Robotic percutaneous coronary intervention (R-PCI): Time to focus on the pros and cons

Aim: To assess the safety, efficiency, and device compatibility of the Second Generation Robotic System. Methods: Data on Robot-Assisted PCI (RePCI) is frequently insufficient in India. Many articles were published in national, non-indexed journals that are not available online and are difficult to obtain. Recognizing these constraints, the current review is intended to compile the available data on this important new innovation technique. This review could encourage future research and serve as a valuable source of information. Results/Conclusion: In terms of procedure efficiency, operator radiation reduction, and safety, the recent implementation and development of second-generation robotic systems have had a significant impact on interventional cardiology. This technology will play a significant role in the future of interventional cardiology as advancements eliminate the need for manual assistance, improve devices compatibility, and expand the use of robotics for telestenting procedures. A larger study demonstrating the safety and feasibility of tele-stenting over greater geographic distances, as well as addressing fundamental technical difficulties, would be required before attempting RePCI

Career Preferences Among Final Year Medical Students and Interns: A Cross Sectional Study

Introduction: The increase in the number of undergraduate medical seats in India, suggests the need for faculties trained in specialist fields to ensure adequate education at the university level. Career selection is considered an important aspect of medical course admission and some career options are often overlooked by students. An insight into factors affecting the decision making could aid preparing workforce to prevent the over or under supply of doctors in various specialties. Aim: To determine the career preferences among final year medical students and interns in a private medical college in Tamilnadu, India. Materials and Methods: A cross sectional survey was conducted among final year part two MBBS students and CRRI’s who were going to complete their internship in three months, by a pre validated questionnaire consisting of two sections, the first section consisting of demographic details and the second section consisting of fixed response questions about their career choices. A sample of 100 final year students and 140 CRRI’s participated in this study. The primary data is analysed with SPSS software, and chi square test was done. Results: Female students mostly preferred General medicine, Obstetrics & gynaecology and Paediatrics, while male students preferred General medicine, Paediatrics, General Surgery and Radiology. Among the students who participated in the study, 20.4% have not decided which speciality to pursue. Conclusion: The medical students career options in our medical college was in favour of a few departments.

Efficiency of honeycomb selection design in early segregating generation in ADT45 × Nona Bokra cross under salt stress

Salt stress is a major abiotic stress that limits rice productivity worldwide including India. As modern rice varieties are salt sensitive, infusing salt tolerance through breeding is a viable farmer-friendly approach. Breeding salt tolerant rice varieties has been slow due to complexity of the trait and high Genotype x Environment interaction in the salt affected field. Selection practiced in such a situation using conventional selection method, in the presence of competition, would be misleading. On the otherhand, selection is effective in the absence of competition in honeycomb selection and counteracts the disturbing effects of competition on effectiveness of selection. The present study was conducted to test the efficiency of honeycomb selection design in early generation of a rice cross to study genetics of yield and practice selection. All the characters studied in both the design showed non normal distribution except for panicle length in CSD. All the characters studied in both the design had lower coefficient of variation, high mean and high standard deviation in the HSD compared to CSD. Large number of genes with duplicate epistasis governs days to flowering whereas panicle length and single plant yield are governed by few number of genes with complimentary epistasis. Twenty nine F2 plants each in CSD and HSD were selected based on mean and plant index (SPY), respectively. Plants selected in HSD recorded higher percentage of increase over base population compared to CSD and found HSD to be superior to CSD because of enhanced phenotypic expression in the former by eliminating confounding effects of negative correlation between yielding and competitive ability.

Serum ferritin as a prognostic marker in acute stroke;a cross-sectional observational study

Background: Stroke is the leading cause of morbidity and mortality all over the world. Several prognostic factors like site and size of infarction, Glasgow coma scale, level of cerebral edema, intracranial tension have been found significant in stroke. Among the prognostic indicators ferritin has gained importance in recent times. It is considered an acute phase reactant and has been used for assessing the severity and prognosis of stroke.Aim of the study was tocorrelate the levels of serum ferritin with early neurological status and to predict the severity and prognosis earlier in patients of acute stroke.Methods: This cross-sectional observational study was done in Saveetha hospital, Chennai. Clinically diagnosed CVA patients within 48 hours of the onset of symptoms were recruited in this study. 122 patients above 18 years who fulfilled the criteria were included and patients with a recent history of inflammation, malignancy, and anemia were excluded.Results: Around 60.7% of patients had improved and the remaining of them deteriorated. The level of serum ferritin was well correlated with the patient's prognosis. Those who deteriorated had high serum ferritin when compared to those who improved and it was statistically significant.Conclusions: From our results, we concluded that patients with increased ferritin concentrations have a higher risk of poor clinical outcomes. These findings suggest that iron overload may counterbalance the benefits of thrombolytic therapy in patients with high ferritin levels. Therefore, serum ferritin can be used as a prognostic marker for assessing the severity and prognosis of stroke.

Can High-Sensitivity C-Reactive Protein Levels Predict Functional Outcome Following Epidural Steroid Injection in Patients with Lumbar Disc Disease?

Methods@#This was a prospective study, with 77 patients in the study group and 23 participants in the control group. Baseline hs- CRP levels were obtained for both groups. Study group patients received a single ESI and were subjected to detailed pre- and postprocedure evaluation using MODY scores. For this group, hs-CRP levels were measured at 1 and 2 months after injection. @*Results@#Out of 77 patients, 52 had acute and 25 had chronic low back pain. Thirty-six patients with acute pain obtained significant improvement, while 16 had an insignificant response to the ESI. None of the chronic cases had a significant response. The mean baseline hs-CRP (mg/L) among the study group (29.83±10.43) was significantly higher than for the controls (10.26±2.783). The baseline hs-CRP among acute cases, where post ESI MODY score at 2 months had significant reduction, was 32.19±5.126, and those with insignificant reduction was 18.13±7.949 (p <0.001). @*Conclusions@#Baseline hs-CRP levels can be used to prognosticate the outcome following ESI in patients with acute lumbar disc disease, with radicular pain refractory to physiotherapy and analgesics.

The Aftermath of Corona Pandemic on the Psychosocial Life of Coimbatore South Population: A Cross-sectional Study

Introduction: Coronavirus disease is an infectious disease caused by a newly discovered coronavirus. Since the new coronaviruscan spread unnoticed so easily, many governments have felt the best way to ensure people having minimal contact with eachother is to order total lockdowns. This study is performed a month after lockdown to evaluate the impact of corona pandemicon the psychosocial life of Coimbatore south population.Materials and Methods: A cross-sectional randomized study was conducted at Coimbatore South, Tamil Nadu, India, betweenApril 26, 2020, and April 30, 2020. The sample size was 600. Pre-tested structured and self-structured e-questionnaire wassent to the study population and the answers were viewed using separate email id.Results: Of the 600 people, 59.5% were males and 40.5% were females. The majority (82.5%) of people felt that they weresafe during the pandemic majority of people (61%) felt that the modern lifestyle was the cause for the pandemic and 66.9% ofthe people increased the usage of traditional and natural remedies during the lockdown.Conclusion: We infer that the majority of the people (55%) enjoyed the break from their routine with an eye on their educationand career.

Meckel’s Diverticulum: Still Formidable during Acute Abdominal Surgeries – An Observational Study

Introduction: Meckel’s diverticulum is a relatively common congenital diverticulum of ileum resulting from incomplete atrophy of the vitellointestinal duct in the embryo. Even though the majority of Meckel’s diverticulum is asymptomatic, their potential to present with severe complications such as bleeding and perforation, intestinal obstruction has, nevertheless, caused much debate regarding whether a silent Meckel’s should be pre-emptively resected when incidentally discovered during acute abdominal surgeries. Aim: Our study aims to analyze the incidental finding of Meckel’s diverticulum during acute abdominal surgeries and its surgical management. Materials and Methods: This prospective observational study was conducted for the incidental findings of Meckel’s diverticulum during acute abdominal surgeries. All the patients clinical, radiological, laboratory, and pathological findings were collected and the results were statistically analyzed and discussed. Results: Out of 13 patients, 9 were males and 4 were females, based on age 10 years, patients had age below 40 years and 3 of them had above 40 years, based on clinical manifestations, 1 had perforative peritonitis, 1 had intestinal obstruction, 1 had acute diverticulitis, 1 had recurrent abdominal pain, and 9 were asymptomatic and incidentally found, among them 5 were found during appendectomy, 1 during gastrectomy, 1 during hernia surgery, 1 during traumatic Whipple’s procedure, and 1 during gastrojejunostomy. Conclusion: Symptomatic Meckel’s diverticulum was associated with dreaded complications such as perforative peritonitis, intestinal obstruction, and diverticulitis with severe pain which made us conclude about even an asymptomatic Meckel’s diverticulum found incidentally during acute abdominal surgeries need to be resected.

Right Direct Inguinal Hernia in Patients Underwent Open Surgery for Appendicitis – A Retrospective Study

Introduction: Acute appendicitis is the most common surgical emergency faced in today’s world. The inguinal hernia is the most common type of hernia seen in surgical practice. It can be of a direct and an indirect type. While the indirect type has a congenital cause, direct hernias are attributable to the weakness of abdominal wall musculature. Aim: This study aims to study the prevalence of right (direct) inguinal hernia in patients who underwent open surgery for appendicitis. Materials and Methods: In this retrospective study, 100 patients who underwent surgery for the right direct inguinal hernia were included in the study. Patients’ demographic details, history of open appendectomy, and the clinical presentation were collected. The examination consisted of inspection, palpation, percussion, and auscultation and included various tests such as cough impulse and three-finger test. These findings were later confirmed with an ultrasound abdomen examination. Results: Among these 100 patients, 13 of them had the previous history of open appendectomy, all the study patients were male and they had the right direct inguinal hernia after 5 years of surgery. Among these 13 patients, 10 had perforated appendicitis, 2 had abscess, and 1 had purulent appendicitis. Among these 13, 11 of them had cosmetic Rutherford Morrison or Lanz incision and 2 of them had classical McBurney’s incision. Conclusion: The choice of the incision during open appendectomy is important and the surgeon should avoid injury to the ilioinguinal nerve motor branches which supplies the internal oblique and transverse abdominis muscles, care must be taken during surgery, especially below the horizontal line extending from the anterosuperior iliac spine to the rectus muscle.

Clinical spectrum of inborn errors of metabolism in children in a tertiary care hospital

Background: Inborn Errors of Metabolism (IEM) are a group of disorders occurring due to disruption of normal biochemical process. Prompt diagnosis is often only the beginning of a long medical journey for the affected children and their family. Pediatricians play a vital role in establishing the continuity of care, providing treatment when needed and referrals to specialists. Reported prevalence of IEM is 1 in 2497 newborn though, true pan India prevalence is still unknown. This study was carried to determine the clinical spectrum of inborn errors of metabolism in a tertiary care hospital in South India.Methods: Records of all patients suspected and diagnosed to have inborn errors of metabolism in Institute of Child Health and Hospital for Children, Madras Medical College from April 2018 to October 2019 were sequentially included in the study. Details of clinical presentation, investigations and treatment were noted and analysed.Results: In this study 65 children diagnosed to have inborn errors of metabolism were included in the study and of them 27(41.5%) had derangement in carbohydrate metabolism, 16(24.6%) in protein metabolism and 22(33.9%) in lipid metabolism. Mean age at presentation was 37 months with range of 2 months to 10 years of age. Most common clinical manifestation was poor feeding (67.7%) followed by fever (64.6%) and dyspnea (63.1%). Of these 65 children, mortality was observed in 10 cases (15%).Conclusions: IEM contribute to a significant cause of global child morbidity and mortality. A high index of suspicion is most important in making the diagnosis. IEM should be considered in children with features mimicking sepsis and unexplained course. Screening programmes and prenatal diagnosis of IEM will go a long way in preventing these disorders and early diagnosis helps initiate prompt therapy which is very much essential to prevent lethal complications.

Estimation of the reproduction number and early prediction of the COVID-19 outbreak in India using a statistical computing approach / 한국역학회지

Coronavirus disease 2019 (COVID-19), which causes severe respiratory illness, has become a pandemic. The World Health Organization has declared it a public health crisis of international concern. We developed a susceptible, exposed, infected, recovered (SEIR) model for COVID-19 to show the importance of estimating the reproduction number (R0). This work is focused on predicting the COVID-19 outbreak in its early stage in India based on an estimation of R0. The developed model will help policymakers to take active measures prior to the further spread of COVID-19. Data on daily newly infected cases in India from March 2, 2020 to April 2, 2020 were to estimate R0 using the earlyR package. The maximum-likelihood approach was used to analyze the distribution of R0 values, and the bootstrap strategy was applied for resampling to identify the most likely R0 value. We estimated the median value of R0 to be 1.471 (95% confidence interval [CI], 1.351 to 1.592) and predicted that the new case count may reach 39,382 (95% CI, 34,300 to 47,351) in 30 days.

Estimation of the reproduction number and early prediction of the COVID-19 outbreak in India using a statistical computing approach / 한국역학회지

Coronavirus disease 2019 (COVID-19), which causes severe respiratory illness, has become a pandemic. The World Health Organization has declared it a public health crisis of international concern. We developed a susceptible, exposed, infected, recovered (SEIR) model for COVID-19 to show the importance of estimating the reproduction number (R0). This work is focused on predicting the COVID-19 outbreak in its early stage in India based on an estimation of R0. The developed model will help policymakers to take active measures prior to the further spread of COVID-19. Data on daily newly infected cases in India from March 2, 2020 to April 2, 2020 were to estimate R0 using the earlyR package. The maximum-likelihood approach was used to analyze the distribution of R0 values, and the bootstrap strategy was applied for resampling to identify the most likely R0 value. We estimated the median value of R0 to be 1.471 (95% confidence interval [CI], 1.351 to 1.592) and predicted that the new case count may reach 39,382 (95% CI, 34,300 to 47,351) in 30 days.

Prevalence of H. pylori in Immune Thrombocytopenic Purpura (ITP) in a tertiary care center, South India

Introduction: Immune thrombocytopenic purpura (ITP) has been linked with Helicobacter Pylori infection. Objectives: The objective of the present study was to determine the prevalence of H pylori infection in adult ITP patients in a tertiary care center in South India. Methods: 50 adult patients with ITP in the Department Hematology, Madras Medical College were recruited for a cross -sectional study over a period of 6 months. Biopsy from the antrum was subjected to Rapid urease test to detect H. pylori. A total of 50 patients participated in the study. Result: The prevalence of H. pylori infection in ITP patients was 36%. The majority of patients were male (78%). Conclusion: The diagnosis of H. pylori in ITP patients may be considered in high prevalent areas.

Potential antioxidative protein-pigment complex Spirulina platensis mediated food grade phycocyanin C -Extraction, purification, antioxidative activity and biocompatibility

Phycocyanin (PC), a photosynthetic pigment produced by cyanobacteria has been gained attention due to its distinct properties such as antioxidant and anti-proliferative. Acute and sub acute toxicity studies were carried out to determine the biocompatibility of the extracted phycocyanin on Wistar rat model. PC was extracted from Spirulina platensis biomass by cold maceration followed by successive purification by ammonium sulphate precipitation and gel filtration chromatography. Biocompatibility of the purified phycocyanin was carried out by acute toxicity studies using Wistar rat model. Acute toxicity has been determined by the effect of single oral dose of PC with two different concentrations (250 and 500 mg/Kg) on the body weight, general behaviour, and mortality. In sub-acute treatment. The effect of phycocyanin on the various parameters at the respective concentration as single oral dose daily during 28 days was studied. Cold maceration followed by maceration brought about food grade phycocyanin C (C-PC) which final yield and purity were increased in the successive purification steps. Antioxidative study using DPPH assay reveals the effective free scavenging activity of the phycocynin as concentration-dependent manner. Biocompatibility studies against Wister rat model did not exhibit any harmful effect. Any sign of toxic effect on biochemical, hematological and histopathological parameters was not observed in all the tested animals of treatment groups during the study period which reveals a high level of biocompatibility. The present study suggests the possible utilization of phycocyanin C as an effective pharmaceutical agent.

​Malignant Pleural Effusion: A Study on Clinical and Investigative Profiles – A Prospective Study

Background and Objective: Malignant pleural effusion (MPE) is a known complication of both thoracic and extrathoracicmalignancies. A detailed clinical and investigative profile of patients presenting with MPE would allow us to intervene early inthe disease and would ensure a better prognosis.Materials and Methods: A prospective study of 60 cases of MPE was carried out in the Department of Thoracic Medicine andCardiothoracic surgery, Thanjavur Medical College Hospital, Thanjavur, from October 2017 to May 2018, with respect to age,sex, clinical findings, biochemical analysis, radiological, cytological investigations, and histopathology.Results: The most common age group of MPE is between 60 and 70 years, male-to-female ratio was 1:1. The right-sidedpleural effusion was a more common finding compared to the left-sided effusion; pleural fluid biochemical analysis revealed amean adenosine deaminase of 23.97 u/l, mean pleural fluid protein/serum protein ratio was 0.95, and mean pleural fluid glucosewas 38.75 mg/dl. Of 60 cases, the most common cause of MPE was adenocarcinoma of lung which accounted for 30 cases,followed by metastatic carcinoma 24 cases and squamous cell carcinoma lung 3 cases and pleural mesothelioma in 3 cases.Conclusion: Pleural fluid cytology analysis for malignant cells was sufficient to diagnose MPE in 85% of cases, and in remainingcases, pleural biopsy can be helpful. The most common primary in cases of MPE was adenocarcinoma of lung.

​Etiology Underlying Pleural Effusion in Thanjavur Medical College Hospital: A Descriptive Study

Background: Pleural effusion is one of the most common signs seen in respiratory pathologies. An attempt to establish commonetiologies underlying pleural effusion helps in effective management of the same.Materials and Methods: After obtaining proper informed consent, patients presenting with pleural effusion underwent clinicalexamination in addition to radiological and biochemical investigations. Where needed, the diagnosis was confirmed usingpleural biopsy and bacteriological analysis.Results: Investigations confirmed tuberculosis in 23 patients, malignancy in seven cases, congestive cardiac failure in fourcases, parapneumonic causes in 12 patients, hypoproteinemia in two patients, and pulmonary thromboembolism in two patients.Conclusion: The present findings show that tuberculosis is the most common cause of pleural effusion in our patients. A morecomprehensive study would help us to further strengthen our findings.

In silico and in vitro analysis of quorum quenching active phytochemicals from the ethanolic extract of medicinal plants against quorum sensing mediated virulence factors of Acinetobacter baumannii

Inhibition of quorum sensing called quorum quenching (QQ) is now extensively utilized in the prevention of bacterial infections. In the present study, in silico and in vitro analysis of quorum quenching (QQ) or anti-Quorum sensing (QS) activity of ethanolic extract of medicinal plants against QS mediated virulence factors of human pathogenic bacteria Acinetobacter baumannii has been investigated. The effect of plant extracts on QS by acyl homoserine lactone (AHL) has been carried out by quantification of secreted AHL by high-pressure liquid chromatography (HPLC). Measurement of QQ activity was determined by maximum inhibition of virulence factors and AHL production which was recorded in E. globules and A. indica extracts. In silico analysis was studied with possible bioactive compounds in the ethanolic extract of respective plant material that were characterized by gas chromatography equipped with mass spectroscopy (GCMS) against the enzyme responsible for the production of signaling molecule which mediates QS AHL synthase. Distinct reduction of all the QS-mediated virulence factors was recorded in the E. globules and A. indica. Among the different bioactive compounds, the ethanolic leaf extract of E. globules of GCMS analyzed compound, Hexadeconoic acid, 1-(hydroxymethyl), 1, 2-ethannediyl ester interacted with 1KZF protein (AHL synthase) and showed binding energy of −11.2 kcal/mol to MET 42 and TYR 54. Phytochemicals mediated inhibition of AHL synthase activity which was responsible for AHL production would suggest the possible utilization of plant extracts as an antibacterial agent to fight against disease-causing pathogenic bacteria.

Preparation of nano albumin-flutamide (Nab-flu) conjugate and evaluation of its in vitro drug control release, anticancer activity and genotoxicity

Cancer is one of the most common noncommnicable diseases of mankind which causes considerable deaths worldwide. Though there have been consistant efforts on prevention and control, cancer still ranks second in global mortality, causing one out of every six deaths. Nanotechnology has radically changed the way cancer is diagnosed, imaged and treated. Researchers have designed novel nanodevices capable of detecting cancer at its earliest stages, pinpointing its location within the body and delivering drugs specifically to malignant cells. Albumin, with active tumor targeting capacity, is a versatile drug carrier in anticancer drug delivery system. In this study, preparation of BSA nanoparticles has been optimized with various parameters such as pH, ethanol to BSA ratio and crosslinking time in order to improve drug delivery. The optimal pH was found to be 8.0, the ethanol to albumin ratio was found to be 4:1 and cross linking time of 8 h which gives the higher yield of BSA nanoparticles. Nanodrug conjugate was prepared using the optimized conditions and the nanospheres formed were characterized using SEM which showed a particle size of nanosphere in the range of 160-230 nm. Fourier transform infrared spectroscopy (FTIR) analysis showed the possible functional groups of nano drug conjugate. The drug loading efficiency and entrapment efficiency were found to be 81 and 83%, respectively. The in vitro drug release profile was studied by continuous dialysis method. Cumulative release reached almost 81% after 24 h and showed an almost released ability of the nanoparticle formulation. Sustained and controlled release profile of flutamide facilitates application of nanoparticles for delivery of anticancer drugs. The Nab-Flu, Nab was found to have very low toxicity on Vero cell line and a higher toxicity in hep2 cell lines. Further, genotoxicity study revealed the Nab and Nab-Flu showed a zero genotoxicity.

Autonomic dysfunction in cardiovascular system of type 2 diabetic mellitus A bedside evaluation

Introduction: In 20 to 40% of all diabetes mellitus patients some abnormalities of autonomic function is present. Diabetic autonomic neuropathy can involve both sympathetic and parasympathetic nervous system. Parasympathetic abnormalities appear earlier and sympathetic innervations may remain intact even in presence of severe Parasympathetic damage. The aim of the study: To determine the various aspect of autonomic neuropathy in the diabetic population using series of standardized test, to interpret the different type of presentation of autonomic neuropathy in diabetes mellitus. Materials and methods: Sixty patients with mean age of 57.7% who had non-insulin dependent diabetes mellitus, varying from one year to fifteen years duration with normal 12 lead electrocardiograph were selected for the study. With standard autonomic function test procedures for both sympathetic and parasympathetic were done with suitable inclusion criteria. Results: Peripheral neuropathy was observed in 40% (24/60) of patients. In 46.6% (28/60) patients Pupillary changes were observed. In patients with peripheral neuropathy, 95.8% (23/24) had Pupillary changes. Postural hypotension was observed in 36.7% (22/60). The results of various tests of autonomic function are as follows. While interpreting the results all borderline cases were considered as normal. The rise of heart rate less than ten was observed in 40% of study group with mean of6.94.Among the patients, 36.7% (22/60) had fallen in blood pressure of more than 30millimeter of mercury. Conclusion: Newer drugs have to be tried for comforting many diabetics with clinical autonomic neuropathy afflicted with this condition in that at least the quality of life of with diabetic neuropathy will improve

Carotid doppler ultrasonography evaluation in patients with stroke

Introduction: Stroke is defined as rapid onset of focal neurological deficit resulting from diseases of cerebral vasculature and its contents. Community surveys in India have shown a crude prevalence rate for hemiplegia in the range of 200 per 100,000 persons, nearly 1.5% of all urban hospital admission, 4.5% of all medical and around 20% of neurological cases. The aim of the study: To determine the usefulness of doing Carotid Doppler Ultrasonography as a screening procedure in predicting the chance of developing stroke in persons having risk factors for stroke. Materials and methods: The study was conducted in Department of Medicine, Government Dharmapuri Medical College, Dharmapuri in December 2017 to January 2018. In this study, patients who were admitted with a history of sudden onset of neurological illness are subjected to CT scan brain. Among the patients who had suffered an ischemic stroke in the anterior circulation are selected and they were further evaluated. Results: Hypertension was present equally in 58% of the males and females studied. Hence this study confirmed that hypertension is one of the major risk factors for the development of stroke and control of hypertension will reduce the risk of developing stroke. In this study diabetes as a risk factor was present in 89% of females and 41% of males. Hence this study observed that patients with diabetes are at increased risk for all forms of ischemic stroke and also are more likely to have hypertension and hyperlipidemia. Information from other studies also suggests that higher total and low-density lipoprotein (LDL) cholesterol levels are associated with an increased risk of ischemic stroke. Conclusion: Carotid Doppler Ultrasonography cannot substitute for angiography as the sole preoperative tests for Carotid endarterectomy. However, it can be used as a screening test for the detection of the asymptomatic Carotid disease in patients with risk factors for stroke.

Influence of jaw tracking in intensity-modulated and volumetric-modulated arc radiotherapy for head and neck cancers: a dosimetric study

PURPOSE: To Study the dosimetric advantage of the Jaw tracking technique in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for Head and Neck Cancers. MATERIALS AND METHODS: We retrospectively selected 10 previously treated head and neck cancer patients stage (T1/T2, N1, M0) in this study. All the patients were planned for IMRT and VMAT with simultaneous integrated boost technique. IMRT and VMAT plans were performed with jaw tracking (JT) and with static jaw (SJ) technique by keeping the same constraints and priorities for a particular patient. Target conformity, dose to the critical structures and low dose volumes were recorded and analyzed for IMRT and VMAT plans with and without JT for all the patients. RESULTS: The conformity index average of all patients followed by standard deviation (x¯±σ(x¯)) of the JT-IMRT, SJ-IMRT, JT-VMAT, and SJ-VMAT were 1.72 ± 0.56, 1.67 ± 0.57, 1.83 ± 0.65, and 1.85 ± 0.64, and homogeneity index were 0.059 ± 0.05, 0.064 ± 0.05, 0.064 ± 0.04, and 0.064 ± 0.05. JT-IMRT shows significant mean reduction in right parotid and left parotid shows of 7.64% (p < 0.001) and 7.45% (p < 0.001) compare to SJ-IMRT. JT-IMRT plans also shows considerable dose reduction to thyroid, inferior constrictors, spinal cord and brainstem compared to the SJ-IMRT plans. CONCLUSION: Significant dose reductions were observed for critical structure in the JT-IMRT compared to SJ-IMRT technique. In JT-VMAT plans dose reduction to the critical structure were not significant compared to the SJ-IMRT due to relatively lesser monitor units.