BACKGROUND Irritable bowel syndrome(IBS)is a prevalent and debilitating gastrointestinal condition.Research has reported persistent,low-grade mucosal inflammation and significant overlaps between patients with IBS and...BACKGROUND Irritable bowel syndrome(IBS)is a prevalent and debilitating gastrointestinal condition.Research has reported persistent,low-grade mucosal inflammation and significant overlaps between patients with IBS and those with dyspepsia,suggesting a possible pathogenic role of Helicobacter pylori(H.pylori)in IBS.This study therefore aimed to provide the first systematic review and meta-analysis on the association between H.pylori infection and IBS.AIM To investigate the association between H.pylori infection and IBS.METHODS Using the keywords“H.pylori OR Helicobacter OR Helicobacter pylori OR infection”AND“irritable bowel syndrome OR IBS”,a preliminary search of PubMed,Medline,Embase,Cochrane Database of Systematic Reviews,Web of Science,Google Scholar and WanFang databases yielded 2924 papers published in English between 1 January 1960 and 1 June 2018.Attempts were also made to search grey literature.RESULTS A total of 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis.Random-effects meta-analysis found a slight increased likelihood of H.pylori infection in patients with IBS,albeit this was not statistically significant(pooled odds ratio 1.47,95%confidence interval:0.90-2.40,P=0.123).It must also be acknowledged that all of the available studies reported only crude odd ratios.H.pylori eradication therapy also does not appear to improve IBS symptoms.Although publication bias was not observed in the funnel plot,there was a high degree of heterogeneity amongst the studies included in the meta-analysis(I2=87.38%).CONCLUSION Overall,current evidence does not support an association between IBS and H.pylori infection.Further rigorous and detailed studies with larger sample sizes and after H.pylori eradication therapy are warranted.展开更多
BACKGROUND Depression is a growing public health problem that affects over 350 million people globally and accounts for approximately 7.5%of healthy years lost due to disability.Escitalopram,one of the first-line medi...BACKGROUND Depression is a growing public health problem that affects over 350 million people globally and accounts for approximately 7.5%of healthy years lost due to disability.Escitalopram,one of the first-line medications for the treatment of depression,is a selective serotonin reuptake inhibitor and one of the most commonly prescribed antidepressant medications worldwide.Although thought to be generally safe and with minimal drug-drug interactions,we herein present an unusual case of cholestatic liver injury,likely secondary to escitalopram initiation.CASE SUMMARY A 56-year-old Chinese lady presented with fever and cholestatic liver injury two weeks after initiation of escitalopram for the treatment of psychotic depression.Physical examination was unremarkable.Further investigations,including a computed tomography scan of the abdomen and pelvis and tests for hepatitis A,B and C and for autoimmune liver disease were unyielding.Hence,a diagnosis of escitalopram-induced liver injury was made.Upon stopping escitalopram,repeat liver function tests showed downtrending liver enzymes with eventual normalization of serum aspartate aminotransferase and alanine aminotransferase one-week post-discharge.CONCLUSION Clinicians should be aware of the possibility of escitalopram-induced liver injury when initiating depressed patients on antidepressant treatment.This requires extra vigilance as most patients may remain asymptomatic.Measurement of liver function tests could be considered after initiation of antidepressant treatment,especially in patients with pre-existing liver disease.展开更多
Magnetic resonance imaging(MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s)on MRI.The role of concurrent systematic in addition to targeted biopsies is currently unclear....Magnetic resonance imaging(MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s)on MRI.The role of concurrent systematic in addition to targeted biopsies is currently unclear.Using our prospectively maintained database,we identified men with at least one Prostate Imaging-Reporting and Data System(PI-RADS)≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May 2020.Clinically significant prostate cancer(csPCa)was defined as any Gleason grade group≥2 cancer.Of 545 patients who underwent MRI fusion-targeted biopsy,222(40.7%)were biopsy naïve,247(45.3%)had previous prostate biopsy(s),and 76(13.9%)had known prostate cancer undergoing active surveillance.Prostate cancer was more commonly found in biopsy-naïve men(63.5%)and those on active surveillance(68.4%)compared to those who had previous biopsies(35.2%;both P<0.001).Systematic biopsies provided an incremental 10.4%detection of csPCa among biopsy-naïve patients,versus an incremental 2.4%among those who had prior negative biopsies.Multivariable regression found age(odds ratio[OR]=1.03,P=0.03),prostate-specific antigen(PSA)density≥0.15 ng ml^(−2)(OR=3.24,P<0.001),prostate health index(PHI)≥35(OR=2.43,P=0.006),higher PI-RADS score(vs PI-RADS 3;OR=4.59 for PI-RADS 4,and OR=9.91 for PI-RADS 5;both P<0.001)and target lesion volume-to-prostate volume ratio≥0.10(OR=5.26,P=0.013)were significantly associated with csPCa detection on targeted biopsy.In conclusion,for men undergoing MRI fusion-targeted prostate biopsies,systematic biopsies should not be omitted given its incremental value to targeted biopsies alone.The factors such as PSA density≥0.15 ng ml^(−2),PHI≥35,higher PI-RADS score,and target lesion volume-to-prostate volume ratio≥0.10 can help identify men at higher risk of csPCa.展开更多
文摘BACKGROUND Irritable bowel syndrome(IBS)is a prevalent and debilitating gastrointestinal condition.Research has reported persistent,low-grade mucosal inflammation and significant overlaps between patients with IBS and those with dyspepsia,suggesting a possible pathogenic role of Helicobacter pylori(H.pylori)in IBS.This study therefore aimed to provide the first systematic review and meta-analysis on the association between H.pylori infection and IBS.AIM To investigate the association between H.pylori infection and IBS.METHODS Using the keywords“H.pylori OR Helicobacter OR Helicobacter pylori OR infection”AND“irritable bowel syndrome OR IBS”,a preliminary search of PubMed,Medline,Embase,Cochrane Database of Systematic Reviews,Web of Science,Google Scholar and WanFang databases yielded 2924 papers published in English between 1 January 1960 and 1 June 2018.Attempts were also made to search grey literature.RESULTS A total of 13 clinical studies were systematically reviewed and nine studies were included in the final meta-analysis.Random-effects meta-analysis found a slight increased likelihood of H.pylori infection in patients with IBS,albeit this was not statistically significant(pooled odds ratio 1.47,95%confidence interval:0.90-2.40,P=0.123).It must also be acknowledged that all of the available studies reported only crude odd ratios.H.pylori eradication therapy also does not appear to improve IBS symptoms.Although publication bias was not observed in the funnel plot,there was a high degree of heterogeneity amongst the studies included in the meta-analysis(I2=87.38%).CONCLUSION Overall,current evidence does not support an association between IBS and H.pylori infection.Further rigorous and detailed studies with larger sample sizes and after H.pylori eradication therapy are warranted.
文摘BACKGROUND Depression is a growing public health problem that affects over 350 million people globally and accounts for approximately 7.5%of healthy years lost due to disability.Escitalopram,one of the first-line medications for the treatment of depression,is a selective serotonin reuptake inhibitor and one of the most commonly prescribed antidepressant medications worldwide.Although thought to be generally safe and with minimal drug-drug interactions,we herein present an unusual case of cholestatic liver injury,likely secondary to escitalopram initiation.CASE SUMMARY A 56-year-old Chinese lady presented with fever and cholestatic liver injury two weeks after initiation of escitalopram for the treatment of psychotic depression.Physical examination was unremarkable.Further investigations,including a computed tomography scan of the abdomen and pelvis and tests for hepatitis A,B and C and for autoimmune liver disease were unyielding.Hence,a diagnosis of escitalopram-induced liver injury was made.Upon stopping escitalopram,repeat liver function tests showed downtrending liver enzymes with eventual normalization of serum aspartate aminotransferase and alanine aminotransferase one-week post-discharge.CONCLUSION Clinicians should be aware of the possibility of escitalopram-induced liver injury when initiating depressed patients on antidepressant treatment.This requires extra vigilance as most patients may remain asymptomatic.Measurement of liver function tests could be considered after initiation of antidepressant treatment,especially in patients with pre-existing liver disease.
文摘Magnetic resonance imaging(MRI)-targeted prostate biopsy is the recommended investigation in men with suspicious lesion(s)on MRI.The role of concurrent systematic in addition to targeted biopsies is currently unclear.Using our prospectively maintained database,we identified men with at least one Prostate Imaging-Reporting and Data System(PI-RADS)≥3 lesion who underwent targeted and/or systematic biopsies from May 2016 to May 2020.Clinically significant prostate cancer(csPCa)was defined as any Gleason grade group≥2 cancer.Of 545 patients who underwent MRI fusion-targeted biopsy,222(40.7%)were biopsy naïve,247(45.3%)had previous prostate biopsy(s),and 76(13.9%)had known prostate cancer undergoing active surveillance.Prostate cancer was more commonly found in biopsy-naïve men(63.5%)and those on active surveillance(68.4%)compared to those who had previous biopsies(35.2%;both P<0.001).Systematic biopsies provided an incremental 10.4%detection of csPCa among biopsy-naïve patients,versus an incremental 2.4%among those who had prior negative biopsies.Multivariable regression found age(odds ratio[OR]=1.03,P=0.03),prostate-specific antigen(PSA)density≥0.15 ng ml^(−2)(OR=3.24,P<0.001),prostate health index(PHI)≥35(OR=2.43,P=0.006),higher PI-RADS score(vs PI-RADS 3;OR=4.59 for PI-RADS 4,and OR=9.91 for PI-RADS 5;both P<0.001)and target lesion volume-to-prostate volume ratio≥0.10(OR=5.26,P=0.013)were significantly associated with csPCa detection on targeted biopsy.In conclusion,for men undergoing MRI fusion-targeted prostate biopsies,systematic biopsies should not be omitted given its incremental value to targeted biopsies alone.The factors such as PSA density≥0.15 ng ml^(−2),PHI≥35,higher PI-RADS score,and target lesion volume-to-prostate volume ratio≥0.10 can help identify men at higher risk of csPCa.
