Post-Pandemic Burden of COVID-19-Related Restrictions in the Management of Digestive Tract Cancers: A Single Center Study.

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has required a complete change in the management of patients with gastrointestinal disease who needed to undergo endoscopic procedures. In the second year of the COVID-19 pandemic, due to restrictions for elective endoscopic procedures, a large number of cancer patients were prevented from early diagnosis of several digestive cancers, which has led to a serious burden in the health system that now needs to be dealt with. We designed a prospective study that included patients in whom access to elective endoscopic examinations during the COVID-19 pandemic had been delayed. Our aim was to investigate the impact of the COVID-19 pandemic on the diagnosis rate of digestive tract malignancies in the context of health crisis management that generates an ethical dilemma regarding the balance of utilitarianism versus deontology. Our study shows that the decrease in the number of newly diagnosed gastrointestinal cancers by endoscopy and biopsy during the pandemic restrictions and the delay in diagnosis have had a clear impact on stage migration due to disease progression.

Current challenges and future perspectives in oral absorption research: An opinion of the UNGAP network.

Although oral drug delivery is the preferred administration route and has been used for centuries, modern drug discovery and development pipelines challenge conventional formulation approaches and highlight the insufficient mechanistic understanding of processes critical to oral drug absorption. This review presents the opinion of UNGAP scientists on four key themes across the oral absorption landscape: (1) specific patient populations, (2) regional differences in the gastrointestinal tract, (3) advanced formulations and (4) food-drug interactions. The differences of oral absorption in pediatric and geriatric populations, the specific issues in colonic absorption, the formulation approaches for poorly water-soluble (small molecules) and poorly permeable (peptides, RNA etc.) drugs, as well as the vast realm of food effects, are some of the topics discussed in detail. The identified controversies and gaps in the current understanding of gastrointestinal absorption-related processes are used to create a roadmap for the future of oral drug absorption research.

Triple Antioxidant Therapy, an Alternative for Patients with Chronic Liver Disease - A Prospective Multicenter Interventional Study.

Background: Non-alcoholic fatty liver disease (NAFLD) has increased exponentially in recent years in Western European countries, where the number of hepatitis of viral etiology has been declining, and it is thought to be the most common cause of chronic liver disease in the near future (1). Currently, NAFLD is both the second most common cause of hepatocellular carcinoma (HCC) and the second most common indication for liver transplantation (2-4). This problem is very serious, as cases of NAFLDs are increasingly in children, a population with a long life ahead, and in whom the disease has all the time to progress to cirrhosis and HCC (5, 6). Objectives: The goal of this prospective study is to determine the effect of an original formula consisting in silymarin, organic selenium and alpha lipoic acid, in reducing liver damage in patients with chronic liver disease. Material and methods: The study started in March 2018, initially with a group of patients from Bucharest, integrated in the study at St. Mary's Hospital. In October 2018 it was expanded at the national level to 1 718 patients, monitored by 145 investigating physicians from 134 centers, with an average of 11.8 patients per investigating physician. Outcomes: Taking each stage of fatty liver disease (FLD) at T0 moment (the beginning of the study), we observed that 25% of patients with grade I FLD had no sign of disease at the end of the study, 74% of those with grade II FLD recovered or improved their health, and 83% of patients with grade III FLD recovered or improved their health. There were 149 patients with no FLD detected at the end of the study (recovered). Conclusion: Based on triple antioxidant therapy, the original formula improved the evolution and prognosis of patients with chronic liver disease.

Interrelations between elevated alpha-fetoprotein levels and tumor morphology of patients with hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related deaths worldwide, while at the same time having a constant growth in incidence. A commonly used biomarker in managing liver cancer cases, alpha-fetoprotein (AFP) is losing clinical ground in favor of imaging studies and emerging biomarkers. The study aims to reassess potential prognosis indicators and risk factors for an elevated level of this glycoprotein by analyzing its relationship with macroscopic morphology tumor-related features. PATIENTS, MATERIALS AND METHODS: One hundred and thirty-one newly diagnosed HCC patients had their clinical, tumor and liver disease features investigated in contrast to elevated AFP levels with 200 IU∕mL being used as preferred cut-off. RESULTS: Tumor size =5 cm [odds ratio (OR) 3.36, 95% confidence interval (CI): 1.29-8.74, p=0.013] is an independent tumor-related predictor of markedly elevated AFP values. Noteworthy connections with the type of tumor, multinodular appearance and portal vein thrombosis were also found through univariate analysis. CONCLUSIONS: AFP could still be a reliable tool in diagnosis and prognosis of HCC patients especially in developing countries due to its relevant association with aspects of advanced tumor and liver disease, gender and a poor functional status.

Extra-intestinal malignancies in inflammatory bowel disease: results of the 3rd ECCO Pathogenesis Scientific Workshop (III).

The incidence of lymphoproliferative disorders (LD) is increasing in developed countries. Patients with inflammatory bowel disease (IBD) exposed to thiopurines are at additional risk of three specific forms of LD: Epstein-Barr-Virus-related post-transplant like LD, hepato-splenic T-cell lymphoma and post-mononucleosis lymphoproliferation. The risk of the two latter forms of LD can be reduced when considering specific immunosuppressive strategies in young males. It is still unclear whether the risk of uterine cervix abnormalities is increased in IBD women, irrespective of the use of immunosuppressants. Given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate. Patients with IBD receiving immunosuppressants are at increased risk of skin cancers. The risk of non-melanoma skin cancer is notably increased in patients receiving thiopurines. Recent data suggest that the risk of melanoma is mildly increased in patients exposed to anti-TNF therapy. All IBD patients should adhere to a program of sun protection and dermatological surveillance, whose details should take into account the other non-IBD-related risk factors.

Is there a risk for lymphoma or extracolonic cancer in patients with inflammatory bowel disease?

An important issue in the management of inflammatory bowel disease (IBD) is the risk for lymphatic or extracolonic malignancies reported in patients receiving prolonged immunosuppressive therapy and/or therapies with biological agents. Azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate. and anti-TNF (infliximab, adalimumab) are reference drugs for IBD forms unresponsive to conventional therapies. The administration of these drugs is a high responsibility because IBD itself is associated with an increased risk for cancer, namely colon cancer. The possibility of a drug-induced additional risk remains controversial, the relative risk for lymphoma being estimated at 1.2%. For extracolonic malignancies, there are variations in standardized incidence per reference population in terms of location (skin, liver and biliary tract, uterine cervix, prostate, etc.), and also IBD phenotype (ulcerative colitis or Crohn's disease). The uncertainty regarding the occurrence of neoplasia in IBD patients for many years on immunosuppressive therapy and/or biological agents is a strong argument both for treatment discontinuation and it's monitoring by inclusion in screening programs. In this paper we aimed to approach the conceptual model risk-benefit in the therapy with imunosuppressive and biological agents given the controversies in the literature generated by the drug-induced risk for malignant lymphatic and extracolonic tumor in patients with IBD.

Malignant tumors of digestive organs and liver metastases at the time of diagnosis.

AIM: Malignant tumors localized in the digestive tract have a tendency to local growth and invasion with lymph node metastasis. Distant metastases through blood with prevalent liver location are detected late in disease progression, in an advanced stage, when therapeutic possibilities are often limited to palliative therapy. MATERIAL AND METHODS: The study included a series of 139 patients with liver metastases admitted to the Center of Gastroenterology and Hepatology lasi between January 1 and October 10, 2011 for the identification of primitive tumor. The patients were investigated by endoscopy, imaging, laboratory tests including tumor markers. RESULTS: At 99 of the patients (71%) we identified primitive digestive tumors, in 19 patients (13.6%) we found tumors with extradigestive location and in 21 patients (15%) the primitive tumor could not be identified. Primitive.tumor was located in various segments of the digestive tract, liver, and pancreas was follows: esophagus 4 - (4%), eso-cardial-tuberositary 2 - (2%), eso-cardial-tuberositary with pancreatic invasion 1 -(1%), stomach 15 - (15%), ileocolon 1 - (1%), colon 19 - (19%), rectum 12 - (12%), liver, multicentric hepatolcellular carcinoma 23 - (23%) billiary tract - cholangiocarcinoma 2 (2%), pancreas 2 - (20%). In a series of 586 patients with malignant tumors of the digestive organs referred to the Iasi Oncology Outpatient Unit between January 1 and September 30, 2011, 132 patients (23%) had liver metastases at the time of diagnosis; the most common locations were the stomach 41% cases (42/119 patients), followed by the pancreas, 35%, and colon 31% patients (28/79 patients and 37/119 patients, respectively). Males were most affected, regardless of primitive tumor. CONCLUSIONS: Although diagnostic and therapeutic methods have made remarkable progress in recent years, these tumors, by their frequency and advanced stage at diagnosis, remain both an oncologic and public health problem mainly due to the limitations of curative treatment.

[Correlational aspects of hematogenous osteomyelitis in children and adults]. / Aspecte corelationale privind osteomielita hematogena la adulti si copii.

UNLABELLED: Osteomyelitis is an inflammation of the bone caused by an infecting organism. The infection may be limited to a single portion of the bone or may involve a number of regions such as the marrow, cortex, periostium and even the surrounding soft tissue. MATERIAL AND METHOD: This retrospective study included a number of 256 cases made by 152 children (56%) and 115 adults (44%). RESULTS: Hematogenous osteomyelitis appears at any age, most frequently in growth period, 85% cases until 16 years. This study relieve a high frequency of subacute (40.1%) and acute (31.1%) hematogenous osteomyelitis compare with chronic form (28.8%). Regarding the distribution of cases by sex, there are no differences between man and woman in chronic osteomyelitis, but subacute form is most frequently at men. The analysis of the cases distribution by location and sex relieve that at womans metaphysis and diaphysis are most interested (70.09%) but only 53.7% at men. Regarding the treatment, the distribution of cases relieve that chronic osteomyelitis generally cannot be eradicated without surgical treatment (sequestrectomy and resection followed by reconstruction with material. Those others forms, acute and subacute hematogenous osteomyelitis, were resolved with medical and surgical treatment, equally. CONCLUSION: Prompt diagnosis and early treatment are required to prevent further destruction and growth disturbance. Generally, a multidisciplinary approach is required, involving an orthopaedic surgeon, an infectious disease specialist and a plastic surgeon in complex cases with soft tissue loss.

[p-ANCA prevalence in ulcerative colitis patients and first-degree relatives]. / Seroprevalenta anticorpilor p-ANCA la pacientii cu rectocolita ulcerohemoragica si la rudele lor de gradul I.

UNLABELLED: Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) are more common in patients with ulcerative colitis (UC) than in patients with Crohn's disease (CD), but its prevalence depends on the population being studied and the method employed for its detection. AIM: To determinate the prevalence of p-ANCA in ulcerative colitis (UC) patients and their first degree in NE Romania area. MATERIAL AND METHOD: In this study, we investigated the prevalence of p-ANCA as detected by ELISA, in the serum of 44 patients with UC and 22 first degree relatives. We also correlated the presence of this antibody with disease activity and extent, extraintestinal complications and therapy. 26 healthy individuals comprised the control group. RESULTS: p-ANCA was detected in 11% of the patients with UC. Of the 5 p-ANCA positive UC patients, 1 case were found to have proctosigmoiditis, 1 cases had left-sided colitis and 3 cases had pancolitis. There was no correlation between the presence of this antibody and any of the studied clinical variables (extend disease, complication, family disease, surgery). No person of the first degree and control group presented positive test. CONCLUSIONS: The prevalence of p-ANCA in NE Romania patients with UC (11%) is lower than that in the Western population. The negativity of p-ANCA in all first degree relatives of NE Romania UC patients should be further elucidated.

[Clinical extraintestinal manifestations in patients with ulcerative colitis]. / Manifestari clinice extraintestinale la pacientii cu rectocolita ulcerohemoragica.

UNLABELLED: Ulcerative colitis (UC) is a chronic disease clinically manifest either by bowel symptoms alone or extraintestinal symptoms. MATERIAL AND METHOD: Our prospective study included 635 patients with ulcerative colitis (334 males and 301 females, mean age 37.54 +/- 13.84, range 20-70 years). The presence of the common extraintestinal symptoms (ES) was analyzed. RESULTS: Of the 635 investigated patients, these symptoms were found in 83 (13%, 49 males and 34 females, mean age 41.6 +/- 13.95 range 21-70). Patients with ES suffered longer from UC on the average, that is 60.6 years. Most commonly ES involved the joints, 38 (45.8%) patients, hepatobiliary, 28 patients (33.7%), skin, 10 patients (12%) and eyes, 7 patients (8.4%). In 18% of the patients two or more ES were present. ES were clinically detectable after the intestinal symptoms in 81% patients. An increased tendency of ES to occur in patients with a more extensive disease was noticed. CONCLUSION: The prevalence of ES in the UC patients from NE Romania is in agreement with data from other countries. The number of ES supports the need for complex follow-up in these patients.

[Role of video-capsule endoscopy in Crohn's disease]. / Place de la videocapsule endoscopique dans maladie de Crohn.

UNLABELLED: The technical and scientific improvements of the miniature electronic equipment made possible the occurrence of video-capsule endoscopy (VCE), which is a device having an enormous noninvasive investigation potential of the small intestine. One of the most attractive indications of VCE is the suspicion of Crohn's disease that has not been confirmed using standard imaging techniques. AIM: To assess the value of VCE in the diagnostic work-up of patients in whom there is clinical suspicion of small bowel Crohn's disease that cannot be confirmed using conventional techniques (upper and lower endoscopy, small bowel follow-through). PATIENTS AND METHODS: A total of 21 patients (10 men, 11 women, mean age 36 +/- 7 years) with clinical and biochemical suspicion of Crohn's disease were included in the study. All the patients were evaluate before by the small bowel follow through, upper gastrointestinal endoscopy and colonoscopy. RESULTS: In 15 patients (68%), lesions supporting the Crohn's disease diagnosis were detected by VCE. Complete visualization of the small bowel was achieved in all patients except for one where the capsule stopped upstream of a stenosis located at the terminal ileum level. The most frequent lesions included mucous erosions, aphthae, lineal or serpiginous mucous lesions, ulcers and fissures. CONCLUSIONS: VCE is an effective modality for diagnosis patients with suspected Crohn's disease undetected by conventional diagnostic techniques.

[Clinical and epidemiological aspects in patients with colorectal cancer]. / Aspecte clinice si epidemiologice la pacientii cu cancer colorectal.

UNLABELLED: The aim of this study was to evaluate the clinical factors of the patients with CCR histologically confirmed. PATIENTS AND METHODS: In the study group there were included 117 patients (females: 49-41%, males: 68-59%, range: 39-88 years) with CCR confirmed (rectosigmoidoscopy/colonoscopy + biopsy, X-ray) hospitalized in the Second Medical Clinic Gastroenterology during January 2000-May 2001. RESULTS: For 56 (47.86%) patients the principal sign was rectal bleeding, intestinal disorders (diarrhoea--constipation) in 24 (20.51%) patients, anemia in 19 (16.23%) patients and abdominal pain in 18 (15.38%) patients. The time interval between the onset and the diagnosis of CCR was 1 month up to 2.5 years. For 83 patients (71%) was possible surgical treatment and for 34 patients (29%) palliative method. CONCLUSIONS: At diagnosis the clinical data suggested a malignant disease for most of the patients. The delay of diagnosis was associated with advanced staging of the disease, with limiting therapeutic possibilities. Using the screening for CCR may give the possibility for a curative treatment.