Obscure duodenal malformation and other midgut malrotation defects in an elder with acute abdomen due to different prominent complicated pathology

A 70-year old  man with severe comorbidities, hemodynamically stable, was emergently admitted for bowel obstruction. His chronic intractable constipation had never been  evaluated.  The patient had  no history of abdominal  surgery.  Computed tomography indicated a large obstructive rectosigmoid tumour  and dolichocolon.   Immediate rectoscopy confirmed the presence of the obstructive tumour. Additionally, on emergent laparotomy, a malformed  right-sided  duodenum with right-sided small bowel and other midgut malrotation defects, along with a small palpable lesion in the proximal descending colon, were also found. We performed a subtotal  colectomy, mobilization of the only existing first and second duodenal portions,  division of mesenteric root adhesions, and  a terminal ileostomy. The patient had a favourable outcome, was discharged on day 8. Histology revealed a pT3N1b rectosigmoid adenocarcinoma and an 1 cm in diameter localized  c-kit+ stromal tumour in the proximal descending colon.  He received chemotherapy. The patient underwent a postoperative upper gastrointestinal contrast study which showed a well-functioning right-sided deranged duodenum. During a 36-months follow-up no recurrence of malignancy or of midgut malrotation defects has been recognized

Anakinra και σύνδρομο ενεργοποίησης μακροφάγων στη νόσο COVID-19

Από την έναρξη της νόσου COVID-19 είναι σαφές ότι αυτή αποτελεί μια επείγουσα ιατρική κατάσταση λόγω της σημαντικής νοσηρότητας και θνητότητας που προκαλεί, σε αντίθεση με άλλες πολύ λιγότερο λοιμογόνες νόσους του αναπνευστικού συστήματος, ακόμα και από ιούς της ίδιας οικογένειας. Σήμερα είναι γνωστό ότι η βαριά νόσος ακολουθεί μια πορεία είτε ανοσοπαράλυσης είτε υπερφλεγμονής, και από τις δύο αυτές καταστάσεις επάγεται τελικά πολυοργανική ανεπάρκεια και θάνατος. Στην περίπτωση της υπερφλεγμονής, το μονοπάτι της ιντερλευκίνης-1 (IL-1) φαίνεται να διαδραματίζει κεντρικό ρόλο, μέσω φαύλου κύκλου αυτοδιέγερσης της IL-1, με τελικό αποτέλεσμα την υπερέκκριση καταρράκτη κυτταροκινών και την εμφάνιση συνδρόμου ενεργοποίησης μακροφάγων. Λόγω αυτής της διαπίστωσης, ιδιαίτερο ενδιαφέρον παρουσιάζει η λογική αναχαίτισης της εξέλιξης της νόσου μέσω παρεμπόδισης του μονοπατιού της IL-1 πριν την πλήρη έκφανση συνδρόμου ενεργοποίησης μακροφάγων, και προς αυτή την κατεύθυνση δοκιμάζεται ο ανταγωνιστής του υποδοχέα της IL-1, Anakinra. Τα αποτελέσματα της δοκιμής χρήσης του Anakinra στο σύνδρομο ενεργοποίησης μακροφάγων στη νόσο COVID-19 στα πλαίσια των μελετών ESCAPE και SAVE-MORE, επιβεβαιώνουν ότι το Anakinra μπορεί να αποτελέσει ένα πολύτιμο όπλο στην φαρέτρα μας για την πρώιμη αντιμετώπιση της υπερφλεγμονής στη νόσο COVID-19.It has become clear since the beginning of COVID-19 pandemic that this disease should be considered a medical emergency, due to the morbidity and mortality associated with COVID-19, which are much higher than in other infectious respiratory diseases, even in infections caused by viruses of the same family as SARS-CoV-2. Critical disease seems to be the clinical result of two separate immunological paths, these of immune dysregulation and hyperinflammation, both resulting in multiple organ dysfunction and death. In case of hyperinflammation, the continuous production of interleukin-1 through an autoactivation loop seems to play a central role, leading to hypercytokinaemia and macrophage activation syndrome. This finding makes interleukin-1 blocking a promising target as a therapeutic approach when cytokine storm is manifested, before the full blown development of macrophage activation syndrome. Anakinra is an interleukin-1 receptor antagonist that has been used in clinical trials based on the aforementioned approach. The results of two clinical trials, ESCAPE and SAVE-MORE, studing the efficacy of Anakinra in COVID-19-related macrophage activation syndrome, suggest that Anakinra can reduce mortality when used early in COVID-19-associated hyperinflammation

Evaluating patients' unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project

International audienc

Evaluating Patients\u27 Unmet Needs in Hidradenitis Suppurativa: results from the Global VOICE project

BACKGROUND: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy. OBJECTIVE: To evaluate unmet needs from the perspective of HS patients. METHODS: Prospective multinational survey of patients between October, 2017 and July, 2018. RESULTS: Majority (63.7%, n=827) visited a physician ≥5 times prior to receiving formal HS diagnosis. Mean delay in diagnosis was 10.2 years (+/- 8.9 years). Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4%, n=798) rated recent HS-related pain as moderate or higher, while 4.5% described recent pain to be worst possible. Access to dermatology was rated as difficult by 37.0% (n=481). Patients reported visiting the emergency department and hospital ≥5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n=563), and 14.5% were disabled due to disease. Patients reported high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.5%, respectively. LIMITATIONS: Data was self-reported. Patients with more severe disease may have been selected. CONCLUSIONS: HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address

Evaluating patients' unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project

Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy. Objective: To evaluate unmet needs from the perspective of HS patients. Methods: Prospective multinational survey of patients between October 2017 and July 2018. Results: Before receiving a formal HS diagnosis, 63.7% (n = 827) of patients visited a physician ≥5 times. Mean delay in diagnosis was 10.2 ± 8.9 years. Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4% [n = 798]) rated recent HS-related pain as moderate or higher, and 4.5% described recent pain to be the worst possible. Access to dermatology was rated as difficult by 37.0% (n = 481). Patients reported visiting the emergency department and hospital ≥5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n = 563), and 14.5% were disabled due to disease. Patients reported a high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.6%, respectively. Limitations: Data were self-reported. Patients with more severe disease may have been selected. Conclusion: HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address

Effect of anakinra on mortality in patients with COVID-19: a systematic review and patient-level meta-analysis

International audienc