Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment

Object Intracranial aneurysms are rare in children and have different epidemiological, clinical, and morphological characteristics and outcome from those in adults. Materials and methods We analyzed demographic, clinical, radiologic features, treatment, and outcome in 55 patients <18 years of age, treated from Jan 1995 through December 2005. Results Intracranial aneurysms in children below 18 years constituted 4% of all intracranial aneurysms. Internal Carotid artery (ICA) bifurcation was the commonest location. About half of the aneurysms were complex. Three-fourth of the patients required surgical treatment. Two patients died, constituting 5% mortality. Two patients (5%) had poor outcome, whereas the majority (90%) had a favorable outcome. Conclusions Pediatric aneurysms have male predominance, higher incidence of clinical features of mass effect or seizures, high incidence of large, traumatic/mycotic aneurysms, associated illnesses and ICH/IVH and hydrocephalus, better Hunt and Hess grades at presentation, ICA bifurcation as the commonest site, and better outcome than their adult counterparts.     

Clinical utility of the AJCC 8th edition pT1 subclassification and impact on practice patterns in stage I seminoma

BackgroundThe American Joint Committee on Cancer 8^th edition staging guidelines for testicular cancer established a 3 cm cutoff to subclassify stage T1 seminomas (<3 cm = pT1a and ≥3 cm = pT1b). The efficacy of this cutoff in predicting metastatic disease and impact on treatment patterns have not been studied.MethodsWe retrospectively reviewed patients with pT1 testicular seminoma in the National Cancer Database from 2004 to 2016. Receiver operating curves were used to determine the efficacy of the 3 cm tumor cutoff in identifying metastatic disease, and multivariable regression was used to compute the effect of tumor size on the rate of adjuvant therapy among Stage I patients.ResultsA total of 10,134 patients with pT1 seminoma were evaluated. The current size cutoff of 3 cm for subclassification did not exhibit high discrimination in identifying metastatic disease (area under receiver operating curve: 0.546). Surveillance has grown as the preferred treatment after orchiectomy ?32.1% in 2004 to 81.2% in 2015. However, the rate of adjuvant therapy for pT1, Stage I seminomas associated positively with tumor size even with adjustment for year of diagnosis. For tumors above 3 cm, the odds ratio stabilized around 1.9. By using the 3 cm cutoff to guide adjuvant therapy, up to 85% of T1b patients may be overtreated.ConclusionThe 3 cm cutoff for subclassification of Stage I seminoma does not predict metastatic recurrence but is associated with increased receipt of adjuvant therapy. A 3 cm cutoff and the pT1a/b classification may therefore contribute to overtreatment in many young patients with a long life expectancy for whom minimizing adverse effects should be prioritized.     

Juvenile dermatomyositis associated with autoantibodies to small ubiquitin-like modifier activating enzyme: a report of 4 cases from North India and a review of literature

Immunologic Research - Juvenile dermatomyositis (JDM) is the commonest inflammatory myositis in children. The clinical phenotype is often characterized by the presence of myositis-specific...     

Factors affecting mechanism and kinetics of drug release from matrix-based oral controlled drug delivery systems

Matrix technologies have often proven popular among the oral controlled drug delivery technologies because of their simplicity, ease in manufacturing, high level of reproducibility, stability of the raw materials and dosage form, and ease of scale-up and process validation. Technological advancements in the area of matrix formulation have made controlled-release product development much easier than before, and improved upon the feasibility of delivering a wide variety of drugs with different physicochemical and biopharmaceutical properties. This is reflected by the large number of patents filed each year and by the commercial success of a number of novel drug delivery systems based on matrix technologies. Matrix-based delivery technologies have steadily matured from delivering drugs by first-order or square-root-of-time release kinetics to much more complex and customized release patterns. In order to achieve linear or zero-order release, various strategies that seek to manipulate tablet geometry, polymer variables, and formulation aspects have been applied. Various drug, polymer, and formulation-related factors, which influence the in situ formation of a polymeric gel layer/drug depletion zone and its characteristics as a function of time, determine the drug release from matrix systems. Various mathematical models, ranging from simple empirical or semi-empirical (Higuchi equation, Power law) to more complex mechanistic theories that consider diffusion, swelling, and dissolution processes simultaneously, have been developed to describe the mass transport processes involved in matrix-based drug release. Careful selection of an appropriate model for drug release provides insight to the underlying mass transport mechanisms and helps in predicting the effect of the device design parameters on the resulting drug-release rate. Thus, a basic understanding of release kinetics and appropriate mechanisms of drug release from matrix system and their inter-relationships may minimize the number of trials in final optimization, thereby improving formulation development processes.     

The impact of age and comorbidities on practice patterns and outcomes in patients with relapsed/refractory multiple myeloma in the era of novel therapies

Objectives

One-third of patients with multiple myeloma (MM) are diagnosed at age ≥ 75 years. Older patients have increased incidence of cardiovascular disease (CVD) and renal insufficiency (RI), hallmark complications of MM. We examined cumulative incidence of CVD and RI in relapsed/refractory MM (RRMM) and outcomes by age and RI/CVD.

Phosphate ion removal from aqueous solution using snail shell dust: biosorption potential of waste shells of edible snails

The freshwater snails, Filopaludina bengalensis and Pila globosa are widely used for human consumption and as a feed in aquaculture in India and Bangladesh. The generation of shells as a waste product following meat extraction from the live snails incites their utilisation as a potential biomaterial. Shell dust was prepared from the dried shells of F. bengalensis (FSD) and P. globosa (PSD) and employed for phosphate adsorption from aqueous solutions. Batch adsorption experiments were performed to examine the effects of various experimental conditions, such as biosorbent dose, agitation speed, temperature, contact time, pH, initial concentration of phosphate ions, and presence of co-existing ions. SEM, EDS, ICP-OES, FTIR, and XRD results indicated that phosphate ions were adsorbed onto the surface of shell dust particles. The experimental data fitted with the Langmuir isotherm with a maximum adsorption capacity of 62.50 and 66.66 mg g⁻¹ for FSD and PSD. The pseudo-second order kinetic model was well fitted, indicating the chemical adsorption process, and the thermodynamic parameters indicated that the adsorption mechanism of phosphate was spontaneous, feasible, and endothermic. Therefore, the results have established the potentiality of the waste shells of edible snails to be used as an eco-friendly and low-cost biosorbent for phosphate removal from wastewater.

The waste shells of Filopaludina bengalensis and Pila globosa can be used as an eco-friendly and low-cost biosorbent for phosphate removal from eutrophicated water or industrial wastewater.     

Performance of Microchannel Heat Sink Made of Silicon Material with the Two-Sided Wedge

New designs of the microchannel with a two-sided wedge shape at the base were studied numerically. Five different wedge angles ranging from 3° to 15° were incorporated into the microchannel design. Simulation of this novel microchannel was carried out using Computational Fluid Dynamics (CFD). Three-dimensional models of the microchannel heat sink were created, discretized, and based on Navier–Stokes and energy equations; laminar numerical solutions were obtained for heat transfer and pressure drop. Flow characteristics of water as coolant in a microchannel were studied. It was observed that numerical results are in good agreement with experimental results. It was found that the Nusselt number and friction factor are significantly varied with the increase in Reynolds number. The Nusselt number varies in the following ranges of 5.963–8.521, 5.986–8.550, 6.009–8.568, 6.040–8.609, and 6.078–8.644 at 3°, 6°, 9°, 12°, and 15°, respectively. The microchannel with a wedge angle of 15° was found to be better in terms of Nusselt number and thermo-hydraulic performance. The enhancement in the Nusselt number is found as 1.017–1.036 for a wedge angle of 15°; however, friction factors do not show the perceptible values at distinct values of wedge angle. Moreover, the thermo-hydraulic performance parameters (THPP) were evaluated and found to be maximum in the range of 1.027–1.045 for a wedge angle of 15°. However, minimum THPP was found in the range of 1.005–1.0185 for a wedge angle of 3°.     

Establishing a telemedicine program for interventional radiology: a study of patient opinion and experience

PURPOSEThe coronavirus disease 2019 (COVID-19) pandemic forced healthcare officials to implement new policies, such as the use of virtual consultations over office-based medical appointments, to reduce the transmission of the virus. The purpose of this study was to quantitatively compare patients’ experiences with virtual outpatient telemedicine encounters at a single academic institution in interventional radiology (IR) and in-person visits during the course of the COVID-19 pandemic.METHODSThe TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were used to survey patients’ satisfaction with both in-person and virtual office visits.RESULTSNinety respondents (38 in-person and 52 virtual) acknowledged numerous benefits of virtual visits versus in-person office visits including reductions in time, cost, and potential viral transmission risk during the COVID-19 pandemic. No statistically significant difference was noted, based on a Likert scale from 1 to 7, between in-person and virtual visits (all P > .05) for scheduling-related factors. No statistically significant difference was noted in any of the MCCS subscales between the 2 cohorts with regard to medical information communication (all P > .05). A majority of patients with virtual encounters (82.7%) stated that it was easy to obtain an electronic device for use during the telemedicine visit, and 73.1% of patients felt that setting up the telemedicine encounter was easy.CONCLUSIONSThis study demonstrates that telemedicine is an acceptable alternative to in-office appointments and could increase access to IR care outside of the traditional physician–patient interaction. With telemedicine visits, patients can communicate their concerns and obtain information from the doctor with noninferior communication compared to in-person visits.

Main points

• In a pilot telemedicine program for interventional radiology clinic visits at a tertiary care hospital, the experience of telemedicine encounters was not inferior to in-person visits.
• There was no significant difference in patient experience and satisfaction between in-person and virtual encounters.
• There was no significant difference in the transmission and understanding of information between in-person and virtual encounters.

Telemedicine is an efficient and cost-effective service “that seeks to improve a patient’s health by permitting a two-way, real-time interactive communication between the patient and the physician at a distant site,” according to the Centers for Medicare and Medicaid Services (CMS).¹ With improvements in real-time audiovisual communications technology and secure high-speed internet access over the past several decades, the practice of telemedicine has evolved to augment and even replace traditional face-to-face medical visits. This has translated into improved accessibility to high-quality medical care for a wide variety of patient populations.In recent years, telemedicine has been shown to improve care logistics and increase the geographic reach of healthcare providers, which is more important than ever in the current environment of specialty care centralized in higher volume urban medical centers.^2,3 The benefits of telemedicine include improved clinical efficiency, increased access for patients in underserved areas to specialty care, reduction in transportation time and costs, as well as increased patient satisfaction.^4-11 Telemedicine has proven useful for a variety of patient appointments (e.g., initial consultations, preoperative evaluation, postoperative checks, and long-term follow-ups) in a broad range of healthcare settings (e.g., primary care, specialty care, stroke care, and physician-to-physician consultation between academic institutions or networks of rural community clinics).^7-15 However, despite this progress, telemedicine had previously not been broadly adopted due to regulatory hurdles and inflexible payment structures until coronavirus disease 2019 (COVID-19).¹⁶The pandemic forced healthcare systems to implement new practice workflows to mitigate the spread of severe acute respiratory syndrome coronavirus-2. Various governing bodies and associations instituted guidelines resulting in the cancelation of elective, non-emergent appointments and procedures. However, a large cohort of patients remained who suffered from time-sensitive ailments that required urgent consultation, evaluation, and medical procedures, making cancellation impossible.In order to continue to deliver care to these patients and reduce both patients’ and healthcare workers’ exposure to the virus, clinical assessments shifted to a virtual platform. Furthermore, CMS authorized a rule stating that virtual telemedicine visits would be temporarily reimbursed at the same rate as face-to-face visits to incentivize the use of telemedicine and thus reduce viral transmission rates.¹⁷ These changes were welcomed by healthcare personnel and patients alike. Additionally, the use of telemedicine allowed for continued routine care of the elderly or high-risk patients who would otherwise have been hesitant to seek face-to-face care in the midst of the pandemic.Telemedicine is a relatively new endeavor for many providers in a variety of specialties. Although various guidelines and recommendations have been published, there are few studies of telemedicine utilization in the practice of interventional radiology (IR).^18-33 The aim of this study was to evaluate patients’ experiences with the newly implemented COVID-19 era telemedicine in IR at a single tertiary care academic center.     

Clinical profile,multimodal imaging,and treatment response in macular serpiginous choroiditis

Purpose:To describe the clinical profile, multimodal imaging, and treatment response in macular serpiginous choroiditis (MSC).Methods:Clinical records of 16 eyes (14 patients) with MSC presenting to a tertiary eye care institute between 2015 and 2019 were analyzed retrospectively.Results:Mean age of 14 patients presenting with MSC was 33 ± 13 yrs with 64% males and 36% females. Mean visual acuity of the eyes with MSC at presentation was 0.43 ± 0.46 (logMAR) improving to 0.16 ± 0.28 (logMAR) at final visit. Thirteen eyes (81.3%) had active lesion at presentation. Mantoux test was positive in seven patients (50%) and QuantiFERON TB gold test positive in 10 patients (71%). HRCT chest showed latent tuberculosis in seven patients (50%). All patients underwent multimodal imaging. All patients received oral steroids as treatment therapy; 11 patients also received immunosuppressives, nine patients received additional anti-tubercular therapy (ATT). Mean duration of follow-up for the patients was 18 ± 10 months. A total of eight (50%) eyes had recurrence of lesions after an average duration of 14 ± 14 (3-36) months and were restarted on the treatment as per the requirement. At final follow-up, all eyes showed a good response to treatment and had healed lesions. Comparing the final BCVA to the initial BCVA, 38% (n = 6) showed improvement, 56% (n = 9) remained stable, and 6% (n = 1) eyes worsened at the final follow-up.Conclusion:Clinical profile and presentation of MSC is similar to that of CSC, and combination treatment with intravenous methyl prednisolone (IVMP), steroids, immunosuppressives, and ATT can salvage vision. A high suspicion of associated tuberculosis in endemic regions should be kept in mind.     

A nucleic acid amplification test‐based strategy does not help inform return to work for healthcare workers with COVID‐19

ObjectiveThe objective of this study is to assess the utility of a nucleic acid amplification test‐based approach to shorten isolation of healthcare workers (HCWs) with COVID‐19 in the setting of the highly transmissible omicron variant.MethodsBetween December 24, 2021, and January 5, 2022, HCWs who tested positive for SARS‐CoV‐2 were retested with PCR at least 5 days since onset of symptoms.ResultsForty‐six sequential fully COVID‐19 vaccinated HCWs who had tested positive for SARS‐CoV‐2 underwent follow‐up testing. All the samples were confirmed as omicron variants and only four (8.7%) were negative in the follow‐up test performed at a median of 6 (range 5–12) since onset of symptoms.ConclusionsImplementation of a test‐based strategy is logistically challenging, increases costs, and did not lead to shorter isolation in our institution.