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1.
J Gastroenterol Hepatol ; 39(3): 422-430, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38058246

RESUMO

BACKGROUND AND AIM: Discrimination of gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) is difficult. Use of artificial intelligence (AI)-based technologies may help in discriminating these two entities. METHODS: We conducted a systematic review on the use of AI for discrimination of GITB and CD. Electronic databases (PubMed and Embase) were searched on June 6, 2022, to identify relevant studies. We included any study reporting the use of clinical, endoscopic, and radiological information (textual or images) to discriminate GITB and CD using any AI technique. Quality of studies was assessed with MI-CLAIM checklist. RESULTS: Out of 27 identified results, a total of 9 studies were included. All studies used retrospective databases. There were five studies of only endoscopy-based AI, one of radiology-based AI, and three of multiparameter-based AI. The AI models performed fairly well with high accuracy ranging from 69.6-100%. Text-based convolutional neural network was used in three studies and Classification and regression tree analysis used in two studies. Interestingly, irrespective of the AI method used, the performance of discriminating GITB and CD did not match in discriminating from other diseases (in studies where a third disease was also considered). CONCLUSION: The use of AI in differentiating GITB and CD seem to have acceptable accuracy but there were no direct comparisons with traditional multiparameter models. The use of multiple parameter-based AI models have the potential for further exploration in search of an ideal tool and improve on the accuracy of traditional models.


Assuntos
Doença de Crohn , Tuberculose Gastrointestinal , Humanos , Inteligência Artificial , Doença de Crohn/diagnóstico por imagem , Redes Neurais de Computação , Estudos Retrospectivos , Tuberculose Gastrointestinal/diagnóstico , Diagnóstico por Computador
2.
Dig Dis Sci ; 67(7): 3200-3209, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34739625

RESUMO

BACKGROUND AND AIMS: Endoscopic dilation is an important therapeutic option for treatment of corrosive strictures. Its safety is unclear with variable perforation rates in previous studies. We aimed to evaluate its safety with regard to perforations and the effect of dilator type to perforation risk. METHODS: A systematic review of published literature from inception to April 24, 2021, using PubMed and EMBASE databases was conducted. Studies in adult subjects (mean age ≥ 18 years) reporting perforation rates of endoscopic dilation of corrosive esophageal and/or gastric strictures were included. Pooled cumulative perforation rates were computed as primary outcome. Secondary outcomes included, perforation with each dilator subtypes, surgical or conservative modes of management and mortality. Random effect meta-analysis was used to estimate the frequency of each of these outcomes. Variables were reported as percentages with 95% CI. RESULTS: A total of 712 subjects (N) who underwent 4840 dilations (n) were noted in the 15 studies that were included. Of which, eight were retrospective, while the remaining seven were prospective. On meta-analysis, the cumulative pooled perforation rate was 1% (1-2%) of the number of dilations (n%). The perforation rates with SG (1%, 0-3%) and balloon (1%, 0-5%) dilators were similar (p value < 0.01). 45/64 (59%, 11-94%) perforations were subjected to surgery while the remaining 14/64 (41%, 6-89%) was managed conservatively. Choice of management strategy was biased to the norms of the treating team. About 3/712 patients (0%, 0-2%) succumbed following perforation. CONCLUSION: Perforation from endoscopic dilation of corrosive strictures occurs rarely, and there is no significant difference in perforation risk related to the type of dilator.


Assuntos
Cáusticos , Estenose Esofágica , Adolescente , Adulto , Cáusticos/toxicidade , Constrição Patológica , Dilatação , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/diagnóstico por imagem , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
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10.
Ann Gastroenterol ; 37(1): 1-14, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38223246

RESUMO

Endoscopic retrograde cholangiopancreatography (ERCP) is the workhorse for biliary and pancreatic ductal interventions. Despite advances in both endoscopes and accessories for ERCP, it still has limitations in the presence of altered anatomy, luminal obstruction hindering access to the papilla, and proximal duct obstructions by tight stricture, calculi or intraductal growth. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and EUS-guided pancreatic duct drainage (EUS-PDD) have expanded the rescue procedures after failed ERCP. This review discusses the techniques and results of various EUS-BD procedures, as well as EUS-PDD.

11.
Indian J Gastroenterol ; 43(1): 254-263, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38396280

RESUMO

INTRODUCTION: Patients with ulcerative colitis (UC) are likely to have poor nutritional intake and increased gut losses. This study was designed to study the prevalence and predictors of nutritional deficiencies in patients with UC and their impact on the quality of life (QOL). METHODS: A prospective study was conducted among consenting patients with UC (cases) and healthy relatives of the cases (controls) visiting a university teaching hospital. They were assessed for clinical, demographic, endoscopic (Mayo score) and histological profile (Robart's score). They were assessed for the presence of macronutrient and micronutrient deficiency, anthropometry, functional status (muscle strength by dynamometer and sit-to-stand test) and the quality of life (short inflammatory bowel disease questionnaire [SIBDQ]). A SIBDQ score of ≤ 50 was considered poor QOL. RESULTS: We studied 126 cases and 57 healthy controls (age [mean ± SD] 37.7 ± 13.2 years vs. 34.40 ± 11.05 years; [p = 0.10] females [38.1% vs. 38.7%]; p = 0.94). Cases more often were underweight (28% vs. 3.5%; p < 0.001), had low mid arm circumference (45% vs. 12%; p < 0.0001), lower functional status in the form of weaker hand grip strength (67% vs. 45.6%; p = 0.007) and weaker lower limb strength (80% vs. 42%; p < 0.0001). Cases more often had the evidence of macronutrient deficiencies: total serum protein deficiency (31% vs. 3.5%; p < 0.0001), serum albumin deficiency (25.4% vs. 0.00%; p < 0.0001) and cholesterol deficiency (63% vs. 28%; p < 0.0001). Micronutrient deficiencies were highly prevalent among cases: calcium (44%), phosphate (21%), magnesium (11%), zinc (76%), iron (87%), folate (16%), vitamin B12 (10%) and vitamin D (81%). Most cases had a poor quality of life (85/126; 67.5%). Factors associated with poor QOL were low hemoglobin, serum albumin, zinc and vitamin D levels and histologically active disease. On multi-variate analysis, low vitamin D levels (odds ratio [OR] = 6.1; 95% confidence interval [CI]: 1.9-19.7) and histologically active disease (OR = 4.0; 95% CI: 1.6-9.9) were identified as independent predictors of poor QOL. CONCLUSIONS: Macronutrient deficiency, micronutrient deficiency, lower functional status and poorer QOL are highly prevalent among patients with UC. The independent predictors of poor QOL were histologically active disease and low serum vitamin D levels. Identifying and correcting the deficiencies may help in improving the QOL of patients with UC.


Assuntos
Colite Ulcerativa , Doenças Inflamatórias Intestinais , Feminino , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/complicações , Qualidade de Vida , Estudos Prospectivos , Estado Funcional , Força da Mão , Vitamina D , Doenças Inflamatórias Intestinais/complicações , Vitaminas , Zinco , Albumina Sérica
12.
J Gastrointest Cancer ; 54(1): 316-322, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35199299

RESUMO

INTRODUCTION: Jejunal gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST is very rare and poses both diagnostic and therapeutic challenges in emergent conditions. METHODS: A case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological findings, surgical procedures and outcomes in these patients were studied. RESULTS: Three patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive. Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination confirmed jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18-month follow-up and the one patient lost to follow-up after 1 year. CONCLUSION: Multiphasic CTA is a single-step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.


Assuntos
Tumores do Estroma Gastrointestinal , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Jejuno/patologia , Margens de Excisão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
Arq Gastroenterol ; 58(4): 534-540, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909862

RESUMO

BACKGROUND: Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE: This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS: In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS: The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION: Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Atenção Terciária à Saúde
14.
BMJ Open ; 11(2): e043837, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619195

RESUMO

OBJECTIVES: Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING: Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS: We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS: Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION: A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.


Assuntos
COVID-19 , Transmissão de Doença Infecciosa do Paciente para o Profissional , Corpo Clínico Hospitalar , Doenças Profissionais , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , COVID-19/transmissão , Países em Desenvolvimento , Feminino , Hospitais Universitários/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Modelos Organizacionais , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Política Organizacional , Equipamento de Proteção Individual , Estudos Prospectivos , Medição de Risco , Centros de Atenção Terciária/organização & administração
15.
J R Coll Physicians Edinb ; 50(4): 408-410, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33469618

RESUMO

Diphtheria is a vaccination preventable infectious disease with local and systemic complications predominantly affecting upper respiratory tract in younger (<5-year age) children. Its virulence is due to its ability to produce toxin which can cause fatal complications such as myocarditis and permanent damage in form of peripheral neuropathy. Diagnosis of diphtheria is primarily clinical supported by demonstration of toxin producing bacteria by culture. Early diagnosis and management with diphtheria anti-toxin can prevent mortality and morbidity. Here we present a case of 16-year-old boy managed with azithromycin, amoxycillin-clavulanic acid and diphtheria anti-toxin with complete recovery.This case brings out the importance of recognising the re-emergence of diphtheria in older age groups. Lacunae in the universal immunisation process, rumours on vaccination effects and poor living conditions for refugee population are likely reasons in Asia and Europe. Universal immunisation, early diagnosis, prophylaxis and adequate supportive care are measures to prevent it.


Assuntos
Difteria , Miocardite , Adolescente , Idoso , Criança , Difteria/diagnóstico , Difteria/tratamento farmacológico , Difteria/prevenção & controle , Europa (Continente) , Humanos , Imunização , Masculino , Vacinação
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