Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Background/Aims@#More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). @*Methods@#A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. @*Results@#Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). @*Conclusion@#The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis

Background/Aims@#More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). @*Methods@#A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. @*Results@#Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). @*Conclusion@#The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Comparative investigation of the free radical scavenging potential and anticancer property of Diospyros blancoi (Ebenaceae)

Objective: To investigate the comparative effects of Diospyros blancoi (Ebenaceae) leaves (DBL), root bark (DBRB) and stem bark (DBSB) on free radicals and cancer. Methods: The polyphenol contents, antioxidant and free radical scavenging properties were determined using standard spectrophotometric methods. Cytotoxicity and anticancer activities were performed on brine shrimp nauplii and Ehrlich ascite carcinoma cells, respectively. Results: Among the extracts, DBSB showed the highest total antioxidant capacity and reducing capacity on ferrous ion. Based on 1,1-diphenyl-2-picrylhydrazyl and hydroxyl radical scavenging activities, DBSB showed (95.760 ± 0.343)% and (67.460 ± 2.641)% scavenging with IC

Present trends in the tareatment of advanced non-small-cell lung cancer

Lung cancer is the leading cause of cancer deaths all over the world. As most patients present with advanced disease, major efforts have been made in the treatment of such disease with systemic chemotherapy. Several new agents and new combinations of chemotherapy have been developed recently. This article reviews the randomized clinical trials investigating chemotherapy for advanced non'small-cell lung cancer [NSCLC] in relapse or progressive disease while being treated and in elderly patients. Therapies that incorporate new biological agents to target specific defects in lung cancer are also discussed. Several clinical trials have demonstrated improvement in overall survival as well as quality of life with presently available chemotherapy treatment of advanced NSCLC. Better options are available for the elderly as well as those having relapse after first-line chemotherapy. Despite all this progress the 5-year survival rate still remains at a dismal 14%. New therapies with good results are still desired

Abdominal tuberculosis Surgeons perspective

The aim was to analyze the clinical presentation and outcome of therapeutic procedures in abdominal tuberculosis. Design: Descriptive study. Place and Duration: Surgical Unit III, Department of Surgery, Jinnah Postgraduate Medical Centre Karachi, of 4 years. All admitted patients [83] with following criteria were included. A. Clinically suspected abdominal tuberculosis supported by investigation and later responding to anti tuberculous drugs. B. Gross morphological operative findings; and histologically proven caseating chronic granulomatous inflammation. Median follow up was 9 months. Young females of low-income group were the common sufferers. Abdominal pain, intestinal obstruction and peritonitis were common presentations. Surgical interventions like loop ileostomy, resection anastomosis and adrenolysis were done in 53% due to peritonitis or intestinal obstruction. 47% patients responded adequately to anti tubercular therapy. In 20%, procedural complications were seen. Diagnosis of abdominal tuberculosis can be made on clinical grounds complications of abdominal tuberculosis can be averted with early commencement of drug therapy. Ileostomy is life saving procedure in malnourished patients. Leaving wound open for delayed primary closure not only allows continuous inspection of parties but also helps easy drainage of abscess if pus accumulates subsequent to surgical intervention or overlooked perforation

Seroprevalence of hepatitis B in children

This Community based study was carried out at Children's Hospital and Institute of Child Health Lahore from July 1996 to September 1996. 392 children with age range of 0.5 to 15 years were included in this study. Their sera were tested for HBsAg by reverse passive hemagglutination technique [RPHA] and positive were reconfirmed be ELISA method. 8/392 samples were positive for HBsAg both by RPHA and ELISA method giving a prevalence rate of 2.04%. All 8/392 cases were asymptomatic carriers

Pulse oximetry - a new method of measuring blood pressure in children

Forty patients were selected from the out patient department of Children's hospital and Institute of Child Health, Lahore and were divided into two groups according to their weight; group 1 [5-15 kg] and group 2 [> 15kg]. Blood pressures were measured in these children by 3 methods i.e. sphygmomanometer. Automated oscillometry and pulse oximetry at the same time. Pulse oximetry measurements were obtained with a blood pressure cuff proximal to the oximeter probe. These readings approximated to the systolic blood pressure recorded by other methods. The absolute differences between mean systolic blood pressure measured by sphygmomanometer and pulse oximetry were 2 and 1.80 mm Hg. in group I and II respectively. The difference between oscillometric and pulse oximetry mean systolic BP were 4.5 and 1.70 mm Hg. in group I and 2 respectively. The correlation coefficients [r] for sphygmomanometer BP compared with oximetric measurements were 0.71 and 0.77 while between oscillometric and oximetric systolic blood pressures were 0.59 and 0.76 for groups 1 and 2 respectively. It was concluded that pulse oximetry is a useful alternative non-invasive method for blood pressure measurement in children

Results of muscle biopsies from cases of progressive muscular weakness

This study was conducted at the Children's Hospital and the Institute of Child Health, Lahore from Dec. 1996 to Nov. 1997 to look for the histological diagnosis of children presenting with progressive muscle weakness. Seventeen patients were included in the study. Open muscle biopsies were taken from calf, deltoid and vastus lateralis muscles according to the involvement of muscle groups. There were 13 males and 4 females. Biopsy specimens were stained with haematoxylin and eosin and read by senior histopathologists. Muscular dystrophy was the most common diagnosis accounting for 10/17 [59 percent] cases. Duchenne muscular dystrophy was the commonest 8/10 followed by Fascioscapulo-humeral 1/10 and Limb-Girdle type 1/10. Myositis was the 2nd common diagnosis 4/17 [23.5 percent] comprising of polymyositis and dermatomyositis 2 each. Spinal muscular atrophy was seen in 3/17 patients. There is a need to develop better diagnostic fascilities and multidisciplinary approach toward these cases