BackgroundIrritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have a strong relationship with psychological stress. Studies have shown increased stress levels in patients with IBS and IBD during the SARS-CoV-2 (COVID-19) pandemic. The current literature on the impact of work environment on IBD and IBS symptoms is limited, particularly during the current pandemic. ObjectiveThis study aims to analyze how the pandemic impacted patients with IBS and IBD in the setting of staying home versus working outside the home. MethodsAfter Institutional Review Board (IRB) approval, a retrospective review of 245 patients with IBS and IBD who followed with our gastroenterology clinic in the past year was performed. Patients were asked about symptoms including, but not limited to, worsening diarrhea, constipation, and abdominal pain. Pearson's chi-squared test was used for analysis. ResultsOf the 245 patients in our study, 67 had IBS, 166 had IBD, and 12 had both. The male-to-female ratio was 1:1.4. A total of 136 (55.5%) patients worked from home during the pandemic, while 109 (44.5%) patients worked outside. Eighty-three patients working from home reported no change in symptoms, 35 reported worsening symptoms, and 18 reported an improvement in symptoms. Sixty-eight patients working outside the home reported no change in symptoms, 26 reported worsening symptoms, and 15 reported improvements. Working outside the home had a statistically significant relationship with COVID-19 infection. Thirty patients were infected, of which 22 (73.3%) worked outside the home (p=0.01). Overall, 203 (82.8%) patients received the vaccine, and only 14 of these patients reported worsening gastrointestinal (GI) symptoms one week after receiving the vaccine. Comparable results were seen after dividing the data into cohorts of IBS and IBD patients. Of the patients with IBD staying at home, 15.9% had depression (p=0.01). ConclusionMost patients had symptoms at baseline. There was no statistically significant correlation between change in symptoms and work settings. Patients were less likely to be infected with COVID-19 while staying home. Our patient population showed a high vaccination rate of 82.9% as compared to the national average of 59.2% (source: Centers for Disease Control and Prevention (CDC)). Only 5.7% of the patients reported new or worsening gastrointestinal symptoms in the week following vaccination. The limitations of the study included its retrospective design and poor correlation in general between symptoms and disease activity in IBD patients.

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INTRODUCTION: To the best of our knowledge, a total of 23 cases of sarcomatoid or carcinosarcoma of the pancreas have been reported. 1 Sarcomatoid carcinoma of the pancreas (SCP) is a rare and aggressive malignant neoplasm with evidence of epithelial and mesenchymal features. Confirmation of this disease currently relies on detailed pathologic examinations. SCP is comparatively more aggressive with a poorer prognosis than that of conventional pancreatic carcinomas. Therefore, SCP can be a challenge both diagnostically and therapeutically for clinicians and surgeons alike. The presenting case illustrates and highlights potential indications that can be used to diagnose and treat SCP much earlier than conventional medicine currently allows. CASE DESCRIPTION/METHODS: We present a case of SCP in an 84-year-old male patient. He had experienced jaundice and epigastric abdominal pain for 4 weeks. An ultrasound revealed a hypoechoic mass at the pancreatic head which prompted referral to our gastroenterology group. Physical examination revealed scleral icterus, cutaneous jaundice, and left hip and lower back pain. Laboratory tests yielded the following results: total bilirubin of 13.4 U/L, AST/ALT of 171 U/L and 240 U/L respectively, and an alkaline phosphatase of 714 U/L. Imaging examinations were performed including MRCP, EUS, and CT noting a mass in the pancreatic head. Due to the aggressiveness of this patient's tumor and despite medical efforts, the patient succumbed to his illness shortly after the official diagnosis was discovered and before any therapeutic measures could have been initiated. DISCUSSION: Our final diagnosis of SCP was made via pathologic examination as high-grade malignant sarcomatoid neoplasm with spindled areas, ample mitosis, and necrosis. IHC analysis showed positive expression for cytokeratin, vimentin, CD56, and a Ki-67 with a proliferative rate of greater than 90%. Other immunomarkers for melanoma, smooth muscle, and lymphoma were negative. These findings are indicative of sarcomatoid morphology and phenotype. Although definitions of SCP vary, it is believed that SCP features spindle cells and possesses mesenchymal-like and epithelial-like appearances. 1 Due to the histological report of spindle cell patterns and the co-presence of mesenchymal-like and epithelial-like cells illustrated using immunostaining techniques, our case is most consistent with SCP.