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Background and Objectives: Sentinel lymph node (LN) biopsy (SLNB) remains to be the standard approach for surgical axillary staging of breast cancer (BC) patients. The aim of this study was to investigate the factors that affect axillary LN involvement in early BC patients. Materials and Methods: Clinically node negative early stage (cT1-2N0) BC patients having undergone breast conserving surgery (BCS) between February 2021 and January 2024 were included. During axillary exploration of all cases, sentinel LNs were excised and reserved for permanent section pathological examination (PS) only. Historical records of patients including clinicopathological features, surgical outcomes as well as pathological results were recorded and analyzed retrospectively. p < 0.05 indicated statistically significant results. Results: The study group consisted of 150 women with cT1-2N0 BC having undergone BCS with a median age of 59 (range: 25–81) years. According to the PS results of the sentinel LNs, the need for reoperation to complete axillary lymph node dissection was present in three (2%) patients. Tumors of the Luminal B subtype were significantly associated with increased sentinel LN positivity (p = 0.014). The risk of sentinel LN metastasis was found to be 5.2 times greater in patients with a Ki-67 ≥ %14 [OR: 5.224 (%95 CI:1.73–15.82, p = 0.003)] and the Ki-67 proliferation index was determined as an independent risk factor. Conclusions: In early-stage BC patients, PS of the excised sentinel LN offers sufficient axillary LN staging. On the other hand, a more careful clinical assessment is necessary for early BC patients harboring tumors with an elevated Ki-67 index and/or tumors of the Luminal B subtype.

Violence against physicians is a global issue that causes impaired physical and mental health, declined work quality, resignations, and even suicides. Studies regarding violence against physicians are very limited. Therefore, our aim is to investigate the physical violence incidents against physicians presented in print media between 2008 and 2018. A total of 8612 news reports acquired in national news database via 45 keywords were assessed. Five hundred and sixty-four of the reports met the inclusion criteria and were retrospectively analyzed. Of 5964 news reports, 3754 (62.9%) were reprimands and protests against violence incidents. In 11 years, 560 individual incidents occurred where 647 physicians were physically assaulted, with 2267 news reports written on those incidents. The number of incidents increased over the years, and in 2012 both the number of incidents (n=91) and news reports count per incident were found highest. About 77.7% of assaulted physicians were male, and incident rate was higher in Western Turkey (42.15%). In 11 years, ten dedicated physicians have lost their lives in the line of duty. Emergency medicine (20.4%), primary care (9.89%) were the departments most exposed to physical violence. The claim of receiving inadequate medical attention was noted to be the primary allegation of the assailants. The frequency of physical violence incidents against physicians is increasing. Throughout the study period, news reports containing condemnations, critiques, and protests are also more frequently, yet not adequately, placed in print media. Thus, social and public awareness ought to be enhanced through national and global media outlets. Furthermore, extensive measures must be taken by governments in order to prevent and eliminate violence.

Perceptions towards Complementary and Alternative Medicine (CAM) are highly variable but are improving globally. However, studies conducted in Jordan about CAM are insufficient. This study aims to explore the attitudes and barriers towards using CAM among university students in Jordan. This cross-sectional study was conducted at the University of Jordan. A self-administered paper questionnaire was distributed to 475 students from the Faculties of Medicine, Pharmacy and Engineering of all academic years. Descriptive and multivariate data analysis was done using SPSS v.20. Seventy percent of all the participants have used at least one type of CAM. Younger female pharmacy students were most likely to use CAM. There were significant differences between students of different academic years regarding their opinions on CAM (p < 0.024). The percentage of medical students who believed that combining CAM with modern medicine would improve the overall treatment quality was significantly lower than the other two faculties (p < 0.001). Of the students who never used CAM, 39% did not do because they doubted its effectiveness. There is a need for including CAM in the universities’ curriculum as mandatory courses for health faculties and elective courses for other disciplines.

Introduction:Malignant melanoma (MM) is a tumor that develops from skin-derived melanocytes and has a poor prognosis. Extracutaneous involvement of MM is also known, and one of these localizations is in the gastrointestinal tract. The study investigated gastrointestinal MM cases diagnosed as primary or metastatic in terms of their clinicopathological findings and survival rates.Methods:Patients diagnosed with gastrointestinal MM in our clinic between August 2013 and December 2022 were retrospectively evaluated. Data including demographics, physical examination, laboratory and imaging findings, surgical procedures, oncological treatment status, presence of metastasis, histopathological features, and mortality were recorded and analyzed.Results:The study group consisted of 9 patients: 4 (44.5%) women and 5 (55.5%) men with a mean age of 57.8±13.5 (median: 61, range: 40-75). Surgery could not be performed in four patients because of locally advanced or metastatic disease. Radical surgical interventions were performed in 4 (44.4%) patients who were operable. A second surgical intervention was performed in one patient. The mean duration of hospital stay of surgically treated patients was 6.4±4.3 (median: 5, range: 2-13) days. The mean overall survival in these patients was 40.0±25.7 (median: 40, range: 12-74) months. Three (33.3%) patients who underwent surgery are still being followed up.Conclusion:In operable cases of histopathologically proven primary or metastatic MM disease, surgical treatment has an important impact on terms of providing local control and improving survival.

Objective: Soft Tissue Sarcomas are rare mesenchymal tumors with many subtypes. Clean margin wide resection is recommended for treatment.In this study, the location, histopathological features, clinical and demographic features, recurrence and prognosis of retroperitoneal sarcomas were investigated. Methods: The demographic, histopathological and immunohistochemical data of 18 patients who were operated on with the diagnosis of retroperitoneal mass between March 2016 and June 2021 were evaluated retrospectively. Results: 18 patients were included in the study. 10 patients were male and 8 patients were female. The mean age was 57 (23-81), the median age was 55. While 14 patients were primary sarcoma, 4 patients were recurrent sarcoma. The most common complaint was abdominal pain with 38,87%. The average follow-up time was 26 (0-55) months. The postoperative mean hospitalstay was 5,83 (2-8) days. The average size of the tumor was 19,81 (6,5-36) cm. A total of 8 different histopathological sarcoma types were detected. The most common histology was Dedifferentiated Liposarcoma (44,45%). R0 resection in 10 patients, R1 resection in 6 patients and R2 resection in 2 patient were performed. Organ resection was performed in 6 patients due to organ invasion. During follow-up, 10 patients had a local recurrence and underwent reresection and 6 patients died. The 30-day mortality number was 0. The mean time to detect relapse was 9,3 (1-55) months. Metastasis developed in 2 (11, 11%) patients. Conclusion:Although we are a low-volume hospital for retroperitoneal sarcomas, our results are similar to those in the literature. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 829-835

Peutz-Jeghers syndrome may be presented with gastrointestinal and extra-intestinal malignancies. Herein, we report a case of Peutz-Jeghers syndrome with a malignant intestinal polyp accompanied by synchronous multiple hamartomatous gastrointestinal polyps that was treated with simultaneous surgical and endoscopic polypectomies.

Background: Cancer is the second leading cause of death globally and is estimated to account for 9.6 million death in 2018. Lung, prostate, colorectal, stomach and liver cancers are those most common among men; while breast, colorectal, lung, cervix and thyroid cancers are most frequent types among women. Objectives: The present study aims to assume a leading role for forthcoming researches to establish a national cancer registry database in Mogadishu, Somalia. Methodology: This is a retrospective 6-months analysis of cancer patients whose data were achieved from pathology department registries of Liban and Veritas Hospitals in Mogadishu, Somalia. Results: 126 (M/F: 51 (41.5%) / 75 (59.5%)) patients were included in the study. Esophagus had been recorded as the most frequent site of organ which was diagnosed with cancer (n=74 (58.7%)). Squamous cell carcinoma was recorded to be the most frequent histopathologically confirmed subtype (n=91 (72%), M/F:34/57), which was followed by adenocarcinoma (n=16 (12.7%), M/F:11/5) and sarcoma (n=6 (4.8%), M/F:5/1) consequtively. Majority of both squamous cell carcinoma (n=37 (40.7%)) and sarcoma patients (n=3 (50%)) were >60 years of age, whereas patients diagnosed with adenocarcinoma (n=7 (43.75%)) were between 41-50 years of age. Conclusion: Emphasis should be placed on finding ways to ensure early detection and diagnosis of cancer in Mogadishu, Somalia promptly. That should begin by giving educations to community to raise public awareness, and establishing national cancer registry to reveal up-to date data in order to make risk assessment and coordinate management strategies accordingly. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.756-761

All adult patients referred to the emergency department (ED) with distal radius fractures were asked to provide informed consent for participation in the study when the performer of USG-guided nerve block was on duty. A single emergency physician (EP), experienced in bedside ultrasound using the M7 model ultrasound machine with 5- to 12-MHz high-frequency linear transducer (Mindray Bio-Medical Electronics Co, Shenzen, China), performed USG-guided supracondylar nerve block with an average 10 mL 2% lidocaine for each patient; this procedure required 5.5 minutes on average when he is on duty. A single emergency physician (EP), experienced in bedside ultrasound using the M7 model ultrasound machine with 5- to 12-MHz high-frequency linear transducer (Mindray Bio-Medical Electronics Co, Shenzen, China), performed USG-guided supracondylar nerve block with an average 10 mL 2% lidocaine for each patient; this procedure required 5.5 minutes on average when he is on duty.

We aimed to present a case of appendiceal mucocele who was admitted with abdominal pain, operated under elective conditions and found to have been spontaneously drained from the root of the appendix to the colon in surgical exploration. A 41-year-old male patient was admitted to the emergency department with abdominal pain. In clinical examination; tenderness, rebound and defense in the lower right quadrant of abdomen and leucocytosis were detected. Computerized tomography scan showed the appearance of a cystic dilated appendix. After resolution of the physical examination findings based on the antibiotic treatment, we decided to perform elective surgery. In surgical exploration, ileocecal resection was performed by determining the mucocele of the appendix that had been spontaneously drained from the root of the appendix into the cecum lumen. On the sixth day after the operation, he was discharged without complications. Histopathological examination revealed high-grade appendiceal mucinous neoplasia. Our patient’s follow-up in the first year after the surgery revealed no recurrence. The patient is disease-free at the end of his first postoperative year. The mucocele of the appendix is a cystic neoplasia containing mucin and its perforation during surgery may result in the development of pseudomyxoma peritonei in the late period. In our case, the fact that the lesion was spontaneously drained into the lumen of the colon reduced the risk of the mucocele rupturing and spreading into the abdomen during surgery.

Objective: Acute appendicitis (AA) is the most common cause of acute abdominal and emergency surgery worldwide. Over the past decades, the incidence of AA has been increasing, and with minimally invasive technology, treatment modalities are changing. This study aimed to examine the incidence of AA in Istanbul, Turkey over the years and seasons and investigate the rates of open and laparoscopic appendectomy (LA). Methods: This retrospective cohort study reviewed the archives of the Turkish Association of Trauma and Emergency Surgery between January 2012 and December 2019. Data from 11 tertiary hospitals with heavy patient flow from Istanbul were included. Descriptive statistics and univariate analysis of variance tests were performed. Statistical significance was defined as p-values of <0.05. Results: A total of 39,932 AA cases were evaluated. The cumulative incidence of AA in Istanbul was 123/100,000 between 2012 and 2019, with increasing incidence over the years (p=0.01). LA rates have increased, and 68.5% of the cases were laparoscopically managed in 2019. AA rates were slightly higher in spring than in other seasons (p>0.05). Conclusion: The incidence rate of AA and its laparoscopic management are significantly increasing in Istanbul.