Background: Recent incidence trends of pancreatic cancers were reviewed by demographics and histologic type to observe any new findings. Methods: Data was used from the Surveillance, Epidemiology, and End Results (SEER) registry 18 (2000-2017) and it underwent temporal trend analysis. Pancreatic cancer incidence rates were reported based on histological subtype and demographics. Results: The incidence rate of white males increased significantly during 2000-2017 (annual percent change (APC) = 3.5%) compared to previously reported APCs. The incidence of white females grew from an APC of 1.29% to 2.9%. Rates among black ethnicity increased with an APC of 4.2%. Rates among Hispanics and other ethnicities also showed increment. The rates for ductal adenocarcinoma showed a positive trend in all races, with the APC ≥ 6 % for females and APC ≥ 6.5 % for males. The rates of non-secretory endocrine tumors showed a decline in both genders of all five races in recent years after showing an initial positive trend till 2010. Rates for pancreatic adenocarcinoma continued to rise in all ethnicities from 2000-2017. Interestingly, there was a rise in carcinoid type pancreatic neuroendocrine tumors (PNETs) in all ethnicities. Cumulatively, males had a higher incidence than females; male to female Incidence Risk Ratio (IRRs) was 1.32. The IRR was > 1 for age groups ≥ 35 years. The male to female IRRs was less than 1 for cystic adenocarcinoma, secretory endocrine, and solid pseudopapillary carcinomas (IRR = 0.5, 0.9, and 0.2 respectively, confidence intervals 0.4–0.6 and 0.9-1.3, 0.2–0.3, respectively). Conclusion: Pancreatic cancer incidence continued to rise in the years 2000-2017. However, incidence differed by demographics and histologic type. Interestingly, recent years discerned a rise in PNETs (carcinoid type) which has not been reported previously.

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Background: Acute coronary syndrome (ACS) and anaphylaxis are both medical emergencies that require prompt intervention. ACS occurring in the setting of hypersensitivity reaction, presumably secondary to inflammatory mediator release, is called Kounis Syndrome (KS). There are three subtypes of KS: Type I (clean coronary arteries), type II (pre-existing CAD), and type III (in-stent restenosis). Allergens such as medications, insect bites, foods, and contrast media have been found to result in KS. However, to our knowledge, there is only one reported case of KS induced by sulfur hexafluoride (echocardiography enhancing agent), which was categorized as KS type III. Here, we report a case of allergic reaction to this agent causing KS type I. Case Presentation: A 74-year-old woman with a history of anaphylaxis (to penicillin and cephalosporins), provoked pulmonary embolism (PE), hypertension, and hypothyroidism presented with dyspnea and was found to have bilateral subacute PE on CTA chest. She was started on a heparin drip and subsequently underwent echocardiography which showed normal RV size, systolic function, and LVEF with no wall motion abnormalities. However, shortly after receiving the sulfur hexafluoride agent, the patient was noted to be somnolent, hypotensive, and diaphoretic. Allergic reaction to the contrast was suspected and she received methylprednisolone, diphenhydramine, and famotidine. STAT EKG revealed ST elevation in inferior leads and the patient subsequently underwent cardiac catheterization which showed no evidence of significant obstructive disease. The patient remained hemodynamically stable throughout the remainder of her admission and was transitioned from heparin drip to apixaban prior to discharge. Discussion: In conclusion, allergic reactions could lead to an acute coronary syndrome with non-obstructive coronaries. As a result, it is crucial to consider KS as a differential. Figure 1 - ST elevations in the inferior leads

Introduction: Percutaneous catheter ablation (PCA) for non-valvular atrial fibrillation (AF) is rapidly becoming commonplace for recently diagnosed paroxysmal AF. Heart failure (HF) and AF commonly coexist in patients. Elevated left ventricular and atrial pressures result in progressive left atrial dilation and remodeling which in turn predisposes to the generation of AF. Since many who undergo PCA for AF could have HF, we aimed to assess peri-procedural outcomes in this population. Methods: We utilized the National Inpatient Sample from 2016-2019 to identify 74,205 hospitalized adults who underwent PCA for AF. These hospitalizations were further stratified based on the presence of HF. A multivariate regression model was used to adjust for confounders and analyze the variables. Results: Of those who underwent PCA for AF, 33,435 (45%) had HF. In-hospital mortality was higher in those with HF (1.9% vs 1.14%; p=0.0001). Figure 1 shows the Forrest plot for multivariate analysis of peri-procedural complications when adjusted for patient demographics, co-morbidities, and hospital characteristics. When adjusted similarly, patients with HF who underwent PCA for AF had longer length of stay (LOS) by 1.5 days (p<0.001) and had additional hospital costs (HC) of $14,726 (p<0.001). Conclusions: In this study, patients undergoing Percutaneous catheter ablation (PCA) for AF with co-existing acute HF had significantly worse end points in terms of in-hospital mortality, LOS, HC, atrial flutter, AKI, sepsis, pneumonia, endotracheal intubation. One major limitation of our study is the lack of outpatient follow up. Although outcomes are worse in the acute setting of HF, there have been several studies such as CASTLE-AF, outlining that early ablation for AF in HF is associated with positive long-term effects including lower rates of death and hospitalization for HF. Despite unfavorable peri-procedural outcomes of HF in PCA, the long-term benefits should not be overlooked.