Search

Aim: This article aimed to present the salient features of the in-house developed Java program for the determination of inflection point and dosimetric parameters of flattening filter-free (FFF) photon beam. Reference levels for the dosimetric parameters of the FFF photon beams were also presented. Materials and Methods: Beam profiles of 6 MV FFF and 10 MV FFF photon beams for a collimator setting of 20 cm × 20 cm measured at 10 cm depth in an isocentric setup acquired from various institutions were analyzed using an in-house developed Java program and manual method. The values of reference dose value (RDV), field size, penumbra, and degree of un-flatness (defined as the lateral separation between 90% [X90%], 75% [X75%], and 60% [X60%] dose points on the profile) were calculated and compared. The reference values of field size, penumbra, and degree of un-flatness were also determined for Varian and Elekta medical electron linear accelerators (LINACs). Results: The maximum differences for RDV determined using the Java method and manual method are 2.4% and 2.7% for 6 and 10 MV FFF photon beams, respectively. The maximum difference between the values of field size, penumbra, and degree of un-flatness determined using Java and manual methods is within 1.3 mm. The reference values of field size and penumbra for Varian LINACs are 19.94 ± 0.10 cm and 0.83 ± 0.08 cm (6 MV FFF) and 19.95 ± 0.10 cm and 0.83 ± 0.08 cm (10 MV FFF). Similarly, the reference values of field size and penumbra for Elekta LINACs are 20.02 ± 0.09 cm and 0.94 ± 0.12 cm (6 MV FFF) and 20.03 ± 0.11 cm and 0.97 ± 0.16 cm (10 MV FFF). Conclusions: A software program was developed in Java for analyzing the beam profiles of FFF photon beams. The results of Java-derived values of dosimetric parameters of FFF photon beams were found in good agreement with the values determined using the manual method. The reference values of these parameters were also derived and quoted using a large cohort of the data. [ABSTRACT FROM AUTHOR]

Context: Hypospadias is a common urological anomaly which could be surgically corrected with good cosmetic results. Aims: We aimed to detect changes in urinary flow parameters both before and after tubularised incised plate urethroplasty (TIPU) using uroflowmetry. Settings and Design: Data collected were clinically implemented hypothesising the probability of urethrocutaneous fistula following stricture with Qmax variation. Materials and Methods: This study is a prospective analysis done from December 2017 to October 2019. A total of 104 cases of anterior hypospadias were included in the study. A single surgical unit did TIPU. Pre-operative and post-operative uroflowmetry was done, and Qmax was recorded at 3 months, 6 months and 1 year after surgery. Mean Qmax was calculated for all intervals. A significant decrease in Qmax of a child (<2 standard deviation) was ascertained. Urethral calibration was done in those cases with a significant decrease of Qmax and analysed statistically. Results: The mean age was 6.97 ± 2.41 years. Out of 104 children, 73 (70.2%) and 31 (29.8%) had distal and mid-shaft hypospadias, respectively. The pre-operative mean Qmax of the population was 6.20 ± 0.42 ml/s. Arithmetic mean Qmax at 3 months, 6 months and 1 year was 8.53 ± 0.42, 11.18 ± 0.47 and 13.71 ± 0.44 ml/s, respectively. On comparing the pre-operative with post-operative mean Qmax, a significant increase was found postoperatively (P < 0.0001). Twenty-four patients had significantly decreased Qmax value after 6 months. In these patients, follow-up urethral dilation was done with significant improvement. Conclusion: The changes in maximum flow rate (Qmax) are suitable for use in routine follow-up. A significant decrease in Qmax over time indicates the onset of urethral stricture. These cases are to be intervened before venturing to redo urethroplasty. [ABSTRACT FROM AUTHOR]

Aim: In nanoparticles-aided radiotherapy, the radiation sensitivity of tumor is increased with the infusion of nanoparticles in tumor. This therapeutic modality is capable of delivering enhanced dose to tumor, without exceeding the normal tissue tolerance dose. Further, the quantification of the enhanced dose using suitable dosimeter is important. The present study is aimed at measuring the dose enhancement factors (DEFs) using the combination of nanoparticles-embedded alginate (Alg) film and unlaminated Gafchromic EBT3 film. Materials and Methods: Gold nanoparticles (AuNPs)- and silver nanoparticles (AgNPs)-embedded Alg polymer films were synthesized and characterized using standard techniques. Further, a customized version of the Gafchromic EBT3 film, i.e., unlaminated EBT3 film, was specially fabricated. The DEFs were measured using Xoft Axxent electronic brachytherapy device. Results: The surface plasmon resonance (SPR) and particle size of AuNPs were found to be 550 and 15 ± 2 nm, respectively. In the case of AgNPs, the SPR and particle size were recorded as 400 and 13 ± 2 nm, respectively. The DEFs measured, using unlaminated EBT3 film, for Xoft Axxent electronic brachytherapy using AuNPs and AgNPs were 1.35 ± 0.02 and 1.20 ± 0.01, respectively. Conclusion: The increase in dose enhancement during nanoparticles-aided electronic brachytherapy can be attributed to dominance of photoelectric effect, due to the presence of low-energy X-rays. The investigation indicates that the Xoft Axxent electronic brachytherapy device is suitable for nanoparticles-aided brachytherapy. [ABSTRACT FROM AUTHOR]

Introduction: In India, approximately 35,000 new cleft patients are born every year. Many patients receive suboptimum, improper, little, or no treatment. The cumulative burden of cleft care is up to 1 million cases. The spectrum of problems is varied, the caseload is enormous, and the logistics of treatment delivery are complicated. The Indian Council of Medical Research (ICMR) task force project was launched in 2012 to evaluate the status of cleft care in India and develop strategies to provide comprehensive cleft care through a dynamic multidisciplinary and multidimensional tool. ICMR task force project (2012.14) was conducted in Delhi, and the National Capital Region reported that at least 50% of studied cases had complex and multiple treatment needs. The needs identified were related to surgical, orthodontic, dental, ENT and Speech, rehabilitation of mutilated dentition, and various psychological disturbances among patients with Cleft anomalies. Aim: The aim of this study was to develop and test web.based application to create a system for national data of patients with cleft anomalies and digitize the patient records in a standardized preagreed format. Methods and Results: Corresponding to contemporary digital technologies and evolutionary improvements in data collection, web.based data collection instrument, including text, photographs, X.rays, and audio files, was considered the most appropriate. The experts from varied domains in consultation with ICMR and National Informatics Centre evolved a web.based data collection instrument which is named the "IndiCleft tool." The tool has been tested and used over the years and is presently being upgraded to dynamic version for a national data and patient care registry. Conclusion: The present article describes the process of the development of a "dynamic" web-based data collection instrument. The IndiCleft tool is the national resource on cleft data in India. [ABSTRACT FROM AUTHOR]

Background: Hairdressers undergo extensive and prolonged exposure to a variety of chemical substances present in the air in their salons. Although in low concentrations, the various products used for hair care are harmful as most of these products generate chemical aerosols during different procedures. These aerosols which have irritant or sensitizing effects on respiratory mucosa have been found to enter into the airways. Aim: The aim of this study is to assess the impairment of lung function in hairdressers in Gangtok. Method: This is a cross-sectional, comparative study conducted on 50 hairdressers and 50 age- and sex-matched non-hairdresser comparison group. The sampling technique used was simple random sampling. Permission from Institutional Ethical Committee was obtained before beginning the study. A standard questionnaire was used to record the respiratory symptoms. The pulmonary function parameters of the subjects were measured using portable spirometer HELIOS 720. Results: All the parameters were decreased in hairdressers and almost all the differences were statistically significant. FEV1 (P = 0.023) and FEV1/FVC ratio (P < 0.05) were reduced significantly. FEF25-75% and PEFR were also significantly reduced (P < 0.05 in both parameters). FVC was also reduced in hairdressers, but it was not statistically significant (P = 0.342). Conclusion: Hairdressers undergo exposure to different chemicals in their workplace and carry the risk of decreased pulmonary function. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetes mellitus is a heterogeneous primary disorder of carbohydrate metabolism with multiple etiological factors that generally involve absolute or relative insulin deficiency or insulin resistance or both. All causes of diabetes ultimately lead to hyperglycemia, which is the hall mark of this disease syndrome. Nutrition and diet play a critical role in the course of disease, in the controlling hyperglycemia in addition to drugs in diabetes mellitus patients. OBJECTIVES: To assess nutritional status of noninsulin-dependent diabetes mellitus (NIDDM) patients and glycemic response to the given type of food as compared to normal individuals. MATERIALS AND METHODS: Out of 40 cases of NIDDM patients, 15 normal subjects belonging to the same age and socioeconomic group were selected for the study on glycemic response to dextrose load and given test food (idly). In another six of NIDDM subjects, glycemic response to test food chapati was studied. In 13 cases of diabetes with hypertension, 12 cases of diabetes without hypertension, and 16 cases of normal subjects, a wide range of biochemical parameters like lipid profile, free fatty acid (FFA) levels, serum, and erythrocyte copper and malondialdehyde levels were estimated among them. DISCUSSION: The results of the study showed that in NIDDM patients, body mass index is significantly lower than the normal, showing that obesity is not a predisposing condition in these subjects. The glycemic response to food (idly) is much higher than the response observed in normal subjects. The extent of suppression and FFA levels in the serum that was brought out by the food for glucose is lower than that observed in normal subjects. CONCLUSION: High lipid profile values and low copper levels can favor the generation of lipid-derived free radicals, which further predispose to the vascular changes and hypertensive states observed in the NIDDM patients. [ABSTRACT FROM AUTHOR]

The expanding burden of Type 2 Diabetes Mellitus (T2DM) in today’s world, with respect to incidence, prevalence, and cost incurred, is an existential risk to society. Various guidelines recommend individualization of treatment. This expert opinion aims to review the recent evidences and reach a consensus on the preferable combination therapy for use in newly diagnosed Indian T2DM patients with HbA1C >7.5%. The core committee included seventeen diabetes specialists. Three statements were developed, discussed, and rated by specialists and recommendations were noted. Specialists were requested to rate the statements using a 9‑point Likert’s scale with score of 1 being “Strongly Disagree” and 9 being “Strongly Agree”. Statement‑specific scores of all the specialists were added and mean score of ≥7.00 was considered to have achieved a consensus. Statements used to meet the consensus were: Statement 1. Majority of newly‑diagnosed Indian diabetics have HbA1C >7.5%; Statement 2. Patients with HbA1C >7.5% may be initiated with dual therapy of dipeptidyl peptidase‑4 inhibitors (DPP4Is) + Metformin; and Statement 3. In Indian patients with HbA1C >7.5% at diagnosis, DPP4Is + Metformin may be considered as a first‑line therapy. Literature review revealed that HbA1C level at the time of diagnosis in majority of Indian T2DM patients is >7.5%. Consensus was reached that dual anti‑diabetic therapy should be initiated in patients with HbA1C >7.5%. DPP4Is + Metformin is the preferred cost‑effective option and may be considered as a first‑line therapy in Indian T2DM patients with HbA1C >7.5% at diagnosis. [ABSTRACT FROM AUTHOR]

Background: The coronavirus-19 (COVID-19) pandemic has affected millions of people across the world since early 2020. Besides the large number of case fatalities, this virus has produced significant health-related sequelae involving multiple systems of the body. As with previous coronavirus infections, this was also found to be associated with various neuropsychiatric symptoms. Psychosis has been uncommon, and the few reported cases across the world have forwarded association with either raised inflammatory markers or the consequences of social isolation. Materials and Methods: This is a retrospective descriptive study of 12 patients, who were admitted with COVID-19 infection and psychosis, between March 2020 and December 2020. Cases of head injury, any neurological or metabolic illnesses, and substance use disorders were excluded. Results: Cases with psychosis formed only 0.19% of all cases of COVID-19 admissions. All of them were young male and employed. Most of them had abrupt onset of psychosis with confusion, delusions, hallucinations, agitation, and sleep disturbances. Investigations including inflammatory markers (C-reactive protein) and computerized tomography scans were largely normal. Medications used were mainly benzodiazepines and antipsychotics. Most of the cases resolved within the second week, and follow-up after a month did not elicit any residual symptoms in majority. Diagnosis was acute and transient psychotic disorder (about 75%), bipolar affective disorder (2 cases), and schizophrenia (one). Conclusions: The major findings included nonreactive inflammatory markers, quick resolution of symptoms, requirement of low doses of antipsychotic drugs, and no long-term sequelae. [ABSTRACT FROM AUTHOR]

Background and Aim: Modern radiotherapy modalities, such as Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy involve complex dose delivery. The dose delivery is complex as it involves beam modulation, hence, manual dose calculations for these techniques are not possible. Film dosimetry is commonly used method of dose verification for these modalities because of the advantages associated with it. The quantification of uncertainty associated with a film dosimetry system under clinical use becomes important for accurate dosimetry. The spread in the distribution of the pixel values (PV) of the irradiated film contributes to the uncertainty. The probability distribution (PD) of the PV was studied for the clinical photon beam energies of 6, 10, and 15 MV. Methods and Materials: Gafchromic EBT3 film and EPSON 10000XL flatbed scanner were used for this purpose and using the resulting PD, the uncertainty budgets for these energies in the red, green and blue color channels were estimated. Results: The PV of exposed films for the energies studied follows t distribution, the sum of the squares of the deviation of the measured data from the fitted value was of the order of 10-7, this indicates the goodness of fit. The "t" value corrected combined standard uncertainty (CSU) at 1σ, confidence level for exposed film and dose measurement at 200 cGy were 1.42%, 1.48%, and 1.63% and 1.99%, 3.23%, and 5.08% for 6, 10, and 15 MV energies, respectively, in the red colour channel. Conclusion: In the case of the limited number of measurements of a quantity, the SU values must be corrected using the "t" value to get the correct CSU. [ABSTRACT FROM AUTHOR]

Introduction: Use of synchrotron radiation (SR) X-ray source in medical imaging has shown great potential for improving soft-tissue image contrast such as the breast. The present study demonstrates quantitative X-ray phase-contrast imaging (XPCI) technique derived from propagation-dependent phase change observed in the breast tissue-equivalent test materials. Materials and Methods: Indian synchrotron facility (Indus-2, Raja Ramanna Centre of Advanced Technology [RRCAT]) was used to carry out phantom feasibility study on phase-contrast mammography. Different phantoms and samples, including locally fabricated breast tissue-equivalent phantoms were used to perform absorption and phase mode imaging using 12 and 16 keV SR X-ray beam. Edge-enhancement index (EEI) and edge enhancement to noise ratio (EE/N) were measured for all the images. Absorbed dose to air values were calculated for 12 and 16 keV SR X-ray beam using the measured SR X-ray photon flux at the object plane and by applying the standard radiation dosimetry formalism. Results and Conclusion: It was observed in case of all the phantoms and test samples that EEI and EE/N values are relatively higher for images taken in the phase mode. The absorbed dose to air at imaging plane was found to be 75.59 mGy and 28.9 mGy for 12 and 16 keV SR energies, respectively. However, these dose values can be optimized by reducing the image acquisition time without compromising the image quality when clinical samples are imaged. This work demonstrates the feasibility of XPCI in mammography using 12 and 16 keV SR X-ray beams. [ABSTRACT FROM AUTHOR]

Background: Although conventional four- field radiotherapy based on bony landmarks has been traditionally used, areas of geographical miss due to individual variation in pelvic anatomy have been identified with advanced imaging techniques.Aims: The primary aim of this study is to evaluate the geographical miss in patientswhen using the conventional four-field planningplanning and to find out the impact of 3-D conformal CT based in patients with locally advanced carcinoma cervix.Materials and Methods: In 50 patients, target volume delineation was done on planning computed tomography (CT) scans, according to guidelines by Taylor et al. Patients were treated with modified four field plan, except for the superior, where field border was kept at L4-L5 interspace A dosimetric comparison was done between the conventional four-field based on bony landmarks and the target volume delineated on computed tomography. The disease free survival, pelvic and para aortic nodal free survival, distant failures free survival were calculated using Kaplan Meir Product Limit Method.Results: Patients were followed-up for a median period of 11 months. The median V95 for conventional and modified extended four field plans were 89.4% and 91.3% respectively. Patients with V95 for modified extended pelvic fields less than 91.3% had a trend toward inferior disease free survival (mean DFS 9.8 vs. 13.9 months) though the difference was not statistically significant log rank test.Conclusions: Our preliminary data shows trend toward lower DFS in patients with inadequate target volume coverage. We recommend routine use of CT based planning for four field technique. [ABSTRACT FROM AUTHOR]

Background: Candida Associated Denture Stomatitis is the prevalent fungal pathosis in denture wearers, especially in immunocompromized patients. Existing antifungal agents are ineffective since the Candida species become resistant and also, they become toxic. Origanum vulgare is a herbal plant with high anti-fungal activity against Candida of blood and urine origin. However, it has never been explored against Candida from oral cavity. Materials & Methodology: Dry leaves of the plant were purchased and authenticated. Oil extraction was done using Hydro-distillation method. Clinical isolates of Candida from denture wearers was speciated using CHROMagar. Well Diffusion test was used to confirm the antifungal activity. Hydro-distillation & Maceration methods of extraction were compared. MIC/MFC was determined using CSLI guidelines. Infra-Red Spectroscopy was used to identify the active functional group. Results: O.vulgare showed 30±3mm of zone of inhibition as against 19mm for fluconazole. The suitable extraction method was Hydro-distillation. MIC & MFC were found to be 0.024% and 0.097% respectively which was much lesser than for fluconazole (0.25%). The active functional group had chemically similar structure as Carvacrol, usually found in antifungal herbs. Conclusion: within the limitations of the study, it was concluded that (a)O.vulgare is anticandidal for clinical isolates of oral Candida, (b) Hydro-distillation is an effective method as compared to Maceration (c) MIC & MFC are much lower than that of fluconazole (d) the major functional group was structurally similar to Carvacrol. [ABSTRACT FROM AUTHOR]

Background and Aims: Proseal laryngeal mask airway (LMA) and laryngeal tube suction (LTS) are both supraglottic devices with an esophageal suction port. In the present prospective, randomized study, the effectiveness of airway seal, hemodynamic variables, ability to pass orogastric tube, and postoperative complications with the two devices were evaluated. Material and Methods: This was a prospective, randomized, single-blind study conducted in a hospital-based setting. Sixty patients (American Society of Anesthesiologists Grade I and II) undergoing elective general surgery were randomly allocated to Group A (Proseal LMA) or Group B (LTS), and airway seal pressure (primary outcome), peak pressure, hemodynamic parameters (blood pressure, pulse rate and pulse oximetry) during and 5 min after insertion, insertion time, ease of insertion, and postoperative complications (sore throat and hoarseness of voice for a period of 24 hours) (secondary outcomes) were noted. The quantitative data was summarized as mean and standard deviation, and analyzed using Student's t-test. All the qualitative data were summarized as proportions and analyzed using Chi-square test. The levels of significance and α-error were kept 95% and 5%, respectively, for all statistical analyses. P = 0.05 was considered significant (S). Results: Proseal LMA had shorter insertion time (16.4 ± 5.6 vs. 20.0 ± 3.9 s), higher seal pressure (27.6 ± 4.6 vs. 24.1 ± 5.6 cm of H2O), lesser peak pressure (16.3 ± 2.3 vs. 18.5 ± 3.9 cm of H2O), higher success rate of orogastric tube passage (86.7 vs. 76.7%), and lesser postoperative sore throat (3.3 vs. 10%). Conclusions: Both Proseal LMA and LTS were acceptable alternatives for airway management in elective surgeries with controlled ventilation, but the quality of ventilation was found to be significantly better with Proseal LMA (in terms of higher seal pressure, lesser peak pressure, lesser insertion time, and lesser complications). [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-years-old female presented with 1 cm-sized, solitary, asymptomatic gradually progressive, bluish nodulocystic swelling over scalp since 4 months. It also discusses that Hidradenoma simplex, dermal duct tumor and apocrine hidradenoma are the differential diagnosis of poroid hidradenoma.

CR-39 detectors, widely used for neutron dosimetry in accelerator radiation environment, have also been applied in tissue microdosimetry by generating the linear energy transfer (LET) spectrum. In this work, the neutron dose has been estimated via LET spectrometry for 9Be (p, n) reaction which is useful for personnel monitoring around particle accelerators and accelerator based therapy facilities. Neutrons were generated by the interaction of protons of 6 different energies from 4-24 MeV with a thick Be target. The LET spectra were obtained from the major and minor radii of each track and the thickness of removed surface. From the LET spectra, the absorbed dose (DLET) and the dose equivalent (HLET) were estimated using Q-L relationship as given by International Commission on Radiological Protection (ICRP) 60. The track density in CR-39 detector and hence the neutron yield was found to be increasing with the increase in projectile (proton) energy. Similar observations were also obtained for absorbed dose (DLET) and dose equivalents (HLET). [ABSTRACT FROM AUTHOR]

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, potentially life-threatening disease of blood, characterized by complement-induced intravascular hemolytic anemia and thrombosis. PNH can sometimes present directly with renal manifestations, without showing any hematological manifestation. It, therefore, becomes essential for clinicians and pathologists to be aware of the spectrum of renal changes in PNH. The aim of this study was to document the morphologic changes observed in renal biopsies in patients with PNH. This is an observational study. We report three cases that presented with acute or chronic renal insufficiency and were suspected as PNH on viewing their renal biopsy in light of their clinical and laboratory details. All the three cases were confirmed as PNH on the basis of flow cytometric analysis of CD55 and CD59. Renal biopsy in these patients showed a variety of morphologic changes, however the most consistent finding was moderate-to-heavy siderosis in their kidneys. PNH per se may be difficult to diagnose clinically and sometimes present directly with renal manifestations. It is, therefore, prudent for nephrologists and nephropathologists to be aware of the spectrum of renal changes in PNH. [ABSTRACT FROM AUTHOR]

Lead (Pb) goggles used by radiation workers while performing fluoroscopy-guided diagnostic and interventional procedures reduce the doses to eye lenses substantially. In majority of the cases, the dosimeter intended to measure eye lens doses is worn close to the eyes but outside the lead (Pb) goggles. In such situations, additional reduction factors are required to approximate the actual doses which eye lens might have received. However, the value of the dose reduction factor (DRF) for a given energy may vary due to the dependence on the methodology of measurement, that is, whether the dose is estimated free-in-air or on a phantom. Due to this reason, the DRFs quoted by suppliers or manufactures cannot be implemented directly for dose estimation. Free-in-air as well as on phantom studies for the measurement of DRFs for lead (Pb) goggles having equivalent thickness of 0.75 mm were performed using optically stimulated luminescence (OSL)-based dosimeters. Measurements were carried out for photon energies having relevance in interventional cardiology (IC) and radiology (IR), and other facilities where eye lens monitoring might be important. It has been found that the DRFs differ substantially for irradiations done free-in-air and on the phantom. The results showed that for X-ray energies relevant to IC/IR procedures, the DRF values were found in the range of ~60-90 and 7-15 for free-in-air and on phantom measurements, respectively. Similarly, the DRF values for N-80 as well as 241Am photons were found to be ~15 and ~3.50 for free-in-air and on phantom measurements, respectively. The difference in the DRF values for free-in-air and on phantom measurements would arise due to the presence of backscattering associated with the phantom studies. [ABSTRACT FROM AUTHOR]

Context: To evaluate the quality of life (QOL) outcome measures in disease-free survivors of pathological T1/T2 tongue cancers and to compare QOL in patients treated with only surgery and with adjuvant treatment.Settings and Design: Cross-sectional survey.Patients and Methods: All pathological T1/T2 anterior tongue cancer cases with follow-up from January 2011 till December 2015, who had locoregionally controlled disease with a minimum disease-free survival period of 1 year, were included in the study.Results: A total of 36 patients, 28 are males and 8 are females with an age range of 24-66 years (median age of 43) were enrolled in the study. The patients were divided into two groups with (n = 26) and without adjuvant postoperative radiotherapy (RT) (n = 10) and the University of Washington-QOL questionnaire version 4 for physical and social domains, global questions and three important domains were analyzed. On the physical and social domain scores, the surgery-alone group outscored the combined modality group on all scales and the differences were statistically significant for specific physical domains such as saliva (0.0001), taste (P = 0.0001), chewing (P = 0.0004), swallowing (P = 0.0026), and social domains such as mood (0.0001), pain (P = 0.0001), and shoulder function (P = 0.0061). The overall global QOL scores were also better for the surgical group compared with group which received adjuvant RT but was not statistically significant. All patients chose saliva as their top priority domain in the group which received radiation, and 60% chose "swallowing ability" as the preferred top priority domain in the only surgical group.Conclusions: Although locoregional control and disease-free survival are the major treatment-related endpoints for cancer management, QOL outcome measures have to assess to determine the impact of a treatment modality on patients well-being and for better rehabilitation of cancer-free patients. [ABSTRACT FROM AUTHOR]

Aim: The aim of work is to explore a quick, efficient, and effective patient-specific intensity-modulated radiation therapy (IMRT) quality assurance (QA).Materials and Methods: Software tools were developed to extract and analyze the multi-leaf collimator (MLC) leaf positions (LPs) from electronic portal imaging device (EPID) images for Varian C-series machine and TrueBeam, to extract useful data from MLC log file of C-series linear accelerator (LINAC), to extract useful information from the trajectory log binary file of TrueBeam LINAC, to compare LPs derived from EPID images with log file/trajectory log data, and to analyze IMRT treatment files using the MATLAB programming language. The difference in LP determined from the trajectory log and EPID images was proposed for patient-specific QA.Results: It was found that the differences in LP for regular radiation fields generated using stationary leaves are <0.5 mm for all the field sizes while for regular radiation fields generated using the moving leaves are more but <2 mm. The differences in LPs for IMRT field were also determined and found to be <2 mm.Conclusions: The methodology demonstrated can be used for establishing the accuracy of trajectory log data and for independent routine IMRT QA by generating single number like gamma index to indicate pass or fail of an IMRT treatment plan. The QA indices such as numbers of occurrences of ≥2 mm error in LPS are found more than 5% of total number of occurrences; the dosimetric review of planned treatment is advisable. [ABSTRACT FROM AUTHOR]

Background: A high prevalence of hypogonadism in men with Type-2 diabetes mellitus (T2DM) has been reported worldwide. Objectives: To evaluate the prevalence of hypogonadism in Indian males with T2DM and assess the primary and secondary hypogonadism along with androgen deficiency. Materials and Methods: In this cross-sectional study, 900 men with T2DM were evaluated using androgen deficiency in aging male questionnaire. They were screened for demographic characteristics, gonadal hormone levels, lipid profile, and glycosylated hemoglobin. Results: The prevalence of hypogonadism in T2DM patients was found to be 20.7% (186 out of 900). Hypogonadism was of testicular origin (primary) in 48/186 (25.8%) patients, of pituitary or hypothalamic origin (secondary) in 14/186 (7.53%), and remaining 124/186 (66.67%) patients were found to have low testosterone with the inappropriate normal level of luteinizing hormone and Follicle-stimulating hormone. 451/900 (50.1%) patients were only symptomatic but had normal testosterone levels. Further 263 patients out 900 were asymptomatic, of which 51/900 (5.7%) patients had low levels of testosterone and 212/900 (23.5%) patients had normal testosterone level without symptoms. There were no deaths or other serious adverse events except mild pyrexia which was not related to the study. Conclusion: Hypogonadism diagnosis, at times, might not be validated with the help of androgen deficiency questionnaire or symptoms only. Given the large number of patients of T2DM in India, the incidence of hypogonadism is more in diabetic patients as compared to the general population. Hence, implementation of screening programs in diabetic patients is necessary to understand and detect individuals with low serum total testosterone at any early stage and to supplement testosterone accordingly. [ABSTRACT FROM AUTHOR]

The objective of this work was to measure patient eye lens dose for different cone-beam computed tomography (CBCT) acquisition protocols of Varian's On-Board Imaging (OBI) system using optically stimulated luminescence dosimeter (OSLD) and to study the variation in eye lens dose with patient geometry and distance of isocenter to the eye lens. During the experimental measurements, OSLD was placed on the patient between the eyebrows of both eyes in line of nose during CBCT image acquisition to measure eye lens doses. The eye lens dose measurements were carried out for three different cone-beam acquisition protocols (standard dose head, low-dose head [LDH], and high-quality head [HQH]) of Varian OBI. Measured doses were correlated with patient geometry and distance between isocenter and eye lens. Measured eye lens doses for standard head and HQH protocols were in the range of 1.8-3.2 mGy and 4.5-9.9 mGy, respectively. However, the measured eye lens dose for the LDH protocol was in the range of 0.3-0.7 mGy. The measured data indicate that eye lens dose to patient depends on the selected imaging protocol. It was also observed that eye lens dose does not depend on patient geometry but strongly depends on distance between eye lens and treatment field isocenter. However, undoubted advantages of imaging system should not be counterbalanced by inappropriate selection of imaging protocol, especially for very intense imaging protocol. [ABSTRACT FROM AUTHOR]

Background: Anemia is a common complication of human immunodeficiency virus (HIV) infection. The role of iron, Vitamin B12, and folate deficiencies, which are otherwise most common causes of anemia, is not well-established in HIV patients. Several studies in India have shown that severe immunodeficiency is associated with higher grade of anemia, but correlation of CD4 cell counts with severity of anemia is not well-documented. Aims: The aims of the present study were: To estimate the point prevalence of anemia in HIV patients, to analyze the causative role of iron, Vitamin B12, and folate deficiencies in anemic HIV patients, and correlating the degree of severity of anemia with CD4 cell counts. Materials and Methods: This study was a cross-sectional study. The study group enrolled 103 consecutive HIV patients attending medical emergency, medical outpatient department, medical wards, and anti-retroviral therapy (ART) center at a tertiary care medical center in North India. Study participation consisted of a single visit during which relevant data, including medical history, current medications, CD4 T-lymphocyte count, complete hemogram with red blood cell indices, peripheral smear picture, iron studies, serum Vitamin B12, serum folate and bone marrow studies, were recorded on a case report form. Anemia was classified according to the World Health Organization criteria. Data analysis was carried out using Microsoft Excel and Statistical Package for the Social Sciences software. Results: 86.4% (89/103) patients were found to be anemic. There was no significant difference in prevalence of anemia in ARTnaive patients from those who were on ART (P > 0.05). Pearson's correlation had shown a highly significant positive correlation of hemoglobin and CD4 cell counts in male patients (r = 0.418) as well as female patients (r = 0.565). Normocytic normochromic was the most common type of anemia in males (46%) as well as females (42%). Significant iron deficiency (P = 0.022) was observed in 42.85% of the patients having microcytic hypochromic anemia. Significant Vitamin B12 and folate deficiencies were observed in patients having macrocytic anemia (47.05%, P = 0.003 and 35.29%, P = 0.012, respectively). Conclusions: This study shows that anemia is highly prevalent in HIV patients and severity of anemia increases with decrease in CD4 cell counts. Nutritional deficiencies play a significant role in causing anemia in these patients. [ABSTRACT FROM AUTHOR]

Clinical application using high-dose rate (HDR) 192Ir sources in remote afterloading technique is a well-established treatment method. In this direction, Board of Radiation and Isotope Technology (BRIT) and Bhabha Atomic Research Centre, India, jointly indigenously developed a remote afterloading machine and 192Ir HDR source. The two-dimensional (2D) dose distribution and dosimetric parameters of the BRIT 192Ir HDR source are generated using EGSnrc Monte Carlo code system in a 40 cm dia X 40 cm height cylindrical water phantom. The values of air-kerma strength and dose rate constant for BRIT 192Ir HDR source are 9.894 x 10-8 ± 0.06% UBq-1 and 1.112 ± 0.11% cGyh-1U-1, respectively. The values of radial dose function (gL(r)) of this source compare well with the corresponding values of BEBIG, Flexisource, and GammaMed 12i source models. This is because of identical active lengths of the sources (3.5 mm) and the comparable phantom dimensions. A comparison of gL(r) values of BRIT source with microSelectron-v1 show differences about 2% at r = 6 cm and up to 13% at r = 12 cm, which is due to differences in phantom dimensions involved in the calculations. The anisotropy function of BRIT 192Ir HDR source is comparable with the corresponding values of microSelectron-v1 (classic) HDR source. [ABSTRACT FROM AUTHOR]

A thin endometrium is encountered infrequently (2.4%) in assisted reproductive technology cycles. When it does occur it is a cause of concern as it is associated with lower implantation rate and pregnancy rate. Though pregnancies have been reported at 4 and 5 mm it is apparent that an endometrial thickness <6 mm is associated with a trend toward lower probability of pregnancy. Hormone replacement therapy - frozen embryo transfer (FET) cycles appear to give better results due to an improvement in endometrial receptivity (ER). The etiology of thin endometrium plays a significant part in its receptivity. A number of treatments have been tried to improve endometrial growth, but none has been validated so far. Confirming ER of a thin endometrium by an ER array test before FET offers reassurance. [ABSTRACT FROM AUTHOR]

The effects of gamma irradiation of various levels on the current-voltage characteristics for the (In2O3)0.1 (TeO2)0.9 thin films, prepared by thermal evaporation in vacuum, have been studied in detail. The current increases linearly with the gamma radiation dose up to certain dose and decreases thereafter. The sensitivity of these thin films, at different applied voltages in the range 0-4.8 V, has been found to be in the range 35-190 mA/cm2/Gy. Correspondingly, the minimum measurable dose has been found to be in the range 0.05-0.26 mGy. The values of the sensitivity are reasonably high in comparison to the commercially available gamma radiation dosimeters, revealing high scope for further developments. [ABSTRACT FROM AUTHOR]

Background: To compare dosimetric parameters of intensity-modulated radiation therapy (IMRT) with 3D conformal radiotherapy (3DCRT) in post-operative patients of vulvar cancer and to assess clinical outcome and toxicity with IMRT.Materials and Methods: A total of 8 post-operative patients of vulvar cancer were treated with IMRT. All patients were also planned by 3DCRT for comparison with IMRT. The two plans were compared in terms of conformity index, homogeneity index, tumor control probability (TCP) and normal tissue complication probability (NTCP) for the planning target volume and organs at risk (OAR).Results: IMRT resulted in significantly lesser doses to rectum, bladder, bowel and femoral head as compared with 3DCRT plans. Mean conformity and homogeneity indices were better and within range with IMRT. The TCP was comparable between the two treatment plans and NTCP for rectum, bladder, bowel and femoral head was significantly less with IMRT as compared with 3DCRT. Treatment was well-tolerated and none of the patients developed Grade 3 or higher toxicity.Conclusion: IMRT yielded superior plans with respect to target coverage, homogeneity and conformality while lowering dose to adjacent OAR as compared with 3DCRT. Thus, IMRT offers a reduction in NTCP while maintaining TCP. [ABSTRACT FROM AUTHOR]

Internal jugular (IJ) catheter insertion for hemodialysis (HD) is an indispensable procedure in the management of patients with renal failure. The central approach is favored over posterior approach to insert IJ catheters. There are no studies comparing the outcomes between the two approaches. The aim of this study was to compare central approach with posterior approach for IJ HD catheter insertion and to analyze various outcomes like procedure-related complication rates, catheter insertion failure rates, interruptions during dialysis due to blood flow obstruction and catheter infection rates between the two methods among patients receiving HD. All patients requiring IJ HD catheter insertion during a 1-month period were randomly assigned to undergo catheter insertion via either conventional central approach or posterior approach. Patients were followed-up till the removal of the catheter. Among 104 patients included in the study, 54 were assigned to the central approach group and 50 to the posterior approach group. The central approach group had higher rate of procedure-related complications (14.81% vs. 6%, P= 0.04). Catheter insertion failure rates were marginally higher in posterior approach group (20% vs. 12.96%, P= 0.07). One or more instance of interruption during HD due to obstruction in blood flow was more common in posterior approach (46% vs. 9.25%, P< 0.01). Catheter infection rates were similar between the two groups; 16.66% (n = 9) in central group vs. 14% (n = 7) in posterior group. Posterior approach is a reasonable alternative to conventional central approach in IJ cannulation for HD catheter. It is, however, associated with a significantly high rate of interruption in HD blood flow and catheter insertion failure rates. The posterior approach can be used in patients with local exit site infection or in failed attempts to cannulate IJ vein via the conventional central approach. [ABSTRACT FROM AUTHOR]

Background: Pheochromocytomas (PHEO) and paragangliomas (PGL) are derived from paraganglia of the sympathetic and parasympathetic nervous system. Most of the sympathetic PHEO/PGL secrete either catecholamine or their metabolites, metanephrines, whereas parasympathetic PHEO/PGL are nonsecretory. We assessed the utility of plasma free 3-methoxytyramine (3MT), normetanephrine (NM), and metanephrine (MN) for the diagnosis of PHEO/PGL. Materials and Methods: Sixty-five patients referred to endocrine/ENT clinics were enrolled. Twelve patients with von Hippel-Lindau (VHL), neurofibromatosis type 1 (NF1) and multiple endocrine neoplasia type 2 (MEN2) syndromes were excluded. Remaining 53 patients (39 patients with adrenal, abdominal, cervical and thoracic PHEO/PGL and 14 patients with head and neck PGL (HNPGL) were taken for this study. Sixty-five age- and sex-matched subjects were taken as controls. Plasma levels 3MT, NM, and MN were measured using high-performance liquid chromatography. Receivers operating characteristics was plotted and cut-off levels were established. Results: When compared with controls, there was a 36-, 8.7- and 9.5-fold increase in levels of NM, 3MT and MN in the patients with PHEO/PGL and 7.2- and 2.7-fold increase in 3MT and NM, in the patients with HNPGL, respectively. In malignant PHEO/PGL, there was a 99-, 16- and 20-fold increase and in benign PHEO/PGL, there was 19-, 6.8- and 6.4-fold increase in levels of NM, 3MT, and MN, respectively. NM in combination with MN was high in 97% of the patients with PHEO/PGL. All three metabolites in combination were high in 83% of patients with HNPGL. In malignant PHEO/PGL, 50% subjects had increased levels of both NM and 3MT. Conclusions: Measurement of plasma-free NM along with 3MT and MN provides a better tool for the diagnosis of PHEO/PGL as well as HNPGL. Further, NM in combination with 3MT can be used for the diagnosis of malignant PHEO/PGL. [ABSTRACT FROM AUTHOR]

The aim of this article is to review randomized and non-randomized trials and meta-analysis comparing neoadjuvant chemotherapy (NAC) plus surgery versus surgery alone in resectable esophageal cancers. The article examines the value of NAC as a standard of care in the era of multimodality treatment with availability of different therapeutic options. The emphasis is on assessment of benefit of NAC in terms of survival (long and short term) rate of RO resection in resectable esophageal cancers of any histopathologic type. The in-hospital post-operative morbidity and mortality in NAC group, chemotherapeutic drug regimens and their response rates and optimal number of cycles to be used will also be addressed. [ABSTRACT FROM AUTHOR]

Context: Premature canities is a common, yet unexplored disorder. Oxidative stress levels have been evaluated within the greying hair follicle but not in the sera of patients with premature canities. Aims: To evaluate the oxidative stress parameters in the sera of patients with premature canities. Settings and Design: A pilot case-controlled study, conducted in a tertiary care setup in Delhi during November 2011 to December 2012. Materials and Methods: Fifty-two self-reporting cases of premature canities (age of onset <20 years) and 30 healthy controls were recruited from outpatient Department of Dermatology. Oxidative stress parameters (serum malonaldehyde (MDA), whole blood reduced glutathione (rGSH) and serum ferric reducing antioxidant potential [FRAP]) were assessed in cases and controls. Mann-Whitney test was used to compare the oxidative stress parameters between the two groups (SPSS version 17.0, SPSS Inc, Chicago, USA; P < 0.05 considered as significant). Results: The age and sex distribution of cases and controls was comparable. The mean serum levels of MDA were higher in cases than controls (3.7 ± 1.6 nmol/ml vs. 2.8 ± 1.5 nmol/ml; P = 0.01). The GSH levels were lower in the cases than controls (31.5 ± 8.9 mg/dl vs. 36.6 ± 16.9 mg/dl; P = 0.064). Similarly, the mean FRAP levels were lower in the cases than controls (400 ± 70 nmol/ml vs. 430 ± 80 nmol/ml; P = 0.038). Conclusions: Patients with premature canities had a higher level of pro-oxidants and lower levels of antioxidants than controls. This is the first humble attempt to document the oxidative stress parameters in sera of patients with premature canities, further studies with larger sample size are required to reach a definite conclusion. [ABSTRACT FROM AUTHOR]

Background: Coagulopathy after living donor hepatectomy (LDH) may endanger donor safety during removal of thoracic epidural catheter (TEC). The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC) and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%), blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 x 105/mm³ on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student 't' test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84) donors had coagulopathy on second day (mean INR 1.9 ± 0.42). Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5. [ABSTRACT FROM AUTHOR]

The main objective of this study was to investigate the characteristics of metal oxide semiconductor field effect transistor (MOSFET) dosimeter for kilovoltage (kV) X-ray beams in order to perform the in vivo dosimetry during image guidance in radiotherapy. The performance characteristics of high sensitivity MOSFET dosimeters were investigated for 80, 90, 100, 110, 120, and 125 kV X-ray beams used for imaging in radiotherapy. This study was performed using Clinac 2100 C/D medical electron linear accelerator with on-board imaging and kV cone beam computed tomography system. The characteristics studied in this work include energy dependence, angular dependence, and linearity. The X-ray beam outputs were measured as per American Association of Physicists in Medicine (AAPM) TG 61 recommendations using PTW parallel plate (PP) ionization chamber, which was calibrated in terms of air kerma (Nk) by the National Standard Laboratory. The MOSFET dosimeters were calibrated against the PP ionization chamber for all the kV X-ray beams and the calibration coefficient was found to be 0.11 cGy/mV with a standard deviation of about ±1%. The response of MOSFET was found to be energy independent for the kV X-ray energies used in this study. The response of the MOSFET dosimeter was also found independent of angle of incidence for the gantry angles in the range of 0° to 360° in-air as well as at 3 cm depth in tissue equivalent phantom. [ABSTRACT FROM AUTHOR]

Silver nanoparticles (AgNP) have unique properties which help in molecular diagnostics, in therapies, as well as in devices that are used in several medical procedures. AgNP are nanoparticles of silver which are in the range of 1 and 100 nm in size. The major methods used for AgNP synthesis are the physical and chemical methods. The major applications of AgNP in the medical field include diagnostic applications and therapeutic applications. In most of the therapeutic applications, it is the antimicrobial property that is being majorly explored though the anti-viral property has its fair share of applications. This review provides a comprehensive view on the synthesis and applications of nanoparticles in the medical field. The focus is on exploring their various prospective applications besides trying to understand the current scenario. [ABSTRACT FROM AUTHOR]

C3 glomerulopathy has recently been described as a distinct entity. The underlying mechanism is unregulated activation of the alternate pathway of the complement system. The most common presentation is with an acute nephritic syndrome. The diagnosis is made on immunofluoroscence by the presence of isolated or dominant C3 staining. In this retrospective study, renal biopsy data were collected from 2010 to 2013 patients with C3 glomerulopathy identified and their clinical and biochemical parameters analyzed. Out of 514 biopsies available for analysis, the incidence of C3 glomerulopathy was 1.16% (n = 6). The mean age of the presentation was 26 years and the average estimated glomerular filtration rate was 30.65 ml/min/1.73 m2. The most common histopathological pattern was membranoproliferative glomerulonephritis (n = 4). [ABSTRACT FROM AUTHOR]

BACKGROUND: Tobacco is a leading risk factor for different types of diseases globally. Tobacco smoking by women is culturally unacceptable in India, but still women smoke tobacco at various times of their life. AIMS: The aim was to estimate the prevalence and pattern of tobacco use among women and to study the associated sociodemographic factors. SETTINGS AND DESIGN: This cross-sectional study was conducted among women aged 30 years or over in an urban resettlement colony for the migrant population at Chandigarh, India. METHODOLOGY: The study included women used tobacco products on one or more days within the past 30 days. Through systematic random sampling, 262 women were studied. As a part of the study 144 bidi smoking women were interviewed using detailed semi-structured questionnaire. STATISTICAL ANALYSIS: Descriptive statistics and hypothesis testing with Chi-squared test and logistic regression were done using SPSS 16.0 version. RESULTS: Overall, the prevalence of tobacco use was 29.4% and that of bidi, zarda and hookah were 19.8%, 8.8%, and 2.7%, respectively. Around 6.2% women used tobacco during pregnancy. Teenage was the most common age of initiation of bidi smoking. Logistic regression analysis showed that the prevalence of tobacco use was high among Hindu unemployed women with no formal education belonged to scheduled caste, and those having grandchildren. CONCLUSIONS: This study highlighted high rates of tobacco use and explored both individual and family factors related to tobacco use among women. Affordable, culturally acceptable, sustainable and gender-sensitive individual and community-specific interventions will reduce the prevalence and effects of tobacco use. [ABSTRACT FROM AUTHOR]

Medical electron linear accelerators with the capability of generating unflat photon (flattening filter-free, FFF) beams are also available commercially for clinical applications in radiotherapy. However, the beam characteristics evaluation criteria and parameters are not yet available for such photon beams. Atomic Energy Regulatory Board (AERB) of India constituted a Task Group comprising experts from regulatory agency, advisory body/research and technical institutions, and clinical radiotherapy centers in the country to evolve and recommend the acceptance criteria for the flattening filter-free (FFF) photon beams. The Task Group thoroughly reviewed the literature and inputs of the manufactures/suppliers of the FFF linac and recommended a set of dosimetry parameters for evaluating the characteristics of the unflat photon beam. The recommendations included the evaluation of quality index, degree of unflatness, difference in percentage surface dose between flat and unflat photon beams, percentage depth dose at 10 cm depth, off-axis-ratios and radiation beam penumbra. The recommended parameters were evaluated for FFF photon beams generated by three different models of the linac, and it was observed that recommended evaluation methods are simple and easy to be implemented with the existing dosimetry and quality assurance infrastructure of the linac facilities of the radiotherapy departments. Recommendations were also made for periodic quality control check of the unflat photon beams and constancy evaluation in the beam characteristics. [ABSTRACT FROM AUTHOR]

Aims: : To compare perioperative complications in esophagectomy after neoadjuvant therapy v/s primary surgery.Settings and Design: : Retrospective analysis of perioperative complications in a prospectively maintained data base of patients who underwent esophagectomy as Primary surgery or after neoadjuvant therapy was done.Methods and Material: : 238 cases of esophagectomies performed for esophageal carcinoma were analysed and compared, out of which 125(52.5%) were given neoadjuvant therapy followed by surgery and 113(47.5%) underwent primary surgery. Surgical procedure was standard for both the groups. All the cases were analysed for perioperative complications.Statistical Analysis Used: : Data was analysed using Open Epi soft ware. Association between the two study group was assessed with Chi square test.Results: : On comparison, both the groups were comparable in demographic profile and type of surgery performed. However, tumour stage was higher for cases who received neoadjuvant therapy as expected. On analysis there was no significant difference in overall morbidity and 30 days mortality.Conclusions: : Neoadjuvant Chemo/chemoradiotherapy is a feasible option in esophageal carcinoma without increase in incidence of peri operative morbidity or mortality. [ABSTRACT FROM AUTHOR]

The characteristics of a mobile metal oxide semiconductor field effect transistor (mobile MOSFET) detector for standard bias were investigated for megavoltage photon beams. This study was performed with a brass alloy build-up cap for three energies namely Co-60, 6 and 15 MV photon beams. The MOSFETs were calibrated and the performance characteristics were analyzed with respect to dose rate dependence, energy dependence, field size dependence, linearity, build-up factor, and angular dependence for all the three energies. A linear dose--response curve was noted for Co-60, 6 MV, and 15 MV photons. The calibration factors were found to be 1.03, 1, and 0.79 cGy/mV for Co-60, 6 MV, and 15 MV photon energies, respectively. The calibration graph has been obtained to the dose up to 600 cGy, and the dose-response curve was found to be linear. The MOSFETs were found to be energy independent both for measurements performed at depth as well as on the surface with build-up. However, field size dependence was also analyzed for variable field sizes and found to be field size independent. Angular dependence was analyzed by keeping the MOSFET dosimeter in parallel and perpendicular orientation to the angle of incidence of the radiation with and without build-up on the surface of the phantom. The maximum variation for the three energies was found to be within ± 2% for the gantry angles 90° and 270°, the deviations without the build-up for the same gantry angles were found to be 6%, 25%, and 60%, respectively. The MOSFET response was found to be independent of dose rate for all three energies. The dosimetric characteristics of the MOSFET detector make it a suitable in vivo dosimeter for megavoltage photon beams. [ABSTRACT FROM AUTHOR]

Aim of the Study: Statistical analysis of pre-treatment dose verification of intensity-modulated radiotherapy (IMRT) fields to assess the quality of the IMRT practice at different radiotherapy centers. Materials and Methods: The dose verification data acquired by the institutional physicist of 10 different hospitals for various types of patients were collected and analyzed for mean, median, standard deviation (SD), range, minimum and maximum % deviation. The percentage of cases having positive and negative dose differences as well dose differences within ± 3% were also determined. Results: The mean values of percentage variation in difference between treatment planning systems calculated dose and difference between measured dose (DTPS and DMeas) are found to be from - 1.79 to 1.48 and median from - 1.79 to 1.51. The SDs are found to be from 0.76 to 3.70. The range of variation at these centers varies from 3.99 to 16.45 while minimum and maximum values of percentage variation in difference between DTPS and DMeas ranges from - 10.33 to 13.38. The percentage of cases having positive dose difference ranges from 8 to 94 and cases having negative dose difference ranges from 6 to 92. The percentage of cases having dose difference within ± 3% varies from 57 to 100. Conclusion: IMRT centers are having random and biased (skewed towards over or under dose) distribution of the percentage variation in difference between measured and planned doses. The analysis of results of the IMRT pre-treatment dose verification reveals that there are systematic errors in the chain of IMRT treatment process at a few centers. The dosimetry quality audit prior to commissioning of IMRT may play an important role in avoiding such discrepancies. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma is the sixth most common cancer reported globally, with an annual incidence of over 300,000 cases, of which 62% arise in developing countries. Radiation therapy is a treatment modality that uses ionizing radiation as a therapeutic agent. It is widely employed in the treatment of head and neck cancer, as a primary therapy coupled with surgical procedure and chemotherapy or as a palliative treatment for advanced tumors. However, radiotherapy can cause a series of complications such as xerostomia, mucositis, osteoradionecrosis, and radiation caries. Composite circular disc containing different ratios of acrylic and barium sulfate (BaSO4) were made in-house. The purpose of this study was to evaluate the percentage attenuation from these composite shields in 60Co gamma rays. A maximum of 8% radiation attenuation was achieved using 1:4 ratio of acrylic-BaSO4 composite shields. The study proposes BaSO4 as one of the compounds in combination with acrylic resin or any other thermoplastic substances for making biocompatible radiation attenuating devices. [ABSTRACT FROM AUTHOR]

Peritonitis in a continuous ambulatory peritoneal dialysis patient by two different species of enterococci is a rare condition. We report a case of peritonitis from which vancomycin sensitive Enterococcus faecalis and vancomycin resistant Enterococcus faecium were isolated. It also emphasizes the effectiveness of linezolid for the treatment of vancomycin resistant enterococcal infection. [ABSTRACT FROM AUTHOR]

The article describes the case of a 16-year-old marathon-runner girl who developed linear focal elastosis (LFE) localized to bilateral knee. Topics covered include the characteristics of LFE, which include linear, symmetric, palpable papules, and cords in a layered fashion on the mid-upper and lower back, and the link between LFE and strenuous mechanical activities such as exercise.

A letter to the editor is presented which discusses a case study of a 56-year-old female patient with pericardial angiosarcoma and recurrent hemorrhagic pericardial effusion.

Introduction Breast-conserving surgery (BCS) followed by radiation therapy to the intact breast is an established standard of care for the majority of women with early stage invasive breast cancer. Recommended whole breast irradiation (WBI) schedule is 45 to 50 Gy and it is followed by a boost of 10 to 16 Gy to the tumour bed. In this study we compared boost schedule of 10Gy/5#/1 week with 16Gy/8#/1.5 weeks in post lumpectomy patients of early stage breast cancer. Materials and methods From October 2012 to December 2016, the study included 87 early stage breast cancer patients post BCS. All patients were treated by WBI of 40Gy/16#/3weeks. WBI was followed by tumor bed boost of 10Gy/5#/1 week in 44 patients or 16Gy/8#/1.5 weeks in 43 patients with either electron beam therapy or 3 dimensional conformal radiotherapy (3D CRT). The primary end point of the study was the assessment of acute and late radiation toxicities, cosmetic score analysis and local control between two schedules. Assessment of acute and late skin toxicity was done as per RTOG scores and LENT SOMA scale. Cosmetic assessment was done with Harvard/NSABP/RTOG Breast Cosmesis Grading Scale. Results Acute skin grade 2 toxicity was more in patients with 16Gy boost 33% as compared to 23% in 10Gy boost arm. Late skin toxicities were also high in patients with 16Gy boost. Grade 2 induration was seen in 4.5% and 12% patients with 10Gy and 16Gy boost respectively. None of the patients with 10Gy had grade 3 induration as compared to 2% with 16Gy. Similarly none of the patients with 10Gy had grade 2 oedema as compared to 5% with 16Gy. Pigmentation was observed in 9% and 23% patients with 10Gy and 16Gy boost respectively. Grade 1 fibrosis was 2% versus 12% in patients with 10Gy and 16Gy boost respectively. Median follow up was 39 months. Cosmetic score was good/excellent in 91% and 84% patients with 10Gy and 16Gy boost respectively. It was fair/poor in 9% and 17% with 10Gy and 16Gy boost respectively. Local recurence occurred in one patient in 16Gy arm. Conclusion Acute and late skin toxicity was higher with 16Gy boost dose. Cosmetic score was better with 10Gy boost. [ABSTRACT FROM AUTHOR]

Introduction: Neoadjuvant chemoradiation followed by surgery has evolved as the Positron Emission Tomography-Computed Tomography (PET-CT) is increasingly being used for radiological response assessment and prediction of pathological response. Pathological complete response (pCR) to neoadjuvant therapy has been shown in various trials to be a surrogate marker for locoregional control and survival. Aim: To evaluate the predictive and prognostic factors for pathological complete response in carcinoma esophagus Methods: All consecutive patients of carcinoma thoracic esophagus attending the Radiation Oncology OPD between December 2013 and December 2014 for preoperative chemoradaiation followed by surgery; were selected for the study. They were prospectively analysed for basic socio-demographic data, patient and treatment related characteristics, response to therapy and survival parameters. All included patients underwent preoperative chemoradiation followed by radiological response evaluation with PET-CT followed by surgical resection. A total disappearance of all target lesions was taken as complete radiological response and a reduction of at least 30% in the maximum standardized uptake (SUVmax) value in the target lesions was taken as partial radiological response (Percist Version 1.0). Subsequently pathological response was assessed with histopathological examination using CAP criteria. Multiple univariate and multivariate analyses were done to establish significant factors associated with complete pathological response. Results: Fifty consecutive patients of carcinoma thoracic esophagus were prospectively recruited and analysed. More than half (52%) were females; with a median age at diagnosis of 55 years (Range: 35 - 71 yrs); mean tumour length on PET-CT was 5.9 cm and mid thoracic esophagus was the most common site of involvement, accounting for 68% of all cases. Squamous Cell Carcinoma was the most common histology accounting for 96% of all cases. Radiological complete response and pathological complete response were seen in 49% and 31% of all patients respectively. On univariate analysis gender (p = 0.02), ECOG (Eastern Cooperative Oncology Group) performance status at presentation, percentage drop in SUVmax (p = 0.01), chemotherapy regimen used and radiological complete response (p = 0.02) emerged as statistically significant factors of pathological complete response. However on multivariate analysis none of the factors reached significant values. Conclusion: One of the significant markers of complete pathological response is radiological response which is achieved in a fair number of patients. There is a significant association between the radiological and pathological response. Overall, complete pathological response can be predicted reasonably well by using PET-CT. Further research with bigger datasets is required to establish the association and institute PETCT as an integral component of management protocol in Carcinoma Esophagus. [ABSTRACT FROM AUTHOR]

The author discusses whether universities in India have sufficient infrastructure to provide quality education and training to produce competent medical physicists and if it is appropriate to flood the field of medical physics with inadequately educated medical physicists. He cites the need to encourage eligible young medical physicists to undergo appropriate competency test to work as clinical medical physicist in the discipline of radiation oncology medical physics (ROMP).

A letter to the editor is presented which discusses a case study of a 39-year-old man presented with a rare Philadelphia negative (p-190) chronic myelogenous leukemia and sudden fall of hemoglobin levels.

A letter to the editor is presented regarding the medical case of a 43-year-old female patient diagnosed with metastatic infiltrating ductal breast carcinoma, with initial optic nerve metastases and subsequent extra-ocular muscle involvement.

Background and Aims: NAFLD is closely associated with type 2 diabetes, an integral component of metabolic syndrome. Materials and Methods: We conducted an initial phase of the long term, prospective, observational FATTYDIAB study in the Western Indian patients, evaluating the physical, biochemical and liver ultrasonography parameters for NAFLD in 200 T2DM confirmed patients, males (n = 144), females (n = 56); mean age 52.7 ± 9.1 years (range 32-80). Results: Stratified 3 age tertile pattern reflects increased prevalence of NAFLD (82%) in economically productive age group (<60 years). 71.5% (n = 143) had grade 1 (mild) to grade 2 (moderate) fatty liver. Bivariate correlation for NAFLD with changes in biochemical parameters were FPG; R = 0.064 (p = 0.368), PPG; R = 0.076 (p = 0.288), HbA1c; R = 0.145 (p = 0.040), SGOT; R = 0.181 (p = 0.010), SGPT; R = 0.162 (p = 0.022) and serum bilirubin; R = 0.069 (p = 0.331). Linear positive trends were evident for HbA1c with different grades of fatty liver (R2 = 0.021, F = 4.22; p = 0.040). Progression of HbA1c with NAFLD was Grade 0; 8.0 (7.6- 8.5), Grade 1; 8.6 (8.3-9.0), Grade 2; 8.7 (7.8-9.5) and Grade 3; 9.2 (7.5-11.0); Ptrend = 0.108. The physical and biochemical parameters revealed distinct patterns of dyslipidemia (low HDL and high triglycerides), blood pressure (mean systolic 133 mm hg) and BMI (mean 27). Conclusion: Epidemiological trends clearly demonstrate that the predominant patterns in the economically productive age group. The glycaemic markers (fasting, post prandial glucose and HbA1c) are strongly coorelated for prediction of NAFLD. However, the association of glycemic markers for progression of NAFLD was not statistically significant. An early aggressive intervention with a customised pharmacological approach to address the co-morbidities in these 'thin-fat' Indians is needed to improve clinical outcomes in type 2 diabetics with NAFLD. [ABSTRACT FROM AUTHOR]