130553 research outputs found
Sort by
Assessment of patient satisfaction levels with teleconsultation services at a tertiary care cancer center in a developing country: a cross-sectional study
No full textPurpose
Telemedicine use in healthcare is rising. However, infrastructural barriers may impede implementation in lower- and middle-income country settings. Patient perspectives regarding teleconsultation need to be explored. This study assesses the feasibility of teleconsultation among patients with cancer, patient satisfaction with its use, determinants of satisfaction, and its economic benefits.
Methods
A cross-sectional telephonic interview-based study was conducted between February and September 2021 in a tertiary care cancer center in India. Adult patients with cancer or their caregivers who had availed of teleconsultation during the 6 months preceding the interview date were included. Teleconsultation was administered through email and telephone conversation. The research team developed an interview guide to elicit demographic details, satisfaction with teleconsultation, and the underlying reasons. Cost savings through teleconsultation were also recorded. Factors predicting subject satisfaction were identified by multivariable logistic regression.
Results
During the study period, 195 subjects, including 84 patients (43.1%) and 111 caregivers (56.9%), were interviewed. The median patient age at diagnosis was 31 years. In our study, 147 (75.4%) patients/caregivers reported satisfaction with teleconsultations. The benefits cited included better access and follow-up (n = 173, 88.7%) and saving time and money (n = 164, 84.1%). In multivariable analysis, a higher patient age (more than 30 years) was the only factor predictive of less satisfaction with teleconsultation. The median cost savings were not a predictor of satisfaction.
Conclusion
Teleconsultation is feasible and acceptable to most patients availing treatment in a tertiary oncology care setting in India. Patient and physician training for better communication may further improve the utility of this modality
Evaluation of full spectrum cell-free RNA in peripheral blood as potential biomarker for acute myeloid leukemia disease profiling
No full textIntroduction: Acute myeloid leukemia is one of the most aggressive haematological malignancies with high relapse/ refractory rate. To date, studies are lacking on extracellular RNA profiling in AML as cell free RNA is relatively unstable but could contain potential biomarkers. In this study, we investigated the potential of total cell-free RNA from small volumes of blood plasma as a potential biomarker for AML disease profiling.
Methods: Peripheral blood was obtained after informed consent from de novo AML patients. Plasma was separated and cfRNA isolated using four different platforms. cfRNA quality was checked by bioanalyzer. Low input total RNA library was generated using cfRNA (QIAseq FastSelect RNA Library kit). In parallel, RNA isolated from paired PBMCs was subjected to library preparation using the same protocol. Sequencing was performed on Novaseq 6000 and data analysis was done using R software.
Results: The yield of cfRNA from peripheral blood ranged between 64 to 380ng/ml plasma. With an average RIN value of 2.2, the cfRNA showed low molecular weight RNA profile. Next generation sequencing analysis of paired cfRNA and cell-associated peripheral blood RNA revealed >2000 protein coding transcripts with >10 TPM value and a high concordance (0.84-0.94) between the paired samples was observed (Figure below). Amongst the transcripts with highest TPM values were ferroptosis related (FTL, FTH1) and extracellular S100 proteins (S100A8 and S100A9), that regulate immune homeostasis, inflammation and serve as danger signals. In addition, long noncoding RNA (MALAT1, RMRP_1, GAS5) and small nucleolar RNA known to play a crucial role in the development of cancer were detected.
Conclusion: Our findings provided the basis for the utilization of cfRNA to enhance our understanding of the AML biology as well as identify potential biomarkers relevant to the diagnosis and prognosis of AML patients
Reproducibility of spatial penalty-based methodologies for intravoxel incoherent motion analysis with diffusion mri
No full textObjective was to assess the precision and reproducibility of spatial penalty-based intravoxel incoherent motion (IVIM) methods in comparison to the conventional bi-exponential (BE) model-based IVIM methods. IVIM-MRI (11 b-values; 0-800 s/mm2) of forty patients (N = 40; Age = 17.7 ± 5.9 years; Male:Female = 30:10) with biopsy-proven osteosarcoma were acquired on a 1.5 Tesla scanner at 3 time-points: (i) baseline, (ii) after 1-cycle and (iii) after 3-cycles of neoadjuvant chemotherapy. Diffusion coefficient (D), Perfusion coefficient (D*) and Perfusion fraction (f) were estimated at three time-points in whole tumor and healthy muscle tissue using five methodologies (1) BE with three-parameter-fitting (BE), (2) Segmented-BE with two-parameter-fitting (BESeg-2), (3) Segmented-BE with one-parameter-fitting (BESeg-1), (4) BE with adaptive Total-Variation-penalty (BE + TV) and (5) BE with adaptive Huber-penalty (BE + HPF). Within-subject coefficient-of-variation (wCV) and between-subject coefficient-of-variation (bCV) of IVIM parameters were measured in healthy and tumor tissue. For precision and reproducibility, intra-scan comparison of wCV and bCV among five IVIM methods were performed using Friedman test followed by Wilcoxon-signed-ranks (WSR) post-hoc test. Experimental results demonstrated that BE + TV and BE + HPF showed significantly (p < 10-3) lower wCV and bCV for D (wCV: 24-32%; bCV: 22-31%) than BE method (wCV: 38-49%; bCV: 36-46%) across three time-points in healthy muscle and tumor. BE + TV and BE + HPF also demonstrated significantly (p < 10-3) lower wCV and bCV for estimating D* (wCV: 89-108%; bCV: 83-102%) and f (wCV: 55-60%; bCV: 56-60%) than BE, BESeg-2 and BESeg-1 methods (D*-wCV: 102-122%; D*-bCV: 98-114% and f-wCV: 96-130%; f-bCV: 94-125%) in both tumor and healthy tissue across three time-points. Spatial penalty based IVIM analysis methods BE + TV and BE + HPF demonstrated lower variability and improved precision and reproducibility in the current clinical settings
Clinicopathological presentations of eyelid malignancy in covid era versus pre-covid era
No full textPurpose:
The coronavirus disease 2019 (COVID-19) pandemic led to overall interrupted medical care, resulting in disease progression and morbidity. The study aimed to evaluate clinicopathological presentations and severity of eyelid malignancy during the COVID era, comparing the results with patients presented during pre-COVID era and evaluating the reasons for delayed presentation in patients with advanced eyelid malignancy in the COVID-era.
Methods:
This was a comparative, ambispective observational study. Data regarding demographic, clinical, histopathology, and treatment modalities of confirmed cases of eyelid malignancy admitted during the period from March 2020 to September 2022 (defined as COVID era group) were collected and compared with retrospectively collected data from March 2017 to March 2020 (defined as pre-COVID era group). COVID era patients were further categorized as localized and advanced disease. Patients with advanced eyelid malignancy during COVID era were further subjected to a questionnaire to evaluate the reasons for delayed presentation.
Results:
In total, 115 patients of eyelid malignancy were studied [COVID era group 40 (35%) and pre-COVID era group 75 (65%)]. A statistically significant increase in the duration of disease (P = 0.0001) and advanced tumor T-stage (P = 0.03) was noticed in the COVID era group. Demographic, histopathology, and ocular morbidity details were similar in both groups. The common reasons that led to delay in presentation and treatment in advanced T-stage patients during the COVID era were fear of acquiring COVID, lockdown, and lack of medical facilities.
Conclusion:
During the COVID-19 pandemic, both hospital- and patient-related factors contributed to delay in presentation, leading to advanced-stage disease indicating need of triaging of eyelid malignancy in the event of such pandemics in future
CT-634 Cytomegalovirus Reactivation Following Allogeneic Hematopoietic Stem Cell Transplantation and Its Association With Donor Virus-Specific Cellular Immunity
No full textIntroduction
The monitoring of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) is known to be useful in predicting CMV reactivation (CMV-R) risk in patients undergoing allogeneic stem cell transplantation (allo-SCT). However, there is lack of data on the impact of pretransplant donor CMI on CMV-R in allo-SCT recipients. We conducted this study to examine the CMV-R profile following allo-SCT in a tertiary care cancer center in India. We also assessed the impact of donor CMI on CMV-R severity.
Methods
This was a prospective, observational study conducted on consecutive allo-SCT recipients from our transplant unit. Baseline demographic data and transplant outcomes were recorded. CMV PCR monitoring was done as per guidelines. CMI was computed at baseline in a subset of 19 donors. CMI was assessed by flow cytometric analysis of cytokines produced after stimulation of subject peripheral blood mononuclear cells with pp65 antigen. The clinical predictors of CMV-R duration were identified using stepwise forward multivariable linear regression. The association of donor CMI with CMV reactivation duration (DOR) and peak titers were examined using univariable linear regression, and adjustment was done for clinical characteristics identified as predictors using multivariable regression.
Results
Fifty-one patients were recruited including 27 haploidentical and 24-matched sibling donor transplants. The mean age of the cohort was 22 years. The incidence of CMV-R after transplant was 74.5% with mean DOR of 21.6 days. Only antithymocyte globulin receipt (regression coefficient [RC], 15.07 [3.71-26.44]; P=0.010) and acute GVHD occurrence (RC, 11.70 [0.71-22.70]; P=0.037) were associated with prolonged DOR. Higher donor age was associated with higher peak CMV titers (RC, 1292.80 [35.09-2550.51]; P=0.044). Higher proportions of donor CD4+ T cells expressing IL-2 were associated with shorter DORs (RC, –6.33 [–12.18 to –0.48); P=0.035) and with lower peak titers (RC, –31002.64 [–60863.88 to –1141.40; P=0.043). The association remained significant after adjusting for clinical characteristics.
Conclusions
The CMV infection incidence following allo-SCT is similar in the Indian setting as that reported world over. This is the first study showing that strong donor cellular immune responses to CMV are independently associated with shorter CMV DORs and lower peak titers in recipients. Pretransplant assessment of CMV-specific cellular immunity may aid in refining donor selection for allo-SCT
Unveiling the potential of halide perovskites for seasonally adaptive CO<sub>2</sub> photoreduction under low light conditions
No full textThe viability of double perovskite Cs2AgBiBr6 in low-light environments is studied for CO2 photoreduction. It is observed that light intensity significantly influences product formation with I0.56 depending on the overall product formation rate. The photodetection measurement reveals that photocurrent as a function of incident power follows a power law ∝I0α with α = 0.80, which is attributed to the carrier trapping at higher light power. Furthermore, power-dependent transient absorption spectroscopy is studied and observed that at higher fluence, carrier scattering can be dominating. Interestingly, it is found that at higher power, hot carrier relaxation dynamics are altered, and electron-phonon coupling is enhanced, resulting in a lower carrier concentration participating in the photocatalytic reaction, which can limit charge carrier extraction and CO2 reduction. This study highlights the potential of perovskite semiconductors as promising candidates for photocatalytic reactions in low-light conditions, broadening their applicability in real-world scenarios
Beyond Traditional Training: Exploring the Benefits of Virtual Reality Simulator in Lumbar Pedicle Screw Insertion - A Randomized Controlled Trial
No full textIntroduction
This study compares the effectiveness of virtual reality simulators (VRS) and a saw bone model for learning lumbar pedicle screw insertion (LPSI) in neurosurgery.
Methods
A single-center, cross-sectional, randomized controlled laboratory investigation was conducted involving residents and fellows from a tertiary care referral hospital. Participants were divided into two groups (A and B). Group A performed 3 LPSI tasks: the first on a saw bone model, the second on VRS, and the third on another saw bone model. Group B completed 2 LPSI tasks: the first on a saw bone model and the second on another saw bone model. The accuracy of LPSI was evaluated through noncontrast computed tomography scans for the saw bone models, while the in-built application of VRS was utilized to check for accuracy of screw placement using the simulator.
Results
The study included 38 participants (19 in each group). Group A participants showed reduced mean entry point error (0.11 mm, P 0.024), increased mean purchase length (4.66 cm, P 0.007), and no cortical breaches (P 0.031) when placing the second saw bone model screw. Similar improvements were observed among group A participants in PGY 1–3 while placing the second saw bone model screws.
Conclusions
Virtual reality simulators (VRS) prove to be an invaluable tool for teaching complex neurosurgical skills, such as LPSI, to trainees. This technology investment can enhance the learning curve while maintaining patient safety
Middle third falcine meningiomas-surgical nuances for cortical venous preservation
No full textPurpose
To improve postoperative outcome in middle third falcine meningiomas by cortical venous preservation.
Background
Falcine meningiomas arise from the falx and do not involve the superior sagittal sinus (SSS). Their complete resection is often associated with the risk of venous infarction in the eloquent cortex due to overlying superficial cortical veins on the tumors.
Method
We report one case of middle third falcine meningioma, where we used the posterior interhemispheric corridor for tumor approach.
Conclusion
Use of the posterior interhemispheric approach, carefully raised bone flap, along with sharp dissection and vein reinforcement using fibrin glue can help to preserve the cortical veins while resecting the falcine meningiomas
Astroblastoma: A molecularly defined entity, its clinico-radiological & pathological analysis of eight cases and review of literature
No full textAstroblastoma, a unique entity of glial tumor, predominantly occur in young women with distinctive MN1 rearrangement, Given its limited documentation in existing literature, we report eight cases of astroblastoma, detailing their clinical, radiological, and histopathological characteristics along with molecular analysis. We conducted a retrospective analysis of our neuropathology archive database spanning the past 8 years. We included all cases that underwent Magnetic Resonance Imaging (MRI), surgical resection, histopathological examination, molecular testing, and follow-up. Histopathological examination involving immunohistochemistry and Fluorescence In Situ Hybridization (FISH) was carried out for all cases. All tumors were found to be located in the supratentorial region (cerebral hemisphere). The median age of the group was 35.1 years, with a female-to-male ratio of 1.6:1. The most common clinical presentation was headache. Morphologically, all tumors exhibited astroblastic features with pseudorosettes and perivascular hyalinization. Immunohistochemistry consistently revealed positivity for EMA and variable immunoreactivity for GFAP, OLIG2, and D2–40. Fluorescence In Situ Hybridization (FISH) analysis conducted for all cases showed MN1 rearrangement in 7 cases. The mean follow-up period was 45 months (ranging from 12 to 105 months). Radiotherapy was administered for high-grade and recurrent astroblastomas. All patients are currently alive and in good health.
Astroblastomas are uncommon central nervous system (CNS) tumors with characteristics morphology and molecular signatures. They typically carry a favorable prognosis. High level suspicion is required for their diagnosis and molecular analysis is must to distinguish them from other morphological mimics
Non-Boltzmann thermoelectric transport in minimally twisted bilayer graphene
No full textThe electronic bands formed in moiré systems with twisted bilayer graphene (tBLG) have emerged as a tunable platform for studying many novel concepts of condensed matter physics due to new interaction and topological effects. In particular, the multitude of closely packed flat bands and a sequence of van Hove singularities (vHSs) in minimally tBLG can not only lead to nontrivial topological transport but also the breakdown of conventional Boltzmann transport formalism due to the competition between the scales of energy variation within the system and that of the external parameters such as temperature or electric field. Here, we demonstrate the violation of the semiclassical Mott relation in small-angle tBLG even at room temperature, which we associate to a narrow diverging density of states. We also show the emergence of nonlinear effects in thermovoltage by exploiting vertical thermoelectric transport in an atomically thin tBLG device. Our results not only point towards the fundamental limitations of the applicability of the semiclassical Boltzmann approach in small-angle tBLG but also outline an experimental approach that can lead to the discovery of different broken-symmetry states