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BackgroundIn 2017, the Accreditation Council for Graduate Medical Education (ACGME) revised its Common Program Requirements to support trainees and faculty by mandating programs to provide dedicated wellness resources and education. Emergency medicine may benefit from this change due to high burnout rates within the specialty. However, the current state of wellness interventions in emergency medicine (EM) residency programs has not yet been well described. Understanding current practices is necessary to assess unmet needs and inform the development and evaluation of future interventions that aim to improve trainee wellness.ObjectivesThe goal of this study was to describe currently implemented wellness interventions in EM residency programs.MethodsThis descriptive study surveyed 250 ACGME-accredited EM residency programs between March 1 and June 1, 2020, regarding wellness interventions. The survey included demographic questions; structured multiple-choice questions about cost, frequency, and champions; and free-text response options to briefly describe interventions. Respondents were also asked to classify the interventions according to the seven factors described in the National Academy of Medicine Model of Clinician Well-Being and Resilience.ResultsNinety of 250 (36% response rate) residency programs participated, describing 162 unique wellness interventions. Respondents classified the majority of interventions (n = 136) as targeting personal factors according to the National Academy of Medicine model. Qualitative analysis revealed five major themes describing the interventions: program culture, program factors, environmental and clinical factors, wellness activities and practices, and wellness resources.ConclusionsResults of this survey may help to inform a national needs assessment addressing the current state of wellness interventions in EM residency programs. Our results highlight the need for more interventions targeting external factors impacting resident wellness.

Introduction: Recent research demonstrates burnout prevalence rates as high as 76% in emergency medicine (EM) residents. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) required that all training programs provide dedicated wellness education for their trainees as a requirement for accreditation. We aimed to conduct a systematic review of published wellness interventions conducted in EM residency programs following the implementation of the 2017 ACGME Common Program Requirements change in order to characterized published intervention and evaluate their effectiveness.Methods: We applied a published approach to conducting systematic reviews of the medical education literature. We performed a search of the literature from January 1, 2017–February 1, 2020. Studies were included for final review if they described a specific intervention and reported outcomes with the primary goal of improving EM resident wellness. Outcomes were characterized using the Kirkpatrick training evaluation model.Results: Eight of 35 identified studies met inclusion criteria. Most described small convenience samples of EM residents from single training programs and used the satisfaction rates of participants as primary outcome data. Only quantitative assessment methods were used. Studies addressed only a limited number of factors affecting resident wellness. The majority of interventions focused on personal factors, although a few also included sociocultural factors and the learning and practice environment.Conclusion: There is a relative dearth of literature in the area of research focused on interventions designed to improve EM resident wellness. Furthermore, the studies we identified are narrow in scope, involve relatively few participants, and describe programmatic changes of limited variety.  Future directions include an increase and emphasis on multi-institutional studies, randomized controlled trials, qualitative methodology, and opportunities for funded research.

PET/CT and radioisotope therapy are diagnostic and therapeutic arms of Nuclear Medicine, respectively. With the emergence of better technology, PET/CT has become an accessible modality. Diagnostic tracers exploring disease-specific targets has led the clinicians to look beyond FDG PET. Moreover, with the emergence of theranostic pairs of radiopharmaceuticals, radioisotope therapy is gradually making it's way into treatment algorithm of common cancers in India. We therefore would like to discuss in detail the updates in PET/CT imaging and radionuclide therapy and generate a consensus-driven evidence based document which would guide the practitioners of Oncology. Keywords: Oncology, PET/CT, radioisotope, radioligand, theranostics, Author(s): Ameya D. Puranik [1]; Sayak Choudhury [1]; Suchismita Ghosh [1]; Indraja D. Dev [1]; Varun Ramchandani [1]; Abhishek Uppal [1]; Vikrant Bhosale [1]; Abhishek Palsapure [1]; Rachita Rungta [1]; [...]

Background: The role of artificial intelligence and radiomics in prediction model development in cancer has been increasing every passing day. Cervical cancer is the 4th most common cancer in women worldwide, contributing to 6.5% of all cancer types. The treatment outcome of cervical cancer patients varies and individualized prediction of disease outcome is of paramount importance. Purpose: The purpose of this study is to develop and validate the digital signature for 5-year overall survival prediction in cervical cancer using robust CT radiomic and clinical features. Materials and Methods: Pretreatment clinical features and CT radiomic features of 68 patients, who were treated with chemoradiation therapy in our hospital, were used in this study. Radiomic features were extracted using an in-house developed python script and pyradiomic package. Clinical features were selected by the recursive feature elimination technique. Whereas radiomic feature selection was performed using a multi-step process i.e., step-1: only robust radiomic features were selected based on our previous study, step-2: a hierarchical clustering was performed to eliminate feature redundancy, and step-3: recursive feature elimination was performed to select the best features for prediction model development. Four machine algorithms i.e., Logistic regression (LR), Random Forest (RF), Support vector classifier (SVC), and Gradient boosting classifier (GBC), were used to develop 24 models (six models using each algorithm) using clinical, radiomic and combined features. Models were compared based on the prediction score in the internal validation. Results: The average prediction accuracy was found to be 0.65 (95% CI: 0.60– 0.70), 0.72 (95% CI: 0.63–0.81), and 0.77 (95% CI: 0.72–0.82) for clinical, radiomic, and combined models developed using four prediction algorithms respectively. The average prediction accuracy was found to be 0.69 (95% CI: 0.62–0.76), 0.79 (95% CI: 0.72–0.86), 0.71 (95% CI: 0.62–0.80), and 0.72 (95% CI: 0.66–0.78) for LR, RF, SVC and GBC models developed on three datasets respectively. Conclusion: Our study shows the promising predictive performance of a robust radiomic signature to predict 5-year overall survival in cervical cancer patients. [ABSTRACT FROM AUTHOR]

Extracranial metastasis from high-grade glial tumors is an extremely rare condition with its reported incidence being <1%. The most common sites reported in the literature are leptomeninges and spinal cord, followed by the liver, lung, and skeletal system. Its low incidence is thought to be related to the intrinsic aggressive biology of the tumor, thus reducing median overall survival in patients. As there is lack of knowledge about the mechanism of extracranial spread of glioma cells, its diagnosis and management remain a major challenge. We report two cases of extracranial metastases from glial tumors to cervical nodes and postoperative site involving preauricular region detected on F18 Fluoro ethyl tyrosine (FET) positron emission tomography-computed tomography and later on confirmed with histopathology Fluoro ethyl tyrosine. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is a major global health threat, particularly affecting low- and middle-income countries, where it accounts for a significant number of premature deaths. Risk factors such as smoking, unhealthy diet, and sedentary lifestyles contribute to its prevalence. Clinical scoring systems like TIMI, GRACE, and HEART scores, alongside biomarker assessments, aid in the early identification of high-risk individuals, facilitating timely interventions to prevent adverse outcomes. Those with advanced age, prior myocardial infarction (MI), and impaired left ventricular function are at increased risk and may benefit from invasive procedures like coronary artery bypass grafting (CABG). Early detection and management of CVD risk factors are pivotal for effective prevention and treatment strategies. This study analyzes angiographic characteristics and evaluates the clinical effectiveness of TIMI and GRACE scores in guiding treatment and predicting outcomes for patients with NSTEMI and Unstable Angina. This was conducted at a tertiary hospital in Ahmedabad over one year. The study population comprised inpatient cases diagnosed with Non-ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina. The majority of NSTEMI patients had double vessel disease with left anterior descending artery involvement, while UA patients predominantly had single vessel disease with similar artery involvement. NSTEMI patients had a significantly higher mortality rate (14.55%) compared to UA patients (4.44%). Mortality was higher in males (15.52%) compared to females (2.38%). Male gender and higher TIMI and GRACE scores are associated with increased mortality and decreased discharge rates. Revascularization may be necessary for patients with higher TIMI risk scores to reduce mortality risk. [ABSTRACT FROM AUTHOR]

Purpose: Refractory and/or recurrent meningiomas have poor outcomes, and the treatment options are limited. Peptide receptor radionuclide therapy (PRRT) has been used in this setting with promising results. We have documented our experience of using intravenous (IV) and intra-arterial (IA) approaches of Lu-177 DOTATATE PRRT. Methods: Eight patients with relapsed/refractory high-grade meningioma received PRRT with Lu-177 DOTATATE by IV and an IA route. At least 2 cycles were administered. Time to progression was calculated from the first PRRT session to progression. The response was assessed on MRI using RANO criteria, and visual analysis of uptake was done on Ga-68 DOTANOC PET/CT. Post-therapy dosimetry calculations for estimating the absorbed dose were performed. Results: Median time to progression was 8.9 months. One patient showed disease progression, whereas seven patients showed stable disease at 4 weeks following 2 cycles of PRRT. Dosimetric analysis showed higher dose and retention time by IA approach. No significant peri-procedural or PRRT associated toxicity was seen. Conclusion: PRRT is a safe and effective therapeutic option for relapsed/refractory meningioma. The IA approach yields better dose delivery and should be routinely practised. [ABSTRACT FROM AUTHOR]

Purpose: We proposed to administer Lu‑177‑DOTATATE in intra‑arterial (IA) mode for higher first‑pass localization to somatostatin receptors, higher residence time in liver metastases, and more radiation to tumor. This study aimed at assessing early hematological, renal and hepatotoxicity; and objective response to IA peptide receptor radionuclide therapy (PRRT). Materials and Methods: Fourteen patients (4 females and 10 males) were prospectively assessed. 5/14 patients underwent 2 cycles, whereas 3/14 underwent 3 cycles, and 6/14 received 1 cycle of IA PRRT. 200 mCi of Lu‑177‑DOTATATE was administered in 15–20 min by IA route under angiographic guidance. Patients were asked to follow‑up at 4 and 8 weeks with hematological, liver, and renal functional parameters, and Ga‑68 DOTATATE positron emission tomography/computed tomography (PET/CT) after 8 weeks. Response was assessed using RECIST 1.1 and EORTC PET criteria. Results: Safety: 2/14 patients had high total and direct bilirubin, which reverted to normal after IA PRRT. Three patients had low albumin, which improved after 1 cycle. Nine patients showed no worsening of liver function. Two patients showed Grade 1 hematotoxicity which reverted to normal. Five patients showed high creatinine, but preserved glomerular filtration rate and EC clearance. On follow‑up at 8 weeks, serum creatinine reverted to normal. Efficacy: In five patients who underwent 2 cycles of IA PRRT, 3 showed partial response (PR) on RECIST 1.1 and partial metabolic response (PMR) on EORTC criteria, whereas 2 showed stable disease (SD). In patients who underwent 3 cycles, 1 showed SD, whereas other patient showed PMR on DOTANOC PET/ CT, with PR in size. Among the remaining seven patients, 5 showed PMR, whereas the other 2 showed SD. Thus 9/14 patients showed PR, whereas 5 showed SD on metabolic and size criteria. Conclusions: IA PRRT is a safe and efficacious approach for the treatment of liver dominant metastatic neuroendocrine tumors. [ABSTRACT FROM AUTHOR]

Fragile X syndrome (FXS) is a neurodevelopmental disorder that is often modeled in Fmr1 knockout mice where the RNA-binding protein FMRP is absent. Here, we show that in Fmr1-deficient mice, RNA mis-splicing occurs in several brain regions and peripheral tissues. To assess molecular mechanisms of splicing mis-regulation, we employed N2A cells depleted of Fmr1. In the absence of FMRP, RNA-specific exon skipping events are linked to the splicing factors hnRNPF, PTBP1, and MBNL1. FMRP regulates the translation of Mbnl1 mRNA as well as Mbnl1 RNA auto-splicing. Elevated Mbnl1 auto-splicing in FMRP-deficient cells results in the loss of a nuclear localization signal (NLS)-containing exon. This in turn alters the nucleus-to-cytoplasm ratio of MBNL1. This redistribution of MBNL1 isoforms in Fmr1-deficient cells could result in downstream splicing changes in other RNAs. Indeed, further investigation revealed that splicing disruptions resulting from Fmr1 depletion could be rescued by overexpression of nuclear MBNL1. Altered Mbnl1 auto-splicing also occurs in human FXS postmortem brain. These data suggest that FMRP-controlled translation and RNA processing may cascade into a general dys-regulation of splicing in Fmr1-deficient cells. This study shows that RNA splicing is widely dysregulated in FMRP-deficient mouse tissues and cells and involves multiple splicing factors, including MBNL1. In FMRP-depleted cells, Mbnl1 RNA is mis-spliced, resulting in improper cytoplasmic localization of MBNL1, which in turn causes impairment of further RNAs. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) can recur locoregionally or at distant sites. Timely diagnosis of recurrence is of paramount importance, as radical treatment of the localized disease can prolong survival. Fluorodeoxyglucose positron emission tomography / computed tomography (PET / CT) is routinely used in restaging and surveillance of colorectal cancer, as it can demonstrate recurrent disease with good accuracy. This article illustrates the spectrum of standard as well as unusual patterns of local recurrence and distant metastases of colorectal cancer.

Background: Spontaneous miscarriage is defined as an involuntary termination of pregnancy before 20th week of gestation or spontaneous expulsion of fetus below a fetal weight of 500 gm. The introduction of ultrasound into the obstetrical practice has been extremely useful in providing better understanding of the etiology of the first trimester spontaneous abortion and a basis for its clinical classification and management. Aims: The aims of assess the early pregnancy developmental changes in first trimester ultrasound screening, to identify any abnormal ultrasound parameters, to correlate abnormal ultrasound findings with clinical outcome measured in terms of spontaneous or missed abortion. Materials and Methods: This prospective observational analytical study was conducted in Department of Obstetrics and Gynaecology, R.G. Kar medical college and hospital, Kolkata. Study was conducted from February 2020 to July 2021. During the period 150 patients were included in the study as per inclusion criteria Thorough history taking and clinical examination was done. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: The mean age in the present study was 23.9800± 2.8906. In the study, 24 (16.0%) patients were Alcoholic, 20 (13.3%) patients were Smokers and 12 (8.0%) patients had Stress. In co-relation of age with Early pregnancy failure, 6 (10.9%) patients were 15-20 years of age, 30 (54.5%) patients were 21-25 years of age and 19 (34.5%) patients were 26-30 years of age. In co-relation with Early pregnancy failure, 30 (54.5%) patients were Booked Association of mean Age with Early pregnancy failure was not statistically significant. In patients with Early pregnancy failure, the mean USG UA RI (mean± s.d.) of patients was .3945± .0699. Association of mean USG UA RI with Early pregnancy failure was not statistically significant Conclusion: We concluded that ultrasound screening in early pregnancy gave a reliable and accurate differentiation between a viable normal pregnancy and an abnormal/pathological pregnancy. [ABSTRACT FROM AUTHOR]

Byline: Sajid. Qureshi, Monica. Bhagat, Seema. Kembhavi, Girish. Chinnaswamy, Tushar. Vora, Maya. Prasad, Siddarth. Laskar, Nehal. Khanna, Mukta. Ramadwar, Sneha. Shah, Navin. Salins, Sanjay. Talole Context: Pediatric solid tumors include [...]

Byline: Nita. Nair, Tanuja. Shet, Vani. Parmar, Rohini. Havaldar, Sudeep. Gupta, Ashwini. Budrukkar, Rajiv. Sarin, Meenakshi. Thakur, Sangeeta. Desai, Prabha. Yadav, Rakesh. jalali, Seema. Gulia, Tabassum. Wadasadawala, Jaya. Gosh, Jyoti. [...]

Byline: Gaurav. Narula, Maya. Prasad, Shalini. Jatia, Papagudi. Subramanian, Nikhil. Patkar, Prashant. Tembhare, Dhanlaxmi. Shetty, Nehal. Khanna, Siddharth. Laskar, Tanuja. Shet, Sridhar. Epari, Seema. Kembhavi, Sneha. Shah, Sajid. Qureshi, Sumeet. [...]