Diarrhea as a Prognostic Factor for Severe COVID-19 Nisrina, Dinda; Maulahela, Hasan
The Indonesian journal of gastroenterology, hepatology, and digestive endoscopy (Jakarta),
09/2022, Letnik:
23, Številka:
2
Journal Article
Odprti dostop
In March of 2020, the WHO has declared the state pandemic of COVID-19 that started in the city of Wuhan, China. The widespread of cases resulted in 2,877,476 cases and 73,582 death reported in ...Indonesia. It is commonly known that the respiratory system was the main problem in COVID-19, but it is recently reported that gastrointestinal involevment has a higher likelihood to develop into severe cases. Moreover, it is found that diarrhea is the most highly prevalent of the gastrointestinal signs and symptoms in COVID-19 patients. The aim of this evidence-based case report is to understand the association between diarrhea and severe cases of COVID-19. A search on Pubmed, Scopus and Cochrane result in five articles to be appraised using Centre for Evidence-Based Medicine (CEBM) critical appraisal tool. The most recent systematic review by Ghimere S et al (2020), found COVID-19 patients with diarrhea has higher likelihood of developin ginto a severe case (OR = 1.63, 95% CI: 1.11 – 2.38). While the cohort studies showed several prognostic factors that may potentially effect the outcome of severe COVID-19 cases. It is concluded that severe COVID-19 cases were more likely to be found in patients presenting with diarrhea. Thus, Confirmed COVID-19 patients with diarrhea should be carefully evaluated to anticipate worsening of symptoms.
The clinical application of a real-time artificial intelligence (AI) image processing system to diagnose upper gastrointestinal (GI) malignancies remains an experimental research and engineering ...problem. Understanding these commonly used technical techniques is required to appreciate the scientific quality and novelty of AI studies. Clinicians frequently lack this technical background, and AI experts may be unaware of such clinical relevance and implications in daily practice. As a result, there is a growing need for a multidisciplinary, international assessment of how to conduct high-quality AI research in upper GI malignancy detection. This research will help endoscopists build approaches or models to increase diagnosis accuracy for upper GI malignancies despite variances in experience, education, personnel, and resources, as it offers real-time and retrospective chances to improve upper GI malignancy diagnosis and screening. This comprehensive review sheds light on potential enhancements to computer-aided diagnostic (CAD) systems for GI endoscopy. The survey includes 65 studies on automatic upper GI malignancy diagnosis and evaluation, which are compared by endoscopic modalities, image counts, models, validation methods, and results. The main goal of this research is to assess and compare each AI method's current stage and potential improvement to boost performance, maturity, and the possibility to open new research areas for the application of a real-time AI image recognition system that diagnoses upper GI malignancies. The findings of this study suggest that Support Vector Machines (SVM) are frequently utilized in gastrointestinal (GI) image processing within the context of machine learning (ML). Moreover, the analysis reveals that CNN-based supervised learning object detection models are widely employed in GI image analysis within the deep learning (DL) context. The results of this study also suggest that RGB is the most commonly used image modality for GI analysis, with color playing a vital role in detecting bleeding locations. Researchers rely on public datasets from 2018-2019 to develop AI systems, but combining them is challenging due to their unique classes. To overcome the problem of insufficient data to train a new DL model, a standardized database is needed to hold different datasets for the development of AI-based GI endoscopy systems.
A Case of Eosinophilic Gastritis with Gastric Bleeding Sudrajat, Dedy G; Maulahela, Hasan
The Indonesian journal of gastroenterology, hepatology, and digestive endoscopy (Jakarta),
12/2020, Letnik:
21, Številka:
3
Journal Article
Odprti dostop
Eosinophilic gastritis is a manifestation of gastrointestinal eosinophilic disease. The clinical symptoms are not specific, similar to other gastric disease complaints. The diagnostic aproach aside ...from clinical manifestations is also from endoscopic and histopathological features as the gold standard. Management includes drugs and diet. In some cases with strictures and perforations, endoscopic or even surgical intervention needed. Steroid-based therapy, especially topical preparations, is still the main choice. Other alternative therapies such as immunosuppression and targeted therapy showed good results in several case reports and small-scale studies. Further research to get a better management needed, considering the prevalence of this disease is elevated.
Aim: To determine the preferred method of treatment in patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) by evaluating efficacy of early laparascopic ...cholecystectomy compared to delayed laparoscopic cholecystectomy.Method: Literature searching was carried out on two databases, PubMed and Cochrane, according to the inclusion and exclusion criteria. Two randomized clinical trial (RCT) studies were appraised critically for validity, importance, and applicability.Results: Early laparascopic cholecystectomy after ERCP shows lower outcomes in incidence of recurrent choledocholithiasis, acute cholecystitis, duration of hospitalization, and treatment costs (p 0.05). Meanwhile, there was no significant difference (p 0.05) between the two groups regarding the incidence of biliary adhesions, bleeding during cholecystectomy, and laboratory parameters such as total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma glutamyl transferase (GGT).Conclusion: Early cholecystectomy, within three days after ERCP, is recommended for the treatment of choledocholithiasis after ERCP removal.
Intestinal tuberculosis still has a high incidence, especially in developing countries. The biggest challenge of this disease is the establishment of the diagnosis because the clinical features are ...not typical. Investigations such as culture, acid-fast bacilli (AFB) staining, and histopathology have low sensitivity, so other investigations are needed. Latest molecular-based diagnostic modalities such as GeneXpert, interferon-gamma (IFN-γ) release assays (IGRA), polymerase chain reaction (PCR), multiplex-PCR, and immunological markers are expected to help diagnose intestinal tuberculosis. This article review will examine the latest diagnostic modalities that can be used as a tool in establishing the diagnosis of intestinal tuberculosis.
Through a literature search, we were able to review the diagnostic values of various available diagnostic modalities as the appropriate additional test in intestinal tuberculosis. Culture as a gold standard has a sensitivity and specificity value of 9.3% and 100% with the MGIT BACTEC system as the most recommended medium. The sensitivity values of AFB staining, histopathology examination, GeneXpert, IGRA, PCR, multiplex-PCR and, immunological markers were ranged between 17.3 and 31%; 68%; 81-95.7%; 74-88%; 21.6-65%; 75.7-93.1%; and 52-87%, respectively. Meanwhile the specificity values were 100%; 77.1%; 91-100%; 74-87%; 93-100%; 96.4-100%; and 70-95%, respectively.
The combination of clinical examination, conventional examination, and the latest molecular-based examination is the best choice for establishing the diagnosis of intestinal tuberculosis. Most recent modalities such as multiplex PCR and immunological marker examinations are diagnostic tools that deserve to be used in diagnosing intestinal tuberculosis as their sensitivity and specificity values are quite high and more evidences are expected to support the application of these examinations shortly soon.
Information regarding Helicobacter pylori antibiotic resistance in Indonesia was previously inadequate. We assessed antibiotic susceptibility for H. pylori in Indonesia, and determined the ...association between virulence genes or genetic mutations and antibiotic resistance. We recruited 849 dyspeptic patients who underwent endoscopy in 11 cities in Indonesia. E-test was used to determine the minimum inhibitory concentration of five antibiotics. PCR-based sequencing assessed mutations in 23S rRNA, rdxA, gyrA, gyrB, and virulence genes. Next generation sequencing was used to obtain full-length sequences of 23S rRNA, infB, and rpl22. We cultured 77 strains and identified 9.1% with clarithromycin resistance. Low prevalence was also found for amoxicillin and tetracycline resistance (5.2% and 2.6%, respectively). In contrast, high resistance rates to metronidazole (46.7%) and levofloxacin (31.2%) were demonstrated. Strains isolated from Sumatera Island had significantly higher metronidazole resistance than those from other locations. Metronidazole resistant strains had highly distributed rdxA amino acid substitutions and the 23S rRNA A2143G mutation was associated with clarithromycin resistance (42.9%). However, one strain with the highest MIC value had a novel mutation in rpl22 without an A2143G mutation. Mutation at Asn-87 and/or Asp-91 of gyrA was associated with levofloxacin-resistance and was related to gyrB mutations. In conclusions, although this is a pilot study for a larger survey, our current data show that Indonesian strains had the high prevalence of metronidazole and levofloxacin resistance with low prevalence of clarithromycin, amoxicillin, and tetracycline resistance. Nevertheless, clarithromycin- or metronidazole-based triple therapy should be administered with caution in some regions of Indonesia.
Both cold snare polypectomy (CSP) and hot snare polypectomy (HSP) have been shown to be effective methods for removing small colorectal polyps, but the optimal method for achieving complete resection ...remains unclear. To address this issue, we conducted a systematic search of relevant articles using databases such as PubMed, ProQuest, and EBSCOhost. The search criteria included randomized controlled trials that compared CSP and HSP for small colorectal polyps ≤10 mm and the articles were screened based on specific inclusion and exclusion criteria. The data were analyzed using RevMan software (version 5.4; Cochrane Collaboration, London, United Kingdom), and meta-analysis was performed with outcomes measured using pooled odds ratios (OR) and 95% confidence intervals (CI). The Mantel-Haenszel random effect model was used to calculate the OR. We selected a total of 14 randomized controlled trials involving 11601 polyps for analysis. Pooled analysis showed no statistically significant difference in the incomplete resection rate between CSP and HSP (OR: 1.22; 95% CI: 0.88-1.73, p-value: 0.27; I
: 51%), en bloc resection rate (OR: 0.66; 95%CI: 0.38-1.13; p: 0.13; I
: 60%), and polyp retrieval rate (OR: 0.97; 95%CI: 0.59-1.57; p: 0.89; I
: 17%). For safety endpoints, there is no statistically significant difference in intraprocedural bleeding rate between CSP and HSP per patient analysis (OR: 2.37, 95% CI: 0.74-7.54; p: 0.95; I
: 74%) and per polyp basis (OR: 1.84, 95% CI: 0.72-4.72; p: 0.20; I
: 85%). CSP had lower OR for the delayed bleeding outcome when compared with the HSP group per patient basis (OR: 0.42; 95% CI: 0.2-0.86; p: 0.02; I
: 25%), but not in the per polyp analysis (OR: 0.59; 95% CI: 0.12-3; p: 0.53; I
: 0%). Total polypectomy time was significantly shorter in the CSP group (mean difference: -0.81 minutes; 95% CI: -0.96, -0.66; p:<0.00001; I
: 0%). Thus, CSP is both an efficacious and safe method for removing small colorectal polyps. Therefore, it can be recommended as a suitable alternative to HSP for the removal of small colorectal polyps. However, more studies are necessary to evaluate any long-term differences between the two methods such as polyp recurrence rates.
PDF
