Relamorelin in Gastroparesis and Diabetic Gastroparesis: A Meta-Analysis on Its Efficacy and Safety.

This meta-analysis aimed to evaluate the efficacy and safety of relamorelin, a synthetic ghrelin receptor agonist, for the treatment of gastroparesis and diabetic gastroparesis. A total of 1,033 participants from five randomized controlled trials were included. The primary outcome was the mean change in gastric emptying time from baseline. Relamorelin demonstrated a statistically significant improvement in gastric emptying time with a mean difference of -11.40 minutes compared to the placebo group. Furthermore, a significant improvement was observed specifically in diabetic gastroparesis patients, with a mean difference of -8.43 minutes. However, adverse effects, such as headaches, dizziness, and gastrointestinal symptoms, were more prevalent in the relamorelin group. Despite these adverse effects, the study concludes that relamorelin offers a promising avenue for gastroparesis treatment, especially given the limited existing therapeutic options. This comprehensive meta-analysis synthesizes existing evidence to inform clinical practice and guides future research in this domain.

The impact of aspirin use on outcomes in patients with inflammatory bowel disease: Insights from a national database.

BACKGROUND: Inflammatory bowel disease (IBD) is an inflammatory disorder that can increase the risk of mortality. Aspirin is an anti-inflammatory drug used for primary prevention of cardiovascular events. A single center analysis previously reported that aspirin use did not impact major outcomes in IBD. In this study, we aim to assess the impact of aspirin use on mortality and other outcomes in patients with IBD using national data. METHODS: National inpatient sample (NIS) 2016-2020 was used to identify adult patients with IBD. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, Intensive Care Unit (ICU) admission, and need for surgery. Multivariate logistic regression analysis was performed. RESULTS: A total of 1,524,820 IBD hospitalizations were included. Of these, 137,430 (9%) were long-term aspirin users. The majority of the patients in the aspirin group were aged > 65 years (34.11%), female (56.37%), White (78.83%) and had Medicare insurance (36.77%). Aspirin users had a lower incidence of in-hospital mortality (1.6% vs 1.4%, P = 0.06), sepsis (2.5% vs 2.9%, P < 0.001), shock (2.9% vs 3.4%, P < 0.001), ICU admission (2.6% vs 2.9%, P < 0.001), need for surgery (2.1% vs 4.2%, P < 0.001). After adjusting for confounders, aspirin was associated with a reduction in mortality (adjusted odds ratio: 0.49, 95%CI 0.45-0.55, P < 0.001). CONCLUSION: Our study reports that aspirin use among patients with IBD was associated with a lower risk of death, sepsis, and shock. Aspirin use may have a protective effect in patients with IBD. Further studies are needed to confirm these results.

Artificial Intelligence in the Detection of Barrett's Esophagus: A Systematic Review.

Barrett's esophagus (BE) remains a significant precursor to esophageal adenocarcinoma, requiring accurate and efficient diagnosis and management. The increasing application of machine learning (ML) technologies presents a transformative opportunity for diagnosing and treating BE. This systematic review evaluates the effectiveness and accuracy of machine learning technologies in BE diagnosis and management by conducting a comprehensive search across PubMed, Scopus, and Web of Science databases up to the year 2023. The studies were organized into five categories: computer-aided systems, natural language processing and text-based systems, deep learning on histology and biopsy images, real-time and video analysis, and miscellaneous studies. Results indicate high sensitivity and specificity across machine learning applications. Specifically, computer-aided systems showed sensitivities ranging from 84% to 100% and specificities from 64% to 90.7%. Natural language processing and text-based systems achieved an accuracy as high as 98.7%. Deep learning techniques applied to histology and biopsy images displayed sensitivities up to greater than 90% and a specificity of 100%. Furthermore, real-time and video analysis technologies demonstrated high performance with assessment speeds of up to 48 frames per second (fps) and a mean average precision of 75.3%. Overall, the reviewed literature underscores the growing capability and efficiency of machine learning technologies in diagnosing and managing Barrett's esophagus, often outperforming traditional diagnostic methods. These findings highlight the promising future role of machine learning in enhancing clinical practice and improving patient care for Barrett's esophagus.

Acute Delirium Post-inguinal Hernia Mesh Repair in a 40-Year-Old Male: An Unusual Case of Cystocerebral Syndrome.

Acute urinary retention is a known complication of inguinal hernia repair. However, the development of severe agitation and delirium as a result of acute urinary retention following inguinal hernia repair is less commonly reported. Here, we present the case of a 40-year-old male with no relevant medical history who underwent open mesh hernia repair for an uncomplicated left-sided indirect inguinal hernia. Postoperatively, the patient became hypertensive, delirious, and violent. He was found to have urinary retention on a bladder scan. Urgent intervention with catheterization and bladder decompression resulted in the prompt resolution of the patient's symptoms. The patient regained his senses and did not remember the events that led to it. This case highlights the importance of recognizing and managing acute urinary retention to prevent the development of severe agitation and delirium following spinal anesthesia. Further research and awareness are necessary to better understand the underlying neurovisceral mechanisms and optimize preventive strategies.

Right Atrial Thrombus and Submassive Pulmonary Embolism in a COVID-19-Infected Patient: A Case Report.

Coronavirus disease 2019 (COVID-19) is primarily a respiratory infection, but it undoubtedly results in systemic illness that affects multiple systems. The high incidence of thromboembolic events is one distinctive clinical characteristic of COVID-19. This case report is about a unique clinical presentation of a 40-year-old homeless female with polysubstance abuse, who was diagnosed with a right atrial thrombus, sub-massive pulmonary embolism, and COVID-19 infection. The patient presented with shortness of breath, subjective fevers, generalized swelling, and chest and upper abdominal pain. Initially, she was treated with tissue plasminogen activator (TPA) and heparin drip for her thrombi, and she was managed conservatively when hemoptysis ensued post-TPA. She was later sent to a higher level of care for surgical embolectomy. In most cases, severe pulmonary parenchymal disease secondary to COVID-19 correlates with the severity of thromboembolic complications, however, in our case report, there was a right atrial thrombus and pulmonary embolism in the absence of COVID pneumonia. This highlights how notorious COVID-19 infections can be.

Herpes Simplex Virus Meningoencephalitis Masquerading as Acute Stroke With Broca's Aphasia: A Case Report.

This case report presents a rare and unique instance of a 70-year-old morbidly obese female with type 2 diabetes mellitus and bilateral lymphedema, who presented with fever and expressive aphasia, initially suspected to be a stroke. A negative CT scan prompted the performance of an MRI, which revealed suggestive imaging findings of herpes encephalitis. Following the MRI, the patient experienced seizures and required intubation in the intensive care unit. Subsequently, a lumbar puncture was performed, confirming the diagnosis of herpes simplex virus (HSV) meningoencephalitis. Prompt initiation of acyclovir therapy led to an improvement in aphasia, ultimately allowing for extubation and transfer to the general ward. The rarity of this case lies in the unusual manifestation of Broca's aphasia caused by HSV, which is not typically associated with this neurological deficit. This report highlights the importance of considering herpes encephalitis as a potential etiology in patients presenting with atypical neurological symptoms, even in the absence of typical radiological findings. Early diagnosis and appropriate management with acyclovir are crucial in improving outcomes in such cases.

Pericardial Cyst in Birt-Hogg-Dubé Syndrome: An Unexpected Discovery.

Birt-Hogg-Dubé syndrome (BHD) is a genetic disorder typically characterized by pulmonary cysts, cutaneous fibrofolliculomas, and renal tumors. We report a case of an 87-year-old male patient with a known diagnosis of BHD and a large pericardial cyst who presented to the emergency room with chest pain. BHD is classically associated with pulmonary cysts and not pericardial cysts. In this report, we highlight the potential of pericardial cysts to independently cause retrosternal pain resembling angina, while also mentioning that BHD too can cause chest pain through the rupture of a pulmonary cyst leading to spontaneous pneumothorax. In our case, coronary angiography revealed non-obstructive coronary arteries, so the cause of chest pain was attributed to myocardial infarction with non-obstructive coronary arteries (MINOCA). Atypical causes of chest pain should be considered, especially in patients with diagnosed genetic syndromes.

Hepatopulmonary Syndrome in a Patient With Autoimmune Hepatitis and Chronic Hepatitis C: A Case Report Highlighting Typical Echo Findings.

Hepatopulmonary syndrome (HPS) is a rare complication of liver disease characterized by intrapulmonary vascular dilatations leading to arterial hypoxemia. We present the case of a 59-year-old female with a past medical history of bilateral breast cancer status post mastectomy who presented with progressive dyspnea on exertion and fatigue. A comprehensive diagnostic workup was conducted to exclude other cardiac, pulmonary, and systemic etiologies. She was diagnosed with autoimmune hepatitis along with chronic hepatitis C. Echocardiography revealed characteristic findings of intrapulmonary shunting characteristic of HPS. The patient showed improvement in pulmonary symptoms and oxygenation status following the initiation of steroid therapy. Although corticosteroids are not the definitive treatment for HPS, they were considered a supportive measure in this case. However, it is important to note that liver transplantation remains the definitive treatment for HPS. This case underscores the importance of echocardiography and the potential role of supportive measures, like corticosteroids, in managing HPS-related symptoms, particularly in patients with autoimmune hepatitis, as a bridging therapy while awaiting liver transplantation.

Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report.

A 60-year-old male patient who presented with right upper quadrant (RUQ) pain was diagnosed with acute cholecystitis after an ultrasound of the abdomen revealed multiple gallstones, gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign. The patient was admitted, administered IV fluids, antibiotics, and pain relief, and scheduled for laparoscopic cholecystectomy. During surgery, an incidental finding of ectopic liver tissue attached to the gallbladder was noted. Histopathology confirmed the presence of chronic cholecystitis and multifaceted cholesterol stones. Normal liver tissue was noted in the ectopic mass. Ectopic liver tissue is defined as liver tissue located outside the main liver parenchyma and is usually asymptomatic. They are usually detected at the time of autopsies, incidentally during surgeries, or during imaging done for other etiologies. They can occur at various sites in the body. Ectopic liver tissue can cause potential complications such as hepatocellular carcinoma and torsion, and in the event that they are incidentally detected, it is advised to remove them. The case report highlights the importance of dealing with incidental findings during laparoscopic cholecystectomy and creating awareness about it.

Family physicians' knowledge and awareness regarding oral health: A survey.

INTRODUCTION: Oral health is an important component of general health. The World Health Organization has highly recommended the integration of oral health promotion into general health care. In majority of the cases, patients visit their physicians with simultaneous oral and systemic complaints, and primary oral complaints are more frequently encountered. Therefore, primary care physicians can play an expanded role within oral health care to raise the overall health of the patients. AIM: This study aimed to assess the knowledge and awareness of family physicians regarding oral health. MATERIALS AND METHODS: An observational (cross-sectional) study was conducted among 250 family physicians who are practicing in Tricity. A self-structured questionnaire (close-ended) prepared by a panel of oral health experts in English language (close-ended) was administered to the study participants. The questionnaire which was divided into two parts, A and B, contained 15 questions on knowledge and awareness regarding oral health. Categorization of knowledge scores was done at three levels: low, medium, and high. Statistical analysis was performed using analysis of variance and Student's t-test. RESULTS: Males comprised 72.8% (182) of the study population and 55.2% (138) of the participants were doing combined practice (academic and private both). Low knowledge scores were reported in 47.2% (118) of the participants whereas only 22.4% (56) of participants had a high score. The mean knowledge score according to educational level and working profile was statistically significant (P < 0.05). CONCLUSION: The results of our study showed a considerable lack of knowledge among family physicians regarding connection of oral health with general health. Therefore, there is an urgent need to increase their knowledge by various continued medical education and training programs.

Knowledge and Awareness Regarding Swine-Influenza A (H1N1) Virus Infection among Dental Professionals in India - A Systematic Review.

INTRODUCTION: Swine flu or Influenza A (H1N1) flu is the most recent of the pandemic disease that has affected the world's population. We, as health care providers should feel responsible for reducing the transmission of influenza. AIM: To conduct a systematic review of observational studies and to assess dental professionals' knowledge and awareness regarding swine flu. MATERIALS AND METHODS: Relevant cross-sectional observational studies were included in the systematic review to assess the level of knowledge and awareness regarding swine flu among dental professionals. Three studies out of 28 were finally included in the present review after conducting both electronic and manual search of scientific databases like Pubmed, Medline, and EMBASE. No limitation in terms of publication date and language was considered. Potential biases were reported and appropriate data were extracted by the concerned investigators. Descriptive statistics, student t-test were used for analysis. RESULTS: Majority of the subjects (92.6%) had heard about swine flu, and 64.3% of them knew about the H1N1 virus in one of the study reports. More than 80% of subjects were aware regarding the availability of swine flu vaccine in one study reports as compared to another study in which only 31.5% had awareness. Majority of the subjects were of the opinion that frequent hand washing and use of sanitizer are one of the effective methods to prevent swine flu in all the three studies. CONCLUSION: The results of the present review showed that some knowledge gaps existed among dental professionals regarding swine flu. Therefore, there is an urgent need for training and continuous education programs regarding infectious diseases.

Evaluation of serum calcium and serum parathyroid levels in post-menopausal women with and without oral dryness.

OBJECTIVE: The primary objective of this study was to estimate and secondary objective was to compare the serum calcium levels and serum parathyroid hormone (PTH) levels in post-menopausal women with and without oral dryness (OD). MATERIALS AND METHODS: A case-control study was carried out on 80 selected post-menopausal women. Salivary flow was assessed by flow rate; serum calcium concentrations were assessed through Semi Autoanalyzer by Arsenazo III reaction. The serum PTH concentration was measured by the enzyme-linked immunosorbent assay. Severity of OD was assessed by a questionnaire through which the xerostomia inventory (XI) score could be measured. Statistical analysis of Student's t-test, Mann-Whitney test and Pearson's correlation was used. RESULTS: There was a significant difference in mean values of both serum PTH concentration and XI score in post-menopausal women with/without OD (p < 0.001). No statistically significant difference (p = 0.354) was found in salivary flow rate and serum calcium levels in post-menopausal women in both groups. A positive correlation was found between the serum PTH and XI score in both case and control groups (p < 0.05). CONCLUSION: Severity of oral dryness in post-menopausal women is associated with the high levels of serum PTH. However, the correlation of severity of OD with serum calcium could not be established.

Saliva as a tool in the detection of hepatitis B surface antigen in patients.

Viral hepatitis is one of the world's most common viral illnesses. Hepatitis B virus infection is a global health problem, and its importance in dentistry is well recognized. The role of saliva in the transmission of hepatitis B makes dentists and dental personnel particularly vulnerable to hepatitis B infection. The objective of this study was to predict the efficacy of saliva as a tool for the detection of hepatitis B surface antigen (HBsAg), which is the hallmark of the infection. The study group comprised 70 patients, 35 of whom were known to be hepatitis B infection seropositive (test group) and the remaining 35 who did not have hepatitis B (control group). All of the subjects were tested with enzyme-linked immunosorbant assay. Of the 35 seropositive subjects, HBsAg was detected in the saliva samples of 26 subjects. The sensitivity and specificity of saliva as a diagnostic tool for detecting HBsAg antigen in this study was 74.29% and 100%, respectively. Because of its noninvasive nature, saliva can be effectively used for large-scale Hepatitis B virus detection.

Correlation of serum oestrogen with salivary calcium in post-menopausal women with and without oral dryness feeling.

OBJECTIVE: The aim of this study was to verify the association between salivary calcium and serum oestrogen levels with oral dryness in post-menopausal women. Also, the correlation between these variables was evaluated. METHODS: A case-control study was carried out on 60 selected menopausal women with and without oral dryness feeling (30 as case and 30 as control) conducted in the Department of Oral Medicine and Radiology, Maharishi Markandeshar University, Mullana, India. Paraffin-stimulated saliva samples were obtained by expectoration. Salivary calcium concentrations were assessed colorimetrically using Arsenazo III reaction. The serum oestrogen concentration was measured using ELISA. Statistical analysis of Student's t-test and Pearson correlation was used. RESULTS: There was significant difference in mean values of both salivary calcium concentration and serum oestrogen between case and control groups. The result obtained also showed that an inverse correlation was found between salivary calcium concentration and serum oestrogen levels in both the groups and in total sample size. CONCLUSION: Oral dryness in post-menopausal women is associated with high levels of salivary calcium and low levels of serum oestrogen. The concentrations of salivary calcium and serum oestrogen are inversely correlated in post-menopausal women, regardless of the presence or absence of oral dryness.