Enhancement of the electrochemical performance of zinc-silver batteries with a gold nano-scaffold.

Primary zinc-silver batteries are widely employed in military, aerospace, and marine applications. However, the development of secondary zinc-silver batteries is still a subject of on-going research. For example, these batteries suffer from rapid capacity loss during cycling due to instabilities of the zinc anode and the silver cathode. While there is a large body of work on the Zn anode, there is limited work toward stabilizing the Ag electrode and thereby achieving a long cycle life. In this work, we propose a gold-silver nanostructure where gold acts as a scaffolding material and improves the retention of structural integrity during cell cycling. We show that this nanostructure improves battery capacity as well as capacity retention after 35 cycles. Our work emphasizes the role of nanostructuring in enabling a newer secondary battery chemistry based on existing primary ones.

Prevalence and risk factors of hyponatremia in hospitalized critically ill children: an observational study.

Critically ill children frequently encounter the most common and potentially life-threatening electrolyte disturbances, i.e., hyponatremia. It is an independent risk factor for prolonged hospitalization in the intensive care unit and increased in-hospital mortality. Hyponatremia occurs in up to 20%-30% of admissions in the pediatric intensive care unit (PICU). This observational study was conducted in the PICU of a tertiary care hospital in a developing country from September 2018 to September 2019. Admission criteria in our PICU are the need for mechanical ventilation, fulminant hepatic failure, vasopressor support, respiratory failure and poorly controlled seizure. We studied 256 children, aged 1 month to 18 years, with normal serum sodium at admission. In our study, 72 (28.1%) children developed hyponatremia, and about two third (n=48, 66.7%) of them developed within 72 hours of admission in PICU. The majority of children (n = 46, 63.9%) in the hyponatremic group were below 5 years. Wasted children (n = 68, 26.6%) in the hyponatremic and isonatremic groups were 20 (27.8%) and 48 (26%), respectively. The most common etiology of hyponatremia was cerebral salt wasting syndrome (n = 20, 27.8%) followed by drug-induced cases (n = 19, 26.4%). The drugs responsible were diuretics and anti-epileptics. In our study, multiorgan failure (OR = 5.05, 95%CI = 1.90-13.43; p = 0.0001), shock (OR = 7.38, 95%CI = 3.56-12.28; p = 0.0001), vasopressor use (OR = 6.74, 95%CI = 3.45-13.17; p = 0.0001) and coagulopathy (OR = 6.74, 95%CI = 3.45-13.17; p = 0.0001) were the risk factors for the development of hyponatremia. Mortality among the hyponatremic group (44.4%) was significantly higher than in the isonatremic group (21.7%). Hyponatremia is a common electrolyte disturbance found in critically ill patients and is associated with prolonged hospitalization and increased mortality.

Toward Rational Design of Mononuclear Nickel Complexes as Water Oxidation Catalysts Exploring the Ligand Effects on the Rate-Determining Step.

The major impediment in realizing a carbon-neutral hydrogen fuel economy is the cost and inadequacy of contemporary electrochemical water splitting approaches towards the energy intensive oxygen evolution reaction (OER). The O-O bond formation in the water oxidation half-cell reaction is both kinetically and thermodynamically challenging and amplifies the overpotential requirement in most of the active water oxidation catalysts. Herein, density functional theory is employed to interrogate 20 Ni(II) complexes, out of which 17 are in silico designed molecular water oxidation catalysts, coordinated to electron-rich tetra-anionic redox non-innocent phenylenebis(oxamidate) and dibenzo-1,4,7,10-tetraazacyclododecane-2,3,8,9-tetraone parent ligands and their structural analogues, and identify the role of substituent changes or ligand effects in the order of their reactivity. Importantly, our computational mechanistic analyses predict that the activation free energy of the rate-determining O-O bond formation step obeys an inverse scaling relationship with the global electrophilicity index of the intermediate generated on two-electron oxidation of the starting complex. Additionally, the driving force is directly correlated with this OER descriptor which enables two-dimensional volcano representation and thereby extrapolation towards the ideal substitution with the chosen ligand. Our study, therefore, establish fundamental insights to overcome the imperative overpotential issue with simple and precise computational rationalization preceding experimental validation.

Glaucarubinone from Simarouba glauca DC. as a potential biocontrol agent for mosquito vector management.

The study explored Simarouba glauca DC. for mosquito larvicidal potential by performing bioactivity-guided chemical investigation of its root extract resulting in isolation of the known bioactive metabolite glaucarubinone (1). Mosquito larvicidal activity of glaucarubinone (1) against the three vector species viz. Anopheles stephensi, Aedes aegypti, and Culex quinquefasciatus was determined using a modified WHO 2005 protocol. It was observed that Culex quinquefasciatus larvae were the most susceptible species with LC50 13.88 ppm and LC90 70.01 ppm followed by Aedes aegypti and Anopheles stephensi at 24 h of exposure. The mode of action as observed microscopically is the lysis of midgut and thorax cells of the third instar larvae. The crystal structure of the glaucarubinone (1) is reported for the first time using X-ray crystallography. This phytochemical product has the potential to act as a green alternative to existing chemical-based insecticides for integrated vector management.

Exploring Curcumin-Loaded Lipid-Based Nanomedicine as Efficient Targeted Therapy for Alzheimer's Diseases.

Alzheimer's disease (AD) is a neurological condition currently with 47 million people suffering from it globally. AD might have many reasons such as genetic issues, environmental factors, and Aß accumulation, which is the biomarker of the disease. Since the primary reason is unknown, there is no targeted treatment at the moment, but ongoing research aims to slow its progression by managing amyloid-beta peptide production rather than symptomatic improvement. Since phytochemicals have been demonstrated to possess antioxidant, anti-inflammatory, and neuroprotective properties, they may target multiple pathological factors and can reduce the risk of the disease. Curcumin, as a phytochemical found in turmeric known for its antioxidant, free radical scavenging properties, and as an antiamyloid in treating AD, has come under investigation. Although its low bioavailability limits its efficacy, a prominent drug delivery system (DDS) is desired to overcome it. Hence, the potency of lipid-based nanoparticles encapsulating curcumin (LNPs-CUR) is considered in this study as a promising DDS. In vivo studies in animal models indicate LNPs-CUR effectively slow amyloid plaque formation, leading to cognitive enhancement and reduced toxicity compared to free CUR. However, a deeper understanding of CUR's pharmacokinetics and safety profile is crucial before LNPs-CUR can be considered as a medicine. Future investigations may explore the combination of NPs with other therapeutic agents to increase their efficacy in AD cases. This review provides the current position of CUR in the AD therapy paradigm, the DDS suggestions for CUR, and the previous research from the point of analytical view focused on the advantages and challenges.

Electron Beam-Supported Fabrication of Biocompatible Silver/iota-Carrageenan for Wound Healing Application.

Silver nanoparticles (AgNPs) are a potent antibacterial agent, especially when used to treat bacteria that are multidrug resistant. However, it is challenging to eliminate the hazardous reducing agents that remain in AgNPs produced by the conventional chemical reduction process. To overcome these challenges, the presented research demonstrates the fabrication of AgNPs using iota-carrageenan (ι-carra) as a carbohydrate polymer using electron beam (EB) irradiation. Well-characterized ι-carra@AgNPs have a face-centered cubic (FCC) structure with spherical morphology and an average size of 26 nm. Herein we explored the approach for fabricating ι-carra@AgNPs that is suitable for scaling up the production of nanoparticles that exhibit excellent water stability. Further, the optimized ι-carra@AgNPs exhibited considerable antibacterial activity of 40% and 30% inhibition when tested with Gram-negative Escherichia coli ATCC 43895 and Gram-positive Staphylococcus aureus (S. aureus) (ATCC 6538), respectively, and low cytotoxicity at 10-50 µg/mL. To establish the potential biomedical application, as proof of the concept, the ι-carra@AgNPs showed significant antibiofilm activity at 20 µg/mL and also showed 95% wound healing abilities at 50 µg/mL compared to the nontreated control groups. Electron beam assisted ι-carra@AgNPs showed significant beneficial effects against specific bacterial strains and may provide a guide for the development of new antibacterial materials for wound dressing for large-scale production for biomedical applications.

Spatiotemporal Epidemiology of Malaria in India from 2007 to 2022.

India is a major contributor to the global burden of malaria, especially Plasmodium vivax infection. Understanding the spatiotemporal trends of malaria across India over the last two decades may assist in targeted intervention. The population-normalized spatiotemporal trends of malaria epidemiology in India from 2007 to 2022 were analyzed using a geographic information system with the publicly available "malaria situation" report of the National Vector Borne Disease Control Program (NVBDCP). The NVBDCP data showed malaria cases to have steeply declined from 1.17 million in 2015 to 0.18 million cases in 2022; this is 10.1 and 18.7 fold lower than the WHO's estimate of 11.93 million and 3.38 million cases in 2015 and 2022, respectively. From 2007 to 2022, Mizoram, Meghalaya, Tripura, Odisha, Chhattisgarh, and Jharkhand consistently reported high caseloads of Plasmodium falciparum. In the same period, the P. vivax caseload was high in Arunachal Pradesh, Mizoram, Nagaland, Jharkhand, Odisha, Chhattisgarh, Goa, Daman and Diu, Dadra and Nagar Haveli, and Andaman and Nicobar Islands. The distribution of forest cover, annual rainfall, and proportion of the Scheduled Tribe population (the most underprivileged in Indian society) spatially correlated with malaria cases and deaths. Mizoram is the only state where cases were higher in 2022 than in 2007. Overall, India has made tremendous progress in controlling malaria and malaria-related deaths in the last decade. The decline could be attributed to the effective vector and parasite control strategies implemented across the country.

Isolated Bilateral Upper Limb Amelia - A Rare Case Report.

Introduction: Congenital upper limb amelia is one of the extremely rare conditions. It is defined as a complete absence of upper limbs. It may present as isolated or with other associated anomalies. Case Report: We present a case of a 2-year-old male child with congenital complete absence of bilateral upper limb. This male child was born after four female children. With the advancement in modern-era prenatal diagnostic facilities and a better understanding of fetal-maternal drug pharmacology, such cases are rare entity. Conclusion: Amelia is a very rare and challenging situation for clinicians. Regular prenatal checkup and knowledge of maternal and fetal drug interactions during pregnancy are key factors for prevention.

Mapping malaria vectors and insecticide resistance in a high-endemic district of Haryana, India: implications for vector control strategies.

BACKGROUND: Achieving effective control and elimination of malaria in endemic regions necessitates a comprehensive understanding of local mosquito species responsible for malaria transmission and their susceptibility to insecticides. METHODS: The study was conducted in the highly malaria prone Ujina Primary Health Center of Nuh (Mewat) district of Haryana state of India. Monthly entomological surveys were carried out for adult mosquito collections via indoor resting collections, light trap collections, and pyrethrum spray collections. Larvae were also collected from different breeding sites prevalent in the region. Insecticide resistance bioassay, vector incrimination, blood meal analysis was done with the collected vector mosquitoes. RESULTS: A total of 34,974 adult Anopheles mosquitoes were caught during the survey period, out of which Anopheles subpictus was predominant (54.7%). Among vectors, Anopheles stephensi was predominant (15.5%) followed by Anopheles culicifacies (10.1%). The Human Blood Index (HBI) in the case of An. culicifacies and An. stephensi was 6.66 and 9.09, respectively. Vector incrimination results revealed Plasmodium vivax positivity rate of 1.6% for An. culicifacies. Both the vector species were found resistant to DDT, malathion and deltamethrin. CONCLUSION: The emergence of insecticide resistance in both vector species, compromises the effectiveness of commonly used public health insecticides. Consequently, the implementation of robust insecticide resistance management strategies becomes imperative. To effectively tackle the malaria transmission, a significant shift in vector control strategies is warranted, with careful consideration and adaptation to address specific challenges encountered in malaria elimination efforts.

Correction: Correlation Between Attendance and Performance of Undergraduate Medical Students in Otorhinolaryngology: A Retrospective Cohort Study.

[This corrects the article DOI: 10.1007/s12070-023-03995-9.].

Evolution in the Design of Water Oxidation Catalysts with Transition-Metals: A Perspective on Biological, Molecular, Supramolecular, and Hybrid Approaches.

Increased demand for a carbon-neutral sustainable energy scheme augmented by climatic threats motivates the design and exploration of novel approaches that reserve intermittent solar energy in the form of chemical bonds in molecules and materials. In this context, inspired by biological processes, artificial photosynthesis has garnered significant attention as a promising solution to convert solar power into chemical fuels from abundantly found H2O. Among the two redox half-reactions in artificial photosynthesis, the four-electron oxidation of water according to 2H2O → O2 + 4H+ + 4e- comprises the major bottleneck and is a severe impediment toward sustainable energy production. As such, devising new catalytic platforms, with traditional concepts of molecular, materials and biological catalysis and capable of integrating the functional architectures of the natural oxygen-evolving complex in photosystem II would certainly be a value-addition toward this objective. In this review, we discuss the progress in construction of ideal water oxidation catalysts (WOCs), starting with the ingenuity of the biological design with earth-abundant transition metal ions, which then diverges into molecular, supramolecular and hybrid approaches, blurring any existing chemical or conceptual boundaries. We focus on the geometric, electronic, and mechanistic understanding of state-of-the-art homogeneous transition-metal containing molecular WOCs and summarize the limiting factors such as choice of ligands and predominance of environmentally unrewarding and expensive noble-metals, necessity of high-valency on metal, thermodynamic instability of intermediates, and reversibility of reactions that create challenges in construction of robust and efficient water oxidation catalyst. We highlight how judicious heterogenization of atom-efficient molecular WOCs in supramolecular and hybrid approaches put forth promising avenues to alleviate the existing problems in molecular catalysis, albeit retaining their fascinating intrinsic reactivities. Taken together, our overview is expected to provide guiding principles on opportunities, challenges, and crucial factors for designing novel water oxidation catalysts based on a synergy between conventional and contemporary methodologies that will incite the expansion of the domain of artificial photosynthesis.

Evaluating the carnivorous efficacy of Utricularia aurea (Lamiales: Lentibulariaceae) on the larval stages of Anopheles stephensi, Culex quinquefasciatus, and Aedes aegypti (Diptera: Culicidae).

The emergence of insecticide resistance in mosquitoes necessitates the exploration and validation of sustainable biological strategies for controlling mosquitoes in their natural habitats. We assessed the predatory effect of Utricularia aurea Lour (Lamiales: Lentibulariaceae), an aquatic carnivorous plant found in the Indian subcontinent, Japan, and Australia, on 4 instars of Anopheles stephensi Liston, Culex quinquefasciatus Say, and Aedes aegypti Linn (Diptera: Culicidae), in the laboratory and field settings. In the laboratory setting, predation of larvae by U. aurea was highest during the first hour when it predated 45%, 61%, and 58% of first instars of An. stephensi, Cx. quinquefasciatus, and, Ae. aegypti, respectively, and, within 12 h, U. aurea preyed upon ~95% of the first, second, and third instars of the 3 mosquito species, ~80% of the fourth instars of An. stephensi and Ae. aegypti, and ~60% of fourth instars of Cx. quinquefasciatus. The predatory effect of U. aurea varied with mosquito species and instar. Broadly, predation risk declined with the increase of the instar size. In the field setting, at the end of 16 days, U. aurea predated 76% and 71% of the immature An. stephensi and Ae. aegypti, respectively. Our findings suggest U. aurea can be utilized as a potential biocontrol agent for controlling mosquito larvae in natural habitats; however, the current claim warrants additional investigations in a variety of natural habitats.

Balancing Routine and Pandemic: The Synergy of India's Universal Immunization Program and COVID-19 Vaccination Program.

The COVID-19 pandemic posed substantial challenges to healthcare systems globally and severely disrupted essential health services, including routine immunization programs. In India, these disruptions were exacerbated due to the sudden emergence of the pandemic and lockdown measures, leading to mass migrations and a shortage of healthcare workers. Caregivers' concerns about routine immunization sessions further compounded the problem, resulting in a sharp increase in zero-dose children. This review paper examines India's strategies for conducting one of the world's largest COVID-19 vaccination programs while effectively restoring and perpetuating its Universal Immunization Program (UIP). The UIP played a pivotal role in sustaining immunization services during the pandemic, ultimately improving immunization coverage compared to pre-pandemic levels. India's accomplishments in this regard are highlighted through key performance indicators, the reach of immunization services, a reduction in zero-dose children, and antigen-wise coverage. The paper also discusses the successful integration of COVID-19 vaccination within the UIP framework, underscoring the significance of existing infrastructure, technology, and capacity building. India's dedication to concurrently managing routine immunization and COVID-19 vaccination showcases the adaptability and resilience of its healthcare system. India's journey serves as a global example of efficient mass immunization during challenging times, emphasizing the importance of political will, healthcare infrastructure investment, skilled healthcare workforces, and comprehensive vaccination programs. In a world grappling with the dual challenge of COVID-19 and routine immunization, India's experience provides a roadmap for strengthening healthcare systems and promoting public health as the critical agenda in challenging times.

Dosimetric Comparision of Coplanar versus Noncoplanar Volumetric Modulated Arc Therapy for Treatment of Bilateral Breast Cancers.

Introduction: The purpose of this study was to compare the dosimetric parameters of volumetric modulated arc therapy (VMAT) treatment plans using coplanar and noncoplanar beams in patients with bilateral breast cancer/s (BBCs) in terms of organ at risk sparing and target volume coverage. The hypothesis was to test whether VMAT with noncoplanar beams can result in lesser dose delivery to critical organs such as heart and lung, which will result in lesser overall toxicity. Materials and Methods: Data of nine BBC cases treated at our hospital were retrieved. Computed tomography simulation data of these cases was used to generate noncoplanar VMAT plans and the parameters were compared with standard VMAT coplanar plans. Contouring was done using radiation therapy oncology group guidelines. Forty-five Gray in 25 fractions was planned followed by 10 Gy in five fractions boost in breast conservation cases. Results: No significant difference in planning target volume (PTV) coverage was found for the right breast/chestwall (P = 0.940), left breast/chestwall (P = 0.872), and in the total PTV (P = 0.929). Noncoplanar beams resulted in better cardiac sparing in terms of Dmean heart. The difference in mean dose was >1 Gy (8.80 ± 0.28 - 7.28 ± 0.33, P < 0.001). The Dmean, V20 and V30 values for total lung slightly favor noncoplanar beams, although there was no statistically significant difference. The average monitor units (MUs) were similar for coplanar plans (1515 MU) and noncoplanar plans (1455 MU), but the overall treatment time was higher in noncoplanar plans due to more complex setup and beam arrangement. For noncoplanar VMAT plans, the mean conformity index was slightly better although the homogeneity indices were similar. Conclusion: VMAT plans with noncoplanar beam arrangements had significant dosimetric advantages in terms of sparing of critical organs, that is Dmean of heart doses with almost equivalent lung doses and equally good target coverage. Larger studies with clinical implications need to be considered to validate this data.

Exploring Vaccine Hesitancy and Uptake during COVID-19: A Review of PM's Mann Ki Baat Dialogue.

Public health programmes are interlinked and intertwined with communication, advocacy and social mobilisation for their success. The unprecedented situation created by COVID-19 brought a medical emergency all over the world, the like of which was probably not seen after the Spanish Flu outbreak, a century ago. First there seemed no solution in sight when tens of thousands of people lost their lives to the coronavirus in various countries, but when the vaccine arrived, there were, in general, doubts about its efficacy and safety. Indian scenario was not any different. When the government launched the vaccine in a campaign mode in January 2021, it was also battling with misperceptions and vaccine hesitancy. Prime Minister Narendra Modi took it upon himself to address the issue through his various addresses to the nation and his signature programme Mann ki Baat (MKB) on the radio. This review paper examines the empirical research on MKB coverage of the COVID-19 pandemic, the media multiplier impact of the MKB, people's voices through their engagement with various social media platforms, and what is the impact on vaccine uptake.

Correlation Between Attendance and Performance of Undergraduate Medical Students in Otorhinolaryngology: A Retrospective Cohort Study.

Introduction: Technology has changed the dynamics of teaching and learning any subject. More emphasis is being laid on e-learning and self-directed learning. In this scenario, there is a rising doubt whether the physical attendance of students in theory lectures and clinical postings is at all important. Various studies have been conducted in different subjects to find a relation between outcome and attendance. However, we could not find any study done in Otorhinolaryngology. Hence, this study was conducted with the aim to know the correlation between attendance and performance for Otorhinolaryngology undergraduate students. Methodology: This is a retrospective cohort study carried out in the Otorhinolaryngology Department of a tertiary care teaching hospital of western Gujarat. The attendance (theory and clinics, biometrically fetched), internal theory examination marks (out of 40), and internal practical examination marks (out of 40) of a single batch students were obtained from the academic records and analyzed using Microsoft Excel sheet. Results: Out of 158 students, data of 151 students was analyzed in this study (7 students were absent on the day of examination). 76 students were boys and 75 girls. The combined (theory and clinics) average attendance of girls was 88.37%, as compared to 78.37% for boys (p < 0.0001). Out of 80 (40 for theory and 40 for clinics), girls got an average of 37.12 marks as compared to 30.89 for boys (p < 0.0001). There was a positive and significant correlation between marks obtained and attendance percentage for total students as well as for boys and girls separately. Conclusion: There is a positive and significant correlation between attendance percentage and marks obtained, both for theory and clinics, for Otorhinolaryngology undergraduate medical students.

Chitosan-Grafted-Poly(N-vinylcaprolactam)-Decorated Fe3O4@SiO2 Core-Shell Nanoformulation as an Efficient Drug Delivery System for Poorly Soluble Drugs.

Hydrocortisone, a commonly used anti-inflammatory drug, has limited aqueous solubility and several side effects. To address this challenge, as a proof-of-concept, this article demonstrates the development of a controlled-release drug delivery system (DDS) for hydrocortisone using chitosan-grafted poly(N-vinylcaprolactam) (CS-g-PNVCL)-coated core-shell Fe3O4@SiO2 nanoformulations (NFs). Reported magnetic nanoparticles (NPs) were synthesized and modified with silica, PNVCL, and CS precursors to enhance the biocompatibility of DDS and drug-loading efficiency. The release rate of hydrocortisone from Fe3O4@SiO2@CS-g-PNVCL NFs was observed to be higher at lower pH values, and the smart polymer coating demonstrated temperature responsiveness, facilitating drug release at higher temperatures. Fe3O4@SiO2@CS-g-PNVCL NFs exhibited a cell viability of around 97.2 to 87.3% (5-100 µg/mL) after 24-48 h, while the hydrocortisone-NFs had a cell viability of around 93.2 to 82.3%. Our findings suggest that CS-g-PNVCL-coated Fe3O4@SiO2 NPs effectively enhance the solubility, loading capacity, and targeted delivery of poorly soluble drugs, thereby improving their therapeutic efficacy and bioavailability.

Combination of image-guided IMRT and IGBT in locally advanced carcinoma cervix: Prospective evaluation of toxicities and clinical outcomes from a tertiary cancer center in India.

Purpose: We aimed to assess the toxicity profile and clinical outcome in patients with locally advanced cervical cancer (LACC) treated with a combination of image-guided intensity-modulated radiation therapy (IG-IMRT) and image-guided brachytherapy (IGBT). Material and methods: 25 LACC patients were recruited in this single-arm prospective study. Whole pelvis IG-IMRT was delivered (45 Gy with simultaneously integrated nodal boost of 55 Gy in 25 fractions), with concurrent weekly cisplatin (40 mg/m2). Patients received IGBT of 7 Gy each in 4 fractions to high-risk clinical target volume (HR-CTV). First fraction was done under MRI, and subsequent fractions were performed under CT guidance. Primary endpoint was acute toxicity, and secondary endpoints were 2-year loco-regional control and late toxicity. Results: The median age was 52 years, and FIGO 2018 stage distribution was IIA2, IIB, IIIB, and IIIC1 in 12%, 40%, 20%, and 28% patients, respectively. All patients received concurrent chemotherapy with median number of 5 cycles (range, 4-5 cycles). Grade 1 and 2 diarrhea, and grade 1 cystitis was reported in 4 (16%), 3 (12%), and 2 (8%) patients, respectively. Grade 1 and 2 anemia, and grade 1 and 2 dermatitis were observed in 3 (12%) and 2 (8%), and 3 (12%) and 3 (12%) patients, respectively. No patient reported grade 3-4 acute toxicity. At median follow-up of 29.5 months (range, 25-37 months), late grade 1 bladder toxicity was observed in 1 (4%) patient. Loco-regional control at 1 and 2 years were 96% and 92%, respectively. Conclusions: The combination of IG-IMRT and IGBT yielded excellent outcomes in terms of acute toxicity and loco-regional control.

Evaluation of doses to pelvic lymph node regions from image-guided high-dose-rate interstitial brachytherapy for carcinoma of the uterine cervix.

Purpose: Interstitial brachytherapy (ISBT) is indicated for intact cervical carcinoma (IN-CC) if intracavitary brachytherapy (ICRT) is not feasible and also in vault carcinoma (VA-C). We aimed to evaluate the doses to pelvic lymph node regions in IN-CC and VA-C treated with ISBT. Material and methods: Ten patients (6 IN-CC, 4 VA-C) were chosen for this dosimetric study. IN-CC had a central tandem in addition to the needles. External iliac (EI-N), internal iliac (II-N), obturator (OB-N) and sacral (SA-N) groups of lymph nodes were delineated. A dose of 10 grays (Gy) and 8 Gy each × 2 fractions was prescribed to the target in IN-CC and VA-C respectively. Doses received by 100%, 90% and 50% volume (D100, D90, D50) and D2cc, D1cc, D0.1cc were evaluated. Doses to lymph nodal groups in IN-CC vs. VA-C were compared using Student's t-test. Results: For 20 implants, the median number of needles was 18 (range, 16-20). Mean D90 and D2cc of the combined bilateral OB-N, II-N, EI-N and SA-N groups were 33.62 ±3.46% and 102.94 ±10.71%, 6.98 ±0.65% and 39.69 ±3.64%, 5.1 ±0.51% and 15.4 ±0.8%, 7.76 ±0.95% and 15.36 ±1.09% of the prescribed doses respectively. Patients with a central tandem (IN-CC) received significantly higher doses to external, internal iliac and sacral group of lymph nodes (p < 0.001) as compared to VA-C. Conclusions: In patients with cervical carcinoma treated with ISBT, pelvic lymph node groups received significant doses. The dose contribution to pelvic lymph nodes is higher in patients with intact cervical cancer where a central tandem is used as compared to post-operative patients.

Toxicities and clinical outcome of adjuvant dysphagia optimized versus standard intensity-modulated radiotherapy for post-operative oral cavity cancers: A prospective comparative study.

BACKGROUND: We prospectively assessed acute and late toxicity in post-operative oral cavity squamous cell carcinoma (PO-OCSCC) treated with adjuvant dysphagia optimized intensity-modulated radiotherapy (Do-IMRT) versus standard IMRT (S-IMRT). MATERIAL AND METHODS: Fifty-six patients of PO-SCC without indications of concurrent chemotherapy were alternatively allocated to adjuvant Do-IMRT (n = 28) versus S-IMRT (n = 28) arms. High- and low-risk planning target volume received 60 and 54 Gy, respectively, in 30 fractions over 6 weeks. Dysphagia aspiration-related structures (DARS) were contoured in both arms. While dosimetric constraints were given in Do-IMRT arm, doses to DARS were only observed without dose constraints in S-IMRT arm. Acute and late toxicity were assessed by common terminology criteria for adverse events (CTCAE) v5.0 and RTOG criteria, respectively. RESULTS: The primary site of disease was buccal mucosa (64% vs. 53%) and oral tongue (21% vs. 32%), in Do-IMRT and S-IMRT, respectively. The mean doses to DARS was significantly less with Do-IMRT (all p < 0.001) as compared to S-IMRT. Median follow-up was 24.2 months. Grade ≥2 oral pain was less in the Do-IMRT arm (50% vs. 78.6%, p = 0.05). Grade ≥2 late dysphagia at 2 years were significantly less in Do-IMRT arm (0% vs. 17.9%, p = 0.016). Two-year locoregional control was 89.2% in Do-IMRT and 78.5% in S-IMRT (p = 0.261). CONCLUSION: DARS can be spared in PO-OCSCC patients treated with Do-IMRT without compromising coverage of the target volumes. Limiting doses to DARS leads to lesser acute and late toxicity without compromising locoregional control.