Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Introduction: Mucormycosis, an aggressive fungal infection, has emerged as a severe complication in COVID-19 patients, particularly in those with diabetes mellitus and corticosteroid exposure. This systematic review aims to assess the epidemiology, clinical characteristics, treatment outcomes, and risk factors of post-COVID-19 mucormycosis.

Materials and Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Embase. Observational studies, case series, and case reports describing mucormycosis in confirmed COVID-19 patients were included. Data extraction focused on demographic details, risk factors, clinical manifestations, therapeutic strategies, and outcomes. Meta-analysis was performed where applicable, with heterogeneity assessed using I² statistics.

Results: Among 1,245 cases, the majority were male (66.84%) with a mean age of 54.72 years. Diabetes mellitus (73.97%) and corticosteroid use (70.48%) were major risk factors. Rhino-orbital-cerebral mucormycosis was the predominant form (69.80%). Antifungal therapy, primarily liposomal amphotericin B (80.97%), and surgical debridement (63.37%) were mainstay treatments. The in-hospital mortality rate was 41.13%, highlighting poor prognosis.

Conclusion: Post-COVID-19 mucormycosis poses significant challenges, with high morbidity and mortality. Early diagnosis, judicious steroid use, and timely surgical intervention are crucial for improving outcomes. Enhanced surveillance and access to antifungal therapy are essential in mitigating this growing threat.

Abstract Introduction: Neoadjuvant chemoradiotherapy (nCRT) has emerged as a promising approach for improving surgical and oncologic outcomes in locally advanced gastric cardia cancer (LAGCC). This study aims to evaluate the impact of nCRT on tumor downstaging, resection rates, and postoperative complications compared to surgery alone.

Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing nCRT followed by surgery versus surgery alone in patients with LAGCC (cT3–T4 and/or N+) were included. Key outcomes analyzed included tumor and nodal downstaging rates, R0 resection rates, operative time, postoperative complications, and length of hospital stay. Statistical heterogeneity was assessed using the I² statistic, and pooled estimates were calculated using appropriate models.

Results: Patients receiving nCRT demonstrated significantly higher tumor downstaging rates (63.46% vs. 30.87%, p<0.001) and nodal downstaging rates (39.74% vs. 18.46%, p<0.001). R0 resection was more frequent in the nCRT group (89.42% vs. 80.87%, p=0.004). Postoperative complications, including severe complications and anastomotic leakage, were comparable between groups. However, nCRT was associated with a longer operative time (214.83 vs. 196.42 min, p=0.031) and hospital stay (13.52 vs. 12.11 days, p=0.029).

Conclusion: nCRT significantly improves tumor downstaging and R0 resection rates without increasing severe postoperative complications. These findings support its role as a standard treatment in LAGCC.

Abstract Introduction: Post-thyroidectomy hemorrhage is a rare but serious complication that can lead to airway compromise and increased morbidity. Identifying the risk factors associated with postoperative bleeding is essential for optimizing patient selection, surgical techniques, and perioperative management. This systematic review aims to evaluate patient-related and surgical risk factors contributing to post-thyroidectomy hemorrhage.

Materials and Methods: A comprehensive systematic review was conducted following PRISMA guidelines. Studies assessing risk factors for post-thyroidectomy hemorrhage were retrieved from PubMed, Scopus, Web of Science, and Embase. Inclusion criteria encompassed observational studies and randomized controlled trials investigating hemorrhage-related factors. Data extraction included demographic characteristics, comorbidities, surgical details, and bleeding incidence. Statistical analyses were performed to determine the odds ratios (ORs) for significant predictors.

Results: A total of 27 studies involving 8,452 patients were analyzed. Key risk factors for hemorrhage included age >55 years (OR: 2.89, p<0.001), male sex (OR: 1.87, p=0.002), hypertension (OR: 3.21, p<0.001), diabetes (OR: 2.68, p<0.001), and anticoagulant use (OR: 3.02, p<0.001). Surgical factors, including total thyroidectomy (OR: 2.91, p<0.001), prolonged operative time >120 minutes (OR: 3.75, p<0.001), and surgeon inexperience (<100 cases, OR: 4.32, p<0.001), were strongly associated with increased bleeding risk.

Conclusion: Post-thyroidectomy hemorrhage is influenced by both patient and surgical factors. Identifying high-risk individuals, optimizing perioperative care, and ensuring surgical expertise can significantly reduce complications. Future research should focus on predictive models and improved hemostatic strategies.

Abstract Introduction: Hepatitis C Virus (HCV) infection remains a major concern among dialysis patients due to the high risk of nosocomial transmission. Despite advancements in infection control, significant variability in HCV prevalence persists across dialysis populations. Identifying key risk factors is essential for improving preventive strategies and patient outcomes.

Materials and Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Embase to identify studies assessing HCV risk factors in dialysis patients. Inclusion criteria encompassed observational studies in adult dialysis populations, while case reports and pediatric studies were excluded. Data on study characteristics, HCV prevalence, and associated risk factors were extracted and statistically analyzed.

Results: HCV prevalence among dialysis patients ranged from 9.38% to 15.04%. Key risk factors included prolonged dialysis duration (>5 years, OR: 3.45), history of blood transfusions (OR: 2.87), reuse of dialysis filters (OR: 2.42), inadequate infection control (OR: 4.12), and hemodialysis modality (OR: 1.89). Geographic variability in prevalence was also observed.

Conclusion: HCV transmission in dialysis patients is driven by multiple modifiable risk factors. Strengthening infection control measures, enhancing routine screening, and expanding access to antiviral therapies are crucial for reducing the burden of HCV in dialysis settings.