Is a follow up endoscopic retrograde cholangiography procedure necessary for removal of biliary stent?

Follow up endoscopic retrograde cholangiopancreatography (ERCP) procedure is routinely performed to remove biliary stents. Simply removing the stents is feasible with upper endoscopy (EGD), which costs less, is technically less challenging, is likely to be more comfortable for the patient, and is safer from a sedation perspective. But therapeutic interventions requiring ERCP may preclude this option. The aim of this study was to analyze the utility of follow up ERCP for biliary stent removal and to determine if follow up ERCP procedure is necessary in all patients. The study population comprised 284 adults who had undergone ERCP for stent placement and stent removal at the West Virginia University Endoscopy Center between January 2005 and December 2011. Detailed information on each patient was obtained from medical records. Patients were categorized into five groups - those with bile leak alone (N=31), choledocholithiasis (N=127), benign stricture (N=77), malignant stricture (N=44) and bile leak with stone or stricture (N=5). On follow up ERCP, only 16% of patients in the bile leak group required therapy. In contrast, 90% of patients with choledocholithiasis, 82% of patients with benign stricture and 100% of patients in the remaining two groups required therapy that could only be accomplished with follow up ERCP. The two most common employed therapies in follow up ERCP were stone or sludge removal (57%) and stent replacement (35%). Conclusions: In this retrospective study spanning 7 years, only 16% of patients with uncomplicated bile leak required a follow up ERCP for stent removal, whereas ERCP related interventions were needed at follow-up in 82-100% of patients with other conditions. Larger prospective studies are needed to confirm these findings and to determine if EGD might serve as a viable and cost effective alternative to ERCP in cases of uncomplicated bile leak

FLY-CAPS- A Hybrid Firefly Feature Optimized Capsule Networks for Plant Disease Classification in Resource Constriant Internet of Things (IoT)

Recent advancements in artificial intelligence, automation, and the Internet of Things (IoT) enable farmers to better monitor and diagnose all agricultural procedures with super-intellectual accuracy. These technologies also contribute to boosting the productivity of agriculture, which increases the country’s economy. Though these technologies help farmers increase productivity, the detection of plant diseases still needs heightened scrutiny for prevention and cultivation. Plant disease categorization has expanded with the introduction of deep learning algorithms, but it still needs more innovation in terms of accuracy and computing burden. Thus, a novel deep learning model based on capsule networks with firefly optimization and potent multi-layered feedforward prediction networks is proposed in this research. The handcrafted features in this proposed system are optimized before being extracted using a capsule network, which reduces the complexity overhead and is suitable for IoT devices with limited resources. Finally fed to the feed forward layers for better classification. The extensive experimentation has been tested with the Plant Village databases, which contain more than 50,000 images of healthy and infected plants. Performance criteria including recall, specificity, recall, accuracy, and f1-score are used to assess the proposed algorithm's performance. Additionally, its efficiency and computational cost are contrasted with those of other recent models. The suggested model has greater performance (95%) with reduced computing overhead, according to experimental data, which is advantageous for the new prediction approach and the welfare of the farmer

Role of Forkhead Transcription Factors in Diabetes-Induced Oxidative Stress

Diabetes is a chronic metabolic disorder, characterized by hyperglycemia resulting from insulin deficiency and/or insulin resistance. Recent evidence suggests that high levels of reactive oxygen species (ROS) and subsequent oxidative stress are key contributors in the development of diabetic complications. The FOXO family of forkhead transcription factors including FOXO1, FOXO3, FOXO4, and FOXO6 play important roles in the regulation of many cellular and biological processes and are critical regulators of cellular oxidative stress response pathways. FOXO1 transcription factors can affect a number of different tissues including liver, retina, bone, and cell types ranging from hepatocytes to microvascular endothelial cells and pericytes to osteoblasts. They are induced by oxidative stress and contribute to ROS-induced cell damage and apoptosis. In this paper, we discuss the role of FOXO transcription factors in mediating oxidative stress-induced cellular response

Yield of a second screening colonoscopy 10 years after an initial negative examination in average-risk individuals

Background and Aims Current guidelines recommend screening colonoscopy at 10-year intervals in average-risk individuals who had baseline screening colonoscopy (no polyps or only hyperplastic polyps ≤5 mm in the recto-sigmoid colon), but the yield of repeat screening at 10 years is unknown. Our aim was to describe the yield of second screening colonoscopy in average-risk individuals performed at least 8 years after a first screening colonoscopy had shown no polyps or only distal hyperplastic polyps ≤5 mm in size. Methods This was a review of a database for colonoscopies performed at Indiana University Hospital between January 1999 and November 2015. Results A total of 4463 individuals underwent screening colonoscopy between January 1999 and July 2007, of which 1566 individuals had no polyps, and 334 individuals had only distal hyperplastic polyps ≤5 mm; 378 individuals (58.4% female) had follow-up screening at least 8 years after the baseline screening examination, with a mean (± standard deviation [SD]) interval of 9.74 years (± 1.2 years; range 8-15 years). Mean (± SD) age at baseline screening examination was 56.7 years (± 5.5 years) and at follow-up screening examination was 66.4 years (± 5.6 years). At the second screening, there were 224 patients (59.3%) with at least 1 polyp, including 144 (38.1%) with at least 1 conventional adenoma. The adenoma detection rate at the second screening examination was 36.1% and 56.8% in the groups with no polyp at baseline and with only distal hyperplastic polyps, respectively. There were 15 advanced neoplasms in 13 individuals (3.4%), of which 12 lesions were proximal to the sigmoid colon. There were no cancers at follow-up. Conclusions Among individuals aged ≥50 years, with normal baseline screening colonoscopy results, the incidence of advanced lesions at a second screening colonoscopy at least 8 years later was comparable to that in baseline screening studies. Our findings support current recommendations for screening at 10-year intervals in average-risk individuals

Prevalence of bacterial vaginosis in preterm and term labour: a one year study

Background: Presence of intra uterine infections is one of the important risk factors for preterm labour. Bacterial vaginosis is one of the commonest genital infections during pregnancy and the prevalence ranges from 4 to 64% depending upon the racial, geographic factors. Most of the cases of bacterial vaginosis during pregnancy are asymptomatic and goes unrecognized. Some of the studies state that treatment of bacterial vaginosis is not associated with reduction in preterm birth rates among mothers with no history of preterm birth. The present was conducted to study the prevalence of bacterial vaginosis in women presenting with preterm labour and term labour and to analyze the causal relationship between bacterial vaginosis and preterm labour. The study also recorded the outcome of maternal and neonatal complications associated with bacterial vaginosisMethods: An observational study was conducted on 100 patients with preterm and term labour. Swabs were collected from all the patients and bacterial vaginosis was diagnosed based on Amsel’s criteria. Pearson’s chi-square test was used to demonstrate the difference between both groups with respect to various categorical data. Independent t- test was used to compare the mean maternal age and mean gestational age at admission in both the groups.Results: The mean maternal age of members in preterm labour was 25.60+4.295 and of term labour was 25.38 ± 4.01 years. Among preterm labour group only 14 cases were suggestive of bacterial vaginosis and 2 cases among 25 cases in labour group. The proportion of cases who were diagnosed as BV positive based on Amsel’s criteria were found more in preterm labour group than term labour group and was found statistically significant (p value = 0.001). Significantly more number of patients in preterm labour group demonstrated culture swab positivity with pathogenic organisms than in term labour group and was found statistically significant with p value=0.048.Conclusions: The present study clearly demonstrates significant association of preterm labour with bacterial vaginosis. Therefore, the screening for bacterial vaginosis as a routine during pregnancy and its prompt treatment may reduce the risk of preterm labour. This will also go a long way in the prevention of neonatal complications due to prematurity

Etiologic characterization of vulvovaginitis among females attending a tertiary care hospital: a one year study

Background: Vulvovaginitis is one among the major pathologies encountered in reproductive age group. Etiologies are always multiple and candidiasis, bacterial vaginitis and trichomoniasis account for 90% of etiology. The incidence is dependable upon multiple factors like age group, ethnicity, socioeconomic status, geographical locale. Improperly treated and untreated vulvovaginitis is associated with long term complications like infertility, pelvic inflammatory disease in nulliparous females and preterm labour, miscarriage, ectopic pregnancy, chorioamnionitis among pregnant females and recurrent UTIs, cervicitis, endometritis, increased risk of acquiring STIs among normal females. The present study was undertaken with the objective of understanding the etiologies associated with vulvovaginitis among women attending Obstetrics clinic of a tertiary care hospital. The risk factors associated with the conditions, the features of the vaginal discharge and symptoms associated with each etiology were studied.Methods: A cross sectional study for a period of one year was conducted among 200 female patients attending the Department of gynecology for vaginitis and evaluated for etiology. Patient’s risk factors, clinical history, symptoms were collected by questionnaire and specimens were collected from all the cases and processed as per standard guidelines. Bacterial vaginosis was confirmed based on Neugent’s criteria, Trichomoniasis by wet mount examination and candidiasis by culture. The study was approved by the institutional ethical committee.Results: 137 cases of vulvovaginitis were diagnosed based on etiology. Vulvovaginitis was most common among 27-36 years and in multiparous women. Most common causative agent was Candida (59.12%) followed by bacterial vaginosis (22.63%) and Trichomoniasis (18.25%). Vaginal discharge was the commonest symptom (100%) followed by malodor and vulval irritation. Following unhygienic practices was the commonest risk factor associated with Vulvovaginitis.Conclusions: A regular evaluation is mandatory for all the females attending hospital for vaginitis. Successful management reduces the morbid conditions and it’s essential to treat the conditions during the pregnancy which prevents the complications associated like preterm birth, miscarriage etc. and adverse outcomes

Outcome of tibial plateau fractures treated by hybrid and Ilizarov external fixation

Background: Tibial plateau fractures pose a challenge to the treating surgeon especially in cases with compromised soft tissue envelope. External fixation achieves good results with minimal complications. The objective of our study was to evaluate the functional outcome of tibial plateau fractures treated by Ilizarov and hybrid external fixation.Methods: 46 patients with tibial plateau fractures were analysed. 6 were lost to follow-up. 20 patients were treated by Ilizarov method and 20 by hybrid external fixation.Results: Mean time for union was 24.5 weeks in Ilizarov fixator group and 28 weeks in hybrid fixator group. Mean Lysholm’s score was 86.1 in Ilizarov cases and 83.4 in hybrid fixator cases. The mean knee society score in Ilizarov fixation cases was 78.5 and 77.3 in hybrid fixator cases. At one year by Lysholm score 6 patients had fair, 10 had good and 4 had excellent result in Ilizarov group and 1 had poor, 8 had fair, 8 had good and 3 had excellent results in hybrid group. 15 patients in Ilizarov method had good and excellent knee society scores and 12 patients had good and excellent results and 1 patient had poor score in Hybrid fixator group.Conclusions: External fixation in complicated tibial plateau fractures gives acceptable outcomes. Ilizarov external fixator has an advantage of earlier mobilization and earlier union but requires longer operation time and a bulky apparatus. Hybrid fixator on the other hand has lesser operating time and simpler construct but has less stability and longer union time

Student Assistant Portal

There is no communication medium which is beneficent to all the people in the college through which they can share their ideas, information and have a personal account where they can save some stuff which is helpful in future. So our aim is to provide an application which provides a good interaction between all members of the college and is available for them anywhere. This is an application which provides a common solution for personal library, schedule our work and Forum. The project is meant for web based which allow the users to access it from anywhere as most of them carry smart phones with them. The proposed project is to help learn subject efficiently with connected to the university network : Faculty, Students, Management and other department

Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis

BACKGROUND AND STUDY AIMS: Familial adenomatous polyposis (FAP) is generally managed by colectomy, but in some cases surgery is delayed and polyp burdens are managed endoscopically. We aimed to describe the use of cold snare polypectomy to control the polyp burden in selected patients with FAP. PATIENTS AND METHODS: This was a retrospective cohort study. Polyps were counted and the range of polyp size recorded at each examination. Patients with a reduction in polyp number and mean size were considered to have successful endoscopic reduction of their polyp burdens. RESULTS: Of 79 patients with FAP, 21 had an attempt at delaying surgery by cold snaring of at least 30 adenomas, and had at least one follow-up at our institution. Ten patients had intact colons, 6 had intact rectums, and 5 had heavy polyp burdens in an ileo-anal pouch. Among the 21 patients, the mean number of polyps resected at the first examination was 85, range 30 - 342. Nineteen of 21 patients had fewer polyps at the second examination, and of those, only one had any persistence of adenomas ≥ 1 cm in size. During follow-up, two patients underwent surgical resection and the remainder had reductions in their polyp burdens at follow-up endoscopy. CONCLUSIONS: Cold snare polypectomy effectively reduces polyp burden in selected FAP patients

Risk of cancer in small and diminutive colorectal polyps

The prevalence of cancer in small and diminutive polyps is relevant to “resect and discard” and CT colonography reporting recommendations. We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements). Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10 mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions. There were 23,524 conventional adenomas <10 mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5 mm in size and 0.8% of adenomas 6–9 mm in size. Of all conventional adenomas, 2.1% of those ≤5 mm in size and 5.6% of those 6–9 mm in size were advanced. Among 36,107 polyps ≤5 mm in size and 6523 polyps 6–9 mm in size, there were no cancers. These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps