Breast Cancer Survivors and COVID-19: Prevalence and Risk of Severe Disease in a Screening Study

Background

Determining the risk of severe course coronavirus disease 2019 (COVID-19) and its related factors in survivors of common cancers such as breast cancer is important. This study has been designed to evaluate the prevalence of COVID-19 infection in breast cancer survivors and also estimate the risk of severe disease in this population.

Methods

Out of 6134 patients in the Shiraz Breast Cancer Registry (SBCR), A total of 292 patients who elapsed less than a year from their breast cancer diagnosis were excluded. We called 5842 patients. Finally, 4135 breast cancer survivors who agreed to cooperate were screened for COVID-19 symptoms by a symptom-based questionnaire in November 2020. COVID-19 in symptomatic participants was confirmed by a polymerase chain reaction (PCR) test. The clinical and paraclinical data of the COVID-19 course were collected for patients with a positive PCR test.

Results

A total of 247 (5.9%) participants had at least reported one of the COVID-19 symptoms. Also, 17% of symptomatic participants had a positive PCR test; 83.7% had mild disease, 9.5% moderate, and 16.7% had severe conditions. Chronic cardiovascular disease, hypertension, and diabetes were related to an increased risk of severe illness ( P = 0.018, P = 0.018, P = 0.002).

Conclusion

This study suggests that breast cancer intermediate and longtime survivors without other underlying diseases are considered at low risk for developing severe/critical COVID-19.

Clinical and manometric evaluation of postoperative anorectal function in patients after trans-anal pull-through for Hirschsprung disease

Background

Transanal endorectal pull-through (TEPT) surgery is a new trend in the treatment of Hirschsprung disease, and evaluating its functional outcome is difficult. The purpose of this study is to evaluate the defecation pattern after TEPT surgery in pediatrics.

Material and methods

In this cross-sectional survey, 40 patients with Hirschsprung disease were studied. They underwent a one-stage transanal pull-through procedure from May 2007 till April 2015 in Namazi hospital by the same surgeon. All the patients had the aganglionic segment in the rectosigmoid, confirmed by pre-operation barium enema and post-operation histopathology. The patients were 40 children with mean operation age of 36.6 months old. The success rate of surgery was evaluated by following the questionnaire form. Clinical evaluation with bowel function score and anorectomanometry were carried out.

Result

One hundred percent of them had a daily stool. Eighty-five percent of patients never experienced pain during defecation, 10% experienced occasional pain, and the rest felt pain with every defecation. Just one case (5%) reported using a laxative. Regarding improvements after the operation, 75% were completely okay, 20% felt much better, and 5% reported some improvements. The average National Health Service score was 8.375, which seems satisfactory. The mean average anal sphincter in the group with soiling was 39.67 and in the group without soiling was 34.83, which is in the normal range in both groups, and there was no significant difference between these groups (P > 0.05).

Conclusion

The defecation pattern after TEPT surgery were satisfactory in almost all cases, even in infancy. Most patients had satisfactory manometry and clinical result.

Association between Pre-Operative 25-Hydroxy Vitamin D Deficiency and Surgical Site Infection after Right Hemicolectomy Surgery

Background: Surgical site infection (SSI) is one of the most important and costly complications of surgical operations. The present study hypothesized that vitamin D deficiency is associated with an increased risk of SSI, and this current study investigated this hypothesis. Patients and Methods: A prospective cohort study was performed with adult patients undergoing open right hemicolectomy operation with stapled anastomosis between February 2018 and March 2021 in the surgery ward of Imam Khomeini hospital. A logistic regression test examined and analyzed the connection between serum 25-OH vitamin D levels and post-operative wound infections. Results: This study comprised 315 participants who met the inclusion criteria. Pre-operative serum vitamin D levels were <30 ng/mL in 107 participants (34%) and ≥30 ng/mL in 208 participants (66%). The mean serum vitamin D level was 35.66 ± 13.26 ng/mL among the study population. Increased vitamin D deficiency was linked with elevated odds of surgical wound infection incidence among the patients after surgery (odds ratio [OR], 5.49; 95% confidence interval [CI], 2.06-14.6; p = 0.001). Conclusions: Pre-operative vitamin D level strongly affects post-operative SSI in patients with colon cancer. This study highlighted the importance of conducting further research to determine the possible advantages of vitamin D in preventing incision infection after surgery.

Rectus sheath hematoma in COVID‐19 patient: The importance of abdominal pain in the course of COVID‐19

We report herein a case of a 58‐year‐old woman with COVID‐19. During the hospitalization, the patient complained of acute abdominal pain, and abdominal CT revealed the rectus sheath hematoma (RSH). Since corticosteroids and anti‐coagulation are commonly administered in COVID‐19 patients, physicians should consider RSH as a possible diagnosis for acute abdominal pain.

Acute Hemolytic Transfusion Reaction Due to Anti-c Rhesus Antibody in a Patient With Subdural Hematoma: A Case Report Emphasizing the Shortcoming of Spin Cross-Match

The Rh blood group system is a complex blood group which includes different antigen specificities such as c antigen. Anti-c antibody is associated with both acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Rh mediated hemolytic transfusion reactions (HTR) are mostly immunoglobulin G (IgG) mediated and results in extravascular hemolysis and delayed HTR (DHTR). However, we are presenting a case of acute intravascular hemolytic transfusion reaction due to anti-c in a patient with acute subdural hematoma. A 77-year-old woman was referred to our hospital with a loss of conscious and left-sided hemiparesis. After an emergency MRI, she was diagnosed with Acute Subdural hematoma, and an emergency craniotomy was performed. Since Acute Subdural hematoma is a neurosurgery emergency, laboratory technician performed an Immediate-spincrossmatchedd for blood bag to preserve time. During the transfusion of the first packed cell, the patient developed severe hypotension and tachycardia. Thus, the transfusion was stopped. Laboratory results raised the suspicion of an Acute Intravascular Hemolysis. Antibody identification revealed that the patient had an irregular blood phenotype (C2+/c-/E-/e3+/K-), and the presence of alloantigen-c Rh antibody confirmed the suspicion of HTR. In patients with multi transfusion history and pregnant women, pre-transfusion screening of irregular antibodies must be performed. The immediate spincrossmatchh must be prevented in patients with a history of multi transfusions, even in emergency situations.