Background Barrett’s esophagus (BE) is a premalignant condition diagnosed using systematic 4-quadrant forceps biopsies (FB) during endoscopy. This method is fraught with errors due to the randomness of sampling and variability among operators. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS 3D ) is an emerging technique used to collect esophageal samples. The aim of this study was to evaluate WATS 3D as a diagnostic tool for detecting BE in addition to FB, compared to FB alone. Methods A retrospective observational cohort study was conducted and included patients who underwent screening for BE with WATS 3D and FB between January 2015 and January 2019 across 3 endoscopy centers in Wichita, Kansas. The FB specimens were reviewed by community pathologists, while the WATS 3D samples were sent to CDX technology labs, NY. Results A total of 108 patients were screened for BE using both modalities concurrently. FB and WATS 3D detected 62 (57.4%) and 83 (76%) cases of BE, respectively. The absolute difference of 21 cases (18.6%) of BE was attributed to the addition of WATS 3D . The number needed to test with WATS 3D was 5. We divided the sample into 4 groups to compare the agreement across all groups: (FB–; WATS 3D +), (FB–; WATS 3D –), (FB+; WATS 3D +), and (FB+ and WATS 3D –). Overall agreement by kappa statistic was 0.74. Conclusion WATS 3D identified 21 cases of BE missed by FB. Using WATS 3D in addition to FB increased the yield of BE during surveillance endoscopy, with no increase in complications.
Metastasis to the pancreas is far less common than primary pancreatic tumors. Bladder cancer metastasis involving the pancreas is rarely reported. Here, we report a case of metastasis to the pancreas of urothelial cell origin, diagnosed via upper endoscopic ultrasound-guided fine-needle aspiration and biopsy, and coupled with immunostaining. A high index of suspicion must be maintained for atypical metastatic locations of urothelial cell carcinoma, especially to the pancreas.
Objective Current guidelines suggest the immediate initiation of crystalloid for sepsis-induced hypoperfusion but note that supporting evidence is low quality. The aim of this study is to examine the effect of timing of fluid initiation on mortality for adults with sepsis. Data Sources Two authors independently reviewed relevant articles and extracted study details from PubMed, Scopus, Cochrane, Google Scholar, and previous relevant systematic reviews from 1-1-2000 to 1-6-2022. Registered with PROSPERO (CRD42021245431) and bias assessed using CLARITY. Study Selection A minimum of severe sepsis (Sepsis-2) or sepsis (Sepsis-3) for patients ≥18 years old. Fluid initiation timing ranging from prehospital to 120 min within sepsis onset defined as “early” initiation. Data Extraction Included studies providing mortality-based odds ratios (or comparable) adjusting for confounders or prospective trials. Data Synthesis From 1643 citations, five retrospective cohort studies were included (n = 20,209) with in-hospital mortality of 21.8%. A pooled analysis (odds ratio = OR [95% CI]) did not observe an impact on mortality for the early initiation of fluids among all patients, OR = 0.79 [0.62-1.02]; heterogeneity: I2 = 86% [70-94%], but when studies analyzed cases of hypotension where available, a survival benefit was observed, OR = 0.74 [0.61-0.90]. Initiation of fluids in two prehospital studies did not impact mortality, OR = 0.82 [0.27-2.43]. However, both prehospital cohorts observed benefit among hypotensive patients individually, although heterogenous results precluded significance when pooled, OR = 0.50 [0.21-1.18]. Three hospital-based studies with initiation stratified at 30, 100, and 120 min, observed survival benefit both individually and when pooled, OR = 0.78 [0.63-0.97]. No differences were observed between prehospital versus hospital subgroups. Conclusion This meta-analysis supports the guideline recommendations for early fluid initiation once sepsis is recognized, especially in cases of hypotension. Findings are limited by the small number, heterogeneity, and retrospective nature of available studies. Further retrospective investigations may be worthwhile as randomized studies on fluid initiation are unlikely.
Spontaneous bacterial peritonitis (SBP) is a common and serious complication of cirrhosis, with gram-negative bacteria being the culprit in most cases. SBP secondary to Salmonella spp . is rare. Here, we report a case of Salmonella enterica SBP in a patient with decompensated cirrhosis, diagnosed via paracentesis coupled with ascitic fluid analysis and culture. A high index of suspicion must be maintained for atypical causes of SBP, with prompt initiation of treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.