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Aim: The purpose of this study is to improve the precision of radiation treatment and sparing of organ-at-risk (OAR) in patients with thoracic esophageal cancer (EC) affecting the heart, lung, and spinal cord. To improve and personalize cancer treatment plans, it assesses the dosimetric benefits of coplanar RapidArc (RAc), hybrid arc (RAHyb), and noncoplanar RapidArc (RAnc). Materials and Methods: Fourteen patients with EC were chosen for our investigation from our hospital’s database. RapidArc (RA) plan patients had already received treatment. Retrospectively, additional RAnc and RAHyb plans were made with a prescription dose of 50.4 Gy in 28 fractions for the planning target volume (PTV). A prescription dose of 95% of PTV was used, so that three different treatment planning procedures could be compared. The cumulative dose-volume histogram was used to analyze the plan quality indices homogeneity index (HI), conformity index (CI), conformation number (CN) as well as the OARs doses to the lung, heart, and spinal cord. Results: In comparison to RAc and RAnc techniques, the study indicated that RAHyb plans significantly increased D95%, CI and HI; Dmax and CN did not differ substantially. In addition, compared to RAc (lung: 16.15 ± 0.03 Gy and heart: 23.91 ± 4.67 Gy) and RAnc (lung: 15.24 ± 0.03 Gy and heart 23.82 ± 5.10 Gy) plans, RAHyb resulted in significantly lower mean lung doses (15.10 ± 0.03 Gy) and heart doses (21.33 ± 6.99 Gy). Moreover, the RAHyb strategy showed a statistically significant (P < 0.05) lower average MU (452.7) than both the RAc (517.5) and RAnc (566.2) plans. Conclusion: The D95%, conformity, and homogeneity indices were better for hybrid arc plans compared to RAc and RAnc plans. They also successfully managed to reduce the lung and heart doses as well as the mean MU per fraction.

This paper delves into the analysis of shear wave propagation with a sandwiched structure comprising a piezoelectric layer and an elastic layer, with a transversely isotropic layer in between. The frequency equation has been derived following Biot’s theory. The dimensionless phase velocities numerical values are computed and visually depicted to demonstrate their dependencies on anisotropy, piezoelectricity, initial stress and porosity in a comparative manner. The explicit demonstration of the relationship between each parameter and the geometry has been presented. The observation shows that as porosity in the medium increases, the phase velocity also increases. Furthermore, the existence of medium anisotropy results in a decrease in the phase velocity of shear waves. Moreover, a correlation is observed where higher tensile initial stress within the medium leads to a corresponding reduction in the phase velocity of shear waves. We conclude that considered parameters (viz. piezoelectricity, anisotropy, porosity, initial stress and thickness of layers) affect the velocity profile of the shear waves significantly. This study holds practical significance in the development of innovative-layered composites, surface acoustic wave (SAW) devices and sensors utilizing intelligent piezoelectric devices for engineering purposes.

Introduction: Distal femoral physeal fractures are commonly observed in children with open growth plates who experience direct trauma. Biplane fractures have been documented, but triplane fractures are exceedingly rare. We present the case of a 17-year-old male with an immature skeletal structure who sustained a direct blow to his right knee in a road traffic accident, leading to this uncommon injury. Case presentation: The patient underwent a knee X-ray initially, followed by a CT scan for a more detailed assessment. The CT scan confirmed the diagnosis of a distal femoral physeal triplane fracture. Subsequently, open reduction and internal fixation were performed using a lateral parapatellar approach. Discussion: Distal femoral physeal triplane fractures are infrequently reported in medical literature, highlighting the rarity of this injury. Accurate diagnosis necessitates meticulous radiological examination, with CT scans being particularly useful. Treatment involves achieving anatomical alignment and stabilizing the fracture with screws or K-wires. Given the potential complication of limb length discrepancy, long-term monitoring until skeletal maturity is crucial. Conclusion: This clinical case highlights the scarcity of documentation in the literature of distal femur physeal triplaner and underscores the significance of precise radiological evaluation for accurate diagnosis. Early surgical intervention, along with careful long-term monitoring, can help mitigate potential complications and ensure favorable outcomes in these rare cases.

Background: Fracture of distal radius may be stable that is extra-articular, non-comminuted without distal radio ulnar joint disruption or unstable that is intra-articular, comminuted displaced with distal radio ulnar joint disruption. Complications of unstable fractures are shortening due to bone loss or due to resorption of the cancellous bone from metaphysis, resistant deformity, residual pain, late collapse, radio carpal arthritis and gross functional impairment. Aims and Objective: The purpose of this study to compare the relative efficacy of external fixation versus plating with regard to functional and radiological outcome. Materials and Methods: Total of 60 patients having intraarticular distal end radius fracture were included in this study and was equally divided into two groups, one group treated by external fixator other group with volar locking compression plate with or without augmentation by k-wire. Follow-up was done after 2 weeks, 4 weeks, 6 weeks and 3 ,6 and 12 months. The radiological evaluation was performed with Sarmiento’s Modification of Lindstrom’s Criteria. With the Modified Mayo Wrist Score, the patient’s functional outcomes were assessed and both groups were compared. Results: In this study we found that volar plate group had good to excellent outcome in 73% cases and 07% with fair outcome however with external fixator group found good to excellent in 50% cases and poor in 17% cases. Conclusion: In our study, we showed that the use of an external fixator and a volar locking plate for the treatment of intraarticular distal radial fractures were reliable. The relative simplicity of use, low surgical exposure, and decreased surgical trauma are benefits of external fixation. Despite these volar locking plates augmented with or without k wire had a good to excellent results in terms of early rehabilitation and less complications related to wrist joint. External fixator with ligamentotaxis provide significant good results in communited intraarticular distal end radius fracture.

Background: As compared to the flattened photon beam, removing the flattening filter (FF) from the head of a gantry decreases the average energy of the photon beam and increases the dose rate, leading to an impact on the quality of treatment plans. Objective: This study aimed to compare the quality of intensity-modulated radiation therapy (IMRT) treatment plans for esophageal cancer with and without a flattened filter photon beam. Material and Methods: In this analytical study, 12 patients, who had already been treated with a 6X FF photon beam, were treated based on new IMRT methods using a 6X the flattening filter-free (FFF) photon beam. Both 6X FF IMRT and 6X FFF IMRT plans used identical beam parameters and planning objectives. All plans were evaluated with planning indices and doses for organs at risk (OARs). Results: Insignificant dose variation was for HI, CI, D98%, and V95% between FF and FFF photon beam IMRT plans. FF-based IMRT plan delivered a 15.51% and 11.27% higher mean dose to both lungs and heart than the FFF plan, respectively. The integral dose (ID) for the heart and lungs was 11.21% and 15.51%, respectively, less in the IMRT plan with an FFF photon beam. Conclusion: In contrast to the FF photon beam, a filtered photon beam-oriented IMRT plan provides significant OAR sparing without losing the quality of the treatment plan. High monitor units (MUs), low ID, and Beam on Time (BOT) are major highlights of the IMRT plan with FFF beam.

Transfusion-related acute lung injury (TRALI), a life-threatening condition, remains an under reported complication, especially among neonates postexchange transfusion for unconjugated hyperbilirubinemia. Appropriate recognition and prompt treatment change the prognosis for good. The present case emphasizes that TRALI must be kept as a differential diagnosis in previously well neonates presenting with sudden onset hypoxia within or during 6 h of transfusion with evidence of bilateral infiltrates on a frontal chest radiograph, and no evidence of circulatory overload, left atrial hypertension, or pre-existing respiratory distress before transfusion. We report the rare occurrence of TRALI and its successful management with supportive hemodynamic management and corrective ventilator strategies.

Abstract Background Women who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of “readiness” drives early disengagement from care and undermines prevention of HIV transmission to infants. Several studies have shown high early attrition of women initiating ART in pregnancy. Although poor ART uptake and adherence have been attributed to various factors including stigma, disclosure issues and structural issues, there is no standard way of determining which pregnant woman will face challenges and therefore need additional support. We developed and validated a novel ART readiness tool in Lusaka, Zambia. Methods The aim of this study was to develop and validate a tool that could be used to assess how ready a newly diagnosed pregnant woman living with HIV would be to initiate ART on the day of diagnosis. Using a mixed method design, we conducted this study in three public-setting health facilities in Lusaka, Zambia. Informed by qualitative research and literature review, we identified 27 candidate items. We assessed content validity using expert and target population judgment approaches. We administered the 27-item questionnaire to 454 newly diagnosed pregnant women living with HIV, who were enrolled into a randomized trial (trials number NCT02459678). We performed item reduction analysis and used Cronbach’s alpha coefficient of 0.70 as threshold for reliability. Results A total of 454 pregnant women living with HIV enrolled in the study between March 2017 and December 2017; 452 had complete data for analysis. The correlation coefficient between the 27 items on the completed ART readiness scale ranged from 0.31 to 0.70 while item discrimination index ranged from -0.01 to 2.38. Sixteen items were selected for the final scale, representing three domains, which we classified as “internalized and anticipated HIV stigma”, “partner support” and “anticipated structural barriers”. Conclusion We developed and validated a tool that could be used to assess readiness of newly diagnosed women living with HIV to initiate ART. This ART readiness tool could allow clinics to tailor limited resources to pregnant women living with HIV needing additional support to initiate and remain on ART.

Background: Increased body weight, repeated micro trauma and work on hard surfaces are the risk factors for plantar fasciitis. Platelet rich plasma (PRP) can be injected to various tissues where it releases high amounts of platelet derived growth factors that increases growth and healing process. Low level laser therapy (LLLT) is an alternative treatment that uses low power lasers. Potential benefits in reducing the pain and spasm. Methodology: Patients between 18 to 60 years were included in this prospective randomized controlled trial. Diagnosis made mainly on clinical grounds. We divided our patients in two groups randomly using simple number random method. GROUP-A patients treated with PRP along with laser therapy. GROUP-B treated with laser therapy only. We used visual analogue scale (VAS) and foot and ankle disability (FAD) index for assessment of pain relief during follow up. Results: 88 patients were included in this study. The VAS score was significantly (P

Background: Increased risk of proximal humerus fractures are seen in elderly group as their bones are osteoporotic or brittle. Mode of trauma in elderly patients with severe osteoporosis, fractures usually resulted from low velocity indirect trauma while high velocity trauma like road traffic accident was the cause of these fractures in younger age group. Surgery can be an option to obtain a better functional outcome or when a complex fracture needs to be fixed. With the advantages and the paucity of data on the functional outcome and efficacy of the following internal fixation with the PHILOS plate for displaced proximal humerus fractures in mind, the present study was planned. Methodology: Patients who fulfilled the selection criteria were informed about the study and were then enrolled. Following the surgery, patients were followed up regularly at six weeks, three months, and six months. Final outcome was analyzed by Constant Shoulder Score. Christopher Constant, with the help of the late Alan Murley during the years 1981–1986, devised the Constant Score, which was first presented in a university thesis in 1986 and whose methodology was later published in 1987. Results: A total of 30 patients sustained with proximal humerus fractures were studied. In this study of final assessment were Found 73.2 % good to excellent outcome by using the Constant Shoulder Score. Conclusion: Following this study, the inference can be drawn that proximal humerus internal locking system for the management of proximal humerus fractures give a good functional outcome in most patients. Hence PHILOS plate application for fixation of fracture proximal humerus in elderly patients hence allowing early mobilization of the shoulder.