Background Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7–17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms. Case presentation We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6. Conclusions Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma.

AimsThis large cohort study aimed to assess the role of chronic statin use on COVID-19 disease severity.MethodsAn observational retrospective study from electronic medical records of hospitalized patients (n = 43 950) with COVID-19 between January and September 2020 in 185 hospitals in the United States. A total of 38 875 patients met inclusion criteria; 23 066 were included in the propensity-matched sampling with replacement cohort; 11 533 were prehospital statin users. The primary outcome was all-cause death; secondary outcomes were death from COVID-19 and serious complications. Mean, standard deviation, chi-square test, Student's t-test, linear regression, and binary and multinomial logistic regressions were used for statistical analysis.ResultsAmong 38 875 patients, 30% were chronic statin users [mean age, 70.82 (±12.25); 47.1% women] and 70% were statin nonusers [mean age, 58.44 (±18.27); 48.5% women]. Key propensity-matched outcomes among 11 533 chronic statin users showed 20% lower risk of all-cause mortality (OR 0.80, 95% CI 0.74–0.86, P < 0.001), 23% lower risk of mortality from COVID-19 (OR 0.77, 95% CI 0.71–0.84, P < 0.001), 16% lower risk of ICU admission (OR 0.84, 95% CI 0.79–0.89, P < 0.001), 24% lower risk of critical acute respiratory distress syndrome with COVID-19 (OR 0.76, 95% CI 0.70–0.83, P < 0.001), 23% lower risk of mechanical ventilation (OR 0.77, 95% CI 0.71–0.82, P < 0.001), 20% lower risk of severe sepsis with septic shock (OR 0.80, 95% CI 0.67–0.93, P = 0.004), shorter hospital length of stay [9.87 (±8.94), P < 0.001] and brief duration of mechanical ventilation [8.90 (±8.94), P < 0.001].ConclusionChronic use of statins is associated with reduced mortality and improved clinical outcomes in patients hospitalized for COVID-19.

Mechanical ventilation provides an artificial lung support that completely or partially supports the work carried by respiratory muscles. It is indicated in patients with inadequate respiratory drive, hypoxia, and failure to maintain adequate ventilation. Delivery of air into the lung under positive pressure via an artificial airway (endotracheal tube/tracheostomy tube) is referred to as invasive ventilation. Noninvasive ventilation uses a different interface (mask) and provides support without invasive artificial airway. The mode of mechanical ventilation defines the relationship between the type of breath (spontaneous, assisted, or mandatory) and a group of control variables (volume, pressure) and phase variables (trigger, limit, cycle) that regulate the pattern of breath delivery. Modes of ventilation include assist control, SIMV (synchronized intermittent mandatory ventilation), pressure support, pressure controlled and inverse ratio, APRV (airway pressure release ventilation), and high-frequency ventilation.