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Bacterial co-infections in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not very common as the prevalence of co-infections with other respiratory viruses. The rate of bacterial co-infection in hospitalized patients infected with influenza is higher than 30%, whereas it is lower than 4% in hospitalized patients with SARS-CoV-2. Respiratory viral infections associated with bacterial co-infection have higher mortality and morbidity rates. The literature shows that most SARS-CoV-2 patients admitted to the hospital do not necessarily screen for bacterial infections and antimicrobial susceptibility. Therefore, clinicians' misdiagnosis of these co-infections can pose a significant risk to the lives of vulnerable patients with COVID-19. In that light, we presented a complicated case of methicillin-resistant Staphylococcus aureus.

Chikungunya virus is positive-sense single-stranded RNA virus that causes an arthropod-borne chikungunya fever, myalgia and arthralgia. Chikungunya virus belongs to the Togaviridae family, and the genus is Alphavirus. Virus-host protein interaction plays a vital role in developing vaccines and antiviral drugs. We designed the current study to establish the in-silico interaction of non-structural protein 2 (nsP2) with proteins of innate immune pathway. The nsP2 sequences of various Chikungunya virus genotypes were retrieved from National Centre for Biotechnology Institute (NCBI). The homology models of proteins were generated through a protein modeling online web server. Protein-protein interaction (PPI) between nsP2 and proteins of innate immune pathway were docked using High Ambiguity-Driven Docking (HADDOCK) webserver. The interactive residues of the bimolecular complexes were analyzed with PDBsum-Generate online webserver. Our findings revealed differentially affinity of nsP2 of various chikungunya genotypes towards key proteins of cellular innate pathway. The nsP2 of Asian genotype demonstrates relatively high interaction with interferon-beta promoter stimulator 1 (IPS-1). Similarly, nsP2 of various genotypes binds with differential affinity to tumor necrosis factor receptor-associated factor 6 (TRAF6) with the highest affinity observed for the nsP2 of the West African genotype. Bimolecular complexes of nsP2 and host proteins demonstrate the interaction of various domains of nsP2 with proteins of the innate immune pathway. Thus, it is sought that the selected panel of the proteins might be helpful to treat the viral infection as a therapeutic drug target in the future.

The history of drama in Asia is as old as the history of the world itself. In India however, according to the popular belief, the tradition of drama dates back to the prehistoric times. Due to this unique approach towards drama, that makes it a valuable divine gift for humanity, the esoteric significance of this art form has never seen decline in the cultural history of India. Drama, thus, acquires in Indian context a religious significance and represents as an art form the union of the celestial and the terrestrial. Drama (in Sanskrit Natak), in the Indian Subcontinent, has distinctive characteristic features. Essentially, as reflection of human existence, it is a combination of all the known art forms and, therefore, becomes the deepest expression of the human soul. The rise of Islamic culture and civilization in the twelfth and thirteenth centuries contributed to the amalgamation of the two great civilizations. The impact of the Muslim culture in transforming the classical features of Indian music, architecture, science, literature, etc. can by no means be undermined. By the end of the sixteenth century, the century of liberal humanism and coincidently the era of the rise of the Mughal Empire, the theatrical art had gained enormous significance in India. There is enough evidence to believe that Shakespeare’s plays were first performed in India during the reign of the Mughals (1526-1857). Later, the newly emerging colonial power, the English, in its first stronghold in India, Calcutta, established alongside other bureaucratic, political and educational institutions, the Garrison Theater. The earliest performances at this theater date back to 1770s and the first ever documented English play on the Indian soil happens to be Shakespeare’s Othello. Shakespeare’s unique dramatic structure smoothly found its place of prominence in the cultural life of India, offering new dimensions to the already existing rich local tradition and at the same time enriching its own dramatic expression. Today, all the major educational institutions of the Subcontinent cherish the tradition of mounting on stage the annual performances of Shakespeare’s plays and the cinematographic tradition has incorporated his works into its popular tradition from the very beginning of the history of the film industry in India.

Patients with cirrhosis are advised to undergo hepatocellular carcinoma (HCC) surveillance every 6 months. Routine surveillance is associated with early tumor detection and improved survival. However, surveillance is underutilized. We aimed to characterize the uptake of HCC surveillance in cirrhotic patients following the implementation of interventional programs. We performed a comprehensive literature search of major databases (from inception to October 2020). Surveillance was defined as having an abdominal sonogram every 6 months. Nine studies were included for meta-analysis which involved 4550 patients. The etiology of liver cirrhosis was largely due to hepatitis C or B (n=2023), followed by alcohol (n=857), and nonalcoholic steatohepatitis (n=432). Patients enrolled in surveillance programs were 6 times more likely to undergo abdominal sonography when compared with standard of care (odds ratio=6.00; 95% confidence interval: 3.35-10.77). On subgroup analysis, clinical reminders were associated with a 4 times higher rate of HCC surveillance compared with standard of care (odds ratio=3.80; 95% confidence interval: 2.25-6.39). Interventional programs significantly improve the rate of HCC surveillance. This is clinically impactful and should be considered as a means for improving surveillance rates.

EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.

The word ‘Islam’ is originated from the word ‘Silm’ which means peace. If a logical and a reasonable person tries to study Islam neutrally, he will come to know that ‘peace’ is present in all the teachings of Islam. In pursuit of that peace a Muslim need to follow Islamic guidelines properly. As soon as he trends that path, he will start having peace. In this article it was tried to mention responsibilities of parents and teachers towards children’s education in the light of Islam. These responsibilities stretch from the religious education to the physical education of the children. It is discussed thoroughly that what is the role of Muslim parents and the teachers in raising the children safe and sound and in line with the instructions of the holy Quran and the traditions and biography of the holy Prophet (May Allah be pleased with him).

Background Splanchnic vein thrombosis is a well-recognized local vascular complication of acute pancreatitis (AP), estimated to occur in approximately 15% of patients. While splanchnic vein recanalization occurs spontaneously in approximately one third of patients, severe complications such as bowel ischemia and liver failure have also been reported. At present, there is no consensus on whether patients presenting with AP-associated splanchnic vein thrombosis should receive therapeutic anticoagulation. Methods We searched multiple databases from inception through December 2020 to collect studies that compared the clinical outcomes of patients with AP and splanchnic vein thrombosis who received therapeutic anticoagulation (AC group) with those who did not (N-AC group). A meta-analysis was performed to calculate the relative risk (RR) of vessel recanalization, bleeding complications, collateral formation and death in the 2 groups. Results Seven studies with 8353 patients, 339 of whom had splanchnic vein thrombosis, were included in the final analysis. A total of 154 patients (45.4%) had acute severe pancreatitis. A significantly higher proportion of patients had vessel recanalization in the AC group: RR 1.6, 95% confidence interval 1.17-2.27; I2=0%; P=0.004. There was no difference between the 2 groups in the RR of bleeding complications, collateral formation and death. Conclusions Our analysis demonstrated that, among patients with AP-associated splanchnic vein thrombosis, therapeutic anticoagulation resulted in recanalization of the involved vessels without significantly increasing the risk of bleeding complications. There was no difference in the RR of death or the rates of collateral vessel formation during the follow up.

Shakespeare studies Nature in the context of human behaviour. His drama deals with transformations and he displays these changes on both social and personal levels through alternating the graphic images from characters to situation. In an authoritarian society where lives of women were governed by a belief system which resulted out of Nature’s disposition of preordained roles in society, the portrayal of dominating female voices would have bothered many. Shakespearean drama is a protest against the society which is always dominated by the destructive forces of male paranoia, egocentrism, patriarchal instinct of exploitation of the weak, male sexual anxiety and corrupt abuse of rules of justice by the powerful. A study of the female mind presented in Shakespearean drama is seen at its best in The Winter’s Tale. The following article is an attempt to explore some of the aspects of Womanhood in Shakespearean art.

Islam guides its followers in every field of life. It requires from Muslims to search solutions of emerging problems keeping in view the golden rules set by the Quran and the Sunnah. Advertising along with its recent ways is somehow a new phenomenon. This study aims to explore antecedences of advertising in the holy Quran and the Traditions of the holy Prophet. (May peace and mercy be upon him.) Firstly, the two meanings of advertising are mentioned, and the examples of both meanings are presented from the Quran, the Traditions of the holy Prophet (PBUH) and the life of one of the holy companions of the Prophet. Secondly shariah ruling of the advertising is discussed in the light of the sources of the shariah. Lastly the results of the study are stated that read: Keeping in view the cases of the advertising from the Traditions of the holy Prophet (PBUH) and bearing in mind importance and need of it in current times, it is clear that publishing ads and broadcasting them for the promotion of the goods or services is basically allowed unless something contradictory to Islam is added to it, like lies, deception, exaggeration, degrading of other’s goods and display of half naked women etc.

In indirect drive inertial confinement fusion (ICF) implosions hydrodynamic instability growth at the imploding capsule ablator-DT fuel interface can reduce fuel compressibility and inject ablator into the hot spot hence reducing hot spot pressure and temperature. As a mitigation strategy, a gentle acceleration of this interface is predicted by simulations and theory to significantly reduce this instability growth in the early stage of the implosion. We have performed high-contrast, time-resolved x-ray refraction enhanced radiography (RER) to accurately measure the level of acceleration as a function of the initial laser drive time history for indirect-drive implosions on the National Ignition Facility. We demonstrate a transition from no acceleration to 20±1.8 μm ns^{-2} acceleration by tweaking the drive that should reduce the initial instabilities by an order of magnitude at high modes.

Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

Background Modifying patient position during colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. The left lateral (LL) decubitus starting position is commonly used during colonoscopy. However, reports indicate that other starting positions may offer additional benefit. We aimed to determine if the right lateral (RL) starting position compared to the standard LL starting position could improve outcomes in colonoscopy. Methods We searched PubMed, Medline, and EMBASE through June 2020 to identify studies comparing RL and LL starting positions during colonoscopy. The primary outcomes included mean cecal insertion time and cecal intubation rate, and adverse events were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR), mean difference, and 95% confidence interval (CI). Results We identified 5 randomized controlled trials, including 809 participants, that compared LL vs. RL colonoscopy. The pooled OR for cecal intubation rate was 1.3 (95%CI 0.8-2.3; P=0.3). The mean difference in mean cecal insertion time was 0.08 (95%CI -0.09 to 0.26; P=0.4). Heterogeneity between studies was low (I 2=0%). No complications were reported in either arm of the study. Pain scores assessed using a visual analog scale were comparable among both arms of the study. Conclusion The RL starting position for colonoscopy was comparable to the LL and offered no additional benefit in terms of cecal intubation time, intubation rate, or patient discomfort.

Inertial confined fusion experiments at the National Ignition Facility have recently entered a new regime approaching ignition. Improved modeling and exploration of the experimental parameter space were essential to deepening our understanding of the mechanisms that degrade and amplify the neutron yield. The growing prevalence of machine learning in fusion studies opens a new avenue for investigation. In this paper, we have applied the Gradient-Boosted Decision Tree machine-learning architecture to further explore the parameter space and find correlations with the neutron yield, a key performance indicator. We find reasonable agreement between the measured and predicted yield, with a mean absolute percentage error on a randomly assigned test set of 35.5%. This model finds the characteristics of the laser pulse to be the most influential in prediction, as well as the hohlraum laser entrance hole diameter and an enhanced capsule fabrication technique. We used the trained model to scan over the design space of experiments from three different campaigns to evaluate the potential of this technique to provide design changes that could improve the resulting neutron yield. While these data-driven model cannot predict ignition without examples of ignited shots in the training set, it can be used to indicate that an unseen shot design will at least be in the upper range of previously observed neutron yields.

Background and aim Extrahepatic unresectable cholangiocarcinoma carries a dismal prognosis. In addition to biliary drainage by stent placement; photodynamic therapy (PDT) and radiofrequency ablation (RFA) have been tried to prolong survival. In this meta-analysis, we appraise the current known data on the use of PDT, RFA in the palliative treatment of extrahepatic unresectable cholangiocarcinoma. Methods We searched multiple databases from inception through July 2020 to identify studies that reported on PDT and RFA. Pooled rates of survival, stent patency, 30-, 90-day mortality, and adverse events were calculated. Study heterogeneity was assessed using I% and 95% prediction interval. Results A total of 55 studies (2146 patients) were included. A total of 1149 patients underwent treatment with PDT (33 studies), 545 with RFA (22 studies), and 452 patients with stent-only strategy. The pooled survival rate with PDT, RFA, and stent-only groups was 11.9 [95% confidence interval (CI): 10.7-13.1] months, 8.1 (95% CI: 6.4-9.9) months, and 6.7 (95% CI: 4.9-8.4) months, respectively. The pooled time of stent patency with PDT, RFA, and stent-only groups was 6.1 (95% CI: 4.2-8) months, 5.5 (95% CI: 4.2-6.7) months, and 4.7 (95% CI: 2.6-6.7) months, respectively. The pooled rate of 30-day mortality with PDT was 3.3% (95% CI: 1.6%-6.7%), with RFA was 7% (95% CI: 4.1%-11.7%) and with stent-only was 4.9% (95% CI: 1.7%-13.1%). The pooled rate of 90-day mortality with PDT was 10.4% (95% CI: 5.4%-19.2%) and with RFA was 16.3% (95% CI: 8.7%-28.6%). Conclusion PDT seemed to demonstrate better overall survival and 30-day mortality rates than RFA and/or stent-only palliation.

Coronavirus disease 2019 (COVID-19) has taken hundreds of thousands of lives globally. Besides the respiratory tract, the virus can affect the gastrointestinal (GI) tract. Data regarding the significance of GI symptoms in the COVID-19 course are limited. In this largest US study to date, the authors reviewed electronic encounters of 1003 consecutive patients who were tested positive for the virus between March 12 and April 3, 2020. Initial GI symptoms were present in up to 22.4% of patients and were associated with worse outcomes after adjustment for demographics, comorbidities, and other clinical symptoms. COVID-19 with GI involvement may define a more severe phenotype.

Intragastric balloon (IGB) therapy has shown efficacy in weight loss but its role in NAFLD remains unknown. We conducted a systematic review and meta-analysis to evaluate the efficacy of IGB in NAFLD. Meta-analysis was performed to estimate the pooled proportion of patients with improvement in steatosis as determined by imaging and histology following IGB placement. Nine studies were included in our analysis. Four hundred forty-two IGBs were placed. Improvement in steatosis was seen in 79.2% of patients and NAS in 83.5% of patients, and HOMA-IR score improved in 64.5% of patients. A reduction in liver volume by CT scan was noticed in 93.9% of patients undergoing IGB placement. IGB is an effective and safe short-term therapeutic modality for patients with NAFLD.

Background Data on efficacy of hepatitis-B vaccine (HBV) in patients with inflammatory bowel disease (IBD) is limited. Our aim was to review the literature and perform meta-analysis of available studies to quantify efficacy of HBV in patients with IBD. Methods We conducted a comprehensive search of several databases (inception to July 2020) to identify studies evaluating efficacy of HBV in patients with IBD. Random effects model was used to calculate the pooled rates and I2 percentage values were used to assess the heterogeneity. Results A total of 14 studies (2375 patients) were included. Four data sets were available from 2 studies that compared HBV response in patients with IBD against healthy controls. The pooled odds ratio of HBV response in IBD patients was 0.13 (95% CI, 0.05–0.33, P = 0.001). The pooled proportion of adequate immune response (AIR) was 64% (95% CI, 55–72.1, P = 0.003) from 13 data sets, and effective immune response (EIR) was 39.7% (95% CI, 30.7–49.5, P = 0.04) from 10 data sets. Conclusion Patients with IBD on immunosuppression demonstrated significantly reduced HBV response as compared with general population.

Assessment of EUS-guided fine-needle tissue acquisition by macroscopic on-site evaluation (MOSE) is gathering attention. Studies report good diagnostic parameters with MOSE; however, the overall data are limited. We conducted this systematic review and meta-analysis to report on the pooled diagnostic assessment parameters of EUS-guided tissue acquisition by MOSE using fine-needle biopsy sampling (FNB).Multiple databases were searched (from inception to December 2021), and studies that reported on the diagnostic assessment of EUS-guided tissue acquisition by MOSE were selected. Pooled diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were calculated by standard meta-analysis methods following the random-effects model. Heterogeneity was assessed by IFourteen studies were included in the analysis, and 1508 lesions were biopsy sampled in 1489 patients undergoing EUS-guided tissue acquisition. MOSE definition included a visible core of tissue with opacity and "wormlike" features of adequate size and length (≥4 mm). The pooled accuracy of FNA and/or FNB specimens in yielding a pathologic diagnosis by MOSE was 91.3% (95% confidence interval [CI], 88.6-93.3; IExcellent pooled diagnostic accuracy parameters were demonstrated in EUS-guided tissue acquisition by FNB using the MOSE method.

Background Intragastric balloons (IGBs) have been used to bridge the obesity treatment gap with the benefits of being minimally invasive but still required endoscopy. The Elipse IGB is a swallowable balloon that is spontaneously excreted at ∼16 weeks. However, studies are limited by small sample sizes. The authors aim to assess clinically relevant endpoints, namely weight loss outcomes, metabolic profile, balloon tolerability, and adverse events. Methods A literature search was performed from several databases from inception to July 2020. The pooled means and proportions of our data were analyzed using a random effects model. Results Seven studies involving 2152 patients met our eligibility criteria and were included. The mean baseline body mass index ranged from 32.1 to 38.6. The pooled mean difference (MD) in body mass index was 0.88 [confidence interval (CI): 0.58-1.18, I2=98%]. Total body weight loss was 12% (CI: 10.1-14.3, I2=94%) and excess body weight loss was 49.1% (CI: 30.6-67.5, I2=97%). The MD in waist circumference was 0.89 (CI: 0.72-1.05, I2=53%). MD in triglyceride level was 0.66 (CI: 0.21-1.1, I2=96%). Pooled early deflation rate was 1.8% (CI: 0.6-5.1, I2=74%). Our study also showed that the Elipse balloon was associated with less adverse events when compared with other IGBs. Conclusions This meta-analysis demonstrates that the Elipse intragastric balloon is a safe, effective, and tolerable device for weight loss and obesity with a minimal side effect profile.

Background Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts. Area of uncertainty Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE. Data sources Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention. Therapeutic advances Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits. Conclusion Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.

Background and study aims Recently, a growing body of evidence has been amassed on evaluation of artificial intelligence (AI) known as deep learning in computer-aided diagnosis of gastrointestinal lesions by means of convolutional neural networks (CNN). We conducted this meta-analysis to study pooled rates of performance for CNN-based AI in diagnosis of gastrointestinal neoplasia from endoscopic images. Methods Multiple databases were searched (from inception to November 2019) and studies that reported on the performance of AI by means of CNN in the diagnosis of gastrointestinal tumors were selected. A random effects model was used and pooled accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Pooled rates were categorized based on the gastrointestinal location of lesion (esophagus, stomach and colorectum). Results Nineteen studies were included in our final analysis. The pooled accuracy of CNN in esophageal neoplasia was 87.2 % (76–93.6) and NPV was 92.1 % (85.9–95.7); the accuracy in lesions of stomach was 85.8 % (79.8–90.3) and NPV was 92.1 % (85.9–95.7); and in colorectal neoplasia the accuracy was 89.9 % (82–94.7) and NPV was 94.3 % (86.4–97.7). Conclusions Based on our meta-analysis, CNN-based AI achieved high accuracy in diagnosis of lesions in esophagus, stomach, and colorectum.

Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods.Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval.Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6).Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

Background Helicobacter pylori (H. pylori) infection, if left untreated, can cause gastric cancer, among other serious morbidities. In recent times, a growing body of evidence has evaluated the use of a type of artificial intelligence (AI) known as "deep learning" in the computer-aided diagnosis of H. pylori using convolutional neural networks (CNN). We conducted this meta-analysis to evaluate the pooled rates of performance of CNN-based AI in the diagnosis of H. pylori infection. Methods Multiple databases were searched (from inception to June 2020) and studies that reported on the performance of CNN in the diagnosis of H. pylori infection were selected. A random-effects model was used to calculate the pooled rates. In cases where multiple 2×2 contingency tables were provided for different thresholds, we assumed the data tables were independent from each other. Results Five studies were included in our final analysis. Images used were from a combination of white-light, blue laser imaging, and linked color imaging. The pooled accuracy for detecting H. pylori infection with AI was 87.1% (95% confidence interval [CI] 81.8-91.1), sensitivity was 86.3% (95%CI 80.4-90.6), and specificity was 87.1% (95%CI 80.5-91.7). The corresponding performance metrics for physician endoscopists were 82.9% (95%CI 76.7-87.7), 79.6% (95%CI 68.1-87.7), and 83.8% (95%CI 72-91.3), respectively. Based on non-causal subgroup comparison methods, CNN seemed to perform equivalently to physicians. Conclusion Based on our meta-analysis, CNN-based computer-aided diagnosis of H. pylori infection demonstrated an accuracy, sensitivity, and specificity of 87%.

Background Peroral endoscopic myotomy (POEM) is increasingly being used as the endoscopic treatment option for achalasia. Data are limited as to the comparative efficacy of anterior vs. posterior myotomy. Methods We searched multiple databases from inception to August 2019 to identify studies reporting on POEM. We selected studies that reported on the outcomes of POEM, along with information on myotomy approach. We performed a comparative analysis of clinical success, gastroesophageal reflux disease (GERD), and adverse events with anterior and posterior myotomy in POEM by meta-analysis. Results 1247 patients from 18 studies were analyzed: 623 patients (11 cohorts) were treated via anterior myotomy and 624 patients (12 cohorts) via posterior myotomy. The pooled rate for clinical success gave an odds ratio (OR) of 1.02 (95 % confidence interval [CI] 0.52 – 2.0; I 2 0; P = 0.9); for GERD by esophagogastroduodenoscopy (EGD) was OR 1.02 (95 %CI 0.62 – 1.68; I 2 0; P = 0.9), and for GERD by pH was OR 0.98 (95 %CI 0.59 – 1.63; I 2 34; P = 0.9). The individual pooled rates of clinical success at 12 months and > 12 months, GERD (by symptoms, EGD, pH), and adverse events (mild, moderate, severe) were comparable. The pooled total procedure time with anterior myotomy was 82.7 minutes (95 %CI 69.0 – 96.4; I 2 98) and with posterior myotomy was 62.1 minutes (95 %CI 48.5 – 75.7; I 2 90). Conclusion Anterior and posterior myotomy in POEM seem comparable to each other in terms of clinical success, GERD, and adverse events. The total procedure time with posterior myotomy seems to be shorter than with anterior myotomy.