Introduction: The role of systemic corticosteroid as a therapeutic agent for patients with COVID 19 pneumonia is controversial. Objective: The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID 19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF). Methods: This was a single-center retrospective cohort study, from the 16th March, 2020 to 30th April, 2020; final follow up on 10th May, 2020. 265 patients consecutively admitted to the non ICU wards with laboratory confirmed COVID 19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO2/FiO2 <= 440 or PaO2/FiO2 <= 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients divided into two cohort based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in hospital mortality, discharge, length of stay, and daily trend of SpO2/FiO2 (SF) ratio from the index date. Cox proportional hazard regression was implemented to analyze the time to event outcomes. Result: Among 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ~57 years, and ~75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P=0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07 to 0.33; P <0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P < 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P= 0.005), death was 0.53 (95% CI, 0.22 to 1.31; P = 0.172), and discharge was 3.65 (95% CI, 2.20 to 6.06; P<0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time. Conclusion: Among non ICU patients hospitalized with COVID 19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in hospital death.

Background and context: Glucagon-like peptide-1 receptor (GLP-1 R) based imaging has shown higher sensitivity for insulinoma localization as compared to other anatomic/functional imaging. Methodology:We reviewed the published English literature for GLP-1 R targeted imaging in insulinoma in PubMed until August 2020 in accordance with PRISMA guidelines using the MeSH terms "((Exendin-4 PET/CT) OR (Exendin-4 SPECT/CT) OR (GLP-1 R imaging)) AND (Insulinoma)". An individual patient data-metanalysis (IPD-MA) was performed, and performance parameters were calculated for the histopathological diagnosis of insulinoma.Main outcome measures: True-positive (TP), false-positive (FP), false-negative (FN), true-negative (TN), sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for insulinoma localization.Results: A total of 179 cases (316 lesions) from 16 publications were included for IPD-MA. For insulinoma localization, exendin-4-PET/CT (Sn & PPV: 94%) performed better than exendin-4-SPECT/CT (Sn: 63%, PPV: 94%). The Sn was lower in malignant insulinoma cases whereas the Sp was higher in cases with MEN-1 syndrome. With exendin-4-based imaging, FP uptakes in Brunner's gland, normal pancreas, and other β-cell pathologies and FN results in pancreatic tail lesions and malignancy were seen in a few patients. TN results suggested the correct diagnosis of other endogenous hyperinsulinemic hypoglycaemia (EHH) subtypes. Conclusion:For insulinoma localization, exendin-4 PET/CT should be preferred over exendin-4 SPECT/CT because of higher sensitivity and specificity. FP uptakes in Brunner's gland, normal pancreas, and other β-cell pathologies and FN results in tail lesions, and malignant insulinomas are limitations. Higher specificity for insulinoma localization is particularly useful in patients with MEN-1 syndrome.

Introduction The role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial. Objective The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF). Methods This was a single-center retrospective cohort study, from 16 th March, 2020 to 30 th April, 2020; final follow-up on 10 th May, 2020. 265 patients consecutively admitted to the non-ICU wards with laboratory-confirmed COVID-19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO 2 /FiO 2 � 440 or PaO 2 /FiO 2 � 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients were divided into two cohorts based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in-hospital mortality, discharge, length of stay, and daily trend of SpO 2 /FiO 2 (SF) ratio from the index date. Cox-proportional hazard regression was implemented to analyze the time to event outcomes.

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Background and Aims Contemporary data on the prevalence, trends, and outcomes of cardiovascular, diseases (CVD) in pregnant patients are limited. This study aimed to analyze the, prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant, patients in the United States (U.S.). Methods This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to, December 31, 2019. Data analyses were conducted from January-February 2022., Pregnancy-associated hospitalizations were identified. Main outcomes were, prevalence and trend of CVD in pregnant patients. Results 39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.3%), and 34,802,180 without CVD (88.8%). The annual age adjusted CVD prevalence, increased from 9.2% in 2010 to 14.8% in 2019 (p &lt; 0.001). Hypertensive disorder of, pregnancy (1069/10,000) was the most common, and aortic dissection (0.1/10,000), was the least common CVD. Trends of all CVD subtypes increased; however, the trend, of valvular heart disease decreased. Age adjusted in-hospital all-cause mortality was, 8.2/10,000 in CVD but its trend decreased from 8.1/10,000 in 2010 to 6.5/10,000 in, 2019 (p &lt; 0.001). CVD was associated with 15.51 times higher odds of in-hospital allcause, mortality compared with non-CVD patients (odds ratio (OR): 15.51, 95% CI, 13.22-18.20, p &lt; 0.001). CVD was associated with higher 6-week postpartum readmission (OR: 1.97, 95% CI: 1.95-1.99), myocardial infarction (OR: 3.04, 95% CI:, 2.57-3.59), and stroke (OR: 2.66, 95% CI: 2.41-2.94) (p &lt; 0.001 for all). Conclusion There is an increasing age adjusted trend in overall CVD and its subtypes among, pregnant patients in the U.S. from 2010 to 2019. Pregnant patients with CVD had, higher odds of in-hospital mortality than those without CVD. However, in-hospital allcause, mortality among patients with and without CVD decreased over the past 10, years. CVD was associated with higher 6-week postpartum all-cause readmission, myocardial infarction, and stroke.

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