To determine if D-dimers are elevated in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who have adverse clinical outcomes including all-cause mortality, intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). Methods: We conducted a systematic review and meta-analysis of the published literature in PubMed, Embase and Cochrane databases through April 9, 2020 for studies evaluating D-dimer levels in SARS-COV-2 infected patients with and without a composite clinical endpoint, defined as the presence of all-cause of mortality, Intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). A total of six studies were included in the meta-analysis. Results: D-dimers were significantly increased in patients with the composite clinical end point than in those without (SMD, 1.67 ug/ml (95% CI, 0.72-2.62 ug/ml). The SMD of the studies (Tang et al, Zhou et al, Chen et al), which used only mortality as an outcome measure was 2.5 ug/mL (95% CI, 0.62-4.41 ug/ml). Conclusion: We conclude that SARS-CoV-2 infected patients with elevated D-dimers have worse clinical outcomes (all-cause mortality, ICU admission or ARDS) and thus measurement of D-dimers can guide in clinical decision making.
Clostridium tertium bacteremia is a rare condition that predominantly occurs in neutropenic patients. Clostridium tertium bacteremia, although extremely rare in non-neutropenic patients, represents the second-most common cause of bacteremia among Clostridium species. Infection with this bacteria can present variably and is usually managed with broad-spectrum antibiotics.
ObjectiveTo assess the outcome and safety of staple line over-sewing for patients undergoing laparoscopic sleeve gastrectomy (LSG).Study design and locationRetrospective descriptive analysis conducted at Shifa International Hospital Islamabad.Materials and methodsConsecutive patients undergoing LSG as a treatment for morbid obesity from October 2013 to December 2016 were included in the study after approval from the ethical review board. Patients were divided into two groups: group A who underwent reinforcement using Vicryl 2.0 and group B where no reinforcement was done.ResultsA total of 225 patients underwent LSG between October 2013 and December 2016, including 147 females (65.4%) and 78 males (34.6%). Both groups were comparable in terms of age, body mass index (BMI) and gender distribution (p-value more than 0.05). There was one leak in group A (1.36%), none in group B. The bleeding rate was 4.3% in group A and 2.7% in group B.ConclusionThis was a retrospective analysis of all the patients who underwent LSG, and it was observed that there was no added benefit of sewing the staple line in terms of rate of bleeding and leak.
Introduction: Nonalcoholic fatty liver disease (NAFLD) comprises a wide range of related liver disorders affecting mainly people who drink no or very little alcohol. Aramchol is a new synthetic molecule that has been shown to reduce liver fat content. There is little evidence supporting its efficacy in humans.Aim: To evaluate the efficacy of Aramchol in patients with NAFLD according to different randomized clinical trials.Material and methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant clinical trials assessing the use of Aramchol in patients with NAFLD. Risk of bias assessment was performed using Cochrane's risk of bias tool. We included the following outcomes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), glycated haemoglobin (HbA 1c ), total cholesterol (TC), triglyceride (TG), HOMA-IR, and insulin level.Results: We included 3 clinical trials. We found that the Aramchol group did not show any significant difference from the control group regarding ALT (
of CC or LC [4]. Diagnosis of MC is made through multiple steps. A complete medical and family history, including habits, diet, and previous medications, is required. A physical examination, blood tests, and stool analysis may also help exclude other diseases causing watery diarrhea. However, colonoscopy or flexible sigmoidoscopy is required to examine the colonic mucosa, which typically appears normal in the majority of cases of MC [1][2][3][4]. Therefore, microscopic examination of biopsy tissue is the gold-standard for diagnosing MC [5][6][7].The American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend collecting two or more biopsies from the right colon, transverse colon, descending colon (DC), and sigmoid colon [5]. However, the recommendation was based on expert opinion and low-quality evidence. The optimal number biopsies and sites for collecting biopsies are uncertain, and no single site in the colon is positive in all MC cases. Therefore, we aim to determine the optimal sites and mean number of biopsies needed to diagnose MC with a high level of certainty from published studies.
MethodsWe conducted this systematic review guided by the Cochrane handbook for systematic reviews [6] and reported the results according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA statement) [7].
Literature searchWe searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to October 2020 using the following search strategy: (biopsy OR biopsies) AND [(microscopic OR lymphocytic OR collagenous) AND colitis].
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