111 In-diethylenetriaminepentaacetic acid (DTPA)-octreotide scintigraphy is currently the nuclear medicine imaging modality of choice for identifying neuroendocrine tumors. However, there are cohorts of patients in whom scintigraphy findings are negative or equivocal. We evaluated the role of 68 Ga-DOTATATE PET in a selected group of patients with negative or weakly positive findings on 111 In-DTPA-octreotide scintigraphy to determine whether 68 Ga-DOTATATE PET is able to detect additional disease and, if so, whether patient management is altered. Methods: Fifty-one patients with a histologically confirmed diagnosis of neuroendocrine tumors were included. Of the 51 patients, 35 who were negative and 16 equivocal for uptake on 111 In-DTPA-octreotide scintigraphy underwent 68 Ga-DOTATATE PET. Findings were compared using a region-by-region analysis. All findings were verified with CT or MRI. After 68 Ga-DOTATATE PET, all cases were reviewed to determine whether the 68 Ga-DOTATATE PET findings resulted in any alteration in management, in terms of suitability for peptide receptor therapy, somatostatin analogs, and surgery. Results: Of the 51 patients, 47 had evidence of disease on cross-sectional imaging or biochemically. 68 Ga-DOTATATE PET was positive in 41 of these 47 patients (87.2%). No falsepositive lesions were identified. 68 Ga-DOTATATE PET detected 168 of the 226 lesions (74.3%) that were identified with crosssectional imaging. 68 Ga-DOTATATE PET identified significantly more lesions than 111 In-DTPA-octreotide scintigraphy (P , 0.001). There was no correlation between 68 Ga-DOTATATE uptake and histologic grade of neuroendocrine tumors. 68 Ga-DOTATATE imaging changed management in 36 patients (70.6%), who were subsequently deemed suitable for peptide receptor-targeted therapy. Conclusion: In patients with negative or equivocal 111 In-DTPA-octreotide findings, 68 Ga-DOTATATE PET identifies additional lesions and may alter management in most cases.

SUMMARY BackgroundOctreotide LAR is an established treatment for malignant carcinoid syndrome. However, studies with large number of patients and long followup are lacking.

We aim to describe a case series of critically and non-critically ill COVID-19 patients in Singapore. This was a multicentered prospective study with clinical and laboratory details. Details for fifty uncomplicated COVID-19 patients and ten who required mechanical ventilation were collected. We compared clinical features between the groups, assessed predictors of intubation, and described ventilatory management in ICU patients. Ventilated patients were significantly older, reported more dyspnea, had elevated C-reactive protein and lactate dehydrogenase. A multivariable logistic regression model identified respiratory rate (aOR 2.83, 95% CI 1.24–6.47) and neutrophil count (aOR 2.39, 95% CI 1.34–4.26) on admission as independent predictors of intubation with area under receiver operating characteristic curve of 0.928 (95% CI 0.828–0.979). Median APACHE II score was 19 (IQR 17–22) and PaO2/FiO2 ratio before intubation was 104 (IQR 89–129). Median peak FiO2 was 0.75 (IQR 0.6–1.0), positive end-expiratory pressure 12 (IQR 10–14) and plateau pressure 22 (IQR 18–26) in the first 24 h of ventilation. Median duration of ventilation was 6.5 days (IQR 5.5–13). There were no fatalities. Most COVID-19 patients in Singapore who required mechanical ventilation because of ARDS were extubated with no mortality.

Highlighting the importance and recognition of palmar fasciitis and polyarthritis syndrome, a paraneoplastic syndrome related to ovarian and other malignancies.

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