Child marriage among displaced populations - a 2019 study in Kurdistan Region of Iraq.

BACKGROUND: Many of the factors that increase risk of child marriage are common among refugees and internally displaced persons (IDPs). We sought to address the gaps in knowledge surrounding child marriage in displaced and host populations in the Kurdistan Region of Iraq (KRI). METHODS: A multistage cluster sample design was employed collecting data of KRI host communities, Iraqi IDPs, and Syrian refugees. Interviews were conducted in eligible households, requiring at least one adult female and one female adolescent present, addressing views of marriage, demographics and socioeconomic factors. Household rosters were completed to assess WHO indicators, related to child marriage including completed child marriage in females 10-19 and completed risk of previously conducted child marriages in females 20-24. RESULTS: Interviews were completed in 617 hosts, 664 IDPs, and 580 refugee households, obtaining information on 10,281 household members and 1,970 adolescent females. Overall, 10.4% of girls age 10-19 were married. IDPs had the highest percentage of married 10-19-year-old females (12.9%), compared to the host community (9.8%) and refugees (8.1%). Heads of households with lower overall education had higher percentages of child marriage in their homes; this difference in prevalence was most notable in IDPs and refugees. When the head of the household was unemployed, 14.5% of households had child marriage present compared to 8.0% in those with employed heads of household. Refugees and IDPs had larger percentages of child marriage when heads of households were unemployed (refugees 13.1%, IDPs 16.9%) compared to hosts (11.9%). When asked about factors influencing marriage decisions, respondents predominately cited family tradition (52.5%), family honor (15.7%), money/resources (9.6%), or religion (8.0%). Over a third of those interviewed (38.9%) reported a change in influencing factors on marriage after displacement (or after the arrival of refugees in the area for hosts). CONCLUSIONS: Being an IDP in Iraq, unemployment and lower education were associated with an increase in risk for child marriage. Refugees had similar percentages of child marriage as hosts, though the risk of child marriage among refugees was higher in situations of low education and unemployment. Ultimately, child marriage remains a persistent practice worldwide, requiring continued efforts to understand and address sociocultural norms in low socioeconomic and humanitarian settings.

Isolated Inguinal Lymph Node Metastasis from Colon Cancer: A Case Report.

Lymphatic spread of colon cancer usually occurs via mesenteric vessels (superior and inferior mesenteric vessels), but inguinal lymph node (LN) metastasis from colon cancer is extremely rare with only few reported cases in the literature. A case of a 35-year-old female patient with a history of sigmoid cancer underwent sigmoidectomy and left salpingo-oopherectomy in 2016 and received adjuvant chemotherapy then presented in 2023 with metastatic left inguinal LNs and underwent left inguinal LN dissection. We reported a rare case of isolated metachronous inguinal lymph node metastasis from colon cancer with a round ligament route of spread as the hypothesized mechanism. Surgical resection with inguinal LN dissection is the preferred treatment option for isolated inguinal lymph node metastasis from colon cancer followed by adjuvant chemotherapy, yet long term follow-up data is needed to support this strategy.

Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer.

RESULTS: The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P=0.010). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) (P=0.252). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance (P value = 0.266). CONCLUSIONS: In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.

Total mesorectal excision for the treatment of rectal cancer.

INTRODUCTION: In the surgical treatment of rectal cancer, a clear circumferential resection margin and distal resection margin should be obtained. The aim of this study was to determine the morbidity, mortality, survival outcome, and local failure after total mesorectal excision (TME) in the surgical treatment of rectal cancer. METHODS: This retrospective study was conducted on 101 patients treated for rectal cancer using low anterior resection (LAR), abdominoperinial resection (APR), or Hartmaan's technique. In all operative procedures, total mesorectal excisions (TMEs) were done. The patients were treated from November 2000 to April 2011 in the South Egypt Cancer Institute (SECI) of Assuit University (Egypt). Neo-adjuvant therapy was given to those patients with serosalin filtration, lymph node involvement, and sexual and urinary function impairment. Data were analyzed using IBM-SPSS version 21, and survival rates were estimated using the Kaplan-Meier method. RESULTS: One hundred one patients were evaluable (61 males, 40 females). Regarding the operative procedure used, it was: (APR), LAR, Hartmaan's technique in 15.8%, 71.3%, and 12.9% of patients, respectively. Operation-related mortality during the 30 days after surgery was 3%. The operations resulted in morbidity in 25% of the patients, anastomotic site leak in 5.9% of the patients, urinary dysfynction in 9.9% of the patients, and erectile dysfunction in 15.8% of the male patients. Regarding safety margin, the median distances were distal/radial margin, 23/12 mm, distal limit 7 cm. Median lymph nodes harvest 19 nodes. Primary tumor locations were anteriorly 23.8%, laterally 13.9%, posteriorly 38.6%, and circumferential 23.8%. Protective stoma 16.8%. Primary Tumor TNM classification (T1, T2, T3, and T4; 3, 28.7, 55.4, and 12.9%, respectively). Nodes Metastases (N0, N1, and N2; 57.4, 31.7, and 10.9%, respectively). TNM staging (I, II, III, and IV; 15.8, 29.7, 46.5, and 7.9%, respectively). Chemotherapy was administered to 67.3% of the patients. Radiotherapy (short course neoadjuvant, long course neoadjuvant, and adjuvant postoperative used in 33.7, 20.8, and 19.8% of patients, respectively). Survival 5-years CSS was 73% and 5-years RFS 71%. Mean operative time was 213 minutes. The average amount of intraoperative blood loss was 344 mL. CONCLUSION: Total mesorectal excision (TME) represents the gold-standard technique in rectal cancer surgery. It is safe with neoadjuvent chemoradiotherapy and provides both maximal oncological efficiency (local control and long-term survival and maintenance of a good quality of life).