Annual report on National Clinical Database 2020 for gastroenterological surgery in Japan

Aim: The National Clinical Database (NCD) of Japan is a nationwide data entry system for surgery, and it marked its 10th anniversary in 2020. The aim was to present the 2020 annual report of gastroenterological surgery of the NCD. Methods: The data of the surgical procedures stipulated by the training curriculum for board-certified surgeons of the Japanese Society of Gastroenterological Surgery in the NCD from 2011 to 2020 were summarized. Results: In total, 5 622 845 cases, including 593 088 cases in 2020, were extracted from the NCD. The total number of gastroenterological surgeries increased gradually in these 10 years, except for the year 2020 due to the COVID-19 pandemic. The annual number of surgeries of each organ, except the pancreas and liver, decreased by 0.4%–13.1% in 2020 compared to 2019. The surgical patients were consistently aging, with more than 20% of all gastroenterological surgeries in 2020 involving patients aged 80 years or older. The participation of board-certified surgeons increased for each organ (75.9%–95.7% in 2020). The rates of endoscopic surgery also increased constantly. Although the incidences of postoperative complications of each organ increased by 0.7%–7.9% in these 10 years, postoperative mortality rates decreased by 0.2%–1.5%. Conclusions: We present here the short-term outcomes of each gastroenterological operative procedure in 2020. This review of the 10-years of NCD data of gastroenterological surgery revealed a consistent increase of the number of surgeries (except for in 2020), especially endoscopic procedures, and aging of the Japanese population. The good safety of Japanese gastroenterological surgeries was also indicated.

An Overview About Pediatric Type 1 Diabetes Mellitus

Background: Diabetes mellitus (DM) represents one of the most common metabolic diseases in the world, with rising prevalence in recent decades. Most cases are generally classified into two major pathophysiological categories: type 1 diabetes mellitus (DM1), which progresses with absolute insulin deficiency and can be identified by genetic and pancreatic islet autoimmunity markers, and type 2 diabetes mellitus (DM2), which is the most prevalent form and involves a combination of resistance to the action of insulin with an insufficient compensatory response of insulin secretion. In the last two decades, in parallel with the increase in childhood obesity, there has also been an increase in the incidence of DM2 in young people in some populations. Other forms of diabetes may affect children and adolescents, such as monogenic diabetes (neonatal diabetes, MODY – maturity onset diabetes of the young, mitochondrial diabetes, and lipoatrophic diabetes), diabetes secondary to other pancreatic diseases, endocrinopathies, infections and cytotoxic drugs, and diabetes related to certain genetic syndromes, which may involve different treatments and prognoses. DM1 is considered an immuno-mediated disease that develops as a result of gradual destruction of insulin-producing pancreatic beta cells that eventually results in their total loss and complete dependence on exogenous insulin. Clinical presentation can occur at any age, but most patients will be diagnosed before the age of 30 years

Pancreaticopleural fistula presenting as respiratory distress in previously healthy adolescent

Case Report: Respiratory distress is one of the most common complaints evaluated by pediatric providers in the office and emergency department setting. While primary cardiopulmonary processes represent the majority of cases of respiratory distress, pleural effusions of extravascular origin remain a rare but important differential. In this case, we present a previously healthy adolescent female who presented to our institution with respiratory distress and was subsequently found to have a pancreatic pleural effusion in the setting of a pancreaticopleural fistula. A 13 year old female with no chronic past medical history presented to the emergency department for three weeks of progressively worsening shortness of breath. History was notable for SARS-CoV-2 infection 6 months prior and intermittent night sweats and fevers for previous 4 weeks. She denied trauma, abdominal pain, nausea, vomiting, diarrhea, or anorexia. Her exam was notable for tachycardia, tachypnea, tripod positioning and absent breath sounds on her left. Chest computed tomography (CT) revealed left pleural effusion of entire left hemithorax with midline shift in addition to right sided pulmonary thromboembolism, small right sided pleural effusion and venous thromboses of the left internal jugular, subclavian, and proximal innominate veins. A left thoracentesis was performed, and patient was admitted to the PICU on a heparin infusion with subsequent left chest tube placement. Follow-up CT imaging revealed bilateral renal infarcts, iliac vein thrombosis, and a pancreatic fluid collection extending into the mediastinum with pancreatic ductal dilation. Magnetic resonance cholangiopancreatography further characterized the pancreatic lesion as a cystic tract traversing from the inferior mediastinum into the retroperitoneum and replacing the majority of the pancreatic gland suggesting a pancreaticopleural fistula as the source of a pancreatic pleural effusion. Serum amylase was 256 U/L and serum lipase was 575 U/L. Pleural fluid amylase was 1702 U/L and pleural fluid lipase was >2400 U/L, exceeding detection limit of this institution's lab. An extensive diagnostic work-up included infectious, hematologic, oncologic, autoimmune and rheumatologic etiologies and was largely unremarkable. Given concern for pancreaticopleural fistula, patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) which was diagnostic for pancreatic divisum. A pancreatic duct stent was placed with normalization of serumpancreatic enzymes prior to discharge and resolution of pleural effusion at one month post ERCP Although an initial episode of acute pancreatitis usually resolves with supportive care, this case is a reminder that pancreatitis can present with local and systemic complications including pulmonary effusion or venous thromboses and keeping a high index of suspicionfor it is crucial toavoid delaying diagnosis and care. Copyright © 2023 Southern Society for Clinical Investigation.

Adult onset refractory nxp2 dermatomyositis following covid 19 infection

Background: Dermatomyositis is a type of systemic inflammatory autoimmune disorder characterised by muscle inflammation and skin rashes. We present a rare adult onset refractory Nxp2 dermatomyositis following COVID 19 infection Methods: 36-year- old male came with the complaints of: Redness of right eye, Easy fatgiuability ,dysphagia of 3 months duration * Patient had uncomplicated COVID-19 1 month prior to onset of present complaints * On examination he had anasarca proximal muscle weakness and muscle tenderness and had neck and pharyngeal muscle weakness dysphagia and nasal regurgitation.He also had malar rash and periribital rash and swelling (Figure 1) * Investigations revealed biochemical radiological and Electrophysiological evidence of myositis (Table 1) * He was managed with pulse sterids ivig rituximab and tacrolimus with gradual but definite resolution Conclusion(s): Auto-antibodies against NXP2 are detected in 15% to 25% cases of Juvenile dermatomyositis and in only 1% of adult cases. This form of DM is characterized by accompanying calcinosis and severe and chronic disease course and is often carcinoma-associated (breast, uterine or pancreatic carcinoma). Post COVID NXP2 DM has not yet been reported. (Figure Presented).

PP01.22 First Lung Cancer Screening Program in Greece - Initial Experience, Preliminary Data and Pitfalls

Background: Poor prognosis of lung cancer is linked to its late diagnosis, typically in the advanced stage 4 in 50-70% of incidental cases. Lung Cancer Screening Programs provide low-dose lung CT screening to current and former smokers who are at high risk for developing this disease. Greece is an EU country, returning strong from a long period of economic recession, ranked 2nd place in overall age-standardized tobacco smoking prevalence in the EU. In December 2020, at the Metropolitan Hospital of Athens, we started the 1st Screening Program in the country. We present our initial results and pitfalls met. Method(s): A weekly outpatient clinic offers consultation to possible candidates. LDCT (<=3.0mGy), Siemens VIA, Artificial Intelligence multi-computer-aided diagnosis (multi-CAD) system and LungRADS (v.1.1) are used for the validation of any abnormal findings with semi-auto measurement of volume and volume doubling time. Patients get connected when necessary with the smoking cessation and Pulmonology clinic. USPSTF guidelines are used, (plus updated version). Abnormal CT findings are discussed by an MDT board with radiologists, pulmonologists/interventional pulmonologists, oncologists and thoracic surgeons. A collaboration with Fairlife Lung Cancer Care the first non-profit organization in Greece is done, in order to offer the program to population with low income too. An advertisement campaign was organized to inform family doctors and the people about screening programs, together with an anti-tobacco campaign. Result(s): 106 people were screened, 74 males & 32 females (mean age 62yo), 27/106 had an abnormal finding (25%). 2 were diagnosed with a resectable lung cancer tumor (primary adenocarcinoma) of early-stage (1.8%). 2 with extended SCLC (lung lesion & mediastinal adenopathy). 1 with multiple nodules (pancreatic cancer not known until then). 3 patients with mediastinal and hilar lymphadenopathy (2 diagnosed with lymphoma, 1 with sarcoidosis). 19 patients were diagnosed with pulmonary nodules (RADS 2-3, 17%) - CT follow up algorithm. Conclusion(s): We are presenting our initial results, from the first lung cancer screening program in Greece. Greece represents a country many smokers, who also started smoking at a young age, with a both public and private health sector, returning from a long period of economic recession. COVID-19 pandemia has cause practical difficulties along the way. LDCT with AI software, with an MDT board and availability of modern diagnostic and therapeutic alternatives should be considered as essential. A collaboration spirit with other hospitals around the country is being built, in order to share current experience and expertise. Copyright © 2022

Abstracts of the 2022 Pediatric Endocrine Society (PES) Annual Meeting

The proceedings contain 228 papers. The topics discussed include: congenital adrenal hyperplasia is associated with increased risk of poor cardiometabolic health;adrenal insufficiency in peroxisomal disorders;patient and parent perspectives on testicular adrenal rest tumors in congenital adrenal hyperplasia;never say never! delayed diagnosis of a rare form of congenital adrenal hyperplasia;prevalence of adrenal insufficiency in pediatric patients with acute recurrent and chronic pancreatitis who undergo a total pancreatectomy with islet auto transplantation (TPIAT);the utility of a random cortisol level in determining neonatal central adrenal insufficiency;neural correlates of obesity and inflammation in youth with congenital adrenal hyperplasia due to 21-hydroxylase deficiency;glucocorticoid dosage and dexamethasone treatment are associated with increased markers of depression in youth with classical congenital adrenal hyperplasia;and new onset primary adrenal insufficiency and autoimmune hypothyroidism in a pediatric patient presenting with MIS-C due to COVID- 19 infection.

Abdominal Imaging Findings in Patients with COVID-19 Part 2: Solid Organs

[...]although solid abdominal organs are rarely affected by COVID-19, clinicians must be familiar with the manifestations since they are associated with the disease severity and poor outcome. Keywords: COVID-19, Abdominal, Imaging, Computed tomography, Ultrasonography Introduction The world has been confronting the upsurge of coronavirus disease 2019 (COVID-19) since the first novel coronavirus infection (SARS-CoV-2) initially emerged in China in December 2019.1 The most common symptoms reported in COVID-19 are related to respiratory system involvement, including fever, dry cough, fatigue, and dyspnea.2 Angiotensin-converting enzyme 2 (ACE2) plays a significant role in mediating the inflammation of COVID-19, which can contribute to COVID-19 manifestations.3 ACE2 receptors are found in various cells, including hepatocytes, cholangiocytes, podocytes, and enterocytes.2,3 Forty percent of infected patients have shown gastrointestinal (GI) manifestations, including loss of taste, nausea, vomiting, diarrhea, and abdominal pain.4 A significant number of patients have GI symptoms, and sometimes it is the only presentation of the disease without respiratory manifestations.2 The reverse-transcriptase polymerase-chain-reaction (RT-PCR) diagnostic test and chest computed tomography (CT) were reported to be highly sensitive in the early diagnostic stage of suspected COVID-19.5 Cross-sectional abdominal imaging is not usually used in COVID-19.6 Nevertheless, abdominal CT may be performed if specific symptoms exist, such as abdominal pain. Radzina et al found that multiparametric ultrasonography may be more sensitive than CT and Magnetic resonance imaging in assessing liver damage at the cellular level in patients with COVID-19 before progressing into liver cirrhosis.37 Pancreas Given the fact that ACE2 receptors are vastly expressed in pancreatic islet cells, COVID-19 can induce islet cell damage presenting with acute diabetes.38 The pancreatic involvement can occur through the direct invasion by SARS-CoV2, a systemic response to pneumonia, or a destructive immune reaction due to viral stimulation.19 According to Wang and colleagues, the pancreas was affected in 17% of patients with COVID-19 pneumonia.19 In reported cases of SARS-CoV-2 infection, abdominal CT revealed features of acute pancreatitis, including edema and inflammation of the pancreas with surrounding fluid collections and fat stranding30-39 (Figure 3). Kidney According to Pei et al, the most prevalent renal abnormalities in the setting of COVID-19 were proteinuria and hematuria, with acute kidney injury (AKI) happening less often.50 Renal infarct might occur because of hypercoagulation.6 The possible mechanisms of AKI in COVID-19 might be related to a variety of factors, including cytokine release syndrome, hypoxia, endotoxin produced by superimposed infections during ICU admission, and rhabdomyolysis.51 Different studies have established that AKI considerably increased the mortality rate in admitted patients with COVID-19.20 Renal parenchymal hypodensity and perirenal fat stranding on non-enhancement CT in patients with COVID-19 represent severe renal impairment.52 Like the spleen, the most common renal finding in abdominal tomograms was infarction.12 In such conditions, the affected kidney presents with patchy, sharply demarcated heterogeneous areas with hypoenhancement.6 A summary of renal imaging findings is shown in Table 6.

Digestive System Involvement During Coronavirus Disease 2019, the Newest Clinical Features and Potential Mechanisms

The coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been recognized as a worldwide pandemic and mostly affects the respiratory system. A considerable proportion of patients;however, might also experience gastrointestinal (GI) manifestations. Several investigations have assessed GI and hepatic involvement in this disease, although the mechanisms of these involvements in relation to the progression of COVID-19 remain unclear. This review summarized the clinical observations and the main mechanisms behind GI, liver, and pancreatic involvement among COVID-19 patients.

Laparoscopic Roux-en-Y cysto-jejunostomy in a complicated Pancreatic Pseudocyst following SARS-CoV-2 virus pancreatitis in a child

Background: Pancreatic pseudocyst (PPC) is the rare complication of pancreatitis. Unlike to adults, it is ensued due to malunion of pancreatic ducts, autoimmune or frequently post-traumatic. During follow up although it might resolve by conservative treatment, may necessitate interventional approaches. Even endoscopic or percutaneous treatments have been the first line treatment, surgery is inevitably necessary in case of complicated or>6 cm diameter. In this study laparoscopic Roux-en-Y cysto-jejunostomy (LRYCJ), to complicated PPC that did not respond to percutaneous drainage, has been presented. Method(s): A 15-year-old boy had been admitted to state hospital with the complains of vomiting, epigastric pain two weeks after SARSCoV- 2 (SARSC2) virus infection. He has been following due to Autism. Initially he had been treated conservatively due to pancreatitis. One month after, PPC (20 mm) distal to pancreas had been specified. He was referred to our department as the cyst got bigger (75 mm) with recurrent complains. No ductal connection was identified however thrombosis of splenic vein, dilated collateral and distal esophageal variceal veins was detected. Ultrasound guided percutaneous drainage has been performed however two weeks after, 95175 mm PPC at the same location was detected. LRYCJ was performed with four ports via suspending stomach and transvers colon. While Roux-en-Y has been performed through expanded umbilical incision cysto-jejunostomy was intracorporeally performed. Penrose drain was left close to cysto-jejunostomy. Oral feeding has begun on postoperative day 2, drain was removed on day 3. Fullfed and discharged on postoperative day 4. Patient did well after a follow up of 3 months. Conclusion(s): Consequently, our case is the first reported PPC following pancreatitis owing to SARSC2 virus infection. Even endoscopic or percutaneous drainage is the most preferred approach for PPC, in case of large cyst or complicated ones, cysto-jejunostomy could be applied by minimally invasive approach in children also.

A Retrospective Study of Findings and Challenges in Conduction of Covid-19-Positive Autopsies

Objectives: In this article, we report our observations as well as the innovations which were adapted in the resource-limited settings which are present in most parts of the country. The standard protocols were adopted for complete COVID-19 autopsies that were conducted. Method(s): The present retrospective study was conducted in the Department of Forensic Medicine and Toxicology, Government Medical College, Amritsar. The medicolegal autopsies were conducted completely in confirmed positive COVID-19 cases. In the medicolegal cases, complete autopsies were conducted, where the investigating officers did not forgo the autopsy. A total of ten COVID-positive autopsies were conducted from July 2020 to August 2021. Result(s): Gross findings of various organs during autopsy include that of lungs showing relatively unremarkable lungs with mild edema and consolidation, brain showing edema, and subarachnoid hemorrhage, pancreas showing necrotic and hemorrhagic changes, and kidneys flea-bitten and were contracted. Conclusion(s): Although a complete autopsy is desired to provide the best possible understanding of the disease process, its variants, such as core biopsies and echopsies, can be taken up as safer alternatives, especially in resource-limited centres. Experience, preparation, and experience are the significant vital aspects which help in managing the COVID-19-positive autopsy. The institution needs to develop guidelines as well as standard operating procedures for the smooth and safe conduct of autopsies in COVID-19 dead bodies. Copyright © 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd.

Pathogenesis and Mechanisms of SARS-CoV-2 Infection in the Intestine, Liver, and Pancreas.

The novel coronavirus, SARS-CoV-2, rapidly spread worldwide, causing an ongoing global pandemic. While the respiratory system is the most common site of infection, a significant number of reported cases indicate gastrointestinal (GI) involvement. GI symptoms include anorexia, abdominal pain, nausea, vomiting, and diarrhea. Although the mechanisms of GI pathogenesis are still being examined, viral components isolated from stool samples of infected patients suggest a potential fecal-oral transmission route. In addition, viral RNA has been detected in blood samples of infected patients, making hematologic dissemination of the virus a proposed route for GI involvement. Angiotensin-converting enzyme 2 (ACE2) receptors serve as the cellular entry mechanism for the virus, and these receptors are particularly abundant throughout the GI tract, making the intestine, liver, and pancreas potential extrapulmonary sites for infection and reservoirs sites for developing mutations and new variants that contribute to the uncontrolled spread of the disease and resistance to treatments. This transmission mechanism and the dysregulation of the immune system play a significant role in the profound inflammatory and coagulative cascades that contribute to the increased severity and risk of death in several COVID-19 patients. This article reviews various potential mechanisms of gastrointestinal, liver, and pancreatic injury.

ENDOCRINE DISORDERS IN THE BACKGROUND OF COVID-19 AND POSTCOVID SYNDROME

The SARS-CoV-2 virus that caused the 2019 new coronavirus infection (COVID-19) pandemic has posed an unprecedented challenge to the global health system and scientific community. As of this literature review, the infection has claimed more than 6 million lives, and more than 500 million people worldwide have already been infected with SARS-CoV-2. In addition to the basic, pulmonary manifestations of the disease, as well as the severe, life-threatening complications of acute COVID-19, the long-term changes that occur in the postcovid period also affect other systems: endocrine, cardiovascular, nervous, and musculoskeletal. In this literature review, using data from current scientific publications obtained by searching <<covid-19 endocrine disorders>>, <<postcovid endocrine disorders>> and <<postcovid syndrome endocrine disorders>> in the MEDLINE (PubMed) database and <<endocrine pathology and covid-19>>, <<postcovid and endocrine pathology>> and <<postcovid syndrome and endocrine disorders>> in the e-Library database, we focused on describing and discussing the complications and consequences that SARS-CoV-2 infection can have on the endocrine glands, including the adrenals, thyroid, pituitary, gonads and pancreas. Copyright © 2022 Russian Association of Endocrinologists. All rights reserved.

Control of blood glucose levels by an artificial pancreas in patients with severe coronavirus disease 2019 pneumonia.

BACKGROUND: Many patients with severe coronavirus disease 2019 (COVID-19) pneumonia experience hyperglycemia. It is often difficult to control blood glucose (BG) levels in such patients using standard intravenous insulin infusion therapy. Therefore, we used an artificial pancreas. This study aimed to compare the BG status of the artificial pancreas with that of standard therapy. METHODS: Fifteen patients were included in the study. BG values and the infusion speed of insulin and glucose by the artificial pancreas were collected. Arterial BG and administration rates of insulin, parenteral sugar, and enteral sugar were recorded during the artificial pancreas and standard therapy. The target BG level was 200 mg/dl. RESULTS: Arterial BG was highly correlated with BG data from the artificial pancreas. A higher BG slightly increased the difference between the BG data from the artificial pancreas and arterial BS. No significant difference in arterial BG was observed between the artificial pancreas and standard therapy. However, the standard deviation with the artificial pancreas was smaller than that under standard therapy (p < 0.0001). More points within the target BG range were achieved with the artificial pancreas (180-220 mg/dl) than under standard therapy. The hyperglycemic index of the artificial pancreas (8.7 ± 15.6 mg/dl) was lower than that of standard therapy (16.0 ± 21.5 mg/dl) (p = 0.0387). No incidence of hypoglycemia occurred under the artificial pancreas. CONCLUSIONS: The rate of achieving target BG was higher using artificial pancreas than with standard therapy. An artificial pancreas helps to control BG in critically ill patients.

Pancreas and islet transplantation in the United Kingdom during the COVID-19 era

Introduction: WHO declared a pandemic of COVID-19 in March 2020. This study analyses the impact of COVID-19 on beta-cell replacement therapy in the UK. Method(s): Pancreas and islet donation and transplant activity in the period March 2020/2021 was compared with the same period the previous year. Result(s): 2,180 patients had a functioning graft during March 2020/2021. 5.8%(n=126) tested positive for COVID-19 and two died (1%). In this period there was a 43% reduction in solid organ donors n=1,615, compared with the previous year, n=2,840. Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% the previous period. 97 whole pancreas and islet transplants were performed in the UK down 54% from the prior period. Of the 84 pancreas transplant recipients;four tested positive for COVID-19 but none died, and two grafts failed within the first week from vascular thrombosis (neither were COVID-19 positive). Of the 13 SIK and islet alone transplant recipients, two tested positive for COVID-19 but neither died. Of these SIK transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period. To our knowledge, no patient receiving beta cell replacement therapy died of COVID during the first year of the pandemic despite immunosuppression. Conclusion(s): In the UK, pancreas, and islet transplantation have continued during the pandemic at a lower rate. Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior. Take-home message: Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.

Anti-SARS-CoV-2 Seropositivity Among Children With Newly Diagnosed Type 1 Diabetes Mellitus: A Case-Control Study

A sudden increase in the number of children with newly diagnosed type 1 diabetes mellitus (T1DM) was experienced during the third wave of COVID-19 epidemic in Hungary. The newly diagnosed T1DM patients had a significantly higher rate of anti-SARS-CoV-2 positivity as compared to prevalent T1DM children [OR (95% CI) 3.74 (1,08,13.55);P=0.04]. The relationship between SARS-CoV-2 infection and diabetes needs to be investigated further. Copyright © 2022, Indian Academy of Pediatrics.

Dorsal pancreatic agenesis: Case report and topic review

Complete agenesis of the dorsal pancreas (ADP) is an exceedingly rare congenital anomaly, compatible with life. It is frequently asymptomatic and usually incidentally diagnosed. In symptomatic cases, the clinical manifestations vary from abdominal pain, pancreatitis and diabetes mellitus to exocrine insufficiency with steatorrhea. We present a case report of a 28-year-old female with ADP, diagnosed incidentally during radiological evaluation for hyperglycemias during a SARS-CoV2 concomitant infection. Magnetic resonance cholangiopancreatography confirmed the absence of neck, body and tail of the pancreas. Familiarization with pancreatic embryogenesis, as well as the clinical presentation and main radiological characteristics of its anomalies is important for the proper diagnosis of these malformations.

Gastrointestinal Cancer and Vaccination Safety during COVID-19 Pandemic

BACKGROUND: During our past 18 months, we must be faced with the current COVID-19 pandemic era with much uncertainty in the continuation of multimodality treatment of the gastrointestinal cancer patients. Especially in this immunocompromised group with the history of previous chemotherapy treatment, these patients have an increased risk of COVID-19 transmission. Many studies have been reported about the current recommendation for gastrointestinal cancer patients during this pandemic, but there might be a lack of evidence about the safety of vaccination for the gastrointestinal cancer patients. AIM: Since the vaccination has been approved by our government medical support, we would evaluate the safety of the COVID-19 vaccination program in gastrointestinal cancer patients. METHODS: All gastrointestinal cancer patients who have been already diagnosed with cancer will be included in this study. The vaccine-related sign symptoms will be recorded and evaluated. The chemotherapy schedule was not been interrupted following the vaccination. The patient who refused to receive the second vaccination dose will be excluded from this study. RESULTS: Thirty-two patients were included in this study (our past 6-month evaluation from February till August 2021), colorectal adenocarcinoma was the most common gastrointestinal cancer according to organ-specific (25 patients), the others were gastric adenocarcinoma, pancreatic adenocarcinoma, and small bowel gastrointestinal stromal tumor. Both of them already received two doses of COVID-19 vaccine during this period, we reported there was no side effect related to these and the chemotherapy cycle has not been interrupted during vaccination. All of the patients could be tolerated it well and did not refuse to continue the treatment. CONCLUSION: There were no significant signs and symptoms of vaccine-related side effects on gastrointestinal cancer patients. COVID-19 vaccination during this pandemic and following the chemotherapy schedule on any kind of gastrointestinal cancer patients was safe and could be suggested as a routine protocol.

Preliminary Data of the Safety and Immunogenicity Protocol of Vaccination for SARS-CoV 2 in Solid Organ Transplant Patients in Argentina

Purpose: To evaluate the safety and generation rate of Ab anti spike rate in SOT patients at 28 and 90 days after completing the Covid 19 vaccination scheme. Method(s): Multicenter prospective study in SOT with a complete vaccination scheme who agreed to participate in the study . Demographic , vaccination: schedule;time;adverse effects and transplant variables were collected. The generation rate of antispike antibodies was evaluated by the COVIDAR-IgG method at the Universidad de Buenos Aires School of Medicine. Result(s): 113 SOT patients were included (September 6th to October 4th). Median age was 53 (IQR 42.5-63, women 36.8%). Transplant type: 72.8% renal , 13.1% cardiac, 12.3% liver, 0.9% pancreas and 0.9% lung. Deceased donors 71.1%. The median time after transplantation to vaccination was 65 months (IQR 30 120 R 2-429). Only 7% of patients developed rejection within the year prior to vaccination and no patient rejected post vaccination. 74.3% (n 84) had triple immunosuppressive maintenance regimen (steroids + calcineurin inhibitors (ICN) + antiproliferative), 24 pts (21.1%) double regimen WITHOUT steroids and 5 (4.3%) monotherapy with IC. Vaccination schedule: Sputnik 14.5%, Sputnik-Astrazeneca 4.4%, Sputnik-Moderna 28.9%, Sinopharm 3.5%, Astrazeneca 34.2%. Vaccine-related adverse events were observed in 18.4% of patients, 82% were mild. 40% of SOT responded with Antispike Ab , with a lower response rate in kidney transplantation p <0.0007 RR 0.48 (0.32-0.71) and use of triple immunosuppressive maintenance regimen p <0.00009 RR 0.419 (0.26 -0.66). Patients previously infected with Covid-19 prior to vaccine (11.45% pts), had a higher response rate p <0.0001 RR 2.58 (1.90-3.51).No patients developed COVID-19 after vaccination. Conclusion(s): In our SOT population, a lower generation rate of anti-spike Ab was observed, compared to the reported in the general population. Renal Tx and the triple IS regimen were associated with a lower response rate. Covid-19 prior to vaccination was associated with a higher antibody response to the vaccine.