Surveillance Guidelines Research Articles

Role of artificial intelligence in pancreatic cystic neoplasms: modernizing the identification and longitudinal management of pancreatic cysts

Mucinous cysts of the pancreas represent the most common identifiable precursor to pancreatic cancer. Evidence-based guidelines for screening and surveillance exist, but many patients are either not properly identified or lost to follow-up. Artificial Intelligence, specifically computational linguistics models, can dramatically improve patient identification and mitigate risk through modernizing pancreatic cyst longitudinal surveillance. Herein we discuss the risk associated with mucinous cysts of the pancreas and modern approaches to patient identification and follow-up.

Personalizing Surveillance in Head and Neck Cancer.

Head and neck squamous cell carcinoma (HNSCC) encompasses a spectrum of heterogeneous diseases originating in the oral cavity, pharynx, and larynx. Within the United States, head and neck cancer (HNC) accounts for 66,470 new cases, or 3% of all malignancies, annually.1 The incidence of HNC is rising, largely driven by increases in oropharyngeal cancer.2-4 Recent molecular and clinical advancements, particularly with regard to molecular and tumor biology, reflect the heterogeneity of the subsites contained within the head and neck. Despite this, existing guidelines for post-treatment surveillance remain broad without much consideration given to different anatomic subsites and etiologic factors (such as human papillomavirus [HPV] status or tobacco exposure).5 Surveillance incorporating the physical examination, imaging, and emerging molecular biomarkers is an essential part of care for patients treated for HNC and allows for the detection of locoregional recurrence, distant metastases, and second primary malignancies aiming for better functional and survival outcomes. Additionally, it allows for evaluation and management of post-treatment complications.

Surveillance Outcomes in Patients With a Family History ofColorectal Cancer in Both Parents.

A family history of colorectal cancer (CRC) in a first-degree relative is a well-established risk factor for CRC. When individuals have 2 parents with CRC, the impact on risk is uncertain, and there are no established guidelines for surveillance. We sought to define the surveillance practices and outcomes in individuals with a family history of CRC in both parents. We identified probands with a family history of CRC in both parents from our Hereditary Gastrointestinal Cancer Database. Charts were retrospectively reviewed for colonoscopy surveillance patterns and incidence of adenomas and CRC. Sixty-six patients met the inclusion criteria. Forty-two patients (64%) had genetic testing, and no pathogenic germline mutations were identified. During a mean surveillance period of 144 ± 82.2 months and a mean surveillance interval of 33.4 ± 16.6 months, a total of 3.2 ± 8.9 adenomas were found per patient. These were small (median 6.5 mm), and 96% exhibited only low-grade dysplasia. Six patients (9%) were diagnosed with CRC at a mean age of 61.5 ± 11.3 years, corresponding to an incidence rate of 14 cases/10,000 person-years. Patients with CRC were older at first colonoscopy than those without cancer (59 vs 46 years, P= .03), and half of these cases were diagnosed at this first colonoscopy. Among patients with a family history of CRC in both parents, cases of CRC were seen primarily in those who significantly delayed their first colonoscopy. Initiation of colonoscopy at age 40 should be recommended to individuals with CRC in both parents, consistent with recommendations for those with 1 first-degree relative with CRC.

An audit of compliance with the updated post-polypectomy and post-colorectal cancer resection surveillance guidelines at a District General Hospital (DGH)

Background: It is important we identify cases of premalignant polyps and stratify patients according to future colorectal cancer (CRC) risk to prevent CRC development. In 2020, the British Society of Gastroenterology (BSG) published guidelines to tailor post-polypectomy and post-CRC resection surveillance. The objective of our audit was to determine whether our department was adhering to these guidelines.

Brain metastasis screening in the molecular age.

The incidence of brain metastases (BM) amongst cancer patients has been increasing due to improvements in therapeutic options and an increase in overall survival. Molecular characterization of tumors has provided insights into the biology and oncogenic drivers of BM and molecular subtype-based screening. Though there are currently some screening and surveillance guidelines for BM, they remain limited. In this comprehensive review, we review and present epidemiological data on BM, their molecular characterization, and current screening guidelines. The molecular subtypes with the highest BM incidence are epithelial growth factor receptor-mutated non-small cell lung cancer (NSCLC), BRCA1, triple-negative (TN), and HER2+ breast cancers, and BRAF-mutated melanoma. Furthermore, BMs are more likely to present asymptomatically at diagnosis in oncogene-addicted NSCLC and BRAF-mutated melanoma. European screening standards recommend more frequent screening for oncogene-addicted NSCLC patients, and clinical trials are investigating screening for BM in hormone receptor+, HER2+, and TN breast cancers. However, more work is needed to determine optimal screening guidelines for other primary cancer molecular subtypes. With the advent of personalized medicine, molecular characterization of tumors has revolutionized the landscape of cancer treatment and prognostication. Incorporating molecular characterization into BM screening guidelines may allow physicians to better identify patients at high risk for BM development and improve patient outcomes.

Mitigating Endoscope-Associated Infections: Revised ANSI/AAMI Standards and New Duodenoscope Surveillance Antimicrobial Sampling and Culturing Protocols

Article| January 2023 Mitigating Endoscope-Associated Infections: Revised ANSI/AAMI Standards and New Duodenoscope Surveillance Antimicrobial Sampling and Culturing Protocols Uday Jain, BSEE, MD, PhD, FASA Uday Jain, BSEE, MD, PhD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 29. https://doi.org/10.1097/01.ASM.0000911792.39689.52 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Uday Jain; Mitigating Endoscope-Associated Infections: Revised ANSI/AAMI Standards and New Duodenoscope Surveillance Antimicrobial Sampling and Culturing Protocols. ASA Monitor 2023; 87:29 doi: https://doi.org/10.1097/01.ASM.0000911792.39689.52 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: age-related cognitive decline, american national standards institute, antimicrobials, duodenoscopes, endoscopes, infections, surveillance, medical Anesthesiologists provide anesthesia for numerous endoscopy procedures. They also perform bronchoscopy and other endoscopies. There are recent developments in mitigating endoscopy-associated infections. Carbapenem-resistant Enterobacteriaceae (CRE) infections, which are resistant to multiple antibiotics, have been traced to duodenal endoscopy, cystoscopy, and ureteroscopy (Am J Infect Control 2016;44:1032-6). These cases had all followed standard disinfection protocols. The outbreaks were traced to difficulty sterilizing complex shapes or materials, such as the hinge of side-viewing duodenoscopes. As a result of these outbreaks, new sterilization standards have been published by the American National Standards Institute (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI) (ANSI/AAMI ST91:2021; asamonitor.pub/3DEYQnI). Additionally, the FDA and the CDC published new surveillance antimicrobial surveillance guidelines (asamonitor.pub/3Qgqiwq). The FDA recommends transitioning to fully disposable duodenoscopes (Clin Gastroenterol Hepatol 2020;18:2108-2117) or using endoscopes with disposable components. This guidance includes developing schedules for routine inspection and... You do not currently have access to this content.

Effectiveness Of Multifaceted Care Bundle Approach To Reduce Device Associated Infection (Dai) In Critical Care Unit (Ccu) In A Multi Specialty Hospital, Mangaluru

Device-associated infections (DAI) can cause major medical and economic sequelae. Multifaceted care bundle is considered as an important part of routine nursing activity, not only as a measures DAI prevention, but as a crucial treatment with a profound effect on the patients general health.
 Objectives
 
 To measure the Device associated infection status of CLABSI, CAUTI, and VAP in pre implementation phase according to HAI surveillance guidelines.
 To determine the compliance status of health care workers of care bundles on prevention and care of device associated infections in CCU in Phase III.
 To evaluate the effectiveness of multifaceted care bundle approach on device associated infections status of CLABSI, CAUTI, & VAP in CCU
 To find the risk of DAI in patients in the Post implementation phase (Phase III)
 
 Methods: An experimental approach was adopted to study the effectiveness of multifaceted care bundle approach to reduce device associated infection (DAI) in critical care unit (CCU) in a multispecialty hospital, Mangaluru. Universal sampling technique was adopted to select the 472 sample retrospectively (MRD and HIC records of DAI patients of critically care units) and 409 samples as prospectively (current critically ill patients) then implementation of bundle was done and post implementation evaluation done.
 Results: While comparing pre and post implementation phases, it is found that there was reduction in CAUTI rate /1000 catheter days and CLASBI rate/1000 central line days from Phase I to phase III and increase in VAP rate /1000 ventilator days from Phase I to phase III. Increase in device utilization ratio of CAUTI and CLASBI from Phase I to III and reduction in VAP device utilization ratio from Phase I to III, also observed that during pre-implementation phase, the VAP rate, CLABSI rate and CAUTI rate for all the ICU’s taken together were 134.37/1000 ventilator days, 412/1000 central line days, and 332.92/1000 urinary catheter days, respectively. However, during the post implementation the rates reduced into 133.92, 287.98, and 242 per 1000 device days respectively. There was a month wise decreasing trend of VAP rate, CLABSI rate, and CAUTI rate during the study period.
 In males CAUTI, CLABSI AND VAP rates were reported highest in the both Phases (I and III) and CAUTI, CLABSI and VAP difference in both Phases was not statistically significant according to age and gender (p=0.500) .Highest number of CAUTI was reported in Phase I compared to Phase III .Total number of device days were more (352) for CAUTI whereas 340 ventilator days for VAP, 292 central line days in the Phase I. While comparing both Phases significant difference was found in CAUTI (0.0017) CLASBI (0.002) and VAP (0.0016 ).
 Conclusion: From the findings of the study it can concluded that multifaceted care bundle significantly reduced DAIs in critically ill patients

Clinical features and long-term outcomes of patients with colonic oligopolyposis of unknown etiology.

Colonic adenomatous polyposis of unknown etiology (CPUE) is an adenomatous polyposis phenotype that resembles Familial Adenomatous Polyposis (FAP) even though no germline pathogenic variant is identified. We sought to better characterize the clinical features and outcomes in a cohort of CPUE patients. This is a retrospective case series of patients 18 years old or older with aden-omatous oligopolyposis (between 10-100 adenomas) and negative genetic testing, identified through the Hereditary Gastrointestinal Cancer Database at Massachusetts General Hospital, a tertiary academic referral center. A retrospective chart review was performed with a focus on demographics, alcohol and tobacco use, medication use, familial malignancy and polyp burden, genetic testing information, endoscopic surveillance data including the corresponding histopathology, colonic and extracolonic malignancies, mortality events, and their etiology. Spearman correlation and Pearson Chi-square test (or Fisher's exact test) were used for continuous and categorical variables respectively. CPUE patients were primarily male (69%) and presented for genetic counseling at 63.7 years. Only 2 patients (2.9%) reported a first-degree relative with polyposis. During an average surveillance period of 12.3 years, 0.5 colonoscopies per year were performed. Patients developed 2.3 new adenomas per year. 4 (5.7%) were diagnosed with colorectal cancer (CRC) at a mean age of 66 years, and 3 were diagnosed prior to the onset of oligopolyposis. 7 (10%) required colectomy due to advanced dysplasia or polyp burden. With respect to upper gastrointestinal manifestations, 1 patient had a gastric adenoma, but there were no cases of gastric or small bowel polyposis. During surveillance, 10 (14%) patients died at a mean age of 72, and none were due to CRC. CPUE is distinct from familial adenomatous polyposis (FAP) syndrome and the use of FAP surveillance guidelines may result in unnecessarily frequent upper and lower endoscopies.

Association between surveillance imaging and survival outcomes in small bowel neuroendocrine tumors

Surveillance guidelines following the resection of small bowel neuroendocrine tumors (SB-NETs) are inconsistent. We evaluated the impact of surveillance imaging on SB-NET recurrence and overall survival (OS). Patients with completely resected SB-NETs referred to a provincial cancer center (2004-2015) were reviewed. Associations between imaging frequency, recurrence, post-recurrence treatment, and OS were determined using univariate and Cox-regression analyses. Among 195 completely resected SB-NET patients, 31% were ≥70 years, 43% were female, and 80% had grade 1 disease. Imaging frequency was predictive of recurrence (hazard ratio 2.52, 95% confidence interval 1.84-3.46, p < 0.001). 72% underwent interventions for recurrent disease. Patients who were treated for the recurrent disease had comparable OS to those who did not recur (median 152 vs. 164 months; p = 0.25). Imaging frequency was not associated with OS in those with treated recurrent disease (p = 0.65). Patients who recurred underwent more computerized tomography(CT) scans than those who did not recur (CT: 1.47 ± 0.89 vs. 1.02 ± 0.81 scans/year, p < 0.001). Detection of disease recurrence was 5%-7% per year during the first 6 years of surveillance and peaked at 17% in Year 9. Less frequent imaging over a longer duration should be emphasized to capture clinically relevant recurrences that can be treated to improve OS.

Questionnaire- and linkage-based outcomes in Dutch childhood cancer survivors: Methodology of the DCCSS LATER study part 1.

Childhood cancer survivors are at risk for developing long-term adverse health outcomes. To identify the risk of and risk factors for specific health outcomes, well-established cohorts are needed with detailed information on childhood cancer diagnosis, treatment, and health outcomes. We describe the design, methodology, characteristics, and data availability of the Dutch Childhood Cancer Survivor Study LATER cohort (1963-2001) part 1; questionnaire and linkage studies. The LATER cohort includes 5-year childhood cancer survivors, diagnosed in the period 1963-2001, and before the age of 18 in any of the seven former pediatric oncology centers in the Netherlands. Information on health outcomes from survivors and invited siblings of survivors was collected by questionnaires and linkages to medical registries. In total, 6165 survivors were included in the LATER cohort. Extensive data on diagnosis and treatment have been collected. Information on a variety of health outcomes has been ascertained by the LATER questionnaire study and linkages with several registries for subsequent tumors, health care use, and hospitalizations. Research with data of the LATER cohort will provide new insights into risks of and risk factors for long-term health outcomes. This can enhance risk stratification for childhood cancer survivors and inform surveillance guidelines and development of interventions to prevent (the impact of) long-term adverse health outcomes. The data collected will be a solid baseline foundation for future follow-up studies.

Treatment and post-operative follow-up of pulmonary sclerosing pneumocytoma: A case report

Pulmonary sclerosing pneumocytoma (PSP) is a rare tumor thought to originate from respiratory epithelial cells. It is usually benign, but may rarely metastasize to lymph nodes. Surgeons face unique challenges in diagnosis and management of this condition, and ideal surgical management is yet to be established. 48-year-old woman with a 7×7 mm pulmonary lesion discovered incidentally on computerized tomography (CT) imaging, which grew to 9 mm over the following year. Seven years later, follow-up imaging revealed that the mass had grown to 1.3 cm in largest dimension. Surgery was recommended and the mass was resected via a right video-assisted thoracic surgery (VATS) middle lobectomy with mediastinal lymph node dissection. All lymph nodes were negative and the patient's postoperative course was unremarkable. There are few evidence-based guidelines available on the treatment and postoperative surveillance of PSP. Research has shown comparable recurrence-free survival rates for sublobar resection and lobectomy, though recurrence can occur, especially following sublobar resection in larger or more centrally-located tumors. In absence of established guidelines, it was decided to follow this patient according to NCCN guidelines for surveillance of early-stage non-small cell lung cancer due to potential risk of recurrence. This case report adds to the limited literature on PSP and depicts a possible treatment and postoperative follow-up plan. Right VATS middle lobectomy can effectively treat some cases of central PSP. In absence of established guidelines for postoperative follow-up of PSP, NCCN guidelines may outline one possible strategy for postoperative management.

Gastric Pouch Gastrointestinal Stromal Tumour Post-Roux-en-Y Gastric Bypass: A First Reported Case

Gastric gastrointestinal stromal tumour is an extremely rare condition to occur after bariatric surgery. To the authors’ knowledge, only two cases of gastric gastrointestinal stromal tumours after Roux-en-Y gastric bypass have been reported in the medical literature, both occurring in the excluded gastric remnant. Herein, the authors report the third case of gastric gastrointestinal stromal tumour post-Roux-en-Y gastric bypass, and the first case to occur in the gastric pouch, which was managed surgically by laparoscopic resection. From here, combining the observations of clinicians treating and following up patients post-bariatric surgery in an international database will be beneficial to patients, and aid in development of surveillance guidelines.

An Open-Access, Interactive Decision-Support Tool to Facilitate Guideline-Driven Care for Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is increasing in incidence and is a leading cause of cancer-related mortality worldwide. Adherence to HCC surveillance guidelines and appropriate treatment triage of liver lesions may improve receipt of curative-intent treatment and improved survival. Late-stage HCC diagnosis reflects sub-optimal implementation of effective HCC surveillance, whereas inappropriate treatment triage or linkage to care accounts for the non-receipt of curative-intent in close to half of early-stage HCC in the USA. A free, open-access decision-support tool for liver lesions that incorporates current guideline recommendations in a user-friendly interface could improve appropriate and timely triage of patients to appropriate care. This review provides a summary of gaps and disparities in linkage to HCC care and introduces a free, internet-based, interactive decision-support tool for managing liver lesions. This tool has been developed by the HCC Steering Committee of the Chronic Liver Disease Foundation and is targeted toward clinicians across specialties who may encounter liver lesions during routine care or as part of dedicated HCC surveillance.

Abstract PR002: Development and validation of a risk prediction model for post-polypectomy colorectal cancer in 4 prospective US cohorts

Abstract Background: Individuals with polypectomy are still at higher risk of developing colorectal cancer than general population and are thus recommended to undergo colonoscopy surveillance for timely detection and prevention of subsequent colorectal cancer. The current clinical guidelines regarding the interval of surveillance are based on weak evidence. There is substantial overuse of surveillance colonoscopy in low-risk individuals and underuse in high-risk individuals. Effective risk stratification tools for post-polypectomy colorectal cancer (PPCRC) are lacking. Methods: Leveraging the integrated endoscopic, histopathologic and epidemiologic data in 3 population-based cohorts (Nurses’ Health Study (NHS) I, II and Health Professionals Follow-up Study (HPFS)), we developed a risk score to predict incident PPCRC among 26,744 patients with a polypectomy between 1986 and 2017. We validated the risk score in the Mass General Brigham (MGB) colonoscopy cohort of 76,603 individuals with a polypectomy between 2005 and 2017. In the MGB cohort, we used the validated natural language processing algorithms to extract detailed histopathologic data and merged them with the endoscopic and other clinical data from the electronic health record systems. The detailed protocol for the cohort development has been published (PMID: 33590405). We used Cox regression to calculate the hazard ratios (HRs) and assessed the discrimination using C-statistics and reclassification using the Net Reclassification Improvement (NRI). Results: During a median follow-up of 12.8 (IQR: 9.3, 16.7) and 5.1 (IQR: 2.7, 7.8) years in the NHS I, II/HPFS and MGB colonoscopy cohorts, we documented 220 and 241 PPCRC cases, respectively. We identified a PPCRC risk score based on 11 predictors. In the validation cohort, the risk score showed a strong association with higher risk of PPCRC (HR for high vs. low, 3.55, 95% CI, 2.59-4.88) and demonstrated a C-statistic (95% CI) of 0.75 (0.70-0.79), and was discriminatory even within the low- and high-risk polyp groups of patients (C-statistic, 0.73 and 0.71, respectively) defined by the current colonoscopy surveillance guidelines, leading to a NRI of 45% for PPCRC patients. Conclusion: We developed and validated a risk stratification model for PPCRC that can be used to guide tailored colonoscopy surveillance. Citation Format: Markus Dines Knudsen, Liang Wang, Kai Wang, Georgios Polychronidis, Paula Berstad, Kana Wu, Xiaosheng He, Dong Hang, Zhe Fang, Shuji Ogino, Andrew T. Chan, Edward L. Giovannucci, Molin Wang, Mingyang Song. Development and validation of a risk prediction model for post-polypectomy colorectal cancer in 4 prospective US cohorts [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr PR002.

13 Investigation of adherence and barriers for posttreatment NCCN surveillance guidelines for cervical cancer

13 Investigation of adherence and barriers for posttreatment NCCN surveillance guidelines for cervical cancer

Cancer incidence and surveillance strategies in individuals with RASopathies.

RASopathies are a set of clinical syndromes that have molecular and clinical overlap. Genetically, these syndromes are defined by germline pathogenic variants in RAS/MAPK pathway genes resulting in activation of this pathway. Clinically, their common molecular signature leads to comparable phenotypes, including cardiac anomalies, neurologic disorders and notably, elevated cancer risk. Cancer risk in individuals with RASopathies has been estimated from retrospective reviews and cohort studies. For example, in Costello syndrome, cancer incidence is significantly elevated over the general population, largely due to solid tumors. In some forms of Noonan syndrome, cancer risk is also elevated over the general population and is enriched for hematologic malignancies. Thus, cancer surveillance guidelines have been developed to monitor for the occurrence of such cancers in individuals with some RASopathies. These include abdominal ultrasound and urinalyses for individuals with Costello syndrome, while complete blood counts and splenic examination are recommended in Noonan syndrome. Improved cancer risk estimates and refinement of surveillance recommendations will improve the care of individuals with RASopathies.

2022 WUOF/SIU International Consultation on Urological Diseases: Active Surveillance for Small Renal Masses.

With greater awareness of indolence underlying small renal masses (SRM ≤ 4 cm) and the morbidity of invasive treatment, active surveillance for SRM patients is being increasingly utilized on an international level. This synopsis summarizes the 2022 review and expert opinion recommendations provided to the International Consultation of Urological Diseases (ICUD) by 10 urologists from high-volume active surveillance practices at international centers. Topics reviewed include SRM biology and clinical behavior, current national and international guidelines for active surveillance of SRM patients, active surveillance utilization patterns and barriers to implementation, outcomes and limitations of the active surveillance literature, criteria for active surveillance patient selection, protocols for active surveillance management including frequency/modality of imaging and the role of renal tumor biopsy, triggers for delayed intervention during active surveillance including tumor factors and patient factors, and pathological outcomes of delayed intervention. We conclude that despite limitations of the current literature, active surveillance is a safe initial management strategy for many SRM patients. The slow growth and low metastatic potential of SRMs, combined with no evidence to suggest oncologic compromise with delay to treatment, should provide confidence to both patients and providers who are considering active surveillance. Future research for prioritization should include characterization of long-term active surveillance outcomes including rates of metastasis and delayed intervention, standardization of objective tumor progression criteria for triggering delayed intervention, and further delineation of the role for active surveillance in young and healthy patients.

CNSC-37. ATYPICAL GERMLINE MUTATIONS AND PRIMARY CNS TUMORS: A SINGLE-CENTER CASE SERIES AND LITERATURE REVIEW

Abstract A growing spectrum of germline mutations and their association with primary CNS tumors has been described over the last decade. These germline mutations are implicated in regulation of DNA integrity and repair, telomere maintenance, and cell cycle regulation resulting in aberrant cellular proliferation and immune surveillance evasion. To date, there are no well-defined guidelines for primary CNS tumor surveillance for these patients. Moreover, the exact role of traditional chemotherapy, immunotherapy, and radiation is unclear. We present a single-institution case series of adult patients with primary CNS tumors with atypical germline mutations and literature review. The most common germline mutations encountered involved heterozygous mutations of one of the mismatch repair (MMR) genes (MSH2, PMS2, MLH1). All patients developed high-grade gliomas defined as astrocytoma or glioblastoma WHO grade 4 based on the WHO 2021 classification. Germline mutations involving RAD51C, POT1, IDH1/2, MutyH, NTHL1, PALB2, and CHEK2 were associated with gliomas of variable grades and molecular subtypes. Non-glial tumors, including atypical rhabdoid tumors, medulloblastomas, hemangioblastomas, and meningiomas were found in association with germline SMARCB1, ATM, BRCA1, and CHEK2 mutations respectively. Review of the existing literature and knowledge obtained from our case series suggests several important concepts: (1) there is an increased risk of both glioma and non-glial tumor types in several atypical germline mutations, (2) multiple risk genes or variants of unknown significance likely contribute to primary brain tumor formation, (3) germline MMR mutations associated with high-grade glioma may be MMR gene-specific with potential increased risk of resistance and/or disease progression in the presence of alkylating agents such as temozolomide, (4) several germline mutations may increase risk of secondary tumor development after radiation, and (5) the role of screening for atypical germline mutations and subsequent disease surveillance remain unanswered.

The SARS-CoV-2 Pandemic and Its Impact on the Incidence of Parasitic Gastrointestinal Illnesses in Pediatric and Adult Populations

Abstract Introduction/Objective The initial months of the SARS-CoV-2 pandemic entailed unprecedented changes to the way lives are lived worldwide, resulting in new means of social and economic engagement. For instance, stay-at-home orders led to youths (and staff) attending school virtually. Likewise, entire sectors of the workforce were blocked from their offices and jobs went online. The aim of these public health policies was to reduce the transmission of SARS- CoV-2; however, less attention has been given to how these policies have impacted the spread of other communicable illnesses. As such, we hypothesized that stay-at-home orders, in conjunction with increased hygiene surveillance and other public health guidelines, altered the transmission cycles of communicable gastrointestinal parasites. We anticipated that when plotted against time, a decrease in positive cases would occur concomitantly with known periods of lockdown; similarly, an increase in positive cases would follow efforts to re-open society. Methods/Case Report To probe this hypothesis, the laboratory information system was queried for positive and negative cases of Giardia and Cryptosporidium identified within the Indiana University Health System based on the Surve-Vue Signature™ Crypto/Giardia assay (Fisher Healthcare, Waltham, MA). Results (if a Case Study enter NA) Results were categorized by patient age: 0 to 18-years-old and 19-110-years-old. Initial review of the pediatric data set reflected that pandemic-related public health measures did not meaningfully alter the incidence of positive test results for these two parasites, though notable observations suggested patterns buried more deeply within the data. Conclusion The findings of this study have broad implications regarding the perceived and actual communicability of Giardia and Cryptosporidium (as well as other gastrointestinal parasites) in both normal and pandemic-times.

Serrated polyposis: an overview

The British Society of Gastroenterology in 2020 updated its guidelines around the management of hereditary colorectal cancer. This document includes recommendations for the management of patients with serrated polyposis in combination with updated (2019) post-polypectomy surveillance guidelines, which replaced the 2017 position statement on serrated polyps in the colon and rectum. This article is intended to serve as an introduction to serrated polyposis, current practice recommendations and the challenges associated with the diagnosis and treatment of serrated polyposis. It covers the definition of serrated polyps and serrated polyposis, the endoscopic approaches for optimising detection and the follow up care that is put in place, for both patients and their families from the perspective of a nurse endoscopist.