Predicting the presence of adenomatous polyps during colonoscopy with National Cancer Institute Colorectal Cancer Risk-Assessment Tool

AIM To evaluate the National Cancer Institute(NCI)Colorectal Cancer(CRC)Risk Assessment Tool as a predictor for the presence of adenomatous polyps(AP) found during screening or surveillance colonoscopy.METHODS This is a retrospective single center observational study.We collected data of adenomatous polyps in each colonoscopy and then evaluated the lifetime CRC risk.We calculated the AP prevalence across risk score quintiles,odds ratios of the prevalence of AP across risk score quintiles,area under curves(AUCs)and Youden’s indexes to assess the optimal risk score cut off value for AP prevalence status.RESULTS The prevalence of AP gradually increased throughout the five risk score quintiles:i.e.,27.63%in the first and 51.35%in the fifth quintile.The odd ratios of AP prevalence in the fifth quintile compared to the first and second quintile were 2.76[confidence interval(CI):1.71-4.47]and 2.09(CI:1.32-3.30).The AUC for all patients was 0.62(CI:0.58-0.66).Youden’s Index indicated the optimal risk score cutoff value discriminating AP prevalence status was 3.60.CONCLUSION Patients with the higher NCI risk score have higher risk of AP and subsequent CRC;therefore,measures to increase the effectiveness of CRC detection in these patients include longer withdrawal time,early surveillance colonoscopy,and choosing flexible colonoscopy over other CRC screening modalities.

Chronic hepatitis-C infection in COVID-19 patients is associated with in-hospital mortality

BACKGROUND There is little evidence about the association of pre-existing hepatitis C infection(HCV)with outcomes in patients with coronavirus disease 2019(COVID-19).AIM To assess the prevalence of history of HCV among patients with COVID-19 and to study the relationship of in-hospital mortality in relation with other predictors of poor outcomes in the presence or absence of COVID-19 induced acute liver injury.METHODS In a retrospective single-center study design,1193 patients with COVID-19 infection were studied.Patients were then classified into those with and without a history of HCV,50(4.1%)and 1157(95.9%)respectively.RESULTS Multivariate cox-regression models showed that age,HCV,D-Dimer,and ferritin were the only predictors of in-hospital mortality.Acute liver injury and fibrosis score(Fib-4 score)were not different between both groups.Multivariate coxregression model for liver profile revealed that aspartate aminotransferase/alanine aminotransferase ratio,Fib-4 score,and HCV were predictors of inhospital mortality.After propensity score matching HCV was the only predictor of mortality in the multivariate cox-regression model.A model including HCV was found to add predictive value to clinical and laboratory parameters.CONCLUSION In patients with COVID-19,history of HCV infection leads to an accentuated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virulence,irrespective of baseline comorbidities,admission laboratory variables,or COVID-19-induced liver injury,which may be related to extrahepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 viral entry,baseline cytokine-mediated pro-inflammation,and endothelial dysfunction.

Rare sequalae of hiatal hernia causing pancreatitis and hepatitis:A case report

Hiatal hernia(HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH,containing stomach and much of the bowel as well as pancreas and distal extrahepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.HH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities.

Chemical colitis caused by hydrogen peroxide vaginal douche: A case report

BACKGROUND Hydrogen peroxide is one of the most common household disinfectants worldwide.Hydrogen peroxide has been documented as a rare cause of chemical colitis.CASE SUMMARY We present a case of 31 years old lady who presented to our hospital with rectal bleeding and abdominal pain after using hydrogen peroxide vaginal douche as an enema.She underwent colonoscopy which showed findings suggestive of chemical colitis and was managed conservatively.Hydrogen peroxide can induce chemical injury in the colon.Clinical presentation and endoscopic findings of chemical colitis are nonspecific.History taking is an important tool in identifying the underlying etiology.Review of literature showed few case reports,mostly were managed with oral antibiotics and conservative approach.CONCLUSION Chemical colitis is usually managed conservatively.Complications including perforation,stricture and peritonitis may happen and need aggressive treatment accordingly.

Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

BACKGROUND Clostridium difficile infection(CDI)occurs due to a dysbiosis in the colon.The appendix is considered a‘safe house’for gut microbiota and may help repopulate gut flora of patients with CDI.AIM To study the impact of prior appendectomy on the severity and outcomes of CDI.METHODS We retrospectively reviewed data of 1580 patients with CDI,admitted to our hospital between 2008 to 2018.Patients were grouped based on the presence or absence of the appendix.The primary aim was to(1)assess all-cause mortality and(2)the severity of CDI.Severity was defined as per the Infectious Diseases Society of America criteria.Logistic regression,and propensity score analysis using inverse probability of treatment weights(IPTW)was performed.RESULTS Of the 1580 patients,12.5%had a history of appendectomy.There was no statistical difference in mortality between patients with a prior appendectomy or without(13.7%vs 14%,P=0.877).However,a history of appendectomy affected the severity of CDI[odds ratio(OR)=1.32,95%confidence interval:1.01-1.75].On IPTW,this association remained significant(OR=1.59,P<0.05).On multivariable toxic megacolon(OR=5.37,P<0.05)and colectomy(OR=2.77,P<0.05).CONCLUSION Prior appendectomy may affect the severity of CDI,development of toxic megacolon and the eventual need for colectomy.Since treatment of CDI is governed by its severity,stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.