Obesity as a mortality risk factor in the medical ward: a case control study

Background Research regarding the association between severe obesity and in-hospital mortality is inconsistent. We evaluated the impact of body mass index (BMI) levels on mortality in the medical wards. The analysis was performed separately before and during the COVID-19 pandemic. Methods We retrospectively retrieved data of adult patients admitted to the medical wards at the Mount Sinai Health System in New York City. The study was conducted between January 1, 2011, to March 23, 2021. Patients were divided into two sub-cohorts: pre-COVID-19 and during-COVID-19. Patients were then clustered into groups based on BMI ranges. A multivariate logistic regression analysis compared the mortality rate among the BMI groups, before and during the pandemic. Results Overall, 179,288 patients were admitted to the medical wards and had a recorded BMI measurement. 149,098 were admitted before the COVID-19 pandemic and 30,190 during the pandemic. Pre-pandemic, multivariate analysis showed a “J curve” between BMI and mortality. Severe obesity (BMI > 40) had an aOR of 0.8 (95% CI:0.7–1.0, p = 0.018) compared to the normal BMI group. In contrast, during the pandemic, the analysis showed a “U curve” between BMI and mortality. Severe obesity had an aOR of 1.7 (95% CI:1.3–2.4, p < 0.001) compared to the normal BMI group. Conclusions Medical ward patients with severe obesity have a lower risk for mortality compared to patients with normal BMI. However, this does not apply during COVID-19, where obesity was a leading risk factor for mortality in the medical wards. It is important for the internal medicine physician to understand the intricacies of the association between obesity and medical ward mortality.

Clinical Profile of Migrant Workers Admitted in Medical Ward at Tertiary Care Hospital

Background: One of the defining elements of Nepal's socioeconomic environment is labor migration. Migrant workers are more likely to develop occupational diseases because they do dangerous tasks and have limited access to occupational health care. The purpose of this paper is to produce clinical profile of migrant workers admitted in medical ward at tertiary care hospital. Materials and Methods: This was a descriptive cross-sectional study carried out in Nobel Medical College Teaching Hospital on migrant workers patients admitted in medical ward from October 2018 to September 2019. The sample enrollment process was consecutively who were admitted under medical ward. Pre-designed questionnaire was used to collect data for clinical profile of the patients. Data were entered in Microsoft Excel and analyzed. Results: The migrant workers in this study mainly came from Malaysia, United Arab Emirates, Saudi Arabia, Qatar and Kuwait. They are almost male (97.1%) in this study with mean age of 30.3±7 years in age. The commonest age group of migration was 20-29 year. The highest number of workers 22 (31.1%) had visited to Malaysia in the seek of work. The most common symptoms among them were weakness 15 (21.7%) and headache 13 (18.8%). The highest diagnosis among them was diabetes mellitus 13 (18.8%) and hypertension 11(15.9%). The highest number of workers was involved in their job at different foreign countries as a labor at factories or at construction site 32 (46.4%). Conclusion: Male from younger age group were mainly observed as migrant worker with their proclivity to work in Malaysia. The most common diagnosis among them was diabetes mellitus and hypertension. Most migrant workers worked as workers in factories and construction sites

Acute inflammatory transverse myelitis post-Pfizer-BioNTech-COVID-19 vaccine in 16-year-old

Coronavirus disease 2019 (COVID-19) originated in China in early March 2019. Saudi Food and Drug Authority approved the registration of the Pfizer-BioNTech COVID-19 vaccine in Saudi Arabia on December 10, 2020, and on May 10, 2021, Pfizer-BioNTech was given an authorized emergency use in 12–15-years-old children. Saudi Arabia’s Ministry of Health started Pfizer-BioNTech COVID-19 vaccination for 12–18-years-old on June 27, 2021. Here, we have a case of a 16-year-old female admitted to the medical ward diagnosed with acute inflammatory transverse myelitis after 2 weeks from second dose of the Pfizer-BioNTech COVID-19 vaccine. The diagnosis was based on normal laboratory workup but significant radiological findings. She was discharged after a full recovery. There are multiple cases of post-vaccine acute inflammatory transverse myelitis shared by medical journals, but due to lack of literature review for the teenager population, we think our case may be the first case of acute inflammatory transverse myelitis following second dose of Pfizer-BioNTech COVID-19 vaccine in this population.

Acute pancreatitis following Pfizer-BioNTech COVID-19 vaccine

The coronavirus disease of 2019 (COVID-19) discovered in China in early December 2019. The Saudi Food and Drug Authority approved the registration of the Pfizer-BioNTech COVID-19 vaccine in Saudi Arabia on December 10, 2020, and on May 10, 2021, Pfizer-BioNTech was given emergency authorization for use of the vaccine in children aged 12 to 15 years. Saudi Arabia’s Ministry of Health started the vaccination phase for ages 12 to 18 years for the Pfizer-BioNTech COVID-19 vaccine on June 27, 2021. An insulin-dependent diabetic 15-year-old female patient admitted to the medical ward diagnosed with acute pancreatitis nine days after being administered her first dose of the Pfizer-BioNTech COVID-19 vaccine. She presented with an amylase level of 340 U/L, lipase level of 937 U/L. She was discharged after eight days of hospitalization with no complications. Medical investigations were unable to link the diagnosis to any known etiology. Medical journals have reported numerous cases of acute pancreatitis in the adult population after Pfizer-BioNTech COVID-19 vaccination. We believe that our case is the first to present with acute pancreatitis after the first dose of the Pfizer-BioNTech COVID-19 vaccine in a teenager population.

Acute inflammatory Transverse Myelitis post Pfizer-BioNTech-COVID-19 vaccine in 16-year-old

Coronavirus disease 2019 (COVID-19) originated in China in early March 2019. Saudi Food and Drug Authorityapproved the registration of the Pfizer-BioNTech COVID-19 vaccine in Saudi Arabia on December 10, 2020 and on May 10, 2021, Pfizer-BioNTech was given an authorized emergency use in 12 to 15 years old children. Saudi Arabia’s Ministry of Health started Pfizer-BioNTech COVID-19 vaccination for 12 to 18 years old on June 27, 2021. Here we have a case of 16-year-old female admitted to the medical ward diagnosed with acute inflammatory transverse myelitis after two weeks from second dose of the Pfizer-BioNTech COVID-19 vaccine. The diagnosis was based on normal laboratory workup but significant radiological findings. She was discharged after a full recovery.There are multiple cases of post-vaccine acute inflammatory transverse myelitisshared by medical journals, but due to lack of literature review for the teenager population, we think our case may be the first case of acute inflammatory transverse myelitis following second dose of Pfizer-BioNTech COVID-19 vaccine in this population.