Prognostic role of the peritoneal cancer index in ovarian cancer patients who undergo cytoreductive surgery: a meta-analysis.

Advanced-stage ovarian cancer is usually associated with peritoneal carcinomatosis. This study evaluates the prognostic role of the Peritoneal Cancer Index (PCI) in predicting the survival of patients with ovarian cancer. A literature search was conducted in electronic databases (Google Scholar, PubMed, Ovid, and Science Direct) and study selection was based on precise eligibility criteria. Random-effects meta-analyses were performed to estimate survival with low and high PCI scores and to pool hazard ratios (HR) of survival between lower and higher PCI scores. A total of 20 studies (2588 patients) were included. Median follow-up was 39 months [95%CI: 25, 54]. Complete cytoreduction rate was 80% [95% CI: 73, 87]. The median PCI score was 11.3 [95% CI: 9.9, 12.7]. Median survival was 56.7 months [95% CI: 45.2, 68.2] with below and 28.8 months [95% CI: 23.0, 34.6] with above any PCI cutoff. Most studies used PCI cutoffs between 10 and 20. The median progression-free survival was 23.7 months [95% CI: 16.5, 30.8] with below and 11.9 months [95% CI: 5.9, 17.9] with above any PCI cutoff. 5-year survival rates were 61.3% [95% CI: 49.9, 72.8] with PCI<10 cutoffs, 21.7% [95% CI: 11.6, 31.8] with PCI>10 cutoffs, 50.1% [95% CI: 39.0, 61.2] with PCI<20 cutoffs, and 21.7% [95% CI: 16.2, 27.1] with PCI>20 cutoffs. Pooled analysis of HRs showed that a higher PCI score was associated with worse survival in both univariate (HR 2.14 [95%CI: 1.63, 2.66]) and multivariate (HR 1.10 [95% CI: 1.02, 1.18]) analyses. In a set of studies that used varying PCI cutoffs, the PCI has been found to have a significant inverse association with the survival of patients with advanced ovarian cancer who underwent cytoreductive surgery.

Malignant, fungating giant-cell tumor of the tendon sheath (GCT-TS) of the foot: A case report.

Giant-cell tumors of the tendon sheath (GCT-TS) are relatively common benign tumors that arise in close proximity to joints and tendons. Malignant GCT-TS are extremely rare. Surgery with wide resection remains the cornerstone for treating malignant giant-cell tumors of the tendon sheath especially in large tumor cases.

Wide resection and reconstruction in a low resource area, cemented nail technique knee arthrodesis; a report of case and surgical technique.

INTRODUCTION AND IMPORTANCE: Osteosarcomas are primary malignant bone tumors that are driven from bone-forming mesenchymal cells and account for nearly 20 % of primary bone tumors. CASE PRESENTATION: A 16-year-old female presented with chief complaint of pain and swelling on her right knee for 6 months with history of trauma. Her knee mobility and ROM was limited due to pain and the mass. Physical examination revealed a 15 × 22 cm mass on distal part of right femur with visible dilated veins. There was normal distal motor, sensory functions. Imaging revealed distal femur mass with mixed lytic and blastic features, wide transitional zone with hair and periosteal reaction; features suggestive of osteosarcoma that was confirmed by histopathological examinations as intramedullary osteosarcoma. She undergone surgical treatment consisting of surgical excision of the mass with safety margins and knee reconstruction by knee arthrodesis using femoral-nail and bone cement technique with excellent outcome. CLINICAL DISCUSSION: Osteosarcoma is best investigated through plain imaging, MRI and possible CT with histology being confirmatory. It is best approached with meticulous dissection to ensure clear margins or if necessary, amputation. Following resection, reconstruction can be done. In this specific case, the tumor was on the distal femur and the underlying knee was arthrodesed using cemented nail technique in which a cemented intramedullary nail was inserted with excellent clinical outcome. CONCLUSION: Surgical approach to osteosarcoma can be performed through limb salvage or amputation. Arthrodesis with cemented nail technique using an intramedullary nail can be performed in some patients with excellent clinical outcome.

Clinical analysis and literature review of a case of ovarian clear cell carcinoma with PIK3CA gene mutation: A case report.

RATIONALE: Ovarian clear cell carcinoma (OCCC) is an uncommon malignant form of 5 subtypes of ovarian cancer, accounting for approximately 5% to 25% of all ovarian cancers. OCCC is usually diagnosed at a young age and an early stage. More than 50% of patients are associated with endometriosis. It shows less sensitivity to platinum-based chemotherapies, high recurrence, and poor prognosis, especially late. However, platinum-based chemotherapies remain the first-line treatment. Meanwhile, new treatment modalities have been explored, including immune checkpoint inhibitors and PI3K-AKT-mTOR pathway inhibitors. PATIENT CONCERN: A 48-year-old Chinese woman, Gravida2 Para1, complained of irregular and painful vaginal bleeding for 4 months. DIAGNOSIS: The patient was diagnosed with stage IC ovarian clear cell carcinoma that presented with a mutation of the phosphatidylinositol 4,5-bisphosphate 3-kinase alpha subunit (PIK3CA) gene. INTERVENTION: We performed an early diagnosis and complete surgical resection of the tumor with platinum-based chemotherapy. OUTCOME: This patient with mutation of the PIK3CA gene was sensitive to platinum-based chemotherapy, showed a significant downwards trend in tumor markers, and was in good health within the year of follow-up. LESSONS: This study described an OCCC case that presented with a PIK3CA mutation and was successfully managed with careful and complete resection of the tumor. This patient with mutation of the PIK3CA gene was sensitive to platinum-based chemotherapy, showed a significant downwards trend in tumor markers, and did not have recurrence after a year of follow-up, indicating a reasonably good prognosis. Therefore, surgery plus platinum drug chemotherapy is still the best strategy for OCCC treatment. In addition, it is recommended for such patients to undergo genetic testing as much as possible to predict the clinical treatment effect.

An unusual cluster of Waugh syndrome as a cause of intestinal obstruction in children - A case series.

INTRODUCTION AND IMPORTANCE: The association of intussusception with intestinal malrotation is a rare phenomenon named Waugh syndrome by Brereton et. It is a rare disease entity with less than 100 cases described so far. A cluster presentation is something unusual for rare diseases. CASE PRESENTATION: All four patients have presented with features suggestive of bowel obstruction as all of them have had colicky abdominal pain. Three patients have vomiting as an additional complaint, so as the diarrhea. Fever has also been reported in one patient. Patients have presented in 6 months period, non-consecutively. Abdominal pain, diarrhea and vomiting are alarming in the pediatric population. When each case presented, an immediate resuscitation was performed including IV lines, nasogastric suctioning, electrolytes correction, and blood and FFP transfusion as necessary. Abdominal ultrasonography was performed revealing target sign. After optimization for surgery, manual reduction of the intussusception was done followed by a Ladd's procedure for the malrotation was performed for all 4 patients with excellent outcomes. CLINICAL DISCUSSION: With the surgery, after case optimization, remains the standard of care; the presence of cluster presentation for Waugh syndrome could suggest that some environmental factors might be implicated and further observations can be carried out to look more into such phenomenon. CONCLUSION: Waugh syndrome, a combined presentation of intestinal malrotation and intussusception, is a rare syndrome that can present in children. Optimization for surgery followed by a 2-step surgical approach is the usual treatment with excellent outcomes described.

Osteosarcoma of the distal fibula and reconstruction of the ankle using inverted fibula, a case report.

INTRODUCTION AND IMPORTANCE: Osteosarcomas are malignant primary bone tumors of mesenchymal origin producing osteoid material and has peak incidence in adolescents. Distal lower limb tumors are rare and can negatively affect ankle joint stability. CASE PRESENTATION: A 24-year-old female who has newly graduated from college presented with distal fibular mass measuring around 5 × 15 cm located on the lateral aspect of the right ankle over a period of 2 months. The mass located on the lateral aspect of the right ankle that was hard, oval and measuring around 5 × 15 cm and originating from the fibula. The overlying skin was normal with no discharging sinuses. Distal neurovascular examination was normal with no lymphadenopathy. Imaging using X-rays and MRI as well as pathological examinations thereafter has proven the diagnosis. She was planned for wide surgical resection at distal fibula and ankle reconstruction after neoadjuvant chemotherapy, then for adjuvant chemotherapy. Ankle reconstruction using fibular autograft was used after its reversal and was then stabilization by syndesmotic screws. She has clinically good outcome. CLINICAL DISCUSSION: Surgery with extensive and meticulous dissection remains the cornerstone for treating osteosarcomas affecting distal fibula. Neoadjuvant and adjuvant chemotherapy are important for managing micro-metastasis. Ankle reconstruction and be performed using different methods with good outcomes. CONCLUSION: Lesson learnt is that ankle reconstruction using fibular autograft can be used after reversal and stabilization by screws with good outcome for managing distal fibular osteosarcomas. However, this finding needs to be strengthened with future reports.

Inflammatory fibroid polyp (Vanek's tumor) causing double compound ileo-ileal intussusception in an adult patient, a case report.

INTRODUCTION AND IMPORTANCE: The majority of the of small bowel intussusception causes are benign, and different types of benign tumors have been reported as the lead points of an intussusception. Among these, some studies have reported inflammatory fibroid polyp as a cause of small bowel intussusception. However, according to our knowledge this is the first case to be reported in Africa of an adult double compound intussusception due to an inflammatory fibroid polyp. CASE REPORT: A 32-year-old female presented with epigastric abdominal pain, nausea, vomiting and diarrhea for 2 weeks. Investigations revealed a small bowel obstruction due to intussusception, and exploratory laparotomy was planned. CLINICAL DISCUSSION: Inflammatory fibroid polyp causing this unique feature of double compound ileo-ileal intussusception should be observed in adult patients who presents with intestinal obstruction. A CT scan is the diagnostic modality of choice, and we think that the disease is the first of its kind to be reported in Africa. CONCLUSIONS: Double ileo-ileal intussusception is a rare cause of intestinal obstruction in adult patients. INTERVENTIONS AND OUTCOME: Laparotomy reviled an ileo-ileal intussusception. After manual reduction of this intussusception, another intussusception was observed and containing a polyp. A clear margin resection and end-to-end primary anastomosis were performed. The histopathological report established the diagnosis of Inflammatory Fibroid Polyp. After the procedure, the patient's condition improved well with no complications. METHODS: This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [1]).

Clinical Characteristics and Risk Factors Associated with Severe Disease Progression among COVID-19 Patients In Wad Medani Isolation Centers: A Multicenter Retrospective Cross-Sectional Study.

Background: Since December 2019, (COVID-19) has had a significant impact on global health systems. Because little is known about the clinical characteristics and risk factors connected with COVID-19 severity in Sudanese patients, it is vital to summarize the clinical characteristics of COVID-19 patients and to investigate the risk factors linked to COVID-19 severity. Objectives: We aimed to assess the clinical characteristics of COVID-19 patients and look into risk factors associated with COVID-19 severity. Methods: This is a retrospective cross-sectional study that took place in two Isolation Centers in Wad Medani, Gezira State, Sudan. Four hundred and eighteen patients were included between May 2020 and May 2021. All COVID-19 patients over the age of 18 who were proven COVID-19 positive by nucleic acid testing or had characteristics suggestive of COVID-19 on a chest CT scan and had a complete medical record in the study period were included. Results: The participants in this study were 418 confirmed COVID-19 cases with a median age of 66.313 years. There were 279 men (66.7%) among the patients. The most prevalent comorbidities were hypertension (n = 195; 46.7%) and diabetes (n = 187; 44.7%). Fever (n = 303; 72.5%), cough (n = 278; 66.5%), and dyspnea (n = 256; 61.2%) were the most prevalent symptoms at the onset of COVID-19. The overall mortality rate (n = 148) was 35.4%. Patients with severe illness had a mortality rate of 42.3% (n = 118). Older age, anemia, neutrophilia, and lymphocytopenia, as well as higher glucose, HbA1c, and creatinine levels, were all linked to severe COVID-19, according to the chi-square test and analysis of variance analysis. Conclusion: Sixteen variables were found to be associated with COVID-19 severity. These patients are more prone to go through a serious infection and as a result have a greater death rate than those who do not have these characteristics.

Hereditary hemorrhagic telangiectasia in a sudanese patient: A case report.

(HHT) is a rare disorder affecting the skin and body's internal organs with a tendency for bleeding. We report a case of Sudanese 42-year-old with family history of HHT presented with recurrent epistaxis and telangiectasias.

Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan.

BACKGROUND: Rheumatic heart disease (RHD) remains a leading cause of morbidity and mortality in Sub-Saharan Africa despite widely available preventive therapies such as prophylactic benzathine penicillin G (BPG). In this study, we sought to characterize facilitators and barriers to optimal RHD treatment with BPG in Sudan. METHODS: We conducted a mixed-methods study, collecting survey data from 397 patients who were enrolled in a national RHD registry between July and November 2017. The cross-sectional surveys included information on demographics, healthcare access, and patient perspectives on treatment barriers and facilitators. Factors associated with increased likelihood of RHD treatment adherence to prophylactic BPG were assessed by using adjusted logistic regression. These data were enhanced by focus group discussions with 20 participants, to further explore health system factors impacting RHD care. RESULTS: Our quantitative analysis revealed that only 32% of the study cohort reported optimal prophylaxis adherence. Younger age, reduced primary RHD healthcare facility wait time, perception of adequate health facility staffing, increased treatment costs, and high patient knowledge about RHD were significantly associated with increased odds of treatment adherence. Qualitative data revealed significant barriers to RHD treatment arising from health services factors at the health system level, including lack of access due to inadequate healthcare staffing, lack of faith in local healthcare systems, poor ancillary services, and patient lack of understanding of disease. Facilitators of RHD treatment included strong interpersonal support. CONCLUSIONS: Multiple patient and system-level barriers to RHD prophylaxis adherence were identified in Khartoum, Sudan. These included patient self-efficacy and participant perception of healthcare facility quality. Strengthening local health system infrastructure, while enhancing RHD patient education, may help to improve treatment adherence in this vulnerable population.

Abdominal cocoon syndrome, a case report of a rare disease entity causing intestinal obstruction.

INTRODUCTION AND IMPORTANCE: Abdominal cocoon syndrome is a rare condition characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. It is an uncommon cause of intestinal obstruction. Less than 300 cases have been reported from all over the world. This is the first case of such a disease entity to be reported from Sudan. CASE PRESENTATION: A young female patient, presented with features of intestinal obstruction that was managed conservatively. Failure of the conservative management has warranted a laparotomy. CLINICAL FINDINGS AND INVESTIGATIONS: Her features were suggestive of intestinal obstruction that was confirmed radiologically. INTERVENTIONS AND OUTCOME: Laparotomy revealed a membrane-like fibrous material and extensive multiple loops adhesions, findings consistent with primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon's disease. The membrane was excised and adhesiolysis was done. Intestinal obstruction was relieved after surgery and the patient showed good outcome. CONCLUSIONS: Abdominal cocoon syndrome is a rare cause of intestinal obstruction. RELEVANCE AND IMPACT: The takeaway lesson from this case would be that the PSEP should be sought in any patient with no clear cause for obstruction can be identified. A contrast-enhanced CT scan is the diagnostic modality of choice. Finally, we think that the disease is underreported from Africa and more efforts should be carried out to increase patients' access to healthcare especially in rural areas with no access to hospitals in order to bring more cases to light. This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [17]).

Chlorination byproducts in drinking water produced from thermal desalination in United Arab Emirates.

Oil activities in the Arabian Gulf can potentially affect the quality of the intake water available for coastal desalination plants. This paper addresses such situation by investigating the quality of intake water and desalinated water produced by a desalination plant located near a coastal industrial complex in United Arab Emirates (UAE). Analyses of the organic compounds on the intake seawater reported non-detected levels in most samples for the three tested organic groups; namely Polyaromatic Hydrocarbons (PAHs), Phenols, and Polychlorinated Biphenyls (PCBs). Trihalomethanes (THMs) and Haloacetic Acids (HAAs) were also tracked in the intake sea water, throughout the desalination processes, and in the final produced drinking water, to evaluate the undertaken pre- and post chlorination practices. The levels of considered Chlorination Byproducts (CBPs) were mostly found below the permissible international limits with few exceptions showing tangible levels of bromoform in the intake seawater and in the final produced drinking water as well. Lab-controlled experiments on the final produced distillate showed little contribution of its blending with small percentage of seawater upon the formation of trihalomethane and in particular, bromoform. Such results indicate that the organic precursors originated in the seawater are responsible for bromoform formation in the final distillate.