Obesity is an established risk factor for severe coronavirus disease 2019 , but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMIassociated risk was increased among those with diabetes. RESEARCH DESIGN AND METHODSWe retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Sitespecific estimates were combined in a meta-analysis. RESULTSAmong 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR], 1.44; 95% CI 1.15-1.80) and invasive mechanical ventilatory support (aOR, 1.22; 95% CI 1.03-1.46). There was no association between overweight and in-hospital mortality (aOR, 0.88; 95% CI 0.74-1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity. CONCLUSIONSIn adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.

Proton pump inhibitor use is associated with increased risk of severity and mortality from coronavirus disease 2019 (COVID-19) infection

Background & aims Coronavirus disease 2019 (COVID-19) has a wide clinical spectrum, ranging from asymptomatic infection to severe diseases with high mortality rate. Early identification of high-risk COVID-19 patients may be beneficial to reduce morbidity and in-hospital mortality. This study aimed to investigate whether baseline levels of inflammatory markers such as C-reactive protein (CRP) and immune-cell-based inflammatory indices, neutrophil to lymphocyte ratio (NLR), derived-NLR (d-NLR), and platelet to lymphocyte ratio (PLR) at hospital admission are associated with adverse disease outcomes in COVID-19 patients. Methods Clinical data from 391 hospitalized COVID-19 patients in three Siloam Hospitals in Indonesia were retrospectively collected and analysed from March 20 to October 30, 2020. Results Fifty-four (13.8%) hospitalized patients had clinical deterioration and required ICU treatment, categorizing them as severe COVID-19 cases. Older age, presence of underlying diseases, and increased inflammatory markers values at admission were significantly associated with severe cases. After adjustment of sociodemographic and comorbidities factors, CRP, NLR, and d-NLR values, but not PLRs, were identified as independent risk factors for disease severity and death in COVID-19 patients. The area under curve (AUC) of CRP, NLR, and d-NLR were 0.854, 0.848, and 0.854, respectively. The optimal cut-off points for CRP, NLR, and d-NLR for identification of COVID-19 patients with potential worse disease outcomes were 47 mg/L, 6, and 4, respectively. Conclusion Initial assessment of CRP, NLR, and d-NLR values at hospital admission may be important predictors for adverse disease outcomes in COVID-19 patients.

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Results 130 patients received endoscopic resection for rectal neuroendocrine tumor (ESD, 45; EMR, 43; 42). The en bloc resection rate was 100% in all three groups. In the ESD, EMR, and EMR-C groups, R0 resection occurred in 93.3%, 60.5%, and 83.3%, respectively (EMR vs. EMR-C, p = 0.019; EMR vs. ESD, p < 0.01), while the median procedure times were 35.2, 7.1, and 6.9 min, respectively (ESD vs. EMR-C, p < 0.01; ESD vs. EMR, p < 0.01). Postoperative bleeding occurred after ESD in two patients, EMR-C in 1 patient, but not after EMR. One patient with tumor-positive margin after EMR underwent an additional surgery, and lymph node metastasis was seen. No local recurrences or distant metastatic lesions were identified in any of the patients during the follow-up period. Conclusions EMR-C was a safe and effective treatment for rectal neuroendocrine tumors.