Effect of the SARS-CoV-2 pandemic on colorectal cancer diagnosis and prognosis.

BACKGROUND AND STUDY AIMS: Our aim was to determine the impact of the SARS-CoV-2 pandemic on the diagnosis and prognosis of colorectal cancer (CRC). PATIENTS AND METHODS: This prospective cohort study included individuals diagnosed with CRC between March 13, 2019 and June 20, 2021 across 21 Spanish hospitals. Two time periods were compared: prepandemic (from March 13, 2019 to March 13, 2020) and pandemic (from March 14, 2020 to June 20, 2021, lockdown period and 1 year after lockdown). RESULTS: We observed a 46.9% decrease in the number of CRC diagnoses (95% confidence interval (CI): 45.1%-48.7%) during the lockdown and 29.7% decrease (95% CI: 28.1%-31.4%) in the year after the lockdown. The proportion of patients diagnosed at stage I significantly decreased during the pandemic (21.7% vs. 19.0%; p = 0.025). Centers that applied universal preprocedure SARS-CoV-2 PCR testing experienced a higher reduction in the number of colonoscopies performed during the pandemic post-lockdown (34.0% reduction; 95% CI: 33.6%-34.4% vs. 13.7; 95% CI: 13.4%-13.9%) and in the number of CRCs diagnosed (34.1% reduction; 95% CI: 31.4%-36.8% vs. 26.7%; 95% CI: 24.6%-28.8%). Curative treatment was received by 87.5% of patients diagnosed with rectal cancer prepandemic and 80.7% of patients during the pandemic post-lockdown period (p = 0.002). CONCLUSIONS: The COVID-19 pandemic has led to a decrease in the number of diagnosed CRC cases and in the proportion of stage I CRC. The reduction in the number of colonoscopies and CRC diagnoses was higher in centers that applied universal SARS-CoV-2 PCR screening before colonoscopy. In addition, the COVID-19 pandemic has affected curative treatment of rectal cancers.

Indications, Efficacy, Safety, and Clinical Outcomes of 585 nm Pulsed Dye Laser in Non-Malignant Laryngeal Lesions: A Systematic Review.

The objective of this manuscript was to review the indications, efficacy, and safety of a 585 nm pulsed dye laser (PDL) in non-malignant laryngeal lesions. Following the PRISMA statement recommendations, three independent authors searched for articles published in PubMed/MEDLINE, the Cochrane Library, Google Scholar, Scielo, and Web of Science. A bias analysis was performed following NICE guidance tools. From the 506 identified publications, 19 observational studies met the inclusion criteria. The PDL improves vocal quality objectively and subjectively in vascular lesions (p < 0.005) and improves vocal quality in patients with dysplasia/leukoplasia without changing the natural history of the disease compared to other treatments. Reinke's edema and granulomas require an average of 1.5 PDL sessions for resolution. Treatment of recurrent respiratory papillomatosis requires multiple sessions, with complete remission achieved in 50-70% of patients. Regardless of the lesion, the tolerance of the procedure under local anesthesia is exceptional (84-97%), and the results in terms of regression and vocal quality are promising. The complication rate is minimal, and the procedure does not interfere with other treatment alternatives. There is no consensus on laser settings. The lack of consistent use in evaluating vocal outcomes, whether objective or subjective, prevents the comparability between studies. The 585 nm pulsed dye laser appears to be an effective and safe therapeutic option in patients with non-malignant laryngeal pathology. Future controlled studies are needed to compare the 585 nm pulsed dye laser with other lasers or cold instrument procedures.

Role of Artificial Intelligence in Colonoscopy Detection of Advanced Neoplasias : A Randomized Trial.

BACKGROUND: The role of computer-aided detection in identifying advanced colorectal neoplasia is unknown. OBJECTIVE: To evaluate the contribution of computer-aided detection to colonoscopic detection of advanced colorectal neoplasias as well as adenomas, serrated polyps, and nonpolypoid and right-sided lesions. DESIGN: Multicenter, parallel, randomized controlled trial. (ClinicalTrials.gov: NCT04673136). SETTING: Spanish colorectal cancer screening program. PARTICIPANTS: 3213 persons with a positive fecal immunochemical test. INTERVENTION: Enrollees were randomly assigned to colonoscopy with or without computer-aided detection. MEASUREMENTS: Advanced colorectal neoplasia was defined as advanced adenoma and/or advanced serrated polyp. RESULTS: The 2 comparison groups showed no significant difference in advanced colorectal neoplasia detection rate (34.8% with intervention vs. 34.6% for controls; adjusted risk ratio [aRR], 1.01 [95% CI, 0.92 to 1.10]) or the mean number of advanced colorectal neoplasias detected per colonoscopy (0.54 [SD, 0.95] with intervention vs. 0.52 [SD, 0.95] for controls; adjusted rate ratio, 1.04 [99.9% CI, 0.88 to 1.22]). Adenoma detection rate also did not differ (64.2% with intervention vs. 62.0% for controls; aRR, 1.06 [99.9% CI, 0.91 to 1.23]). Computer-aided detection increased the mean number of nonpolypoid lesions (0.56 [SD, 1.25] vs. 0.47 [SD, 1.18] for controls; adjusted rate ratio, 1.19 [99.9% CI, 1.01 to 1.41]), proximal adenomas (0.94 [SD, 1.62] vs. 0.81 [SD, 1.52] for controls; adjusted rate ratio, 1.17 [99.9% CI, 1.03 to 1.33]), and lesions of 5 mm or smaller (polyps in general and adenomas and serrated lesions in particular) detected per colonoscopy. LIMITATIONS: The high adenoma detection rate in the control group may limit the generalizability of the findings to endoscopists with low detection rates. CONCLUSION: Computer-aided detection did not improve colonoscopic identification of advanced colorectal neoplasias. PRIMARY FUNDING SOURCE: Medtronic.

Causa infrecuente de abdominalgia y diarrea / No disponible

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An uncommon cause of chronic abdominal pain and diarrhea.

The intestinal spirochaetosis is defined as the presence of spirochetes on the colonic surface. We present the case of a 57-years-old male, with a history of 4-5 months of diffuse abdominal pain, watery diarrhoea due to this infection. The colonoscopy revealed a serpiginous ulcer in the cecum. The biopsy was positive for intestinal spirochaetosis. It is rare infection, more common among immunocompromised patients and HIV, with a faecal-oral transmission. Most cases are incidental findings in the endoscopic screening. In symptomatic patients the watery diarrhoea and non-specific abdominal pain are the most common symptoms. The macroscopic appearance on the colonoscopy is often normal or non-specific lesions can be identified. The diagnosis is based on the biopsy with haematoxylin and eosin and the confirmation can be made with a Warthin-Starry stain. In symptomatic patients the metronidazole is the preferred treatment option. Although it is rare infection, clinicians should be aware of it in patients with common gastrointestinal symptoms.

Primary squamous cell carcinoma of the stomach: a rare case report

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Secondary aortoduodenal fistula with the presentation of gastrointestinal bleeding: a case report

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Secondary aortoduodenal fistula with the presentation of gastrointestinal bleeding: a case report.

Secondary Aorto-enteric fistula (SAEF) is a communication between the aorta and the intestines which occurs in a setting prior aortic surgery such as abdominal aortic aneurism (AAA) repairing. Gastrointestinal bleeding and abdominal pain have been described in the majority of cases. SAEF is a rare and life-threatening complication so a high degree of clinical suspicion is necessary for diagnosis.

Primary squamous cell carcinoma of the stomach: a rare case report.

Primary squamous cell carcinoma (SCC) of stomach is a rare disease. There are fewer than 100 cases published in the literatura. The pathogenesis remains to be elucidated and the prognosis is poor. In the case presented here, clínical, endosopy, histopathological examination and staging are described; However, the outcome was bad and the patient died 6 months later.

Exploración de la estructura fenotípica del trastorno por déficit de atención con hiperactividad (TDAH): subtipos frente a continuo de gravedad / AN Exploration of the phenotypic structure of attention deficit hyperactivity disorder (ADHD): Subtypes vs. continuum of severity

El DSM-5 requiere para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH) la presencia de al menos seis síntomas, dando lugar a tres subtipos o presentaciones. Sin embargo la validez de los subtipos sigue siendo objeto de debate. Nuestros objetivos fueron (a) investigar si el TDAH es mejor caracterizado como una tipología, un continuo o una mixtura de ambos, e (b) investigar si las presentaciones del TDAH propuestas por el DSM-5 pueden ser empíricamente validadas. Para ello, comparamos modelos factoriales, modelos de perfiles latentes y modelos factoriales mixtos estimados sobre los datos provenientes de 871 niños (de 5 a 14 años). El mejor modelo fue el de dos factores (déficit de atención e hiperactividad/impulsividad) y cuatro clases. Las clases no representaron grupos con perfiles sintomáticos cualitativamente distintos, sino una mixtura de distribuciones aproximadamente normales subyacentes a un mismo continuo de gravedad. Estos resultados no apoyan la categorización de los niños en subtipos o presentaciones, sino su evaluación en un continuo de gravedad cuyo extremo superior podría entenderse como la manifestación clínica del TDAH

DSM-5 requires for the diagnosis of attention deficit hyperactivity disorder (ADHD) the presence of at least six symptoms, resulting in three subtypes or presentations. However, the validity of the subtypes remains debated. Our objectives were (a) to investigate whether ADHD is best characterized as a typology, a continuum, or a mixture of both, and (b) to investigate whether ADHD presentations proposed by DSM-5 can be empirically validated. For this purpose, we compared confirmatory factor models, latent profile models and mixture factor models on data from 871 children (5 to 14 years old). The best model was that of two factors (attention deficit and hyperactivity/impulsivity) and four classes. The classes did not represent groups with qualitatively different symptomatic profiles, but a mixture of approximately normal distributions underlying the same severity continuum. These results do not support the categorization of children in subtypes or presentations, but their assessment in a continuum of severity whose upper end could be understood as the clinical manifestation of ADHD

Endoscopic treatment of Zenker's diverticulum with Ligasure: simple, safe and effective.

Background and study aims Zenker's diverticulum may cause disabling symptoms, especially in the elderly. Treatment has changed in recent decades from open surgery to management with flexible endoscopy, resulting in lower morbidity and mortality. The goal of this study was to present the largest series, with the longest follow-up, of patients with Zenker's diverticulum receiving outpatient treatment with flexible endoscopy using a diverticuloscope and Ligasure (Covidien, Minneapolis, Minnesota, United States), a device that allows tissue sealing and coagulation of vessels before cutting the septum between the diverticulum and esophagus. Patients and methods We performed 79 diverticulotomies in 69 patients (65.2 % male, mean age 73.4 years). The mean diverticulum size was 2.8 cm. In three cases with a diverticulum ≤ 1.5 cm, the diverticuloscope could not be placed. Results The technical success was 95.83 % and the clinical success 96.7 %: 84 % of the 56 patients followed for a mean of 34.6 months (24 - 64 months) had no dysphagia. The recurrence rate was 10.4 %, with a good response to a second diverticulotomy at 12 months (IQR: 11.5 - 17) in most cases. The most severe complications were two microperforations, resolved with conservative treatment, and one case of delayed bleeding endoscopically-controlled with a clip. Conclusions Diverticulotomy of the esophageal-diverticular septum with Ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with Zenker's diverticulum. In symptomatic recurrences, a second procedure was equally safe and effective in most patients.

Role of Full-spectrum Endoscopy in Colorectal Cancer Screening: Randomized Trial.

GOALS: The aim of this study was to compare a new, full-spectrum endoscope (Fuse; EndoChoice, Alpharetta, GA) to standard forward-viewing colonoscopy in the detection of colorectal neoplasms. BACKGROUND: Colonoscopy, the gold standard for the detection of colorectal cancer, fails to detect 22% to 28% of polyps, increasing the risk of interval cancer. Endoscopic improvement of the adenoma detection rate decrease interval carcinomas. Full-spectrum endoscopy (FUSE) (330-degree field of view), in a tandem study, has been shown to reduce the adenoma miss rate. STUDY: Prospective, randomized study of 249 patients in patients referred from the colorectal screening program with a positive fecal occult blood test (FOBT). Patients were randomized to standard forward-viewing colonoscopy (170 degrees) or to full-spectrum colonoscopy with the Fuse system (330 degrees). Study variables were the adenoma detection rate, the polyp detection rate, the mean number of adenomas per procedure, the lesions detected according to the location, morphology and size, cecal intubation rate, total procedure time, insertion time to the cecum, therapeutic success, and adverse events. RESULTS: The Fuse system did not produce a significantly higher adenoma detection rate than standard forward-viewing colonoscopy (FUSE 73.1% vs. standard colonoscopy 68.1%; P=0.47) but did have a significantly longer insertion time (FUSE 6.2 min vs. standard colonoscopy 4.2 min; P< 0.001). Further analysis failed to reveal any significant difference in polyp/adenoma detection rates by lesion size or colonic section. CONCLUSIONS: FUSE did not detect significantly more colorectal neoplasia than forward viewing colonoscopy in a medium-risk CRC screening population with positive FOBT.

Nodular colitis: endoscopic image an unusual finding.

An 82-year-old male with a history of high blood pressure, COPD, chronic myeloid leukemia, and stage-4 chronic renal failure. Admitted to hospital for lower-limb cellulitis and severe COPD exacerbation, he received antibiotic therapy and bronchodilators. During his hospital stay he developed severe anemia and had an hematochezia event with no diarrhea. A complete colonoscopy found small (4-7 mm) nacreous elevated lesions, circumferential in shape, in the cecum and ascending colon with some bleeding stigmata and submucosal bleeding suggestive of infectious colitis; stool culture was negative and Clostridium difficile toxins were positive. The condition was histologically confirmed.

Colitis infecciosa nodular: un hallazgo inusual / Nodular colitis: endoscopic image an unusual finding

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Evaluación de las habilidades sociales en adultos con discapacidad intelectual: calibración de la escala SPSS-R mediante el modelo de Rasch / Assessment of social skills in adults with intellectual disability: calibration of the SPSS-R Scale with Rasch model

El objetivo del presente estudio ha sido la calibración de la "Escala de actuación social revisada" (Social Performance Schedule Scale Revided, SPSS-R, en una muestra de 181 personas adultas con discapacidad intelectual, mediante el modelo de escalas de clasificación de Rasch-Andrich, a fin de clarificar su estructura, dimensionalidad y propiedades psicométricas. Fue necesaria una reducción drástica de la escala, a fin de obtener una versión con una estructura factorial clara y consistente con el constructo evaluado (habilidades sociales). La escala resultante, de 24 ítems, se configuró en dos dimensiones bien definidas. Sus propiedades psicométricas (fiabilidad y validez) resultaron adecuadas y presentó un correcto ajuste de ítems y personas al modelo de Rasch. Conforme a su dificultad, los ítems se concentraron en al zona media de las dimensiones evaluadas, lo que aconseja en futuras revisiones incluir ítems en rangos altos y bajos de la variable latente

The study aims at calibrating the Social Performance Schedule Scale Revised (SPSS-R) in a sample of 181 adults with intellectual disability using the Rasch Andrich Rating Scale Model with the purpose of elucidating its structure, dimensionality and psychometric properties. In order to obtain a version with a clear factorial structure and coherent with the analysed construct (social skills), it was necessary to proceed with a drastic reduction of the scale. The resulting scale, composed of 24 items, showed the emergence of two distinct dimensions. Its psychometric properties (reliability and validity) turned out to be adequate, and it showed correct items and individuals fit to the Rasch model. According to their difficulty, the items concentrated in the mean zone of the analysed dimensions, which makes it advisable to include, in future studies, items in the high and low range of the latent variable