Granulocytic Sarcoma of the Stomach Presenting as Dysphagia during Pregnancy

Granulocytic sarcoma also known as extramedullary myeloid sarcoma or chloroma is an uncommon manifestation of leukemia and presents as a deposit of leukemic cells outside the bone marrow. We report a case of a twenty-five-year-old pregnant woman who presented with progressive dysphagia and recurrent postprandial vomiting. Upper GI endoscopy had shown large flat laterally spread nodular lesions in the cardia and proximal body of stomach. Biopsies from the gastric lesion showed granulocytic sarcoma of the stomach. Concurrent peripheral and bone marrow picture was suggestive of acute myeloid leukemia (AML–M4). There is limited reported literature on granulocytic sarcoma of the stomach. Concurrent gastric granulocytic sarcoma involving cardia and AML in pregnancy has not been reported till date

Rare case of primary esophageal synovial sarcoma with (x;18) translocation presenting as dysphagia

Synovial sarcoma (SS) in young adult mainly involves periarticular region of the extremities. Synovial sarcomas are exceedingly rare neoplasms of the digestive tract. In this report, we describe a very rare occurrence of primary SS of the esophagus in a 30-year-old female. Patient presented with dysphagia. Endoscopy showed submucosal esophageal polyp. Piecemeal polypectomy was done. Histologically, the tumor demonstrated biphasic morphology with epithelial and mesnchymal component. Tumor cells expressed pancytokeratin, bcl-2 and CD99 antigens. Differential diagnosis of synovial sarcoma and epithelial mesenchymal biphasic tumor was made. Cytogenetics was done to confirm the diagnosis of SS. It showed translocation (x;18). Synovial sarcomas are very rare tumor entities, particularly in the gastrointestinal tract and are likely to be mistaken with other more common tumors such as gastrointestinal stromal tumors

Role of Interventional IBD in Management of Ulcerative Colitis(UC)-Associated Neoplasia and Post-Operative Pouch Complications in UC: A Systematic Review

Interventional inflammatory bowel disease (IIBD) is going to play a major role in complex IBD including ulcerative-colitis associated neoplasia (UCAN) and postoperative complications after ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC). We performed a literature search in PubMed using keywords such as “UCAN” and “endoscopic management of pouch complications,” After screening 1221 citations, finally, 91 relevant citations were identified for the systematic review. Endoscopic recognition of dysplasia should be done by high-definition white light endoscopy (HD-WLE) or dye-based/virtual chromoendoscopy (CE) especially in known dysplasia or primary sclerosing cholangitis (PSC). Endoscopically visible lesions without deep submucosal invasion can be resected endoscopically with endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or using full-thickness resection device (FTRD). Image-enhanced endoscopy (IEE) and IIBD have an emerging role in screening, diagnosis, and management of colitis-associated neoplasia in UC and can avoid colectomy. IIBD can manage a significant proportion of post-IPAA complications. Pouch strictures can be treated with endoscopic balloon dilation (EBD) or stricturotomy, whereas acute and chronic anastomotic leak or sinuses can be managed with through the scope (TTS)/over the scope clips (OTSC) and endoscopic fistulotomy/sinusotomy

Endoscopic Management of Fistulas and Abscesses in Crohn’s Disease

Fistulas and abscesses in Crohn’s disease (CD) are mechanical complications of long term disease and can indicate an aggressive disease course. Usually chronic inflammation leads to stricture which leads to high intra-luminal pressure with resultant fistula and abscess upstream to stricture. Exceptions to that may include perianal fistulizing CD which may even precede luminal CD. Hence, management of fistula and abscesses entails management of associated strictures without which these are bound to recur. These mechanical complications (stricture/fistula/abscess) usually occur after initial 4–5 years of disease. Traditionally the management of these complications include surgical therapy. However, surgical therapy can be associated with substantial morbidity specially in these patients on immunosuppressive medications and post-operative recurrence is not uncommon. Interventional radiological procedures to drain intra-abdominal/pelvic abscess can be helpful provided that there are no intervening bowel loops. Hence, there is an unmet need of relatively less invasive endoscopic therapies for treatment of CD related fistulas and abscesses. In this chapter, we shall discuss the role of endoscopic therapy in CD related fistula and abscess

Benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement

The number of artificial intelligence (AI) tools for colonoscopy on the market is increasing with supporting clinical evidence. Nevertheless, their implementation is not going smoothly for a variety of reasons, including lack of data on clinical benefits and cost-effectiveness, lack of trustworthy guidelines, uncertain indications, and cost for implementation. To address this issue and better guide practitioners, the World Endoscopy Organization (WEO) has provided its perspective about the status of AI in colonoscopy as the position statement. WEO Position Statement: Statement 1.1: Computer-aided detection (CADe) for colorectal polyps is likely to improve colonoscopy effectiveness by reducing adenoma miss rates and thus increase adenoma detection; Statement 1.2: In the short term, use of CADe is likely to increase health-care costs by detecting more adenomas; Statement 1.3: In the long term, the increased cost by CADe could be balanced by savings in costs related to cancer treatment (surgery, chemotherapy, palliative care) due to CADe-related cancer prevention; Statement 1.4: Health-care delivery systems and authorities should evaluate the cost-effectiveness of CADe to support its use in clinical practice; Statement 2.1: Computer-aided diagnosis (CADx) for diminutive polyps (≤5 mm), when it has sufficient accuracy, is expected to reduce health-care costs by reducing polypectomies, pathological examinations, or both; Statement 2.2: Health-care delivery systems and authorities should evaluate the cost-effectiveness of CADx to support its use in clinical practice; Statement 3: We recommend that a broad range of high-quality cost-effectiveness research should be undertaken to understand whether AI implementation benefits populations and societies in different health-care systems

Валидация опросника для оценки качества жизни пациентов с хронической приобретенной полинейропатией (Chronic Acquired Polyneuropathy – Patient Reported Index, CAP-PRI) в России

Background. Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common immune‑mediated polyneuropathy. CIDP is characterized by a long‑term progressive or recurrent course of the disease and the development of neurological deficits and disability, it is important to assess the quality of life of patients. The paper presents the results of the first and second steps of validation of the Chronic acquired polyneuropathy – Patient Reported Index (CAP‑PRI) questionnaire designed to assess quality of life in patients with immune‑mediated polyneuropathy.Aim. To develop the Russian version of the CAP‑PRI questionnaire.Materials and methods. 85 patients with CIDP (according to EAN / PNS 2021 criteria) were enrolled. At the first step we conducted linguocultural validation according to the standard protocol. Two Russian‑speaking professional translators in the field of medicine performed direct translation of the original English‑language questionnaire, and the back translation was performed by native speakers with a medical background. At the second step the psychometric parameters were evaluated.Results. The developed Russian version of the CAP‑PRI questionnaire demonstrated a high level of reliability, validity and sensitivity.Conclusion. The Russian version of the CAP‑PRI questionnaire is recommended for clinical practice and research. In addition, the relationship between improved quality of life and the reduction of neurological deficits, disability and fatigue (as assessed by the IRODS, NIS and FSS scales) has been shown.Введение. Хроническая воспалительная демиелинизирующая полинейропатия (ХВДП) – самая частая из иммуноопосредованных полинейропатий. Для ХВДП характерны многолетнее прогрессирующее или рецидивирующее течение, развитие неврологического дефицита и инвалидизации, в связи с чем важен мониторинг качества жизни пациентов. Представлены результаты 1‑го и 2‑го этапов валидации русскоязычной версии опросника Chronic Acquired Polyneuropathy – Patient Reported Index (CAP‑PRI) для оценки качества жизни у пациентов с иммуноопосредованными полинейропатиями.Цель исследования – проведение валидации опросника CAP‑PRI у пациентов с ХВДП с разработкой его русскоязычной версии.Материалы и методы. В исследование было включено 85 пациентов с ХВДП, диагностированной на основании критериев EAN / PNS 2021. На 1‑м этапе проведена лингвистическая валидация оригинальной англоязычной версии опросника согласно общепринятым рекомендациям: 2 русскоязычными профессиональными переводчиками в сфере медицины выполнен прямой перевод оригинальной англоязычной шкалы, обратный перевод осуществлен носителями языка с медицинским образованием. На 2‑м этапе валидации проводилось исследование психометрических показателей разработанного русскоязычного варианта.Результаты. Разработана русскоязычная версия опросника CAP‑PRI с высоким уровнем надежности, содержательной валидности и чувствительности.Заключение. Представленная официальная русскоязычная версия опросника для пациентов с хронической приобретенной полинейропатией (CAP‑PRI) рекомендована для отечественной клинической практики и научно‑исследовательской работы с целью оценки качества жизни пациентов. Дополнительно показана связь между улучшением качества жизни и уменьшением выраженности неврологического дефицита, степени инвалидизации и утомляемости (по результатам оценок по шкалам IRODS, NIS и FSS)

The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry

Objective: To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. Research design and methods: We analyzed data on 17,280 cases of T1D diagnosed during 2018-2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. Results: The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1-12.2) in 2018 to 21.7 (20.6-22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2-14.0) in 2018 to 26.7 (25.7-27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5-12.9) to 24.7 (24.0-25.5) for adolescents ages 12-18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018-2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. Conclusions: The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.info:eu-repo/semantics/publishedVersio

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

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