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.

Disseminated Histoplasmosis Diagnosed in an Immunocompetent Patient from a Non-Endemic Area: Neglected or Emerging Disease?

Histoplasma capsulatum (H. capsulatum) is considered to be one of the most extensively spread dysmorphic fungi worldwide. Histoplasmosis primarily impacts patients with weakened immune systems and can result in a diverse range of clinical manifestations. In immunocompetent patients, the disease may manifest as a self-limiting or asymptomatic infection; however, in immunocompromised individuals, it can occur as a debilitating, disseminated disease. Diagnosing histoplasmosis may be challenging. A medical professional that specializes in treating endemic fungal illnesses is better able to assist with an accurate and timely diagnosis since they have a deeper grasp of these illnesses. Consequently, the process of diagnosing histoplasmosis might be difficult for less experienced physicians. The case presented is an example of the myriad faces that histoplasmosis can take on, mimicking other common infectious or malignant conditions, leading to extensive work-up and invasive procedures in establishing the diagnosis of this otherwise benign condition. We hereby report the case of disseminated histoplasmosis in a young immunocompetent female patient.

Eosinophilic ascites in a patient with toxocara canis infection. A case report.

We report the case of a young female patient, admitted for a recent ascites of unknown origin. The acute onset was with colicky abdominal pain and peritoneal effusion, which led to the suspicion of perforated ulcer. A diagnostic laparoscopy was performed which showed free peritoneal fluid and normal abdominal viscera. At upper gastro-intestinal endoscopy, performed a few days later, patchy erythema in the antral region and duodenal edema were revealed. Duodenal biopsies showed marked eosinophilic infiltration. The ascitic fluid was straw coloured, sterile with 90% eosinophils. Eosinophilic gastroenteritis was suspected, but differential diagnosis required the exclusion of migrant parasites. The stool exams were negative but serology for Toxocara antibodies was positive. The treatment with albendazole (Zentel 400 mg twice a day for 5 days) led to the disappearance of signs and symptoms. The eosinophilic infiltrate of the gut was absent in duodenal biopsies taken two months later.

The effect of two antidiarrhoeal drugs on the psychosocial adjustment to illness in chronic functional diarrhoea.

BACKGROUND: Chronic functional diarrhea is an embarrassing symptom, causing the impairment of the quality of life. AIM: We looked for the effect of two antidiarrheal drugs, diosmectite and loperamide on the psychosocial adjustment to illness, a predictor for the health-related quality of life, in chronic functional diarrhea. METHODS: Prospective controlled randomized trial including 50 consecutive patients with chronic functional diarrhea. They received either diosmectite 3 g b.i.d (n=25, 11M/14F, age 43+/-12 years) or loperamide 2 mg b.i.d. (n=25, 12M/13F, 47+/-11 years) for 2 weeks. Diarrhea and four other digestive symptoms were evaluated on a 0-16 scale, as well as patient's satisfaction (scale 1-10) and physician's satisfaction (scale 0-4). Psychosocial adjustment to illness was assessed with the PAIS-SR scale. RESULTS: Symptom score for diarrhea was reduced from 10.5+/-5.7 to 2.6+/-1.2 (mean+/-SD), p<0.001 by diosmectite and from 8.5+/-4.2 to 1.2+/-0.6, p<0.0001 by loperamide. Diosmectite had a stronger effect than loperamide on accompanying pain (p<0.05) and bloating (p<0.01), but not on nausea, anorexia and emesis. The overall ratings of the patient's satisfaction (8.7+/-0.9 vs. 8.2+/-1.1, NS) and physician's satisfaction (3.2+/-0.3 vs. 3.1+/-0.4, NS) were similar. Psychological adjustment to illness was not changed for following items: health care orientation and domestic environment. Diosmectite improved more than loperamide the psychological distress (from 12.7+/-3.8 to 7.7+/-2.1 vs. 11.8+/-3.3 to 9.05+/-2.2, p<0.05), vocational environment (from 3.2+/-1.1 to 2.2+/-1.2 vs. 3.3+/-1.2 to 3.4+/-1.5, p<0.05) and sexual relationship scores (from 6.4+/-2.2 to 3.0+/-1.5 vs. 7.2+/-2.2 to 5.5+/-2.1, p<0.05). Both drugs similarly improved the items: family relationship and social environment. CONCLUSIONS: Diosmectite and loperamide are both potent drugs for chronic functional diarrhea. Diosmectite has better effects on associated symptoms and some items of psychosocial adjustment to illness (distress, sexual activity and vocational environment).

[Prevalence of bronchial asthma in 7 years -old children in Cluj-Napoca, an ISAAC study]. / Prevalenta astmului bronsic la copiii de 7 ani din municipiul Cluj-Napoca. Studiu ISAAC.

The authors studied the prevalence of asthma in children of 7 years from Cluj Napoca and analyzed the possible risk factors. We used the questionnaire elaborated by International Study on Asthma and Allergic Diseases in Children (ISAAC) which allowed the comparison of our data with those from other countries. Anamnesis, functional tests and allergic skin tests were performed in children with positive answers for questionnaire. 1334 children completed the study, 52.5% being males. Prevalence of asthma diagnosed previous to the questionnaire was of 5.7%, and it was higher in males (6.1%). By anamnesis, functional and skin tests data the diagnosis of asthma was made in a total of 217 children, so that the real prevalence of asthma is of 16.3% in this age group. Maternal smoking during the first year of life was significantly higher in children with wheezing. The high number of respiratory tract infections in the first year of life could also play a role. In conclusion, prevalence of asthma diagnosed in children of 7 years of age from Cluj Napoca is of 5.7% with a real prevalence of disease that seems to be much higher, of 16.3%. Maternal smoking represents a risk factor correlated with wheezing.