1.Predictive factors for malignancy in undiagnosed isolated small bowel strictures.
Ujjwal SONIKA ; Sujeet SAHA ; Saurabh KEDIA ; Nihar Ranjan DASH ; Sujoy PAL ; Prasenjit DAS ; Vineet AHUJA ; Peush SAHNI
Intestinal Research 2017;15(4):518-523
BACKGROUND/AIMS: Patients with small bowel strictures have varied etiologies, including malignancy. Little data are available on the demographic profiles and etiologies of small bowel strictures in patients who undergo surgery because of intestinal obstruction but do not have a definitive pre-operative diagnosis. METHODS: Retrospective data were analyzed for all patients operated between January 2000 and October 2014 for small bowel strictures without mass lesions and a definite diagnosis after imaging and endoscopic examinations. Demographic parameters, imaging, endoscopic, and histological data were extracted from the medical records. Univariate and multivariate analyses were conducted to identify factors that could differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) and between malignant and benign strictures. RESULTS: Of the 7,425 reviewed medical records, 89 met the inclusion criteria. The most common site of strictures was the proximal small intestine (41.5%). The most common histological diagnoses in patients with small bowel strictures were ITB (26.9%), CD (23.5%), non-specific strictures (20.2%), malignancy (15.5%), ischemia (10.1%), and other complications (3.4%). Patients with malignant strictures were older than patients with benign etiologies (47.6±15.9 years vs. 37.4±16.4 years, P=0.03) and age >50 years had a specificity for malignant etiology of 80%. Only 7.1% of the patients with malignant strictures had more than 1 stricture and 64% had proximally located strictures. Diarrhea was the only factor that predicted the diagnosis of CD 6.5 (95% confidence interval, 1.10–38.25; P=0.038) compared with the diagnosis of ITB. CONCLUSIONS: Malignancy was the cause of small bowel strictures in approximately 16% patients, especially among older patients with a single stricture in the proximal location. Empirical therapy should be avoided and the threshold for surgical resection is low in these patients.
Constriction, Pathologic*
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Crohn Disease
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Diagnosis
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Diarrhea
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Humans
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Intestinal Obstruction
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Intestine, Small
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Ischemia
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Medical Records
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Multivariate Analysis
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Retrospective Studies
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Sensitivity and Specificity
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Tuberculosis
2.Toward more uniform conflict disclosures: the updated ICMJE Conflict of Interest Reporting Form.
Jeffrey M DRAZEN ; Peter W de LEEUW ; Christine LAINE ; Cynthia MULROW ; Catherine D DEANGELIS ; Frank A FRIZELLE ; Fiona GODLEE ; Charlotte HAUG ; Paul C HÉBERT ; Astrid JAMES ; Sheldon KOTZIN ; Ana MARUSIC ; Humberto REYES ; Jacob ROSENBERG ; Peush SAHNI ; Getu ZHAORI
Chinese Medical Journal 2010;123(13):1621-1622
3.High mucosal cytomegalovirus DNA helps predict adverse short-term outcome in acute severe ulcerative colitis
Saransh JAIN ; Divya NAMDEO ; Pabitra SAHU ; Saurabh KEDIA ; Peush SAHNI ; Prasenjit DAS ; Raju SHARMA ; Vipin GUPTA ; Govind MAKHARIA ; Lalit DAR ; Simon PL TRAVIS ; Vineet AHUJA
Intestinal Research 2021;19(4):438-447
Background/Aims:
Predictors of short-term outcome of intravenous (IV) steroid therapy in acute severe ulcerative colitis (ASUC) have been well described, but the impact of cytomegalovirus (CMV) infection as a predictor of outcome remains debatable. We investigated the role of quantitative CMV polymerase chain reaction (PCR) as a predictor of short-term outcome in patients with ASUC.
Methods:
Consecutive patients with ASUC satisfying Truelove and Witts criteria hospitalized at All India Institute of Medical Sciences (AIIMS) from May 2016 to July 2019 were included; all received IV steroid. The primary outcome measure was steroid-failure defined as the need for rescue therapy (with ciclosporin or infliximab) or colectomy during admission. AIIMS’ index (ulcerative colitis index of severity > 6 at day 1+fecal calprotectin > 1,000 μg/g at day 3), with quantitative CMV PCR on biopsy samples obtained at initial sigmoidoscopy were correlated with the primary outcome.
Results:
Thirty of 76 patients (39%) failed IV corticosteroids and 12 (16%) underwent surgery. Patients with steroid failure had a significantly higher mucosal CMV DNA than responders (3,454 copies/mg [0–2,700,000] vs. 116 copies/mg [0–27,220]; P< 0.01). On multivariable analysis, mucosal CMV DNA load > 2,000 copies/mg (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.6–39.7; P< 0.01) and AIIMS’ index (OR, 39.8; 95% CI, 4.4–364.4; P< 0.01) were independent predictors of steroid-failure and need for colectomy. The combination correctly predicted outcomes in 84% of patients with ASUC.
Conclusions
High mucosal CMV DNA ( > 2,000 copies/mg) independently predicts failure of IV corticosteroids and short-term risk of colectomy and it has an additional value to the established markers of disease severity in patients with ASUC.
4.Data Sharing Statements for Clinical Trials: A Requirement of the International Committee of Medical Journal Editors.
Darren B TAICHMAN ; Peush SAHNI ; Anja PINBORG ; Larry PEIPERL ; Christine LAINE ; Astrid JAMES ; Sung Tae HONG ; Abraham HAILEAMLAK ; Laragh GOLLOGLY ; Fiona GODLEE ; Frank A FRIZELLE ; Fernando FLORENZANO ; Jeffrey M DRAZEN ; Howard BAUCHNER ; Christopher BAETHGE ; Joyce BACKUS
Journal of Korean Medical Science 2017;32(7):1051-1053
No abstract available.
Information Dissemination*
5.Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors.
Darren B TAICHMAN ; Joyce BACKUS ; Christopher BAETHGE ; Howard BAUCHNER ; Peter W de LEEUW ; Jeffrey M DRAZEN ; John FLETCHER ; Frank FRIZELLE ; Trish GROVES ; Abraham HAILEAMLAK ; Astrid JAMES ; Christine LAINE ; Larry PEIPERL ; Anja PINBORG ; Peush SAHNI ; Si-Nan WU
Chinese Medical Journal 2016;129(2):127-128
6.A Disclosure Form for Work Submitted to Medical Journals: a Proposal from the International Committee of Medical Journal Editors
Darren B TAICHMAN ; Joyce BACKUS ; Christopher BAETHGE ; Howard BAUCHNER ; Annette FLANAGIN ; Fernando FLORENZANO ; Frank A FRIZELLE ; Fiona GODLEE ; Laragh GOLLOGLY ; Abraham HAILEAMLAK ; Sung Tae HONG ; Richard HORTON ; Astrid JAMES ; Christine LAINE ; Pamela W MILLER ; Anja PINBORG ; Eric J RUBIN ; Peush SAHNI
Journal of Korean Medical Science 2020;35(4):39-
No abstract available.
Disclosure
7.Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
Sanchit SHARMA ; Arti GUPTA ; Saurabh KEDIA ; Samagra AGARWAL ; Namrata SINGH ; Sandeep GOYAL ; Saransh JAIN ; Vipin GUPTA ; Pabitra SAHU ; Sudheer Kumar VUYYURU ; Bhaskar KANTE ; Raju SHARMA ; Rajesh PANWAR ; Peush SAHNI ; Govind MAKHARIA ; Vineet AHUJA
Intestinal Research 2021;19(3):291-300
Background/Aims:
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods:
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results:
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.
8.Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease
Sanchit SHARMA ; Arti GUPTA ; Saurabh KEDIA ; Samagra AGARWAL ; Namrata SINGH ; Sandeep GOYAL ; Saransh JAIN ; Vipin GUPTA ; Pabitra SAHU ; Sudheer Kumar VUYYURU ; Bhaskar KANTE ; Raju SHARMA ; Rajesh PANWAR ; Peush SAHNI ; Govind MAKHARIA ; Vineet AHUJA
Intestinal Research 2021;19(3):291-300
Background/Aims:
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods:
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results:
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.
9.A Disclosure Form for Work Submitted to Medical Journals: a Proposal from the International Committee of Medical Journal Editors
Darren B TAICHMAN ; Joyce BACKUS ; Christopher BAETHGE ; Howard BAUCHNER ; Annette FLANAGIN ; Fernando FLORENZANO ; Frank A FRIZELLE ; Fiona GODLEE ; Laragh GOLLOGLY ; Abraham HAILEAMLAK ; Sung Tae HONG ; Richard HORTON ; Astrid JAMES ; Christine LAINE ; Pamela W MILLER ; Anja PINBORG ; Eric J RUBIN ; Peush SAHNI
Journal of Korean Medical Science 2020;35(4):e39-
10.Time to treat the climate and nature crisis as one indivisible Global Health Emergency
Kamran Abbasi ; Parveen Ali ; Virginia Barbour ; Thomas Benfield ; Kirsten Bibbins-Domingo ; Stephen Hancocks ; Richard Horton ; Laurie Laybourn-Langton ; Robert Mash ; Peush Sahni ; Wadeia Mohammad Sharief ; Paul Yonga ; Chris Zielinsk
Philippine Journal of Otolaryngology Head and Neck Surgery 2023;38(2):6-8
Over 200 health journals call on the United Nations, political leaders, and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe. This overall environmental crisis is now so severe as to be a global health emergency.
Armed Conflicts
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Nuclear Energy
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Radiation
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Climate Change
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Global Warming