Chronic inflammatory demyelinating polyneuropathy as a paraneoplastic manifestation of colorectal carcinoma: What do we know?

The pathogenesis of chronic inflammatory demyelinating polyneuropathy (CIDP) remains highly debated among experts. In recent times, literature has divulged a riveting yet plausible association between colorectal carcinoma and CIDP as its paraneoplastic ramification. Initially, research suggested that chronic inflammatory demyelinating polyneuropathy (CIDP) was caused solely by macrophages. However, recent studies have insinuated towards an alternative pathogenesis, one involving autoantibodies against paranodal junction proteins. These two distinct mechanisms are the primary contenders responsible for the development of CIDP, rendering it an elusive paraneoplastic manifestation of colorectal carcinoma.</p

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Epidemiology of Colorectal Cancer in Average Risk Adults 20-39 Years of Age: A Population-Based National Study.

BACKGROUND/AIMS: While overall rates of colorectal cancer (CRC) have declined in individuals aged above 50 years of age, this decline has not been seen in younger individuals who do not benefit from current screening guidelines. We sought to describe the prevalence of CRC in adults 20-39 years of age without family history of CRC or inflammatory bowel disease as early-onset CRC (EoCRC), evaluate associated signs and symptoms and medical comorbidities in EoCRC, and compare them with individuals aged 20-39 years without CRC (NoCRC). Our secondary aim was to compare EoCRC with individuals aged 40 years and above with CRC (LoCRC). METHODS: Utilizing a commercial database (Explorys Inc, Cleveland, OH), we identified a cohort of patients aged 20-39 years with first ever diagnosis of CRC between 2013 and 2018 based on the Systematized Nomenclature of Medicine-Clinical Terms. We calculated the overall prevalence rate of EoCRC, described age, race, and gender-based prevalence rates of EoCRC, and identified associated symptoms and medical comorbidities associated with EoCRC. RESULTS: The overall rate of EoCRC was 18.9/100,000. Compared to NoCRC, EoCRC patients were more likely to be Caucasian and female, with predominant symptoms of hematochezia, anemia, and decreased appetite. EoCRC group had higher prevalence rates of medical comorbidities such as diabetes, smoking, and obesity. Compared to LoCRC, EoCRC group presented more frequently with left-sided CRC and rectal cancers. CONCLUSION: This is one of the largest studies to date to describe the epidemiology of EoCRC in USA. We found EoCRC to occur predominantly in the Caucasian and female population. EoCRC presented more frequently with left-sided and rectal CRC. We also identified signs/symptoms as well as comorbidities associated with EoCRC. Patients with these features may benefit from earlier screening