IntroductionSerum Soluble Interleukin-2 Receptor (sIL-2R) levels are used clinically as a disease activity marker for systemic sarcoidosis. Studies have investigated the diagnostic role of serum soluble interleukin-2 receptor (sIL-2R) level for sarcoidosis relative to biopsy. We performed a systematic review and meta-analysis of studies evaluating the diagnostic utility of sIL-2R.MethodsWe carried out an electronic search in Medline, Embase, Google Scholar, and Cochrane databases using keyword and Medical Subject Heading (MeSH) terms: sarcoidosis and sIL-2R. Studies evaluating the sIL-2R levels as a diagnostic tool in clinically diagnosed or biopsy-proven sarcoidosis patients compared to control groups with non-sarcoidosis patients were included. Forest plots were constructed using a random effect model depicting pooled sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy.ResultsWe selected ten studies comprising 1477 patients, with 592 in the sarcoidosis group and 885 in the non-sarcoidosis group. Pooled sensitivity and specificity of sIL-2R levels were 0.88 (95% CI: 0.75-0.95) and 0.87 (95% CI 0.73-0.94) respectively. Pooled negative predictive value and positive predictive value were 0.91 (95% CI 0.77-0.97) and 0.85 (95% CI 0.59-0.96) respectively with diagnostic accuracy of 0.86 (95% CI 0.71-0.93).ConclusionIn addition to its utility as a marker of sarcoidosis disease activity, sIL-2R has high diagnostic accuracy. Despite the limitations of the heterogenous sarcoidosis population and different sIL-2R cutoffs, our results suggest that sIL-2R is an important biomarker that can be used to confirm sarcoidosis diagnosis in unconfirmed or unclear cases.

The second hit hypothesis in pulmonary hypertension refers to the development of pulmonary vascular disease in individuals at risk, after an additional exposure or “hit” to factors with potential injury to the pulmonary circulation, such as drugs or toxins. We here present a case of severe pulmonary hypertension diagnosed during the third trimester of pregnancy, in a patient with familial history of pulmonary hypertension, found to have a heterozygous mutation in the BMPR2 gene, who also had chronic exposure to prescription amphetamines. We hypothesize that exposure to prescription amphetamines could act as a second hit of pulmonary vascular injury in individuals at risk of pulmonary vascular disease.

Rationale: Multiple studies have been published investigating the diagnostic performance of serum soluble interleukin-2 receptor (sIL2R) level for diagnosing sarcoidosis relative to biopsy, the gold standard diagnostic tool. We performed a systematic review and meta-analysis of studies evaluating the diagnostic utility of sIL2R. The aim is to derive pooled estimates of the sensitivity, specificity, negative predictive value, and positive predictive value of soluble serum sIL2R for the diagnosis of sarcoidosis. Methods: We carried out an electronic search in Medline (PubMed), Embase, Google Scholar, and Cochrane database using keywords and Medical Subject Heading (MeSH) terms: sarcoidosis and sIL2R. Studies evaluating the sIL2R levels as a diagnostic tool in clinically diagnosed or biopsy-proven sarcoidosis patients compared to control groups with nonsarcoidosis patients were included. Covidence software was used for primary and secondary screening by two reviewers. Forest plots were constructed using a random effect model depicting pooled sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. The summary receiver operating characteristic (ROC) curve was drawn, and the area under the curve was calculated. Heterogeneity was assessed and reported in I 2 and τ 2 . Data were analyzed using R V.4.0.3 Results: We selected a total of 10 studies that fulfilled the inclusion criteria, 5 of which included only patients with uveitis. The cumulative sample size was 1477, with 592 in the sarcoidosis group and 885 in the non-sarcoidosis group. Pooled sensitivity and specificity of soluble IL-2 receptor levels were 0.88 ( 95% CI: 0.75-0.95) and 0.87( 95% CI 0.73-0.94) respectively. Pooled negative predictive value and positive predictive value were 0.91( 95% CI 0.77-0.97) and 0.85 (95% CI 0.59-0.96) respectively with diagnostic accuracy of 0.86 (95% CI 0.71-0.93). The area under the ROC curve was 0.78. On subgroup analysis of patients with uveitis, sensitivity and specificity were 0.84 [0.74, 0.96] and 0.79 [0.67, 0.93] respectively. Conclusion: In addition to its utility as a marker of sarcoidosis disease activity, sIL2R has high diagnostic accuracy, as revealed in this systematic review and metanalysis. Despite the limitations of the heterogenous sarcoidosis population and different sIL2R cutoffs, this study results suggest that sIL2R is an important biomarker that can be used to confirm sarcoidosis diagnosis in unconfirmed or unclear cases.

Introduction: Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure.Methods: A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated.Results: A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA

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