Are We Identifying Malnutrition in Hospitalized Patients with Hematologic Malignancies? Results from a Quality Clinical Audit.

Disease-related malnutrition (DRM) is highly prevalent among patients with hematologic malignancies. The aim of the present study was to evaluate the prevalence of DRM in hospitalized patients with hematologic malignancies and investigate the level of awareness of DRM among the medical team treating this group of patients. A cross sectional quality clinical audit took place in two hematology units of a tertiary university hospital. Inpatients were screened within 48 h of their admission using the Malnutrition Universal Screening Tool (MUST) to identify their nutritional risk, and they were reassessed to identify the implemented interventions during their hospitalization. One hundred eighty-five patients were included in the audit analysis. On admission, 37.3% of the audited population was identified as being at high risk of malnutrition according to the MUST score. Forty-nine (26.5%) patients reported reduced food intake during the past 5 days, while four (2.2%) reported no food intake. During the hospitalization, only five patients (2.7%) received nutritional support, as indicated. Low levels of awareness of the early detection and treatment of DMS were found. Moreover, the prevalence of DRM and low nutritional intake was reported to be low. Measures to increase awareness of DMR in the medical team and better coordination of the nutrition support teams is vital to ensure better management and early nutrition intervention in hematological patients.

Clear cell sugar tumor of the lung; a systematic review for a rare entity.

PURPOSE: The diagnosis and management of patients with a clear cell sugar tumor of the lung (CCSTL) is challenging in the clinical practice due to its rarity. METHODS: We performed a systematic review on this field according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We sought eligible articles in Medline through January 1st, 2019. RESULTS: Overall, 104 CCSTL cases were identified and included in the present study. The median age at diagnosis was 52 years (interquartile range 42.5-62.5), whereas the cases were almost equally distributed among males (n=48) and females (n=49). Most of the tumors were asymptomatic (60.7%) and had a benign clinical course (73.3%). Complete tumor resection with a curative intent was the treatment of choice and pathology along with immunohistochemical indices established the diagnosis. However, long-term follow up is recommended, especially among patients with underlying genetic diseases, because disseminated disease may become evident many years following the resection of the primary lesions. Furthermore, an extensive workup for excluding metastasis from another occult primary site is necessary. The updated classification of lung neoplasms has enabled the more frequent reporting of CCSTL cases in the last decade. Interestingly, our time trend analysis showed an increase in malignant cases throughout the years. CONCLUSION: Both collaborative multicenter studies and basic research on the underlying pathogenetic mechanisms are deemed necessary in order to optimize the diagnosis and personalize the management of patients with this rare entity.

Emerging treatment strategies for COVID-19 infection.

The new type of coronavirus (COVID-19), SARS-CoV-2 originated from Wuhan, China and has led to a worldwide pandemic. COVID-19 is a novel emerging infectious disease caused by SARS-CoV-2 characterized as atypical pneumonia. As of July 1, 2020, more than 10 million people worldwide had been infected with SARS-CoV-2. The typical manifestations of COVID-19 include fever, sore throat, fatigue, cough, and dyspnoea combined with recent exposure. Most of the patients with COVID-19 have mild or moderate disease, however up to 5-10% present with severe and even life-threatening disease course. The mortality rates are approximately 2%. Therefore, there is an urgent need for effective and specific antiviral treatment. Currently, supportive care measures such as ventilation oxygenation and fluid management remain the standard of care. Several clinical trials are currently trying to identify the most potent drug or combination against the disease, and it is strongly recommended to enroll patients into ongoing trials. Antivirals can be proven as safe and effective only in the context of randomized clinical trials. Currently several agents such as chloroquine, hydroxychloroquine, favipiravir, monoclonal antibodies, antisense RNA, corticosteroids, convalescent plasma and vaccines are being evaluated. The large numbers of therapeutic interventions aim to define the most efficacious regimen. The aim of this article is to describe the treatment strategies that have been used for COVID-19 patients and review all the available literature.

Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses.

BACKGROUND: The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity. METHODS: An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included. RESULTS: Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity. CONCLUSIONS: Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.

Meat, fish, dairy products and risk of hematological malignancies in adults - a systematic review and meta-analysis of prospective studies.

This systematic review and meta-analysis of cohort studies examine the association of meat, fish, and dairy product consumption with the risk of hematological neoplasms in adults. Thirteen studies encompassing 1,480,986 participants and 10,442 incident cases were included. Red or processed meat consumption was not associated with the risk of leukemia, acute myeloid leukemia, non-Hodgkin lymphoma (NHL) and small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL/SLL). Poultry consumption did not seem to affect the risk of leukemia, NHL, CLL/SLL, and multiple myeloma (MM). Fish consumption was not associated with leukemia, NHL, CLL/SLL, and MM risk. Interestingly though, fish consumption was positively associated with myeloid leukemia risk (pooled RR = 1.74, 95% CI: 1.22-2.47, random effects, highest vs. lowest category). Milk and dairy product consumption was not associated with NHL and leukemia risk. In conclusion, methodologically strict prospective studies are mandatory, in order to extract reliable conclusions concerning the role of these dietary factors in hematological malignancies.

Anthropometric characteristics, physical activity and risk of hematological malignancies: A systematic review and meta-analysis of cohort studies.

Overweight/obesity, adult attained height and physical activity are possible risk factors for hematological malignancies. This meta-analysis aims to evaluate the associations between these factors and hematological cancer risk in adults. Eligible cohort studies were sought in PubMed up to May 31, 2016; overall, 44 studies were included in the present analyses. Pooled relative risk estimates were calculated using random-effects models; separate analyses were conducted for non-Hodgkin lymphoma (NHL) and subtypes (diffuse large B-cell lymphoma, DLBCL; follicular cell lymphoma; small lymphocytic lymphoma/chronic lymphocytic leukemia, SLL/CLL), Hodgkin lymphoma (HL), multiple myeloma (MM), leukemia and subtypes (acute lymphoblastic leukemia, acute myeloid leukemia, AML). Obesity was associated with increased risk of NHL, HL, MM, leukemia overall and AML in both sexes, as well as with higher DLBCL risk in women; the dose-response meta-regression analysis confirmed these associations. Less pronounced effects were observed regarding overweight, as it was associated with increased MM risk in both sexes, NHL risk in males, DLBCL and overall leukemia risk in females. Taller men presented with significantly higher risk of NHL and taller women were affected by higher risk of NHL, DLBCL, FL, CLL/SLL, MM, leukemia and AML. On the other hand, physical activity and abdominal fatness were not associated with the risk of hematological malignancies. In conclusion, this meta-analysis highlights the pivotal role of anthropometric measures in shaping the risk of hematological malignancies in adults. Additional, well-designed studies stemming from all the continents are needed for the further substantiation and generalization of the results.

Micronutrient Intake and Risk of Hematological Malignancies in Adults: A Systematic Review and Meta-analysis of Cohort Studies.

There has been accumulating evidence that several micronutrients may play a protective role in the risk of solid cancers. However, their role in hematological malignancies remains to be elucidated; this meta-analysis aims to evaluate the associations between micronutrient intake as well as supplementation and risk of hematological cancer in adults. Eligible cohort studies (examining intake of vitamin A, vitamin C, vitamin D, vitamin E, lycopene, folate, iron, carotenoids, beta-carotene, selenium, pyridoxine) were sought in PubMed up to July 31, 2016. Random-effects models were used for the calculation of pooled relative risks (RR) with their 95% confidence intervals (CI). Twelve cohort studies were deemed eligible. Null associations were noted regarding supplemented vitamin A (pooled relative risk [RR] = 0.92, 95% confidence interval [CI]: 0.80-1.07), supplemented vitamin C (pooled RR = 1.00, 95%CI: 0.90-1.12), total vitamin D (pooled RR = 1.05, 95%CI: 0.91-1.20), supplemented vitamin E (pooled RR = 0.98, 95%CI: 0.88-1.10), and dietary lycopene intake (pooled RR = 1.00, 95%CI: 0.86-1.16) and the risk of non-Hodgkin lymphoma. No summary estimates are provided for other hematological malignancies due to the limited number of studies. Future prospective trials should be conducted for a better understanding of this field; especially regarding Hodgkin lymphoma, leukemia and plasma cell neoplasms, on which data are scarce.

Alcohol consumption and risk of hematological malignancies: A meta-analysis of prospective studies.

Current convincing evidence suggests that alcohol intake increases the risk of several carcinomas, which might subsequently lead to a recommendation toward limiting alcohol consumption. However, there are accumulating data worth meta-analyzing that show a different effect on the risk of hematological malignancies. Eligible cohort studies were sought in PubMed database up to August 31, 2016. Separate analyses were performed by subtype of hematological malignancy (non-Hodgkin lymphoma [NHL] and subtypes, Hodgkin lymphoma [HL], leukemia and subtypes), time status (ever, current, former), level of consumption (light, moderate, heavy), alcoholic beverage (total alcohol, beer, liquor, wine) and gender. Moderate and heavy alcohol consumption were significantly associated with reduced risk of NHL (relative risk [RR] = 0.85, 95% confidence interval [CI]: 0.80-0.90 and RR = 0.73, 95%CI: 0.60-0.89, respectively); a protective trend was also shown for light alcohol intake (RR = 0.93, 95%CI: 0.87-1.00). Specifically, beer consumption was associated with reduced NHL risk (RR = 0.88, 95%CI: 0.81-0.95). However, the association regarding other alcoholic beverages seemed null. The beneficial effects of alcohol mainly pertained to Diffuse Large B-Cell Lymphoma (DLBCL) (RR = 0.83, 95%CI: 0.77-0.89) and Follicular Lymphoma (FL) (RR = 0.85, 95%CI: 0.78-0.93). There was also no association between alcohol consumption and risk of HL or leukemias. In contrast to most solid malignancies, alcohol seems to confer a protective effect on NHL risk, especially on DLBCL and FL subtypes, with beer being notably beneficial.

Consumption of fruits, vegetables, and risk of hematological malignancies: a systematic review and meta-analysis of prospective studies.

We examined the association between fruit/vegetable consumption and the risk of hematological malignancies in cohort studies (end of search: August 31, 2016). Total fruit consumption was not associated with the risk of non-Hodgkin lymphoma (NHL) (RR = 1.03, 95% CI: 0.92-1.16, I2 = 12.1%, n = 7), acute myeloid leukemia (RR = 1.23, 95% CI: 0.94-1.61, I2 = 0%, n = 3), multiple myeloma (MM; RR = 1.05, 95% CI: 0.72-1.55, I2 = 60.0%, n = 4), and Hodgkin lymphoma. However, citrus fruit consumption was associated with reduced NHL risk (RR = 0.85, 95% CI: 0.73-1.00, p = .044, I2 = 0%, n = 6). Vegetable intake was marginally associated with reduced NHL risk (RR = 0.89, 95% CI: 0.79-1.00, p = .056, I2 = 16.2%, n = 7), but not with acute myeloid leukemia, multiple myeloma, and Hodgkin lymphoma risk. Nevertheless, NHL risk was inversely associated with cruciferous vegetable consumption (RR = 0.84, 95% CI: 0.71-1.00, p = .047, I2 = 0%, n = 3). Notably, combined fruit/vegetable consumption was associated with decreased NHL risk (RR = 0.79, 95% CI: 0.65-0.96, I2 = 11.2%, n = 3). This meta-analysis reveals possible protective effects; however, confounding and reporting bias could have affected the results.

Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-analysis.

OBJECTIVE: To examine the impact of surgical margin width on survival following R0 hepatic resection for colorectal metastases (CRLM). SUMMARY OF BACKGROUND DATA: Although negative resection margin is considered of paramount importance for the prognosis of patients with colorectal liver metastases, optimal resection margin width remains controversial. METHODS: Eligible studies examining the association between margin status after R0 hepatic resection for CRLM and survival, including overall survival (OS) and disease-free survival (DFS) were sought using the Medline, Cochrane, and EMBASE databases. Random-effects models were used for the calculation of pooled relative risks (RRs) with their 95% confidence intervals (95% CIs). RESULTS: Thirty-four studies were deemed eligible for inclusion representing a cohort of 11,147 hepatic resections. Wider resection margin (>1 vs <1 cm) was significantly associated with improved OS at 3 years (pooled RR = 0.86, 95% CI: 0.79-0.95), 5 years (pooled RR = 0.91, 95% CI: 0.85-0.97), and 10 years (pooled RR = 0.94, 95% CI: 0.88-1.00). Similarly, DFS was positively associated with >1 cm resection margin at 3, 5, and 10 years. Interestingly, >1 mm (vs <1 mm) resection margin was significantly associated with improved OS at all-time points. Meta-regression analyses did not reveal any significant modifying role of the study features under investigation, such as the administration of neoadjuvant/adjuvant therapy. CONCLUSIONS: Importantly, our findings suggest that while a >1 mm margin is associated with better prognosis than a submillimeter margin, achieving a margin >1 cm may result in even better oncologic outcomes and should be considered if possible.

The Emerging Role of Tyrosine Kinase Inhibitors in Ovarian Cancer Treatment: A Systematic Review.

The present systematic review summarizes current evidence regarding the mechanisms of action, the efficacy, and the adverse effects of tyrosine kinase inhibitors (TKIs) in ovarian cancer patients. Phase II and III clinical trials were sought in the PubMed database and in the Clinical Trials.gov registry through September 30, 2015. Seventy-five clinical trials regarding TKIs targeting mainly vascular endothelial growth factor receptor, epidermal growth factor receptor, platelet-derived growth factor receptor, and sarcoma tyrosine kinase (Src) were yielded. The most promising results were noted with cediranib, nintedanib, and pazopanib. However, drawing universal conclusions about the potential integration of TKIs in ovarian cancer therapy remains elusive. Furthermore, emerging challenges and directions for the future research are critically discussed.

Management and Outcomes in Metaplastic Breast Cancer.

Metaplastic breast cancer (MBC) constitutes a rare clinical entity with special clinicopathologic, immunohistochemical, and molecular features. Resistance to systemic therapies, whether chemotherapy or hormonal therapy, is among its main characteristics, which in turn explains the poor prognosis and renders its management a challenge. Thus, the scope of the present review is to discuss the current therapeutic strategies for MBC in clinical practice and the corresponding outcomes and to suggest possible directions for future research. Potential novel targeted therapies could provide a hope for better outcomes but limited data are available owing to the rarity of MBC. As knowledge accumulates on the pathogenesis and genetic characteristics of MBC, emphasis should be given to the implementation of more targeted treatments, which will allow more efficient and individualized management of the disease.

Physical Activity and Gastric Cancer Risk: A Systematic Review and Meta-Analysis.

OBJECTIVE: Physical activity represents a well-established way to prolong the life span; yet, it remains an unfulfilled goal for a great part of the population. In parallel, the burden of gastric cancer is considerable throughout the globe. In that context, the present meta-analysis aims to shed light on the association between physical activity and gastric cancer risk. DATA SOURCES: Eligible observational studies were sought in PubMed up to June 01, 2015. In addition, a snowball procedure was conducted and contact with authors was implemented. Separate analyses were performed by type of physical activity (total; occupational; recreational), study design, published/provided data, anatomical site, and study location, along with stratification by gender. MAIN RESULTS: Ten cohort studies (7551 incident cases in a total cohort size of 1 541 208 subjects) and 12 case-control studies (5803 cases and 73 629 controls) were eligible. "Any" type of physical activity was associated with lower risk of gastric cancer [pooled relative risk (RR) = 0.81; 95% CI: 0.73 to 0.89], which was reproducible in men (pooled RR = 0.87; 95% CI: 0.77-0.99). The protective effect was significant in the subgroup analyses of published data, noncardia cancer (pooled RR = 0.62; 95% CI: 0.52-0.75), and studies stemming from Asia (pooled RR = 0.82; 95% CI: 0.74-0.90). CONCLUSIONS: This meta-analysis suggests a protective effect of physical activity regarding gastric cancer risk, especially in Asian populations.

Obesity and Risk for Brain/CNS Tumors, Gliomas and Meningiomas: A Meta-Analysis.

OBJECTIVE: This meta-analysis aims to examine the association between being overweight/obese and risk of meningiomas and gliomas as well as overall brain/central nervous system (CNS) tumors. STUDY DESIGN: Potentially eligible publications were sought in PubMed up to June 30, 2014. Random-effects meta-analysis and dose-response meta-regression analysis was conducted. Cochran Q statistic, I-squared and tau-squared were used for the assessment of between-study heterogeneity. The analysis was performed using Stata/SE version 13 statistical software. RESULTS: A total of 22 studies were eligible, namely 14 cohort studies (10,219 incident brain/CNS tumor cases, 1,319 meningioma and 2,418 glioma cases in a total cohort size of 10,143,803 subjects) and eight case-control studies (1,009 brain/CNS cases, 1,977 meningioma cases, 1,265 glioma cases and 8,316 controls). In females, overweight status/obesity was associated with increased risk for overall brain/CNS tumors (pooled RR = 1.12, 95%CI: 1.03-1.21, 10 study arms), meningiomas (pooled RR = 1.27, 95%CI: 1.13-1.43, 16 study arms) and gliomas (pooled RR = 1.17, 95%CI: 1.03-1.32, six arms). Obese (BMI>30 kg/m2) females seemed particularly aggravated in terms of brain/CNS tumor (pooled RR = 1.19, 95%CI: 1.05-1.36, six study arms) and meningioma risk (pooled RR = 1.48, 95%CI: 1.28-1.71, seven arms). In males, overweight/obesity status correlated with increased meningioma risk (pooled RR = 1.58, 95%CI: 1.22-2.04, nine study arms), whereas the respective association with overall brain/CNS tumor or glioma risk was not statistically significant. Dose-response meta-regression analysis further validated the findings. CONCLUSION: Our findings highlight obesity as a risk factor for overall brain/CNS tumors, meningiomas and gliomas among females, as well as for meningiomas among males.