BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor ...BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition.Herein,we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis.CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis,presented with altered mental status and dizziness.He was found to have severe hypoglycemia refractory to glucose supplements.Imaging studies and biopsy discovered well differentiated HCC without metastasis.Further evaluation showed low insulin,C-peptide and betahydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio,consistent with the diagnosis of NICTH.As patient was not a candidate for surgical resection or chemotherapy,he was started on prednisolone with some improvements in the glucose homeostasis,but soon decompensated after a superimposed hospital acquired pneumonia.CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal.Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC,even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.展开更多
Objective:This study aimed to investigate the incidence and predictors of non-variceal upper gastrointestinal bleeding(NVUGIB)in hospitalized patients with coronavirus disease 2019(COVID-19),as well as the inpatient o...Objective:This study aimed to investigate the incidence and predictors of non-variceal upper gastrointestinal bleeding(NVUGIB)in hospitalized patients with coronavirus disease 2019(COVID-19),as well as the inpatient outcomes associated with this complication.Methods:This was an analysis of the National Inpatient Sample Database from January to December 2020.Adult COVID-19 patients were categorized into two groups based on NVUGIB development during hospitalization.Multivariate logistic analysis was performed to identify predictors and outcomes associated with NVUGIB in hospitalized COVID-19 patients in the US,after adjusting for age,sex,race,and Charlson Comorbidity Index(CCI)score,using Stata/BE 17.0.Results:Among 1050045 hospitalized patients,1.87%developed NVUGIB.Asian Americans had the highest risk,followed by Native Americans,Hispanics,and African Americans,with odds ratios(ORs)of 1.70,1.59,1.40,and 1.14,respectively.Patients with higher CCI scores were also at greater risk(with ORs of 1.47,2.09,and 3.45 for CCI scores of 1,2,and 3,respectively).COVID-19 patients with NVUGIB had a higher risk of inpatient mortality(OR=3.84),acute kidney injury(OR=3.12),hypovolemic shock(OR=13.7),blood transfusion(OR=7.02),and in-hospital cardiac arrest(OR=4.02).Conclusion:NVUGIB occurred in 1.87%of hospitalized COVID-19 patients and was associated with a threefold increase in mortality.Further research is necessary to identify strategies for reducing its incidence in COVID-19 patients with multiple risk factors.展开更多
文摘BACKGROUND Non-islet cell tumor hypoglycemia(NICTH)is a rare cause of persistent hypoglycemia seen in patients with hepatocellular carcinoma(HCC).It is likely to be underdiagnosed especially in the patients with poor hepatic function and malnutrition.Herein,we report a rare case of NICTH as the initial presentation of HCC in a patient with chronic hypoglycemia due to end-stage liver cirrhosis.CASE SUMMARY A 62-year-old male with chronic fasting hypoglycemia secondary to end-stage hepatitis C-related cirrhosis,presented with altered mental status and dizziness.He was found to have severe hypoglycemia refractory to glucose supplements.Imaging studies and biopsy discovered well differentiated HCC without metastasis.Further evaluation showed low insulin,C-peptide and betahydroxybutyrate along with a high insulin-like growth factor-2/insulin-like growth factor ratio,consistent with the diagnosis of NICTH.As patient was not a candidate for surgical resection or chemotherapy,he was started on prednisolone with some improvements in the glucose homeostasis,but soon decompensated after a superimposed hospital acquired pneumonia.CONCLUSION NICTH can occur as the sole initial presentation of HCC and is often difficult to correct without tumor removal.Clinicians should maintain high clinical suspicion for early recognition of paraneoplastic NICTH in patients at risk for HCC,even those with chronic fasting hypoglycemia in the setting of severe hepatic failure and malnutrition.
文摘Objective:This study aimed to investigate the incidence and predictors of non-variceal upper gastrointestinal bleeding(NVUGIB)in hospitalized patients with coronavirus disease 2019(COVID-19),as well as the inpatient outcomes associated with this complication.Methods:This was an analysis of the National Inpatient Sample Database from January to December 2020.Adult COVID-19 patients were categorized into two groups based on NVUGIB development during hospitalization.Multivariate logistic analysis was performed to identify predictors and outcomes associated with NVUGIB in hospitalized COVID-19 patients in the US,after adjusting for age,sex,race,and Charlson Comorbidity Index(CCI)score,using Stata/BE 17.0.Results:Among 1050045 hospitalized patients,1.87%developed NVUGIB.Asian Americans had the highest risk,followed by Native Americans,Hispanics,and African Americans,with odds ratios(ORs)of 1.70,1.59,1.40,and 1.14,respectively.Patients with higher CCI scores were also at greater risk(with ORs of 1.47,2.09,and 3.45 for CCI scores of 1,2,and 3,respectively).COVID-19 patients with NVUGIB had a higher risk of inpatient mortality(OR=3.84),acute kidney injury(OR=3.12),hypovolemic shock(OR=13.7),blood transfusion(OR=7.02),and in-hospital cardiac arrest(OR=4.02).Conclusion:NVUGIB occurred in 1.87%of hospitalized COVID-19 patients and was associated with a threefold increase in mortality.Further research is necessary to identify strategies for reducing its incidence in COVID-19 patients with multiple risk factors.
