Esophagogastroduodenoscopy revealed an oedematous and exuberant lymphangiectasia appearance into the duodenum, without any ulceration or suspected infiltration component (figure 1 – A/B). However, duodenal biopsies unveiled infiltration by badly differentiated carcinoma (figure 1 – C/D). For the time being, infection and inflammatory/autoimmune factors were ruled out. A CT scan ended up being performed exposing a thickened and enlarged pancreas with ill-defined limitations and many intra-abdominal adenopathies, increasing suspicion of pancreatic lymphoproliferative disease. EUS with FNB had been done with biopsy associated with pancreas and one associated with the bigger adenopathy. EUS also revealed an enlarged, non-nodular pancreas and a thickened duodenal wall. Minor ascites ended up being detected. Both EUS-biopsies were concordant on the diagnosis of carcinoma with gastric or pancreatic-biliary origin, highly aggressive (Ki67>80%). Therefore, the analysis of pancreatic adenocarcinoma was assumed (cT4N1Mx). The patient happens to be on palliative chemotherapy and remains paucisymptomatic.In a reaction to the kind letter from Joaquin Cabezas et al. We agree that health care bills when you look at the COVID age has radically changed; making use of new mechanisms in the SANT-1 research buy proper care of various conditions is without question now a priority to prevent contagion of both the in-patient and also the medical staff, although the vaccine could protect the populace, you can still find numerous concerns to answer; The design we use for the proper care of customers with a diagnosis of HCV in Mexico showed great advantages, as with other scientific studies, because it considerably decreased prices, practically 50% of the clients had been not even close to the center the next amount but could possibly be included, addressed, monitored and cured utilizing this design, with cost savings additionally in the complications that were averted due to the non-progression of the disease and/or the stabilization regarding the currently established liver illness, always centered on recommendations international and nationwide. This model could be used for other pathologies that require an assessment and follow-up by experts and subspecialists in communities far from tertiary hospitals. Also first contact health practitioners are consulted, certainly with extraordinary advantages when you look at the end result of diligent care, but especially now in the COVID age that requires better security for patients and wellness employees. We also agree with Dr. Javier Crespo’s group that scientific societies as well as the governments of the nations are much more interested in promoting this kind of care and generating the appropriate basics for this purpose.Apart from pulmonary manifestations, there is certainly a heightened incidence of pancreatic participation and intense pancreatitis (AP) reported in COVID-19 patients. In January 2021, a PubMed search using the terms “Acute Pancreatitis, COVID-19″ yielded an outcome including 94 researches. All of the researches relate to remote situations or limited series, with all the added difficulty that some authors have considered AP as increased lipase and/or amylase levels with no diagnostic criteria for AP being found, as highlighted by Chivato et al. in terms of the situation they report. Pancreatic participation was reported in 17 per cent of COVID-19 clients and AP in 1.8-2.0 per cent of those customers..Letter to publisher in reference to Chronic Viral Hepatitis C Micro-Elimination Program Using Telemedicine. The Mexican Experience by Perez Hernandez et al.Endoscopic submucosal dissection (ESD) is a technique for the en bloc resection of early neoplastic lesions into the gastrointestinal area. A step that must definitely be free open access medical education completed after excision is the pinning down regarding the specimen on a support plate such as for example a cork board to prevent artifacts because of structure biosocial role theory contraction (1). After ESD lesion edges typically relax from contraction, hence this procedure needs to be very carefully done to stop damaging the specimen. Recently, Nishizawa T, et al. (2) reported that losing adrenaline onto the lesion outcomes in advantage relaxation, which facilitates fixation (2). Nonetheless, the usage of other drugs-such as Buscapine-that cause intestinal smooth muscle relaxation, possibly with comparable effects, has not been explained. Under, two ESD specimens from two different organizations tend to be shown. These specimens correspond to gastric lesions. Buscapine is put on their particular area while the edges become relaxed, thus facilitating stretching and thus fixation. In closing, the application of Buscapine might help when you look at the handling of excised lesions by assisting pinning away and decreasing damage risk for specimens.Regarding our article “Daño pancreático pancreatitis aguda en pacientes COVID-19″, we would like to simplify that the outcome formerly described met the diagnostic criteria for intense pancreatitis, defined within the Atlanta classification and mentioned in several guidelines.A case of a huge gastrointestinal bleeding additional to a between esophagus and aberrant right subclavian artery (arteria lusoria) is provided, treated initially with haemostatic clips and soon after with a Sengstaken-Blakemore pipe and endovascular stent. A brief literary analysis is completed.