Incidence versus treatment outcomes and survival in patients before age 40 with colorectal cancer.

<b><br>Introduction:</b> Colorectal cancer (CRC) was the third most common cancer and the second cause of cancer deaths worldwide in 2020. Its incidence has increased dramatically in people under 50 years of age (early-onset colorectal cancer; EOCRC).</br> <b><br>Aim:</b> The aim of this study was to compare two age groups of patients with colorectal cancer in terms of stage, prognostic factors, survival and incidence of recurrence.</br> <b><br>Materials and methods:</b> The study group consisted of 588 patients operated on between 1995 and 2005 at the University Hospital in Krakow in the Clinical Department of General, Oncological and Gastroenterological Surgery. A method of retrospective documentation analysis was used. Patients were divided into two age groups: up to forty years of age and between 45 and 65 years of age.</br> <b><br>Results:</b> Up to 40 years of age, stage IV colorectal cancer was diagnosed in 33.3% of patients, while between 45 and 65 years of age, it was diagnosed in 26.1%. Five-year survival differed according to tumour stage. In the two groups analysed, there was a significant difference between the survival curves (P = 0.00000). Also, comparing recurrence times in the paired group excluding cancer-independent deaths revealed a statistically significant difference between the groups (P = 0.006).</br> <b><br>Discussion:</b> The incidence of colorectal cancer has increased worldwide in young people under 50 years of age, and it is therefore recommended that the research presented here be studied, and that prognostic factors be analysed and multicentre prophylactic studies combined with health education of those at risk be encouraged. Cancer occurring in younger patients is characterized by advanced stage at diagnosis and five-year survival is lower and has a poorer prognosis. The availability is very important of early diagnosis to detect pre-cancerous and considered pre-cancerous conditions is important. This involves detecting lesions at a lower stage of the disease.</br> <b><br>Conclusions:</b> The availability of early diagnosis to detect precancerous and considered pre-cancerous conditions is very important. This involves detecting lesions at a lower stage of the disease. Diagnosing colorectal cancer at an early stage and treating the pre-cancerous lesions will improve treatment outcomes, resulting in fewer metastases and longer survival and recurrence times.</br>.

An audit of breast cancer in patients 40 years and younger in two Johannesburg academic hospitals.

Background: Breast cancer is the most common cancer in females, usually diagnosed after the age of 50 years. There is a perceived increase in breast cancer cases in young women in two public sector Johannesburg academic hospitals; however, there is a shortage of data to confirm this. Objectives: This study aimed to assess data on breast cancer in young patients and determine any increase in the number of cases in patients 40 years and younger. Method: A retrospective analysis of radiology and histopathology reports of patients 40 years and younger, seen at the radiology departments of two Johannesburg academic hospitals, was performed over a 5-year period. The frequency, histology and immunohistochemical results of breast cancer diagnoses were determined in patients with a Breast Imaging - Reporting and Data System (BI-RADS) classification of 4 or above. Results: Breast cancer was diagnosed in 73% of the total eligible 469 patients. The mean patient age was 34.35 years. Invasive ductal carcinoma was diagnosed in 83% (n = 283) of patients classified as BI-RADS 5 on imaging. Luminal A and B subtypes were the most common. The highest number of patients (n = 142) were seen in 2016 of which 92 had breast cancer. Conclusion: In this very specific sample set, there was a lower number of breast cancer diagnoses in 2015 and then an increase of breast cancer diagnoses in young patients from 2016 to 2018. Contribution: Earlier breast cancer detection benefits the patient, their families and their reproductive ability. Knowledge of breast cancers in young patients can increase awareness, leading to effective, early diagnoses.

Study on Vitamin D Levels in 30 to 40-Year-Old Females With Low Back Pain.

BACKGROUND: Vitamin D is associated with many skeletal-related processes in the body. A major health problem concerning decreased quality of life is chronic low back pain (LBP). Many studies have proved that chronic pain improves with Vitamin D supplementation. This study aimed to explore the correlation between vitamin D levels and the occurrence of LBP in women aged 30 to 40. MATERIALS AND METHODS: A case-control study was taken up at PK Das Institute of Medical Sciences wherein 50 cases (women aged 30-34 years who had chronic LBP >3 months) and 50 age-matched controls were included. Frequencies of Vitamin D deficiency, inadequacy, and sufficiency were studied. The t-test for examining statistical significance was employed to compare means. Keeping a 95% confidence interval (p<0.05), the odds ratio was calculated. RESULTS: Vitamin D deficiency diagnosed when Vitamin D level is <20ng/mL was found in 74% of cases and 48% of controls. Vitamin D levels were not found to be statistically different between cases and controls. The odds ratio was found to be 3.083 (p=0.009), showing that participants with LBP are more expected to be deficient in Vitamin D compared to those without LBP. CONCLUSIONS: Although a higher frequency of Vitamin D deficiency was found in cases compared to controls, the mean value of Vitamin D levels was not found to be statistically different amongst cases and controls. A significant Odds ratio establishes a positive association between LBP and Vitamin D deficiency. The reason could be due to most people being restricted indoors due to COVID-19 restrictions. It is essential to standardize the biochemical analysis of Vitamin D and establish appropriate Vitamin D level ranges specifically tailored for the Indian population.

Case report of choledocholithiasis 40 years post cholecystectomy.

Choledocholithiasis occurring 40 years postcholecystectomy surgery is not commonly seen and is one of the longest reported latency period in literature today. Herein, we report a case of a 72 year old lady with previous open cholecystectomy 40 years ago, presented with acute onset right upper quadrant pain. Her bloods result revealed an obstructive jaundice picture with total bilirubin 125 µmol/L. Computed tomography imaging revealed high burden calculi in the common bile duct. The choledocholithiasis was subsequently completely retrieved by endoscopic retrograde cholangiopancreatography procedure. The commonest causes for delayed presentation of choledocholithiasis is retained or regeneration of stones within a gallbladder remnant or cystic duct with majority of retained stones present within 2-3 years of surgery. Presentation later than that is thought to be secondary to migratory surgical clips as it acts as a nidus for stone formation. There are other studies that revealed common bile duct stones formation to be associated with bile duct stricture, periampullary diverticulum, parasites or foreign bodies within bile duct or other factors that can cause bile stasis. Our aim for this case report is to add to the current handful of cases with such lengthy latency and hopefully this will give rise to future research and to better our understanding of the potential risk factors and causation of this prolonged latency postcholecystectomy.

Imaging Patterns in Breast Cancer for Women Under 40 Years: A Descriptive Cohort Study.

BACKGROUND AND AIM: Breast cancer is the most frequently occurring malignant disease in women and remains the leading cause of cancer-related deaths among females worldwide. The aim of this study is to evaluate the imaging findings of breast cancer in women under the age of 40 and analyze their pathological patterns. METHOD: A retrospective study was conducted from 2013 to 2019, involving 120 patients below 40 years of age with pathologically confirmed primary epithelial breast cancers. The data were collected from the electronic records of a tertiary hospital in Riyadh, Saudi Arabia. Mammograms were performed for 115 patients, ultrasounds were conducted for all patients, and MRI scans were carried out for 47 patients. RESULTS: All radiological findings and clinical characteristics of the 120 cases were retrieved from our digital-based system. The majority of breast cancer patients (83.4%) were between 30 and 40 years old, and the most common clinical presentation was a mass (45.8%). Out of the 73 patients who underwent genetic tests, 32.9% tested positive for gene mutations. No statistically significant correlation was found between specific age groups and breast composition (P = 0.216), specific mammogram abnormalities such as masses (P = 0.262), or microcalcifications (P = 0.421). Ultrasonography was performed for all patients, with abnormalities detected in only one patient who was diagnosed with Paget's disease of the nipple. Masses, with or without parenchymal changes, were the predominant feature in 88.3% of cases. CONCLUSION: The imaging findings in breast cancer cases typically involve masses with suspicious features, irregular shape, and spiculated margins on mammograms, and irregular shape with microlobulated or angular margins on ultrasound. MRI features commonly include masses with irregular shape and heterogeneous enhancement. The luminal B subtype was identified as the most prevalent pathological feature, characterized by a high proliferative index (Ki-67%).

Pregnancies in Elderly Mothers over 40 years: What to Expect from the Rising New Age High-Risk Cohort?

Introduction: Elderly women are believed to experience many risks associated with pregnancy. Literature fails to provide a clear consensus on the age group in which there is a rise in risk and pathophysiology contributing. 'Pregnancies over forty' are increasing in society, owing to changing lifestyles and sensibilities of youth and the advent of assisted reproductive techniques. In India, studies on elderly pregnant women above 40 years of age are lacking. The aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women delivering above 40 years. Methods: The study group (Group A) comprised of pregnancies in 50 women at age ≥ 40 years on the date of delivery. The control group (Group B) had 50 women who delivered subsequent to the study group and age < 40. Various parameters and outcomes including parity, gestational age, number of gestations, co-existing medical illnesses, the incidence of hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), pre-term labor, mode of delivery, birth weight and obstetric and neonatal outcomes were compared. Chi-square test and independent T test were used for statistical analysis. Results: While a good number of patients conceived spontaneously and with basic infertility management, i.e., 84% in the elderly gravid group (Group A) and 96% in the control group (Group B), the number of patients who required ART in Group A were statistically significant (Group A 16% and Group B 4%). Incidence of pre-existing medical diseases like hypertension, diabetes mellitus, thyroid dysfunction, other auto-immune diseases and chronic diseases were noted to be high (26%) in Group A (statistically significant difference). Incidence of HDP, GDM and fetal growth restriction were high in Group A. Tendency to have the presence of fibroid uterus was high in patients in Group A, i.e., 24%, compared to only 8% in the control group; difference was statistically significant. Proportion of pre-term deliveries were high in Group A. Cesarean section rate was high in Group A, though it was not statistically significant. Other perinatal observations and neonatal outcomes were comparable in both groups; differences were not statistically significant. Conclusion: The study reveals an association of a high-risk course of pregnancies in women above the age of 40 years. Proportions of IVF pregnancies are higher in elderly women. Interestingly, the proportion of women in elderly group who conceived spontaneously and with basic infertility management including IUI was 84% in the present study. Medical comorbidities and incidence of fibroids were high in elderly women. Obstetric and neonatal outcomes of these pregnancies when managed efficiently are favorable.

Awareness, knowledge, and factors that influenced the uptake of screening tests for prostate cancer among men aged 40 and older in Ido-Ekiti, Ekiti State, Nigeria.

Background: Despite being the second most common and deadliest cancer in males, prostate cancer could go unnoticed in the early stages. Prevention programs have been set in place to help in the early detection and reduction of mortality rates in developed countries. Objective: The aim of this study was to determine awareness, knowledge, and the uptake of prostate cancer screening tests. Another objective was to identify the factors that determine the uptake of prostate cancer screening among men living in Ido-Ekiti. Methods: A cross-sectional study was conducted among males aged 40 and above living in Ido-Ekiti in Ido-Osi local government area, Ekiti State, Nigeria. The sample size of 380 respondents was obtained using Leslie Fisher's formula. Results: The study revealed that the majority of the correspondents are aware of prostate cancer (57.9%). More than two-thirds of the respondents have poor knowledge of prostate cancer and the screening test (74.4%), with a median knowledge score of 30%. The uptake of prostate cancer screening tests was very low among the respondents (18.2%). Conclusion: Despite the high level of awareness of prostate cancer disease among the respondents, the majority have poor knowledge of the disease and the screening test. There was a low uptake of prostate cancer screening tests among the respondents.

Efficacy, safety and acceptability of a benzalkonium chloride spermicide cream in women aged 40 years and over needing contraception: A prospective multicentre study.

OBJECTIVE: This multicenter prospective study (BZK40+) aims to determine the efficacy and tolerance of a benzalkonium chloride-containing spermicide as contraceptive among women aged 40 and over. PROCEDURE: Fertile women enrolled in this open single-arm study were instructed to systematically use the benzalkonium chloride spermicide before each intercourse. At the end of a 6-month mandatory period, participants were given the option of continuing the study for a further 6 months. The primary endpoint for contraceptive efficacy was the Pearl Index (PI) up to 12 months of typical use. MAIN FINDINGS: A total of 151 women (mean age: 45.9 years) were enrolled, 144 (95.4%) completed the initial 6-month period and 63 (41.7%) completed the optional 6-month period. The median number of intercourses ranged from 3 to 5 per month. The spermicide was applied before 96.3% of the 5,895 sexual intercourses. The PI up to 12 months of typical use was 0 pregnancies (95% confidence interval: 0-2.88). The cumulative treatment exposure was 1249.7 women-months. CONCLUSION: This first study in women aged 40 years and over shows that benzalkonium chloride spermicide (Pharmatex®) is effective, well tolerated and well accepted in this population. Although very interesting, these results with a PI equal to zero are surprising and not in accordance with the low efficacy of spermicides in the overall population according to the WHO. So, our results should be interpreted with caution and confirmed by future research. Clinical trial registration number (EudraCT): 2016-004,188-38.

The Impact of Breast Awareness on the Early Detection of Breast Cancer in Young Women: A Systematic Review.

Background: "Breast awareness" is a recommendation that women understand the symptoms of breast cancer and become familiar with the usual look and feel of their breasts. It is recommended for women of all ages in breast cancer screening guidelines around the world. The objective of this study was to assess the evidence for breast awareness by investigating its effect on breast cancer outcomes in women of pre-mammographic-screening age (under age 40), at average risk of breast cancer. Methods: A systematic review was performed using PRISMA methodology. Following the search, abstracts and full-text articles were assessed against eligibility criteria. Data were extracted into evidence tables, risk of bias was assessed, narrative synthesis was performed, and results were described. Eligible studies were original research studies assessing the impact of breast awareness on cancer outcomes (such as stage at diagnosis or survival) in women ≤40. Medline, PubMed, and Cochrane Library were searched. Results: After screening the 6,204 abstracts identified in the search, no studies meeting all eligibility criteria were found. Two partially eligible studies were identified. These met the intervention and outcomes criteria but included mixed-age cohorts that included but were not limited to women ≤40. These studies provided low-level (Level IV) evidence of moderate quality that there is some benefit (earlier stage at diagnosis and/or improved survival) of breast awareness in a mixed-age cohort that included some younger women. Conclusions: No studies evaluating the impact of breast awareness exclusively in young women were identified. Limited evidence of benefit of breast awareness was found. Guidelines that recommend breast awareness should be reviewed and qualified with an explanation that the evidence of benefit is weak. Women have limited screening options available to them for the early detection of breast cancer until they reach mammographic screening age. The study was registered on Prospero (ID: CRD42021279457).

Association of ABO blood groups with ovarian reserve: a retrospective cohort study in Chinese Han women younger than 40 years with infertility.

BACKGROUND: Ovarian reserve reflects both the quantity and quality of oocytes available for procreation and is affected by many known and unknown factors. ABO blood type is related to several infertility processes, but it is unclear whether and how ABO blood type affects ovarian reserve. OBJECTIVE: The purpose of the study was to explore the correlation between ABO blood types and ovarian reserve in infertile Chinese Han women under 40 years of age undergoing the in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)-embryo transfer (IVF/ICSI-ET) treatment. METHODS: Women aged < 40 years who underwent IVF/ICSI-ET at our institution and had a documented ABO blood type were eligible for this study. In this study, patients were divided into two groups according to the diminished ovarian reserve (DOR) group (AMH < 1.1 ng/mL, AFC < 6) and the non-diminished ovarian reserve (non-DOR) group (AMH ≥ 1.1 ng/mL, AFC ≥ 6). The relationship between ovarian reserve and ABO blood group was determined by correlation analysis. RESULTS: In this retrospective cohort study, clinical data were collected from 1690 Chinese Han women treated with IVF/ ICSI-ET in hospital records between April 2019 and March 2020 in the affiliated hospital of Southwest Medical University, located in Luzhou, China. The differences in age, duration of infertility, BMI, FSH, FSH / LH, and p (DOR vs non-DOR) for each parameter (DOR vs non-DOR) were statistically significant, and the differences in LH and E2 were not statistically significant. ABO blood groups were most prevalent in the DOR group with O (143, 34.8%) and A (122, 29.7%) and in the non-DOR group with A (428, 33.5%) and O (419, 32.8%). ABO blood groups were most prevalent in the DOR group with O (n = 57, 30.5%) and A (n = 54, 28.9%) and in the non-DOR group with A (n = 335, 34.0%) and O (n = 323, 32.8%) were the most frequent in the non-DOR group. CONCLUSIONS: In this retrospective cohort study, we confirmed the lack of a significant association between ABO blood type and ovarian reserve. Further studies are needed to clarify whether there is any prognostic correlation between ABO blood group and ovarian reserve in women undergoing IVF/ICSI-ET.

Prosthetic shoulder arthroplasty in patients 40 years or younger: outcomes stratified by diagnosis and surgery.

BACKGROUND: The outcomes of patients 50-55 years old or younger undergoing prosthetic shoulder arthroplasty (PSA) may not generalize to younger patients. We report outcomes following PSA in a consecutive series of patients 40 years or younger. We hypothesize that total shoulder arthroplasty (TSA) provides better outcome and durability than resurfacing hemiarthroplasty (RHA). METHODS: Patients were stratified by diagnosis and surgical procedure performed, RHA or TSA. Active range of motion and self-assessed outcome were evaluated preoperatively and at final follow-up. RESULTS: Twenty-nine consecutive PSAs were identified in 26 patients, comprising 9 TSAs and 20 RHAs, with a minimum of 2-year follow-up. Twelve PSAs were performed for chondrolysis. Mean active forward elevation, abduction, external rotation, and internal rotation improved significantly (p<0.001 for all). Mean pain score improved from 6.3 to 2.1, Simple Shoulder Test from 4.0 to 9.0, and American Shoulder and Elbow Surgeons score from 38 to 75 (p<0.001 for all). Patients undergoing RHA and TSA had similar outcomes; but three RHAs required revision, two of these within 4 years of implantation. Four of five patients undergoing revision during the study period had an original diagnosis of chondrolysis. CONCLUSIONS: PSA in young patients provides substantial improvement in active range of motion and patient reported outcomes irrespective of diagnosis and glenoid management. However, patients undergoing RHA, especially for chondrolysis, frequently require subsequent revision surgery, so that RHA should be considered with caution in young patients and only after shared decision-making and counsel on the risk of early revision to TSA.

Forty-Year Trends in Cardiac Implantable Electronic Device Infective Endocarditis.

Background: Studies investigating cardiac implantable electronic device infective endocarditis (CIED-IE) epidemiological changes and prognosis over long periods of time are lacking. Methods: Retrospective single cardiovascular surgery center cohort study of definite CIED-IE episodes between 1981-2020. A comparative analysis of two periods (1981-2000 vs 2001-2020) was conducted to analyze changes in epidemiology and outcome over time. Results: One-hundred and thirty-eight CIED-IE episodes were diagnosed: 25 (18%) first period and 113 (82%) second. CIED-IE was 4.5 times more frequent in the second period, especially in implantable cardiac defibrillators. Age (63 [53-70] vs 71 [63-76] years, P < .01), comorbidities (CCI 3.0 [2-4] vs 4.5 [3-6], P > .01), nosocomial infections (4% vs 15.9%, P = .02) and transfers from other centers (8% vs 41.6%, P < .01) were significantly more frequent in the second period, as were methicillin-resistant coagulase-negative staphylococcal (MR-CoNS) (0% vs 13.3%, P < .01) and Enterococcus spp. (0% vs 5.3%, P = .01) infections, pulmonary embolism (0% vs 10.6%, P < .01) and heart failure (12% vs 28.3%, p < .01). Second period surgery rates were lower (96% vs 87.6%, P = .09), and there were no differences in in-hospital (20% vs 11.5%, P = .11) and one-year mortalities (24% vs 15%, P = .33), or relapses (8% vs 5.3%, P = 0.65). Multivariate analysis showed Charlson index (hazard ratios [95% confidence intervals]; 1.5 [1.16-1.94]) and septic shock (23.09 [4.57-116.67]) were associated with a worse prognosis, whereas device removal (0.11 [.02-.57]), transfers (0.13 [.02-0.95]), and second-period diagnosis (0.13 [.02-.71]) were associated with better one-year outcomes. Conclusions: CIED-IE episodes increased more than four-fold during last 40 years. Despite CIED-IE involved an older population with more comorbidities, antibiotic-resistant MR-CoNS, and complex devices, one-year survival improved.

Incidence of Brain Metastases in Women Treated With Neoadjuvant Chemotherapy for Breast Cancer: Implications for Screening.

PURPOSE: Patients with metastatic breast cancer may develop brain metastases. Our study identified high-risk patients to refine selection criteria for BM screening approaches. PATIENTS: We reviewed breast cancer patients treated with neoadjuvant chemotherapy (NAC) at a single university center between 2005 and 2019. METHODS: Competing risks analysis was performed with the Fine and Gray model to analyze the cumulative incidence of BM and loco-regional recurrence. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier and log-rank tests. Multivariable analysis was performed with Cox proportional hazards regression to identify factors predictive for development of BM. Statistical significance was determined as a 2-sided P value of <.05. RESULTS: In total, 112 patients experienced distant failure (DF) and 49 patients developed BM. Twenty patients with BM (41%) presented with symptoms requiring craniotomy +/- whole brain radiation treatment. Patients with BM were significantly more likely to have local (P < .01) and regional (P < .01) failure. On multivariable analysis, age <40 years (P = .011), presence of lung metastases (P < .0001), and residual nodal disease with >4 lymph nodes positive after NAC (P = .024) all predicted for increased likelihood of BM. Patients with these criteria had higher likelihoods of having BM (P = .013) and worse PFS (P = .044). On multivariable analysis for OS, presence of lung metastases was the most significant predictor of poor outcome (P < .0001). CONCLUSION: We propose a study of screening brain MRI for young (<40 years) patients with breast cancer receiving NAC and patients who develop metastatic disease post-NAC, especially those with lung involvement.

Outcomes of Ewing sarcoma in adults over 40 years of age from a low-middle income country.

Introduction: The data on outcomes and toxicity in adult Ewing sarcoma (ES) patients, particularly those aged ≥40 years, is exceedingly scarce around the world, particularly in low- and middle-income countries (LMICs) and mandates research. Methods: The study involved histologically ascertained ES patients aged ≥40 years who registered at our institute from 2013 to 2018. Prospectively collected data were analysed for overall survival (OS), event-free survival (EFS) and chemotherapy-related toxicities. Results: There were 66 patients, of which 34 were non-metastatic, and 32 were denovo metastatic, recurrent or had doubtful metastasis. At presentation, median age was 46 years, and 42 (63.6%) had extra-skeletal primary and 24 (36.3%) had extremity tumours. Curative treatment was offered to 40 (60.6%) patients. Significant grade 3/4 toxicities in non-metastatic and metastatic cohort, respectively, were febrile neutropenia (61.3%, 37.5%), anaemia (58.1%, 37.5%), thrombocytopenia (45.2%, 25.0%), peripheral neuropathy (25.8%, 12.5%) and dyselectrolytemia (25.8%, 6.25%). Chemotherapy-related toxicity led to death in three patients in the metastatic cohort, versus none in the non-metastatic patients. The 5 year EFS and OS for non-metastatic cohort were 53.8% and 67.8%, while the same for metastatic cohort were 20.7% and 27.5%, respectively. On multivariate analysis, Eastern Cooperative Oncology Group-performance status >2 and metastasis at presentation predicted poorer EFS and OS. Additionally, raised lactate dehydrogenase, larger tumours (>8 cm) and palliative intent treatment predicted worse EFS, while extra-skeletal primary and female gender were indicators of worse OS. Conclusions: Older adult ES patients benefit from aggressive multimodality treatment even in LMIC infrastructure. However, careful patient selection, close monitoring and pertinent dose modifications is imperative due to higher propensity for potential toxicities.

A longer duration from injury to surgery is associated with preoperative deterioration of an isolated meniscal tear in patients aged 40 years or older.

PURPOSE: To evaluate the preoperative deterioration of an isolated meniscal tear in patients aged 40 years or older, and whether time from injury to surgery is associated with worsening of a meniscal tear. METHODS: Patients aged 40 years or older who underwent arthroscopic surgery for isolated meniscal tear between 2014 and 2019 were retrospectively reviewed. The diagnostic magnetic resonance imaging (MRI) findings and arthroscopic findings were compared to evaluate the deterioration of meniscal tears. Predictors of the development of meniscal tears; patient demographic factors, duration from injury to surgery (injury to MRI and MRI to surgery), and image findings were assessed. RESULTS: A total of 58 patients (58 knees) were included (mean age, 55.9 ± 8.5 years; male/female, 31/27). An isolated meniscal tear deteriorated in 28 (48.3%). Compared patients with and without deteriorated meniscal tear, significant differences were found in the MRI grade of meniscal tear (p = 0.03), duration from injury to MRI (164.2 ± 167.9 vs 45.2 ± 48.7 days, p < 0.001), and from MRI to surgery (148.8 ± 91.1 vs 67.6 ± 56.7 days, p < 0.001). A multivariate regression analysis showed that the duration from injury to MRI (odds ratio [OR], 1.03; p < 0.001) and from MRI to surgery (OR, 1.02; p < 0.001) were independent predictors. CONCLUSION: Approximately 50% of isolated meniscal tears deteriorated preoperatively in patients aged 40 years or older. The duration from injury to surgery was an independent predictor of worsening of an isolated meniscal tear.

Complex Regional Pain Syndrome after Carpal Tunnel Syndrome Surgery: A Systematic Review.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. One of the most devastating complications is complex regional pain syndrome. Objectivities: The aim of this study was to systematically analyze available evidence about complex regional pain syndrome after carpal tunnel syndrome surgery (CTSS), its risks, associated factors, and treatments. Material and Methods: Research conducted from 1962 through December 31, 2018, in the following databases: PubMed, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials. The quality assessment of the methodology followed the definitions by the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The GRADE system (Grades of Recommendation, Assessment, Development, and Evaluation) was applied to evaluate the efficacy of the stellate ganglion block, one of the most cited and recurrent treatments. Results: Of the 246 studies retrieved, 44 articles were included. Concerning patients' gender, we identified a ratio of 5 females: 3 males. The mean age for women was 57.79, a standard deviation of 14.96, and for men 60.75, a standard deviation of 9.4. Considering the total of primary publications of CTSS outcomes, the accumulated incidence reached the maximum of 0.15 CRPS after CTSS patients/CTSS patients. The known risk factors for CRPS after CTSS: female gender, from the fifth decade of life, tourniquet time, immobilization and surgery on dominant hand. Conclusion: CRPS affects 2-5% of people undergoing CTSS. Its diagnosis is still a challenge and its risk factors are unclear, although it seems more likely to affect women, in the dominant hand. The most used treatments include physiotherapy and stellate ganglion block. Most patients show improvement of symptoms within one year. Further clinical trials comparing treatment modalities are required.

Breast cancer trends in women younger than 40 years in Brazil.

BACKGROUND: A recent Brazilian populational database analysis showed a concerning increase in breast cancer mortality rates among patients under 40 years. We aimed to evaluate the trends in the proportion of new breast cancer cases and deaths occurring in patients younger than 40 years over the last decade in Brazil. METHODS: We evaluated all consecutive breast cancer patients treated from 2009 to 2020 in a Brazilian tertiary cancer center. The proportions of new cases and deaths in patients younger than 40 years was compared between two time periods (2015-2020 versus 2009-2014) using Chi-squared test. Linear regression was used to evaluate the trends in the proportion of new cases and deaths in young patients over the years. RESULTS: From 2009 to 2020, a total of 12,569 breast cancer patients started treatment at our institution; 1441 were younger than 40 years. From 2009 to 2014, 9.9% (95% CI 9.2-10.7%) were patients younger than 40 years compared to 12.9% (95% CI 12.1-13.8%) from 2015 to 2020. Similarly, the proportion of deaths among breast cancer patients younger than 40 years increased during the period (2009-2014: 9.6%, 95% CI 7.8-11.6%; 2015-2020: 12.4%, 95% CI 10.9-14%). The linear regression model showed a trend for an increasing proportion of new breast cancer cases occurring in patients under 40 years (P = 0.005). Proportion increased from 7.9% (95% CI 6.2-9.8%) in 2009 to 21.8% (95% CI 19.1-24.8%) in 2020. The trend for the increase in the proportion of deaths in this young population was also observed in the linear regression model (P = 0.01). CONCLUSIONS: The proportion of new breast cancer cases and deaths among patients younger than 40 years has increased in a public Brazilian cancer center over the past decade. These results raise the concern for the need to reconsider primary and secondary prevention strategies for young women.

Clinical Outcomes and Prognosis Analysis of Younger Bladder Cancer Patients.

BACKGROUND: Generally, little is known about prognostic factors in bladder cancer patients under 40 years of age. We therefore performed a retrospective study to identify prognostic factors in these younger bladder cancer patients. METHODS: We collected clinicopathological data on bladder cancer patients ≤40 years old diagnosed between 1975 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were generated using the Kaplan-Meier method, and the differences between groups were analyzed using the log-rank test. Univariate and multivariate Cox hazards regression analyses were performed to define hazard ratios (HRs) for cancer-specific survival (CSS). RESULTS: There were statistical differences in race, histological type, cancer stage, tumor size, and surgery treatment groups between overall survival and CSS. Only tumor size and cancer stage were significant independent prognostic risk factors in younger bladder cancer patients for the prediction of CSS. CONCLUSION: Tumors greater than 30 mm in size and a more advanced stage of bladder cancer were indicative of a poor prognosis in bladder cancer patients ≤40 years old, and long-term follow-up is suggested.

A Clinicopathological Correlation of Bladder Cancer in Young and Old Patients: Our Experience and Review of Literature.

To compare the clinical, cystoscopic, and pathological characteristics of bladder cancer in patients younger than 40 years of age and those of patients older than 40 years of age. We conducted a prospective observational study at our department from September 2019 to February 2021 to compare the clinico-pathological characteristics of young and old patients with biopsy proven bladder cancer after a transurethral resection of bladder tumour. The patients were managed according to standard guidelines. Two hundred sixty-eight patients of bladder cancer were included in the analysis. Out of these, 58 patients were < 40 years of age and 210 were > 40 years. The mean age of two groups were 31.43 ± 6.30 vs 59.08 ± 9.87 years. With respect to tumour grade, 36.2% (versus 17.6%) of young patients had low grade tumour, and 58.6% had high-grade tumour (versus 82.4%). In the young population, 63.8% patients had NMIBC (versus 61.9%) and 36.2% had MIBC (versus 38.1%). Even in the NMIBC group, a large majority of young patients had high-risk disease (51.4%). The incidence of bladder cancer is on the rise in the northern belt of India, especially in the younger age group. High exposure to smoke and heavy metals in drinking water/occupation are the major risk factors. Majority of young patients aged < 40 years had a high-grade disease on presentation and a large subset had muscle invasive bladder cancer, contrary to previously reported studies.

Socio-demographic determinants of mammography uptake among women of 40 years and above in Calabar, South-South, Nigeria: a cross-sectional study.

Introduction: mammography has the potential for identifying high risk women with breast cancer. Early detection is important in reducing mortality and morbidity, and crucial for better prognosis. Mammography is poorly practiced in Nigeria. This study assessed the association between socio-demographic characteristics and uptake of mammography among women ≥40 years. Methods: a cross-sectional descriptive study design was employed and data was collected from 365 consenting participants in Calabar, Nigeria, using pre-tested questionnaire. SPSS Version 20 was used for data entry and analysis. The results were descriptively presented by frequencies and percentages. Pearson Chi-Square (χ2) analysis was performed to detect the association between variables at 5% level of significance (p-value of ≤0.05). Results: only 9.9% of participants had a mammography, majority 90.1% never had. Uptake was highest among respondents with tertiary education, married, Civil/Public Servants, and those in the high income level categorization. Educational status, marital status, occupation and age were not statistically significantly associated with mammography uptake (p>0.05). Only religious denominational affiliation (p = 0.02) and income level (p = 0.002) were statistically significantly associated with uptake. Barriers to uptake were poor knowledge about mammography (49.8%), psychosocial (37.8%), economic (17.1%) and health systems (11.5%). Key facilitators to uptake were encouragement/counselling by health workers (44.0%) and presence of breast problems (37.4%). Conclusion: mammography uptake in Calabar, Nigeria was extremely low. Therefore, regular awareness campaigns targeting women at faith-based settings, and provision of mammography screening services at subsidized rates will enhance knowledge level and uptake of mammography.