Jalpa Devi's research while affiliated with Washington University in St. Louis and other places

This study scrutinizes gender representation in invited faculty and conference committee leadership at key gastroenterology and hepatology conferences in Pakistan over five years, exploring the impact of the “glass ceiling” and “sticky floor” phenomena on gender diversity within academic medicine. This cross-sectional study was conducted between January and March of 2023. The three major national societies of gastroenterology and hepatology in Pakistan that had been established for more than 10 years and the scientific programs of their annual conferences, which were publicly accessible, were included and coded as Society 1, Society 2 and Society 3 to maintain anonymity. The scientific programs for the last five years (2018–2022) were retrieved. The roles of invited faculties were identified as invited speakers, moderators, chairs/panelists, presidents and chairs of organizing or scientific committees and the gender makeup of the faculty was compared. Regression analysis was used to evaluate the trends for female representation over time for each role. Significant gender disparity was evident by an extremely lower cumulative proportion of female invited faculty compared to males (211 [11.9%] vs. 1567 [88.1%], p 0.001). The predominance of invited male faculty was observed across all societies as well as in various roles of invited faculty (p 0.01). A significant disparity has also been observed in leadership positions of all three societies (43 [95.5%] males vs. 2 [4.5%] females, p 0.001), while the trend of women’s underrepresentation across all societies remained almost unchanged over time (slope = 0.08, R2 = − 0.078, p-value = 0.875). Our study unveils striking gender disparities in women’s representation as invited speakers and other roles at the annual scientific conferences of major gastroenterology and hepatology. Additionally, male dominance remains entrenched, notably in leadership positions, necessitating a proactive, multifaceted approach to rectify gender inequities.

Crohn’s disease (CD), a chronic inflammatory bowel disorder, manifests in various phenotypes, with fistulizing perianal CD (CD-PAF) being one of its most severe phenotypes. Characterized by fistula formation and abscesses, CD-PAF impacts 17% to 34% of all CD cases and with a significantly deleterious impact on patient’s quality of life, while increasing the risk for anorectal cancers. The pathogenesis involves a complex interplay of genetic, immunological and environmental factors, with cytokines such as tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) playing pivotal roles. Diagnostic protocols require a multi-disciplinary approach including colonoscopy, examination under anesthesia and magnetic resonance imaging. In terms of treatment, biologics alone often prove inadequate, making surgical interventions such as setons and fistula surgeries essential. Emerging therapies such as mesenchymal stem cells are under study. The South Asian context adds layers of complexity, including diagnostic ambiguities related to high tuberculosis prevalence, healthcare access limitations and cultural stigma toward perianal Crohn’s disease and ostomy surgery. Effective management necessitates an integrated, multi-disciplinary approach, especially in resource-constrained settings. Despite advances, there remain significant gaps in understanding the disease’s pathophysiology and a dearth of standardized outcome measures, underscoring the urgent need for comprehensive research.

BACKGROUND Perianal fistulizing Crohn’s disease (CD-PAF) is difficult to treat, and several MR scoring systems have been developed to assess treatment response. OBJECTIVE To assess the relationship between CD-PAF MR scoring systems and radiologists’ subjective assessment of CD-PAF severity and treatment response on baseline and follow-up pelvic MR. METHODS Retrospective single-institution study of consecutive symptomatic CD-PAF patients who underwent pelvic MR before and ≥3 months after initiating biologic therapy during a 10-year period (December 2011 to December 2021). One of four radiologists interpreted baseline and follow-up MRs. Scoring systems included variables in the modified Van Assche index (mVAI), magnetic resonance novel index for fistula imaging in CD (MAGNIFI-CD), and pediatric MR-based perianal Crohn’s disease (PEMPAC) index. For initial and follow-up MR, a 5-point Likert scale assessed severity (1=mild, 3=moderate, 5=marked). On follow-up MR, radiologists evaluated fistula response as 1-improved, 3-stable, or 5-worsened CD-PAF severity. All four study radiologists scored the baseline MR in 20 patients to calculate inter-reader agreement statistics. Interrater reliability was assessed with the Krippendorff α coefficient for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS The cohort included 96 CD-PAF patients (50 men; mean age=33.0 years) with 192 baseline and follow-up MRs. Agreement between radiologists was moderate to substantial for the MAGNIFI-CD, mVAI, PEMPAC, and Likert scores, with ICC values of 0.716, 0.756, 0.535, and 0.679, respectively. Individual components of MR scoring systems had fair to substantial agreement (Alpha: 0.195 to 0.730). Significant univariate associations were found between MR scoring systems and radiologists’ Likert severity assessments (p<.001, Pearson correlation coefficients ≥.820). In patients meeting criteria for change in disease severity (n=17), all scoring systems demonstrated AUC values ≥.93. CONCLUSION The MR scoring systems for CD-PAF (MAGNIFI-CD, mVAI, and PEMPAC) demonstrated strong associations with radiologists’ subjective assessments of severity and treatment response on baseline and follow-up pelvic MR. These scoring systems demonstrated better inter-reader agreement compared to individual MR factors. CLINICAL IMPACT The introduction of new medical therapies for CD-PAF and the growing utilization of MR fistula response in CD-PAF highlight the importance of a standardized approach in defining changes in CD-PAF severity on MR. Table 1 Inter-reader reliability perianal Crohn’s disease MR scoring systems and length of fistula tract

Recently, a single letter change has taken the world by storm. A group of experts have developed a consensus to upgrade the term non-alcoholic fatty liver disease (NAFLD) to metabolic associated fatty liver disease (MAFLD), suggesting that MAFLD would more accurately reflect not only the disease pathogenesis but would also help in patient stratification for management with NAFLD. However, the difference of opinion exists, which has made the NAFLD vs MAFLD debate the current talk of the town. This review will focus on the plausibility and implications of redefining NAFLD as MAFLD.