Exploring the Effects of Tasks with Different Decision-Making Levels on Ball Control, Passing Performance, and External Load in Youth Football

This study aimed to understand how the design of decision-making tasks affects youth football players' ball control, passing performance, and external load. A total of 16 male youth football players (age: 12.94 ± 0.25 years) competed in various tasks based on the following levels of decision-making: (i) low decision-making (Low DM), which consisted of a predefined ball control and passing sequence; (ii) moderate decision-making (Mod DM), which consisted of maintaining possession in a square with four players and two balls while maintaining the same position; and (iii) high decision-making (High DM), which consisted of a 3 vs. 3 + 2 neutral players ball possession game. The study design consisted of a pre-post design (a 6 min pre-test game, a 6 min intervention, and a 6 min post-test game). The players' ball control and passing performance were measured using the game performance evaluation tool and notational analysis, while GPS data were used to determine their physical performance. The pre-post test analysis revealed decrements in players' ability to identify more offensive players after the Mod DM task (W = 9.50, p = 0.016), while there was an increase in their ability to receive the ball towards the space following the High DM task (t = -2.40, p = 0.016). Analysis between groups showed lower values in most ball control variables for the Low DM task compared to the Mod DM task (ball control execution, p = 0.030; appropriateness, p = 0.031; motor space, p = 0.025), while there were also lower values in the distance covered while sprinting (p = 0.042). Overall, prescriptive tasks (Low DM) that are repetitive in nature may affect players' perceptual attunement, whereas static tasks (e.g., Mod DM) may limit their ability to locate players in more offensive positions. Moreover, game-based situations (High DM) seem to acutely enhance players' performance, possibly due to contextual dependency. Overall, coaches should carefully consider the type of practice structure when designing tasks that aim to improve players' technical skills in youth football.

Manipulation of Stroke Rate in Swimming: Effects on Oxygen Uptake Kinetics

The study aimed to assess the effect of different front crawl stroke rates (SRs) in the oxygen uptake (̇VO₂) kinetics and ̇VO₂ peak, the total time to exhaustion (TTE), and blood lactate concentration ([La]) at 95% of the 400-m front crawl test (T400) mean speed (S400). Twelve endurance swimmers performed a T400 and four trials at 95% of the S400: (i) free SR, (ii) fixed SR (100% of the average free SR trial), (iii) reduced SR (90% of the average free SR trial), and (iv) increased SR (110% of the average free SR trial). ̇VO₂ was accessed continuously with breath-by-breath analysis. The results highlighted: (i) the time constant at increased SR (13.3±4.2 s) was lower than in the reduced SR condition (19.5±2.6 s); (ii) the amplitude of the primary phase of ̇VO₂ kinetics in the fixed SR (44.0±5.8 ml·kg^-1·min^-1) was higher than in the increased SR condition (39.5±6.4 ml·kg^-1·min^-1); and (iii) TTE was lower in the fixed SR (396.1±189.7 s) than the increased SR condition (743.0±340.0 s). The results indicate that controlled SR could be considered a swimming training strategy, focusing on physiological parameters overload.

Comparing Sleep in Shared and Individual Rooms During Training Camps in Elite Youth Soccer Players: A Short Report

CONTEXT

Athletes' sleep is the most important recovery strategy and has received growing attention. However, athletes may experience sleep disruptions due to numerous factors, such as training and competition workloads, travel, changes in sleep-wake schedules, and sleeping environments. They often spend nights in unfamiliar hotels, and sharing a bed, room, or both with another person might affect sleep duration and quality.

OBJECTIVE

To analyze the effect of sleeping in shared (SRs) versus individual (IRs) rooms on objective and subjective sleep and on slow-wave-sleep-derived cardiac autonomic activity during an official training camp in elite youth soccer players. Training and match workloads were characterized.

DESIGN

Observational case study.

SETTING

Hotel accommodations.

PATIENTS OR OTHER PARTICIPANTS

Thirteen elite male youth soccer players.

RESULTS

Players slept longer in IRs than in SRs (+1:28 [95% CI = 1:18, 1:42] hours:minutes; P < .001). Sleep efficiency was higher in IRs than in SRs (+12% [95% CI = 10%, 15%]; P < .001), whereas sleep latency was shorter in IRs than in SRs (-3 [95% CI = -15, -4] minutes; P < .001). Subjective sleep quality was lower in IRs than in SRs (-2 [-3 to -2] arbitrary units; P < .001). No differences were found for slow-wave-sleep-derived cardiac autonomic activity or for training or match workloads between training camps.

CONCLUSIONS

During soccer training camps, sleep may be affected by whether the athlete is in an SR versus an IR.

The perception of injury risk and prevention among football players: A systematic review

Football is associated with a certain risk of injury, leading to short- and long-term health consequences. However, the perception of football players about injury risk and prevention strategies is poorly documented. The present article reviewed the literature about perceptions, beliefs, attitudes and knowledge toward injury risk and prevention strategies in football players. An electronic search was performed in PubMed, Scopus, Web of Science, and APA PsychINFO until July 2022. Studies were eligible if they included the perceptions, beliefs, attitudes, and knowledge about injury risk and prevention in football players from any competitive level. The risk of bias was assessed in included studies using the Joanna Briggs Institute critical appraisal checklist. A total of 14 studies were included. Most football players agreed that their risk of injury is high and prevention strategies are important, however they do not intend to use some of these strategies. The most frequent perceived injury risk factors were low muscle strength, lack of physical fitness, fatigue, excessive training and type and condition of surfaces. The most frequent perceived injury prevention factors were warm-up, workload monitoring and strength and conditioning training. It is essential to acknowledge perceived injury risk factors, as well as a better understanding of how coaching and medical departments' perceptions match with players' perceptions, and a modification in the perceptions of the several stakeholders at different levels of action.

Severe acute autoimmune hepatitis: How to early predict who will not respond to corticosteroids and needs urgent liver transplantation?

BACKROUND

In acute severe autoimmune hepatitis (AS-AIH), the early identification of predictors of non-response to corticosteroids and the optimal timing for liver transplantation (LT) remains controversial.

AIMS

To determine early predictors of non-response to corticosteroids and to assess the usefulness of severity scores, namely the recently developed SURFASA.

METHODS

Retrospective multicentre cohort study including consecutive patients admitted for AS-AIH between 2016 and 2020. Definitions- response to corticosteroids: LT-free survival at 90 days (D90); SURFASA score: -6.8 + 1.92x(D0-INR)+1.94xINR[(D3-D0)/D0]+1.64xbilirubin[(D3-D0)/D0].

RESULTS

We included 26 patients [median age 56 (45-69) years; 22 (84.6%) women]. All patients underwent corticosteroid therapy. Overall survival reached 73%. amongst the non-responders, 2 (7.8%) underwent LT and 5 (19.2%) died. The interval between admission and initiation of corticosteroids was not different between responders and non- responders [13 (7-23) vs. 8 (3-10), P:0.06], respectively. SURFASA and MELD-Na⁺ (D3) scores showed an AUROC of 0.96 (0.87-1) and 0.92 (0.82-0.99), respectively, for prediction of non-response. SURFASA >-2.5 had a sensitivity of 85.7% and a specificity of 100% and MELD-Na⁺ (D3) >26 had sensitivity of 85.7% and a specificity of 78% for the prediction of non-response.

CONCLUSIONS

SURFASA and MELD-Na⁺ at D3 scores are useful in early identification of non-responders to corticosteroids.

Duodenal variceal bleeding as a presentation of hepatocellular carcinoma

A 79-year-old man with alcoholic liver cirrhosis without regular medical follow-up, presented at the emergency room with hematemesis. An upper endoscopy revealed a varix at the anterior wall of bulb with a red wale sign, indicating recent bleeding. An injection N-butyl-2 cyanoacrylate plus metacryloxisulfolane was successfully performed. The abdominal computed tomography angiography scan revealed a 29x26-mm nodule consistent with hepatocellular carcinoma (HCC), tumoral portal vein thrombosis (and communicating collateral from the superior mesenteric vein feeding the duodenal varix with no splenorenal shunt. After endoscopic therapy, the patient remained asymptomatic without rebleeding. Given HCC stage D (Barcelona Clinic Liver Cancer), after multidisciplinary discussion, the patient was evaluated for best supportive care. Ectopic varices are clinically challenging causes of portal hypertensive bleeding associated with significant mortality, requiring a high index of suspicion and multimodal diagnostic and therapeutic approaches. The management includes endoscopic therapy, interventional radiology techniques (TIPS with variceal embolization, balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration) or surgery. The best endoscopic treatment modality remains unclear because there are no studies directly comparing the different endoscopic techniques. In setting of ectopic varices, abdominal imaging is mandatory to exclude splanchnic vein thrombosis, HCC and to map portosystemic collaterals to guide further treatments.

Front crawl swimming coordination: a systematic review

Several constraints, including environmental (e.g., aquatic resistance, temperature and viscosity), organismic (e.g., anthropometry, buoyancy) and task-related (e.g., imposed swim speed or stroke rate) impact motor coordination and swimming performance. As motor coordination requires structurally organising intra- and inter-limb coupling, the purpose of this review was to update the literature concerning coordination between the upper-limbs in front crawl swimming. We focused on the effects of biomechanical, physiological, and personal (gender, skill level, and age) factors on coordination and performance. In fact, it could be highlighted that upper-limbs coordination varies with organismic, task and environmental constraints, resulting in several available motor solutions that should be adopted according to how each swimmer deals with occurring constraints. As such, there is no ideal or optimal coordination pattern that youth, learners and less-skilled swimmers should imitate.

Contextual variables affect peak running performance in elite soccer players: A brief report

The current brief research report aimed to investigate the influence of contextual variables on peak running performance in male elite soccer players. We analyzed 29 matches of an elite soccer team during the Brazilian Serie A 2019. Twenty players were tracked using GPS units. Peak physical performance was determined using moving average running values with different time windows (1, 3, and 5-min periods). The variables analyzed were total distance covered, total distance covered in high-intensity running (≥19.8 km·h⁻¹), and the distance in accelerations (≥2 m·s⁻²) and decelerations ( ≤-2 m·s⁻²). Four contextual variables were considered: 1) positional status; 2) match location; 3) match outcome; and 4) match status. Central defenders showed a lower 1-min peak total distance in relation to all other positions (p = 0.001–0.03). Peak physical performance was higher in away matches for high-intensity running, acceleration, and deceleration (p = 0.01–0.03). In matches that ended in losses, peak values for high-intensity running and acceleration were higher compared to draws and wins (p = 0.01–0.04). Regarding the match status, higher values were observed in draws than wins and losses (p = 0.01). Peak running performance vary according to contextual variables of the match in male elite soccer players. Positional differences were found for peak periods, and physical performance was higher in away matches.

P02-12 The implementation cost of a walking football exercise program for patients with type 2 diabetes: a case study of SWEET-Football (Portugal)

Background

Economic analysis of health interventions is essential to the development and implementation of sustainable health policies, especially in noncommunicable diseases area. Type 2 diabetes (T2D) is one of the most relevant noncommunicable diseases globally. Regular physical activity is an established cornerstone of T2D control, with benefits in glycemic control, cardiovascular risk factors and quality of life. Thus, the current study aimed to assess the cost of a community-based physical activity intervention for patients with T2D.

Methods

We assessed the SWETT-Football program - a community-based walking football exercise program for middle-aged and older male patients with T2D. The program was tested in Portugal through a scientific project (NCT03810846) funded by FIFA (FIFA Research Scholarship 2018). One season of this program consists of three sessions per week (60 minutes per session) during nine months (October to June). For the calculations, we considered a total of 40 patients (two groups of 20). We calculated the direct costs of one season for the host institution: 216 hours of renting a sports hall and hiring human resources (a football coach and a nurse); cardiac stress tests and sports insurance for the participants; sports equipment (balls, cones, vests); vital signs monitoring equipment (blood pressure, heart rate and capillary blood glucose); logistical equipment (disposable and non-disposable); and technical training. In addition, we considered an economic depreciation of five years for sports and electronic materials. Cost analysis dated January 2022.

Results

One season of this program for 40 patients with T2D was estimated to have a total implementation cost of 11,026.51€: 1,225.17€/month; 275.66€/patient; 51.05€/session; 30.63€/patient/month; and 2.55€/patient/session.

Conclusions

A community-based walking football program for patients with T2D has an affordable cost and is feasible for large-scale implementation by local communities with the involvement of football clubs, municipalities and primary health care units, promoting physical activity and contributing to T2D control.

Season Match Loads of a Portuguese Under-23 Soccer Team: Differences between Different Starting Statuses throughout the Season and Specific Periods within the Season Using Global Positioning Systems

This study aimed to quantify the external match loads (EMLs) of a Portuguese u-23 soccer team, competing at the highest national level for the age group, comparing players with different starting status throughout a competitive season and specific blocks. Thirty-five outfield soccer players were split into three groups for the entire season analysis and for each 3-month block, based on the percentage of games played as a starter. The three groups consisted of “starters” (≥55% of the games as a starter), “fringe” (30−54%), and “non-starters” (<30%). EMLs were recorded using 10 Hz GPS technology throughout the whole season (26 matches). Differences (p < 0.05) were found for total distance (TD), exposure time, and the number of accelerations and decelerations between starters and non-starters throughout the season (d = 0.73 to 1.08), and within each block (d = 0.59 to 1.68). Differences were also found between starters and fringe players for the number of accelerations in Block 2 (p = 0.03; d = 0.69), and TD (p = 0.006; d = 1) and exposure time (p = 0.006; d = 0.95) in Block 3. Differences in the EML were almost always accompanied by large differences in game time. Our results highlight the differences in the EML of starters and non-starters, emphasizing the need for compensatory training, especially with players that obtain significantly less playing time, to prepare the players for match demands (e.g., high-intensity efforts such as sprinting, accelerations, and decelerations).

Hemobilia due to porto-biliary fistula complicating endoscopic retrograde cholangiopancreatography after a recent liver transplantation

A 60-year-old woman with autoimmune hepatitis submitted to liver transplantation presented with a biliary anastomotic stenosis. An endoscopic retrograde cholangiopancreatography (ERCP) was complicated with a porto-biliary fistula due to the misplacement of a biliary stent. After multidisciplinary discussion, and the stent was endoscopically removed while a percutaneous transhepatic fully-covered self-expanded metal stent was placed in portal vein. Iatrogenic porto-biliary fistula following biliary stent placement is a rare and potentially life-threatening ERCP complication. In a suspected stent-related portal vein injury, this multidisciplinary strategy combining gastroenterology and radiology proved to be an effective and safe minimally invasive technique avoiding catastrophic consequences.

Training in women soccer players: A systematic review on training load monitoring

Objective

The present systematic review aimed to provide an overview of training load (TL), along with their responses, monitoring during training sessions in highly trained and elite adult women soccer players.

Data source

Electronic databases searches (PubMed, Scopus, Web of Science and Ebsco) for relevant studies published in peer-reviewed journals were conducted, and eligibility criteria were based on the PICOS model in accordance with PRISMA guidelines.

Study selection

Studies were considered as follows: (a) highly trained and elite adult (>18 years) women's soccer players; (b) continuous (minimum 1-week duration) TL monitoring in the context of the team routine; (c) TL collected from entire training session. Methodological qualitative assessments and risk of bias criteria were used for judging the studies.

Data extraction

A total of 1,163 studies were identified, and 16 were included. The selected studies were fully screened to extract the population characteristics; the number of players; a type of study design; region where the study was performed; the main findings.

Data synthesis

Accumulated external TL (ETL) during the pre-season was positively correlated to enhanced adaptations in intermittent exercise capacity. Daily ETL was negatively correlated to next-day self-reported fatigue and muscle soreness. Daily internal TL (ITL) was negatively correlated to post-session sleep duration and sleep efficiency. One study showed that higher accumulated player load and total distance were associated with injury.

Conclusion

Information about TL during training sessions in women soccer players is very sparse, and it is currently very difficult to consider evidence-based practices for training sessions in highly trained and elite adult women soccer players. Moreover, the dose-response relationships between TL and training outcome (e.g., fatigue, training adaptations and injuries) need to be further explored to understand the optimal training stimulus to enhance performance outcomes while preserving player health.

Biomechanical and physiological implications to running after cycling and strategies to improve cycling to running transition: A systematic review

OBJECTIVES

This systematic review summarises biomechanical, physiological and performance factors affecting running after cycling and explores potential effective strategies to improve performance during running after cycling.

DESIGN

Systematic review.

METHODS

The literature search included all documents available until 14th December 2021 from Medline, CINAHL, SportDiscus, and Scopus. Studies were screened against the Appraisal tool for Cross-sectional Studies to assess methodological quality and risk of bias. After screening the initial 7495 articles identified, fulltext screening was performed on 65 studies, with 39 of these included in the systematic review.

RESULTS

The majority of studies observed detrimental effects, in terms of performance, when running after cycling compared to a control run. Unclear implications were identified from a biomechanical and physiological perspective with studies presenting conflicting evidence due to varied experimental designs. Changes in cycling intensity and cadence have been tested but conflicting evidence was observed in terms of biomechanical, physiological and performance outcomes.

CONCLUSIONS

Because methods to simulate cycle to run transition varied between studies, findings were conflicting as to whether running after cycling differed compared to a form of control run. Although most studies presented were rated high to very high quality, it is not possible to state that prior cycling does affect subsequent running, from a physiological point of view, with unclear responses in terms of biomechanical outcomes. In terms of strategies to improve running after cycling, it is unclear if manipulating pedalling cadence or intensity affects subsequent running performance.

Water dynamics in human cancer and non-cancer tissues

Normal-to-malignant transformation is a poorly understood process associated with cellular biomechanical properties. These are strongly dependent on the dynamical behaviour of water, known to play a fundamental role in normal cellular activity and in the maintenance of the three-dimensional architecture of the tissue and the functional state of biopolymers. In this study, quasi-elastic neutron scattering was used to probe the dynamical behaviour of water in human cancer specimens and their respective surrounding normal tissue from breast and tongue, as an innovative approach for identifying particular features of malignancy. This methodology has been successfully used by the authors in human cells and was the first study of human tissues by neutron scattering techniques. A larger flexibility was observed for breast versus tongue tissues. Additionally, different dynamics were found for malignant and non-malignant specimens, depending on the tissue: higher plasticity for breast invasive cancer versus the normal, and an opposite effect for tongue. The data were interpreted in the light of two different water populations within the samples: one displaying bulk-like dynamics (extracellular and intracellular/cytoplasmic) and another with constrained flexibility (extracellular/interstitial and intracellular/hydration layers).

Gut microbiota of elite female football players is not altered during an official international tournament

The current study aimed to investigate if the gut microbiota composition of elite female football players changes during an official international tournament. The study was conducted throughout ten consecutive days, encompassing seven training sessions, and three official matches. The matches were separated by 48-72 h. Seventeen elite female football players from the Portuguese women's national football team participated in the study. Fecal samples were collected at two time points: at the beginning and end of the tournament. Fecal microbiota was analyzed by sequencing the 16S rRNA gene. Throughout the study, the duration and rating of perceived exertion (RPE) were recorded after training sessions and matches. The internal load was determined by the session RPE. The gut microbiota of players was predominantly composed of bacteria from the phyla Firmicutes (50% of relative abundance) and Bacteroidetes (20%); the genera Faecalibacterium (29%) and Collinsella (16%); the species Faecalibacterium prausnitzii (30%) and Collinsella aerofaciens (17%). Overall, no significant changes were observed between time points (p ≥ 0.05). Also, no relationship was found between any exercise parameter and the gut microbiota composition (p ≥ 0.05). These findings demonstrate that the physical and physiological demands of training and matches of an official international tournament did not change the gut microbiota composition of elite female football players. Furthermore, it supports that the gut microbiota of athletes appears resilient to the physical and physiological demands of training and match play.

Transvenous Obliteration Procedure in the Management of Parastomal Variceal Bleeding: A Case Report

<b><i>Introduction:</i></b> Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established. <b><i>Case Presentation:</i></b> A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient’s evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects. <b><i>Discussion:</i></b> This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre­sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.

Rare cause of obstructive haemobilia with recurrent biliopancreatic complications: a paradigmatic case

Haemobilia is an unusual but significant cause of upper gastrointestinal bleeding. Two-thirds of haemobilia cases are secondary to invasive hepato-biliopancreatic procedures. Biliary angiodysplasia is exceptionally unusual, with only three cases reported. Herein, we report the case of an autonomous 80-year-old woman with a history of cholecystectomy 5 years ago and cardiovascular disease-hypertension, heart failure, acute myocardial infarction, stroke and non-valvular atrial fibrillation, anticoagulated with apixaban 2.5 mg two times per day. Since July 2019, she had four episodes of acute cholangitis of mild-to-moderate severity, having undergone broad spectrum antibiotics treatment and endoscopic retrograde cholangiopancreatography (ERCP), with sphincterotomy and bile sludge extraction. After 3 months, the patient presented with a new episode of acute cholangitis, this time with haemobilia (Quincke's triad). An abdominal CT angiography showed no evidence of active bleeding, with plastic biliary prosthesis left by ERCP. The patient continued presenting new episodes of acute cholangitis with haemobilia, some of them with associated pancreatitis. A cholangioscopy with Spyglass DS II was performed, showing an angiodysplasia occupying half of the luminal circumference of the middle choledoccus, without active haemorrhage. After a multidisciplinary meeting and given the high haemorrhagic/thrombotic risk (CHA2DS2-VASc 8), closure of the left atrial appendage was considered. However, relapse of the condition after beginning the antiaggregation protocol for cardiovascular intervention made it unfeasible. Another cholangioscopy with an ultra-thin endoscope for argon-plasma coagulation was attempted, without success. The abdominal CT angiography was repeated, this time with identification of dilated ramifications of the gastroduodenal and inferior pancreatic arteries. After embolisation of these aberrant vessels with microcoils, the patient went well, with no recurrence of bleeding or biliopancreatic complications. We present a case of obstructive haemobilia with multiple biliopancreatic complications, secondary to an extremely rare cause-choledochal angiodysplasia. Cholangioscopy had a decisive role in the diagnosis and therapeutic guidance. The diagnostic/therapeutic challenge associated with haemobilia stands out, with the need for a personalised and multidisciplinary approach.

Appropriateness of Endoscopic Procedures: A Prospective, Multicenter Study

INTRODUCTION

Advances in endoscopy and open-access systems led to an increase in endoscopic procedures. However, overuse of endoscopy has been consistently reported. This study aims to assess the appropriateness of esophagogastroduodenoscopy (EGD) and colonoscopy referral in the private and public setting.

PATIENTS AND METHODS

We conducted a prospective, multicenter study at 2 public and 5 private endoscopy units. Patients scheduled for elective EGD or colonoscopy were enrolled. Clinical data and endoscopy findings were recorded. Appropriateness of endoscopy was defined according to the American Society for Gastrointestinal Endoscopy guidelines (for EGD) and the European Panel on Appropriateness of Gastrointestinal Endoscopy II (for colonoscopy).

RESULTS

Regarding EGD: 215 patients enrolled (43.7% were males) with a mean age of 61.0 ± 15.1 years; 54.0% (n = 116) were in public hospitals. Referral by a gastroenterologist was made for 34.9% (n = 75). Appropriate indications were made for 62.3% (n = 134): 42.4% in private versus 79.3% in public endoscopy units (odds ratio [OR] 5.20; 95% confidence interval [CI] 2.85-9.49; p < 0.01). Rate of appropriate EGD was 74.7% for gastroenterologist referral and 56.1% for other specialties (OR 2.31; 95% CI 1.24-4.28; p < 0.01). Diagnostic yield for relevant findings was 47.9%. No association between indication appropriateness, gastroenterologist referral, and relevant endoscopic findings was found. Regarding colonoscopy: 287 patients enrolled (49.1% were males) with a mean age of 60.4 ± 14.4 years; 48.1% (n = 138) were in public hospitals. Referral by a gastroenterologist was made for 20.6% (n = 59). Appropriate indications were made for 70.0% (n = 201): 53.0% in private vs. 88.4% in public endoscopy units (OR 6.75; 95% CI 3.66-12.47; p < 0.01). Diagnostic yield was 57.1%. Relevant endoscopic diagnosis was associated with indication: 63.2% in the appropriate vs. 43.0% in the nonappropriate indication group (p < 0.05).

DISCUSSION

A significant percentage of endoscopies, mainly in the private setting, were performed without an appropriate indication. This influenced the diagnostic yield. The use of adequate criteria is fundamental for the rational use of an open-access system.

HSV-1 hepatitis in an immunocompetent patient – Act before you know

Herpes simplex virus type 1 (HSV-1) hepatitis is an unusual complication of HSV infection, which frequently results in acute liver failure. Even though the most affected individuals are immunosuppressed patients, around 25 % patients who present with HSV hepatitis are immunocompetent. We report a case of an anicteric febrile hepatitis in a 46-year-old immunocompetent women in which the early suspicion of HSV hepatitis allowed empirical treatment and later diagnosis confirmation by liver biopsy.

•

HSV disseminated infection may occur in immunocompetent patients.

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Febrile anicteric hepatitis should raise the suspicion of herpetic etiology.

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When suspecting HSV hepatitis, empirical therapy should be immediately instituted pending diagnostic confirmation.

An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

INTRODUCTION

Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required.

CASE REPORT

A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic.

DISCUSSION/CONCLUSION

Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.

Lymphoma presented as dysphagia: a diagnosis hard to swallow

An 18-year-old woman presented with progressive oesophageal dysphagia, weight loss and night sweats over a 6-month period. Oesophagogastroduodenoscopy revealed a diffuse luminal narrowing with normal mucosa, whose biopsies were inconclusive. A cervical and thoracic CT scan showed a thickening of the upper oesophagus, densification of the mediastinal fat, several adenopathies and a 4.3×2.4 cm mass with infiltrative appearance and heterogeneous enhancement in right cervical paravertebral location. Positron emission tomography-CT showed marked increased fluorodeoxyglucose uptake in supradiaphragmatic lymph nodes, pleuropulmonary tissue, paraspinal musculature and bone marrow. Imaging-guided and surgical incisional biopsies of the paravertebral mass were inconclusive. During hospitalisation, she developed right cervicobrachial paraesthesia. Only excisional biopsy of the mass allowed the diagnosis of high-grade B-cell lymphoma not otherwise specified, Ann Arbor stage IV-B. The patient underwent chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone), followed by R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin hydrochloride). Follow-up at 12 months revealed complete response.