A deep learning framework for autonomous detection and classification of Crohnʼs disease lesions in the small bowel and colon with capsule endoscopy

Background and study aims Small bowel ulcerations are efficiently detected with deep learning techniques, whereas the ability to diagnose Crohnʼs disease (CD) in the colon with it is unknown. This study examined the ability of a deep learning framework to detect CD lesions with pan-enteric capsule endoscopy (CE) and classify lesions of different severity. Patients and methods CEs from patients with suspected or known CD were included in the analysis. Two experienced gastroenterologists classified anonymized images into normal mucosa, non-ulcerated inflammation, aphthous ulceration, ulcer, or fissure/extensive ulceration. An automated framework incorporating multiple ResNet-50 architectures was trained. To improve its robustness and ability to characterize lesions, image processing methods focused on texture enhancement were employed. Results A total of 7744 images from 38 patients with CD were collected (small bowel 4972, colon 2772) of which 2748 contained at least one ulceration (small bowel 1857, colon 891). With a patient-dependent split of images for training, validation, and testing, ulcerations were diagnosed with a sensitivity, specificity, and diagnostic accuracy of 95.7 % (CI 93.4–97.4), 99.8 % (CI 99.2–100), and 98.4 % (CI 97.6–99.0), respectively. The diagnostic accuracy was 98.5 % (CI 97.5–99.2) for the small bowel and 98.1 % (CI 96.3–99.2) for the colon. Ulcerations of different severities were classified with substantial agreement (κ = 0.72). Conclusions Our proposed framework is in excellent agreement with the clinical standard, and diagnostic accuracies are equally high for the small bowel and colon. Deep learning approaches have a great potential to help clinicians detect, localize, and determine the severity of CD with pan-enteric CE.

Aphthous Ulceration – Risk Factors Among Dental Students at Khyber College of Dentistry, Peshawar

OBJECTIVES: The aim of this study was to assess the risk factors of aphthous ulceration (AU) among dental students. METHODOLOGY: This cross-sectional study was conducted at Khyber College of Dentistry, Peshawar in March 2021 among dental students of all four professional years. It was a questionnaire-based study. Questionnaire comprised of demographics and questions about aphthous positivity, risk factors. Risk factors were stress, family history, menstruation (hormonal changes), food allergy, gastrointestinal diseases and medication. Most questions were closed ended. Hospital Anxiety, and Depression Scale (HADS) was used to assess anxiety and depression. RESULTS: Total of 245 dental students responded to questionnaire. Out of 245 dental students, 117 (47.8%) gave a positive history of AU. Mean age in AU positive subjects was 23±1.5 years. AU was seen in males (48.7%) and females (51.3%) with no association between them. Among risk factors, 69 (28.2%) had positive family history, 93 (38%) had stress and 8 (3.3%) reported menstruation. Present study included spice (3.7%), fast food (0.4%), sweets (0.4%), dry fruit (0.4%) and walnut (0.4%) as food allergies related to AU. Only 13 (5.3%) reported a gastrointestinal disease. Medication like NSAIDS and antihypertensive were not involved in any AU case. Anxiety and depression was present in 65% and 38.5% with AU positivity. CONCLUSION: Stress was the most common risk factor and positive family history turned out to be the second common risk factor for AU among dental students.

Spontaneously Regressing Neonatal Oral Aphthous Ulceration of the Palate

Background. Neonatal oral aphthous ulceration of the palate also known as Bednar’s aphthae is not an uncommon presentation. They clinically present as spontaneously regressing, shallow, and symmetrical ulcers on the posterior palate of newborns from 2 days up to 6 weeks of age. Case Presentation. We, herein, report a case of a one-month-old baby girl who presented with an ulcer in the posterior palate and intermittent mild fever. The patient was admitted and monitored in the ward. Haematologic investigations disclosed features of ongoing infection. Nasogastric feeding was commenced to avoid any irritation of the ulcer, and glycerine was applied on the ulcer. Antibiotic therapy was continued because of the intermittent mild fever. The lesion healed spontaneously within one week, and fever subsided afterwards. Currently, the patient is faring healthily without any complications. Conclusion. Although Bednar’s aphthae is not a rare presentation, clinicians are often met with a diagnostic dilemma due to the alarming clinical presentation of this condition. Therefore, it leads to overinvestigation and overtreatment. With this case report, we would like to highlight the importance of being aware of this condition to provide the patients with the appropriate treatment.

Comparative study of the antioxidant effects of lavender and flax oils in recurrent aphthous ulceration treatment

Background: Recurrent aphthous ulceration (RAU) is an inflammatory condition of unknown etiology characterized by painful recurrent (single or multiple) ulcerations of the oral mucosa. It is one of the most common and poorly understood mucosal disorders. It occurs more frequently in times of stress. Local and systemic conditions, genetic, immunologic, microbial factors, and oxidative stress may play a role in the pathogenesis of RAU. The objective of this study was to evaluate the free radical metabolism and antioxidant activity of RAU patients treated by lavender or flax oil paint. Materials and Methods: Sixty-six RAU patients were enrolled in this prospective randomized double-blind placebo-controlled study. Analysis of the plasma levels of malondialdehyde (MDA), glutathione (GSH), Nitric oxide (NO), myeloperoxidase (MPO), Vit. E, Vit. C, and Trolox equivalent antioxidant capacity (TEAC) were determined. The ulcer size, healing time, and healing process were correlated to the plasma levels of the studied parameters for the assessment of the antioxidant mechanism of action of lavender and flax oil paint in the treatment of RAU. Results: Statistical analysis showed that lavender antioxidant action was higher than flax oil paint compared to placebo. The decreased oxidative stress and the damage caused by free radicals was significant in the lavender group than both flax group and placebo (P<0.001). Conclusion: This study proves the significant antioxidant mechanism of both lavender and flax in the treatment of RAU patients. Keywords: Recurrent aphthous ulceration (RAU), oxidative stress, antioxidants, lavender, flax

The knowledge of Iraqi Dentist about the diagnosis of common orallesions

Background: the scientific knowledge of dentist regarding the diagnosis of common oral lesions may vary. Oral aphthous ulceration, oral lichen planus, pyogenic granuloma and oral irritating fibroma are common oral lesions. Objectives: The aim of this study is to assess the knowledge of Iraqi dentist about the ability to diagnose the common oral lesions. Materials and methods: A two hundred and seventy-eight dentist from both the health and education sectors were including in the questionnaire. The questionnaire included four pictures of common oral lesion that the dentist might see during his daily work and the question was (what is the most probable diagnosis?) Results: The overall assessment of knowledge of dentist regarding the four oral lesions is shown in table (6) with the higher mean of score for the diagnosis of aphthous ulceration (1.75), while the least mean of score was for the diagnosis of lichen planus (1.61). The total mean of scores of the knowledge of all dentists for the diagnosis of the four oral lesions was moderate (1.66). Conclusions: This study showed that the Iraqi dentist’s knowledge about the diagnosis of lichen planus, pyogenic granuloma and fibroma was moderate knowledge, while for the diagnosis of aphthous ulceration the assessment was good and better than other lesions. Bangladesh Journal of Medical Science Vol.19(2) 2020 p.304-309

Recurrent Aphthous Ulcers (RAS) and Its Prevalence among People of Punjab

OBJECTIVE: At times neglected, an oral ulcer is usually benign in nature and resolves spontaneously, howevers, a small proportions of it are malignant in nature.AIM: To determine the prevalence of recurrent aphthous ulcers (RAS) screened in different locations in the Indian state of Punjab.Material and Methods: over a period of three months, a total of 2245 patients were screened among various camps organized around various states of Punjab using an ADA Type IV examination with recording a detailed family and medical history. Data was analysied using SPPS version 19.0.RESULTS: 779 patients presented with recurrent aphthous ulceration (34.7%). Females (413, 53.1%) were more commonly affected than males (366, 46.9%) with those being affected in the Patients in the third and fourth decade of their life and this difference was statistically significant. The most factor associated was stress stomatitis seen in 453 patients (58.2%). Food consumed was the second common factor related with the condition (121 patients, 15.5%), closely followed by nutritional deficiency (113 patients, 14.5%). There were no significant difference seen between any of the factors and the occurrence of RAS in the patients.CONCLUSION: It was revealed that recurrent aphthous ulceration is a common mucosal disorder in the people of Punjab. Early, proper and prompt diagnosis of the ulcers will help the dental practitioner in providing information to the patient, educate the patient regarding this condition and regarding and management of the condition.