On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.
The goal of this study is to compare the response rate and the recurrence rate of available therapeutic modalities in the treatment of Idiopathic Granulomatous Mastitis (IGM). 374 patients with pathologically confirmed IGM, were included. They were subdivided into three levels of severity. Close observation had the best response rate with the lowest recurrence rate in mild to moderate cases. Severe cases were mostly treated by prednisolone or underwent surgery. The outcome of prednisolone use in severe cases was comparable to NSAIDs. Overall 9% were resistant to treatment and surgical intervention is still an option among them.
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Introduction: To survive is the first concern of people after disasters. The ability to keep performing and offering services in hospitals at the same time as appropriate responding to the medical needs of disaster victims, matters tremendously. An effective element in this regard is having appropriate safety level in hospitals. The aim of this study was to specify the safety index of hospitals covered by Alborz University of Medical Sciences. Methods: This descriptive-provisional study was conducted between 2014 and 2015 in Alborz province. Nine public hospitals, affiliated with Alborz University of Medical Sciences, were chosen by the means of census method. The data collection tool was the standard tool of hospital safety index, WHO / PAHO, through which the level of hospital safety (in three structural, non-structural and functional areas) were determined. Data were analyzed through Excel software. The outcomes were rated between zero to one, and accordingly, in terms of safety, hospitals were classified as either A, B or C. Results: Based on the results of this study, most of the examined hospitals were at B level of safety. Although the group B hospitals can put up with disasters in time but, their vital equipment and services will be put at jeopardy. Conclusion: Measuring the safety index of hospitals as well as determining their level of safety, it can be figured out how much a hospital can preserve its organization and function in disasters. This index will be helpful for decision makers and policymakers, when it comes to prioritizing management and civil interventions.
Background: The gut microbiota influences human health and disease. Alterations in gut microbiota may have pathological consequences. Scientific knowledge about gut microbiota can facilitate predicting the likelihood of certain intestinal and/or extra-intestinal diseases. There are six main phyla in gut including Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, Verrucomicrobia, and Fusobacteria, among which Proteobacteria and Fusobacteria are associated with colon cancer. Association of the gut microbiota pattern with colon cancer is conceivable because of their close proximity. Accordingly, breast tissue microbiota has been associated with breast tumor. Objective: This study aimed to identify the gut microbiota pattern in breast cancer, therefore, the six phyla in fecal sample from patients with breast cancer were investigated and compared with those from healthy individuals and colon cancer patients. Methods: Real-time polymerase chain reaction (PCR) was performed on DNA extracted from fecal samples based on variable region of 16S ribosomal DNA gene of the six main phyla in the gut. Results: Bacteroidetes and Firmicutes levels in breast cancer patients were higher than those in colon cancer patients and healthy individuals. Inversely, Actinobacteria, Verrucomicrobia, Proteobacteria, and Fusobacteria levels in breast cancer were lower than those in colon cancer patients and healthy individuals. Conclusion: Taking into account the decreased level of oncogenic microbiota in fecal sample from breast cancer patients compared to the level of that from colon cancer or healthy cases as well as the presence of oncogenic microbiota in breast tumor, some bacteria may have translocated from gut to breast tissue in some circumstances which likely contribute to the breast tumorigenesis (gut-tumor axis). Migration of the bacteria from gastrointestinal tract to tumor may have occurred in a similar fashion to that of the bacteria from gastrointestinal to fetus. It is worth mentioning that tumor and fetus are immune privileged sites.
Background Idiopathic granulomatous mastitis (IGM) is a rare benign disease involving breast parenchyma mostly in periareolar region. Women of childbearing with recent history of pregnancy and lactation are more at risk of IGM. The common locations of IGM are retro areolar and periareolar of the breast, however involvement of axillary region has never been reported elsewhere. Case presentation A 36-year-old female with history of two times pregnancy and lactation 8 months prior to presentation, referred with pain and swelling in the right axillary area. The past medical history and habitual history were negative and she did not use oral contraceptives or other medications. Local physical examination showed normal breasts with bilateral accessory breasts. A tender mass with the size of 4x6cm was palpable in the right axillary region accompanied by erythema and a few secretory fistulas without lymphadenopathy. Routine blood test came back negative and serum prolactin was normal. Ultra-sonography (US) demonstrated a soft tissue swelling, edema, and decreased echogenicity area in the right axillary region compatible with IGM. The patient started on prednisolone 50 mg per day, and the condition has not been improved for two months. To exclude other possible etiologies due to atypical location, the patient underwent a second US and core-needle biopsy which confirmed the diagnosis of axillary IGM. Prednisolone tapered off and a non-steroidal anti-inflammatory drug (NSAID) started. All the symptoms improved in a month and fully resolved in 3 months. Conclusion Since IGM is not fully known yet, the presentation and the location can be variable. Considering IGM as a probable diagnosis in inflammatory presentation in the axillary region in patients with accessory breasts is suggested.
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