Use of GammaPlan convolution algorithm for dose calculation on CT and cone-beam CT images

Purpose@#The aim of this study was to assess the suitability of using cone-beam computed tomography images (CBCTs) produced in a Leksell Gamma Knife (LGK) Icon system to generate electron density information for the convolution algorithm in Leksell GammaPlan (LGP) Treatment Planning System (TPS). @*Materials and Methods@#A retrospective set of 30 LGK treatment plans generated for patients with multiple metastases was selected in this study. Both CBCTs and fan-beam CTs were used to provide electron density data for the convolution algorithm. Plan quality metrics such as coverage, selectivity, gradient index, and beam-on time were used to assess the changes introduced by convolution using CBCT (convCBCT) and planning CT (convCT) data compared to the homogeneous TMR10 algorithm. @*Results@#The mean beam-on time for TMR10 and convCBCT was found to be 18.9 ± 5.8 minutes and 21.7 ± 6.6 minutes, respectively. The absolute mean difference between TMR10 and convCBCT for coverage, selectivity, and gradient index were 0.001, 0.02, and 0.0002, respectively. The calculated beam-on times for convCBCT were higher than the time calculated for convCT treatment plans. This is attributed to the considerable variation in Hounsfield values (HU) dependent on the position within the field of view. @*Conclusion@#The artifacts from the CBCT’s limited field-of-view and considerable HU variation need to be taken into account before considering the use of convolution algorithm for dose calculation on CBCT image datasets, and electron data derived from the onboard CBCT should be used with caution.

Use of GammaPlan convolution algorithm for dose calculation on CT and cone-beam CT images

Purpose@#The aim of this study was to assess the suitability of using cone-beam computed tomography images (CBCTs) produced in a Leksell Gamma Knife (LGK) Icon system to generate electron density information for the convolution algorithm in Leksell GammaPlan (LGP) Treatment Planning System (TPS). @*Materials and Methods@#A retrospective set of 30 LGK treatment plans generated for patients with multiple metastases was selected in this study. Both CBCTs and fan-beam CTs were used to provide electron density data for the convolution algorithm. Plan quality metrics such as coverage, selectivity, gradient index, and beam-on time were used to assess the changes introduced by convolution using CBCT (convCBCT) and planning CT (convCT) data compared to the homogeneous TMR10 algorithm. @*Results@#The mean beam-on time for TMR10 and convCBCT was found to be 18.9 ± 5.8 minutes and 21.7 ± 6.6 minutes, respectively. The absolute mean difference between TMR10 and convCBCT for coverage, selectivity, and gradient index were 0.001, 0.02, and 0.0002, respectively. The calculated beam-on times for convCBCT were higher than the time calculated for convCT treatment plans. This is attributed to the considerable variation in Hounsfield values (HU) dependent on the position within the field of view. @*Conclusion@#The artifacts from the CBCT’s limited field-of-view and considerable HU variation need to be taken into account before considering the use of convolution algorithm for dose calculation on CBCT image datasets, and electron data derived from the onboard CBCT should be used with caution.

Clinical profile of falciparum, vivax and mixed infections of malaria, from a tertiary care hospital, Coastal Andhra, India

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh is one of the endemic areas for malaria. The objective was to study clinical profile and outcome of malaria in both species and mixed infection.Methods: Present study was carried out on 100 patients admitted during the period of November 2016 - October 2018 in Narayana medical college and hospital, Nellore. Malaria confirmed by Peripheral thick and thin smear or Antigen Assay underwent detailed clinical history and physical examination. This was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out Of the 100 patients 58 patients were from rural background, males were predominant, most common age group was 20-30 (34%) followed by 31-40 (31%). Out of 100 patients, 54 patients were falciparum,44 patients had vivax and two had mixed infection. All of the patients had fever followed by chills and rigors (75%), nausea and vomiting (59%), easy fatiguability (28%), pain abdomen (17), cough (14%) in both infections, altered sensorium was seen in only falciparum (20.3%). On clinical examination,70% of the patients had pallor, splenomegaly in 46%, icterus (23%), hepatomegaly (14%) and pedal edema in12 patients were observed. All 0f the patients were treated with appropriate antimalarial drugs for appropriate duration, and all were recovered without any mortality.Conclusions:Malaria is very common disease in our country especially in South India, which is one of the endemic areas. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.

Management of Mandibular Body Fracture in an Eighteen-Month Old Child - A Case Report

@#With the advancement of the transportation system and improvement in road conditions, the number of high-velocity accidents has also increased. Almost all of these reported cases involve individuals who had travelled in vehicles without adhering to personal protection standards and with rash driving. Injuries to the facial region can be profoundly disturbing and particularly in children. Parents find it very distressing to see their child in pain with a disfigured or injured face. It is difficult to manage such crying & sometimes uncontrollable children. The most commonlyinjuredfacialbonesareNasal,Zygomaticandthe Mandible. The incidence of facial bone fracture in children is uncommon, and we present a case report of an18-month old child with a history of road traffic accident and swelling on the right side of the face. Intraoral examination shows limited mouth opening with submucosal ecchymosis in the right buccal mucosa and based on clinical and computed tomographic scan working diagnosis of fracture in the right body of the mandible was arrived. The child was treated with the circum-mandibular wiring to stabilize the mandibular fracture under general anaesthesia. After three weeks the splint was removed. The injury healed without complications in the post-operativeperiod.

Chemopreventive and Chemotherapeutic Effect of Propolis and Its Constituents: A Mini-review

Propolis is a bee wax rich in various phytocomponents and traditionally used to treat various ailments. Propolis is reported to possess an array of biological properties including anti-inflammatory, antioxidant, anti-cancer, and anti-diabetic as well as cardioprotective, hepatoprotective, renoprotective, and derma protective activities. A plethora of studies confirmed that propolis is effective against various types of cancer including head and neck, lung, liver, brain (glioma), pancreas, kidney, prostate, skin (melanoma), breast, oral, esophagus, gastric, colorectal, and bladder cancers. However, many researchers have demonstrated that propolis displays potent chemoprotective/chemopreventive or anti-cancer activity against only a few types of cancers like oral, gastrointestinal, dermal (melanoma), breast, and prostate cancers. Therefore, this mini-review only summarizes the chemopreventive/chemotherapeutic activities of propolis and its updated underlying mechanisms. Taken together, propolis displays potent chemoprotective or anti-cancer effect due to the presence of various phytocomponents which contribute to pro-apoptotic, cytotoxic, anti-proliferative (cell cycle arrest), anti-metastatic, anti-invasive, anti-angiogenic and anti-genotoxic or anti-mutagenic properties along with antioxidant, immunomodulatory, and anti-inflammatory functions. Hence, propolis could be used as an adjuvant for treating various cancers along with standard chemotherapeutic drugs. However, many large-scale clinical studies are needed to justify such applications.

Clinicopathological profile of colorectal polyps: retrospective analysis from tertiary care center in Southern India

Background: Colorectal Cancer is the fourth most commonly diagnosed and chronological changes in colorectal polyps and cancer is important in efficacy of screening strategies. In this study, we aimed to compare clinicopathological features of colorectal polyps and also aimed to characterise the distribution and the pathological features of polyps during an 18-year period divided in to two groups.Methods: This is retrospective analysis of cases that underwent colonoscopy and found to have colorectal polyps were re-viewed retrospectively for 18 year period are retrieved. 18 year period was divided in to 2001 to 2010 and 2011 to 2018.Results: Among 4230 patients underwent colonoscopy between January 2001 and September 2018, 1356 were excluded; of the remaining 2874, 986 were found to have 1,272 polyps. 306 patients had 412 polyps in 2001 to 2010 group and 680 patients had 860 polyps in 2011 to 2018 group. Adenomas on the left sided colon were significantly higher in the first time period (40.2% vs 30%, p <0.0003). Polyps on the right sided colon were significantly higher in the second time period (37.3% vs 36.9%, p <0.0005). The most common histology in the both periods is tubular adenoma. Histology of adenomas with high grade dysplasia were significantly more in first period (12.4% vs 7.6%, p <0.005).Conclusions: Our data shows shift in polyps from left side to right side colon in recent years. There was no significant change in shift in advanced adenomas from left side to right side of colon.

Autism Spectrum Disorders and Celiac Disease: Is there an Association?

We included 150 children aged 2-12 years with Autism SpectrumDisorders and normal serum total IgA levels, and screened themfor celiac disease using anti-tissue transglutaminase IgA levels.All the children were screen negative, suggesting lack ofpositive association between Autism Spectrum Disorders andCeliac disease.

Idiopathic Horner’s Syndrome: An Enigma.

Horner’s syndrome (Bernard-Horner’s syndrome or oculosympathetic palsy) is a clinical syndrome caused by paralysis of the cervical sympathetic trunk. It is characterized by miosis, ptosis, enophthalmos and anhidrosis. Most of the cases are due to vascular causes, trauma or cancer. Occasionally, Horner’s syndrome is encountered in a patient where no cause can be ascertained. Here, we describe one such case.

Antihypercholesterolemic effect of Bacopa monniera linn. on high cholesterol diet induced hypercholesterolemia in rats

OBJECTIVE@#To explore the effect of alcoholic extract of Bacopa monniera (AEBM) on high cholesterol diet-induced rats.@*METHODS@#The shade-dried and coarsely powdered whole plant material (Bacopa monniera) was extracted with 90% ethanol, finally filtered and dried in vacuum pump. The experimental rats were divided into 4 groups: control (group-I), Rats fed with hypercholesterolemic diet (HCD) for 45 days [4% cholesterol (w/w) and 1% cholic acid], Rats fed with HCD for 45 days+AEBM (40mg/kg, body weight/day orally) for last 30 days (group-III) and AEBM alone (group-IV). Blood and tissues (Aorta) were removed to ice cold containers for various biochemical and histological analysis.@*RESULTS@#AEBM treatment significantly decreased the levels of TC, TG, PL, LDL, VLDL, atherogenic index, LDL/HDL ratio, and TC/HDL ratio but significantly increased the level of HDL when compared to HCD induced rats. Activities on liver antioxidant status (SOD, CAT, GPx, GR, GST) were significantly raised with concomitant reduction in the level of LPO were obtained in AEBM treated rats when compared to HCD rats. Treatment with AEBM significantly lowered the activity of SGOT, LDH and CPK. Histopathology of aorta of cholesterol fed rat showed intimal thickening and foam cell deposition were noted.@*CONCLUSIONS@#These results suggests that AEBM extended protection against various biochemical changes and aortic pathology in hypercholesterolemic rats. Thus the plant may therefore be useful for therapeutic treatment of clinical conditions associated hypercholesterolemia.

Light chain deposition disease presenting as cholestatic jaundice: a case report

Light-chain deposition disease [LCDD] is characterized by tissue deposition of the immunoglobulin light chains in multiple organs. These deposits appear similar to amyloid on routine sections, but differ in their staining properties and ultrastructural appearance. The deposits of LCCD are non -Congophilic and do not exhibit a fibrillar ultrastructure; while, the proteinaceous substance seen in primary amyloidosis is Congo red positive and fibrillar. One of the most common organs to be involved in LCDD is the kidney. Earlier reports on cases of LCDD have mostly shown simultaneous liver and renal involvement, there are very few cases in the literature describing LCDD of the liver without renal involvement. This report describes a patient who presented with severe cholestatic jaundice and liver cell failure with normal renal function

Efficacy of differential non-invasive approaches in determining the clinical course in patients with Crohn’s disease.

Background: We tested the hypothesis that, elevated levels of C-reactive protein might serve as prognostic marker for the classification of Crohn’s disease and its clinical course. Objectives: The present study was undertaken to explore if serum C-reactive protein (sCRP) levels along with the conventional cytogenetic and molecular genetic approaches might serve as efficient prognostic markers with respect to disease classification and clinical course in Crohn’s disease (CD) patients. Methods: We enrolled 43 patients with Crohn’s disease from Tamilnadu region, south of India. The patients were mainly classified into four groups based on disease location. A further sub-classification based on activity of disease was also undertaken in the study. Classification of type of disease activity was based on colonoscopic reports and radiological findings. An equal number of healthy normal age and sex-matched controls were also taken for the study. Results: A positive correlation between sCRP levels, and disease location was observed. Employing a cut-off level of 10 mg/dL, the index CRP level was found to discriminate patients with different locations of the disease along with disease condition when compared to controls. Cytogenetic analysis showed sporadic changes in such patients. The widely reported NOD2 single nucleotide polymorphisms (SNPs) were absent in the patients studied. Conclusion: Different levels of sCRP seem to correlate well with disease location and disease activity. In some of the patients, the CRP levels appeared to reflect disease activity, while in others persistently high levels seem to suggest active disease. Altogether, a positive correlation of CDAI values with CRP levels along with an increase in frequency of chromosomal aberrations was observed in CD patients.

Peribulbar anesthesia for cataract surgery: Effect of lidocaine warming and alkalinization on injection pain, motor and sensory nerve blockade.

Aim: To compare self-reported pain and efficacy of warmed, alkalinized, and warmed alkalinized lidocaine with plain 2% lidocaine at room temperature for peribulbar anesthesia in cataract surgery. Materials and Methods: Through a prospective, single-blinded, randomized, controlled clinical trial 200 patients were divided into four groups. They received either lidocaine at operating room temperature 18°C, control group (Group C), lidocaine warmed to 37°C (Group W), lidocaine alkalinized to a pH of 7.09 ± 0.10 (Group B) or lidocaine at 37°C alkalinized to a pH of 6.94 ± 0.05 (Group WB). All solutions contained Inj. Hyaluronidase 50 IU/ml. Pain was assessed using a 10-cm visual analog score scale. Time of onset of sensory and motor blockade and time to onset of postoperative pain were recorded by a blinded observer. Results: Mean pain score was significantly lower in Group B and WB compared with Group C (P < 0.001). Onset of analgesia was delayed in Group C compared with Group B (P = 0.021) and WB (P < 0.001). Mean time taken for the onset of complete akinesia and supplementation required for the block was significantly lower in Group B. Time of onset of pain after operation was significantly earlier in Group W compared with Group C (P = 0.036). Conclusion: Alkalinized lidocaine with or without warming produced less pain than lidocaine injected at room temperature. Alkalinization enhances the effect of warming for sensory nerve blockade, but warming does not enhance alkalinization, in fact it reduces the efficacy of alkalinized solution for blocking the motor nerves in the eye.

Arginase isoforms in frog and lizard tissues.

Isoforms of arginase in the liver and kidney tissues of the ureotelic frog (Rana tigerina) and uricotelic lizard (Calotes versicolor) were fractionated by DEAE-cellulose chromatography (pH 8.3). Four molecular forms, designated as A’1, A2, A3 and A4 based on the KCl concentration required for their elution from the ion-exchange column, were detected in lizard liver, while only two forms were found in lizard kidney (A3 and A4) and frog liver and kidney (A2 and A3). No major differences were found in the pH optimum, substrate affinity and molecular weight of the isoenzymes. The isoforms in lizard tissues were either totally unaffected or only partially immunoprecipitated by antibodies raised against rat liver and beef liver arginases, but those in frog tissues were significantly activated by the two antibodies. While the physiological importance of the presence of four isoforms in lizard liver remains enigmatic, different sets of isoenzymes were present in the liver of the two ureotelic vertebrates, rat and frog. Hence, it appeared that a given mode of nitrotelism was not associated with a specific set of isoenzymes. Also, the data were not consistent with the generally held view that a basic isoform of arginase served as a component of the urea cycle in liver and a neutral/slightly acidic form functions in the synthesis of proline, glutamate and polyamines in extra-hepatic tissues. The isoforms appeared to show considerable functional overlap.

Assessing in vitro solubilization potential of different zinc solubilizing bacterial (zsb) isolates

A capacidade de Bacillus sp. e Pseudomonas sp. solubilizar zinco foi avaliada usando óxido de zinco, sulfeto de zinco e carbonato de zinco, em ensaios em placas e em caldo. A cultura ZSB-O-1 (Bacillus sp.) apresentou maior dissolução no sulfeto de zinco, com 2,80 cm de zona de dissolução e 14,50 cm2 de área no ensaio em placa e 13,60 mg kg-1 de zinco no ensaio em caldo, no 15º dia de incubação. A cultura ZSB-S-2 (Pseudomonas sp.) apresentou maior capacidade de dissolução no óxido de zinco, com 3,30 cm de zona de dissolução e 20,43 cm2 de área no ensaio em placa e 16,40 mg kg-1 de zinco no ensaio em caldo no mesmo período de inoculação. A cultura ZSB-S-4 (Pseudomonas sp.) apresentou maior potencial de solubilização em carbonato de zinco, com 6,20 cm de zona de dissolução e 13,40 cm2 de área no ensaio em placa e 13,40 mg kg-1 de zinco no ensaio em caldo. Assim, o potencial de solubilização variou de acordo com a cultura. A solubilização pode ser devida à produção de ácido, uma vez que o pH do caldo abaixou de 7,0-7,3 para 4,8-6,5 após 15 dias de incubação. O limite de tolerância ao zinco para as duas culturas (ZSB-O-1 and ZSB-S-2) foi mensurada, verificando-se ser 100 mg kg-1 no ensaio in vitro em caldo.

Assessing in vitro solubilization potential of different zinc solubilizing bacterial (zsb) isolates

Zinc solubilizing ability of Bacillus sp. and Pseudomonas sp. was assessed using zinc oxide, zinc sulphide (sphalerite) and zinc carbonate in both plate and broth assays. ZSB-O-1 (Bacillus sp.) showed highest dissolution in the zinc sulphide (Sphalerite ore), with 2.80 cm of dissolution zone and 14.50 cm² of area in the plate assay and 13.60 mg kg-1 of zinc in the broth assay on the 15th day after inoculation. The ZSB-S-2 (Pseudomonas sp.) showed more solubilizing ability in the zinc oxide, with 3.30 cm clearing zone and 20.43 cm² area in the plate assay and 16.40 mg kg-1 of zinc in the broth assay over the same inoculation period. The isolate ZSB-S-4 (Pseudomonas sp.) has highest solubilizing potential in zinc carbonate with 6.20 cm of dissolution zone and 13.40 cm² area in the plate assay and 13.40 mg kg-1 of zinc in the broth assay. Thus, the solubilization potential varies among different cultures. The solubilization might be due to production of acids by the culture, since the pH of the culture broth has been shifted form 7.0-7.3 to 4.8-6.5 after 15 days of inoculation. The zinc tolerance limit for two cultures (ZSB-O-1 and ZSB-S-2) was studied and determined to be upto 100 mg kg-1 of zinc in the in vitro broth assay.

A capacidade de Bacillus sp. e Pseudomonas sp. solubilizar zinco foi avaliada usando óxido de zinco, sulfeto de zinco e carbonato de zinco, em ensaios em placas e em caldo. A cultura ZSB-O-1 (Bacillus sp.) apresentou maior dissolução no sulfeto de zinco, com 2,80 cm de zona de dissolução e 14,50 cm² de área no ensaio em placa e 13,60 mg kg-1 de zinco no ensaio em caldo, no 15º dia de incubação. A cultura ZSB-S-2 (Pseudomonas sp.) apresentou maior capacidade de dissolução no óxido de zinco, com 3,30 cm de zona de dissolução e 20,43 cm² de área no ensaio em placa e 16,40 mg kg-1 de zinco no ensaio em caldo no mesmo período de inoculação. A cultura ZSB-S-4 (Pseudomonas sp.) apresentou maior potencial de solubilização em carbonato de zinco, com 6,20 cm de zona de dissolução e 13,40 cm² de área no ensaio em placa e 13,40 mg kg-1 de zinco no ensaio em caldo. Assim, o potencial de solubilização variou de acordo com a cultura. A solubilização pode ser devida à produção de ácido, uma vez que o pH do caldo abaixou de 7,0-7,3 para 4,8-6,5 após 15 dias de incubação. O limite de tolerância ao zinco para as duas culturas (ZSB-O-1 and ZSB-S-2) foi mensurada, verificando-se ser 100 mg kg-1 no ensaio in vitro em caldo.

Acute pancreatitis with disseminated intravascular coagulation.

Acute Pancreatitis is seen very frequently. We report a case of acute pancreatitis with a rare complication of disseminated intravascular coagulation (DIC), who recovered completely.