Assessing the antiviral potential of melatonin: A comprehensive systematic review.

This review assesses the antiviral potential of melatonin through comprehensive analysis of studies across human subjects, animal models, cell cultures, and in-silico simulations. The search strategy targeted relevant research until 22 June 2023, resulting in 20 primary studies after screening and deduplication. The findings highlight strong evidence supporting antiviral properties of melatonin. In silico studies identify melatonin as a candidate against SARS-CoV-2, reducing cytokine storm-related respiratory responses. Cell culture experiments reveal its multifaceted effects on different viruses including respiratory syncytial virus, anti-dengue virus, transmissible gastroenteritis virus, and encephalomyocarditis virus. Animal studies show melatonin reduces mortality and viral replication in various infections such as Venezuelan equine encephalomyelitis and COVID-19. Clinical trials show how it could be evaluated, but with no conclusive evidence of efficacy and safety so far from large, double-blind placebo-controlled trials. These insights showcase the potential of melatonin as a versatile antiviral agent with immunomodulatory, antioxidant, anti-inflammatory and antiviral properties. In summary, our review highlights melatonin's promising antiviral properties across diverse settings. Melatonin's immunomodulatory and antiviral potential makes it a compelling candidate for further investigation, emphasising the need for rigorous clinical trials to establish its safety and efficacy against viral infections.

Comprehensive exploration of FCHO1 mutations: Clinical manifestations and implications across disorders.

FCH domain only 1 (FCHO1) is a key player in clathrin-mediated endocytosis, vital for various cellular processes, including immune regulation and cancer progression. However, the clinical implications of FCHO1 mutations, particularly in combined immunodeficiency, remain unclear. This systematic review aims to provide an objective analysis of the molecular genetics, clinical manifestations, and potential therapeutic targets associated with FCHO1 mutations. A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted across electronic databases up to March 25, 2024, to identify studies investigating the relationship between FCHO1 and different clinical manifestations. Eligibility criteria were applied to screen studies, and data extraction included study characteristics, reported symptoms, genetic variants, and primary outcomes. In silico analyses were performed to assess protein-protein interactions and gene expression patterns. Five studies were included, offering insights into the molecular genetics, T-cell deficiency mechanisms, clinical manifestations, and potential therapeutic targets associated with FCHO1 mutations. Molecular analyses identified specific mutations disrupting FCHO1 function, leading to impaired T-cell proliferation, cytokine production, and susceptibility to infections. Clinically, patients exhibited recurrent infections, lymphopenia, and malignancies, with allogeneic hematopoietic stem cell transplantation emerging as a therapeutic option. In silico analyses revealed potential interactions and co-expression between FCHO1 and genes involved in cancer progression and immune signaling pathways. This systematic review objectively elucidates the multifaceted role of FCHO1 in immune regulation and disease pathogenesis. Understanding the molecular mechanisms underlying FCHO1 mutations and their impact on disease manifestations is crucial for guiding clinical management and developing targeted therapeutic strategies.

Transvaginal morcellation within an enclosed bag in gynecological surgeries: a comprehensive systematic review and analysis of safety, efficacy, and outcomes.

PURPOSE: This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use. METHODS: We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique. RESULTS: Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique. CONCLUSION: Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions.

Combined Stromal Vascular Fraction and Fractional CO2 Laser Therapy for Hypertrophic Scar Treatment: A Systematic Review and Meta-Analysis.

BACKGROUND: Hypertrophic scars (HTSs) result from aberrant wound healing processes, leading to raised, thickened tissue with functional discomfort and cosmetic concerns. Current treatments, including corticosteroid injections and laser therapy, have limitations. Stromal vascular fraction (SVF) therapy and CO2 laser treatment offer promising avenues, with SVF therapy showing regenerative potential and CO2 laser therapy promoting precise tissue removal and wound healing. This study aims to investigate the combined application of SVF therapy and CO2 laser treatment for HTS, aiming to enhance treatment efficacy, tissue remodeling, and aesthetic outcomes, ultimately improving patient satisfaction in HTS management. METHOD: PubMed, Scopus, Embase, and Web of Science databases have been searched for relevant studies. The "R" software (version 4.3.1) along with the "tidyverse" and "meta" statistical packages utilized to analyze data related to the efficiency of this combined method. A random-effects model was fitted to the data. For each study, continuous outcomes were pooled by calculating the standardized mean difference, along with their 95% confidence intervals. The assessment of heterogeneity utilized the I2 and chi-squared tests, applying the random effect model. RESULTS: Six articles fulfilled our inclusion criteria and were included in our review. Results from the pooled analysis of Vancouver Scar Scale (VSS) scores across three included studies indicated a significant impact of the SVF+CO2 method on VSS scores post-treatment (SMD=-3.0144; 95% CI:-4.3706 to -1.6583, p<0.0001). However, analysis of transepidermal water loss levels before and after treatment showed no significant difference (SMD=-2.7603; 95% CI: -6.8729 to 1.3522; p=0.1883). Comparatively, in a pooled analysis of two studies, the combined SVF+CO2 method demonstrated superior efficacy in VSS scores compared to other methods (SMD= -1.3573; 95% CI: -2.2475 to -0.4672, p = 0.0028), with moderate heterogeneity across studies (I^2=23.0%, p = 0.2545). CONCLUSION: The combined application of SVF and CO2 laser treatment shows significant promise in improving hypertrophic scars' appearance and texture. The SVF+CO2 method demonstrates superior efficacy compared to other modalities, suggesting its potential as a valuable therapeutic approach for hypertrophic scar management. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Parents' Attitude Towards Their Feverish Children in Buraydah, Saudi Arabia.

BACKGROUND: Fever is a very common problem among pediatric age groups globally. Parents' adequate knowledge and practice make a huge difference in the areas of cost as well as time. The objective of this study is to determine parents' knowledge and practice about their feverish child and the socio-demographic characteristics associated with such knowledge and practice. METHODS: A cross-sectional study was conducted among 194 parents attending primary healthcare centers (PHCs) by using a convenient sampling method. Informed consent was obtained from each participant. Data were collected through a validated self-administered questionnaire and later analyzed with SPSS software. For inferential statistics, the chi-square test was applied. RESULTS: Of the 194 participants in our study, 59.8% were men (n=116) and 40.2% were women (n=78). About 37.1% (n=72) of parents had defined the maximum normal temperature for children as 37.5°C. Additionally, 71.6% (n=139) of the parents were concerned about convulsions in feverish children. Approximately 39.2% (n=76) of parents considered PHC doctors to be their source of information. About 70.1% (n=136) of participants applied cold compresses when their child developed a fever. Nearly 88.1% (n=171) of parents preferred to visit the doctor when their child had a high fever. There was a statically significant association observed between occupation categories and source of information (P<0.05). CONCLUSION: Based on the study results, it was found that parents had poor knowledge about defining the normal body temperature. Approximately two-thirds of the study participants had good practices about health-seeking behavior.

Unveiling the Link Between Celiac Disease and Premature Graying of Hair: A Case Report and Discussion on the Potential Implications for Diagnosis and Management.

Celiac disease (CD) is a systemic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals and characterized by diverse clinical presentations. Despite its prevalence, CD often remains undiagnosed due to its heterogeneous symptoms and inadequate awareness. Here, we present a case of a 42-year-old male with gastritis who presented with epigastric discomfort and pancytopenia. Initial investigations revealed a hemoglobin level of 3.7 g/dL, a mean corpuscular volume (MCV) of 84 fL, a white blood cell count (WBC) of 2420 cells/µL, a neutrophil count (NEU) of 1400 cells/µL, and a platelet count (PLT) of 140,000 cells/µL. A diagnostic workup revealed evidence of CD, and after that, the diagnosis was confirmed by gastro-colonoscopy. The patient's subsequent adherence to a gluten-free diet resulted in significant clinical improvement. Notably, during follow-up appointments, a notable change in the patient's hair color was observed, prompting further inquiry. The patient reported experiencing premature graying of hair during his late thirties, which remained unchanged until the diagnosis of CD and the initiation of a gluten-free diet. This unique manifestation highlights the potential association between CD and premature graying of the hair, warranting further investigation. While the precise mechanism remains unclear, it is plausible that CD-induced malabsorption and nutritional deficiencies may contribute to such changes. Therefore, we advocate for increased awareness and international collaboration to enhance understanding of this phenomenon and its implications for CD management. This case underscores the importance of early diagnosis and management of CD, as well as the potential for dietary interventions to alleviate associated symptoms and complications.

A case of ocular flutter associated with sole anti-sulphatide antibody positivity: successful treatment with intravenous immunoglobulin in a pediatric patient.

BACKGROUND: Ocular flutter is a neurological disorder characterized by irregular, rapid horizontal eye movements and is often associated with autoimmune diseases, infections, drug intoxication, or paraneoplastic syndromes. The brain regions involved in ocular flutter have not been definitively determined. Sulfatide is an acidic glycolipid crucial for maintaining myelin sheath integrity and neuronal transmission. Antibodies against sulfatide can disrupt neuronal signals, and their formation is linked to autoimmune conditions such as Guillain-Barré syndrome and GALOP syndrome. To our knowledge, no pediatric cases of ocular flutter associated with sulfatide antibody-positive neuropathy have been reported. CASE DESCRIPTION: A 15-year-old male with no medical history presented with oscillopsia and blurred vision. His prenatal, natal, and developmental history were unremarkable. Neurological examination revealed rapid, low-amplitude horizontal saccadic oscillations (ocular flutter) with no other neurological abnormalities. Extensive testing, including MRI of the brain and spine; blood tests; lumbar puncture; and screenings for viral, bacterial, and autoimmune conditions, returned normal or negative results. A high titer of anti-sulfatide IgM antibodies was detected. The patient was treated with intravenous immunoglobulin (IVIG), which led to complete resolution of ocular flutter. At the 3-month follow-up, his neurological examination was normal, and he remained asymptomatic with monthly IVIG infusions. CONCLUSION: This is the first reported case of ocular flutter associated solely with anti-sulfatide antibody positivity. This finding underscores the importance of considering sulfatide antibody testing in atypical or treatment-resistant cases of ocular flutter. The resolution of symptoms following IVIG treatment suggests its potential effectiveness in managing sulfatide antibody-positive conditions. Further research is needed to explore the role of sulfatide antibodies in ocular flutter and the benefits of targeted immunotherapy.

A Survey of the Turkish Oncology Group (TOG): Are the Oncologists Trained for Decision Making on Geriatric Cancer Patients?

INTRODUCTION: Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. Therefore, clinicians need enhanced competencies and skills to effectively care for this population. However, most clinicians receive minimal to no training in geriatrics. This study aims to evaluate the education and training levels in geriatric oncology among Turkish physicians and to understand the factors influencing oncologists' treatment decisions for geriatric cancer patients. MATERIALS AND METHODS: A 24-question survey was prepared to obtain the participating physicians' demographic information, as well as to inquire whether they had received training during their medical education and residency on how to approach geriatric patients, in what process(es) they had received the training, whether they were currently treating geriatric patients, what they focused on when evaluating geriatric patients, and what they thought about their training and preparedness for approaching geriatric patients. The questionnaire was sent online to radiation and medical oncologists, and the link was published on the Turkish Society of Radiation Oncology and the Turkish Society of Medical Oncology websites. RESULTS: Two hundred and three physicians participated in the survey, 131 of whom were women. The median age was 41.66 years (24-69 years). One hundred and fifty-six physicians (76.1%) received specialty education at the university hospital. One hundred and three of them were radiation oncologists, and 80 were medical oncologists. Of the physicians, 19.7% received education in geriatrics before they specialized in oncology, and 6.9% said they were educated after specialization. When determining suitability for radiotherapy, 10.7% of radiation oncologists said that they use geriatric assessment tools. Similarly, 13.8% of medical oncologists claimed that they used geriatric assessment tools in determining suitability for chemotherapy. Of the physicians, 177 (86.3%) thought that geriatric evaluation could independently increase patient survival rate. Furthermore, patient cognitive status, functional status, physiological age, polypharmacy, geriatric specialist recommendations, inpatient services, patient relatives, and similar factors were found to be useful in treatment decisions. Finally, 92.7% of the participants believed that receiving education would have changed their perspectives on treating geriatric patients. CONCLUSION: Our results provide perspectives on developing knowledge on and skills in geriatric training among oncologists. Learning new approaches is necessary for oncologists who more frequently confront geriatric patients with cancer.

General analysis of breast cancer patients tested for BRCA mutations and evaluation of acute radiotherapy toxicity.

OBJECTIVE: The objective of our study is to evaluate breast cancer patients with BRCA1 or BRCA2 gene mutations and compare them with patients without these mutations. Specifically, we aim to assess the acute side effects of radiotherapy in both groups. METHODS: Data were collected from four participating centers, comprising information from 73 patients who underwent known mutation analysis and had complete data. Patients were monitored on a weekly basis throughout their treatment for acute toxicity, which was evaluated using the Radiation Therapy Oncology Group (RTOG) acute toxicity criteria. RESULTS: The median age of the 73 patients included in our study was 43. Among them, 17 had BRCA1-positive mutations and 19 had BRCA2-positive mutations. Invasive ductal carcinoma was present in 67 patients, all of whom underwent surgery. Of the patients, 57 received conventional radiotherapy doses, while 16 received hypofractionated radiotherapy doses. During follow-up, metastasis occurred in three patients. In BRCA-positive patients, those under 40 years of age (p<0.001), with high nodal positivity (p=0.008), grade 2-3 (p=0.022), and lymphovascular invasion (p=0.002) were significantly more frequent compared to BRCA-negative patients (p<0.001). The median survival was 35.8 months. Grade 1 dysphagia developed in seven BRCA-negative patients and four BRCA-positive patients, with no significant difference observed between the two groups (p=0.351). There was also no statistical difference observed in the occurrence of grade 2-3 skin reactions, with 11 BRCA-negative patients and eight BRCA-positive patients experiencing these side effects. CONCLUSION: Our study supports existing literature by identifying an association between the presence of BRCA mutations and young age, nodal status, grade, and lymphovascular invasion. Additionally, we found no significant difference in the occurrence of radiotherapy toxicity between BRCA-positive and BRCA-negative patients. These findings suggest that radiotherapy can be safely administered to BRCA-positive patients after breast-conserving surgery or mastectomy. Keywords for our study include breast cancer, BRCA mutation, radiotherapy, and side effects.

Factors Influencing Anxiety Levels in Oncology Patients: A Study on the Impact of Earthquakes.

OBJECTIVE: This study aims to explore the multifaceted factors influencing anxiety levels in oncology patients, with a specific focus on the impact of earthquakes in the context of Turkey. Our objective is to identify and understand sociodemographic, clinical, and lifestyle determinants associated with anxiety in cancer patients, examining how traumatic events, such as earthquakes, contribute to heightened anxiety levels. MATERIALS AND METHODS: A cross-sectional study was conducted, involving 149 oncology patients undergoing treatment at two prominent oncology centers in Turkey. The study collected comprehensive sociodemographic information and assessed anxiety levels using the Beck Anxiety Scale. The dataset was analyzed using SPSS 20.0 (IBM Corp., Armonk, NY), employing a range of statistical methods including descriptive statistics, independent t-tests, Mann-Whitney U tests, and Chi-square tests. RESULTS: The findings underscore several factors significantly linked to anxiety levels in oncology patients. Notably, women, younger patients (age <65), and individuals with specific cancer types exhibited higher anxiety levels. Elevated anxiety was also associated with compromised physical functioning, experiences of earthquakes, irregular sleep patterns, dietary habits, fatigue, and the use of antidepressants. CONCLUSION: This study provides insights into the intricate interplay of factors influencing anxiety levels in oncology patients. Understanding these determinants is paramount for tailoring effective psychosocial support and interventions. The results underscore the need for holistic approaches to enhance the overall quality of life for cancer patients. Gender, age, cancer type, physical well-being, lifestyle choices, and exposure to trauma all play pivotal roles in influencing anxiety levels. These findings hold practical implications for the development and implementation of targeted psychosocial interventions aimed at improving anxiety management and overall well-being for oncology patients.

The use of lung ultrasound in evaluation of extravascular lung water in hemodialysis patients: Systematic review and meta-analysis.

RATIONALE AND OBJECTIVES: Determining dry weight is crucial for optimizing hemodialysis, influencing efficacy, cardiovascular outcomes, and overall survival. Traditional clinical assessment methods for dry weight, relying on factors such as blood pressure and edema, frequently lack reliability. Lung ultrasound stands out as a promising tool for assessing volume status, given its non-invasiveness and reproducibility. This study aims to explore the role of Lung ultrasound in evaluating the impact of hemodialysis and ultrafiltration on extravascular lung water, with a specific focus on changes in B-lines post-hemodialysis compared to pre-hemodialysis. MATERIALS AND METHODS: The research encompassed searches across PubMed, WOS, and Scopus databases for studies related to lung ultrasound and hemodialysis. A meta-analysis was then performed to determine the mean differences in various parameters before compared to after, hemodialysis, including the number of B-lines, indexed end-inspiratory and end-expiratory inferior vena cava diameters, inferior vena cava collapsibility index, weight, blood pressure, and serum levels of NT-pro-BNP. RESULTS: Our meta-analysis, included 33 studies with 2301 hemodialysis patients, revealed a significant decrease in the number of B-lines post-hemodialysis (mean difference = 8.30, 95% CI [3.55 to 13.05]). Furthermore, there was a noteworthy reduction in inspiratory and expiratory inferior vena cava diameters post-hemodialysis (mean difference = 2.32, 95% CI [0.31 to 4.33]; mean difference = 4.05, 95% CI [2.44 to 5.65], respectively). Additionally, a significant positive correlation was observed between B-lines and the maximum inferior vena cava diameter both pre- and post-hemodialysis (correlation coefficient = 0.39; correlation coefficient = 0.32, respectively). CONCLUSION: These findings indicate the effectiveness of lung ultrasound in detection of volume overload and assessment of response to ultrafiltration in hemodialysis patients.

Exploring the Clinical Impact of RANK Pathway Inhibition in Advanced Breast Cancer: Insights From a Retrospective Study on CDK4/6 Inhibitors and Antiresorptive Therapy.

BACKGROUND AND OBJECTIVE: Breast cancer (BC) remains a significant health concern, particularly in advanced stages where the prognosis is poor. The combination of endocrine therapy (ET) with cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) has improved outcomes for advanced BC (aBC) patients. However, resistance to CDK4/6i remains a challenge, with no validated biomarkers to predict response. The receptor activator of the nuclear factor-kB (RANK) pathway has emerged as a key player in aBC, particularly in luminal BC. RANK overexpression has been associated with aggressive phenotypes and resistance to therapy. In view of these findings, we proceeded to investigate the potential involvement of the RANK pathway in luminal BC resistance to CDK4/6i. The objective was to evaluate the effectiveness of denosumab in increasing overall survival (OS) and progression-free survival (PFS). METHODS: In this retrospective analysis, 158 BC patients with bone metastases were included. Patients with human epidermal growth factor receptor-2 (HER2)-negative and hormone receptor-positive BC who received palbociclib or ribociclib in addition to antiresorptive medication were included. Patients received either denosumab or zoledronic acid (ZA) therapy. The primary endpoint was OS, with PFS as a secondary endpoint. RESULTS: Although the PFS and OS of denosumab were better than ZA in this study, it did not show a significant difference between the two drugs. Meanwhile, mOS was not achievable in patients in the denosumab group, while it was 34.1 months in patients in the ZA group. The hazard ratio (HR) showed a significant improvement for the denosumab group in patients under 60 of age (HR: 0.33, p<0.01), patients with a score of 1 HER2 overexpression (HR: 0.09, p=0.01), and patients with resistant endocrine (HR: 0.42, p=0.02) compared to ZA. CONCLUSION: This study highlights the potential clinical relevance of the RANK pathway in BC treatment, and our findings suggest that denosumab may offer significant benefits in terms of PFS and OS for certain subgroups, particularly those with HER2 scores of 1, patients under 60, and those with endocrine-resistant BC. In conclusion, considering that RANK pathway status may be a predictive biomarker for CDK4/6i treatment and may cause treatment resistance, our results demonstrate the clinical relevance of the combination of CDK4/6i + ET with RANKL inhibition.

Multicenter Study on Breast Cancer in the Geriatric Population: Insights for Effective Treatment Strategies.

OBJECTIVE: Breast cancer is common among women aged 65 and over. There is a significant lack of evidence regarding the treatment of breast cancer in patients in this age group due to the rare inclusion of these patients in clinical studies. However, it is known that survival in elderly patients with breast cancer is significantly reduced in those not receiving standard therapy. Several factors, including patients' comorbidities, performance status, life expectancy, and tumor pathological and molecular characteristics, can affect the outcomes of treatment. In this study, we aimed to update the knowledge in this field by assessing these factors among the geriatric population in our multicenter dataset. METHODS: This retrospective study analyzed data from 335 breast cancer patients aged 65 and over who received adjuvant radiotherapy at five oncology centers (Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Meram Medical Faculty - Necmettin Erbakan University, Konya, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Umraniye Training and Research Hospital, Istanbul, and Istanbul Oncology Hospital, Istanbul) between May 2010 and September 2022. Demographic, clinical, and pathological data were collected, including age, gender, clinical symptoms, tumor characteristics, treatment approaches, and outcomes. Statistical analyses, including descriptive statistics, Kaplan-Meier analysis, log-rank test, and Cox regression analysis, were performed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), with a significance level of p < 0.05. RESULTS: The tumor characteristics and survival time of 335 breast cancer patients were examined. In the results, performance status, T stage, and perineural invasion were found to be factors affecting the survival of elderly breast cancer patients. In multivariate analysis, it was seen that performance status played an important role as an independent prognostic factor. CONCLUSION: The treatment of breast cancer in the geriatric age group necessitates a personalized approach, taking into account the patient's overall health status, life expectancy, and comorbidities.

Hypogammaglobulinemia and infections in patients with multiple sclerosis treated with anti-CD20 treatments: a systematic review and meta-analysis of 19,139 multiple sclerosis patients.

Background: Recent years have seen the emergence of disease-modifying therapies in multiple sclerosis (MS), such as anti-cluster of differentiation 20 (anti-CD20) monoclonal antibodies, aiming to modulate the immune response and effectively manage MS. However, the relationship between anti-CD20 treatments and immunoglobulin G (IgG) levels, particularly the development of hypogammaglobulinemia and subsequent infection risks, remains a subject of scientific interest and variability. We aimed to investigate the intricate connection between anti-CD20 MS treatments, changes in IgG levels, and the associated risk of hypogammaglobulinemia and subsequent infections. Method: PubMed, Scopus, Embase, Cochrane, and Web of Science databases have been searched for relevant studies. The "R" software utilized to analyze the occurrence of hypogammaglobulinemia, infections and mean differences in IgG levels pre- and post-treatment. The subgrouping analyses were done based on drug type and treatment duration. The assessment of heterogeneity utilized the I2 and chi-squared tests, applying the random effect model. Results: Thirty-nine articles fulfilled our inclusion criteria and were included in our review which included a total of 20,501 MS patients. The overall prevalence rate of hypogammaglobulinemia was found to be 11% (95% CI: 0.08 to 0.15). Subgroup analysis based on drug type revealed varying prevalence rates, with rituximab showing the highest at 18%. Subgroup analysis based on drug usage duration revealed that the highest proportion of hypogammaglobulinemia occurred in individuals taking the drugs for 1 year or less (19%). The prevalence of infections in MS patients with a focus on different infection types stratified by the MS drug used revealed that pulmonary infections were the most prevalent (9%) followed by urinary tract infections (6%), gastrointestinal infections (2%), and skin and mucous membrane infections (2%). Additionally, a significant decrease in mean IgG levels after treatment compared to before treatment, with a mean difference of 0.57 (95% CI: 0.22 to 0.93). Conclusion: This study provides a comprehensive analysis of the impact of anti-CD20 drugs on serum IgG levels in MS patients, exploring the prevalence of hypogammaglobulinemia, based on different drug types, treatment durations, and infection patterns. The identified rates and patterns offer a foundation for clinicians to consider in their risk-benefit. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=518239, CRD42024518239.

Survival characteristics of Wilms Tumor, a reference developed from a longitudinal cohort study.

BACKGROUND: Wilms tumor (WT) survival has been affected by the evolution in clinical and biological prognostic factors. Significant differences in survival rates indicate the need for further efforts to reduce these disparities. This study aims to evaluate the clinicopathological data impact on survival among patients after Wilm's diagnosis. METHODS: The study utilized the SEERStat Database to identify Wilms tumor patients, applying SEERStat software version 8.3.9.2 for data extraction. Selection criteria involved specific codes based on the International Classification of Diseases for Oncology (ICDO-3), excluding cases with unknown SEER stage, incomplete survival data, unknown size, or lymph node status. Statistical analyses, including Kaplan-Meier estimates and Cox regression models, were conducted using R software version 3.5. Standardized mortality ratios (SMR) were computed with SEER*Stat software, and relative and conditional survival analyses were performed to evaluate long-term survival outcomes. RESULTS: Of 2273 patients diagnosed with Wilms tumor, (1219 patients, 53.6% were females with an average age group of 3-8 years (50.2%). The overall mean survival after five years of diagnosis was 93.6% (2.6-94.7), and the overall mean survival rate was 92.5% (91.3-93.8) after ten years of diagnosis. Renal cancers were identified as the leading cause of death (77.3%), followed by nonrenal cancers (11%) and noncancer causes (11%). Additionally, robust relative survival rates of 98.10%, 92.80%, and 91.3% at one, five, and ten years, respectively, were observed, with corresponding five-year conditional survival rates indicating an increasing likelihood of survival with each additional year post-diagnosis. Univariate Cox regression identified significant prognostic factors: superior CSS for patients below 3 years (cHR 0.48) and poorer CSS for those older than 15 years (cHR 2.72), distant spread (cHR 10.24), regional spread (cHR 3.09), and unknown stage (cHR 4.97). In the multivariate model, age was not a significant predictor, but distant spread (aHR 9.22), regional spread (aHR 2.84), and unknown stage (aHR 4.98) were associated with worse CSS compared to localized tumors. CONCLUSION: This study delving into WT survival dynamics reveals a multifaceted landscape influenced by clinicopathological variables. This comprehensive understanding emphasizes the imperative for ongoing research and personalized interventions to refine survival rates and address nuanced challenges across age, stage, and tumor spread in WT patients.

Does shortening the duration of radiotherapy treatment in breast cancer increase the risk of radiation pneumonia: A retrospective study.

Randomized studies evaluating hypofractionation and conventional fractionation radiotherapy treatments (RT) in patients with breast cancer have shown that hypofractionation achieves similar results to conventional fractionation in terms of survival and local control rates. It has also been shown that their long-term toxicities are similar. This study aimed to evaluate the effects of hypofractionated radiotherapy (H-RT) and conventional radiotherapy (C-RT) on lung toxicity and identify factors affecting this toxicity in patients with breast cancer. The study included 118 patients who underwent adjuvant RT following breast-conserving surgery (BCS). Out of these, 63 patients were assigned to receive C-RT, while the remaining 55 were assigned to receive H-RT. To clarify, we treated 63 patients with C-RT and 55 patients with H-RT. 60 patients were treated using 3-dimensional conformal radiotherapy (3DCRT) and 58 patients were treated using intensity modulated radiotherapy (IMRT). The patients were evaluated weekly for toxicity during radiotherapy (RT) treatment and were called every 3 months for routine controls after the treatment. The first control was performed 1 month after the treatment. Statistical analysis was performed using the SPSS20 program, and a P value of <.005 was considered statistically significant. The study found that the median age of the participants was 54.9 years and tomographic findings were observed in 70 patients. Radiological findings were detected at a median of 5 months after RT. The mean lung dose (MLD) on the treated breast side (referred to as ipsilateral lung or OAR) was 10.4 Gy for the entire group. Among patients who received 18 MV energy in RT, those with an area volume (V20) of the lung on the treated breast side >18.5%, those with a mean dose of the treated breast side lung (ipsilateral lung) >10.5 Gy, and those who received concurrent hormone therapy had significantly more tomographic findings. However, patients treated with YART had fewer tomographic findings. No symptomatic patients were observed during the follow-up period. Our findings show that the risk of lung toxicity is similar with H-RT and C-RT, and H-RT can be considered an effective and safe treatment option for breast cancer. The key factors affecting the development of lung toxicity were found to be the type of RT energy used, RT to the side breast, volume receiving 20 Gy in the side lung, side lung mean dose, and simultaneous hormonal therapy.

Investigating the levels of depression, anxiety, sexual disorders, and other influencing factors in breast cancer patients: Turkish radiation oncology integrative group study (12-05).

The fear of death associated with cancer and the side effects of its treatments can have a detrimental psychological impact on breast cancer patients. Early detection and support services play a crucial role in alleviating the expected symptoms of depression, anxiety, and sexual dysfunction. The objective of our study is to assess the levels of depression, anxiety, and sexual dysfunction in breast cancer patients, as well as identify the factors that influence these conditions. The study involved 329 voluntarily participating breast cancer patients who had undergone surgery and were in the follow-up stage. Data were collected from 8 different centers after obtaining ethical approval. The assessment utilized tools such as the Sociodemographic Information Form, Beck Depression and Anxiety Scale, and Arizona Sexual Experiences Scale. Data analysis was performed using SPSS 20. The study included 329 breast cancer patients in the follow-up stage post-surgery. Their average age was 52.7 years (range: 27-83). Results indicated that 33.1% experienced moderate to severe depression, 18.2% reported severe anxiety, and 82.7% scored above 11 on the sexual scale. Factors linked to higher scores were mastectomy, surgical dissatisfaction, insufficient information on sexual side effects, and comorbidities like smoking and diabetes. The study emphasizes the importance of closely monitoring anxiety, depression levels, and sexual side effects in breast cancer treatment. It underscores the need to focus not only on reducing mortality rates but also on supporting patients' psychological and sexual well-being, ultimately improving their overall quality of life.

Revisiting the Radical Radiotherapy-Radiochemotherapy Results in Anal Canal Cancers: (TROD Gastrointestinal Group Study 02-005).

BACKGROUND AND AIM: This study aimed to determine treatment outcomes and factors affecting prognosis in patients diagnosed with anal canal cancer who received radical radiotherapy (RT) or radiotherapy combined with chemotherapy (CT-RT) in radiation oncology centers in Turkey and compare the results with literature. MATERIAL AND METHOD: The study included 193 patients with anal canal cancer reported between 1995 and 2019, of which 162 had complete data. The study was conducted in 11 radiation oncology centers, and a joint database was shared among them. Patients received radiotherapy doses of 45 Gy to 60 Gy. Data analysis was done using SPSS for Windows version 20. RESULTS: Median follow-up was 48.51 months (2-214). All patients received radiotherapy, and 140 (86.4%) received concurrent chemotherapy. Radiotherapy doses of 50.4 Gy to 60 Gy were administered to 74 patients (45.7%) using 2-dimensional-3-dimensional (2D-3D) conformal therapy and 70 patients (43.2%) using intensity modulated radiotherapy technique (IMRT). Acute phase hematologic toxicity was observed in 62 patients (38.3%), and nonhematologic toxicity in 123 patients (75.9%). The 5-year overall survival (OS) rate was 75.1% and disease-specific survival (DSS) rate was 76.4%. OS without colostomy was achieved in 79,8 % at 5 years, and complete response in 112 patients (69.1%). OS rate was significantly higher in 142 patients with positive response (P < .000) and 112 with complete response (P < .000). Anemia (P < .002), local progression, and systemic progression (P < .000) resulted in lower OS (P < .002). In univariate analysis, factors affecting OS rate were: gender, age, stage, lymph node status, T stage, RT treatment duration, and treatment planning with PET fusion, which were found to be statistically significant. Completing radiotherapy in less than 45 days, concurrent chemotherapy, and continued administration of mitomycin and 5 FU as chemotherapy had a significant positive effect on overall survival. OS rate was higher in patients receiving RT dose of 58 Gy or less and undergoing IMRT planning in radiotherapy. IMRT was associated with lower acute and late side effects. CONCLUSION: Radiochemotherapy is the primary treatment for anal canal cancer and advanced radiotherapy techniques may increase survival by reducing side effects and improving treatment continuation. Higher treatment doses require further investigation. The efficacy of treatment can be improved by including patients treated with modern radiotherapy techniques in multicenter prospective studies using new and more effective chemotherapy and immunotherapy agents.