Longitudinal Remote SBRT/SRS Training in Latin America: A Prospective Cohort Study

BACKGROUND: Continuing medical education in stereotactic technology are scarcely accessible in developing countries. We report the results of upscaling a longitudinal telehealth training course on stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), after successfully developing a pilot course in Latin America. METHODS: Longitudinal training on SBRT and SRS was provided to radiation oncology practitioners in Peru and Colombia at no cost. The program included sixteen weekly 1-hour live conferencing sessions with interactive didactics and a cloud-based platform for case-based learning. Participant-reported confidence was measured in 16 SBRT/SRS practical domains, based on a 1-to-5 Likert scale. Pre- and post-curriculum exams were required for participation credit. Knowledge-baseline, pre- and post-curriculum surveys, overall and single professional-group confidence changes, and exam results were assessed. RESULTS: One hundred and seventy-three radiotherapy professionals participated. An average of 56 (SD ±18) attendees per session were registered. Fifty (29.7%) participants completed the pre- and post-curriculum surveys, of which 30% were radiation oncologists (RO), 26% radiation therapists (RTT), 20% residents, 18% medical physicists and 6% neurosurgeons. Significant improvements were found across all 16 domains with overall mean +0.55 (SD ±0.17, p\u3c0.001) Likert-scale points. Significant improvements in individual competences were most common among medical physicists, RTT and residents. Pre- and post-curriculum exams yielded a mean 16.15/30 (53.8 ± 20.3%) and 23.6/30 (78.7 ± 19.3%) correct answers (p\u3c0.001). CONCLUSION: Longitudinal telehealth training is an effective method for improving confidence and knowledge on SBRT/SRS amongst professionals. Remote continuing medical education should be widely adopted in lower-middle income countries

Single-Fraction Adjuvant Electronic Brachytherapy after Resection of Conjunctival Carcinoma

A retrospective study was performed to assess the outcomes of a single-fraction adjuvant electronic brachytherapy (e-BT) approach for patients with squamous cell conjunctival carcinoma (SCCC). Forty-seven patients with T1–T3 SCCC were included. All patients underwent surgery followed by a single-fraction adjuvant e-BT with a porTable 50-kV device. Depending on margins, e-BT doses ranged between 18 to 22 Gy prescribed at 2 mm depth, resembling equivalent doses in 2 Gy (EQD2) per fraction of 46–66 Gy (α/β ratio of 8–10 Gy and a relative biological effect (RBE) of 1.3). The median age was 69 (29–87) years. Most tumors were T1 (40.4%) or T2 (57.5%) with a median size of 7 mm (1.5–20). Margins were positive in 40.4% of cases. The median time from surgery to e-BT was nine weeks (0–37). After a median follow-up of 24 (17–40) months, recurrence occurred in only two patients (6 and 7 months after e-BT), yielding a median disease-free survival (DFS) of 24 (6–40) months and DFS at two years of 95.7%. Acute grade 2 conjunctivitis occurred in 25.5%. E-BT is a safe and effective for SCCC treatment, with clinical and logistic advantages compared to classical methods. Longer follow-up and prospective assessment are warranted

Single-Fraction Adjuvant Electronic Brachytherapy after Resection of Conjunctival Carcinoma

A retrospective study was performed to assess the outcomes of a single-fraction adjuvant electronic brachytherapy (e-BT) approach for patients with squamous cell conjunctival carcinoma (SCCC). Forty-seven patients with T1–T3 SCCC were included. All patients underwent surgery followed by a single-fraction adjuvant e-BT with a porTable 50-kV device. Depending on margins, e-BT doses ranged between 18 to 22 Gy prescribed at 2 mm depth, resembling equivalent doses in 2 Gy (EQD2) per fraction of 46–66 Gy (α/β ratio of 8–10 Gy and a relative biological effect (RBE) of 1.3). The median age was 69 (29–87) years. Most tumors were T1 (40.4%) or T2 (57.5%) with a median size of 7 mm (1.5–20). Margins were positive in 40.4% of cases. The median time from surgery to e-BT was nine weeks (0–37). After a median follow-up of 24 (17–40) months, recurrence occurred in only two patients (6 and 7 months after e-BT), yielding a median disease-free survival (DFS) of 24 (6–40) months and DFS at two years of 95.7%. Acute grade 2 conjunctivitis occurred in 25.5%. E-BT is a safe and effective for SCCC treatment, with clinical and logistic advantages compared to classical methods. Longer follow-up and prospective assessment are warranted

Low-dose radiotherapy for COVID-19 pneumonia treatment: case report, procedure, and literature review

Background!#!The COVID-19 pandemic outbreak has set the emergency services in developing countries on major alert, as the installed response capacities are easily overwhelmed by the constantly increasing high demand. The deficit of intensive care unit beds and ventilators in countries like Peru is forcing practitioners to seek preventive or early interventional strategies to prevent saturating these chronically neglected facilities.!##!Case presentation!#!A 64-year-old patient is reported after presenting with COVID-19 pneumonia and rapidly progressing to deteriorated ventilatory function. Compassionate treatment with a single 1‑Gy dose to the bilateral whole-lung volume was administered, with gradual daily improvement of ventilatory function and decrease in serum inflammatory markers and oxygen support needs, including intubation. No treatment-related toxicity developed. Procedures of transport, disinfection, and treatment planning and delivery are described.!##!Conclusion!#!Whole-lung low-dose radiotherapy seems to be a promising approach for avoiding or delaying invasive respiratory support. Delivered low doses are far from meeting toxicity ranges. On-going prospective trials will elucidate the effectiveness of this approach

Prevalence of Metabolic Syndrome in a Predominantly Cuban, Psychiatrically Ill, and Homeless Population

OBJECTIVE: This study examined the prevalence of metabolic syndrome among a group of psychiatric outpatients enrolled in a homeless program that is located in a predominantly Hispanic geographic area of South Florida. METHOD: Data for this retrospective, cross-sectional analysis were obtained from a record review of 122 adult patients who received full medical and psychiatric assessments based on DSM-IV criteria during participation in our homeless program from January 2009 to May 2009. The primary outcome measure was the presence of metabolic syndrome. RESULTS: The prevalence of metabolic syndrome within this population was 29.5%. Elevated waist circumference (48.5%) and elevated blood pressure (44.3%) were the 2 most frequent risk factors for the syndrome. Mean length of homelessness was 3.93 years, with no significant relationship noted between the presence of metabolic syndrome and duration of homelessness. Ninety-three percent of the subjects had been diagnosed with either schizophrenia or a mood disorder, and 61% had been treated with an atypical antipsychotic for at least 2 months over the preceding year. Our sample was predominantly Hispanic (79.5%), with Cuban Americans comprising 95% of that group. Among Hispanics, the prevalence rate of metabolic syndrome was 28.9%. CONCLUSIONS: Within our sample, homeless individuals compared to the general adult population in the United States seem to be at equal risk for metabolic syndrome. Although other studies have suggested an increased prevalence for metabolic syndrome among Hispanics, the obtained rate for our particular Hispanic sample was consistent with estimated prevalence of non-Hispanic individuals in the United States. Intervention programs rendering services to this population should include routine screening for presence of cardiovascular risk factors constituting metabolic syndrome

Prevalence of Metabolic Syndrome in a Predominantly Cuban, Psychiatrically Ill, and Homeless Population

OBJECTIVE: This study examined the prevalence of metabolic syndrome among a group of psychiatric outpatients enrolled in a homeless program that is located in a predominantly Hispanic geographic area of South Florida. METHOD: Data for this retrospective, cross-sectional analysis were obtained from a record review of 122 adult patients who received full medical and psychiatric assessments based on DSM-IV criteria during participation in our homeless program from January 2009 to May 2009. The primary outcome measure was the presence of metabolic syndrome. RESULTS: The prevalence of metabolic syndrome within this population was 29.5%. Elevated waist circumference (48.5%) and elevated blood pressure (44.3%) were the 2 most frequent risk factors for the syndrome. Mean length of homelessness was 3.93 years, with no significant relationship noted between the presence of metabolic syndrome and duration of homelessness. Ninety-three percent of the subjects had been diagnosed with either schizophrenia or a mood disorder, and 61% had been treated with an atypical antipsychotic for at least 2 months over the preceding year. Our sample was predominantly Hispanic (79.5%), with Cuban Americans comprising 95% of that group. Among Hispanics, the prevalence rate of metabolic syndrome was 28.9%. CONCLUSIONS: Within our sample, homeless individuals compared to the general adult population in the United States seem to be at equal risk for metabolic syndrome. Although other studies have suggested an increased prevalence for metabolic syndrome among Hispanics, the obtained rate for our particular Hispanic sample was consistent with estimated prevalence of non-Hispanic individuals in the United States. Intervention programs rendering services to this population should include routine screening for presence of cardiovascular risk factors constituting metabolic syndrome

Impact of a SBRT/SRS longitudinal telehealth training pilot course in Latin America

PURPOSE: To assess the impact of longitudinal telehealth training in stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) for clinicians in Latin America. MATERIALS AND METHODS: Professionals from two Peruvian centers received an initial SBRT/SRS on-site training course and subsequently received follow-up telehealth training (interventional group) or not (negative control arm). Twelve live video conference sessions were scheduled. Surveys pre- and post-curriculum measured participants\u27 confidence in seven practical domains of SBRT/SRS, based on Likert scales of 1-5, and post-curriculum surveys assessed educators\u27 experiences. RESULTS: Sixty-one participants were registered, with an average of 24 attendees per session. Pre- and post- surveys were completed by 22 participants. For interventional and negative-control groups, mean changes in Likert scale were satisfactory for the former and remained unmodified for the latter. CONCLUSIONS: Conducting telehealth educational programs via virtual classroom sessions could be a reliable method to augment training for SBRT and SRS