Liquid biopsy testing in metastatic or advanced breast cancer patients during the COVID-19 pandemic

Objective: During the COVID-19 pandemic, cancer patients had restricted access to standard of care tissue biopsy. Liquid biopsy assays using next generation sequencing technology provides a less invasive method for determining circulating tumour mutations (ctDNA) associated with targeted treatments or prognosis. As part of deploying technology to help cancer patients obtain molecular testing, a clinical program was initiated to offer liquid biopsy testing for Canadian patients with advanced or metastatic breast cancer. Method(s): Blood was drawn in two 10 mL StreckTM DNA BCTs and sent to the CAP/CLIA/DAP accredited Imagia Canexia Health laboratory for testing using the clinically validated Follow ItTM liquid biopsy assay. Plasma was isolated using a double spin protocol and plasma cell-free DNA (cfDNA) extracted using an optimized Promega Maxwell RSC method. Extracted cfDNA was amplified using the multiplex amplicon-based hotspot 30 or 38 gene panel and sequenced. An inhouse developed bioinformatics pipeline and reporting platform were used to identify pathogenic single nucleotide variants (SNVs), indels (insertions and deletions), and gene amplification. Included in the panel are genes associated with metastatic breast cancer: AKT1, BRAF, ERBB2, ESR1, KRAS, PIK3CA, TP53. Result(s): To identify biomarkers, 1214 metastatic or advanced breast cancer patient cfDNA samples were tested. There were 15 cases sent for repeat testing. We reported 48% of samples harboring pathogenic ctDNA mutations in TP53 (22%), PIK3CA (19%), ESR1 (18%), AKT1 (2%), ERBB2 (1.5%). Co-occurring variants were identified in samples with ESR1/PIK3CA as well as TP53/PIK3CA (both p-values <0.001). Interestingly, 29% of samples with mutated ESR1 harbored >= 2 ESR1 ctDNA mutations. In 56% of cases, previous molecular testing indicated the cancer subtype as hormone receptor (ER, PR) positive with/without HER2 negative status. In this specific subgroup, 49% harbored ctDNA mutations with 63% of those being PIK3CA and/or ESR1 mutations. Conclusion(s): A population of Canadian women with metastatic breast cancer were tested using a liquid biopsy gene panel during the COVID-19 pandemic for identification of biomarkers for targeted therapeutic options. Over 50% of the samples were identified as hormone positive, with greater than 60% harboring PIK3CA and ESR1 ctDNA mutations. Studies have shown that metastatic PIK3CA mutated ER-positive/HER2-negative tumors are predictive to respond to alpelisib therapy and have FDA and Health Canada approval. Additionally, ESR1 mutations are associated with acquired resistance to antiestrogen therapies, and interestingly we identified 29% of ESR1 mutated samples with multiple mutations possibly indicating resistance subclones. In future studies, longitudinal monitoring for presence of multiple targetable and resistance mutations could be utilized to predict or improve clinical management.

Perception of undergraduate medical students toward online learning in comparison with traditional learning

Background: The E-Learning has significant impact in developing medical education and accepted by medical students. It can be used either as sole platform for teaching or can be integrated with traditional teaching. However, during the time of COVID-19 outbreak, online learning was ahead and continued to provide education in the pandemic phase. Aims and Objectives: The study was aimed to assess medical students' perception toward usefulness and challenges of online learning and to compare the students' perception toward online learning and traditional learning. Material(s) and Method(s): This survey based educational study was carried out among total no of 501 undergraduate medical students of our institution. A pre-validated structured feedback questionnaire was sent to the participants and the response was collected. Result(s): Out of 501 students, a total number of 201 (40.11%) students experienced that the online learning is not comfortable as well as it is exhausting in comparison of face to face learning. About 255 (50.8%) students thought that online learning does not motivate students for interactive learning. It was found that 52% students preferred traditional with online learning, 41.51% students liked face to face learning while only 6.38% students have chosen only online learning. Conclusion(s): The online learning has its own advantages but, classroom-based learning is still most preferred by students for effective learning in terms of motivation and interaction. However, it can be incorporated in traditional learning for better teaching learning experience. Copyright © 2022 Shruti Brahmbhatt, et al.

Algorithmic Approach to Select MOOCs Platform: An Institutional Perspective

During COVID-19 pandemic, learning without four walls, i.e. virtual learning, played a vital role in the education system. Massive open online courses (MOOCs) became one of the most effective academic warriors. It is always a challenge to the institutions when some new platform or learning culture needs to be identified. As per survey, Internet users in India are growing at a rate of 14%. Its high time for institutions to provide an alternate or additional environment of learning, i.e. e-Learning. This manuscript focussed on selection of MOOCs platform from the view of institutions. It explored global MOOCs providers such as Edx, Coursera, Udacity & Course Builder and its parameters with respect to institutions. The authors identified indicators of MOOCs platform through which any institution can take the decision to implement the e-Learning environment in their campus. A tree algorithm (ID3) used for the same which helped to take the decision on MOOCs platform. The proposed algorithm took account of every question relating to each institute-centric indicators and provided a final assessment as per the institute preference. The author has implemented the decision tree algorithm on the four important institutional-centric core indicators/parameters which are courses, learner-centric platform, multimedia enrichment into content and administrative indicators (certificate and financial). © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Diabetes in covid-19: Management

The COVID-19 (Corona Virus Disease-19) has become the most critical health problem worldwide. It was first started from Wuhan, China and now it has affected more than 230 countries and millions of people. The diabetic patients with uncontrolled glycemic state for long term can result in many microvascular and macrovascular complications. Hence they are most commonly affected individuals during COVID-19. In this review we have briefed about the impact of COVID-19 in diabetes, the different pathophysioloy and management of diabetes in this phase. © 2021, Institute of Medico-Legal Publications. All rights reserved.