Department Of Gastroenterology Research Articles

Percutaneous radiofrequency ablation for stage B1 of modified Bolondi’s subclassification for intermediate-stage hepatocellular carcinoma

Abstract Background Hepatocellular carcinoma is considered the most common cause of hepatic focal lesions in Egypt. TACE is still the recommended treatment approach for patients in the intermediate stage. In the current research, we evaluated the safety and efficacy of percutaneous radiofrequency ablation (RFA) for a selected category in the intermediate stage (BCLC stage B). Methods This prospective study was conducted in the Department of Gastroenterology, Hepatology, Faculty of Medicine, Beni-Suef University between September 2022, and March 2024. In addition to AFP, Pelviabdominal ultrasound and computerized tomography (CT) were used for HCC diagnosis. According to the Child–Pugh score plus Milan and up-to-7 criteria, we used Modified Bolondi’s Subclassification (Kinki Criteria), to sub-classifies the BCLC B stage into B1/B2/B3 subcategories. Radiofrequency ablation was done in the interventional ultrasound unit. Treatment efficacy was assessed 6 months after tumor ablation. Results One hundred twenty participants were enrolled in our research trial, 72 (60%) were within the intermediate stage, and 48 (40%) had early-stage HCC. Most of our patients were males, 78 (65%). All the early-stage-HCC patients were Child–Pugh Score A (n = 48), while the intermediate-stage (BCLC B) group was classified in both Child–Pugh Score A (n = 59) and B (n = 16). Within the intermediate group (BCLC-stage B), All enrolled cases fell within category “B1” within the Kinki Criteria. Logistic regression analysis illustrated that the pre-treatment level of Platelet count and post-treatment level of AFP shows a statistically significant prediction effect on treatment response rate with p-value (0.028 and 0.007 respectively). Conclusion percutaneous radiofrequency ablation is considered an effective treatment option for the B1 subcategory according to Kinki Criteria for intermediate-stage HCC (BCLC-B1) but long-term follow-up is recommended.

What We Know So Far About ECG for Pancreatic Pseudocysts

Background: Endoscopic cysto-gastrostomy (ECG) has become the treatment of choice for pancreatic pseudocysts (PPCs). Endoscopic drainage of PPCs requires the creation of an anastomosis between the lumen of the PPCs and the lumen of the gastrointestinal tract. Various types of stents are used for this purpose. The aim of the study is to compare the indications, quantity, and results of using double pigtail plastic stents (DPPSs) and lumen-apposing fully covered metal stents (LAMSs) in ECG. Methods: A retrospective analysis was conducted of 39 patients (24 men, 15 women) treated for PPCs in the Department of Digestive Tract Surgery and the Department of Gastroenterology and Hepatology between October 2018 and February 2023. The mean age of patients was 51.13 (28–77). Data about etiology, cyst diameter, type, and complications of the stents were collected. Results: DPPSs were placed in smaller cysts (108 vs. 140 millimeters, p = 0.04) and were maintained for a longer duration compared to LAMSs (106 vs. 34 days, p = 0.001). Cyst recurrence was reported less frequently in patients with a LAMS (0 (0%) vs. 4 (19.05%), p = 0.05) and the therapeutic success was non-significantly higher in the LAMS group compared to the DPPS group (100% vs. 85.71%), p = 0.095. Conclusions: Both DPPSs and LAMSs are characterized by high therapeutic success and low complication rates in patients undergoing ECG for PPCs.

Relationship of Dyspeptic Symptoms with Dinner to Breakfast Time Interval

Objective: To ascertain the relationship of dyspeptic symptoms with dinner to breakfast time interval. Study Design: Cross-sectional study. Place and Duration of Study: Department of Gastroenterology, Liaquat National Hospital, Karachi Pakistan, from Aug 2021 to Apr 2022. Methodology: We enrolled patients of either gender, between 18 to 50 years of age, with persistent symptoms of dyspepsia for at least two months and/or confirmed cases of dyspepsia. Written, informed consent was taken from all patients prior to recruiting them. Patients visiting outpatient department with symptoms of dyspepsia and/or confirmed cases of dyspepsia were interviewed to fill out Short-form Leeds Dyspepsia Questionnaire (SF-LDQ). Results: Total 400 patients were studied with nearly half of the participants being female 188 (47%) with 72(18%), 87(21.8%), 113(28.2%) and 128(32%) patients had dinner to breakfast duration of ≤8 hours, 8.1-10 hours, 10.1-12 hours and >12 hours, respectively. There was moderate positive correlation between fasting duration and SF-LDQ (r=0.46, p<0.001). Nightly fasting duration of more than 10 hours had increased risk of indigestion, heartburn and regurgitation. Conclusion: Longer duration between dinner and breakfast was found to be associated with increased likelihood of dyspeptic symptoms including indigestion, heartburn and regurgitation.

Gastric cancer and associated pathogens: is there any association in Moroccan region?

Helicobacter pylori, Epstein-Barr virus and human papillomavirus are three pathogens associated with various human cancers. This study aimed to investigate the role of these pathogens in gastric cancer in Moroccan population. For this, a retrospective study has been conducted on participants attending the gastroenterology department of Hassan II University Hospital of Fez. A total of 279 participants were enrolled. H. pylori, EBV and HPV were detected and genotyped by PCR. In results, a significant association has been established between H. pylori, EBV and gastric cancer. 93.4% and 43.3% of gastric cancer cases are related to H. pylori and EBV respectively (p≤0.01). H. pylori-EBV co-infection is responsible of 31.6% of gastric cancer cases (p<0.01). Correlation between pathogens genotypes and gastric cancer shows 54.6% of GC EBV positives are carrying the 30 bp deletion in LMP1gene, while 16% of gastric cancers cases are carrying high-risk genotypes of HPV (p=0.21). The obtained results highlight the possible role of co-infection in gastric cancer development.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients with Chronic Liver Disease and Ascites

Chronic liver disease (CLD) contributes significantly to morbidity and mortality around the world. In Pakistan, it is due mainly to infections of Hepatitis B and C. One of the complications of CLD, which is often important for such patients, involves an infection of spontaneous bacterial peritonitis. Asymptomatic spontaneous bacterial peritonitis commonly develops in asymptomatic patients with ascites and is therefore preventable when it develops early. This study will determine the incidence of asymptomatic SBP in patients with CLD and ascites, providing potentially valuable data to support screening protocols for early intervention and improved outcomes. It was a cross-sectional study carried out for six months in the Gastroenterology Department of Sheikh Zayed Hospital, Lahore. A total of 121 CLD patients with ascites, meeting particular inclusion criteria, were assessed. The cases were categorized as asymptomatic SBP if the cultures were positive with more than 10⁵ colonies or more than 250/mm³ polymorphonuclear cells, without fever, pain, or tenderness. The patients were stratified according to age, gender, and Child-Pugh classification. The data were analyzed using SPSS version 24, along with the Chi-square test for correlation between the Child-Pugh class and SBP.The proportion of asymptomatic SBP was at 14.8 % among 121 patients. The patients were older: 66.1%, were mostly more than 50 years old, with a fair sex distribution ratio of 52.1 females against 47.9 males. Patients classified into Child-Pugh Class C constituted the highest proportions of patients with SBP cases of 14.8 % and significant association at p=0.000. Asymptomatic SBP in 14.8% of the patients with CLD and ascites forms the justification for routine screening on hospital admission. Critical importance is placed on detecting asymptomatic SBP because this leads to earlier intervention and a potential reduction in the risk of major complications, particularly in patients classified as Child Class C. Keywords- Frequency, Asymptomatic, Spontaneous Bacterial Peritonitis, Patients Chronic Liver Disease, Ascites

Krankenhaussterblichkeit bei Patienten mit und ohne Demenz

Background: Studies reported a higher in-hospital mortality in patients living with dementia (PlwD) with limited evidence across age groups, clinical departments and admission diagnoses. Study aim was to compare the in-hospital mortality rate of PlwD with non-demented controls across groups, clinical departments and admission diagnoses. Methods: This case-control study included patients aged ≥ 60 years hospitalized in one of 36 German hospitals between January 2019 and July 2023. PlwD were matched to non-demented controls. The associations between dementia and in-hospital mortality across groups were assessed using univariable logistic regression analyses. Results: 29,203patients with and 29,203 without dementia were included (mean age: 84 years, 60% female). PlwD had a significantly higher in-hospital mortality rate than non-dementia controls. The excess mortality rate was highest in the youngest age group (60–70 years), decreased with age, and became non-significant in the oldest age group (≥ 90 years). Significant differences were found for digestive system, cardiovascular and cerebrovascular disorders, endocrine, nutritional and metabolic diseases, and pneumonia, as well as for internal medicine and gastroenterology departments. Conclusion: The excess mortality rate was highest in younger age groups, where the general mortality and complication rate is relatively low in the general population. Appropriate approaches are needed.

Comparison between Split Dose and Single Dose Bowel Laxatives for Preparation of Colonoscopy in Patients with Bangladeshi Diets: A Randomized Clinical Trial

Introduction: Colonoscopy is an important diagnostic tool for colonic disease and its efficacy and safety have been correlated with adequate bowel preparation. This study compared the efficacy and tolerability of single-dose and split-dose sodium picosulfate lavage as a colon cleansing agent for colonoscopy preparation. Methods: This randomized clinical trial was conducted at the Department of Gastroenterology in Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from June 2021 to May 2022.A total of 110 patients were selected by randomized sampling technique who underwent elective colonoscopy and were divided into split-dose (n=57) and single-dose (n=53) laxative groups. Bowel preparation was assessed by the Ottawa Bowel Preparation Scale (OBPS) and data were analyzed by SPSS 24.0. Result: The mean age of the patients was 47.4±17.7(SD) years in split-dose and 47.6±15.9 (SD) years in single-dose group. Both groups were statistically similar in terms of socio-demographic profile, medical history, clinical manifestation, and indication of colonoscopy (p&gt;0.05). The mean of total OBPS score (4.39±2.0 vs 5.56±2.2, p=0.004) and caecal intubation time (6.60±3 vs 7.74±2.5, p=0.035) was lower significantly in split-dose than the single-dose group. However, colonoscopy findings, adverse events, and patient compliance were similar between groups (p&gt;0.05). Conclusion: Split-dose is superior to single-dose bowel laxatives for colonoscopy preparation in terms of better mucosal cleanliness and lower caecal intubation time. However, further randomized controlled trial is recommended. J Bangladesh Coll Phys Surg 2024; 42: 329-335

Growth Status of Bangladeshi Children in Functional Constipation: Experience From A Tertiary Care Hospital

Background: Constipation is one of the common complaints of children with long-term hazardous consequences. It is a frequent cause of hospital visit in both primary and specialized care which needs proper evaluation and management. Recently in few studies, impairment of growth status has been reported as a result of functional constipation. But the relation is not well evaluated, especially in the pediatric population of our country. Aim: To assess the growth status of Bangladeshi children in functional constipation. Methods: This analytical study was conducted at the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka. A total 150 children aged 2-18 years were enrolled in this study. Children were divided into two groups, 75 having functional constipation (FC) and 75 healthy children with no constipation. Samples were collected randomly from pediatric out-patient department of BSMMU with consent of parents and child’s approval. Diagnosis of functional constipation was made by Rome IV criteria. Children with any red flag sign, chronic disease and on treatment of constipation were excluded from the study. Growth status (weight, height &amp; BMI) was evaluated by using growth charts. Data collected in semi-structured questionnaire and analyzed by SPSS 23.0. Results: We evaluated 75 constipated children with the mean age of 7.61±3.50 years and 75 healthy children with the mean age of 7.40±3.88 years. The mean weight of children with functional constipation was 22.8±10.01 kg, mean height 117.7 ±18.4 cm and BMI 15.6±2.3 kg/m2. The mean weight of children with no constipation was 28.6± 13.72 kg, mean height 124.49±23.3 cm and BMI 18.11±2.9 kg/m2,demonstrated significant difference between two sets. In functional constipation group, on weight for age and height for age chart, 28% and 24% children were below the 3rd centile respectively and 18.6% children had BMI below 5th centile. All these parameters (weight, height, BMI) were statistically significant in compare to children without constipation and p value is &lt;.05. Presenting features of functional constipation were anorexia (64%), abdominal pain (73.3%), hard stool (84%), blood mixed hard stool (13.3%) and nausea (34%). Conclusion: Growth impairment occurs in children with functional constipation in comparison to children without constipation. Children aged 2 to 18 years with functional constipation may have decelerated weight, height and BMI growth. And this observation needs further large-scale multicenter study for ensuring optimal growth of children with constipation. J Shaheed Suhrawardy Med Coll 2023; 15(1): 73-77

Comparative analysis of the characteristics of high-resolution anorectal manometry in children with outlet obstructive constipation of different age groups

Objective: To compare the characteristics of high-resolution anorectal manometry (HR-ARM) in children with outlet obstructive constipation (OOC) in different age groups. Methods: Retrospective inclusion of clinical data of functional constipation (FC) patients who underwent HR-ARM examination in the Department of Gastroenterology of Children's Hospital Affiliated of Zhengzhou University from January 2019 to September 2023 was conducted. The patients were divided into low age group (4 years old≤age<6 years) and high age group (6 years old≤age≤15 years old) according to age. They were divided into OOC group (the pediatric patients with uncoordinated pelvic floor muscle contractions, insufficient rectal thrust during defecation, or insufficient relaxation of anal sphincter muscles during contraction) and non-OOC group based on HR-ARM results. The rectal motility [rectal resting pressure, maximum squeeze pressure (MSP), rectal pressure during force delivery, residual anal pressure, rectal anal pressure gradient], rectal sensory function (initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold) and other indicators were compared between OOC group and non-OOC group in 2 age groups, respectively. Results: A total of 228 children with FC were included, including 146 males and 82 females, with an age [M (Q1, Q3)] of 7.5 (6.0, 9.7) years, including 54 in the low age group and 174 in the high age group. There were 131 cases in the OOC group and 97 cases in the non-OOC group. Compared with non OOC children (24 cases), there were no statistically significant differences in rectal resting pressure, anal sphincter resting pressure, MSP, rectal pressure during force delivery, initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold among OOC children (30 cases) in the low age group (all P>0.05). In the high age group, the residual anal pressure of the OOC children (101 cases) was higher than that of the non-OOC children (73 cases) [102 (70, 113) vs 41 (24, 58) mmHg (1 mmHg=0.133 kPa), P<0.001], and the rectal anal pressure gradient was lower than that of the non-OOC children [-43 (-55, -23) vs 16 (9, 29) mmHg, P<0.001];The initial fecal sensory capacity threshold of the OOC children was higher than that of the non-OOC children [90 (54, 110) vs 60 (50, 91) ml, P=0.024]. Conclusions: Compared with non-OOC children in the same age group, OOC children aged 6 years and above have higher residual anal pressure and initial fecal sensory capacity threshold, and lower rectal anal pressure gradient. There is no statistically significant differences in the rectal sensory function in children under 6 years old with OOC.

Predictors of bleeding from esophagus veins in patients with liver cirrhosis

Aim: to identify clinical and laboratory predictors of bleeding from the esophageal veins in patients with liver cirrhosis and evaluate their practical significance. Materials and methods. The study materials were the results of an examination of 50 patients treated in the gastroenterology department for liver cirrhosis and 160 patients in surgical departments hospitalized for bleeding from esophageal varices due to liver cirrhosis. All patients were subjected to a standard set of general clinical examinations, ultrasound examination of the abdominal organs, and videoesophagogastroduodenoscopy. Results. When comparing patients with cirrhosis of the liver with and without bleeding from the veins of the esophagus, a statistically significant difference was revealed between the groups in the gender and age composition, blood bilirubin level, and de Ritis coefficient. At the same time, no differences were found in the etiology and severity of liver cirrhosis, blood protein levels, the diameter of the portal and splenic veins, and the proportion of patients with ascites. Conclusions. The detection of a de Ritis coefficient equal to or exceeding 1.8 in a patient with liver cirrhosis can be considered a predictor of a high risk of bleeding from the esophageal veins (sensitivity of the parameter 60.87%, specificity 93.94%) and can be recommended for identifying those in need of priority measures primary prevention.

Collagenising gastritis

It is a rare condition defined histologically by superficial subepithelial collagen layer. Collagenous gastritis occurs in bimodal age distribution both paediatric and adults.Sub epithelial collagen distribution favours the body or fundus in paediatric age group and antrum in adults. Now present a case of collagenising gastritis in 50 year male who presented with vomiting to medical gastroenterology department.

Falls and malnutrition are associated with in-hospital mortality in patients with cirrhosis.

Hospitalized patients with end-stage liver disease are at risk of malnutrition, reduced body function, and cognitive impairment due to HE. This combination may have an impact on in-hospital falls and mortality. The purpose of this study was to identify factors associated with the risk of falls and to analyze the consequences regarding in-hospital mortality. We performed a retrospective analysis of patients hospitalized with liver cirrhosis between 2017 and 2019 at the Department of Gastroenterology at the University Hospital Frankfurt. Clinical data, laboratory work, and follow-up data were analyzed. Factors associated with the risk of falls and in-hospital mortality were calculated using a mixed effect poisson regression model and competing risk time-to-event analyses. Falls occurred with an incidence of 4% (80/1985), including 44 injurious falls with an incidence rate of 0.00005/100 patient-days (95% CI: 0.00001-0.00022). In the multivariate analysis malnutrition (incidence risk ratio: 1.77, 95% CI: 1.04-3.04) and implanted TIPS (incidence risk ratio: 20.09, 95% CI: 10.1-40.1) were independently associated with the risk of falling. In a total of 21/80 (26.25%) hospitalizations, patients with a documented fall died during their hospital stay versus 160/1905 (8.4%) deaths in hospitalizations without in-hospital fall. Multivariable analysis revealed as significant clinical predictors for in-hospital mortality a Nutritional Risk Screening ≥2 (HR 1.79, 95% CI: 1.32-2.4), a falling incident during hospitalization (HR 3.50, 95% CI: 2.04-6.0), high MELD, and admission for infections. Malnutrition and TIPS are associated with falls in hospitalized patients with liver cirrhosis. The in-hospital mortality rate of patients with cirrhosis with falls is high. Specific attention and measures to ameliorate these risks are warranted.

The outcomes of robotic-assisted enucleation for tumors located in uncinate process of pancreas in 16 cases

Objective: To summarize the experience of robot-assisted enucleation of tumors located in uncinate process of pancreas. Methods: This is a retrospective case series study. The clinical data of patients with robot-assisted enucleation of tumors located in the uncinate process of pancreas at the Department of Gastroenterology and Pancreatic Surgery,Zhejiang Provincial People's Hospital from June 2019 to December 2023 were retrospectively analyzed. A total of 16 cases were enrolled,including 10 males and 6 females,with an age(M(IQR)) of 56(21)years (range: 28 to 77 years),and body mass index of 22.4(2.3)kg/m2 (range:19.8 to 25.6 kg/m2). Follow-up was asked every 6 to 12 months after the first 3-month postoperative follow-up through out-patient service or via telephone. Results: In total 16 cases,there were 11 cases with pancreatic enucleation,and 5 cases with resection of the uninate process. The operation time was 70(60) minutes (range: 40 to 165 minutes),and the blood loss was 30(13)ml (range: 10 to 80 ml). The rate of pancreatic fistula was 5/16. The length of stay was 8(6)days (range: 5 to 33 days). The pathological finding included non-functional neuroendocrine tumor(n=3),insulinoma(n=2),introductal papillary mucinous neoplasm (n=5),solid pseudopapillary neoplasm (n=2),mucinous cystadenoma (n=1),serous cystadenoma (n=2),pseudocyst (n=1). Follow-up as of March 12, 2024, the follow-up time was 16(12)months (range: 3 to 41 months). All patients had no new onset diabetes and no dyspepsia. Conclusion: Robot-assisted surgical system can be used for local resection of uncinate process tumors of pancreas,and the quality of life of patients can be improved.

A Cross Sectional Descriptive Research On Prevalence Of Digestive Diseases In Moroccan Population

Background: Gastrointestinal diseases are a real public health problem, that decreases the quality of life. The aim of the present study is to investigate gender and age differences in the sociodemographic and clinical profile of digestive diseases in Morocco. Methods: We conducted a cross sectional descriptive study including 569 patients, during a period of four years, from January 2016 to December 2019. We included all patients with digestive disorders, at the gastroenterology department of a Moroccan Hospital in Rabat. Subjects were selected through simple random sampling method. Data was collected using questionnaire. The studied parameters were the age, the gender and the type of disease. Results: During the period, we registered 569 cases of digestive diseases. Men were more affected, 53% were male and 47% were female with a sex-ratio of 1.13. Moreover, the most concerned age group was [45-65 [ years then ≥65 years. The average age was 56.8 ± 22.8 years. The most common digestive diseases in our target population were Crohn’s disease (39 % of cases), gastritis with 32%, followed by colitis (10 %) and cirrhosis with 8 %. There is a statistically significant association between age and type of disease (chi-square = 227, p=0. These diseases mainly affect the age group between 45 and 64. Conclusion: The chronic nature of many of these diseases result in a significant impact in terms of medical care utilization, direct and indirect economic costs, and quality of lif

High Blood Ammonia Level Is a Predictor of Medium and Large Size Esophageal Varices In Cirrhotic Patients

Background: The development of esophageal varices (EV) and rupture of them are the most serious complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV but it is a costly and troublesome invasive procedure. To find a non-invasive method for detection of size of EV and to predict the bleeding risk is appealing and would decrease the indications cost and discomfort of upper GI endoscopy. The aim of the study is to evaluate high blood ammonia level is a predictor of medium and large size of esophageal varices in Cirrhotic patients. Methods: This was an observational Cross-sectional study conducted on 40 cirrhotic patients in Department of Gastroenterology, BSMMU using a pre-designed data collection sheet. Information about clinical profile, laboratory parameters- blood ammonia, serum bilirubin, serum albumin, prothrombin time, and ultrasonography of abdomen, endoscopy upper GIT was collected and recorded. The collected data was analyzed by computer with the help of SPSS version 22. Statistical analysis was done by using appropriate statistical tool like Chi-square test, Student’s t- test. P value &lt; 0.05 was considered as significant. Diagnostic efficacy of blood ammonia was calculated by using a value. Results: A total of 40 patients with cirrhosis. Mean age of cirrhotic patients were 47.47±12.98 years. Mean blood ammonia of small size EV of cirrhotic patients was 73.70±32.11 (μmol/L) and medium and large size EV was 118.3±38.37 (μmol/L) (P&lt; .001). At the level of 78.5 (μmol/L), sensitivity and specificity of blood ammonia was 95% and 65% respectively in detection of size of EV. Conclusion: Blood ammonia estimation could be a good tool for identifying individuals with medium and large size esophageal who will need to undergo endoscopy more frequently. Bangladesh J Medicine 2024; 35: 167-172

Relation between sarcopenia and hepatic encephalopathy in liver cirrhosis - a study in tertiary care hospital

Introduction: Liver cirrhosis is a common medical problem associated with high morbidity and mortality. Consequences of cirrhosis leading to encephalopathy is a neuropsychiatric manifestation requiring hospital admission and poor prognosis. Similarly, sarcopenia in cirrhosis, resulting from multifactorial cause confers prognostic significance. The objective of this study is to find the relation between sarcopenia and hepatic encephalopathy. Methods: A retrospective observational study was conducted and data was taken from electronic medical records of patients admitted with hepatic encephalopathy in department of gastroenterology of Tribhuvan university Teaching hospital. A total of 96 cirrhotic patients were included during one and half year study duration. Sarcopenia was assessed using assessment tool like hand grip strength, chair stand test and CT measurement of either skeletal muscle area (SMA) or skeletal muscle index (SMI). Hepatic encephalopathy was graded according to West Haven criteria among admitted patients. Results: Among 96 patients with cirrhosis, 85 patients (88.5%) were found to have sarcopenia. Prevalence of sarcopenia was higher among female compared to male (97% vs 84%). Similarly, sarcopenia was found to be higher in patients with HE-2 and HE-3 compared to HE-1 ( 91% vs 93% vs 79% respectively). Conclusion: Sarcopenia is commonly associated with hepatic encephalopathy. Bangladesh J Medicine 2024; 35: 195-199

Using 3D facial information to predict malnutrition and consequent complications.

Phase angle (PhA) correlates with body composition and could predict the nutrition status of patients and disease prognosis. We aimed to explore the feasibility of predicting PhA-diagnosed malnutrition using facial image information based on deep learning (DL). From August 2021 to April 2022, inpatients were enrolled from surgery, gastroenterology, and oncology departments in a tertiary hospital. Subjective global assessment was used as the gold standard of malnutrition diagnosis. The highest Youden index value was selected as the PhA cutoff point. We developed a multimodal DL framework to automatically analyze the three-dimensional (3D) facial data and accurately determine patients' PhA categories. The framework was trained and validated using a cross-validation approach and tested on an independent dataset. Four hundred eighty-two patients were included in the final dataset, including 176 with malnourishment. In male patients, the PhA value with the highest Youden index was 5.55°, and the area under the receiver operating characteristic curve (AUC) = 0.68; in female patients, the PhA value with the highest Youden index was 4.88°, and AUC = 0.69. Inpatients with low PhA had higher incidence of infectious complications during the hospital stay (P = 0.003). The DL model trained with 4096 points extracted from 3D facial data had the best performance. The algorithm showed fair performance in predicting PhA, with an AUC of 0.77 and an accuracy of 0.74. Predicting the PhA of inpatients from facial images is feasible and can be used for malnutrition assessment and prognostic prediction.

COMPARATIVE OUTCOMES OF ERCP IN BENIGN VERSUS MALIGNANT BILIARY OBSTRUCTION

Background: The causes of biliary obstruction include choledocholithiasis, which is a non malignant condition, and malignant conditions like cholangiocarcinoma or pancreatic cancer. ERCP is a common procedure that is undertaken in diagnosing and managing these obstructions and depending on the type of obstruction, the results vary. Objectives: The purpose of this work is to assess the success rate, endoscopic modalities and complications of ERCP in cases of benign and malignant blockage of common bile duct. Study design : A prospective study Place and duration of study: July 2023 to December 2023 Jinnah Postgraduate Medical Centre, Karachi Gastroenterology Department. Methods: A prospective study was done in 100 patients of Biliary obstruction 50 benign and 50 malignant. After performing the ERCP on the patients, various factors were documented which include; success rate of the procedure, any adverse effects that may have occurred after the procedure and final results. Data analysis included using mean, standard deviation and ‘P’ value in order to determine the differences between the two groups. Results: In the benign group, the overall success rate of ERCP was 92 % and the overall complication rate was 8%. In the malignant group it was 78% of success and 18% complications. The length of the hospital stay was 3. 4 (±1. 1) for benign group and 5. 2 (±1. 5) days for the malignant group. There was found statistical significance of the complication rate difference, p=0. 03. Conclusions: ERCP is very beneficial in both primary benign and malignant biliary strictures, but patients with malignant strictures have greater complication rates and hospital stays than patients with benign strictures. Hence early management and rigorous screening of the patients involved will go a long way in ensuring better results are achieved.

Clinical and Biochemical Differences in Patients Having Non-Variceal Upper Gastrointestinal Bleeding on NSAIDs, Oral Anticoagulants, and Antiplatelet Therapy.

Introduction: Upper gastrointestinal bleeding (UGIB) is among the most common causes of morbidity and mortality worldwide, accounting for major resource allocation and increasing incidence. This study aimed to evaluate the severity of non-variceal bleeding in patients at risk of bleeding through the use of NSAIDs, oral anticoagulants, and antiplatelet therapy. Material and Method: The study included 296 patients admitted in the Gastroenterology Department of the Municipal County Emergency University Hospital, Timisoara, between 01.01.2018 and 01.04.2020, and diagnosed via gastroscopy with non-variceal gastrointestinal bleeding. The patients were divided among four groups based on their use of different drugs known to induce UGIB, i.e., aspirin and clopidogrel, NOACs, NSAIDs, and anti-vitamin K drugs, respectively. Statistical analyses were performed based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables with pairwise comparisons based on Bonferroni adjusted significance tests. Results: The results showed several parameters having statistical significance among the different groups of patients. Patients on NOACs had statistically significant lower hemoglobin levels, lower hematocrit values, lower erythrocytes, lower RDW and higher fibrinogen levels compared to patients on VKA. Discussion: Surprisingly, the results from our study suggest that the use of NOACs was associated with a higher risk of bleeding when compared to VKA, which differs from the existing literature. Conclusions: One of the important factors causing upper non-variceal bleeding can be iatrogenic, either due to antiplatelet drugs or anticoagulants, to which NSAID treatment is additionally associated for various reasons. In our study, the use of NOACs seemed to have a more severe bleeding spectrum with higher morbidity compared to VKA.

Hypogammaglobulinemia in a child with atypical hemolytic-uremic syndrome

We present a unique clinical case of an atypical hemolytic-uremic syndrome in a child. The mutation in exon 6 of the CD46 gene (chr1:207940532G&gt;C) leads to a homozygous or hemizygous missense substitution. An 8-year-old girl was urgently hospitalized with symptoms of hemorrhagic syndrome and acute kidney injury. The child from the second pregnancy with an aggravated obstetric anamnesis, the first operative labor at the 38th week, who has an aggravated genealogical anamnesis. Initially, the disease developed in the guise of gastroenterological pathology: the girl had dyspeptic disorders, most likely associated with pathology of carbohydrate metabolism, also frequent infectious diseases and a lag in physical development. From the age of 4 years, the girl suffered from persistent hypoalbuminemia, hypoproteinemia and hypogammaglobulinemia, requiring replacement therapy with intravenous immunoglobulins. She was repeatedly examined in gastroenterological departments in Yekaterinburg and Moscow in 2021-2023, but no data concerning protein-losing enteropathies or primary immunodeficiency was obtained. Also, the whole-exome sequencing with result validation hasn’t confirmed an inherited etiology of the presumed congenital immune error. However, a CD46 gene mutation, associated with the development of hemolytic-uremic syndrome in some publications, was identified in the study. The signs of thrombotic microangiopathy were preceded by fever of unspecified etiology: microangiopathic hemolysis, thrombocytopenia, hyperazotemia, C3 consumption, proteinuria, and macrohematuria; hypercholesterolemia, protein metabolism disorder, increased transaminases, ferritin were also noted. According to the ultrasound of the kidneys there were diffuse changes in the parenchyma, decreased velocity indices of blood flow in both renal arteries at all levels. Differential diagnosis was carried out with thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, antinuclear form of atypical hemolytic-uremic syndrome, viral and bacterial infections, systemic pathology, antiphospholipid syndrome, and hemoblastosis. The girl didn’t need a renal replacement therapy. When complement-blocking therapy with eculizumab was initiated on vital indications, the signs of the disease were gradually eliminated. The prolonged absence of nephropathy in the child may indicate the diversity of the CD46 gene’s functions and different phenotypic manifestation of its mutations. Analysis of literature sources and detection of CD46 “environment” genes (CYBA, LYST, ARPCIB) by full-exome sequencing suggest ambiguity and polymorphism of phenotypic manifestations of complement-mediated mutation.