Polyps and Polyposis Syndromes in Children: Novel Endoscopic Considerations.

Polypectomy is the most common therapeutic endoscopic intervention in children. Management of sporadic juvenile polyps is limited to polypectomy to resolve symptoms, whereas polyposis syndromes pose a multidisciplinary challenge with broader ramifications. In preparation for polypectomy, there are key patient, polyp, endoscopy unit, and provider characteristics that factor into the likelihood of success. Younger age and multiple medical comorbidities increase the risk of adverse outcomes, classified as intraoperative, immediate postoperative, and delayed postoperative complications. Novel techniques, including cold snare polypectomy, can significantly decrease adverse events but a more structured training process for polypectomy in pediatric gastroenterology is needed.

Cronkhite-Canada Syndrome: A Case Report.

Cronkhite-Canada Syndrome is a rare disease characterised by diffuse gastrointestinal polyposis, abdominal pain, diarrhoea, cutaneous and mucosal hyperpigmentation, alopecia, and onychodystrophy. Here we report a case of a 40-year-old female with Cronkhite-Canada Syndrome, who presented with the complaints of diffuse abdominal pain, blood mixed stools, and diarrhoea associated with tenesmus. She had nausea and reduced appetite and lost 10 kgs in 3 months. She had hair fall (alopecia), atrophic changes of nails (onychodystrophy), and hyperpigmentation of the skin in fingers, tongues, and lips. Histopathological biopsy of the gastric and colonic biopsy revealed polypoid edematous mucosa and the colonic biopsies showed scattered dilated glands with inflammatory exudate and mucin. She got Entamoeba histolytica and COVID-19. She received respective antibiotics and protein diets that helped relieve the symptoms. After 4 weeks of steroids, her symptoms improved drastically. Corticosteroids, treating co-infection along with nutritional counselling can be helpful to relieve the symptoms. Keywords: alopecia; case reports; cronkhite-canada syndrome; hyperpigmentation.

Stringency of Containment and Closures on the Growth of SARS-CoV-2 in Canada prior to Accelerated Vaccine Roll-Out (preprint)

Background: Many studies have examined the effectiveness of non-pharmaceutical interventions (NPIs) on SARS-CoV-2 transmission worldwide. However, less attention has been devoted to understanding the limits of NPIs across the course of the pandemic and along a continuum of their stringency. In this study, we explore the relationship between the growth of SARS-CoV-2 cases and a stringency index across Canada prior to accelerated vaccine roll-out.Methods: We conducted an ecological time-series study of daily SARS-CoV-2 case growth in Canada from February 2020 to February 2021. Our outcome was a back-projected version of the daily growth ratio in a stringency period (i.e., a 10-point range of the stringency index) relative to the last day of the previous period. We examined the trends in case growth using a linear mixed effects model accounting for stringency period, province, and mobility in public domains.Results: Case growth declined, rapidly, by 37–50% and began plateauing within the first two weeks of the first wave, irrespective of the starting values of the stringency index. Across individual stringency periods, there was a lag of 11·3 days, on average, to observe the largest cumulative decline in relative growth. The largest decreasing trends from our mixed effects model occurred over the first stringency period in each province, at a mean index value of 25·2 out of 100.Conclusions: There was a negative correlation between NPI stringency and growth of SARS-CoV-2 that attenuated throughout the course of Canada’s epidemic. We suggest that individual- and network-level risk factors need to guide the use of NPIs in future epidemics.

What we know and still ignore on COVID-19 immune pathogenesis and a proposal based on experience of allergic disorders. (preprint)

The coronavirus disease 2019 (COVID-19) pandemic started over one year ago and produced almost 3.5 million deaths worldwide. We have been recently overwhelmed by a wide literature on how the immune system recognizes Severe Acute Respiratory Syndrome Coronavirus 2 and contributes to COVID-19 pathogenesis. Although originally considered a respiratory viral disease, COVID-19 is recognized as a far more complex, multi-organ-, immuno-mediated-, and mostly heterogeneous disorder. Though efficient innate and adaptive immunity may control infection, when the patient fails to mount an adequate immune response, a high innate-induced inflammation can lead to different clinical outcomes through heterogeneous compensatory mechanisms. The variability of viral load and persistence, the genetic alterations of virus-driven receptors/signaling pathways and the plasticity of innate and adaptive responses may all account for the extreme heterogeneity of pathogenesis and clinical patterns. As recently done for some inflammatory disorders as asthma, rhinosinusitis with polyposis and atopic dermatitis, herein we suggest to define different endo-types and the related phenotypes along COVID-19. Patients should be stratified for evolving symptoms and tightly monitored for surrogate biomarkers of innate and adaptive immunity. This would allow to preventively identify each endo-type (and its related phenotype) and to treat patients precisely with agents targeting pathogenic mechanisms.

Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study (preprint)

Background Numerous countries imposed strict travel restrictions, contributing to the large socioeconomic burden during the COVID-19 pandemic. The long quarantines that apply to contacts of cases may be excessive for travel policy. Methods We developed an approach to evaluate imminent countrywide COVID-19 infections after 0–14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as “sufficient.” Findings We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. Interpretation For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. Funding EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families’ endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM). Research in context Evidence before this study Evidence from early in the pandemic indicates that border closures at the epicentre slowed global dissemination of COVID-19. As community transmission became established in many nations, studies have suggested that the benefit of strict border closures in mitigating the transmission of disease from travellers diminished. Research for community settings has shown that testing later during quarantine, rather than upon entry into quarantine, can substantially shorten the duration of quarantine needed to reduce post-quarantine transmission. In particular for international air travellers, a 14-day quarantine can effectively be shortened to five or seven days. The number of infectious COVID-19 cases that escape from these quarantines depends on the prevalence of disease in the country the traveller originated as well as the travel volume into the country. Added value of this study We developed a framework to identify quarantine and testing strategies that enable travel from specific origins without increasing their infection rates per capita within destinations. No prior study has evaluated the appropriate duration of quarantine necessary to prevent any rise in infection rates per capita in the destination countries as a result of travel. By accounting for prevalence, daily incidence, vaccine coverage, immunity, age demographics, and travel flow between countries, we quantified the contribution of travel towards within-country the imminent infections in the destination country under different quarantine and testing strategies. For travel between 26 European countries, our results for the pandemic situation observed on November 21, 2021 demonstrate that there are often less burdensome quarantine and testing strategies that can serve as effective alternatives to strict border closure. Specifically, these estimated sufficient quarantine durations are especially dependent on COVID-19 prevalence and immunity within the two countries. We also found that asymmetry in the travel flow, just not the volume of travel flow, can also influence the estimated sufficient quarantine durations. Using data on variants of concern, including Omicron, we found that the adequacy of a border control strategy to limit variant spread depends strongly on the geographical distribution of the variant. While our results pertain to European countries, we also provide an interactive spreadsheet that can be used to determine appropriate quarantine durations between any two countries. Moreover, our framework can also be applied at any spatial or population scale within which movement restrictions could feasibly be implemented. Implications of all available evidence Travel quarantine and testing strategies can effectively mitigate importation and onward transmission within a country. Identifying sufficient strategies can allow countries to permit travel to and from other countries, without risking a short-term increase in infection rates. As long as the community transmission is occurring, the long-term epidemic trend within the destination country is more apt to be determined by other disease control measures, e.g., contact tracing, vaccination, and non-pharmaceutical interventions. Together, travel quarantine and other related control measures can mitigate the risk of transmission between countries, limiting the threat of variants of concern.

Investigating the Impact of COVID-19 Outbreak On Canada’S Government Treasury Bills (preprint)

SARS-Cov-2 was first recorded in Wuhan, a town in the Hubei Province of China with a population of 11 million in December 2019, following a clear-cut outbreak of non-pneumonia. More than 200 countries and territories have now spread the virus around the globe, and the World Health Organization (WHO) identified it as a pandemic on 11 March 2020. On the economic front, COVID-19 contributed to a partial or absolute lockout in more than 200 nations.This has undermined the global supply chain and has contributed to a major decline in both economic growth and the values of financial assets. Canada is one of the countries afflicted by the outbreak with 731 000 cases and 18 622 deaths as of 21 January 2020. Vaccines have recently been created, but the surge of infection continues to escalate every day. On the socio-economic front, COVID-19 led more than 200 countries to a partial or absolute lockdown, interrupted global supply chains and led to a collapse in both economic growth and financial asset prices.The impact of COVID-19 is unclear because the public health crisis is still unfolding. There is limited amount of studies concerning this topic, because the crisis is still unfolding. The objective of this study is to investigate the impact of COVID-19 on Canada’s Treasury Bills. The author uses extreme bound analysis for market interpretation and sourced data from Bank of Canada and Our World in Data COVID-19, from January 1 to December 31 2020. The result of the study show that, Stringency Index have an impact on Canada’s 6-month Treasury bill auction average yield (V80691304) because of the robust relationship between them. Furthermore, 3 months Treasury bill auction average yields (V80691303) has positive correlation with 6months Treasury bill auction average yields (V80691304), 1-year Treasury bills auction average yields (V80691305), 3 months Treasury bills (V80691344), 6 months Treasury bills (V80691345), 1 year Treasury bills (V80691346) and a negative correlation with Government Stringency index (SI). Furthermore, 6months Treasury bill auction average yields (V80691304) has positive correlation with 3 months Treasury bill auction average yields (V80691303), 1-year Treasury bills auction average yields (V80691305), 1 month Treasury bills (V80691342), 3 months Treasury bills (V80691344), 6 months Treasury bills (V80691345), 1 year Treasury bills (V80691346) and a negative correlation with Government Stringency index (SI). Again, 1-year Treasury bills auction average yields (V80691305) has positive correlation with 3 months Treasury bill auction average yields (V80691303), 6months Treasury bill auction average yields (V80691304), 1 month Treasury bills (V80691342), 3 months Treasury bills (V80691344), 6 months Treasury bills (V80691345), 1 year Treasury bills (V80691346) and a negative correlation with Government Stringency index (SI).

Primary intestinal follicular lymphoma presenting as multiple lymphomatous polyposis.

Multiple lymphomatous polyposis (MLP) is a rare condition, described in the literature as a presentation of extranodal mantle cell lymphoma. We report a rare case of follicular lymphoma presenting as MLP in a young woman with a short history of haematochezia who underwent colonoscopy. Immunohistochemistry on colonic biopsies confirmed follicular lymphoma. Microscopic examination found an extensive and dense lymphoid infiltrate, which demonstrated a follicular growth pattern. The neoplastic cells were positive with BCL2, BCL6, CD10 and CD20, and were negative with CD3, CD5, Cyclin D1 and SOX11. CT staging showed disseminated lymphadenopathy and the patient was commenced on chemotherapy. Endoscopic evaluation and histopathological analysis are vital for the accurate diagnosis of MLP. Our case demonstrates that follicular lymphoma should be considered as a differential, as not all cases of diffuse colonic MLP are related to mantle cell lymphoma. This distinction must be made to provide the best clinical management for the patient.