PURPOSE To understand readiness measures taken by oncologists to protect patients and health care workers from the novel coronavirus (COVID-19) and how their clinical decision making was influenced by the pandemic. METHODS An online survey was conducted between March 24 and April 29, 2020. RESULTS A total of 343 oncologists from 28 countries participated. The median age was 43 years (range, 29-68 years), and the majority were male (62%). At the time of the survey, nearly all participants self-reported an outbreak in their country (99.7%). Personal protective equipment was available to all participants, of which surgical mask was the most common (n = 308; 90%). Telemedicine, in the form of phone or video encounters, was common and implemented by 80% (n = 273). Testing patients with cancer for COVID-19 via reverse transcriptase polymerase chain reaction before systemic treatment was not routinely implemented: 58% reported no routine testing, 39% performed testing in selected patients, and 3% performed systematic testing in all patients. The most significant factors influencing an oncologist’s decision making regarding choice of systemic therapy included patient age and comorbidities (81% and 92%, respectively). Although hormonal treatments and tyrosine kinase inhibitors were considered to be relatively safe, cytotoxic chemotherapy and immune therapies were perceived as being less safe or unsafe by participants. The vast majority of participants stated that during the pandemic they would use less chemotherapy, immune checkpoint inhibitors, and steroids. Although treatment in neoadjuvant, adjuvant, and first-line metastatic disease was less affected, most of the participants stated that they would be more hesitant to recommend second- or third-line therapies in metastatic disease. CONCLUSION Decision making by oncologists has been significantly influenced by the ongoing COVID-19 pandemic.
Results from in vitro experiments on the phrenic nerve—diaphragm and the hypogastric nerve—vas deferens preparations of the guinea‐pig have been used to plot log concentration‐effect curves for skeletal neuromuscular and ganglion blockade, respectively, for (+)‐tubocurarine, pancuronium, alcuronium, gallamine and fazadinium (AH 8165). From the log concentration‐effect curves, EC50s and equipotent ratios were calculated. The order of neuromuscular blocking potency was pancuronium = alcuronium > (+)‐tubocurarine > fazadinium = gallamine. The ratio EC50 for ganglion blockade/EC50 for neuromuscular blockade was 2.3 for fazadinium, 6.7 for (+)‐tubocurarine, 22.9 for alcuronium, 24.3 for gallamine and 200.0 for pancuronium. For pancuronium and gallamine there was a range of concentrations below those producing ganglion blockade at which the response of the vas deferens to hypogastric nerve stimulation was augmented. The results are compared with some of those available in the literature, measured on other species by other methods.
A 4-month-old female Saanen-cross kid goat was presented to the University Veterinary Hospital (UVH), Universiti Putra Malaysia (UPM), for a traumatic injury of the right hind limb. Radiographic examination revealed open comminuted fracture of the mid shaft of 3 rd and 4 th metatarsal bones and Salter-Harris fracture type IV at the distal end of tibial bone. A mid femoral amputation was considered as an alternative to euthanasia. This report describes the surgical procedure and medical management following surgical intervention.
To study the management of carcinoma cervix when the patient has an associated pelvic kidney. The simultaneous occurrence of carcinoma cervix and pelvic kidney is rare. It is an interesting scenario where surgery is technically challenging and radiation is difficult since the pelvic kidney lies within the field of radiation. In our department, we treated three cases of cervical carcinoma with pelvic kidney. First case was FIGO IIB treated with external beam radiotherapy followed by radical hysterectomy; second case stage IB1 treated with radical hysterectomy, third case was referred to us after panhysterectomy with carcinoma detected in postoperative histopathological report, and she was treated with external beam radiotherapy. We made an online database search and found few case reports of gynecological malignancies associated with pelvic kidney and reviewed their management. All the three patients are alive and disease free in the last follow up. None of the patients developed uremia. The pelvic kidney of the patients treated with radiotherapy has shrunken in size. Surgery is preferred over radiotherapy in early stages of carcinoma cervix with pelvic kidney to avoid radiation-induced damage to pelvic kidney.
Objective The COVID-19 pandemic has forced healthcare providers worldwide to bring in changes in the way cancer patients are cared for. Many cancer departments globally have brought in changes to their daily practice. This article is about our experience of evolving “COVID 19 PROTOCOL” devised in our department and taking a shape to suit a health care system with limited budget. Materials and methods All the patient census & details of department of surgical oncology, Royapettah cancer hospital, from month of March 2020 to July 2020, who were subjected to COVID protocol were compared to patient census of similar duration in immediate past five months of October 2019 to February 2020. The data from out-patient department, ward in-patient census and healthcare personnel data was analyzed. Results There was a drop to 63.5% in OP census and 61.6% in IP census. There was a drop to 64.5% in number of major cases operated during initial phases of COVID pandemic. Health care workers were also infected with the COVID but cross infectivity can be checked if proper steps to adhere to an institutional protocol based on general measures of cleanliness are taken. Conclusion Adherence to an institutional protocol based on compliance to general measures of masking, hand washing and social distancing plays a major role in minimizing disease spread. The Royapettah COVID protocol, though in process of evolution, can be recommended for any health care center with limited resources.
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