Govaresh
Volume:29 Issue: 3, Autumn 2024

Colorectal cancer is known as one of the most common cancers with a high mortality rate. Early diagnosis of the disease helps to reduce mortality. Regarding the rapid development of artificial intelligence (AI) models for the diagnosis of different cancers, this study compares the diagnostic performance of AI models with the ability of experts or non-expert endoscopists to diagnose cancerous polyps.

The present study was conducted as a systematic review in PubMed, Scopus, and Web of Science databases, as well as those studies that were designed according to the research question and referenced methods to compare the performance of endoscopists and AI models. Data extraction was done by two researchers, and the criteria for comparison were accuracy, sensitivity, specificity, and positive and negative predictive values.

Out of the total 838 articles obtained from the database search, 112 duplicates and 683 irrelevant records were excluded. Besides, 35 records were removed after content analysis, and finally, nine articles remained for data extraction. Based on the results, AI-based models can improve the diagnostic performance of less experienced experts. However, by considering quantitative performance indicators such as accuracy, sensitivity, and specificity, the performance of experienced endoscopists was significantly higher than AI models and the less experienced experts.

AI-based models can be suitable for improving the diagnostic performance of endoscopists; however, the focus of using these models should be on helping less experienced ones.

Cirrhosis is a significant public health concern, causing approximately 790,000 deaths annually. Despite the possibility of adverse effects from analgesics, which can be fatal and preventable, guidelines for their use in this setting do not exist, and there is a lack of research in this field. Thus, this review aims to summarize and analyze published data on different opioids in patients with liver cirrhosis to provide possible evidence-based guidelines for the safe use of opioids. Both compensated and decompensated patients should avoid NSAIDs. Because of the risk of hepatic encephalopathy, opioids must be avoided or used sparingly at low and infrequent doses. A long-term follow-up is required for toxicity, adverse effects, and complications of all pain relievers.

In patients undergoing liver transplantation (LT), the risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the severity of the consequences are almost unknown. Therefore, this study aimed to examine the influencing factors in the relationship between LT and the consequences of coronavirus disease 2019 (COVID-19).

In this cross-sectional study, all individuals with a history of LT who contracted COVID-19 through the Liver Transplantation Clinic, Imam Khomeini Hospital Complex, Tehran, Iran, were recruited during the 2 years of the COVID-19 pandemic from March 2020 to March 2022. The required data were extracted from patients’ medical records and hospital databases. The analyses were conducted using IBM SPSS software version 22.

162 patients were studied. The mortality prevalence was 24.1%. A significant relationship was found between COVID-19 severity and the number of LTs, presence of pulmonary involvement, need for remdesivir and steroid treatment, and death. Also, a significant relationship was found between death and age at the time of LT, lung involvement, early infection (within one month after LT) with COVID-19, and the need for hospitalization due to COVID-19. A significant relationship was found between liver enzyme disorders (elevated alanine and aspartate transferase levels [>40 U/L] and bilirubin levels [>1.5 mg/dL]) and early infection with COVID-19, severe COVID-19 involvement, pulmonary involvement, need for remdesivir and steroid treatment, and death due to COVID-19.

Advanced age, pulmonary involvement, dependence on corticosteroid and remdesivir treatment, the number of LTs, and elevated liver enzyme levels were significant risk factors associated with severe COVID-19 and mortality.

Patients with inflammatory bowel diseases (IBDs) are at high risk of contracting hepatitis B virus (HBV) or its reactivation due to surgical procedures, blood transfusions, and immunosuppressive therapy. Little is known about the HBV immune status in patients with IBD.

We aimed to evaluate the HBV serology of adult patients with IBD in Mashhad, northeastern Iran.

A cross-sectional study was conducted among patients with IBD referred from Mashhad gastrointestinal clinics between June 2021 and August 2022. Demographic and other related data were collected. Hepatitis B surface antigen (HBS-Ag), hepatitis B surface antibody (anti-HBS Ab), and hepatitis B core protein antibody (anti-HBC Ab) were measured. Patients were classified into sub-groups of chronic HBV infection, past HBV infection, effective vaccination, and non-immune against HBV. A decision tree (DT) algorithm was applied to analyze data. Results also were performed using SPSS software version 23.0 at a significant level of 0.05.

90 patients (30 with Crohn’s disease and 60 with ulcerative colitis) with an average age of 40.48±15.1 years were examined. 35.6% were men. The rate of past HBV infection and chronic HBV infection was 4.4% and 1.1%, respectively. Effective vaccination was 31.1%, and non-immunity against HBV was 63.4%. Use of biological agents was significantly higher among subjects with IBDs ≥10 years (P=0.032). The DT model showed that type of therapy, type of disease, and sex have the most effect on effective vaccination development and anti-HBS Ab level.

We recommend fully vaccinating seronegative patients with IBD before the initiation of immunosuppressive therapy and routinely monitoring anti-HBS Ab levels, especially in patients under combined therapy.

In light of the relatively low prevalence of epidermolysis bullosa and the absence of research focused on gastrointestinal complications in Iran, our study sought to address this gap. Given the limited body of knowledge in this particular area, there is a crucial need to explore and identify gastrointestinal complications in patients with epidermolysis bullosa and understand the associated factors.

The present study was conducted cross-sectionally. 67 patients with epidermolysis bullosa were selected by census and included in the study. Demographic information of patients, including age and sex, was recorded. The patients were fully examined by a gastroenterology specialist, and a history was taken for gastrointestinal diseases. The data were statistically analyzed using the SPSS software, version 28.

67 individuals with epidermolysis bullosa were evaluated for this investigation. The patients had simplex (23.9%), dystrophic (29.9%), junctional (4.5%), and unknown (41.8%) varieties of epidermolysis bullosa. Halitosis (64.2%), constipation (59.7%), food stuck in the throat (56.7%), mouth ulcers (52.2%), flatulence (50.7%), stomach discomfort and unpleasant taste in the mouth (47.8%), difficult swallowing (44.8%), and reflux (37.3%) were the most frequent gastrointestinal problems among these individuals.

The current study found that gastrointestinal issues are widespread in individuals with epidermolysis bullosa; hence, it is advised that suitable preventative and therapeutic measures be implemented, as well as multispecialty therapy.

Illness anxiety disorder (IAD) is a psychiatric condition marked by excessive concern about having or developing a serious, undiagnosed medical issue. It is a well-known condition for psychiatrists and most other physicians. However, this diagnosis is often considered in cases such as cancer, multiple sclerosis (MS), or acquired immune deficiency syndrome (AIDS). Regarding IAD, we found a case with a fear of appendicitis, which is very rare and interesting. In this report, we have documented an unusual and rare case of a 31-year-old married woman with a specific fear of developing appendicitis. The patient had overrated thoughts that have interfered with her life. Examinations by surgeons and gastroenterologists have not confirmed anything. Instead, the patient was experiencing a series of psychological issues and mental conflicts. She underwent clinical assessments for evaluation of other possible physical disorders, including irritable bowel disease. Fear of appendicitis can be considered a rare case of IAD, which will create a challenge between gastroenterologists and general surgeons.

This case has been reported in line with the SCARE 2020 criteria. The volvulus of the transverse colon is rare when compared with the cecal and sigmoid volvulus. Cases involving simultaneous volvulus of the transverse colon and another colonic segment are extremely rare. In adolescents, sigmoid volvulus is rare, and because of this, diagnosis is usually missed or delayed. Volvulus is commonly defined as a twisted loop of the intestinal bowel and associated mesentery around a fixed point at its base. Surgery is the main course of treatment for volvolus, ranging from simple detorsion to right colectomy. Sigmoid volvulus remains an uncommon cause of intestinal obstruction among adolescents. A high index of suspicion is necessary to reach a diagnosis and manage accordingly. A delay in diagnosis can lead to complications such as necrosis and perforation of the twisted colon. Caecal volvulus is a rare cause of bowel obstruction, mainly caused by an exceedingly mobile caecum. Early diagnosis can be difficult due to its unspecific symptoms. Computed tomography (CT) plays a major role in diagnosis. The main course of treatment is surgical, and modalities depend on various factors such as patient status and perioperative findings. Currently laparoscopic evolution continues to reduce postoperative morbidity. Transverse colon volvulus is an uncommon cause of intestinal obstruction. It is a surgical emergency that can lead to bowel infarction, peritonitis, and death. Our case was a 52-year-old woman just with abdominal distention. We performed CT for her and found triple volvulus of the large bowel. In history, she had signs for 10 days in 3 years before. We operated on her, and a total colectomy and anastomosis of the small bowel to rectum was done and discharged her healthy. The surgical options in the management of acute large bowel obstruction, as a consequence of transverse colon volvulus, are one- or two-stage procedures.

Chilaiditi syndrome is a rare condition incidentally found in radiography of the chest and abdomen. It may be associated with transient dyspnea and abdominal or chest pain. Herein, we present a man with ischemic heart disease who was incidentally found to have Chilaiditi sign. A 65-year-old man, a known case of ischemic heart disease who had undergone percutaneous coronary intervention twice, the last of which was 10 months before, presented with dyspnea on exertion in the last week. On physical examination, he had no abnormal findings. A chest radiograph showed the interposition of a segment of the colon in between the liver and right hemidiaphragm, a condition called Chilaiditi sign. For the possibility of in-stent restenosis of the coronary arteries, the patient was visited by a cardiologist who followed the patient up and finally ruled out the diagnosis based on his clinical judgment, electrocardiography, and serum troponin. After 10 months of follow-up, the patient is doing well. The presence of Chilaiditi sign may lead to a false-positive diagnosis of diaphragmatic hernia. Chilaiditi syndrome may cause transient dyspnea; however, persistent dyspnea on exertion in a patient with ischemic heart disease should primarily be attributed to cardiovascular causes rather than the Chilaiditi syndrome.