N-acetylcysteine does not prevent post-endoscopic retrograde cholangiopancreatography hyperamylasemia and acute pancreatitis

The presented recommendations concern the current management of acute pancreatitis. The recommendations relate to the diagnostics and treatment of early and late phases of acute pancreatitis and complications of the disease taking into consideration surgical and endoscopic methods. All the...

(1) Background: The use of virtual reality (VR) in improving patient comfort related to medical procedures in oncology patients raised the question of whether similar benefits could be obtained by patients with inflammatory bowel disease (IBD). (2) Methods: In this prospective, randomized, controlled, single-center clinical trial, a total of 90 patients with IBD treated with vedolizumab were enrolled and randomized in a 1:1 allocation to either the VR immersion group or the routine-treated group. The primary outcome was to evaluate whether VR could decrease stress and anxiety related to a medical procedure. The secondary outcome was to assess the safety of the VR. (3) Results: A statistically significant improvement in well-being and psychological comfort (p = 0.046), feeling of relaxation (p = 0.046), sense of influence on the treatment process (p < 0.001), improved perception of the way the drug works (p < 0.001), improved positive attitude while waiting for the next administration of the drug (p = 0.026), and increased motivation for treatment (p = 0.026) was noticed in the intervention group. There were no statistically significant differences in the incidence of complications in the intervention and control groups. (4) Conclusions: The use of VR had a positive effect on the reduction of stress associated with vedolizumab treatment and could improve compliance.

The COVID-19 pandemic caused by SARS-CoV-2 has led to a wide range of clinical presentations, with respiratory symptoms being common. However, emerging evidence suggests that the gastrointestinal (GI) tract is also affected, with angiotensin-converting enzyme 2, a key receptor for SARS-CoV-2, abundantly expressed in the ileum and colon. The virus has been detected in GI tissues and fecal samples, even in cases with negative results of the reverse transcription polymerase chain reaction in the respiratory tract. GI symptoms have been associated with an increased risk of ICU admission and mortality. The gut microbiome, a complex ecosystem of around 40 trillion bacteria, plays a crucial role in immunological and metabolic pathways. Dysbiosis of the gut microbiota, characterized by a loss of beneficial microbes and decreased microbial diversity, has been observed in COVID-19 patients, potentially contributing to disease severity. We conducted a comprehensive gut microbiome study in 204 hospitalized COVID-19 patients using both shallow and deep shotgun sequencing methods. We aimed to track microbiota composition changes induced by hospitalization, link these alterations to clinical procedures (antibiotics administration) and outcomes (ICU referral, survival), and assess the predictive potential of the gut microbiome for COVID-19 prognosis. Shallow shotgun sequencing was evaluated as a cost-effective diagnostic alternative for clinical settings. Our study demonstrated the diverse effects of various combinations of clinical parameters, microbiome profiles, and patient metadata on the precision of outcome prognostication in patients. It indicates that microbiological data possesses greater reliability in forecasting patient outcomes when contrasted with clinical data or metadata. Furthermore, we established that shallow shotgun sequencing presents a viable and cost-effective diagnostic alternative to deep sequencing within clinical environments.

INTRODUCTION Fecal calprotectin (FC) is a well-established biomarker of intestinal inflammation in Crohn disease (CD) and ulcerative colitis (UC). However, standard laboratory methods are time-consuming and not always useful in clinical practice. OBJECTIVES We analyzed the efficacy of a rapid bedside FC test to detect disease flares in a hospital setting. We also assessed the influence of disease location on the diagnostic accuracy of FC. PATIENTS AND METHODS This prospective study included 140 patients (46 with UC; 94 with CD). FC was measured by an enzyme-linked immunosorbent assay (ELISA) and by the rapid Quantum Blue (R) test. Endoscopic activity was assessed using the Mayo endoscopic subscore or the Simple Endoscopic Score for Crohn's Disease (SES-CD). RESULTS FC levels highly correlated with endoscopic activity in CD (area under the receiver operating characteristic curve [AUC], 0.83) and UC (AUC, 0.80), with the cut-off values of 238.5 mu g/g and 499 mu g/g, respectively. FC levels increased dynamically even with early signs of inflammation both in CD (SES-CD, 4-10 vs 0 points: 252 vs 100.0 mu g/g; P = 0.02) and UC (Mayo subscore, 1 vs 0 points: 323.3 vs 100.0 mu g/g; P < 0.001). In UC, FC levels were lower in proctitis than in left-sided UC and pancolitis (340.0, 500.0, and 421.5 mu g/g, respectively), but the differences were not significant. In CD, lower FC values were observed in isolated small bowel disease. CONCLUSIONS FC levels increased dynamically even with mild signs of intestinal inflammation. The rapid Quantum Blue (R) test presents a potential alternative to the time-consuming ELISA, because its diagnostic accuracy is not influenced by disease location. It may be useful in the hospital setting, providing faster diagnosis and allowing cost reduction by lowering the number of endoscopic procedures.

In recent years the use of faecal and serologic biomarkers has been evaluated in the diagnosis and management of inflammatory bowel disease (IBD). Faecal calprotectin (FC) has been proposed as a surrogate marker for intestinal inflammation; elevated concentrations in IBD patients have been...