BACKGROUND & AIMS:Ulcerative colitis (UC) has increasingly been recognized as a progressive disease. However, unlike Crohn's disease, evidence in UC has not demonstrated a clear benefit of early biologic therapy (BT), and disease progression has not been formally evaluated. We aimed to assess whether early intervention improves UC outcomes, particularly in preventing disease progression. METHODS:We conducted a retrospective multicenter study (11 centers) including adult patients with UC with at least 5 years of follow-up. Early intervention was defined as BT initiation within ≤12 months of diagnosis. The primary outcome was UC progression, defined as a composite endpoint including proximal disease extension, colonic structural changes (stenosis or tubularization), and dysplasia/cancer. Secondary outcomes included clinical endpoints: hospitalizations, surgery, and corticosteroid use. RESULTS:A total of 236 patients were included, 28.8% (n = 68) with early BT (median follow-up, 6.9 years; interquartile range, 5.8-8.8 years). Late BT initiation (23.2% vs 5.9%) independently predicted the composite outcome of progression (hazard ratio, 4.39; 95% confidence interval, 1.57-12.29; P = .005). Assessing each outcome separately, early BT was associated with a reduced risk of proximal extension (28.6% vs 0.0%; P = .001). In multivariable Cox regression, late BT initiation (13.1% vs 2,9%) was an independent predictor of colonic structural damage (hazard ratio, 4.83; 95% confidence interval, 1.14-20.58; P = .033). No differences in clinical outcomes were observed. CONCLUSIONS:Starting BT early in the disease course may reduce the long-term risk of disease progression, reshaping the window of opportunity in UC.

INTRODUCTION AND OBJECTIVES:The Urgency Numeric Rating Scale (U-NRS) assesses the severity of bowel urgency, a common symptom that is often underestimated in ulcerative colitis. This study aimed to translate the U-NRS into Portuguese and to provide validation in clinical practice, as well as to assess the prevalence of bowel urgency in a cohort of ulcerative colitis patients and, in those in clinical remission, to evaluate its relationship with endoscopic and histological activity and manometric changes. METHODS:After translation of the U-NRS into Portuguese, patients with ulcerative colitis seen at the outpatient clinic were asked to complete the scale at T0, after 2 weeks (T1) and after 3 months (T2). Patient-reported outcome-2 ulcerative colitis (PRO-2-UC), EQ-5D, EQ-Visual Analogue Scale (EQ-VAS), inflammatory bowel disease disk (IBD-Disk), and the Global Perceived Effect Scale were also completed. Acceptability, reliability, construct validity, responsiveness, and interpretability were assessed. A subgroup of patients in clinical remission with bowel urgency underwent sigmoidoscopy with rectal biopsies and anorectal manometry and were compared with a control group (in clinical remission without bowel urgency). RESULTS:In total, 126 patients were included, of whom 49.21% ( n  = 62) had bowel urgency. Test-retest reliability was excellent (intraclass correlation coefficient: 0.768). The U-NRS correlated significantly with the PRO-2-UC, IBD-Disk, EQ-VAS, and EQ-5D ( P  < 0.001), demonstrating construct validity. The U-NRS values correlated with the first constant sensation volume on anorectal manometry ( rs = -0.374, P  = 0.038). CONCLUSION:The U-NRS scale is an easy and quick tool for assessing bowel urgency and can be incorporated into clinical practice.

OBJECTIVE:Corticosteroids (CS) are effective in the induction of remission in inflammatory bowel disease (IBD), but have an unfavorable side effect profile. A CS sparing strategy is frequently recommended, but its consequences in IBD outcomes have been scarcely studied. Our primary aim was to evaluate current CS use and excess in IBD patients, comparing them with a historic cohort. Our secondary aims were to identify predictors of CS excess and compare outcomes (surgery, hospitalization, new CS cycle, structural damage and a composite outcome) at 12 months between three prescription groups (no CS use, standard CS use, and excess CS use). PATIENTS AND METHODS:A retrospective study, including adult IBD outpatients from two trimesters (one in 2014 and one in 2023). CS prescription trends were compared between groups. The latter was used to identify predictors of CS excess and compare outcomes between prescription groups. RESULTS:A total of 1131 outpatients with IBD were included, 374 in 2014 and 757 in 2023. CS use was 3.2 times lower in 2023 (6.5% vs. 20.6%, p<0.001), and CS excess was 5.5 times lower (12.0% vs. 2.2%, p<0.001). Crohn's disease, extraintestinal manifestations, absence of medication, clinical activity and hospitalization in the previous 12 months were independent predictors of CS excess. CS excess prescription was an independent predictor of hospitalization (HR 15.225, 95% CI 2.189-105.913, p=0.006), new CS cycle (HR 38.392, 95% CI 13.866-106.299, p<0.001) and the composite outcome (HR 32.253, 95% CI 13.260-78.452, p<0.001) at 12 months. CONCLUSIONS:CS prescription rate has significantly decreased in our center. CS excess was associated with negative outcomes, namely hospitalization and new CS cycles. Improving quality-of-care in IBD should focus on avoiding excess CS prescription.

A man in his 70s, without prior foreign body history, presented to the emergency department 15 days after accidentally inserting a tubular object into his anus. He reported a reduction in normal bowel movements. Initial physical examination was normal. An abdominal X-ray revealed a tubular hypodensity in the pelvic region, without perforation. Subsequently, it was decided to perform a colonoscopy during which a foreign body was visualized in the distal rectum, that was successfully removed with the use of a rat tooth forceps. The foreign body was a plastic tube about 18cm in size. Afterwards, the rest of the colon was assessed, having identified an ulcer in the lower rectum related to the presence of the object. Six months later, the patient reported no complains and a follow-up colonoscopy was conducted which was normal. Discussion: Rectal foreign bodies, whose size and shape are variable and sometimes aberrant, are often self-inserted for self-gratification by adults, and its incidence is increasing. Patients typically avoid immediate medical attention and seek help only when complications arise. Formal clinical guidelines are lacking, and this case illustrates the importance of clinical judgement in the management of rectal foreign bodies, whether endoscopic or surgical.

Introduction: The use of oral iron in iron deficiency (ID) and ID anemia (IDA) in inflammatory bowel disease (IBD) is controversial. Its lower cost and ease of administration must be weighed against side effects and efficacy. The aim of this study was to compare the efficacy and tolerability of two oral iron formulations (Sucrosomial® iron [SI] and ferric hydroxide-polymaltose complex [FHPC] for correcting ID and IDA in IBD. As a secondary objective, we aimed to assess the impact of oral iron on correcting ID, IDA, and disability in IBD. Methods: This was a prospective, observational, bicentric cohort study. We included patients with IBD diagnosed with ID or IDA between November 2022 and November 2023. Physicians were preassigned by the investigators to prescribe SI or FHPC. The primary outcome was the efficacy of treatment with oral iron (Hb increase ≥2 g/dL and/or normalization of Hb levels in patients with IDA or correction of iron parameters in patients with ID alone) by week 12. The secondary outcomes were tolerability and the impact of oral iron on the quality of life and disability (IBD-Disk). Results: A total of 56 patients were included in this study (FHPC group, 33; SI group, 23). A total of 47 patients had ID alone and 9 had IDA. There was no difference in the efficacy between the two formulations. After 12 weeks, 22% of the patients had an increase in Hb ≥2 g/dL and/or normalization of Hb levels or iron parameters. There was an improvement in serum iron (53.5 [45] vs. 64.5 [73]; p = 0.017), transferrin saturation index (17.0 [10] vs. 26.0 [13]; p < 0.001), and Hb levels (in patients with IDA) (11.9 ± 0.9 vs. 12.5 ± 1.2; p = 0.041). The IBD-Disk scores improved (p = 0.004) after treatment, and this improvement correlated with increased serum iron (rs = −0.43; p = 0.010) and Hb (rs = −0.50; p = 0.002) levels. Twelve (21.4%) patients had side effects (8.7% in the SI group vs. 30.3% in the FHPC group [p = 0.006]), leading to iron discontinuation in 5 (4/1: FHPC group/SI group). Discussion: Both iron formulations had similar efficacy. There were fewer side effects in the SI group. Oral iron replacement improved Hb and iron levels after 12 weeks of treatment, and these changes correlated with improvement in disability.

BACKGROUND:An ideal test to evaluate the inflammatory burden in ulcerative colitis is still an unmet need. Fecal calprotectin (FCP) and C-reactive protein (CRP) have significant limitations. Plasma calprotectin (PC) seems to be promising in inflammatory diseases, but its value in IBD is still to be determined. Our aim was to assess whether PC correlates with inflammatory activity in UC. METHODS:Prospective single center cohort study. Consecutive patients previously diagnosed with UC undergoing endoscopy were included (June 2021-September 2022). Demographic, clinical, analytical (CRP, PC and FCP), endoscopic and histologic data was collected at the time of colonoscopy. PC was assessed with Gentian Calprotectin Immunoassay and, in a subgroup of patients, also with QUANTA Flash Circulating Calprotectin from INOVA. RESULTS:Inclusion of 98 patients (60.2% male) with a median age 49 (38-61) years. The extent of colitis was distal in 12 (12.2%), left-sided in 49 (50%), and extensive in 37 (37.8%). Mesalazine was taken by 65 (66.3%) patients, with biologic monotherapy used in 24 (24.5%) and combination therapy in 6 (6.1%). Clinical, endoscopic and histological remission were detected, in 56 (57.1%), 48 (49%) and in 55 (56.1%) patients, respectively. Comparing MES 0/1 vs MES 2/3, a statistically significant difference was found with PC, CRP and FCP. Concerning endoscopic (MES=1) and histological (GS<2) remission, FCP was the only biomarker able to detect these outcomes. PC (Gentian) and PCi (INOVA) were highly correlated with CRP. CONCLUSION:PC has low value in distinguishing patients in remission from patients with endoscopic or histologic activity in UC. This essential role must continue be played by FCP.

Public policy aimed at preventing undesired phenomena has increasingly sought to engage representatives of the target population. Little is known, however, about how power dynamics function to shape the processes and outcomes of risk governance engagement interventions. In order to study the ways in which, and the extent to which, power differentials can be reduced in participatory health promotion initiatives, we develop a conceptual framework synthetising theories of participatory action, phenomenology and governmentality. Based on the empirical research into youth participation in the EU project CO-CREATE, involving 15-19-year-old adolescents in five European countries (2019-2021), we show that diverse forms of knowledge may become available in engagement interventions. We analyse the use and relative inclusion and exclusion of these different forms of knowledge in terms of a three-level framework of different depths of democratisation in participatory health promotion: risk management, risk definition and risk negotiation. Advanced democratisation can only be achieved if risk negotiation is carried out in ways which embrace and encourage a range of different, and potentially conflicting forms of knowing.

Introduction. Recently, a subcutaneous formulation of infliximab was approved. The switch from intravenous infliximab to subcutaneous infliximab may improve convenience, but data on pharmacokinetics and immunogenicity are limited. We aimed to compare the efficacy and tolerability of subcutaneous infliximab and to assess whether the formulation results in higher plasma levels of infliximab. Methods. Retrospective, single-center cohort study. Patients with Crohn’s disease or ulcerative colitis, 18 years of age or older, clinically stable, receiving intravenous infliximab (5mg/kg every eight weeks) for more than 6 months were switched. Subcutaneous infliximab (120 mg) was administered every 2 weeks. Clinical and analytical evaluations were performed on day 0, week 2, week 8, and week 16. Plasma levels of infliximab and anti-drug antibodies were measured at these time points. Results. 41 patients included (27 with Crohn’s disease and 14 with ulcerative colitis. Azathioprine was administered concomitantly in 47.6%. All patients remained in clinical remission. Analytical biomarkers remained stable. Treatment persistence: 95.1%. Median plasma levels of infliximab at day 0, week 2, week 8, and week 16: 4.89 (3.25 - 7.27), 9.17 (7.89 - 12.6), 19.91 (15.02 - 21.64) and 21.55 (17.18 - 29.57) ug/mL, respectively. Statistically significant difference of plasma levels of infliximab in day 0 vs. week 2 and week 2 vs week 8. Azathioprine resulted in a statistically significant difference in plasma levels of infliximab only at day 0 (not at week 2, week 8, or week 16). Plasma levels of infliximab at week 2, week 8, and week 16, but not at baseline, were statistically associated with body mass index. No anti-drug antibodies were detected. No severe adverse effects. Three patients developed injection site reactions. Three patients developed arthralgia of undetermined significance. Conclusions. Switching from intravenous infliximab to subcutaneous infliximab maintained clinical response. Plasma levels of infliximab at week two were still lower than expected, considering the results at week eight. A possible advantage of subcutaneous infliximab may be the diminished necessity for concomitant immunomodulators.

Introduction: The IBD-Control questionnaire and IBD-Disk are two patient-reported outcome measures designed to evaluate the impact of inflammatory bowel disease (IBD) on different health domains. Unlike IBD-Disk, there is no fully published validated Portuguese version of IBD-Control. Furthermore, the two instruments have not yet been compared. We aimed to translate and validate IBD-Control in Portugal and compare it with IBD-Disk. Methods: After translation into Portuguese, the IBD-Control was administered to IBD patients, at baseline (T0), after 1–4 weeks (T1), and >3 months (T2). Patients also completed the Portuguese versions of the PRO2, EQ-5D, SIBDQ, and IBD-Disk. We assessed the reliability, validity, responsiveness, and interpretability of IBD-Control. We compared the usability (3 questions) and the ability to identify good disease control (area under the curve [AUC]) of IBD-Control and IBD-Disk. Results: At T0, the IBD-Control was completed by 142 patients (108 Crohn’s disease, 34 ulcerative colitis). At T1 and T2, 68 and 101 patients completed the questionnaire, respectively. Factor analysis confirmed the one-dimensionality of the scale with 8 items (IBD-Control-8). Internal consistency (Cronbach’s alpha) was 0.80. Test-retest reproducibility for stable patients (n = 54) was high (intraclass correlation coefficient-0.86). IBD-Control-8 significantly correlated (r between 0.55 and 0.82; p ≤ 0.001) with PRO2, EQ-5D, SIBDQ and IBD-Disk. The variation in IBD-Control-8 between T0 and T2 correlated significantly (r between 0.48 and 0.53; p ≤ 0.01) with the variation in PRO2 (only for Crohn’s disease), SIBDQ and IBD-Disk. The IBD-Control-8 significantly discriminated between well and poorly controlled disease (15 ± 2 vs. 11 ± 4; p < 0.001). No significant differences were observed between IBD-Control-8 and IBD-Disk regarding usability and the ability to identify good disease control (AUC: −0.79 vs. 0.76, respectively). Conclusions: The IBD-Control is reliable and valid for measuring disease control from the perspective of patients with IBD in Portugal, presenting no significant differences regarding usability and assessment of disease control when compared to IBD-Disk.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n = 132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.

Humidity sensors are of huge importance in diverse domains. Several types of materials present a moisture-sensing capacity; however, frequently, their electrical response does not display time stability. Due to its high thermal stability, high ionic conductivity, and different conduction mechanism contributing to its overall conductivity, polyantimonic acid (PAA) is seen as a promising material for humidity-sensing devices. In the present work, crystalline PAA was obtained via a simple and safe hydrolysis technique using SbCl3 as a precursor. Bulky sensor samples were produced using different amounts of polyvinyl alcohol (10–20 wt.% PVA) as a binder. The obtained PAA solid sensors were tested at room temperature (RT) in order to evaluate their moisture detection/measuring ability in the relative humidity range 0–100%; the evaluation was carried out with electrical impedance spectroscopy. The sample’s structure and morphology were studied using diverse experimental techniques (porosimetry, scanning electron microscopy, X-ray diffraction analysis, and thermogravimetry analysis, etc.). The sensors’ electrical response was in line with the found structural and morphological features. The slope of the resistance variation with an RH percentage concentration between 1 kΩ and 1.5 kΩ was noted for all sensors (showing no changes with time) in the interval between 30 and 100% RH. A good repeatability and reproducibility of the evaluated sensors’ electrical response was observed: the ones that displayed a higher sensitivity were the ones with a high PVA binder content, higher than previously published results for PAA, as well as a very good time stability along the time and low hysteresis.

Abstract Background Rectosigmoidoscopy is frequently used to assess disease activity in patients with ulcerative colitis (UC). Most recent guidelines suggest that the inflammatory activity of the whole colon can be inferred by endoscopic findings in the rectosigmoid colon. Nevertheless, whether the right colon can have endoscopic or histological activity when there is endoscopic and histological remission in the left colon, is yet to be completely determined. Aim To assess whether UC histological activity (HA) and improvement (HI) can be deduced by the findings in the rectosigmoid colon. Methods Retrospective single center cohort study. Consecutive patients with previously diagnosed UC undergoing endoscopic assessment, from January 2014 to September 2022, were included. Inclusion criteria were: a complete colonoscopy with adequate bowel preparation and biopsies made in all the four segments of the colon and in the rectum. Demographic, clinical, endoscopic (Mayo endoscopic subscore (MES)) and histological (Geboes score (GS)) data at the time of the colonoscopy was collected. Agreement and correlation between findings in the rectosigmoid and the whole colorectum were calculated with the kappa coefficient (k) and the Spearman correlation coefficient (r). Results Inclusion of 264 patients (49.2% male). Median age was 5015.7years. Smoking history in 33.5% of patients. Extension of UC was: proctitis in 13 (4.9%), left colitis in 109 (41.3%) and extensive colitis in 142 (53.8%) patients. MES was 0 in 139 (53.7%) patients, 1 in 52 (20.1%), 2 in 36 (13.9%) and 3 in 32 (12.3%). GS was 0 in 19 (7.3%), 1 in 124 (47.5%), 2 in 50 (19.1%), 3 in 40 (15.3%), 4 in 10 (3.8%) and 5 in 18 (6.9%). Regarding endoscopic activity, a very high correlation was found between MES of the whole colorectum and MES of the left colon (k=0.88, r=0.92). As far as HA (GS1.1) is concerned, HA in the whole colorectum was highly correlated with HA in the rectosigmoid colon (k=0.8, r=0.82), both in the whole cohort and in the subgroup of patients with extensive colitis (k=0.8, r=0.82). When assessing HI (GS<3.1) moderate coefficients (k=0.66, r=0.69) were found in the whole cohort. Patients with extensive colitis revealed similar agreement and correlation coefficients (k=0.69, r=0.71). Conclusion Endoscopic and histological activity in the rectosigmoid colon of patients with UC has a high correlation with activity in the whole colorectum. Therefore, UC activity can be inferred by analysis of the distal segments of disease. These findings reinforce that inflammatory activity in patients with UC can be assessed with rectosigmoidoscopy alone.

Humidity sensors are in high demand for many applications, such as environmental monitoring and air and food quality control. Despite many inorganic and organic materials exhibit moisture sensing properties, the electrical response of many existing sensors is not stable along the time. Polyantimonic acid (PAA) is characterized by elevated proton conductivity and by high thermal stability: consequently, it is seen as promising proton conductor for usage in humidity sensing devices. In this work, for the first time, PAA-based bulk solid membranes were produced and tested as potential materials for relative humidity (RH) detection and their moisture sensitivity was evaluated. Two different amounts of binder were used for moulding the solid sensors: the ones with 10% of binder were designated as 90PAA, while the ones with 20% were named 80PAA. The structures of the solid samples were investigated by X-ray diffraction (XRD) technique, adsorption–desorption curves via Brunauer–Emmett–Teller (BET), scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) techniques. The electrical behaviour was examined at ambient temperature by electrical impedance spectroscopy in the entire relative humidity (RH) interval (0–100%) and in the frequency range of 40 Hz up to 60 MHz. Electrical response of the materials was correlated with the structural features of the membranes. Both 90PAA and 80PAA sensors showed total resistance 3 × 10 5 and 3.5 × 10 5 Ω at 10% RH, respectively. A linear decrease of the resistance on RH was observed in the range 30–90% RH for both sensors. The electrical response of the evaluated PAA-based sensors displays good repeatability and reproducibility: the ones with lower binder content showed higher moisture sensitivity as well as very good time stability over 1 year.

Drug-induced liver injury (DILI) is a challenging diagnosis regarding the complexity of mechanisms, drugs, supplements, and herbs that can have hepatotoxic potential. Biologics are increasing as common drugs in the treatment of chronic inflammatory diseases and some DILI were previously reported with those agents. Natalizumab, a recombinant monoclonal antibody used for the treatment of multiple sclerosis (MS) has a good safety profile with extremely rare liver-related adverse events. The clinical case of a 44-year-old female with the history of MS and the recent start of natalizumab was reported. The patient was admitted with jaundice, choluria, fatigue, anorexia, nausea, and diffuse abdominal discomfort. No signs of encephalopathy or MS flare on examination. Laboratory values: aspartate aminotransferase, 905 U/L; alanine transaminase, 1559 U/L; ALP, 127 U/L; GGT, 301 U/L; total bilirubin, 12.8 mg/dL; direct bilirubin, 5.9 mg/dL, Albumin 2.9 g/dL, platelet 137 g/L, and 2.44 INR. No infectious, vascular, metabolic causes, or biliary obstruction were found. Liver biopsy suggested toxic hepatitis with autoimmune features. Since no definite criteria for autoimmune hepatitis (AH) were met, steroids were not given. The patient was on supportive measures and was presented to a liver transplant unit. Therefore, DILI due to natalizumab was assumed and its discontinuation led to the resolution of all symptoms in a 6-month window. The increasingly common use of biological therapy or with direct influence on the immune system should raise the suspicion of the gastroenterologist in all cases of suspected DILI.

Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development.

Introduction: The COVID-19 pandemic drastically changed the daily routine of all healthcare systems worldwide, and endoscopy units were no exception. Endoscopic exams were considered to have a high risk of transmission, and therefore, the safety of endoscopy units and the consequent need for pre-endoscopy SARS-CoV-2 screening were questioned early on. The aim of our study was to assess the safety of endoscopy units during the COVID-19 pandemic, as well as the effectiveness/necessity for SARS-CoV-2 screening prior to endoscopies. Material and Methods: This is a retrospective and single-center study carried out in a Portuguese tertiary hospital. All patients who underwent endoscopic procedures between September 1, 2020 and February 28, 2021 were included. The pre-endoscopy screening consisted of a specific questionnaire or a RT-PCR test for SARS-CoV-2 (nasal and oropharyngeal swab). Data were obtained through patient’s clinical records and the Trace COVID platform. Results: A total of 2,166 patients were included. Patients had a mean age of 61.8 years and were predominantly male (56.2%, n = 1,218). Eighty-one (3.7%) patients had previous SARS-CoV-2 infection, with a median difference of 74 days (IQ 40.5:160.5) between infection and endoscopy. Most patients (70.2%, n = 1,521) underwent PCR screening for SARS-CoV-2 up to 72 h before the procedure, with the remaining patients (29.8%, n = 645) answering a questionnaire of symptoms and risk contacts up to 3 days before endoscopy. Of the patients who underwent RT-PCR screening for SARS-CoV-2, 21 (1.4%) tested positive, and all were asymptomatic at the time of the screening. The evaluation for SARS-CoV-2 infection up to 14 days after the endoscopic exams identified 9 positive patients (0.42%) for SARS-CoV-2. The median difference in days between endoscopy and the diagnosis of infection was 10 days. Discussion/Conclusion: Pre-endoscopy screening with RT-PCR test for SARS-CoV-2 identified a very small number of patients with COVID-19 infection as well as patients with COVID-19 infection in the following 14 days. Therefore, the risk of infection in endoscopy units is negligible if screening of symptoms and risk contacts is applied and individual protective equipment is used.

Klebsiella pneumoniae is a gram-negative pathogen that is a common cause of severe infections, including pyogenic liver abscess. Dissemination of K. pneumoniae to other organs, including the eye, is associated with significant morbidity and mortality. In the particular case of endogenous endophthalmitis (EE) by K. pneumoniae the prognosis is poor. We report the case of a middle-aged female with K. pneumoniae liver abscess. The patient developed metastatic endophthalmitis that was aggressively treated with systemic antibiotics. The liver abscess resolved with antimicrobials and percutaneous transhepatic drainage, but regarding the endophthalmitis she was discharged from our hospital without recovery of her eyesight. Metastatic spread to the eye should be considered in all patients with liver abscesses who experience ocular signs and symptoms in order to establish a timely diagnosis of EE.