Introduction The safety of upper gastrointestinal cancer patients in the SARS-CoV-2 outbreak is extremely important and most surgeons need to establish a contingency management. Aim In this study, we present the surgical outlines of patients suffering from upper gastrointestinal cancers. Materials and Methods Data were obtained from PubMed, Cochrane Database of Controlled Trials, and SCOPUS of reports up to September 2020. Results The COVID-19 outbreak makes surgical procedures extremely difficult to be performed. The most common criteria to prioritize patients for surgical treatment are stage, tumor biology, presence of tumor-related symptoms, the risk of tumor to become non-resectable, and time interval from neoadjuvant therapy. The multidisciplinary teams can help assigning a priority level to each clinical case. Conclusion We have to continue providing treatment to oncologic patients in the face of COVID-19 uncertainty, with higher caution and responsibility in order to develop a safer and more effective personalized treatment plan.
Asthma is generally characterized by variable symptoms such as dyspnea and wheezing and variable airflow obstruction. This review focuses on a subset of patients suffering from asthma with persistent airflow limitation that is not fully reversible (asthma with fixed airflow obstruction, FAO). The pathophysiology, the risk factors and the clinical outcomes associated with FAO are presented, as well as the distinct clinical entity of severe asthma and its inflammatory subtypes (T2 and non-T2). The current strategies for the treatment of these endotypes and treatment of the distinct Asthma/COPD overlap (ACO) phenotype are described. Management and medical interventions in FAO and/or ACO patients demand a holistic approach, which is not yet clearly established in guidelines worldwide. Finally, a treatment algorithm that includes FAO/ACO management based on pharmacological and non-pharmacological treatment, guideline-based management for specific co-morbidities, and modification of the risk factors is proposed.
With improvements in the outcomes for cholestatic liver diseases that present in childhood, increasing numbers of patients will require ongoing care as adults. The recent advances in management options coupled with the fact that each adult physician will have a limited number of patients with these conditions means there is a need for those in adult services to develop expertise in these conditions that were historically the domain of paediatrics. This review provides an overview of the most common paediatric cholestatic liver diseases and outlines the clinical manifestations and potential complications, and identifies key management issues unique to each condition for effective ongoing care of these patients.
Background: The coronavirus disease 2019 (COVID-19) pandemic has changed inflammatory bowel disease (IBD) care. The use of telemedicine was quickly adopted, however the impact of COVID-19 on IBD patients’ feelings and sense of security for their health has not been extensively evaluated.Aims: Our aim was to assess patients’ views and concerns regarding their IBD condition, compliance with treatment and preventive measures, accessibility to health services and sources of information they used during the coronavirus pandemic.Methods: A questionnaire-based survey of patients with IBD (n=237) was conducted at a University and an NHS GI Units.Results: Greek patients with IBD expressed high levels of fear of coronavirus infection, with more than 50% being afraid of dying as a result of COVID-19. Seven out of ten participants felt that their IBD medications increased risk of infection and this fear was significantly higher in patients on immunosuppression. Only 2% of patients discontinued treatment on their own, all of whom were receiving immunosuppression. More than 90% of participants reported staying home and washing their hands. Three quarters of patients had access to a doctor when needed and almost 50% used the electronic paperless prescription system. Participants were satisfied with the information they received regarding COVID-19. The main sources of information were media, internet and social networks, with only one third seeking guidance from their gastroenterologist. Conclusions: The COVID-19 pandemic had a profound, negative effect on IBD patients’ lives. COVID-19-related fears need to be actively addressed, particularly in IBD patients on immunosuppression, and relevant information should be continuously provided.
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