Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Background/Aims@#Sigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus. @*Methods@#A literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups’ analysis of continuous outcome standardized mean difference was used as the summary measure. @*Results@#Eleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I 2 = 0%], 98.47% [95% CI, 92.72-99.69; I 2 = 0%] and 87.92% [95% CI, 80.68-92.70; I 2 = 37%], 88.36% [95% CI, 62.62-97.17; I 2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I 2 = 0%) and 88.66% (95% CI, 81.65-91.22; I 2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06). @*Conclusions@#POEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megae sophagus.

Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis

Background/Aims@#Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. @*Methods@#We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. @*Results@#Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively. @*Conclusions@#The clinical presentation of COVID-19 in IBD patients is similar to the general population.

Gastrointestinal histoplasmosis: a case series from a non-endemic region in North India

No abstract available.

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers

Recent studies have identified sprue-like illness associated with the use of the antihypertensive agent olmesartan medoxomil. However, whether this condition is specific to the use of olmesartan or is associated with the use of drugs belonging to the class of “sartans” remains to be clarified. A 45-year-old woman with chronic kidney disease along with hypothyroidism and hypertension presented with chronic diarrhea and significant weight loss. Endoscopy of the upper gastrointestinal tract showed scalloping and grooving of the duodenum, and histopathological examination showed subtotal villous atrophy. She was on telmisartan for hypertension, which was discontinued. Subsequently, diarrhea ameliorated dramatically, and she regained weight. To our knowledge, this is the first study to report telmisartan-associated sprue-like enteropathy. Further, we have reviewed the cases of patients with sprue-like enteropathy caused by valsartan, irbesartan, and eprosartan.

Epidemiology of malaria in amritsar district of India

Malaria is today one of the major causes of human suffering, both in terms of increasing morbidity/mortality and stunting intellectual/ economic growth. In a developing country like India, it has devastating socioeconomic consequences. The present study was therefore carried out to study the epidemiology of malaria in Amritsar district. Diagnosed cases of Malaria reported from 1[st] January to 31[st] December 2009 in the erstwhile District of Amritsar were collected from the District Epidemiologist of Amritsar and Taran Taaran and studied. A total of 314 patients were studied. Data was assessed, systematically compiled and statistically analyzed. Most [84%] of the malaria patients in our study were less than 45 years of age. Male patients [57%] outnumbered females [43%]. The majority of patients with malaria [98%] were from rural areas and 68.5% of the studied patients belonged to upper lower socioeconomical class according to Kuppuswamy socioeconomic status scale. The majority [83%] of patients took treatment from Registered Medical Practitioners/quacks. Out of the total patients, only 14% used mosquito nets, 13% used repellents, and 7% had wire gauze doors in their homes. The people living in rural areas were found to be more vulnerable to malaria. The disease was found to be more prevalent among the lower socio economic strata and young population leading to considerable adverse effect on health and economy. Our study aims to stress the estimation of the true burden of malaria.

In vitro activity of vancomycin and teicoplanin against coagulase negative staphylococci

With the increase in nosocomial infections caused by coagulase negative staphylococci [CNS], laboratory diagnosis of CNS with reduced susceptibility to glycopeptides [vancomycin and teicoplanin] has become important. This study was designed to determine the glycopeptide susceptibility of clinical isolates of methicillin resistant coagulase negative staphylococci [MRCNS] at the department of microbiology, government medical college and hospital, Amritsar, India. A total of 250 CNS isolated from various clinical specimens were speciated and their methicillin resistance was detected by studying the minimum inhibitory concentration [MIC] of oxacillin by macrobroth dilution method. Glycopeptide susceptibility of 130 methicillin resistant strains obtained was determined for vancomycin by vancomycin screen agar test, MIC of vancomycin by macrobroth dilution/and E test. Teicoplanin susceptibility was determined using teicoplanin disc diffusion test and MIC was determined by macrobroth dilution method. All the MRCNS isolates were found to be susceptible to vancomycin and teicoplanin. MIC of vancomycin ranged between

single-centre randomized-controlled trial to study effect of dilution on propofol-induced injection pain at injection site

Propofol is a commonly used short-acting intravenous anaesthetic agent. A major disadvantage of propofol is pain at injection site with high incidence up to 90%. Various modalities have been tried to obtund propofol-induced pain; however, search for an ideal agent continues. We assessed the effect of double and triple dilution of 1% propofol emulsion with normal saline on pain at injection site. This randomized, double-blinded study was done on 60 adult patients of both sexes, belonging to ASA grade I and II scheduled for elective surgery under general anesthesia, divided into three groups named I, II, III of 20 patients each. The patients of group I, II, and III received 1% propofol 2 ml, 0.5% propofol 4 ml, and 0.33% propofol 6 ml, respectively, over a period of 4 s and pain felt was assessed. There was no statistically significant difference in the pain score in group II as compared to patients in group I. However, there was a statistically significant decrease in the pain score in group III as compared to patients in group I [P value 0.02] and group II [P value 0.03]. Conclusions: We found a significant decrease in both incidence and severity of pain during injection with a 0.33% propofol solution without significant adverse hemodynamic effects. The small size of data was a limitation in our study and a large-scale study will be needed to prove its therapeutic beneficence