Positive Fecal Test Research Articles

Diagnostic Transitions of Cystic Fibrosis and CRMS Compared After 12 Years of Newborn Screening in California

To compare the long-term diagnostic transitions for cystic fibrosis (CF) and CF-Related Metabolic Syndrome (CRMS) side-by-side during follow-up since the onset of newborn screening in California. Using real-world data, we conducted a retrospective cohort study to compare long-term observations of CRMS and CF in California and the diagnostic transitions from one to the other using clinical and diagnostic metrics. The California Genetic Disease Screening Program (GDSP) newborn screening for CF employs an immunoreactive trypsinogen tier-1 laboratory test, followed by molecular testing. This approach captures CF and CRMS, a diagnosis of "watchful waiting" among infants at risk for CF but with signs and symptoms that may emerge outside the screening window. Waiting entails periodic diagnostic reviews that can continue for many years; GDSP routinely conducts five years of follow-up for each child identified with a disorder. We utilized categorial logistic regression to compare the transitions with CRMS. After screening 5,944,700 newborns between July 2007 and July 2019, 694 CF cases and 1,258 CRMS cases were identified. Of the 1,258 CRMS cases, 66 (5.2%, 95% CI=3.9%,6.4%) transitioned from CRMS to CF (CRMS2CF) at a mean age of 3.3 years (median=2.9 years). CRMS2CF cases had longer follow-up periods and were more likely later to develop positive sweat chloride and fecal elastase test results after 6 months of life than other CRMS cases. These results suggest that children who have a CRMS2CF transition are more likely to develop positive biochemical markers than other CRMS patients and have few clinical indications during the first five years of follow-up.

Patterns of Care Following a Positive Fecal Blood Test for Colorectal Cancer: A Mixed Methods Study.

Multilevel barriers to colonoscopy after a positive fecal blood test for colorectal cancer (CRC) are well-documented. A less-explored barrier to appropriate follow-up is repeat fecal testing after a positive test. We investigated this phenomenon using mixed methods. This sequential mixed methods study included quantitative data from a large cohort of patients 50-89years from four healthcare systems with a positive fecal test 2010-2018 and qualitative data from interviews with physicians and patients. Logistic regression was used to evaluate whether repeat testing was associated with failure to complete subsequent colonoscopy and to identify factors associated with repeat testing. Interviews were coded and analyzed to explore reasons for repeat testing. A total of 316,443 patients had a positive fecal test. Within 1year, 76.3% received a colonoscopy without repeat fecal testing, 3% repeated testing and then received a colonoscopy, 4.4% repeated testing without colonoscopy, and 16.3% did nothing. Among repeat testers (7.4% of total cohort, N = 23,312), 59% did not receive a colonoscopy within 1year. In adjusted models, those with an initial positive test followed by a negative second test were significantly less likely to receive colonoscopy than those with two successive positive tests (OR 0.37, 95% CI 0.35-0.40). Older age (65-75 vs. 50-64years: OR 1.37, 95% CI 1.33-1.41) and higher comorbidity score (≥ 4 vs. 0: OR 1.75, 95% CI 1.67-1.83) were significantly associated with repeat testing compared to those who received colonoscopy without repeat tests. Qualitative interview data revealed reasons underlying repeat testing, including colonoscopy avoidance, bargaining, and disbelief of positive results. Among patients in this cohort, 7.4% repeated fecal testing after an initial positive test. Of those, over half did not go on to receive a colonoscopy within 1year. Efforts to improve CRC screening must address repeat fecal testing after a positive test as a barrier to completing colonoscopy.

Extra-appendiceal mucinous neoplasms: A tumour with clinicopathologic similarities to low- and high-grade appendiceal counterpart

AimsAppendiceal mucinous neoplasms feature neoplastic mucinous epithelium with pushing borders and densely fibrotic walls. We have identified five examples of analogous colorectal tumours. Methods and resultsSlides, pathology reports, and clinical data were reviewed. Whole genome sequencing was performed in two cases. Three were women and the mean age was 70. Associated GI conditions included Crohn's disease [1], diverticulosis [2], and sarcoma of the terminal ileum [1]. Signs/symptoms included obstruction [2], nausea, vomiting, abdominal pain [1], and positive faecal immunohistochemical test [1]. Colonoscopic findings included narrowing [1], “fullness” [1], and caecal lesion concerning for GIST [1]. Tumours involved the rectosigmoid [2], sigmoid [1], transverse colon [1], and cecum [1] and ranged from 1.5 cm to 8.5 cm. All but one tumour arose in the setting of faecal stream abnormalities related to obstruction, diverticulosis, or bowel diversion. All cases showed columnar, variably mucinous epithelium associated with little-to-no lamina propria. All but one case showed fibrosis of the submucosa. Three cases had high-grade areas. Neoplastic glands and/or mucin dissected through the muscularis propria or subserosa in 3 examples. No extracolonic neoplastic cells/mucin, infiltrative invasion, or desmoplastic response were identified. Three patients with available follow-up [5.5–28 months] are alive. Whole genome sequencing identified pathogenic TP53 and ERBB2 variants, as well as ERBB2 copy number amplification in one high-grade example. ConclusionsThough these tumours share clinicopathologic characteristics with their appendiceal counterparts, our cohort is too small to draw solid conclusions. We propose the term “extra-appendiceal mucinous neoplasm [EAMN]” for these rare lesions.

Association between time to colonoscopy after positive fecal testing and colorectal cancer outcomes in Alberta, Canada.

To quantify the associations between time to colonoscopy after a positive fecal immunochemical test (FIT+) and colorectal cancer (CRC)-related outcomes in the context of a provincial, population-based CRC screening program. Population-based, retrospective cohort study in Alberta, Canada, including Albertans aged 50-74 with at least one FIT+ in 2014-2017. Study outcomes were CRC diagnosis after a FIT+ and a diagnostic follow-up colonoscopy in 2014-2019 and CRC stage at diagnosis. Multivariable logistic regression models were used to evaluate the relative risk of any CRC or advanced-stage CRC. Results were presented as crude odds ratio (OR) and adjusted OR (aOR) with 95% confidence intervals (CIs). Of the 787,967 participants who had a FIT, 63,232 (8%) had a FIT+ and met the study's eligibility criteria. The risk of any CRC or advanced-stage CRC stayed high and was relatively consistent for follow-up colonoscopies performed within 1-12 months of the FIT+. After 12 months, the risk of CRC was considerably higher, particularly for advanced-stage CRC. The OR and aOR for any CRC were 1.40 (95% CI: 1.13-1.73; p < 0.05) and 1.20 (95% CI: 0.96-1.49), respectively, and the OR and aOR for advanced-stage CRC were 1.42 (95% CI: 0.98-2.08) and 0.88 (95% CI: 0.59-1.32), respectively, for colonoscopy follow-up within 12-18 months versus 1-2 months. For Albertans who used FIT for CRC screening, a longer time interval between a FIT+ and follow-up colonoscopy, particularly over 12 months, increases the risk of having CRC and decreases the effectiveness of CRC screening programs.

Fecal methylated syndecan-2 (SDC2) testing for early screening of colorectal cancerous and precancerous lesions: A real-world retrospective study in China

BackgroundColorectal cancer (CRC) is a major public health concern and the second leading cause of cancer-related deaths worldwide. However, challenges remain in deploying effective screening strategies for early-stage CRC. This study aimed to evaluate the effectiveness of a fecal-based syndecan-2 (SDC2) methylation test for the detection of colorectal lesions and CRC. MethodsWe retrospectively collected data on participants who underwent fecal SDC2 methylation testing from January 1, 2019, to May 30, 2023. Patients with positive results were recommended to undergo colonoscopy. Performance indicators associated with certain clinical characteristics, including positive rate (PR), positive predictive value (PPV), and colonoscopy compliance rate (CCR), were subjected to statistical analysis. ResultsWe analyzed data from 113,209 participants, of whom 11,841 (10.4% PR) had positive fecal SDC2 methylation test results. A total of 4315 participants with positive results adhered to the colonoscopy recommendations, and the CCR was 36.4%. Finally, 3169 colorectal lesions were detected, including 1134 polyps, 875 non-advanced adenomas (NAAs), 770 advanced adenomas (AAs), and 390 CRCs, with PPV values of 26.3% (1134/4315), 20.3% (875/4315), 17.8% (770/4315), and 9.0% (390/4315), respectively. Notably, the PPV for CRC increased significantly with age (χ2 = 164.40, P < 0.0001). In addition, as the cycle threshold (CT) values increased, the PPVs of AAs and CRCs generally decreased, whereas those of NAAs and polyps significantly increased. Moreover, the clinical patient group had the highest incidence of late-stage CRC (stage II and higher), whereas asymptomatic populations from the staff physical examination group and rural town-based screening programs had the highest number of stage 0 and I CRCs detected (P = 0.0107). ConclusionsThis study indicates that fecal SDC2 methylation testing combined with colonoscopy may be an effective screening method for colorectal lesions and CRC.

Epstein-Barr virus-positive mucocutaneous ulcer in a patient with ulcerative colitis: a recently described entity to take into account.

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is a new entity recently included in the classification of B-cell lymphoproliferative disorders associated with Epstein-Barr virus (EBV). It is related to immunosuppression and it usually appears in the oropharynx or the skin, being the colon an uncommon location. We present the case of a 31-year-old man with ulcerative proctitis being treated with azathioprine (AZA) and adalimumab (ADA), who was admitted to the hospital due to suspicion of a moderate-severe flare of ulcerative proctitis. Microbiological stool analyses were negative, with a positive fecal calprotectin test (2700 mg/kg). Rectoscopy showed severe endoscopic activity, taking multiple biopsies. Intravenous steroids were started at a dose of 60 mg/day. He presented a favorable clinical and analytical evolution, being discharged from the hospital. The histological results were received at gastroenterology consultation, being compatible with EBVMCU. AZA and ADA were withdrawn, whereas descending steroid regimen and oral and topical mesalazine were continued, being the clinical response adequate.

S319 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database

S319 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database

S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

The impact of COVID-19 on national program of colorectal cancer screening in Tehran, Iran: a multicenter study

BackgroundThe COVID-19 pandemic has affected all aspects of the healthcare system, including prevention, treatment, rehabilitation of diseases and health education; access to essential therapies; allocation of finance & facilities to health issues, and governance of diseases, including COVID-19 and other diseases. Consequently, the burden of COVID-19 was not only attributable to the multiorgan involvement and detailed presentation of the disease but also to the inadequate management of other diseases resulting from the exclusive allocation of resources and medical personnel to the pandemic crisis. Over the mentioned period, one observed deficiency was the lack of public and official favor for conventional screening protocols. To this end, this study aims to evaluate the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening protocols at Shahid Beheshti University of Medical Sciences in Tehran, Iran, in an effort to identify individuals at risk for CRC and provide them with intensive screening and therapy.MethodsThis is an observational study comparing the number of candidates for CRC screening referred to primary, secondary, and tertiary health-care centers under supervision of Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran in a 2-year interval before and after COVID-19 pandemics. Patients with intermediate- and high-risk criteria for colorectal cancer were included in the study and were screened by fecal immunochemical test. Patients with positive or indeterminate fecal test results were further evaluated with colonoscopy in research institute for gastroenterology and liver diseases where is a tertiary referral center for CRC screening. Finally, the decrease percentage of screening tests and endoscopic findings during the pandemic period compared to pre-pandemic period was calculated and interpreted.ResultsA significant decrease in the number of performed fecal immunochemical tests (FITs), referred positive FITs, and referred patients with positive alarm signs to the Research Institute of Gastroenterology and Liver Diseases (RIGLD) center inevitably led to a considerable decrease in the number of endoscopic findings, including high-risk adenomas, sessile serrated polyps, and even early-stage colorectal cancers (CRCs).ConclusionThe disruption of screening protocols caused by the COVID-19 pandemic appears to increase the number of patients with high-grade and end-stage CRCs referred in the near future.

Screening for colorectal cancer in employees of ROSTEСH enterprises in the Sverdlovsk region. Pilot project

AIM: to evaluate the pilot program results for colorectal cancer (CRC) screening of the Sverdlovsk region (April — October 2021)PATIENTS AND METHODS: a pilot program of three-stage CRC screening included at the first stage, the fecal immunochemical test was performed (patients aged 45–65 years). The second stage included questionnaire. According to the results of the questioning, patients with a positive fecal test and a potential risk of CRC underwent colonoscopy at the third stage.RESULTS: at the first and second stages, 969 fecal immunochemical tests and questionnaires were performed. In 149 (15.4%) cases, a positive fecal test was detected. In 22 cases, employees with a negative fecal test were referred for colonoscopy according to the results of the questionnaire. At the third stage, 168 screening colonoscopies were performed. In 87 (51.5%) patients, epithelial colorectal neoplasia was detected, adenoma — in 57 (33.7%) cases, adenocarcinoma in 4 (2.4%), including T0 — in 3 patients, T2 — in 1 patient. In 182 cases, neoplasia occurred in 17.6% in the rectum and in 82.4% in the colon.CONCLUSION: colorectal cancer (CRC) screening showed high efficacy.

Atypical form of cystic fibrosis in early childhood

Introduction: Cystic fibrosis (CF) is an autosomal recessive genetic disorder, more prevalent in the Caucasian population. The disease is the result of mutations in a gene that codifies a chloride channel called CFTR (cystic fibrosis transmembrane conductance regulator) at affects most critically the lungs, pancreas, sweat glands and wolffian ducts. The variety of mutations in the CFTR gene is in some way responsible for the clinical variations by having and presentation in its atypical forms. Other factors, such as environmental factors and other genetic modifiers, affect the clinical variability of the disease. Aim: The purpose of the case presentation is to show that CF is also presented with unusual signs and symptoms of the disease, causing it to be diagnosed late in time. Case report: An 8 years old child A.D. admitted to the University Hospital Center of Tirana with a history of hypertransaminasemia, hypergammaglobulinemia and hepatomegaly which were found after a routine check. From the laboratory tests which were normal, causes such as: HIV, Viral Hepatitis, CMV infection, Toxoplasmosis and Rubeola are excluded as causes of increased transaminases and hepatomegaly. Antibodies for autoimmunity and liver-specific antibodies were normal, so autoimmune pathologies were excluded as their cause. Based on the history, the girl had repeated history of pulmonary infections, defecation with a heavy and greasy smell, poor weight gain, mother with a history of two spontaneous abortions, so the cystic fibrosis was suspected. Also, changes with an inflammatory aspect were found in chest radiography. Two sweat tests were performed, which were positive within a period of two weeks. The positive fecal elastase test confirmed pancreatic insufficiency. The child was started therapy with vitamine ADEK and ursodeoxycholic acid and an improvement was observed in the laboratory values ​​of the examinations. Conclusion: Continue neonatal screening for cystic fibrosis. Since we have cases with atypical clinical presentation that are diagnosed late in time when we have cases with hepatic manifestations and the child has a history of repeated respiratory infections, steatorrhea, poor weight gain according to age, a differential diagnosis of hepatic pathologies should be made with Cystic Fibrosis. Since hepatic involvement can be the first manifestation that leads to the diagnosis of cystic fibrosis in its atypical forms.

What happens with cancer screening participants with a positive faecal test that do not complete colonoscopy?

What happens with cancer screening participants with a positive faecal test that do not complete colonoscopy?

OP23 Asymptomatic inflammatory bowel disease diagnosed during the colorectal cancer population screening in Catalonia

Abstract Background Background: It has been postulated that early treatment of inflammatory bowel disease (IBD) is associated with a better long-term response. In Catalonia, the early detection program for colorectal cancer (EDPCRC) has been active since 2010, and was extended to the entire Catalan territory in 2015. The aim of this study is to describe the natural history of IBD asymptomatic diagnosed through the EDPCRC in Catalonia. Methods Methods: Observational, longitudinal and retrospective study of patients with IBD detected in the EDPCRC with a positive faecal immunological test in 21 centers in Catalonia between 2010 and 2019. Data was collected from the clinical histories. Results Results: 237 patients were identified; 35 patients had symptoms before endoscopy and were excluded from the study, finally 200 patients were diagnosed with asymptomatic IBD during the EDPCRC; 109 ulcerative colitis (54.5%), 63 Crohn’s disease (31.5%) and 28 unclassifiable colitis (14%). 35.5% were women (n=71) with an average age of 60 years (range 49-79). Of the asymptomatic, 40.5% developed symptoms (n=81), being diarrhea the most frequent (n=45; 55.6%). The median time to first symptom was 368 days. Treatment was prescribed in 74.5% (n=149) of the patients. Mesalazine was the most frequently prescribed drug (n=130). The main reason for prescribing it was endoscopic activity (n=107), followed by the appearance of symptoms (n=39) and the biochemical activity (n=9). Only 19 patients (9.5%) required biological treatment (5 infliximab, 10 adalimumab, 2 vedolizumab and 2 ustekinumab). 4 patients (2%) required surgery. Conclusion Conclusion: Less than half of patients diagnosed with IBD at a preclinical stage develop symptoms after the first year of follow-up. Only 9.5% require biological treatment and 2% surgery. Three-quarters of patients are prescribed treatment; the most used was mesalazine.

Perceived Importance of the Benefits and Harms of Colorectal Cancer Screening: A Best-Worst Scaling Study

ObjectivesTo elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population. MethodsIn a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false-positive and false-negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Dutch Health Care Consumer Panel of The Netherlands Institute for Health Services Research to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression. ResultsOf 265 participants, 234 (89%) had ever participated in CRC screening. Compared with the stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (odds ratio [OR] 4.5; 95% confidence interval [CI] 3.9-5.1), followed by risk of CRC (OR 4.1; 95% CI 3.6-4.7), a false-negative FIT result (OR 3.1; 95% CI 2.7-3.5), colonoscopy complications (OR 1.6; 95% CI 1.4-1.8), and a false-positive FIT result (OR 1.4; 95% CI 1.3-1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background, and whether the individual had previously participated in CRC screening. ConclusionDutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.

Comorbidities and Risk Factors of Patients Diagnosed with CRC after Positive Fecal Test in Real Life.

(1) Background: Fecal occult blood test (FOBT) is the modality of choice in most countries for colorectal cancer (CRC) screening. We aimed to investigate the risk factors for CRC among patients with a positive FOBT in real life. (2) Methods: This was a retrospective study that included patients who tested positive for FOBT. Data regarding the comorbidities and laboratories were collected and compared between CRC and non-CRC groups. (3) Results: Positive FOBT was found among 45,500 (5.36%) subjects and CRC was found in 1502 (3.3%). CRC patients were older, age 62.7 ± 7.15 years compared with 59.33 ± 7.3 years (p &lt; 0.001), and had significantly higher rates of hypertension (48.4% vs. 44.7%, p = 0.002), iron-deficiency anemia (20.6% vs. 16.4, p &lt; 0.001), family history of CRC (7.3% vs. 5.1%, p &lt; 0.001), and previous CRC (6.5% vs. 0.3%, p &lt; 0.001). Lower levels of hemoglobin, iron, and ferritin were found in the CRC group. Age, family history of CRC, and previous CRC were found to be significant risk factors for diagnosis of CRC after positive FOBT with OR of 1.057, 1.4, and 15.9, respectively. (4) Conclusions: Iron-deficiency anemia, family history of CRC, previous colorectal cancer, and low hemoglobin, iron, and ferritin levels should direct physicians to give high priority to colonoscopy scheduling.

Robot-assisted total pelvic exenteration for rectal cancer after neoadjuvant chemoradiotherapy: a case report

BackgroundThere are numerous indications for minimally invasive surgery. However, the laparoscopic approach for extended pelvic surgery is currently provided by only a few institutions specializing in cancer treatment, primarily because of technical difficulties that arise in cases involving a narrow pelvis and rigid forceps. We report a case of robot-assisted total pelvic exenteration for rectal cancer involving the prostate. We assessed the feasibility of robot-assisted total pelvic exenteration and compared the short-term outcomes of other conventional and minimally invasive approaches.Case presentationA 67-year-old man was referred to our hospital after positive fecal blood test results. The initial diagnosis was clinical T4bN2aM0, Stage IIIC rectal cancer involving the prostate. The patient underwent neoadjuvant chemoradiotherapy. Consequently, robot-assisted total pelvic exenteration with an ileal conduit and end colostomy creation were performed. The total operative duration was 9 h and 20 min. The durations of robot console usage by the colorectal and urological teams were 2 h 9 min and 2 h 23 min, respectively. The patient was discharged on postoperative day 21. The pathological diagnosis was T4b (prostate) N0M0, Stage IIC. The resection margin was 2.5 mm. During reassessment at 2 years after resection, no evidence of recurrence was observed.ConclusionsRobot-assisted total pelvic exenteration was performed for a patient with advanced rectal cancer without serious complications. Robot-assisted total pelvic exenteration may provide the advantages of minimally invasive surgery, particularly in the enclosed space of the pelvis.

Analysis of SARS-CoV-2 viral loads in stool samples and nasopharyngeal swabs from COVID-19 patients in the United Arab Emirates

Coronavirus disease 2019 (COVID-19) was first identified in respiratory samples and was found to commonly cause cough and pneumonia. However, non-respiratory symptoms including gastrointestinal disorders are also present and a big proportion of patients test positive for the virus in stools for a prolonged period. In this cross-sectional study, we investigated viral load trends in stools and nasopharyngeal swabs and their correlation with multiple demographic and clinical factors. The study included 211 laboratory-confirmed cases suffering from a mild form of the disease and completing their isolation period at a non-hospital center in the United Arab Emirates. Demographic and clinical information was collected by standardized questionnaire and from the medical records of the patient. Of the 211 participants, 25% tested negative in both sample types at the time of this study and 53% of the remaining patients had detectable viral RNA in their stools. A positive fecal viral test was associated with male gender, diarrhea as a symptom, and hospitalization during infection. A positive correlation was also observed between a delayed onset of symptoms and a positive stool test. Viral load in stools positively correlated with, being overweight, exercising, taking antibiotics in the last 3 months and blood type O. The viral load in nasopharyngeal swabs, on the other hand, was higher for blood type A, and rhesus positive (Rh factor). Regression analysis showed no correlation between the viral loads measured in stool and nasopharyngeal samples in any given patient. The results of this work highlight the factors associated with a higher viral count in each sample. It also shows the importance of stool sample analysis for the follow-up and diagnosis of recovering COVID-19 patients.

EVALUATION OF CLINICAL DIAGNOSTICS FOR PROVENTRICULAR NEMATODIASIS DUE TO SYNHIMANTUS NASUTA IN LORIKEETS (TRICHOGLOSSUS SPP.).

In this case series, clinical investigations were pursued during a Synhimantus nasuta infection in a lorikeet (Trichoglossus spp.) flock outbreak situation to better describe and document clinical presentations. In 11 lorikeets suspected to be infected with Synhimantus based on at least one abnormal finding on their physical examination (lethargy, feather-damaging behavior on the ventrum, weight loss, pale iris), the presence of five additional parameters was documented: anemia, relative eosinophilia, increased proventricular diameter-to-keel height ratio (PKR), proventricular barium filling defect, and positive fecal occult blood detection test. A total score (X of 9) was calculated by combining all these findings. Synhimantus nasuta infection was confirmed in four of these individuals by modified Wisconsin fecal examination. Suspected cases (n = 7 of 11) presented only with low scores (1-3 of 9), whereas birds with confirmed infections (n = 4 of 11) presented with both low (1-3 of 9, n = 2 of 4) and high (6-7 of 9, n = 2 of 4) total scores. High scores were associated with clinical anemia. Fecal occult blood was present in all confirmed cases and 4 of 7 suspected cases. An enlarged proventriculus was only observed in birds with active shedding (n = 3 of 4). Follow-up evaluations after 6 mon of treatment with ivermectin and selamectin suggested complete recovery with lowered or normalized total scores. In conclusion, during an S. nasuta outbreak, a rapid physical examination helps to identify suspect cases, including individuals requiring immediate medical attention. In the absence of ova shedding, infection cannot be excluded on the basis of scarce clinical findings, but the detection of occult fecal blood and an increased PKR should raise the index of suspicion.

Colorectal cancer screening in sub-Saharan Africa

Colorectal cancer screening in sub-Saharan Africa

SARS-CoV-2: Reinfection after 18 Months of a Previous Case with Multiple Negative Nasopharyngeal Swab Tests and Positive Fecal Molecular Test.

This short communication describes the reinfection after nearly 18 months of the same patient who was previously infected with coronavirus disease 2019 (COVID-19) and who showed multiple negative real-time quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) results by nasal swabs for severe acute respiratory syndrome coronavirus (SARS-CoV-2) but positive results on a fecal sample. We previously noted how, in the presence of symptoms suggestive of pneumonia, visible on a chest computed tomography (CT) scan and confirmed by fecal molecular testing, it was possible to draw the diagnosis of SARS-CoV-2 infection. One year later, the same patient was again affected by SARS-CoV-2. This time, the first antigenic nasal swab showed readily positive results. However, the patient’s clinical course appeared to be more attenuated, showing no signs of pulmonary involvement in the radiographic examinations performed. This case shows a novelty in the pulmonary radiological evaluation of new SARS-CoV-2 infection.