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Background: Infliximab is a monoclonal anti-TNF-alpha antibody that has been shown to be effective in Crohn's disease therapy. However, data are scarce about the mechanism of action and its efficacy in ulcerative colitis (UC). Aim: To assess intracellular changes of the colonic mucosa in patients with UC before and after infliximab treatment. Methods: 7 patients (18-65 years, 4 men) with active, refractory, moderate to severe UC (Lichtiger's Clinical Activity Index >6, Endoscopic Index >4) underwent colonoscopy before and 4 weeks after the initial infusion of infliximab 5mg/kg of body weight. Endoscopically obtained biopsy specimens were processed specifically, stained with uranyl-acetate and lead citrate and examined with a JEOL-1010 transmission electron microscope. Results: Before treatment we noticed severe alterations of the epithelium: microvilli depletion, shattering of the epithelial junctions, cytoplasmic vacuolization, dilatation of the endoplasmic reticulum, pycnotic nuclei, altered structure of mitochondria and Golgi complexes. Rarefaction of the goblet cells, and abnormal mucus formation and secretion were also observed. The corresponding chorion showed structural alteration of component cells, obstructed capillaries, erythrocyte extravasation, and many plasmocytes and neutrophils. After infliximab, improvement in morphology and function of the epithelial organelles, rich mucus secretion and recovery of the chorionic components were noticed. Conclusions: Our study revealed important intracellular alterations of the UC mucosa that were restored after infliximab therapy. These features may contribute to a better understanding of UC pathogenesis and mechanism of action of the anti-TNF-alpha therapies. [ABSTRACT FROM AUTHOR]

Background & Aims: Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. Methods: We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. Results: A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. Conclusions: Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high. [ABSTRACT FROM AUTHOR]

Introduction. The ingestion of caustic substances represents a medical/surgical emergency, the severity of the lesions usually depends on the nature and quantity of the ingested product, and the treatment requires a multidisciplinary approach. Aim and methods. to retrospectively analyze the profile of the patients with caustics ingestion from Bihor Emergency Clinical County Hospital between 1st of January 2013 and 31st of December 2023. We carefully analyzed the files of the aforementioned patients for clinical, biological, endoscopic, therapeutic as well as the evolving patterns. Results. We included 42 patients, with a clear male predominance, M/F ratio of 1.62. The mean age was 34.6 years ±14.2, rural/urban ratio 24/18. From the studied group, 12 patients (28.5%) were known and followed-up with a psychiatric illness. Accidental ingestions were less frequent n=13 (31%) than voluntary ingestions n=29(69%). Among the substances, HCl/bleach was the most used n=20 (47.6%), followed by ethylene glycol n=12 (28.6%), NaOH n=5 (11.9%), H2SO4 n=2 (4.8%), unknown substance n=3 (7.1%). At admission, 23 (54.8%) patients presented oropharyngeal lesions, vomiting in 32 cases (76.2%), epigastric pain in 32 cases (76.2%), esophageal syndrome in 10 cases (23.8%), hematemesis in 4 cases (9.5%), peritoneal syndrome in 3 cases (7.1%), acute renal failure in 7 cases (16.7%). After excluding a surgical emergency, the UGIE performed in the first 24 hours after admission, showed according to the Zargar classification: grade I esophageal lesions -7 cases (16.7%), grade II -18 cases (42.9%), grade III - 6 cases (14.3%) and grade IV -3 (7.1%). Grade I gastric lesions were observed in 18 patients (42.8%), grade II in 4 patients (9.5%), grade III in 13 patients (31%), grade IV in 2 (4.8%). All patients received medical treatment (PPI, metoclopramide) and parenteral nutrition according to severity. Early pneumomediastinum after UGIE was observed in 3 patients (7.1%). The in-hospital mortality rate was (16.7%). A predictive factor for unfavourable prognosis is hyperleukocytosis (p=0.018). There is no significant correlation between the amount ingested (p=0.8) or age (p=0.6) and the evolution of the patients or between the product ingested and the severity of esophageal/gastric involvement at admission. Conclusion. In our study, the epidemiological profile of caustic ingestion was dominated by the voluntary ingestion of HCL/bleach, the symptomatology was mainly digestive, and hyperleukocytosis represented an unfavourable prognostic factor. [ABSTRACT FROM AUTHOR]

Introduction. Wild mushroom poisoning provoked by the consumption of mushrooms from uncontrolled sources (personal harvesting from woods) is still a frequently encountered emergency in our country, especially in rainy seasons and with dominant digestive manifestations. Aim and methods. we performed a retrospective study between 1st of January 2019 and 31st of December 2022, with the purpose of identifying and characterizing all the mushroom poisoning cases that sought medical care in Bihor Emergency Clinical County Hospital. All the medical files of the patients were carefully analyzed for epidemiological and personal data, clinical manifestations, blood tests disturbances and mortality rate. Results. between the aforementioned periods we identified 103 cases with mushroom poisoning, 51.4 in women (of which 1.94% were pregnant) and 48.5 in men, most of them coming from rural areas (69.9%). The dominant age decades were 50-59 and 60-69 years, each with 24.7%. Regarding clinical manifestations, most of the patients expressed digestive complaints comprising nausea (71.84), vomiting (61.1%), abdominal pain (23.3%) and diarrhea (15.5%). The nervous system manifestations came second in place, dominated by vertigo (20.3%) and hallucinations (16.5%). Regarding laboratory parameters, 50% of the patients had normal routine blood analysis, the rest of the patients presenting with high levels of the liver tests and creatinine (29.1% and respectively 20.3%). The medium hospital admission period was 2.47 days. From 103 cases of poisoning there were 3 deaths, 2 induced by respiratory failure secondary to aspiration pneumonia caused by vomiting, and 1 case of multiple organ failure, leading to a general mortality of 2.91%. Conclusions. Wild mushroom poisoning in our region is mostly dominated by digestive symptoms and abnormal liver tests. Despite the fact that mushroom poisoning seems to bear a relative low mortality rate it still has a high incidence in our region/hospital suggesting that ancestral habits are still present especially in rural areas and in people of adult age (50-70 years), thus indicating the need of more sanitary education measures from young ages. [ABSTRACT FROM AUTHOR]

Introduction. Since the start of the COVID-19 pandemic, many patients reported persistent symptoms and/or complications lasting beyond 4 weeks, now referred to as the post COVID-19 syndrome. Although SARS-CoV-2 is a virus with an essentially respiratory tropism, the extra-pulmonary manifestations of this pathogen are currently described. Aim and methods: to assess the digestive manifestations of the post COVID-19 syndrome. We conducted a single-center retrospective study (between January 2021-February 2023) including all the patients that suffered from a SarsCov2 infection and who later (after at least 4 weeks since the infection) addressed to the outpatient unit of Bihor Emergency Clinical County Hospital. We collected and analyzed demographic, clinical complaints and biological data. Results. We identified a number of 312 patients with a positive SarsCov2 PCR test, with a male/female ratio of 1.2 and a mean age of 51±14.2. Fifty four patients (17.3%) presented for a gastroenterological consultation in our unit for persistent digestive symptoms dating back at least 4 weeks since the Covid-19 infection. Among these patients, 7 (12.9%) had a personal history of inflammatory bowel disease (IBD), 9 (16.6%) had liver cirrhosis, 5 (9.3%) had chronic hepatitis and 4 (7.4%) patients had gastro-esophageal reflux disease. In addition, 21 patients (38.9%) had functional digestive disorders. The mean time between the SarsCov2 infection episode and the gastroenterology consultation was 3±2.4 months. The major clinical complaints regarding digestive system in our patients were: bowel movement disturbances (33.3%), unspecific dyspepsia (29.6%), abdominal bloating (16.6%), heartburn (14.8%), rectal bleeding (11.1%), vomiting (7.4%), upper gastrointestinal bleeding (3.7%) and anal pain (3.7%). Eighteen (85.7%) of the patients already known with functional diseases expressed a worsening of the chronic symptoms. Four (44.4%) of the patients with liver cirrhosis presented with a decompensation of the disease (edema and ascitis) and we were not able to identify and other decompensating factor except for the recent Covid-19 infection. Two patients with IBD had a moderate flare of the disease and 12 cases (22.2%) had transient increase of the liver function tests (up to 3xUNL) and cholestasis. Conclusions. Digestive symptoms, widely found as manifestations of SarsCov2 active infection, seem to be also part of the post COVID-19 syndrome. Though the exact causality link is hard to establish, it seems that these symptoms can be the first manifestation of a functional digestive disorder, aggravate a known functional pathology or complicate an evolving organic digestive disease. [ABSTRACT FROM AUTHOR]

Introduction. Esophageal cancer (EC) is a significant public health concern, as it remains one of the leading causes of cancer-related death worldwide. Oncological, surgical and palliative treatments are the management options. Aim and methods. to analyze the epidemiological, personal data, clinical characteristics, investigations and treatment approach for patients with EC. We retrospectively studied the files of patients diagnosed with EC between 1st of January 2021 and 31st of December 2022 in Bihor Emergency Clinical County Hospital (surgical and non-surgical wards). Results. In the above mentioned period, we identified 83 cases of EC, with a mean age of 65.66 years, with a predominance of male gender (81.92%) and rural geographic background (50.60%). The clinical picture was dominated by dysphagia in 73 patients (87.95%), followed by loss of appetite, in 38 patients (45.78%) and weight loss in 35 patients (42.16%). Other symptoms included vomiting, hoarseness and nausea in a smaller subset of patients. Only 69 patients (83.13%) had an upper gastrointestinal endoscopy (UGIE), 59 patients (71.08%) underwent CT scan examination and the rest of the patients being diagnosed and evaluated directly during surgery. Regarding the localization of the tumors, most of them were found in the lower esophagus (37.14%), followed by the medium part (36.14%) and superior region (26.50%). Based on the UGIE, most cases were already obstructive (53.01%). Histologically 62 patients (74.69%) had squamous carcinoma followed by adenocarcinoma (14.45%) of mainly moderate differentiation G2 (20.48%). Management strategies included: 41 surgeries (49.39%) of which 28 (33.73%) ended up in the placement of a feeding gastrostomy, 21 patients (25.30%) had an esophageal stent placement, 42 patients (50.60%) received chemotherapy and 38 (45.78%) had radiotherapy. During the 2 years of our study, 18 patients (21.68%) died. Conclusions. Our study revealed that unfortunately most cases of EC were diagnosed in an advanced stage of the disease when mostly palliative treatment options remained available. We also want to emphasize the need of an early diagnosis with a standardized workup and staging approach to avoid unnecessary surgery and provide best outcomes for the patients. Rising awareness of these aspects must become a flagship of our daily practice. [ABSTRACT FROM AUTHOR]