Iranian Journal of Colorectal Research
Year:2021 | Volume:9 | Issue:4|Papers Count:8

In the recent two decades, the rate of sphinctersaving procedures following rectal resections has increased with improving pelvic dissection techniques, and this has significantly reduced the number of patients with a permanent ostomy. Reconstruction following rectal resection includes a colonic pouch after low anterior resection or a small bowel pouch following total proctocolectomy in cases of ulcerative colitis or polyposis. Maintaining gastrointestinal continuity is not necessarily associated with a good functional result as up to 60% of patients undergoing sphincter-saving procedures report some degrees of frequency, urgency, and uncontrolled passage of feces or gas. . .

Context: Colorectal cancer (CRC) survivors experience persistent late effects of treatment, including a range of symptoms and functional impairments. There is limited evidence on the prevalence of such problems in CRC survivors. We conducted a systematic review to synthesize the evidence on the range and prevalence of patient-reported symptoms and functional impairments experienced by CRC survivors in the acute and longterm period following primary treatment for CRC. Evidence Acquisition: We searched the Embase, Pubmed, and Cochrane electronic databases (from 2000 to April 2021) to identify studies reporting longitudinal prevalence (i. e., a minimum of two assessment time-points) of any patient-reported outcomes (PROs) at 12 months or more since treatment. Two reviewers independently screened and extracted data on study characteristics and PRO prevalence. PROs were synthesized descriptively across different time points (baseline, during treatment, and up to three years post-treatment) to determine the prevalence of PROs over time and the extent of persistent problems in long-term post-treatment survivorship. Results: Of 5587 studies screened, 29 met eligibility criteria and were included. Three years after primary treatment, up to 55-65% of CRC survivors reported issues with mobility, 40% reported pain and discomfort, and up to 83% reported fecal incontinence. Many patients had impaired sexual and/or urinary function. Conclusion: CRC survivors should be screened for persistent late effects of treatment, assessed with validated patient-reported measures. Appropriate management strategies should be implemented to reduce symptom burden and improve the quality of life of these patients.

Introduction: Inflammatory bowel disease (IBD) is associated with primary sclerosing cholangitis (PSC), an uncommon chronic and progressive cholestatic liver disease. Liver transplantation (LT) is the only therapeutic strategy for PSC that may also affect the IBD course. Considering the lack of systematic reviews and pursuing debates on this issue, we aim to systematically assess the frequencies of patients with an improved, unchanged, or exacerbated IBD course following LT and to conduct a meta-analysis. Methods: In this systematic review, PubMed/MEDLINE, Scopus, WoS (Clarivate Analytics), and Embase will be searched. Our search strategy (i. e., the eligibility criteria) covers prospective and retrospective observational studies evaluating the clinical course of ulcerative colitis or Crohn’, s disease after LT, with no language limitation, published between 01/01/1970 and 30/12/2020. Two authors will independently implement the selection phase, data extraction, and quality assessment. In case of any disagreement between the authors, the issue will be resolved by consensus,if not resolved, the opinion of a third expert will be asked. If there are sufficient studies, the pooled frequencies (%) of patients with improved, unchanged, or exacerbated IBD activity following LT will be calculated using random or fixed effect models according to severity of methodological heterogeneity. Forest plots will show the separated and combined frequencies and the corresponding 95% CIs. The Q-statistic test and I 2 statistics will be used to evaluate statistical heterogeneity. We will use the funnel plot technique to assess reporting bias and Begg’, s and Egger’, s tests for publication bias. The trim and fill method will correct the effect of any potential publication bias. Ethics and Dissemination: As this review will use published primary studies, an ethics committee review is not necessary. The results of our research will be published in peer-review journals and presented in relevant conference meetings.

Introduction: Gabapentin is an anticonvulsant drug prescribed to treat partial seizures and neuropathic pain. Niosomes, as lipid-based drug carriers, can improve the pharmacokinetic properties of therapeutic agents. In this study, we developed an optimal niosomal formulation for gabapentin and assessed its cytotoxicity effect on normal cells and a colon cancer cell line. Methods: Several niosomal formulations were developed and analyzed regarding physicochemical properties. For the G3 and G4 formulations, the release profiles complied much better with the Korsmeyer-Peppas model, suggesting the Fickian diffusion mechanism in gabapentin release. The effect of the optimized niosomal formulation of gabapentin on the SW48 colon cancer cell line was assessed using the MTT assay. Results: The niosomal formulation of G3 showed 60% drug release in 48 hours, and the G4 formulation showed 52%. The cytotoxic effect of the optimized formulation (G3) on the colon cancer cell line resulted in an IC50 of 45 µ, g/ml (200 µ, M) after 48 h, compared to 0. 2 mg/mL (1. 17 mM) for free gabapentin. Hence, the niosomal formulation of gabapentin was more cytotoxic for the colon cancer cell line than pure gabapentin. Conclusion: The optimal niosomal formulation of gabapentin exhibited good storage stability and provided slow, prolonged release. This formulation showed cytotoxic effects on colon cancer cells without significant toxicity for normal fibroblasts.

Background: Pilonidal sinus disease is frequently seen among adolescents, affecting the sacrococcygeal region. Surgical management of sacrococcygeal pilonidal disease remains debatable. This study introduces the modified sinus laser therapy (mSiLaT) technique and presents our experience in the surgical management of pilonidal sinus disease using this novel approach. Methods: From September 2018 to June 2019, a total of 17 patients presenting with symptoms attributed to sacrococcygeal pilonidal sinus disease underwent the mSiLaT procedure at our center. Patients were admitted to the same day care surgery unit 2 hours prior to surgery. They were discharged 6 hours after surgery. Preoperative antibiotics were given intravenously 30 minutes prior to incision. A single surgeon completed all the operations, with no change in the surgical technique. The patients were followed up for at least one year. Results: All patients returned to normal daily activities without pain-induced limitations on the first postoperative day. All patients returned to work two days after surgery. None of the patients experienced necrosis of the sinus roof. No hematoma or seroma was documented. The mean complete wound healing time was 15 days. After one year of follow-up, no recurrence was documented. Conclusion: The mSiLaT procedure provides promising results as an emerging minimally invasive procedure that can conclude the everlasting debate on the optimal surgical management of pilonidal disease. Randomized studies are needed to better define the future role of this procedure in comparison with other techniques.

Background: The coronavirus disease 2019 (COVID-19) pandemic undoubtedly has a sustained psychological impact on healthcare workers (HCWs), particularly frontline workers. Actions are needed to mitigate the effects of COVID-19 on mental health by protecting and promoting the psychological well-being of HCWs during and after the outbreak. The present study sought to determine the views and concerns of HCWs regarding the fight against COVID-19, to assess their stress and burnout levels, and to evaluate the awareness and measures of prevention utilized by them during these testing times. Methods: The study utilized a survey form developed by researchers as a data collection tool. Research was conducted on 242 healthcare professionals in the Indian population using the online survey method. Appropriate statistical methods (chi-squared, Kruskal-Wallis, and Mann-Whitney U test) were recruited in SPSS version 21 to analyze the data. The finalized questionnaire included background information, stress caused by COVID-19, the Generalized Anxiety Disorder 7-item (GAD-7) scale, and awareness of and preventive measures against COVID-19. Results: Doctors were found to be most anxious among the different HCWs, with greater anxiety in females. Television was the preferred source of information. Conclusion: Results of the present study showed that although HCWs provide services to COVID-19 patients, they are not protected against the risk of infection.

Background: Celiac disease is an autoimmune disease with a high incidence of multi-organ involvement,particularly, gastrointestinal manifestations and a doubled risk of malignancies. Here, we report a case of celiac disease with autoimmune hemolytic anemia (AIHA) Case Presentation: A nine-year-old girl presented to us with a history of abdominal pain, fever, nausea, and vomiting. Her examination findings were pallor and splenomegaly,her laboratory tests showed increased liver enzymes and macrocytosis with positive Coombs without a decrease in hemoglobin or high reticulocyte count. Poly-autoimmunity was considered, and AIHA and celiac disease were diagnosed throughout the admission following an in-depth workup. The patient responded to a strict gluten-free diet and pulse corticosteroids. This was a rare case of celiac disease presenting with such an array of signs and symptoms, with management also being distinctive and challenging. Conclusion: Celiac disease is very rarely associated with conditions like Evans syndrome and autoimmune hemolytic anemia. Still, tests of autoimmune hemolytic anemia are recommendable when a patient has celiac disease-associated anemia with a normal hematocrit level.

Background: Rectal foreign bodies are uncommon in the emergency department, though their incidence has increased gradually in the past few decades. Management depends on whether there is any perforation or not, and on the size, shape, consistency, and site of the foreign body. Case Presentation: A 55-year-old male with a history of foreign body insertion per rectum following an alleged history of assault. The patient was soft per abdomen without any signs of peritonitis on abdominal examination. In spite of repeated attempts in the emergency ward, we were unable to retrieve the foreign body per rectum manually. After retrieving the foreign body wholly via the transanal approach along with suprapubic pressure manually, the foreign body was a 25*5*5 cm cylindrical pencil case with a condom over it. Conclusion: Surgery with a laparotomy should be reserved for patients with perforation or ischemic bowel or cases of failed transanal attempts. After removal of the foreign body, we suggest a period of observation, rigid or flexible endoscopy to evaluate for rectal injury, and repeat plain films to examine for evidence of injury and perforation that may have occurred during the extraction process.