Dose-volume histogram parameters and patient-reported EPIC-Bowel domain in prostate cancer proton therapy

Purpose@#To analyze rectal dose and changes in quality of life (QOL) measured with the Expanded Prostate and Cancer Index Composite (EPIC) bowel domain in patients being treated for prostate cancer with curative-intent proton beam therapy (PBT) within a large single-institution prospective registry. @*Materials and Methods@#Data was collected from 243 patients with localized prostate cancer treated with PBT from 2016 to 2018. The EPIC survey was administered at baseline, end-of-treatment, 3, 6, and 12 months, then annually. Dose-volume histogram (DVH) parameters for the rectum were computed, and rectal dose was analyzed using BED (α/β = 3), EQD2Gy, and total dose. Repeated measures mixed models were implemented to determine the effect of patient, clinical, and treatment factors (including DVH) on patient-reported bowel symptom burden (EPIC-Bowel). @*Results@#Treatment overall resulted in changes in EPIC-Bowel scores (baseline score = 93.7), most notably at end-of-treatment (90.6) and 12 months (89.7). However, they returned to baseline at 36 months (92.9). On multivariate modeling, rectal BED D25 (Gy) ≥23% was significantly associated with decline in QOL scores measuring bother (p < 0.01; 4.06 points different). @*Conclusion@#Rectal doses, specifically BED D25 (Gy) ≥23%, are significantly associated with decline in bowel bother-related QOL in patients undergoing definitive radiotherapy for localized prostate cancer. This study demonstrates BED as an independent predictor of bowel QOL across dose fractionations of PBT.

Dose-volume histogram parameters and patient-reported EPIC-Bowel domain in prostate cancer proton therapy

Purpose@#To analyze rectal dose and changes in quality of life (QOL) measured with the Expanded Prostate and Cancer Index Composite (EPIC) bowel domain in patients being treated for prostate cancer with curative-intent proton beam therapy (PBT) within a large single-institution prospective registry. @*Materials and Methods@#Data was collected from 243 patients with localized prostate cancer treated with PBT from 2016 to 2018. The EPIC survey was administered at baseline, end-of-treatment, 3, 6, and 12 months, then annually. Dose-volume histogram (DVH) parameters for the rectum were computed, and rectal dose was analyzed using BED (α/β = 3), EQD2Gy, and total dose. Repeated measures mixed models were implemented to determine the effect of patient, clinical, and treatment factors (including DVH) on patient-reported bowel symptom burden (EPIC-Bowel). @*Results@#Treatment overall resulted in changes in EPIC-Bowel scores (baseline score = 93.7), most notably at end-of-treatment (90.6) and 12 months (89.7). However, they returned to baseline at 36 months (92.9). On multivariate modeling, rectal BED D25 (Gy) ≥23% was significantly associated with decline in QOL scores measuring bother (p < 0.01; 4.06 points different). @*Conclusion@#Rectal doses, specifically BED D25 (Gy) ≥23%, are significantly associated with decline in bowel bother-related QOL in patients undergoing definitive radiotherapy for localized prostate cancer. This study demonstrates BED as an independent predictor of bowel QOL across dose fractionations of PBT.

Potential Impacts of Climate Change on UK Potato Production

This study assessed the potential impacts of climate change on potato production in the United Kingdom. Climate change actions are becoming a nightmare for growers worldwide, and the British potato industry is not an exception. Extreme weather conditions were experienced in 2006, 2012, and 2018, respectively. Thus, this study identified the future climate risk associated with major potato producing regions in the UK using the recent climate projection weather data (UKCP18) based on RCP 8.5. In total, the study considered seven (7) regions with a minimum average of 3000 hectares of potato planted area in the past five years. Findings showed that drought, high temperatures, and prolonged precipitation caused significant yield and quality loss in the past, with a likelihood of causing a more harmful impact in the future. The analysis revealed a hotter (Tmax ≥ 25°C, Tmin ≥ 15°C) and drier (1-1.5 mm day-1) summer most especially in the EE, EM, SW, WM, and YH as well as a warmer (Tmax& Tmin 6-10°C) and wetter winter (5 mm day-1 on average) in Scotland and North West England respectively. Future climate is predicted to hinder land preparation and harvesting operation in the Northern regions while the EE, EM, SW, WM, and YH would be faced with drought, with irrigation and water demand increasing by 20-30% as evapotranspiration also increases by 20-30% in 2050-2080. Irrigated potatoes are predicted to double its current spatial coverage in the future. The study identified suitable adaptation measures and strategies required to reduce the impacts of climate change on the British potato industry.

Biochemical and bacteriological profiles of asymptomatic bacteriuria among school children in Ago-Iwoye, Nigeria

Background: Asymptomatic bacteriuria (ASB) in children is a predisposing factor to symptomatic urinary tract infection (UTI) that may be complicated by blood stream infections if not appropriately treated with resultant mortality or morbidity. The objectives of this study are to determine the prevalence of ASB, and evaluate both biochemical and bacteriological characteristics of urine samples of primary school pupils in Ago-Iwoye, Ijebu North Local Government Area (LGA), Ogun State, Nigeria. Methodology: Three hundred and seventy-two (186 males and 186 females) apparently healthy (asymptomatic) pupils aged 2-16 years from four randomly selected primary schools in the LGA were screened for ASB. Clean catch specimen of midstream urine was collected from each subject. Biochemical analysis of the urine was performed with Combi 10 reagent strip. MacConkey and Cysteine Lactose Electrolyte Deficient (CLED) agar plates were inoculated with calibrated wireloop delivering 0.01 ml of urine for aerobic culture at 37oC for 24 hours. Identification of significant bacteria on culture plates was done using conventional biochemical tests. Results: The frequency of clear, slightly turbid and turbid urine were 31 (8.3%), 99 (26.6%) and 56 (15.1%) respectively. All analyzed urine samples were alkaline and negative for ketone, glucose and blood, but contained protein in 230 (61.8%), bilirubin in 184 (49.5%), nitrites in 64 (17.2%) and urobilinogen in 14 (3.7%) subjects. The prevalence of significant bacteriuria was 11.8% (44 of 372) with 7.0% in males and 16.7% in females (p = 0.0063). The frequency of bacteria isolated in descending order were Escherichia coli 61.4%, Staphylococcus saprophyticus 61.4%, Staphylococcus aureus 45.5%, Bacillus subtilis 45.5%, Enterococcus faecalis 43.2%, Enterobacter spp 36.4%, Serratia marscencen 31.8%, Klebsiella pneumoniae 22.7%, Proteus mirabilis 22.7% and Pseudomonas aeruginosa 20.5%. Conclusion: This result highlights the presence of significant bacteriuria among apparently healthy pupils in the study area, with higher prevalence in the female pupils. The apparent risk of developing symptomatic UTI with the attendant complications in these pupils should spur preventive education of parents/guardians and the general populace about this entity

Oral Health and Ageing: A Literature Review / Salud Oral y Envejecimiento: Una Revisión Bibliográfica

ABSTRACT Background: The number of persons aged sixty years and over is increasing worldwide. Oral health in the elderly is frequently under-appreciated. The aim of this narrative literature review is to highlight oral health problems affiliated with ageing and to bring about awareness of these conditions in the elderly. Results: Older individuals have poor oral health due to physiological age induced changes in teeth and oral mucosa, edentulism, dental caries, periodontal disease, xerostomia and oral cancer. Oral health problems in the elderly negatively impact their quality of life. Conclusion: Poor oral health in the elderly adversely impacts general health and quality of life. An integrated and multidisciplinary approach is important for preventing oral diseases and improving and maintaining oral health in the elderly.

RESUMEN Antecedentes: El número de personas de 60 años o más está aumentando en todo el mundo. Con frecuencia se subestima la salud oral de los ancianos. El objetivo de esta revisión de la literatura narrativa es resaltar los problemas de salud bucodental asociados con el envejecimiento y contribuir a la concientización de estas condiciones en los ancianos. Resultados: Las personas mayores tienen salud oral pobre debido a los cambios fisiológicos inducidos por la edad en los dientes y la mucosa oral: edentulismo, caries dentales, enfermedad periodontal, xerostomía y cáncer oral. Los problemas de salud oral en los ancianos impactan negativamente su calidad de vida. Conclusión: La pobre salud oral en los ancianos afecta negativamente su salud general y su calidad de vida. Un enfoque integral y multidisciplinario es importante para prevenir, enfermedades bucales y mejorar y mantener la salud bucal en ancianos.

Prevalence of probable mental illness among college students in a select university in Bangalore rural district.

Background: Mental health is an important aspect in defining the “health status” of a person. Mental health of young adults plays an important role in shaping one’s life, social relationships, career and ultimately a country’s economy. Aims & Objective: (1) To assess the prevalence of probable mental illness among college students in a select university in Bangalore rural district; (2) To find the risk factors associated with probable mental illness. Material and Methods: This study was a cross sectional study undertaken at a private university (having colleges dealing with various academic streams under it) in Bangalore rural district. 404 students under the university were taken for the study considering the sample size required was 300. The General Health Questionnaire-28 (GHQ-28) was used to screen each participant for mental illness. Data was analyzed using measures of central tendency, frequencies & Chi square test. Results: A total of 404 students participated in the study. Males were 265 (65.6%) and females were 139 (34.4%). The mean age of the participants was 20.37 years with SD 1.7 years. Age of the participants ranged between 18- 26 years. A total of 152 (38%) participants were screened positive for mental illness. Probable mental illness was significantly higher among: (a) females; (b) those who reported abuse by parents; (c) those who reported gender bias at home; (d) whose parents were separated/ divorced/ one parent had died; (e) those who were day scholars. Whereas no significant association was found between probable mental illness and (a) age; (b) academic streams; (c) parental marital disharmony; (d) absence of siblings; (e) father being alcoholic. About 50 (12%) participants reported to have had definite suicidal thoughts. Conclusion: The prevalence of probable mental illness is 38% in this study which is high. We recommend screening programmes for mental illness among college students which can go long way in preventing severe forms of mental illness and dire consequences like suicide among young adults

Tel hashomer camptodactyly syndrome a case report / El síndrome de camptodactilia de tel hashomer un reporte de caso

Tel Hashomer camptodactyly syndrome (THCS) is a rare autosomal recessive camptodactyly with muscular involvement. The manifestations of THCS other than camptodactyly are clubbed feet, thenar and hypothenar hypoplasia, abnormal palmar creases and dermatoglyphic ridges, spina bifida and mitral valve prolapse. The syndrome was first described by Goodman et al in 1972 and thereafter two further cases with similar phenotype were seen. Herein, we present another case report and review of the literature of other syndromes associated with camptodactyly and mitral valve prolapse. Further cases with this syndrome need to be reported for mapping of the candidate loci. This will help in planning management and genetic counselling.

El síndrome de camptodactilia de Tel Hashomer (SCTH) es una camptodactilia autosómica recesiva rara con compromiso muscular. Las manifestaciones de SCTH, aparte de la camptodactilia, son: pies equinovaros (zambos), hipoplasia tenar e hipotecar, pliegues palmares anormales, y dermatoglifos, espina bífida, y prolapso de la válvula mitral. El síndrome fue descrito por primera vez por Goodman et al en 1972, tras lo cual se vieron otros dos casos con fenotipos similares. Aquí presentamos otro reporte de caso, y revisamos la literatura de otros síndromes asociados con camptodactilia y el prolapso de la válvula mitral. Se necesitan reportes de otros casos con este síndrome para hacer el mapa de los locus candidatos. Esto ayudará a planear el tratamiento y a decidir el asesoramiento genético.

Caffey disease or infantile cortical hyperostosis: a case report

Caffey disease or Infantile Cortical Hyperostosis [ICH] is a rare and mostly self limiting condition affecting young infants. It is characterized by acute inflammation of the periostium and the overlying soft tissue and is accompanied by systemic changes of irritability and fever. Diagnosis may be delayed as this disorder mimics a wide range of diseases including osteomyelitis, hypervitaminosis A, scurvy, bone tumors and child abuse. The emphasis here is to remind clinicians about the existence of the disease in this country

Immunomodulators for Asthma

New information regarding the molecular mechanisms of allergic disorders has led to a variety of novel therapeutic approaches. This article briefly reviews the pathogenesis of asthma and allergic diseases, discusses the rationale behind using immunomodulators in these diseases; and examines the therapeutic effects of immunomodulators on allergic diseases. There are a number of immunomodulators that have been developed for the treatment of allergic disorders. Some have looked very promising in pre-clinical trials, but have not shown significant benefits in human clinical trials thus indicating the disparity between mouse models and human asthma. This review focuses on immunomodulators that are in human clinical trials and not molecules in pre-clinical development.

Gender differences in sexual behaviour among people living with HIV in Chennai, India.

Background & objectives: Risky sexual behaviour is usually the focus of HIV prevention programmes and little attention has been given to sexual behaviour patterns among HIV positive individuals. In order to ensure that people with HIV receive high quality sexual and mental health services, providers must have a comprehensive understanding of the issues and challenges faced by men and women with HIV. This study was conducted to gain insight into the gender differences in sexual behaviour patterns among HIV seropositive men and women in south India. Methods: This descriptive cross-sectional study on a cohort of 203 seropositive patients (102 women and 101 men) attending outpatient clinics in the Tuberculosis Research Centre and the STD clinic of the Government General Hospital, Chennai, India. A semi-structured interview schedule was administered to collect information from the respondents. Results: Fifty three per cent of the women were discontented with the sexual relationship with their spouse as compared to 23 per cent of the men (P<0.001). Thirty two of the 54 women who refused sex said that their spouses reacted violently to their refusal. More men than women reported to having extramarital relationships most often with a commercial sex worker or a friend, without condoms and usually under the infl uence of alcohol. Interpretation & conclusions: There are gender differences in sexual behaviour patterns among men and women. Understanding these differences is important to plan gender based intervention strategies in order to ensure that people living with HIV have a better quality of life, addressing their sexual concerns both within and outside of marriage. The fi ndings will also help in advocacy and prevention programmes aimed at HIV/AIDS control.

Endovascular treatment of scalp cirsoid aneurysms.

Background: Scalp is the most common site of soft tissue arteriovenous fistulae and surgical excision has been the primary mode of treatment. Endovascular treatment has evolved as an alternative to the surgery. Aims: To evaluate the effectiveness of percutaneous direct-puncture embolization of cirsoid aneurysms. Materials and Methods: From January 1995 to December 2004, 15 patients underwent percutaneous direct-puncture embolization of cirsoid aneurysms. Plain X-ray, computerized tomography scan and complete selective cerebral angiogram were done in all. Seven patients had forehead lesions, four had temporal and the remaining four patients had occipital region cirsoid aneurysms. Lesions were punctured with 21-gauge needle and embolized with 20-50% cyanoacrylate-lipiodol mixture. Circumferential compression was applied during injection. Results: Post-embolization angiogram showed complete obliteration in 11 patients. The remaining four patients required adjunctive transarterial embolization with polyvinyl alcohol particles for complete lesion devascularization. Two patients had post procedure surgery for removal of disfiguring and hard glue cast. There were no major procedure-related complications. No patients had any recurrence in the follow-up. Conclusion: Percutaneous direct puncture embolization of cirsoid aneurysms is a safe and effective procedure. It can be effectively used as an alternative to surgery. Sometimes adjunctive transarterial embolization is also required to deal with deeper feeders.

Delineando a pesquisa clínica: uma abordagem epidemiológica / Designing clinical research: an epidemiologic approach

Um guia prático para o planejamento e a implementação da pesquisa clínica. Direto e de fácil leitura, o texto oferece a médicos e a investigadores clínicos descrições rigorosas dos componentes básicos, enfatizando o bom senso como o ingrediente fundamental do sucesso. Diferenciais dessa segunda edição: exemplos e idéias sobre o que há de novo na pesquisa clínica; expansão dos tópicos relativos ao delineamento e à implementação de ensaios clínicos randomizados; novas abordagens para estimativas de tamanho de amostra, abrangendo novas opções de delineamento; atualização nas questões éticas e na condução responsável da pesquisa clínica; novos capítulos sobre estudos de testes médicos, dados secundários (incluindo estudos suplementares e metanálise), gerenciamento de dados e pesquisa comunitária e internacional.

Mortality in Patients Treated for Tuberculous Pericarditis in Sub-Saharan Africa

Objective: To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design: Between 1 March 2004 and 31 October 2004; we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon; Nigeria; and South Africa; and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study; with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression; we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results: We obtained the vital status of 174 (94) patients (median age 33; range 14-87 years). The overall mortality rate was 26. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40versus 17; P=0.001). Independent predictors of death during follow-up were: (1) a proven non-tuberculosis final diagnosis (hazard ratio [HR] 5.35; 95confidence interval 1.76 to 16.25); (2) the presence of clinical signs of HIV infection (HR 2.28; 1.14-4.56); (3) co-existent pulmonary tuberculosis (HR 2.33; 1.20-4.54); and (4) older age (HR 1.02; 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80; 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34; 0.10-1.19). Conclusion : A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africans. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease

Computational immunology--from bench to virtual reality

Drinking from a fire-hose is an old cliché for the experience of learning basic and clinical sciences in medical school, and the pipe has been growing fatter at an alarming rate. Of course, it does not stop when one graduates; if anything, both the researcher and clinician are flooded with even more information. Slightly embarrassingly, while modern science is very good at generating new information, our ability to weave multiple strands of data into a useful and coherent story lags quite far behind. Bioinformatics, systems biology and computational medicine have arisen in recent years to address just this challenge. This essay is an introduction to the problem of data synthesis and integration in biology and medicine, and how the relatively new art of biological simulation can provide a new kind of map for understanding physiology and pathology. The nascent field of computational immunology will be used for illustration, but similar trends are occurring broadly across all of biology and medicine.

Carotid artery stenting: results and long-term follow-up.

BACKGROUND AND PURPOSE: The role of carotid artery stenting (CAS) as an alternative to carotid endarterectomy in the treatment of for symptomatic carotid artery stenosis is investigated. MATERIALS AND METHODS: Forty-seven patients underwent CAS over 10-year period. Forty-nine vessels were treated. Stenosis quantification was done using North American symptomatic carotid endarterectomy trial method. The mean follow-up period by clinical and Duplex examination ranged is 5.6 years. RESULTS: The technical success rate was 100%. There were four deaths (8.1%) and two (4.1%) minor strokes within thirty days of procedure. There was no major strokes. All patients with minor stroke achieved complete recovery at 1-month follow up. Two deaths occurred probably due to hyperperfusion syndrome (HS) and two due to cardiac arrest. CONCLUSION: CAS is an effective treatment modality of symptomatic carotid artery disease but should be carefully done in high-risk groups having severe medical ailments and those having severe bilateral stenosis of the carotid arteries.

Reliability & validity of the Malayalam hospital anxiety & depression scale (HADS) in cancer patients.

BACKGROUND & OBJECTIVE: The hospital anxiety and depression scale (HADS) has been widely used on cancer patients as an indicator of psychological morbidity. Though the scale has been used in India, no reports are available on translation of HADS in any Indian language and testing the reliability. The present study describes the translation process of HADS into Malayalam and testing its reliability and validity on psychological morbidity in cancer patients. METHODS: The English version of the HADS was translated into Malayalam and was used in this study. The questionnaire was administered to 240 cancer patients and statistical analysis was carried out using Chronbach's alpha to test the internal consistency of the HADS scale while confirmatory factor analysis was carried out using principal axis factoring with equimax rotation and Kaiser Normalization to test its construct validity. RESULTS: The Cronbach's alpha was found to be 0.81 for the HADS anxiety subscale, 0.71 for the HADS depression subscale, and 0.85 for HADS tool. Confirmatory factor analysis (CFA) indicated two depression items (i.e., enjoyment and anhedonia) loading onto the anxiety subscale. Clinical caseness for anxiety was observed in 8 per cent, while 11 per cent of the patients had borderline mood disorder. Clinical caseness for depression was identified in 7.6 and 13 per cent of patients were found to have borderline mood disturbances. INTERPRETATION & CONCLUSION: This preliminary validation study of the Malayalam version of the HADS showed it as an acceptable, and reliable measure of psychological morbidity among cancer patients. The prevalence of anxiety and depression in Indian population was low and enjoyment and anhedonia might present as anxiety initially.

Percutaneous vertebroplasty in the management of vertebral lesions.

BACKGROUND: Debilitating backache due to different types of vertebral lesions is a common cause of morbidity in all age groups. Percutaneous vertebroplasty (PV) gives substantial pain relief and stabilizes the weak vertebrae. Most of the information regarding PV comes from the Western literature. The effect of PV in our population should be studied. AIMS: The primary objective is to assess the therapeutic benefit of PV in alleviating back pain and improving the functional status in patients with painful pathologic vertebrae. The secondary objectives are to study the technical aspects of the procedure and their relation to outcome and complications. SETTINGS AND DESIGN: This is a retrospective hospital-based (tertiary teaching hospital) study. MATERIALS AND METHODS: From January 2001 to December 2004, 46 patients underwent PV procedures. Sixty-five vertebroplasties were done in 13 males and 33 female patients. Twenty-four (36.92%) procedures were done for osteoporotic compression collapse, 26 (40.0%) for hemangioma, and 15 (23.07%) for different vertebral body tumors and metastasis. The Wilcoxon signed rank test was used to evaluate the statistical significance of differences between the preoperative and postoperative levels of pain, mobility and analgesic usage. RESULTS: Most of the patients had pain relief within 48 h. Only minor side effects were encountered. No patient had any deficit related to the procedure. On follow up of 3-48 months, all patients had statistically significant improvement in clinical condition (P < 0.001). CONCLUSION: Percutaneous vertebroplasty is a safe and effective procedure in relieving debilitating backache and can be used to treat vertebral lesions in selected cases.