Impact of nationwide lockdown on cancer care during COVID-19 pandemic: A retrospective analysis from western India

Background and aimsCOVID-19 has impacted healthcare system worldwide including cancer case. Aim of this study was to describe the experience of lockdown on cancer care concerning patient's visit and reception of treatment in western India.MethodsThis is a retrospective observational study conducted in patients with cancer attending a tertiary care center pre-lockdown and during lockdown (from January to May 2020). Data related to demographic parameters, type of tumor, type of treatment received and functional status of patients were retrieved from hospital medical records of patients.ResultsOf the 5258 patients included, 4363 visited hospital pre-lockdown (median age, 50 years) and 895 visited during the lockdown period (median age, 47 years). A total of 1168 and 106 patients visiting hospital before and during lockdown, respectively, had comorbidities. Breast cancer (25.6% and 29.7%), head and neck cancer (21.3% and 16.9%) were the most common type of solid tumors; leukemia (58.0% and 73.0%), lymphoma (18.8% and 13.5%) and multiple myeloma (18.6% and 12.2%) were the most common type of hematological malignancies observed in patients visiting pre-lockdown and during lockdown, respectively. Chemotherapy was most commonly received treatment (pre-lockdown, 71.8%; during lockdown, 45.9%). Other therapies reported includes supportive/palliative, targeted, hormonal, and immunotherapy. The majority of patients who visited the hospital pre-lockdown (68.4%) and during lockdown (62.8%) had 0 or 1 Eastern Cooperative Oncology Group (ECOG) score.ConclusionOverall observations highlight a substantial impact of an imposed nationwide lockdown during COVID-19 pandemic on cancer care of patients in terms of reduced patient visits and number of treatments received.     

Diagnosis of cardiac sarcoidosis: an era of paradigm shift

Cardiac sarcoidosis is a granulomatous disease that may affect any organ, including the heart. Diagnosis of cardiac sarcoidosis is challenging, given the varied and non-specific clinical presentation and limited sensitivity and specificity of available diagnostic tests. With the growing interest and developments in imaging techniques, cardiac magnetic resonance imaging (CMR) and positron emission tomography (PET) have emerged as important tools in the diagnostic evaluation of patients with suspected cardiac sarcoidosis. These modalities have been given increasing emphasis in successive published diagnostic guidelines for CS. This review will provide an update on the recent paradigm shift in diagnostic guidelines for cardiac sarcoidosis, with a focus on the advanced cardiac imaging modalities and their developed role in clinical practice.     

Resident education and training in female sexuality: results of a national survey

IntroductionConsidering the prevalence of female sexual dysfunction, the lack of education and training in female sexual function and dysfunction (FSF&;D) during and obstetrics and gynecology residency highlights a need for greater focus on this topic.AimTo assess understanding and confidence among third and fourth year Ob/Gyn residents with respect to FSF&;D.MethodsAn Internet‐based survey was constructed to evaluate third and fourth year residents in American Council for Graduate Medical Education‐approved Ob/Gyn programs. Residents were asked about familiarity, knowledge, and confidence in treating various aspects of FSF&;D, based on the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives for Ob/Gyn training. They were also queried regarding areas of improvement for their education.Main Outcome MeasureResponses to survey instrument.ResultsTwo hundred thirty‐four residents responded. The majority (91.5%) reported attending ≤5 didactic activities on FSF&;D. Only 19.6% reported often or always screening women for sexual function problems; most had very little or no knowledge in administering or interpreting screening questionnaires. While many (82.8%) felt confident about obtaining a complete sexual history, only 54.7% felt able to perform a targeted physical exam. Although most residents had cared for women with dyspareunia (55.1%), a minority had managed many women with low desire (18.4%), arousal problems (8.1%), anorgasmia (5.6%), or vaginismus (16.7%). In treating patients, 34–56% reported rarely or never suggesting ancillary therapy such as counseling and medications. However, the majority believed that their confidence would increase through FSF&;D lectures (97.9%), FSF&;D patient observations (97.4%), rotating with a urogynecologist (94.4%), and online modules (90.6%).ConclusionDespite CREOG requirements for Ob/Gyn training in female sexuality, most residents feel ill‐equipped to address these problems. Additional evidence‐based educational and didactic activities would enhance residents' knowledge and confidence in treating these common, quality‐of‐life issues. Pancholy AB, Goldenhar L, Fellner AN, Crisp C, Kleeman S, and Pauls R. Resident education and training in female sexuality: Results of a national survey.     

Serum nevirapine and efavirenz concentrations and effect of concomitant rifampicin in HIV infected children on antiretroviral therapy

Objective  

To determine factors affecting serum levels of Efavirenz and Nevirapine and analyze the effect of Rifampicin on Nevirapine drug levels.     

The mitochondrial phase of the glucocorticoid-induced apoptotic response in thymocytes comprises sequential activation of adenine nucleotide transporter (ANT)-independent and ANT-dependent events

In thymocytes, dexamethasone initiates cytochrome c-dependent processing of caspase-9 and the activation of caspase-3 to trigger apoptotic damage. Using murine thymocytes or a thymocyte cell line WEHI 7.1, we show that this pathway is inhibited by dominant-negative caspase-9, the anti-apoptotic protein Bcl-2, or by blocking components of the mitochondrial permeability transition pore complex (PTPC). We use DIDS (dithiocyanatostilbene-2,2-disulfonic acid), a pharmacological modifier of VDAC (voltage-dependent anion channel) function or ectopic expression of hexokinase-II, to examine the role of the VDAC--a mitochondrial outer membrane protein--in this apoptotic pathway. This approach implicated the VDAC in dexamethasone-mediated cytochrome c release, processing of caspase-9 and caspase-3, the loss of mitochondrial transmembrane potential (Deltapsim), nuclear damage and cell lysis. Inhibiting the adenine nucleotide transporter (ANT), a protein on the mitochondrial inner membrane, also blocks dexamethasone-induced apoptosis, but the ANT regulates caspase-3 processing and nuclear damage but not the mitochondrial efflux of cytochrome c. Collectively, the data identify two separable, but connected events in dexamethasone-induced mitochondrial damage in thymocytes. The first event is an increase in permeability of the mitochondrial outer membrane leading to VDAC-regulated efflux of cytochrome c and initial processing of caspase-9 followed by ANT-dependent caspase-3 processing and apoptotic damage to cells.