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1.
BMJ Case Rep ; 15(3)2022 Mar 16.
Article in English | MEDLINE | ID: covidwho-1745765

ABSTRACT

Non-bacterial thrombotic endocarditis (NBTE) is a rare condition related to a state of hypercoagulability in advanced neoplastic disease. Most of the time, arterial thromboembolic event precedes the diagnosis of NBTE. We report here a case of NBTE responsible for multiple ischaemic strokes, which leads to the diagnosis of metastatic pancreatic adenocarcinoma. Aortic and mitral valvular regurgitations secondary to NBTE appeared within 6 weeks despite therapeutic anticoagulation with direct oral anticoagulant (DOAC) in stroke prevention of paroxysmal atrial fibrillation. Bivalvular regurgitations resolved 8 weeks after therapeutic switch to low-molecular-weight heparin (LMWH) and chemotherapy. DOACs are a possible alternative to LMWH for the prevention of venous thromboembolism in patients with active neoplasia. There is a lack of evidence for a clinical efficiency for the prevention of arterial thromboembolism in NBTE. We propose here a short review of the efficacy of anticoagulant therapy for the prevention of arterial thromboembolism in NBTE.


Subject(s)
Adenocarcinoma , Endocarditis, Non-Infective , Pancreatic Neoplasms , Adenocarcinoma/drug therapy , Anticoagulants/therapeutic use , Endocarditis, Non-Infective/diagnosis , Endocarditis, Non-Infective/drug therapy , Endocarditis, Non-Infective/etiology , Heparin , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/drug therapy
2.
JPEN J Parenter Enteral Nutr ; 45(S2): 41-46, 2021 11.
Article in English | MEDLINE | ID: covidwho-1718419

ABSTRACT

Advances in treatment of malignancy including novel pharmacologic therapies and surgical interventions has led to significant improvement in survival. As cancer becomes a chronic disease, nutrition interventions play an increasingly important role in short- and long-term outcomes. The current manuscript presents a case of a 66-year-old male with new diagnosis of pancreatic cancer diagnosed incidentally in the setting of COVID-19. Expert panelists in the field of nutrition discuss optimal strategies for diagnosis of malnutrition along with preoperative, perioperative, and postoperative optimization of nutrition. This discussion focuses on the use of probiotics, immune-modulating nutrition, fish oil, specialized proresolving mediators, and use of enteral and parenteral nutrition support.


Subject(s)
COVID-19 , Nutrition Disorders , Pancreatic Neoplasms , Aged , Humans , Nutrition Disorders/therapy , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapy , Parenteral Nutrition , SARS-CoV-2
3.
In Vivo ; 35(2): 1307-1311, 2021.
Article in English | MEDLINE | ID: covidwho-1100489

ABSTRACT

BACKGROUND/AIM: The aim of this study is to report a case series of three patients who developed postoperative severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection, although the initial tests were negative. PATIENTS AND METHODS: Between April and September 2020, three patients submitted to pancreatoduodenectomy developed SARS-CoV-2 infection; their outcomes were compared to those of a similar group in which the postoperative outcomes were uneventful. RESULTS: There were no significant differences between the two groups in terms of pre- and intraoperative outcomes; however, all of the three cases who developed SARS-CoV-2 infection postoperatively required re-admission in the intensive care unit and a longer hospital in stay. The overall mortality rate was null. CONCLUSION: Patients submitted to pancreatoduodenectomy for pancreatic head cancer who develop SARS-COV-2 infection postoperatively need a more appropriate supportive care; however, the overall mortality does not appear to increase, justifying, in this way, the continuation of programmed oncological of surgeries.


Subject(s)
COVID-19/prevention & control , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , SARS-CoV-2/isolation & purification , Adult , COVID-19/complications , COVID-19/virology , Humans , Length of Stay/statistics & numerical data , Middle Aged , Outcome Assessment, Health Care/methods , Pancreatic Neoplasms/complications , Postoperative Period , SARS-CoV-2/physiology
4.
Intern Med ; 60(2): 231-234, 2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-1067518

ABSTRACT

Cancer patients are regarded as highly vulnerable to severe acute respiratory syndrome coronavirus (SARS-CoV)-2. However, little is known regarding how cancer treatments should be restarted for cancer patients after coronavirus disease (COVID)-19. We herein report a pancreatic cancer case in which chemotherapy was able to be reinstituted after COVID-19. The patient was a 67-year-old man diagnosed with pancreatic cancer. On day 7 after first chemotherapy, he was infected with COVID-19. A SARS-CoV-2 test was negative after one month of treatment, and we reinstituted chemotherapy. The patient has received three cycles of chemotherapy without recurrence of COVID-19. It may be feasible to reinstitute chemotherapy for cancer patients after a negative SARS-CoV-2 test.


Subject(s)
Antineoplastic Agents/therapeutic use , COVID-19/diagnosis , Pancreatic Neoplasms/drug therapy , SARS-CoV-2 , Aged , COVID-19/complications , COVID-19/diagnostic imaging , Diagnosis, Differential , Drug Administration Schedule , Humans , Male , Pancreatic Neoplasms/complications , Tomography, X-Ray Computed
5.
HPB (Oxford) ; 22(8): 1128-1134, 2020 08.
Article in English | MEDLINE | ID: covidwho-592305

ABSTRACT

BACKGROUND: The extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery. METHODS: An online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects of service delivery. RESULTS: Overall, 145 (25%) members responded. Most units, particularly in COVID-high countries (>100,000 cases) reported insufficient critical care capacity and reduced HPB operating sessions compared to COVID-low countries. Delayed access to cancer surgery necessitated alternatives including increased neoadjuvant chemotherapy for pancreatic cancer and colorectal liver metastases, and locoregional treatments for hepatocellular carcinoma. Other aspects of service delivery including COVID-19 screening and personal protective equipment varied between units and countries. CONCLUSION: This study demonstrates that the COVID-19 pandemic has had a profound adverse impact on the delivery of HPB cancer care across the continents of Europe and Africa. The findings illustrate the need for safe resumption of cancer surgery in a "new" normal world with screening of patients and staff for COVID-19.


Subject(s)
Betacoronavirus , Biliary Tract Neoplasms/surgery , Coronavirus Infections/complications , Digestive System Surgical Procedures/methods , Liver Neoplasms/surgery , Pancreatic Neoplasms/surgery , Pneumonia, Viral/complications , Africa/epidemiology , Biliary Tract Neoplasms/complications , COVID-19 , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Delivery of Health Care/methods , Europe/epidemiology , Female , Humans , Liver Neoplasms/complications , Male , Pancreatic Neoplasms/complications , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Societies, Medical
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