ABSTRACT
Genetic defects of SLC29A3 result in a wide range of syndromic histiocytosis that encompasses H syndrome. Patients with SLC29A3 variants typically have hyperpigmentation, hypertrichosis, hepatosplenomegaly, sensorineural hearing loss, diabetes mellitus, and hypogonadism. Herein, we identify a novel phenotype in a girl presenting with clinical and laboratory findings similar to systemic juvenile arthritis and hyperferritinemia. Exome sequencing identified a homozygous variant in SLC29A3 (NM_018344.5: c.707C>T [p.T236M]). Our patient did not show the cardinal features of the broad spectrum of SLC29A3-related disorders. She demonstrated remarkable improvement in her clinical and laboratory manifestations after starting interleukin-1 blockade (Anakinra). Recent research suggests that SLC29A3-related disorders are accompanied with autoinflammation and autoimmunity due to an overactive inflammasome pathway, which is most likely induced by mitochondrial and lysosomal dysfunction. Hence, our findings may expand the phenotypic features of the SLC29A3 variant. Patients with the SLC29A3 variant and systemic inflammation may benefit from interleukin-1 blockade as a therapeutic option.
ABSTRACT
Background@#Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19–positive autopsies performed in Jordan. @*Methods@#The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples. @*Results@#Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings. @*Conclusions@#The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.
ABSTRACT
Macroamylasemia is a rare condition characterized by the formation of an amylase–globulin complex that is too large to be readily excreted by the kidneys and leads to elevated serum amylase levels. It is a benign condition lacking severe signs and symptoms that does not require treatment. This paper presents a case of a middle-aged man with unexplained elevated serum amylase levels. Despite an initially elevated triglyceride level, clinical findings, laboratory test results, and radiological findings were not suggestive of pancreatitis. The ratio of renal amylase clearance to creatinine clearance was calculated at <1%, consistent with macroamylasemia. No specific treatment was given, and he was monitored periodically. Nevertheless, macroamylasemia is a diagnostic challenge because of the need to differentiate it from other causes of hyperamylasemia to avoid unnecessary tests and treatments.
ABSTRACT
Objective@#Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases. @*Methods@#All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient’s electronic medical record and procedure reports. @*Results@#Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure. @*Conclusions@#Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.
ABSTRACT
Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.
ABSTRACT
@#Introduction: Although vitamin D deficiency among young children is widespread, deficiency status may vary among regions. Data on the prevalence of vitamin D deficiency among children in Mosul city are lacking. This study aimed to determine the prevalence of vitamin D deficiency among primary school children in Mosul city, North Iraq. Methods: This cross-sectional study was conducted in the government primary schools in Mosul city over the period from February to May 2019. Multistage random sampling technique was applied; four governmental primary schools in Mosul city were selected. A representative sample size of 1072 children, aged between 6 and 12 was enrolled, serum 25OHD was analyzed in all the participants. Results: Vitamin D deficiency (25OHD < 12 ng/ml) was found in 59.7% of children, vitamin D insufficiency (25OHD 12-19 ng/ml) was evident in 33.8% of children, whereas only 6.3 % of children had vitamin D sufficiency (25OHD ≥ 20 ng/ml). Boys had significantly higher levels of 25OHD compared to girls, (p = 0.0001). There was no significant difference in 25OHD concentrations in relation to parental education. There was a weak reverse significant correlation between body weight and 25OHD concentrations, (r = - 0.117, p = 0.000). Conclusion: Only 6.3 % of primary school children in Mosul city had sufficient vitamin D status. Vitamin D supplementation to primary school children is essential.
ABSTRACT
Objective:To investigate the effect of Corchorus olitorius aqueous fraction (COAF) on quorum sensing (QS)-regulated virulence factors and biofilm formation in Pseudomonas aeruginosa (PAO1). Methods:The preliminary screening of the anti-QS effect of COAF was performed by evaluating the anti-pathogenic activity against Chromobacterium violaceum CV026 biosensor strain. Next, the inhibitory effects of COAF on QS-regulated pyocyanin production, proteolytic and elastolytic activities, swarming motility, and biofilm formation were evaluated in PAO1.Results:The results showed that the treatment of COAF significantly decreased the biofilm biomass, attenuated virulence factors, and inhibited swarming motility of PAO1 without affecting the growth of the bacteria in a dose-dependent manner. COAF at 2000 μg/mL significantly decreased Las B elastase activity in PAO1 culture, exopolysaccharide production, swarming motility, pyocyanin level, and biomass of PAO1 by 55％ (P<0.05), 60％ (P<0.01), 61％ (P<0.01), 65％(P<0.01) and 73％ (P<0.01), respectively. In addition, the production of violacein was decreased by 62％ (P<0.01) with the treatment of a high dose of COAF. Conclusions:These findings indicate that COAF can be a potential source of anti-QS agents.
ABSTRACT
Background:Teeth are among the most important parts of our body which help in mastication, phonetic and esthetic. Now a daystooth extraction can be avoided due to availabilities of most advanced treatment. Mostly, extraction is the treatment of choice for extensive caries and severe periodontitis because of late reporting to dentist due to lack of knowledge. Knowledge about post extraction complications and their management can prevent the occurrence of untoward sequalae following extraction. Previous studies have shown that preoperative patient education can help in decreasing postoperative anxiety, pain and complications Methodology:This is a questionnaire based cross-sectional descriptive study. The study was conducted during the period of January to March 2018. Total of 250 patients (138 males and 112 females) were included in the study by the convenient method of sampling that visited the dental clinics of college of Dentistry, TaibahUniversity.Validated questionnaire was asked about post extraction preventive knowledge.Categories of answer was good, average and poor according to number of correct answers.The statistical analysis was performed by the Statistical Package for Social Science version 21 (SPSS Inc Chicago, IL, USA). The significant value was obtained by using Chi Square test and p< 0.05 was set to be significant. Results:Females and 31-45 years age group had betterpost extraction preventive knowledge and there was significant relation. Nationality and education level had no significant relation with level of post extraction preventive knowledge. The patients who had better knowledge followed the instructions precisely. Conclusion:It was concluded that female, patients above middle age group and more qualified patients had more post extraction preventive knowledge and they also followed the instructions very strictly. The importance of study came out that dentist or dental assistant should explain and convince them to follow proper post-operative instruction to avoid complications
ABSTRACT
Background: Acute myocardial infarction (heart attack) is a condition of the heart that occurs when blood flowto the heart muscles is stopped abruptly. The disruption in blood flow to the heart muscles is usually caused by ablockage of one or several coronary arteries. Heart attacks can be fatal owing to the critical functions performedby blood in the heart. Fatalities arising from heart attacks are witnessed all over the world. The difference infatality rates of heart attacks is highly dependent on the exposure to risk factors such as smoking and obesity.Healthy living populations will rarely encounter high cases of a heart attack. This study was set out to assess anddocument the knowledge level of acute myocardial infarction patients regarding the modifiable risk factors of aheart attack in Saudi Arabia. Patients suffering from a heart attack are at great danger of fatality. Knowledge ofmodifiable factors can promote healthy living habits and behaviors among them. Methods: A cross-sectionalsurvey was developed to assess knowledge levels of acute myocardial infarction patients in the three cities ofRiyadh, Jeddah, and Dammam. A total of 123 participants were recruited through convenient sampling across15 hospitals in the cities. The eligibility criteria for recruitment included a mandatory age of 18 years and SaudiArabian citizenship. Participants were issued with questionnaires containing different questions on modifiablerisk factors (fatty foods, vegetables, fruits, smoking, physical exercise, and obesity). Results: Five out of the sixmodifiable factors represented knowledge levels of less than 50%. Participants were only knowledgeable on therisk factor of obesity which saw 52.8% associating it with a heart attack. Conclusion: There is a need to boosteducation and awareness among acute myocardial infarction patients in Saudi Arabia.
ABSTRACT
Background: Acute back pain is any pain located at the back that lasts for less than 4 weeks duration. Theprevalence is fair with as many as 84% of the adult population around the globe experience back pain at somepoint in life and is often self-limiting. However, in few selected patients it may serve as indicator of a seriousunderlying disease making it crucial to properly evaluate, characterize and address this concern. Objectives: Inthis review we intend to explore the prevalence, risk factors and highlight the available methods using diagnosticimaging modalities to evaluate and address this condition. Materials and Methods: A review of relevant articlespublished from 1987 onwards in English language was done using the electronic databases of PubMed Pico and,Google Scholar with preset keywords. Conclusion: Acute back pain prevalence range between 22 to 48 percentand risk factors are non-modifiable such as advanced age and female gender while modifiable risk factors areobesity, smoking, low education, sedentary lifestyle, etc. Employment related factors such as physically strenuouswork also increase the risk of developing back pain. Notably, under-appreciated risk factors includingpsychological risk factors such as anxiety should be screened for while evaluating patients. Evaluation of backpain mostly relies on comprehensive history and physical examination, as most cases are self-limited. Diagnosticimaging is only recommended in cases presenting with red flag symptoms.
ABSTRACT
Background: Colorectal cancer is a common type of cancer in Saudi Arabia and globally. Timely screening isneeded to improved treatment outcomes. The success of colorectal cancer (CRC) depends on the compliance bythe targeted population. The aim of this study is to determine how patients’ knowledge, beliefs, behavior, selfefficacy, and barriers affect CRC screening. Materials and Methods: A cross-sectional study design was used. Atotal of 925 patients were recruited as participants from 38 hospitals in Riyadh, Jeddah, Makkah, Dammam, AlAhsa, and Albaha. Data was collected using questionnaire delivered to the participants. Results: Most of theparticipants (over 95%) were aware of CRC. More than half knew about CRC screening. However, response toscreening programs was low due to the lack of knowledge, fear, and insufficient patient awareness programs.Conclusion: Majority of the patients are willing to get regular CRC screening. However, there are low rates ofactual screening due to fear and embarrassment, lack of knowledge, and other barriers. Healthcare workers needto intervene by creating enough public awareness.
ABSTRACT
Purpose@#To investigate macular microvasculature changes using optical coherence tomography angiography (OCTA) and analyze their correlation with the structural parameters in highly myopic eyes. @*Methods@#We measured the area of the foveal avascular zone (FAZ) and the parafoveal vessel density in the superficial and deep retinal plexuses using OCTA. The magnification effect of the FAZ area was corrected using Bennett's formula. Retinal thickness measured at each corresponding area of the OCTA parameters, subfoveal choroidal thickness, and ocular characteristics were reviewed, and the relationships between the microvasculature measurements and the ocular structural characteristics were explored. @*Results@#Fifty-two eyes with high myopia and 52 normal sex- and age-matched controls were included in the analysis. The FAZ area was significantly larger in the myopic eyes (p = 0.023). The superficial parafoveal vascular density was significantly decreased (p= 0.007) in the myopic eyes compared with the normal eyes, whereas there was no significant difference in the deep parafoveal vascular density (p = 0.226). Regarding the retinal thickness, only the parafoveal inner retinal thickness was significantly smaller in the myopic eyes than in the normal eyes (p = 0.023). The FAZ and subfoveal choroidal thickness were significantly correlated with the axial length, and the parafoveal inner retinal thickness was significantly correlated with the superficial parafoveal vascular density (all p < 0.05). @*Conclusions@#The FAZ was enlarged and the parafoveal vascular density was reduced in the highly myopic eyes. The decrease was prominent in the superficial capillary plexuses and well-correlated with the retinal thickness profiles. The macular microvascular network alteration may be attributed to the ocular axial elongation that occurs with myopia.
ABSTRACT
Sternalis muscle (SM) is an anatomical variant that lies parallel to the sternum. It is present in (8%) of human population. Awareness about its presence during thoracic imaging is important, since it might be misdiagnosed as a tumor.This study is the first that discusses the prevalence of SM in the Jordanian population and document the level of awareness about SM among intern doctors and surgery and radiology residents. Our aims are to know the prevalence of SM in the Jordanian population, using thoracic multi-detector computerized tomography (CT) images, and to assess the awareness about SM among a sample of intern and resident Jordanian physicians. Random anonymous axial thoracic multi-detector CT images of 1,709 (801 females and 908 males) Jordanian patients, were examined for the presence or absence of unilateral and/ or bilateral SM. A questionnaire aiming to identify SM was distributed among 175 intern doctors, 26 surgery resident and 28 radiology resident doctors, their answers were summarized. The prevalence of SM among Jordanians is 5.9%. The prevalence of unilateral SM is 2.1% on the right side of the thorax and 1.9% on the left side, bilateral prevalence was 1.8%. While 35.7% of the radiology residents could identify SM using CT and/or anatomy images, only 3.9% of surgery residents and none of the intern doctors could. We concluded that SM is present in the Jordanian population, with a prevalence of 5.9% which falls within the global average. Intern doctors and surgery and radiology residents are almost unaware and unfamiliar about SM.
ABSTRACT
Sternalis muscle (SM) is an anatomical variant that lies parallel to the sternum. It is present in (8%) of human population. Awareness about its presence during thoracic imaging is important, since it might be misdiagnosed as a tumor.This study is the first that discusses the prevalence of SM in the Jordanian population and document the level of awareness about SM among intern doctors and surgery and radiology residents. Our aims are to know the prevalence of SM in the Jordanian population, using thoracic multi-detector computerized tomography (CT) images, and to assess the awareness about SM among a sample of intern and resident Jordanian physicians. Random anonymous axial thoracic multi-detector CT images of 1,709 (801 females and 908 males) Jordanian patients, were examined for the presence or absence of unilateral and/ or bilateral SM. A questionnaire aiming to identify SM was distributed among 175 intern doctors, 26 surgery resident and 28 radiology resident doctors, their answers were summarized. The prevalence of SM among Jordanians is 5.9%. The prevalence of unilateral SM is 2.1% on the right side of the thorax and 1.9% on the left side, bilateral prevalence was 1.8%. While 35.7% of the radiology residents could identify SM using CT and/or anatomy images, only 3.9% of surgery residents and none of the intern doctors could. We concluded that SM is present in the Jordanian population, with a prevalence of 5.9% which falls within the global average. Intern doctors and surgery and radiology residents are almost unaware and unfamiliar about SM.
ABSTRACT
@#Multiple mechanisms can cause ischemic stroke in systemic lupus erythematosus (SLE) patients. When a known case of SLE present with an acute ischemic stroke, the decision for offering thrombolytic therapy can be challenging since some of the mechanisms which may have caused the stroke can be a contraindication or a relative contraindication for thrombolytic therapy. Here we present a case where successful intravenous thrombolytic therapy was offered in an SLE patient where a careful history, clinical examination and imaging features were helpful in taking a judicious decision. This is only the third case in the English literature of a known SLE patient being offered thrombolytic therapy.
ABSTRACT
Background: Zamzam water (ZW) is a natural alkaline water that contains several minerals that may represent a powerful tool for cancer therapy. Objectives: In this research, in vitro antiproliferative and apoptotic effects of ZW were investigated in the human breast cancer cell line MCF-7. Materials and Methods: This study was conducted between January 2015 and February 2016. The effects of ZW on the morphology and the cell viability of human breast cancer cell line MCF-7 were determined. The cell death type and cell cycle changes were investigated using flow cytometry. Finally, reactive oxygen species (ROS) were also measured by fluorometric technique. Results: MCF-7 cells treated with either ZW with adjusted pH at 7.2 or unadjusted pH at 8 showed reduced cell viability of cancerous cells. The cell death occurred through the apoptosis pathway under both treatment conditions. The treated MCF-7 cells were arrested in the G2/M phase and decreased in the G1 phase. Only the unadjusted pH ZW sample demonstrated an increase in the production of both cytoplasmic and mitochondrial ROS in MCF-7 cells. Conclusion: All the results in the present study indicated, for the first time, that ZW might have anticancer and apoptotic effects on breast cancer cell line
ABSTRACT
Back ground: Hepatitis C Virus (HCV) infection is one of the leading causes of morbidity and mortality in under-developed countries like Yemen. According to an estimate, 2.0 % of Yemeni's total population suffers from HCV infection which makes a total of 600,000 people. Hepatitis C has emerged as a big challenge for Yemen. Health care workers are at increased risk of being infected due to tremendous exposure. Objective: The purpose of this study was to nd the prevalence of hepatitis C, its risk factors contributing for infection among health care Workers at Sana'a City. Methods: Across sectional survey conducted among 345 health care workers in the main general hospitals and health centers in Sana'a City. Blood samples were collected, and HCV antibodies were measured by using both Enzyme Immunoassay (EIA) and Recombinant ImmunoBlot Assay (RIBA) Results:The prevalence rate of Hepatitis C virus among HCWs was 4.1%. Those who used needle cupping, needle stick injury, surgical operation, the rate was (8.7%), (4.9%) and (4.2%) respectively. Conclusion: The frequency of HCV among health care workers is high. Awareness programs, training and continuing education should be mandatory and establishment of a national policy roadmap to increase knowledge about hepatitis C prevention. It will decrease the incidence of hepatitis C infection among health care workers.
ABSTRACT
Clostridium perfringens is a major cause of gas gangrene. The morbidity of C. perfringens is connected with producing toxins. This cross-sectional study was designed to isolate, genetically diagnose, and study the antibiotic susceptibility patterns of C. perfringens isolated from clinical samples. Different wound swabs (from diabetic patients, cellulitis, and bullet wounds) were taken from 140 patients. For isolation of anaerobic bacteria, samples (in thioglycolate broth) were immediately incubated anaerobically then identified according to the cultural properties and biochemical tests. DNA was extracted from all specimens. Polymerase chain reaction was applied for detection of 16SrRNA and internal transcribed spacer (ITS) genes of C. perfringens. The susceptibility of bacterial isolates to different antibiotics was determined using Vitek 2 system and disk diffusion test. Out of 140 clinical samples collected during this study, 3 (2.14%) C. perfringens isolates were recovered of which 2 isolates (1.43%) obtained from diabetic patients and one (0.71%) from bullet wounds. Results also showed that only 7 isolates (5%) were detected by a molecular method using specific primers 16S rRNA and ITS genes of C. perfringens. Results of antibiotic susceptibility testing showed that all isolates were highly susceptible to penicillins and β-lactamase inhibitors, metronidazole, and aminoglycosides. On the other hand, all isolates were highly resistant to tetracycline, levofloxacin, and erythromycin. The susceptibility patterns of C. perfringens isolates showed that all isolates were multidrug resistance. Using the amplification of ITS gene increases specificity and sensitivity (by reducing non-specific annealing and primer dimer formation) which increases the probability of detection of suspected C. perfringens isolates.
ABSTRACT
PURPOSE: The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. METHODS: This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. RESULTS: The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). CONCLUSION: MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
Subject(s)
Female , Humans , Diagnosis , Magnetic Resonance Imaging , Muscle Contraction , Palpation , Pelvic Floor , Prospective Studies , UltrasonographyABSTRACT
PURPOSE: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation orre-planning prior to commencement of RT. Minor modification included treatment plan changes which didn’t necessarily require RT re-planning. RESULTS: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.