Endoscopic Management Using Novel Haemostatic Agents for Immediate Bleeding during Endoscopic Retrograde Cholangio-Pancreatography.

Bleeding after endoscopic sphincterotomy (ES) remains as a major challenge during ERCP procedure. Standard endoscopic haemostatic procedures have demonstrated good performance for bleeding control. Novel endoscopic haemostatic agents have also been widely used in gastrointestinal bleeding management. Regardless, there is still a paucity of high-quality evidence evaluating the practicality of these agents in ERCP. This case series study was performed on the patients who underwent ERCP procedure in a tertiary referral private hospital within 2 years period. Post-ES immediate bleeding is defined as the onset of bleeding at the time of sphincterotomy. Treatment groups for post-ES bleeding are divided into (1) standard haemostatic methods and (2) novel haemostatic agents. There were 40 patients who received standard haemostatic treatment and 60 patients who received novel haemostatic agents. Initial haemostasis was achieved in all patients. Two patients who received standard haemostatic treatment had rebleeding. Meanwhile, no patients in novel haemostatic treatment group had rebleeding. In conclusion, novel haemostatic agent can be considered as an easy and practical method in daily practice, especially when an ERCP procedure is performed. Further studies with larger sample size which, if possible, can also include a cost-effectiveness analysis are still required to implement these agents as a standard procedure in clinical practice. (This abstract has been presented at the American College of Gastroenterology meeting October 2021).

Clinical significance of isolated gastric varices in liver cirrhotic patients: A single-referral-centre retrospective cohort study.

INTRODUCTION: Gastric varices (GVs) occur in 10-30% of liver cirrhotic patients, with a mortality rate of up to 45%. Rupture of isolated GVs (IGVs) is less prevalent but often results in more severe hemorrhage and a higher risk of mortality than rupture of esophageal varices (EVs). However, there is no clear consensus yet about the optimal management for incidentally discovered IGVs. OBJECTIVE: To determine the clinical significance of IGVs in liver cirrhotic patients. METHODS: This was a retrospective cohort endoscopy database study within a 2-year period (2016-2017). All study subjects were liver cirrhotic patients with OVs or GVs. The exclusion criteria were noncirrhotic portal hypertension, presence of malignancy, absence of varices, and incomplete data. Statistical analysis was performed using IBM SPSS 23. RESULTS: A total of 153 patients were included in this study. IGVs were found in 13 (8.49%) patients, whereas OVs were found in 112 (73.20%) patients and gastro-OVs were found in 28 (18.30%) patients. Child-Pugh class C (CP C) score was the strongest independent risk factor for variceal bleeding in bivariate analysis (hazard ratio [HR]: 10.21, 95% confidence interval [CI]: 4.15-25.12, P = 0.001) and multivariate analysis (HR: 12.49, 95% CI: 4.95-31.54, P 0.001); however, the presence of IGVs was not an independent risk factor. CP C score was also the only significant risk factor associated with 1-year mortality in liver cirrhotic patients on multivariate analysis (HR: 26.77, 95% CI: 6.01-119.34, P 0.001). CONCLUSION: The presence of IGVs has no clinical significance in the occurrence of 1-year rebleeding and in patient survival.

VENTILATORY SUPPORT IN SARS-VOC-2 DURING INTENSIVE THERAPY

IntroductionThe SARS-CoV-2 disease outbreak has now become a pandemic. Critical patients with COVID-19 require basic and advanced respiratory support. Therefore, the objective was to describe the ventilatory support strategies in SARS-CoV-2 during intensive therapy. Materials and methodsA systematic review of observational studies of the available scientific literature was performed in accordance with the recommendations of the Cochrane collaboration and the criteria of the PRISMA Declaration. ResultsFifteen observational studies were included that gave a study population of 4,081 patients. Mechanical ventilation is the main respiratory support treatment for critically ill patients, which should be administered as soon as normal oxygenation cannot be maintained, and despite the fact that there is no current consensus on the parameters of mechanical ventilation, the evidence collected suggests the use of Fio2 on average 50%, PEEP of 14 cmH2O, lung compliance of 29-37 ml per cm of water, driving pressure between 12-14 cm of water and a plateau pressure of 22-25 cm of water. ConclusionsIL-6 is shown as a possible marker of respiratory failure and a worse prognosis as well as obesity. In addition, the use of prone position, neuromuscular blockade, pulmonary vasodilators, ECMO, and mechanical ventilation based on the clinical conditions and needs of the patient with COVID-19 are strategies that could benefit patients entering intensive therapy for SARS-CoV-2.

PHYSIOTHERAPY AND ITS CHALLENGE AGAINST COVID-19: PHYSIOTHERAPY AND COVID-19 / FISIOTERAPIA Y SU RETO FRENTE AL COVID-19: FISIOTERAPIA Y COVID-19 / FISIOTERAPIA E SEU DESAFIO CONTRA COVID-19: FISIOTERAPIA E COVID-19

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness. The coronavirus disease 2019 (COVID-19), affecting thousands of people around the world; currently, more than 300,000 cases are reported worldwide due to COVID-19 and statistics mention that 5% of the population infected by COVID-19 requires intensive care units with mechanical ventilation support. It ́s for that urgent guidance for clinicians, physiotherapist and nurse caring for the sickest of these patients is needed. Highlighting that this document focuses mainly on professionals who practice physical therapy.

El nuevo coronavirus del síndrome respiratorio agudo severo (SARS-CoV-2), es la causa de una enfermedad de rápida propagación. La enfermedad por coronavirus 2019 (COVID-19), que afecta a miles de personas en todo el mundo. Actualmente, se reportan más de 2'500.000 casos en todo el mundo debido a COVID-19 y las estadísticas mencionan que el 5% de la población infectada por COVID-19 requiere unidades de cuidados intensivos con soporte de ventilación mecánica. Es por eso que se necesita orientación urgente para los médicos, fisioterapeutas y enfermeras que atienden a los pacientes más enfermos. Resaltando, que el presente documento se enfoca principalmente en los profesionales que ejercen la fisioterapia.

O novo coronavírus da síndrome respiratória aguda grave (SARS-CoV-2) é a causa de uma doença que se espalha rapidamente. Doença de coronavírus 2019 (COVID-19), que afeta milhares de pessoas em todo o mundo. Atualmente, mais de 2.500.000 casos são relatados em todo o mundo devido ao COVID-19, e as estatísticas mencionam que 5% da população infectada com COVID-19 requer unidades de terapia intensiva com suporte de ventilação mecânica. É por isso que é necessária orientação urgente para médicos, fisioterapeutas e enfermeiros que cuidam dos pacientes mais doentes. Destacando que este documento se concentra principalmente nos profissionais que praticam fisioterapia.

Hyperuricemia as an independent risk factor for non-alcoholic fatty liver disease (NAFLD) progression evaluated using controlled attenuation parameter-transient elastography: Lesson learnt from tertiary referral center.

BACKGROUND AND AIM: Hyperuricemia is one of the metabolic parameter which has been considered to play an important role in non-alcoholic fatty liver disease (NAFLD). However, there is still lack of studies about association between serum uric acid with liver disease progression in NAFLD. This study aimed to know the association between hyperuricemia with moderate to severe steatosis and significant fibrosis along with other metabolic factors in NAFLD patients evaluated using Controlled Attenuation Parameter (CAP) - Transient Elastography (TE). METHODS: This is a prospective study in NAFLD patients who came to our tertiary referral center University hospital hepatobiliary outpatient's clinic. All patients underwent metabolic parameters measurement including serum uric acid level and CAP-TE examination. Cutoff value used for significant liver fibrosis ≥7 kPa and ≥285 dB/m for moderate-severe steatosis. RESULTS: Of 113 NAFLD patients, there were 45 patients with moderate-severe steatosis and 34 patients with significant fibrosis. Multivariate analysis showed only high level of fasting blood glucose (OR 2756; 95% CI 1.131-6.717) and low HDL level (OR 4.196, 95% CI 1.22-14.430) to be independent risk factors of moderate-severe steatosis. High level of fasting blood glucose (OR 3.98, 95% CI 1.105-14.389) and hyperuricemia (OR 2.501, 95% CI 1.095-5.714) were found to be independent risk factors for significant liver fibrosis. CONCLUSION: Hyperuricemia is found to be an independent risk factor for significant liver fibrosis.