Physician-scientists or celebrities? Kardashian-index of gastroenterologists

BACKGROUND

The coronavirus disease 2019 pandemic unleashed a flood of untrustworthy information on social media platforms, resulting in the unfortunate consequence of expert scientists' opinions getting lost amidst the chaotic sea of misinformation. The question of how much influence these esteemed scientists hold on social media platforms remains elusive. To address this scientific quandary, we sought to explore the concept of the Kardashian index (K-index), a term introduced by Hall in 2014. This metric provides a rudimentary means of evaluating whether a physician scientist's popularity on social media aligns with their significant scientific contributions.

AIM

To evaluate if a Gastroenterologist physician's popularity on social media is at par with their scientific contributions (research articles and publications).

METHODS

We conducted an extensive search to identify all gastroenterologists actively practicing and associated with the top 100 hospitals as reported by the United States News. We collected specific data on a sub-group including their names, affiliations, degrees, and sub-specializations. To gauge their social media popularity, we utilized the K-index calculation which is determined by dividing the actual number of Twitter followers by the number of researcher's citations. The expected number of followers (F) is calculated using the formula F = 43.3 C ^ 0.32, where C represents the number of citations.

RESULTS

Physicians affiliated with the Mayo Clinic emerged as the most prominent presence on Twitter, constituting 16% of the total. They were followed closely by physicians from Mount Sinai Hospital (9%) and the University of Michigan Hospital (9%). Surprisingly, 76% of the physicians evaluated exhibited a low K-index, falling within the range of 0 to less than 2. This suggests that a significant number of highly influential physician-scientists are not receiving due recognition, as indicated by their relatively low number of followers. On the other hand, 24% of the physicians had an inflated K-index, exceeding 5, which positioned them as the "Kardashians". These individuals enjoyed greater social media popularity than their actual scientific contributions. Interestingly, our analysis revealed no discernible association between sex and K-index (P value of 0.92).

CONCLUSION

In the gastroenterology field, our study estimated that a majority (76%) of highly researched physicians are undervalued despite their significant scientific contributions.

PPI efficacy in the reduction of variceal bleeding incidence and mortality, a meta-analysis

Objective

To review the efficacy and safety of proton pump inhibitors (PPIs) in gastroesophageal varices (GEVs).

Methods

We searched PubMed MEDLINE, Scopus, and Web of Science for studies that measured the effect of PPI for prophylaxis and treatment of post-band ligation ulcers up to July 20, 2021. We included studies that measured the effect of PPI as treatment or prophylaxis for post-band ligation ulcers; articles that were published in peer-reviewed international journals and had enough data for qualitative and quantitative analysis were included with no language restriction. Heterogeneity was evaluated using the inconsistency (I2) and chi-squared (χ2) test. I2 > 50% was considered substantial heterogeneity in the studies, and a P value less than 0.05 was considered statistically significant. The data was continuous, and we used the standardized mean difference (MD) and risk ratio (RR) with a 95% confidence interval to assess the estimated effect measure.

Results

A total of 7 studies with 2030 patients were included in our study of which 1480 participants were males (72%) and 550 females (18%). Mean age was 59.7 years old. Rebleeding post-band ligation was compared between PPI and placebo with significant favor for PPI (p = 0.00001). The pooled risk ratio was 0.53 (95% CI of 0.41, 0.68); furthermore, bleeding-related death at a 1-month period was compared between PPI and placebo with significant favor for PPI (p = 0.00001). The pooled risk ratio was significant at 0.33 (95% CI of 0.20, 0.53). The length of hospital stay postoperative was compared between PPI and placebo with cumulative mean difference of 0.13 (95% CI of −1.13, 1.39), yet without significance.

Conclusions

The study suggests a twofold reduction in the risk of bleeding and a threefold reduction in the risk of bleeding-related death with the use of PPI following EVL.

Role of metformin in the treatment of cholangiocarcinoma: A systematic review

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Background: Non-cancer medications and their potential anti-cancer activity have attracted significant interest in recent years. The aim of this research is to conduct a systematic assessment of the existing evidence on the usefulness of metformin in the treatment of cholangiocarcinoma. Methods: We conducted literature search using PubMed, Clinicaltrials.gov, Embase, and Cochrane to retrieve studies evaluating the role of Metformin in the treatment of Cholangiocarcinoma. Three studies were finalized after careful screening. Results: We analyzed 3 studies. The total population was 638. The types of Cholangiocarcinoma varied from intrahepatic cholangiocarcinoma found in 293, to extrahepatic Cholangiocarcinoma in 365 and gallbladder carcinoma in 149 patients. Patients were in different stages of treatment such as undergoing chemotherapy, surgery or post- resection and/or post chemotherapy. The mean survival rate was significantly increased to 30.4 months and 13.2 months in patients using Metformin vs. 23.48 months and 10.3 months among patients not using Metformin (p < 0.0005) after resection of the tumor. An increase in the mean survival rate was reported among patients using Metformin vs. non-users after the administration of chemotherapy, i.e., 25.9 months vs. 10.6 months (p = 0.0016), respectively. Metformin in combination with Chloroquine showed favorable results regarding adverse events, however, no clinical activity was reported against IDH-1 mutated intrahepatic cholangiocarcinoma. Conclusions: Our analysis concludes while the use of Metformin is associated with significantly improved post-operative survival, it does not show any significant clinical activity against IDH-1 mutated intrahepatic cholangiocarcinoma. Metformin also showed significant improvement in patients taking chemotherapy. Studies, including trials to evaluate the effectiveness of Metformin alone or used in combination with non-cancer medications or chemotherapeutic agents could provide more definitive recommendations for the treatment of Cholangiocarcinoma.[Table: see text]

Primary Mediastinal B-Cell Lymphoma: A 2021 Update on Genetics, Diagnosis, and Novel Therapeutics

Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive B-cell lymphoma arising from thymic B-cells having clinicopathologic features distinct from systemic diffuse large B-cell lymphoma (DLBCL). PMBCL comprises 2% to 4% of all non-Hodgkin lymphomas (NHL), 7% of DLBCL and seen predominantly in young females with a median age of 35 years at diagnosis. The annual incidence of PMBCL is 0.4 per million with a 5-year survival rate exceeding 70% with improving supportive care and genetic characterization of the disease. Pathogenesis involves dysregulation of Janus kinase-signal transducer and activator of transcription (JAK-STAT), nuclear factor-kB (NF-kB) pathways and amplification of the 9p24.1 region of chromosome 9. PMBCL patients have a prolonged life expectancy necessitating the need for treatment approaches that are based on maximizing cure with minimal long-term toxicity. Due to rarity and its recognition as a distinct entity, therapeutic decisions are guided by clinical presentation, clinician and center experience, and analysis of patients with PMBCL within DLBCL registries. Historically R-CHOP has been the usual first line treatment for PMBCL followed by involved site radiotherapy (ISRT), however clinical practice varies across centers with emerging consensus to avoid upfront RT by utilizing dose intense regimens (DA-EPOCH-R) in younger and fit patients. Prognosis of relapsed refractory PMBCL not responding to salvage chemotherapy is dismal, however there are many emerging options including Brentuximab Vedotin, immune check point inhibitors and chimeric antigen receptor T-cell therapy. In this article, we focus on the pathogenesis, current and evolving treatments, and provide recommendations for optimal management of patients with PMBCL.

A systematic review of post-transplant lymphoproliferative disorder after liver transplant

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Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication after liver transplantation. This study aims to explore the association of PTLD with the immunosuppression, types of PTLD, clinical presentation, and outcomes. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and 22 studies were included. Results: Data includes 22,235 total patients who underwent a liver transplant, and 449 (2.0%) patients who developed PTLD were studied. Of the 394 patients where gender was reported, 226 were male and 168 were female. Post-transplant EBV status was positive for 63/115 (56%). 11 studies showed that the median time from transplant to the development of PTLD was 33.4 months. Among the histological types of PTLD, the monomorphic B-cell was the most common type with 127/235 (54%) cases, followed by early lesions 25/235, polymorphic 24/235, Hodgkin lymphoma 8/235, and monomorphic T-cell type 7/235. Treatment of PTLD involved reduction or cessation of the immunosuppressive drugs along with chemotherapy surgery and radiotherapy. Mortality data from 13 studies showed 68/259 (31.3%) patients died either due to PTLD or its complication. Conclusions: PTLD is rare but associated with high mortality after liver transplantation. EBV seropositivity is associated with PTLD in the majority of cases. Monomorphic PTLD is the most common type of PTLD after liver transplantation with DLBCL being the most common subtype. Abdominal symptoms and fever are among the most common symptoms. PTLD after Liver transplant a review of studies. [Table: see text]

A systematic review of post-transplant lymphoproliferative disorder after lung transplant

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Background: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. This study aims to explore the association of PTLD diagnosed after lung transplant with infectious agents and immunosuppression regimen, explore types of PTLD, and their outcome. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and included five studies. Results: We analyzed data from five studies, n=13,643 transplant recipients with n=287 (2.10%) developed PTLD. Four studies showed that 32/63 (51%) PTLD patients were male and 31 (49%) were female. Three studies reported 53/55 (96.4%) patients were EBV positive at PTLD diagnosis. Courtwright. et al, reported that 217/224 (97%) PTLD was associated with either EBV positive donor or recipient. Four studies showed that the monomorphic B cell type 48/63 (76%) was the most common histological type of PTLD diagnosed with DLBCL the most common subtype 31/48 (64.6%). Data from 3 studies showed that the onset of PTLD following lung transplant varies with a median duration of 18.3 months (45 days to 20.2 years). Three studies showed that 26/55 (47.3%) patients had early-onset (≤ 1 yr of Tx) and 29/55 (52.7%) patients had late-onset PTLD (> 1 yr of Tx). Management of PTLD included a reduction in immunosuppression including corticosteroids, CNI, purine synthesis inhibitors, Rituximab, and chemotherapeutic agents. Three studies showed a mortality rate of 30/45 (66.7%) and 13/30 (43.3%) deaths were PTLD related. Conclusions: Our review concludes that PTLD is a serious complication, only 2% of lung transplant recipients developed PTLD. EBV seropositivity is the most factor associated with PTLD diagnosis. Monomorphic PTLD was reported as the most common type in the adult population and no association between gender and PTLD was found. The analysis shows that there is a slightly lower incidence of early (≤ 1 yr of Tx) than late-onset (> 1 yr of Tx) PTLD. Table 1 PTLD after a Lung transplant in adults - a review. [Table: see text]

Role of biogenetic markers in differentiation and prognosis of giant cell tumor: A systemic review

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Background: Giant cell tumor (GCT) is a locally aggressive bone tumor. Early diagnosis and potential for recurrence are often difficult to assess due to a lack of bio-genetic markers and radiographic findings overlap with other osteolytic lesions. The purpose of this study is to explore biological and genetic markers that can be used for detection, differentiation, recurrence, and prognosis of GCT. Methods: We conducted a literature review including 24 articles out of 1568 articles, summarizing the role of biogenetic markers in the prognosis of GCT. Results: P63 is 98.6% sensitive and relatively specific for GCT as compared to other multinucleated giant cells containing neoplasms. MDM2(Mouse double minute 2 homolog), IGF1(Insulin-like growth factor 1), STAT1(Signal transducer and activator of transcription 1), and RAC1(Ras-related C3 botulinum toxin substrate 1) are associated with GCT recurrence. Increased expression of proteins like STAT5B, GRB2, and OXSR1 are related to a higher probability of metastasis. Neutrophil to lymphocyte ratio > 2.70, platelets to lymphocyte > 215.80, lymphocyte to monocyte ≤ 2.80, and AGR albumin to globulin < 1.50 ratio were significantly associated with decreased disease-free survival (DFS) (p < 0.05). Large amounts of osteoclast-related mRNA in GCTs (P < 0.05) are associated with the grade of bone resorption. We propose that subarticular primary malignant bone sarcoma with H3.3 mutations represent true malignant GCTB. IMP3 and IGF2 might be potential biomarkers in regulating the angiogenesis of GCT spine and predicting the patients’ prognosis. Conclusions: This review study has shown serological markers are significant in determining the diagnosis, differentiation, prognosis, and recurrence of GCT, which can be added to tumor work-up for definitive diagnosis and prognosis. [Table: see text]

A systematic review of post-transplant lymphoproliferative disorder after renal transplantation

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Background: Post Transplant Lymphoproliferative Disorder (PTLD) is a rare but severe complication following renal transplant. This study aims to explore the treatment modalities, histological types, and risk factors related to PTLD. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase & clinicaltrials.gov. A total of 1741 articles were screened and 16 studies were included. Results: We reviewed 275915 adult patients who underwent renal transplantation out of which 2484 (0.9%) patients developed PTLD. Data for gender shows that 61.1% were males and 38.9% females. 576/2484 (23%) cases were EBV positive post-transplant. Seven studies showed the median duration from transplant to the development of PTLD was 80 months (5m-22yrs). Monomorphic PTLD was reported in 585 cases as the most common histological type. 5 studies suggested mortality due to PTLD was 41.38%. OS at 5 and 10 years was 55% and 41% respectively. Conclusions: Our study shows that PTLD is a rare complication after renal transplant which was more common in males. EBV did not show association with PTLD. Monomorphic is the most common histological type of PTLD after renal transplant. Our results show that it is associated with significantly high mortality. [Table: see text]

COVID-19 and Its Psychological Impacts on Healthcare Staff - A Multi-Centric Comparative Cross-Sectional Study

Background

Since the first case of coronavirus disease-19 (COVID-19) in Pakistan was reported in February 2020, the medical and paramedical staff has been working on the frontlines to deal with this disease. They have been facing significant strain and stress due to the pandemic, affecting their social, mental, and personal life. The purpose of this study is to investigate the psychological effects of the COVID-19 pandemic, etiology, personal coping mechanisms, and the strategies that are being adopted to reduce stress by the healthcare workers (HCWs) working in COVID-19 dedicated wards (group 2) and compare it with staff working in other departments but not in COVID-19 wards amid this pandemic (group 1) in various hospitals of Lahore, Pakistan.

Methods

The comparative cross-sectional study was designed which included doctors, nurses, and allied health professionals from various hospitals of Lahore, Pakistan. A questionnaire was designed which consisted of five sections, and 51 questions. A Chi-square test was used to compare the responses between these two groups.

Results

The study questionnaire was submitted by 200 participants, 100 responses for each group (see the Appendix). In group 1, HCWs not working in COVID-19 dedicated floors were afraid of getting infected, transmitting the infection to their families and concerned about using personal protective equipment (PPE) improperly. They reported a lack of concentration and tense muscles. The coping mechanisms of this group were exercise, strict precautions at work, and social distancing measures. While HCWs serving in COVID-19 dedicated wards were concerned and afraid of putting their families at risk by working in the high-risk environment; the major stresses in this group were: lack of knowledge about proper strategies for treatment, they faced insecurity due to physical and verbal violence by caretakers of COVID-19 patients, and lack of concentration. The coping mechanism was the support of their families and taking strict precautions, with self-isolation if required, to avoid any disease transmission to their families. The proposed strategies to be implemented included teaching skills for self-rescue as well as the implementation of policies at the administrative level to reduce working hours and frequent shift rotation.

Conclusion

The COVID-19 outbreak posed a great deal of mental stress among HCWs working on the COVID-19 floor as well as those serving in other departments of the hospital. The HCWs from group 1 were most afraid of getting infected and putting family members at risk, experienced tense muscles and lack of concentration, coped their stress by exercise and being more vigilant, and suggested the strategies of teaching skills for self-rescue and better community awareness. While the staff from the second group were most afraid of being the source of infection and violence from the caretakers of patients, experienced tense muscles, used family support, and strict isolation measures as coping mechanisms and suggested the strategies of self-rescue and increase in wages of directly exposed healthcare workers to deal with such pandemics in future in a better way.

Catalyst-Free Three-Component Synthesis of Spirobenzimidazolidines Bearing an Indole Scaffold

An efficient catalyst-free one-pot three-component reaction was developed for the synthesis of a new family of N- and S-containing spirocyclic compounds. Various derivatives of spirobenzimidazolidine containing an indole scaffold were synthesized for the first time in a modestly toxic solvent and under mild reaction conditions. The reaction times were of the order of several minutes, and all the products were obtained in moderate to high yields (overall yields 58–80%).

Physico-chemical analysis of drinking groundwater of around Tehran by seasonal variation

This study was a cross-sectional descriptive study and done in four seasons during April 2011 to March 2012.The objective of the present study was to examine Physico-chemical properties of groundwater around Tehran. The results are also compared with the guideline values of Iranian legislation. A total of 160 drinking water samples were collected from different drinking groundwater around the Tehran. Total Dissolved Solids (TDS), conductivity and pH, were measured by using standard methods and the concentration of ions Cl-, F-, NO3-, NO2-, Br-, SO4(2-), PO4(3-), Ca2+, K+, Na+ and NH4+ in groundwater was performed using Ion chromatography (Metrohm Company, USA) with standard method. This study showed that most of the parameters in groundwater were below the Iranian permissible limit except total dissolved solids (N = 2), conductivity (N = 2), nitrate as NO3- (N = 22), chloride (N = 3), sulphate (N = 2), fluoride (N = 3) and ammonia (N = 8). There were significant differences (p < 0.05) between physico-chemical parameters such as pH, nitrite (NO2-), sodium, potassium, sulphate, ammonia, bromide and phosphate in different seasons. These results are important, not only for the many people who drink groundwater but also for the health supervisory agencies such as Ministry of Health and Institute of Standards and Industrial of Iran (ISIRI) to have more effective control on groundwater.

A metabolomic study on the effect of intravascular laser blood irradiation on type 2 diabetic patients

Intravenous laser blood irradiation (ILBI) is widely applied in the treatment of different pathologies including diabetes mellitus. The aim of this study is to evaluate the effects of ILBI on the metabolites of blood in diabetic type 2 patients using metabolomics. We compared blood samples of nine diabetic type 2 patients, using metabolomics, before and after ILBI with blue light laser. The results showed significant decrease in glucose, glucose 6 phosphate, dehydroascorbic acid, R-3-hydroxybutyric acid, L-histidine, and L-alanine and significant increase in L-arginine level in blood and blood sugar in the patients have reduced significantly (p < 0.05). This study clearly demonstrated a significant positive effect of ILBI on metabolites of blood in diabetic type 2 patients. These findings support the therapeutic potential of ILBI in diabetic patients.

Early detection of immunization: a study based on an animal model using 1H nuclear magnetic resonance spectroscopy

Vaccines require a period of at least three months for clinical trials, hence a method that can identify elicitation of immune response a few days after the first dose is a necessity. Evolutionary variable selections are modeling approaches for proper manipulation of available data which were used to set up an animal model for classification of time dependent 1HNMR metabolomic profiles and pattern recognition of fluctuations of metabolites in two groups of male rabbits. One group of rabbits was immunized with human red blood cells and the other used as control. Blood was obtained every 48 h from each rabbit for a period of six weeks and the serum monitored for antibodies and metabolites by 1HNMR spectra. Evaluation of data was carried out using orthogonal signal correction followed by principal component analysis and partial least square. A neural network was also set up to predict immunization profiles. A distinct separation in patterns of significant metabolites was obtained between the two groups, just a few days after the first and the second dose. These metabolites were used as targets of neural networks where each sample was used as test, validation and training and their quantitative influence predicted by regression. This model could be used for prediction of immunization in rabbits a few days after the first dose with 96% accuracy. Similar animals and human vaccine trials would assist greatly in reaching early conclusions in advance of the usual two month immunization schedule; resulting in an appreciable saving of cost and time.

Evaluation of serum levels of essential trace elements in patients with pulmonary tuberculosis before and after treatment by age and gender

The purpose of this study was to evaluate the levels of Zinc, Copper, Iron and Copper/Zinc ratio in the serum of adult patients with pulmonary tuberculosis in Iran. Serum levels of Zinc and Copper were determined by flame atomic absorption spectrophotometer and scrum iron concentration was measured by using an Auto Analyzer. The study group consisted of 50 pulmonary tuberculosis patients before treatment and after 6 months of anti-tubercular therapy. Levels of scrum Zn (p < 0.001) and Fe (p < 0.001) in TB patients were significantly increased after 6 months of anti-tubercular therapy. However, serum Cu concentration (p < 0.01) and Cu/Zn ratio (p < 0.05) were decreased after 6 months of anti-tubercular therapy. Some studies indicated a strong association of Zn, Cu, Fe and the Cu/Zn ratio with TB. In this study, we found remarkable change in Cu/Zn ratio. Some researchers mentioned that serum Cu/Zn ratio could be used as an important laboratory marker for diagnosis and treatment of tuberculosis. They also mentioned that trace element levels must be closely monitored during the process of disease.

Evaluation of serum levels of zinc, copper, iron, and zinc/copper ratio in cutaneous leishmaniasis

BACKGROUND

The purpose of this study was to evaluate the levels of zinc (Zn), copper (Cu), iron (Fe) and zinc/ copper ratio in the serum of patients with cutaneous leishmaniasis in Qom Province, center of Iran.

METHODS

Serum levels of zinc and copper were determined by flame atomic absorption spectrophotometer and serum iron concentration was measured by using an Auto Analyzer. The study group consisted of 60 patients with cutaneous leishmaniasis and the control group of 100 healthy volunteers from the same area who were not exposed to cutaneous leishmaniasis.

RESULT

There were no statistically significant differences in age and body mass index between the two groups. Serum Zn (P< 0.001) and Fe (P< 0.05) levels were lower in patients with cutaneous leishmaniasis than the control group. We also found serum Cu concentration (P< 0.05) in the patient group was significantly higher than that of the control group. However, zinc/ copper ratio (P< 0.001) was lower in patients with cutaneous leishmaniasis than in the control group.

CONCLUSION

Our data indicated that Zn/Cu ratio was significantly lower in patients with CL as compared to the controls. Earlier reports suggest that, this ratio imbalance could be a useful marker for immune dysfunction in leishmaniasis. There was also strong association of Zn, Cu and Fe with CL. It suggests the use of blood zinc, copper, iron concentration and the copper/zinc ratio (Zn/Cu), as a means for estimating the prognosis of CL.