Proton therapy for reducing heart and cardiac substructure doses in Indian breast cancer patients

Purpose@#Indians have a higher incidence of cardiovascular diseases, often at a younger age, than other ethnic groups. This higher baseline risk requires consideration when assessing additional cardiac morbidity of breast cancer treatment. Superior cardiac sparing is a critical dosimetric advantage of proton therapy in breast cancer radiotherapy. We report here the heart and cardiac-substructure doses and early toxicities in breast cancer patients treated post-operatively with proton therapy in India’s first proton therapy center. @*Materials and Methods@#We treated twenty breast cancer patients with intensity-modulated proton therapy (IMPT) from October 2019 to September 2022, eleven after breast conservation, nine following mastectomy, and appropriate systemic therapy, when indicated. The most prescribed dose was 40 GyE to the whole breast/chest wall and 48 GyE by simultaneous integrated boost to the tumor bed and 37.5 GyE to appropriate nodal volumes, delivered in 15 fractions. @*Results@#Adequate coverage was achieved for clinical target volume (breast/chest wall), i.e., CTV40, and regional nodes, with 99% of the targets receiving 95% of the prescribed dose (V95% > 99%). The mean heart dose was 0.78 GyE and 0.87 GyE for all and left breast cancer patients, respectively. The mean left anterior descending artery (LAD) dose, LAD D0.02cc, and left ventricle dose were 2.76, 6.46, and 0.2 GyE, respectively. Mean ipsilateral lung dose, V20Gy, V5Gy, and contralateral breast dose (Dmean) were 6.87 GyE, 14.6%, 36.4%, and 0.38 GyE, respectively. @*Conclusion@#The dose to heart and cardiac substructures is lower with IMPT than published photon therapy data. Despite the limited access to proton therapy at present, given the higher cardiovascular risk and coronary artery disease prevalence in India, the cardiac sparing achieved using this technique merits consideration for wider adoption in breast cancer treatment.

Using PCR-PIRA based genotyping for identifying complex vertebral malformation allele in Frieswal young bulls in India

Complex vertebral malformation [CVM] has considerable economic impact on dairy cattle breeding due to extensive use of artificial insemination [AI]. Identifying the carrier is an important factor to reduce the incidence of the genetic disorder. The study was conducted to identify the carriers of CVM in Frieswal cattle by polymerase chain reaction-primer-introduced restriction analysis [PCR-PIRA] method, which was further confirmed by sequencing. Carrier prevalence of 1% was observed in the Frieswal cattle. The results of the study clearly demonstrated the existence of carriers of CVM among Frieswal bull calves. Due to the widespread use of AI it is recommended to screen young bulls at early stages for this defective allele in order to avoid its rapid spread within the population

Case report of rehabilitation of a subject with post polio syndrome.

Post-Polio Syndrome (PPS) affects polio survivor’s years after the initial polio attack. They report new musculoskeletal symptoms. The purpose of this case report was to determine the effect of a physical therapy intervention on these symptoms in a 53 year old male subject with residual poliomyelitis of left lower limb more than right. Strengthening and aerobic exercises along with lifestyle modification advices were found to be beneficial with respect to all outcome measures taken after 4 and 12 weeks of program, with deterioration in none. This is a first case report documenting benefits of physical therapy following PPS in India. Its findings support the use of exercise in subjects with late effects of poliomyelitis and provide clinically valuable knowledge regarding the treatment efficacy of PPS exercise regimens.

Comparison of intraperitoneal and periportal bupivacaine and ropivacaine for postoperative pain relief in laparoscopic cholecystectomy: a randomized prospective study

Patients experience considerable pain during the first 24 hours after laparoscopic surgeries in spite of great progress in pain relief methods. Intraperitoneal local anesthetics in different doses have been used effectively to reduce this pain.The present study was conducted to compare whether moderate dose [75 mg] intraperitoneal and peri-portal bupivacaine or ropivacaine can produce effective pain relief after laparoscopic cholecystectomy. Eighty ASA I and II female patients undergoing laparoscopic cholecystectomy under general anesthesia were included in the study and were assigned to either of the two groups in a double blind randomized manner, Group B and Group R. At the end of the surgery, patients in Group B received 20 ml of 0.25% bupivacaine intraperitoneally and 10 ml was infiltrated in periportal area. Patients in Group R received 20 ml of inj. ropivacaine 0.25% intraperitoneally and 10 ml was infiltrated in periportal areas. Visual analogue score for pain and vital signs were recorded for 24 hours in the postoperative period. Injection of tramadol was administered as rescue analgesic. Total analgesic consumption in 24 hours and side effects were recorded. Statistically significant difference [p<0.05] was found in pain intensity [visceral and parietal pain] within groups during the first 4-6 hrs in the postoperative period. The total number of rescue analgesic doses were similar in both groups and statistically insignificant. Variables of post operative recovery were similar in both groups. Moderate dose intraperitoneal analgesia with local anesthetic [ropivacaine and bupivacaine] is simple to use and effective method with minimal side effects

Thyroidectomy of massive goiter always a surgical challenge

Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with a few especially in endemic areas as marked by WHO, weighing approximately 200-250 grams and very rarely weighing more than 450 grams pose a challenge for an operating surgeon. Herein we report removal of giant goiter in a 60 year old female

Cervicodorsal dermoid cyst

Dermoid cyst is a slow growing benign true hamartoma. It is more common intracranially but comprises 0.7% of all the spinal tumours. Cervicothoracic region is an uncommon site of occurrence of this tumour. Authors present a large intradural dermoid cyst in cervicodorsal region. A 13-year-old boy presented with gradual onset ascending spastic weakness involving both the lower limbs. Magnetic resonance imaging of cervicodorsal region revealed intraspinal intradural extramgdullary cystic lesion extending from C6 - D6 level. C5 - D7 laminotomy and laminoplasty with total excision of the dermoid cyst was done. Here, we report a large intradural dermoid cyst at unusual site with relevant review of literature

study on morbidity and psychosocial behaviour of children of commercial sex workers of North Bengal, India

Background: Children of commercial sex workers [CSW] are deprived from almost all the rights of the society. More attention is paid to the CSWs but their children are neglected. This study was conducted to estimate the morbidity and psychosocial behaviour of children of CSWs and their needs. Methods: A community-based cross-sectional study was conducted. Results: Among 152 children, 72% were malnourished. Exclusive breast feeding [EBF] practices were poor. Only 47% were immunized and health status was not at par with national averages. The high prevalence of cerebral palsy may reflect poor antenatal, perinatal and essential new born care. The most popular desired profession was teacher [20%] followed by player, doctor, and artist. 7% wanted to become soldier while 8% felt very bad about themselves and 10.5% could not sleep well at night. Conclusion: The indirectly elucidated needs regarding health and behaviour of the children of CSWs are only the tip of the iceberg. The children need formal and non-formal health and life skill education and the caregivers need behavioural change communication on health and hygiene

Restorative therapy using autologous bone marrow derived mononuclear cells infusion intra-arterially in patients with cerebral palsy: An open label feasibility study

Cerebral Palsy is a common and devastating neurological disorder, with no medical treatment apart from physiotherapy regimes to alleviate the functional disability. Regenerative medicine using stem cells has gained momentum in recent years as a possible strategy to repair the injured brain. Present study was undertaken in a open label series to evaluate the safety, feasibility and observe for any benefi cial effects of intra-arterial infusion of autologous bone marrow derived mononuclear cells in patients with cerebral palsy with moderate disability. Functional improvement was assessed using the motor power and spasticity scales, dystonia and abnormal movements scale and the activities of daily living scales by modifi ed Barthel Index and modifi ed Rankin Scores. Serial structural imaging with MRI and functional imaging with FDG-PET scans were done. Of the 30 patients injected with an average of 10-30 million cells into each carotid artery, improvements were observed in all clinical scales, and predominantly in the disability scores. No adverse events were noted on a 12 months follow up.

Fibrous hamartoma of infancy in an unusual location - a case report

Fibrous hamartoma of infancy is an uncommon fibroproliferative lesion that occurs only in infancy and childhood. It predominantly affects healthy boys and can be found in almost any subcutaneous tissue. The tumor is most frequently found in the axilla, followed by shoulder, inguinal area, and chest wall. This tumor can cause much concern about malignancy because it is firm and may be fixed to underlying tissues. Despite the occasional local recurrence, the clinical course is benign and the prognosis is excellent. Treatment is by local excision. The diagnosis is made by the characteristic histologic features. In order to avoid the misdiagnosis of malignancy and unnecessary radical therapy, both surgeon and pathologist must be familiar with this entity. We report a case of fibrous hamartoma of infancy in a 4-year-old boy in gluteal region

Combined spinal epidural anesthesia for cesarean section in a pregnant patient with rare intracranial neoplasm

There are several reports of obstetric emergencies in pregnant patients with malignant intracranial tumors precipitated by worsening of the mother's neurological status which necessitate an early delivery of the fetus before definite therapy can be administered to the mother[1-3]. We describe a patient with a sphenoid sinus tumor who developed loss of vision due to rapid tumor progression necessitating an early delivery of her twin fetuses by cesarean section. The patient had co morbidities and requested to be awake during the surgery, she was managed using a combined spinal epidural anesthesia. The advantages of combined spinal epidural anesthesia as compared to a single shot subarachnoid block, epidural block or general anesthesia are discussed in a pregnant patient with decrease in intracranial compliance

Study of agricultural impacts through fish base variables in different rivers

Dominant agricultural society of Nepal demonstrates the sign of compromises on its rural and virgin landscape. The current study investigates the fish base indices on some of its watershed. It is a proven fact that fish base variables such as species diversity and the abundance indicate the extent of impact by various disturbances on the ecological integrity of the river system. Three rivers, namely Jhikhukhola, Rapti and Tinau were studied to see the agricultural impact by taking fish species number and their abundance as the indicators in this work. The study was done for an academic purpose from 2003 to 2006 in which sampling was done using electro-fishing gear by standard wading method. Four replicates of sample taken in four major seasons were obtained in the field. Altogether, 10542 fishes of 24 genera and 34 species were captured during the entire sampling. The comparison of their distribution and abundance showed a clear sign of impact mainly on the downstream of the rivers indicating the rapid increase in unaccounted and indiscriminate use of agricultural inputs such as synthetic fertilizers and pesticides. This was further verified by nonparametric Kruskal-Wallis test which showed the significant variations in the impact on the downstream in major agricultural season

Intramedullary spinal cord abscess

Intramedullary tubercular abscess is a very rare condition, however it needs to be considered in the differential diagnosis of neurological deterioration in a patient of tuberculosis as timely intervention often gives good neurological recovery. The authors report a rare case of intramedullary tuberculous abscess of dorsal spinal cord in a 35-year-old female patient who presented with paraplegia and bladder involvement. Magnetic resonance imaging scans revealed D6-D10 arachnoiditis with intramedullary lesion with extradural compression locally. A dorsal laminectomy with decompression of intramedullary abscess with biopsy of extradural granulation tissue was carried out and patient was started on antituberculous therapy and gradually improved neurologically postoperatively. Intrameduallry tuberculous abscess is a rare condition and surgical intervention is helpful even in the presence of profound neurological deficits

clinical study on the effect of shirodhara and jatamansayadi powder in the management of hypertension w.s.r. to [uccharaktachapa]

As man entered the 21[st] century with modernization in almost each and every walk of life, he has also paid for it by living in several stressful psychological conditions. The response to the psychological conditions varies from person to person because each has different psychic and bodily constitution. However, these stressors play certain roles in the development progression, prognosis as well as management of the disease. This stressful life-style affects one's mind and homeostasis of body by several psychosomatic mechanisms and causes many psychosomatic disorders. The 'Uccharaktachapa' [Essential Hypertension] is one of such diseases. Hypertension is the most prevalent cause for cerebrovascular and cardiovascular disorders, causing high rate of mortality and morbidity. So, hypertension is gaining more and more attention globally. Due to its high prevalence in our country, India is known as the Nation of Hypertension. Hypertension is also known as silent killer of mankind because most sufferers [85%] are asymptomatic and as per available reports, in more than 95% cases of hypertension the under lying cause is not found. Such patients are said to have Essential-Hypertension [EHT]

Seasonal variation of radon, thoron and their progeny levels in dwellings of Haryana and Western Uttar Pradesh

Radon and thoron are invisible, odorless, heavy and radioactive gases which are ubiquitously present in dwellings and in the environment. In the present work, seasonal variation of indoor radon, thoron and their progeny concentrations has been studied in the dwellings of industrially polluted cities in District Faridabad, Haryana and District Mathura in Uttar Pradesh. LR-115, Type-II [Kodak Pathe, France], peelable, plastic track detectors commonly known as solid state nuclear track detectors [SSNTDs] were used to measure the radon thoron concentration over long integrated times. The measurements were carried out in the mixed field of radon and thoron and the detectors were exposed for about 90 days. The average value of radon and thoron concentration in the dwellings varied from 23.5 Bq/m[3] to 65.2 Bq/m[3] and 9.8 Bq/m[3] to 18.7 Bq/m3 respectively in different seasons. The average annual exposure and annual effective dose in living rooms due to radon and thoron progeny was estimated to be 0.195 WLM [working level month] and 0.74 mSv respectively. The average life time fatality risk of lung cancer from the chronic radon and thoron progeny exposure was estimated to be 5.8 ' 10[-3] [0.58%]. The seasonal variations of measured radon levels in the environment of LPG bottling plant, radon-thoron levels and inhalation dose due to radon and thoron and their progeny in dwellings indicate that the levels were higher in winter [October to January] than in summer [April to July]

Impact of high plasma concentrations of dioxin and polychlorinated biphenyls [PCBS] in south Indian women with endometriosis

To estimate the levels of Dioxin and PCBs present in the plasma of women with different stages of endometriosis and relation between Dioxin, PCBs and their possible impact on the pathogenesis of endometriosis. A prospective case control study. Department of Reproductive Medicine, Bhagawan Mahavir Medical Research centre, Maternal Health and Research Trust, and Owaisi Hospital AND Research Center Hyderabad, Andhra Pradesh, India. 97 women with endometriosis undergoing laparoscopy and 102 controls. Heparinised blood samples were collected for dioxins, PCBs estimation. The levels of dioxins and PCBs were measured via gas chromatography. Women with endometriosis showed significantly higher concentrations of dioxin and PCBs when compared with the control group. The correlation between the concentrations of dioxin -TCDD, PCBs, and difference in the severity of endometriosis was strong and statistically significant at p<0.05 for all the four compounds PCB-1: r=+0.53; P<0.0001, PCB-5: r=+0.67; P<0.0001, PCB-29: r=+0.64; p<0.0001, PCB-98: r=+0.43; p<0.0014 and concentration of dioxin-TCDD: r=+0.36, p<0.0001. These results suggest that women having higher concentration of Dioxin and PCBs might have an increased susceptibility to endometriosis

Prognostic value of admission serum albumin levels in patients with head injury

Head injury is major cause of disability and death in the society, however no effective biochemical prognostic markers are available. To assess the prognostic significance of admission serum albumin levels in patients of head injury. Prospective cohort study with control group. Within 24 hours of head injury, 154 patients underwent serum analysis for albumin along with 38 normal volunteers, studied in relation to various factors and subsequently followed-up. Statistical analysis was made with SPSS software, p<0.05 was considered significant. Mean serum albumin in head injury and control were 3.24 and 4.15 g/dL respectively [p<0.001]. Admission albumin had significant positive correlation with Glasgow coma score [GCS] [p<0.001]. Hypoalbuminemia [

Giant pituitary adenomas: surgical outcome in a series of 127 cases

To analyze the surgical and visual outcome of giant pituitary adenomas. One-hundred-twenty-seven patients surgically treated over a 9-year period were studied. Fifty-four-point-three percent had non-functioning adenomas. Among the functioning adenomas, prolactinomas were the most common. A total of 90 transsphenoidal and 52 transcranial procedures were performed in 127 patients. The complications and deaths were significantly higher in the transcranial group. There were a total of 15 deaths [11.8%], Thirty-two-point-two percent had single/multiple postoperative complications. Vision improved in 49 patients [41.9%] at the time of discharge. Thirteen-point-eight percent of the pituitary adenomas are giant. Transsphenoidal surgery was the procedure of choice for most of the patients. These tumours represent a difficult group to treat. Prolactin estimation and preferably immunohistochemical analysis should be done in all patients in order to clinically diagnose indistinct prolactinomas

Superoxide radical formation in isolated PMN from experimental vaginal trichomoniasis

Trichomoniasis, the most widespread sexually transmitted disease is caused by Trichomonas vaginalis. This parasite is site specific for the genitourinary tract and recruitment of macrophages as well as polymorphonuclear nutrophils [PMN] to the site of infection is the first line of defense as a component of non-specific resistance and immunity. In this study, BALB/c mice were infected with 10 isolates from symptomatic and 10 from asymptomatic patients. Then PMN from vaginal washes, vaginal tissue and blood of infected mice was isolated and the rate of superoxide formation by intact stimulated PMN was measured. Results showed that, mice infected with symptomatic isolates indicated significant increase in polymorphs with increase in days of infection as compared with mice infected with asymptomatic isolate and control [uninfected] animals. Vaginal tissue cells generated maximal amount of superoxide in symptomatic isolates infected animals [5.17 +/- 0.36] as compared to asymptomatic isolates [4.54 +/- 0.43], which brings out the maximal abnormality in PMN in this localized area. The amount of superoxide radicals generated by cells of vaginal washes and blood of symptomatic isolate infected mice] 4.29 +/- 0.25 and 2.16 +/- 0.35] was less than the asymptomatic isolate [4.94 +/- 0.49 and 3.18 +/- 0.26], respectively. This study indicates that super oxide radical generation may play role in establishing the infection

Length-weight relationship of sucker head, garra gotyla gotyla [gray, 1830] in different rivers of nepal and the influence of monsoon

Size structure data particularly that of length and weight is very important fisheries management tool, which is also applied to assess the health, habitat and integrity of the rivers. Nepal is tremendously rich in both fisheries and water resource and thus, this analysis is very important. However, this kind of analysis is not common in fisheries studies and hence the size structure information of all the fish in Nepal is wanting. This study simply tries to open the door for such studies with the study of the sucker head Garra gotyla gotyla, a very common fish in Nepal. The field observation was done in nine rivers of the country in all the seasons of the 2003 by using electrofishing gear. The length-weight relationship was found to vary both spatially and temporally among rivers and seasons respectively indicating different conditions in different rivers. The length weight relationship also showed some interesting facts about the seasonal cycle of the species indicating the period of growth and stress in different rivers. The monsoon event was found to be highly influential in this relationship

Measurement of inhalation dose due to radon and its progeny in an oil refinery and its dwellings

Radon, an invisible, odorless, heaviest [nine times heavier than air] and radioactive gas is an aberration [the only gas in the long decay chain of heavy metal elements]. It is ubiquitously present in dwellings and in the environment. Humans receive the greatest radiation dose in their homes. That's where they spend most time - typically 70%, more for small children. Recent worldwide surveys reveal that an average person receives each year more radiation from radon than from all other natural or man-made sources combined. Over the years, the radiation exposure accumulated at home may exceed the exposure of uranium miners and lead to lung disorders. Therefore it is fundamental and justified to make a quantitative assessment of the radon in dwellings and the environment of work place. In this study, measurement of radon and its progeny levels was carried out in the environment of an oil refinery. Besides, radon and its progeny levels were also measured in the dwellings situated on the refinery premises and the dwellings in the city for comparison. Materials and LR-115, Type- II [Kodak Pathe, France], plastic track detectors commonly known as solid state nuclear track detectors [SSNTDs] were used to measure the radon concentration over long integrated times. Alpha particles emitted from radon cause radiation damage tracks, which were subsequently revealed by chemical etching in NaOH. These alpha tracks registered were counted by optical microscope at suitable magnification and converted into radon concentration. The geometric means [GM] of potential alpha energy concentration [PAEC], Equilibrium Equivalent Concentration of radon [EEC value], annual exposure and annual effective dose in the environment of refinery premises was 10.09 mWL, 93.43 Bq m-3, 0.41 WLM and 1.61 mSv, in refinery dwellings 12.21 mWL, 112.96 Bq m-3, 0.50 WLM and 1.94 mSv and in city dwellings 8.24 mWL, 76.23 Bq m-3, 0.34 WLM and 1.31 mSv respectively. The dose levels in the refinery premises were found to be marginally below the ICRP recommendations. The radon and its progeny levels were higher in the dwellings of refinery township as compared to the city dwellings. While studying seasonal variation, it was found that the measured values of radon and its progeny levels were higher in winter [November to February] than in summer [May to August]. This study showed that the presence of fossil fuels like natural gas, LPG etc. in the environment had resulted into higher levels of radon and its progeny in the refinery dwellings