Hospital admissions from alcohol-related acute pancreatitis during the COVID-19 pandemic: A single-centre study.

BACKGROUND: The United Kingdom government introduced lockdown restrictions for the first time on 23 March 2020 due to coronavirus disease 2019 (COVID-19) pandemic. These were partially lifted on 15 June and further eased on 4 July. Changes in social behaviour, including increased alcohol consumption were described at the time. However, there were no data available to consider the impact of these changes on the number of alcohol-related disease admissions, specifically alcohol-related acute pancreatitis (AP). This study evaluated the trend of alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown. AIM: To evaluate the trend in alcohol-related AP admissions at a single centre during the initial COVID-19 lockdown in the United Kingdom. METHODS: All patients admitted with alcohol-related AP from March to September 2016 to 2020 were considered in this study. Patient demographics, their initial presentation with AP, any recurrent admissions, disease severity and length of stay, were evaluated using ANOVA and χ 2 and Kruskal-Wallis tests. RESULTS: One hundred and thirty-six patients were included in the study. The highest total number of AP admissions was seen in March-September 2019 and the highest single-month period was in March-May 2020. Admissions for first-time presentations of AP were highest in 2020 compared to other year groups and were significantly higher compared to previous years, for example, 2016 (P < 0.05). Furthermore, the rate of admissions decreased by 38.89% between March-May 2020 and June-September 2020 (P < 0.05), coinciding with the easing of lockdown restrictions. This significant decrease was not observed in the previous year groups during those same time periods. Admissions for recurrent AP were highest in 2019. The median length of hospital stay did not differ between patients from each of the year groups. CONCLUSION: An increased number of admissions for alcohol-related AP were observed during months when lockdown restrictions were enforced; a fall in figures was noted when restrictions were eased.

Can Preoperative Characteristics Predict the Outcomes of Laparoscopic Cholecystectomy?

Background: Intraoperative findings during laparoscopic cholecystectomy (LC) are highly unpredictable and operative difficulty varies from straightforward to very challenging procedures. Several studies described predictors of technical difficulty and graded intraoperative findings of LC; however, none specifically reported on the effect of such factors on clinical outcomes. This study aims to evaluate if preoperative characteristics of patients undergoing LC predict how likely they are to fail to be day case (DC). Methods: Data of patients who underwent LC from 2015 to 2017 were retrospectively analyzed. Subjects were divided into four groups, according to Nassar's classification of intraoperative difficulty. Differences in frequencies were evaluated with the the chi square and post hoc chi square tests or Fisher's exact test; logistic regression analysis was used to identify independent variables that were predictors of intraoperative complexity, postoperative morbidity, and length of stay. Results: A total of 1043 patient were included with male to female ratio of 1:2.5. Older age, male gender, and comorbidities were associated with higher Nassar score (P < .0001); Nassar 3 and 4 were predictors of postoperative morbidity (P < .05). The DC rate was 74.2% (Nassar 1), 75.8% (Nassar 2), 61.1% (Nassar 3), and 26.2% (Nassar 4), respectively. Age ≥60 years (P < .05), body mass index ≥35 (P < .05), and Nassar 3 and 4 (P < .05) were predictors of increased conversion from DC to inpatient (IP) stay. Conclusion: LC can be safely performed on a DC basis even when surgery is technically challenging. The need of IP stay can be predicted in comorbid old adult men with anticipated higher Nassar's score.

Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma.

BACKGROUND: Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy-this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens' examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. METHODS: Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student's t-test and ANOVA. RESULTS: Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in six cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease-73.7 [Formula: see text] 5.38 years vs 55.8 [Formula: see text] 0.79 years (p < 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage-one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression-median survival was 7 months (range 2-14). CONCLUSIONS: In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.

Evaluation of Immune Response and Protection Induced by V-ATPase Subunit F as DNA Vaccine Against Leishmania tropica (LCED Syrian 01) After Detection and Sequencing.

BACKGROUND: Leishmaniasis is one of the major emerging health problems worldwide and Leishmania tropica (L. tropica) is most prevalent in the Middle East due to conflict and environmental factors, and there is no effective prevention strategy available until now. An effective vaccine has not been developed to date. DNA vaccines are considered a promising approach to protect against this infection. In this study, since vacuolar (H+)-ATPase (V-ATPase) enzyme has an essential role in the life cycle of eukaryotes, V-ATPase subunit F gene has been chosen to design DNA vaccine and evaluate its immunogenicity in BALB\c mice. METHODS: Genomic DNA was isolated from promastigote culture, synthesized complementary DNA (cDNA) after standardization of Polymerase Chain Reaction (PCR) conditions. The V-ATPase subunit F gene was placed into plasmid PCI. Then, recombinant plasmids were transformed into competent cells. Cloning was confirmed by PCR, restriction enzyme assays, and finally, DNA sequence analysis, after making miniprep from positive colonies and finally the gene was sequenced. BALB/c mice were immunized subcutaneously three times at an interval of two weeks with designed vaccine. BALB\c mice were challenged with 106 promastigotes of L. tropica 7 days post-immunization. IL-12, IFN-γ and IL-4 were quantified by RT-qPCR. RESULTS: The present study proved the existence of subunit F gene in Syrian strain of L. tropica (LCED Syrian 01) promastigotes genome. Its expression was also proved in these parasites and the gene length was 414 bp. CONCLUSION: This study showed that vaccination of BALB\c mice with this gene induced partial protection against Leishmania by reduction of lesion size by 41.9% and parasite burden reduction by 3-log in the dLNs when compared with control group. IFN-γ\IL-4 was 1.6 after challenge test, so the immune response consisted of both Th1 and Th2.