COVID-19: Screening and triage challenges in people with disability due to Spinal Cord Injury.

An outbreak of a novel coronavirus disease (COVID-19) that emerged in the Chinese city of Wuhan has rapidly become a global public health pandemic. As of March 2020, the Centers for Disease Control and Prevention (CDC) has described priority levels for testing patients with suspected COVID-19 and information on when to seek medical attention. However, there is a paucity of further guidance for people with spinal cord injury (SCI) who may not present with typical symptoms of COVID-19 due to altered physiology. This may pose challenges with surveillance, risk stratification, and initial management of this vulnerable population. In this point-counterpoint discussion, we outline important differences in presentation along with COVID-19 cases co-morbid with SCI.

Colon cancer in cystic fibrosis patients: is this a growing problem?

In the last decade, we have found an increased incidence of gastrointestinal (GI) malignancies among Cystic Fibrosis (CF) patients. We discuss the case of a 30-year-old woman of mixed descent, with CF, who was referred to the emergency department for persistent abdominal pain and constipation, complicated by blood-streaked stools. On physical examination, her abdomen was soft, nontender, and without organomegaly or palpable masses. Rectal examination was unrevealing. The patient's initial laboratory evaluation revealed a hemoglobin level of 11.7g/dl. A CT scan of the abdomen was unremarkable. A colonoscopy performed one day after admission showed an intraluminal mass in the proximal Sigmoid Colon, from which biopsies were taken. Pathology reports subsequently revealed invasive Adenocarcinoma of the Colon. The patient underwent tumor resection followed by initiation of chemotherapy. The pathophysiology underlying the increased risk of GI cancers in CF patients is unknown. Possible explanations include genetic mutations or persistent pathologic alterations in digestive tract structures. It is our hope that this case will bring to light the need to further delineate cancer risk among CF patients and to develop screening recommendations tailored to this population.