Pancreatic adenocarcinoma is a malignant cancer seen predominantly in males presenting with high-risk factors including chronic pancreatitis, familial history of cancer, and tobacco and alcohol abuse. The etiology of pancreatic adenocarcinoma is deceptive, and research continues to investigate its molecular patterns. Herein, we present a case of a 74-year-old Caucasian male who presented to the emergency department (ED) with tarry stools and hematochezia in the rectum for two weeks. Colonoscopy was terminated prematurely due to a mass at 70 cm within the splenic flexure of the colon. Exploratory laparotomy revealed a palpable mass at the splenic flexure invading the spleen. Splenectomy, distal pancreatoduodenectomy, and left hemicolectomy were performed. Pathological imaging revealed locally invasive pancreatic adenocarcinoma presenting in the splenic flexure, pancreatic parenchyma, peripancreatic soft tissue, and colonic wall. The patient is currently undergoing chemotherapy and radiation treatment. Below, we discuss risk factors, pathology, screening methods, and current treatment guidelines regarding pancreatic cancer. When pancreatic adenocarcinoma becomes metastatic, it most commonly involves the liver and lungs, but the review of current literature shows that limited cases of local invasion to the splenic flexure have been reported.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded, positive-sense, enveloped ribonucleic acid (RNA) virus. SARS-CoV-2 and its associated disease coronavirus disease 2019 (COVID-19) has caused a global pandemic in the year 2019-2020. COVID-19 has caused widespread death, economic burden, and overcrowding of hospitals. As of September 2020, there is no reliable pharmacological treatment for patients affected by COVID-19. Herein we present a case of a 41-year-old Caucasian female who presented to the emergency department with flu-like symptoms for the past five days. The patient was admitted for COVID-19 symptoms and subsequently developed COVID-19 associated thrombotic syndrome and ischemic stroke. Below, we discuss risk factors, pathology, and rare manifestations resulting from COVID-19 infection. COVID-19 primarily affects the lungs, but a review of the current literature shows limited cases of ischemic stroke and diffuse thrombosis induced by infection of the novel COVID-19 in relatively healthy individuals with minimal risk factors.

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Cohen syndrome is an extremely rare disease with characteristic somatic and multi-system features that severely affect vision. Ophthalmologists must consider Cohen syndrome when developmental delay, high-grade myopia, and retinal dystrophy are present in a child. Here we report a case of Cohen syndrome in a 10-year-old boy presenting with cystoid macular edema (CME), only the second reported case of its kind. This case illustrates the phenotypic variability that can occur in Cohen syndrome, with rare features in addition to CME including trace posterior subcapsular cataracts, growth hormone deficiency, mild vermian hypoplasia, a nasolacrimal cyst, hearing loss, and high-functioning intelligence quotient (IQ). Our patient did not have an identifiable second mutation even after extensive genetic testing, which raises questions about whether the patient has a novel gene variant for the disease or an autosomal dominant mode of inheritance exists for Cohen syndrome. In addition to peripheral vision loss, the rare appearance of macular edema can threaten the remaining vision and requires intervention. This case also demonstrates that, without a high index of suspicion, there can be considerable delay in diagnosing Cohen syndrome. Though little is known about the prevalence of many of the clinical features seen in our case in the Cohen syndrome population, this case raises awareness of the syndrome and the need to recognize various clinical features, perform genetic testing, and direct appropriate treatment to prevent complications and help improve quality of life.

Introduction:The COVID-19 pandemic has caused millions of deaths and infections worldwide. Patients with multiple medical comorbidities are more vulnerable. Veterans have more health conditions than the general population with higher prevalence of HTN, DM, and lung disease. Veterans with IBD are predisposed to COVID-19 and have higher rates of associated hospitalizations and mortality. COVID-19 vaccination rates in IBD patients in community settings is 41%, lower than the general population and WHO recommendations. The 2020 veteran mortality rate rose to an all-time high, with a 13% increase or 50,299 excess deaths). We examined the rates of and barriers to COVID-19 vaccination in the veteran population with IBD. Methods: We conducted a retrospective cross-sectional study at a VAMC. Data for demographics, subtype of IBD (i.e., ulcerative colitis or Crohn's disease), and biologic therapy were collected. Unvaccinated veterans completed a 15-item survey of 4 structural barriers and 11 attitudinal barriers to vaccination via a phone call. Results: We identified 206 veterans with IBD, 34 (16.5%) of whom were not vaccinated. Mean age for the vaccinated was 66 years and for the unvaccinated 54 years (p, 0.001). The two groups did not differ on sex (male 95% and 91%), race (Caucasian 86% and 87%), type of IBD (UC 63% and 55%), and biologic therapy (37% and 35%). The leading structural barrier was primary care provider or GI physician did not provide enough information about the vaccine(41%). The leading attitudinal barriers were (1) not agree that the government mandates were appropriate (91%) and ( 2) afraid of vaccinations (62%). Conclusion: The 83.5% COVID-19 vaccination rate for IBD patients was higher than the general population rate of 66%.1 Lack of provider counseling, disagree with government mandates, and fear of vaccines were major barriers. Due to their comorbidities and immunologic suppression from treatment, gastroenterologists managing IBD patients should discuss COVID-19 immunization including the importance of being immunized, fear of vaccines, and possible side effects. Vaccine hesitancy must be targeted locally and nationally, with compassion and empathy. Our findings can be applied to future pandemics and global health policies and be the basis for studies of psychosocial components that impact veterans' compliance with vaccinations.