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Purpose@#Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. @*Materials and Methods@#Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm’s patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. @*Results@#Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). @*Conclusion@#Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.
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Purpose@#Intensity-modulated radiotherapy (IMRT) provides higher dose to target volumes and limits the dose to normal tissues. IMRT may be applied using either simultaneous integrated boost (SIB-IMRT) or sequential boost (SEQ-IMRT) technique. The objectives of this study were to compare acute toxicity and objective response rates between SIB-IMRT and SEQ-IMRT in patients with locally advanced head and neck cancer. @*Materials and Methods@#Total 110 patients with locally advanced carcinoma of oropharynx, hypopharynx, and larynx were randomized equally into the two arms (SIB-IMRT vs. SEQ-IMRT). Patients in SIB-IMRT arm received dose of 66 Gy in 30 fractions, 5 days a week, over 6 weeks. SEQ-IMRT arm’s patients received 70 Gy in 35 fractions over 7 weeks. Weekly concurrent cisplatin chemotherapy was given in both arms. Patients were assessed for acute toxicities during the treatment and for objective response at 3 months after the radiotherapy. @*Results@#Grade 3 dysphagia was significantly more with SIB-IMRT compared to SEQ-IMRT (72% vs. 41.2%; p = 0.006) but other toxicities including mucositis, dermatitis, xerostomia, weight-loss, incidence of nasogastric tube intubation and hospitalization for supportive management were similar in both the arms. Patients in SIB-IMRT arm showed better treatment-compliance and had significantly less treatment-interruption compared to SEQ-IMRT arm (p = 0.028). Objective response rates were similar in both the arms (p = 0.783). @*Conclusion@#Concurrent chemoradiation with SIB-IMRT for locally advanced head and neck cancer is well-tolerated and results in better treatment-compliance, similar objective response rates, comparable incidence of mucositis and higher incidence of grade 3 dysphagia compared to SEQ-IMRT.
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Background: Antimicrobial agents (AMAs) are the most frequently used drugs in the intensive care units (ICU) and regular auditing can prevent the development of resistance to AMAs, reduce the cost and incidence of adverse drug reactions. The present study was conducted to assess the drug utilisation pattern by measuring the defined daily dose (DDD) per 100 bed days for the AMAs used and their correlation with the APACHE score II.Methods: This was a prospective observational study, conducted in the Central ICU of SCB Medical College and Hospital, Cuttack, Odisha for 4 months. Data regarding demographic profile, diagnosis, APACHE II score, microbiologic investigation, length of stay, outcome and utilisation pattern of AMAs assessing anatomic therapeutic chemical (ATC) classification and measuring the antimicrobial consumption index (ACI) equal to DDD per 100 bed days were collected and subjected to descriptive analysis. Multinomial logistic regression model was used to predict probabilities of different possible outcomes of categorically distributed variables and independent variables.Results: Mean age of study population was 44.70±14.814 with male and female ratio of 1.63:1. Septicaemia was the most common cause of admission. AMAs were prescribed to 92.66% of patients during their stay which constitutes 37.32% of the total drugs used. The DDD per 100 bed days for the AMAs were 118.59 and ceftriaxone was found to be most frequently used. Patients having higher APACHE II score received more no of AMAs (4.20±1.30). Patients having low APACHE II Scores received less number of antibiotics as compared to patients having higher score.Conclusions: AMAs were prescribed to 92.66% patients in the central ICU and there is significant relation between the APACHE II score and number of AMAs prescribed.
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Oxygen is vital for aerobic processes of metabolism and respiration- It has been also implicated in many diseases and degenerative conditions. Free radicals formed from reactive oxygen and nitrogen species act as key players in the initiation and progression of tumor cells and enhance their metastatic potential. The imbalance in the formation and use of free radicals in the tissue creates oxidative stress. Inadequacy in normal cells antioxidant defense system or excessive free radical formation or even both can cause the cell to experience the oxidative stress. This review outlines the involvement of free radicals in different aspects of cancer, from prevention to initiation, progression, treatment and to reduce morbidity and mortality.
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Garcinia lanceifolia and Citrus maxima are two indigenous fruits of East India, particularly Assam; which has been used in various folkloric medicines to treat disorders ranging from diarrhea and jaundice to stomach and heart problems. The main aim of this study was to establish and compare the antioxidant potential of these two plants. The methanolic extracts of the bark of G. lanceifolia and C. maxima were tested for their antioxidant potential using various established in vitro assay procedures. The estimation of the total phenolic and total flavonoid content were also carried out. The phytochemical screening was also done prior to these assays, and it revealed that both the extracts were found to contain tannins and phenolic compounds and flavonoids along with other phytoconstituents. The results reveal that both these plants have a considerable amount of antioxidant activity which can be compared with each other and also the standards.
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BACKGROUND: This study has been conducted with the aim of evaluating modified T-plate interpositional arthroplasty. METHODS: A prospective comparative study in patients admitted with temporomandibular joint ankylosis. Ankylotic temporomandibular joint arthroplasty included condylectomy gap arthroplasty in 7, temporalis muscle flap interpositional arthroplasty in 8, and modified T-plate interpositional arthroplasty in 13 cases. The patients were followed for three years. Collected data were tabulated and subjected to Fisher's exact test, chi-square test and probability estimation. RESULTS: A significant increase in interincisal distance of 32 mm was seen in 12 (92.31%) patients in the T-plate interposition group, in 2 (25%) cases of the temporalis muscle flap interposition group, and in 1 case (14.28%) of the condylectomy group at 12, 24, and 36 months. Re-ankylosis was observed in 1 case (9.69%) of the T-plate interposition group, while as it was observed in 4 (50%) cases in the temporalis muscle flap interposition group and 4 (57.14%) cases in the condylectomy group, and these differences were statistically significant. CONCLUSIONS: Our clinical experience with the use of the T-plate over the past 5 years has been encouraging, and our physiotherapy technique is quite simple. Even illiterate parents can assess it easily. Hence, we recommend this easy technique that does not damage the temporalis muscle for the management of temporomandibular joint ankylosis.
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Humans , Ankylosis , Arthroplasty , Parents , Prospective Studies , Temporomandibular JointABSTRACT
Computational methods play a central role in modern drug discovery process. It includes the design and management of small molecule libraries, initial hit identification through virtual screening, optimization of the affinity as well as selectivity of hits and improving the physicochemical properties of the lead compounds. In this review article, computational drug designing approaches have been elucidated and discussed. The key considerations and guidelines for virtual chemical library design and whole drug discovery process. Traditional approach for discovery of a new drug is a costly and time consuming affair besides not being so productive. A number of potential reasons witness choosing the In-silico method of drug design to be a more wise and productive approach. There is a general perception that applied science has not kept pace with the advances of basic science. Therefore, there is a need for the use of alternative tools to get answers on efficacy and safety faster, with more certainty and at lower cost. In-silico drug design can play a significant role in all stages of drug development from the initial lead designing to final stage clinical development.
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Homocysteine has emerged as a significant marker for occlusive vascular disease, but there has been some debate as to whether it is just an association (risk marker) or actually a causative factor (risk factor). To elucidate this, a retrospective statistical analysis was done of data generated in the course of our study on homocysteine and vascular disease. Homocysteine, lipid profile components and lipoprotein(a) were estimated in fasting blood samples drawn from 252 controls and 536 patients of occlusive vascular disease. The data were analyzed by SPSS version 17. Mean homocysteine levels were significantly higher (p<0.001) in all patients categories, as compared to controls. In fact, homocysteine level was the most significant biochemical risk factor for vascular disease. The odds ratios due to hyperhomocysteinemia varied from 3.170-4.153. When the cut-off was increased by 5 µmol/L, the odds ratio became almost three-fold. The prevalence of hyperhomocysteinemia increased by @20%, when the cut-off was reduced by 5 µmol/L. Statistical analysis of our data revealed that homocysteine conformed to Hill’s criteria of causation. Moreover, hyperhomocysteinemia was treatable by the administration of B-vitamins, even if the cause was genetic. Hence morbidity due to vascular disease could be reduced by identification and treatment of hyperhomocysteinemia.
Subject(s)
Arterial Occlusive Diseases/diagnosis , Biomarkers , Homocysteine/diagnosis , Humans , Data Interpretation, Statistical , Risk FactorsABSTRACT
OBJECTIVE@#To investigate the impact of the most potent petroleum ether extract of Artemisia annua (A. annua) and Azadirachta indica (Az. indica) on total carbohydrate, lipid and protein level of Anopheles stephensi and Culex quinquefasciatus larvae.@*METHODS@#Mosquito larvae were exposed to the extracts selected as per standard WHO procedure. Carbohydrate (glucose), total lipid and protein were estimated by the methods as Nelson, Bragdon and Lowry described, respectively.@*RESULTS@#The glucose levels were increased to 27.87% and 46.8%, respectively in anopheline larval tissues after treatment with petroleum ether extract of A. annua and methanolic extract of Az. indica. In culicine larvae, glucose levels were reduced to 58.96% and 24.65%, respectively. After treatment with A. annua extract, lipid contents in anopheline and culicine larvae decreased by 28.57% and 25.0%, respectively and increased by 14.29% and 50.00% in the Anopheles and Culex larvae, respectively after treatment with methanolic extract of Az. indica. Total protein levels were reduced to 63.13% and 92.62% in anopheline and to 32.39% and 48.12% in culicine larvae after treatment with A. annua and Az. Indica extracts, respectively.@*CONCLUSIONS@#Two extracts produce significant alterations in the biochemical profiles of anopheline and culicine larvae. Further, the impacting factors of extracts on carbohydrate, lipid and protein contents of larvae are species and specific extraction. It indicates the disturbed metabolic activity of the larvae.
Subject(s)
Animals , Anopheles , Chemistry , Artemisia annua , Chemistry , Azadirachta , Chemistry , Carbohydrates , Culex , Chemistry , Insecticides , Pharmacology , Larva , Chemistry , Lipids , Metabolic Networks and Pathways , Plant Extracts , Pharmacology , ProteinsABSTRACT
Severe crush injuries to the upper limb may require a formal amputation with devastating consequences to the patient. We report a patient with a near total amputation at the level of mid-forearm who underwent revascularization and salvage of his hand. The operative details of this case are described. It is the first time that such a patient has been treated successfully by plastic surgeons and orthopedic surgeons at the Sultan Qaboos Hospital, Salalah, Awareness of the possibility of salvage should be spread among health care personnel as well as the need for immediate attention by a multispeciality team. Literature related to the operative technique, contraindications and long term results is reviewed
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Humans , Male , Amputation, Traumatic/surgery , Patient Care Team , Bone Wires , Forearm/surgeryABSTRACT
The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient storage and retrieval of the enormous amounts of information. A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and password is issued separately to each individual according to the person's job responsibilities and accountability, so that users will be able to only access data that is related to their job responsibilities. With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or accidental destruction of information.
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Computer Simulation , Computer Systems , Humans , Internet/instrumentation , Medical Records Systems, Computerized/instrumentation , Programming Languages , Radiation Oncology/instrumentation , Radiography , Radiology Information Systems , Radiotherapy , Radiotherapy Planning, Computer-Assisted/instrumentation , Software , User-Computer InterfaceABSTRACT
We report an important observation that the surface conductivity of antibody layer immobilized on polylysine-coated glass substrate decreases upon the formation of complex with their specific antigens. This change in conductivity has been observed for both monoclonal and polyclonal antibodies. The conductance of monoclonal mouse IgG immobilized on polylysine-coated glass substrate changed from 1.02x10(-8) ohm(-1) to 1.41x10(-11) ohm(-1) at 10 V when complex is formed due to the specific biomolecular interactions with rabbit anti-mouse IgG F(ab')(2). Similar behavior was observed when the same set up was tested in two clinical assays: (1) anti-Leishmania antigen polyclonal antibodies taken from Kala Azar positive patient serum interacting with Leishmania promastigote antigen, and (2) anti-p21 polyclonal antibodies interacting with p21 antigen. The proposed concept can represent a new immunodiagnostic technique and may have wide ranging applications in biosensors and nanobiotechnology too.
Subject(s)
Animals , Humans , Rabbits , Antigen-Antibody Complex , Biosensing Techniques , Electric Conductivity , Immunoassay , MethodsABSTRACT
We report a case of a congenital atraumatic lung hernia who underwent a successful operation.
Subject(s)
Child , Female , Follow-Up Studies , Hernia/congenital , Humans , India , Lung Diseases/diagnostic imaging , Radiography, Thoracic , Risk Assessment , Severity of Illness Index , Thoracotomy/methods , Treatment OutcomeABSTRACT
We report the case of a three year old female child with combined occurrence of von Willebrand's disease and factor XIII deficiency, an extremely rare combination. The patient presented with prolonged bleeding following cuts and wounds. Clot solubility test using 5M urea was positive. Platelet aggregation using ristocetin was reduced, which corrected on adding normal plasma. Aggregation with other agonists was normal. We discuss the clinico- hematological profile of the case. Only one such case has been reported in literature in the past to the best of our knowledge.