Eastern Regional Medical Center

BackgroundIn Ghana, temperature check at various points of entry was adopted as a means of screening people for coronavirus disease 2019 without taking into consideration data on the local prevalence of fever associated with the disease. Our objective was to assess fever prevalence and its associated risk factors among patients hospitalised with coronavirus disease 2019 at the Eastern Regional Hospital, Koforidua in Ghana.MethodsWe reviewed medical records of 301 coronavirus disease 2019 patients who were admitted at the Eastern Regional Hospital, Koforidua between May 5, 2020, and August 31, 2021. Data collected on a pre-designed extraction sheet was processed, entered and analysed using Microsoft excel 2019 and Stata/IC version 16.1 software. Prevalence of fever was estimated and a multivariable logistic regression model was fitted to establish risk factors associated with fever among hospitalised coronavirus disease 2019 patients. A relationship was accepted to be significant at 5% level of significance.ResultsThe prevalence of fever among hospitalised coronavirus disease 2019 patients was 21.6% (95% CI, 17.1%-26.7%). Risk factors associated with fever were age group [0–19 years (AOR, 5.75; 95% CI, 1.46–22.68; p = 0.013); 20–39 years (AOR, 3.22; 95% CI, 1.42–7.29; p = 0.005)], comorbidity (AOR, 2.18; 95% CI, 1.04–4.59; p = 0.040), and disease severity [moderate (AOR, 3.89; 95% CI, 1.44–10.49; p = 0.007); severe (AOR, 4.08; 95% CI, 1.36–12.21; p = 0.012); critical (AOR, 4.85; 95% CI, 1.03–22.85; p = 0.046)].ConclusionsThe prevalence of fever was low among hospitalised coronavirus disease 2019 patients at the Eastern Regional Hospital, Koforidua. However, there was an increasing risk of fever as the disease severity progresses. Fever screening may be utilised better in disease of higher severity; it should not be used alone especially in mild disease.

Primary care collaborative memory clinics (PCCMCs) address existing challenges in dementia care by building capacity to meet the needs of persons living with dementia within primary care. This paper describes the strategic implementation of the PCCMC care model in two regions within Ontario. Evaluation of this initiative included the completion of individual interviews (N = 32) with key informants to identify impacts associated with the PCCMCs and tracking of all referrals and assessments completed in the first nine months of clinic implementation. The qualitative analysis of interview transcripts generated five major themes: (1) earlier identification of dementia and intervention; (2) increased capacity for dementia care within primary care; (3) better patient and caregiver experience with care; (4) improved continuity, integration and coordination and improved care; and (5) system efficiencies. Across both regions, 925 patients were referred to PCCMCs, of which 631 (68%) had been assessed during the evaluation period. Strategic, regional implementation of PCCMCs provides a significant opportunity to support better integrated and coordinated dementia care.

Whole-slide imaging has ushered in a new era of technology that has fostered the use of computational image analysis for diagnostic support and has begun to transfer the act of analyzing a slide to computer monitors. Due to the overwhelming amount of detail available in whole-slide images, analytic procedures-whether computational or visual-often operate at magnifications lower than the magnification at which the image was acquired. As a result, a corresponding reduction in image resolution occurs. It is unclear how much information is lost when magnification is reduced, and whether the rich color attributes of histologic slides can aid in reconstructing some of that information. To examine the correspondence between the color and spatial properties of whole-slide images to elucidate the impact of resolution reduction on the histologic attributes of the slide. We simulated image resolution reduction and modeled its effect on classification of the underlying histologic structure. By harnessing measured histologic features and the intrinsic spatial relationships between histologic structures, we developed a predictive model to estimate the histologic composition of tissue in a manner that exceeds the resolution of the image. Reduction in resolution resulted in a significant loss of the ability to accurately characterize histologic components at magnifications less than ×10. By utilizing pixel color, this ability was improved at all magnifications. Multiscale analysis of histologic images requires an adequate understanding of the limitations imposed by image resolution. Our findings suggest that some of these limitations may be overcome with computational modeling.

Abstract INTRODUCTION: Local-regional recurrence after definitive treatment of breast cancer is reported in 5 – 40 % of patients depending risk factors and initial treatment. Chest wall recurrence is associated with poor quality of life and limited treatment options. Lyso-thermosensitive liposomal doxorubicin (LTLD, Thermodox®) is an intravenously administered agent designed to selectively release doxorubicin when exposed to temperatures ≥39.5° C at a targeted tumor. Hyperthermia, the elevation of tissue temperature in the range of 40° C to 44° C, causes direct cytotoxicity, enhanced blood flow, and oxygenation. We are reporting the interim findings of an ongoing Phase I/II Study Evaluating the Maximum Tolerated Dose, Bioequivalence/Pharmacokinetics, Safety, and Efficacy of LTLD in Patients with Local-Regional Recurrent Breast Cancer. Final results will be presented in December. METHODS: Patients with breast carcinoma on the chest wall with progression following radiation were eligible; prior chemotherapy and hormone therapy were allowed. LTLD was administered intravenously followed immediately by hyperthermia in up to two treatment fields for 1 hour per field for a goal of 40–42°C. Response was measured using clinical assessment, CT, and digital photos. All subjects were assessed for safety. Up to six cycles of LTLD/hyperthermia were administered depending on disease progression or tolerance. A total of 11 patients were enrolled on the Phase I portion of the study and 9 were evaluable for efficacy review. To date, 17 patients are enrolled on the Phase II portion of the study and 13 are evaluable for efficacy review. Once 12 patients are found to be evaluable for PK the primary endpoint of bioequivalence can be evaluated. RESULTS: A dose of 50 mg/m2 was recommended by the DSMB at completion of the Phase I study. Seven subjects were dosed at 50mg/m2, two patients developed a localized reaction in the treatment area consisting of erythema, woody induration, and pain which resolved with discontinuation of treatment. Twenty patients were dosed at 40mg/m2 without recurrence of symptoms. To date, twenty-eight patients were enrolled in the phase I/II study; one subject was excluded due to dose modification following 2 cycles of ThermoDox at a dose of 50mg/m2 to 40mg/m2 at cycle 3. This subject had a durable partial response. The tables summarize the safety and efficacy data. All efficacy data is investigator reported. Combined Phase I/II Safety DataSafety Data40 mg/m2 (N=20)50 mg/m2 (N=7)Any AE Event (n, %)17 85.07 100.0Grade 3+ AE (n, %)10 50.06 85.7Serious AE (n, %)5 25.03 42.9Hematological AE (n, %)10 50.07 100.0Deaths due to AE (n, %)0 0.00 0.0 Combined Phase I/II Efficacy DataEfficacy Data40 mg/m2 (N=20)50 mg/m2 (N=7)Responders (Partial & Complete) (n, %)10 50.03 42.9Complete Response (n, %)5 25.01 14.3Partial Response (n, %)5 25.02 28.6Durable Response (lasting ≥ 3 months) (n, %)3 15.00 0.0 CONCLUSION: These findings suggest that LTLD at a dose of 40 mg/m2 combined with hyperthermia offers a promising and well tolerated treatment option for patients with recurrent chest wall disease from breast cancer. Additional data will be presented based on full trial accrual. Citation Format: Rugo H, Pabbathi H, Shrestha S, Aithal S, Borys N, Musso L, Zoberi I. Lyso-thermosensitive liposomal doxorubicin shows efficacy with minimal adverse events in patients with breast cancer recurrence at the chest wall. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-13-15.

BackgroundThe quality and viability of mastectomy flaps remain a central challenge in reconstructive surgery, particularly for immediate breast reconstruction. Insufficient perfusion in tissue flaps is a leading cause of early complications following reconstructive procedures, and clinical judgment alone is not completely reliable for the assessment of flap viability. Accurate and reliable intraoperative methods for assessment of tissue perfusion are needed to help surgeons identify tissue at risk for ischemia and necrosis, thereby allowing for maneuvers to improve tissue flap viability.MethodsThis study evaluates the use of intraoperative laser angiography using the SPY System (LifeCell Corp., Branchburg, NJ) for the assessment of perfusion in mastectomy flaps for immediate breast reconstruction. The SPY System uses the contrast agent indocyanine green, which has an excellent safety profile and pharmacokinetics that allow for repeat evaluations during the same surgical procedure. In recent work, the SPY System has demonstrated high sensitivity and specificity for detection of tissues at risk for ischemia and necrosis during reconstructive surgery. Using a retrospective, chart-review design, the authors compared consecutive cases of immediate breast reconstruction using a prosthesis, before and after implementation of the SPY System.ResultsNinety-one subjects were included in the analysis: 52 prior to SPY (Pre-SPY) and 39 after implementation of SPY (Post-SPY). Baseline characteristics were similar between the groups. Both groups had high rates of comorbidities, chemotherapy, and radiation therapy. The rate of postoperative complications was two-fold higher in the Pre-SPY group compared to the Post-SPY group (36.5% vs. 17.9%); this difference was of borderline significance (P = 0.0631). However, mean number of repeat visits to the OR per patient was significantly higher in the Pre-SPY group (1.21 ± 1.47 vs. 0.41 ± 0.71; P = 0.0023). Of the seven patients with complications in the Post-SPY group, five were identified by SPY as having poor flap perfusion; none were identified by clinical judgment alone.ConclusionsThis study suggests that the SPY System can contribute to reduced ischemia-related complications in a population of women undergoing immediate breast reconstruction following mastectomy for breast cancer.

Since the first description nearly half a century ago, medical lasers have become a vital component of the therapeutic armamentarium of interventional pulmonologists. Over this time, medical lasers have been utilized to relieve nearly every form of airway luminal obstruction with beneficial effect on patient symptoms. Through the review of more than 10,000 published airway laser applications, our collective understanding of the power of this technique has been refined. With the growing access to this powerful tool exists an obligation of the operator to fully realize the mechanism of how lasers work, appropriate indications, complications, techniques, safeguards, and outcomes of employing medical lasers for therapeutic effects in the airway. The following chapter provides a discussion of these points designed to serve as a reference for the interventionalist interested in the use of medical lasers.