Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Background/Aims@#Sigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus. @*Methods@#A literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups’ analysis of continuous outcome standardized mean difference was used as the summary measure. @*Results@#Eleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I 2 = 0%], 98.47% [95% CI, 92.72-99.69; I 2 = 0%] and 87.92% [95% CI, 80.68-92.70; I 2 = 37%], 88.36% [95% CI, 62.62-97.17; I 2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I 2 = 0%) and 88.66% (95% CI, 81.65-91.22; I 2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06). @*Conclusions@#POEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megae sophagus.

Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis

Background/Aims@#Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. @*Methods@#We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. @*Results@#Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively. @*Conclusions@#The clinical presentation of COVID-19 in IBD patients is similar to the general population.

An Explainable Artificial Intelligence based Prospective Framework for COVID-19 Risk Prediction

Given the spread of COVID-19 to vast geographical regions and populations, it is not feasible to undergo or recommend the RT-PCR based tests to all individuals with flu-like symptoms. The reach of RT-PCR based testing is still limited due to the high cost of the test and huge population in few countries. Thus, alternative methods for COVID-19 infection risk prediction can be useful. We built an explainable artificial intelligence (AI) based integrated web-based prospective framework for COVID-19 risk prediction. We employed a two-step procedure for the non-clinical prediction of COVID19 infection risk. In the first step we assess the initial risk of COVID19 infection based on carefully selected parameters associated with COVID-19 positive symptoms from recent research. Generally, X-ray scans are cheaper and easily available in most government and private health centres. Therefore, based on the outcome of the computed initial risk in first step, we further provide an optional prediction using the chest X-ray scans in the second step of our proposed AI based prospective framework. Since there is a bottleneck to undergo an expensive RT-PCR based confirmatory test in economically backward nations, this is a crucial part of our explainable AI based prospective framework. The initial risk assessment outcome is analysed in combination with the advanced deep learning-based analysis of chest X-ray scans to provide an accurate prediction of COVID-19 infection risk. This prospective web-based AI framework can be employed in limited resource settings after clinical validation in future. The cost and time associated with the adoption of this prospective AI based prospective framework will be minimal and hence it will be beneficial to majority of the population living in low-income settings such as small towns and rural areas that have limited access to advanced healthcare facilities.

Gastrointestinal histoplasmosis: a case series from a non-endemic region in North India

No abstract available.

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers

Recent studies have identified sprue-like illness associated with the use of the antihypertensive agent olmesartan medoxomil. However, whether this condition is specific to the use of olmesartan or is associated with the use of drugs belonging to the class of “sartans” remains to be clarified. A 45-year-old woman with chronic kidney disease along with hypothyroidism and hypertension presented with chronic diarrhea and significant weight loss. Endoscopy of the upper gastrointestinal tract showed scalloping and grooving of the duodenum, and histopathological examination showed subtotal villous atrophy. She was on telmisartan for hypertension, which was discontinued. Subsequently, diarrhea ameliorated dramatically, and she regained weight. To our knowledge, this is the first study to report telmisartan-associated sprue-like enteropathy. Further, we have reviewed the cases of patients with sprue-like enteropathy caused by valsartan, irbesartan, and eprosartan.

Alois Alzheimer (1864-1915) and the Alzheimer syndrome.

Alois Alzheimer is known for his seminal work in recognizing a form of presenile dementia. His early interests were natural history and botany. He started his medical education in Berlin and attended the universities of Wurzburg and Tübingen. Nissl and Alzheimer worked together on extensive investigation of the pathology of the nervous system, especially the anatomy of the cerebral cortex. In 1902 Emil Kraepelin invited Alzheimer to work with him in the university psychiatric clinic in Heidelberg. In 1903 both moved to work in the university psychiatric clinic in Munich. It was during these years that Alzheimer described the Alzheimer's disease. He also described brain changes in arteriosclerosis, loss of nerve cells in Huntington's disease in the corpus striatum and brain changes in epilepsy. Alzheimer presented a preliminary report of his histological findings in 1906 at Tübingen about a 51-year-old lady who had developed presenile dementia and died within four years of onset of the disease. He published his findings in 1907, reporting the atrophic brain with neurofibrillary deposits and areas in the cerebrum resistant to staining. During the later years of his career Alzheimer concentrated on the study of changes in glial cells. His best-known works from this period were on Westphal-Strümpell pseudo-sclerosis of the brain, now assumed to be the same as Wilson's Disease. His death, at age 51, was the result of cardiac failure following endocarditis.