38 research outputs found

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

    Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

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    Background: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods: We prospectively included adults aged ≄18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

    Eriocaulon goaense Kolte, I. Yadav & Janarth. 2022, sp. nov.

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    Eriocaulon goaense Kolte, I.Yadav & Janarth., sp. nov. (Fig 1 & 2) Allied to Eriocaulon cuspidatum Dalzell, but differs in its broadly cuneate floral bracts that are densely hoary dorsally towards apex (vs. oblanceolate, sparsely hoary dorsally towards apex), narrowly keeled sepals of male flowers (vs. not keeled), obovate, conduplicate, broadly keeled sepals of female flowers that are smooth along margin, densely hairy along keel and on dorsal side (vs. oblanceolate, conduplicate, acuminate, keeled, scarious, glabrous), and unequal, linear to lanceolate petals of female flowers that are hoary at apex in odd petal (vs. subequal, spathulate, sparsely hoary at apex in all the petals). Type:— INDIA. Goa: North Goa, Goa University Campus, 15027 ’43.09” N 73049 ’ 59.77” E, 53m, 14 September 2019, R. R. Kolte RRK 1890 (holo BSI!; iso SUK!). Acaulescent herb. Rootstock absent. Leaves 6–10 × 0.7–1 cm, rosulate, glabrous, entire along margin, cuspidate at apex. Sheaths up to 10 cm long, glabrous; limb ovate, acute, entire. Peduncles many, up to 35 cm high, 9–11 ridged. Heads ca. 7 mm across, hemispherical, straw coloured. Receptacles convex, glabrous. Involucral bracts 1.6–1.8 × 1.4–1.5 mm, chartaceous, oblong, spreading, obtuse, straw coloured. Floral bracts 1.4–1.5 × 1.1–1.2 mm, hyaline, broadly cuneate, obtuse, densely hoary dorsally towards apex. Male flowers: Sessile, sepals 2, ca. 2 mm long, hyaline, free, spathulate, narrowly keeled, densely hairy along keel and on dorsal side. Stipe of corolla 1.2–1.5 mm long. Petals 3, subequal, pubescent, dotted with black glands; odd one ca. 1 mm long, remaining 2 of same size, smaller than odd petal; anthers black. Female flowers: Shortly pedicelled. Sepals 2, free, similar, 1.4–1.5 × ca. 1 mm, obovate, conduplicate, broadly keeled, smooth along margin, hoary outside towards apex. Petals 3, unequal; odd one ca. 2 × 0.4 mm, lanceolate, hoary towards apex, black gland dotted; 2 petals similar, ca. 1.5 mm long, linear to narrow lanceolate, glabrous, black gland dotted. Ovary sessile, ellipsoid; style 3-fid. Seeds ca. 1 × 0.5 mm, ovoid, apiculate; cells of seed coat transversely elongated, arranged in vertical rows, appendage 1 from transverse radial walls. Distribution:—Scattered in distribution at low level lateritic plateaus of Goa. Habitat:—Shallow seasonal ponds of lateritic plateaus in association with Eriocaulon fysonii R.Ansari & N.P.Balakr. (1994: 89), Oryza rufipogon Griff. (1851: 5) and Wiesneria triandra (Dalzell 1850: 144) Micheli (1881: 82). Flowering & Fruiting:—July to November. Etymology:—Specific epithet ‘ goaense ’ refers to the state of Goa, wherein it is distributed. Additional specimens examined (Paratypes):— INDIA. Goa: North Goa, Goa University Campus, 16 July 2010, I. Yadav 1; 24 July, 2010, I. Yadav 2; 31 July 2010, I. Yadav 5; 17 August 2010, I. Yadav 8; Succoro (Sukor) plateau, 18 September 2010, I. yadav & M. K. Janarthanam 64; South Goa, Farmagudi (Ponda), IIT Campus, 28 August 2010, I. Yadav & M. K. Janarthanam 32; 18 September, 2010, I. Yadav & M. K. Janarthanam 35; Loliem, 5 September 2010, M. K. Janarthanam & I. Yadav 47; 1 September 2018, R. R. Kolte RRK 1710 (All at BSI!) Note:—This species is closely allied to E. cuspidatum which is occasionally found in wet or marshy places from sea level to 250 m altitude in Western Peninsular India, especially in Karnataka, Kerala and Maharashtra (Ansari & Balakrishnan, 2009). Eriocaulon goaense is so far known from shallow seasonal ponds of low level lateritic plateaus of Goa.Published as part of Kolte, Rutuja R., Yadav, Indu & Janarthanam, Malapati K., 2022, Eriocaulon goaense (Eriocaulaceae), a new species from lateritic plateaus of Goa, India, pp. 188-191 in Phytotaxa 532 (2) on pages 189-190, DOI: 10.11646/phytotaxa.532.2.8, http://zenodo.org/record/591266

    Clinical outcomes of patient migration in locally advanced rectal cancer from community cancer centers: An analysis of the National Cancer Database

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    Background: With cancer care changing at a rapid pace, patients are becoming increasingly involved with their management and oftentimes migrating to a different facility to seek better care. Our study evaluated the characteristics of such patients who were initially diagnosed at a community cancer center (CCC) and how this affects clinical outcomes. Methods: The National Cancer Database identified 11,977 patients with stage II/III rectal cancer initially diagnosed at a CCC between 2005 and 2015. Clinical characteristics and outcomes between patients who received all of their treatments at the CCC versus those who received part or all of their treatments elsewhere were compared using rank-sum and X tests where appropriate. Cox model was used for survival analysis. Results: Of the total population, 51% were stage II and 49% were stage III. Gender and ethnic distributions were similar between the groups. Approximately 44 % of patients received all their treatment at the CCC and 56% had part or all of their care elsewhere. Patients who migrated were younger (63 vs 65 years, p\u3c0.001) and had govt insurance (43.5 vs 35.8%, p\u3c0.001). On multivariate analysis, age \u3c65 years (OR 1.12, 95% CI 1.02-1.24), govt insurance (OR 1.17, 95% CI 1.06-1.29), Charlson/Deyo comorbid score \u3c2 (OR 1.29, 95% CI 1.11-1.49), higher income (OR 1.21, 95% CI 1.16-1.27) and Stage III (OR 1.15, 95% CI 1.07-1.24) were associated with higher probability of migration. The treatment characteristics and outcomes are shown in Table. The 5y-OS rate was better in patients who received part or all of their treatment at other institutions (adjusted HR 0.80, 95% CI 0.74-0.86, p\u3c0.001). Conclusions: Further studies are needed to provide direction for future strategies to reduce the apparent survival disparities in patients who migrate from CCC

    Purification, Structural Elucidation, and Anticancerous Properties of a Novel Flavonoid from Flowers of Leucas indica

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    Previously, we showed that the crude methanol extracts of Leucas indica flowers exhibited antioxidant properties and in the current study, crude methanol flower extracts of L. indica showed anticancerous properties as evidenced cytotoxicity (MTT assay test) against the selected cancerous cell lines HeLa, HCT116, HL-60, and MCF-7. Therefore, further analysis was performed to isolate and purify the bioactive compound using activity-guided repeated fractionation of the methanol extract by silica gel column chromatography. After collection of different fractions, all the fractions were subjected to TLC analysis and the fractions which yielded the same compounds on TLC were further analyzed for physicochemical and spectroscopic analyses, e.g., UV, IR, 1H NMR, 13C NMR, COSY, HSQC, and mass spectroscopy. The bioactive compound isolated was elucidated as 6-hydroxy-3-(4-hydroxyphenyl)-7-(3,4,5-trihydroxy-6-)(hydroxymethyl)tetrahydro-2H-pyran-2yl)-4H-chromen-4-one. Based on the antioxidant and anticancerous properties, L. indica might be a promising source of useful natural products and the newly bioactive compound might offer opportunities to develop new anticancerous drugs
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