Implications of applicators orientations on bladder, and rectal doses in gynecological mHDR brachytherapy: A retrospective analysis of reproducibility in multi-fractionated regimen

Introduction: Variation of doses due to positional uncertainties of applicators based on orthogonal radiograph has been evaluated by several researchers. The present study has analyzed the various possibilities of special alterations of applicator placements in intracavitary brachytherapy (ICBT) and its impact on the dose to target volume, rectum, and bladder. An innovative approach has been suggested to quantify and utilize the special coordinates for reproducibility of applicator based on the pelvic bone landmark. Materials and Methods: A total of 27 fractions of 9 (n = 9) cancer cervix patients treated with external beam radiotherapy followed by ICBT have been evaluated retrospectively. The first fraction of each patient was planned as per the International Commission on Radiation Units and Measurements report 38 guidelines and was considered reference for consecutive fractions regarding dwell positions, dose to target volume, bladder, and rectum points. For each fraction, positioning of applicators regarding their spatial orientations with respect to pelvic bone landmarks and their correlation with dose to bladder and rectum was recorded and analyzed. Results: It was found that mean angulations between (1) the two applicator points with respect to tip of central tandem (α), (2) the two applicator points with junction point situated on the sacrum bone (β) and (3) the angle between the line joining applicator points and a point defined on pelvic bone (γ) is 62.20° ± 5.74°, 37.13° ± 5.64° and 105.51° ± 6.58°, respectively. Bladder dose increased with increment in α but decreased with increase of β and γ. Dose to rectum remained unaffected for γ. Mean distance from couch top to tip of central tandem and two ovoids is, respectively, 11.17 cm and 8.70 cm. Conclusion: Optimal plans even with orthogonal radiographs may be generated by verifying the application based on the parameters mentioned in the present study and computed tomography-based plans could be utilized more effectively instead of doing automatic or manual optimization. Whereever orthogonal radiograph based or template based ICBT practices is performed this study may create a dataset to have an optimal treatment plan even without three-dimensional images

Conservative Management Of Ameloblastoma In An Adolescent Patient

Introduction- Ameloblastoma is an aggressive, benign odontogenic tumour of the jaw with varying clinical features and histologic patterns. The treatment options of en block and segmental resection reduce the chance of recurrence. Resection of the mandible is associated with many complications like loss of jaw bone integrity, deformity, dysfunction, cosmetic and psychological distress. For these reasons, young, growing patients find these treatment options simply unacceptable. An alternative method for young growing patients is the conservative approach. Materials and methods- Enucleation and chemical cauterization of the lesion with carnoy's solution (6% ethanol, 3%chloroform, 1% acetic acid, 1 gm ferric chloride) followed by iodoform dressing routinely. Results- Patient was followed up for 1.5 year. No recurrence was noticed. Conclusion-In young growing patient a more conservative approach with close postoperative follow-up will significantly reduces the morbidity

Management Of Phimosis With Use Of Betamethasone And Prepucial Dilatation -A Prospective Study

Introduction: Physiological phimosis, a common complaint in the surgery outpatient department presenting as non–retractile foreskin is due to adhesions between the inner layer of the prepuce with glans penis or due to tight tip of the prepuce. These patients are managed with circumcision, preputial dilatation and topical application of steroid. In this study, we compare different outcomes measures in children treated with dilatation along with Betamethasone ointment. Methods: This prospective study was conducted in the department of General surgery outpatient department in 2018. We followed up 50 patients who underwent application of betamethasone ointment followed by dilatation and application of betamethasone impregnated antibiotic cream twice daily over a period of six weeks. We recorded basic demographic features, parent anxiety, parental compliance, parent satisfaction, complete response and persistence of phimosis at the end of the treatment. Results: The median age of the patients was 36 with range (23–48) months. At the end of six weeks, with regard to all outcome measures namely parent compliance, parent satisfaction, symptom resolution. Moreover, phimosis persisted in 3 (6%) of the patients treated with dilatation and betnovate ointment. Conclusions: This study shows that Dilatation and local application of betnovate ointment is a better alternative to circumcision.

Serum Lipid Profiles in Breast Carcinoma and Benign Breast Diseases in Rohilkhand Region of Uttar Pradesh.

Aim: The study was carried out with an aim to evaluate an association of serum lipid profile with breast carcinoma and benign breast disease. Methods: For this purpose, a case-control study was planned in which a total of 105 subjects were enrolled according to a purposive sampling design - A total of 35 (33.3%) patients in each group having breast carcinoma, benign breast disease, and healthy controls were included for assessment. Lipid levels were assessed. Data were analyzed. Results: Age of subjects enrolled in the study ranged from 16 to 58 years. The mean age of subjects in malignant, benign and control group was 45.71 ± 10.04, 24.91 ± 6.83 and 35.60 ± 12.42 years, respectively. The majority of malignant cases were in advanced stage (T3 and T4), together accounted for 94.29% of total malignant cases. The remaining 2 (5.7%) cases were in T2-stage. A total of 21 (60%) cases had metastasis too. Mean triglyceride (TG) levels of malignant cases were significantly higher as compared to that of benign and healthy controls. Mean serum high density lipoproteins levels were significantly higher in benign group as compared to healthy controls. Mean serum low density lipoproteins levels were maximum in healthy controls and minimum in benign breast disease group. Statistically, the difference between healthy controls and benign breast disease was also found to be significant. Conclusion: For different lipid components, the relationship with different types of breast lesions was found to be varying. In malignant cases, TG levels showed an increased trend. The possibility of these relationships being random cannot be ignored. A larger study on larger sample size is recommended.

Assessment of Genetic Fidelity of in vitro Raised Plants in Swertia chirayita through ISSR, RAPD analysis and Peroxidase Profiling during Organogenesis

ABSTRACT An efficient in vitro regeneration protocol for medicinally important herb Swertia chirayita was developed and the genetic fidelity was assessed using RAPD and ISSR markers. The best shoot regeneration was observed on MS basal supplemented with 1.0 mg/L Benzyl amino purine (BAP) in combination with Indole-3-acetic acid (IAA) (0.5 mg/L) that resulted in the increase by multiplication rate (7.65) with an average of 33.33 numbers of shoots and average shoot length of 2.70 cm. It was further enhanced by the addition of adenine sulfate (0.007%) that resulted in an average of 42 shoots per clum with 4.13 cm of average shoot length and the increase in multiplication fold to 9.75 that further resulted in the reduced use of other cytokinins and auxins. The rooting was nearly 100 % on 1/4 MS augmented with 1.0 mg/L Indole butyric acid with maximum average root length of 5.1cm. Plantlets were successfully acclimatized with 85-90 % survival rate. Ascorbate peroxidase activity increased with the maximum activity during the shoot multiplication. Clonal fidelity has been checked by two marker systems ISSR and RAPD and regenerated plants showed high clonal fidelity.

Estimation of magnitude of various health conditions under 4Ds approach, under RBSK Programme in Devendranagar block of Panna District, Madhyapradesh, India.

Background: The Rashtriya Bal Swasthya Karyakram (RBSK) aims early detection and management of the 4Ds - Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities in children in the community which are hidden may be due to unawareness or unaffordbility for treatment. Methods: We followed the operational guidelines of ‘Child Health Screening and Early Intervention Services’ under RBSK. Surveys done along with RBSK team for 6 months. Results: Total 26977 children were screened. Out of which 53 children were found to have birth defects, 434 children were found to have some kind of deficiency, 21768 children were found to have diseases and 113 children were found with developmental delay including disabilities. Globally, 200 million children do not reach their developmental potential in the first five years because of poverty, poor health, nutrition and lack of early stimulation. Here in our study 83% children deprived of good health due to 4Ds. Conclusion: We observed that still there are many children are undiagnosed and deprived of treatment for curable diseases. Child Health Screening and promotion of Early Intervention Services is most beneficial for improvement in health status of children in rural community.

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes. A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median [range] of 2 [1-3] doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median [range] number of doses of acetaminophen in the first 24 h was also 2 [1-3]. There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block. Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.

Efficacy of statins in dyslipidemia: a non interventional comparative study in a tertiary care hospital, Ajman, UAE

The reduction of serum total cholesterol and LDL-cholesterol levels varies with different statins. The objective of the present study was to compare the efficacy of Simvastatin, Atorvastatin and Rosuvastatin in the treatment of newly diagnosed dyslipidemia. A prospective, non-interventional 12-week study was conducted after approval from the Ethics Committee. A total of 70 patients with newly diagnosed dyslipidemia receiving 20mg of Simvastatin, Atorvastatin or Rosuvastatin were included. The primary efficacy measure was reduction of lipid levels from the initial baseline values at the end of 12 weeks with the respective Statins. Data was analyzed using descriptive statistics, Paired -t test, and analysis of variance [ANOVA]. Of total 70 patients, 14 patients received Simvastatin; 40 patients received Atorvastatin and 16 patients received Rosuvastatin. Demographic and baseline clinical characteristics were similar between the three groups. Significant reduction in lipid levels [total cholesterol, and LDL] was seen within the three treatment groups [p<0.01]. However, statistically significant difference in the reduction lipid levels was not observed between the three groups. We found no significant difference in the reduction of lipid levels between Simvastatin, Atorvastatin or Rosuvastatin patients with newly diagnosed dyslipidemia

Prostate cancer: emerging pharmacotherapeutic modalities.

Prostate cancer is the most common cancer in the world due to factors like old age, family history, ethnicity, diet and some elements exposure, with lot of controversies regarding prevention of prostate cancer. Though the exact pathogenesis is not clear, epidemiological evidence supports a relationship between prostate cancer and hormone levels. In this review article we are focusing on the advances in different pharmacotherapeutic modalities i.e. Chemoprevention, Prostate-Specific Antigen, Hormone Therapy, Anti-Inflammatory Drugs, SERM, Vaccines, Cryotherapy, Watchful Waiting, Radiotherapy and Androgen Deprivation Therapy etc. and new possibilities with strategies to provide maximal benefits while effectively balancing risks for the prostate cancer treatment.

Study of coronary artery atherosclerosis in sudden deaths and its medico-legal relevance.

The coronary artery diseases can play a crucial medico- legal role to decide the cause of sudden death whether natural or unnatural. There are certain occasions, when a person dies on the operating table or soon after surgery, and a coronary attack is probably the cause of death. A final coronary episode may sometimes be associated with an operative procedure supposedly due to hypotensive state. During driving or piloting a person may goes into a state of confusion because heart attack. In this state he may lose control and an accident can happen. These conditions indicate that intervention of Forensic Pathologist is significant to decide the actual cause of death apart from injury or disease of vital organs. We examine coronary arteries for atherosclerotic changes in 50 cases of sudden deaths. We observed that there were marked intimal thickening with luminal narrowing ≤ 75% of luminal diameter in 20 cases (40%) in total hearts. In natural deaths 17 cases (48.57%) showed luminal narrowing ≤ 75% of luminal diameter. These findings are suggestive of medico legal intervention to clarify the mode of death in some instances.

Abdominal organ involvement in blunt injuries.

Visceral injuries of the abdomen following blunt trauma present a great medico-legal problem to the forensic experts. Thus the doctor should remain alert to the development of signs and symptom after blunt trauma to the abdomen in vehicular accident otherwise he may be charged of negligence. Among 55 fatal cases of blunt abdominal injury, maximum number of cases belongs to the age group 20-29 yrs. Males were the predominant victims with ratio 4:1. It was found that road traffic accidents by heavy vehicle like bus; car and truck were responsible for 70% of blunt abdominal injuries. Among 55 cases of blunt injury, the incidence of the involvement of liver, spleen, small intestine, kidney, stomach and urinary bladder were 67%, 30.91%, 18%, 10.9%, 9.09%, 5% cases respectively. Genitals were found injured in 3% cases of blunt injury abdomen. For Blunt Injuries of Abdomen majority of the cases i.e. 78.18% were of accidental, 18.18% were homicidal and 3.6% suicidal in nature. Immediate cause of death was shock and hemorrhage and in those cases where death was delayed, cause of death was septicemia.

Faculty outlook towards animal experiments in postgraduate medical education

Animal experiments form an essential component of postgraduate medical education in the discipline of Pharmacology. In this context, the present study aimed to assess the perceptions of Pharmacology faculty members in South Indian medical colleges regarding the use of animals in postgraduate training. A cross-sectional survey was done among 70 Pharmacology faculty in 15 South Indian medical colleges. A validated pre-tested 27-statement, 5-domain questionnaire was used to collect the data. Data were analyzed using SPSS 19 version. Categorical variables were described by frequencies and percentage. With 52 faculty members responding to the content validated questionnaire, the response rate was 84.3%. The analysis of results revealed that the majority of the faculty members agreed with statements about the advantages and some disadvantages of animal experiments. About 88% stated that animal experiments should be conducted in the program. The majorities were also aware of alternatives to animal experiments and agreed that animal experiments should be continued with a reduction in the number or with refinement of the use of animals in spite of the availability of alternatives. The majority of faculty members of South Indian medical colleges, who took part in our study, support animal use in postgraduate courses in spite of being aware of their drawbacks and the availability of alternatives. Hence, in view of the trend to "Replace, Reduce and Refine" animal use, greater awareness is needed regarding the utilization of alternatives to animal experiments in postgraduate medical education

Original research paper age at menarche and affecting bio-social factors among the girls of Lucknow, Uttar Pradesh.

The age at which first menstrual bleeding occurs in female, i.e menarche is viewed as an excellent physiological marker of adolescent maturation. The aim of this study is to determine the mean age at menarche among adolescent girls and to assess the influence of some Bio-social parameters affecting it.This study was conducted among 150 adolescent girls in the age group of 10 to 19 years, randomly selected from urban & rural government schools of Lucknow. 75 girls from each school were selected from November 2009 to March 2010. This was a cross sectional descriptive study. Girls were studied about their socioeconomic status, weight, height, place of residence. Out of 150 cases studied 108 cases were having menstruation, most frequent age of menarche being 13 years when 32 cases (29.63%) had its onset. The lowest age was 8 years and highest was 15 year. Mean age at menarche was found to be 12.43 ± 1.49. There seems to be definite association of various factors which modify the age at menarche like socio-economic status, body mass index, place of residence.

Environment quality at Maitri station in Antarctica.

A comprehensive study of air, water and soil quality was undertaken during the austral summer of 1999-2000 at the Indian Polar Research Station "Maitri" in compliance with the statutory requirements of the article 3 of Protocol on Environmental Protection to the Antarctic Treaty. The main objective of the study was to assess the impacts of various scientific programs and their associated logistic support facilities on the fragile ecosystem of Antarctica. Identification of major sources of pollution and quantification of pollutants in different environmental components were carried out through an extensive environmental monitoring program spread over a period of 5-7 weeks. Preliminary studies reveal that the levels of pollution are not alarming but there is scope for concern looking into the critical aspects of Antarctic environment and the carrying capacity of the environment surrounding Maitri station.

Leprosy in hyderabad

Background: Leprosy is endemic in Pakistan with an uneven distribution. Hyderabad is the fifth largest city of the country with a polyethnic population. To document demographic and clinical characteristics of leprosy in patients of Hyderabad region

Patients and methods: We reviewed 1938 patients of leprosy registered during 1967 to 2002 in all the functional leprosy centres of Hyderabad

Results: Males and females were equally affected. Over 65% of cases were in their 2nd to 5th decade of life. Pauci- and multibacillary leprosy were seen with almost similar frequency. The commonest presentation was tuberculoid leprosy [34.5%], followed by the rest. The prevalence of leprosy was highest in Indian migrants [57.53%] as compared to local Sindhis [15.37%]

Conclusion: Leprosy in Hyderabad more commonly occurs in Indian migrants than in other ethnic groups. It equally affects both sexes and paucibacillary disease is more common