Low platelet to lymphocyte ratio and high platelet distribution width have an inferior outcome in chronic lymphocytic leukaemia patients

Introduction.  Chronic lymphocytic leukaemia (CLL) is an incurable disease of the elderly, characterised by gradual accu­mulation of small mature B lymphocytes which escape apoptosis through inflammatory signals from the microenviron­ment. Elevated inflammatory markers are associated with very poor prognosis in different types of cancer. Therefore, we examined retrospectively the impact of platelet lymphocyte ratio (PLR) and platelet distribution width (PDW) on 180 CLL patients’ outcome. Materials and methods.  This retrospective study included 180 patients with CLL who were diagnosed and selected among cases referred to the Oncology Center Mansoura University between January 1st, 2008 and June 30th, 2016. All the relevant information was collected from the electronic medical records of the selected patients. Results.  Our results revealed that low PLR (<2.5) was more frequently observed in patients with stage C (p < 0.001), with 17p deletion (p = 0.017), and CD38 expression (p = 0.08), but not with seropositive HCV patients (p = 0.2). High PDW (≥18.5 fl) was more frequently associated with intention to treat population (p = 0.038), and CD38 expression (p = 0.068), but not with 17p deletion (p = 0.25) and seropositive HCV patients (p = 0.4). Multivariate analysis for overall survival showed that stage A and low PDW were independent factors for overall survival (p = 0.014 and 0.04 respectively), while high PLR (p = 0.05), and seronegative HCV patients (p = 0.1) lost their significance. Conclusion.  Our data showed that low PLR and high PDW were associated with poor prognostic markers. Stage C-CLL and high PDW were independent predictors of survival

Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours

<p>Abstract</p> <p>Background</p> <p>surgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps.</p> <p>Methods</p> <p>Ninety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients.</p> <p>Results</p> <p>Wound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all.</p> <p>Conclusions</p> <p>Immediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.</p

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda. (Globalsurg Collaborative