Background: Obesity has been associated with adverse COVID-19 outcomes, but nationally representative data across multiple pandemic years remain limited. We evaluated the association between obesity and in-hospital outcomes among adults hospitalized with COVID-19 infection in the United States during 2020–2022. Methods: We conducted a retrospective cohort study using the National Inpatient Sample. Adult COVID-19 hospitalizations were categorized according to obesity status. Survey-weighted multivariable regression analyses assessed associations with in-hospital mortality, respiratory support, renal complications, thromboembolic events, sepsis-related outcomes, cardiovascular complications, length of stay, hospitalization charges, and discharge disposition. Results: The study included 1,186,914 COVID-19 hospitalizations, representing 5,934,565 weighted hospitalizations of which 1,529,022 had obesity and 4,406,543 did not have obesity. Hospitalizations with obesity involved younger individuals and greater proportions of female individuals.After adjustment, obesity was associated with increased odds of mortality (adjusted odds ratio, 1.38; 95% confidence interval, 1.36–1.40; p < 0.001), mechanical ventilation, vasopressor use, sepsis, septic shock, acute respiratory distress syndrome, extracorporeal membrane oxygenation, acute pulmonary embolism, venous embolism and thrombosis, tracheostomy, acute kidney injury, and renal replacement therapy. Obesity was also associated with longer hospital stays and higher hospitalization charges. Mortality among hospitalizations with obesity peaked in 2021 and declined in 2022. Conclusions: Obesity was independently associated with adverse clinical outcomes and greater hospital resource utilization among adults hospitalized with COVID-19 infection.
Objectives: Helicobacter pylori (HP) infection has an estimated prevalence of ~4.4 billion individuals worldwide. Clinical manifestations range from asymptomatic to mucosa-associated lymphoid tissue lymphoma. Effective eradication depends on both appropriate treatment selection and patient adherence. The study aims were compare HP eradication rates, antibiotic regimen selection and confirmation testing between patients managed by a clinical pharmacist versus standard care. Methods: A retrospective review of adults diagnosed and treated for HP was performed between March 2019 and November 2021. Patients were divided into two sequential cohorts: a pre-pharmacy group receiving standard care, and a pharmacist intervention group in which a clinical pharmacist managed treatment and documented HP eradication. Data analyzed included multiple demographic and clinical factors. Eradication was assessed by intention-to-treat (ITT) and per-protocol analysis with proportions compared using chi-square or Fisher’s Exact Test for low cell counts. Results: A total of 134 patients were diagnosed and treated for HP during the study period: 38 in the pre-pharmacy group and 96 in the pharmacist intervention group. In ITT analysis, successful eradication did not differ significantly between groups. Per-protocol analysis revealed significantly higher eradication in the pharmacist group. Antibiotic regimens overall differed between the cohorts with less use of clarithromycin-based triple therapy and greater use of non-bismuth quadruple (concomitant) therapy in the pharmacist group. Other evaluated items were not significantly different between groups. Conclusions: Clinical pharmacist HP care management was associated with more consistent, guideline-concordant antibiotic regimen selection and higher eradication rates among patients completing confirmatory testing. These findings support a role for pharmacist-led HP care for process improvement including regimen selection and eradication testing; prospective studies with systematic confirmatory testing are needed to determine the model’s effect on eradication itself.
Autoimmune gastritis (AIG) is a chronic disorder involving an immune response that leads to the destruction of the oxyntic glands, which leads to gastric atrophy, intestinal metaplasia, and nutritional deficiencies. It increases the risk of type 1 gastric neuroendocrine tumors and, although the extent of this association is still disputed, also carries a risk of gastric adenocarcinoma. The present review covers the current understanding of AIG from clinical and pathologic points of view, addressing its pathogenesis, clinical and endoscopic manifestations, histopathological characteristics, diagnosis, management, and surveillance. We also point out recent findings regarding the variability in pathology reporting, clinicians’ interpretation of pathology reports, and the emerging uses of artificial intelligence in the diagnosis and surveillance of AIG, as well as what obstacles still exist before these tools can be used in a clinical setting. Improved recognition of the condition and the establishment of a common diagnostic standard would enable earlier diagnosis, more reliable risk stratification, and a form of surveillance that corresponds to the actual neoplasia risk.
Irinotecan-loaded drug-eluting bead transarterial chemoembolization (DEBIRI) has an established but evolving evidence base for colorectal liver metastases, while its use in small-cell lung cancer (SCLC) liver metastases remains poorly characterized. To the best of our knowledge, this is the first published report of DEBIRI use from Indonesia. We describe a single-center case series of patients treated for colorectal liver metastases and small-cell lung cancer liver metastases. Six patients underwent DEBIRI at a tertiary oncology center: five with colorectal liver metastases and one with SCLC liver metastases. Clinical characteristics, procedural details, imaging response, toxicity, and outcomes were retrospectively reviewed. ECOG performance status ranged from 0 to 2. Cumulative irinotecan doses ranged from 40 to 360 mg across one to three sessions. Technical success was achieved in all procedures. Among five patients with evaluable follow-up, four had documented progression between 2.6 and 7.8 months, while one remained progression-free at last follow-up at 3.7 months. Three patients with CRLM demonstrated stable disease followed by documented progression at 3.7, 5.1, and 7.8 months. The SCLC case demonstrated progressive disease approximately 3 months after DEBIRI and subsequently showed a marked metabolic response following systemic chemotherapy. DEBIRI was technically feasible across colorectal liver metastases and SCLC with liver metastases. The colorectal cases were broadly consistent with published evidence, while the SCLC case is hypothesis-generating.
Background/Objectives: Endoscopy is an invasive and expensive tool for evaluating ulcerative colitis (UC). Noninvasive biomarkers may complement endoscopy. Aim: To evaluate serum Trefoil Factor 3 (TFF3) as a potential noninvasive biomarker for UC activity and remission. Methods: This is a prospective longitudinal observational study including patients with UC. Disease activity was assessed by the Lichtiger Clinical Activity Index (LCAI) and UC Endoscopic Index of Severity (UCEIS). Clinical and endoscopic remission were defined as LCAI ≤ 3 and UCEIS ≤ 1, respectively. Serum TFF3 and fecal calprotectin were measured to evaluate the within-patient change in serum TFF3 from active disease to remission. Results: Follow-up of 75 patients with active UC showed that TFF3 was significantly higher in active UC than in remission and controls (9.85 ± 2.17 vs. 5.66 ± 2.42 vs. 2.64 ± 0.99 ng/mL; p < 0.001). TFF3 correlated positively with LCAI, UCEIS, and fecal calprotectin (p < 0.001). In multivariable analysis, fecal calprotectin was independently associated with baseline TFF3 concentrations. TFF3 discriminated active disease from remission (AUC = 0.902; 95% CI 0.869–0.936, patient-level cluster bootstrap), with 88.0% sensitivity and 73.3% specificity at an exploratory Youden-optimal cutoff of >7.27 ng/mL derived in the same cohort. Fecal calprotectin had an AUC of 0.915 (95% CI 0.877–0.950; difference −0.013, 95% CI −0.049 to 0.026). Adding TFF3 to a calprotectin model increased the AUC only slightly (+0.016, 95% CI 0.001–0.038). Conclusions: In this two-center cohort, serum TFF3 was associated with clinical, endoscopic, and fecal calprotectin-based measures of disease activity and decreased after remission, although it remained higher than in healthy controls. TFF3 may be a possible complementary noninvasive biomarker, but it is not a replacement for endoscopic evaluation, and its cutoff requires external validation before clinical use.
