Active search for hepatitis C patients in primary care.

INTRODUCTION: undiagnosed active hepatitis C virus (HCV) infections are an obstacle to achieve the WHO (World Health Organization) hepatitis C elimination goal by 2030. One of the possible strategies to identify these patients is the active search for patients in primary care (PC). METHODS: patient medical records in PC were reviewed with a "hepatitis C" open case in the last five years. Cases with an incomplete diagnostic study (due to the absence of active infection confirmation) or those who did not start or finish treatment were included. A blood analysis was recommended to prove the existence of an active infection. The one-step diagnosis (OSD) was implemented to assess viremia in all patients with a new serologic diagnosis. RESULTS: of 253 cases with a "hepatitis C" open case in their medical records, 24.1 % (61) did not finish the diagnostic study or did not follow the treatment. Four were not suitable candidates to finish the study. Of the other 57, 92.9 % accepted the diagnostic test. Active infections were confirmed in 40 patients (75.4 %) and the treatment was completed in all of them. CONCLUSIONS: active searching for patients with hepatitis C in PC together with the OSD are effective measures to detect hidden infections and to increase the number of treatments, thus contributing to the elimination of hepatitis C.

Indications and Outcomes From 32 Consecutive Patients for the Treatment of Rectal Lesions by Transanal Minimally Invasive Surgery.

BACKGROUND: The aim of this study was to evaluate the feasibility, safety, perioperative morbidity, and short-term outcomes of the transanal minimally invasive surgery (TAMIS) technique. METHODS: This is a descriptive review of prospectively collected data from 32 consecutive patients who underwent TAMIS procedures in our colorectal unit over a 40-month period. GelPOINT Path port was used in all cases. Demographic data, indications, tumor characteristics, morbidity, and follow-up data were collected. Primary endpoints included feasibility, safety, perioperative morbidity, and resection quality. RESULTS: Fifteen adenomas, 12 carcinomas, 1 gastrointestinal stromal tumor, and 1 neuroendocrine tumor were locally excised. Additionally, 3 pelvic abscesses were drained transanally using the TAMIS port. Mean distance from the anal verge was 5.6 ± 1.5 cm. Early postoperative complications occurred in 22%, with only one case of major complication (3.1%) requiring reoperation, and no postoperative mortality. Four carcinomas were understaged (33.3%) and 1 adenoma overstaged (6.7%) preoperatively. Three carcinomas were not suspected preoperatively (25%). Microscopic positive lateral margin was found in one case, and no affected deep margin was found. Fragmentation rate was 6.9%, 2 cases, both lesions over 20 cm2. In cases of fit patients with high-risk carcinomas, 2 underwent immediate salvage surgery and another 2 refused and were treated with adjuvant radiotherapy. With a median follow-up of 26 months, the overall recurrence rate was 10.3%, 1 adenoma and 2 carcinomas. CONCLUSION: TAMIS seems to be a safe and reproducible procedure for local excision of well-selected rectal lesions with low morbidity and good functional outcomes.