Liver Function Tests and FIB-4 Score as Predictors of Severity in COVID-19 Patients from the South-West of Romania.

BACKGROUND: The coronavirus disease 2019 pandemic (COVID-19) is the most important global health crisis to date. In this study, we performed an analysis to find the association between liver damage, FIB-4 score and the severity of COVID-19 disease. METHODS: We included a total of 580 patients that tested positive for SARS-CoV-2 infection and were hospitalized. No patient included had any known history of liver disease. Liver function tests were performed, and FIB-4 score was calculated in order to assess their involvement in the disease progression. RESULTS: More than half of the patients had elevated liver function tests. Age, high body mass index, associated heart disease and diabetes were associated with poor outcome. Corticosteroids, antibiotics, and anticoagulants strongly correlated with liver injuries. Liver impairment and injury, as well as a FIB-4 score higher than 3.5, also correlated with higher degrees of disease severity. CONCLUSION: Liver injury and elevated FIB-4 score were associated with poor clinical outcome and disease severity, as well as being a valuable tool to predict COVID-19-related mortality.

EUS and cytological EUS-FNA prognostic factors in patients with unresectable pancreatic cancer receiving chemotherapy.

BACKGROUND/AIMS: The incidence of pancreatic cancer is increasing. It is usually diagnosed in an advanced stage despite the improvement in diagnostic techniques. The current study was designed to prospectively analyze several demographic and tumour related variables identified by EUS and EUS-FNA cytology that may affect survival in patients with unresectable pancreatic cancer receiving chemotherapy. METHODOLOGY: The study prospectively included 72 patients diagnosed with pancreatic cancer. Only patients without surgery were selected. All the patients received chemotherapy with the same drug (5-FU). They underwent power Doppler EUS followed by EUS-FNA in all cases. The following information obtained by EUS and EUS-FNA cytology were prepared for inclusion in multivariate survival analysis (tumour localization, portal vein invasion, power Doppler signals presence, collateral circulation, signs of chronic pancreatitis, T and N status, nuclear atypia, nuclear enlargement, pleomorphism, nuclear/cytoplasm ratio, and coarse chromatin). RESULTS: The entire included population was analyzed to identify factors affecting prognosis. The overall Cox model had a significance level of p = 0.032. There were three factors that had a major impact on the survival time of the patients: regional lymph node involvement (p = 0.029), nuclear pleomorphism (p = 0.037) and nuclear enlargement (p = 0.019). CONCLUSIONS: The current pre-treatment evaluation of the pancreatic cancer patients by EUS and EUS-FNA could offer some valuable information for appreciation of patients' future evolution. However, extensive studies are required for a complex prognosis scoring system.

Autofluorescence imaging and magnification endoscopy.

It is well known that angiogenesis is critical in the transition from premalignant to malignant lesions. Consequently, early detection and diagnosis based on morphological changes to the microvessels are crucial. In the last few years, new imaging techniques which utilize the properties of light-tissue interaction have been developed to increase early diagnosis of gastrointestinal (GI) tract neoplasia. We analyzed several "red-flag" endoscopic techniques used to enhance visualization of the vascular pattern of preneoplastic and neoplastic lesions (e.g. trimodal imaging including autofluorescence imaging, magnifying endoscopy and narrow band imaging). These new endoscopic techniques provide better visualization of mucosal microsurface structure and microvascular architecture and may enhance the diagnosis and characterization of mucosal lesions in the GI tract. In the near future, it is expected that trimodal imaging endoscopy will be practiced as a standard endoscopy technique as it is quick, safe and accurate for making a precise diagnosis of gastrointestinal pathology, with an emphasis on the diagnosis of early GI tract cancers. Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted before their endorsement in the routine practice of GI endoscopy.

Vascular endothelial growth factor expression and microvessel density--two useful tools for the assessment of prognosis and survival in gastric cancer patients.

BACKGROUND AND AIMS: The role of angiogenesis in progression and metastasis of gastric cancer has been studied over the last years. The aim of our study was to assess the microvessel density and vascular endothelial growth factor (VEGF) expression in correlation with prognosis, survival and the risk for upper gastrointestinal (GI) bleeding as well. METHOD: We prospectively assessed angiogenesis in 40 patients with gastric carcinoma. Microvessel density was calculated using CD31 and CD34 markers, and VEGF expression was assessed in biopsy samples. The tumor stage was established using imaging methods: CT scan for M and N stage and endoscopic ultrasound for T and N stages. The correlation between pathological markers and tumor stage, survival rate and risk of upper gastrointestinal bleeding was assessed. RESULTS: The study included 40 patients with gastric cancer; among them 8 patients presented with upper GI bleeding. The average microvessel density was 10.21 for CD31 and 11.85 for CD34 in all patients VEGF was positive only in 45% of patients. The microvessel density was higher in patients with advanced TNM stage, and a correlation with the risk of UGIB and survival rate was also found. VEGF expression correlated with TNM stage and with the risk of upper GI bleeding. CONCLUSIONS: Microvessel density (estimated by CD34) was involved in locally advanced disease, while VEGF was correlated with loco-regional extension and distant metastasis in gastric cancer patients. There was a clear correlation between angiogenic parameters, survival rate and the risk of upper GI bleeding.

Postcholecystectomy syndrome - an algorithmic approach.

BACKGROUND AND AIM: The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach. METHOD: We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months. RESULTS: In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP. CONCLUSION: An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.

[The role of endoscopic ultrasound-guided transesophageal fine needle aspiration and immunocytochemistry assesment of the patients with suspected lung cancer and negative bronchoscopic biopsies]. / Rolul endoscopiei ultrasonografice cu punctie fina aspirativa transesofagiana si examen imunocitochimic în evaluarea pacientilor cu suspiciune de cancer bronhopulmonar si biopsii bronsice negative.

INTRODUCTION: Endoscopic ultrasound-(EUS) guided fine needle aspiration (FNA) allows the assessment of the posterior mediastinum, as well as the diagnosis and staging of lung cancer patients. The purpose of this feasibility study was to assess the importance of EUS-FNA combined with cytology and immunocytochemistry for patients with suspected lung cancer and negative bronchoscopic biopsies. MATERIAL AND METHODS: Our study included 20 consecutive patients assessed at the Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova. The patients were initially examined by chest X-ray, computer tomography scans and bronchoscopy, without a tissue confirmation of malignancy. RESULTS AND DISCUSSION: Of the 20 patients included in our study without a tissue confirmation of malignancy, 16 patients had a positive EUS-FNA for malignancy. For 11 patients the samples were obtained from the mediastinal lymphnodes, and for 4 cases directly from the primary mediastinal tumor, some of the obtained samples being included in paraffin to obtain cell blocks. The cell blocks allowed us to accomplish imunocytochemistry for two purposes: to establish the epithelial and mesenchimal fenotype of the malignant cells, as well as the origin of the identified atypical cells. CONCLUSIONS: EUS-FNA combined with cytology, is an excellent minimal invasive technique, highly accurate for the assessment of lung cancer, showing not only the tumoral and lymph node invasion, but also offering the ideal alternative for surgical staging. Association of immunocytochemistry determined an increase in the accuracy of the method, as well as the confirmation of a tissue diagnosis of malignancy.