Prognostic Significance of Tumor and Inflammatory Markers in Disease-Free and Overall Survival Duration in Colonic Adenocarcinoma Patients.

Introduction Colorectal carcinoma (CRC) continues to be a major global health concern, contributing substantially to cancer incidence and mortality. Colonic adenocarcinoma, a common subtype of CRC, is influenced by various prognostic factors, including tumor stage, histopathological characteristics, and tumor markers. Despite their routine use in clinical settings, the prognostic value of traditional tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), and others, is still under debate. In this study, we aim to analyze the tumor markers' prognostic significance in our CRC patients in terms of disease-free survival and overall survival. Methods A retrospective study was conducted on 71 patients who underwent surgery for colonic adenocarcinoma between January 1, 2018, and January 1, 2024. Data on patient demographics, recurrence rates, survival times, and tumor marker levels (CEA, CA 19-9, CA 125, AFP, and CRP to albumin ratio (CAR)), disease-free survival duration (DFS), and overall survival durations (OS) were collected and analyzed. Statistical analyses included Pearson and Spearman correlation coefficients, the Mann-Whitney U test, ROC curve analysis, and Kaplan-Meier survival analysis. Results The study found that elevated CAR and CA 125 levels were significantly associated with higher mortality and recurrence rates, whereas elevated CEA levels were strongly predictive of recurrence. Receiver operating characteristic (ROC) analysis identified optimal cutoff values for these markers, with CEA ≥ 47.145, CA 125 ≥ 15.85, and CAR ≥ 6.796 demonstrating high specificity and predictive value for recurrence. Kaplan-Meier analysis revealed that patients with CEA < 47.145 had a significantly longer DFS (67.7 months) compared to those with CEA ≥ 47.145 (24 months, p < 0.001). Similarly, patients with CA 125 < 15.85 and CAR < 6.796 showed longer DFS compared to those with higher values. Overall survival analysis also highlighted that patients with CA 125 < 21.71 and CAR < 4.09 had better survival outcomes, with significant differences of 26 and 10 months, respectively (p < 0.001 and p = 0.001). Conclusion Tumor markers, such as CEA, CA 125, and CAR, hold significant prognostic value in colonic adenocarcinoma, with higher levels correlating with poorer outcomes. These findings underscore the importance of integrating tumor markers into clinical decision-making to optimize treatment strategies and improve patient survival. Future research should focus on standardizing the use of these markers and exploring novel biomarkers for enhanced prognostication.

Effects of the COVID-19 pandemic on the management of diabetic foot ulcers: experiences from a dedicated diabetic foot care center.

INTRODUCTION: As did many other nations, the Turkish government implemented precautions and lockdown measures in response to the rapid spread of the COVID-19 viral infection. The pandemic has caused millions of deaths globally, resulted in the development of comorbidities, and negatively affected national health care systems. The increased workload at hospitals and spread of the virus among health care professionals have resulted in delays in health care services delivery. The fear of COVID-19 transmission has resulted in people mostly staying at home. OBJECTIVE: The aim of this study is to present the effects of the pandemic on the behavior of patients with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Patients with DFU were categorized into 2 groups: patients hospitalized during the COVID-19 pandemic and patients hospitalized during the same period in 2019 (prepandemic). Demographic data, length of hospital stay, place of residence, Wagner grade of DFU, comorbidities, laboratory parameters, wound duration, duration of diabetes, and treatments applied were recorded. RESULTS: During the pandemic, the length of hospital stay decreased, and patient referrals from other cities significantly decreased (P <.001). Hemoglobin A1c level was higher and Wagner grade was more advanced during the pandemic period (P =.014 and P =.033, respectively). The number of patients undergoing debridement alone decreased during the pandemic period, while those requiring amputation increased (P =.008 and P =.005, respectively). CONCLUSIONS: Patients with DFU delayed seeking timely proper medical advice during the pandemic. This resulted in a significantly higher amputation rate, with physical, psychosocial, and economic consequences. Virtual techniques (eg, video consultation) can be used to identify patients who require hospitalization. Close follow-up can be provided via home nursing care and by supplying advanced wound care products for in-home use. Patients with DFU should be encouraged to seek proper medical advice and take recommended precautions.

Does lymph node ratio (metastasis/total lymph node count) affect survival and prognosis in gastric cancer?

OBJECTIVES: To investigate the influence of the metastatic lymph node/total lymph node ratio (N-ratio) on survival and prognosis in surgically treated gastric carcinomas. METHODS: A retrospective review of 73 patients who underwent curative resection at the Department of General Surgery, Hitit University Faculty of Medicine, Turkey. Receiver operating characteristic analysis was used to calculate the cut-off value for the N-ratio of the patients. The N-ratio cut-off value was determined to be 0.32. Patients were divided into 2 groups: below 0.32 (Group 1) and 0.32 and above 0.32 (Group 2). RESULTS: Group 2 patients had a total lymph node mean of 25.10±13.64 while Group 1 patients had a total lymph node mean of 18.77±9.36 (p=0.04). In Group 2, the mean of metastatic lymph node was 15.97±10.30 (p<0.001). The mortality rate of Group 1 was 18% while Group 2 was 51.7%, and were statistically significant (p=0.0039). The estimated survival duration of Group 2 was 24.22 months, and Group 1 was 48.01 months (p=0.001). The mean estimated survival time for the entire group was 40.92 months. We differentiated patients from the development of mortality cut-off value in ROC analysis with 65.2% sensitivity and 72% specificity. This ratio was found to be 0.32, which was statistically significant (p=0.003). Ratios greater than 0.32 raised the risk of mortality by 4.8 times, which was statistically significant (p=0.003). CONCLUSION: The N-ratio could be a new metric to evaluate prognosis following curative gastrectomy and improve the existing tumor lymph node metastasis staging system.

Analysis of Risk Factors for Rectus Sheath Hematoma.

OBJECTIVE: To evaluate the risk factors for developing rectus sheath hematoma (RSH). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Hitit University School of Medicine, Erol Olcok Training and Research Hospital, Turkey; from January 2018 to April 2020. METHODOLOGY: Patients with RSH were studied. Those with other pathologies in rectus sheath, and repeat studies, were excluded. Demographic data, presenting symptoms, comorbidities, medications administered containing anticoagulant drugs, imaging results, laboratory findings, coagulation parameters, length of hospital stay, treatments administered, type of RSH, morbidity, mortality and risk factors of increased bleeding diathesis, were recorded. RESULTS: Of the 61 studied patients, 56 (91.8%) had at least one chronic disease, and 77% were receiving anticoagulation therapy. RSH size was significantly larger for patients taking acetylsalicylic acid than for patients taking other anticoagulants, and an RSH area less than 1,924 mm2 was associated with increased length of hospital stay. Binary logistic regression analysis showed that a unit increase in gender was associated with a 1.5-fold increase in the risk of greater RSH size, and that female gender was associated with a 45.3-fold risk of increase in the risk of RSH. Notably, if up to 4 units of erythrocyte suspension replacement is not applied for conservative treatment of RSH, RSH size may increase by 23.5 times. CONCLUSION: Risk factors of RSH include chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, asthma, hypertension, diabetes mellitus, chronic renal failure, prior abdominal surgery, female sex, older age, anticoagulant drug use and cancer-related immunosuppression. Key Words: Rectus sheath hematoma, Conservative treatment, Anticoagulant treatment.