Search

In recent years, we have faced an increasing incidence of inflammatory bowel disease (IBD), especially among young people, affecting them during their reproductive years. The paucity of data and reduced knowledge regarding the evolution of the disease during pregnancy and the adverse effects of the therapy on the mother and infant increase voluntary childlessness in this group of patients. Depending on the type of IBD, severity and surgical or medical management, this can negatively affect the pregnancy. C-sections and the risk of low-birth-weight babies are higher in women with IBD, independent of active/inactive disease, while preterm birth, stillbirth and miscarriage are associated with disease activity. In the last period, medicinal therapy has evolved, and new molecules have been developed for better control of the lesions, but the effect on pregnancy and breastfeeding is still controversial. We conducted this review by studying the literature and recent research in order to have a better image of the practical management of IBD during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. Obesity, lack of physical activity and diet have been inconsistently associated with pancreatic cancer. Aim. To evaluate the prevalence of overweight, body weight change trends, diet and physical activity level in pancreatic cancer patients diagnosed between 01.2018-02.2023. Methods. Prospective observational study that included patients diagnosed with pancreatic adenocarcinoma who were interviewed about dietary habits and weight changes, and physical activity over time. Results. A total of 186 patients with pancreatic adenocarcinoma were included. Regarding weight changes, it was observed that 56% of patients were under or normal weight at diagnosis, while a BMI below 25 was observed at one year and 5 years before only in 19.35%, respectively 12.9%. Excluding the data 5 years before diagnosis, the overweight and obesity prevalence between 20-29 years old was 43.54% respectively 11%, at 30-39 years old 43.54% respectively 25.8%, at 40-49 years old 22% respectively 45,6%, and at 50-59 years old 34% respectively 52.3%. Over 50 % of patients led a sedentary life. Regarding diet more than 75% of patients consumed red meat, dairy products, bread and bakery products, fruits and vegetables regularly more than 5 times a week. The consumption of fish and nut products was generally much less frequent, maximum 2 times a week in over 80% of cases. Less than half of the patients (47%) confirmed alcohol consumption, mostly occasionally, only 17% reported drinking more than 5 times a week. The favorite alcoholic drink was liquor, followed by wine, generally homemade. Conclusions. Most of the patients in the study were obese throughout their lives, but there was a weight loss starting 5 years before diagnosis, more severe in the last year. This can be explained by the advanced degree of the disease at diagnosis associated with a possible paraneoplastic hyperanabolic syndrome, the majority not complaining of loss of appetite or early satiety in the last year. Diet studies have suggested a protective effect against pancreatic cancer of the Mediterranean diet and regular consumption of nuts, even if in small quantities. This can also be confirmed by the patients included in this study whose diet does not respect these principles. Alcohol consumption does not seem to increase the risk of pancreatic neoplasm. This has also been observed in numerous studies with inconsistent results, and can also be determined by a declarative reduced consumption, due to the stigma associated with high consumption. [ABSTRACT FROM AUTHOR]

A case study of a 47-year old white male having diffuse abdominal pain and mild weight loss is presented.

Odată cu introducerea terapiei cu antivirale directe în opţiunile terapeutice ale hepatitei C, s-au stabilit şi criterii de eligibilitate pentru tratament. În România, în anul 2016, s-a aprobat, în cadrul unui program naţional, tratamentul cu ombitasvir / paritaprevir / ritonavir şi dasabuvir pentru pacienţii cu fibroză stadiu F4 dovedită prin Fibromax sau biopsie hepatică. Scopul acestui studiu a fost evaluarea eligibilităţii pacienţilor pentru terapie şi a concordanţei între testele serologice, elastometrice şi imagistice pentru evaluarea fibrozei într-o cohortă de pacienţi cu hepatită C. Au fost evaluaţi atât pacienţi nou diagnosticaţi, cât şi pacienţi cunoscuţi cu hepatită cronică C cu fibroză avansată, pe durata a 7 luni, între 1 noiembrie 2015 şi 31 mai 2016. S-au colectat date clinice, biologice, ultrasonografice, elastografice şi endoscopice. Au fost evaluaţi 146 de pacienţi pentru eligibilitatea la terapia antivirală fără interferon. Dintre aceştia, 89 (61%) au fost femei şi 57 (39%) bărbaţi, cu o medie de vârstă de 60 ± 8 ani. În ceea ce priveşte terapiile antivirale anterioare, 58 (52,5%) au fost naivi, 30 (27,4%) nonresponderi, 19 (17,81%) relapseri si 3 (2,74%) netoleranţi la biterapie. 80 (54,8%) au prezentat valori crescute ale alfa-fetoproteinei, fiind evaluaţi imagistic pentru excluderea unui hepatocarcinom - dintre aceştia, 8 pacienţi au fost diagnosticaţi cu hepatocarcinom. Ecografic, apoape jumătate dintre pacienţi aveau dilataţie de ax spleno-port, iar la endoscopia digestivă superioară 42% aveau varice esofagiene. Elastografia Fibroscan a fost efectuată la 88 / 146 de pacienţi: 82,95% aveau fibroză F4, 1,14% F3-F4, 9,09% F3 şi 7,2%

With the introduction of direct acting antivirals in the therapeutic armamentarium of hepatitis C (HCV), policy makers have set criteria for treatment eligibility. In Romania, the combination of ombitasvir/paritaprevir/ritonavir and dasabuvir is reimbursed for F4 fibrosis on liver biopsy/Fibromax, or F3 with contraindication to interferon (IFN). Our aim was to assess treatment eligibility and discordance between serological, elastometric and imaging evaluation of fibrosis in a cohort of patients with HCV. We evaluated both newly diagnosed and previously known HCV patients with advanced fibrosis, from our database, during a period of 7 months, between November 1st, 2015 and May 31st, 2016. Clinical, biological, ultrasound, elastography and endoscopy data were collected. Altogether 146 patients were assessed for treatment eligibility. Among them, 61% were females, with a mean age of 60 ± 8 years. Regarding treatment status, 52.5 % were naive, 27.4% nonresponders, 17.81% relapsers and 2.74% intolerant to bitherapy. 54.8% had elevated alpha-fetoprotein and were checked by advanced imaging for exclusion of hepatocellular carcinoma (HCC) - of them, 8 were diagnosed with HCC. On ultrasound, almost 1/2 patients had dilated splenoportal axis and at endoscopy 42% had esophageal varices. Transient elastography (Fibroscan) was done in 88/146 patients: 82.95% were F4, 1.14% F3-F4, 9.09% F3 and 6.82%

Hepatocellular carcinoma (HCC) is the fifth most common cancer, with an increasing incidence in recent years. The prognosis is unfavorable, representing the third most frequent cause of cancer-related death worldwide. This is because it generally develops in patients with pre-existing liver pathology, thus limiting therapeutic options. The role of ablative therapies is well-established in nodules smaller than 3 cm, but for nodules from 3 to 5 cm, the best therapeutic management is not well defined. Recent studies reported that combining minimally invasive procedures like transarterial chemoembolization (TACE) with microwave ablation (MWA) or radiofrequency ablation is superior to each alone. However, there is no consensus regarding the timing and the order in which each procedure should be performed. We report a case of an 86 years old male with HCV-related compensated hepatic cirrhosis and multiple cardiac comorbidities diagnosed with a 47/50 mm HCC. Pre-surgical evaluation of the associated pathologies determined that the risk for the surgical approach outweighs the benefits, so the committee decided to treat it in a less invasive manner. We performed MWA and TACE in a single session with technical success according to the modified Response Evaluation Criteria in Solid Tumors (m-RECIST). This case illustrates the first case of simultaneous MWA and TACE performed in our center. This new approach of hepatocellular carcinoma appears to be a good alternative to more invasive methods, with good results even in older people that are unfit for surgery. [ABSTRACT FROM AUTHOR]