ABSTRACT
The shortage of N95 masks have spurred efforts on developing safe and scientifically-validated decontamination and reuse protocols that are easily scalable and universally applicable even in low-resource settings. We report on the development and implementation of a heat-based N95 mask decontamination system in a large hospital setting (Tata Memorial Hospital, Mumbai, India) with over 8000 N95 masks from about 1400 individual users decontaminated and in reuse till date. We describe the challenges and constraints in choosing a proven, scalable, and easy-to-implement decontamination solution. We discuss the heat treatment and particle filtration efficiency measurement experiments done to validate a decontamination treatment protocol at a target temperature of 70{degrees}C for a duration of 60 minutes, and the scaling up of this method using a standard hot drying cabinet at the hospital. The logistics of ensuring optimal utilization of the decontamination facility without compromising on basic safety principles are detailed. Our method relies on equipment available in standard hospitals, is simple to set-up, scalable, and can be easily replicated in low-resource settings. We further believe such limited reuse strategies, even in times of abundant N95 mask availability, would not only be cost-saving but also be environmentally responsible in reducing the amount of medical waste.
ABSTRACT
OBJECTIVE: The aim of the study was to evaluate diagnostic performance of FDG PET-CT in suspected recurrence of carcinoma esophagus after curative-intent surgical resection and impact of FDG PET-CT on intended management. MATERIAL AND METHODS: This was retrospective study of patients with clinical or radiological suspicion of recurrent esophageal carcinoma who were referred for PET-CT from January 2006 to December 2017. Diagnostic performance of PET-CT was evaluated for disease recurrence and its impact on management decisions. PET-CT findings were confirmed with tissue diagnosis. When tissue diagnosis was not available clinical and radiological follow-up was used as reference standard. RESULTS: Relevant clinical data were available in 68 patients which were considered for analysis. In 91% (62/68) patients FDG PET-CT findings were suggestive of disease recurrence. Histopathological confirmation was available in 43 patients, whereas in remaining patients recurrence was confirmed by radiological and clinical follow-up. Forty percent (28/68) patients were detected with distant metastases. Sensitivity, specificity, positive and negative predictive values of FDG PET-CT was found to be 98.4, 80, 98 and 80% with accuracy of 97%. Change in management was observed in 41% (28/68) of patients from salvage radiotherapy/surgery to palliative chemotherapy/best supportive care based on evidence of distant metastases seen on FDG PET-CT. CONCLUSION: FDG PET-CT is highly sensitive in detection of recurrent disease in esophageal cancer patients after surgical resection. It can detect distant metastases in high proportion of patients thus changing the intent of management from radical salvage to palliative chemotherapy/best supportive care.
