Basic Endoscopic Findings — Normal and Pathological Findings

Since its inception, colonoscopy has evolved to become the cornerstone for colorectal imaging. The increasing indications for endoscopic evaluation and potential therapeutic intervention parallels technological advances and the expanding diagnostic and therapeutic capabilities of colonoscopy. The diagnostic and therapeutic yield of colonoscopy is highly user dependent. Thus, it is essential for the clinical endoscopist to perform a thorough endoscopic evaluation and be cognizant of normal and pathologic findings. This review details normal and pathologic endoscopic findings in a variety of disease states that are often encountered by the clinical endoscopist including colon polyps, inflammatory bowel disease, and infectious and non-infectious colitides. In addition, we review the diagnostic and therapeutic role of colonoscopy in the evaluation of an acute lower gastrointestinal bleed

A comparative study of different anatomical position, clinical presentation and USG findings with operative findings in patients of appendicitis

Background: The objective was to find out and compare accuracy of USG findings with that of per-operative findings of location & status of appendix, to compare , evaluate & study the signs and symptoms in different varieties of appendicitis, to compare & study pre, per & post op follow up of patients with such different location of appendix undergoing appendicectomy and to study the type of appendicitis responsible for inflammation/infection by histopathological examination of different locations of appendix.Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U. Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st October 2010 till 31st September 2012. A total of 100 cases were subjected to clinical assessment using signs, symptoms and laboratory criteria, histopathology and also the position of the appendix, which were recorded in the proforma. All patients were subjected to ultrasound examination by a qualified radiologist to exclude any other associated pathology and also to confirm the diagnosis. At surgery the Position of the appendix was first identified before disturbing the structures and the position of the appendix. After completion of the appendectomy the specimen was subjected to histopathological examination by the qualified pathologist only those cases, which were proved as, appendicitis by the histopathology were included in the study.Results: Out of 100 cases, a total of 62 cases presented with clinical features suggestive of retrocaecal appendicitis, out of which 51 had typical presentation & 11 had atypical presentation with overall sensitivity of 72.9%, followed by pelvic position which had a sensitivity of 15.29% in which 8 patients had typical presentation & 5 had atypical presentation. All modalities (clinical presentation + lab investigations + USG + intra operative + histopathology) patients were 47; with clinical presentation + lab investigations + USG + intra operative patients were 51; with clinical presentation + lab investigations + USG patients were 57; with clinical presentation + lab investigations patients were 69 and with only clinical presentation patients were 85.Conclusions: A total of five modalities that were used for the diagnosis of position of appendix & appendicitis, i.e. clinical features, lab Ix, ultrasound, intraoperative findings & histopathology, only 47% of cases all the modalities were positive. So the diagnosis of position of appendix & appendicitis is a combination of all the modalities and not just dependent on one basis

Drug price control order: the impact on pharmacoeconomics

Background: The objective of the present study was to analyze the prices of metformin, losartan, atorvastatin, paracetamol and aspirin for the doses which are included in the list of Drug Price Control Order (DPCO) 2013.Methods: Current index medical specialties India, 37th year, April-July 2015 issue was used for analysis. The retail prices of the drugs in INR were tabulated in Microsoft Office Excel 2013. The prices of the above listed drugs were compared with prices of DPCO 2013 for the same doses of drugs. The analysis of drugs costing more than the prices listed in the DPCO with the margin of the difference in percentage was carried out.Results: Out of 25 brands of metformin 500 mg tablet, 11 (44%) brands had price higher than listed in DPCO 2013. Similarly, prices for losartan 25 mg and 50 mg tablets, 8 (25%) out of 32 and 11 (31.42%) out of 35 were higher respectively. For atorvastatin 5 mg and 10 mg tablets, 2 (9.52%) out of 21 and 8 (13.55%) out of 59 brands had higher prices. For paracetamol 500 mg tablet, 12 (63.15%) out of 19 brands were priced higher than DPCO list. For aspirin 100 mg tablet and 325 mg tablet, 3 (100%) out of 3 brands and 1 (100%) out of 1 brand had higher prices.Conclusions: Many of the brand formulations have higher prices than the DPCO 2013 issued by government of India. The clinicians prescribing these drugs should be aware of these brand formulations to reduce the cost of the drug therapy

Contextual Localization Through Network Traffic Analysis

opportunitiesforcontentserviceproviderstooptimizethecontent delivery based on user’s location. Since sharing precise location remainsamajorprivacyconcernamongtheusers,manylocationbased services rely on contextual location (e.g. residence, cafe etc.) as opposed to acquiring user’s exact physical location. In this paper, we present PACL (Privacy-Aware Contextual Localizer), which can learn user’s contextual location just by passively monitoring user’s network traffic. PACL can discern a set of vital attributes (statistical and application-based) from user’s network traffic, and predict user’s contextual location with a very high accuracy.WedesignandevaluatePACLusingreal-worldnetwork traces of over 1700 users with over 100 gigabytes of total data. OurresultsshowthatPACL(builtusingdecisiontree)canpredict user’s contextual location with the accuracy of around 87%. I

The “Scope” of Post-ERCP Pancreatitis

AbstractPancreatitis is the most common adverse event of endoscopic retrograde cholangiopancreatography, with the potential for clinically significant morbidity and mortality. Several patient and procedural risk factors have been identified that increase the risk of post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Considerable research efforts have identified several pharmacologic and procedural interventions that can drastically affect the incidence of PEP. This review article addresses the underlying mechanisms at play for the development of PEP, identifying patient and procedural risk factors and meaningful use of risk-stratification information, and details current interventions aimed at reducing the risk of this complication

Do welfare benefits cause the welfare caseload?

Analyses of the welfare system generally examine one of five competing models: (1) The work disincentive model; (2) the human capital model; (3) the macroeconomic model; (4) the public choice model; or (5) the cost-of-job-loss model. This paper employs the Granger causality concept and the multiple-rank F statistic to test the implications of all five of these models simultaneously. The results offer modest support to all but the macroeconomic model. The relationships among welfare benefits, caseloads, and labor market conditions appear to be too complex to be fully captured by a single model.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45518/1/11127_2005_Article_BF01047904.pd

Carbohydrate restriction for glycemic control in Type 2 diabetes : a systematic review and meta-analysis

Aim To conduct a systematic review and meta‐analysis to evaluate the effect of carbohydrate restriction on glycaemic control in Type 2 diabetes. Methods We searched Medline, EMBASE and CINAHL for the period between 1976 and April 2018. We included randomized controlled trials comparing carbohydrate restriction with a control diet which aimed to maintain or increase carbohydrate intake, and that reported HbA1c as an outcome and reported the amount of carbohydrate consumed during or at the end of the study, with outcomes reported at ≥3 months. Results We identified 1402 randomized controlled trials, 25 of which met the inclusion criteria, incorporating 2132 participants for the main outcome. Definitions of low carbohydrate varied among the studies. The pooled effect estimate from meta‐analysis was a weighted mean difference of –0.09% [95% CI –0.27, 0.08 (P = 0.30); I2 72% (P <0.001)], suggesting no effect on HbA1c of restricting the quantity of carbohydrate. A subgroup analysis of diets containing 50–130 g carbohydrate resulted in a pooled effect estimate of –0.49% [95% CI –0.75, –0.23 (P <0.001); I2 0% (P = 0.56)], suggesting a clinically and statistically significant effect on HbA1c in favour of low‐carbohydrate diets in studies of ≤6 months’ duration. Conclusions There was no overall pooled effect on HbA1c in favour of restricting carbohydrate; however, restriction of carbohydrate to 50–130 g per day had beneficial effects on HbA1c in trials up to 6 months. Future randomized controlled trials should be of >12 months’ duration, assess pre‐study carbohydrate intake, use recognized definitions of low‐carbohydrate diets and examine reasons for non‐concordance in greater detail