Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Early antiplatelet therapy used for acute ischemic stroke and intracranial hemorrhage

In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical Cases.We evaluate their claims on the benefit of use of Aspirin in the early management of patients with ischemic stroke.We also comment on their contention of using aspirin in the early management of patients with intracranial hemorrhage,a practice not seen in modern medicine.Large clinical trials such as the International Stroke Trial and the Chinese Acute Stroke Trial have shown the benefit of Aspirin use within 48 h of patients with Acute Ischemic Stroke.The findings were corroborated in the open-label trial performed by Zhang et al in a smaller sample group of 25 patients where they showed improvement in functional scores at 90 days without an increase in adverse events.As such,this intervention is also recommended by the American Heart Association stroke guidelines from 2021.With regard to Intracranial hemorrhage,traditional practice has been to discontinue or avoid antiplatelet therapy in these patient groups.However,no studies have been done to evaluate this management strategy that is more borne out of the mechanism behind Aspirin’s effect on the coagulation pathway.Zhang et al evaluate the benefits of Aspirin on patients with low-volume intracranial hemorrhage,i.e.,less than 30 mL on computed tomo-graphy imaging,and show no increase in mortality.The caveat of this finding is that all outcomes were pooled into one group for results,and the number of patients was low.While more studies with larger patient groups are required,the data from Zhang et al suggests that patients with small-volume intracranial hemorrhages may benefit from Aspirin administration in the acute phase of management.

Driving pressure in mechanical ventilation:A review

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

Cardiac implications in myasthenia gravis

This editorial aimed to consolidate the current evidence in literature on the association between myasthenia gravis(MG)and cardiac involvement,focusing on the impact of thymoma,antistriational antibodies,and late-onset MG.Additionally,the study aimed to explore the influence of genetic differences among populations on the association with cardiac disease.We conducted a review of existing literature in PubMed and Google Scholar to find relevant studies on cardiac involvement in MG.We created search criteria using a combination of free text words,including MG,antistriational antibodies,thymectomy,cardiomyopathy,myocarditis,arrhythmias,autonomic dysfunction.Relevant articles published in English language were analyzed and incorporated.The findings indicate a strong association between thymoma,myasthenic crisis,antistriational antibodies,and late-onset MG with cardiac involvement.The study also revealed that genetic differences among populations influence the risk of cardiac disease and electrocardiography(ECG)abnormalities in MG patients.Autonomic dysfunctions altered cardiac autonomic response and increased susceptibility to arrhythmias and sudden cardiac death in MG patients.The study supports the significance of thymoma,antistriational antibodies,and late-onset MG as key factors associated with cardiac involvement in MG patients.It emphasizes the importance of ECG as the initial test in managing MG patients,particularly in the perioperative period,to identify and genetic testing if needed to address their cardiac risk effectively.

Immunoglobulin A glomerulonephropathy:A review

In this editorial,we comment on the article by Meng et al published in the World Journal of Clinical Cases.We comprehensively review immunoglobulin A nephro-pathy(IgAN),including epidemiology,clinical presentation,diagnosis,and management.IgAN,also known as Berger's disease,is the most frequent type of primary glomerulonephritis(GN)globally.It is mostly found among the Asian population.The presentation can be variable,from microscopic hematuria to a rapidly progressive GN.Around 50%of patients present with single or recurring episodes of gross hematuria.An upper respiratory infection and tonsillitis often precede these episodes.Around 30%of patients present microscopic hematuria with or without proteinuria,usually detected on routine examination.The diagnosis relies on having a renal biopsy for pathology and immunofluorescence microscopy.We focus on risk stratification and management of IgAN.We provide a review of all the landmark studies to date.According to the 2021 KDIGO(kidney disease:Improving Global Outcomes)guidelines,patients with non-variant form IgAN are first treated conservatively for three to six months.This approach consists of adequate blood pressure control,reduction of proteinuria with renin-angiotensin system blockade,treatment of dyslipidemia,and lifestyle modifications(weight loss,exercise,smoking cessation,and dietary sodium restrictions).Following three to six months of conservative therapy,patients are further classified as high or low risk for disease progression.High-risk patients have proteinuria≥1 g/d or<1 g/d with significant microscopic hematuria and active inflammation on kidney biopsy.Some experts consider proteinuria≥2 g/d to be very high risk.Patients with high and very high-risk profiles are treated with immunosuppressive therapy.A proteinuria level of<1 g/d and stable/im-proved renal function indicates a good treatment response for patients on immu-nosuppressive therapy.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Safety of teplizumab in patients with high-risk for diabetes mellitus type 1:A systematic review

BACKGROUND The incidence of diabetes mellitus type 1(DM1)has been rising worldwide because of improvements in diagnostic techniques and improved access to care in countries with lower socioeconomic status.A new anti-CD4 antibody,Teplizumab,has been shown to delay the progression of DM1 and is the only medication approved for this indication.However,more information is needed about the safety profile of this drug.AIM To identify the odds ratios(OR)of systems-based adverse effects for Teplizumab when compared to Placebo.METHODS An extensive systematic review was conducted from the inception of the medication until December 31,2023.All clinical trials and studies that evaluated Teplizumab vs placebo were included in the initial review.The study protocol was designed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guidelines and was registered in PROSPERO(ID:CRD42024496169).Crude OR were generated using RevMan Software version 5.4.RESULTS After screening and review,5 studies were selected to determine the risk of adverse effects of teplizumab compared to placebo.A total of 561 patients were included in the study population.Total adverse effects and system-based adverse effects were studied and reported.We determined that patients receiving Teplizumab had a higher risk of developing gastrointestinal(GI)(OR=1.60,95%CI:1.01-2.52,P=0.04),dermatological(OR=6.33,95%CI:4.05-9.88,P<0.00001)and hematological adverse effects(OR=19.03,95%CI:11.09-32.66,P<0.00001).These patients were also significantly likely to have active Epstein-Barr Virus infection(OR=3.16,95%CI:1.51-6.64,P<0.002).While our data showed that patients receiving Teplizumab did have a higher incidence of total adverse effects vs placebo,this finding did not reach statistical significance(OR=2.25,95%CI:0.80-6.29,P=0.12).CONCLUSION Our systematic review suggests that Teplizumab patients are at risk for significant adverse effects,primarily related to GI,dermatological,and hematological systems.The total adverse effect data is limited as study populations are small.More studies should be conducted on this medication to better inform the target population of potential adverse effects.

Removal of intrahepatic bile duct stone could reduce the risk of cholangiocarcinoma

Hepatolithiasis(HL)poses a significant risk for cholangiocarcinoma(CCA)development,with reported incidences ranging from 5%-13%.Risk factors include older age,smoking,hepatitis B infection,and prolonged HL duration.Chronic inflammation and mechanical stress on the biliary epithelium contribute to CCA pathogenesis.Hepatectomy reduces CCA risk by removing stones and atrophic liver segments.However,residual stones and incomplete removal increase CCA risk.Kim et al identified carbohydrate antigen 19-9,carcinoembryonic antigen,and stone laterality as CCA risk factors,reaffirming the importance of complete stone removal.Nonetheless,challenges remain in preventing CCA recurrence post-surgery.Longer-term studies are needed to elucidate CCA risk factors further.

Investigating causal links between gastroesophageal reflux disease and essential hypertension

Gastroesophageal reflux disease(GERD)is a prevalent global health concern with a rising incidence.Various risk factors,including obesity,hiatal hernia,and smo-king,contribute to its development.Recent research suggests associations bet-ween GERD and metabolic syndrome,cardiac diseases,and hypertension(HTN).Mechanisms linking GERD to HTN involve autonomic dysfunction,inflammatory states,and endothelial dysfunction.Furthermore,GERD medications such as pro-ton-pump inhibitors may impact blood pressure regulation.Conversely,antihy-pertensive medications like beta-blockers and calcium channel blockers can exacerbate GERD symptoms.While bidirectional causality exists between GERD and HTN,longitudinal studies are warranted to elucidate the precise relationship.Treatment of GERD,including anti-reflux surgery,may positively influence HTN control.However,the interplay of lifestyle factors,comorbidities,and medications necessitates further investigation to comprehensively understand this relation-ship.In this editorial,we comment on the article published by Wei et al in the recent issue of the World Journal of Clinical Cases.We evaluate their claims on the causal association between GERD and HTN.

Obstructive sleep apnea-hypopnea syndrome immunological relationship

Obstructive sleep apnea-hypopnea syndrome(OSAHS)is a complex disorder cha-racterized by symptoms resulting from intermittent hypoxia and hypopnea,with research indicating a crucial role of immune system dysregulation and genetic variations in its pathogenesis.A recent Zhao et al study utilizes Mendelian ran-domization analysis to explore the causal relationship between immune cell characteristics and OSAHS.The study identifies specific lymphocyte subsets as-sociated with OSAHS,providing valuable insights into the disease's pathophy-siology and potential targets for therapeutic intervention.The findings underscore the significance of genetic and immunological factors in sleep disorders,offering a fresh perspective on OSAHS's complexities.Compared to existing literature,Zhao et al's study stands out for its focus on genetic markers and specific immune responses associated with OSAHS,expanding upon previous research primarily centered on systemic inflammation.In conclusion,the study represents a signi-ficant advancement in the field,shedding light on the causal role of immune cells in OSAHS and paving the way for future research and targeted treatments.

Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding:Meta-analysis of randomized controlled trials

BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Remimazolam in intensive care unit:Potential applications and considerations

This manuscript explores the potential use of Remimazolam in the intensive care unit(ICU)and critical care units,considering its pharmacological characteristics,clinical applications,advantages,and comparative effectiveness over current sedatives and anesthetics.We reviewed existing PubMed and Google Scholar literature to find relevant studies on Remimazolam in ICU.We created search criteria using a combination of free text words,including Remimazolam,critical care,intensive care,sedation,anesthesia,pharmacokinetics,and pharmacodynamics.Relevant articles published in the English language were analyzed and incorporated.Remimazolam is an ultra-short-acting benzodiazepine derivative promising for sedation and anesthesia.It is a safer option for hemodynamically unstable,elderly,or liver or kidney issues.It also has comparable deep sedation properties to propofol in the ICU.Furthermore,it reduces post-procedural delirium and patient comfort and reduces the need for additional sedatives in pediatric patients.In conclusion,Remimazolam is an excellent alternative to current sedatives and anesthetics in the ICU.Its cost is comparable to that of current medications.Further research on its long-term safety in the ICU and its broader application and incorporation into routine use is necessary.

Violence study of healthcare workers and systems in the Caribbean:ViSHWaS-Caribbean study

BACKGROUND Violence against healthcare workers(HCWs)in the Caribbean continues to prevail yet remains underreported.Our aim is to determine the cause,traits,and consequences of violence on HCWs in the Caribbean.AIM To determine the cause,traits,and consequences of violence on HCWs in the Caribbean.METHODS This research adopted an online cross-sectional survey approach,spanning over eight weeks(between June 6th and August 9th,2022).The survey was generated using Research Electronic Data Capture forms and followed a snowballing strategy to contact individuals using emails,social media,text messages,etc.Logistic regression analysis was performed to evaluate the variables that influence violence,including gender,age,years of experience,institution type,and night shift frequency.RESULTS The survey was completed by 225 HCWs.Females comprised 61%.Over 51%of respondents belonged to the 21 to 35 age group.Dominica(n=61),Haiti(n=50),and Grenada(n=31)had the most responses.Most HCWs(49%)worked for government academic institutions,followed by community hospitals(23%).Medical students(32%),followed by attending physicians(22%),and others(16%)comprised the most common cadre of respondents.About 39%of the participants reported experiencing violence themselves,and 18%reported violence against colleague(s).Verbal violence(48%),emotional abuse(24%),and physical misconduct(14%)were the most common types of violence.Nearly 63%of respondents identified patients or their relatives as the most frequent aggressors.Univariate logistic regression analyses demonstrated that female gender(OR=2.08;95%CI:1.16-3.76,P=0.014)and higher frequency of night shifts(OR=2.22;95%CI:1.08-4.58,P=0.030)were associated with significantly higher odds of experiencing violence.More than 50%of HCWs felt less motivated and had decreased job satisfaction post-violent conduct.CONCLUSION A large proportion of HCWS in the Caribbean are exposed to violence,yet the phenomenon remains underreported.As a result,HCWs’job satisfaction has diminished.

Dosage and utilization of dexamethasone in the management of COVID-19: A critical review

BACKGROUND The severe respiratory manifestations observed in severe coronavirus disease 2019(COVID-19)cases are often associated with an excessive inflammatory response.Dexamethasone,a synthetic glucocorticoid,exerts its anti-inflammatory effects by inhibiting the transcription of pro-inflammatory genes and suppressing the activity of various immune cells.This mechanism has implications for mitigating the cytokine storm observed in severe COVID-19 cases.Early on in the pandemic,the Recovery Collaborative working group showed a mortality benefit of using dexamethasone in decreasing mortality in patients with COVID-19 requiring respiratory support.However,the optimal dosage of corticosteroids remains debatable.Several studies that compare different doses of dexamethasone in COVID-19 exist,but the results are conflicting.AIM To review the latest evidence regarding dosage,safety,and efficacy of dexamethasone in severe COVID-19.METHODS We followed preferred reporting items for systematic reviews and meta-analysis guidelines.A detailed literature search was conducted across PubMed,Google Scholar,and Medline to include publications up to March 2024.Our keywords included“COVID-19”“SARS-CoV-2”“dexamethasone”“corticosteroid”“steroid”and“glucocorticoid”-along with their combinations.We employed the Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale to evaluate the integrity and potential of bias in the included studies.A meta-analysis was conducted using a random-effects model,assessing pooled odds ratios and mean differences,with heterogeneity gauged by the I2 statistic and theχ^(2) tests.RESULTS No statistical differences were found in 28-day all-cause mortality[pooled odds ratio(OR)=1.109,95%CI:0.918-1.340],60-day all-cause mortality(OR=0.873,95%CI:0.744-1.024;I2=47.29%),mean length of hospital stay(mean difference=-0.08 days,95%CI:-0.001 to 0.161)and adverse events(OR=0.877,95%CI:0.707-1.087).CONCLUSION Differing doses of corticosteroids have no clinical implications on mortality,mean length of hospital stay,and adverse events in COVID-19 patients.Additional research is required in patients requiring invasive or noninvasive ventilation.

Climate change and the emergence and exacerbation of infectious diseases:A review

Experts expressed severe concerns over the possibility of increasing burden of infectious diseases as the planet’s climate began to change years ago.There have been increased rates of climate-related catastrophes and as global temperatures rise,emergence of certain viruses has become a serious concern.Vectors are susceptible to changing temperatures as they exhibit innate responses to thermal stress to increase survivability.Climate change impacts virus reservoirs,increasing transmission rates of vectors.Vector-borne diseases have already witnessed increasing numbers compared to before.Certain non-endemic areas are encountering their first-ever infectious disease cases due to increasing temperatures.Tick-borne diseases are undergoing transformations provoking a heightened prevalence.Food-borne illnesses are expected to increase owing to warmer temperatures.It is important to recognize that climate change has a multivariable impact on the transmission of viruses.With climate change comes the potential of increasing interspecies interactions promoting jumps.These factors must be considered,and an informed strategy must be formulated.Adaptation and mitigation strategies are required to curb these diseases from spreading.Despite significant evidence that climate change affects infectious diseases,gaps in research exist.We conducted this review to identify the potential role climate change plays in the emergence of new viruses.

Association of non-alcoholic fatty liver and metabolic-associated fatty liver with COVID-19 outcomes:A systematic review and metaanalysis

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)and metabolic-associated fatty liver disease(MAFLD)are on the rise like any other liver disease,and tend to affect 25%of the United States population.The impact of NAFLD and MAFLD on patients with coronavirus disease 2019(COVID-19)remains unclear.AIM To identify the association of NAFLD and MAFLD with mortality,hospitalization,hospital length of stay,and supplemental oxygen utilization in COVID-19 patients.METHODS A systematic review of literature on Cochrane,Embase,PubMed,ScienceDirect,and Web of Science databases was conducted from January 2019 to July 2022.Studies that evaluated NAFLD/MAFLD using laboratory methods,noninvasive imaging,or liver biopsy were included.The study protocol was registered in PROSPERO(ID CRD42022313259)and PRISMA guidelines were followed.The National Institutes of Health quality assessment tool was used to assess the quality of the studies.Pooled analysis was conducted using software Rev Man version 5.3.The stability of the results was assessed using sensitivity analysis.RESULTS Thirty-two studies with 43388 patients were included in the meta-analysis of whom 8538(20%)patients were observed to have NAFLD.There were 42254 patients from 28 studies included in the mortality analysis.A total of 2008 patients died from COVID-19;837(10.52%)in the NAFLD group and 1171(3.41%)in the non-NAFLD group.The odds ratio(OR)was 1.38 for mortality with a 95%confidence interval(95%CI)=0.97-1.95 and P=0.07.A total of 5043 patients from eight studies were included in the hospital length of stay analysis.There were 1318 patients in the NAFLD group and 3725 patients in the non-NAFLD group.A qualitative synthesis showed that the mean difference in hospital length of stay was about 2 d between the NAFLD and non-NAFLD groups with a 95%CI=0.71-3.27 and P=0.002.For hospitalization rates,the OR was 3.25 with a 95%CI of 1.73-6.10 and P=0.0002.For supplemental oxygen utilization,the OR was 2.04 with a 95%CI of 1.17-3.53 and P=0.01.CONCLUSION Our meta-analysis suggests that there are increased odds of hospitalization,longer hospital length of stay,and increased use of supplemental oxygen in NAFLD/MAFLD patients.

Non-clostridium difficile induced pseudomembranous colitis

Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia,ischemia,endothelial damage,and toxin production.The majority of cases of pseudomembranous colitis are due to Clostridium difficile.However,other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon.Common presenting symptoms and signs include crampy abdominal pain,nausea,watery diarrhea that can progress to bloody diarrhea,fever,leukocytosis,and dehydration.Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis.Bacterial infections other than Clostridium difficile,Viruses such as cytomegalovirus,parasitic infections,medications,drugs,chemicals,inflammatory diseases,and ischemia are other differential diagnoses to look out for in pseudomembranous colitis.Complications of pseudomembranous colitis include toxic megacolon,hypotension,colonic perforation with peritonitis,and septic shock with organ failure.Early diagnosis and treatment to prevent progression are important.The central perspective of this paper is to provide a concise review of the various etiologies for pseudomembranous colitis and management per prior literature.

Artificial intelligence in sleep medicine:Present and future

Artificial intelligence(AI)has impacted many areas of healthcare.AI in healthcare uses machine learning,deep learning,and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes.In the sleep medicine field,a large amount of physiological data is gathered compared to other branches of medicine.This field is primed for innovations with the help of AI.A good quality of sleep is crucial for optimal health.About one billion people are estimated to have obstructive sleep apnea worldwide,but it is difficult to diagnose and treat all the people with limited resources.Sleep apnea is one of the major contributors to poor health.Most of the sleep apnea patients remain undiagnosed.Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors,and AI can help in this situation.AI can also help in the diagnosis and management of other sleep disorders such as insomnia,hypersomnia,parasomnia,narcolepsy,shift work sleep disorders,periodic leg movement disorders,etc.In this manuscript,we aim to address three critical issues about the use of AI in sleep medicine:(1)How can AI help in diagnosing and treating sleep disorders?(2)How can AI fill the gap in the care of sleep disorders?and(3)What are the ethical and legal considerations of using AI in sleep medicine?

Gastrointestinal tract and viral pathogens

Viral gastroenteritis is the most common viral illness that affects the gastro-intestinal(GI)tract,causing inflammation and irritation of the lining of the stomach and intestines.Common signs and symptoms associated with this condition include abdominal pain,diarrhea,and dehydration.The infections commonly involved in viral gastroenteritis are rotavirus,norovirus,and adenovirus,which spread through the fecal-oral and contact routes and cause non-bloody diarrhea.These infections can affect both immunocompetent and immunocompromised individuals.Since the pandemic in 2019,coronavirus gastroenteritis has increased in incidence and prevalence.Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition,treatment with oral rehydration salts,and prompt vaccination.Improved sanitation measures have also played a key role in reducing the transmission of infection.In addition to viral hepatitis causing liver disease,herpes virus,and cytomegalovirus are responsible for ulcerative GI disease.They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals.Hepatitis viruses,Epstein-Barr virus,herpesvirus 8,and human papillomavirus have been involved in benign and malignant diseases.This mini review aims to list different viruses affecting the GI tract.It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management.This will help primary care physicians and hospitalists diagnose and treat patients more easily.