Era of direct acting anti-viral agents for the treatment of hepatitis C.

Hepatitis C infection is universal and the most common indication of liver transplantation in the United States. The period of less effective interferon therapy with intolerable side effects has gone. Now we have stepped into the era of direct acting anti-viral agents (DAAs) against hepatitis C virus. Treatment of hepatitis C is now extremely effective, tolerable and requires a short duration of intake of oral agents. Less monitoring is required with the current therapy and drug-drug interactions are less than the previous regimen. The current treatment options of chronic hepatitis C with various DAAs are discussed in this article

Checkpoint inhibitors: What gastroenterologists need to know.

Checkpoint inhibitors are increasingly being used in clinical practice. They can cause various gastrointestinal, hepatic and pancreatic side effects. As these side effects can be serious, appropriate management is essential. The different checkpoint inhibitors with their mechanisms of action and indications, as well as evaluation and management of gastrointestinal, hepatic and pancreatic side effects, are discussed in this article

SUPA: Strewn user-preserved authentication**

Objective – This paper presents the high level conceptual architecture of SUPA, an authentication system that would allow a system to authenticate users without having its own repository of users’ secret identification related data. Methodology/Technique – Central storage and management of user credentials or passwords leave a single tempting repository for the attackers. If the credentials are not stored by a system at all, there will be no stored ‘vault’ to allure the attackers. At the same time, there will be no single resource that holds the credentials of all users of a system. SUPA enables a system to authenticate itself users without having their secret credentials stored in it. Findings – The proposed authentication system uses the features of asymmetric encryption as part of its authentication process. Novelty – SUPA eliminates the requirement of secret user credentials at the system end, the user credentials are retained within the end-user’s devices

Peptic Ulcer Disease

Peptic ulcer disease (PUD) is one of the commonest diseases seen throughout the world. There are various risk factors for the development of peptic ulcer disease, but the most important ones are Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs). Patients generally present with dyspepsia or peptic ulcer bleeding. Acid suppressant therapy, H. pylori eradication, and avoidance of nonsteroidal anti-inflammatory drugs are the cornerstones of treatment of peptic ulcer disease. Peptic ulcer bleeding could be life-threatening. It is managed by appropriate supportive care, intravenous proton pump inhibitor therapy, and endoscopic hemostasis. Transarterial embolization (TAE) and surgery are rarely required if endoscopic therapy fails

Mid-Gastrointestinal Bleeding

Mid-gastrointestinal bleeding constitutes a small proportion of all cases of gastrointestinal bleeding. It is more difficult to manage mid-gastrointestinal bleeding than upper or lower gastrointestinal bleeding. The etiology differs in younger and older age groups. The clinical presentation, investigations, and management are also different. Capsule endoscopy has improved the diagnostic accuracy to a great extent. Device-assisted enteroscopies (balloon-assisted enteroscopies and spiral enteroscopy) have both diagnostic and therapeutic potentials. Most of the time, patients present with obscure gastrointestinal bleeding which could be overt or occult. Another common presentation is iron deficiency anemia. A stepwise approach is essential to accurately diagnose and manage mid-gastrointestinal bleeding

Non-alcoholic Fatty Liver Disease and Surgery

There is an epidemic of nonalcoholic fatty liver disease (NAFLD) paralleling the epidemic of obesity and metabolic syndrome. NAFLD is the most common cause of abnormal liver function test and chronic liver disease in the Western world. NAFLD can progress to nonalcoholic steatohepatitis, cirrhosis of the liver, and hepatocellular carcinoma. Most patients with NAFLD die from cardiovascular disease and malignancy. Medical therapy for NAFLD is not very effective at the present time. Treatment of NAFLD starts with weight loss. Bariatric surgery is able to cause significant and sustained weight loss. There are different models of bariatric surgery. Commonly performed ones are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and laparoscopic adjustable gastric banding (LAGB). They can improve steatosis, steatohepatitis, and fibrosis in non-cirrhotic and compensated cirrhotic patients. Each of them has benefits and risks. The bariatric surgical procedures need to be individualized according to the patient’s condition

Management of Nonalcoholic Fatty Liver Disease (NAFLD)

Although there is an epidemic of NAFLD throughout the world, the management of NAFLD is not very satisfactory at the present time. Lifestyle modification is the main mode of therapy. Other modalities like pharmacotherapy and bariatric endoscopy or surgery should be individualized. Various pharmacological agents are being investigated to optimize the treatment of NAFLD

A Redundancy-based Security Model for Smart Home

Recent developments in smart devices, Cloud Computing and Internet of Things (IoT) are introducing network of intelligent devices. These intelligent devices can be used to develop smart home network. The home appliance in a smart home forms an ad-hoc network. A smart home network architecture can be exploited by compromising the devices it is made up of. Various malicious activities can be performed through such exploitation. This paper presents a security approach to combat this. By using a collaborative and redundant security approach, the ad-hoc network of a smart home would be able to prevent malicious exploitation. The security approach discussed in this paper is a conceptual representation on the proposed security model for smart home networks

Recent advances in the management of gastrointestinal stromal tumor.

Gastrointestinal stromal tumor (GIST) is a rare but an important clinical entity seen in our clinical practice. It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine. Although the exact prevalence of GIST is not known, the incidence of GIST has been increasing. GISTs arise from interstitial cells of Cajal. Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene. 15% of GISTs do not have these mutations and they are called wild-type GISTs. Almost all GISTs express KIT receptor tyrosine kinase. Histologically, GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type. The median size of GISTs varies from 2.7 cm to 8.9 cm. Clinically, patients with small GISTs remain asymptomatic but as the GIST size increases, patients present with various symptoms depending on the location of the GIST. Most of GISTs are located in the stomach or small bowel. Diagnosis is suspected on imaging and endoscopic studies, and confirmed by tissue acquisition with immunohistochemical staining. The aggressiveness of GISTs depends on the size, mitotic index and location. Surgical resection is the treatment of choice. But various endoscopic modalities of resection are increasingly being tried. Tyrosine kinase inhibitors are extremely useful in the management of large GISTs, unresectable GISTs and metastatic GISTs. Treatment options for metastatic GISTs also include radiotherapy, chemotherapy, hepatic artery embolization, chemoembolization and radiofrequency ablation

SUPA: Strewn User-Preserved Authentication

Central storage and management of user credentials or passwords leaves a single tempting repository for the attackers. If the credentials are not stored by a system at all, there will be no stored ‘vault’ to allure the attackers. At the same time, there will be no single resource that holds the credentials of all users of a system. This paper presents the high level conceptual architecture of SUPA, an authentication system that would allow a system to authenticate users without having its own repository of users’ credentials. SUPA enables a system to authenticate its users without having their credentials stored in it. The proposed authentication system uses the features of asymmetric encryption as part of its authentication process