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Introduction: In late December 2019, the coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. It quickly spread and emerged as a global pandemic with far-reaching impacts on society. As clinical research on this novel virus emerges, there is a limited amount of data that review clinical and laboratory predictors of severe disease. We present a case of a patient with severely elevated inflammatory markers who remained clinically stable during his hospital course. Case discussion: A 53-year-old male presented to the emergency room with 11 days of persistent fevers and new-onset anterior chest tightness. He was admitted to the hospital due to a reported oxygen desaturation at home to 87% (taken by his spouse, a healthcare professional) and ambulatory oxygen desaturation down to 87%. He was noted to have severely elevated inflammatory markers, lymphopenia, and computed tomography pulmonary angiograph findings consistent with COVID-19. He remained on room air and clinically stable throughout his 3-day hospital course. While his C-reactive protein levels improved, his ferritin and erythrocyte sedimentation rate continued to elevate. He was discharged home and was symptom-free within 4 days of hospital discharge. Discussion: COVID-19 has proven to be a viral disease with a high transmission rate, that has caused over 100,000 deaths in the United States, thus far. The decision to admit a patient must balance the risks of transmission with the benefit of being readily available to provide urgent supportive care should the patient develop complications. Thus, there is a significant benefit to being able to predict poor outcomes. We performed a targeted review of the literature, focusing on clinical and laboratory predictors of poor outcomes in COVID-19. Our case report and narrative review outline these findings within the context of our case.

Blunt pancreatic trauma is rare, and the reported mortality is high. The true outcomes in isolated pancreas trauma are not known, and the optimal management according to injury severity is controversial. The present study evaluated the incidence, outcomes, and optimal management of isolated blunt pancreatic injuries.National Trauma Data Bank study, including patients with blunt pancreatic trauma. Patients with major associated injuries or other severe intra-abdominal injuries were excluded. Patients' demographics, vital signs on admission, Abbreviated Injury Scale for each body area, Injury Severity Score (ISS), and therapeutic modality were extracted. Mortality and hospital length of stay were stratified according to the severity of pancreatic injury and therapeutic modality.There were 388,137 patients with blunt abdominal trauma. Overall, 12,112 patients (3.1%) sustained pancreatic injury. Isolated pancreatic injury occurred in 2,528 (0.7%) of all abdominal injuries or 20.9% of pancreatic injuries. Most injuries were low-grade Organ Injury Scale ((OIS) score of 2, 82.7%) with only a small percentage of higher-grade injuries (OIS score of 3, 7.9%; OIS score of 4, 3.9%; and OIS score of 5, 5.5%). Overall, most patients (74.1%) were managed nonoperatively. Nonoperative management was selected in 80.5% of pancreas OIS score of 2, 48.5% of OIS score of 3, and 40.9% of OIS scores of 4 to 5. The overall mortality rate was 2.4%, while in severe pancreatic trauma it was 3.0%. In minor pancreatic trauma, nonoperative management was associated with lower mortality and shorter hospital length of stay than operative management. However, in the group of patients with severe pancreatic trauma (OIS scores, 4-5) nonoperative management was associated with higher mortality and longer hospital stay than definitive operative management of the pancreas.The mortality in isolated pancreatic trauma is low, even in severe injuries. Nonoperative management of minor pancreatic injuries is associated with lower mortality and shorter hospital stay than operative management. However, in severe trauma, nonoperative management is associated with higher mortality and longer hospital stay than operative management.Prognostic study, level III; therapeutic study, level IV.

New findings regarding the mechanisms of action of electroconvulsive therapy (ECT) have led to novel developments in treatment technique to further improve this highly effective treatment for major depression. These new approaches include novel electrode placements, optimization of electrical stimulus parameters, and new methods for inducing more targeted seizures (eg, magnetic seizure therapy [MST]). MST is the use of transcranial magnetic stimulation to induce a seizure. Magnetic fields pass through tissue unimpeded, providing more control over the site and extent of stimulation than can be achieved with ECT. This enhanced control represents a means of focusing the treatment on target cortical structures thought to be essential to antidepressant response and reducing spread to medial temporal regions implicated in the cognitive side effects of ECT. MST is at an early stage of development. Preliminary results suggest that MST may have some advantages over ECT in terms of subjective side effects and acute cognitive functioning. Studies designed to address the antidepressant efficacy of MST are underway. As with all attempts to improve convulsive therapy technique, the clinical value of MST will need to be established through controlled clinical trials. This article reviews the experience to date with MST, and places this work in the broader context of other means of optimizing convulsive therapy in the treatment of depression.

Ehlers-Danlos syndrome-hypermobility type (EDS-HT) is a connective tissue disorder associated with chronic musculoskeletal pain. The diagnosis is based on simple clinical examination, although it is easily overlooked. Herein we present a case of EDS-HT associated with hemorrhoids and suggest that there may be an association between the two conditions.

The optimal management of fulminant or complicated diverticulitis is the subject of debate in recent literature. The most common management strategy remains resection and end colostomy or Hartmann’s procedure, first introduced in the 1940s, despite the introduction of more current approaches supported by decreased morbidity and mortality by various studies. The purpose of this paper is to provide a review of the strategies described for the management of fulminant diverticulitis and the most recent evidence available to support these approaches. We discuss the advantages and disadvantages of the Hartmann’s procedure approach, as well as the most current management strategies, and offer both citation and review of relevant recent studies.

Intermediary signals, precociously enhancing GLUTS transcription in response to perfusion of its substrate, fructose, in the small intestine of neonatal rats, are not known. Because glucose-6-phosphatase (G6Pase), glucose-6-phosphate trans-locase (G6PT), and fructose-1,6-bisphosphatase (FBPase) expression increases parallel to or precedes that of GLUTS, we investigated the link between these gluconeogenic genes and GLUTS by using vanadate or tungstate, potent inhibitors of gluconeogenesis. Small intestinal perfusions of 20-d-old rats were performed with fructose alone, fructose + vanadate or tungstate, glucose alone, and glucose + vanadate or tungstate. As expected, fructose, but not glucose nor glucose + inhibitor perfusion, increased GLUTS mRNA abundance and fructose transport. Fructose perfusion dramatically increased G6Pase mRNA abundance but had no effect on G6Pase activity. In sharp contrast, fructose perfusion did not increase FBPase gene expression but stimulated FBPase activity. Both vanadate and tungstate significantly inhibited G6Pase activity but did not prevent the fructose-induced increases in G6Pase and G6PT gene expression. Perfusion with fructose + vanadate prevented the fructose-induced increases in fructose transport and GLUT5 mRNA abundance, whereas perfusion with fructose + tungstate did not. Interestingly, vanadate, but not tungstate, inhibited the fructose-induced increase in FBPase activity. Thus, vanadate inhibition of fructose-induced increases in FBPase activity paralleled exactly vanadate inhibition of fructose-induced increases in GLUTS mRNA abundance and activity. Fructose-induced changes in FBPase activity may regulate changes in GLUTS expression and activity in the small intestine of neonatal rats. The marked increases in intestinal G6Pase and GLUTS mRNA abundance may be a parallel response to different factors released during fructose perfusion.

Elongin C is a highly conserved, low molecular weight protein found in a variety of multiprotein complexes in human, rat, fly, worm, and yeast cells. Among the best characterized of these complexes is a mammalian E3 ligase that targets proteins for ubiquitination and subsequent degradation by the 26 S proteasome. Despite its crucial role as a component of such E3 ligases and other complexes, the specific function of Elongin C is unknown. In yeast, Elongin C is a non-essential gene and there is no obvious phenotype as associated with its absence. We previously reported that in Saccharomyces cerevisiae Elongin C (Elc1) interacts specifically and strongly with a class of proteins loosely defined as stress response proteins. In the present study, we examined the role of yeast Elc1 in the turnover of two of these binding partners, Snf4 and Pcl6. Deletion of Elc1 resulted in decreased steady-state levels of Snf4 and Pcl6 as indicated by Western blot analysis. Northern blot analysis of mRNA prepared from elc1 null and wild type strains revealed no difference in mRNA levels for Snf4 and Pcl6 establishing that the effects of Elc1 are not transcriptionally mediated. Reintroduction of either yeast or human Elongin C into Elc1 null strains abrogated this effect. Taken together, these data document that the levels of Snf4 and Pcl6 are dependent on the presence of Elc1 and that binding to Elc1 inhibits the degradation of these proteins. The results suggest a new function for yeast Elongin C that is distinct from a direct role in targeting proteins for ubiquitination and subsequent proteolysis.