Mendiratta, Ayushi

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide, accounting for approximately 10% of all cancer cases. Despite the proven effectiveness of conventional screening modalities such as colonoscopy and fecal immunochemical testing (FIT), their invasive nature, high cost, and limited patient compliance hinder widespread adoption. Recent advancements in artificial intelligence (AI) and bowel sound-based signal processing have enabled non-invasive approaches for gastrointestinal diagnostics. Among these, bowel sound analysis—historically considered subjective—has reemerged as a promising biomarker using digital auscultation and machine learning. Objective: This review explores the potential of AI-powered bowel sound analytics for early detection, screening, and characterization of colorectal cancer. It aims to assess current methodologies, summarize reported performance metrics, and highlight translational opportunities and challenges in clinical implementation. Methods: A narrative review was conducted across PubMed, Scopus, Embase, and Cochrane databases using the terms colorectal cancer, bowel sounds, phonoenterography, artificial intelligence, and non-invasive diagnosis. Eligible studies involving human bowel sound-based recordings, AI-based sound analysis, or machine learning applications in gastrointestinal pathology were reviewed for study design, signal acquisition methods, AI model architecture, and diagnostic accuracy. Results: Across studies using convolutional neural networks (CNNs), gradient boosting, and transformer-based models, reported diagnostic accuracies ranged from 88% to 96%. Area under the curve (AUC) values were ≥0.83, with F1 scores between 0.71 and 0.85 for bowel sound classification. In CRC-specific frameworks such as BowelRCNN, AI models successfully differentiate abnormal bowel sound intervals and spectral patterns associated with tumor-related motility disturbances and partial obstruction. Distinct bowel sound-based signatures—such as prolonged sound-to-sound intervals and high-pitched “tinkling” proximal to lesions—demonstrate the physiological basis for CRC detection through bowel sound-based biomarkers. Conclusions: AI-driven bowel sound analysis represents an emerging, exploratory research direction rather than a validated colorectal cancer screening modality. While early studies demonstrate physiological plausibility and technical feasibility, no large-scale, CRC-specific validation studies currently establish sensitivity, specificity, PPV, or NPV for cancer detection. Accordingly, bowel sound analytics should be viewed as hypothesis-generating and potentially complementary to established screening tools, rather than a near-term alternative to validated modalities such as FIT, multitarget stool DNA testing, or colonoscopy.

Objective To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education. Methods The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ 2 test was performed to determine the association between gender and different violence forms. Results A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26–35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26–65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55–65 age group, which lost statistical significance. Conclusion This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

Abstract Background Although visceral leishmaniasis is endemic in various parts of India, management is still a challenge due to multiple drug resistance. Here we describe a case of a 50 years old female who was diagnosed with visceral leishmaniasis at a tertiary care hospital in northern parts of India and was managed with a repeated trial of liposomal Amphotericin B. Methods Case Discussion: The patient presented in the outpatient department with recurrent fever, mild intermittent abdominal discomfort associated with generalized weakness for the past one month. On per abdomen examination the patient had splenomegaly with spleen palpable 8 cm below the left costal margin. Blood investigations were suggestive of pancytopenia (leukocyte of 1800/cumm, Hemoglobin 7 g/dl, Platelet count: 80,000/cumm) along with severe neutropenia (Absolute neutrophil count: 400/cumm) . The CT abdomen showed massive splenomegaly (23 cm) with mild hepatomegaly . Leishmania Immunoglobulin G was positive. Bone marrow biopsy revealed hyperproliferative marrow with plasmacytosis (12-15%). Bone marrow Leishman-Donovan bodies were negative. Serum immunofixation was negative for M spike and serum light chain assay was also negative. She was managed with liposomal Amphotericin B (3mg/kg) for 7 days and was subsequently discharged. After 3 months, the patient again presented with continuous fever, lethargy, running nose, palpitations. Her blood work-up revealed severe pancytopenia again. She was tested for Leishmania anti- rk39 antibody, which was positive. She was given a repeat trial of Liposomal Amphotericin B with a different regimen-3 mg/kg dose on Day 1 to 5, followed by 6th dose on Day 14, followed by 7th dose on Day 21, as per the FDA approved regimen. Patient recovered well. The most recent total leukocyte counts eventually improved to 4800 with normal differential count. Platelets increased to 180,000, Hemoglobin was around 10.8g/dl and spleen was non palpable on physical examination. Results Treatment of leishmania can become complicated due to resistance to various drugs especially when a single agent is being given. Conclusion But in resource limited countries different regimens of liposomal amphotericin B can be tried which might be helpful due to speedy clinical recovery and cost effectiveness. Disclosures All Authors: No reported disclosures.