The consumption of alcohol has long been associated with the development of liver disease as well as cancers including colorectal cancer (CRC). Leading healthcare concerns include the prevalent use of alcohol and the high burden of CRC mortality. Many CRC deaths are attributed to the development of colorectal liver metastasis (CRLM) as the liver is the foremost site of CRC spread. However, an association has not been defined for the role of alcohol intake and related liver injury with the development of CRLM. Here, a mapping review of recent research was undertaken to evaluate the relationship between alcohol consumption and the risk of CRLM. The literature search revealed 14 articles meeting the inclusion criteria that included patient database analyses and preclinical studies. Most of the human data analyses found alcohol use independently associates with worse CRC outcomes. The preclinical evaluations identified several pathways involved in the alcohol-mediated promotion of CRLM burden and CRC cell metastatic behavior. The limited number of studies identified exposes a significant need for more prospective analyses to define the role of alcohol intake and advanced CRC as well as the translation of preclinical research to fully characterize targetable mechanisms for the generation of new therapeutic options.
Introduction: In late 2019, a novel strain of coronavirus, discovered in the city of Wuhan, China, was found to cause a disease later named coronavirus disease 2019, or COVID-19. In January 2020, COVID-19 first reached the Gulf region. Afterwards, the disease spread rapidly across the countries of the Gulf and the number of COVID-19 cases rose significantly. Now, more than a year later, there are only a limited number of studies regarding COVID-19 and its behavior in this region. In this article, we aim to assess the mortality caused by the disease in the Gulf region by calculating the Case Fatality Rates (CFR) for all of the Gulf Cooperation countries and comparing the results with those of Europe. Methods: Data was obtained from the official statistics of the World Health Organization (WHO) from January to May 2020. From the data, the CFR was calculated for every Gulf and European country included in the study. Following the calculation, the results were compared and analyzed. To make our comparison more accurate, we added the total number of COVID-19 tests per 1000 population and the Health Access and Quality index for each individual country. Results: CFRs in the Gulf region to May 12, 2020 were: United Arab Emirates (1.06%), Kuwait (0.69%), Saudi Arabia (0.62%), Oman (0.45%), Bahrain (0.15%), and Qatar (0.06%). Within Europe over the same time period, 10 countries had CFRs above 10%, with the majority above 3%. Conclusions: Compared to Europe, the COVID-19 mortality rate in the Gulf region has been much lower. The difference in age groups between the Gulf region and Europe may be the most important factor, mainly due to a younger population and a smaller elderly demographic in the Gulf region. Although age is a strong factor for the lower CFR in the Gulf, other factors must also be considered. These include the number of COVID-19 tests conducted per population, different country capabilities, and varying criteria for reporting COVID-19 deaths(Table–1)(Table–2). Table 1 Extracted from WHO Weekly Epidemiological Update and Weekly Operational Update on 12/5/2021. Country Total Cases Total Deaths Case Fatality Rate Total Number of COVID-19 Tests per 1,000 People Healthcare Access and Quality Index Saudi Arabia 41,014 255 0.62% 19.89 79.4 United Arab Emirates 18,878 201 1.06% 186.34 72.2 Kuwait 9,286 65 0.69% 60.02 82 Qatar 23,623 14 0.06% 59.16 85.2 Bahrain 5,236 8 0.15% 150.23 79 Oman 3,721 17 0.45% N/A 77.1 COVID-19 related data for individual Gulf countries. N = 6 Table 2 Extracted from WHO Weekly Epidemiological Update and Weekly Operational Update on 12/5/2021. Country Total Cases Total Deaths Case Fatality Rate Total Number of COVID-19 Tests per 1,000 People Healthcare Access and Quality Index Spain 227,436 26,744 11.75% 47.51 89.6 Italy 219,814 30,739 13.98% 52.46 88.7 Germany 170,508 7,533 4.42% 43.35 86.4 United Kingdom 223,064 32,065 14.37% 35.55 84.6 France 137,491 26,600 19.35% N/A 87.9 Belgium 53,449 8,707 16.29% 66.78 87.9 Netherlands 42,788 5,456 12.75% 17.53 89.5 Switzerland 26,670 3,256 12.2% 41.94 91.8 Portugal 27,679 1,144 4.13% 69.56 84.5 Ireland 23,135 1,467 6.34% 60.89 88.4 Austria 15,874 620 3.91% 42.15 88.2 Sweden 26,670 3,256 12.20% N/A 90.5 Poland 16,326 811 4.97% 16.33 79.6 Romania 15,588 972 6.24% 17.28 74.4 Denmark 10,513 533 5.07% 86.84 85.7 Norway 8,106 224 2.76% 41.95 90.5 Czech Republic 8,176 282 3.45% 35.51 84.8 Serbia 10,176 218 2.14% 28.93 75.4 Belarus 23,906 135 0.56% 41.03 74.4 Ukraine 16,023 425 2.65% 5.68 72.7 Finland 5,984 271 4.53% 30.36 89.6 Luxembourg 3,888 101 2.60% 102.65 89.3 Republic of Moldova 4,995 179 3.58% N/A 73.1 Greece 2,726 151 5.54% 13.38 87 Hungary 3,313 425 12.83% 14.77 79.6
Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.
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