INTRODUCTION:
The prevalence of obesity and the medical costs associated with it are steadily rising, both among the adult and adolescent populations. New procedures such as the intragastric balloon ...(IGB), can provide rapid improvement in overall health to help manage and maintain weight loss with few adverse events.
CASE DESCRIPTION/METHODS:
A 61-year-old male patient with class III-IV obesity and multiple comorbidities had been in discussion with his gastroenterologist for over a year to undergo an IGB procedure. Peak weight was 302 lbs, with BMI of 43 kg/m
2
. He underwent intensive lifestyle and medical therapy, was started on Liraglutide 1.8 mg daily, with 15 lbs weight loss that plateaued. On his pre-procedure visit, hemoglobin A1C was 9.4, with a weight of 275 lbs and BMI 40.7 kg/m
2
. An intragastric Orbera™ IGB System (Apollo Endosurgery Inc, Austin, TX, United States) was placed and inflated with 600 ml of saline. On 2-month follow-up, the patient had lost 34 pounds. A number of his chronic medications, including those for hypertension and diabetes mellitus, were held due to improvement in lab and exam findings. The IGB was removed after 6 months. The patient continued to lose weight and has maintained daily exercise and dietary guidelines. Most recently, the patient's A1C level has trended down to 6.4%, with a weight of 202 lbs and a BMI of 29.9 kg/m
2
. Since starting the program, he has lost a total of 101 lbs.
DISCUSSION:
This case highlights the dramatic weight loss after a minimally invasive weight loss procedure in conjunction with proper diet and, exercise. The patient lost 27% of his body weight (275 lbs to 202 lbs) and went from class III obesity (>40 BMI), to an overweight range (25.0–29.9 BMI) with the IGB. Overall, he has lost over 100 lbs with 34.4% total weight loss, making him the “biggest loser' in our program. The effect on the patient's overall well-being has been extraordinary; over time, he has been able to start a regular exercise and dietary regimen, use less medication or experience remission of his chronic conditions. The typical weight loss expected with a gastric balloon is 10-12%. This patient's results have far exceeded the expected trajectory. Given the chronicity of obesity, and improvements in health seen with even 5-10% weight loss, a relatively safe endoscopic procedure such as the gastric balloon can significantly improve the health status of patients with obesity and should be considered before more invasive interventions.
Gastrointestinal (GI) symptoms occur among patients diagnosed with coronavirus disease 2019 (COVID-19), and there is clear evidence that SARS-CoV-2, the causative pathogen, infects the GI tract. In ...this large, multicenter cohort study, we evaluated variations in gastrointestinal and hepatic manifestations of COVID-19 throughout the United States (US).
Patients hospitalized with a positive COVID-19 test prior to October 2020 were identified at 7 US academic centers. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were abstracted. Descriptive and regression analyses were used to evaluate GI manifestations and their potential predictors.
Among 2031 hospitalized patients with COVID-19, GI symptoms were present in 18.9%; diarrhea was the most common (15.2%), followed by nausea and/or vomiting (12.6%) and abdominal pain (6.0%). GI symptoms were less common in the Western cohort (16.0%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. Compared to nonintensive care unit (ICU) patients, ICU patients had a higher prevalence of abnormal aspartate aminotransferase (58.1% vs 37.3%; P < .01), alanine aminotransferase (37.5% vs 29.3%; P = .01), and total bilirubin (12.7% vs 9.0%; P < .01). ICU patients also had a higher mortality rate (22.7% vs 4.7%; P < .01). Chronic liver disease was associated with the development of GI symptoms. Abnormal aspartate aminotransferase or alanine aminotransferase was associated with an increased risk of ICU admission.
We present the largest multicenter cohort of patients with COVID-19 across the United States. GI manifestations were common among patients hospitalized with COVID-19, although there was significant variability in prevalence and predictors across the United States.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
INTRODUCTION:
Cytomegalovirus (CMV) primarily affects immunocompromised patients, and has multiple manifestations in the gastrointestinal (GI) tract. The incidence of CMV-related GI disease has ...decreased since the advent of antiretroviral therapy (ART) for HIV. This, along with varied and nonspecific symptoms, makes it difficult to diagnose.
CASE DESCRIPTION/METHODS:
We report a 34-year-old man with AIDS (CD4 count 114 cells/µL) on ART presenting with five days of fevers. He was admitted to the ICU for sepsis and stabilized. His course was complicated by pulmonary embolism, recurrent fevers, and development of biopsy proven pyoderma gangrenosum. He also reported odynophagia, and was empirically treated for candida esophagitis with fluconazole. On hospital day 37, he developed massive hematochezia. An urgent esophagogastroduodenoscopy (EGD) did not reveal the source of bleeding, but showed a 5-cm linear esophageal scar, which appeared to be a healing tear. Sigmoidoscopy revealed a solitary rectal ulcer with a visible vessel, which was clipped for hemostasis. His bleeding resolved. The patient’s odynophagia persisted, significantly limiting his ability to tolerate oral intake. Repeat EGD revealed a large, cratered, non-bleeding esophageal ulcer which was biopsied. The same day, the patient developed hematochezia; repeat sigmoidoscopy showed a deeply cratered rectal ulcer with a visible vessel successfully treated with hemostatic clips. Esophageal biopsies returned positive for CMV; valganciclovir was initiated. His odynophagia improved after starting treatment and he had no further GI bleeding. Given the clinical response, the rectal ulcers were presumed to be due to CMV, making this a case of extensive CMV-related GI disease.
DISCUSSION:
This is a case of extensive CMV-related GI disease which eluded diagnosis during a prolonged and complicated hospitalization. CMV-related GI disease has varied presentations, most commonly affecting the esophagus, but has also been noted to manifest with gastritis, duodenitis, pancreatitis, and colitis. The most common endoscopic findings for esophageal involvement are discrete, shallow, punched-out ulcers surrounded by normal appearing mucosa. Clinical manifestations of colonic CMV include abdominal pain and diarrhea, while discrete ulceration causing bleeding is less commonly reported. This case highlights the importance of a high index of suspicion for CMV in immunocompromised patients with multiple, unexplained GI symptoms to avoid a delay in diagnosis and management.
Nalsarovar Bird Sanctuary, a natural freshwater lake (a relict sea) that is the largest natural wetland in the Thar Desert Bio-geographic Province and represents a dynamic environment with salinity ...and depth varying depending on rainfall. For maintaining ecological balance in coastal and inland environments, wetlands play an important role and the changes in wetland environment can be monitored using satellite remote sensing technique. The present study was carried out using Landsat-7 TM (Feb-2002), Landsat-5 TM (Feb- 2009) and Sentinel-2 multi-spectral data (Feb-2018) covering Nalsarovar area in Ahmedabad district. The study area of Nalsarovar with 10 km buffer was extracted from the satellite digital data. Various spectral indices like Normalized difference Vegetation Index (NDVI), Normalized difference Water Index (NDWI) and Normalized difference Turbidity Index (NDTI) were generated for better identification and delineation of water body and aquatic vegetation in the Nalsarovar. The composite images of these indices were also generated to map and monitor changes in water spread and aquatic vegetation in the Nalsarovar. The water spread and aquatic vegetation in the Nalsarovar along with the land use classes were mapped using False Colour Composite (FCC) images of differed years.
The result indicates that the water spread in Nalsarovar has changed from 2002, 2009 and 2018 depending on the monsoon pattern during these years. During drought year of 2002 total precipitation was very less resulting drastic reduction in the water spread in Nalsarovar. The aquatic vegetation has changed from 146.81 ha during 2002 to 510.93 ha during 2018. The land use change indicates that agriculture land, built-up, water body & wetland has increased and barren land, salt affected area has decreased. The aquatic vegetation in Nalsarovar was clearly visible on composite images generated using NDVI, NDWI and NDTI of different years. This study gives clear idea for land use change detection and water spread monitoring using two different techniques using Composite image of NDVI, NDWI and NDTI.
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