Does technology-enhanced communication improve Helicobacter pylori eradication outcomes?-A meta-analysis.

BACKGROUND: Helicobacter pylori (H. pylori) is a highly prevalent organism that can induce an inflammatory state in the upper gastrointestinal tract and lead to complications such as peptic ulcer and gastric cancer. The treatment regime is complicated, and mild-to-moderate adverse effects are common, making patient compliance a key determinant of successful eradication. One attractive strategy is to leverage on technology-enhanced communication (TEC) strategies. However, the current data on the efficacy of TEC modalities in improving H. pylori eradication are limited. This is the first meta-analysis evaluating its effectiveness to the best of our knowledge. Thus, it is essential to evaluate the current body of evidence to learn the impact of TEC initiatives. METHODS: A literature search was done on PubMed, World of Science, and Embase. A total of 9 studies variably reported on compliance rate, eradication rate, adverse effect rate, symptom relief, patient satisfaction, treatment cost, patient disease awareness, and follow-up rates. RESULTS: This meta-analysis showed that TEC initiatives significantly improve patient compliance (OR 4.52, 95% CI 2.09 - 9.77, p < .01) and eradication rate (OR 1.98, 95% CI 1.34 - 2.93, p < .01) but not adverse effect rate (OR 0.65, 95% CI [0.27 - 1.57], p = .34). Due to the small number of studies and population sample, patient satisfaction, symptom relief, treatment costs, disease awareness, and follow-up rates were assessed qualitatively. CONCLUSION: TEC initiatives effectively improve compliance to the H. pylori eradication regime and increase the eradication rate.

A high-risk airway mycobiome is associated with frequent exacerbation and mortality in COPD.

INTRODUCTION: The chronic obstructive pulmonary disease (COPD) bacteriome associates with disease severity, exacerbations and mortality. While COPD patients are susceptible to fungal sensitisation, the role of the fungal mycobiome remains uncertain. METHODS: We report the largest multicentre evaluation of the COPD airway mycobiome to date, including participants from Asia (Singapore and Malaysia) and the UK (Scotland) when stable (n=337) and during exacerbations (n=66) as well as nondiseased (healthy) controls (n=47). Longitudinal mycobiome analysis was performed during and following COPD exacerbations (n=34), and examined in terms of exacerbation frequency, 2-year mortality and occurrence of serum specific IgE (sIgE) against selected fungi. RESULTS: A distinct mycobiome profile is observed in COPD compared with controls as evidenced by increased α-diversity (Shannon index; p<0.001). Significant airway mycobiome differences, including greater interfungal interaction (by co-occurrence), characterise very frequent COPD exacerbators (three or more exacerbations per year) (permutational multivariate ANOVA; adjusted p<0.001). Longitudinal analyses during exacerbations and following treatment with antibiotics and corticosteroids did not reveal any significant change in airway mycobiome profile. Unsupervised clustering resulted in two clinically distinct COPD groups: one with increased symptoms (COPD Assessment Test score) and Saccharomyces dominance, and another with very frequent exacerbations and higher mortality characterised by Aspergillus, Curvularia and Penicillium with a concomitant increase in serum sIgE levels against the same fungi. During acute exacerbations of COPD, lower fungal diversity associates with higher 2-year mortality. CONCLUSION: The airway mycobiome in COPD is characterised by specific fungal genera associated with exacerbations and increased mortality.

Occam's razor or Hickam's dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal.

BACKGROUND: Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP. AIM: To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system. METHODS: A systematic review was conducted on PubMed, World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021. Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection, age < 18 years old, review articles and retrospective cohort studies. The original 10-item Naranjo scoring system (total score 13) was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction. We modified the original scoring system into a 8-item modified Naranjo scoring system (total score 9) to determine the cause-effect relationship between COVID-19 and AP. A cumulative score was decided for each case presented in the included articles. Interpretation of the modified Naranjo scoring system is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable cause. RESULTS: The initial search resulted in 909 articles, with 740 articles after removal of duplicates. A total of 67 articles were included in the final analysis, with 76 patients which had AP reported to be due to COVID-19. The mean age was 47.8 (range 18-94) years. Majority of patients (73.3%) had ≤ 7 d between onset of COVID-19 infection and diagnosis of AP. There were only 45 (59.2%) patients who had adequate investigations to rule out common aetiologies (gallstones, choledocholithiasis, alcohol, hypertriglyceridemia, hypercalcemia and trauma) of AP. Immunoglobulin G4 testing was conducted in 9 (13.5%) patients to rule out autoimmune AP. Only 5 (6.6%) patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum. None of the patients had other recently diagnosed viral infections apart from COVID-19 infection, or underwent genetic testing to rule out hereditary AP. There were 32 (42.1%), 39 (51.3%) and 5 (6.6%) patients with doubtful, possible, and probable cause-effect relationship respectively between COVID-19 and AP. CONCLUSION: Current evidence is weak to establish a strong link between COVID-19 and AP. Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology.

Carcinosarcoma of gallbladder: A world review.

BACKGROUND: Gallbladder carcinosarcoma is a rare hepatobiliary tumor comprising of both carcinomatous and sarcomatous components. Due to its rarity, the literature with regards to the topic is scarce and currently lacking, spanning less than 100 cases. AIM: To summarize the current literature on gallbladder carcinosarcoma. METHODS: A literature review was performed on the PubMed database using the keywords "Gallbladder" AND "Carcinosarcoma" from 1970 to 2021. Additionally, similar searches were performed on MEDLINE and Web of Science. RESULTS: Risk factors noted include female gender, gallstones and chronic cholecystitis. In the absence of any diagnostic biochemical testing or tumor markers, imaging modality serves as the key initial impression tool, which can be histologically confirmed only post-resection. While surgery is the only curative option, the use of adjunctive chemotherapy has been considered on top of excision in recent years, with some success. CONCLUSION: While this study has taken steps to bridge the gap in the literature, more cases should be reported to further ascertain the current associations and management potential for gallbladder carcinosarcoma.