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Abstract Introduction Rectal bleeding is a common symptom prompting an urgent investigation. Colonoscopy plays a crucial role in diagnosing the underlying cause and guiding treatment. We aimed to analyze colonoscopic findings in patients with rectal bleeding at a single center. Methods A retrospective review was conducted on the medical records of patients who underwent colonoscopy for suspected rectal bleeding. Data collected included demographics, clinical presentation, colonoscopic findings, and final diagnoses. Results A total of 205 patients underwent colonoscopy for rectal bleeding. The mean age was 47.35 ± 14.6 years, with a male predominance of 57.5%. Hematochezia was the most common presentation (73%), followed by melena (18%) and maroon stools (9%). Colonoscopy identified 5 different sources of bleeding. Hemorrhoids were the most common endoscopic finding (76%), followed by combined hemorrhoids and colonic polyps (38%), colonic polyps alone (28%), and colorectal cancer (20%). No lesions were detected in 10% of patients. The left colon emerged as the most frequent site for bleeding lesions (88.1%). Age influenced the distribution of endoscopic findings. Hemorrhoids were prevalent in both age groups, but the presence of both hemorrhoids and polyps/masses was more frequent in younger patients (<45 years). Rectal ulcers were observed exclusively in younger patients, while CRC showed a slightly higher prevalence in this group. Conclusion Hemorrhoids are the leading cause of LGIB in Upper Egypt, with a higher prevalence compared to other regions. The left colon was the common location for bleeding lesions. Age may influence the causes of LGIB, younger patients present more frequently with combined pathologies.

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Abstract Introduction Modulation of the liver-gut axis, including interventions that reduce oxidative stress, is essential in the management of cirrhosis and in the prevention of its complications. Physical exercise and the use of antioxidants such as melatonin (MLT) improve oxidative stress by increasing the production of endogenous antioxidants, resulting in a better ability of the body to neutralize free radicals. Objective To investigate the effects of EX and the use of MLT, the possible biological markers and mechanisms involved in the disease process. Materials and Methods Twenty-six male Wistar rats were used, divided into 4 groups: Control (CO), Bile duct ligation (BDL), BDL + EX, and BDL + MLT. Physical exercise (swimming) was conducted daily, starting on the 15th day after BDL surgery, as well as MLT, intraperitoneally at a dose of 20 mg/kg, lasting until the 28th day, the end of the experiment. Blood, liver, and intestine were collected. Statistical analysis was performed using One-Way ANOVA followed by the student-Newman-Keuls test (p < 0.05). Results The treatments were effective in preserving the tissue architecture of the liver and intestine. Hepatic integrity enzymes showed a significant reduction in the EX and MLT groups. The treatments reduced lipid peroxidation (LPO) levels, restored antioxidant activity and total antioxidant capacity, as well as lowered the levels of nitric oxide metabolites. It was found that the treatments activated the Nrf2 pathway and reduced inflammatory mediators. Conclusion The treatments (EX and MLT) were effective against the damage assessed in this experimental model, suggesting that these interventions may be promising for future clinical use.

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Abstract Objective We aimed to assess the predictors of response to infliximab treatment in individuals with ulcerative colitis to personalize its use. Methods This study included the initial 100 UC patients who were administered Infliximab. We Excluded individuals under 18 years old, primary non-responders, and those who declined participation or measurement of their IFX trough levels. We evaluated laboratory tests conducted within 3 months of assessing clinical and endoscopic remission for patients who already started infliximab. Laboratory data, including albumin and C-reactive protein (CRP) test results, and PANCA were collected. We observed the patients for any clinical changes or problems while they had Infliximab treatment. Result mean age was 34.36 ± 15.5. 73 cases were male while 27 were female. 36 were smokers. In Multivariate correlation regression, there were strong significant correlations between good response and PANCA, Pan-ulcerative, CRP, ESR, NAR, and Fecal calprotectin. Conclusion PANCA, Pan-ulcerative colitis (E3), CRP, ESR, NAR and Fecal calprotectin are good predictors of infliximab response

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Abstract Introduction Colorectal cancer (CRC) is a major global health concern and a leading cause of cancer-related mortality. Understanding temporal trends in CRC mortality is crucial for guiding public health policies and resource allocation. Objective To evaluate the temporal trends of CRC mortality rates across the American continent. Materials and Methods This retrospective, population-based study used data from the Pan American Health Organization for its development. Age-adjusted mortality rates per 100,000 individuals were collected for the period 2000–2019 and stratified by country and sex. Joinpoint regression analysis was conducted to estimate the annual percentage change (APC) and assess temporal trends. Results CRC mortality trends varied across regions and sexes. In South and Central America, mortality rates increased, particularly in the early 2000s, whereas North America experienced a general decline. Gender-specific trends showed significant increases in South and Central American women, while men exhibited rising trends except in North America, where rates steadily declined. Conclusions The study identified distinct trends in CRC mortality across the Americas, with increasing rates in some countries and declines in others. Socioeconomic factors, healthcare access, and sex-based differences appear to contribute to these variations. These findings underscore the need for targeted public health strategies to reduce colorectal cancer burden and address disparities in early detection and treatment.

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Abstract Introduction Chronic anal fissure is a common condition affecting all ages. Surgical intervention is often necessary for severe cases. Recent studies indicate that the success of surgical procedures for chronic anal fissures is closely linked to the patient's bowel movements. Constipation can impede healing and increase the risk of complications post-surgery. This article investigates the correlation between pre-surgery constipation and the efficacy of fissure surgery, while also examining its impact on treatment outcomes. Methods We conducted a retrospective cohort study. Patients who underwent surgery for chronic anal fissures were evaluated for age, complaints, anorectal examination characteristics, and anatomical localization of fissures. The Rome IV criteria were used to diagnose functional constipation associated with anal fissures. We investigated the relationship between pre-surgery constipation and treatment success. Results Baseline constipation was detected in 21.4% of patients. At the 6-month follow-up, 28 patients failed to fully recover, but baseline constipation did not affect treatment success (p = 0.306). Additionally, Among the 28 patients with pre-surgery constipation, 15 still experienced constipation, while 8 of the 103 patients without pre-surgery constipation developed constipation postoperatively. Conclusions Our study found that the success of fissure surgery treatment was not affected by constipation. These results suggest that the theory of constipation and hard stool may be inadequate to fully explain the causes and success of surgical treatment for anal fissures. Other theories, such as high basal internal sphincter pressure and related ischemia, should be considered.

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Abstract Introduction Anal cancer accounts for 2% of malignant neoplasms of the gastrointestinal tract, and squamous cell carcinoma is the most common histology. Its incidence and mortality have risen over the past four decades in different countries, concomitant with the increase in human papillomavirus (HPV) infection rates. Our objective was to analyze the trends in anal cancer mortality rates in Brazil from 2012 to 2021, with a focus on gender and age. Methods This descriptive study of anal cancer deaths (ICD-10 code C21) in Brazil utilized data from the Mortality Information System of the Unified Health System (DATASUS) Results From 2012 to 2021, the number of deaths from anal cancer was higher among women, and the number of anal cancer mortality rates increased in both sexes. Additionally, the average annual percent change (AAPC) in anal cancer mortality rates was higher in males than females across all age groups except for ages 30-39. In individuals aged 40 and over, the AAPC of anal cancer mortality rates increased progressively with age in males, while in females it remained stable across different age groups. As a result, the ratio between the female and male mortality rate decreased from 1.88 (2012-2016) to 1.41 (2017-2021), reaching its lowest value of 1.14 in 2021. Conclusion Despite its rarity, anal cancer warrants recognition due to its rising mortality rates. Initially, women experienced significantly higher mortality rates from anal cancer, but recent trends show a rapid increase among men, resulting in comparable mortality rates between genders by 2021.

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Abstract Introduction The use of Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to treat peritoneal carcinomatosis (PC) has grown in popularity in recent years. The aim of the study was to report our own experience concerning morbidities, complications, and survival outcomes in CRS and HIPEC in tumors of gastrointestinal vs ovarian origin. Patients and Methods The current study included 62 patients who were admitted by peritoneal Carcinomatosis and eligible for CRS and HIPEC. Follow-up was planned for 5 years. Results The age of eligible patients was 40.6 ± 3.9 and 39.2 ± 4.6 years in patients with gastrointestinal PC and those with OC respectively. The reported mean Peritoneal Carcinomatosis Index (PCI) was less in Group B (p = 0.056). There was no reported significant difference between both groups regarding intra-hospital mortality, postoperative complication rate, rate of reintervention, or even the length of hospital stays. However, the ICU stay was significantly less in Patients with Ovarian Cancer (OC). The mean Overall Survival (OS) was 31.2 ± 6.2 and 39.1 ± 4.22 in groups A and B respectively with significantly more OS and Disease-free Survival (DFS) reported in Group B (P = 0.046*). The reported 5-year Survival was insignificantly different between both Groups. Conclusion In certain patient groups with PC from gastrointestinal and Ovarian malignancies, CRS + HIPEC could produce long-term OS with tolerable morbidity and mortality with better outcome OS and DFS in patients with OC.

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Abstract Introduction Colorectal cancer (CRC) is a global public health concern, ranking third among the most common cancer types in Brazil. Colorectal polyps play a crucial role in CRC prevention when identified and removed during colonoscopy. Objective This study aims to analyze the profile of patients with colorectal polyps at a reference clinic in the southernmost region of Santa Catarina, during the period from January to June 2023. Methods A cross-sectional, descriptive study was conducted, with analysis of secondary data from medical records, followed by statistical analyses to describe the sample and evaluate associations between variables. Results A total of 206 colonoscopic exams were analyzed, revealing a female predominance, with the predominant age group between 45 and 75 years old and the predominant location in the sigmoid colon. Most polyps were small and sessile, primarily removed by biopsy forceps. Conclusion The study provided important insights into the profile of patients with colorectal polyps in the study region, highlighting epidemiological patterns and challenges in the removal of these lesions. The findings underscore the importance of more effective prevention and treatment strategies.

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Abstract Sporadic intraabdominal desmoid tumor is a rare occurrence, comprising 0.03% of all neoplasms. It has an estimated incidence of 2 to 4 per million in the general population. Only 15% of all desmoid tumors are intraabdominal. Often, they are present with abdominal distension or bowel obstruction symptoms. Desmoid tumors are not readily differentiated from others through computed tomography (CT) scans. We are sharing a case of a young (34-year-old) patient who presented with tender palpable right lower quadrant mass. The CT scan shows a well-defined intraperitoneal mass over the right lumbar region. Limited right hemicolectomy was done. Histopathology shows features consistent with desmoid tumors. Surgical excision remains the mainstay of treatment, though various nonsurgical treatments have been described with promising results. Our case of sporadic intraabdominal desmoid tumor was managed with surgical resection.

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Abstract Anorectal malformations (ARMs) are congenital anomalies that can be related to poor functional prognoses for the patient, with issues such as fecal incontinence and obstructed defecation, despite the performing of corrective surgery in early childhood. Given the complexity of treating this type of disease, the aim of this study is to present the feasibility of sacral neuromodulation as a minimally invasive technique that can be used for managing pelvic floor dysfunctions in children with ARM, refractory to conventional therapies, and show outcomes improvement in the bowel function, and especially psychosocial well-being of the child more than one year of follow-up.

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Abstract The article "Enhancing CAR-T Efficacy: The Role of Anti PD-1/PD-L1 Checkpoint Inhibitors in Modern Cancer Treatment" provides an exhaustive study on CAR-T cell therapy and its role in cancer treatment, focusing on the problem of T-cell exhaustion and tumor immune evasion. Anti-PD-1/PD-L1 checkpoint inhibitors are said to help achieve enhanced CAR-T therapy by countering immune suppression within the tumor microenvironment. The introduction emphasizes the success level of CAR-T cells, especially in B-cell hematologic malignancies, while humbly candid in its limitation concerning solid tumors through mechanisms of immunosuppression. Of specific interest herein are the PD-1 and PD-L1 pathways as key immune checkpoints exploited by cancer to escape an immune response. To elaborate on this, it also explains how tumors upregulate PD-L1 to prevent T-cell functions through T-cell exhaustion, which entails depression in cytokine production and proliferation. The article explains the mechanisms of T-cell exhaustion: chronic antigen exposure, transcriptional reprogramming, metabolic dysfunction, and the suppressive nature of the tumor microenvironment. All these mechanisms combined lead to a loss of T-cell efficacy in counteracting tumor progression. The PD-1/PD-L1 axis preserves T-cell exhaustion and inhibits a strong immune response against the tumor. The paper puts forth the argument that the combination of CAR-T cell therapy with PD-1/PD-L1 checkpoint inhibitors leads to the reversal of immune suppression, improving T-cell function and persistence. A review of the preclinical and clinical trials, especially for solid tumor malignancies, puts forth advantages as well as challenges. Such challenges are experienced in terms of T-cell exhaustion, immunosuppressive tumor microenvironments, optimization of a dose, issues of toxicity, and inconsistent clinical outcomes.

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Abstract Objective To evaluate the efficacy and safety of mesenchymal stem cells (MSCs) for treating complex anovaginal and rectovaginal fistulas in Crohn's disease (CD) patients through a systematic review. Methods This review adhered to PRISMA and Cochrane guidelines. Literature searches were conducted on PubMed, Cochrane Library, Embase, and Web of Science using a PICO framework (P: CD patients with complex fistulas; I: MSC therapy; C: conventional treatments; O: efficacy and safety). Keywords included "stem cell," "fistula," and "Crohn's disease." Articles were screened via the Rayyan® platform for inclusion based on eligibility criteria, with conflicts resolved by consensus. Results Of 1,197 records, 7 studies met inclusion criteria. MSC therapy demonstrated variable healing rates ranging from 50% to 75%, with low adverse event profiles. Studies highlighted therapeutic potential in reducing fistula drainage and promoting tissue regeneration. However, significant heterogeneity in patient populations, MSC doses, and study methodologies complicated outcome standardization. A meta-analysis reported fistula healing rates of 58–62% and clinical remission of 62.52%, superior to conventional therapies. Factors such as disease severity, prior treatments, and anatomical differences influenced outcomes. Conclusions MSCs offer promising treatment for complex fistulas in CD, demonstrating favorable safety and efficacy. However, variability in study designs, dosing protocols, and patient profiles underscores the need for standardized methodologies and larger clinical trials. Optimizing MSC use, particularly as a first-line therapy, could enhance outcomes and provide a viable alternative to conventional surgical approaches.

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Abstract The management of complex anorectal fistulas associated with Crohn's Disease (CD) remains a significant clinical challenge, with current treatments achieving limited success in long-term remission. This article explores the application of autologous nanofragmented lipoinjection (Nanofat) for the treatment of Perianal Fistulizing Crohn's Disease (PFCD). Nanofat, derived from adipose tissue and containing mesenchymal stem cells, offers the potential for tissue regeneration and immune modulation in the inflammatory environment of perianal CD. A patient with a chronic fistula, previously treated with Seton and maintained biologic therapy, underwent liposuction and nanofragmentation of adipose tissue. The resulting Nanofat was injected into the fistula tract following surgical debridement. The patient demonstrated complete healing with no recurrence of symptoms after six months, showcasing the efficacy of this technique. This autologous approach is low-cost, minimally invasive, and reproducible, with promising clinical outcomes. The addition of nanofragmented fat enhances tissue penetration and fat survival compared with traditional Microfat, increasing the chances of successful fistula repair. Further controlled studies comparing Nanofat with other established fistula repair methods are warranted to assess its long-term efficacy and standardize treatment protocols.