Fuse move the future

Most existing businesses plan for a world that is straightforward and static. Unfortunately, the world does not work that way. In an increasingly complex and uncertain world, FUSE provides a way to tackle problems whilst incorporating uncertainty into our analyses. This book: Shows to make decisions in the present to better affect your future Explains why foresight is important even when struggling with day-to-day operations. Written by renowned strategist and thinker Devadas Krishnadas, FUSE is a valuable tool for any business leader, manager or strategist. Describes how to best harvest the daily deluge of information from your internal and external environment Offers a process-driven way of thinking about strategy that places principles at its very core Highlights the importance of retaining flexibility and agility to adapt when things go wrong

Metastatic <i>Crohn&#x2032;s disease</i> of external genitalia

Metastatic Crohn&#x2032;s disease is an uncommon extraintestinal manifestation of Crohn&#x2032;s disease. Its hallmark features include the presence of cutaneous noncaseating granulomas that are noncontiguous with the gastrointestinal tract or fistula. We report a rare case of metastatic Crohn&#x2032;s disease involving the external genitalia in a 14-year-old girl. Diagnosis was based on skin biopsy. Patient had complete recovery on treatment with oral and topical steroids along with azathioprine

Pancreatic pseudocyst presenting as dysphagia: A case report

Pancreatic pseudocysts are relatively common complications of acute pancreatitis. However, extension of pseudocysts into the mediastinum rarely occurs. In such situations they commonly present with chest pain or shortness of breath. We herein report the case of a patient with a pseudocyst presenting with dysphagia. The clinical presentation, current modalities of diagnosis and management of mediastinal pancreatic pseudocyst is reviewed in this article

CRAB score for prediction of colectomy within 2 years following admission for acute severe ulcerative colitis

Background: The Oxford and Swedish indexes were developed to predict in-hospital colectomy in acute severe ulcerative colitis (ASUC), but not long-term prediction, and all these indexes were based on Western data. Our study aimed to analyze the predictors of colectomy within 3 years of ASUC in an Indian cohort and derive a simple predictive score. Methods: A prospective observational study was conducted in a tertiary health care center in South India over a period of 5 years. All patients admitted with ASUC were followed up for a period of 24 months after the index admission, to look for progression to colectomy. Results: A total of 81 (47 male) patients were included in the derivation cohort. Fifteen (18.5%) patients required colectomy during a follow-up period of 24 months. On regression analysis, C-reactive protein (CRP) and serum albumin were independent predictors of 24-month colectomy. The CRAB (CRP + AlBumin) score was obtained by multiplying coefficient of beta to albumin and CRP (CRAB score = CRP x 0.2 – Albumin x 0.26). The CRAB score demonstrated an AUROC of 0.923 and a score of >0.4 with a sensitivity of 82% and specificity of 92% for the prediction of 2-year colectomy following ASUC. The score was validated in a validation cohort of 31 patients, and at >0.4, the score had a sensitivity of 83% and a specificity of 96% in predicting colectomy. Conclusion: CRAB score is a simple prognostic score that can predict 2-year colectomy in ASUC patients with high sensitivity and specificity

METASTATIC CROHN'S DISEASE OF EXTERNAL GENITALIA

Metastatic Crohn's disease is an uncommon extraintestinal manifestation of Crohn's disease. Its hallmark features include the presence of cutaneous noncaseating granulomas that are noncontiguous with the gastrointestinal tract or fistula. We report a rare case of metastatic Crohn's disease involving the external genitalia in a 14-year-old girl. Diagnosis was based on skin biopsy. Patient had complete recovery on treatment with oral and topical steroids along with azathioprine

Pancreatic Pseudocyst Presenting as Dysphagia: A Case Report

Pancreatic pseudocysts are relatively common complications of acute pancreatitis. However, extension of pseudocysts into the mediastinum rarely occurs. In such situations they commonly present with chest pain or shortness of breath. We herein report the case of a patient with a pseudocyst presenting with dysphagia. The clinical presentation, current modalities of diagnosis and management of mediastinal pancreatic pseudocyst is reviewed in this article

Imatinib-induced pancreatitis

Drug-induced pancreatitis is a rare but serious complication of many drugs, some of which have been well documented. Here we present a case of a middle-aged man with chronic myeloid leukemia who developed acute pancreatitis after being initiated on imatinib mesylate. The case history, the pharmacodynamics, uses, and adverse effects of imatinib mesylate are discussed in detail

Mycobacterium abscessus infection in the stomach of patients with various gastric symptoms.

Development of gastric diseases such as gastritis, peptic ulcer and gastric cancer is often associated with several biotic and abiotic factors. Helicobacter pylori infection is such a well-known biotic factor. However, not all H. pylori-infected individuals develop gastric diseases and not all individuals with gastric diseases are infected with H. pylori. Therefore, it is possible that other gastric bacteria may contribute to the formation and progression of gastric disease. The aim of this study was to isolate prevalent gastric bacteria under microaerobic condition and identify them by 16S rRNA gene sequence analysis. Analysis of gastric biopsies showed infection of Mycobacterium abscessus (phylum Actinobacteria) to be highly prevalent in the stomachs of subjects included. Our data show that of 129 (67 male and 62 female) patients with gastric symptoms, 96 (51 male and 45 female) showed the presence of M. abscessus in stomach tissues. Infection of M. abscessus in gastric epithelium was further confirmed by imaging with acid fast staining, immunohistochemistry and immunofluorescence. Our imaging data strongly suggested that M. abscessus is an intracellular colonizer residing inside the gastric epithelial cells rather than in macrophages. Additionally, phylogenetic analysis of the mycobacterial hsp65 gene showed that the nearest match to the M. abscessus strains isolated from our study subjects is the M. abscessus strain ATCC 19977. Surprisingly, the subjects studied, the prevalence of M. abscessus infection in stomach is even higher than the prevalence of H. pylori infection. This, to the best of our knowledge, is the first study showing the colonization of M. abscessus in human gastric mucosa among patients with various gastric symptoms. This study could provide usher in a new opportunity to understand the role of less studied gastric bacteria in the development of gastric diseases

Doppler assessment of hepatic venous waves for predicting large varices in cirrhotic patients

Background/Aim: Color Doppler examination of changes in hepatic venous waveforms is being evaluated as a means of prediction of severity of portal hypertension and presence of esophageal varices. Normal hepatic venous waveform shows a triphasic pattern. In cirrhosis, this pattern changes to a biphasic or monophasic pattern. We aimed to study the sensitivity of loss of normal hepatic venous waveforms in predicting large varices in a cross-sectional analysis. Materials and Methods: All patients, admitted or attending the outpatient department, with a diagnosis of cirrhosis were included in the study. All patients were subjected to oesophagogastroduodenoscopy and Color Doppler examination, and waveform patterns in hepatic vein were recorded. The sensitivity and specificity of changes in waveform in detecting large varices were studied. Results : A total of 51 cases were examined. Triphasic waves were seen in 4 (7.8%) cases, biphasic in 26 (51%) cases, and monophasic in 21 (41.2%) cases. Small varices were seen in 30 (58.8%) cases and large varices in 21 (41.2%) cases. The sensitivity of loss of the triphasic wave pattern in detecting significant varices (Grade 3 or 4) was very high (95.23%) and negative predictive value was also high (75%). Severity of liver disease as indicated by Child-Pugh and MELD scores did not correlate with changes in hepatic venous waveforms. Conclusion : Loss of triphasic hepatic venous waveform is highly sensitive in predicting significant varices in patients with cirrhosis