Point of Care Testing for SARS-COV-2 Antibodies before doing Endoscopy.

Objectives: COVID-19 has taken the world by storm, creating much disparity among both healthcare and non-healthcare centres regarding the provision of services. The purpose of our study was to see the prevalence of the SARS-COV-2 exposure in the asymptomatic patients undergoing the endoscopic procedure, already triaged based on history and examination. Methods: Total 207 patients were enrolled during a time period of five months during October 2020 to April 2021 at Dr. Ziauddin Hospital Clifton campus, Karachi. In this prospective observational study patients undergoing endoscopic procedures were included after taking informed consent. The patients who already tested positive for COVID-19 by PCR were excluded. Patients were tested for Covid serology by immunochromatographic rapid serology test (ICT). Standard Operating Procedures for dealing with endoscopy patients during the COVID era were followed in all patients irrespective of antibody status. Result: Total number of patients included was 207; males were 121 (58.5%). The mean age was 48.5 ± 17.55 (range 13 to 92). Forty eight patients (23.2%) were positive for either antibody suggesting exposure to the COVID-19 virus. Out of these combined IgM and IgG positivity was seen in 24 (11.5%), IgM mono antibody positivity was seen in 7 (3.38%) and 17 (8.21%) of the study population tested positive for IgG only. 15 out of 46 (32.6%) patients with chronic liver disease in the cohort were seropositive for COVID antibodies. Conclusion: About one-fourth of the patients undergoing the endoscopic procedure were tested positive for COVID antibodies of which a significant percentage had chronic liver disease. It stresses the need of observing standard precautions to prevent the spread of infection during these procedures, especially in the vulnerable population.

Patients visiting gastroenterology clinics avoid giving honest history for COVID-19 related symptoms in the pre-clinic triage.

OBJECTIVE: To assess the discrepancy in terms of history related to coronavirus disease-2019 and symptoms given in the pre-clinic triage and to the doctor attending the patient in a gastroenterology clinic. METHODS: The observational study was conducted from September 2020 to January 2021 at the Gastroenterology outpatient department of Dr Ziauddin Hospital's Clifton unit in Karachi, and comprised all patients visiting the facility regardless of age and gender. Data was collected using a questionnaire that was first filled up by the receptionist outside the clinic and was then administered again once the patient entered the clinic. Discrepancy on the answers was then checked and associations were determined with clinical assessment. Data was analysed using SPSS 20. RESULTS: Of the 300 patients, 184(61.3%) were males and 116(38.6%) were females. The overall mean age was 55 ± 16.98 (range: 18-92 years). Discrepancy between pre-clinic and in-clinic self-reported data was significant for fever, cough, fatigue, headache, body ache, diarrhoea, sore throat, loss of sense of smell/taste, shortness of breath, and contact with someone positive for coronavirus disease-2019 was significant (p<0.05). CONCLUSIONS: Patients were found to be afraid of getting barred from seeing a consultant, had fear of hospital-based isolation or were in denial regarding the pandemic.

Hybrid endoscopic ultrasound in the covid-19 era for the tissue diagnosis of solid lesions;an initial experience from a tertiary care centre from Pakistan

BackgroundEndoscopic Ultrasound (EUS) is a well-established mode of intervention for tissue acquisition in solid organs with rapid on-site evaluation (ROSE). In the Covid-19 era, the implementation of infection control mechanisms has led to modified hybrid techniques to get high diagnostic yield for tissue sampling. Combination of Covid-19 SOPs and tissue acquisition method outline this hybrid technique to get a high diagnostic Yield. We share our initial experience of EUS cases performed with this approach without ROSE.MethodsAll 125 cases who underwent EUS-guided biopsy from June 2020 till June 2022 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during the procedure.ResultsAmong these cases, 85 were male, mean age of 56 years (range 22–90), Mean duration of procedure 28 minutes mean (10–90 min). 91 cases for organs targeted for malignant pathology include pancreas 53, liver 03, lymph nodes 22, subepithelial lesions 10, mediastinal lesions 15, common-bile duct/gall bladder 07, gastric and retroperitoneal 01 case, 13 cases had a multi-targeted biopsy for the additional staging of disease. The number of ‘passes’ with the needle was average 02 with single pass 20, two pass 60, three passes 20, multitarget single pass in 25. Needle size (Franseen design) used for procedures was 22G in 115 cases and 25G in 10. Common tissue diagnoses include pancreatic adenocarcinoma 38, neuroendocrine tumours 06, tuberculosis 07, gastrointestinal stromal tumours 03, leiomyoma 05, lymphoma 06, metastatic renal cell carcinoma 05, squamous cell carcinoma 05, cholangiocarcinoma/gall bladder adenocarcinoma 13, Sarcoma 03, solid pseudopapillary epithelial neoplasm of pancreas (SPEN) 03 and one case for Schwannoma, breast metastasis, accessory spleen, ectopic pancreas, sarcoidosis There were no immediate or early complications in all cases.ConclusionsHybrid EUS in Covid 19 Era has emerged as a useful/cost-effective and safe approach to get tissue yield without the need for ROSE.

Severe COVID-19 Associated With Liver Injury in Patients Without Preexisting Liver Disease.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is known to disturb liver function tests (LFTs). Not much literature is available regarding the effect of COVID-19 on LFTs in patients without preexisting liver disease. The study aimed to find the effect of COVID-19 in these patients. METHODS:  This was a single-center, observational study with 142 patients who were admitted with COVID-19 during three months. Seven patients were excluded due to the presence of chronic liver disease.  Results: A total of 135 patients were included in the study aged between 18 and 95 years (mean 57.7 ± 15.6); among them, 93 were males (68.9%). Hypertension was present in 74 patients (54.8%), and diabetes was present in 48 patients (35.6%). Fever was the chief complaint in 112 patients (83%), followed by dyspnea in 93 patients (68.9%) and cough in 79 patients (58.5%). Elevated aspartate aminotransferase (AST) was seen in 35 patients (26%), gamma-glutamyl transferase (GGT) in 43 patients (32%), alanine transaminase (ALT) in 18 patients (24%), alkaline phosphatase in 19 patients (14%), bilirubin in six patients (4%), and low albumin in 27 patients (20%). Severe COVID-19, when compared with mild to moderate disease, was associated with elevated AST > two-time upper limit normal (2ULN) (p = 0.002), GGT > 2ULN (0.026), and lower albumin (p = 0.020), higher systemic inflammatory response syndrome (SIRS) (0.045), raised procalcitonin (p = 0.045), higher ferritin (p = 0.005), lower pO2 (p = 0.044), and higher Sequential Organ Failure Assessment score (SOFA) (p = 0.002) pointing to the inflammatory response as cause of liver injury. Factors predicting mortality with COVID-19 were assessed, which showed that direct bilirubin (p = 0.001), low albumin (p = 0.013), tachypnea (0.002), and leukocytosis (<0.001) were independently associated with increased COVID-19-related mortality. CONCLUSION:  Patients suffering from COVID-19 have evidence of liver injury, which appears to be secondary to an inflammatory response that correlates with the severity of COVID-19.

Assessing the knowledge of trainee residents for liver involvement and related issues in COVID-19 pandemic

Background: Regular educational activities have suffered since the start of COVID-19 pandemic. New data has been emerging regularly regarding COVID-19 and the optimal way of care for patients with COVID-19 infection. Emphasis upon dispensing knowledge in current pandemic times should be made. Aims and Objective: We assessed the knowledge of internal medicine and gastroenterology trainees regarding liver involvement and related issues in the current COVID-19 pandemic. Materials and Methods: This online survey comprised of 10 questions designed to examine the basic knowledge of Sars-Cov-2 virus, knowledge regarding liver involvement in COVID-19, and the ability to decide on patient care. Results: A total of 100 responses were collected. Most of the responses were from Pakistan (n=75). More than 80% of trainees responded correctly regarding the accurate indication of endoscopic procedures during COVID-19 pandemic, absence of ACE-II receptor expression on astrocytes, upper respiratory secretions being an eligible sample for SARSCOV-II, avoiding regular outpatient follow up, avoiding hydroxychloroquine as a prophylactic drug, and azithromycin in decompensated cirrhosis, continuing beta-blockers and lactulose in a decompensated patient, melena being an accurate indication for screening endoscopy and the choosing right set of PPEs. Less than 50% of responders knew correctly regarding NAFLD being a notorious factor for COVID-19 related complications, ACE-II receptor expression by cholangiocytes and enterocytes, saliva and stool being an eligible sample for SARS-COV-II detection, palliative approach as an appropriated management step for decompensated-CLD patients and history of ascites as an appropriate indication for screening endoscopy. GI trainees performed better in some areas of knowledge Conclusions: Trainees were updated in many aspects of the recent guidance in the management of COVID-19 but there were many lacunae in the knowledge. So, continuous medical education activities are essential to keep the residents updated about the changing developments in the management of COVID-19. [ABSTRACT FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)