Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Estrogènes chez l’homme: le modèle du déficit en aromatase.

Estrogen role on adult male studied on the basis of human model of congenital estrogen deficiency: aromatase deficiency and estrogen resistanc

I supporti tecnologici nella pratica clinica del diabete mellito: un valido strumento per un miglior controllo glicemico

Descrizione di un caso clinico e dell'utilità dei Sistemi di Monitoraggio Continui della glicemi

Unfused Epiphyses Due to Unrecognized and Untreated Congenital Hypogonadotropic Hypogonadism (HH): Evidence for an E2 Threshold for Bone Maturation in Men

The study identify a threshold for serum estradiol below which bone maturation in men is not possible

Thyroid Disease in Patients with Type-1 Neurofibromatosis: A New Chapter?

The study explore the prevalence of thyroid diseases (mainly thyroid nodules) in patients with the neurofibromatosis

Lower serum testosterone and estradiol (E2) in adult men with unfused epiphyses due to unrecognized and untreated congenital hypogonadotropic hypogonadism: evidence for an E2 threshold for bone maturation in men

This study confirms that estrogen and relative estrogen deficiency are responsible for the lack of bone maturation in men with severe hypogonadis

Thyroid disease in patients with type-1 neurofibromatosis: an underestimated issue ?

The study deals with the incidence of medullary thyroid cancer in patients with type-1 neurofibromatosi

Lower serum testosterone (T) and estradiol (E2) in adult men with infuse epiphyses due to unrecognized and untreated congenital hypogonadotropic hypogonadism (HH): evidence for an E2-threshold for bone maturation in men

Estrogens rather than androgens are able to complete bone maturation only if the value is above a thresholds. In men with hypogonadotropic hypogonadism who have a serum estrogen below this threshold the growth plate does not fuse and the patient continues to growth in height

Impaired basal and stimulated GH secretion in four aromatase-deficient adult men: new aspects of the estrogen action on pituitary function

In aromatase-deficient men, GH response to potent provocative stimuli is impaired and is not restored by exogenous estrogens. Furthermore, a tall stature may be reached, notwithstanding the coexistence of GHD: the prolonged time for growth due to a delay in bone maturation, and other growth factors different from GH promote growth