International Journal of Research in Medical Sciences
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Shielding design and calculation of a treatment room for a 15-MV versa HD LINAC at BMU, Dhaka, Bangladesh
Get PDFBackground: Effective shielding design is essential for ensuring radiation safety for both patients and healthcare staff in medical radiation therapy facilities, particularly with high-energy LINACs. This study investigates the shielding design and calculation for a 15-MV versa HD LINAC treatment room at Bangladesh Medical University (BMU), focusing on primary and secondary radiation barriers.
Methods: Shielding design and calculation were performed using empirical equations based on NCRP report no. 151 (2005). Maximum photon energy (15 MV) was considered for barrier design. Calculations for primary and secondary barrier thicknesses were performed using workload, use factor, and occupancy factor, with ordinary concrete (2.35 g/cm³) as the material. Radiation levels were measured at various gantry positions (0°, 90°, and 270°) with calibrated radiation detectors.
Results: The primary barrier thicknesses were calculated as 2.75 m for east and west sides, and 2.58 m for the roof. Secondary barrier thicknesses for the north, south, and roof sides were 1.02 m, 1.14 m, and 1.18 m, respectively. Radiation measurements at different gantry angles showed a maximum photon dose rate of 2.15 μSv/hr at the main entrance door, with values consistently below 10 μSv/hr at all locations. The standard deviation of dose rates ranged from 0.03 to 0.15 μSv/hr. Statistical analysis showed a p=0.04, indicating significant differences between radiation exposure at different gantry positions. The coefficient of variation (CV) was calculated as 0.23%, confirming low variability in the shielding performance across measurements.
Conclusions: The shielding design effectively meets safety standards, with radiation levels well below permissible limits, ensuring the safety of both hospital staff and patients
Expert opinion on the burden, etiology, and management of respiratory tract infection with a special focus on cefpodoxime in Indian settings
Get PDFBackground: To assess clinician-reported practices in managing respiratory tract infections in Indian settings, with a focus on antibiotic use and experiences with cefpodoxime, including infection prevalence, treatment choices, dosing patterns, and clinical outcomes.
Methods: The cross-sectional study used a 23-item questionnaire to gather the expert opinion among clinicians in managing respiratory tract infections, with a focus on antibiotic use and experiences with cefpodoxime in Indian settings. The study covered various aspects such as infection prevalence, treatment choices, dosing patterns, clinical outcomes, and common infection types. Data visualization, including bar charts, was performed using Microsoft Excel 2013.
Results: The study involved 1,243 clinicians practicing across various settings in India. Cefpodoxime was preferred as the first-line anti-infective for upper respiratory tract infections by approximately 74% of clinicians, with 65% selecting a dose of 10 mg/kg/day. It was prescribed in 11-25% of chronic bronchitis cases by nearly 52% of respondents, in less than 10% of bone and joint infections by 51%, and in 25-50% of ENT infections by 43%. For skin and soft tissue infections, 42% reported using it in less than 10% of cases. Diarrhoea was identified as the most common adverse effect by 50% of clinicians, while approximately 51% considered its broad-spectrum activity to be the main advantage.
Conclusions: This study provides a detailed analysis of the clinical use of cefpodoxime, highlighting its frequent use in upper respiratory and ENT infections, with relatively limited use in chronic bronchitis, bone and joint, and skin and soft tissue infections
Optimizing blood utilization: insights from a tertiary care hospital in Hubballi, Northern Karnataka, India
Get PDFBackground: Blood transfusion is a cornerstone of modern medical care. With the shift from whole blood to component therapy, especially in resource-limited settings, optimizing blood utilization is essential to ensure availability, minimize wastage, and improve patient outcomes.
Methods: To analyze the utilization patterns of blood and its components at a tertiary care center in Hubballi, Karnataka, over a three-year period, with an emphasis on usage trends, demographic distribution, and discard rates. A descriptive, observational study was conducted at the blood centre of Karnataka Medical College and Research Institute, Hubballi, India from January 2021 to December 2023. Data were extracted from blood bank records, including type of components used, patient demographics, clinical indications, and reasons for discards. Trends were compared with national and international studies.
Results: A total of 45,514 units were collected, and 44,139 units utilized. Component therapy accounted for 78% of transfusions, with packed red blood cells (39%), fresh frozen plasma (29%), and platelets (10%). Whole blood usage remained at 22%. Female recipients constituted 57% of transfusions, primarily in reproductive age groups. The discard rate was 3.02%, mainly due to transfusion-transmitted infections and donor-related issues.
Conclusion: The study highlights a favorable shift toward component therapy, though whole blood use still exceeds national benchmarks. Strengthening clinician awareness, donor screening, and inventory practices, along with regular audits, is vital for enhancing transfusion efficiency and safety
Pulmonary lymphangioleiomyomatosis: a rare and challenging case report with unusual presentation of human melanoma black-45
Get PDFLymphangioleiomyomatosis (LAM) is a very rare disease that generally affects young women of reproductive health group. It is characterized by abnormal proliferation of smooth muscle like cells (LAM cells) in the lungs (pulmonary LAM) and extrapulmonary sites (extrapulmonary LAM). Patients usually present with spontaneous pneumothorax, hemoptysis and progressive dyspnea. There is a poor awareness, knowledge and records about this disease making it a difficult diagnosis. Herein this report presents a case of pulmonary LAM in a 63 years old female with h/o dyspnea and chest pain. Her imaging studies showed fibrosis and nodular lesions in both lungs suggesting metastatic lesions. Later on, after a lung biopsy the diagnosis of lymphangioleiomyomatosis was given and immunohistochemical staining was positive for spinal muscular atrophy (SMA), CD34 and negative for human melanoma black-45 (HMB45). HMB45 negative PLAM is very rare with only few instances in the literature making it a difficult diagnosis. Our patient was given mTOR inhibitors along with supportive and conservative management and she responded well to the treatment. This rare cystic lung disease can be devastating as it causes progressive lung damage. Limited options in the management of PLAM makes early diagnosis as key and there is also a need for high index suspicion with cystic lung disease in women
COVID-19 mRNA vaccination: implications for the central nervous system
Get PDFBackground: Neuroinflammatory conditions involving the central nervous system (CNS) are on the rise and while the etiology is currently unknown the parallel rise in cases to mass COVID-19 vaccination is of particular interest. This study explores the association between the CNS infection rate and vaccination.
Methods: This is a retrospective study. Retrospective data were utilized from the U. S. centers for disease control and prevention (CDC) and the U.S. food and drug administration (FDA) vaccine adverse event reporting system (VAERS). Adverse events (AEs) encompassing CNS conditions following all vaccines were queried from January 1, 1990, through November 30, 2024. The timeframe for all vaccines except COVID-19 vaccines was 419 months and the timeframe for COVID-19 vaccines was 47 months (January 1, 2021, to November 30, 2024). Observed AEs are presented as odds ratios (ORs) by time which compare these events occurring after COVID-19 vaccination to those after influenza vaccination and to those after all other vaccines.
Results: Comparing COVID-19 vaccination to annual influenza vaccinations and all vaccines combined, the CDC/FDA’s safety signal thresholds were breached for the multiple outcomes. Data are expressed as OR, 95% confidence interval (CI), p value, Z score. All CNS categories reviewed produced a safety signal when comparing events after COVID-19 vaccination to influenza vaccination (referent). Thirty-nine events were categorized as CNS infection (29.4, 21.6-40.1, <000.1, 21.4); 11 events grouped as herpetic CNS Infection (171, 93.9-312, <000.1, 16.8); and 4 categorized as CNS abscess (107, 40.9-280, <000.1, 9.53). Similarly, CNS Infections, herpetic CNS infection, and CNS abscess categories also produced a safety signal when comparing events after COVID-19 vaccination to all vaccines combined (referent) (except COVID-19): 39 events categorized as CNS Infections (4.11, 3.03-5.57, <000.1, 9.09); 11 events grouped as herpetic CNS Infection (22.3, 15.4-32.4, <000.1, 16.4) and; 4 events noted as CNS abscess (17.8, 10.5-30.4, <000.1, 10.6). When comparing COVID-19 vaccination to influenza vaccination as well as all vaccines combined, 7 of 9 events in the uncommon neurological disease grouping exceeded safety thresholds for both comparisons.
Conclusions: All safety signals reported are concerning and support an immediate global ban on the COVID-19 vaccination program.
Tobacco consumption pattern and dependence in an urban slum community of Mumbai
Get PDFBackground: Globally India ranks as second highest in terms of tobacco users. As per the GATS survey, 11% of all adults smoke and 21% of all adults are using the smokeless form of tobacco. The aim of the study is to assess the level of dependence on tobacco in the urban slum population aged 18 years and above in Mumbai.
Methods: A descriptive cross-sectional study amongst 100 adults aged 18 years and above, selected sequentially from the sampling frame of tobacco users in the urban slum of Mumbai.
Results: Amongst the 100 respondents 63 were males and 37 were females, 48% were aged 55 years or older and only 12% were below 35 years of age. All females in the study used smokeless form of tobacco, whereas 74.6% of the males used smokeless form of tobacco. 51% respondents reported the age of initiation of tobacco as 20-24 years and 34% reported a family member using tobacco products. Less than Rs. 200 per month was being spent on purchasing tobacco products by 77% of the respondents. High dependency score in Fagerstrom Test for Nicotine Dependence (FTND) was observed in 26.3% and 51.2% of smokers and smokeless tobacco users respectively.
Conclusions: In the urban slum of Mumbai, smokeless form of tobacco is more prevalent than smoke form of tobacco and is highly addictive both in males and females. Family influence played a major role in initiation of tobacco use among females as compared to males
Managing irritable bowel syndrome via gut-brain axis modulation and antispasmodic - anxiolytic dual action: an Indian expert panel review
Get PDFIrritable bowel syndrome (IBS) is a complex, multifactorial functional gastrointestinal disorder characterized by recurrent abdominal discomfort, altered bowel habits, and a high prevalence of psychological comorbidities, particularly anxiety. In the Indian clinical landscape, IBS remains underdiagnosed, largely due to symptom overlap with other gastrointestinal conditions and the lack of standardized diagnostic protocols. Anxiety significantly contributes to the exacerbation of IBS symptoms, primarily through dysregulation of the gut-brain axis. This manuscript explores the evolving paradigm of IBS diagnosis and management in India, with a particular focus on the therapeutic potential of antispasmodic-anxiolytic combinations. Among these, the fixed-dose combination of clidinium and chlordiazepoxide stands out for its dual mechanism of action, offering both peripheral antispasmodic and central anxiolytic effects. This makes it especially effective in managing IBS cases where psychological stress is a key aggravating factor. Unlike conventional monotherapies, this combination addresses both visceral hypersensitivity and the psychological dimensions of IBS, thereby enhancing symptom control in stress-amplified presentations. The manuscript also explores recent advancements in digital health tools, biomarker discovery, and precision medicine approaches that are reshaping IBS diagnostics and enabling more personalized treatment strategies. Insights from real-world clinical practice and patient profiling underscore the importance of individualized, multimodal management integrating pharmacologic interventions with lifestyle and behavioural therapies
Analysis of visually handicapped patients attending outpatient department of a tertiary eye care hospital for visual disability certification in North Bihar
Get PDFBackground: This study aimed to analyse the demographic details, causes and severity of visual disability of the patients coming for Visual Disability Certificate in North Bihar.
Methods: A retrospective study including patients applied for visual disability certificates between January 2023 and August 2024 (20 months) was performed from medical record of tertiary centre in North Bihar. The demographics, aetiologies, grades and classification of visual impairment according to the new guidelines provided in the Gazette of India published in 2018 of the study subjects were analyzed. Results were compared with data from studies on blindness certificates and population-based studies.
Results: Out of total, 104 patients eligible for 40% or above visual disability certification of which 66 patients were males. The age range was 1-90 years with the maximum number of patients in 11-20 years range. According to the grade and percentage of disability, low vision grade 3c (60%) was most commonly seen in 28.92% of individuals followed by 3a (40%). Blindness 4a and 4b (90-100%) was seen in 40 patients (38.46%). Most common cause for visual disability found was glaucomatous optic atrophy followed by retinitis pigmentosa and fundal coloboma.
Conclusions: Analysis of blindness certificates provides valuable information regarding different causes of visual disability and provides an insight into the overall trends in visual disability profile and help in rehabilitation
Unicentric hyaline vascular Castleman’s disease presenting as an intraparenchymal parotid mass: a rare case report
Get PDFCastleman’s disease (CD) is a rare, benign lymphoproliferative disorder of unknown etiology that can affect any lymph node group, with the mediastinum being the most common site. Salivary gland involvement is exceptionally rare. We present a case of a 30-year-old female with a slowly progressive, painless left-sided parotid swelling persisting for four months. Clinical examination, ultrasonography and fine-needle aspiration cytology (FNAC) initially suggested an intraparotid lymph node enlargement. The lesion was excised and histopathological examination confirmed hyaline vascular CD. Given its rarity and lack of specific clinical or radiological features, CD should be considered in the differential diagnosis of persistent parotid gland swellings. Surgical excision remains the mainstay of treatment for unicentric Castleman’s disease (UCD) with an excellent prognosis
Safety and efficacy of dexpramipexole in eosinophilic asthma: a comparative study in a tertiary care hospital in Bangladesh
Get PDFIntroduction: Eosinophilic asthma is characterized by elevated eosinophil levels and frequent exacerbations, which are difficult to control with standard therapies. Dexpramipexole, an oral small molecule, has shown promise in reducing eosinophil counts, but data on its long-term efficacy and safety are limited. This study aimed to evaluate the efficacy and safety of Dexpramipexole in patients with eosinophilic asthma, focusing on changes in blood eosinophil counts, lung function, quality of life, and asthma exacerbation rates.
Methods: This was a cross-sectional observational comparative study conducted at the department of Reparatory Medicine during January-2021 to December-2021, in Uttara Adhunik Medical College Hospital, Dhaka Bangladesh. A total of 200 confirmed cases with eosinophilic asthma were purposively employed to receive Dexpramipexole (n=100) and placebo (n=100) for 12 months follow up. The collected data were analyzed using Statistical Package for Social Sciences (SPSS), version-23.0.
Results: The Dexpramipexole group achieved a 75% reduction in eosinophil counts compared to 12% in the placebo group (p<0.001). FEV1 improved by 15% in the Dexpramipexole group versus 2% in the placebo group (p<0.01). Quality of life scores increased by 1.5 points compared to 0.3 points in the placebo group (p<0.001). A 30% reduction in asthma exacerbations was observed (p=0.03).
Conclusion: Dexpramipexole demonstrated significant improvements in eosinophil reduction, lung function, quality of life, and exacerbation rates over a 12-months period, with a favorable safety profile. These results suggest Dexpramipexole may be a promising long-term therapeutic option for eosinophilic asthma