Notes

Area distinct organization involving physical activity as well as have an effect on throughout adolescents' everyday life: a good environmental short-term examination examine.
ies on vulnerable population groups.
Despite the small size of the Maltese islands and the expected social homogeneity, health inequities still exist, highlighting the importance of social factors in the epidemiology of disease. This study provides information for healthcare professionals and policy-makers to mitigate the effects of social inequities on vulnerable population groups.We sincerely thank Viscido et al. for their appropriate and sharable comments on our recent study on adalimumab biosimilar ABP 501 in Crohn's disease (CD). The use of a biosimilar in inflammatory disorders is one of the current main topics, given the great opportunity to save resources that can be invested in innovative drugs and the ethical problems that non-medical switching can generate.We have read with interest the case published by Plua-Muñiz as an example of how endovascular treatment may be an acceptable and safe option even in an emerging situation as long as swift action is taken and the patient is stabilized previously. Hepatic artery aneurysms are an infrequent entity and their management is a great challenge. In the following letter we show our point of view and what the literature says about its management.We report the case of a hypertensive 54-year-old female who had been under treatment with olmesartan (40 mg daily) for a month. She was referred due to hypertransaminasemia and also reported asthenia and a 7 kg weight loss.It is important to think about the viral involvement of the gastrointestinal tract in the immunocompromised patients. We present the case of a patient with a digestive hemorrhage secondary to a gastric ulcer due to herpes simplex virus (HSV) type 7 and Epstein-Barr virus (EBV) after an allotransplantation of hematopoietic progenitors because of an acute myeloblastic leukaemia. With this, we try to remark the importance of thinking about others pathogens in these patients and the implications that this implies for the treatment, since the gastric involvement by HSV 7 has not been previously reported in the literature.A 43-year-old female with a history of anorexia nervosa presented to our hospital with diffuse abdominal pain and distension after a binge eating episode. Vital signs and routine laboratory test results were unremarkable, except for a slightly elevated white blood cell count (14.5 x 109/l). Abdominal radiography and computed tomography (CT) revealed a massively dilated stomach, with a craniocaudal measurement of 37 cm.We report the case of a 67-year-old male who was referred to our hospital due to severe abdominal pain and fever. His past medical history included a total gastrectomy surgery for stomach cancer. Abdominal examination showed intense pain on deep palpation in the epigastric region. Cucurbitacin I Laboratory test revealed elevated C-reactive protein (235 mg/l) and amylase (1,789 U/l). Computerized tomography reported a pancreatic collection with the presence of air bubbles inside and areas of necrotic pancreatic parenchyma.We present the case of a 25-year-old female who presented due to refractory chronic constipation and fecal incontinence. She had bowel movements every 7-30 days with an increased consistency (1-2 Bristol type stools), together with soiling and passive fecal incontinence (Wexner Scale 12/20). She had previously undergone surgery shortly after birth for an anorectal malformation repair. The colonoscopy and histological study of the rectum were normal. A pelvic magnetic resonance imaging (MRI) was performed, which showed a right pararectal mass that compressed the rectum without invading it. This mass was compatible with a presacral teratoma or hamartoma. MRI also revealed coccyx agenesis and hypoplasia of the last sacral vertebrae (Image 1), which were consistent with Currarino syndrome (CS). The patient received 14 sessions of transcutaneous electrostimulation of the posterior tibial nerve, resulting in an increase in bowel movements (every 3 days) and a reduction in fecal incontinence. She was then referred to surgery for presacral mass removal.
endoscopic full-thickness resection (EFTR) is widely accepted for the treatment of gastric submucosal tumors (SMTs). However, technical difficulties sometimes occur. The aim of the present study was to assess the safety and efficacy of EFTR for gastric SMTs and to explore risk factors for technical difficulty.

the clinical data of patients who received EFTR for gastric SMTs was retrospectively collected from April 2011 to September 2019. Efficacy was defined as an en bloc resection. Difficult EFTR was defined as a procedure time ≥ 120 minutes and/or the occurrence of major adverse events, such as major bleeding, abdominal pain or peritonitis. Finally, risk factors for technical difficulty of EFTR such as gender, age, tumor location, size, symptomatic, regular, outgrowth, operator experience and pathology were analyzed in a univariate and multivariate analysis.

one hundred SMTs were removed by EFTR. The average surgery time was 75.73 ± 45.9 (range 20-250) minutes and the average tumor size was 16.23 ± 7.tors for a difficult EFTR.A 65-year-old female with a history of chronic gastritis presented with repeat epigastric pain and heartburn after meals. A physical examination was unremarkable, other than a mild fever and epigastric tenderness. Laboratory data revealed leucocytosis of 11,340/μl with 86.8 % of neutrophils, elevated γ-glutamyltransferase at 282.1 IU/l and mildly abnormal AST 40.5 IU/l, ALT 74.9 IU/l, total bilirubin 30.4 μmol/l (direct bilirubin 9.4 μmol/l) and amylase 202 IU/l. A gastroscopy showed a 4 mm fistula on the anterior wall of the proximal duodenal bulb, without ulcerations and the patient was admitted for intravenous antibiotic therapy.We read with great interest the article "Effectiveness and safety of adalimumab biosimilar ABP 501 in Crohn's disease an observational study" by Ribaldone et al., which was recently published in your journal. The authors report the first real-life study of the adalimumab biosimilar ABP 501 in Crohn's disease (CD). The study investigated the short-term effectiveness and safety of ABP 501 in 87 patients with CD, 25 patients naïve to adalimumab and 62 switched from the adalimumab originator. A meaningful proportion of CD patients treated with ABP 501 showed clinical benefit with a satisfactory safety profile until the end of follow-up.Acute pancreatitis is one of the main reasons for hospitalization, with an increasing incidence and associated non-negligible morbidity and mortality. Its most common causes are alcohol and gallstones, and medications are a rare cause. The pathogenesis of acute drug pancreatitis is not yet known exactly and the diagnosis is based on the evident temporal relationship, having excluded the rest of the possible known causes of acute pancreatitis. We present the case of a 71-year-old patient diagnosed with IgG multiple myeloma treated with the Daratumumab, Bortezomib and Dexamethasone regimen. After Bortezomib administration, he developed epigastric pain and elevated pancreatic enzymes in the range of acute pancreatitis. After ruling out common causes, the diagnosis of acute pancreatitis caused by Bortezomib was reached, which presents a favorable rapid evolution after its elimination.Here, we present the case of a 51-year-old male with pain in the right hypochondrium, jaundice, fever, chills and septic shock. A computed tomography (CT) scan showed a juxtapapillary diverticulum with inflammatory changes, which caused bile duct ectasia and left biliary radicals. We considered this to be a septic shock of a biliary origin due to the cholangitis associated with Lemmel syndrome, with signs of juxtapapillary diverticulitis.Hepatic hemangioendothelioma is a rare tumor which has malignant potential and a difficult radiological differential diagnosis that includes many others liver tumors as metastasic carcinoma, cholangiocarcinoma and, especially, angiosarcoma. Thus, it is an entity that is usually not diagnosed in an accurate way by radiology and further histolopathological study is needed. However, hemangioendothelioma can present certain specificied patterns in contrast-enhanced imaging. In this regard, we present the case of a patient with an epithelioid hemangioendothelioma that shows these radiological features.Not applicable.We present the case of a 79-year-old male who underwent endoscopic retrograde cholangiopancreatography (ERCP) after cholangitis. The papilla was rigid and the biliary tract was dilated with sharpening of the distal bile duct, with no obvious cause. There was no bile flow after sphincterotomy, no stone after sweeping the duct with a balloon and the brush did not expand properly when trying to obtain cytologic material. Finally, a plastic stent was placed and purulent bile flowed. Biopsies of the papilla were taken due to the suspicion of tumor infiltration. The next day, the patient had pain in the right upper quadrant and blood tests highlighted mild anemization.Hepatitis C virus (HCV) is estimated to affect 3.26 million children worldwide, with the highest number of cases registered in Pakistan and China. Vertical transmission is the principal route in industrialized countries. However, iatrogenic transmission is relevant in low-income settings. We present the case of a 12-year-old Pakistani child who suffered from beta-thalassemia major and hepatitis C, successfully treated with glecaprevir/pibrentasvir.Levodopa-carbidopa intestinal gel (LCIG) continuous infusion into the jejunum through a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J) is an alternative therapy for Parkinson's disease (PD) patients, with a very poor control of their symptoms on regular oral medications (Hoehn-Yahr stage IV). Around 62.2 % of patients present procedure and device-related adverse effects (AE), with an 8.2 % rate of mayor complications.A 50-year-old male patient, without a previous medical history, presented sudden severe abdominal pain with no alterations in the blood analysis. A CT-Angiography (CTA) was performed that showed a wall thickening of the celiac trunk extended to the hepatic artery with a filiform lumen and no involvement of the splenic artery. There were no signs of intestinal or liver ischemia, therefore no further radiological tests were performed. The proteinogram and serology were normal, with no immunological and acute phase reactant markers, excluding vasculitis. It appeared as an isolated lesion with no signs of arterial dissection or pseudoaneurysms of the remaining abdominal vessels or the aorta. Therefore, it was considered as a Segmental Arterial Mediolisis (SAM).Eosinophilic enterocolitis is a rare entity included in the group of primary eosinophilic gastrointestinal disorders. It is characterized by eosinophilic infiltrate in the absence of other causes of enterocolonic eosinophilia (infection, allergic or drug reaction, inflammatory disease, etc). The most common gastrointestinal manifestations are abdominal pain, diarrhea or malabsorption. The lack of well-defined diagnostic criteria and patchy microscopic involvement make diagnosis difficult. We report the case of a 44-year-old male with chronic diarrhea. After performing multiple studies, he was diagnosed of eosinophilic enterocolitis, with a suitable response to corticosteroids.
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