Hematologic markers of distant metastases and poor prognosis in gynecological cancers.

BACKGROUND: Despite the recent progress in the development of anti-cancer drugs, the treatment of metastatic tumors is usually ineffective. The systemic inflammatory response performs key roles in different stages of the carcinogenesis process including metastasis. The high neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were found to be associated with poor survival rates in the majority of solid tumors. However, only a few studies were conducted to further investigate this association in patients with advanced gynecological cancers. METHODS: Clinical data from 264 patients with FIGO stage III and IV gynecological (endometrial, ovarian and cervical) cancers treated at King Hussein Cancer Center (Amman-Jordan) from 2006 to 2012 were retrospectively reviewed. We examined the association between absolute neutrophil count (ANC), absolute monocyte count (AMC), MLR, PLR, and NLR with distant metastases, overall survival and event-free survival in gynecological cancers. For survival analysis, Receiver Operating Characteristic (ROC) curve analysis was operated to determine the optimal cutoff values. RESULTS: Patients with high baseline NLR (≥4.1) had more baseline distant metastases than patients with low baseline NLR (< 4.1), (p-value 0.045). Patients with high baseline AMC (≥560) had more distant metastases in comparison to patients with low baseline AMC (< 560), (p-value 0.040). Furthermore, Patients with high baseline PLR (≥0.3) had more distant metastases in comparison to patients with low baseline PLR (< 0.3), (p-value 0.025). Additionally, patients with high baseline ANC (≥5700) had worse overall survival compared to the patients with low baseline ANC (< 5700), (p-value 0.015). Also, patients with high baseline AMC (≥490) had worse overall survival compared to the patients with low baseline AMC (< 490), (p-value 0.044). CONCLUSION: Different hematologic markers obtained from a cheap test (CBC) could potentially be used to predict the presence of distant metastases thus used as prognostic indices in gynecological cancers.

Role of Dentist: COVID19 and Mucormycosis.

Dental practice has evolved over time and has adapted to the challenges that it has faced. The risk of infection spread via droplet and airborne routes poses a significant risk to the dentist who works close to patients. The risk of cross-infection between dental health-care personnel and patients can be very high due to the peculiar arrangements of dental settings. Dental clinics should have air purification systems with high volume excavators and negative pressure rooms for COVID-19 screening. Mucormycosis is a fungal disease that mostly occurs in immunocompromised individuals and those with uncontrolled diabetes. Dental extraction can trigger the occurrence. Increased occurrence of mucormycosis is seen in COVID-affected patients. This article gives a review on the dentistry-related transmission of COVID 19, the relation of COVID and mucormycosis.

Factors influencing disposition decisions for patients seen in a psychiatric emergency service.

OBJECTIVE: The study examined factors influencing clinicians' decisions about disposition of patients seen in a psychiatric emergency service. METHODS: A stratified random unduplicated retrospective sample of 378 patient records was drawn from the records of 1,823 patients who visited the emergency service of an acute care psychiatric hospital in Israel during a seven-month period. Patients were selected from each of the following dispositions: not admitted (N = 96), discharged after brief observation in the emergency service (N = 90), admitted to a open unit (N = 104), and admitted to a locked unit (N = 88). Data on demographic and clinical characteristics of patients and on some clinician and system variables were analyzed using univariate statistical techniques and stepwise logistic regression. RESULTS: Patients were more likely to be admitted if they were judged by clinicians to be suicidal, had more than three previous hospitalizations, were psychotic, had suicidal behavior as the presenting complaint, and were brought to the hospital involuntarily. Variables favoring assignment to a locked unit were age between 20 and 30, dangerousness to self or others, male gender, and a low Global Assessment of Functioning score. CONCLUSIONS: Patients' level of psychopathology and dangerousness were the primary factors influencing clinicians' decisions about disposition of patients from the emergency service.

Extraperitoneal endoscopic inguinal hernia repair.

The endoscopic extraperitoneal hernioplasty as reported in this study is a similar repair to that achieved by the conventional preperitoneal repair as described by Stoffa, Nyhus, and Rignault. However, this new repair is completed via a totally extraperitoneal approach. Thus, it eliminates all early and late complications related to the violation of the peritoneal cavity as proposed by other intraperitoneal laparoscopic approaches to hernia repair. This report demonstrates the safety and feasibility of this procedure while offering the patient the advantages of a minimally invasive surgical procedure which can be performed under regional anesthesia.

La reforma de la salud en Chile / Health reform in Chile

This is a document presented to the Chilean Academy of Medicine by the Health Minister, the Economist Carlos Massad. First of all, he refers to the general context of the reform, that he considers a process and not a breakpoint. Afterwards, he enumerates the change tasks: to generate awareness of the change and to convert health in a State issue; to adequate programs to population's new health profile; to install new management instruments in the health system; to descentralize decisions and to promote the participation of beneficiaries; to establish incentives and to flexibilize the Health System and to introduce correctives to private health insurance. He believes that Chile must drift to a economical protection system for universal and solidary health events. The additional assurances that people wants to buy, must be delimited