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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.

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.

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.

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.

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.

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%.

Healthcare workers (HCWs) remain on the front line of the battle against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and coronavirus disease 2019 (COVID‐19) infection and are among the highest groups at risk of infection during this raging pandemic. We conducted a systematic review and meta‐analysis to assess the incidence of postvaccination SARS‐CoV‐2 infection among vaccinated HCWs. We searched multiple databases from inception through August 2021 to identify studies that reported on the incidence of postvaccination SARS‐CoV‐2 infection among HCWs. Meta‐analysis was performed to determine pooled proportions of COVID‐19 infection in partially/fully vaccinated as well as unvaccinated individuals. Eighteen studies with 228 873 HCWs were included in the final analysis. The total number of partially vaccinated, fully vaccinated, and unvaccinated HCWs were 132 922, 155 673, and 17 505, respectively. Overall pooled proportion of COVID‐19 infections among partially/fully vaccinated and unvaccinated HCWs was 2.1% (95% confidence interval [CI] 1.2–3.5). Among partially vaccinated, fully vaccinated and unvaccinated HCWs, pooled proportion of COVID‐19 infections was 2.3% (CI 1.2–4.4), 1.3% (95% CI 0.6–2.9), and 10.1% (95% CI 4.5–19.5), respectively. Our analysis shows the risk of COVID‐19 infection in both partially and fully vaccinated HCWs remains exceedingly low when compared to unvaccinated individuals. There remains an urgent need for all frontline HCWs to be vaccinated against SARS‐CoV‐2 infection., Highlights The overall pooled proportion of COVID‐19 infections in partially vaccinated healthcare workers was 2.3%.The overall pooled proportion of COVID‐19 infections in fully vaccinated healthcare workers was 1.3%.The overall pooled proportion of COVID‐19 infections in unvaccinated healthcare workers was 10.1%.Our findings show decreased incidence of COVID‐19 infection as well as decreased incidence of hospitalization, ICU admission and deaths, amongst vaccinated HCWs. There remains an urgent need for healthcare workers to consider getting vaccinated against COVID‐19.

Broad-leaved subtropical forests are the most productive, diversified, and complex ecosystems on the planet. Unfortunately, they are currently under severe threat from anthropogenic activities, such as. deforestation, housing settlements, and agricultural expansion. In response to these severe effects, the present study was conducted to explore the current conservation status and population structure of a wide range of bird species inhabiting different subtropical broad-leaved urban forests of Pakistan. In total, 2879 individuals comprising 53 species and 28 families were detected between December 2017 and November 2018 as revealed through the distance sampling line transect method. The habitat selection among bird species varied according to vegetation structure and composition, food resources, adjoining habitats, and human settlements. According to IUCN Red List data, one species was deemed vulnerable out of 53 bird species, while the remaining 52 species were ranked as ofleast concern. The findings of the density analysis revealed that bird density varied between six subtropical broad-leaved forests. Palamar (3.954 ± 0.221 birds/ha) and Kityari (3.138 ± 0.162 birds/ha) were densely populated, whereas Kamal Khan (1.102 ± 0.178 birds/ha) was of the least concern. Likewise, the diversity analysis showed that Kamal Khan was a more diverse habitat (Shannon–Wiener Index; H’ = 3.581 ± 0.021). Shahabad was richer (Margalef Richness Index; R1 = 8.007 ± 0.053) and Dob Ghar was evenly distributed (Pielou J Evenness Index; E = 0.940 ± 0.005) compared to other urban habitats studied. Eight foraging guilds were identified among the bird species. Insectivores were the most abundant bird species utilizing the urban dwelling habitats. carnivores/piscivores/insectivores utilized Dob Ghar forest, while more frugivores utilized Kamal Khan and Dob Ghar. Based on the data, it was concluded that subtropical broad-leaved urban forests are dynamic, complex, and of vital significance for a diverse range of bird species.

The optimal sampling techniques for EUS-FNA remain unclear and have not been standardized. To improve diagnostic accuracy, suction techniques for EUS-FNA have been developed and are widely used among endoscopists. The aim of this study was to compare wet-suction and dry-suction EUS-FNA techniques for sampling solid lesions. We performed a comprehensive literature search of major databases (from inception to June 2020) to identify prospective studies comparing wet-suction EUS-FNA and dry-suction EUS-FNA. Specimen adequacy, sample contamination, and histologic accuracy were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Six studies including a total of 418 patients (365 wet suction vs. 377 dry suction) were included in our final analysis. The study included a total of 535 lesions (332 pancreatic lesions and 203 nonpancreatic lesions). The pooled odds of sample adequacy was 3.18 (CI: 1.82–5.54, P = 0.001) comparing wet- and dry-suction cohorts. The pooled odds of blood contamination was 1.18 (CI: 0.75–1.86, P = 0.1). The pooled rate for blood contamination was 58.33% (CI: 53.65%–62.90%) in the wet-suction cohort and 54.60% (CI 49.90%– 59.24%) in the dry-suction cohort (P = 0.256). The pooled odds of histological diagnosis was 3.68 (CI 0.82–16.42, P = 0.1). Very few adverse events were observed and did not have an impact on patient outcomes using either method. EUS-FNA using the wet-suction technique offers higher specimen quality through comparable rates of blood contamination and histological accuracy compared to dry-suction EUS-FNA.

The propagation properties of electrostatic cnoidal waves (periodic waves) and solitons are studied in a magnetized electron-positron-ion (EPI) plasma bearing ion pressure anisotropy and superthermality. In a two-dimensional geometry, we considered the ions to be warm having pressure anisotropy due to magnetic field. The anisotropic ions are modeled via double adiabatic Chew-Golberger-Low (CGL) theory and the lighter species (electron and positron) are following kappa distributions. A Korteweg-de Vries (KdV)-type equation is derived by employing reductive perturbation technique, and obtained the nonlinear periodic waves solutions with appropriate boundary conditions. The anisotropy in the ion thermal pressure relative to the external magnetic field (different values in parallel and perpendicular directions) have significant effects on the characteristics of cnoidal waves. It is observed that by increasing the ion parallel and perpendicular pressure (keeping the relative anisotropy) tends to reduce the wavelength of the cnoidal wave structure, while the amplitude tends to increase. The influence of superthermality of electron and positron, the positron content and strength of the external magnetic field on the cnoidal waves are studied in detail. Furthermore, phase portrait analysis is carried out and traced out the equilibrium points around which nonlinear periodic waves can be formed. The saddle points which correspond to the homoclinic orbits are also shown. The investigation can be useful in exploring the nonlinear wave dynamics in both laboratory and space plasma where ion pressure anisotropy and superthermality exist.

Background: Recent prospective randomized controlled trials have evaluated deep convolutional neural network (CNN) based computer aided detection (CADe) of lesions in real-time colonoscopy. We conducted this meta-analysis to compare the adenoma detection rate (ADR) of deep CNN based CADe assisted colonoscopy to standard colonoscopy (SC) from randomized controlled trials (RCTs). Methods: Multiple databases were searched (from inception to May 2020) and parallel RCTs that compared deep CNN based CADe assisted colonoscopy to SC were included for this analysis. Using Mantel-Haenzel (M-H) random effects model, pooled risk ratios (RR) and mean difference (MD) were calculated. In between study heterogeneity was assessed by I2% values. Outcomes assessed included other per patient adenoma parameters. Findings: Six RCTs were included in our final analysis that utilized deep CNN based CADe system in real-time colonoscopy. Total numbers of patients assessed were 4962 (2480 in CADe and 2482 in SC group). CADe based colonoscopy demonstrated statistically higher pooled ADR, RR=1.5 (95% CI 1.3–1.72), p

Background Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant transformation. Nonsurgical methods of differentiating mucinous and nonmucinous pancreatic cysts are challenging and entail a multi investigational approach. Low intracystic glucose levels have been evaluated in multiple studies for its accuracy in differentiating mucinous from nonmucinous cysts of the pancreas. Methods Multiple databases were searched and studies that reported on the utility of intracystic glucose levels in diagnosing mucinous pancreatic cysts were analyzed. Meta-analysis was conducted using the random-effects model, heterogeneity was assessed by I2%, and pooled diagnostic test accuracy values were calculated. Results Seven studies were included in the analysis from an initial total of 375 citations. The pooled sensitivity of low glucose in differentiating mucinous pancreatic cyst was 90.5% [95% confidence interval (CI): 88.1-92.5; I2=0%] and the pooled specificity was 88% (95% CI: 80.8-92.7; I2=79%). The sensitivity at a glucose cut-off of 50 was 90.1% (95% CI: 87.2-92.5; I2=0%) and the specificity was 85.3% (95% CI: 76.8-91.1; I2=76%). The sensitivity of glucose levels in pancreatic cyst fluid taken by endoscopic ultrasound guided fine-needle aspiration was 90.8% (95% CI: 87.9-93.1; I2=0%) and the specificity was 90.5% (95% CI: 81.7-95.3; I2=83%). The sensitivity of point-of-care glucometers was 89.5% (95% CI: 87.9-93.1; I2=0%) and specificity was 83.9% (95% CI: 68.5-92.6; I2=43%). Conclusions Low glucose level at a cut-off of 50 mg/dL on fluid samples collected by endoscopic ultrasound guided fine-needle aspiration and analyzed by point-of-care glucometer achieves excellent diagnostic accuracy in differentiating mucinous pancreatic cysts.

Abtract Background and study aims Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES. Methods We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS-GE in comparison to ES. Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I2% and 95 % confidence interval. Results Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS-GE was 95.2 % (CI 87.2-.98.3, I2 = 42) and 93.3 % (CI 84.4–97.3, I2 = 59) while for ES it was 96.9 % (CI 90.9–99, I2 = 64) and 85.6 % (CI 73–92.9, I2 = 85), respectively. Pooled rate of re-intervention was significantly lower with EUS-GE i. e. 4 % (CI 1.8–8.7, I2 = 35) compared to ES, where it was 23.6 % (CI 17.5–31, I2 = 35), p = 0.001. Pooled rates of overall and major AEs were comparable between the two techniques. Conclusion EUS-GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the pandemic of coronavirus disease 2019 (COVID-19) is a global health crisis. Possible pancreatic involvement has recently been observed in these patients; however, its significance is unclear. The aim of this study was to evaluate the association of significantly elevated lipase with disease outcomes. METHODS: Data about demographics, symptoms, laboratory values, and clinical outcomes were collected for 1,003 consecutive patients testing positive for COVID-19. Elevated lipase was defined as greater than 3 times the upper limit of normal (>3 × ULN). Baseline characteristics among patients with or without elevated lipase were compared using Fisher exact test or Student t-test for categorical or numerical variables, respectively. Logistic regression was used to evaluate the association of lipase levels with primary clinical outcomes (intensive care unit admission and intubation) adjusted for age, sex, body mass index, history of diabetes, and hypertension. RESULTS: Of 1,003 patients with COVID-19, 83 had available lipase levels and were all admitted to the hospital. Of 83, 14 (16.8%) had elevated lipase (>3 × ULN), which was associated with higher rates of leukocytosis (P < 0.001) and abnormal liver enzymes (P < 0.01). Compared with lower lipase levels (