A systematic review and meta-analysis on mortality rate following total pelvic exenteration in cancer patients.

BACKGROUND: Total pelvic exenteration (TPE), an en bloc resection is an ultraradical operation for malignancies, and refers to the removal of organs inside the pelvis, including female reproductive organs, lower urological organs and involved parts of the digestive system. The aim of this meta-analysis is to estimate the intra-operative mortality, in-hospital mortality, 30- and 90-day mortality rate and overall mortality rate (MR) following TPE in colorectal, gynecological, urological, and miscellaneous cancers. METHODS: This is a systematic review and meta-analysis in which three international databases including Medline through PubMed, Scopus and Web of Science on November 2023 were searched. To screen and select relevant studies, retrieved articles were entered into Endnote software. The required information was extracted from the full text of the retrieved articles by the authors. Effect measures in this study was the intra-operative, in-hospital, and 90-day and overall MR following TPE. All analyzes are performed using Stata software version 16 (Stata Corp, College Station, TX). RESULTS: In this systematic review, 1751 primary studies retrieved, of which 98 articles (5343 cases) entered into this systematic review. The overall mortality rate was 30.57% in colorectal cancers, 25.5% in gynecological cancers and 12.42% in Miscellaneous. The highest rate of mortality is related to the overall mortality rate of colorectal cancers. The MR in open surgeries was higher than in minimally invasive surgeries, and also in primary advanced cancers, it was higher than in recurrent cancers. CONCLUSION: In conclusion, it can be said that performing TPE in a specialized surgical center with careful patient eligibility evaluation is a viable option for advanced malignancies of the pelvic organs.

Successful treatment of a high-risk diabetic foot ulcer by ozone therapy and collagen powder: A case report.

Key Clinical Message: A high risk diabetic foot ulcer is treated by ozone therapy and collagen powder. The goal of this study was to report a high risk case, treated by ozone therapy, and collagen powder. Ozone therapy and collagen powder can improve healing process of diabetic foot ulcers. Abstract: This case report presents a successful nonsurgical outpatient approach for managing a high-risk diabetic foot ulcer with tendon exposure in an older adult with uncontrolled diabetes mellitus and severe heart failure. Due to the patient's comorbidities, surgical intervention was not an option, leading to the utilization of ozone therapy, collagen powder, and Phenytoin ointment. The significance of this case lies in the treatment of a high-risk foot ulcer through a nonsurgical approach, considering the patient's uncontrolled diabetes and severe heart failure. Diabetic foot ulcers (DFUs) are debilitating and life-threatening complications, often resulting in amputations, socio-psychological burdens, and lifestyle changes. Conventional treatment methods have shown limited success, necessitating the exploration of new and innovative approaches. The use of ozone therapy has emerged as a potential treatment, but its safety and efficacy in DFUs require further investigation. The positive outcomes observed in this case report suggest that ozone therapy may be a viable option for treating DFUs, and further studies are recommended to evaluate its effectiveness.

Inflammatory markers and functional outcome score in different subgroups of ischaemic stroke: a prospective cohort study.

Background: Acute ischaemic stroke (AIS) is a leading cause of disability and mortality worldwide. Determining subgroups and outcomes of AIS may lead to better treatment. We aimed to investigate the relationship between inflammatory markers and subgroups of AIS with further follow-up of patients in terms of functional outcome score. Methods: In this prospective cohort study, we examined white cell count (WCC), neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR) and qualitative C reactive protein (CRP), in the first 24 hours of patients' admission. Patients were assigned to AIS subgroups as defined by the TOAST criteria. Then patients' disability score was followed up after 3 and 6 months, using the modified Rankin Scale. Results: We included 217 patients with AIS. The mean age of participants was 72.07 years, and we included 92 women (42.4%). For the AIS subgroup, 83 (38.25%) patients had large artery atherosclerosis (LAA), 41 (18.89%) had cardioembolism and 62 (28.57) had small vessel obstruction. Neutrophil count and NLR showed a statistically significant difference in the subgroups of AIS and were highest in the 'other' subgroup of AIS (p<0.05). Lymphocyte count, ESR and qualitative CRP showed no statistically significant difference between subgroups (p>0.05). WCC, neutrophil count and NLR showed a positive correlation with functional outcomes (p<0.05), other markers did not correlate with outcomes (pp>0.05). Conclusion: We can conclude that neutrophil count and NLR are available inflammatory biomarkers for predicting outcomes and these two biomarkers are associated with AIS subgroups. However, ESR, qualitative CRP and lymphocyte count do not appear to be correlated with outcomes or subgroup of AIS.

Stiff-person syndrome revealing an occult gray zone lymphoma: A diagnostic challenge.

Key Clinical Message: Stiff-Person Syndrome (SPS) can be associated with various malignancies, including lymphomas. Therefore, clinicians should always remain vigilant for the presence of an underlying malignancy, especially in older patients presenting with SPS. Abstract: Stiff-person syndrome (SPS) is a rare neurological disorder characterized by painful muscle spasms. It can occur as a paraneoplastic syndrome associated with various malignancies. We present a case of an older male adult with a history of recurrent fever episodes and elevated inflammatory markers for 1 year who subsequently developed neurological symptoms. The presence of positive amphiphysin antibodies led to the diagnosis of SPS, which prompted further investigations revealing an underlying Gray Zone lymphoma (GZL). This case highlights the challenges in diagnosing lymphoma and emphasizes the importance of considering SPS as a paraneoplastic syndrome in guiding toward the final diagnosis. The diagnostic challenge in our case is summarized in Chart 1.

Guillain-Barré syndrome following COVID-19 vaccine: A case report.

Coronavirus disease is a viral infection affecting different organs with various morbidities and mortality. Vaccines are used to control the disease. COVID-19 vaccines have brought many benefits but their adverse effects should not be ignored. Here, we report a case of Guillain-Barré Syndrome Following Sinopharm COVID-19 Vaccine.