Mutational load may predict risk of progression in patients with Barrett\u27s oesophagus and indefinite for dysplasia: A pilot study

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Background and aims Mutational load (ML) has been shown to help risk-stratify those that may progress from non-dysplastic Barrett\u27s oesophagus (BE) to dysplastic disease. Management of patients with BE and indefinite for dysplasia (BE-IND) is challenging and risk stratification tools are lacking. The aim of this pilot study is to evaluate the utility of ML for risk stratification in patients with BE-IND. Methods This is a single-centre, retrospective pilot study evaluating ML quantification in patients with BE-IND. Histology at follow-up endoscopy at least 1 year after the baseline endoscopy was used to determine if a patient progressed to low or high dysplasia. The ML levels were then compared among patients who progressed to dysplasia versus those who did not. Results Thirty-five patients who met the inclusion criteria were identified, and seven met the exclusion criteria. Twenty-eight patients were analysed, of whom eight progressed to low-grade dysplasia (6) and high-grade dysplasia (2). Seven of these eight patients had some level of genomic instability detected in their IND biopsy (ML ≥0.5). Ten of the 20 (50%) who did not progress had no ML level. At an ML cut-off above 1.5, the risk of progression to high-grade dysplasia was 33% vs 0% (p=0.005), with a sensitivity of 100% and a specificity of 85%. Conclusion These results indicate that ML may be able to risk-stratify progression to high-grade dysplasia in BE-IND. Larger studies are needed to confirm these findings

Adherence to quality indicators in endoscopic surveillance of Barrett\u27s esophagus and correlation to dysplasia detection rates

© 2018 Elsevier Masson SAS Background and aims: The American Gastroenterological Association introduced quality guidelines for the endoscopic management of Barrett\u27s esophagus (BE) in 2015. Our aim was to determine if these guidelines are being followed and to correlate adherence with outcomes in surveillance endoscopy. Methods: This is a retrospective study from December 2015 to June 2017. Charts were abstracted to determine if the recommended quality measures were successfully accomplished during surveillance endoscopic exams in BE. Five of the recommendations pertain to surveillance endoscopy. Findings: One hundred and seventy-four patients with Barrett\u27s esophagus who underwent endoscopic surveillance were included. Adherence to recommendations one (78%), two (70%), six (99%), and seven (95%) were generally observed (P \u3c 0.001) but not to recommendation five (41%). When recommendations one (documenting important landmarks) and two (documenting the Prague classification) were followed, there was a statistically significant increase in dysplasia detection compared with those that did not adhere to the recommendations (36% vs. 13%, P = 0.006 and 36% vs. 19%, P = 0.003). The odds of detecting dysplasia when recommendations one and two were followed were 3.7 (95% CI 1.37–10.2) and 2.4 (95% CI 1.1–5.2) respectively. Conversely, there was no statistical difference in dysplasia yield for adherers compared with non-adherers to statement five (if systematic biopsies were performed; 35% vs. 27%, P = 0.3). Conclusion: Adherence to statements one and two resulted in higher dysplasia detection. This has implications for the use of quality indicators in BE management in endoscopy units

Prevalence of metabolic syndrome in dialysis and transplant patients

Sameeha AlShelleh,1 Izzat AlAwwa,1 Ashraf Oweis,2 Saif Aldeen AlRyalat,1 Mohammad Al-Essa,1 Iyad Saeed,1 Hussein H Alhawari,1 Karem H Alzoubi31Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan; 2Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JordanBackground: Several epidemiological studies have assessed various components of Metabolic Syndrome (MS) in different populations, but only a few compared the prevalence of metabolic syndrome in dialysis and transplant patients.Aim: The aim of this study is to compare the prevalence of MS in dialysis and transplant patients. Two groups of patients were included; hemodialysis patients and patients with transplanted kidneys.Methods: Demographic and clinical history, and lab data were collected. A total of 108 patients were included in this study with a mean age of 52.3 (±16.29) years. Study groups included 61 (56.5%) dialysis patients, and 47 (43.5%) patients with transplanted kidneys.Results: Upon comparing the prevalence of metabolic syndrome between the two study groups, transplant patients had significantly lower prevalence of metabolic syndrome (34%) compared to that of metabolic syndrome in patients on dialysis (55.7%; P=0.016).Conclusion: As metabolic syndrome plays an important role in the pathology of elderly patients, especially those with transplanted kidneys, such findings indicate the need for close monitoring of kidney transplant patients for the manifestations of metabolic syndrome.Keywords: metabolic syndrome, renal transplant, chronic kidney disease, elderl

Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan

Background. Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods. A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results. 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion. AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality

Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study.

Background and study aims  There are numerous studies published on the diagnostic yield of the new fine-needle biopsy (FNB) needles in pancreas masses. However, there are limited studies in suspected gastrointestinal stromal tumors (GIST lesions). The aim of this study was to evaluate the diagnostic yield of a new fork-tip FNB needle. Patients and methods  This was a multicenter retrospective study of consecutive patients from prospectively maintained databases comparing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided FNB (EUS-FNB) using the fork-tip needle. Outcomes measured were cytopathology yield (ability to obtain tissue for analysis of cytology), ability to analyze the tissue for immunohistochemistry (IHC yield), and diagnostic yield (ability to provide a definitive diagnosis). Results  A total of 147 patients were included in the study of which 101 underwent EUS-FNB and 46 patients underwent EUS-FNA. Median lesion size in each group was similar (21 mm vs 25 mm, P  = 0.25). Cytopathology yield, IHC yield, and diagnostic yield were 92 % vs 46 % ( P  = 0.001), 89 % vs 41 % ( P  = 0.001), and 89 % vs 37 % ( P  = 0.001) between the FNB and FNA groups, respectively. Median number of passes was the same between the two groups at 3.5. Conclusion  EUS-FNB is superior to EUS-FNA for diagnostic yield of suspected GIST lesions. This should be confirmed with a prospective study