Access to brachytherapy treatment for cervical cancer management in Africa

Background and purpose: Cervical cancer is an important public health issue with a high incidence and death rate in Africa. It is mostly treated with Brachytherapy as the gold standard but its access is limited. This study set out to investigate the distribution and accessibility of brachytherapy units in Africa for the treatment of cervical cancer, and to provide some recommendations for increasing the quantity and accessibility of such equipment throughout the continent. Materials and methods: The International Atomic Energy Agency’s Division of Human Health’s Directory for radiotherapy Centers (DIRAC) was the principal source of data for this study. The number of brachytherapy equipment in the 54 African countries was obtained from the DIRAC database. The number of cervical cancer cases was obtained from the GLOBOCAN 2022 database, and country’s income was calculated using the Gross Domestic Product (GDP) per capita from the global economics database. All of these searches were conducted in February 2024. Results: Africa exhibited a greater number of cervical cancer cases. A total of one hundred (100) brachytherapy units were present across 84 radiotherapy centres spanning 20 African countries. Egypt and South Africa each possess 23 units, which accounts for 46% of the overall quantity. With just two brachytherapy facilities, Nigeria had the most cervical cancer cases. A significant quantity of brachytherapy unit was situated in countries of northern Africa. The quantity of these units varied among countries, from those without any to those with many, and was not only influenced by GDP per capita. Conclusion: Due to the rising incidence of cervical cancer in Africa, the number of brachytherapy equipment was woefully inadequate. Consequently, Africa requires partnerships and financial support to facilitate the quantity and accessibility of brachytherapy services. This will enable the provision of thorough and holistic care to patients and enhance their quality of life

SARS-CoV-2 infection dynamics in household case-contact study: Biological sample analysis from India

Introduction: This study aimed to determine RNA positivity in nasopharyngeal samples, urine and stool, period to seropositivity, viral clearance and associated factors. Methods: A cohort study was conducted multicentrically in Kerala, India, among 147 SARS-CoV-2 patients and 347 household contacts. Serial nasopharyngeal swabs, feces, urine, and serum samples were collected on days 1, 7, 14, and 28. Multivariable logistic regression was used to determine factors associated with RNA positivity, viral clearance and seropositivity. Results: Among the index cases, median duration for respiratory samples to test negative was 10.5, 7 days in 18 years respectively. The median period of RNA detection in feces was longer at 14 days (IQR 7, 28). The independent determinants of RT-PCR negativity of nasopharyngeal samples at >7 days was fever a OR 3.3 (95 % CI 1.1, 10.5). In the multivariable analysis for antibody response, those with less than or equal to 12 years of schooling had five times higher risk of being seronegative [aOR 5.2 (95 % CI 1.6, 16.7)]. Shedding of the virus in stool was more common among those aged <40 years (a OR 2.8, 95 % CI 1.2, 6.4) and among those who had fever (a OR 3.4, 95 % CI 1.1, 10.8). Among the contacts the seropositivity was determined by being illiterate 1.8 (95 % CI 1.1, 3.2), and reporting any symptom from day 1–14 aOR 3.2 (95 % CI 1.9, 5.2). Conclusion: The shorter duration of RNA positivity in respiratory samples and viral shedding in stool has implications for managing infection control and monitoring in diverse populations

Failure mode effect analysis use and limitations in medical device risk management

This study aims to investigate the application of risk analysis techniques in the medical device industry and the techniques most utilised to address compliance with ISO 14971:2019 with a view to assessing the challenges of risk management. Failure Mode Effect Analysis (FMEA) and its limitations as a tool are also investigated, as well as the risk management competencies that may contribute to effective risk management implementation. Qualitative interviews were conducted with risk management experts to gain insights into current risk management practices and challenges. The study found that FMEA is the most utilised risk analysis tool by the medical device industry but does not meet all risk analysis requirements per ISO14971:2019. FMEA focuses on device functionality and risk of failure and does not account for safety risks during normal device usage. It is the first focussed study on FMEA limitations in the medical device risk assessment process, and the study can be utilised to inform regulatory policy and industry best practices. Benchmarking the pros and cons of FMEA as a tool can strengthen Risk management thinking and deployment. This study is also novel in relation to the analysis of risk analysis requirements per ISO 14971, as well as looking at risk management competency gaps in Medtech in terms of risk analysis

A nationwide planning model for argon supply chains with coordinated production and distribution

In this work, we address a nationwide tactical planning for industrial gas supply chains, particularly argon. The proposed approaches follow as extensions of our previous work (Comp. &amp; Chem. Eng., 161 (2022) 107778) in which a regional argon supply chain problem is addressed; in that work, both production and distribution could be represented in detail. Two different types of deliveries from the Air Separating Units (ASU) to customers, which involve single driver deliveries for short distance trips and sleeper team that require multiple days. The nationwide problem requires simplifications to keep the problem mathematically tractable, primarily the representation of production sites with different tier costs and the aggregation of customers in clusters. The regional problem addressed in our previous work is used as a benchmark case study for benchmarking. We then focus on a real-world problem that represents a nationwide argon supply chain. Despite the size of the models, near optimal solutions could be found in reasonable times. Finally, we highlight important features of the proposed approaches

Relation between free testosterone levels and body composition in hemodialysis patients

Introduction Testosterone deficiency is common among hemodialysis (HD) patients. Numerous studies demonstrated a correlation between testosterone levels and body composition in the general population. However, this correlation was not thoroughly investigated in HD patients. Therefore, we conducted this study to assess the correlation between free testosterone levels and body composition in HD patients.Methods A total of 80 males were included in this study, compromising 40 hD males in addition to age-matched 40 healthy controls. Free testosterone levels and body composition were measured using the InBody device.Results Free testosterone level was significantly lower in the HD group (median; 75 pg/dl and interquartile range (IQR); 55.8–87.8 pg/dl) than in the control group (median; 101 pg/dl and IQR 82.8–115 pg/dl) with p = 0.004. The skeletal muscle index (SMI) was significantly lower in the HD group (median; 10.18 and IQ; 9.5–10.6) compared to the control group (median; 11.1 and IQR; 10.3–11.7), with p < 0.001. The lean tissue index (LTI) was significantly lower in the HD group (median; 18.44 and IQ; 17.3–19.3) than in the control group (median; 19.88 and IQ; 18.4–20.8), with p = 0.006. The free testosterone level demonstrated a positive correlation with SMI (r = 0.34, p = 0.03) and LTI (r = 0.33, p = 0.04).Conclusion There is a correlation between free testosterone levels and body composition in HD patients

Myocardial functional recovery following durable ventricular assist device in children

Background: Ventricular assist device (VAD) explantation following myocardial functional recovery (MFR) for heart failure (HF) is uncommon in children and is associated with a risk of HF recurrence. Material and Methods: Retrospective, single-center study of pediatric patients who were supported with durable VADs, both intracorporeal continuous flow devices (CFD) and paracorporeal pulsatile flow devices (PFD), between 2004 and 2022. Results: A total of 74 children, of which 43 were female, underwent VAD implantation (PFD = 61 and CFD = 14) at a median (interquartile range) age of 5.6 (0.8, 13.5) years and with a weight of 16.2 (7.5, 40.7) kg. From this cohort, we identified 9 of 75 (12%) children who underwent VAD explantation for MFR. Of those, 7 of 9 (77%) were under 2 years of age and 6 of 9 (67%) were supported for >90 days. Five patients had dilated cardiomyopathy, 3 with anomalous left coronary artery from pulmonary artery and 1 with tachycardia-induced cardiomyopathy. Six were listed for transplantation as a part of their HF management strategy following VAD implantation. After explant, 8 of 9 patients remained in HF remission with no symptoms and stable left ventricular function. One patient had a recurrence of HF following explantation after demonstrating MFR while on VAD support. Conclusions: MFR resulting in VAD explantation is feasible in children with chronic HF especially for those <2 years of age. Further work is needed to better identify the features that promote MFR and maintain it after explant

Enhanced radiosensitivity of head and neck cancer cells to proton therapy via hyperthermia-induced homologous recombination deficiency

Background and purpose: Radiotherapy induces tumor cell killing by generating DNA double strand breaks (DSBs). The effectiveness of radiotherapy is significantly influenced by the repair of DSBs, which counteracts this lethal effect. Current investigations are focused on determining whether non-homologous end joining (NHEJ) or homologous recombination is the predominant repair pathway following proton and photon radiation. Materials and methods: In this study, we examined the response of FaDu cells, a head and neck squamous cell carcinoma model, to spread-out Bragg peak (SOBP) proton and photon radiation combined with mild hyperthermia (42 °C for one hour) to induce homologous recombination deficiency or NHEJ inhibition by AZD7648. Results: Hyperthermia resulted in stronger radiosensitization after proton radiation (SR = 1.53) compared to photon radiation (SR = 1.32). Conversely, NHEJ inhibition did not produce a significant differential effect between photon and proton radiation. This indicates a greater reliance on homologous recombination following proton radiation compared to photon radiation. We found that the number of DSBs formed after photon versus proton irradiation is comparable. Interestingly, the homologous recombination protein Rad51 accumulated more frequently at DSBs following proton irradiation than photon irradiation. Conclusions: These findings support the hypothesis that cells rely more on homologous recombination to repair proton-induced DNA damage compared to photon-induced DNA damage. As clinically applied hyperthermia enhances the therapeutic effect of photon irradiation by, among other factors, inducing homologous recombination deficiency, our results suggests that hyperthermia could be more effective in combination with proton irradiation than photon irradiation

Noninvasive Mechanical Ventilation Is a Promising Way to Improve Lung Cancer Radiation Therapy

Purpose: Accurate radiation therapy (RT) for lung cancer is challenging because of the respiratory motion of the tumor and surrounding organs at risk. Recently, non-invasive mechanical ventilation (NIMV) has been investigated as a novel respiratory motion management strategy. Using NIMV, respiratory motion can be minimized, while a larger lung volume yields less overall lung dose. The purpose of this study was to determine the potential benefit of NIMV to improve lung cancer RT using magnetic resonance imaging (MRI) data of healthy volunteers. Methods and Materials: Twelve healthy volunteers practiced NIMV at 60 breaths per minute (NIMV60) with added positive end-expiratory pressure (PEEP) in 2 sessions and subsequently underwent NIMV60 in 2 MRI sessions. We acquired single-slice sagittal 2-dimensional MRI images at 2.6 Hz for 6 minutes during free breathing and NIMV60. We quantified the motion of all visible cross-sections of lung arteries, as a surrogate for lung tumors, in cranio-caudal and anterior-posterior directions using deformable image registration, distinguishing between 4 quadrants in the lungs (posterior-cranial, posterior-caudal, anterior-caudal, and anterior-cranial). Also, we analyzed average lung area, as a surrogate for lung volume, on the sagittal images using automatic segmentation. Results: All volunteers were successfully trained to be ventilated with NIMV60, and completed all sessions. The reduction of the median lung artery motion in each of the quadrants varied from 61% to 67% (from 10.7-29.9 to 3.8-11.7 mm) in cranio-caudal direction and from 51% to 68% (from 8.0-13.7 to 3.0-5.1 mm) in anterior-posterior direction using NIMV60. NIMV60 increased the sagittal lung area by 35% compared with free breathing. Conclusions: NIMV60 with added PEEP is a promising way to improve lung cancer RT because of reduced respiratory motion and increased lung area compared with free breathing

Performance of activated carbon derived from tea twigs for carbon dioxide adsorption

Activated carbon from agro-industrial waste, namely tea twigs derived from the processing of Camellia Sinensis branches, using a potassium hydroxide activator for CO2 adsorption has been conducted in this study. Various carbonization temperatures (4000C and 5000C) and heating times of 1 h and 3 h were used in this study. The concentration of potassium hydroxide (40 % and 60 %) and the ratios of activator solutions to carbon precursor made from pyrolysis of tea twigs (2:1 and 4:1) were varied for the chemical activation process. The effectiveness results of the obtained activated carbon were characterized through using Brunauer-Emmett-Teller analyzer and Temperature Programme Desorption-CO2 to determine the surface area and capacity maximum of CO2 adsorption. The optimum condition for the synthesis of activated carbon that produces high surface area was obtained at sample CCS 400/1 A2B1 where biochar carbonized at temperature of 400 °C kept for 1 h with a ratio of activator solution and precursor 4:1 using KOH concentration of 40 %. The highest surface area was obtained 1403 m2 g−1 with pore volume 0.9 m2 g−1 and pore size 1.11 nm and proved the presence of microporous areas in produced activated carbon. The maximum CO2 adsorption capacity obtained in this study was 5.1573 mmol g−1. This result could be related to the higher amount of microporous present in the activated carbon that facilitates the access of CO2 to the active sites at the pores of activated carbon

Assessment of social isolation and changes in Parkinson’s disease symptoms during the COVID-19 pandemic: A longitudinal study

Background: COVID-19-related social restrictions provided an opportunity to evaluate the impact of social isolation on Parkinson’s disease. Objective: This study aimed to explore changes in social isolation and their associations with PD symptoms using the Lubben Social Network Scale-Revised (LSNS-R). Methods: Data from 80 participants of the Early Parkinson’s Disease Longitudinal Singapore cohort were collected from April 2019 to April 2023, covering the periods before and after the imposition of COVID-19 restrictions. Individuals with LSNS-R scores ≤ 24 were considered socially isolated. Data were stratified into strata 1 (improved LSNS-R scores) and strata 2 (worsened/unchanged scores). Linear regression was used to identify predictors of LSNS-R change, and MANCOVA was used to examine associations between LSNS-R change and motor/ non-motor symptoms. Results: Mean LSNS-R scores decreased (p = 0.014), and proportions of social isolation increased (p < 0. 001) during COVID-19 restrictions. However, 35 % showed improved LSNS-R scores, while 65 % had worsened/unchanged scores. The regression model was significant in strata 1 (R2 = 0.806, p = 0.001), with age, marital status, and social isolation status being significantly associated with change in LSNS-R scores. LSNS-R. Results of MANCOVA indicated that LSNS-R improvements in LSNS-R were significantly associated with outcomes (Roy’s Largest Root statistic = 126.638, p < 0.001), particularly for changes in PDQ8, HADS-Anxiety, and HADS-Depression scores. The regression model was not significant in strata 2 (R2 = 0. 279, p = 0.206), wherein motor and non-motor symptoms worsened. Conclusion: While worsening LSNS-R scores were associated with poorer outcomes, improvements in social networks were associated with improved non-motor symptoms and quality of life. These findings underscore the complexity of social isolation in PD and the need for targeted interventions