The whole world has been continuously afflicted by the coronavirus disease 2019 (COVID-19) pandemic for the past 3 years. Many countries have tried many methods to control this virus infection with varying successes and failures. The gut microbiota is a biosystem spanning the entire length of the digestive tract and playing important roles in health and disease. It is much affected by COVID-19. In return it also substantially impacts infection. In particular, the gut microbiota has established a bidirectional interaction with the COVID-19 vaccines, enhancing or reducing vaccine efficacy by virtue of its varying components. Conversely, COVID-19 vaccines also make a substantial impact on the gut microbiota, re-ducing its overall population and biodiversity. It is hoped that by exploring and harnessing this bidirectional interaction we may break new ground and develop new methods to prevent and treat this formidable virus infection.

In particular, I appreciate the very useful mnemonic "AEIOU" and "ABBCCC". 1 Nonetheless, A for antidepressants was used in both mnemonics. May I suggest substituting the second one with "A" for "Absence of attention of caretaker" for an additional cause of falls. ese are examples from my case files that illustrate my point. 1. An 84-year-old woman in a reputable nursing home with chronic obstructive pulmonary disease and left hemiparesis following stroke was passing a bowel motion. Her attendant could not stand the smell and left briefly. Within minutes she fell off the toilet and sustained a wrist fracture. 2. On a rainy New Year's Eve, a young woman took her 86-year-old godmother to her apartment. As she left the car and went to unlock the apartment gate, her godmother got out the car

To the Editor-We are most appreciative of the communication and comments by Ng et al 1 which draws our attention to the seminal works and landmark paper by Kwong et al 2 in which no less than seven bacteria are listed to have significant association with colon cancer, with Clostridium septicum (hazard ratio [HR]=17.1), Gamella morbillorum (HR=15.2), and Streptococcus gallolyticus or Streptococcus bovis (HR=5.73) high on the list. Others have reported cancer association with even seemingly benign organisms such as Enterococcus faecalis or Escherichia coli. 3 Conceivably, and with further validation, circulating intestinal bacteria may eventually become a new biomarker for colonic cancer especially at a pre-symptomatic stage. But here we need a word of caution. With an early doubling time of over 30 months, the early growth of a colorectal cancer has been shown to be slow. 4 Early detection of a slow-growing cancer warrants other considerations. In our ageing population it is not too uncommon to see a patient in advanced age with multiple co-morbidities and limited life expectancy. In such cases further extensive investigations may not be justified. To complete the story of the patient with S gallolyticus septicaemia we barely mentioned in an earlier communication, 5 he was a 91-year-old Caucasian missionary, with advanced atherosclerotic disease, severe dementia, recurrent heart failure, deteriorating renal function, and an abdominal aneurysm for which interventional treatment was rejected. The question of colonoscopy was raised but vetoed by all parties concerned. His septicaemia was successfully controlled by penicillin and his constipation well relieved by judicious enemas instead of lactulose. He lived for another

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