The effects of the COVID-19 pandemic on the diagnosis and prognosis of melanoma 2 years after the pandemic in two Romanian counties

Background

The COVID-19 pandemic disrupted the healthcare system and negatively affected the diagnosis and management of melanoma worldwide. The purpose of this study is to investigate the long-term effects of the COVID-19 pandemic on the diagnosis and prognosis of melanoma.

Materials and methods

This retrospective cohort study included histopathologically confirmed melanoma cases from March 2019 to February 2023 in Cluj and Bihor counties. Data from the post-COVID-19 period (March 2021 to February 2023) were compared to the pre-COVID-19 period (March 2019 to February 2020) and the COVID-19 period (March 2020 to February 2021). Patient characteristics, monthly diagnostics, histological subtypes, and key histological features were analyzed using statistical tests.

Results

The number of melanoma cases diagnosed annually decreased by 31.37 and 23.75% in the first and second post-pandemic years, respectively, compared to pre-pandemic numbers. Diagnostic rates also decreased by 14.9 and 5.4% in the first and second post-pandemic years, respectively, compared to the pandemic period. Prognostic factors worsened in the post-pandemic period, with higher Breslow index and mitotic rate, and increased ulceration and thick melanomas compared to the pre-pandemic period.

Conclusion

The COVID-19 pandemic had a long-lasting impact on the diagnosis of melanoma in Romania, resulting in advanced stages and unfavorable prognostic factors. Larger global studies are needed to comprehensively understand the pandemic's long-term effects on the diagnosis of melanoma.

Severe Acute Ischemia of Glans Penis after Achieving Treatment with Only Hyperbaric Oxygen Therapy: A Rare Case Report and Systematic Literature Review

Acute ischemia of the glands is a severe complication after circumcision. We outline the challenging case of a seventeen-year-old boy with glandular ischemia (GI) that appeared shortly after circumcision. Methods: We present a case report and literature review related to glans ischemia, and the complications of circumcision are reviewed. We note that there are very few cases described in the literature. Our patient was successfully treated with hyperbaric oxygen therapy (HBOT) after four days of no positive effect after all medical and surgical treatments written in the literature: Subcutaneous enoxaparin, local application of a glyceryl trinitrate, continuous epidural perfusion, intravenous pentoxifylline, alprostadil, intraoperative drainage, and aspiration with saline solution and epinephrine. Clinical improvement was noted at the first session of HBOT. A number of days after the operation, the penis looked normal and was healing. Complete healing of the penile glans was successfully realized one month after surgery. Conclusion: Based on the review and the case presented, we conclude that HBOT is the treatment of choice for acute ischemia of the penile glans, especially when other treatments do not work.

Impact of the COVID-19 Pandemic on Melanoma Diagnosis in Romania-Data from Two University Centers

The COVID-19 pandemic affected the healthcare system in our country and led non-COVID patients to postpone medical visits that were not urgent. The purpose of this study was to investigate the impact of the first year of the COVID-19 pandemic on the trends in melanoma diagnosis and to compare the pathological characteristics of melanoma patients before and during the pandemic. The number of primary cutaneous melanomas diagnosed each month between 1 March 2019 and 29 February 2020 (pre-COVID-19) and between 1 March 2020 and 28 February 2021 (COVID-19) in the North-Western Region of Romania (Cluj and Bihor counties) was determined. The pathological characteristics of melanomas diagnosed in the two intervals were compared. The number of melanoma diagnoses substantially decreased during the pandemic, with 66 (-19.3%) fewer cutaneous melanomas being diagnosed in the first year of the pandemic when compared with the previous year. The tumor thickness and mitotic rate were significantly higher in cases found during the COVID-19 pandemic. Our study suggests that COVID-19 has delayed diagnosis in patients with melanoma, leading to the detection of thicker melanomas that may increase morbidity and mortality. Further studies are needed to determine the consequences of this delay on outcomes.

Advantage of proton-radiotherapy for pediatric patients and adolescents with Hodgkin's disease

Abstract

Radiotherapy is frequently used in the therapy of lymphoma. Since lymphoma, for example Hodgkin’s disease, frequently affect rather young patients, the induction of secondary cancer or other long-term adverse effects after irradiation are important issues to deal with. Especially for mediastinal manifestations numerous organs and substructures at risk play a role. The heart, its coronary vessels and cardiac valves, the lungs, the thyroid and, for female patients, the breast tissue are only the most important organs at risk. In this study we investigated if proton-radiotherapy might reduce the dose delivered to the organs at risk and thus minimize the therapy-associated toxicity.

Methods

In this work we compared the dose delivered to the heart, its coronary vessels and valves, the lungs, the thyroid gland and the breast tissue by different volumetric photon plans and a proton plan, all calculated for a dose of 28.8 Gy (EURO-NET-PHL-C2). Target Volumes have been defined by F18-FDG PET-positive areas, following a modified involved node approach. Data from ten young female patients with mediastinal lymphoma have been evaluated. Three different modern volumetric IMRT (VMAT) photon plans have been benchmarked against each other and against proton-irradiation concepts. For plan-evaluation conformity- and homogeneity-indices have been calculated as suggested in ICRU 83. The target volume coverage as well as the dose to important organs at risk as the heart with its substructures, the lungs, the breast tissue, the thyroid and the spinal cord were calculated and compared. For statistical evaluation mean doses to organs at risk were evaluated by non- parametric Kruskal-Wallis calculations with pairwise comparisons.

Results

Proton-plans and three different volumetric photon-plans have been calculated. Proton irradiation results in significant lower doses delivered to organ at risk. The median doses and the mean doses could be decreased while PTV coverage is comparable. As well conformity as homogeneity are slightly better for proton plans. For several organs a risk reduction for secondary malignancies has been calculated using literature data as reference.

According to the used data derived from literature especially the secondary breast cancer risk, the secondary lung cancer risk and the risk for ischemic cardiac insults can be reduced significantly by using protons for radiotherapy of mediastinal lymphomas.

Conclusion

Irradiation with protons for mediastinal Hodgkin-lymphoma results in significant lower doses for almost all organs at risk and is suitable to reduce long term side effects for pediatric and adolescent patients.

Electronic supplementary material

The online version of this article (10.1186/s13014-019-1360-7) contains supplementary material, which is available to authorized users.

Predicting the outcome of mid-urethral tape surgery for stress urinary incontinence using preoperative urodynamics - a systematic review

Urodynamics are currently widely used in most of urogynecology services, mainly as a diagnostic tool routinely preoperatively or for complicated cases. The urodynamic parameters, mainly Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP), are increasingly researched for the promising value in predicting the outcome of urinary incontinence surgery. Despite the increasing evidence, their predictive role for mid-urethral sling surgery outcome is still unclear. We systematically searched theliterature for articles published between January 1990 to January 2014, analysing the value of urodynamic variables in predicting the outcome of mid-urethral sling surgery. We calculated relative risks of failure of surgery for patients with low MUCP and VLPP compared with those with high values.Low preoperative MUCP was associated with higher risk of failure for both transobturator and retropubic techniques (RR1.83; 95% confidence interval (CI) 1.44-2.33 and RR 1.41;95% CI 1.17-1.69 respectively). Low preoperative VLPP was predictive as well for higher risk of failure for both transobturator and retropubic routes (RR 1.76; 95% CI 1.37-2.28 and RR 2.01; 95% CI 1.56-2.60 respectively). Concluding, preoperative MUCP and VLPP could be used as predictors for postoperative outcome after mid-urethral sling surgery for SUI.

Development and performance evaluation of a dynamic phantom for biological dosimetry of moving targets

A dynamic phantom has been developed to allow for measurement of 3D cell survival distributions and the corresponding distributions of the RBE-weighted dose (RBED) in the presence of motion. The phantom consists of two 96-microwell plates holding Chinese hamster ovary cells inside a container filled with culture medium and is placed on a movable stage. Basic biological properties of the phantom were investigated without irradiation and after irradiation with a carbon ion beam, using both a stationary (reference) exposure and exposure during motion of the phantom perpendicular to the beam with beam tracking. There was no statistically significant difference between plating efficiency measured in the microwells with and without motion (0.75) and values reported in the literature. Mean differences between measured and calculated cell survival for these two irradiation modes were within +/-5% of the target dose of 6 Gy (RBE).

Human papilloma virus and cervical preinvasive disease

Cervical cancer lesions represent a major threat to the health of the women worldwide. Human Papillomavirus (HPV) is responsible for 99.7% of cervical cancer cases, the infectious etiology giving the possibility of preventing cervical cancer by vaccination. The most aggressive HPV types are 16 and 18, which cause about 70% of cases of invasive cancer. The vaccination is recommended to the girls aged 11-12. The diagnosis and the treatment of cervical preinvasive disease allow the doctor to prevent the development of the invasive disease.

Sensitive detection of Fusarium circinatum in pine seed by combining an enrichment procedure with a real-time polymerase chain reaction using dual-labeled probe chemistry

Fusarium circinatum is the causal agent of pitch canker disease on numerous Pinus spp. This aggressive fungus may infect pine seed cryptically and, therefore, can easily be spread long distances by the seed trade. F. circinatum has recently been listed as a quarantine organism in numerous countries throughout the world, which prompted the development of a specific and sensitive tool for the detection of this pathogen in conifer seed. A new detection protocol for F. circinatum based on a biological enrichment step followed by a real-time polymerase chain reaction (PCR) assay was developed. Several enrichment protocols were compared and a 72-h incubation of the seed with potato dextrose broth was the most efficient technique to increase F. circinatum biomass before DNA extraction. The relative accuracy, specificity, and sensitivity of the real-time PCR assay was evaluated in comparison with a previously published conventional PCR test on 420 seed DNA extracts. The real-time PCR described here proved to be highly specific and significantly more sensitive than the conventional PCR, and enabled the detection of F. circinatum in samples artificially contaminated with less than 1/1,000 infected seed, as well as in naturally infected samples. Last, in order to routinely check the quality of the seed DNA extracts, a primer-probe combination that targets a highly conserved region within the 18S ribosomal DNA in plants or fungi was successfully developed. This assay allows for quick and reliable detection of F. circinatum in seed, which can help to prevent long-distance spread of the pathogen via contaminated seed lots.

Nuclear fragmentation cross-sections of 400AMeV 36Ar and 40Ar in collisions with light and heavy target nuclei

We have measured fragmentation cross-sections of Ar projectile nuclei at beam energy of 400 A MeV using experimental set-ups with plastic nuclear track detectors and different targets. In this paper total charge changing cross-sections and elemental fragmentation cross-sections for the production of fragments with charges ZF > or = 7 in interactions with H, C, Al, Cu, Ag and Pb target nuclei are presented. The dependence of the cross-sections on the fragment charge number and target charge number are discussed. The experimental results are compared to predictions of semi empirical cross-section models.

Sensitivity to augmentin and cephalosporines of some bacterial strains isolated from hospitalized patients

The study allowed the determination of the degree of antibacterial efficiency of three antimicrobial agents belonging to the betalactamine family namely cefuroxime (IInd generation), ceftazidime (IIIrd generation) and augmentin. Likewise the relationship bacterial species-antibiotic could be established. It was found that the pathogenic staphylococcus strains were very sensitive to cefuroxime (92.1%) and equally sensitive to ceftazidime and augmentin (61.0%). The enterococci were 100% sensitive to augmentin and 100% resistant to both cephalosporines. The enterobacteriaceae presented a higher percentage of sensitive strains to cephalosporines than to augmentin 89.6% of the E. coli strains were sensitive to ceftazidime, 77.9% to cefuroxime and 27.3% to augmentin. Klebsiella was sensitive in 68.2%, 45.14% and 13.6% of the cases to ceftazidime, cefuroxime and respectively augmentin. Proteus presented 64.7% strains sensitive to ceftazidime, 35.3% sensitive to cefuroxime and 29.3% sensitive to augmentin. All the enterobacter strains proved resistant to the three antibiotics studied.