Human Fascioliasis a Silent Menace: Case Report With Review of Literature

Fascioliasis is a tropical zoonotic disease caused by liver flukes (Fasciola hepatica and Fasciola gigantica) mostly in sheep, goats, and cattle. It is a prevalent infection in developing countries like Bolivia, Peru, and Egypt, affecting both humans and livestock. It remains under-reported due to lack of awareness. Humans accidentally acquire it by consuming contaminated watercress or water contaminated with infective metacercaria. It affects the hepatobiliary system, manifesting as tender hepatomegaly, bile duct obstruction, liver fibrosis, and secondary cholangitis. Diagnosing fascioliasis is a challenge as it presents with nonspecific symptoms like prolonged fever, anorexia, ascites, and with limited availability of testing. Triclabendazole, currently the only approved drug, is unavailable in India. Fascioliasis has been reported only in reports from India. We here report a case of a 4-year-old patient who presented with fever and tender hepatomegaly. Hepatobiliary imaging showed infiltrative liver disease with small cystic lesions and periportal thickening. Liver biopsy showed microabscesses with eosinophilic infiltration. The patient was tested for Fasciola IgG antibody, which was positive. Triclabendazole was procured from Geneva for treatment. Through this report, we highlight this neglected parasitic infection that presented in a nonendemic region that needs improved diagnostic tools, increased awareness, and control measures to mitigate the disease.

Role of nutrient supplements in children with post-COVID condition: a retrospective preliminary observation and narrative review

BACKGROUND

Post-COVID Condition (PCC), emerging as a significant long-term consequence of SARS-CoV-2 infection, affects not only adults but also the pediatric population. Despite ongoing research, the precise pathophysiology of PCC remains elusive. However, several putative mechanisms have been identified, leading to the exploration of various therapeutic strategies. Notably, in the adult population, there has been substantial interest in the potential efficacy of nutritional supplements. Regrettably, information regarding the use of such supplements in the pediatric population is currently lacking.

METHODS

The present study was conducted to assess the impact of nutritional supplements on alleviating long COVID symptoms in children. To achieve this, we conducted a retrospective analysis of nutrient supplements administered by parents to children with Post-COVID Condition (PCC) between February 2020 and October 2022. Statistical analyses were employed to determine associations between categorical variables.

RESULTS

A total of 1243 children were enrolled following documented SARS-CoV-2 infection, with 940 (76.2%) diagnosed as recovered and 294 (23.8%) diagnosed with Long COVID. Among Long COVID patients experiencing disabling symptoms, treatment with oral lactoferrin and/or a Multi-Element Product (MEP) with antioxidant and anti-inflammatory properties was initiated. The correlation analysis between the use of supplements and persistence of long COVID at the next follow-up showed that the use of MEP alone (OR 5.7, 95% CI 3.8-8.5), or the combination of MEP and lactoferrin (OR 5.06, 95% CI 3.3-7.6) three months after the initial infection and for the following three months, were associated with a lower risk having long covid at six months following initial infection, when compared with the use of lactoferrin alone (OR 7.6 95% CI 5.1-11.4).

CONCLUSIONS

This proof-of-concept study revealed that MEP and lactoferrin, when administered three months after initial infection in patients with a new diagnosis of long covid, may have a positive impact on improving Long COVID symptoms in children during follow-up evaluations. This positive trend toward reducing Post-COVID Condition (PCC) exhibited by MEP and lactoferrin suggested a potential benefit worthy of exploration in future randomized controlled trials.

Does endoscopic management have a role in chronic radiation proctopathy: A systematic review

AIM

Chronic radiation proctopathy (CRP) is a significant side-effect of radiotherapy, and poses a challenge in clinical management, necessitating effective and standardized therapeutic approaches. The aim of this review is to investigate the role of endoscopic interventions for CRP, focusing on argon plasma coagulation (APC) and formalin application.

METHOD

A literature search was undertaken for studies that investigated the clinical responses to endoscopic management in patients with CRP. A systematic review was performed in accordance with PRISMA guidelines, and a meta-analysis of proportions was conducted with a random-effects model. ROBINS-I and the Cochrane Collaboration's tool were used to assess risk of bias in cohort studies and randomized control trials, respectively.

RESULTS

A total of 82 studies met the inclusion criteria, including 11 randomized control trials, 20 systematic reviews, one cohort study and 50 case series. A robust 89% (95% CI 84%-92%, p < 0.01 and 95% CI 84%-93%, p = 0.03) pooled response rate was demonstrated for both APC and formalin therapies, respectively. Adverse effects were generally minimal.

CONCLUSION

Endoscopic therapies, particularly APC and formalin, exhibit commendable clinical response rates in the management of CRP. However, the lack of standardized treatment protocols highlights the need for larger prospective studies. Clear guidelines, informed by defined outcomes and quality-of-life assessments, are imperative for enhancing patient outcomes and minimizing the morbidity associated with CRP.

Epidemiology of Hepatitis D Virus and Associated Factors in Patients Referred to Level Three Hepatitis Clinic, Fars Province, Southern Iran

Background

Hepatitis D is caused by the hepatitis D virus (HDV) and affects those who have already been infected with the hepatitis B virus (HBV). The epidemiology of hepatitis D in Fars Province, Iran, is poorly understood. This study aimed to investigate the epidemiology of HDV and its associated factors in patients attending Shahid Motahari Clinic, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran).

Methods

This prospective cohort study was conducted in Shiraz, Iran, from 2001 to 2023. This study screened individuals with low HBV viral load and elevated liver enzymes for HDV. Pearson Chi square, Fisher's exact, and Mann-Whitney U tests were used to examine the univariate associations between hepatitis D and various risk factors. Risk factors with P<0.2 were analyzed using multiple logistic regression to estimate odds ratios and 95% confidence intervals. P<0.05 was considered statistically significant.

Results

The variables were compared between the HDV+ (29) and HDV- (108). The variables of age (P=0.002) and using hookah (P=0.040) were statistically significant. The other variables examined in this study were not statistically significant. Increasing age (OR=1.06, 95% CI=[1.019, 1.102], P=0.003) was identified as a risk factor, while dental visits (OR=0.290 95% CI=[0.101, 0.836], P=0.022) were assessed as a protective factor.

Conclusion

Age was a significant risk factor for HDV infection, while a history of dental procedures appeared to be a protective factor. To better understand the epidemiology of HDV, further comprehensive research is necessary, focusing on diverse demographic groups in different regions.

Selective Modulation of PAR-2-Driven Inflammatory Pathways by Oleocanthal: Attenuation of TNF-α and Calcium Dysregulation in Colorectal Cancer Models

Colorectal cancer (CRC) remains a principal contributor to oncological mortality worldwide, with chronic inflammation serving as a fundamental driver of its pathogenesis. Protease-activated receptor-2 (PAR-2), a G-protein-coupled receptor, orchestrates inflammation-driven tumorigenesis by potentiating NF-κB and Wnt/β-catenin signaling, thereby fostering epithelial-mesenchymal transition (EMT), immune evasion, and therapeutic resistance. Despite its pathological significance, targeted modulation of PAR-2 remains an underexplored avenue in CRC therapeutics. Oleocanthal (OC), a phenolic constituent of extra virgin olive oil, is recognized for its potent anti-inflammatory and anti-cancer properties; however, its regulatory influence on PAR-2 signaling in CRC is yet to be elucidated. This study interrogates the impact of OC on PAR-2-mediated inflammatory cascades using HT-29 and Caco-2 CRC cell lines subjected to lipopolysaccharide (LPS)-induced activation of PAR-2. Expression levels of PAR-2 and TNF-α were quantified through Western blotting and RT-PCR, while ELISA assessed TNF-α secretion. Intracellular calcium flux, a pivotal modulator of PAR-2-driven oncogenic inflammation, was evaluated via Fluo-4 calcium assays. LPS markedly elevated PAR-2 expression at both mRNA and protein levels in CRC cells (p < 0.01, one-way ANOVA). OC administration (20-150 μg/mL) elicited a dose-dependent suppression of PAR-2, with maximal inhibition at 100-150 μg/mL (p < 0.001, Tukey's post hoc test). Concomitant reductions in TNF-α transcription (p < 0.01) and secretion (p < 0.001) were observed, corroborating the anti-inflammatory efficacy of OC. Additionally, OC ameliorated LPS-induced calcium dysregulation, restoring intracellular calcium homeostasis in a concentration-dependent manner (p < 0.01). Crucially, OC exhibited selectivity for PAR-2, leaving PAR-1 expression unaltered (p > 0.05), underscoring its precision as a therapeutic agent. These findings position OC as a selective modulator of PAR-2-driven inflammation in CRC, disrupting the pro-tumorigenic microenvironment through attenuation of TNF-α secretion, calcium dysregulation, and oncogenic signaling pathways. This study furnishes mechanistic insights into OC's potential as a nutraceutical intervention in inflammation-associated CRC. Given the variability in OC bioavailability and content in commercial olive oil, future investigations should delineate optimal dosing strategies and in vivo efficacy to advance its translational potential in CRC therapy.

Comparison of the head-up tilt test and the 10-minute NASA lean test for assessing blood pressure and heart rate responses in young individuals with postacute COVID-19 syndrome

BACKGROUND

Individuals with postacute COVID-19 syndrome (PACS) typically exhibit abnormal hemodynamic responses during upright positioning, including orthostatic hypotension and postural orthostatic tachycardia syndrome. The 10-minute NASA lean test (NLT) has been suggested for this condition. However, no comparative study with the head-up tilt table test (HUTT) has been conducted. This study aimed to compare blood pressure and heart rate responses during the 10-minute duration of NLT and HUTT.

METHODS

Eighty young individuals (aged 22.0 ± 3.1 years) with PACS underwent both tests, with a 30-minute interval between tests. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured every minute, and the differences between supine and upright positions were analyzed.

RESULTS

There were no significant differences in SBP changes between HUTT and NLT (-7.8 ± 6.2 vs. -7.1 ± 7.5 mmHg) with a mean difference of -0.7 ± 9.0 mmHg. However, DBP changes were significantly lower in HUTT compared to NLT (-0.9 ± 6.4 vs. 1.5 ± 6.9 mmHg for NLT) with a mean difference of -2.4 ± 7.1 mmHg. Maximal HR was significantly lower in HUTT compared to NLT (92.0 ± 11.4 vs. 96.2 ± 10.8 bpm for NLT) with a mean difference of -4.2 ± 6.9 bpm. Additionally, HR changes were significantly lower in HUTT compared to NLT (21.5 ± 8.1 vs. 27.0 ± 9.0 bpm) with a mean difference of -5.4 ± 6.4 bpm.

CONCLUSION

The NLT demonstrated comparability with the HUTT in detecting SBP changes. However, clinical applications should consider differences in measuring DBP and HR changes.

The use of telemedicine in family medicine: a scoping review

BACKGROUND

Telemedicine is becoming increasingly important in primary health care globally. It is recognized as safe, convenient, and cost-effective. The aim of this study is to explore the use of telemedicine in family medicine services, focusing on identifying its areas of application, advantages, disadvantages, and the infrastructure required for effective implementation of this technology.

METHODS

This scoping review was conducted in 2024 using the 5-step framework of Arksey and O'Malley. Comprehensive searches were carried out in the Web of Science, PubMed, and Scopus databases, using keywords such as telemedicine, telehealth, virtual care, teleconsultation, family physician, and family medicine. The search was limited to publications from 2015 to 2024. A total of 37 relevant articles were included in the analysis.

RESULTS

Telemedicine is utilized in four primary areas of family medicine: prevention, treatment, monitoring and control, and consultation/administration. According to the frequency of mention in the studies reviewed, the key advantages of telemedicine include improved patient access, enhanced convenience for both patients and healthcare providers, increased patient safety, and greater flexibility in service delivery. However, several challenges were also noted, including the lack of physical examinations, communication and cognitive barriers, low digital literacy among patients and family physicians, and concerns about patient privacy. Essential infrastructure for effective telemedicine implementation comprises reliable information and communication technology, appropriate devices for patients and family physicians, robust technical support, well-defined guidelines and initiatives to enhance digital literacy.

CONCLUSION

Recognizing the advantages of telemedicine in family medicine, it is essential for national health systems to prioritize its integration and development. Telemedicine has the potential to transform the delivery of family medicine services by enhancing access for remote and underserved communities while substantially reducing costs for both patients and providers. However, achieving this potential necessitates the establishment of appropriate legal, technical, and cultural infrastructure.

The challenge of treating hepatitis C virus infection in children with comorbidities

Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment and enabled the treatment of those who could not be treated using interferon. The aim of this work was to assess the efficacy and safety of oral DAAs in HCV-infected children with associated comorbidities. This analytical retrospective study included children with HCV mono-infection versus those with associated comorbidities. The study included 187 HCV-infected children aged 6-18 years; 114 patients (61%) had associated comorbidities. The most frequent comorbidities were hematological disorders (30.7%), followed by renal and cardiac diseases. Baseline total bilirubin, aspartate aminotransferase, and gamma glutamyl transpeptidase were significantly more elevated in patients with comorbidities. Sustained virologic response (SVR) was achieved in 100% of patients with HCV mono-infection versus 98.2% of patients with comorbidities. The most frequently reported treatment adverse effects were headache, asthenia, and irritability. All side effects were transient and did not necessitate treatment discontinuation.

CONCLUSION

DAAs allowed treatment of HCV-infected children with comorbidities with high SVR and excellent safety profile. Treatment with sofosbuvir/ledipasvir achieved an SVR of 98.9% in HCV-infected children with comorbidities. Treatment was safe and well tolerated with mild transient adverse events.

WHAT IS KNOWN

• The novel DAAs have revolutionized the landscape of HCV treatment and enabled the treatment of those who could not be treated using IFN. • When treating HCV, clinicians should take into consideration the presence of other comorbid conditions. In the IFN-RBV era, many HCV patients with comorbidities were ineligible for therapy.

WHAT IS NEW

• There are limited data in the literature about the efficacy and tolerability of DAAs in children with comorbidities. • We reported in the current study that DAAs allowed treatment of HCV-infected children with comorbidities with high SVR and excellent safety profile. These patients should be offered treatment with oral DAAs to help decrease the infectious pool and hence reach the ambitious final goal of global eradication.

The Clinical Picture Caused by Fasciola gigantica: Analysis of 3250 Patients Along the 1995-2019 Countrywide Spread in Vietnam

Background

Fasciola gigantica is the causal agent of human fascioliasis, which is emerging in southern Asia and increasingly reported in Africa. Unfortunately, knowledge of the clinical picture by F gigantica is insufficient, because of the sporadic individual case reports, or few case series of short number of patients from areas where the 2 genetically pure fasciolid species geographically overlap and specific causality was not verified.

Methods

The clinical picture is assessed from patients examined in well-equipped hospitals of big cities in Vietnam. Records of 3250 Fasciola-infected patients were registered in individual cards and a database for their complete analysis was constructed. Case profile was based on typical symptoms, blood eosinophilia, serological test, imaging techniques, Kato-Katz test, and ex juvantibus confirmation. Anamnesis furnished information about place of residence, professional activities, and infection source.

Results

Symptoms, signs, and manifestations, including neurological, meningeal, neuropsychic, and ocular disorders, are analyzed according to frequency, sex, and age groups. Early patient diagnosis and treatment facilitated by radio broadcasting underlie differences between serological positivity, coprological positivity, and liver lesions and explain the absence of severe long-term complications and posttreatment sequelae.

Conclusions

This is the first sufficiently wide study of the clinical picture caused by F gigantica. The assessment has been made in a population without previous contact with fascioliasis and shows that F gigantica (and F gigantica-like hybrids) do not cause clinical pictures different from those caused by Fasciola hepatica. This clinical picture will be useful for physicians and health officers in endemic areas of Asia and Africa.

Temporal Trends in Upper Gastrointestinal Endoscopy: A Comprehensive Audit Comparing the Pre-COVID, COVID, and Post-COVID Eras for Quality Enhancement

Upper gastrointestinal (UGI) endoscopy, vital for diagnosing and managing gastrointestinal diseases, experienced challenges in continuity and training during the COVID-19 pandemic. This study evaluates trends in UGI endoscopy procedures across pre-COVID, COVID, and post-COVID periods at a government tertiary care institute, assessing volumes, common indications and findings, trainee involvement, and service delivery barriers. This retrospective study reviewed 2,165 patient records from January 2018 to February 2023, including demographics, procedural details, indications, findings, and trainee participation. Descriptive statistics were used to analyze trends and service interruptions caused by equipment failures. Despite the challenges posed by the pandemic, proactive equipment maintenance and crisis response remain essential. Enhancing endoscopy training programs is crucial for maintaining service quality and continuity during healthcare crises. Continuous improvement efforts are important for optimizing patient care and mitigating future disruptions.

Community pharmacist-led point-of-care colorectal cancer screening program: Early detection of colorectal cancer in high-risk patients

BACKGROUND

The prevalence of colorectal cancer (CRC) is on the rise among the younger population, with an anticipated increase in new cases for individuals aged 20-49 years by 2030. The accessibility of community pharmacists and their strong community connections present unique opportunities to enhance patient engagement in a population-based CRC screening program.

OBJECTIVES

This study seeks to assess the effectiveness of a community pharmacist-led point-of-care CRC screening program utilizing fecal immunochemical test (FIT) kits to identify CRC prevalence in high-risk individuals.

METHODS AND MATERIALS

Over the course of a 10-month prospective intervention conducted in UAE community pharmacies, we evaluated the impact of a pharmacist-led point-of-care colorectal cancer screening program. Six pharmacies were selected based on their services and capabilities. Eligible participants were those identified during medication reviews as exhibiting colorectal cancer risk factors. Pharmacists provided communication materials, distributed FIT kits, and implemented reminders. Participants collected samples for hemoglobin analysis, which served as an indicator of colorectal bleeding. Collected data encompassed demographics, lifestyle, and health-related characteristics. Pharmacists performed medication reviews and offered recommendations.

RESULTS

A total of four hundred and one recruited int the study. The mean age of study cohort at baseline was 66.6 ± 11.3 years. In our study with 401 participants, 36.4 % had undiagnosed colorectal cancer (CRC). Univariate logistic regression identified older age, a history of Type 2 diabetes mellitus (DM), and inflammatory bowel disease (IBD) as significant factors associated with increased CRC prevalence, while aspirin users exhibited a lower likelihood of CRC. In the multivariate regression model, the history of Type 2 DM and IBD remained significant predictors for heightened CRC risk.

CONCLUSION

This study strengthens the plausibility of cause-and-effect relationships between colorectal cancer and demographic variables using epidemiological evidence. The significant relationships found between prevalence of CRC and age, type 2 diabetes, IBD and aspirin use support the effectiveness of using FIT kits in community pharmacist-led point-of-care CRC screening program to identify high-risk individuals. The finding highlights the significance of improving efforts on colorectal cancer prevention and control.

Trends and Gaps in Colorectal Cancer Screening Research in the Arab World: A 16-Year Bibliometric Analysis (2007-2023)

Colorectal cancer (CRC) is a significant public health concern, ranking third in incidence and second in mortality worldwide. Despite rising CRC incidence rates in the Arab world, understanding of trends and patterns in CRC screening research remains limited. This study addresses this gap through a bibliometric analysis of CRC screening research in the Arab world from 2007 to 2023. We conducted an extensive literature search in Web of Science and Scopus databases, analyzing 124 articles using the Bibliometrix Package in R. Our findings revealed a 16.5% annual growth in research output, with significant increases from 2014 onwards. Saudi Arabia led in scientific production, followed by Lebanon, Jordan, and Egypt, while Qatar had the highest country production when adjusted for population size. Disparities in research output relative to the CRC burden were evident, especially in lower-resource countries. Three regional clusters were identified: Saudi Arabia, with strong collaborations with Canada and Egypt; a second cluster including Lebanon, UAE, Jordan, Qatar, Iraq, and Oman; and a third cluster featuring Morocco, with significant collaboration with France. Thematic analysis showed a focus on CRC screening awareness, barriers, and adherence but a lack of studies on implementation strategies and cost-effectiveness. This analysis highlights significant trends and gaps in CRC screening research in the Arab world, underscoring the need for increased investment in CRC research and screening initiatives to improve outcomes in the region.

Effect of sarcopenia on the survival of patients undergoing liver transplantation: a meta-analysis

PURPOSE

The relationship between sarcopenia and post-liver transplant (LT) mortality is still not well understood. This study aims to provide an updated and comprehensive meta-analysis evaluating the impact of sarcopenia on the survival of LT patients.

METHODS

We conducted searches in PubMed, Web of Science, and EMBASE up until May 2, 2024, without language restrictions. The primary outcome measured was the overall post-LT mortality risk associated with sarcopenia. The DerSimonian-Laird random effects model was used to calculate pooled adjusted hazard ratios (HRs).

RESULTS

Eighteen cohort studies comprising a total 6297 LT patients were included. The overall prevalence of sarcopenia was 27% (95% CI: 26%-28%), and this rate was lower when sarcopenia was defined using the third lumbar-skeletal muscle index in men, and among patients with lower Child-Pugh class. Sarcopenia remained significantly associated with higher mortality, with a pooled adjusted HR of 1.55 (95% CI 1.28-1.89). This association held across subgroups based on sex, study location, sarcopenia definition, study quality, and living donor LT recipients. A sensitivity analysis excluding groups with a high proportion of hepatocellular carcinoma patients showed similar findings (HR 1.63, 95% CI 1.13-2.35). No significant heterogeneity was identified in any of the analyses.

CONCLUSIONS

This meta-analysis shows that sarcopenia is significantly associated with increased mortality after LT. Thus, the risk of sarcopenia should be factored into the initial evaluation of LT candidates.

Imaging-based noninvasive liver disease assessment for staging liver fibrosis in chronic liver disease: A systematic review supporting the AASLD Practice Guideline

BACKGROUND AND AIMS

Transient elastography (TE), shear wave elastography, and/or magnetic resonance elastography (MRE), each providing liver stiffness measurement (LSM), are the most studied imaging-based noninvasive liver disease assessment (NILDA) techniques. To support the American Association for the Study of Liver Diseases guidelines on NILDA, we summarized the evidence on the accuracy of these LSM methods to stage liver fibrosis (F).

APPROACH AND RESULTS

A comprehensive search for studies assessing LSM by TE, shear wave elastography, or MRE for the identification of significant fibrosis (F2-4), advanced fibrosis (F3-4), or cirrhosis (F4), using histopathology as the standard of reference by liver disease etiology in adults or children from inception to April 2022 was performed. We excluded studies with <50 patients with a single disease entity and mixed liver disease etiologies (with the exception of HCV/HIV coinfection). Out of 9447 studies, 240 with 61,193 patients were included in this systematic review. In adults, sensitivities for the identification of F2-4 ranged from 51% to 95%, for F3-4 from 70% to 100%, and for F4 from 60% to 100% across all techniques/diseases, whereas specificities ranged from 36% to 100%, 74% to 100%, and 67% to 99%, respectively. The largest body of evidence available was for TE; MRE appeared to be the most accurate method. Imaging-based NILDA outperformed blood-based NILDA in most comparisons, particularly for the identification of F3-4/F4. In the pediatric population, imaging-based NILDA is likely as accurate as in adults.

CONCLUSIONS

LSM from TE, shear wave elastography, and MRE shows acceptable to outstanding accuracy for the detection of liver fibrosis across various liver disease etiologies. Accuracy increased from F2-4 to F3-4 and was the highest for F4. Further research is needed to better standardize the use of imaging-based NILDA, particularly in pediatric liver diseases.

The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study

Dysautonomia refers to any disorder involving altered function of the autonomic nervous system. Dysautonomia can be debilitating as it often affects multiple organ systems. The diagnostic journey for individuals affected by dysautonomia can be hindered by symptom overlap with other conditions and by limited access to autonomic specialists. The present patient-reported outcome study aims to characterize the diagnostic journey of 672 adult individuals affected by different types of dysautonomia. The average time to diagnosis was 7.7 years (SD 10 years) and diagnosis was made primarily by cardiologists, followed by neurologists, and internists or primary care physicians. Common comorbid conditions are Ehlers-Danlos syndrome, mast cell disorders, vitamin deficiency, fibromyalgia, and myalgic encephalomyelitis, all of which can contribute to the symptoms burden and can potentially confound the diagnostic process. We suggest that the prolonged time to diagnosis contributes to morbidity and compounds the psychological and economic burden of dysautonomia. Raising awareness about the numerous obstacles that hinder the diagnostic process among both clinicians and dysautonomia patients is the first step to reduce morbidity and improve clinical outcomes.

Attributes and factors associated with long covid in patients hospitalized for acute COVID-19: A retrospective cohort study

BACKGROUND

It is now recognized that many patients have persistent symptoms after recovery from acute COVID-19 infection, an infection caused by the coronavirus SARS-CoV-2. This constellation of symptoms known as 'Long COVID' may manifest with a wide range of physical and cognitive/psychological symptoms. Few data are available on the prevalence, attributes, and factors associated with Long COVID in Africa.

METHOD

This was a retrospective review of patients' electronic medical records from Hallelujah General Hospital (one of the first private hospitals to treat COVID-19 patients). The hospital's database was searched for patients hospitalized for acute COVID-19 infection from March 2020 to December 2022. Two hundred and forty-seven participants who underwent follow-up beginning four weeks after symptom onset were assessed for Long COVID. Admission and follow-up data were collected using Kobo Toolbox and exported into SPSS 27 for analysis. The relationship between the independent and dependent variables was explored through binary logistic regression.

RESULTS

One hundred seventy-eight (72.1%) participants had at least one persisting symptom 4 weeks post-symptom onset, at a median follow-up time of 35 (IQR 32-40) days. The most frequently reported symptoms were fatigue (41.7%), shortness of breath (31.2%), cough (27.1%), and sleep disturbances (15%). Duration of symptoms more than 7 days before admission [aOR = 1.97; CI95% = 1.04 to 3.75; P = 0.038] and length of stay more than 10 days in the hospital [aOR = 2.62; CI95% = 1.20 to 5.72; P = 0.016] were found to be significantly associated with Long COVID.

CONCLUSION

There is a high prevalence of Long COVID among patients hospitalized for acute COVID-19. Those who had a longer duration of symptoms before admission and a longer stay in the hospital appear to have a higher risk.

Recent Advancements in Localization Technologies for Wireless Capsule Endoscopy: A Technical Review

Conventional endoscopy is limited in its ability to examine the small bowel and perform long-term monitoring due to the risk of infection and tissue perforation. Wireless Capsule Endoscopy (WCE) is a painless and non-invasive method of examining the body's internal organs using a small camera that is swallowed like a pill. The existing active locomotion technologies do not have a practical localization system to control the capsule's movement within the body. A robust localization system is essential for safely guiding the WCE device through the complex gastrointestinal (GI) tract. Moreover, having access to the capsule's trajectory data is highly desirable for drug delivery and surgery, as well as for creating accurate user profiles for diagnosis and future reference. Therefore, a robust, real-time, and practical localization system is imperative to advance the field of WCE and make it desirable for clinical trials. In this work, we have identified salient features of different localization techniques and categorized studies in comprehensive tables. This study is self-contained as it offers a comprehensive overview of emerging localization techniques based on magnetic field, radio frequency (RF), video, and hybrid methods. A summary at the end of each method is provided to point out the potential gaps and give directions for future research. The main point of this work is to present an in-depth review of the most recent localization techniques published in the past five years. This will assist researchers in comprehending current techniques and pinpointing potential areas for further investigation. This review can be a significant reference and guide for future research on WCE localization.

Management of metastatic colorectal cancer: consensus in the Gulf Cooperation Council countries

Colorectal cancer (CRC) represents a major public health challenge globally, particularly in the Gulf Cooperation Council (GCC) countries, where it is identified as the second most prevalent form of cancer. Despite advancements in management strategies, tailored guidelines specific to the Gulf region are lacking. This paper presents consensus recommendations developed by a panel of experts from the GCC countries to address this gap. The guidelines cover epidemiology, screening, biomarkers, and treatment strategies for metastatic CRC. Treatment guidelines emphasize tailored approaches based on tumor characteristics, including sidedness and molecular profiles. Furthermore, the importance of maintenance therapy and emerging biomarkers are discussed. These guidelines aim to improve CRC management and outcomes in the Gulf region.

Cancer Genetics in the Arab World

Cancer remains a major global health burden, with incidence rates rising globally. The Arab world, which is often regarded as an underrepresented population in literature, shows distinct patterns in cancer incidences, genetics, and outcomes in comparison with Western populations. This review aims to highlight key genomic studies conducted in the Arab world. We describe the epidemiological and genetic landscape of cancer in the Arab populations, focusing on lung, breast, and colorectal cancers, given their prominence and distinctive patterns in the region. We utilised data from GLOBOCAN 2022 and published genomic studies to assess subregional incidence trends, identify significant mutations, and explore hereditary and early-onset cancers profiles. Breast, lung, and colorectal cancers dominate the cancer profile in the region, with disparities in genetic alterations when compared to global trends. Variation in EGFR mutation frequencies in lung cancer across diverse ethnicities in the MENA region is representative of the extreme heterogeneity in the Arab region. Variations in BRCA1/2 mutation frequency, and unique founder mutations highlight breast cancer's particular regional genetic traits. Similarly, colorectal cancer studies show variations in mutational profiles, such as a low incidence of BRAF mutations and distinct epigenetic characteristics that represent region-specific disease pathways. Early-onset cancers, particularly breast and colorectal cancers, occur at higher rates than in Western populations and often diverge from the typical germline mutation patterns reported globally. The review emphasises the importance of conducting localised genetic studies in improving personalised medicine and public health strategies. Despite these efforts, significant gaps remain, particularly in understanding early-onset cancers and hereditary cancer genetic disorders, which are overrepresented in the region. Further research on the genetic basis of cancer in Arab populations is essential for advancing personalised treatment and improving cancer outcomes in these under-researched groups.

Adverse Events Involving Telehealth in the Veterans Health Administration

BACKGROUND

Telehealth involves providing health care remotely using communication tools such as telephone, video, and remote patient monitoring. Research on telehealth has shown many benefits, including improved access to care and reduced costs, and drawbacks, including delays in care, breakdowns in communication, and missed diagnoses. The use of telehealth nationally, including in the Veterans Health Administration (VHA), expanded dramatically during the COVID-19 pandemic. Despite its increased use, few studies have described adverse events or the role of patient safety in the provision of telehealth.

METHODS

The authors looked at all reports of adverse events and close calls in the VHA involving the use of telehealth between October 1, 2022, and February 2, 2023, and coded each case for the location of the event, type of event, and causes.

RESULTS

A total of 145 reports met criteria for review. Most events occurred in primary care, outpatient behavioral health, and radiology, with delays in care, medication errors, and equipment problems being common types. Most reported events did not cause harm; 45 cases were identified as an unsafe condition, 37 as a close call, and 15 as causing some harm to the patient. There were 3,609,105 telehealth episodes of care during this time, resulting in a reporting rate of 4.02 per 100,000 episodes of care and 0.42 reports of harm per 100,000 episodes of care.

CONCLUSION

The most frequent telehealth-related events were delays in care, medication errors, and equipment issues, and most events were not unique to this modality. Further research is needed to characterize safety events unique to telehealth to better define parameters for patient safety activities. Recommendations to reduce errors include ongoing provider training, human factors analysis of telehealth processes, simplifying processes and procedures for providers and patients to get help for technical or knowledge deficits in real time, and examining the business rules for telehealth care.

Gastrointestinal manifestations of long COVID

Long COVID is estimated to have affected 6.9 % of US adults, 17.8 million people in the US alone, as of early 2023. While SARS-CoV-2 is primarily considered a respiratory virus, gastrointestinal (GI) symptoms are also frequent in patients with coronavirus disease 2019 (COVID-19) and in patients with Long COVID. The risk of developing GI symptoms is increased with increasing severity of COVID-19, the presence of GI symptoms in the acute infection, and psychological distress both before and after COVID-19. Persistence of the virus in the GI tract, ensuing inflammation, and alteration of the microbiome are all likely mediators of the effects of SARS Co-V-2 virus on the gut. These factors may all increase intestinal permeability and systemic inflammation. GI inflammation and dysbiosis can change the absorption and metabolism of tryptophan, an important neurotransmitter. Long COVID GI symptoms resemble a Disorder of Gut Brain Interaction (DGBI) such as post infection Irritable Bowel Syndrome (IBS). Current standards of treatment for IBS can guide our treatment of Long COVID patients. Dysautonomia, a frequent Long COVID condition affecting the autonomic nervous system, can also affect the GI tract, and must be considered in Long COVID patients with GI symptoms. Long COVID symptoms fall within the broader category of Infection Associated Chronic Conditions (IACCs). Research into the GI symptoms of Long COVID may further our understanding of other post infection chronic GI conditions, and elucidate the roles of therapeutic options including antivirals, probiotics, neuromodulators, and treatments of dysautonomia.

Characteristics of Hepatobiliary Fascioliasis and the Role of Endoscopic Retrograde Cholangiopancreatography in Management: A Single Center Experience

BACKGROUND

Hepatobiliary fascioliasis has two phases, each requiring specific management approaches. Triclabendazole has been widely effective in treating the two phases of clinical fascioliasis and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary phase. We aimed to characterize presentations of hepatobiliary fascioliasis and highlight the role of ERCP in management.

SUBJECTS AND METHODS

This retrospective cohort includes patients diagnosed with clinical hepatobiliary fascioliasis between January 2013 and December 2022. Demographic data, clinical presentation, laboratory and radiological investigations, treatment, and endoscopy reports were collected from the records of 62 participants. Patients were divided into two groups: acute hepatic and chronic biliary phases.

RESULTS

Thirty-six patients were in the biliary phase, and 26 were in the hepatic phase. All patients were from rural areas, and females were predominant (76%). Hypereosinophilia was detected in 92% of acute cases and 58% of chronic biliary cases. In chronic biliary cases, the levels of liver biochemicals, including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and bilirubin, were higher at levels of 189 ± 76, 127 ± 47, 268 ± 77, and 2.4 ± 0.7 respectively, compared to acute hepatic cases, 35.6 ± 8.2, 32.7 ± 4.3, 69.2 ± 45.45, and 0.58 ± 0.01. The corresponding P-values were 0.003, 0.001, <0.001, and <0.001, respectively. Triclabendazole effectively cured 93.5% of patients and was used in combination with ERCP in biliary-phase cases where the fluke was extracted from the biliary system in 34 patients (94.4%). Three patients (8.8%) were diagnosed with post-ERCP pancreatitis. None of the patients experienced bleeding, perforation, or required biliary stenting.

CONCLUSION

Clinical fascioliasis could manifest in acute hepatic or chronic biliary phases. Hypereosinophilia was more evident in the hepatic phases, while ALT, AST, GGT, and bilirubin were higher in the biliary phase. Triclabendazole is effective in the hepatic phase and when combined with ERCP in the biliary phase. ERCP is highly effective for relieving obstruction and treating biliary fascioliasis.

Clinical Prevalence of Hepatitis D Virus Among Hepatitis B Patients in Sulaymaniyah Governorate, Northern Iraq

Hepatitis D virus (HDV), which occurs as a co-infection with the hepatitis B virus (HBV), is a significant public health burden. Currently, there is a scarcity of data regarding this co-infection in the developing countries. This study aims to address the clinical prevalence of HDV among HBV-infected patients in Sulaymaniyah Governorate, Iraq. This prospective cross-sectional study, conducted from May to November 2022, screened HBV DNA-positive patients visiting Sulaimani Teaching Hospital in Sulaymaniyah governorate, Iraq, for anti-HDV antibodies and HDV RNA. The study included 150 confirmed HBV DNA-positive patients. Of these, 54.7% were male. The mean age of the patients was 49.1 ± 10.1 (18-68). Serological assessment found that 23 (15.3%) of the patients had anti-HDV IgG antibodies, suggesting past or chronic HDV infection, while 16 (10.7%) tested positive for anti-HDV IgM, indicating recent/acute infection. Further molecular analysis confirmed HDV RNA in 15 (10%) of HBV patients, indicating real HDV prevalence. The prevalence of anti-HDV and HDV RNA did not significantly differ by age, gender, marital status, residency, medical, family or medical history (p > 0.05). In conclusion, this study demonstrated a relatively high HDV prevalence among HBV patients in Sulaymaniyah Governorate, Iraq, at 10%, which stresses the need for better screening, health strategies and focused research to combat its impact.

Subcapsular Liver Hematoma: One of the Many Faces of Acute Fascioliasis

Subcapsular liver hematoma is an uncommon and underdiagnosed manifestation of fascioliasis. We report 6 cases and review 21 previous reports. The mean age was 51 years; 12 cases were from Peru; and 18 were women. Only 6 patients required surgical drainage. Medical management is the mainstay treatment.

A Systematic Review of the Impact of Dietary and Lifestyle Factors on Colorectal Cancer Prevention in Gulf Cooperation Council Countries

Colorectal cancer (CRC) remains a significant health burden in the Gulf Cooperation Council (GCC) countries, necessitating a deeper understanding of modifiable risk factors. Thus, the aim of the study was to evaluate the impact of dietary and lifestyle factors on the prevention of CRC in GCC countries. Studies were identified through electronic searches and reviewed based on relevant keywords. Databases searched included Ovid's MEDLINE, EMBASE, Google Scholar, and Web of Science, covering titles and abstracts published between January 1, 2000 and July 25, 2024. The search strategy encompassed four thematic areas: "colorectal cancer," "adults above 18," "risk factors," and "GCC countries." The primary focus was on dietary and lifestyle factors. Two reviewers screened titles and abstracts to determine whether the inclusion criteria were met. A total of 1,883 records were identified across these databases. After removing 513 duplicate records, 1,370 records were screened based on titles and abstracts. Of these, 1,284 records were excluded, leaving 86 full-text articles for assessment. Eight studies were ultimately included in the final systematic review, consisting of seven case-control studies and one cross-sectional study. In GCC countries, a diet rich in fruits, vegetables, and fiber has shown protective effects against CRC, while high red meat and refined carbohydrate intake may increase risk. Regular physical activity reduces CRC risk, though the impact of smoking remains inconclusive. Evidence regarding dairy products is contradictory. There is a shortage of high-quality longitudinal studies, highlighting gaps in current research and underscoring the need for larger studies with consistent methodologies.

Characteristics of Immunogenicity against SARS-CoV-2 in a Community-Based Model of Care during the Fourth Wave of COVID-19 Outbreak in Ho Chi Minh City

PURPOSE

Although some immune protection from close contact with individuals who have coronavirus disease 2019 (COVID-19) has been documented, there is limited data on the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals who were in lockdown with confirmed COVID-19 cases. This study investigated immunogenicity against SARS-CoV-2 in household members and people who lived near home-quarantined patients with COVID-19.

MATERIALS AND METHODS

This cross-sectional study was conducted during the community-based care that took place during lockdowns in District 10, Ho Chi Minh City, Vietnam from July to September 2021. SARS-CoV-2 antibody levels were determined in index cases of COVID-19, household contacts, and a no-contact group from the same area.

RESULTS

A total of 770 participants were included (355 index cases, 103 household contacts, and 312 no contacts). All index cases were unvaccinated, but >90% of individuals in the household and no-contact groups had received ≥1 vaccine dose. SARS-CoV-2 neutralizing antibodies (Nabs) were present in >77% of unvaccinated index cases versus 64%/65.4% in the household/no-contact groups (p=0.001). Antibody concentrations in unvaccinated index cases were significantly higher than those in household contacts and no contacts, with no difference between the latter groups. In all cases, antibody levels declined markedly ≥6 weeks after infection, and failed to persist beyond this time in the household and no-contact groups.

CONCLUSION

Community-based care may have helped to create community immunogenicity, but Nabs did not persist, highlighting a need for vaccination for all individuals before, or from 6 weeks after, infection with SARS-CoV-2.

Preservation of fat mass at the expense of lean mass in children with end-stage chronic liver disease

BACKGROUND

Sarcopenia predicts morbidity and mortality in end-stage chronic liver disease (ESCLD). Here, we describe changes in body composition in children with ESCLD before and after liver transplantation (LT).

METHODS

Retrospective analysis of whole body DXA scans performed before and after LT over 4 years. Appendicular and whole-body fat mass and lean mass were expressed as fat mass (FMI) and lean mass (LMI) index z-scores. Sarcopenia was defined as leg LMI z-score <-1.96.

RESULTS

Eighty-three DXA scans of children before or after LT were studied. Sarcopenia had a positive correlation with weight (0.8, p < .01), height (0.48, p < .05), and BMI z-score (0.77, p < .01), as well as arm, trunk, and total mean mass indices. It correlated negatively with indices of hypersplenism: PLTs (-0.57, p < .01), Neu (-0.50, p < .05), WCC (-0.44, p < .05), and days to discharge (-0.46, p < .05). At baseline: 13/25 (52%) children were sarcopenic and stayed in the hospital after LT for longer. Eight were stunted with a higher WCC and Ne/Ly ratio. All had normal FM indices. One year after LT, 12/26 children remained sarcopenic. Seven were stunted. Two years after LT, 5/15 were sarcopenic, and 5 were stunted. Three years after LT, 1/10 was sarcopenic, and 2 were stunted. By 4 years after LT, 1/7 was sarcopenic, and the same one was stunted. FM indices remained normal.

CONCLUSIONS

Sarcopenic patients stayed longer in the hospital after LT. Lean mass indices were mostly within the normal range by 4 years after LT. 32% of children were stunted, and markers of inflammation were correlated with stunting. Fat mass was preserved at the cost of lean mass.

Colorectal Cancer Detection during a Screening Awareness Campaign in a High-Risk Region in Oman

INTRODUCTION

Colorectal cancer (CRC) constitutes the third most frequently diagnosed cancer in Oman.  This study report the result of a community based screening campaign to promote the early detection and explore the associated risk factors of CRC amongst Omani population.

METHODS

We launched a colorectal cancer awareness campaign in Oman's South Ash Sharqiyah Governorate between January and March, 2023. We conducted a stratified random study including 688 adult Omani participants aged over 40 years old. Local Health Centers collected the questionnaire forms. Fecal occult blood tests (FOBTs) were carried out at Local Health Centers; while medical professionals performed the colonoscopy examination in Sur University Hospital.

RESULTS

Overall, the screening response rate was 68.8%. The data indicated that 8.1% of the total sample yielded positive FOBTs; of whom, 85.7% were aged 40-59 years old and 67.9% were obese or overweight. Abnormal colonoscopy was reported in 7 participants. One participant had a confirmed CRC of stage I.

CONCLUSION

Screening and early detection campaign can have effect and increase the rate of early detection among population in Oman.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Management of patients with high C-reactive protein levels after elective colorectal surgery: Pilot study on a proactive diagnostic and therapeutic approach (GESPACE)

STUDY OBJECTIVE

To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery.

PATIENTS AND METHODS

Prospective study including patients with CRP>125mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15d. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit.

RESULTS

One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay<15d. Major deviations from the management algorithm occurred in 38% of cases. No patients had an early endoscopy. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed.

CONCLUSION

It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management.

Operative trends for pancreatic and hepatic malignancies during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic disrupted routine health care, including many elective and non-cancer operations in the United States. Most hepato-pancreato-biliary malignancy patients require outpatient imaging, tissue sampling, and staging, and many undergo neoadjuvant therapy before operative intervention. The aims of this study were to evaluate the effect of the COVID-19 pandemic on hepato-pancreato-biliary oncologic operations and to determine whether trends in neoadjuvant therapy were altered by the pandemic.

METHODS

Adult patients in the United States undergoing oncologic operations for pancreatic, primary and secondary hepatic malignancies, with or without neoadjuvant therapy, were extracted from the Vizient Clinical Data Base. Control chart analysis was used to plot trends over time and to determine whether changes were statistically significant. Wilcoxon rank-sum tests also compared monthly operative volume from pre-pandemic (12 month) and pandemic (28 months) periods.

RESULTS

A total of 36,553 patients were identified over 40 months. Mean monthly pancreatic oncologic operations were unaffected by the pandemic (P = .257). Operations for pancreatic oncologic operations with prior neoadjuvant therapy increased throughout the pandemic (P = .002). Oncologic operations for primary and secondary hepatic malignancies were significantly reduced for 4 and 2 months, respectively, at the beginning of the pandemic but returned to their pre-pandemic baseline within 4 months (P = .169 and P = .598).

CONCLUSION

Pancreatic operation volumes for cancer did not change, but pancreatic operations after neoadjuvant therapy continued to increase during the pandemic. Operations for hepatic malignancy were transiently disrupted but quickly normalized. These observations suggest that surgery for hepato-pancreato-biliary malignancies was prioritized during the pandemic.

Resonant breathing improves self-reported symptoms and wellbeing in people with Long COVID

Introduction

Long COVID involves debilitating symptoms, many of which mirror those observed with dysautonomia, and care must be taken with rehabilitation for autonomic dysfunction to avoid post-exertional malaise/post-exertional symptom exacerbation. Resonant breathing (breathing slowly at a defined rate of breaths per minute) requires less exertion and can potentially improve autonomic function. The objective of this work was to report on the impact of a resonant breathing program on self-reported symptoms and wellbeing in people with Long COVID.

Methods

A retrospective analysis of de-identified data was completed in a convenience sample of people with Long COVID, who participated in the Meo Health (formerly known as Stasis HP) resonant breathing program. Participants completed baseline and follow up surveys.

Results

Data were available for 99 participants. Most measures of symptoms and wellbeing improved at follow up, with the largest differences per participant seen in sense of wellness (47.3%, p < 0.0001), ability to focus (57.5%, p < 0.0001), ability to breathe (47.5%, p < 0.0001), ability to control stress (61.8%, p < 0.0001) and sleep quality (34.9%, p = 0.0002). Most (92%) participants reported improvement at follow up on the Patient Global Impression of Change Scale.

Conclusion

Self-reported symptoms and wellbeing improved in people with Long COVID completing resonant breathing. Resonant breathing can be considered as an option within the broader treatment plan of people with Long COVID.

Composite Autonomic Symptom Score-31 for the diagnosis of cardiovascular autonomic dysfunction in long-term coronavirus disease 2019

BACKGROUND

Composite Autonomic Symptom Score-31 (COMPASS-31) is an easy-to-use screening tool for the evaluation of autonomic dysfunction in various diseases affecting neural function but has rarely been used in the assessment of long coronavirus disease 2019 (COVID-19). This study aimed to evaluate the diagnostic accuracy of the COMPASS-31 score in detecting dysfunction of the autonomic nervous system in patients 3 months after COVID-19 infection.

MATERIALS AND METHODS

Fifty-nine subjects were recruited and grouped into 2: (a) controls (n = 31) who had never had positive polymerase chain reaction results for COVID-19 before and (b) the post-COVID-19 patients (n = 28) who had confirmed COVID-19 infection 3-6 months before recruitment. COMPASS-31 questionnaire was utilized to evaluate subjective symptoms or evidence of autonomic dysfunction. Autonomic dysfunction was assessed objectively by cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV). For comparison of quantitative variables between two groups, t-test or Mann-Whitney U test, as appropriate, were used. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio (LR), and positive LR were used as measures of diagnostic accuracy. Receiver operating characteristic (ROC) curve analysis determined the overall accuracy of COMPASS-31.

RESULTS

The median COMPASS score was found to be significantly higher in post-COVID-19 participants than controls (15.5 vs. 10, P = 0.021). The median total CART score was also significantly higher in post-COVID-19 participants (0 vs. 1, P < 0.001). Out of 6 domains of the COMPASS score, the median value for orthostatic dysfunction was found to be significantly higher in post-COVID-19 participants than controls (12 vs. 0, P = 0.008). There was significantly fair accuracy of the COMPASS score with an area under the receiver operating curve 0.68 (0.54-0.82) following the total CART score ≥2 as the gold standard in the diagnosis of autonomic dysfunction (P = 0.021). The best cutoff point of the total COMPASS score was 12.5, where the optimal values of sensitivity, specificity, and positive and negative predictive values were achieved. Nonsignificant and weak correlations between CARTs, HRV parameters, and COMPASS score were found.

CONCLUSION

COMPASS-31 could be used as a user-friendly screening tool to detect autonomic dysfunction in post-COVID-19 cases with acceptable sensitivity and specificity.

Expert consensus on the diagnosis and treatment of end-stage liver disease complicated by infections

End-stage liver disease (ESLD) is a life-threatening clinical syndrome and when complicated with infection the mortality is markedly increased. In patients with ESLD, bacterial or fungal infection can induce or aggravate the occurrence or progression of liver decompensation. Consequently, infections are among the most common complications of disease deterioration. There is an overwhelming need for standardized protocols for early diagnosis and appropriate management for patients with ESLD complicated by infections. Asia Pacific region has the largest number of ESLD patients, due to hepatitis B and the growing population of alcohol and NAFLD. Concomitant infections not only add to organ failure and high mortality but also to financial and healthcare burdens. This consensus document assembled up-to-date knowledge and experience from colleagues across the Asia-Pacific region, providing data on the principles as well as evidence-based current working protocols and practices for the diagnosis and treatment of patients with ESLD complicated by infections.

Long COVID-19 Enigma: Unmasking the Role of Distinctive Personality Profiles as Risk Factors

Background: The COVID-19 (Coronavirus disease 2019) pandemic has prompted extensive research into lingering effects, especially in 'Long COVID' patients. Despite exploration, contributing factors remain elusive; Objective: This study explores the potential link between distinctive personality profiles, particularly type D personality, and an increased risk of Long COVID; Methods: A retrospective cross-sectional study at Tel-Aviv Sourasky Medical Center's Post-COVID clinic analyzed data from 373 Long COVID patients through comprehensive questionnaires covering Long COVID syndrome, Fibromyalgia criteria, personality assessments, social support, and subjective evaluations of cognitive decline, health and life quality. In total, 116 out of 373 patients completed the questionnaire, yielding a 31% participation rate; Results: Cluster analysis revealed two groups, with Cluster 1 (N = 58) exhibiting Type D personality traits while Cluster 2 (N = 56) not meeting criteria for Type D personality. In comparison to Cluster 2, Cluster 1 patients reported heightened anxiety, depression, reduced social support, increased pain symptoms, manifestations of fibromyalgia, cognitive decline, and poor sleep quality, contributing to a diminished quality-of-life perception; Conclusions: findings highlight diverse personality profiles among Long COVID patients, emphasizing the need for tailored care. This approach shows potential for improving Long COVID patient care, aligning with the evolving personalized medicine paradigm.

Rare liver diseases in Egypt: Clinical and epidemiological characterization

Illnesses that afflict a tiny number of individuals are referred to as rare diseases (RDs), sometimes called orphan diseases. The local healthcare systems are constantly under financial, psychological, and medical strain due to low incidence rates, unusual presentations, flawed diagnostic standards, and a lack of treatment alternatives for these RDs. The effective management of the once widely spread viral hepatitis B and C has altered the spectrum of liver diseases in Egypt during the last several years. The detection of uncommon disorders such as autoimmune, cholestatic, and hereditary liver diseases has also been made easier by the increasing knowledge and greater accessibility of specific laboratory testing. Finally, despite Egypt's large population, there are more uncommon liver disorders than previously thought. This review article discusses the clinical and epidemiological characteristics of a few uncommon liver disorders and the information currently accessible concerning these illnesses in Egypt.

Disease burden and projection of total and early-onset colorectal cancer in Gulf cooperation council countries from 1990 to 2019

BACKGROUND

Early-onset colorectal cancer (EO-CRC) incidence and prevalence trends in the rise in high income countries, such as the Gulf Cooperation Council (GCC) countries. The study aimed to offer an up-to-date assessment of the overall burden of CRC, and EO-CRC in GCC countries and project its incidence and mortality in 2030.

METHOD

The prevalence, incidence, mortality, years of life lived with disability (YLDs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC, and EO-CRC up to 2030 were predicted.

RESULTS

All GCC countries showed a higher annual average percentage changes (AAPC) AAPC incidence rate for EO-CRC compared to CRC. In Saudi Arabia the number of CRC cases has increased from 1990 1484.57; (95 % UI 1987.98,1083.86) 11.4-fold-increase to 16991.83; (95 % UI 21754.79,12892.12) in 2019. In 2030, the total incidence cases of CRC for the six Gulf countries are expected to reach 13,339 thousand, primarily driven by Saudi Arabia with 7,910.19 cases. In 2030, the CRC mortality rate is projected to be 7,647 cases, with nearly 57 % of CRC mortality cases anticipated in Saudi Arabia.

CONCLUSION

This study sheds light on the alarming rise in CRC and EO-CRC across Gulf countries from 1990 to 2019, emphasizing Saudi Arabia's significant burden. It projects a concerning increase in CRC incidence and mortality by 2030, primarily in Saudi Arabia, and highlights the need for immediate public health interventions.

Management of cognitive impairment associated with post-COVID-19 syndrome: recommendations for primary care

Introduction: Although post-COVID-19 syndrome (PCS) with cognitive impairment is increasingly encountered in primary care, evidence-based recommendations for its appropriate management are lacking. Methods: A systematic literature search evaluating the diagnosis and treatment of cognitive impairment associated with PCS was conducted. Practical recommendations for the management of PCS-associated cognitive impairment in primary care are summarized, based on an evaluation of pharmacological plausibility and clinical applications. Results: Currently, the pathology of cognitive impairment associated with PCS remains unclear with no high-quality data to support targeted interventions. Existing treatment approaches are directed towards symptom relief where counseling on the chronicity of the disease and regular reassessments at 4- to 8-week intervals is considered reasonable. Patients should be informed and encouraged to adopt a healthy lifestyle that centers around balanced nutrition and appropriate physical activities. They may also benefit from the intake of vitamins, micronutrients, and probiotics. The administration of Ginkgo biloba extract could offer a safe and potentially beneficial treatment option. Other non-pharmacological measures include physiotherapy, digitally supported cognitive training, and, if indicated, ergotherapy or speech therapy. In most patients, symptoms improve within 8 weeks. If serious, ambiguous, or when new symptoms occur, specialized diagnostic measures such as comprehensive neurocognitive testing or neuroimaging should be initiated. Very few patients would require inpatient rehabilitation. Conclusion: PCS with cognitive impairment is a debilitating condition that could affect daily functioning and reduce work productivity. Management in primary care should adopt a multidisciplinary approach, centering around physical, cognitive, and pharmacological therapies.

Recovery of neurophysiological measures in post-COVID fatigue: a 12-month longitudinal follow-up study

One of the major consequences of the COVID-19 pandemic has been the significant incidence of persistent fatigue following resolution of an acute infection (i.e. post-COVID fatigue). We have shown previously that, in comparison to healthy controls, those suffering from post-COVID fatigue exhibit changes in muscle physiology, cortical circuitry, and autonomic function. Whether these changes preceded infection, potentially predisposing people to developing post-COVID fatigue, or whether the changes were a consequence of infection was unclear. Here we present results of a 12-month longitudinal study of 18 participants from the same cohort of post-COVID fatigue sufferers to investigate these correlates of fatigue over time. We report improvements in self-perception of the impact of fatigue via questionnaires, as well as significant improvements in objective measures of peripheral muscle fatigue and autonomic function, bringing them closer to healthy controls. Additionally, we found reductions in muscle twitch tension rise times, becoming faster than controls, suggesting that the improvement in muscle fatigability might be due to a process of adaptation rather than simply a return to baseline function.

Improving Access to Anti-HDV Testing: Development and Validation of an Affordable In-House ELISA Assay

In certain low-income nations, the hepatitis Delta virus and hepatitis B virus (HBV) pose a serious medical burden, where the prevalence of hepatitis B surface antigen (HBsAg) is greater than 8%. Especially in rural places, irregular diagnostic exams are the main restriction and reason for underestimation. Utilizing serum samples from a Pakistani isolate, an internal ELISA for the quick identification of anti-HDV was created, and the effectiveness of the test was compared to a commercial diagnostic kit. HDV-positive serum samples were collected, and a highly antigenic domain of HDAg antigen was derived from them. This antigenic HDAg was expressed in a bacterial expression system, purified by Ni-chromatography, and confirmed by SDS-PAGE and Western blot analysis. The purified antigen was utilized to develop an in-house ELISA assay for anti-HDV antibody detection of the patient's serum samples at very low cost. Purified antigens and positive and negative controls can detect anti-HDV (antibodies) in ELISA plates. The in-house developed kit's efficiency was compared with that of a commercial kit (Witech Inc., USA) by the mean optical density values of both kits. No significant difference was observed (a P value of 0.576) by applying statistical analysis. The newly developed in-house ELISA is equally efficient compared to commercial kits, and these may be useful in regular diagnostic laboratories, especially for analyzing local isolates.

Results of the interim analysis of a prospective, multicenter, observational study of small subepithelial lesions in the stomach

OBJECTIVES

Long-term outcomes of gastric subepithelial lesions have not been elucidated. To reveal the natural history, we initiated a prospective, 10-year follow-up of patients with small (≤20 mm) gastric subepithelial lesions in September 2014. Here, we report the results of an interim analysis of a prospective observational study.

METHODS

In total, 567 patients with 610 lesions were prospectively registered between September 2014 and August 2016. The location, size, morphology, and number of subepithelial lesions were recorded on a web-based case report form. This study has been conducted as an Academic Committee Working Group of the Japan Gastroenterological Endoscopy Society.

RESULTS

The endoscopic follow-up period was 4.60 ± 1.73 years (mean ± standard deviation), and survival data were investigated for 5.28 ± 1.68 years. This interim analysis revealed that the estimated cumulative incidence of a size increase ≥5 mm, after accounting for patients' death and resection of the tumor as competing risk events, was 4.5% at 5 years. In addition, the estimated cumulative incidence of lesion size increase ≥5 mm or resection of lesions was 7.9% at 5 years, and that of size increase ≥10 mm or resection of lesions was 4.5% at 5 years.

CONCLUSION

These results indicate that approximately one in 13 patients with small (≤20 mm) gastric subepithelial lesions may require resection or further investigation for increased tumor size (≥5 mm) within 5 years.

Association of Autonomic Symptom Burden with Sudden Sensorineural Hearing Loss

OBJECTIVE

To investigate the autonomic symptom burden in patients with sudden sensorineural hearing loss (SSNHL) and its association with the severity and prognosis.

STUDY DESIGN

Observational prospective study.

SETTING

Tertiary academic medical center.

METHODS

Patients diagnosed with SSNHL at a single medical center completed the COMPASS 31 questionnaire, which assesses dysautonomia across 6 domains with 31 questions. A total COMPASS 31 score was calculated by summing the scores from each weighted domain. The treatment outcome was evaluated by the percentage of recovery, calculated as the hearing gain in pure tone average (PTA) after treatment divided by the pretreatment PTA difference between the 2 ears. We defined poor recovery as a percentage of recovery <80%.

RESULTS

A total of 63 SSNHL patients were included. The mean COMPASS 31 score was 23.4 (SD 14). Patients with poor recovery had significantly higher COMPASS 31 scores than those with good recovery (mean 26.4 [SD 14.4] vs 16.9 [SD 10.4]; 95% confidence interval [CI] 2-17). There was a negative association between COMPASS 31 score and both hearing gain (r = -.323, 95% CI -0.082 to -0.529) and percentage of recovery (r = -.365, 95% CI -0.129 to -0.562). Multivariate analyses of independent factors indicate that patients with higher COMPASS 31 scores had a greater risk for poor recovery (OR 1.06 [95% CI 1.003-1.117]).

CONCLUSION

This study highlights the association between autonomic symptom burden and poor hearing outcomes in SSNHL patients. The findings underscore the importance of evaluating autonomic function during the treatment of SSNHL.

Cardiovascular dysautonomia in postacute sequelae of SARS-CoV-2 infection

Coronavirus disease 2019 (COVID-19) has led to a worldwide pandemic that continues to transform but will not go away. Cardiovascular dysautonomia in postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection has led to persistent symptoms in a large number of patients. Here, we define the condition and its associated symptoms as well as potential mechanisms responsible. We provide a careful and complete overview of the topic addressing novel studies and a generalized approach to the management of individuals with this complex and potentially debilitating problem. We also discuss future research directions and the important knowledge gaps to be addressed in ongoing and planned studies.

Age-period-cohort analysis of colorectal cancer mortality in Saudi Arabia from 1990 to 2019

OBJECTIVES

The current study aimed to describe and estimate the independent effects of age, period, and cohort on colorectal cancer (CRC) mortality in Saudi Arabia from 1990 to 2019.

STUDY DESIGN

This was an epidemiological study.

METHODS

Data were obtained from the Global Burden of Disease study 2019. Age-period-cohort modelling was used to compute the net drift, local drift, cross-sectional age curve, longitudinal age curve, and rate ratios (RRs) of period and cohort of CRC mortality in Saudi Arabia.

RESULTS

In 2019, there were 1629 (95% uncertainty interval [UI]: 1263 to 2045) CRC cancer deaths in Saudi Arabia, and the age-standardised mortality rate of CRC was 9.7 (95% UI: 7.8 to 11.6) per 100,000 population. For men, between 1990 and 2019, the total number of CRC deaths increased dramatically from 199 (95% UI: 130 to 286) in 2019 to 942 (95% UI: 725 to 1228). For the period effects, the relative risk (RR) of mortality rate for both sexes followed similar monotonic increase patterns throughout the study period.

CONCLUSIONS

Results from this study highlight a concerning increase in CRC mortality rates in Saudi Arabia from 1990 to 2019, particularly among individuals aged 30-50 years. While mortality rates for men were higher at the start of the study period, more favourable trends for men were seen in the later years of the study period, indicating evolving gender disparities. Establishing evidence-based national screening guidelines and adopting multi-level diagnostics, risk assessment, and population-wide screening, especially for younger populations, is crucial.

Efficacy and safety of DAA in children and adolescents with chronic HCV infection: A systematic review and meta-analysis

BACKGROUND AND AIMS

We evaluated the effectiveness and safety of pan-genotypic regimens, glecaprevir/pibrentasvir (GLE/PIB), sofosbuvir/velpatasvir (SOF/VEL), and sofosbuvir/daclatasvir (SOF/DCV) and other direct-acting antivirals (DAA) regimens for the treatment of hepatitis C virus (HCV)-infected adolescents (12-18 years), older children (6-11 years), and young children (3-5 years). The purpose of this systematic review and meta-analysis was to inform the World Health Organization (WHO) guidelines.

METHODS

We included clinical trials and observational studies published up to August 11, 2021, that evaluated DAA regimens in HCV-infected adolescents, older children, and young children. We searched MEDLINE, EMBASE, and CENTRAL databases and key conference abstracts. Sustained virological response 12 weeks after the end of treatment (SVR12), adverse events (AEs), and treatment discontinuation were the outcomes evaluated. Risk of bias was assessed using a modified version of the ROBINS-I tool. Data were pooled using random-effects models, and certainty of the evidence was assessed using the GRADE approach.

RESULTS

A total of 49 studies including 1882 adolescents, 436 older children, and 166 young children were considered. The SVR12 was 100% (95% Confidence Interval: 96-100), 96% (90-100), and 96% (83-100) for GLE/PIB in adolescents, older, and young children, respectively; 95% (90-99), 93% (86-98), and 83% (70-93), for SOF/VEL, respectively; and 100% (97-100) and 100% (94-100) for SOF/DCV in adolescent and older children, respectively. There was a clear trend towards a higher rate of any reported AE from adolescents (50%), older children (53%), to young children (72%). Serious AEs and treatment discontinuations were uncommon in adolescents and older children (<1%) but slightly higher in young children (3%).

CONCLUSIONS

All three pan-genotypic DAA regimens were highly effective and well-tolerated and are now recommended by the WHO for use in adults, adolescents, and children down to 3 years, which will simplify procurement and supply chain management. The evidence was based largely on single-arm non-randomized controlled studies. Moreover, there were also missing data regarding key variables such as route of HCV acquisition, presence or absence of cirrhosis, or HIV co-infection that precluded evaluation of the impact of these factors on outcomes.

PROSPERO RECORD

CRD42020146752.

Prevalence and clinical impact of sarcopenia in liver transplant recipients: A meta-analysis

BACKGROUND

The prevalence of sarcopenia in patients undergoing liver transplantation (LT) remains to be determined partly because of different diagnostic criteria. Sarcopenia has recently been recognized as a new prognostic factor for predicting outcomes in LT candidates.

AIM

To estimate the prevalence of sarcopenia and evaluate its clinical effect on LT candidates.

METHODS

This systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library for original English-language articles that investigated the prevalence and influence of sarcopenia in patients undergoing LT from database inception to November 30, 2022. Cohort studies of the definition of sarcopenia that estimate sarcopenia prevalence and evaluate its effect on clinical outcomes and the risk of mortality were included.

RESULTS

Twenty-five studies involving 7760 patients undergoing LT were included. The pooled prevalence of sarcopenia in patients undergoing LT was 40.7% [95% confidence intervals (95%CI): 32.1-49.6]. The 1-, 3-, and 5-year cumulative probabilities of post-LT survival in patients with preoperative sarcopenia were all lower than those without sarcopenia (P < 0.05). Sarcopenia was associated with an increased risk of post-LT mortality in patients undergoing LT (adjusted hazard ratio: 1.58; 95%CI: 1.21-2.07). Patients with preoperative sarcopenia had a longer intensive care unit stay, a high risk ratio of sepsis, and serious post-LT complications than those without sarcopenia.

CONCLUSION

Sarcopenia is prevalent in a substantial proportion of patients undergoing LT and is strongly and independently associated with higher a risk of mortality risk.

SARS-CoV-2 Infection Impairs Oculomotor Functions: A Longitudinal Eye-tracking Study

Although Severe Acute Respiratory Syndrome Coronavirus 2 infection (SARS-CoV-2) is primarily recognized as a respiratory disease, mounting evidence suggests that it may lead to neurological and cognitive impairments. The current study used three eye-tracking tasks (free-viewing, fixation, and smooth pursuit) to assess the oculomotor functions of mild infected cases over six months with symptomatic SARS-CoV-2 infected volunteers. Fifty symptomatic SARS-CoV-2 infected, and 24 self-reported healthy controls completed the eye-tracking tasks in an initial assessment. Then, 45, and 40 symptomatic SARS-CoV-2 infected completed the tasks at 2- and 6-months post-infection, respectively. In the initial assessment, symptomatic SARS-CoV-2 infected exhibited impairments in diverse eye movement metrics. Over the six months following infection, the infected reported overall improvement in health condition, except for self-perceived mental health. The eye movement patterns in the free-viewing task shifted toward a more focal processing mode and there was no significant improvement in fixation stability among the infected. A linear discriminant analysis shows that eye movement metrics could differentiate the infected from healthy controls with an accuracy of approximately 62%, even 6 months post-infection. These findings suggest that symptomatic SARSCoV- 2 infection may result in persistent impairments in oculomotor functions, and the employment of eye-tracking technology can offer valuable insights into both the immediate and long-term effects of SARS-CoV-2 infections. Future studies should employ a more balanced research design and leverage advanced machine-learning methods to comprehensively investigate the impact of SARSCoV- 2 infection on oculomotor functions.

Post-COVID dysautonomias: what we know and (mainly) what we don't know

Following on from the COVID-19 pandemic is another worldwide public health challenge that is referred to variously as long COVID, post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC). PASC comes in many forms and affects all body organs. This heterogeneous presentation suggests involvement of the autonomic nervous system (ANS), which has numerous roles in the maintenance of homeostasis and coordination of responses to various stressors. Thus far, studies of ANS dysregulation in people with PASC have been largely observational and descriptive, based on symptom inventories or objective but indirect measures of cardiovascular function, and have paid little attention to the adrenomedullary, hormonal and enteric nervous components of the ANS. Such investigations do not consider the syndromic nature of autonomic dysfunction. This Review provides an update on the literature relating to ANS abnormalities in people with post-COVID syndrome and presents a theoretical perspective on how the ANS might participate in common features of PASC.