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Background To contain the spread of infection and reduce the burden on healthcare infrastructure, many countries globally adopted a lockdown strategy during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Hospitals were converted to dedicated coronavirus disease 2019 (COVID-19) centers, and non-COVID-19 patients were intervened on a triage basis. During this time, only emergency procedures were performed. The impact of this lockdown strategy during the first wave of the SARS-CoV-2 pandemic on various gastrointestinal endoscopy interventions remains unknown. Methodology In this retrospective, observational study conducted in the Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar from March 25 to September 30, 2020, data related to clinical profile, indication, and endoscopic interventions performed in reverse transcriptase-polymerase chain reaction (RT-PCR)-negative patients with the use of personal protective kits were analyzed and compared with the historical controls. Results A total of 2,282 patients were admitted and 422 endoscopic procedures were performed during the six-month study period with an intervention rate of 18.49%. The most common procedure was upper gastrointestinal endoscopy (228, 58.13%), followed by endoscopic retrograde cholangiopancreatography (ERCP) (88, 22.50%). Chronic liver disease (CLD) (144 patients) followed by malignancy (111 patients) were the most common diagnosis. During the first phase of the lockdown (March to May), only 52 procedures were performed (52 vs. 506). None of the patients underwent endoscopic ultrasound. In 2019, 4,501 patients were admitted and 1,224 procedures were performed with an intervention rate of 27.19 (p < 0.0001). None of the staff of the Department of Gastroenterology developed symptomatic SARS-CoV-2 infection during this period. Conclusions There was a significant drop in endoscopic procedures during the lockdown and most of the esophagoduodenoscopy procedures were done for CLD and ERCP for biliary tract malignancy. Endoscopic procedures done on RT-PCR for COVID-19-negative patients were safe using personal protective kits.
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Background The gamma-glutamyl transpeptidase (GGT)-to-platelet ratio (GPR) is identified as a new model for the assessment of liver fibrosis in patients with chronic hepatitis B (CHB). We aimed to determine the diagnostic performance of GPR for the prediction of liver fibrosis in patients with CHB. Methods In an observational cohort study, patients with CHB were enrolled. The diagnostic performance of GPR was compared with transient elastography (TE), aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) scores for the prediction of liver fibrosis using liver histology as a gold standard. Results Forty-eight patients with CHB with a mean age of 33.42 ± 15.72 years were enrolled. Liver histology showed meta-analysis of histological data in viral hepatitis (METAVIR) stage F0, F1, F2, F3, and F4 fibrosis in 11, 12, 11, seven, and seven patients, respectively. The Spearman correlation of METAVIR fibrosis stage with APRI, FIB-4, GPR, and TE were 0.354, 0.402, 0.551, and 0.726, respectively (P value < 0.05). TE had the highest sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (80%, 83%, 83%, and 79%, respectively), followed by GPR (76%, 65%, 70%, and 71%, respectively) for predicting significant fibrosis (≥F2). However, TE had comparable sensitivity, specificity, PPV, and NPV with GPR (86%, 82%, 42%, and 93%, and 86%, 71%, 42%, and 92%, respectively) for predicting extensive fibrosis (≥F3). Conclusion The performance of GPR is comparable to TE in predicting significant and extensive liver fibrosis. GPR may be an acceptable, low-cost alternative for predicting compensated advanced chronic liver disease (cACLD) (F3-F4) in CHB patients.
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INTRODUCTION: Gastric cancer develops in a multistep progression and is determined by genetic and environmental factors. Over-expression of Alpha Methylacyl CoA Racemase (AMACR) is useful in diagnosis of prostate cancer. There is plenty of genetic alteration that occurs in gastric adenocarcinoma. The present study was planned to determine if AMACR can be used as a diagnostic marker in gastric adenocarcinoma similar to prostate cancer. AIM: To study the expression of AMACR in gastric adenocarcinoma and correlate its expression with density of Helicobacter pylori. MATERIALS AND METHODS: This cross-sectional, prospective study was conducted from August 2013-2015. Fifty gastric cancer biopsies were taken. Adjacent biopsy from normal/reactive mucosa was also taken from 21 cases. Samples were stained with H&E for morphological details, Loeffler's methylene blue for Helicobacter pylori and immunohistochemistry (IHC) was done to check for the expression of AMACR proteins. Statistical analysis was done using chi square test, Spearman's correlation coefficient and Fisher's exact test. The p-value ≤ 0.05 was taken as critical level of significance. RESULTS: Overexpression of AMACR was observed in 88.89% of intestinal type and 78.05% of diffuse type adenocarcinoma. AMACR expression was significantly less in adjacent reactive/dysplastic mucosa. Helicobacter pylori were seen in 8/9 (88.89%) and 35/41(85.36%) cases of intestinal adenocarcinoma and diffuse adenocarcinoma respectively. When grades of Helicobacter pylori were compared with the positivity of AMACR, no significant association and correlation was found. CONCLUSION: The expression of AMACR in neoplastic tissue was significantly higher as compared to adjacent dysplastic, reactive or normal tissue. Thus, IHC for AMACR can be used for differentiating the cases of reactive atypia from early neoplastic lesions similar to its role in prostatic tissue. Helicobacter pylori does not affect the expression of AMACR in neoplastic gastric lesions.