Impact of an Evidence-Based Prioritization System and Electronic Consultation in Early Diagnosis of Colorectal Cancer.

(1) Background: Colorectal cancer (CRC) is one of the most common causes of cancer. Timely diagnosis is critical, with even minor delays impacting prognosis. Primary care providers face obstacles in accessing specialist care. This study investigates the impact of implementing an electronic consultation (eConsult) system combined with a specific prioritization system on CRC diagnosis delay and tumor staging. (2) Methods: The study analyzes 245 CRC patients from November 2019 to February 2022, comparing those referred before and after the eConsult system's implementation during the COVID-19 pandemic. Data on referral reasons, pathways, diagnosis delays, and staging were collected. Multivariate analysis aimed to identify independent risk factors for advanced staging at diagnosis. (3) Results: The eConsult system significantly reduced CRC diagnosis delay from 68 to 26 days. The majority of patients referred via eConsult presented with symptoms. Despite expedited diagnoses, no discernible difference in CRC staging emerged between eConsult and traditional referrals. Notably, patients from screening programs or with a positive fecal immunochemical test (FIT) experienced earlier-stage diagnoses. A positive FIT without symptoms and being a never-smoker emerged as protective factors against advanced-stage CRC. (4) Conclusions: This study highlights eConsult's role in reducing CRC diagnosis delay, improving diagnostic efficiency and prioritizing urgent cases, emphasizing FIT effectiveness.

Safety and Efficacy of an Oncolytic Adenovirus as an Immunotherapy for Canine Cancer Patients.

The use of oncolytic viruses is an innovative approach to lyse tumor cells and induce antitumor immune responses. Eight dogs diagnosed with carcinoma/adenocarcinoma were intratumorally treated with ICOCAV15, an oncolytic canine adenovirus (CAV). To evaluate the treatment's safety, a blood count, biochemistry, and coagulation test were performed before treatment and during follow-up. Immune populations were analyzed by flow cytometry. Anti-adenovirus antibodies were also determined. The immune infiltration, vascularization, and viral presence in the tumor were determined by CD3, CD4, CD20, CD31 and CAV by immunohistochemistry. All the dogs maintained a good quality of life during follow-up, and some had increased median survival time when compared with dogs treated with chemotherapy. No treatment-related adverse effects were detected. The Response Evaluation Criteria In Solid Tumors criteria were also assessed: two patients showed a partial response and the rest showed stable disease at various times during the study. ICOCAV15 was detected inside the tumor during follow-up, and antiviral antibodies were detected in all patients. Furthermore, the tumor-infiltrating immune cells increased after viral administration. Therefore, we suggest that intratumorally administered ICOCAV15 could represent as a new tool for the treatment of canine carcinoma because it is safe, well-tolerated by dogs, and shows promising results.

Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study).

BACKGROUND AND AIMS: Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists' and pathologists' size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI. METHODS: NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps' measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level. RESULTS: 532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed. CONCLUSION: Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm. CLINICAL TRIALS REGISTRATION NUMBER: NCT04232176.

Severe hepatotoxicity secondary to nintedanib.

Nintedanib is a multikinase inhibitor used for the treatment of pulmonary idiopathic fibrosis. We present the first report published to date of severe hepatotoxicity and jaundice secondary to nintedanib.

A Gastroenterologist' clinical experience in COVID 19 and in-hospital mortality and length of stay analysis.

OBJECTIVES: COVID19 pandemic has forced physicians from different specialties to assist cases overload. Our aim is to assess gastroenterologist's assistance in COVID-19 by assessing mortality, ICU admission, and length of stay, and seek for risk factors for in-hospital mortality and longer hospital stay. METHODS: A total of 41 COVID-19 patients assisted by gastroenterologist (GI cohort) and 137 assisted by pulmonologist, internal medicine practitioners, and infectious disease specialists (COVID expert cohort) during October-November 2020 were prospectively collected. Clinical, demographic, imaging, and laboratory markers were collected and compared between both cohorts. Bivariate analysis and logistic regression were performed to search for risk factors of mortality and longer hospital stays. RESULTS: A total of 27 patients died (15.1%), 11 were admitted to ICU (6.1%). There were no differences between cohorts in mortality (14.6% vs 15.4%;p = 0.90), ICU admission (12.1% vs 4%;p = 0.13), and length of stay (6.67 ± 4 vs 7.15 ± 4.5 days; p = 0.58). PaO2/FiO2 on admission (OR 0.991;CI95% 0.984-0.998) and age > 70 (OR 17.54;CI95% 3.93-78.22) were independently related to mortality. Age > 70, history of malignancy, diabetes, and cardiovascular disease were related to longer hospital stays (p < 0.001, p = 0.03, p = 0.04, p = 0.02 respectively). CONCLUSIONS: COVID-19 assistance was similar between gastroenterologist and COVID experts when assessing mortality, ICU admission, and length of stay. Age>70 and decreased PaO2/FiO2 on admission were independent risk factors of mortality. Age and several comorbidities were related to longer hospital stay.

Adenocarcinoma gástrico de tipo intestinal en paciente con síndrome de ataxia-telangiectasia / No disponible

No disponible

Intestinal-type gastric adenocarcinoma in a patient with ataxia-telangiectasia syndrome.

We introduce a 20-year-old patient, with prior diagnosis of ataxia-telangiectasia syndrome, urgently assesed because of an upper gastrointestinal bleeding, identifying in the urgent endoscopy an intestinal-type gastric adenocarcinoma as its origin.

Consejo sanitario previo a inmigrantes que viajan para visitar a familiares y amigos / Prior health advice to immigrants who travel to visit family and friends

OBJETIVO: Los inmigrantes que realizan o proyectan viajes para visitar a sus familiares en sus países de origen (inmigrantes-visiting friends and relatives [I-VFR]) tienen un riesgo superior a adquirir enfermedades relacionadas con el viaje que otros viajeros. El objetivo principal de este estudio es analizar los conocimientos de la población inmigrante sobre la necesidad de recibir consejo sanitario (CS) antes de realizar viajes internacionales en general y, específicamente, antes de viajar a sus países de origen. DISEÑO: Estudio observacional y multicéntrico. Emplazamiento: Participaron 10 médicos de familia de 10 Centros de Salud de Cataluña y Aragón. Participantes: Quinientos cincuenta y cinco inmigrantes ≥ 15 años de edad, que consultaron a su médico de familia y accedieron a responder un cuestionario. Se realizó un muestreo oportunista. RESULTADOS: Consideraban necesario recibir CS antes de realizar un viaje internacional 389 (70,1%) personas; 406 (73,2%) eran I-VFR y 145 (35,7%) habían solicitado CS previamente al viaje, con mayor frecuencia a su médico de familia (n = 60; 41,1%).No habían solicitado CS 261 (65,2%) sujetos, siendo el motivo más frecuente por considerarlo innecesario 173 (42,6%). CONCLUSIONES: Los I-VFR no suelen solicitar CS previo a viajar, fundamentalmente por considerarlo innecesario. Cuando lo solicitan, con gran frecuencia se dirigen en primera instancia a su médico de familia

OBJECTIVE: Immigrants who make or plan journeys to visit their families in their countries of origin (immigrants -visiting friends and relatives, I-VFR) have a higher risk of acquiring travel associated diseases than other travellers. The main aim of this study is to analyse the knowledge of the immigrant population on the need to receive health advice (HA) before making international journeys in general and in particular before travelling to their country of origin. DESIGN: Observational, multicentre study. Setting: Ten Family Doctors from 10 Health Centres in Catalonia and Aragon participated. Participants: A total of 555 immigrants ≥15 years of age, who consulted their Family Doctor and agreed to answer a questionnaire. Opportunity sampling was used. RESULTS: A total of 389 (70.1%) of those surveyed considered it necessary to receive HA before making an international journey, 406 (73.2%) were I-VFR and 145 (35.7%) had requested HA prior to the journey, mostly from their Family Doctor (n=60; 41.1%).Almost two-thirds (261, 65.2%) of the subjects did not seek HA, with the most common reason being that they did not consider it necessary (173, 42.6%). CONCLUSIONS: I-VFR do not usually request HA prior to travelling, basic due to considering it unnecessary. When they do request it, they are very often initially directed to their Family Doctor

[Prior health advice to immigrants who travel to visit family and friends]. / Consejo sanitario previo a inmigrantes que viajan para visitar a familiares y amigos.

OBJECTIVE: Immigrants who make or plan journeys to visit their families in their countries of origin (immigrants -visiting friends and relatives, I-VFR) have a higher risk of acquiring travel-associated diseases than other travellers. The main aim of this study is to analyse the knowledge of the immigrant population on the need to receive health advice (HA) before making international journeys in general and in particular before travelling to their country of origin. DESIGN: Observational, multicentre study. SETTING: Ten Family Doctors from 10 Health Centres in Catalonia and Aragon participated PARTICIPANTS: A total of 555 immigrants ≥ 15 years of age, who consulted their Family Doctor and agreed to answer a questionnaire. Opportunity sampling was used. RESULTS: A total of 389 (70.1%) of those surveyed considered it necessary to receive HA before making an international journey, 406 (73.2%) were I-VFR and 145 (35.7%) had requested HA prior to the journey, mostly from their Family Doctor (n=60; 41.1%). Almost two-thirds (261, 65.2%) of the subjects did not seek HA, with the most common reason being that they did not consider it necessary (173, 42.6%). CONCLUSIONS: I-VFR do not usually request HA prior to travelling, basic due to considering it unnecessary. When they do request it, they are very often initially directed to their Family Doctor.