No abstract

Serrated pathway polyps are a relatively new area of interest in the field of colorectal cancer screening and prevention. Akin to conventional adenomas, some serrated polyps (SPs) have the potential to develop into malignant serrated neoplasms, yet little is known regarding risk factors for these lesions. Early epidemiological studies of hyperplastic polyps (HPs) were performed without knowledge of the serrated pathway, and likely included a mixture of SPs. More recently, studies have specifically evaluated premalignant SPs, such as the sessile serrated adenoma (SSA) or surrogates for these polyps such as large or proximally-located SPs. SPs share some risk factors with conventional adenomas, and have been associated with tobacco use, obesity, and age. Nonsteroidal anti-inflammatory drug (NSAID) use, fiber, folic acid, and calcium have been associated with reduced risk of SPs. Studies focused on SSAs specifically have reported associations with age, female sex, smoking, obesity, diabetes, and possibly diets high in fat, carbohydrates, and calories. Higher education has also been associated with risk of SSAs, while an inverse association between NSAID use and SSAs has been reported. Risk factors for traditional serrated adenomas (TSAs) are largely unknown. Studies are largely limited by varying inclusion criteria, as well as differences in pathological classification schemes. Further epidemiological studies of SPs are needed to aid in risk stratification and screening, and etiological research.

Drug-induced liver injury (DILI) remains a significant clinical challenge and is the leading cause of acute liver failure in most countries. An aging population that uses more medications, a constant influx of newly developed drugs and a growing risk from unfamiliar herbal and dietary supplements will make DILI an increasing part of clinical practice. Currently, the most effective strategy for disease management is rapid identification, withholding the inciting agents, supportive care and having a firm understanding of the expected natural history. There are resources available to aid the clinician, including a new online “textbook” as well as causality assessment tools, but a heightened awareness of risk and the disease’s varying phenotypes and good history-taking remain cornerstones to diagnosis. Looking ahead, growing registries of cases, pharmacoepidemiology studies and translational research into the mechanisms of injury may produce better diagnostic tools, markers for risk and disease, and prevention and therapeutics.

Bus systems provide a versatile form of public transportation with the flexibility to serve a variety of access needs throughout an urban area. Efficient operation of the public transport is a key factor for the improvement of living condition in Dhaka city. Transport service performance should be assessed from the passengers' perspectives to evaluate these perceptions in transportation planning. The exploration of service quality of bus is essential in order to provide a better service in future. The objective of this research is to access overall customer satisfaction in public bus transport of Dhaka city. A questionnaire survey was conducted in five locations in Dhaka city. Bus users' satisfaction was analyzed by discrete choice logit model towards quality, reliability, safety and security and service provided by buses functioning in Dhaka city. The result indicated that more than half of the respondents believed that the present condition of bus service is not satisfactory. In case of the quality of buses, people think that the body and sitting arrangement of the buses are uncomfortable. Regarding the safety and security condition, main three reasons of dissatisfaction of passengers' are unsafe driving practices, poor boarding and alighting facilities and lack of law enforcing agencies surveillance. Reasons which make the service unsatisfactory include irregular service provided by buses, regular overcrowding, lack of good standard buses and lack of cleanliness. In spite of these negative views, users' possessed a positive attitude for buses which is the low travel cost.

Colonoscopy offers incomplete protection from colorectal cancer, particularly in the right colon. Part of this inadequacy may be related to serrated neoplasia. Serrated polyps of the colorectum are now understood to be a heterogeneous group of polyps, some of which are cancer precursors, such as the sessile serrated adenoma (SSA) and the traditional serrated adenoma (TSA). In contrast to conventional adenomas, there is limited published literature on the epidemiology and natural history of these lesions. Furthermore, existing guidelines regarding screening and surveillance practices for these polyps are based largely on expert opinion without firm evidence. In this review, we describe the current understanding of the molecular biology, histopathology, and endoscopic features of serrated neoplasia of the colorectum, with an emphasis on aspects relevant to the practicing gastroenterologist.