Clinical practice guideline on the use of single-operator cholangioscopy in the diagnosis of indeterminate biliary stricture and the treatment of difficult biliary stones.

BACKGROUND AND AIMS: Single-operator cholangioscopy (SOC) offer a diagnostic and therapeutic alternative with an improved optical resolution over conventional techniques; however, there are no standardized clinical practice guidelines for this technology. This evidence-based guideline from the Colombian Association of Digestive Endoscopy (ACED) intends to support patients, clinicians, and others in decisions about using in adults the SOC compared to endoscopic retrograde cholangiopancreatography (ERCP), to diagnose indeterminate biliary stricture and to manage difficult biliary stones. METHODS: ACED created a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. Universidad de los Andes and the Colombia Grading of Recommendations Assessment, Development and Evaluation (GRADE) Network supported the guideline-development process, updating and performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The GRADE approach was used, including GRADE Evidence-to-Decision frameworks. RESULTS: The panel agreed on one recommendation for adult patients with indeterminate biliary strictures and one for adult patients with difficult biliary stones when comparing SOC versus ERCP. CONCLUSION: For adult patients with indeterminate biliary strictures, the panel made a conditional recommendation for SOC with stricture pattern characterization over ERCP with brushing and/or biopsy for sensitivity, specificity, and procedure success rate outcomes. For the adult patients with difficult biliary stones the panel made conditional recommendation for SOC over ERCP with large-balloon dilation of papilla. Additional research is required on economic estimations of SOC and knowledge translation evaluations to implement SOC intervention in local contexts.

Retraction: Relationship Between Chronic Kidney Disease Staging and Vitamin D Deficiency: A Retrospective Study.

[This retracts the article DOI: 10.7759/cureus.21221.].

Retraction: Comparison of the Performance of Various Scores in Predicting Mortality Among Patients Hospitalized With COVID-19.

[This retracts the article DOI: 10.7759/cureus.20751.].

Retraction: Comparison of High-Statin Therapy vs Moderate-Statin Therapy in Achieving Positive Low-Density Lipoprotein Change in Patients After Acute Coronary Syndrome: A Randomized-Control Trial.

[This retracts the article DOI: 10.7759/cureus.20710.].

Retraction: Evaluating the Clinical Outcomes of Remdesivir Among Patients Admitted With COVID-19 in a Tertiary Care Hospital.

[This retracts the article DOI: 10.7759/cureus.19487.].

Retraction: The Impact of Charlson Comorbidity Index on Mortality From SARS-CoV-2 Virus Infection.

[This retracts the article DOI: 10.7759/cureus.19937.].

Relationship Between Chronic Kidney Disease Staging and Vitamin D Deficiency: A Retrospective Study.

Introduction Vitamin D deficiency is a rising health issue in patients with chronic kidney disease (CKD). It can lead to serious issues such as rickets, periodontitis, osteoporosis, weakness, muscle ache, and depression. This study was conducted to determine the vitamin D status of patients with CKD in Pakistan and evaluate the correlation between serum vitamin D and renal function progression. Methodology A retrospective study enrolled patients who visited Liaquat National Hospital, Karachi, Pakistan, from January 2015 to January 2021 with a primary diagnosis of CKD. Anthropometric, laboratory, and demographic data were collected from the hospital management information system (HMIS). Results A total of 513 patients with CKD were included in the study. More than 50% of the patients were from stage 3 to stage 5 of CKD while the rest were from stage 1 and stage 2. Significant differences are in relation to calcium, phosphate, and albumin across categories of severity of CKD. Calcium is lowest in stage 5 while phosphate is highest in stage 5. Vitamin D deficiency was found in all participants, but serum vitamin D concentration was lowest in stage 5, i.e., 8.14+6.00. The changing of vitamin D level was associated with the severity of CKD staging (p-value=0.003). Conclusion The current study has shown that vitamin D deficiency, calcium deficiency, and hyperphosphatemia are more common in patients with CKD, but their severity is more common in advanced stages of CKD.

Meta-analysis of incidence and outcomes of life-threatening arrhythmias in takotsubo cardiomyopathy.

BACKGROUND: Takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy is a transient heart condition that clinically resembles an acute coronary syndrome. This study aims to assess the incidence of life-threatening arrhythmias in patients with Takotsubo cardiomyopathy and evaluate the outcomes of patients with life-threatening arrhythmias (LTAs) in Takotsubo cardiomyopathy compared with those without LTA. METHODS: We comprehensively searched the PubMed, Google Scholar, and Embase databases from inception to February 2021. The primary aim of the study was to determine the incidence of LTAs in TC patients. Other outcomes of interest were the odds of in-hospital, long-term mortality, and cardiogenic shock (CS) in TC patients with LTAs versus those without LTAs. For all statistical analyses, ReviewManager and MedCalc were used. RESULTS: Eighteen studies were included in this study involving 55,557 participants (2,185 with LTAs and 53,372 without LTAs). The pooled incidence of LTAs in the patients of TC was found to be 6.29% (CI: 4.70-8.08%; I2 = 94.67%). There was a statistically significant increased risk of in-hospital mortality (OR = 4.74; CI: 2.24-10.04; I2 = 77%, p < 0.0001) and cardiogenic shock (OR = 5.60; CI: 3.51-8.95; I2 = 0%, p < 0.00001) in the LTA group versus the non-LTA group. LTA was not associated with long-term mortality (OR = 2.23; CI: 0.94-5.28; I2 = 53%, p = 0.07). CONCLUSION: The pooled incidence of life-threatening arrhythmias in the patients of TC was found to be 6.29%. In the group of TC patients with LTAs, the odds of in-hospital mortality and CS, was higher than in the TC patients without LTAs.

Prevalence and clinical outcomes of pleural effusion in COVID-19 patients: A systematic review and meta-analysis.

Observational studies indicate that pleural effusion has an association with risk and the clinical prognosis of COVID-19 disease; however, the available literature on this area is inconsistent. The objective of this systematic review and meta-analysis is to evaluate the correlation between COVID-19 disease and pleural effusion. A rigorous literature search was conducted using multiple databases. All eligible observational studies were included from around the globe. The pooled prevalence and associated 95% confidence interval (CI) were calculated using the random effect model. Mantel-Haenszel odds ratios were produced to report overall effect size using random effect models for severity and mortality outcomes. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 23 studies including 6234 COVID-19 patients was obtained. The overall prevalence of pleural effusion in COVID-19 patients was 9.55% (95% CI, I2 = 92%). Our findings also indicated that the presence of pleural effusions associated with increased risk of severity of disease(OR = 5.08, 95% CI 3.14-8.22, I2 = 77.4%) and mortality due to illness(OR = 4.53, 95% CI 2.16-9.49, I2 = 66%) compared with patients without pleural effusion. Sensitivity analyses illustrated a similar effect size while decreasing the heterogeneity. No significant publication bias was evident in the meta-analysis. The presence of pleural effusion can assist as a prognostic factor to evaluate the risk of worse outcomes in COVID-19 patients hence, it is recommended that hospitalized COVID-19 patients with pleural effusion should be managed on an early basis.

Evaluating the Clinical Outcomes of Remdesivir Among Patients Admitted With COVID-19 in a Tertiary Care Hospital.

INTRODUCTION: This study was conducted to determine whether remdesivir administration for treatment of coronavirus disease 2019 (COVID-19) is associated with reducing deaths among COVID-19 hospitalized patients. METHODOLOGY: It was a retrospective study, and the data was acquired at Ziauddin Hospital in Karachi, Pakistan. All patients admitted between February and May 2021 with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection confirmed by polymerase chain reaction testing from nasopharyngeal samples were included in the study, including those who received at least five-day treatment of remdesivir and who did not receive even a single dose of remdesivir. RESULTS: Data of overall 174 patients were used, out of which 71 (40.80%) received remdesivir. After propensity score matching, 71 patients in the remdesivir group were successfully matched with the non-remdesivir patients on the basis of age, gender, and disease severity. Results of multivariable logistic regression showed that there is no significant difference in deaths between patients who received remdesivir and patients who did not receive remdesivir (p-value=0.122). However, the length of hospital stay was significantly lower in the remdesivir group than in the control group (p-value=0.001). CONCLUSION: Results of this study can provide evidence that remdesivir can be efficient in reducing the duration of COVID-19 illness, and a five-day course of treatment is sufficient for patients to get clinical benefits.

Metastatic Breast Cancer Presenting as Pulmonary Nodules and Right Axillary Lymph Node in a Male with Chronic Lymphocytic Leukemia.

To our knowledge, this is the first case reported in the English literature of simultaneous occult male metastatic breast cancer presenting as pulmonary nodules and right axillary lymph node metastasis in a chronic lymphocytic leukemia (CLL) patient and is the second case of simultaneous male breast cancer and CLL reported. The first case was reported by Dubashi et al. [Curr Oncol. 2011;18(2):e101-2] in 2011. This unique clinical and pathological entity presents various challenges in its management, including early detection, screening, and treatment.

Comparison of High-Statin Therapy vs Moderate-Statin Therapy in Achieving Positive Low-Density Lipoprotein Change in Patients After Acute Coronary Syndrome: A Randomized-Control Trial.

INTRODUCTION: Statin use in secondary prevention after acute coronary syndrome (ACS) can play an important role in enhancing clinical outcomes, this has been proven in several randomized trials. This study was conducted to compare the efficacy of moderate-intensity and high-intensity statins in controlling low-density lipoprotein (LDL) after ACS. METHODOLOGY: A randomized control trial was conducted at the Cardiology Department of Liaquat National Hospital, Karachi, Pakistan, from July 2020 to September 2021. During admission, patients were either started on a high-intensity statin dose (rosuvastatin 20 mg) or moderate-intensity statin (rosuvastatin 10 mg) by a computer-generated allocation sequence. Patients were followed-up in the outpatient department (OPD) after 3 months, and a lipid profile at follow-up was obtained. The percentage of LDL change was determined on 3 months of follow-up. RESULTS: A total of 590 patients were enrolled in the study. Out of all participants enrolled, 334 (80.48%) completed the 3-month follow-up. The mean age of participants was 58.08 (+12.06) years. High-intensity statin therapy is positively associated with positive LDL change (adjusted odds ratio [AOR]=4.45, P-value=0.001). CONCLUSION: Our data implies that high-intensity statin medication may be an initial therapeutic option to decrease LDL. However, future randomized clinical trials should corroborate these findings.

Comparison of the Performance of Various Scores in Predicting Mortality Among Patients Hospitalized With COVID-19.

Introduction Coronavirus disease 2019 (COVID-19) is a major social and economic challenge, devastating the health care system in several countries around the world. Mortality scores are important as they can help health care professionals to plan treatment as per the patients' condition for proper resource allocation. When it comes to patients, it provides invaluable information for implementing advance directives. The aim of the study is to validate mortality scores for predicting in-hospital mortality in patients with COVID-19. Methodology This was a retrospective cohort study that included data from three tertiary care hospitals in Karachi, Pakistan. Data of patients diagnosed with confirmed COVID-19 infection and hospitalized in Ziauddin Hospital, Aga Khan Hospital, and Liaquat National Hospital were enrolled in the study from November 1, 2020, to April 30, 2021. Data was extracted from the hospital management information system (HMIS) using a structured questionnaire. Results Overall, 835 patients were included in the final analysis. The mean age of patients was 53.29 (SD ± 15.17) years, and 675 patients (80.72%) were males. The sensitivity of the CALL score is highest among all four scores, i.e., 77.25%, and the quick Sequential Organ Failure Assessment (qSOFA) score has the lowest sensitivity (59.79%). However, CALL has the lowest specificity (58.04%), while qSOFA has the highest specificity (73.91%). However, MulBSTA and CRB-65 have a sensitivity of 70.11% and 64.96%, respectively. Conclusion The current study showed that the CALL score had better sensitivity as compared to other mortality scores.

19p13.3 Deletion With Polyotia: A Case Report and Literature Review.

Mutations at chromosome 19 are rare, and reports in the literature are scarce and clinically variable. This chromosome has a high genetic density, and hence a given deletion can cause distinctive effects on body systems and, in addition, result in a characteristic phenotype.  We report the case of a patient who presented with distinctive signs and symptoms such as delayed psychomotor development, severe postnatal delay, dolichocephaly, polyotia, and ocular hypertelorism. Even though all cases with a chromosome 19 deletion do not present in the same way, they still share some clinical manifestations that should be considered, which prompted us to present a summary of the available literature on the subject. Additionally, to our knowledge, this is the first and only case with polyotia in its phenotype to be reported in Colombia to date.

The Impact of Charlson Comorbidity Index on Mortality From SARS-CoV-2 Virus Infection.

INTRODUCTION: Charlson Comorbidity Index (CCI) is a simple, validated, and readily acceptable method of determining the risk of mortality from comorbid disease. It has been used as a predictor of long-term survival and prognosis. The aim of this study is to determine the impact of CCI score on mortality in COVID-19 hospitalized patients and test the efficacy of the CoLACD score (COVID-19 lymphocyte ratio, age, CCI score, dyspnoea) in predicting mortality among hospitalized COVID-19 patients. METHODOLOGY: It was a retrospective cohort, and the data of this study were gathered from two tertiary hospitals of Karachi, including Liaquat National Hospital and Ziauddin Hospital. Data of patients hospitalized in any of these tertiary care hospitals and diagnosed with confirmed COVID-19 infection were used in the study from January 15, 2021, to April 30, 2021. RESULTS: The mean age of participants was 53.22 (±14.21) years. The majority of participants were males (74.91%). Predictors of mortality include CCI score, age of participants, D-dimer, smoking status, and shortness of breath. The sensitivity of this CoLACD score was 80.23%, and specificity was 50.23% (diagnostic accuracy is 60.45%). The negative predictive value (NPV) of this test was 39.44%, and the positive predictive value (PPV) was 83.01%. CONCLUSION: Our study showed that CCI can be used in a clinical setting to achieve a prediction of mortality in COVID-19 patients.