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On March 28, 2020, in response to the rapidly accelerating COVID-19 pandemic, U.S FDA issued emergency use authorization for hydroxychloroquine (HCQ) in hospitalized COVID-19 patients based on limited in-vitro and anecdotal clinical data. Analysis of the accumulated real-world data utilizing electronic medical records (EMR) could indicate HCQ therapy benefits as we await the results of clinical trials. However, any such analysis of retrospective observational data should account for variables such as demographics and comorbidities that could affect treatment strategies or outcomes. Therefore, we report the outcomes of HCQ treatment in a propensity-matched cohort of COVID-19 hospitalized patients. Our analysis of a large retrospective cohort of hospitalized COVID-19 patients treated with HCQ did not show benefits in mortality or the need for mechanical ventilation when compared to a matched cohort of patients who did not receive HCQ.

Importance COVID-19 epidemiological data show higher mortality rates among males compared to females. However, it remains unclear if the disparity in mortality is due to gender differences in high-risk characteristics. Objective To study the clinical characteristics of a large and diverse cohort of COVID-19 patients stratified by gender and determine the outcomes after matching for age and other high-risk characteristics. Design Retrospective cohort between January 20, 2020, and April 15, 2020 Setting TriNetX COVID-19 Research Network consisting of multiple healthcare organizations (HCOs) predominantly in the United States Participants and Exposure A cohort of male and female patients > 10 years of age diagnosed with COVID-19 identified with real-time analyses of electronic medical records of patients from participating HCOs. A 1:1 propensity score matching of cohorts was performed for age, race, nicotine use, and all possible confounding comorbidities. Main Outcome Risk of mortality, hospitalization and mechanical ventilation within 30 days after the diagnosis of COVID-19 Results A total of 5980 males and 7730 females diagnosed with COVID-19 were identified. Males were significantly older than females (54.9 (18.3) vs. 50.9 (18.4), p-value <0.0001). There were significant differences in patient characteristics, but after propensity matching, both groups (N=5350 each group) were balanced. Males had a significantly higher risk for mortality both before (Risk Ratio (RR) 2.1, 95% CI 1.8-2.4) and after matching (RR 1.4, 95% CI 1.2-1.7). Similarly, the risk of hospitalization (RR 1.3, 95%CI 1.2-1.4) and mechanical ventilation (RR 1.71, 95% CI 1.3-2.3) was significantly higher in males even after matching. On subanalysis, males age > 50 had higher mortality than matched females of similar age (RR 1.6, 95% CI 1.4-1.8), whereas the risk of mortality in matched groups < 40 years was similar (RR 1.00, 95% CI 0.4-2.4). Conclusion In conclusion, males are more severely affected and have higher mortality from COVID-19. This gender-specific risk is especially more pronounced in advanced age. Gender disparity in poor outcomes can only be partially explained by differences in high-risk behavior and comorbidities. Further research is needed to understand the causes of this disparity.

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Liver biopsy plays an essential role in the diagnosis, evaluation and management of a vast proportion of liver diseases. Conventionally, percutaneous and trans-jugular approaches have been used to obtain liver biopsies. Endoscopic ultrasound guided liver biopsy (EUS-LB) has emerged as a safe and effective alternate in the past two decades. EUS-LB carries a role in evaluation of both benign and malignant diseases of the liver. It can offer higher resolution imaging of the liver and can detect smaller lesions than computed tomography scan of the abdomen or ultrasound scans with the option for doppler assistance to reduce complications. Current evidence demonstrates the superiority of EUS-LB for a targeted approach of focal lesion and there is also evidence of less sampling variability in heterogeneous parenchymal pathologies. These advantages combined with an improved safety profile had led to the rapid progress in the development of new techniques, equipment and procedures for EUS-LB. We provide a comprehensive review of EUS-LB for parenchymal liver disease.

Background and aimsWith expanding available treatment options and evolving understanding of the risks and benefits of medical therapies for inflammatory bowel disease (IBD), there is the possibility of significant variations in treatment and outcomes. Little is known about the variation in treatment between IBD specialists and other gastroenterology (GI) physicians. Evaluating possible variations is an important first step to help address standardized care and optimize treatment. We studied the differences in use of biologics and immunomodulators in the management of IBD patients at a tertiary care hospital between IBD-trained physicians and other gastroenterologists.MethodsA total of 325 IBD patients were included in the analysis. Of these, 216 patients received care with an IBD physician and 109 had other GI/non-IBD physicians as their main caregivers.ResultsThe unadjusted use of immunomodulators (35.6% vs 16.5%, p = 0.001), biologics (45.8% vs 22.9%, p =0.001) and dual therapy (biologics and immunomodulator) (14.4% vs 3.7%, p =0.001) was significantly higher in the IBD-physician group. These differences in therapy between the two groups remained after adjusting for patient and disease characteristics.ConclusionThere are significant variations in the treatment of patients with IBD by GI physicians. The use of biologics and immunomodulators is higher in GI physicians with dedicated IBD interest and training.

BackgroundColonoscopies performed in the afternoon (PM) have been shown to have lower adenoma detection rates (ADR) compared to those in the morning (AM). Endoscopist fatigue has been suggested as a possible reason. Colonoscopies tend to be technically more challenging in female patients. Furthermore, women have a lower incidence of adenomas then men. The impact of the timing of colonoscopy based on sex has not been studied. We hypothesized that any decrease in ADR in PM colonoscopies would be more pronounced in female patients when compared to male patients.MethodsWe retrospectively reviewed colonoscopies performed for screening or surveillance in our outpatient endoscopy center from January 2008 to December 2011. Complete colonoscopies with a documented cecal intubation were included. All patients with a history of colorectal cancer or colonic resection, inadequate bowel preparation, or incomplete data were excluded.ResultsA total of 2305 patients (1207 female) were included. Overall, ADR was significantly higher in AM than in PM procedures. Multivariate analysis demonstrated that ADR for females was lower in PM than in AM colonoscopies (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.44-0.91, P=0.015). There was a non-significant trend towards a lower ADR for males in PM (OR 0.84, 95% CI 0.62-1.15, P=0.28). Females had a prolonged intubation time and a longer procedure time.ConclusionThe difference in ADR between AM and PM procedures seems to apply mainly to female patients. No significant change in ADR was noted in male patients in the afternoon.