Direct oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice. However, their use in the treatment of acute venous thromboembolism (VTE) in morbidly obese patients (bodyweight of > 120 kg or BMI > 40 kg/m²) guarded. This is due to the scarce data supporting their use in this population. As a result, the International Society on Thrombosis and Haemostasis recommended against their use in this cohort of patients. New data emerged supporting the use of DOACs in these patients. Hence, we aimed to systematically review the literature exploring the efficacy and safety of these agents compared to warfarin in VTE treatment in morbidly obese patients. A systematic review of PubMed and EMBASE since inception until 01/04/2020. Subsequently, a non-inferiority (NI of 1.75) meta-analysis utilizing the random-effects model. Five observational studies (6585 patients) were included in our meta-analysis. DOAC analogs were non-inferior compared to warfarin in reducing the primary efficacy outcome of VTE recurrence (OR 1.07, 95% CI 0.93–1.23) and the primary safety outcome (major bleeding events) (OR 0.80, 95% CI 0.54–1.17). Our meta-analysis comprising real-world observational data concludes that the use of DOAC analogs in morbidly obese patients (bodyweight of > 120 kg or BMI > 40 kg/m²) is non-inferior with regards to efficacy and safety compared to warfarin. This finding helps to resolve the uncertainty associated with the use of DOACs in this cohort. Additionally, it invites for a confirmatory non-inferiority randomized controlled trial testing DOAC vs. Warfarin in this group of patients.

Cancer metastasis is the leading cause of cancer-related mortality worldwide. To date, several in vitro methodologies have been developed to understand the mechanisms of cancer metastasis and to screen various therapeutic agents against it. Nevertheless, mimicking an in vivo microenvironment in vitro is not possible; while in vivo experiments are complex, expensive and bound with several regulatory requirements. Herein, we report a novel in ovo model that relies on chicken embryo to investigate cancer cell invasion and metastasis to various organs of the body. In this model, we directly inject green fluorescent protein (GFP) expressing cancer cells to the heart of chicken embryo at 3 days of incubation, then monitor cell migration to various organs. To this end, we used a simple tissue processing technique to achieve rapid imaging and quantification of invasive cells. We were able to clearly observe the migration of GFP expressing cancer cells into various organs of chicken embryo. Organ specific variation in cell migration was also observed. Our new slide pressing based tissue processing technique improved the detectability of migrated cells. We herein demonstrate that the use of GFP expressing cancer cells allows easy detection and quantification of migrated cancer cells in the chicken embryo model, which minimizes the time and effort required in this types of studies compared to conventional histopathological analysis. In conclusion, our investigation provides a new cancer metastasis model that can be further improved to include more complex aspects, such as the use of multiple cell lines and anti-metastatic agents, thus opening new horizons in cancer biology and pharmaceutical research.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infection is a recently emerged viral infection causing predominantly mild upper respiratory symptoms. However, in some instances, it might result in acute respiratory distress syndrome (ARDS) that poses a significant mortality risk. ARDS is postulated to be mediated by a surge of pro-inflammatory cytokines and chemokines, leading to a dysregulated hyper inflammatory response. Colchicine being an anti-inflammatory agent, might mitigate this dysregulated response. Thus, in the absence of therapeutic options available to manage coronavirus disease 2019 (COVID-19), it is imperative to ascertain the effect of colchicine on improving outcomes in COVID-19 patients. Method: We will perform a systematic review including a search of the following databases: PubMed, EMBASE, MEDLINE, Clinicaltrials.gov, Cochrane library, and google scholar since inception. We will include randomized controlled trials exploring the effect of colchicine on the efficacy and safety outcomes of COVID-19 patients. Subsequently, we will perform a meta-analysis utilizing the random-effects to ascertain the effect of colchicine on reducing COVID-19 related mortality (primary endpoint) and other efficacy and safety outcomes. Results: Our review results are anticipated in early 2021 (based on the completion of several ongoing randomized controlled trial). Our review results will be published in a peer-reviewed journal. Conclusion: This systematic review and meta-analysis, is exploring the effect of colchicine on the efficacy and safety outcomes of COVID-19 patients. If colchicine proved to be effective, it would be a significant milestone in the management of COVID-19, a disease with limited available therapeutic options. PROSPERO registration number: CRD42020191086

Background Informed consent is a fundamental aspect of modern medical practice that requires effective communication and an ample understanding of medical ethics, patient autonomy, and the legal obligations of healthcare professionals. Maintaining high-quality surgical informed consent is a crucial step in the healthcare process. Thus, we aimed to obtain surgical written consent on abdominoplasty, suction-assisted abdominal dermo lipectomy, and lower body lifting from our hospital database over three months (January to March, 2023) to assess our level across the American Society of Plastic Surgeons (ASPS) system. Results A total of 45 surgical written consents were obtained and 37 consents remained after exclusion. Bleeding, infection, and hematoma were mentioned in more than 80% of our consents. However, important complications such as ileus and umbilical malposition were never mentioned. Overall, the completion rate of written complications ranged from 14% to 56% in comparison to data from the ASPS. Conclusions Our results show a measurable inconsistency in surgical written consents at our center. Thus, establishing a comprehensive and accurate surgical written consent will aid in protecting our center against deficient surgical written consent accusations, improve the experience of patients, and enhance the quality of service provided by our center.

Background: Liposuction has emerged as one of the most common cosmetic procedures globally, increasing by more than two-fold since 1997. While different liposuction techniques exist, each with distinct advantages and potential sequelae, a comprehensive comparative analysis of complication rates across various techniques in purely aesthetic cases remains unexplored. We aimed to (1) systematically review the literature on complications of distinctliposuction techniques, and (2) compare complication rates between different techniques. Methods: PubMed, EMBASE, and Web of Science databases were searched for studies reporting on complications of isolated cosmetic liposuction techniques in specific anatomical regions. Complication rates were pooled, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using the Luis Furuya-Kanamori index and Doi plot. Results: Twenty-three studies were included. Laser-assisted liposuction (LAL) demonstrated the lowest overall complication rates for hemorrhage, infection, seroma formation, thermal injury, and cutaneous necrosis (all 0.13%). Power-assisted liposuction (PAL) exhibited the highest rates for hemorrhage (0.72%), infection (1.34%), and cutaneous necrosis (0.72%). Radiofrequency-assisted liposuction (RFAL) showed the highest rates for seroma formation (3.93%) and thermal injuries/blistering (1.64%). Suction-assisted liposuction (SAL) presented the highest rate of cutaneous irregularities (3.36%). Heterogeneity varied widely across complication types and techniques, with I² values ranging from 0 to 91.4%. Conclusions: This study provides the first comprehensive comparison of complication rates across different liposuction techniques in aesthetic cases. LAL demonstrated superior safety profiles, while PAL and RAL showed higher rates for specific complications. These findings can inform surgical decision-making and patient counseling. Level of Evidence: Not gradable.

Liposuction is a very common aesthetic procedure nowadays. The complication rate is very minimal, and it increases relatively when combined with other procedures. Infection is an expected complication in liposuction and its risk is below 1% in isolated procedures. Although the risk is very low, it might lead to fatal consequences. In this manuscript, the authors present a previously healthy female who presented to the authors’ emergency department post-vibration amplification of sound energy at resonance (VASER)-assisted liposuction and lipofilling done in a private center. Her signs and symptoms started after the procedure and she visited the private center multiple times; however, no significant improvement was felt. Upon her presentation to the authors’ facility, immediate resuscitation was initiated, and she was admitted for further investigations and management. Despite all resuscitation efforts and interventions, the patient’s condition kept deteriorating. She was admitted to the surgical intensive care unit and taken to the operating theater twice with no observed significant improvement. The patient developed septic shock, a multiorgan failure state, followed by cardiac arrest. All resuscitation measures were taken, but the patient could not be revived and was declared dead. Early recognition of signs and symptoms of infection could be lifesaving. Aggressive resuscitation and surgical interventions (extensive debridement and antibiotics) might be necessary to produce successful outcomes. Level of Evidence: 5