COVID-19 lockdown learning: The uprising of virtual teaching

Abstract

Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer. 1 Indocyanine green (ICG) lymphography 2 can assess lymphatic functionality. However, some patients undergoing taxane-based chemotherapy experience a period of interstitial edema during which no flow is observed on ICG lymphography, because when the dye is injected near the first web space over the dorsum of the hand, it does not flow beyond the wrist. 3 Over time, this resolves and either returns to normal or results in dermal backflow (DBF). The present study aimed to investigate the association between lymphatic functionality and the risk factors for BCRL using ICG lymphography, while particularly focusing on the no-flow pattern.This study retrospectively reviewed 422 breast cancer cases involving axillary lymph node dissection (ALND). BCRL was diagnosed based on ICG lymphography patterns or, for patients with edema unable to undergo ICG lymphography, by comparing volume differences. The patients were divided into two groups based on the presence/absence of BCRL: BCRL( + ) and BCRL( −). The following characteristics were compared between the groups: age, body mass index, laterality, type of surgery (breast-conserving or mastectomy), disease staging, regional lymph node irradiation, hormone therapy, and type of chemotherapy (taxane, nontaxane, or no chemotherapy).Patients exhibiting the no-flow pattern underwent ICG lymphography every 3 months. DBF patterns typically do not change within such a short period, but because the noflow pattern was the result of temporary interstitial edema, changes were observed from one lymphography to the next ( Figure 1 ). Patients with prolonged edema who could not be diagnosed by ICG lymphography alone were assessed by lymphoscintigraphy. 4 Of the 422 patients who underwent ALND, 100 (23.7%) were diagnosed with BCRL. Compared with the BCRL( −) group, the BCRL( + ) group had significantly higher rates of lymph node irradiation (45% vs. 32%; P = 0.020) and taxanebased chemotherapy (94% vs. 63%; P < 0.001). Postsurgical disease staging was significantly more severe in the BCRL( + )

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“…We read with a great deal of interest the article on the "uprising" of virtual teaching during the COVID-19 pandemic 1 leading to upheaval not only in the healthcare system but also in the entire education network. Many different fields have found themselves catapulted into the remote world adapting to the challenge of maintaining learning and research under the constraints of COVID-19.…”

Short-term surgical missions to resource-limited settings in the wake of the COVID-19 pandemic

“…We are pleased to see many of our colleagues from around the world, including Addis Ababa, during the new era of excellent international educational webinars. 5 It is our intention, even if we cannot run our 2021 surgical mission to Addis Ababa, that we will still run our third annual head and neck conference remotely, using now tried and tested virtual platforms.…”