Artificial intelligence in inflammatory bowel disease: implications for clinical practice and future directions

Inflammatory bowel disease encompasses Crohn’s disease and ulcerative colitis and is characterized by uncontrolled, relapsing, and remitting course of inflammation in the gastrointestinal tract. Artificial intelligence represents a new era within the field of gastroenterology, and the amount of research surrounding artificial intelligence in patients with inflammatory bowel disease is on the rise. As clinical trial outcomes and treatment targets evolve in inflammatory bowel disease, artificial intelligence may prove as a valuable tool for providing accurate, consistent, and reproducible evaluations of endoscopic appearance and histologic activity, thereby optimizing the diagnosis process and identifying disease severity. Furthermore, as the applications of artificial intelligence for inflammatory bowel disease continue to expand, they may present an ideal opportunity for improving disease management by predicting treatment response to biologic therapies and for refining the standard of care by setting the basis for future treatment personalization and cost reduction. The purpose of this review is to provide an overview of the unmet needs in the management of inflammatory bowel disease in clinical practice and how artificial intelligence tools can address these gaps to transform patient care.

Magnetic resonance imaging and 3-dimensional transperineal ultrasound evaluation of pelvic floor dysfunction in symptomatic women: a prospective comparative study

PURPOSE: The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. METHODS: This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. RESULTS: The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). CONCLUSION: MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.

Assessment of knowledge, attitude and practice toward acne vulgaris among community in Jeddah City, 2016

Background: acne vulgaris is the most common skin condition seen by the dermatologists. It is a chronic inflammatory disease of pilosebaceous unit characterized by seborrhea, comedones, papules, pustules, nodules, cysts and in some cases scars and keloids, which persist for rest of the life

Objectives: the present work aimed at evaluating the level of awareness, Attitude and Practice toward acne vulgaris in Jeddah city

Methods: a cross sectional analytical questionnaire based study was carried out among the general population in Jeddah city. This study started in the year [2016] and composed of 461 subjects. The mean age of citizens was 28, 82. To assess citizens' demographic factors and beliefs about acne vulgaris, consenting citizens completed an anonymous online questionnaire. The data was entered and analyzed using SPSS version 20

Results: The sample is consisted of 65, 8% women and 34, 2% men. Among the respondents 7, 7% reported suffering from acne vulgaris and 13, 6% confirmed having a history of acne vulgaris illness in their family. The results of the study showed that 153 [34, 8%] subjects had weak knowledge related to the disease, 260 [59, 1%] subjects had average level of knowledge while only 27 [6, 1%] subjects had good knowledge regarding acne vulgaris. There was a statistical significant association between gender, educational level and the level of awareness about acne vulgaris

Conclusion: acne vulgaris is a disease that is potentially controllable but that cannot be cured. Education still be important overall the treatment of the patients

[Use of locking plate in combination with dynamic compression plate for repair of tibial fracture in a young horse]

Grade 1 open spiral fracture of left tibia in a 1.5 year-old horse was treated using a combination of 4.5 mm locking compression plate [LCP] and a dynamic compression plate applied in a neutralization manner. The open wound was managed postoperatively by regular dressing and lavage. Radiograph at 24 days post-treatment revealed callus formation and at two months complete bridging callus was observed. At the end of six months complete healing of the fracture with functional recovery of the limb was observed

Characterization of the ABCC8 gene mutation and phenotype in patients with congenital hyperinsulinism in western Saudi Arabia

To understand the genetic etiologies of congenital hyperinsulinism [CHI] in a population of Saudi patients, and to explore genotype-phenotype characteristics. We retrospectively reviewed a cohort of 11 children with CHI presenting to King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between March 2007 and February 2012. Mutational analysis [ABCC8 and KCNJ11] was performed retrospectively to identify phenotype and genotype characteristics. Analysis revealed ABCC8 mutations in 81.8% [9/11] of patients, with 2 patients not revealing any gene mutation. All positive patients showed a homozygous mutation in the ABCC8 gene, one in exon 29, 2 in exon 1-22, 2 in exon 28, and 4 in intron 36; one patient had a heterozygous mutation. Five patients [45.4%] responded well to treatment with diazoxide not requiring subtotal pancreatectomy, while 6 patients [54.6%] required subtotal pancreatectomy despite treatment with diazoxide and octreotide. Three patients [33.3%] died while waiting for surgery due to sepsis and thrombosis. Two patients [18.1%] showed remission, one of them after subtotal pancreatectomy. Homozygous mutations in ABCC8 are the most common causes of CHI in Saudi patients. Early diagnosis and therapy for persistent hyperinsulinemic hypoglycemia of infancy are essential to prevent neurodevelopmental delay

Appropriateness of pediatric hospitalization in a general hospital in Kuwait

To determine the rate of inappropriate pediatric admissions using the Pediatric Appropriateness Evaluation Protocol [PAEP] and to examine variables associated with inappropriateness of admissions. A prospective study was conducted in the Department of Pediatrics, Farwania General Hospital, Kuwait, to examine successive admissions for appropriateness of admission as well as several sociodemographic characteristics over a 5-month period [August 2010 to December 2010]. A total of 1,022 admissions were included. Of the 1,022 admissions, 416 [40.7%] were considered inappropriate. Factors associated with a higher rate of inappropriate admission included older age of patients and self-referral. The rate of inappropriate hospitalization of children was high in Farwania Hospital, Kuwait, probably due to the relatively free health care services, parental preference for hospital care, easy access to hospital services, and insufficient education about the child's condition

Stem cells therapy as a treatment for spinal cord injury

Stem cells therapy holds a great promise to treat several degenerative diseases and repair damaged tissues that are otherwise very difficult to treat by conventional therapies. In future, stem cells therapy will treat spinal cord injury [SCI] which is a major problem associated with demyelination of neurons caused by trauma resulting in cell death that is irreplaceable. Patients usually survive with spinal cord injury but this trauma remains uncure. After SCI, endogenous neuroprogenitor cells migrate towards the affected tissue but many messenger cascades suppress their proliferative activity. Different exogenous stem cells sources are another option to treat SCI patients. Although there is no permanent cure of SCI patients but due to excitable development in the field of stem cells transplantation, promises a hope for its cure in future. Due to intricacy of factors involved after SCI, there is a need for combinatorial therapies

overview of purification, biological activities and therapeutic applications of thymosin alpha

Thymosin alpha 1 [T alpha 1] is 28 amino acid residues peptide. Thymic epithelial cells produce acetylated N-terminal T alpha 1 that has powerful immunostimulatory and antitumor activites. Inside the body T alpha 1 effects endocrine, immune and central nervous system. T alpha 1 can be purified by using fractionation procedures from thymus. Many recombinant DNA techniques are being used for the production of T alpha 1. In addition T alpha 1 is being expressed as fusion proteins with other therapeutically important proteins. For the high-throughput production of T alpha 1, different expression systems are being used such as E.coli and yeast. T alpha 1 has unique antitumor and immunoregulatory properties and also have capacity to protect cells from oxidative damage. T alpha 1 has many therapeutic applications specifically against many infectious diseases [hepatitis B and C, AIDS, SARS etc.] and cancer

Effects of diabetes education program on metabolic control among Saudi type 2 diabetic patients

To assess the effect of the 5-days intensive diabetes health education program on metabolic control among Saudi type 2 diabetic patients. The study included 438 individuals, 158[36.1%] females and 280[63.9%] males with type 2 diabetes. All patients completed the 5-days diabetes education program. They did not require any change in their current therapy regimen, had not previously participated in any diabetes education programs, Saudi patients, of both genders, non-pregnant and older than 30 years. They were followed for one year after attending a 5-days structured education program conducted at University Diabetes Center in Riyadh, Saudi Arabia. Data were collected for each individual before attending the program, three months later, and one year after completion of the program. After one year, all metabolic parameters had improved significantly [P<0.0001] except for high density lipoprotein[HDL] [P =0.097] as follows: body weight [mean +/- SD] 78.72 +/- 13.77 to 78.11 +/- 13.33 Kg; systolic blood pressure 137.69 +/- 15.56 to 129.5 +/- 15.09 mmHg; diastolic blood pressure 77.27 +/- 8.11 to 72.9 +/- 7.30 mmHg; fasting blood sugar 10 +/- 2.62 to 8.19 +/- 2.04 mmol/l; HbA1c 8.78% +/- 1.78% to 7.87% +/- 1.56% ; triglycerides 1.98 +/- 0.9 to 1.51 +/- 0.67 mmol/l; total cholesterol 4.77 +/- 0.83 to 3.9 +/- 0.83mmol/l; low density lipoprotein 2.71 +/- 0.66 to 2.15 +/- 0.59mmol/l, and high density lipoprotein improved by an increase from 1.28 +/- 0.4 to 1.31 +/- 0.24 mmol/l. This study demonstrates that intensive education program provided by a trained professional healthcare team is an effective approach and reinforces the need for implementing such education program as an essential part for metabolic control among diabetic patients.

Short term outcome of carotid artery angioplasty and stenting with cerebral protection devices

Management of carotid bifurcation stenosis is a cornerstone of stroke prevention. Carotid artery stenting [CAS] is now used as an alternative to surgical endarterectomy. To evaluate short term outcome of CAS with the use of cerebral protection devices as well as assess the impact of various adverse anatomical features of the aortic arch and culprit carotid lesion oil difficulty and rate of complication during CAS procedures. The study included consecutive eligible patients with internal carotid artery [ICA] stenosis with >/= 50% in symptomatic stenosis and >/= 70% in asymptomatic stenosis presented to the catheterization labs of Catania and Ragusa hospitals during the period from October 2009 till May 2011. According to the anatomical adverse characteristics, the patients were classified into 4 groups: group I represented the least anatomical complexity while group IV represented the most complex anatomical features. Data of the CAS procedures and intra-procedural complications as well as during the 1st month after the procedures were collected and studied. The study included 104 ICA lesions in 100 consecutive eligible patients. Seventy-one males and twenty-nine females, mean age 71.9 +/- 7.85 years and 21 patients were >/= 80 years old [octogenarians]. Most of the patients had asymptomatic ICA stenosis [76%] while 24% of patients had symptomatic ICA stenosis. Technical success was obtained in 103 procedures [99%], failed one procedure due to complex anatomical features. Combined cerebrovascular events had occurred in 5 patients [1 major stroke, 1 minor stroke and 3 transient ischemic attacks] with estimated rate 4.8%. No cases of amaurosis fugax, myocardial infarction or death had occurred. Symptomatic patients had stroke rate of 4.1% while stroke rate in asymptomatic patients was 1.3%. Adverse events showed significant statistical difference with increased anatomical complexity [P < 0.001]. Cerebrovascular events in symptomatic patients did not show significant statistical difference in comparison to asymptomatic patients [P = 0.064]. CAS procedures in octogenarians [>/=80 years] showed no significant statistical difference with the number of cerebrovascular adverse events [P = 0.285]. CAS is a relatively safe procedure could be done with low incidence of complications when performed by trained operators. Evaluation of the anatomical characteristics has an important impact oil procedural difficulty and complications

[Obesity in type 2 diabetes: a review of health economics evidences]

Introduction: Type 2 diabetes mellitus, a serious chronic disease, is increasing worldwide. Obesity is one of the main independent risk factors in development of the diabetes and its related complications. Weight loss is an important part of disease management

Methods: We searched for the studies conducted on obesity treatment of patients with diabetes until the end of September 2010 in the SID and Pub Med databases. We used the economic evaluation methods in order to evaluate the cost of obesity in patients with type 2 diabetes and its treatment methods. We also analyzed the costs and outcome implications of obesity and its management in people with type 2 diabetes

Results: Studies have shown that obesity treatment with Orlistat is cost effectiveness. In Germany and France, surgery is a dominant option in comparison with the other common methods. In England, surgery is reported to be cost effective and in Austria, Italy and Spain, it is approved

Conclusion: All studies have reported that obesity treatments are in the range of what is generally considered as cost-effective. It seems that medication therapy and surgery are cost-effective options for all obese patients

Adiponectin levels in serum of women with pre-eclampsia

Adiponectin has profound insulin-sensitizing, anti-inflammatory and anti-atherogenic effects. However, reports of the role of adiponectin in pre-eclampsia are conflicting. This study in Egypt investigated the association between serum adiponectin levels and pre-eclampsia and between adiponectin levels and some clinical and hormonal parameters. A sample of 60 pregnant women in the third trimester were divided into 3 equal groups: normal pregnancy, mild pre-eclampsia and severe pre-eclampsia. Serum adiponectin levels in pre-eclamptic women were significantly higher than in normal pregnant women and the increase was more marked in cases of severe pre-eclampsia. There was a significant negative correlation between adiponectin levels and arterial blood pressure in all groups. However, there was no correlation between serum adiponectin and proteinuriaorestradiol and progesterone levels. The results support the theory that adiponectin might be part of a feedback mechanism improving insulin sensitivity and cardiovascular health in pre-eclamptic patients

Indications and complications of intestinal stomas -a tertiary care hospital experience

An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. An observational study was carried out in Services Hospital Lahore, over a period of two years from Feb. 2007 - 09. A total of 85 patients needing intestinal stomas, ileostomy or colostomy, were included in the study. Patients under 12 years, with enterocutaneous fistula and urinary conduits were excluded from study. Indications, immediate and late complications of stomas were recorded. Reversal of stoma usually performed after 12 weeks and complications of reversal were also recorded. Majority [73%] of patients were males. There were 36 ileostomies and 49 cases of colostomy making a total of 85 patients. Main indications of Ileostomy were intestinal tuberculosis [58%], enteric perforation [31%] and penetrating injuries [5.5%]. Colostomy was mostly required in penetrating injuries [33%], blunt trauma [23%] and intestinal obstruction [28%]. In a total 0/35 stomas local complications appeared in 54 [41.77%]. General problems included anxiety, psychological and social isolation. Skin excoriation and ulceration were the most common [25%]; they were worse in ileostomy than colostomy. In laparotomy wound infection [9.4%], stoma diarrhea [7%], stoma retraction [6%] and prolapse [6%] were other notable comp-lications. A mortality rate of 1.6% was found in cases of ileostomy. Hospital admission ranged from 10 - 62 days. 62 stomas including 25 ileostomies and 37 colostomies were closed on an average of 3 months after primary operation. There were 9 cases of wound infection, three anastamotic leakages and a single mortality [1.6%] in the stoma reversal group. Common indications for intestinal stomas were abdominal trauma, intestinal tuberculosis and enteric perforation. Main complications included local skin problems, stoma diarhoea, prolapse and retraction. Early identification and treatment of tuberculosis and enteric fever can reduce stoma formation and its associated complications

Fluoroquinolone and macrolide co-resistance in clinical isolates of Campylobacter species: a 15-year study in Karachi, Pakistan

Fluoroquinolone and macrolide antibiotics are generally considered as first-line drugs for the treatment of severe campylobacteriosis. This study was conducted to analyse the trend of erythromycin and ofloxacin resistance among Campyiobacter spp. isolated from stool specimens over a period of 15 years [1992-2007] at The Aga Khan University clinical laboratory in Karachi, Pakistan. A total of 83 396 stool specimens were processed, with a 14% isolation rate for enteric pathogens. The isolation rate of Campylobacter spp. was low during 1992-93 [6%-13%], peaked in 1996 [46%], then ranged from 20% to 40%. We report a rising trend in ofloxacin resistance, re-emergence of erythromycin resistance and indications of co-resistance to both drugs in clinical isolates of Campylobocter spp.

Experienced airway management in laryngotracheal injuries: series of cases, survey and review of literature

Definitive airway control of penetrating laryngotracheal injury can be an extremely difficult challenge for the emergency physician. We report three serious cases of penetrating neck trauma with laryngeal injury that were managed successfully using different techniques of airway control in the Emergency Department [ED] of Hamad General Hospital during the three years from January 2006 through December 2008. Individualized assessment, identification of type of injury and familiarity with airway control techniques and the available options assure timely, safe and proper airway control in such injuries. Choice of technique in penetrating Iaryngotracheal injury is multifactorial and depends upon case presentation, physician preference, skill, and clinical constraints. The incidence of neck injury during this period was lower than in other reports; being 0.07% of total trauma cases, while the incidence of penetrating neck injuries represented 17.6% of total neck injuries with no deaths. Familiarity and availability of variant airway management techniques and variant surgical interventions in penetrating laryngotracheal injuries, improve outcome and reduce mortality

Evaluation of the RIPASA Score: a new appendicitis scoring system for the diagnosis of acute appendicitis

Introduction: We recently developed a scoring system for diagnosis of acute appendicitis. This study prospectively evaluates the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score for the diagnosis of acute appendicitis in patients presenting to the Accident & Emergency department or the Surgical wards with right iliac fossa pain. Materials and Methods: From November 2008 to April 2009, consecutive patients presenting to the Accident & Emergency department or the surgical wards with right iliac fossa pain were recruited for the study. The RIPASA score was applied but the decision for radiological investigations or emergency appendicectomy was made based on clinical judgement. Receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived. Ethical approval for the study was obtained from the Medical & Health Review Ethics Committee. Results: Within six months, 144 consecutive patients with a mean age of 29.5 ± 13.3 yrs were recruited to the study. Ninety-eight patients underwent emergency appendicectomy of which 79 were confirmed histologically for acute appendicitis. The observed negative appendicectomy rate was 19.4%. The optimal cut-off threshold score from the ROC was 7.5, with a sensitivity of 97.5%, specificity of 81.8%, PPV of 86.5%, NPV of 96.4% and a diagnostic accuracy of 91.8%. The predicted negative appendicectomy rate was 13.5%, which is a 5.9% reduction from the observed rate of 19.4% (p=0.3). Conclusion: The RIPASA score is a more suitable appendicitis scoring system developed for our local settings with a population that is reflective of our region in South-east Asia and has high sensitivity, specificity and diagnostic accuracy.

review of medicinal plants exhibiting potential anti-ulcer activity

Plants have been used for medicinal purposes from the time immemorial. Medicinal plants are an indispensable source of new chemical substances with potential therapeutic effects. Their chemical compounds may serve as lead for the development of new drugs. In the present communication a review of the plants exhibiting antiulcer activity is presented

Serum ghrelin and resistin levels in women with polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is the most common endocrine disease in women of reproductive age, with the incidence reported to be about 4-6% in this age group. Ghrelin and resistin hormones are known to be related with the energy metabolism and insulin resistance, moreover, ghrelin is reported to interact with the reproductive function. The aim of the present study was to determine the levels of ghrelin and resistin in patients with PCOS, we also aimed to find out any possible correlations between their levels and other biochemical and hormonal features of this syndrome. A total number of 40 women were enrolled in this study. They were divided into 2 groups: group I [control group] [n=20], group II [PCOS group] [n=20]. Venous blood samples were collected for estimation of serum ghrelin, resistin, insulin and sex hormones. Serum ghrelin levels were markedly decreased in women with PCOS, moreover, there was a negative correlation between its levels and serum levels of luteinizing hormone [LH], testosterone, 17-OH progesterone, and insulin, in addition to its negative association with measures of insulin resistance. As regards resistin, no significant changes were found in serum levels of resistin in PCOS patients in comparison with that of the controls, furthermore, no significant correlation could be detected between its levels and serum insulin levels or measures of insulin resistance in those patients. However, a significant negative correlation was found between resistin levels and testosterone levels. Finally, no significant correlation between ghrelin and resistin levels could be detected in women with PCOS. In the light of the above results it can be concluded that, this peptide ghrelin is involved in the pathogenesis of PCOS syndrome. Regarding resistin, our data is not in favor of resistin being the factor that leads to insulin resistance in PCOS patients, but it could be a factor can interact with testosterone production in those women, this finding needs to be confirmed with further studies because, to our knowledge there is yet no data pointing out the possible relationship between resistin and sex hormones

Early detection of factor VIII inhibitors in hemophilia a patients with different treatment modalities

Hemophilia care in underdeveloped and developing countries is extremely inadequate and in some instances, completely absent. Persons with hemophilia battle the complications of both the disease and its treatment. One of the most serious of these problems is the development of the inhibitors. The development of the inhibitors influences their quality of life. This work was designed to: 1- elucidate the inhibitors status 2-to study the relation of factor VIII inhibitors and modes of therapy and duration of treatment 3- to clarify the cause of bleeding, is it related to insufficient treatment or development of inhibitors 4- to study the effect of the severity of hemophilia in the frequency of factor VIII inhibitors and their correlation with factor VIII level. The study included 63 hemophilic patients under different treatment modalities and were classified to four groups according to the types of treatment; they were group [I] included [7] patients with no previous anti hemophilic treatment and were considered as a control group, group [II] included [12] patients who were on treatment with fresh frozen plasma, group [III] consists of [16] patients who were under treatment with cryoprecipitate and group [IV] was [28] patients who were under treatment with concentrated factor VIII.To all groups of patients complete blood count, prothrombin time and prothrombin concentration, activated partial thromboplastin time, factor IX, von willebrand factor, factor VIII levels and factor VIII inhibitor levels were performed. Development of inhibitors was obvious in severe hemophilic patients especially in those who were receiving on demand factor VIII concentrate therapy