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  Most popular articles (Since December 19, 2017)

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Is COVID-19 man-made?
Pankaj Chaturvedi, Natarajan Ramalingam, Arjun Singh
April - June 2020, 3(2):284-286
  40,091 728 1
Stepwise cox regression analysis in SPSS
Sampada Dessai, Vijai Simha, Vijay Patil
July-December 2018, 1(2):167-170
This article is a beginners' guide for performing Cox regression analysis in SPSS. The article provides practical steps toward performing Cox analysis and interpreting the output of SPSS for Cox regression analysis. Along with it, the article touches on the test to be performed before performing a Cox regression analysis and its interpretation.
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Blindness during the coronavirus outbreak
Sunny Chi Lik Au
April 2020, 3(5):90-91
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A step-wise guide to performing survival analysis
Santam Chakraborty
January-June 2018, 1(1):41-45
Survival analysis refers to statistical techniques which have been designed to circumvent the issues arising out of incomplete information regarding the time until which a desired event or endpoint occurs. The reasons for this may be manifold, for example, lost to follow-up, dropouts from the study, lack of sufficient research budget, and short follow-up period. It is one of the common but complicated analysis done in trials. The current article provides a step-wise guide toward understanding survival functions and performing it.
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Testing and interpreting assumptions of COX regression analysis
Sampada Dessai, Vijay Patil
January-June 2019, 2(1):108-111
The COX regression analysis is like any statistical test that is based on multiple assumptions. This is a guide for how to test the assumptions and how to interpret the results.
  5,328 537 2
Coronavirus disease 2019 pandemic: Nursing challenges faced
Swapna Joshi
April 2020, 3(5):136-137
  5,127 326 -
Management of COVID-19: A brief overview of the various treatment strategies
Burhanuddin Qayyumi, Florida Sharin, Arjun Singh, Vidisha Tuljapurkar, Pankaj Chaturvedi
April - June 2020, 3(2):233-243
Background: Coronavirus disease 2019 (COVID-19) has posed a new challenge to the entire world. Many speculations revolve around its treatment. Numerous theories have been put forth and several medications have been tried, but not many promising results have been achieved. Objective: We aim to provide an overview of the various treatment modalities for patients with COVID-19. Methodology: A systematic search was performed to identify all the relevant studies on PubMed, Embase, and Google Scholar published until May 23, 2020, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles that reported the various treatment modalities for COVID-19 were included in the analysis. Results: Currently, only remdesivir has been approved by the Food and Drug Administration (FDA) for the treatment of severe COVID-19. Corticosteroids and anticoagulant therapy have been recommended in patients with severe acute respiratory distress syndrome (ARDS). Some drugs such as lopinavir–ritonavir and Chinese herbal medicine have been shown to be beneficial in a few trials, while others such as chloroquine/hydroxychloroquine, tocilizumab, sarilumab, oseltamivir, and plasma therapy are being tested in ongoing trials. Conclusion: No treatment has been definitively proven to be effective against COVID-19 to date. The only FDA-approved drug is remdesivir, and several others are under investigation. Anticoagulant therapy and corticosteroids (weak recommendation) have been recommended in patients with severe ARDS.
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Imaging and COVID-19: Preparing the radiologist for the pandemic
Ankita Ahuja, Abhishek Mahajan
April 2020, 3(5):80-85
Diagnosing COVID-19 cases poses a challenge. The viral nucleic acid detection using real-time polymerase chain reaction (RT-PCR) remains the standard of reference. As the world is hit by this pandemic, the health resources are facing tremendous pressure. Though imaging has a role to play in the management of COVID-19, one must judiciously use the health and imaging resources which would take us a long way in combating this pandemic. In this article we will discuss the role of imaging in management of COVID-19 infection. Imaging guidelines are also given that will aid in precise communication with other health-care providers and efficient use of health resources.
  3,802 287 1
COVID-19 and head and neck cancer treatment
Vijay Patil, Vanita Noronha, Pankaj Chaturvedi, Kaustav Talapatra, Amit Joshi, Nandini Menon, Durgatosh Pandey, Kumar Prabhash
April 2020, 3(5):15-28
The coronavirus disease 2019 (COVID-19) pandemic is exponentially increasing, as are the risks of COVID-related complications and fatalities. Hence, health-care resources are being allocated for its management. Cancer treatment has taken a back seat in multiple countries due to resource scarcity and the risk of COVID-19-related complications. Head and neck cancer is no different. Probably, by the time COVID-related data get generated specifically for head and neck cancers, either the pandemic will be over, or it will be too late. Hence, there is an urgent need for guidance for head and neck cancer treatment in this situation. In this review article, we have provided evidence-based guidance for selecting the most appropriate therapy in the current pandemic situation.
  3,709 365 3
On being a surgeon and a mother
Sabita Jiwnani
January-June 2019, 2(1):1-3
  3,658 199 -
Neoadjuvant chemotherapy in oral cancer: Current status and future possibilities
Alok Goel, Anshul Singla, Kumar Prabhash
January - March 2020, 3(1):51-59
Eighty-five percent of oral cavity cancers present as locally advanced disease and are treated with multimodality approach. Patients who can undergo radical resection have the best outcomes, although the overall results are still unsatisfactory. Neoadjuvant chemotherapy (NACT) has been studied in oral cavity cancers with the aim of improving locoregional control and overall survival (OS) and as an organ preservation tool in resectable oral cavity cancers, It has also been studied in borderline resectable/technically unresectable tumors in order to reduce surgical margins, increase resectability, and achieve R0 resection and in unresectable tumors in order to improve disease-free survival and OS. In this review, we will critically analyze the current evidence for the use of NACT in oral squamous cell carcinoma (OSCC) and suggest an approach to select a patient who might benefit from NACT.
  3,235 557 -
Epidermal growth factor receptor-mutated non-small-cell lung cancer: A primer on contemporary management
Akhil Rajendra, Vanita Noronha, Amit Joshi, Vijay Maruti Patil, Nandini Menon, Kumar Prabhash
January-June 2019, 2(1):36-53
Non-small-cell lung cancer (NSCLC) constitutes 85% of patients diagnosed with lung cancer. In metastatic cases, its treatment classically consists of systemic cytotoxic chemotherapy, which resulted in a median overall survival of 7.9 months. However, over the last decade, improved understanding of driver mutations, especially identification of epidermal growth factor receptor (EGFR) mutation, has changed the treatment landscape of these patients. Our understanding of EGFR mutations has improved tremendously, and we now have three generations of EGFR tyrosine kinase inhibitors, have identified secondary resistance mutations, and have developed agents targeting these resistance mutations, making precision medicine a reality. We review these developments and try to propose an optimal approach toward the management of these patients with EGFR-mutated NSCLC.
  3,532 249 2
Artificial intelligence in healthcare in developing nations: The beginning of a transformative journey
Abhishek Mahajan, Tanvi Vaidya, Anurag Gupta, Swapnil Rane, Sudeep Gupta
July-December 2019, 2(2):182-189
Introduction: Artificial intelligence (AI) is the fascinating result of the convergence of various technologies, algorithms and approaches. Its role in early detection and diagnosis will be a boon to society in the next few years and should be seen as 'Augmented Intelligence.' Issues like ethical considerations and collaborations need to be sorted out to ensure apt implementation in healthcare. This article reviews the current status of AI in developing nations like India and highlights some insights that could provide new directions and opportunities for AI in healthcare, especially in the field of radiology. Implications for Patient Care: (1) AI will aid in nation-wide research and cooperation that will provide an impetus for the development of imaging science and decentralization of medical services. (2) AI may help to bridge the gap for need of specialized medical personnel in the peripheral areas in developing countries like India. (3) Government initiatives, ethical considerations and joint public private sector collaborations will ensure smooth transition and implementation of AI in healthcare especially in radiology. Summary Statement: This manuscript highlights the existing gap between the developed and developing nations regarding implementation and acceptance of AI in healthcare and at the same time brings out insights in regard to the government initiatives to ease the progress of AI in healthcare in developing countries like India.
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Social issues faced by cancer patients during the coronavirus (COVID-19) pandemic
Nirjari Viren Dalal
April 2020, 3(5):141-144
  2,942 277 2
Palliative care for advanced cancer patients in the COVID-19 pandemic: Challenges and adaptations
Pankaj Singhai, Krithika S Rao, Seema Rajesh Rao, Naveen Salins
April 2020, 3(5):127-132
  2,699 398 2
Current management strategies in gallbladder cancers
Vikas Ostwal, Sanyo Dsouza, Shraddha Patkar, Sherly Lewis, Mahesh Goel, Krunal Khobragade, Anant Ramaswamy
January-June 2018, 1(1):2-9
Gallbladder cancers (GBC) are common in the Indo-Gangetic belt of India. Most consensus guidelines in the West have considered GBC as part of the biliary tract cancer spectrum; however, considering the markedly higher burden of GBC in India, there is a need to have specific management treatment strategies in the Indian scenario. The extent of surgical resections, the use of staging laparoscopies, the optimum adjuvant therapy for resected high-risk GBC (T3 or T4 disease and node-positive disease), as well as the preferred second-line chemotherapeutic regimens for advanced GBC are questions that remain incompletely defined and answered. The current review presents a synopsis of currently available evidence and emerging approaches in the treatment of GBC.
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Repurposing valproate to prevent acute respiratory distress syndrome/acute lung injury in COVID-19: A review of immunomodulatory action
Prabhat Bhargava, Pankaj Panda, Vikas Ostwal, Anant Ramaswamy
April 2020, 3(5):65-70
The novel coronavirus disease 2019 (COVID-19) is reported to cause acute respiratory distress syndrome (ARDS) in 20%–40% of the hospitalized patients. The pathophysiology of ARDS caused by a viral infection is still unknown; however, a histopathological hallmark of ARDS is diffuse alveolar damage due to excessive inflammation of the lung tissue from the inflammatory mediators released by the local epithelial and endothelial cells. ARDS is caused when there is an excessive inflammatory response compared to the anti-inflammatory response to the viral agent. It is often associated with multiorgan failure and increased chances of mortality. Epigenetic changes are known to cause rapid changes in the gene expression, thereby increasing hyperinflammatory/anti-inflammatory responses. Valproate (VPA), a histone deacetylase inhibitor, has been shown to inhibit the production of the nuclear factor-κB (NF-κB), tumor necrosis factor-alpha, and interleukin-6 in human cells stimulated with lipopolysaccharide. VPA has also been shown to block the migration of macrophages through the inhibition of pro-inflammatory cytokines. VPA can promote the differentiation of T cells toward Th2/M2 rather than Th1/M1, and it also stimulates the generation of the regulatory T cells (Treg), thereby reducing the percentage of CD8+ T lymphocytes. However, the anti-inflammatory action of VPA could decrease the cytokine expression and suppress the effector T cells, thereby delaying the viral clearance. This delayed clearance of the virus could be taken care of by the proposed direct antiviral activity of VPA.
  2,811 192 6
Clinical–radiological features of methotrexate-induced subacute leukoencephalopathy in patients with acute lymphoblastic leukemia: 'Panda eye sign' on diffusion weighted-magnetic resonance imaging
Abhishek Mahajan, Hasmukh Jain, Vijai Simha, Tanvi Vaidya, GV Santhosh Kumar, Anurag Gupta, Bhausaheb Bagal, Manju Sengar
January-June 2019, 2(1):28-33
Background and Purpose: Subacute leukoencephalopathy in ALL is a rare complication after high dose methotrexate (HDMTX) administration and recognizing this self-remitting entity has important therapeutic implications. We did a retrospective study to evaluate the role of magnetic resonance imaging (MRI) in diagnosing this entity and asses the incremental value of diffusion weighted MR (DW-MRI). Materials and Methods: We did a retrospective analysis of adult ALL patients being treated with the modified Berlin-Frankfurt-Münster (BFM)-90 protocol at our center between January 2014 and January 2015 and identified those who developed neurotoxicity after HDMTX. All these patients underwent a contrast enhanced CT and contrast enhanced MRI of brain with DW-MRI within 48 hours of presentation. Results: Eleven patients were identified from a cohort of 239 patients (~5%). They presented with focal neurological deficits within ~14 days after HDMTX that resolved completely with conservative measures. The CT scans were normal in all these patients. A consistent finding seen in all these cases was the occurrence of restricted diffusion in the region of the centrum semiovale on DW-MRI. On diffusion maps, symmetrical areas of hyperintensity resembled Panda eyes and mean apparent diffusion coefficient cut-off of our series was 0.000453 x 10–3 +/- 0.000120 cm2/sec. Conclusion: CT brain and conventional MR imaging have no significant role to play in diagnosing this entity however restricted diffusion in the centrum semiovale is a consistent imaging finding and the 'panda eye sign' as seen on DW imaging can be considered diagnostic for methotrexate induced subacute leukoencephalopathy and this sign can help in timely establishment of the diagnosis and appropriate management.
  2,809 141 4
Clinical management and prognostic outcome of intracranial ventricular tumors: A study of 134 cases
CK Kriankumar, Ravindra Pramod Deshpande, Y B. V K. Chandrasekhar, I Satish Rao, Manas Panigrahi, Phanithi Prakash Babu
January-June 2019, 2(1):10-15
Introduction: Ventricular tumors are known to have a relatively rare occurrence and are underlined by complex pathophysiology. Methods: We retrospectively analyzed the clinicopathological details of 134 patients with intracranial ventricular lesions over a 5-year period. The patients were selected on the basis of diagnosed lesions by magnetic resonance imaging and further histopathology study. We have assessed the clinicopathological details from the database. Results: The median age of patients was 30 years (range: 1–73 years). In 47% of the cases, the lesions were located in the anterior third ventricle; glioma (n = 43) and colloidal cysts (n = 41) were the most common lesions. Presenting symptoms included seizures and features of hydrocephalus in 38.8% of patients. Open microsurgical (81.6%) and endoscopic (18.4%) surgery were performed. An open microsurgical approach was the main surgical treatment with operative mortality of 0.86% and permanent morbidity of 6.7%. Sixteen of the 27 patients in the endoscopic group underwent endoscopic third ventriculostomy (ETV) with biopsy. Survival was affected by the type of lesion. The progression-free survival was highest in the patients with neurocytoma and lowest in the patients with glioma (P = 0.01). Twenty-three patients received adjuvant radiation therapy. The decision regarding radiation therapy was made on the basis of individual lesion, histopathological type, and proliferative index. The mean overall survival was 34 months. Conclusions: Management of intraventricular tumors requires multimodality treatment including open microscopic surgery, neuroendoscopy, and radiation therapy as per the tumor pathology and hydrocephalus status. Simultaneous endoscopic biopsy with ETV can avoid major open surgery and mitigate the possible postsurgical complications.
  2,711 219 1
Quality of life and needs of the Indian advanced cancer patients receiving palliative careAssessment of the quality of life, problems, and needs of the advanced cancer patient receiving palliative care
Smita Asthana, Surbhi Bhatia, Rashmi Dhoundiyal, S Preeti Labani, Rakesh Garg, Sushma Bhatnagar
July-December 2019, 2(2):138-144
Context: Studies related to need, problems, and quality of life in advanced cancer patients receiving palliative care are scarce in India. Aim: The aim of the study 'was to assess the quality of life, problems, and needs in advanced cancer patients receiving palliative care. Settings and Design: This was a cross-sectional survey in the palliative care outpatient department of a tertiary care hospital. Materials and Methods: Survey was conducted using structured questionnaires with tools of problems and need in palliative care and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL. Statistical Analysis Used: Survey results were presented for various palliative care needs and domains as per magnitude of palliative care received. Comparison of the scores for males and females was done using Mann–Whitney U-test. Results: More than 50% patients had difficulty in daily living and majority of patients (77%) had difficulty in doing heavy work. 82% patients presented with fatigue, 47% patients had issues regarding others being overconcerned, 71% were afraid of physical suffering, 77% faced difficulties in usual activities, and 80% felt the need for being informed about the possibility of treatment and side effects. Needs were more in female patients including a statistically significant difference in sleep quality (P < 0.05). Conclusions: Palliative care needs and quality of life in Indian patients with advanced cancer are of concern and need further attention for optimal care. Quality of life, problems, and needs in such patients need to be assessed, and provisions should be made for delivery of adequate services.
  2,633 258 1
A Varanasi experience
Sujay Srinivas, Somnath Roy, Tanmoy K Mandal, Sudeep Das
January - March 2020, 3(1):160-161
  2,750 72 -
COVID-19 in oncology settings
Nitin Bansal, Abdul Ghafur
April 2020, 3(5):13-14
  2,418 254 1
Cancer care: Challenges in the developing world
Chepsy C Philip, Amrith Mathew, M Joseph John
January-June 2018, 1(1):58-62
Objective: Cancer care in the developing world remains a challenge. Limitations in the diagnosis, poverty, and knowledge are recognized as some of the challenges. Health-care financing and treatment facilities are limitations toward availing cancer care. An assessment of the extent of the burden and strength of available infrastructure is limited. We performed an assessment to gather information from young oncologists in the developing world to identify similarities and differences among the countries. Methods: Information on services was gathered using a questionnaire from young oncologists participating in the American Society of Clinical Oncology annual meet selected to represent various developing countries. Descriptive statistics were used to report results. Results: The median doctor: outpatient ratio was 1:20 (1:2–1:80). Median: staffing ratio in an oncology ward was 1:6 (1:2–1:20). Four (22.2%) respondents reported complete social security support for health care in oncology. Stem cell transplant facility was reported as available in 8 (44.4%) centers out of 20. South Asian respondents reported the highest out-of-pocket expenditure (65%) and the least doctor: outpatient ratio at 1:20. Conclusion: Cancer care challenges appear similar in the regions surveyed. Additional strategies to improve the health-care infrastructure and provide a health security net to treat all cancer patients are required to benefit the efforts to tackle the growing burden of cancer in the developing countries.
  2,327 255 -
Novel therapeutic options for recurrent metastatic salivary gland tumors: Review of ongoing clinical trials
Avinash Pandey, Manish Kumar, Heena Shahi, Aishwarya Kumari, Shivkant Singh
January-June 2018, 1(1):10-18
The clinical behavior and biology of recurrent malignant salivary gland tumors are myriad with slow-growing indolent disease at the one end of spectrum and aggressive symptomatic illness with metastases to bone, lung, and liver at the other end. Several different agents and combination chemotherapy regimens have been explored in patients whose disease is symptomatic with response rates between 15% and 40%. Recently, molecular studies have evolved to reveal targetable biomarkers which can be further explored in the therapeutic landscape with specific targeted therapies. A subset of tumors also expresses hormone receptors and hence is amenable to conventional antihormonal agents to obtain a possibly meaningful benefit. We searched for all ongoing and completed clinical trials involving chemotherapy, targeted therapy, hormonal therapy, and immunotherapy valid for patients with recurrent metastatic salivary gland tumors. We present the current viable therapeutic options for such a cohort of patients in routine clinical practice.
  2,108 272 -
Determination of ROS1 positivity by immunohistochemistry in a multicentric cohort of 426 non-small-cell lung cancer cases in India
Jugnu Jain, Deepthi Chinta, Umeshnandan B Jayaraman, Neha Pathak, Manpreet Kaur, Soma Chatterjee, Meenakshi Swain, Vijay Anand Reddy
January-June 2019, 2(1):16-20
Introduction: ROS1 is a receptor tyrosine kinase of the insulin receptor family that acts as a driver oncogene in 1%–2% of non-small cell lung carcinoma (NSCLC) patients via a gene translocation between ROS1 and other genes, the most common one being CD74. Histologic and clinical features that are associated with ROS1 translocations include never smokers, younger age, and adenocarcinoma (AC) histology. The identification of ROS1 fusion is important because it responds to targeted therapies such as crizotinib that can greatly improve the survival of the patient. The goal of this study was to determine the percentage of population harboring ROS1 mutation in India. Materials and Methods: ROS immunohistochemistry (IHC) method was optimized using Cell Signalling Technology, ROS antibody (ROS1 clone D4D6 rabbit mAb), and appropriate positive and negative controls in a fully automated procedure using Ventana automated stainer. Approximately 2000 retrospective lung cancer cases from six different Apollo hospitals were identified. The formalin-fixed paraffin-embedded blocks and corresponding diagnostic and demographic data were retrieved. A total of 426 cases with confirmed diagnosis of NSCLC were then tested by IHC for ROS1. Results: Given the retrospective nature of the cancer cases and diagnostic data being used for the study, there was high attrition in the availability of the blocks and data. Among the 2000 cases examined, there were 604 cases that were initially reported as lung cancer in the hospital medical records and for whom corresponding blocks were available, but blocks for only 485 cases had sufficient tumor content, as judged by hematoxylin and eosin staining and microscopic examination, to enable testing for ROS1 staining. Of these 485 cases, 225 were confirmed AC cases. A single case stained positive for ROS1 among the 225 AC cases. The percentage is calculated to be 0.44% based on this single positive case. No positive case was observed in squamous cell carcinomas or other cancers of the lung such as neuroendocrine tumors, germ cell tumors, and adenoid cystic tumors. Conclusion: The percentage positivity for ROS1 in the study comprising 225 Indian NSCLC AC cases appeared similar to the 0.3%–1.6% range reported for smokers and lower than 0.9%–1.7% positivity reported in mixed patient populations.
  2,170 188 2