Endosonographic and ERCP findings in COVID-19 critical illness cholangiopathy

A 56-year-old female developed deep jaundice months after struggling with critical illness due to COVID-19, requiring hemodialysis and tracheostomy. Lab tests included alkaline phosphatase 1,574 U/l, total bilirubin 11 mg/dl, alanine transaminase (ALT) 88 U/l and aspartate aminotransferase (AST) 101 U/l. Baseline liver tests were normal before illness. Anti-nuclear antibodies (ANA), IgG4 level and viral hepatitis were negaCritical illness cholangiopathy resulted in secondary sclerosing cholangitis. In this case, it is unclear whether the patient suffered these changes as a direct cause of COVID-19 or as a result of critical illness cholangiopathy. The overall prognosis is guarded given its progressive nature and likely need for liver transplantation.tive.

Intraductal suture leading to biliary stone formation and recurrent obstruction and cholangitis: cholangioscopy-guided forceps removal

Video 1Intraductal suture leading to biliary stone formation.

Outcomes of Open, Laparoscopic, and Percutaneous Drainage of Infected Walled-Off Pancreatic Necrosis: A Nationwide Inpatient Sample Study

Background

Walled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN.

Methods

Using the Nationwide Inpatient Sample (NIS), patients aged 18 years and older discharged with the diagnosis of WOPN between January 1, 2016 and December 31, 2016 who underwent open, laparoscopic, or percutaneous drainage were included. Patients’ characteristics including age, gender, and body mass index were reported. The primary endpoints were the mortality rate as well as length and cost of stay in each group. The secondary endpoint was the rate of procedural complications in each arm. Endpoints were reported and compared with studies assessing similar outcomes. Statistical Analysis System (SAS) statistical software (SAS Institute Inc., Cary, NC, USA) was used to perform the analysis.

Results

A total of 229 patients with the diagnosis of acute pancreatitis with infected necrosis were identified. Of these 229 patients, 27, 15, and 20 underwent open, laparoscopic, and percutaneous drainage, respectively. A total of eight studies were used for comparison of outcome variables. Mortality rate was found to be similar among comparison studies. LOS and costs varied widely among studies. There were significantly fewer pancreatic fistula and significantly more multi-organ failure complications as a result of open necrosectomy in the NIS study sample.

Conclusion

Overall, in analyzing the outcomes of patients undergoing intervention for infected WOPN through the 2016 NIS database, it appears that the database is representative of the majority of outcomes seen in similar clinical trials.

Knowledge, Perceptions, and Attitudes of Medical Residents Towards Nanomedicine: Defining the Gap

Even though the general public opinion towards nanotechnology applications to health has been studied, medical residents' opinions remain unknown. The purpose of this study was to evaluate the perception, knowledge, and attitude of medical residents towards nanomedicine using a 35-item questionnaire. Correlations between intrinsic factors, heuristics, and attitude towards nanomedicine were analyzed using the χ ² test. Seventy medical residents participated. Nanomedicine was perceived as a developing field in its clinical trial stages. Responsibility for nanomedicine was attributed to scientists, whereas its ethical responsibility to physicians. The majority reported not having adequate access to information. A positive attitude towards nanomedicine was correlated with higher willingness to use nanomedicine to diagnose and treat patients (p < 0.05). Medical residents had a positive attitude towards nanomedicine. However, they lacked accurate knowledge in the field. Participants might have relied on availability heuristics to form their opinion. Formal education for the "handlers" of nanomedicine seems to be needed.

In-hospital acute upper gastrointestinal bleeding: What is the scope of the problem?

BACKGROUND

Acute upper gastrointestinal bleeding (AUGIB) is a frequently encountered condition in the Gastroenterology field with a mortality rate of 10-14%. Despite recent newer innovations and advancements in endoscopic techniques and available medications, the mortality rate associated with AUGIB remained persistently elevated.

AIM

To explore mortality, characteristics and outcome differences between hospitalized patients who develop AUGIB while in-hospital, and patients who initially present with AUGIB.

METHODS

This is a retrospective of patients who presented to Northwell Health Staten Island University Hospital from October 2012 to October 2016 with AUGIB that was confirmed endoscopically. Patients were divided in two groups: Group 1 comprised patients who developed AUGIB during their hospital stay; group 2 consisted of patients who initially presented with AUGIB as their main complaint. Patient characteristics, time to endoscopy, endoscopy findings and interventions, and clinical outcomes were collected and compared between groups.

RESULTS

A total of 336 patients were included. Group 1 consisted of 139 patients and group 2 of 196 patients. Mortality was significantly higher in the 1st group compared to the 2nd (20% vs 3.1%, P ≤ 0.05). Increased length of stay (LOS) was noted in the 1st group (13 vs 6, P ≤ 0.05). LOS post-endoscopy, vasopressor use, number of packed red blood cell units and patients requiring fresh frozen plasma were higher in group 1. Inpatients were more likely to be on corticosteroids, antiplatelets and anticoagulants. Conversely, the mean time from bleeding to undergoing upper endoscopy was significantly lower in group 1 compared to group 2.

CONCLUSION

In-hospital AUGIB is associated with high mortality and morbidity despite a shorter time to endoscopy. Larger scale studies assessing the role of increased comorbidities and antithrombotic use in this setting are warranted.

Telomerase as a potential marker for inflammation and cancer detection in bronchial washing: a prospective study

OBJECTIVES

The diagnosis of lung cancer remains difficult especially in peripheral tumors, given the absence of relevant markers and of sensitive imaging techniques. Telomerase is a ribonucleotide enzyme responsible for the immortalization of cancerous cells and seems to increase in bronchial aspirates of lung cancer patients. The purpose of our study is to further investigate the value of telomerase measurement in bronchial aspirates as a diagnostic tool for lung cancer.

DESIGN AND METHODS

Random 82 bronchial aspirates were obtained from patients undergoing bronchoscopy to diagnose any lung illness including inflammation and cancer. Cytology examination, quantification of proteins by Bradford method, and telomerase activity measurement by quantitative Real-time PCR were performed. Out of 82 specimens, 11 were excluded because of hemolysis, absence of elements or lack of final diagnosis. ROC curve analysis was done.

RESULTS

A significant difference in telomerase activity average was noted between normal patients and those with inflammation and cancer. Discriminatory capacity of telomerase activity was: for cancer vs. non cancer, AUC =0.74 (95% CI: 0.62-0.84), sensitivity=78%, specificity=72%, Negative Predictive Value=87%, at cut-off >0.46 atmol/mg protein/20 min; for cancer vs. normal, AUC=0.87 (95% CI: 0.72-0.96), se=78%, sp=92%, NPV=71%, at cut-off >0.46; for cancer vs. inflammation, AUC=0.69 (95% CI: 0.55-0.80), se=74%, sp=70%, NPV=79%, at cut-off >1.03, and for inflammation vs. normal, AUC=0.76 (95% CI: 0.62-0.88), se=79%, sp=77%, NPV=59%, at cut-off >0.

CONCLUSION

Telomerase activity in bronchial aspirates is a promising diagnostic marker for lung cancer and inflammation detection.

Abstract 4703: Telomerase activity in bronchial aspiration is a potential marker for inflammation and cancer detection: A prospective study

Background: Lung cancer is the leading cause of cancer death in the United States for both men and women. Bronchoscopy is one of the major tools, along with bronchial aspirates, brushings, biopsies and bronchoalveolar lavage, used to obtain specimens revealing the diagnosis in more than 85% of cases. The diagnosis remains difficult especially in distal tumors, given the absence of a relevant marker and/or sensitive imaging technique. Telomerase is a ribonucleotide enzyme that elongates telomeres and is responsible for the immortalization of cancerous cells. This enzyme, that is expressed in more than 90% of cancers, seems to increase in bronchial aspirates of patients with lung cancer. Purpose: The objective of our study is to further investigate the value of telomerase measurement in the bronchial aspirates as a diagnostic tool for lung cancer. Methods: Random 82 bronchial aspirates were obtained from patients undergoing bronchoscopy to diagnose any lung illness type including inflammation and cancer.

Patient consent form was filled. The bronchial aspirates were divided for cytology examination and telomerase activity measurement. The latter were washed twice with ice-child phosphate buffer, observed by microscope, treated with lysis buffer, incubated 30 minutes on ice and then centrifuged at 14 000 rpm at 4oC for 25 minutes. The supernatant was used to quantitate proteins using Bradford reagent and to measure telomerase activity by quantitative Real-time PCR technique. Out of 82 specimens, 11 were excluded because of high hemolysis that interfered with the technique and/or because of the complete absence of cells or elements. Results: A significant difference in telomerase activity average was noted between normal patients and those with inflammation and cancer (0.27, 3.83 and 19.96 atmol/mg protein/20min, p&lt;0.05) respectively. Using the ROC (Receiver

Operating Characteristic) curve, telomerase activity was predictive of cancer vs. non cancer conditions (including normal and inflammation), area under the curve (AUC) = 0.74 [(95% CI: 0.62-0.84); sensitivity (se) =78%, specificity (sp)

=72%, Negative predictive value (NPV) = 87%, at cut-off &gt;0.46]. Telomerase activity was also predictive of cancer vs. normal condition, AUC=0.87 [(95% CI:

0.72-0.96); se=78%, sp=92%, NPV = 71%, at cut-off &gt;0.46]. Its predictive power of cancer vs. inflammation was AUC=0.69 [(95% CI: 0.55-0.80); se=74%, sp=70%,

NPV = 79%, at cut-off &gt;1.03], and of inflammation vs. normal condition was

AUC=0.76 [(95% CI: 0.62-0.88); se=79%, sp=77%, NPV = 59%, at cut-off &gt;0].Conclusion: The detection of telomerase activity in bronchial aspirates is a promising diagnostic marker for lung cancer and inflammation detection.

Citation Format: George Hilal, Najib Nassani, Georges Khayat. Telomerase activity in bronchial aspiration is a potential marker for inflammation and cancer detection: A prospective study. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4703. doi:10.1158/1538-7445.AM2013-4703