50 research outputs found
Diagnostic imaging and radiation exposure in inflammatory bowel disease.
No full textDiagnostic imaging plays a key role in the diagnosis and management of inflammatory bowel disease (IBD). However due to the relapsing nature of IBD, there is growing concern that IBD patients may be exposed to potentially harmful cumulative levels of ionising radiation in their lifetime, increasing malignant potential in a population already at risk. In this review we explore the proportion of IBD patients exposed to high cumulative radiation doses, the risk factors associated with higher radiation exposures, and we compare conventional diagnostic imaging with newer radiation-free imaging techniques used in the evaluation of patients with IBD. While computed tomography (CT) performs well as an imaging modality for IBD, the effective radiation dose is considerably higher than other abdominal imaging modalities. It is increasingly recognised that CT imaging remains responsible for the majority of diagnostic medical radiation to which IBD patients are exposed. Magnetic resonance imaging (MRI) and small intestine contrast enhanced ultrasonography (SICUS) have now emerged as suitable radiation-free alternatives to CT imaging, with comparable diagnostic accuracy. The routine use of MRI and SICUS for the clinical evaluation of patients with known or suspected small bowel Crohn's disease is to be encouraged wherever possible. More provision is needed for out-of-hours radiation-free imaging modalities to reduce the need for CT
The course of time, a poem. By Robert Pollok, A. M. With a memoir of the author, an introductory notice, a copious index, and an analysis prefixed to each poem.
No full text12th American ed.xxxii, [3]-240 p
Temporal trends in imaging and associated radiation exposure in inflammatory bowel disease.
Get PDFOBJECTIVES: Increasing use of diagnostic imaging in inflammatory bowel disease (IBD) has led to concerns about the malignant potential of ionising radiation in a cohort that have an increased lifetime risk of gastrointestinal malignancy. The aim was to quantify radiation exposure in IBD patients referred from primary care, determine predictors of high exposure and evaluate temporal trends in diagnostic imaging over a 20-year period. METHODS: This was a retrospective cohort study whereby IBD patients were recruited from the outpatient clinic and evaluated retrospectively. The total cumulative effective dose (CED) received from tests was calculated for each subject. Cox regression was performed to assess factors associated with potentially harmful levels of ionising radiation defined as total CED > 50 milli-sieverts (mSv; equivalent to five CT abdomen scans). RESULTS: The cohort included 415 patients. Median total CED was 7.2 mSv (IQR: 3.0-22.7) in Crohn's disease and 2.8 mSv (IQR: 0.8-8.9) in ulcerative colitis patients, respectively. A total of 32 patients (8%) received a CED > 50 mSv. A history of IBD-related surgery was associated with high exposure (HR 7.7). During the study period, usage of abdominal CT increased by 310%. CONCLUSION: Approximately 1 in 13 patients in the study cohort were exposed to potentially harmful levels of ionising radiation. Strategies to minimise exposure to diagnostic medical radiation in IBD patients are required
Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery.
Get PDFCONTEXT: Corticosteroids are the mainstay of medical therapies to induce remission in acute episodes of inflammatory bowel disease (IBD). However, evidence suggests that this may increase the risk of postoperative complications among patients with IBD who go on to have abdominal surgery. OBJECTIVE: To estimate the risk of postoperative complications following abdominal surgery in patients with IBD on steroids at the time of abdominal surgery. DESIGN: Meta-analysis of observational studies. METHODS: We searched medical electronic databases for full journal articles published after 1965 reporting on postoperative complications in patients with IBD undergoing abdominal surgery provided they compared patients treated with steroids with those not on steroids. We hand searched the reference lists of all retrieved articles. Two independent reviewers extracted data from studies meeting the inclusion criteria and any discrepancies were resolved by discussion. We carried out fixed effects meta-analysis, funnel plot and sensitivity analyses. RESULTS: A total of seven observational studies involving 1,532 patients met the inclusion criteria for risk of total complications, and five observational studies involving 1,714 patients met the inclusion criteria for risk of infectious complications. Pooled analysis showed an increased risk of all postoperative complications (OR 1.41, 95% confidence interval 1.07-1.87), as well as an increased risk of postoperative infectious complications (OR 1.68, 95% confidence interval 1.24-2.28) among patients on steroids. Patients who received higher doses of perioperative oral steroids (>40 mg) had a higher risk of total complications (OR 2.04 (95% CI 1.28-3.26). CONCLUSIONS: There is an increased risk of total as well as infectious complications following the use of steroids in patients with IBD
Changing nationwide patterns in UK admissions for medical therapy, surgery, lower gi endoscopy and anti-tnf infusions for inflammatory bowel disease between 2003-2013
No full textMETHODS OF ECONOMIC ANALYSIS OF POVERTY
Get PDFPoverty is one of the worst and most common oppressions that afflict humanity. This phenomenon
occurs in any community, whether rich or poor. Wherever it affects more than a few individuals,
it turns into a serious social problem. Social studies on poverty have been conducted for over
a century (in Poland they were clearly intensified over the last decade). Despite its long history,
the contemporary study is still unable to provide unambiguously a single definition of poverty or
define its causes. This fact largely hinders both a close study of this phenomenon and an effective
social policy against poverty and its results. The article attempts to summarize the results of the
research done so far on the subject, in particular concerning the notion, typology, and changing
perception of poverty. The article includes a proposed classification of poverty causes and a discussion
of its main sources indicated by the contemporary study. Furthermore, the main poverty
measurement methods have been discussed with an emphasis upon the problems involved and the
practical implication of applying study results.
Fighting poverty has been considered a priority of any country’s economic policy. According to
the author, it is paramount to create a socially desirable goods and service division system that
also promotes the production sphere as the source of universal prosperity
The course of time; a poem. With a memoir of the author ... A copious index, and an analysis prefixed to each book.
No full textMode of access: Internet
Parasitic colitis misdiagnosis as inflammatory bowel disease in high-income settings and association with poor clinical outcomes when exposed to corticosteroids: a systematic review of case reports
Get PDFSteroid use and misuse: a key performance indicator in the management of IBD
Get PDFCorticosteroids remain an important tool for inducing remission in inflammatory bowel disease (IBD) but they have no role in maintenance of remission. The significant adverse side effect profile of these drugs means their use should be avoided where possible or measures taken to reduce their risk. Despite an expanding array of alternative therapies, corticosteroid dependency and excess remain common. Appropriate steroid use is now regarded a key performance indicator in the management of IBD. This article aims to outline indications for corticosteroid use in IBD, their risks and strategies to reduce their use and misuse
