Immunohistochemical determination of mismatch repair gene product in colorectal carcinomas in a young indigenous African cohort.

BACKGROUND: Colorectal cancer (CRC) in the indigenous African population of South Africa is uncommon (age standardised incidence rates of 11.29 for males and 7.27/100 000 for females) and tends to occur at a young age. Lynch syndrome (LS), an inherited mismatch repair (MMR) gene abnormality, accounts for 3-4% of newly diagnosed CRCs in high incidence areas. There is some evidence that the contribution of an MMR abnormality to the overall CRC burden may be increased in low incidence areas. We aimed to determine the prevalence of MMR deficiency in an indigenous African population. METHODS: A cohort of 66 self-declared indigenous African patients, less than 50 years of age at diagnosis with CRC was identified from clinical and pathological records. The original histopathology was reviewed to confirm the diagnosis and features suggestive of MMR abnormality determined (pushing edge, mucinous, lymphocytic infiltration, Crohn's like reaction). Where sufficient tissue was available, samples were sectioned and stained for the four MMR proteins. RESULTS: Histopathological examination confirmed adenocarcinoma in 31 individuals. At least one feature suggestive of MMR was identified in 22 of these specimens. Twenty-seven cases were stained for all four MMR proteins using standard immunohistochemistry (IHC). MMR deficiency was found in 37% (n = 10/27) of cases. Median age of diagnosis was 35 years in the MMR-proficient group and 44 years in the MMR-deficient group, p < 0.008. No other significant differences between the groups were noted. CONCLUSION: MMR deficiency was common in colorectal carcinomas in the older patients in this cohort, but very young indigenous Africans CRCs do not appear to result from mismatch repair gene mutations.

Stereotactic body radiation therapy for hepatocellular carcinoma: Experience from a tertiary cancer care center in India.

AIM: The aim of this retrospective study is to assess the toxicity and tumor response of stereotactic body radiation therapy (SBRT) protocol for hepatocellular carcinoma (HCC) in our institution. BACKGROUND: Hepatocellular cancer is one of the leading cancers among men in India. In recent years, SBRT has emerged as a promising tool in the treatment of HCC. MATERIALS AND METHODS: Ten patients diagnosed as HCC with Barcelona Clinic Liver Cancer Stage B and C, treated with SBRT technique from January 2013 to December 2016, were included in this study. SBRT was delivered using 6 MV photons with volumetric modulated arc therapy. Acute and late toxicities were graded, and tumor response was assessed using response evaluation criteria in solid tumors criteria. Kaplan-Meier curves were generated for progression-free survival (PFS) and overall survival (OS). RESULTS: The median age was 61.5 (52-69) years. The radiation dose ranged from 35 Gy to 60 Gy. All patients obtained partial response during assessment at 3 months after completion of treatment. The median PFS is 8 months (95% confidence interval [CI] - 5.22-10.77 months). The median OS is 51 months (95% CI - 17.64-65.10 months). The OS at 1 and 2 years is 75% and 57%, respectively. CONCLUSIONS: SBRT is well tolerated by our patients. The 1- and 2-year OS of 75% and 57% is consistent with other prospective and retrospective SBRT studies from the literature.

Self-care activities among patients with diabetes attending a tertiary care hospital in mangalore karnataka, India.

BACKGROUND: Increasing prevalence of diabetes in India is resulting in an epidemiological transition. The care of the people with diabetes is traditionally seen as doctor centered, but the concept of self-care of people with diabetes is a new domain and is proven beneficial. AIM: The aim was to determine the practice of self-care activities among people with diabetes attending a tertiary care hospital in Mangalore. SUBJECTS AND METHODS: A facility-based cross-sectional study was conducted in Government Wenlock Hospital, Mangalore during September-October 2012. A total of 290 patients with >1-year duration of diabetes mellitus (DM) were asked to respond to summary diabetes self-care activities questionnaire after obtaining the consent from them. The statistical analysis was performed in terms of descriptive statistics and association between the variables was tested using Mann-Whitney U-test. RESULTS: A healthy eating plan on a daily basis was followed by 45.9% (133/290) of the participants, daily exercises for 30 min were followed by 43.4% (126/290), and regular blood sugar monitoring was done by 76.6% (222/290). Regarding the adherence to oral hypoglycemic agents and insulin, daily adherence to medication was seen among 60.5% (155/256) and 66.9% (138/206) were found to be adherent to insulin injections on a daily basis. CONCLUSIONS: Self-care practices were found to be unsatisfactory in almost all aspects except for blood sugar monitoring and treatment adherence. As these practices are essential for prevention of complications and better quality-of -life, more efforts should be put to educate the people with diabetes.

Compliance with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India.

BACKGROUND: Anaemia is highly prevalent among pregnant women and iron deficiency is the most important cause. Like many other countries, India has policies to give pregnant women iron supplements. Non-compliance is one important challenging factor in combating anaemia. OBJECTIVE: To estimate the compliance for IFA tablets among pregnant women and to study the social factors influencing it. METHODOLOGY: This study included 190 pregnant women seeking ante-natal care in tertiary health Centres in the Mangalore city in South India. After Institutional Ethics Committee (IEC) approval, data was collected by personal interview. Missing ≥2 doses consecutively was considered non-compliance. The data was analyzed using SPSS (Statistical Package for Social Sciences) version 11.5. RESULTS: The mean age of the study population was 25.8 years (SD: 4.1). Majority of the subjects consumed mixed diet and 72.1% belonged to lower socioeconomic status. Overall, compliance with IFA tablets was 64.7%. Compliance increased with the increase in age, birth order and single daily dose. Forgetfulness and both perceived as well as experienced side effects of IFA therapy were the important factors for non-compliance. CONCLUSION: There was a moderate level of Compliance towards IFA tablets with key social and demographic factors playing important role.

Molecular virology of hepatitis E virus.

Hepatitis E virus (HEV) is the causative agent of hepatitis E. It is a nonenveloped virus with a ∼7.2 kilobases positive-stranded RNA genome. The molecular virology of HEV is getting better understood with the development of replicons and in vitro infection systems, and the discovery of related viruses that infect animal species other than humans. This review focuses on the virology of HEV and updates the current knowledge on the HEV genome and its constituent proteins--ORF1, ORF2, and ORF3, and the viral life cycle.

Quality assurance of dynamic parameters in volumetric modulated arc therapy.

OBJECTIVES: The purpose of this study was to demonstrate quality assurance checks for accuracy of gantry speed and position, dose rate and multileaf collimator (MLC) speed and position for a volumetric modulated arc treatment (VMAT) modality (Synergy S; Elekta, Stockholm, Sweden), and to check that all the necessary variables and parameters were synchronous. METHODS: Three tests (for gantry position-dose delivery synchronisation, gantry speed-dose delivery synchronisation and MLC leaf speed and positions) were performed. RESULTS: The average error in gantry position was 0.5° and the average difference was 3 MU for a linear and a parabolic relationship between gantry position and delivered dose. In the third part of this test (sawtooth variation), the maximum difference was 9.3 MU, with a gantry position difference of 1.2°. In the sweeping field method test, a linear relationship was observed between recorded doses and distance from the central axis, as expected. In the open field method, errors were encountered at the beginning and at the end of the delivery arc, termed the "beginning" and "end" errors. For MLC position verification, the maximum error was -2.46 mm and the mean error was 0.0153 ±0.4668 mm, and 3.4% of leaves analysed showed errors of >±1 mm. CONCLUSION: This experiment demonstrates that the variables and parameters of the Synergy S are synchronous and that the system is suitable for delivering VMAT using a dynamic MLC.

SU-E-T-152: Development of a Phantom for Commissioning and Patient Specific QA for Volumetric Modulated Arc Therapy (VMAT).

PURPOSE: To design a cost effective phantom for commissioning tests and patient specific quality assurance in VMAT techniqueMethods: The phantom is made of PMMA with the physical density of 1.18 gm/cc. It consists of 20 numbers of 20cm diameter discs connected together in a horizontal stack, making a cylinder of length 20cm. The centers of the discs are drilled with 2.1cm hole which accommodates chamber sleeve of near 2.1cm diameter, which is made of Delrin with the physical density of 1.414gm/cc. The cylindrical geometry of the phantom is ideal for rotational therapy QA like VMAT or Rapid arc. The entire phantom is self supporting and hence no supporting bar or holders are in the path of beam geometry. The chamber sleeve itself acts as the supporting rod for these discs and it can be inserted in to the disc assembly from distance of-9cm to +10cm from the origin and hence any axial point from -9cm to +10cm with respect to isocenter can be used for point dose measurement. The other side of the chamber sleeve is filled by spacer rod for sustaining the discs in place. The films can be inserted, transversely in any XZ plane from -9cm to +10cm from the origin between the discs next to the chamber center. RESULTS: Simultaneous irradiation for the chamber and the film is done for VMAT plans without collapsing the gantry angles to nominal angle of zero. Evaluated the results using RIT film analysis software for gamma index of 3%, 3mm. Good agreement is found with more than 95% of pixels passing 3% 3mm criteria. The point dose verification showed less than 3% variation with TPS planned dose. CONCLUSIONS: Most of the commercial QA systems needs gantry to be collapsed to zero degree to perform QA for modern RT techniques. Especially for techniques like VMAT, collapsing gantry to zero will fail to validate the influence of gantry speed on dose delivery.

Daily immunization services: A moral duty, not an empty slogan.

BACKGROUND: Immunization services in Armed Forces hospitals are provided once or twice a week leading to children missing important vaccines. Vaccines offered are restricted to vaccines provided under the Universal Immunization Programme (UIP). This system is inadequate to meet the challenge of providing 100% immunization to children in a station. Two large service hospitals were selected for provision of daily immunizations under the 'CHOICE' banner (Comprehensive child Healthcare, OPD services and Immunization Clinic Everyday), which was conducted under the supervision of the Pediatrician. The immunization delivery before and after institution of the daily immunization program was compared. METHOD: This retrospective study compares the vaccine delivery rate of two systems, namely a restricted approach providing UIP vaccines on a weekly basis and a comprehensive approach providing both UIP as well as optional vaccines on a daily basis. RESULTS: There was a significant increase in attendance at the immunization clinic, which was progressive over the years with the comprehensive approach. The delivery rates of all vaccines increased, in particular the combination vaccines. The workload per immunization session showed a concomitant decrease. CONCLUSION: Daily immunization is a better method of vaccine delivery to children, leading to a marked increase in attendance at the immunization clinic and utilization of hospital services.

Relative dosimetrical verification in high dose rate brachytherapy using two-dimensional detector array IMatriXX.

For high dose rate (HDR) brachytherapy, independent treatment verification is needed to ensure that the treatment is performed as per prescription. This study demonstrates dosimetric quality assurance of the HDR brachytherapy using a commercially available two-dimensional ion chamber array called IMatriXX, which has a detector separation of 0.7619 cm. The reference isodose length, step size, and source dwell positional accuracy were verified. A total of 24 dwell positions, which were verified for positional accuracy gave a total error (systematic and random) of -0.45 mm, with a standard deviation of 1.01 mm and maximum error of 1.8 mm. Using a step size of 5 mm, reference isodose length (the length of 100% isodose line) was verified for single and multiple catheters of same and different source loadings. An error ≤1 mm was measured in 57% of tests analyzed. Step size verification for 2, 3, 4, and 5 cm was performed and 70% of the step size errors were below 1 mm, with maximum of 1.2 mm. The step size ≤1 cm could not be verified by the IMatriXX as it could not resolve the peaks in dose profile.

Molecular virology of hepatitis E virus.

This review details the molecular virology of the hepatitis E virus (HEV). While replicons and in vitro infection systems have recently become available, a lot of information on HEV has been generated through comparisons with better-studied positive-strand RNA viruses and through subgenomic expression of viral open reading frames. These models are now being verified with replicon and infection systems. We provide here the current knowledge on the HEV genome and its constituent proteins--ORF1, ORF2 and ORF3. Based on the available information, we also modify the existing model of the HEV life cycle.

To determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation.

BACKGROUND: Cross-sectional study was carried out to determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation (MR). METHOD: Multiplex ligation-dependant probe amplification technique was used to detect subtelomeric abnormalities. RESULTS: Out of 35 children, 21 (60%) were males. Family history of MR was present in 23%. Main clinical features included speech delay in all motor delay cases (83%) and non-specific dysmorphic features (77%). CONCLUSION: Associated clinical features were more in children with intelligence quotient (IQ) < 50 (P < 0.05). Subtelomeric deletion (4q35) was observed in one child.