfully managed through the utilization of cyanoacrylate basis glue allowing for elective surgical resection. Methods A chart review was undertaken. Also, a literature review of the topic was also conducted using the terms “GIST, Cyanoacrylate Glue, Bleeding” Results A 75-year-old male presented with a four week history of exertional chest pain. He had noticed persistent black stools for the previous two weeks. His past medical history was relevant for coronary artery disease; two years earlier he had drug eluting stents placed. His medications included ASA 81mg PO OD and Pantoprazole 40mg OD. Physical examination revealed stable vital signs, a soft abdomen and melena on rectal examination. Laboratory investigations showed a hemoglobin of 75 g/L, and 2 weeks prior his hemoglobin had been 120 g/L. Platelets were 149. His liver enzymes and liver function tests were unremarkable. His BUN was 9.9 mmol/L and creatinine of 96.0 umol/L. An esophagogastroduodenoscopy (EGD) revealed a 5cm smooth mass with a central deep depression, in the antrum, that was actively bleeding. Attempts to clip were unsuccessful due to the width of the central depression which was the source of bleeding. (See image 1). The endoscopist chose to inject 1cc of cyanoacrylate basis glue directly into the bleeding site. A subsequent CT scan revealed a 5.2cm polypoid mass in the gastric antrum, favored to be a GIST with no evidence of metastatic disease. Surgery and Cardiology were involved in the care of this patient, and emergency surgery was delayed due to the patient having an intercurrent acute coronary syndrome. Post EGD, the patient underwent an angiogram and the culprit coronary artery was stented and patient was started on dual antiplatelet therapy. Patient then successfully underwent a laparoscopic gastric wedge resection for his GIST, this was completed 1 week after EGD. The pathology of the resected area was in keeping with a GIST. Of note, the patient’s hemoglobin had been stable from the time of EGD until surgical intervention. Conclusions Managing GIST bleeding endoscopically can be challenging, and surgical resection is the recommended treatment modality. In situations where surgical intervention is contraindicated, endoscopic therapy with cyanoacrylate basis glue can be considered to achieve hemostasis in GIST bleeding. Funding Agencies None

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Amyloidosis: An Act of Deception in the Liver

We report a case of end-stage liver disease initially attributed to acute on chronic liver failure (ACLF) in a 59 YO African American female. She presented encephalopathic with stable vital signs. Her laboratory tests were as follows: bilirubin: 24.3 mg/dL, INR 2, Creatinine 4.2 mg/dL, MELD of 40 with rapidly declining renal function. Magnetic resonance cholangiopancreatography (MRCP) was negative. Her serologic work-up was unrevealing. She was deemed to have decompensated cryptogenic cirrhosis for which she received simultaneous liver &amp; kidney transplantation. Her explanted liver revealed extensive amyloidosis, AL Amyloid kappa type. Urine electrophoresis showed a monoclonal free kappa light chain. Bone marrow biopsy and flow cytometry were negative for plasma cell dyscrasia. Further work up suggested no systemic involvement. We present this rare case of primary hepatic amyloidosis and discuss the importance of this diagnostic consideration in patients with otherwise unclear etiology of liver disease.