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Fmt Placed By Colonoscopy: Systematic Review And Meta-Analysis, Nadia Huq, Veena Kumaravel, Aboud Affi, Maharaj Singh 2017 Department of Internal Medicine, Aurora Sinai Medical Center

Fmt Placed By Colonoscopy: Systematic Review And Meta-Analysis, Nadia Huq, Veena Kumaravel, Aboud Affi, Maharaj Singh

Journal of Patient-Centered Research and Reviews

Background: Fecal transplants are successful in the treatment of recurrent or refractory Clostridium difficile infections (CDI), but there is no consensus on the best method of instillation. Studies have shown greater success with lower gastrointestinal tract placement, but technical aspects of placement are not validated.

Purpose: This review aims to identify common traits and procedural techniques of successful fecal microbiota transplant (FMT) therapy via colonoscopy.

Methods: An electronic search was conducted using OVID Medline and PubMed for articles published from January 2010 to January 2016. The primary outcome of interest was cure by FMT placed via colonoscopy.

Results: Of the ...


Conference Proceedings: Aurora Scientific Day 2017, 2017 Aurora Health Care

Conference Proceedings: Aurora Scientific Day 2017

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 43rd Annual Aurora Scientific Day research symposium on May 24, 2017. Aurora Scientific Day hosts a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system headquartered in Milwaukee, Wisconsin.


Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza 2017 Aga Khan University

Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza

Hasnain Zafar

Objective: to determine the outcome of splenectomy done in adult patients of Idiopathic Thrombocytopenic Purpura over a period of 10 years and, secondarily, to determine the predictors of complete response to therapy. Methods: The retrospective review comprised of adult patients over 14 years of age who underwent open or laparoscopic splenectomy for Idiopathic Thrombocytopenic Purpura at Aga Khan University Hospital, Karachi, from January 2000 to December 2010. Data was reviewed in January 2011 by a surgical resident. Outcome was the response to splenectomy as per new definition of response set by the American Society of Haematology 2011 evidence based practice ...


Amoebic Brain Abscess Associated With Renal Cell Carcinoma, Umme Hani Abdullah,, Mirza Zain Baig,, Muhammad Azeemuddin,, Mohammad Wasay,, javed Yakoob, Mohammad Asim Beg 2017 Aga Khan University

Amoebic Brain Abscess Associated With Renal Cell Carcinoma, Umme Hani Abdullah,, Mirza Zain Baig,, Muhammad Azeemuddin,, Mohammad Wasay,, Javed Yakoob, Mohammad Asim Beg

Section of Gastroenterology

Entamoeba histolytica is a protozoan parasite that is associated with diarrhea, but can extend to involve several organs. We report a case of amoebic brain abscess in a man who presented with fever, vomiting and headache with confusion and right hemiparesis. Brain magnetic resonance imaging showed a mass in the left frontal lobe, while abdominal computerized tomography showed a left renal malignancy. Brain biopsy showed Entamoeba histolytica infection. He was treated with intra- venous metronidazole and nephrectomy that was followed by complete recovery. The present case report emphasizes that cerebral amoebiasis is associated with renal cell carcinoma.


Comparison Of The Diagnostic Accuracy Of Three Current Guidelines For The Evaluation Of Asymptomatic Pancreatic Cystic Neoplasms., Ming-Ming Xu, Shi Yin, Ali A. Siddiqui, Ronald R. Salem, Beth Schrope, Amrita Sethi, John M. Poneros, Frank G. Gress, Jeanine M Genkinger, Catherine Do, Christian A. Brooks, John A. Chabot, Michael D. Kluger, Thomas E. Kowalski, David E. Loren, Harry Aslanian, James J. Farrell, Tamas A. Gonda 2017 Columbia University Medical Center

Comparison Of The Diagnostic Accuracy Of Three Current Guidelines For The Evaluation Of Asymptomatic Pancreatic Cystic Neoplasms., Ming-Ming Xu, Shi Yin, Ali A. Siddiqui, Ronald R. Salem, Beth Schrope, Amrita Sethi, John M. Poneros, Frank G. Gress, Jeanine M Genkinger, Catherine Do, Christian A. Brooks, John A. Chabot, Michael D. Kluger, Thomas E. Kowalski, David E. Loren, Harry Aslanian, James J. Farrell, Tamas A. Gonda

Division of Gastroenterology and Hepatology Faculty Papers

Asymptomatic pancreatic cysts are a common clinical problem but only a minority of these cases progress to cancer. Our aim was to compare the accuracy to detect malignancy of the 2015 American Gastroenterological Association (AGA), the 2012 International Consensus/Fukuoka (Fukuoka guidelines [FG]), and the 2010 American College of Radiology (ACR) guidelines.We conducted a retrospective study at 3 referral centers for all patients who underwent resection for an asymptomatic pancreatic cyst between January 2008 and December 2013. We compared the accuracy of 3 guidelines in predicting high-grade dysplasia (HGD) or cancer in resected cysts. We performed logistic regression analyses ...


A Multi-Institutional Consensus On How To Perform Endoscopic Ultrasound-Guided Peri-Pancreatic Fluid Collection Drainage And Endoscopic Necrosectomy., Jintao Guo, Adrian Saftoiu, Peter Vilmann, Pietro Fusaroli, Marc Giovannini, Girish Mishra, Surinder S. Rana, Sammy Ho, Jan-Werner Poley, Tiing Leong Ang, Evangelos Kalaitzakis, Ali A. Siddiqui, Jose G. De La Mora-Levy, Sundeep Lakhtakia, Manoop S. Bhutani, Malay Sharma, Shuntaro Mukai, Pramod Kumar Garg, Linda S. Lee, Juan J. Vila, Everson Artifon, Douglas G. Adler, Siyu Sun 2017 Sheng Jing Hospital of China Medical University

A Multi-Institutional Consensus On How To Perform Endoscopic Ultrasound-Guided Peri-Pancreatic Fluid Collection Drainage And Endoscopic Necrosectomy., Jintao Guo, Adrian Saftoiu, Peter Vilmann, Pietro Fusaroli, Marc Giovannini, Girish Mishra, Surinder S. Rana, Sammy Ho, Jan-Werner Poley, Tiing Leong Ang, Evangelos Kalaitzakis, Ali A. Siddiqui, Jose G. De La Mora-Levy, Sundeep Lakhtakia, Manoop S. Bhutani, Malay Sharma, Shuntaro Mukai, Pramod Kumar Garg, Linda S. Lee, Juan J. Vila, Everson Artifon, Douglas G. Adler, Siyu Sun

Division of Gastroenterology and Hepatology Faculty Papers

There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should ...


Covering The Cover, Wei Wu, Jingdi Chen, Qianshan Ding, Dongmei Yang, Honggang Yu, Jun Lin 2017 Renmin Hospital of Wuhan University, Wuhan, China

Covering The Cover, Wei Wu, Jingdi Chen, Qianshan Ding, Dongmei Yang, Honggang Yu, Jun Lin

Department of Medicine

Background/Aims: Endoscopic submucosal dissection has been widely accepted. At present, the number of antiplatelet (APT) users has been growing. Moreover, because of high risks of thromboembolism, some patients need to continuously receive APT agents. The relationship between hemorrhage and continuous therapy with low-dose aspirin (LDA) remains controversial.

Materials and Methods: A systematic search was conducted; studies were screened out- if data of no-anticoagulant/APT drugs use and interrupted and continued-LDA use were reported separately. The Newcastle-scale was chosen to assess the quality of the included studies. Review Manager 5.2 was used for quality assessment statistical analysis, and the ...


Clinical Characteristics And Predictors Of Positive Stool Culture In Adult Patients With Acute Gastroenteritis, Muhammad Mehmood Riaz, Muhammad Junaid Patel, Muhammad Shoaib Khan, Muhammad Ali Anwar, M. Tariq, Harith Hilal, Safia Awan, Shahzad Razi 2017 Aga Khan University

Clinical Characteristics And Predictors Of Positive Stool Culture In Adult Patients With Acute Gastroenteritis, Muhammad Mehmood Riaz, Muhammad Junaid Patel, Muhammad Shoaib Khan, Muhammad Ali Anwar, M. Tariq, Harith Hilal, Safia Awan, Shahzad Razi

Muhammad Tariq

OBJECTIVE: To identify the presenting features and spectrum of pathogens in adult patients with acute diarrhoea and to determine the predictors of stool culture positivity. METHODS: A descriptive study was conducted in a tertiary care hospital from April 1, 2005 to March 31, 2006. Medical records of all consecutive adult patients with history of acute diarrhoea were reviewed between June 2006 to December 2006 for clinical characteristics and laboratory investigations. RESULTS: A total of 454 patients were admitted from April 1, 2005 to March 31, 2006. Stool cultures were performed in 233 (50%) patients, 96 (42%) had positive results. Patients ...


The Circadian Clock Gene Bmal1 Coordinates Intestinal Regeneration, Kyle Stokes, Abrial Cooke, Hanna Chang, David R. Weaver, David T. Breault, Phillip Karpowicz 2017 University of Windsor

The Circadian Clock Gene Bmal1 Coordinates Intestinal Regeneration, Kyle Stokes, Abrial Cooke, Hanna Chang, David R. Weaver, David T. Breault, Phillip Karpowicz

Neurobiology Publications and Presentations

BACKGROUND and AIMS: The gastrointestinal syndrome is an illness of the intestine caused by high levels of radiation. It is characterized by extensive loss of epithelial tissue integrity, which initiates a regenerative response by intestinal stem and precursor cells. The intestine has 24-hour rhythms in many physiological functions that are believed to be outputs of the circadian clock: a molecular system that produces 24-hour rhythms in transcription/translation. Certain gastrointestinal illnesses are worsened when the circadian rhythms are disrupted, but the role of the circadian clock in gastrointestinal regeneration has not been studied.

METHODS: We tested the timing of regeneration ...


Patient Safety During Procedural Sedation Using Capnography Monitoring: A Systematic Review And Meta-Analysis, Rhodri Saunders, Michel M.R.F. Struys, Richard F. Pollock, Michael Mestek, Jenifer R. Lightdale 2017 Coreva Scientific

Patient Safety During Procedural Sedation Using Capnography Monitoring: A Systematic Review And Meta-Analysis, Rhodri Saunders, Michel M.R.F. Struys, Richard F. Pollock, Michael Mestek, Jenifer R. Lightdale

Pediatric Publications and Presentations

OBJECTIVE: To evaluate the effect of capnography monitoring on sedation-related adverse events during procedural sedation and analgesia (PSA) administered for ambulatory surgery relative to visual assessment and pulse oximetry alone.

DESIGN AND SETTING: Systematic literature review and random effects meta-analysis of randomised controlled trials (RCTs) reporting sedation-related adverse event incidence when adding capnography to visual assessment and pulse oximetry in patients undergoing PSA during ambulatory surgery in the hospital setting. Searches for eligible studies published between 1 January 1995 and 31 December 2016 (inclusive) were conducted in PubMed, the Cochrane Library and EMBASE without any language constraints. Searches were conducted ...


Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour MD, Yousef Abdel-Aziz MD, Hesham Awadh, Nihar Shah MD, Akash Ajmera 2017 Marshall University

Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour Md, Yousef Abdel-Aziz Md, Hesham Awadh, Nihar Shah Md, Akash Ajmera

Akash Ajmera

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.


Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour MD, Yousef Abdel-Aziz MD, Hesham Awadh, Nihar Shah MD, Akash Ajmera 2017 Marshall University

Complete Esophageal Obstruction After Endoscopic Variceal Band Ligation In A Patient With A Sliding Hiatal Hernia, Munthir Mansour Md, Yousef Abdel-Aziz Md, Hesham Awadh, Nihar Shah Md, Akash Ajmera

Nihar Shah, MD, FACP

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.


Enhancing Informative Frame Filtering By Water And Bubble Detection In Colonoscopy Videos, Ashok Dahal, JungHwan Oh, Wallapak Tavanapong, Johnny S. Wong, Piet C. de Groen 2017 University of North Texas

Enhancing Informative Frame Filtering By Water And Bubble Detection In Colonoscopy Videos, Ashok Dahal, Junghwan Oh, Wallapak Tavanapong, Johnny S. Wong, Piet C. De Groen

Johnny Wong

Colonoscopy has contributed to a marked decline in the number of colorectal cancer related deaths. However, recent data suggest that there is a significant (4-12%) miss-rate for the detection of even large polyps and cancers. To address this, we have been investigating an ‘automated feedback system’ which informs the endoscopist of possible sub-optimal inspection during colonoscopy. A fundamental step of this system is to distinguish non-informative frames from informative ones. Existing methods for this cannot classify water/bubble frames as non-informative even though they do not carry any useful visual information of the colon mucosa. In this paper, we propose ...


Cable Footprint History: Spatio-Temporal Technique For Instrument Detection In Gastrointestinal Endoscopic Procedures, Chuanhai Zhang, Wallapak Tavanapong, Johnny S. Wong, Piet C. de Groen, JungHwan Oh 2017 Iowa State University

Cable Footprint History: Spatio-Temporal Technique For Instrument Detection In Gastrointestinal Endoscopic Procedures, Chuanhai Zhang, Wallapak Tavanapong, Johnny S. Wong, Piet C. De Groen, Junghwan Oh

Johnny Wong

We propose a new fast spatio-temporal technique that detects an operation scene---a video segment corresponding to a single purpose diagnosis action or a single purpose therapeutic action. The technique utilizes (1) color contrast of the cable region and the background, (2) the new area-based coordinate system to compute spatial features, and (3) the history of locations of detected cables of the instrument in a video to discard false regions. The proposed technique and software are useful for (1) automatic documentation of diagnostic or therapeutic operations at the end of the procedure, (2) a second review for causes of complications due ...


Prevalence Of Non Helicobacter Pylori Species In Patients Presenting With Dyspepsia, Javed Yakoob, Zaigham Abbas, Rustam Khan, Shagufta Naz, Zubair Ahmad, Muhammad Islam, Safia Awan, Fatima Jafri, Wasim Jafri 2017 Aga Khan University

Prevalence Of Non Helicobacter Pylori Species In Patients Presenting With Dyspepsia, Javed Yakoob, Zaigham Abbas, Rustam Khan, Shagufta Naz, Zubair Ahmad, Muhammad Islam, Safia Awan, Fatima Jafri, Wasim Jafri

Zubair Ahmad

Background: Helicobacter species associated with human infection include Helicobacter pylori, Helicobacter heilmannii and Helicobacter felis among others. In this study we determined the prevalence of H. pylori and non-Helicobacter pylori organisms H. felis and H. heilmannii and analyzed the association between coinfection with these organisms and gastric pathology in Patients presenting with dyspepsia. Biopsy specimens were obtained from Patients with dyspepsia on esophagogastroduodenoscopy (EGD) for rapid urease test, histology and PCR examination for Helicobacter genus specific 16S rDNA, H. pylori phosphoglucosamine mutase (glmM) and urease B (ureB) gene of H. heilmannii and H. felis. Sequencing of PCR products of H ...


Size Or The Number Of Portal Tracts: Which Matters In A Liver Biopsy Core In Chronic Hepatitis C?, Om Parkash, Khalid Mumtaz, Zubair Ahmad, Saeed Hamid, Fatima Jafri, Wasim Jafri 2017 Agha Khan University

Size Or The Number Of Portal Tracts: Which Matters In A Liver Biopsy Core In Chronic Hepatitis C?, Om Parkash, Khalid Mumtaz, Zubair Ahmad, Saeed Hamid, Fatima Jafri, Wasim Jafri

Zubair Ahmad

Liver biopsy has an important role in staging of fibrosis (SoF) and grading of inflammation (GoI) in chronic hepatitis C (CHC) patients. The effect of size and number of portal tracts (NoP) on grading and staging of liver biopsy was evaluated. A total of 150 consecutive liver biopsy core (LBC) of patients with CHC were obtained. There were 98 (65.3%) males. Mean length of LBC was 1.45 ± 0.48 cm. Mean number of portal tracts (NoP) was 11±4.6. Mean length of LBC was greater (1.60±0.45 cm) in stage 4 (n=41; 27.3 ...


The Clinical, Endoscopic And Histological Spectrum Of The Solitary Rectal Ulcer Syndrome: A Single-Center Experience Of 116 Cases, Shahab Abid, Ali Khawaja, Salima Ahmed Bhimani, Zubair Ahmad, Saeed Hamid, Wasim Jafri 2017 Aga Khan University

The Clinical, Endoscopic And Histological Spectrum Of The Solitary Rectal Ulcer Syndrome: A Single-Center Experience Of 116 Cases, Shahab Abid, Ali Khawaja, Salima Ahmed Bhimani, Zubair Ahmad, Saeed Hamid, Wasim Jafri

Zubair Ahmad

Background Solitary rectal ulcer syndrome (SRUS) is an uncommon although benign defecation disorder. The aim of this study was to evaluate the variable endoscopic manifestations of SRUS and its association with other diseases. Methods All the patients diagnosed with SRUS histologically from January 1990 to February 2011 at The Aga Khan University, Karachi were included in the study. The medical records were reviewed retrospectively to evaluate the clinical spectrum of the patients along with the endoscopic and histological findings. Results A total of 116 patients were evaluated. The mean age was 37.4 ± 16.6 (range: 13–80) years, 61 ...


Gastric Juice For The Diagnosis Of H Pylori Infection In Patients On Proton Pump Inhibitors, Javed Yakoob, Shahid Rasool, Z Abbas, Wasim Jafri, Shahab Abid, Muhammad Islam, Zubair Ahmad 2017 Aga Khan University

Gastric Juice For The Diagnosis Of H Pylori Infection In Patients On Proton Pump Inhibitors, Javed Yakoob, Shahid Rasool, Z Abbas, Wasim Jafri, Shahab Abid, Muhammad Islam, Zubair Ahmad

Zubair Ahmad

Aim:To determine the efficacy of gastric juice polymerase chain reaction (PCR) for the detection of H pylori infection in comparison with histology and gastric antral biopsy PCR in Patients on a proton pump inhibitor (PPI). Methods: Eighty-five consecutive Patients with dyspeptic symptoms were enrolled. Gastric biopsies for histology, PCR and gastric juice were collected at endoscopy for PCR of the H pylori urease C gene (ure C). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive and negative likelihood ratio for PCR of gastric juice for the H pylori ure C gene was compared to histology ...


Distribution Of Helicobacter Pylori Virulence Markers In Patients With Gastroduodenal Diseases In Pakistan, Javed Yakoob, Shahab Abid, Zaigham Abbas, Wasim Jafri, Zubair Ahmad, Rashida Ahmed, Muhammad Islam 2017 Aga Khan University

Distribution Of Helicobacter Pylori Virulence Markers In Patients With Gastroduodenal Diseases In Pakistan, Javed Yakoob, Shahab Abid, Zaigham Abbas, Wasim Jafri, Zubair Ahmad, Rashida Ahmed, Muhammad Islam

Zubair Ahmad

Background: Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in Patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU). Methods: H. pylori infection established by both rapid urease test and histology were studied. The cagA and vacA allelic status was determined by polymerase chain reaction (PCR). Sequencing of vacA i1 and i2 PCR product was carried out. Results: Two hundred and twenty-four Patients were included, 141 ...


Gastric Corpus Polyps Associated With Proton Pump Inhibitors Therapy, Javed Yakoob, Zaigham Abbas, Wasim Jafri, Zubair Ahmad 2017 Aga Khan University

Gastric Corpus Polyps Associated With Proton Pump Inhibitors Therapy, Javed Yakoob, Zaigham Abbas, Wasim Jafri, Zubair Ahmad

Zubair Ahmad

The prevalence of Gastroesophageal Reflux Disease (GERD) is rapidly rising in Asia. We describe here a case of 51 years old man who had surgery for esophageal leiomyoma and received long-term therapy with Proton Pump Inhibitors (PPIs) for persisting reflux symptoms. On Esophago-Gastroduodenoscopy (EGD) several sessile polyps were seen in the gastric corpus. Earlier EGD done 15 years back had not demonstrated those polyps. Sections revealed polypoid fragments of glandular epithelium with dilated glands and negative histology for H. pylori. Polymerase chain reaction for 16S ribosomal RNA gene (16S rRNA PCR) of H. pylori was also negative. This is the ...


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