Importance The ongoing pandemic of the novel Corona Virus Disease 2019 (COVID-19) is an unprecedented challenge to global health, never experienced before. Objective This study aims to describe the clinical characteristics and outcomes of patients with COVID-19 admitted to Mercy Hospitals. Design and methods Retrospective, observational cohort study designed to include every COVID-19 subject aged 18 years or older admitted to Mercy Saint (St) Vincent, Mercy St Charles, and Mercy St Anne’s hospital in Toledo, Ohio from January 1, 2020 through June 15th, 2020. Primary Outcome Measure was mortality in the emergency department or as an in-patient. Results 470 subjects including 224 males and 246 females met the inclusion criteria for the study. Subjects with the following characteristics had higher odds (OR) of death: Older age [OR 8.3 (95% CI 1.1–63.1, p = 0.04)] for subjects age 70 or more compared to subjects age 18–29); Hypertension [OR 3.6 (95% CI 1.6–7.8, p = 0.001)]; Diabetes [OR 3.1 (95% CI 1.7–5.6, p<0.001)]; COPD [OR 3.4 (95% CI 1.8–6.3, p<0.001)] and CKD stage 2 or greater [OR 2.5 (95% CI 1.3–4.9, p = 0.006)]. Combining all age groups, subjects with hypertension had significantly greater odds of the following adverse outcomes: requiring hospital admission (OR 2.2, 95% CI 1.4–3.4, p<0.001); needing respiratory support in 24 hours (OR 2.5, 95% CI: 1.7–3.7, p<0.001); ICU admission (OR 2.7, 95% CI 1.7–4.4, p<0.001); and death (OR 3.6, 95% CI 1.6–7.8, p = 0.001). Hypertension was not associated with needing vent in 24 hours (p = 0.07). Conclusion Age and hypertension were associated with significant comorbidity and mortality in Covid-19 Positive patients. Furthermore, people who were older than 70, and had hypertension, diabetes, COPD, or CKD had higher odds of dying from the disease as compared to patients who hadn’t. Subjects with hypertension also had significantly greater odds of other adverse outcomes.

Histoplasmosis is a fungal disease caused by a dimorphic fungus known as Histoplasma capsulatum (H. capsulatum), which is endemic to areas around river valleys and southeastern states in the United States (US). Patients with histoplasmosis are asymptomatic, and the condition is usually diagnosed by an incidental finding of a pulmonary granuloma on a chest radiograph. In rare cases, this disease can develop into a progressive disseminated form and cause fatal and diffuse pulmonary infiltrates in immunocompromised adults. Moreover, there is a close association between disseminated histoplasmosis and the use of tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA). Our case report discusses a unique presentation of disseminated histoplasmosis in a patient with RA who was not on any biological immune modulators. The disseminated histoplasmosis in this case was progressive and involved the central nervous system, liver, lungs, and oral mucosa and was treated successfully with amphotericin therapy. We also discuss the disease process in detail and hypothesize that RA could be an independent risk factor for the increased incidence of disseminated histoplasmosis in adults. Based on the findings in this case report, we recommend screening for latent Histoplasma infections in adults with RA living in endemic areas and keeping a low threshold to evaluate flare-ups from this disease regardless of the use of anti-TNF inhibitors. Specific experimental and epidemiological studies can be conducted to examine the association between RA and similar indolent fungal infections.

Systemic sclerosis (SSc) is a rare connective tissue disorder with a complex pathogenesis involving vascular dysfunction, small vessel proliferation as well as alterations of innate and adaptive immunity. Gastrointestinal (GI) involvement in SSc is almost universal and affects nearly 90% of the patients. Of all the GI manifestations, 30%–75% are oesophageal abnormalities, including gastro-oesophageal reflux disease, reflux oesophagitis and Barret’s oesophagus. The incidence of gastric manifestations is about 22% with a common presentation of gastric antral vascular ectasia (GAVE). However, autoimmune atrophic gastritis (AIG) is not a known manifestation of SSc. Our case has a unique presentation of the coexistence of GAVE and AIG. We have conducted a thorough literature review to study a possible association of AIG and SSc and understand the pathology of SSc.

INTRODUCTION: Pulmonary embolism (PE) represents a mechanical obstruction of one or more branches of the pulmonary vasculature, usually due to a blood clot. Saddle PE lodges at the bifurcation of the main pulmonary artery, often extending into the right and left main pulmonary arteries. Approximately 3 to 6 percent of patients with PE present with a saddle embolus. We report an atypical case of asymptomatic large saddle PE with normal right heart function.

It is already well known that Hydralazine can induce ANCA associated vasculitis(mentioned as AAV) and Pauci-Immune RPGN which is sometimes associated with pulmonary renal syndrome [1,2]. Hydralazine induced membranous nephritis has never been documented before. We present a case of hydralazine induced RPGN, with biopsy findings of Membranous Glomerulonephritis. This is a unique presentation of hydralazine induced renal failure and helps us to study the spectrum of pathological reactions induced from this drug. This case study also reviews the pathological similarities in the hydralazine induced reactions and SLE and discusses the treatment of such pathology.