Advanced Treatment Modalities Research Articles

Prostate-Specific Membrane Antigen-Targeted NIR Phototheranostics for Prostate Cancer.

The evolution of targeted cancer theranostics has revolutionized personalized medicine by integrating diagnostic and therapeutic capabilities. Prostate-specific membrane antigen (PSMA) has emerged as a key theranostic target in the context of prostate cancer, paving the way for the clinical approval of multiple drugs. However, the persistent challenge of off-target toxicity, which plagues both conventional and advanced treatment modalities such as targeted chemotherapy and radiotherapy, thus demands further innovation. Considering this critical issue, this review discusses the recent advances in the binary treatment techniques, i.e., phototherapies, that have the potential to circumvent the key concern of off-target toxicity associated with personalized chemotherapy and radiotherapy. Precisely, an up-to-date overview of the latest developments in the near-infrared (NIR)-based phototheranostic strategies for prostate cancer by targeting PSMA has been presented. Furthermore, we have discussed the associated particulars that require specific attention in enhancing the translational potential of phototheranostic techniques.

Radiotherapeutic advances in the management of glioblastoma.

Glioblastoma remains a fatal diagnosis despite continuous efforts to improve upon the current standard backbone management paradigm of surgery, radiation therapy, systemic therapy and Tumor Treating Fields. Radiation therapy (RT) plays a pivotal role, with progress recently achieved in multiple key areas of research. The evolving landscape of dose and fractionation schedules and dose escalation options for different patient populations is explored, offering opportunities to better tailor treatment to a patient's overall status and preferences; novel efforts to modify treatment volumes are presented, such as utilizing state-of-the-art MRI-based linear accelerators to deliver adaptive therapy, hoping to reduce normal tissue exposure and treatment-related toxicity; specialized MR techniques and functional imaging using novel PET agents are described, providing improved treatment accuracy and the opportunity to target areas at risk of disease relapse; finally, the role of particle therapy and new altered dose-rate photon and proton therapy techniques in the treatment paradigm of glioblastoma is detailed, aiming to improve tumor control and patient outcome by exploiting novel radiobiological pathways. Improvements in each of these aforementioned areas are needed to make the critical necessary progress and allow for new approaches combining different advanced treatment modalities. This plethora of multiple new treatment options currently under investigation provides hope for a new outlook for patients with glioblastoma in the near future.

Applying a “medical deserts” lens to cancer care services in the North-West region of Romania from 2009 to 2022 – a mixed-methods analysis

BackgroundMedical deserts pose significant challenges to healthcare systems worldwide, leading to unmet healthcare needs and exacerbated health issues, particularly in underserved regions.MethodsThis study aims to characterise cancer care services in the North-West region of Romania through the lens of medical desertification, employing a mixed-methods approach.Quantitative analysis – descriptive statistics – of secondary data from the Activity of Healthcare Units reports from 2009 to 2022, along with qualitative data – thematic analysis – from interviews with cancer patients and healthcare professionals, were employed to uncover the current state of cancer care in Romania.ResultsThe qualitative analysis highlighted the prevalence of medical deserts in oncology, with inadequate human resources, facility deficiencies, prolonged waiting times, high costs, and socio-cultural barriers hindering access to cancer care.Opportunities for action include revising treatment protocols, enhancing palliative care, implementing prevention strategies, promoting collaboration among healthcare professionals, and digitalising the healthcare system. However, challenges persist, including a shortage of oncology specialists, geographical disparities in cancer prevalence, and limited access to advanced treatment modalities in rural areas.ConclusionsAddressing medical deserts in cancer care requires comprehensive approaches, including strategic resource allocation, workforce development, infrastructure investments, access to innovative treatments, and digital health technologies. Collaboration among policymakers, healthcare providers, and communities is crucial to mitigating medical deserts and improving cancer outcomes.Despite limitations, this study provides valuable insights into cancer care services and underscores the need for concerted efforts to overcome medical desertification and ensure equitable access to high-quality cancer care.

Clinical Outcomes of Carbon Ion Radiation Therapy for Malignant Peripheral Nerve Sheath Tumors

Purposeto investigate outcome and toxicity of patients affected by malignant peripheral nerve sheath tumors (MPNSTs) treated with high-dose carbon ion radiotherapy (CIRT). Patients and methodswe retrospectively analyzed the outcome of 23 patients with MPNST treated between July 2013 and December 2020. Out of these, 13 patients (56.5%) had incompletely resected tumors, 8 patients (34.7%) experienced recurrence after surgery, and 2 patients (8.7%) had unresectable tumors. Before CIRT treatment, 4 patients underwent a second surgery after the first local recurrence (LR), and 1 patient underwent a third surgery for the second local relapse of disease. Six (26%) of patients received neoadjuvant chemotherapy. The most frequent tumor site was brachial plexus (N=9; 39.1%). In five patients (21.7%) neurofibromatosis type 1 (NF1) disorder was found, while 4 patients (17, 4%) had radiation-induced MPNST. The median CIRT prescribed total dose was 69.8 Gy [RBE] (range, 54-76.8) delivered in a median of 16 fractions (range, 15-22). Eleven patients (47.82%) were treated according to a sequential boost protocol with a median prescribed dose to CTV-LR of 45 Gy[RBE] (range, 41.4 – 54). ResultsAfter a median follow-up time of 23 months (range 3-100 months), the OS rates at 1-year and 2-year were respectively: 82.38%, 61.51%. The 1-year and 2-year LRFS rates were respectively: 65.07%, 48.80%; the 1-year and 2-year PFS rates were respectively: 56.37%, 40.99%. No patients showed acute or late Grade 4 toxicity or any treatment-related deaths. Ten patients (43.48%) reported acute toxicities of Grade ≥2: dermatitis in 6 patients, mucositis in 2 patients, peripheral neuropathy in 4 patients. Eight patients (34.78%) reported late toxicities of Grade ≥2, mainly due to loco-regional neuropathy. Conclusionshigh dose CIRT shows favorable local effect with acceptable toxicities in patients with gross residual and LR after surgery, or unresectable malignant peripheral nerve sheath tumors. Advanced treatment modalities such as particle therapy should be considered for MPNSTs.

Frequency and MIC-based Antimicrobial Resistance Profile of MDR and XDR Gram Negative Isolates of Blood Culture Specimens in a Tertiary Care Setting

The escalation of antimicrobial resistance (AMR) among Gram-negative bacteria, particularly multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens, posed a significant challenge in tertiary care settings. This paper comprehensively analyzed the antimicrobial resistance profile of MDR and XDR Gram-negative isolates from blood culture specimens at Jinnah Hospital, Lahore, a leading tertiary care facility. Over a period of one year, 9600 blood culture specimens were processed, revealing a high incidence of resistance to a wide array of antibiotics, with notable findings including 100% susceptibility to Colistin and over 90% resistance to several commonly used antibiotics such as Ciprofloxacin and Piperacillin/Tazobactam. Among the positive isolates, 33.8% were classified as MDR and 66.2% as XDR. The study emphasized the critical role of Minimum Inhibitory Concentrations (MICs) in guiding therapeutic decisions, highlighting the wide variability in resistance patterns and the necessity for personalized antimicrobial therapy. The prevalence of MDR and XDR isolates underscored the urgent need for advanced treatment modalities, comprehensive surveillance, and robust antimicrobial stewardship initiatives. Additionally, the study pointed to the emergence of colistin resistance as a critical challenge in managing infections caused by these pathogens. Through detailed analysis and discussion, this study illuminated the grave challenge posed by AMR in tertiary care settings. It emphasized the importance of innovative approaches to antimicrobial stewardship, developing new antimicrobial agents, and ongoing surveillance to effectively combat this public health crisis.

An in-vivo treatment monitoring system for ion-beam radiotherapy based on 28 Timepix3 detectors

Ion-beam radiotherapy is an advanced cancer treatment modality offering steep dose gradients and a high biological effectiveness. These gradients make the therapy vulnerable to patient-setup and anatomical changes between treatment fractions, which may go unnoticed. Charged fragments from nuclear interactions of the ion beam with the patient tissue may carry information about the treatment quality. Currently, the fragments escape the patient undetected. Inter-fractional in-vivo treatment monitoring based on these charged nuclear fragments could make ion-beam therapy safer and more efficient. We developed an ion-beam monitoring system based on 28 hybrid silicon pixel detectors (Timepix3) to measure the distribution of fragment origins in three dimensions. The system design choices as well as the ion-beam monitoring performance measurements are presented in this manuscript. A spatial resolution of 4mm\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${{4}\\,\\hbox {mm}}$$\\end{document} along the beam axis was achieved for the measurement of individual fragment origins. Beam-range shifts of 1.5mm\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${1.5}\\,\\hbox {mm}$$\\end{document} were identified in a clinically realistic treatment scenario with an anthropomorphic head phantom. The monitoring system is currently being used in a prospective clinical trial at the Heidelberg Ion Beam Therapy Centre for head-and-neck as well as central nervous system cancer patients.

Revolutionary Role of Stem Cell Therapy Coupled with Modern AI Based Technologies in Diabetes Management and Remission

Type 2 diabetes is a chronic metabolic disorder characterized by high blood sugar levels over a prolonged period. It is a significant global health issue, affecting millions of people worldwide. The traditional treatment for diabetes involves medication, lifestyle changes, and regular monitoring of blood sugar levels to decide on treatment modifications accordingly. However, recent advancements in modern technologies/techniques involving artificial intelligence (AI) and stem cell therapy have shown promising results in achieving excellent diabetes care outcomes and even remission, which was never conceivable a few decades ago. AI-driven interventions enable the development of tailored treatment plans, leveraging patient data to optimize glycaemic control and predict complications. Whole Body Digital Twin (WBDT) models provide holistic insights, facilitating significant rates of diabetes remission. Stem cell therapy when coupled with newer technologies has shown to be revolutionary towards this. Especially therapies targeting the mammalian Target of Rapamycin (mTOR) pathway show a great potential for regenerating damaged pancreatic beta cells and improving insulin production. However, challenges such as data privacy concerns with AI models utilising big data and ethical considerations in stem cell research persist; there is a need for regulatory norms towards this especially with the availability of these advanced treatment modalities, which would be the face of medical science in the coming years. For sure, combining AI and stem cell-based therapies present an innovative approach to enhance diabetes management, enabling the identification of suitable candidates for treatment and predicting treatment success. Diabetes was considered a lifelong disease that carried a huge burden of secondary organ complications over a period. This manuscript explores the potential of these innovative approaches in treating diabetes and discusses the scientific evidence supporting their utility.

HER2/neu in head and neck cancers: A worthy target or not?

e18022 Background: Head and neck cancers (HNC) account for a major public health problem across the globe, more so in India where it ranks as the second most common cancer. Most cases involve oral cavity due to use of chewable tobacco products and more than 65% present in locally advanced stage. It thus becomes imperative to continuously look for newer, more advanced targets and treatment modalities. One such target we sought to evaluate was HER2/neu, which has been successfully used for treatment in different tumors showing HER2/neu amplification from breast cancers to Gastric cancers and others, significantly improving survival outcomes. Further, with the development of Trastuzumab Deruxtecan now being evaluated as a tumor agnostic antibody for cancers showing even low levels of HER2/neu expression, we attempted to assess the incidence of HER2/neu expression (including HER2 low) in 50 cases of HNC using Immunohistochemistry (IHC) and Fluorescence In Situ Hybridization (FISH) with an aim to evaluate the utility vs futility, of treatment with Anti-HER2 antibody. Methods: Retrospective analysis was done in 50 recent cases of HNC diagnosed at Global Reference Laboratory, Agilus Diagnostics and they were evaluated for HER2/neu expression by IHC using the FDA approved Ventana clone. The study design was akin in most aspects to HER2/neu analysis in breast cancer, in which, on IHC, Score 3+ was considered positive and Score 0 was considered negative, both of which not warranting subsequent FISH analysis. Score 2+ on IHC was considered equivocal and thus subjected to FISH for confirmation. Positive cases in this category would be considered positive while negative cases would be considered negative but analyzed for appropriate group and kept in a separate category of HER2/neu low for analysis and future reference. Score 1+ though considered negative was also subjected to FISH to analyze copy numbers and HER2/CEP17 ratio and these cases were also clubbed separately in HER2/neu low group for analysis and future reference. Results: In 50 cases analyzed, none tested positive (Score 3+) for HER2/neu on IHC. Two cases showed equivocal staining while six cases showed Score 1+. Both equivocal cases tested negative on FISH and fell in Group 5 as per the latest 2023 guideline update. Of the six cases which showed Score 1+ on IHC, four cases fell in Group 5 while two showed Group 4 pattern. Thus, none of the cases were positive for HER2/neu as per the recent guidelines, while 8 cases fell under the category of HER2/neu low expression by definition. Conclusions: This study is in concordance with extremely low HER2 expression documented in HNC implying the futility of treatment with current Anti- HER2 antibodies. However, 16% cases showing HER2/neu low expression definitely make it prudent to do clinical studies assessing the utility of Trastuzumab Deruxtecan and similar antibody drug conjugates in this setting just like other tumor types where numerous studies are already undergoing at the moment.

Current Perspectives on Extensive Applications of Nanocochleates-based Drug Delivery

Abstract: Enhancing therapeutic efficacy stands as a pivotal concern across various medical conditions. Traditional therapeutic approaches have encountered limitations in addressing numerous issues. Over the recent years, the integration of nanotechnology has successfully overcome these obstacles, ushering in a new era of advanced treatment modalities. One notable stride has been the utilization of lipid-based nanocarriers, which have demonstrated substantial improvements in therapeutic outcomes. Among these innovative drug delivery systems (lipid-based), nanocochleates have emerged as the focal point for augmenting therapeutic potential and enabling targeted actions. Originally employed for vaccines, genes, and fungal infections, nanocochleates have evolved to address significant life-threatening diseases where conventional therapies fall short. The distinctive capability of nanocochleates lies in their ability to deliver drugs with enhanced precision in comparison with supplementary lipid-based systems, making them a promising novel carrier for improved efficacy. This piece of writing delves into the fundamentals of nanocochleates, exploring their safety and stability aspects, recent trends, and diverse applications. Notably, nanocochleates have shown promise in managing conditions such as diabetes mellitus, malaria, leishmaniasis, cancer, viral infections, and osteoporosis. By elucidating the unique attributes and potential of nanocochleates, this review aims to contribute valuable insights into their role as a cutting- edge drug delivery system across a spectrum of critical medical scenarios

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa.

The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Patterns and treatment outcomes of primary bone tumors in children treated at tertiary referral hospital, Ethiopia

BackgroundBone tumors account for approximately 6% of all cancers in children. Malignant bone tumors, commonly occurring in children and adolescents, are associated with high mortality and morbidity. The overall survival of children with primary malignant bone tumors is affected by the stage of disease, time of diagnosis, and treatment response. Despite advanced treatment modalities with chemotherapy, surgery, and radiotherapy, bone tumor is the third leading cause of death in children with malignancy. Patients with metastatic disease at diagnosis have poor outcomes compared to localized disease at presentation. The 5-year Overall Survival and event-free survival in children with primary malignant bone tumors were 85.2% and 69.2%. The study aimed to assess the clinicopathological profile and treatment outcomes of children with primary malignant bone tumors in our setup.Materials and methodsA hospital-based cross-sectional study was conducted on 95 children who met the inclusion criteria through structured questionnaire. The collected data were analyzed using a statistical package for social sciences (SPSS) version 25. P-value < 0.05 was considered to be statistically significant. Kaplan Meier survival estimate was used for overall and event-free survival analysis.ResultsA total of ninety-five patients met the study inclusion criteria and the median age at diagnosis with primary malignant bone tumors was 10 years, with an interquartile range of 8–12 years. The duration of the illness from the onset of symptoms to the oncologic treatment center ranges from three weeks to 2 years with a mean duration of five months. Swelling was the commonest presenting symptom accounting for 95.8% (n = 91). Lower extremity was the commonest primary site of involvement accounting for 55.8% (n = 53) of children with primary malignant bone tumors. Osteosarcoma was the commonest malignant bone tumor constituted 66.3% (n = 63), followed by Ewing sarcoma at 33.7% (n = 32).About 41.2% (n = 39) of children had metastatic disease at presentation and the lung was the commonest site of distant metastasis. The Kaplan Meier survival estimate analysis showed the 1-year and 5-year overall survival probabilities for all pediatric primary malignant bone tumor patients were 65% (95% CI: 0.3–0.56) and 38% (95% CI:0.19–0.47) respectively. The 1-year and 5-year event-free survival probabilities were 55% (95% CI: 0.32–0.73) and 33% (95% CI: 0.10–0.59). The stage of the disease at presentation had a significant association with the outcome (p = 0.023).ConclusionOur study showed the mean duration of the illness from the onset of symptoms to the oncologic treatment center was 5 months ranging from 3 weeks to 2 years. More than one-third of the presented with metastatic disease at presentation. The 1-year and 5-year overall survival (OS) probabilities of children with primary malignant bone tumors were low in our setup compared to other studies.

Ovarian Cancer in the Older Manitoban Population-Treatment Tolerance and Cancer-Related Outcomes: A Manitoba Ovarian Cancer Outcomes (MOCO) Group Study.

In Canada, individuals with gynecologic reproductive organs (ovaries, fallopian tubes, uterus) over the age of 70 comprise a large proportion of epithelial ovarian cancer patients. These patients often have co-morbidities, polypharmacy, or decreased functional status that may impact treatment initiation and tolerance. Despite this, there is limited evidence to guide treatment for older patients diagnosed with ovarian epithelial carcinoma. This is a retrospective study with data from Manitoba, Canada. The data were obtained from the Manitoba Ovarian Cancer Database, the Manitoba Cancer Registry, and electronic health records. All individuals with epithelial ovarian, fallopian tube, or peritoneal cancer diagnosed between 2009 and 2018 were identified. Patients aged > 70 at the time of diagnosis were included in the study cohort. Four hundred and forty individuals were included. The majority had advanced stage disease (56%). Moreover, 59% of patients received no chemotherapy. Of the patients who received chemotherapy, 20% received <2 cycles and 21% required a dose reduction due to toxicity. Univariable and multivariable analysis identified advanced stage (p < 0.001), treatment modality (p < 0.001), and advanced age at diagnosis (p < 0.001) with poorer overall survival. Our study demonstrated a high rate of chemotherapy dose reduction and discontinuation in the elderly epithelial ovarian cancer population. Further research is needed to identify risk factors for treatment discontinuation and intolerance in this population.

Different response of two primary neoplastic lesions to neoadjuvant therapy: a case report

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor, which is mostly solitary in the pancreas. Surgery-based comprehensive treatment with adjuvant chemotherapy is the currently advanced treatment modality, neoadjuvant chemotherapy has achieved satisfactory results, however, due to the high heterogeneity of PDAC, its sensitivity to chemotherapy is also different. A 66-year-old man presented with discomfort in the upper abdomen and Computed Tomography (CT) scans revealed two tumor lesions in the head and tail of the pancreas, respectively. Endoscopic ultrasonoraphy guided fine needle aspiration (EUS-FNA) was performed to clarify the pathology and the patient was recommended to undergo neoadjuvant therapy. Through five courses of neoadjuvant chemotherapy, the two tumors showed different treatment effects, and after evaluation, total pancreatectomy and splenectomy were provided to patients.We report a case of the one patient presenting with two pancreatic cancer lesions, who demonstrated different therapeutic responses after receiving neoadjuvant chemotherapy due to the heterogeneity of PDAC.

Impact of COVID-19 Pandemic on Cardiovascular Healthcare in Croatia: A Comprehensive Nationwide Survey.

The impact of the COVID-19 pandemic on cardiovascular healthcare in Croatia remains largely unexplored. This study aimed to compare the utilization and provision of cardiovascular services during the pre-pandemic (2017-2019) and pandemic (2020-2021) periods, leveraging nationwide data from the Croatian Health Insurance Fund, which covers 95% of all insurance claims in the country. Our findings reveal that while the use of coronary angiographies decreased during the pandemic, there was a notable increase in the utilization of advanced heart failure treatment modalities and percutaneous coronary interventions, particularly in the context of acute myocardial infarction. Additionally, transcatheter aortic valve implantations saw a significant rise during the pandemic period. Furthermore, laboratory diagnostic testing for troponin and natriuretic peptides experienced a marked increase, while the utilization of most other cardiovascular services remained stable or showed only minor declines compared to the pre-pandemic era. These observations suggest that the Croatian cardiovascular healthcare system displayed resilience during the COVID-19 pandemic, successfully maintaining and even expanding access to various diagnostic and interventional procedures despite facing widespread societal and logistical challenges.

A trinuclear Zn (II) schiff base dicyanamide complex attenuates bacterial biofilm formation by ROS generation and membrane damage and exhibits anticancer activity

A trinuclear Zn (II) complex, [(ZnL{N(CN)2})2Zn], termed complex 1 has been synthesized by the reaction of an aqueous solution of sodium dicyanamide to the methanolic solution of Zn (CH3COO)2, 2H2O and corresponding Schiff base (H2L) which is derived from 1:2 condensation of 1, 4 butane diamine with 3-ethoxy salicylaldehyde. Complex 1 is characterized by elemental analysis, IR, UV and Single X-ray diffraction study. Drug resistance is a growing global public health concern that has prompted researchers to look into advanced alternative treatment modalities. In this context, complex 1 has shown promising antibacterial and antibiofilm efficacy against gram-positive Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus strains. Complex 1 attenuated Staphylococcal biofilm formation by reducing several virulence factors including the formation of extracellular polysaccharide matrix, slime, haemolysin, staphyloxanthin, auto-aggregation, cell surface hydrophobicity, and motility. Notably, complex 1 mechanistically potentiated Reactive Oxygen Species (ROS) generation within the bacterial cells, leading to the damage of bacterial cell membrane followed by DNA leakage and thereby impeding the growth of Staphylococcus aureus. Furthermore, complex 1 significantly exhibited anticancer activity by reducing the growth of prostate adenocarcinoma cells. It obstructed the migration of cancer cells by potentiating apoptosis and arresting the cell cycle at the G2/M phase. In summary, complex 1 could act as a potent candidate for the generation of novel antibacterial, antibiofilm as well as anticancer treatment regimens for the management of drug-resistant biofilm-mediated Staphylococcus aureus infection and lethal prostate malignancy.

Practicing Otorhinolaryngology in moderntimes – ‘The conflict between the art and the science’

In the modern times, the practice of medicine has become more a science than art because the focus is more onusing advanced diagnostic and treatment modalities and practising evidence based medicine. The psychologicalcondition of the patient is not paid attention to. However, from ancient times, the art and science of medicinehave both been proved to be equally important to relieve human suffering. This article delves into the nuances ofpractising modern medicine today with equal emphasis on both the art and the science of medicine.

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation.

Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.

Wound Healing Outcomes Following Treatment With Synthetic Hybrid-Scale Fiber Matrix After Resection of Soft Tissue Tumors or Infections

Background. Wide excision of soft tissue tumors or infections often results in large defects that can be challenging to manage. Advanced treatment modalities—including NPWT, skin grafts, and xenografts—can all be considered for post-resection wound management, but each has its limitations. An SHSFM, engineered to resemble human extracellular matrix, has demonstrated positive wound healing outcomes in prior studies. Materials and Methods. Adult patients at a single institution who underwent resection of soft tissue tumor or infected tissue followed by treatment with SHSFM from 2020-2023 were retrospectively reviewed. Results. Ten patients were included in the review after meeting the inclusion criteria. Overall, 7 of 10 wounds had documented complete closure, with 3 lost to follow-up. Average time to wound closure was 119 days. Patients either healed via secondary intention or were bridged to a split-thickness skin graft. The average VSS score was 3.3 when assessed. Conclusion. The current case series demonstrated that the SHSFM can support granulation tissue formation over exposed structures as a bridge to skin graft or can completely reepithelialize large wounds without skin grafting. The SHSFM offers a novel treatment option for post-resection surgical wounds.

The differential effect of the immune system in breast cancer

Cancer cure with immunotherapy is an innovative step towards cancer treatment with better survivability, but it is mostly dependent on the response of the patient’s immune system to the immunotherapeutic approach. This descriptive review article emphasizes the conventional and advanced treatment modalities currently available for breast cancer management. This review also highlights the clinical management of breast cancer concerning immune response especially to unravel the prospects for manipulation of immune cells: such as lymphocytes, including T-cells, T-regulatory cells and natural killer cells, and others like macrophages, dendritic cells, and the panel of interleukins or interferons released by them which has made a significant impact on breast cancer research. In addition, an effort was made to emphasize the different clinical trials and their future implication for the reduction of breast cancer cases. Overall, an attempt has been made to shed light on the possibilities of immunotherapeutics in breast cancer care, as well as the role of immune response in the incidence, aggressiveness, and survival of breast cancer.

CONCEPTUAL ANALYSIS OF NASYA KARMA YOGAS IN BAHUGATA VIKARA

In Ayurveda, Pioneers have used all the possible routes of drug administration in different treatments, even from the era when the other medical sciences had not yet evolved. Among them, Nasya Karma, the non-invasive drug administration route with transmucosal nasal drug delivery, is a unique detoxification therapy in Panchakarma that aims at the alleviation of disorders that are related to the head and neck region. Bahugata Vikara is one of the most common neuromuscular ailments that hampers the day-to-day routine of an individual due to impairment of the upper limb. Even with advanced allopathic treatment modalities, patients are not getting satisfactory relief where Nasya karma is the prime treatment modality, especially for Urdhwajatrugata and Bahushirsagata Roga. It acts on higher centers of the brain, controlling different neurological, endocrinal, and circulatory functions, thus showing local and systemic effects. This article attempts to compile the various types of classical Nasya formulations specifically indicated in Bahugata Vikara by different Acharyas from Ayurveda classical texts, relevant information from previous research, and published materials from reputed sources.