Medical Treatment Procedures Research Articles

Efficacy of Panchakarma in a Patient of Multiple Myeloma: A Case Study

The role of Ayurveda is now globally recognized for the quality of life. It has both, the preventive and curative potentials. Panchakarma is one unique principle of Ayurveda which deals with detoxification of body and mind. In this article, a case study of patient suffering from multiple myeloma will be discussed and how his quality of life changed after getting Panchakarma therapy. A male patient aged 67 years; known case of multiple myeloma approached Panchakarma unit having chief complaint of severe back ache due to burst fractures at D8, D12 and weakness. The patient had already taken the Western medical treatment and surgical procedures like bone marrow transplantation; with these treatments, he got slight relief but getting weakness and fractures of thoracic spine due to hypercalcemia, the patient was upset. Hence, the patient came with a hope from Panchakarma. An effort is made by treating this patient with Panchakrma procedures under strict supervision. Keywords: Multiple myeloma, quality of life, Panchakarma Cite this Article Vaidya Ish Sharma, Tribhuvan Pareek, Aparna Sharma. Efficacy of Panchakarma in a Patient of Multiple Myeloma: A Case Study. Trends in Drug Delivery . 2017; 4(2): 11–15p.

OR.NET: multi-perspective qualitative evaluation of an integrated operating room based on IEEE 11073 SDC

Clinical working environments have become very complex imposing many different tasks in diagnosis, medical treatment, and care procedures. During the German flagship project OR.NET, more than 50 partners developed technologies for an open integration of medical devices and IT systems in the operating room. The aim of the present work was to evaluate a large set of the proposed concepts from the perspectives of various stakeholders. The demonstration OR is focused on interventions from the head and neck surgery and was developed in close cooperation with surgeons and numerous colleagues of the project partners. The demonstration OR was qualitatively evaluated including technical as well as clinical aspects. In the evaluation, a questionnaire was used to obtain feedback from hospital operators. The clinical implications were covered by structured interviews with surgeons, anesthesiologists and OR staff. In the present work, we qualitatively evaluate a subset of the proposed concepts from the perspectives of various stakeholders. The feedback of the clinicians indicates that there is a need for a flexible data and control integration. The hospital operators stress the need for tools to simplify risk management in openly integrated operating rooms. The implementation of openly integrated operating rooms will positively affect the surgeons, the anesthesiologists, the surgical nursing staff, as well as the technical personnel and the hospital operators. The evaluation demonstrated the need for OR integration technologies and identified the missing tools to support risk management and approval as the main barriers for future installments.

P165 Impact of double balloon endoscopy on management of small bowel Crohn's disease

Background: Since Double Balloon Endoscopy (DBE) enables us to examine deep small bowel either oral or anal it could be of great utility in the management of Crohn's disease (CD) patients. Aim: To evaluate the diagnostic yield and therapeutic impact of DBE on small bowel CD. Methods: The medical records of 180 CD patients, from October 2009 to April 2015, were retrospectively analyzed. Patients were included if they had known CD based on clinical, colonoscopic and histological findings and had been subjected to DBE. If one patient underwent more than one DBE examination only the first evaluation was considered. The primary end point of our study was to evaluate small bowel involvement that is beyond the reach of conventional colonoscopy. The secondary endpoints were to determine the impact of DBE findings on management strategy of CD. The diagnostic yield of DBE in small bowel CD was determined. In addition, the changes in medical treatment, endoscopic intervention and surgical procedures, within three months after DBE, were analyzed. Results: Among 180 patients with CD, 90 patients underwent 168 DBE examinations and included. The mean age of included patients was 40±13.6 years. They were 63 males and 27 females. Eighty-two (91%) patients with established CD underwent DBE for evaluation of small bowel involvement and 8 (9%) patients underwent DBE because of suspicion of CD and had been newly diagnosed. The overall diagnostic yield of DBE was 69%. Within 3 months after DBE examination the management strategy of CD changed in 47 (52.2%) patients, based on DBE findings. The medical treatment escalated in 20 (32%) patients, and decreased in 7 (11%). 14 (24%) patients underwent DBE assisted balloon dilatation, and 6 (9.6%) patients underwent CD-related surgery. Conclusions: DBE is able to uncover small bowel involvement in a significant proportion of CD patients. The DBE findings modified the management strategy in at least one half of CD patients.

Evaluation of hypnotherapy in pain management of cancer patients: A clinical trial from India

Context: In the present era, cancer is one of the major growing diseases in human beings. People with cancer often experience a lot of problems ranging from psychological impairments to pain, fatigue, and sleep disorders. Pain is closely associated with all types of cancer. Cancer patients feel intense pain in the affected organ not only because of cancer but also because of the medical treatment procedure. Aim: The present study aimed at exploring the efficacy of hypnotherapy in mollifying the pain in persons with cancer. Settings and Design: This study was systematically planned through before and after control group design with matching; a quasi-experimental research design. Subjects and Methods: The present study was carried out by taking a total of 57 cancer patients as per inclusion/exclusion criteria from Jawaharlal Nehru Cancer Hospital and Research Center, Bhopal, Madhya Pradesh, through convenience sampling method. Out of these 57 participants, the experimental group consisted of thirty participants who were given intervention in the form of 15 sessions of hypnotherapy along with medical treatments. The control group consisted of another 27 participants who were administered medical treatments alone. Participants were given Numerical Rating Scale for a rating of pain in cancer patients. Statistical Analysis Used: Independent samples t -test and Eta-squared statistics were used to analyze the mean difference between experimental group and control group on pain and computing the magnitude of the effect of intervention, respectively. Results: The directional hypothesis was accepted P d was estimated at 0.38 which indicates a large effect of the intervention on pain. Conclusions: The finding of the present study indicates that hypnotherapeutic interventions are effective in the management of pain in individuals with cancer.

Incidence of ventilator associated pneumonia and its risk factors

Hospitals are intended to heal the sick; but they are also sources of infection. Ironically, the advances in medicine are partly responsible for the fact that today; hospital infections are the leading cause of death worldwide. Newer technology and latest surgical and medical diagnostic methods and treatment procedures have increased the number of invasive techniques leading to higher chances of nosocomial infection. Pneumonia is the leading cause of death due to nosocomial infections. Intubation & mechanical ventilation greatly increases the risk for ventilator-associated pneumonia (VAP). In developing country like India, such hospital-acquired infections have a significant impact on patient’s morbidity, mortality, hospital stay and on financial concerns of the patient, hospital and community. The present investigation was aimed to determine the incidence of ventilator associated pneumonia in the neurosurgery intensive care unit of a tertiary care centre and to determine the risk factors of ventilator associated pneumonia. A total of 30 samples belonging to the age group of 15 to 75 years who where on mechanical ventilator for more than 48 hours in the neurosurgery intensive care unit of a tertiary care centre were selected using convenience sampling. The incidence of VAP was estimated to be 30%. The risk factors identified for the development of VAP was found to be combined head and cervical spine injury (P=0.001), associated injuries (P=0.035), additional surgeries (P=0.025), nasogastric feeding (P=0.001), intake of immuno suppressive drugs (P=0.004), pre operative antibiotics (p=0.000) and duration of mechanical ventilation >5 days (P=0.000). The mortality among patients with VAP was found to be higher than patients without VAP (88.9% than non VAP patients).

The new medical treatment procedure of the German Statutory Accident Insurance: From the perspective of BG hospitals

The Hospital Group of the Statutory Accident Insurance (BG hospitals) was affected by the new requirements for severe injury procedures (SAV) in the same manner as all other maximum care hospitals. Simultaneously, the BG clinics were merged to form acentrally organized hospital group. Asubstantial need for adjustment existed for specialties, such as neurosurgery and visceral surgery at some sites. Needless to say, all trauma victims benefit from the high standards required by the Statutory Accident Insurance regardless of their insurance status. The provision of medical treatment with respect to its implementation into routine practice must be further optimized and additions, e.g. for the occurrence of complications are necessary.

Protocolo de diagnóstico y tratamiento de las complicaciones perianales de la enfermedad de Crohn

IntroductionPerianal disease (PD) is a common complication of Crohn's disease (CD) that significantly impairs the quality of life of these patients, being an important cause of morbidity. A combined assessment of gastroenterologist and surgeon is crucial in the management of this disease. DiagnosisThe diagnostic approach should include a thorough examination of the perianal area, along with an endoscopic evaluation, examination under anaesthetic and imaging techniques such as pelvic magnetic resonance or anorrectal ultrasound. TreatmentThe therapeutic strategy, in most cases, required a combination of medical treatment and surgical procedures.

Elderly health care in the Family Health Strategy and the prevalence of common mental disorders

The aims of the present study were to characterize the reasons for medical appointments and treatment procedures of elderly people in the Estratégia Saúde da Família ("Family Health Strategy") (ESF), with emphasis on mental health, as well as to identify the prevalence of common mental disorders, and compare this with the approaches described in medical records. A descriptive and cross-sectional study of 219 elderly persons was performed by reviewing medical records and applying a Self-Response Questionnaire (SRQ-20). For this population the average number of appointments per year was three, 42.3% of appointments were to obtain a medical prescription, and 70.9% of medical procedures involved the provision of medical prescriptions. There were eight referrals to specialized mental health services. The most prescribed psychiatric drugs were anxiolytics (55%), and antidepressants (29.7%). A total of 19.6% of the elderly persons had scores above seven in the SRQ-20. It was observed that a large proportion of mental disorders were not detected, and there was a failure in the procedures adopted. More investment in patient flow and the definition of assistance criteria for this population is required.

Prevalence of Monoclonal Gammopathy in Individuals Undergoing Routine Health Checkup in Brazil

Introduction: the occurrence of a monoclonal gammopathy (MG) is identified in approximately 3% of the population older than 50 years in US and Europe, and is usually an occasional finding. There is very few data about the prevalence of MG in the general population in Brazil and in Latin America, especially in individuals undergoing routine health checkups (HC).Objectives: to evaluate the prevalence of MG in a general population undergoing routine HC in Brazil. Also, to compare demographic and laboratory data between individuals with and without MG.Methods: between January and December 2014, patients with 45 years of age or older who presented for a routine HC at a general hospital in Sao Paulo, Brazil, had a blood sample tested for serum protein electrophoresis (SPEP). Independently of the previous general medical history of these individuals, the reason for going to the hospital was only the HC and not any specific medical diagnostic or treatment procedure. Samples with a positive SPEP for MG were further submitted to serum immunofixation (IF) and serum free light chain assays (FLC- Freelite ®-The Binding Site, UK). The study was approved by the IRB and all participants signed an informed consent.Results: during the 12 months period, 3,095 individuals were studied, 2,393 men (77.3%) and 702 women (22.7%). MG was detected in 37 (1.2%), 31 men (1.3%) and 6 women (0.9%), p=0.35. The table shows the age distribution: there is an increase in the prevalence of MG for the older age groups, and this was statistically significant for individuals with 65 years or older when compared to those less than 55 years old.Age Range (years) MG negative MG positive p45-54 2,081 (99.0%) 20 (1.0%)55-64 841 (98.5%) 13 (1.5%) 0.19≥ 65 136 (97.1%) 4 (2.9%) 0.04All 37 cases also presented a positive IF. The immunoglobulin involved was IgG in 28 cases (75.7%), IgM in 5 (13.5%), IgA in 2 (5.4%) and a double MG in 2 (5.4%).The FLC ratio of the patients with a MG ranged from 0.28 to 38.50 and one case showed a very high abnormal FLC ratio of >55.0 (normal FLC ratio range = 0.26 to 1.65). The analysis showed an abnormal FLC ratio in 9 samples (24.3%).The total gammaglobulin levels were significantly higher in the population with MG then in the population without MG (median results were respectively 1.16 g/dL and 1.06 g/dL, p< 0,001). There was no difference in the hemoglobin levels in the two groups (median levels respectively 14.4 g/dL and 14.7 g/dL, p=0.65).Conclusion: it was observed that 1.2% of this general Brazilian population showed a MG. This prevalence is lower than reported in the medical literature in other countries for this age group, but may be explained by the also lower number of individuals older than 65 years studied. The presence of a MG increased significantly with age, as reported in other observations. These results are useful as a reference for epidemiological analysis of MG studies performed in the region. Larger regional studies should be performed, including analysis of environmental and behavioral factors. DisclosuresNo relevant conflicts of interest to declare.

Spontaneous penetration of gold nanoparticles through the blood brain barrier (BBB).

BackgroundThe blood brain barrier (BBB) controls the brain microenvironment and limits penetration of the central nervous system (CNS) by chemicals, thus creating an obstacle to many medical imaging and treatment procedures. Research efforts to identify viable routes of BBB penetration have focused on structures such as micelles, polymeric nanoparticles and liposomes as drug carriers, however, many of them failed to provide unequivocal proof of BBB penetration. Here we proved that gold nanoparticles (AuNPs) penetrate the BBB in rats to reach brain regions.ResultsInjection of AuNPs to the abdominal cavity of rats resulted in levels of gold found in blood, urine, brain regions and body organs. After perfusion the concentration of gold in brain regions diminished dramatically indicating that most of the gold was in venous blood and not in the brain tissues. Injection of Na, K or Ca ion channel blockers reduced BBB penetration by half. A biological half-life of 12.9 ± 4.9 h was found for the gold nanoparticles. Possible mechanisms for the transport of AuNPs through the BBB are discussed.ConclusionsBBB penetration by AuNPs is spontaneous without the application of an external field. A major amount of gold resides in blood vessels therefore perfusion required. Ion channel blockers can be used to control the transport of AuNPs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12951-015-0133-1) contains supplementary material, which is available to authorized users.

An Evaluation of Commercial Pedometers for Monitoring Slow Walking Speed Populations.

Pedometers are considered desirable devices for monitoring physical activity. Two population groups of interest include patients having undergone surgery in the lower extremities or who are otherwise weakened through disease, medical treatment, or surgery procedures, as well as the slow walking senior population. For these population groups, pedometers must be able to perform reliably and accurately at slow walking speeds. The objectives of this study were to evaluate the step count accuracy of three commercially available pedometers, the Yamax (Tokyo, Japan) Digi-Walker(®) SW-200 (YM), the Omron (Kyoto, Japan) HJ-720 (OM), and the Fitbit (San Francisco, CA) Zip (FB), at slow walking speeds, specifically at 1, 2, and 3 km/h, and to raise awareness of the necessity of focusing research on step-counting devices and algorithms for slow walking populations. Fourteen participants 29.93 ±4.93 years of age were requested to walk on a treadmill at the three specified speeds, in four trials of 100 steps each. The devices were worn by the participants on the waist belt. The pedometer counts were recorded, and the error percentage was calculated. The error rate of all three evaluated pedometers decreased with the increase of speed: at 1 km/h the error rates varied from 87.11% (YM) to 95.98% (FB), at 2 km/h the error rates varied from 17.27% (FB) to 46.46% (YM), and at 3 km/h the error rates varied from 22.46% (YM) to a slight overcount of 0.70% (FB). It was observed that all the evaluated devices have high error rates at 1 km/h and mixed error rates at 2 km/h, and at 3 km/h the error rates are the smallest of the three assessed speeds, with the OM and the FB having a slight overcount. These results show that research on pedometers' software and hardware should focus more on accurate step detection at slow walking speeds.

Population-Averaged Geometric Model of Mitral Valve From Patient-Specific Imaging Data1

The mitral valve (MV) is one of the atrioventricular heart valves and regulates the blood flow between the left atrium and ventricle during the cardiac cycle. Its anatomical structure is comprised of anterior and posterior leaflets, chordae tendineae, and papillary muscles. The main function of the MV is to prevent blood flow regurgitation back into the left atrium during systole. Abnormalities in geometry of MV can lead to mitral insufficiency disorder, which requires either valve replacement or surgical repair to restore proper MV coaptation. Annually, over 40,000 patients in the U.S. alone are treated for MV disorders [1]. In the past two decades, the emphasis in MV treatment has been shifting from replacement toward repair due to lower morbidity and mortality of the latter approach [2]. However, the natural anatomical variability of human MV geometry precludes the use of single or simplified geometries for the simulation of surgical repair. One of the ways to address this issue is by using patient-specific diagnosis and modeling [3], or population-averaged geometric models of MV. The existing approaches for characterization and reconstruction of the cardiovascular organ-level geometry include fitting of predefined sets of nonuniform rational B-splines (NURBS) to the imaging data [4], and using spheroidal harmonics representations [5]. Even though it is possible to construct average geometric models this way, the analysis of anatomical shape variations becomes difficult in this setting because of the confounding of dimensional and shape descriptors. At the same time, none of the existing methods allow integration of the high-fidelity in vitro data with lower-resolution in vivo imaging in a consistent manner. In this work, we formulate the framework for building the population-averaged geometric model of MV, which lends to straightforward analysis of dimensional and anatomical variations. In the sections to follow, we discuss the procedure and advantages of this method for the development of robust medical devices and treatment procedures.

A standardized treatment regimen for patients with severe haemophilia A undergoing orthopaedic or trauma surgery: a single centre experience.

Recommendations on the administration of clotting factor concentrates in patients with severe haemophilia undergoing surgery are usually determined by monitoring target clotting factor levels. In this retrospective cohort study, we enrolled patients with severe haemophilia A who underwent major orthopaedic or trauma surgery. We wanted to evaluate the feasibility and the safety of a standardized medical treatment procedure. Further on, we wanted to assess whether our standardized treatment regimen enables surgical procedures in certain situations in which measuring clotting factor VIII (FVIII) activity is not available. We created a standardized medical treatment procedure that included a medical protocol and close cooperation with the Haemophilic Treatment Centre. Thirteen surgical procedures in nine patients were examined. The feasibility and safety of this standardized treatment concept were assessed by identifying perioperative complications and by means of a questionnaire. Depending on the surgery, the amount of FVIII administered within the first 10 days ranged between 653 and 1027 units/kg body weight. No allogeneic blood transfusion was required. The measurement of FVIII activity was performed repeatedly in five patients. In all patients activated partial thromboplastin time monitoring was performed during the hospital stays. The surgeons and patients were satisfied with our treatment concept and adhered to the medical regimen protocol. By means of a detailed, standardized medical protocol and by ensuring close cooperation between the patient, the surgeons and the Haemophilic Treatment Centre, we could show that elective and emergency operations can be safely performed even in situations in which FVIII activity could not be monitored.

English

The authors reviewed 15 cases of spinal tuberculosis from 2013 to 2014 attending NH Mallareddy hospital, Suraram, Qutbullapur, Hyderabad. A real control of tuberculou disease requires a serious and sustained global effort to eliminate immune-compromised states, poverty, malnutrition and overcrowding. Tuberculosis of the spine is one of the most common spine pathology in India. Over last four decades a lot has changed in the diagnosis, medical treatment and surgical procedures to treat this disorder. More common in poorly nourished, over crowed and in subnormal social conditions. Early diagnosis and management of spinal tuberculosis has special importance in preventing the serious complications like kyphosis, paraperesis, paraplegia etc.

Medicare is scrutinizing evidence more tightly for national coverage determinations.

We examined Medicare national coverage determinations for medical interventions to determine whether or not they have become more restrictive over time. National coverage determinations address whether particular big-ticket medical items, services, treatment procedures, and technologies can be paid for under Medicare. We found that after we adjusted for the strength of evidence and other factors known to influence the determinations of the Centers for Medicare and Medicaid Services (CMS), the evidentiary bar for coverage has risen. More recent coverage determinations (from mid-March 2008 through August 2012) were twenty times less likely to be positive than earlier coverage determinations (from February 1999 through January 2002). Furthermore, coverage during the study period was increasingly and positively associated both with the degree of consistency of favorable findings in the CMS reviewed clinical evidence and with recommendations made in clinical guidelines. Coverage policy is an important payer tool for promoting the appropriate use of medical interventions, but CMS's rising evidence standards also raise questions about patients' access to new technologies and about hurdles for the pharmaceutical and device industries as they attempt to bring innovations to the market.

Human placental growth hormone: A potential new biomarker in gestational trophoblastic disease

ObjectivesGestational trophoblastic disease (GTD) involves a spectrum of abnormal proliferations arising from the placental villous trophoblast. Although the incidence is low, a biomarker with short serum half-life would be a major clinical advance to monitor surgical and medical treatment reducing the socioeconomic burden of multiple control visits as well as patient's anxiety.Placental growth hormone (hGH-V) plays an important role in the regulation of normal placental growth and has shown angiogenic effects.We aimed to determine by immunohistochemistry (IHC) whether hGH-V is expressed in GTD and whether it can be detected in the patient's blood for potential monitoring of surgical or medical treatment procedures. MethodsTissue and sera were collected from women undergoing treatment for GTD in a tertiary care university hospital. We evaluated partial and complete hydatidiform moles, invasive moles and choriocarcinoma, n=16.Trophoblast specimens were examined by a newly developed IHC set-up for hGH-V in addition to gross morphologic and histopathological examination. Serum samples were analyzed by a highly sensitive hGH-V specific immunoassay. ResultshGH-V was localized in all entities of GTD to the syncytiotrophoblast by immunohistochemistry. Serum hGH-V was detected for the first time in GTD and was present in a high percentage of all analyzed entities. ConclusionshGH-V can be detected in all entities of GTD by IHC as well as by serum analysis and may therefore serve as a novel biomarker for the disease. Its clinical utility in diagnosis of GTD and monitoring surgical or medical treatment needs to be determined in further studies.

A LEGAL ANALYSIS OF “SAVIOUR SIBLINGS” AND “BENEFACTOR CHILDREN” IN SOUTH AFRICA

This contribution aims to explain how the constitutional rights to bodily integrity and autonomy affect, firstly, the legal position of “saviour siblings” and, secondly, “benefactor children”. The article also considers whether parents, in terms of South African law, have the right to make decisions concerning medical treatment and surgical procedures of this nature, on behalf of their children. A number of legal and ethical issues are considered, with the focus being on the legal implicationsassociated with these categories of children being used to save the life of an ill sibling through the donation of tissue or organs. A set of recommendations are advanced so that the legal position may be better regulated.

Not all adverse outcomes are medical errors

Garry et al.'s paper, documenting ‘iatrogenic events’ preceding admissions to intensive care units (ICUs) 1, continues a long line of publications that have followed the Institute of Medicine's 1999 publication To Err is Human 2. Such papers continue to equate adverse outcomes falsely with iatrogenic errors, obscuring the fact that system failures and even patients’ actions can significantly contribute to adverse outcomes, and contribute to accusations that medical incompetence is a leading cause of death – which it is not 3 – in turn, scaring the public. The fact of the matter is that interventions are indeed dangerous by their very nature and optimal outcome is never assured. This is particularly true for the very sickest patients, for example, those requiring intensive care, for whom double-digit death rates are not uncommon. Indeed, every unwanted outcome of medical care fulfills the definition of iatrogenic, meaning ‘induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures’. Reviewing Garry et al.'s paper, some issues exemplify this problem. Delay securing the airway after out-of-hospital cardiac arrest (their Table 3) may represent adherence to the newest Advanced Cardiac Life Support guidelines which de-emphasise airway management in favour of chest compression 4, rather than iatrogenic damage. The patient who experienced pulmonary oedema after presumed laryngospasm received appropriate care for a recognised event, which may have resulted from inherent patient factors within exemplary medical care. The inadequate resuscitation of a patient with suspected appendicitis undergoing diagnostic computerised tomography (CT) would seem to represent the failing of a defensive requirement for ordering a CT in a patient with acute abdomen and shock, rather than an iatrogenic event. A four-hour delay in ICU admission is indicative of organisational/resource limitations, rather than iatrogenesis. Regarding all sub-optimal outcomes as ‘adverse, iatrogenic or erroneous’ consequences of medical care obscures the detection of specific errors that lead to patient harm. Demanding 100% perfection in outcome is a noble aspiration, but is simply not realistic, and impairs the efforts of patients, physicians and politicians to improve the quality of medical care.

Informed Consent: A Myth of Ethical Spirit and Legal Paradigm in Medical Profession

Informed consent may not be major significance in medical malpractice litigations but, it is one of the critical issues in modern medicine. The development of informed consent has given rise to two major perceptions of ethical and legal foundations in health care system. The principle of informed consent is applicable to surgical operations, medical treatment and diagnostic procedures involving intentional interference with the patient. No doubt, medico-legal issues are more common in the western part of the world, the autonomy of the patient along with other principles of informed consent followed regularly in the west. In India lack of disclosure and negligence of not following seriously informed consent in health care is commonly seen. Institutional policies and procedures in obtaining medical consent may form a legal document but, may not necessarily achieve the goal of informed consent, patient or relatives for instance may sign documents, they do not understand. Medical professionals should consider the need to achieve informed consent in two symbiotic senses: the ethical sense and the legal sense.

Risk of second cancers in merkel cell carcinoma: a meta-analysis of population based cohort studies.

The risk of second cancers in Merkel cell carcinoma (MCC) remains uncertain since risk estimates vary worldwide. The global MCC population is growing and there is a demand for better knowledge of prognosis of this disease. The Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE search engines were searched for the relevant literature between January 1999 and September 2014 by use of explicit search criteria. The main outcome was second malignancies associated with MCC patients measured by standardized incidence ratios (SIRs) or other estimates of risks. Five papers fulfilled the inclusion criteria and reported SIRs of second cancer in MCC which varied from 1.07 to 2.80. Performing meta-analysis using random effects model revealed that there was an increased risk for second malignancies due to MCC (SIR, 1.52; 95% CI, 1.10–2.11). There was a significant increase in risk for malignant melanoma (SIR, 3.09; 95% CI, 2.02–4.73) as compared to all common second malignancies among the studies. Updated knowledge about risk of second malignancies in MCC will help in better assessment of the disease prognosis and will help in optimizing the medical and surgical treatment, radiotherapy, follow-up, and surveillance procedures.