Safety and efficacy of topical drug-free cream in subjects with hemorrhoidal disease: a randomized, double blind, clinical trial.

BACKGROUND: Hemorrhoidal disease (HD) is one of the most common anorectal benign disorder affecting millions of people around the world. Grade I-II HD are generally treated with a conservative approach with topical products such as creams and ointments considered a safe and effective option to treat mild symptoms. The aim of the present study was to assess the safety and efficacy of a topical medical device (Lenoid™; International Health Science [IHS] - Biofarma Group, Mereto di Tomba, Udine, Italy) in patients affected by symptomatic HD. METHODS: This study is a randomized, double blind, placebo-controlled, 2-weeks clinical trial. Patients affected by I-II grade symptomatic HD were enrolled in the study and then randomly assigned to Lenoid™ arm (LA) or placebo arm (PA), respectively. Patients were evaluated before and after intervention through clinical examination and disease-specific questionnaires assessing symptoms such as pain, tenesmus, pruritus and anal discharge. RESULTS: A total of 68 patients were screened and 60 (30 in each group) were enrolled into the study. All patients belonging to LA showed a statistically significant improvement of each symptom after 7 and 14 days of treatment when compared to PA (P<0.001). Furthermore, subjective improvement of change in overall assessment of disease was observed in the LA but not in the PA. No serious adverse events were recorded. CONCLUSIONS: The tested product was found safe and effective in improving clinical signs and symptoms in patients with grade I-II HD.

Oncología y pandemia: revisión narrativa de sus desafíos y experiencia local

The COVID-19 pandemic had a significant impact on the management of chronic diseases such as cancer. Comprehensive care, from preventive strategies to palliative care for cancer patients, has been strongly affected by multiple factors associated with the pandemic. The hampering of early detection, timely diagnosis, as well as recommended treatment and follow-up are side effects of SARS-CoV-2 infection worldwide that will undoubtedly produce changes in the prognosis and survival of oncologic patients. Through this narrative review, we report global and local figures of these effects, as a first approach to tackle the challenge of updating cancer care.

[The effects of COVID-19 pandemic on the prevention, diagnosis and treatment of oncologic diseases]. / Oncología y pandemia: revisión narrativa de sus desafíos y experiencia local.

The COVID-19 pandemic had a significant impact on the management of chronic diseases such as cancer. Comprehensive care, from preventive strategies to palliative care for cancer patients, has been strongly affected by multiple factors associated with the pandemic. The hampering of early detection, timely diagnosis, as well as recommended treatment and follow-up are side effects of SARS-CoV-2 infection worldwide that will undoubtedly produce changes in the prognosis and survival of oncologic patients. Through this narrative review, we report global and local figures of these effects, as a first approach to tackle the challenge of updating cancer care.

Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times.

INTRODUCTION: Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing through a double stapler technique to resect the adequate amount of prolapse, finally coming to the use of high volume devices. METHODS: Nevertheless, each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, the introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with forceps, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery is Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left. RESULTS: Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results. CONCLUSION: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may offer the patients a safe, effective treatment with less pain and fast recovery.

Impacto de la pandemia por coronavirus (SARS-CoV-2) en el diagnóstico, tratamiento y seguimiento de los pacientes oncológicos / Impact of the coronavirus pandemic (SARS-COV-2) on the diagnosis, treatment and follow-up of cancer patients

El síndrome respiratorio agudo severo por coronavirus (SARS-CoV-2) ha generado una pandemia que ha requerido ajustes significativos en los sistemas de salud mundiales, tanto a nivel hospitalario como ambulatorio. Para patologías crónicas no transmisibles, como las oncológicas, esta pandemia ha tenido repercusiones importantes especialmente a nivel primario de atención. Se ha afectado el manejo oncológico integral, desde la detección precoz, el tratamiento, los exámenes de control y el seguimiento de los pacientes. Entre ellos destaca la disminución, a nivel mundial, del número de procedimientos diagnósticos digestivos, de imágenes, citológicos, quirúrgicos, de tratamiento sistémico, consultas e interconsultas oncológicas. Diversas organizaciones han recopilado cifras de ello y han proyectado cifras de como la disminución de diagnóstico oportuno o el retraso y/o interrupción del tratamiento repercutirán en un aumento de la morbimortalidad. Por ello, han elaborado guías de recomendaciones para minimizar el riesgo de contagio por coronavirus, para retomar a la brevedad el nivel de atención. Esta revisión ejemplifica el impacto de la pandemia de COVID-19 en el manejo habitual de los pacientes con patologías oncológicas, lo que permitirá dimensionar su efecto, así como delinear un plan multidisciplinario de recuperación y puesta al día en el manejo integral de los pacientes oncológicos. (AU)

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical-Therapeutic Classification (A/CTC).

Introduction The introduction and diffusion of new techniques for hemorrhoidal surgery have made it clear how much Goligher classification is inadequate in the modern times, lacking in any correlation between anatomical and clinical features to a surgical procedure. The aim of the study was to evaluate if the application of a new classification of hemorrhoidal diseases might lead to an improvement in the postoperative surgical outcomes. Methods From January 2014 to December 2015, all patients undergoing surgery for hemorrhoidal disease were enrolled. The procedures performed were based upon a new anatomical/clinical-therapeutic classification (A/CTC) considering these items: anatomical presentation, symptom types and frequency, associated diseases, and available surgical treatments and their related contraindications. The new classification identified four groups: A (outpatient), B, C, and D (surgical approaches). The overall outcomes were assessed and then stratified by surgical groups. These data were then analyzed in comparison with the published data about all the surgical procedures performed. Results A total of 381 patients underwent surgery and they were stratified as follows: Group B (39), C (202), and D (140). Group B underwent Doppler-guided dearterialization with mucopexies or tissue selective therapy, Group C stapled procedures, and Group D hemorrhoidectomy. The mean follow-up was 30 months. The overall outcomes were: success rate 92.4%, recurrences 7.6%, postoperative complications 4.8%, long-term complications 5.4%, and reoperation rate 2.7%. The success rates stratified by groups were: B, 85%); C, 91.4%; and D, 95.7%. Conclusion The A/CTC proved to be useful in stratifying the patients and choosing the proper treatment for each case. This classification seems to improve the outcome of different surgical procedures if compared with those already published.

Safety and Efficacy of Proctosoll Allevia in the Management of Haemorrhoidal Disease in Adults: A Prospective Randomized Clinical Trial.

INTRODUCTION: Hemorrhoidal Disease (HD) is a very common anorectal disorder that affects millions of people around the world and represents a major medical and socioeconomic problem. The aim of the present study was to assess the safety and efficacy of Proctosoll Allevia® in patients affected by symptomatic HD in comparison with the results obtained from a control group. MATERIALS AND METHODS: From January to February 2019, all the patients referred to the outpatient clinic of Rajalakshmi Hospital, who were complaining of first or second degree hemorrhoidal symptoms, were enrolled in the study. They were randomly assigned to either of the 2 arms. Group 1: patients were treated with the Proctosoll Allevia® and were under a controlled diet. Group 2: patients were only under a controlled diet without any treatment - control group. RESULTS: A total of 51 subjects were screened and 45 (13 F- 32 M) enrolled in the study. All the patients treated with topical application of the cream showed a statistically significant improvement of symptoms within 14 days from the beginning of the therapy if compared to patients who were treated only with a controlled diet. No major adverse events associated with the use of the new product were recorded. CONCLUSION: The treatment of I-II degree symptomatic HD with Proctosoll Allevia® has demonstrated to be promising with a good profile of tolerability, safety and efficacy.