International Journal of Medical Research & Review (IJMRR)
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Conformal radiotherapy plans for palliative bone metastasis - comparison of dosimetric parameters
Get PDFBackground:Palliative radiotherapy offers significant relief in the huge physical distress of patients with bony metastasis. The enormous potential of conformal techniques has not been tested in palliative settings. However,the increasing life span of patients with metastatic disease demands to optimize the radiotherapy techniques to provide maximal durable symptomatic relief. Despitean increase in the utilization of the 3DCRT technique for palliative bony metastasis, the optimal beam arrangement remains unknown.
Materials and Methods:Ten patients of vertebral bony metastasis were retrospectively selected and four virtual 3DCRT plans were generated for each patient. The field approaches were a single field, two fields, three fields and five field approaches. For PTV, D90, D50, Dmean, Conformity index (CI) were evaluated.Dmean was evaluated for the esophagus, bowel, kidneys, and combined lungs. Dose-volume histograms were computed for the various treatment plans and compared. Statistical analysis was done by ANOVA test.
Results:A total of forty radiotherapy plans were generated. PTV parameters were significantly better with two field plans over one field plans in terms of D90 (p= 0.002), D50 (p= 0.02), Dmean(p=0.0009). Dmeanwassignificantly better with three field approach compared to two field approach (p=0.0006). The Dmeanwas significantly increased for organs at risk in two fields and three field plans.Five field approach did not showan advantage in terms of dosimetry of PTV but there was a significant rise in the dose to Organs at risk (OAR’s).
Conclusion:The three field plans showed better dose distribution to the PTV with an acceptable increase in the dose to OAR’s
Management of penetrating cardiac injury in a tertiary hospital in Northeast India
Get PDFBackground: Penetrating cardiac injuries are rare and considered the most lethal of all trauma patients. Managing cardiac injuries is a great challenge for the trauma surgeons and the outcome of the treatment of such critical condition depends on the mechanism of injury, haemodynamic status of the patients at the time of presentation, heart chamber involved and other associated injuries.
Materials and Methods: This is a prospective observational study of consecutive six patients with penetrating cardiac injuries from January 2015 to December 2019 treated in Regional Institute of Medical Sciences, Imphal, India. eFAST and CT scan of the chest were the main imaging methods used for diagnosis. All patients underwent tube thoracostomy for associated haemothorax in the emergency ward.
Results: All the patients had penetrating cardiac injuries due to stabbing. Five (63.3%) patients presented with features of cardiac tamponade or with severe hypotension (systolic BP less than 80 mmHg) and one (16.7%) patient who was haemodynamically stable at the time of presentation had developed features of cardiac tamponade after 24 hours. Four patients had undergone emergency left anterolateral thoracotomy, one patient had undergone median sternotomy, and one patient underwent left anterolateral thoracotomy on the second day after admission.
Conclusion: A high index of suspicion for cardiac trauma is extremely important in patients presented with penetrating thoracic injuries or upper abdominal injuries. Computed tomography of the chest can show the haemopericardium giving detailed information of associated pulmonary injury and hemothorax. Prompt diagnosis and early surgical intervention play a vital role to save these critically injured patients
Estimation of prostate size by trans-rectal ultrasound and its correlation with DRE and endoscopic grading
Get PDFAim: Digital rectal examination (DRE) grading and the grade of prostatomegaly on cystoscopy are routinely used in clinical practice, but its correlation to prostate volume is understudied. This study was done to assess the correlation of DRE and endoscopic grading with the prostate volume on trans-rectal ultrasound (TRUS).
Materials and Methods: This study was carried out in 101 eligible patients with prostatomegaly. Each patient was evaluated for three parameters, prostate volume by TRUS examination, DRE and endoscopic grading on cystoscopy. Pearson correlation coefficient was calculated to find the correlation between variables, p<0.05 was taken to be statistically significant. Data were analyzed using the Epi Info (TM) 7.2.2.2.
Results: Significant positive correlation (p<0.001) was found between TRUS Volume and DRE grading (Pearson Correlation=0.945) and TRUS volume and Endoscopic grading (Pearson Correlation=0.949). Both the grading were also significantly positively correlated (Pearson Correlation=0.989, p<0.001).
Conclusion: Our attempt for correlating the digital rectal grading and endoscopic grading with prostate volume is satisfactorily validated in the clinical setting. These grades are sufficient to provide a rough estimation of the prostate volume and to classify patients with prostatomegaly
Changes in Cardiovascular system among smokeless tobacco users attending tertiary care hospital in Andhra Pradesh, India
Get PDFBackground: Tobacco can be consumed as cigarettes and also as smokeless tobacco. Smokeless tobacco is a harmful tobacco product that contains over 3,000 chemicals, 7 including 28 known carcinogens (cancer-causing agents). Various forms of smokeless tobacco (mainly snuff and chewing tobacco) cause an immediate increase in heart rate and blood pressure. However, the relationship between smokeless tobacco uses on blood pressure remains unknown, especially in tertiary level hospitals. Our aim is to find out the smokeless tobacco use influence on cardiovascular parameters, for instance, pulse rate and blood pressure.
Methods: This cross-sectional study was carried out to assess cardiovascular changes among adult male smokeless tobacco (ST) users. For this purpose, 50 male respondents were selected. The participants were selected from the medicine outpatient department of Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh. Pulse rate and blood pressure were measured and ST uses behavior was assessed using self-reports. Statistical analysis was done by SPSS20.
Results: In this study, the mean (±SD) of pulse rate was 83.2±12.3 beats/min. The mean (±SD) of systolic blood pressure was 158.72±24.84 mm of Hg and the mean (±SD) of diastolic blood pressure was 98.78±9.87 mm of Hg in smokeless tobacco users.
Conclusion: Mean systolic and diastolic blood pressures were higher in smokeless tobacco users in the tertiary level hospital. However, the mean pulse rate was within the normal range
A prospective study comparing induction chemotherapy followed by chemoradiation versus chemoradiation alone in stage III non-small cell lung cancer
Get PDFBackground: Although concurrent chemoradiation (CCRT) is the standard of care for stage III non-small cell lung cancer(NSCLC), the five years overall (OS) survival is very poor. Most of the patients developed distant metastasis later which can be improved by induction chemotherapy.
Aims: This study was designed to observe the difference in epidemiology, acute toxicities, overall responses [complete response (CR)+partial response (PR)] after treatment completion, disease-free survival (DFS) and progression-free survival (PFS) at the end of the study.
Settings and Design: This was a prospective, interventional, randomized hospital-based study.
Methods and Material: Eligible patients were randomized into arm A (CCRT with weekly paclitaxel(P) + Carboplatin(C) with 66 Gray radiation) and arm B (two cycles of induction chemotherapy consisted of P+C followed by CCRT as of arm A. During treatment weekly, after completion of treatment at 6th week and thereafter 3 monthly evaluation was done till the end of study. S
tatistical analysis used: Chi-Square and Fisher Exact test did statistical analysis, t-test with 95%CI, Kaplan Meier survival analysis, Log Rank test using SPSS version 18.
Results: Among 44 patients, male (88.6%), Smokers (85.1%) were predominant with the most common histology was squamous cell carcinoma (52.4%). Overall response (Complete Response +Partial Response) was higher in Arm B 66.66% but statistically non-significant. Acute toxicities in both the arms were comparable and similar. DFS and PFS in the induction chemotherapy arm (Arm B) were numerically superior to concurrent chemoradiation arm (Arm A) but statistically nonsignificant
Conclusion: To conclude there were no significant differences in results between two arms in the present study population. Further studies with the larger sample size and longer duration of follow up are necessary
The occurrence of cryptosporidiosis and amoebiasis among HIV infected female sex workers with symptomatic diarrhoea
Get PDFObjectives: Manipur is one of the high HIV prevalence states of India.Quite a good number of HIV infected females are indulged in the profession of sex workers. These female sex workers (FSWs) are experiencing a number of gastrointestinal related disorders including diarrhoea caused by a wide variety of pathogens, including parasites. Therefore, the present study is being undertaken with a view assessing the occurrence of enteric parasites, especially Cryptosporidium sp and Entamoeba histolytica towards their involvement as the diarrhoeagenic agent(s) in these groups of patients.
Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipurfrom1stJanuary to 31stDecember 2018.The study group included54 HIVseropositive female sex workers with symptomatic diarrhoea. Stool sample(s) preserved in 2.5% K2Cr2O7for Cryptosporidium sp and 10% buffer formalin for Entamoeba histolytica and other classical parasites were collected for this study.
Results: The present study reveals that out of the selected 54 HIV positive FSWs screened for the presence of enteric parasitosis, 16 (29.62%) individuals were found positive for three parasitic infections– cryptosporidiosis, amoebiasis and hookworm infection. Both mixed infection (31.25%) and single infection (68.75%) were observed among the patients. Single infection with Cryptosporidium sp and Entamoeba histolytica were observed in 5 (31.25%) and 6 (37.5%) patients respectively. Patients in the age group of 25 -30 and 30-35 years were observed to have been more infected.
Conclusion: The study reveals that intestinal parasitic infection caused by Cryptosporidium sp and Entamoeba histolytica are prevalent among the present study group of HIV infected female sex workers
Effectiveness of underlay myringoplasty in inactive mucosal chronic otitis media; a prospective study
Get PDFIntroduction: Patients with a mucosal type of chronic otitis media (COM) usually have recurrent ear discharge and conductive hearing loss. It is characterized by the central perforation of the tympanic membrane. Myringoplasty is an operation performed to repair tympanic membrane perforation when there is no ossicular damage. It helps to prevent ear discharge and improves hearing. Different techniques used for myringoplasty are underlay and overlay. Underlay technique is an effective procedure for tympanic membrane repair.
Methods: 125 patients who underwent underlay myringoplasty over two years in a tertiary care center in Kerala were included in the study. Patients with actively discharging ears were excluded from the study.
Results: The majority of the patients were in the age group of 20-29 years (49.6%). There were 47 males (37.6%) and 78 females (62.4%). In 63 patients the surgery was done on the right side (50.4%) and in 62 patients on the left side (49.6%). Maximum preoperative hearing loss was in the range of 30-34 dB (39.2%). 100 patients (80%) showed successful graft uptake with the improvement of hearing in the range of 10-15 dB. Eight patients (6.4%) showed small residual perforation with the improvement of hearing. In 17 patients (13.6%) there was a complete rejection of graft with continuous ear discharge and no improvement in hearing.
Conclusion: Underlay myringoplasty is an effective surgical technique for the repair of tympanic membrane perforations in terms of graft take up and improvement of hearing
Classification, diagnosis of reversibility and severity assessment of patients having respiratory distress based on pulmonary function test
Get PDFIntroduction: Pulmonary function testing is the gold standard for physicians to diagnose and manage respiratory problems. An obstructive defect is indicated by low forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, defined as less than 0.7 or below the fifth percentile. If an obstructive defect is present, the physician should determine if the disease is reversible based on the increase in FEV1 or FVC after bronchodilator treatment (i.e., increase of more than 12% and 200 ml in adults). An FVC below the fifth percentile indicates a restrictive pattern based on NHANES III data in adults. If both the FEV1/FVC ratio and the FVC are low, the patient has a mixed defect.
Method: A total of 60 patients having respiratory distress, who attended chest OPD underwent a pulmonary function test.
Results: In this study out of 60 patients, 32 patients had obstructive airway diseases with low FEV1/FVC (53.33%), 8 of them (13.33%) had restrictive lung diseases, ten patients(16.66%) had mixed features and rest ten patients(16.66%) had normal spirometry. Among those 32 patients of obstructive features, 22 (68.75%) had reversible airway diseases. Severity was measured among the other ten non-reversible obstructive patients according to the GOLD criteria.
Conclusion: Pulmonary function test is the fundamental first-line investigation to diagnose obstructive and restrictive lung diseases and also to differentiate between reversible and non-reversible obstruction. It is also a vital tool for determining the severity among non-reversible obstructive airway patients
Dosimetric evaluation of 6 MV and 18 MV intensity-modulated radiotherapy plans for treatment of carcinoma of the cervix
Get PDFIntroduction: Cervical cancer (Ca Cx) is the fourth most frequent cancer in women with an estimated 57000 new cases in 2018 representing 6.6% of all female cancers. Approximately 90% of deaths from cervical cancer occurred in low- and middle-income countries.
Material and Methods: A retrospective radiotherapy treatment planning comparative study conducted at the Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore during June 2018- March 2019.
Result: All the plans were normalized to 100 % at Target mean to achieve a similar target dose for quantitative comparison of DVHs. The results for target coverage, OAR sparing, integral dose, and monitoring units.
Conclusions: The tradeoff of using 6 MV and 18 MV for cervix patients depends on many parameters. Since the same PTV coverage was forced for both energies by having the same optimization constraints, there was little difference in target coverage and conformity index for both energies
Isthmus agenesis with variant topography of levator glandulae thyroideae: A case report
Get PDFThe thyroid gland is an imperative endocrine gland present in the neck known commonly for its morphological variations. During routine dissection agenesis of the isthmus of the thyroid gland was observed with levator glandulae thyroidea extending from both the lateral lobes with stout stalks of pyramidal lobes bilaterally. The Levator glandulae thyroidea is a fibro-musculo-glandular band. usually, present unilaterally or extending from isthmus connecting the pyramidal lobe of the thyroid gland to the hyoid bone. The site of the isthmus is often associated with anastomosis of vessels supplying thyroid gland but strikingly no such anastomosis was observed. The presence of such variant of levator glandulae thyroidea with agenesis of the isthmus is a rare finding and knowledge of such topographical anatomical variations is crucial for understanding associated pathologies related to the thyroid gland and modus operandi in their management