Hassan Awad Saad

Background: Intra-ductal cancer (IDC) is the most common type of breast cancer, with intra-lobular cancer (ILC) coming in second. Surgery is the primary treatment for early stage breast cancer. There are now irrefutable data demonstrating that the immune context of breast tumors can influence growth and metastasis. Adjuvant chemotherapy may be administered in patients who are at a high risk of recurrence. Our goal was to identify the processes underlying both types of early local recurrences. Methods: This was a case-control observational study. Within 2 years of receiving adjuvant taxan and anthracycline-based chemotherapy, as well as modified radical mastectomy (MRM), early stage IDC and ILC recurred. Vimentin, α-smooth muscle actin (SMA), platelet-derived growth factor (PDGF), matrix metalloproteinase (MMP1), and clustered differentiation (CD95) were investigated. Results: Of the samples in the ductal type group, 25 showed local recurrence, and 25 did not. Six individuals in the lobular-type group did not experience recurrence, whereas seven did. Vimentin (p = 0.000 and 0.021), PDGF (p = 0.000 and 0.002), and CD95 (p = 0.000 and 0.045) expressions were significantly different in ductal and lobular carcinoma types, respectively. Measurement of ductal type was the sole significant difference found in MMP1 (p = 0.000) and α-SMA (p = 0.000). α-SMA and CD95 were two variables that helped the recurrence mechanism in the ductal type according to the pathway analysis. In contrast, the CD95 route is a recurrent mechanism for the lobular form. Conclusions: While the immune system plays a larger role in ILC, the tumor microenvironment and immune system both influence the recurrence of IDC. According to this study, improving the immune system may be a viable cancer treatment option.

An elevated risk of mortality, secondary sarcopenia, multiorgan dysfunction, sepsis, and severe oxidative stress are all brought on by major burn injuries. They also set off a systemic inflammatory response and a chronic hypermetabolic and hypercatabolic state. Following heat damage, poor clinical outcomes have been linked to calorie shortfalls, negative protein balance, and antioxidant micronutrient insufficiency. In this situation, early enteral feeding at the onset of resuscitation, together with tailored nutrition therapy, is recommended. Various pharmacological and dietary therapies targeting immunological and metabolic response modulation have been studied during the past 40 years. In this patient population, these tactics have demonstrated the ability to reduce acute malnutrition, control the immunoinflammatory response, and enhance pertinent clinical outcomes. Summarising the most recent research on nutrition therapy and metabolic response in critically ill burn patients is the aim of this updated review. Keywords Burn wounds; Emergency medical care; Intense metabolism; Acrometalization; Tiny nutrition; Phospholipid

Context and purpose Research reviews the findings, course of therapy, and outcomes of gastric metastases (GM). With this investigation, we hope to contribute to the increasing amount of information by providing practitioners with a reliable and practical platform for understanding stomach metastases from various primary malignancies. Methods: This study covered papers published in English from the MEDLINE and Cochrane databases until May 2022. The deleted materials included editorial emails, billboards, surgical photos, and non-English publications. Hematogenous and lymphogenic metastases were noted, yet primary tumor progression and dissemination were not. Using pre-established criteria for eligibility, the ultimate selection was made after the articles and abstracts were reviewed and cross-referenced. Results: A total of 186 GM cases were listed in 1,521 papers that were eventually found. The average of sixty-two years. The majority of GM cases (67) were attributed to reproductive cancers, with lung tumors (33 patients), carcinoma of the kidney (20 patients), and melanomas (19 patients) trailing closely behind. The main treatment strategy for metastases is excision surgery (n = 62), often in combination with immunotherapy or chemotherapy (ChT). Among the 78 therapeutic options, ChT was the second-most preferred choice. Furthermore, immunotherapy was one of the most preferred treatment alternatives (n = 10) following surgery and ChT. Conclusions: Heterogeneity was inevitable because 172 case reports from different journals were included in this systematic review. Certain papers have omitted crucial facts such as comprehensive monitoring and scientific information. Additionally, since every article featured was a personal study, it was not possible to evaluate the quality of the work. In the majority of the 172 cases that were examined, resected procedures occurred; on rare occasions, immunotherapy and ChT were also combined. The best course of action for patients with stomach metastases requires further investigation.

Background The benefits of ghost ileostomy (GI) in avoiding formal covering ileostomies in > 80% of cancer patients have been documented in numerous studies. However, none of the articles explained precisely how the GI tract was removed in the end in 80% of patients for whom formal maturation was not necessary. Goal To describe and evaluate the GIRD technique, including possible issues, hospital stays, and procedure times, for patients with GI for rectal carcinoma who underwent low anterior resection (LAR/uLAR) or ultra-low anterior resection (LAR/uLAR). Methods In this prospective cohort study, patients underwent restorative colorectal resection with GI for rectal cancer. Patients’ ease of GI release and any problems that might arise were then examined. Information was gathered, examined, and deduced. Results The final statistical analysis included 26 patients who required GIRD. Between the seventh and sixteenth postoperative days (POD), treatment was performed, all patients recovered well, and no additional surgeries were required. No further analgesics or injections of local anesthesia were required for any of the patients. The surgery took an average of five minutes, and none of the patients experienced any notable difficulties with GI release. No post-procedural issues emerged. Conclusion Without the need for anesthesia or additional analgesics, the GIRD approach is a rapid, easy, and safe operation that can be performed at the patient's bedside around the tenth POD.

Setting This investigation looked at the consequences of neuromuscular mesh reinforcing following posterior component separation (CS) and transversus abdominis muscle release (TAR) in patients with primary abdominal wall dehiscence (AWD). The frequency of incisional hernias (IH) at the area of operation following AWD restoration with posterior CS and TAR strengthened by neuromuscular mesh, as well as the potential variables for IH, served as the other goals. Methods The time frame for this prospective, multicenter cohort study was April 2015–January 2020. A total of 404 individuals administered posterior CS with TAR release supported by a neuromuscular mesh had median laparotomies and were identified with category IA primary AWD (Björck's first categorization). Results The mean age of the group was 42 ± 10 years, with women making up 59.9% of the total. From the midline laparotomy index surgery to the primary AWD, the average time was 7 ± 3 days. The vertical length had an average of 16 ± 2 cm. The average time interval between the onset of AWD and the posterior CS + TAR procedure was 3.1 ± 1 days. The average duration of operation for posterior CS with TAR was 95 ± 12 min. The AWD did not reappear. The percentages of cases with seroma, hemorrhage-contaminated mesh, infection from the surgical site (SSI), and IH were 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. 2.5% of mortality was recorded in total. Old age, sex, cigarettes, albumin value < 3.5 gm%, SSI, ileus, contaminated mesh, and the time between AWD and posterior CS + TAR with bridge surgery were significantly more common in IH patients. IH rates were 0.5% and 8.9% at 2 and 3 years, respectively. Ileus, SSI, contaminated mesh, and the interval between AWD and posterior CS + TAR operations were identified as variables that indicated IH in multivariate logistic regression analysis. Conclusions When posterior CS with TAR and retro-muscular mesh implants were combined, the low mortality rate was 2.5%. Additionally, minimal relapse rates of AWD and IH were noted.

Background:Perianal abscess is an infectious disease that frequently affects the perianal region. Body mass index (BMI) is a commonly used statistic to assess weight and weight gain. Although there is evidence linking obesity to several medical conditions, the relationship between BMI and perianal abscesses remains unclear. Whether BMI influences the likelihood of perianal abscess remains unclear. Methods A two-sample Mendelian randomization (MR) study was conducted using weighted average, weighting the median, weighted inverse-variance weighted (IVW), and MR-Egger regression approaches. Using the accessible to everybody summarized collections of GWAS meta-analyses for BMI among people of South Asian descent (n = 8,658) as being exposed, a genome-wide association experiment (GWAS) for anal and rectal abscess from people who are involved in the OpenGWAS database (total n = 183 710; case = 1 287, control = 182 423) was used as the outcome. Results: We used GWASs to find 29 single nucleotide polymorphisms (SNPs) of genome-wide relevance, using BMI as the variable in question. The IVW technique indicateds that there was not enough information to determine a cause-and-effect link between BMI and perianal abscess (Beta = -0.093, SE = 0.097, P = 0.340). An analysis of MR-Egger regression revealed a lack of causality between BMI and perianal abscess (beta = -0.254, SE = 0.177, P = 0.162). The analysis also showed that directed multiplication did not influence the results (intercept = 0.024; P = 0.285). Furthermore, there is no evidence that a link between BMI and perianal abscess exists according to the weighted mean (Beta = -0.207, SE = 0.182, P = 0.813) or weighted median (Beta = -0.126, SE = 0.139, P = 0.363). The funnel plot and Cochran's Q test, which also revealed no evidence of diversity or imbalances, demonstrated that there was no directional pleiotropy. In summary, there were insufficient data from the MR analysis to substantiate the theory linking a greater BMI with a higher incidence of perianal abscess.

Context According to national guidelines, a mortality risk assessment should be performed on all patients undergoing emergency surgery at the time of admission. This will allow the hospital to assign the "high-risk" patient the proper seniority and level of care. Our goal was to determine whether perioperative risk scoring systems could reliably estimate the risk of death and morbidity. Methods 86 consecutive emergency laparotomies had their mortality risk scores determined using pre-operative risk calculation techniques (ASA, Lee index) and post-operative risk calculation tools (POSSUM, P-POSSUM, and CR-POSSUM). Using the Clavien-Dindo classification, morbidity risk scores were computed using the POSSUM projected morbidity and compared to actual morbidity. Results In reality, the death rate was 10.5%. All laparotomies had average predicted risk scores of 26.5% for ASA, 2.5% for Lee Index, 29.5% for POSSUM, 18.5% for P-POSSUM, and 10.5% for CR-POSSUM. Seventy-eight percent of the 67 laparotomies had complications. Most (51%) of the problems were categorized as non-life-threatening in Clavien-Dindo grades 2–3. Compared to patients who projected a morbidity risk of less than or equal to 50%, patients with a POSSUM morbidity risk of greater than 50% suffered significantly more life-threatening complications (CD 4-5) (P = 0.01). Summary Because the ASA overpredicts mortality risk and the Lee Index underpredicts it, pre-operative risk categorization is still difficult. We propose that patients who need intensive care after surgery can be identified with greater accuracy by utilizing the CR-POSSUM for post-operative risk grading. In conclusion It is impossible to audit the fulfillment of national standards of care for the "high-risk" patient in a reliable manner in the absence of reliable risk scoring instruments that can be utilized at the time of hospital admission.

Context Here, we discuss our surgical experience treating traumatic diaphragmatic hernias while attempting to determine the historical influence of various time periods on mortality risk factors and outcomes. methods From Mau 2005 to April 2022, we operated on 126 individuals who had been with traumatic diaphragmatic hernias in emergency Zagazig University Hospital. In order to show the features of the injuries, determine the best course of treatment, identify death risk factors, and compare two time periods (2010–2016 and 2016–2022) separated by the introduction of computed tomography at our institution, the patient records were examined and statistically evaluated. Results The average age of the population was 31.2 ± 16.3 years, with a ratio of 11/52 for men to women. In 38 cases (30.2%), penetrating trauma was the mechanism; in 88 cases (69.9%), blunt trauma was the cause. Computed tomography was performed on two-thirds of the patients in the second group (201 6–2022) but not on any of the patients in the first group (2010–2016). Twenty patients (15.9%), with four in the second group and sixteen in the first (p = .042), received their diagnoses later than expected. Thoracotomies were the most often performed incision (n = 86, 89.6%). Between the two periods, there was no statistically significant variation in either mortality or etiology. According to univariate analysis, survivors outnumbered non-survivors in terms of age, injury severity scores (ISS), and American Association for the Surgery of Trauma (AAST) grade. Increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were found to be risk factors for death in all patients by multivariate logistic regression analysis. In conclusion The preoperative diagnostic rate has increased dramatically with the use of high-definition computed tomography. With favorable results, the transthoracic technique may be performed in certain cases of traumatic diaphragmatic hernia. Patients who are older and have a higher ISS have a higher mortality rate.

Context Receiving a personalized forecast for lip squamous cell carcinoma (LSCC) is crucial. This study aimed to develop predictive models for postoperative prognosis prediction in LSCC patients. Methods Two medical institutes provided 136 postoperative LSCC patients diagnosed between April 2015 and July 2022. The patients were randomly assigned to training and validation groups at a 7:3 ratio. Based on the results of univariate and multivariate Cox regression analyses, two nomograms were made to predict overall survival (OS) and progression-free survival (PFS) in LSCC patients who had surgery. Results According to univariate and multivariate Cox regression analyses, a lower pathological grade, being older than 70 years, having a higher T-stage, positive lymph node metastasis (LNM), perineural invasion (PNI), vascular invasion (VI), and positive surgical margin were all independent predictors of a lower OS. The independent predictors of worse PFS included higher pathological grade, age ≥ 70 years, higher T-stage, LNM, PNI, and positive surgical margins. Two nomograms were created based on the data above to forecast the 3- and 5-year OS and PFS rates in patients with LSCC. In the training group, the C-indices for the OS and PFS nomograms were 0.865 and 0.801, respectively, whereas those in the validation group were 0.915 and 0.815, respectively. The calibration curves demonstrated a reasonable degree of agreement between the observed survival rates and the predictions. Conclusions Curve analysis revealed superior performance of the nomogram compared to other related predictors. Kaplan-Meier curves showed statistical distinctions between the high-, medium-, and low-risk groups. In summary, With a good clinically personalized applicability value, this retrospective study developed and validated two nomograms for predicting OS and PFS in patients with postoperative LSCC.