ABSTRACT
Background/Aims@#The coronavirus disease of 2019 (COVID-19) pandemic has impacted the training of medical trainees internationally. The aim of this study was to assess the global impact of COVID-19 on endoscopy training from the perspective of endoscopy trainers and to identify strategies implemented to mitigate the impact on trainee education. @*Methods@#Teaching faculty of gastroenterology (GI) training programs globally were invited to complete a 36-question web-based survey to report the characteristics of their training programs and the impact of COVID-19 on various aspects of endoscopy training, including what factors decisions were based on. @*Results@#The survey response rate was 52.6% (305 out of 580 individuals); 92.8% reported a negative impact on endoscopy training, with suspension of elective procedures (77.1%) being the most detrimental factor. Geographic variations were noted, with European programs reporting the lowest percentage of trainee participation in procedures. A higher proportion of trainees in the Americas were allowed to continue performing procedures, and trainers from the Americas reported receiving the greatest support for endoscopy teaching. @*Conclusions@#This study demonstrated that the COVID-19 pandemic has had a significant negative impact on GI endoscopy training internationally, as reported by endoscopy trainers. Focus-optimizing endoscopy training and assessment of competencies are necessary to ensure adequate endoscopy training.
ABSTRACT
Background/Aims@#The coronavirus disease of 2019 (COVID-19) pandemic has impacted the training of medical trainees internationally. The aim of this study was to assess the global impact of COVID-19 on endoscopy training from the perspective of endoscopy trainers and to identify strategies implemented to mitigate the impact on trainee education. @*Methods@#Teaching faculty of gastroenterology (GI) training programs globally were invited to complete a 36-question web-based survey to report the characteristics of their training programs and the impact of COVID-19 on various aspects of endoscopy training, including what factors decisions were based on. @*Results@#The survey response rate was 52.6% (305 out of 580 individuals); 92.8% reported a negative impact on endoscopy training, with suspension of elective procedures (77.1%) being the most detrimental factor. Geographic variations were noted, with European programs reporting the lowest percentage of trainee participation in procedures. A higher proportion of trainees in the Americas were allowed to continue performing procedures, and trainers from the Americas reported receiving the greatest support for endoscopy teaching. @*Conclusions@#This study demonstrated that the COVID-19 pandemic has had a significant negative impact on GI endoscopy training internationally, as reported by endoscopy trainers. Focus-optimizing endoscopy training and assessment of competencies are necessary to ensure adequate endoscopy training.
ABSTRACT
Background: Considering the importance of Helicobacter pylori [H. pylori] eradication, this clinical trial was designed to prospectively evaluate the efficacy of levofloxacin-based, sequential therapy in comparison with quadruple therapy for eradicating H. pylori
Methods: Overall 156 patients with dyspepsia and H. pylori infection were included in this study and were randomly allocated to either 10-day sequential therapy group [group A] to receive pantoprazole [40 mg twice daily], amoxicillin [1 gr twice daily], levofloxacin [500 mg twice daily], and tinidazole [500 mg twice daily] [PALT] or 14-day quadruple therapy group [group B] to receive pantoprazole, clarithromycin, bismuth subcitrate, and amoxicillin [PABC]. At the end of the study the eradication rate in each group was assessed by urea breath test [UBT]
Results: Age range of the participants was 18-65 years [average 36.9 years] and 50% of them [78 patients] were men. 78 patients were allocated to group A and 78 patients to groupe B. After antibiotic therapy, all the patients received acid suppression therapy with Proton Pump Inhibitor [PPI] for 4 weeks and then the eradication rate was confirmed by UBT [Heli FAN plus 13C, Germany]. Before performing UBT, all the participants were requested to halt consumption of PPI for at least 1 week. During the treatment there was not any major complication but in group A [sequential therapy], two patients complained of minor complications including musculoskeletal pain. None of the patients in group B had any complaint or side effect.The rate of H. pylori eradication in group A was 78.2% [61 patients] while this rate in group B was 83.3% [65 patients] with no significant difference between the two groups [p = 0.42]. In subgroup analysis, the rate of eradication among men in group A and B were 76.9% and 89.7%, respectively [p = 0.22] while the eradication rate among women were 79.4% and 76.9%, respectively [p = 1.00]
Conclusion: It seems that levofloxacin base sequential therapy does not have any advantage in comparison with quadruple regimen and until finding any more effective short course therapy for H. Pylori eradication; we encourage quadruple regimen to be used as the first line therapy
ABSTRACT
A young man was admitted due to gastrointestinal obstruction and was diagnosed as having cocoon peritonitis secondary to perforated appendicitis. He suffered from small intestine partial obstruction because of multiple adhesion bands whose obstructive symptoms completely resolved after single balloon enteroscopy. So balloon enteroscopy could be offered as a therapeutic option for partial small intestine obstruction
Subject(s)
Humans , Gastrointestinal Hemorrhage , Rectum , Hyperostosis , Ultrasonography , ColonoscopyABSTRACT
One of the rare causes of dysphagia is vascular malformation due to abnormal origin of right subclavian artery. This vascular abnormality, which is originated during embryonic development, is usually asymptomatic and is found incidentally Herein we present a 36-year-old lady with the complaint of dysphagia who was diagnosed as having dysphagia lusoria caused by aberrant right subclavian artery. With reassurance and treatment of symptoms, her symptoms completely relieved without any further intervention
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This was a case of acute pancreatitis who complicated by left side hemiplegia and dysarthria. It diagnosed as Lacunar infarction and therapy with intravenous heparin started according to neurologist order. In third day of admission, the patient suddenly got dyspnea, tachycardia and tachypnea. Infusion of heparin continued with clinical diagnosis of pulmonary emboli and also warfarin added to his therapeutic regimen. The clinical condition of patient gradually got better and on 7th day of admission, he could tolerate oral regimen without any respiratory difficulty and his hemiplegia improved. On the following day, he discharged from ward with prescription of warfarin
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The appropriate dose of proton pump inhibitors for treatment of patients with upper [GI] bleeding remains controversial. This study compares high-dose versus low-dose intravenous proton pump inhibitor [PPI] infusion for prevention of GI bleeding complications. A total of 166 patients with bleeding peptic ulcers underwent therapeutic endoscopy using concomitant therapy by argon plasma coagulation [APC] and diluted epinephrine injection. Patients were randomly divided into two groups: high-dose pantoprazole [80 mg bolus, 8 mg per hour] and low-dose pantoprazole [40 mg bolus, 4 mg per hour] infused for three days. Initial outcomes were rebleeding, need for surgery, hemoglobin drop more than two units, and hospitalization for more than five days. Secondary outcome included mortality rate. Overall, 166 patients [83 patients per group] enrolled in the study. The average age of patients in the high-dose group was 59.5 +/- 15.6 years and 52.3 +/- 13.3 years in the low-dose group [p=0.58]. Males comprised 69.7% of patients. In the high-dose group, the mean number of units of transfused blood was 3.3 +/- 1.71 and in the low-dose group, it was 2.82 +/- 1.73 [p=0.50]. There were 36 [43.37%] patients in the high-dose group and 40 [48.19%] in the low-dose group who were hospitalized for more than 5 days [p=0.53]. Rebleeding was observed in 27 [32.53%] patients in the high-dose group and in 21 [25.30%] in the low-dose group [p=0.30]. There were no significant differences observed in drop in hemoglobin of more than two units [p=0.15], mortality [p=0.99] and surgery [p=0.75] between the two groups. For controlling peptic ulcer bleeding, there is no difference between high dose and low dose pantoprazole infusion
ABSTRACT
BACKGROUND: Celiac disease presents with a wide spectrum of symptoms
This study clarifies different aspects of celiac disease along with the most common patterns of celiac presentation in Khuzestan Province, Iran
METHODS: Patients' information was obtained by evaluation of their files from the archives of the Khuzestan Celiac Society and records at gastroenterologists' offices in this province
RESULTS: Overall, there were 103 [40 males, 63 females] patients included in this study. Patients' mean ages were 33 +/-11 years [males] and 31.6 +/- 11.7 years [females]. In terms of geographic distribution, 54.1% resided in the center of the province followed by 26.5% who were residents of the northern area. The rate of employment among men was 70.6% whereas it was 8.3% for women. In terms of education, 21.9% of men and 33.3% of women had academic educations. The rate of matrimony was 80.6% [n=29] for men, 65.4% [n=38] for women and 3.4% [n=2] who were divorced. Mean height was 164 +/- 14 cm in men and 157.5 +/- 10 cm in women. Mean BMI at the time of presentation was 22.7 in men and 22.6 in women. The most common gastrointestinal [GI] complaints in male patients were diarrhea [35%], reflux [20%], bloating [17.5%], abdominal pain [15%], vomiting [15%] and constipation [7.5%]. Female patients experienced diarrhea [49.2%], abdominal pain [31.7%], bloating [31.7%], vomiting [19%], constipation [9.5%] and reflux [7.9%]. The most common concomitant non-GI disorders among male patients were anemia [17.1%], thyroid disease [14.3%], and weight loss (14.3%); women experienced anemia [33.9%], thyroid disease [12.5%], and weight loss [7.1%]. Approximately half of the patients exhibited symptoms for more than five years prior to diagnosis and 90% were diagnosed by gastroenterologists. Of these, 43% had normal endoscopy results. The most common serologic markers were anti-TTG [69.9%], anti-EMA [27.7%]
CONCLUSION: Physicians, prior to attributing patients' symptoms to irritable bowel syndrome [IBS] should be aware that patients who present with long-term nonspecific symptoms might possibly have celiac disease. During endoscopy, the threshold for obtaining biopsies should be low