The Influence of Serum Leptin Level and Body Mass Index on the Prognosis of Patients with Diffuse Large B Cell Lymphoma

Background: More research is ongoing on obesity as a risk factor for cancer occurrence.Cell of origin (COO), stage and National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) are frequently used for risk evaluation and treatment tailoring in patients with Diffuse large B-cell lymphoma (DLBCL). Relatively, few studies assessed the prognostic role of obesity and leptin level in patients with DLBCL. Aim: The aim of this study was to investigate the effect of obesity and leptin level on response and prognosis in DLBCL. Methods: A single institution prospective study that included patients with DLBCL. For each patient, demographic data, body mass index (BMI), serum leptin level by ELISA, response and survival were determined. Results: Seventeen (24.3%) out of the 70 patients in our cohort were classified as obese (BMI>30). They had a higher serum leptin level (p < 0.001) and less response to R-CHOP chemotherapy (P= 0.003). Forty (57.14%) patients had elevated serum leptin level with B symptoms, Cell of origin and response to chemotherapy were significantly different between the two groups.  There was no significant relationship between BMI and survival. On the other hand, higher serum leptin was associated with worse disease-free survival (p=0.035). Conclusion: The results support a relationship between both BMI and serum leptin level and response to treatment in DLBCL patients. Leptin level like other common prognostic factors is related to disease-free survival

Heat Stroke in Emergency Department: Diagnosis and Management

Background: Heat stroke is a severe health concern with the potential for multi-organ failure, necessitating rapid and effective management. With rising global temperatures, there is increasing concern regarding the vulnerability of populations in high-heat areas, notably in Saudi Arabia, especially during the annual Hajj pilgrimage. Objective: This paper aims to review the epidemiology, evaluation and management techniques of heat stroke, emphasizing the situation during Hajj pilgrimages in Saudi Arabia, and to outline the best practices for emergency management. Methodology: A comprehensive review of literature and studies related to heat stroke, both globally and specific to Saudi Arabia, was undertaken. An in-depth analysis of emergency management, including initial assessment, cooling methods, organ support, medication, and prevention strategies, was conducted. Results: Heat stroke remains a significant cause of emergency department visits, with specific groups, such as men and the elderly, being more susceptible. During the Hajj in 2016, 267 patients were diagnosed with heat-related illnesses, with heatstroke accounting for 29% of these cases. With the threat of global warming, studies indicate a potential tenfold increase in heat stroke risk with a 2°C rise in temperatures. Swift and comprehensive cooling is pivotal for recovery. Management emphasizes rapid recognition, assessment, and varied cooling methods, along with targeted treatments for organ dysfunctions. Prevention strategies play a vital role, given the higher efficacy and practicality over treating organ dysfunctions. Conclusion: Heat stroke is a pressing health challenge, particularly in high-risk environments like Saudi Arabia during the Hajj pilgrimage. While effective emergency management protocols exist, an emphasis on prevention is crucial. It is imperative to incorporate a comprehensive approach to address both the immediate threat and long-term risks of heat stroke, especially with the looming challenge of global warming

Synchronous occurrence of primary mucinous carcinoma of recto-sigmoid colon and primary breast Carcinoma: A case report and review of literature

Background: Multiple primary malignant tumors (MPMTs) is simultaneous occurrence of two or more malignancies in different sites with different histopathological type and origin.Diagnosis and management of those patients are challenging due to uncertain guidelines. Case Presentation: A 63-year-old postmenopausal female patient of synchronous MPMTs in which the patient was diagnosed with a malignant mass in recto-sigmoid colon and a synchronous breast cancer was incidentally discovered during clinical and radiological patient evaluation. Treatment: Both colon procedure and breast procedure were performed together in one setting. The anterior resection of the reco-sigmoid mass and colocolonic anastomosis were done. Conclusion: Synchronous colon and breast cancer treatment plan should be individualized for each patient through a complete preoperative evaluation and MDT meeting to provide the best possible treatment for the patient