Assessment of Surgeons' Stress Levels with Digital Sensors during Robot-Assisted Surgery: An Experimental Study.

Robot-Assisted Minimally Invasive Surgery (RAMIS) marks a paradigm shift in surgical procedures, enhancing precision and ergonomics. Concurrently it introduces complex stress dynamics and ergonomic challenges regarding the human-robot interface and interaction. This study explores the stress-related aspects of RAMIS, using the da Vinci XI Surgical System and the Sea Spikes model as a standard skill training phantom to establish a link between technological advancement and human factors in RAMIS environments. By employing different physiological and kinematic sensors for heart rate variability, hand movement tracking, and posture analysis, this research aims to develop a framework for quantifying the stress and ergonomic loads applied to surgeons. Preliminary findings reveal significant correlations between stress levels and several of the skill-related metrics measured by external sensors or the SURG-TLX questionnaire. Furthermore, early analysis of this preliminary dataset suggests the potential benefits of applying machine learning for surgeon skill classification and stress analysis. This paper presents the initial findings, identified correlations, and the lessons learned from the clinical setup, aiming to lay down the cornerstones for wider studies in the fields of clinical situation awareness and attention computing.

Insights into treatment of complex Crohn's perianal fistulas.

Complex perianal fistula is a common complication of Crohn's disease (CD) which leads to negative impact on patient's quality of life. Successful management of the disease requires a multidisciplinary approach, including a gastroenterologist and a colorectal surgeon, applying combined surgical and medical therapy. One of frequently practiced surgical procedures is seton placement in the fistula tract, which is used to control perianal sepsis and drain the fistula, while preventing recurrent abscess formation.Darvadstrocel, a suspension of expanded, allogeneic, adipose-derived, mesenchymal stem cells, is safe and effective for treatment-refractory complex perianal fistulas in patients with Crohn's disease. Following approval of darvadstrocel, the INSPIRE registry is being conducted in order to evaluate long-term safety and effectiveness of the drug on a large, heterogenous population.An online expert meeting was held from March 20 to March 30, 2023, which provided relevant insights into the decision-making process regarding seton use and obtained feedback on the first experiences with darvadstrocel. The aim of this article is to present the perspectives from gastroenterologists and colorectal surgeons practicing in Czechia, Hungary, Israel, Lithuania, Serbia, and Slovenia in topics such as diagnosis and treatment options for patients with complex Crohn's perianal fistulas (CPF), specifically focusing on the use of setons and darvadstrocel.During this virtual session, unavailability of comprehensive data on safety and efficacy of available treatment procedures was emphasized as an important obstacle towards development of standardized recommendations and improvement of outcomes in treatment of (CPF). Furthermore, achieving consensus in seton use, duration of its placement, and frequency of change is recognized as one of CPF treatments major challenges. Despite these issues, it is important to promote better understanding and treatment of complex perianal fistulas in order to improve the quality of life of those affected by this condition.

Low-Dose vs Standard-Dose Valganciclovir for Cytomegalovirus Prophylaxis After Kidney Transplantation: A Single-Center Retrospective Analysis.

BACKGROUND: Prophylactic administration of valganciclovir (VG) is an accepted method for the prevention of cytomegalovirus (CMV) infection after kidney transplantation (KTx). The standard dosage of oral VG is 900 mg/day, adjusted to renal function. There is growing evidence that low-dose 450 mg/day VG might be safe and effective. We compared low-dose vs standard-dose prophylaxis after KTx in a single-center follow-up study. METHODS: Data from 603 renal transplantations at a single center were retrospectively analyzed (2011-2014, 12-month follow-up). Recipients with donor IgG positive-recipient IgG positive (D+/R+), (D+/R-), and (D-/R+) CMV serostatus were routinely treated with 450 mg/day VG for 3 months. Based on the same prophylactic dose, patients could be categorized into two groups according to their postoperative renal function: those receiving standard-dose VG due to a lower estimated glomerular filtration rate (eGFR) (average eGFR<60 mL/min/1.73 m2) and those receiving low-dose VG due to higher eGFR (average eGFR>60 mL/min/1.73 m2). RESULTS: Estimated glomerular filtration rate-based VG serum alterations significantly affected the risk of CMV infection with a higher incidence in higher VG levels (standard-dose: 357 patients, CMV: 33 cases (9.2 %); low-dose: 246 patients, CMV: 10 cases (4.1%). The occurrence of known risk factors: serologic risk distribution and rate of induction therapy were not statistically different between the 2 groups. Treatment of an acute rejection episode influenced the infection rate significantly in the standard-dose group. As a side effect of prophylaxis, leucopenia (<3G/L) was 2.46 times higher in standard-dose vs low-dose group. CONCLUSION: Low-dose VG administration is safe and non-inferior to the standard dose in the prophylaxis of CMV infection after KTx.

[Surgery of peritoneal surface malignancies - surgical cytoreduction and hyperthermic intraperitoneal chemotherapy]. / A peritoneális felszín tumorainak sebészete ­ citoreduktív sebészet és hipertermiás intraperitoneális kemoterápia.

Peritoneal carcinosis has historically been considered as inoperable, although the technique of its resesection together with high dose intraperitoneal chemotherapy potentiated by heat has been described decades ago. It has not became a widely practiced routine except in specialized centers - the complex technique, weakly standardized but resource demanding chemotherapy, lacking financial background and the many times questionable clinical benefit at a cost of high surgical load might have been the key factors. Refined technology, developing chemotherapy protocols together with growing clinical evidence are now more sharply delineating the range of indications where the procedure might be beneficial, increases survival, or is the only curative therapy. These include tumors of the appendix and pseudomyxoma peritonei, mesothelioma, and selected cases of ovarian, colorectal and gastric cancer. In addition to technical description of the intervention, we summarize the currently valid indications and describe our institutional protocol for the treatment of appendiceal malignancies.

[The most common gastrointestinal alterations in patients with post-COVID syndrome]. / A poszt-COVID-szindrómával diagnosztizált betegek leggyakoribb gastrointestinalis eltérései.

INTRODUCTION: Post-COVID syndrome may affect the gastrointestinal tract. However, risk factors of post-COVID syndrome are still unknown. OBJECTIVE: We aimed to identify the most common gastrointestinal symptoms, abnormal laboratory findings and risk factors relevant to post-COVID syndrome. METHOD: In this retrospective study, we included 79 patients admitted to Semmelweis University Department of Surgery, Transplantation and Gastroenterology between October 2020 and September 2022. We investigated clinical data, laboratory findings and determined the major risk factors. RESULTS: Most of the patients were women (46/79), their mean age was 47.6 years and patients were overweight (BMI: 26.3 kg/m2). The most common comorbidities were cardiovascular diseases (21/79), hypertension (20/79), diabetes (11/79) and malignant diseases (9/79). Typical indications for gastroscopy were dyspepsia (16/79) and epigastric pain (10/79). The most common indications for colonoscopy were diarrhea (29/79) and weight loss (28/79). Among abnormal laboratory findings, liver enzymes levels (GOT: 83.5 U/L, GPT: 85 U/L, GGT: 70 U/L) and ferritin (351.5 ng/mL) were higher in post-COVID patients. Typical conditions diagnosed by gastroscopy, colonoscopy and abdominal ultrasound were gastroesophageal reflux disease (11/26), irritable bowel syndrome (2/19) and diffuse hepatic lesions, respectively. The number of unvaccinated patients was higher compared to those receiving any COVID-19 vaccines (58% vs. 29%). Of the vaccinated patients, 12 patients received mRNA vaccines (10 Pfizer-BioNTech, 2 Moderna) and 6 patients received viral vector vaccines (2 AstraZeneca, 4 Sputnik V). CONCLUSION: We identified female gender, obesity, cardiovascular diseases, cancer, hypertension and diabetes as major risk factors of post-COVID syndrome. Vaccinated status may prevent post-COVID gastrointestinal symptoms. Orv Hetil. 2023; 164(31): 1206-1212.

[Possibilites of application of traditional Chinese medicine - acupuncture - in the perioperative period.] / A hagyományos kínai orvoslás ­ akupunktúra ­ alkalmazásának lehetoségei a perioperatív idoszakban.

Chinese medicine is a holistic method of therapy with thousands of years of history. There are more assumptions regarding the mechanism of action, nevertheless, several studies have demonstrated its therapeutic effect. Nowadays, patients and physicians have become open to complementary medicine, but acupuncture used in the perioperative period has not yet widespread in Hungary. The aim of the article is to describe traditional Chinese medicine, primarily the effect of acupuncture and laser acupuncture on patients undergoing surgery. Relieving anxiety before surgery, alleviating pain, nausea and vomiting during and after surgery is a basic anesthesiology task, however, the drug therapy can be supplemented with any technique of acupuncture. Based on numerous studies, acupuncture effectively reduces the incidence of postoperative nausea, has an anxiolytic and analgesic effect, and also has an anti-inflammatory effect caused by surgical stress. There are rarely contraindications to its application, accurate knowledge of the rules of point selection and with proper technique acupuncture is a low-risk, pain-free procedure that can be performed by inducing a mild needling sensation. Based on all this, it can become a part of multimodal therapy. Orv Hetil. 2023; 164(30): 1187-1193.

Hypocalcemia on Admission Is a Predictor of Disease Progression in COVID-19 Patients with Cirrhosis: A Multicenter Study in Hungary.

Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 (p < 0.05; 95% CI 1.566-15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683-0.953, p < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child-Turcette-Pugh score (r = -0.400, p < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.

[Surgery of the colorectal polyps and early stage cancer - Expected standards]. / Colorectalis polypok és korai rákok sebészete ­ Elvárható standardok.

Benign polyps and early-stage cancer of the colon and rectum traditionally belong to the territory of endoscopic removal. Even though the quality of endoscopic imaging systems and additional diagnostic methods have undergone a substantial evolution over the past decade, large, sessile and lateral-spreading lesions of the large bowel still represent a significant risk of malignancy. This doubt may be undispellable until the removal of the lesion. Therefore endoscopists need to be highly cautious, and keep a very low threshold to involve an expert surgeon even at the phase of diagnostics, as well as treatment. We summarise state-of-the-art treatment principles of benign polyps and early malignant colorectal cancer. Finally, we propose national quality measures of surgical interventions for colorectal polyps.

[Machine perfusion in kidney transplantation]. / Gépi perfúzió a vesetranszplantációban.

The field of organ transplantation has been facing the problem of organ shortage for several years. It is even more crucial since the number of patients on the waiting list is growing steadily. There have been numerous approaches to resolve the issue: on the one hand, extending the donation criteria and, on the other hand, improving organ preservation using machine perfusion. Experimental and clinical studies have already proven that machine perfusion decreases the incidence of delayed graft function and improves graft survival, which is particularly significant in extended criteria donation. Machine perfusion is used widely in kidney transplantation. The most frequently used method is hypothermic machine perfusion but the normothermic method is gaining more attention as well. Depending on the temperature set, machine perfusion may not only be used for organ preservation but also for organ conditioning. There is still ongoing research in the field of therapeutic approaches during machine perfusion, which may play an important role in decreasing ischaemia-reperfusion injury and immunogenicity in grafts. After a brief description of extended criteria donation, our review aims to summarize the methods and the latest results of machine perfusion, including diagnostic and therapeutic approaches in the field of kidney transplantation. Orv Hetil. 2023; 164(9): 339-347.

[Successful pregnancy of a patient with primary sclerosing cholangitis awaiting liver transplantation]. / Primer szklerotizáló cholangitisben szenvedo, májtranszplantációra váró beteg sikeres várandóssága.

In women, primary sclerotising cholangitis (PSC) associated with ulcerative colitis and intrahepatic cholestasis is a rare disease. To date, there are no data from Hungary on the fertility and pregnancy outcome of women with this chronic liver disease. Our aim is to present the favorable pregnancy outcome of a woman with PSC associated with ulcerative colitis, intrahepatic cholestasis and postpartum colectomy, and review of the literature. A young nulligravida was first diagnosed with ulcerative colitis. Five years later, PSC developed with progressive fibrosis and cholestasis necessitating liver transplantation. While on waiting list, spontaneous conception occurred. Except for pregnancy-induced hypertension, pregnancy uneventfully progressed until the third trimester when 8 g oral cholestyramine/day was administered to lower high maternal (over 100 µmol/L) total bile acid (TBA) level. In the 36th week of gestation acute exacerbation of ulcerative colitis resulted in maternal fever and chorioamnionitis leading to fetal distress. Elective delivery of the eutrophic neonate followed by emergency cesarean section. In the early puerperium, colitis progressed to septic pancolitis resistant to medical treatment. 12 days after laparoscopic subtotal colectomy, the patient was discharged in good health condition. 3 months later, ileostomy was closed and she got back on the transplantation waiting list. Our data correspond with previous reports and suggest that women with PSC with underlying ulcerative colitis and cholestasis have a good chance for favorable pregnancy outcome. However, both PSC and underlying colitis might progress during pregnancy and puerperium. Oral cholestyramin is an effective and safe treatment for high maternal TBA levels. Orv Hetil. 2023; 164(6): 234-240.

Evidence-based hand hygiene: Liquid or gel handrub, does it matter?

BACKGROUND: Recent studies put under scrutiny the prevailing hand hygiene guidelines, which incorporate quantitative parameters regarding handrub volume and hand size. Understanding the criticality of complete (i.e., efficient) hand hygiene in healthcare, objectivization of hand hygiene related parameters are paramount, including the formulation of the ABHR. Complete coverage can be achieved with optimal Alcohol-Based Hand Rub (ABHR) provided. The literature is limited regarding ABHR formulation variances to antimicrobial efficiency and healthcare workers' preference, while public data on clinically relevant typical application differences is not available. This study was designed and performed to compare gel and liquid format ABHRs (the two most popular types in Europe) by measuring several parameters, including application time, spillage and coverage. METHODOLOGY: Senior medical students were invited, and randomly assigned to receive pre-determined ABHR volumes (1.5 or 3 ml). All the 340 participants were given equal amounts of gel and liquid on two separate hand hygiene occasions, which occurred two weeks apart. During the hand hygiene events, by employing a digital, fully automated system paired with fluorescent-traced ABHRs, disinfectant hand coverage was objectively investigated. Furthermore, hand coverage in relation to the participants' hand sizes was also calculated. Additional data collection was performed regarding volume differences and their effect on application time, participants' volume awareness (consciousness) and disinfectant spillage during the hand hygiene events. RESULTS: The 1.5 ml ABHR volume (commonly applied in healthcare settings) is insufficient in either formulation, as the non-covered areas exceeded significant (5%+) of the total hand surface area. 3 ml, on the contrary, resulted in almost complete coverage (uncovered areas remained below 1.5%). Participants typically underestimated the volume which they needed to apply. While the liquid ABHR spreads better in the lower, 1.5 ml volume compared to the gel, the latter was easier handled at larger volume. Drying times were 30/32 s (gel and liquid formats, respectively) when 1.5 ml handrub was applied, and 40/42 s when 3 ml was used. As the evaporation rates of the ABHR used in the study are similar to those available on the market, one can presume that the results presented in the study apply for most WHO conform ABHRs. CONCLUSION: The results show that applying 1.5 ml volume was insufficient, as large part of the hand surface remained uncovered (7.0 ± 0.7% and 5.8 ± 1.0% of the hand surface in the case of gel and liquid, respectively) When 3 ml handrub was applied drying times were 40 and 42 s (gel and liquid, respectively), which is a very long time in daily clinical practice. It looks like we cannot find a volume that fits for everyone. Personalized, hand size based ABHR volumes may be the solution to find an optimal balance between maximize coverage and minimise spillage and drying time. 3 ml can be a good volume for those who have medium size hands. Large handed people should use more handrub to reach appropriate coverage, while small-handed ones may apply less to avoid massive spillage and not to take unrealistically long to dry.

[Philosophy and technque in everyday practice of robotic surgery]. / Filozófia és technika a robotsebészet mindennapjaiban.

A modern, betegközpontú sebészet alapja a pácienst ért mutéti stressz minimalizálása. E tekintetben jelentett forradalmi újítást a minimálisan invazív sebésztechnikák megjelenése. A laparoscopos kulcslyuksebészet mára számos kórkép kezelésében "gold standard" megoldássá vált. A párhuzamosan megjeleno robotsebészeti rendszerek a sebészi beavatkozások invazivitásának további csökkenését eredményezték. A laparoscopos beavatkozások elonyei mellett a robotsebészet alkalmazása során a még precízebb technikai megvalósítás jelentos javulást hozott egyes mutatókban, úm. onkológiai, funkcionális eredmények. A szöveti szintu preparálás, a képletek speciális szögekbol való megközelítése a sebészet határait újra kijjebb tolta. A kezdeti lépések után a robotasszisztált beavatkozások körében, az urológiai és nogyógyászati területek után, egyre nagyobb teret kaptak az emésztoszervi megbetegedések is. Jelen összefoglaló tanulmány célja a robotasszisztált mutétek sajátosságainak bemutatása, valamint a robotsebészet szerepének, eredményeinek összefoglalása gastrointestinalis tumorok tekintetében.

[Comparison of outcome of rigid and self-expanding stents for palliation of malignant dysphagia]. / A malignus eredetu dysphagia palliatív kezelésére használt merev és öntáguló sztentek eredményeinek összehasonlító vizsgálata.

INTRODUCTION: Between 1984 and 2019, 1005 rigid prostheses and 423 self-expanding stents were inserted for palliation of malignant esophageal stenosis. OBJECTIVE: The aim of this study was the comparison of the treatment results using the two types of prosthesis. METHOD: Retrospective analysis has been performed comparing the characteristics and treatment results of the two patients groups referring to the technical success of the procedures, procedure-related complications, change in the quality of life, and survival time. RESULTS: A comparison of average ages, duration time of dysphagia, quantity of weight loss, and the progress of the malignancy proves that palliation with self-expanding stents made it possible to treat more patients in worse condition. The number of complications in the patient group treated with stents was significantly higher at 29.3%/20.9%. Endoscopic intervention was performed to treat complications in 68.6% of cases with rigid prostheses and in 53.2% of patients treated with stents. Relevant improvement of dysphagia and the patients' quality of life was observed in 97% of those who were treated with a rigid prosthesis and in 91.3% of those who were treated with self-expanding stents. The survival time in the group of patients treated with stents was significantly shorter by 4.3/5.4 months than in the other group. CONCLUSION: The use of self-expanding stents in palliative treatment of malignant strictures have brought significant changes in everyday practice with increasing the possibilities. The treatment results were not improved by their application as much as the worse condition of the patient group worsened them. Orv Hetil. 2022; 163(49): 1952-1961.

Physical prehabilitation improves the postoperative outcome of associating liver partition and portal vein ligation for staged hepatectomy in experimental model.

Aiming to improve the postoperative outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the effect of physical prehabilitation (PP) was investigated in experimental model. Male Wistar rats (n = 106) divided to PP and sedentary (S) groups underwent ALPPS. Changes in liver weight, Ki67 index and liver volume by magnetic resonance imaging (MRI) were evaluated. Liver function was assessed by laboratory parameters and 99mTc-mebrofenin single-photon emission computed tomography (SPECT) hepatobiliary scintigraphy (HBS). Utilizing endotoxemia model mortality and septic parameters were investigated. Liver mass (p < 0.001), Ki67 index (p < 0.001) and MRI liver volume (p < 0.05) increased in the PP group compared to the S group. Both standard laboratory parameters (p < 0.001) and HBS (p < 0.05) showed enhanced liver function in the PP group compared to the S group. The vulnerability of animals improved in the PP group, as mortality decreased (p < 0.001), while septic laboratory parameters improved (p < 0.05) compared to the S group in the endotoxemia model. Our study demonstrated for the first time the beneficial role of PP on not only volumetric but also functional liver regeneration and postoperative vulnerability after ALLPS.

The Elevated De Ritis Ratio on Admission Is Independently Associated with Mortality in COVID-19 Patients.

Liver damage in COVID-19 patients was documented as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels or an elevated AST/ALT ratio, known as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic value of the De Ritis ratio compared to other abnormal laboratory parameters and its relation to mortality. We selected 322 COVID-19 patients in this retrospective study conducted between November 2020 and March 2021. The laboratory parameters were measured on admission and followed till patient discharge or death. Of the 322 COVID-19 patients, 57 (17.7%) had gastrointestinal symptoms on admission. The multivariate analysis showed that the De Ritis ratio was an independent risk factor for mortality, with an OR of 29.967 (95% CI 5.266-170.514). In ROC analysis, the AUC value of the the De Ritis ratio was 0.85 (95% CI 0.777-0.923, p < 0.05) with sensitivity and specificity of 80.6% and 75.2%, respectively. A De Ritis ratio ≥1.218 was significantly associated with patient mortality, disease severity, higher AST and IL-6 levels, and a lower ALT level. An elevated De Ritis ratio on admission is independently associated with mortality in COVID-19 patients, indicating liver injury and cytokine release syndrome.

Prognostic Ability of Tumor Budding Outperforms Poorly Differentiated Clusters in Gastric Cancer.

The prognostic value of histological phenomena tumor budding (TB) and poorly differentiated clusters (PDCs) have been less studied in gastric cancer (GAC) and the data provided so far are controversial. In our study, 290 surgically resected GAC cases were evaluated for TB according to the criteria of International Tumor Budding Consensus Conference (ITBCC) and PDC, and both parameters were scored on a three-grade scale as described for colorectal cancer previously (0: Grade0, 1-4: Grade1, 5-9: Grade2 and ≥10: Grade3) and classified as low (Grade0-2) and high (Grade3) TB/PDC. High TB/PDC was associated with diffuse-type morphology, higher pT status, incomplete surgical resection, poor tumor differentiation and perineural and lymphovascular invasion. Multivariable survival analyses have shown an independent prognostic role of high TB with poorer overall survival in the total cohort (p = 0.014) and in intestinal-type adenocarcinomas (p = 0.005). Multivariable model revealed high TB as an independent predictor for lymph node metastasis in both the total cohort (p = 0.019) and in the intestinal type adenocarcinomas (p = 0.038). In contrast to tumor budding, no significant association was found between PDC and the occurrence of lymph node metastasis and tumor stage and even survival. In conclusion, tumor budding is an independent prognostic factor of survival in gastric cancer, especially in intestinal-type adenocarcinomas.

Quantitative Software Analysis of Endoscopic Ultrasound Images of Pancreatic Cystic Lesions.

Endoscopic ultrasonography (EUS) is the most accurate imaging modality for the evaluation of different types of pancreatic cystic lesions. Our aim was to analyze EUS images of pancreatic cystic lesions using an image processing software. We specified the echogenicity of the lesions by measuring the gray value of pixels inside the selected areas. The images were divided into groups (serous cystic neoplasm /SCN/, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms /Non-SCN/ and Pseudocyst) according to the pathology results of the lesions. Overall, 170 images were processed by the software: 81 in Non-SCN, 30 in SCN and 59 in Pseudocyst group. The mean gray value of the entire lesion in the Non-SCN group was significantly higher than in the SCN group (27.8 vs. 18.8; p < 0.0005). The area ratio in the SCN, Non-SCN and Pseudocyst groups was 57%, 39% and 61%, respectively; significantly lower in the Non-SCN group than in the SCN or Pseudocyst groups (p < 0.0005 and p < 0.0005, respectively). The lesion density was also significantly higher in the Non-SCN group compared to the SCN or Pseudocyst groups (4186.6/mm2 vs. 2833.8/mm2 vs. 2981.6/mm2; p < 0.0005 and p < 0.0005, respectively). The EUS image analysis process may have the potential to be a diagnostic tool for the evaluation and differentiation of pancreatic cystic lesions.

Case report of actinomycotic liver abscess following COVID-19 infection.

Introduction and importance: In the last few years, the novel coronavirus, named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), generated a large health care problem worldwide. Due to the immunomodulation effect of the virus the number of opportunistic infections has also increased. Case presentation: We present the unique case of a patient who was diagnosed with an actinomycotic liver abscess after coronavirus disease 2019 (COVID-19) without the presence of any chronic disease or mucosal injury. Clinical discussion: According to the results of the computer tomography (CT scan) and the liver biopsy, the patient was treated with antibiotics and ultrasound-guided drainage. Conclusion: With this case we would like to draw attention to the possible occurrence of liver abscesses caused by an opportunistic pathogen following COVID-19.