Colon carcinoma (CA) is one of the most common cancers worldwide. Cardiac metastasis in CA is quite rare with only a few incidences. These tumors are usually clinically silent and are discovered on autopsy. We present a case of a 62-year-old woman, known diabetic, hypertensive, and hypothyroid patient, who presented with complaints of abdominal distention and obstipation with multiple episodes of vomiting undigested food particles for three days. She had been passing dark tarry stools infrequently for over a month. She complained of a progressive loss of appetite and 5 kg weight loss over a month. Her examination revealed pallor and irregular pulse with a rate of 94/min. She had a distended non-tender abdomen and absent bowel sounds. Contrast-enhanced computed tomography (CECT) abdomen showed circumferential thickening of the descending colon, causing acute stenosis with multiple liver metastases and enlarged pericolic lymph nodes. Serum carcinoembryonic antigen (CEA) was elevated, 55.45 ng/mL. She underwent an emergency exploratory laparotomy with transverse loop colostomy. Histopathology report showed moderately differentiated adenocarcinoma. ECG showed atrial fibrillation and two-dimensional echocardiogram showed right ventricular metastasis. High-resolution computed tomography (HRCT) thorax was done to confirm the diagnosis.The common sites of metastases from colorectal cancer are the lymph nodes, liver, and lungs. When cardiac metastasis occurs, it often presents with features of heart failure. Our patient presented with atrial fibrillation. As the incidence of cardiac metastasis is quite rare, there is no standard established treatment. Certain chemotherapeutic drugs, such as 5-fluorouracil, oxaliplatin, irinotecan (FOLFIRINOX regimen), have been shown to improve cardiac metastases. Due to the extensive spread of primary cancer in our patient, she was planned for palliative chemotherapy; however, the patient expired before initiation of therapy.

To develop a clinical risk score to predict adverse outcomes among diabetic hospitalized COVID-19 patients MethodsThe data was collected retrospectively from patients hospitalized with the SARS-CoV-2 virus at Sri Ramachandra Institute of Higher education and research. It integrated independent variables such as sex, age, glycemic status, socioeconomic status, and preexisting lung conditions. Each variable was assigned a value and the final score was calculated as a sum of all the variables. The final score was then compared with patient outcomes. The patients were scored from 0 to 8 and a score of 3 or more was considered as being at greater risk for developing complications. Number of mortalities in each group, any clinical deterioration requiring ICU admission, and the number of patients requiring a prolonged hospital stay of more than 10 days in each group were noted and the results compared. ResultsHigher blood glucose levels and preexisting lung conditions like chronic obstructive pulmonary disease (COPD), asthma, and pulmonary tuberculosis have been associated with a higher risk of developing complications related to SARS-CoV-2 illness. Of the 5023 patients enrolled in the study, 2402 had a score of 2 or below, and 2621 had a score of 3 or above. Among patients with a score of 2 or below 1.7% of the patients contracted a severe disease resulting in death. 2.9% were shifted to ICU, but recovered and 12.2% of patients had a prolonged hospital stay. Of those with a score of 3 or greater, 5.1% died, 7.36% were shifted to ICU, but recovered, and 19.5% required a prolonged hospital stay. The observed results were analyzed using the Chi-square test and were found to be significant at a p-level of 0.0001. ConclusionThis clinical risk score has been built with routinely available data to help predict adverse outcomes in diabetic patients hospitalized with the SARS-CoV-2 virus. It is a good tool for resource-limited areas as it uses readily available data. It can also be used for other severe acute respiratory illnesses or influenza-like illnesses.