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Introduction Acute appendicitis (AA) is the most common surgical emergency in pediatric patients, yet its diagnosis remains challenging due to variable clinical presentations and the overlap with other causes of abdominal pain. Predictive scores can enhance diagnostic accuracy, reduce unnecessary surgeries, and optimize resource utilization, especially in resource-limited settings. This study aimed to identify key predictive factors for acute appendicitis in children and to develop a combined clinical and biological scoring system to enhance diagnostic accuracy for this condition. Patients and methods We prospectively enrolled children aged 2 to 14 years presenting with abdominal pain to the pediatric surgery department at Fattouma Bourguiba University Hospital over a one-year period. Clinical, biological, and sonographic data were analyzed to identify key predictive factors and derive a predictive scoring model for acute appendicitis in this population. Model performance was assessed using the area under the curve (AUC) on the same dataset used for model derivation. Results Among 420 children presenting with abdominal pain, 91 (21.7%) were diagnosed with AA. The median age of the children was 7 years, with a male-to-female ratio of 1.48. Binary logistic regression identified the following predictive factors: right iliac fossa tenderness, right iliac fossa guarding, positive right single-leg hop, and neutrophil percentage ≥ 75%. The predictive model achieved an AUC of 0.901 (95% CI [0.85–0.93]) with a significance of P < 0.0001. The optimal cut-off for the model was 5, yielding a sensitivity of 61.04%, specificity of 95.38%, positive predictive value (PPV) of 76.4%, and negative predictive value (NPV) of 90.5%. Stratified management strategies based on the score were proposed to guide clinical decision-making effectively. Conclusion The developed predictive score offers a simple, practical, and highly specific tool for diagnosing AA in pediatric emergencies. Its integration of functional signs, such as the right-sided single-leg hop test, enhances clinical utility, making it particularly valuable in resource-constrained settings. Further validations are warranted to confirm its generalizability and reliability. Clinical trial number Not applicable. Level of evidence II

The simultaneous occurrence of Wilms tumor (WT) and multicystic kidney disease (MCKD) is extremely uncommon. Diagnosing WT in pediatric patients with multicystic dysplastic kidney (MCDK) substantially impacts management strategies, especially in surgical interventions and long-term outcomes. In summary, while the exact prevalence of WT in children with MCKD is not well-defined, children with MCDK are followed up throughout childhood by ultrasound because of the perceived risk of developing WT, although this risk is poorly defined and somewhat controversial. Herein, we present the case of an 8-year-old child diagnosed with WT arising in a clearly defined MCDK, discovered incidentally through histological analysis. This case contributes to the ongoing discussion by adding to the existing reports in the literature.

The association between multiple myeloma and solid cancers is rarely described in the literature. Some authors report that multiple myeloma increases the risk of developing some cancers such as breast cancer. We report three cases of multiple myeloma and breast cancer metachronous in order to study the etiopathogenesis of this association. Such a big spectrum of these studies should be done to understand whether there is a relation between causes of these two diseases or the risk factors behind this rare association. Our objective is to be able to define patients with high and low risk of developing secondary cancer in order to adapt the therapies and propose possibly screening for colon and breast cancers every two years for patients with high-risk multiple myeloma.

ObjectiveChemotherapy-induced peripheral neurotoxicity (CIPN) ranges from simple paresthesia to paralysis, which may be transient or irreversible. The aim of our study was to detect CINP in our patients undergoing chemotherapy and to study the cumulative neurotoxic doses for the different drugs.MethodsThis is a cross-sectional prospective study carried out in the medical oncology department of the Habib Bourguiba University Hospital in Sfax. A survey was conducted to detect and explore possible chemo-induced peripheral neuropathy in patients undergoing known potentially neurotoxic anti-cancer treatments.ResultsSeventy-three patients were included in the study. The average age was 51.8 years (13–80 years). The prevalence of CIPN was 52.1%. CIPN was classified as grade I in 24 (63.2%) cases and grade II in 14 (36.8%) cases. No grade III or IV peripheral neuropathy was detected in our patients. Paclitaxel was the drug with the highest incidence of CIPN (76.9%). The chemotherapy (CT) protocols most prone to chemotherapy-induced peripheral neurotoxicity (CIPN) were based on taxanes (47.3%) and oxaliplatin (59%). Paclitaxel was the drug most likely to cause CIPN (76.9%) (p=0.031). Paclitaxel single dose per cycle of 175 mg/m2 (66.67%) was more associated with the occurrence of CIPN than 80 mg/m2 (40%), but without significant difference (p=0.437). The average cumulative dose was estimated at 315 mg/m2 for docetaxel, 474 mg/m2 for oxaliplatin and 579 mg/m2 for paclitaxel (p=0.16).ConclusionThe prevalence of NPCI was 51.1% in our series. Oxaliplatin and taxanes were the main contributors to this complication with cumulative dose over than 300 mg/m2.

Purpose The use of complementary and alternative medicine (CAM) is common among breast cancer patients, but less is known about whether CAM influences breast cancer survival. The primary aim of this study was to determine the impact of self-use of herbs on the overall survival. Methods This was a prospective study including 110 patients with breast cancer. All patients were questioned about the concept of taking herbs. We analyzed the demographic data and the overall survival. Results The average age was 51 years (30–80 years old). 37 had metastatic disease (33.6%). 48 patients had taken plants (43.6%). 19 patients consumed Graviola (39.6%) and 29 Alenda (60.4%). Overall survival at 3 years and at 5 years were, respectively, 96.2% and 82.4% in the absence of plant consumption versus 78.5% and 78.5% in case of plant consumption ( p  = 0.015). Conclusion This study concluded that self-medication with Graviola or Alenda may be associated with an increase of death risk in patients with breast cancer. Further studies are needed to confirm these results.

A totally implantable venous access port (TIVAP) plays a crucial role in the treatment of patients in oncology. Catheter fracture is a serious complication with an estimated incidence of 0, 1% - 1%. The objective of this systematic review is to analyze the mechanism of TIVAP fracture to make physicians aware of this fatal entity. A search of the literature between 1980 and 2019 was conducted using PubMed, Ovid, MEDLINE, and Cochrane Systematic Review databases. The search identified 18 case reports and 8 retrospective studies. Fracture of the middle part of the catheter may be induced by constant compression of the catheter between the first-rib and clavicle, which is called the pinch-off syndrome. Catheter fracture at the port-catheter junction may be caused by extrinsic compression near the port-catheter junction combined with material fatigue due to repeated bending of the catheter with shoulder movement. There is no specific cause for the fracture of a catheter tip. An annual chest X-ray is recommended for the early detection of TIVAP catheter fracture. Percutaneous endovascular retrieval of a dislodged Port-A catheter is both safe and effective. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2020;57(12):686-689.

Table 1 Factors correlated with the diagnosis of breast cancer and cancer concerns Diagnosis of cancer Cancer concerns P value χ2 value P value χ2 value Family history of breast cancer 0.07 2.456 0.06 2.586 Educated versus illiterate 0.1 1.231 0.03 3.5624 Work versus no work 0.2 1.564 0.08 2.356 Age>40 versus ≤40 years 0.0001 6.779 0.001 5.352 BIRADS 5 versus BIRADS 4 0.0001 5.872 0.2 1.235 Mass at physical examination versus no mass 0.0001 5.601 0.02 4.521 Right versus left breast 0.09 2.786 0.7 1.256 p significant if <0.05. Cancer is often described as the ‘number one’ health fear, but little is known about whether this affects quality of life by translating into high levels of concerns or distress in everyday life. Because cancer fear is an unpleasant emotion, as well as potentially influencing cancer-protective behaviours, it is important to gain a better understanding of its origins and consequences, and find ways to minimise its impact on quality of life without undermining participation in cancer prevention.2 We suggest that these women may particularly benefit from discussions regarding the possibility of false-positive test results. Contributors WBK: data collection, statistical analysis, writing and revision.

Metastases of ovarian carcinoma to the breast are uncommon. The incidence of ovarian metastasis to the breast ranges from 0.5% to 1.2%. Nevertheless, its detection and distinction from other primaries, especially primary breast carcinoma, is important as treatment and prognosis differ significantly. We report the case of a 38-year-old Tunisian woman with bilateral metastases to breast from ovarian carcinoma. Through a review of literature, we discuss the clinical, radiological and histological characteristics of ovarian metastases to the breast.

Background Multiple myeloma (MM) is a systemic disease in the elderly. Its incidence in patients younger than 40 years old and especially in pregnant women is extremely rare. MM may involve extraosseous sites, and only in rare cases it is observed in the breast. Case report We describe the case of a 39-year-old woman diagnosed with an IgG lambda light-chain MM (Durie-Salmon stage IIIA, International Staging System II) in the 26th week of pregnancy, presenting with bilateral breast lumps. Dexamethasone (20 mg/m 2 /day on days 1–4, 9–12, and 17–20) was given as an induction agent to decrease tumor mass during pregnancy. Adverse response to dexamethasone was minor with excellent tolerance. A healthy baby was delivered at week 34 of gestation. Conclusion Breast nodules revealing MM are extremely rare. Clinical and radiological features are atypical. Presentation during pregnancy is extremely rare, making anti-MM treatment potentially challenging.