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Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review

World Journal of Gastroenterology 2016年第31期22卷 7166-7174页

作者： Jasbir Makker bharat bajantri Sailaja Sakam Sridhar Chilimuri Division of Gastroenterology Department of Medicine Bronx Lebanon Hospital Center Department of Internal Medicine Bronx Lebanon Hospital Center

Involvement of gastrointestinal tract by cytomegalovirus(CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

关键词： Cytomegalovirus Gastrointestinal Duodenal bleed Duodenal hemorrhage

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Predictors of acute gastrointestinal bleeding in diabetic ketoacidosis:a retrospective observational study in minority population

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Gastroenterology Report 2017年第4期5卷 293-297,I0002页

作者： Kanthi Rekha Badipatla Preeti Jadhav Sushma Vaddigiri bharat bajantri Amandeep Singh Chaitanya Chandrala Vijay S Are Suresh Kumar Nayudu Department of Medicine Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA Division of Gastroenterology Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA Division of Pulmonary and Critical Care Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA Division of Cardiology Bronx Lebanon Hospital CenterIcahn School of Medicine at Mount SinaiBronxNew YorkNYUSA

Background:Diabetic ketoacidosis(DKA)is a common acute complication of diabetes mellitus requiring aggressive medical *** attempted to study the incidence and various clinical and laboratory variables associated with acute gastrointestinal bleeding(AGIB)and acute upper AGIB(AUGIB)in patients with ***:We conducted a retrospective chart review of all the patients admitted to our hospital with DKA between January 2010 and December *** collected demographic,clinical,laboratory,endoscopy and hospitalization details using an electronicmedical-record *** were divided into two groups based on the occurrence of gastrointestinal ***:A total of 234 patients with DKA were admitted during this period,of which 27(11.5%)patients had documented *** majority of patients had hematemesis(n=22,9.4%)except two had rectal and three had occult *** did not notice any difference in age,gender and ethnicity distribution between the two *** was no difference in the serum levels of electrolytes,anion gap,pH and hemoglobin A1C between the two ***,patients with AGIB had significantly higher initial blood glucose levels(738 vs 613 mg/dL,p=0.014).There was also increased mortality(7.4%vs 4.8%)in patients with AGIB,but this did not reach statistical ***:We conclude that higher initial serum blood glucose was associated with increased incidence of AGIB in patients admitted with *** also noted increased in-patient mortality in patients with DKA who had AGIB,even though statistically *** aggressive measures to correct blood glucose levels may result in decreased incidence of AGIB,thereby reducing mortality during hospitalization in patients with DKA.

关键词： diabetic ketoacidosis gastrointestinal bleeding mortality

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Rare case of dysphagia, skin blistering, missing nails in a young boy

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World Journal of Gastrointestinal Endoscopy 2015年第2期7卷 154-158页

作者： Jasbir Makker bharat bajantri Prospere Remy Division of Gastroenterology Department of Medicine Bronx Lebanon Hospital Center Albert Einstein College of Medicine of Yeshiva University

Epidermolysis bullosa is a group of genetic disorders with an autosomal dominant or an autosomal recessive mode of inheritance and more than 300 mutations. The disorder is characterized by blistering mucocutaneous lesions and has several varying phenotypes due toanchoring defect between the epidermis and dermis. The variation in phenotypic expression depends on the involved structural protein that mediates cell adherence between different layers of the skin. Epidermolysis bullosa can also involve extra-cutaneous sites including eye, nose, ear, upper airway, genitourinary tract and gastrointestinal tract. The most prominent feature of the gastrointestinal tract involvement is development of esophageal stricture. The stricture results from recurrent esophageal mucosal blistering with consequent scarring and most commonly involves the upper esophagus. Here we present a case of a young boy with dominant subtype of dystrophic epidermolysis bullosa who presented with dysphagia, extensive skin blistering and missing nails. Management of an esophageal stricture eventually requires dilatation of the stricture or placement of a gastrostomy tube to keep up with the nutritional requirements. Gastrostomy tube also provides access for esophageal stricture dilatation in cases where antegrade approach through the mouth has failed.

关键词： Epidermolysis bullosa Dysphagia Esophagealstenosis Gastrostomy Blistering

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