Initiating chemotherapy in joint arthroplasty patients increases the risk of periprosthetic joint infections.

BACKGROUND: Total Joint Arthroplasties (TJAs) are becoming more popular, resulting in a growing economic burden due to potential postoperative complications, with periprosthetic joint infections (PJIs) playing a significant role. The effect of immunosuppression on PJI risk, particularly in cancer patients following chemotherapy, is unknown. The hypothesis of this study investigated whether chemotherapy increases PJI rates in patients who received post-arthroplasty chemotherapy within one year of surgery. METHODS: Data from the M161Ortho dataset of PearlDiver patient records database were utilized using ICD-9, ICD-10, and CPT codes. The cohort includes Total Knee Arthroplasty (TKA), Total Hip Arthroplasty (THA), and Total Shoulder Arthroplasty (TSA) patients who underwent post-arthroplasty chemotherapy within one year after surgery between 2010 and 2022. Patients in the matched control group did not receive post-arthroplasty chemotherapy. Pre-arthroplasty chemotherapy recipients, PJI, and post-op first year revisions were excluded. Analyses including the linear logistic regression were performed via R statistical software. RESULTS: Totally, 17,026 patients (8,558 TKAs, 6,707 THAs, and 1,761 TSAs) were included. At two (OR = 1.59, p = 0.034), three (OR = 1.57, p = 0.009), and four (OR = 1.40, p = 0.032) years for TKA, and two (OR = 2.27, p = 0.008), three (OR = 2.32, p < 0.001), and four (OR = 2.25, p0.001) years for THA, PJI rates were significantly higher in the chemotherapy group. TSA patients had a significant rise in PJI after four years (OR = 2.20, p = 0.031). CONCLUSIONS: This study reveals a possible relationship between postoperative chemotherapy and an increased incidence of PJI in patients with arthroplasty. Chemotherapy suppresses the immune system, rendering patients more vulnerable to infections. Additional research is required to confirm these findings.

Examining the immunological responses to COVID-19 vaccination in multiple myeloma patients: a systematic review and meta-analysis.

BACKGROUND: Impaired immune response in multiple myeloma renders the patients vulnerable to infections, such as COVID-19, and may cause worse response to vaccines. Researchers should analyze this issue to enable the planning for special preventive measures, such as increased booster doses. Therefore, this meta-analysis aimed to evaluate the response and efficacy of COVID-19 vaccines in patients with multiple myeloma. METHODS: This meta-analysis followed PRISMA 2020 guidelines, conducting a comprehensive database search using specified keywords. Study selection involved a two-phase title/abstract and full-text screening process. Data extraction was performed by two researchers, and statistical analysis involved meta-analysis, subgroup analysis based on vaccine dosage and study time, random effects meta-regression, and heterogeneity testing using the Q test. RESULTS: The meta-analysis revealed that patients with multiple myeloma (MM) had a lower likelihood of developing detectable antibodies after COVID-19 vaccination compared to healthy controls (Log odds ratio with 95% CI: -3.34 [-4.08, -2.60]). The analysis of antibody response after different doses showed consistent lower seropositivity in MM patients (after first dose: -2.09, [-3.49, -0.69], second: -3.80, 95%CI [-4.71, -3.01], a booster dose: -3.03, [-5.91, -0.15]). However, there was no significant difference in the mean level of anti-S antibodies between MM patients and controls (Cohen's d -0.72, [-1.86, 0.43]). Evaluation of T-cell responses indicated diminished T-cell-mediated immunity in MM patients compared to controls. Seven studies reported clinical response, with breakthrough infections observed in vaccinated MM patients. CONCLUSIONS: These findings highlight the impaired humoral and cellular immune responses in MM patients after COVID-19 vaccination, suggesting the need for further investigation and potential interventions.

Colorectal Cancer Incidence in Iran Based on Sex, Age, and Geographical Regions: A Study of 2014-2017 and Projected Rates to 2025.

BACKGROUND: While there has been extensive research on colorectal cancer (CRC) incidence and its associated factors in Iran, a significant gap exists in studies predicting its future trends. Our study aimed to thoroughly report CRC incidence across Iran from 2014 to 2017, by sex, age, and geographical regions, and provide a projection for 2025. METHODS: This retrospective study utilized data from the Iranian National Population-based Cancer Registry (INPCR). Patients with the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes C18 to C21 were included. The age-standardized incidence rate (ASR), was calculated per 100000 individuals annually, and crude incidence rates were retrieved for various demographic groups and years. RESULTS: Between 2014 and 2017, a total of 43580 new CRC cases (55.96% males) were registered. Men exhibited an ASR of 134.45, while women's ASR was 94.85. The highest ASRs were observed in Tehran, Qom, and Ilam (18.99, 18.26, and 18.06, respectively). Incidence rates surpassed 20 after age 50 for both genders, reaching their peak within the 80-84 age group. Adenocarcinoma was the most frequent histological type of CRC in nearly all provinces. Case numbers and ASRs are projected to continuously rise until 2025, with a predominance of male cases. CONCLUSION: The anticipated increase in CRC incidence in Iran emphasizes the need for additional studies to better identify risk factors. Furthermore, implementing screening programs is recommended for individuals at a higher risk of CRC, including men, the elderly population, and those residing in regions with a notable prevalence of CRC.

Patient satisfaction following robotic unicompartmental knee arthroplasty: A systematic review and meta-analysis.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a viable alternative to total knee arthroplasty (TKA) for osteoarthritis patients with single-compartment involvement, with advantages including accelerated recovery, reduced pain, and improved function. Robotic-assisted UKA (rUKA) is a promising development that ensures precise implant positioning and limb alignment. However, concerns about complications remain. OBJECTIVE: This study looks at patient satisfaction as a key metric for determining the efficacy of rUKA versus manual UKA (mUKA). METHODS: The search strategy for this study followed PRISMA. Using precise keywords, PubMed, Scopus, Web of Science, and the Cochrane library were searched. English articles were searched until August 2, 2023. Selection criteria included mUKA and rUKA patient satisfaction studies. The NOS scale evaluated study quality. Meta-analysis was done with R and heterogeneity analysis. RESULTS: This systematic review examined 5 studies with 1060 UKAs (532 robotic-assisted and 528 manual). Variable satisfaction assessment methods were used. Three studies found no difference in patient satisfaction after robotic-assisted UKA, but two found a higher satisfaction. Meta-analysis showed robotic-assisted UKA improved patient satisfaction (OR = 1.72 [1.25-2.37]). Overall, most studies showed low risk of bias, except one with higher bias. CONCLUSION: This review suggests that robotic assistance may enhance patient satisfaction in UKA procedures.

Uterine and Cervical Cancer in Iran: An epidemiologic analysis of the Iranian National Population-Based Cancer Registry.

BACKGROUND: Gynecologic cancers, including neoplasms of the cervix and uterine, are the fourth most common malignancies, causing 3.46% of deaths in women aged 15 to 59. OBJECTIVES: We aimed to report the Iranian National Population-based Cancer Registry (INPCR) results for Cervical and Uterine cancers in 2017. METHODS: The total population of Iran in 2017 was 80881792. INPCR collected data on cervical and uterine cancer incidence from 31 provinces of Iran. In this project, we retrospectively examined all the country's regions in terms of screening for the existence of these two cancers. The registry data bank in Iran was used. RESULTS: Overall, 3481 new cervical and uterine cancer cases were registered in INPCR, including 842 cases of cervical cancer (with a crude rate of 1.04) and 2639 cases of uterine cancer (with a crude rate of 3.26). The average age-standardized incidence rate (ASR) was 0.99 for cervical cancer and 3.29 for uterine cancer. Out of 3481 new cervical and uterine cancer cases, 2887 were registered with pathological findings and 594 without pathological confirmation. In cervical cancers, the highest rate was related to squamous cell carcinoma, with 486 cases (57.72%). CONCLUSION: Our results showed that Iran is a low-risk area for the incidence of cervical and uterine cancers. In this study, the highest rate of cervical cancer was related to squamous cell carcinoma, confirming previous reports. However, this rate was lower than previous studies and suggested an increase in other types of cervical cancer in Iran.

Medical Students' Point of View About Virtual Classes, Technological Infrastructures, and Length of Education During the COVID-19 Pandemic: A Cross-sectional Study.

Background: Most in-person classes are being held via virtual platforms, and bedside education has faced serious challenges during the coronavirus disease-2019 (COVID-19) pandemic. This study evaluated the Iranian medical students' point of view regarding the virtual classes and length of education during the COVID-19 pandemic. Methods: We designed a cross-sectional study using convenience sampling about 6 months after the beginning of the COVID-19 pandemic. We formulated 4 questions regarding their satisfaction with infrastructures and contents of virtual classes, length of education, and their perspectives on how clinical and practical education should continue during the COVID-19 pandemic. We designed an online questionnaire and sent it to medical students all over the nation using virtual platforms and groups in social media. The attained data have been coded and analyzed with SPSS version 22 using descriptive and analytic tests. Results: A total of 1999 medical students participated in the study, and most students were from type 1 universities (50.4%) and were in the clerkship stage (33.3%) of education. Medical interns (mean = 3.34 [SD = 1.29]) were most satisfied with the infrastructures of virtual classes compared with students in basic sciences (mean = 2.93 [SD = 1.18]), physiopathology (mean = 2.62 [SD = 1.26]), and clerkship (mean = 2.56 [SD = 1.31]) stages (P < 0.001). Also, students in type 1 and the nongovernmental (NG) type universities were significantly more satisfied with the content, with mean scores of 2.94 and 3.14, respectively, and infrastructures, with mean scores of 2.77 and 2.98, respectively, of virtual classes than students in type 2, with mean scores of 2.59 and 2.42, respectively, and 3 universities, with mean scores of 2.54 and 2.34, respectively (P < 0.05). Conclusion: Infrastructure is a crucial component in virtual learning, and it can also affect satisfaction with the provided virtual content. Also, providing better clinical content should be performed for medical students before their internship during the current pandemic situation.

Risk perception, attitude, and practice related to COVID-19: A cross-sectional study among 1085 Iranian healthcare workers.

BACKGROUNDS: Healthcare workers are at risk of mental illness during COVID-19 pandemic. We investigated the level of perceived risk and adherence to preventive behaviors regarding COVID-19 among medical students and physicians. MATERIALS AND METHODS: We conducted an online nationwide cross-sectional survey among Iranian physicians and medical students. We collected data regarding perceived risk, perceived stress scale (P·S·S.), attitude, practice, and information sources. We assessed the association of four main outcomes (risk perception, P·S.S. score, attitude, and practice) with demographic variables. RESULTS: A total of 1085 participants with an overall fear score of 6.48 ± 2.29 out of 10 filled the questionnaires. Older and more educated participants had a higher risk perception level and adherence to protective measures. In contrary, participants in lower-risk workplaces had lower risk perception scores. Main sources of information did not affect the scores of risk perception, P·S·S., and practice. Higher risk perception scores were observed in those with higher practice and P·S.S. scores.Contrary to risk perception, the P·S.S. score was not affected by many of the demographic variables, except gender. The most positive attitude was observed in individuals with a higher level of trust in governmental information sources. Participants with higher P·S.S. scores adhered more to protective measures. CONCLUSION: Risk perception had the greatest impact on adherence to preventive behaviors. Therefore, policymakers should consider perceived risk as a predictor of the extension of the pandemic. Both risk perception and P·S.S. reflect the severity of fear from COVID-19; however, P·S.S. is less affected by sociodemographic and workplace characteristics.

Bipolar loop device versus bipolar diathermy for tonsillectomy: A pilot randomized controlled trial.

OBJECTIVE: Tonsillectomy is one of the most common surgeries performed in the pediatric population. Although different forms of instruments and various methods are used to perform tonsillectomy, none of them is still recognized as the best global technique. This study aimed to compare the outcomes of the new Bipolar Loop tonsillectomy versus bipolar diathermy technique. METHODS: This study is a pilot randomized clinical trial and was conducted on 40 pediatric patients who were the candidate of tonsillectomy. Patients were divided into two groups of Bipolar Loop or bipolar diathermy. Operation time, intraoperative bleeding, tonsillar fossa wound, postoperative complications, and duration of return to normal diet were evaluated in the current study. RESULTS: In both of the Bipolar Loop and bipolar diathermy groups, no significant difference was found in terms of sex, age, and weight. The average amount of the operative time, intra-operative blood loss, and postoperative pain loss were significantly less in the Bipolar Loop group (P < .001). In addition, the tonsillar fossa wound healing scores were significantly better (on the 14th day, P = 0.009). However, there was no significant difference between the two groups in terms of postoperative bleeding, duration of return to a normal diet, and postoperative symptoms of fever, otalgia, or voice change between the groups. CONCLUSION: The study showed that blood loss and postoperative pain through day 7 were significantly less in the Bipolar Loop group. Tonsillectomy with Bipolar Loop can be recommended as one of the methods for tonsillectomy, especially in pediatric patients.