A comparative study of RapidArc and intensity-modulated radiotherapy plan quality for cervical cancer treatment

Background: RapidArc therapy, a complex form of intensity-modulated radiotherapy (IMRT), is now widely used to treat cancer patients. Aims: This study aimed to investigate and compare the plan quality of IMRT and RapidArc techniques using various dosimetric indices to find the better treatment modality for treating patients with cervix cancer. Materials and Methods: Thirteen cervical cancer patients treated with IMRT were selected for analysis and original plans were subsequently re-optimized using the RapidArc technique. Plans were generated such that dose of 5000 cGy was delivered in 25 equal fractions. Inverse planning was done by Eclipse (Varian Medical Systems, Palo Alto, CA) treatment planning system for 15 MV photon beams from computed tomographic data. Double arcs were used for RapidArc plans. Quality of treatment plans was evaluated by calculating conformity index (CI), homogeneity index (HI), gradient index (GI), coverage, and unified dosimetry index (UDI) for each plan. Results and Conclusion: RapidArc resulted in better planning target volume (PTV) coverage as is evident from its superior conformation number, coverage, CI, HI, GI, and UDI. Regarding organs at risk (OARs), RapidArc plans exhibit superior organ sparing as is evident from integral dose comparison. Difference between both techniques was determined by statistical analysis. For all cases under study, modest differences between IMRT and RapidArc treatment were observed. RapidArc-based treatment planning is safer with similar planning goals compared to the standard fixed IMRT technique. This study clearly demonstrated that favorable dose distribution in PTV and OARs was achieved using RapidArc technique, and hence, the risk of damage to normal tissues is reduced.

Mid-upper-arm circumference as a screening measure for identifying children with elevated body mass index: a study for Pakistan / 소아과

PURPOSE: Mid-upper-arm circumference (MUAC) is considered an alternative screening method for obesity. The aims of this investigation were to examine the ability of MUAC to correctly identify children with elevated body mass index (BMI) and to determine the best MUAC cutoff point for identification of children with high BMI. METHODS: Anthropometric measurements (height, weight, and MUAC) from a cross-sectional sample of 7,921 Pakistani children aged 5–14 years were analyzed. Pearson correlation coefficients between MUAC and other anthropometric measurements were calculated. Receiver operating characteristic curve analysis was used to determine the optimal MUAC cutoff point for identifying children with high BMI. RESULTS: Among 7,921 children, the mean (±standard deviation) age, BMI, and MUAC were 10.00 (±2.86 years), 16.16 (±2.66 kg/m2), and 17.73 (±2.59 cm), respectively. The MUAC had a strong positive correlation with BMI. The optimal MUAC cutoff points indicating elevated BMI in boys ranged from 16.76 to 22.73, while the corresponding values in girls ranged from 16.38 to 20.57. CONCLUSION: MUAC may be used as a simple indicator of overweight/obesity in children, with reasonable accuracy in clinical settings.

Tobacco smoking; association and risk of leading cancers among males in the southern Punjab, Pakistan

To assess the risk of different cancer sites among the male smokers of the Southern Punjab, Pakistan. Case-control design. March - July 2012. A data set of 596 males, belonging to the Southern Punjab was collected from the Outdoor Ward of Cancer, Oncology Ward of Nishtar Hospital and Multan Institute of Nuclear Medicine and Radiotherapy [MINAR] Hospital. Through a self-administered questionnaire, smoking status and respondent's history and medical record of various types of cancers were noted. The Chi-square test was used to assess the association between tobacco smoking and cancer disease. For the risk analysis, odds ratios and attributable risk were computed. Among the respondents, 49.0% smoked tobacco. From the medical record, 438 respondents were confirmed cancerous. The average age to start tobacco was noted to be 23.41 +/- 4.85 while the age was 45.29 +/- 12.24 years for tobacco cessation. The percentage of lung cancer among smokers is 24.01 which is highest among all the stated cancer sites. The risk of a smoker getting all types of the stated cancers is at least three times. The risk of lung cancer attributed to smoking is 17.65 and 50.7% of all the stated cancers. Smokers in the Southern Punjab can greatly reduce their risk [more than 50%] of cancer if they quit smoking

Obesity; prevalence among drivers and conductors in Multan, Pakistan

Obesity is currently considered as a global issue to public health. Overweight and obesity among professional workers, particularly among professional drivers and conductors is becoming an equally challenging, yet under recognized, problem in developing countries including Pakistan. The study aimed to assess the prevalence of obesity and central obesity among professional drivers and conductors in Multan city, Pakistan. A cross-sectional study. A total of 345 professional drivers and conductors were studies for public transport and loader vehicles. The anthropometric characteristics of the participants were focused including the body mass index [BMI], waist circumference [WC] and waist-to-hip ratio [WHR]. Along with descriptive statistics and percentages, two-sample t-test was used. The mean BMI of all the participants was 24.35. More than 50% of the drivers and conductors had excess body weight [i.e. BMI >/= 25 kg/m2]. For central obesity, 86 [43.7%] drivers and 28 [18.9%] of conductors had increased waist [i.e. WC >/=0. 94 cm]. Similarly, 34.5% of the said professionals had WHR above the adequate level [i.e. WHR > 0.95]. The averages of BMI, WC and WHR of the public transport vehicle drivers were significantly higher than those of the loader vehicle drivers. The present study concludes that the professional drivers and conductors are much likely to have excess weight

Growth charts of body surface area for adults in Pakistan using quantile regression

To construct growth charts of body surface area [BSA] for men and women, separately using quantile regression approach. A cross-sectional data comprising of 2000 individuals aged 14 years or more, both males and females were taken from Multan city. Data about gender, weight, height, age, marital status and other demographic measures were recorded. Pregnant women were not included in the study. A latest set of formulas was used to compute BSA for men and women, separately. A brief statistical description was provided for the variables under study. Quantile regression approach was used to construct BSA growth charts taking BSA as dependent variable while age with its square and cube as covariates in the said regression. For our data set, the mean age of the respondents was 24.35 +/- 6.96 years. The mean BSA [m[2]] is 1.68 +/- 0.16 and 1.46 +/- 0.15 for men and women, respectively with the respective 95% confidence intervals, [1.67, 1.69] and [1.45, 1.47]. Married men and women have larger BSA as compared to unmarried ones. The percentile curves of BSA for men show a rapid drop followed by a quick growth until the age 20, showing greater concavity between the ages 20 to 30 and then stability at the ages of 30 and above. For women, on the other hand, no obvious concavity is found and the BSA growth increases slowly up to the age 40 and then becomes stable for older ages. Since the use of empirical BSA percentiles with grouped age provide a discrete approximation for the population percentiles so it is more accurate to use continuous BSA percentile curves against given ages while using quantile regression approach. Furthermore, this approach can also be adopted to construct many other growth charts for physiological and medical sciences