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Vadan R, Iacob R, Costache R, Stroie T, Saizu IA, Iacob S, Gheorghe L, Diculescu M, Gheorghe C. Inflammatory Bowel Disease Management in a Romanian Tertiary Gastroenterology Center: Challenges of the COVID-19 Pandemic. J Gastrointestin Liver Dis 2020; 29:549-553. [PMID: 33331349 DOI: 10.15403/jgld-3183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBD) patients management has been challenging during the ongoing coronavirus disease 2019 (COVID-19) pandemic, due to lockdowns, limitation of access to medical facilities and new recommendations regarding patient management. The implications of the COVID-19 pandemic on IBD patients' management were assessed in our Tertiary Gastroenterology Center in Bucharest, Romania. METHODS Medical records of IBD patients admitted between 15th of March and 15th of August 2020 were retrospectively reviewed and compared to a control cohort of consecutive IBD patients admitted to our unit during the corresponding period of 2019. RESULTS There was a highly significant shift towards one-day hospitalization during the referral period in 2020 for IBD cases (91% in 2020 vs 82.2% in 2019, p=0.0001). There was no statistically significant difference between the distribution of patient's gender, IBD phenotype or newly diagnosed IBD cases. A significantly lower proportion of admitted patients received 5-aminosalicylic acid (29% vs 41.2%, p=0.0001), whereas a substantially higher number of patients were prescribed biological therapy in 2020 in comparison to the corresponding 2019-time frame (79.5% vs 57.9%, p<0.0001). The distribution of the biological agent used was significantly different in 2019 in comparison to the 2020 period mainly due to the increase in vedolizumab prescription in 2020 (p<0.0001). During the study period in 2020, seven IBD patients (1.7%) were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection, all of them with mild symptoms without impact on the IBD course. CONCLUSIONS The COVID-19 pandemic led to reorganizing medical care, limiting the hospital admissions in favor of severe IBD cases, favoring telemedicine for mild disease and optimization of treatment for moderate to severe IBD with an increased use of biologicals aimed to maximize the risk/benefit ratio. Incidence of SARS-Cov2 infection during the first wave of COVID-19 infection in our study group was 1.7% and did not adversely impact the IBD disease course.
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Affiliation(s)
- Roxana Vadan
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania. .
| | - Razvan Iacob
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. .
| | - Roxana Costache
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania.
| | - Tudor Stroie
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania.
| | - Ionut Adrian Saizu
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania.
| | - Speranta Iacob
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Liliana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Mircea Diculescu
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Cristian Gheorghe
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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Les A, Dimitriu A, Costache R, Gheorghe L, Gheorghe C. Ultrasonographic assessment of Crohn's disease patients: can be easier and more affordable for clinical practice? J Gastrointestin Liver Dis 2019; 28:130-131. [PMID: 30851184 DOI: 10.15403/jgld.2014.1121.281.crh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Anda Les
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
| | - Anca Dimitriu
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
| | - Roxana Costache
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
| | - Liana Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania.
| | - Cristian Gheorghe
- Center of Gastroenterology and Hepatology, Fundeni Clinic Institute, University of Medicine "Carol-Davila", Bucharest, Romania
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Bunduc Ș, Iacob R, Costache R, Stoica B, Radu C, Gheorghe C. Very Early Onset Pancreatic Adenocarcinoma - Clinical Presentation, Risk Factors and Therapeutic Options. Chirurgia (Bucur) 2018; 113:405-411. [PMID: 29981672 DOI: 10.21614/chirurgia.113.3.405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
Abstract
Background: Pancreatic cancer (PC) is usually diagnosed in the 7th decade, but cases diagnosed in younger patients are associated with a greater disease burden, through the potential years of life lost. The aim of our study was to compare the differences in risk factors, clinical presentation and treatment options between patients diagnosed with pancreatic adenocarcinoma below 45 years of age (very early onset pancreatic adenocarcinoma - VEOPC), and those diagnosed over 45 years. Methods: A retrospective study has been conducted by registering in standardized Excel Worksheets all PC cases diagnosed in our tertiary referral center between 01.01.2015 and 31.12.2017. Only patients with a documented diagnosis of pancreatic adenocarcinoma (PDAC) were included in the statistical analysis that has been conducted using the NCSS v9 Statistical Software package. Categorical data have been compared using Chi2 test or Fisher Exact as appropriate, with a statistical significance p value 0.05. Results: There were 296 patients diagnosed with pancreatic solid tumors during the study period, 183 cases with documented histology: 80.87% PDAC, 17.5% neuroendocrine tumors, 2 cases of LMNH and 1 MANEC tumor. In our study group there were 24 patients (16.22%) with VEOPC. Family history of pancreatic neoplasia (33.3% vs 1.03%, p=0.0004) and alcohol consumption (42.86% vs 5.41%, p=0.01) were significantly more prevalent in young patients. Pain, as primary symptom, was reported at higher rates in patients with VEOPC (60% vs 22.94%, p=0.006). Tumors were more frequently located in the head of the pancreas in younger patients (56.52%) and in the body of the pancreas in older patients (52.07%, p=0.02). There was no significant difference in therapy or death rate during follow-up period between the two study groups, although patients diagnosed under 45 years were more frequently subjected to a radical resection (33.3% vs 22.69%). Conclusions: Our study has identified alcohol consumption and family history of pancreatic neoplasia as risk factors for VEOPC. Pain is the primary symptom at diagnosis in young patients with PDAC. In our cohort, therapeutic options do not differ significantly in PDAC patients with age of onset.
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Bancila I, Becheanu G, Dumbrava M, Costache R, Gheorghe C. Brunner's gland hyperplasia - a rare cause of gastrointestinal bleeding. J Gastrointestin Liver Dis 2018; 27:9. [PMID: 29557409 DOI: 10.15403/jgld.2014.1121.271.brn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ion Bancila
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
| | - Gabriel Becheanu
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania.
| | - Mona Dumbrava
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
| | - Roxana Costache
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
| | - Cristian Gheorghe
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
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Trifa AP, Bănescu C, Tevet M, Bojan A, Dima D, Urian L, Török-Vistai T, Popov VM, Zdrenghea M, Petrov L, Vasilache A, Murat M, Georgescu D, Popescu M, Pătrinoiu O, Balea M, Costache R, Coleș E, Șaguna C, Berbec N, Vlădăreanu AM, Mihăilă RG, Bumbea H, Cucuianu A, Popp RA. TERT rs2736100 A>C SNP and JAK2 46/1 haplotype significantly contribute to the occurrence of JAK2 V617F and CALR mutated myeloproliferative neoplasms - a multicentric study on 529 patients. Br J Haematol 2016; 174:218-26. [PMID: 27061303 DOI: 10.1111/bjh.14041] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/22/2016] [Indexed: 12/14/2022]
Abstract
Polycythaemia vera (PV), essential thrombocythaemia (ET) and primary myelofibrosis (PMF) represent typical myeloproliferative neoplasms (MPN), usually characterized by specific somatic driver mutations (JAK2 V617F, CALR and MPL). JAK2 46/1 haplotype and telomerase reverse transcriptase gene (TERT) rs2736100 A>C single nucleotide polymorphism (SNP) could represent a large fraction of the genetic predisposition seen in MPN. The rs10974944 C>G SNP, tagging the JAK2 46/1 haplotype, and the TERT rs2736100 A>C SNP were genotyped in 529 MPN patients with known JAK2 V617F, CALR and MPL status, and 433 controls. JAK2 46/1 haplotype strongly correlated to JAK2 V617F-positive MPN and, to a lesser extent, CALR-positive MPN. The TERT rs2736100 A>C SNP strongly correlated to all MPN, regardless of the phenotype (PV, ET or PMF) and major molecular subtype (JAK2 V617F- or CALR-positive). While both variants have a significant contribution, they have nuanced consequences, with JAK2 46/1 predisposing essentially to JAK2 V617F-positive MPN, and TERT rs2736100 A>C having a more general, non-specific effect on all MPN, regardless of phenotype or major molecular subtype.
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Affiliation(s)
- Adrian P Trifa
- Department of Medical Genetics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Genetics, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania
| | - Claudia Bănescu
- Department of Genetics, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania
| | - Mihaela Tevet
- Department of Haematology, Colentina Hospital, Bucharest, Romania
| | - Anca Bojan
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania.,Department of Haematology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Delia Dima
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania
| | - Laura Urian
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania.,Department of Haematology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tünde Török-Vistai
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania.,Department of Haematology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Viola M Popov
- Department of Haematology, Colentina Hospital, Bucharest, Romania
| | - Mihnea Zdrenghea
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania.,Department of Haematology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ljubomir Petrov
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania.,Department of Haematology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anca Vasilache
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania
| | - Meilin Murat
- Department of Haematology, Colentina Hospital, Bucharest, Romania
| | | | - Mihaela Popescu
- Department of Haematology, Colentina Hospital, Bucharest, Romania
| | - Oana Pătrinoiu
- Department of Haematology, Colentina Hospital, Bucharest, Romania
| | - Marius Balea
- Department of Haematology, Colentina Hospital, Bucharest, Romania
| | - Roxana Costache
- Department of Medical Genetics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Coleș
- Department of Haematology, Colțea Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Carmen Șaguna
- Department of Haematology, Colțea Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicoleta Berbec
- Department of Haematology, Colțea Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana-Maria Vlădăreanu
- Department of Haematology, University Emergency Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Romeo G Mihăilă
- Department of Haematology, Sibiu County Emergency Hospital, 'Lucian Blaga' University, Sibiu, Romania
| | - Horia Bumbea
- Department of Haematology, University Emergency Hospital, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Andrei Cucuianu
- Department of Haematology, 'Ion Chiricuță' Cancer Institute, Cluj-Napoca, Romania.,Department of Haematology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu A Popp
- Department of Medical Genetics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania
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