Shoulder Dysfunction and Quality of Life Following Modified Radical and Selective Neck Dissection: A Prospective Comparative Study.

Head and neck cancers are fairly common in India due to the widespread consumption of tobacco and neck dissection is a major component in the surgical management. The objective of this study is to analyze the effect of MRND and SND on shoulder function and quality of life in patients of head and neck cancer. Our study is a prospective comparative study on 65 head and neck cancer patients divided into 2 groups-33 in group A (MRND group) and 32 in group B (SND group). Clinical evaluation of shoulder function was done pre-operatively, 1 week, 1 month, 3 month and 6 month post-operatively using arm abduction scores (AAS) and shoulder pain and disability index (SPADI). Nerve-conduction study (NCS) was done pre-operatively and 3 months post-operatively for assessment of SAN. Neck dissection quality of life questionnaire (NDQOL) was used as a quality-of-life measure. A total of 65 neck dissections were included in the analysis (33 in group A and 32 in group B) out of which 53 were males and 12 were females. The mean AAS on the 6th post-operative month in group A was significantly lower than that of group B (p = 0.01). The mean SPADI scores on the 6th post-operative month was significantly worse in group A than group B (p value 0.01). On NCS, a significant decrease in amplitude was seen in group A (p = 0.02) and a significant increase in latency was noted in group B (p = 0.005). Quality of life score on 6th post-operative month showed no significant difference between both the groups (p > 0.05). Level V dissection in MRND is associated with higher incidence and greater severity of shoulder dysfunction. AAS and SPADI score are useful tools in post operative follow up of shoulder dysfunction. NCS helps in the detection of neuropathy and to determine its severity. Early rehabilitation promotes long term recovery.

Implementation of a hybrid neural network control technique to a cascaded MLI based SAPF.

This paper presents a naïve back propagation (NBP) based i cos ∅ technique implemented to a cascaded multilevel inverter (MLI) based shunt active power filter (SAPF). The recommended control algorithm is applied to extract the fundamental component of load current and to decide the compensating current reference for harmonic elimination. The performance of the SAPF using the proposed NBP-based i cos ∅ technique is compared with another two classical control techniques, such as, i d - i q technique and i cos ∅ technique. The accuracy of the proposed control technique depends on the tuned estimation of active and reactive weights. The performance study of the proposed SAPF with the proposed control technique is investigated under non-linear conditions, with balanced and unbalanced loading conditions. The results reveal that the recommended SAPF is efficient enough to reduce the harmonics from the source current with smooth variation in DC link voltage. The effectiveness of the proposed method is validated by simulation using MATLAB Simulink, and the real-time results are also validated by the experimental setup.

Review of Satralizumab for Neuromyelitis Optica Spectrum Disorder: A New Biologic Agent Targeting the Interleukin-6 Receptor.

Currently, three monoclonal antibodies (MABs) have received regulatory approval from the federal agency, the United States Food and Drug Administration (USFDA), for the medical management of neuromyelitis optica spectrum disorder (NMOSD). Satralizumab was the third approved therapy after MABs like eculizumab and inebilizumab for NMOSD, an uncommon but severe enfeebling autoimmune neurological disease. Satralizumab, a humanized monoclonal antibody, exerts its action in NMOSD by acting against cytokine interleukin-6 (IL-6), a foremost mediator in the pathological process of NMOSD. Two pivotal clinical trials carried out in NMOSD patients had established that satralizumab significantly decreased the rate of relapse in patients suffering from NMOSD as opposed to placebo. The trials also demonstrated that satralizumab is relatively safe. Thus, satralizumab provides an efficacious and safe treatment option for this rare, disabling central nervous system (CNS) disease. Our review aimed to elucidate the pharmacological characteristics of satralizumab and illustrate the available evidence regarding its safety and efficacy in patients with NMOSD.

Reporting of adverse events related to medical devices: A single-center experience from a tertiary care institute of national importance in India.

As frontline health workers, nursing professionals have a crucial role in reporting medical device-associated adverse events (MDAEs). A questionnaire-based study was carried out to evaluate the knowledge, attitude, and practice of senior nursing officers (SNOs), nursing officers (NOs), and nursing students (NSs) toward MDAE. The response rate of the survey was 84% (n = 134). The mean score of knowledge of SNOs, NOs, and NSs was 2.03 ± 0.92, 1.71 ± 0.96, and 1.52 ± 0.82, respectively (P = 0.9). A large proportion of study participants (97%) considered that the use of medical device could sometimes cause untoward occurrences and detecting and reporting those events will enhance the safety of patients. However, many of them (67%) have not reported it during clinical posting. The participants of this survey possessed limited knowledge of MDAE. However, their attitude toward MDAE was encouraging and a continuous training program may improve their knowledge regarding MDAE and enhance the reporting practice.

Comparison of Efficacy and Safety of Azilsartan and Amlodipine Combination Versus Telmisartan and Amlodipine Combination in Hypertensive Patients: A Non-inferiority Trial.

Introduction Hypertension (HTN) is one of the most common conditions encountered in daily practice in hospitals. Combination therapy is mostly initiated in the management of HTN when target blood pressure is not achieved with monotherapy. There are few studies comparing the antihypertensive effect of a combination of azilsartan and amlodipine with a combination of amlodipine and other angiotensin receptor blockers (ARBs), however, the results are contradictory. The objective of this study was to compare the efficacy and safety of the azilsartan and amlodipine combination versus the telmisartan and amlodipine combination in hypertensive patients. Methods The present study was a prospective, randomized, active-controlled, open-label, parallel-group clinical trial. Hypertensive patients were randomized into two groups of 25 patients each. Baseline evaluations of systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-sensitivity troponin I (hsTnI) were done. Patients were reassessed after 12 weeks of drug therapy with azilsartan 40 mg and amlodipine 5 mg combination or telmisartan 40 mg once daily (QD) and amlodipine 5 mg combination QD. Results The response rate (defined as a reduction of more than 20 mm Hg in SBP or 10 mm Hg in DBP or both from baseline at 12 weeks) for HTN in the test group and control groups was found to be 88% and 96% respectively. The response rate of the azilsartan amlodipine group was found to be non-inferior to the telmisartan amlodipine group (odds ratio, OR, 0.31, p = 0.61) at the end of 12 weeks of drug therapy. At 12 weeks of follow-up, there was a significant decrease in SBP (p < 0.001), DBP (p < 0.001), and hsTnI levels (p < 0.001) in both groups from baseline values. However, differences between the test and control groups for blood pressure and hsTnI were found to be not statistically significant at 12 weeks of follow-up. The most commonly reported adverse effect in both groups was headache. Conclusion Azilsartan amlodipine combination had an 88% response rate, which was non-inferior to the telmisartan and amlodipine combination. Biomarkers such as hsTnI showed a significant decrease in both groups after 12 weeks of follow-up. However, there was no significant difference between the two groups.

A Dosimetric Study Comparing 3D-CRT vs. IMRT vs. VMAT in Left-Sided Breast Cancer Patients After Mastectomy at a Tertiary Care Centre in Eastern India.

Introduction Post-mastectomy radiation in left-sided breast cancer in women continues to pose a significant risk to the underlying lungs and heart. This study analyzed the difference in planning target volume (PTV) coverage and dose to the organs at risk (OAR) by using three different planning methods for the same patient - three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT). Material and methods Thirty-five left-sided breast cancer patients' post-mastectomy were included in this study, and three different plans for adjuvant radiation were created using 3D-CRT, IMRT, and VMAT. The prescribed dose was 50Gy in 25 fractions. Kruskal-Wallis analysis of variance (ANOVA) was done, followed by a pairwise t-test to establish a hierarchy of plan quality and dosimetric benefits. The plans were compared with PTV95, homogeneity index (HI), conformity index (CI), hotspot (V107%), left lung V20Gy, mean lung dose, heart V25Gy, mean heart dose, and integral dose (ID) to the body. Results Both VMAT and IMRT led to improved PTV95% coverage (95.63±1.82%, p=0.000 in VMAT; 93.70±2.16 %, p=0.000; 81.40±6.27% in 3D-CRT arm) and improved CI (0.91±0.06 in IMRT [p<0.05] and 0.96±0.02 for VMAT plans [p<0.05]) as compared to 3D-CRT (0.66±0.11), which was statistically significant on pairwise analysis. In contrast, the difference in HI and reduction in hotspots were not significantly different. Left lung V20 was statistically very different between the three arms with the highest values in IMRT (36.64±4.45) followed by 3D-CRT (34.80±2.24) and the most negligible value in VMAT (33.03±4.20). Mean lung dose was also statistically different between the three arms. There was a statistically significant difference in mean heart dose between the three arms on pairwise analysis. Both the inverse planning methods led to a statistically significant increase in low dose volume (V5 and V10) of the ipsilateral lung, opposite lung, and heart, and increased ID to the body excluding the PTV. Conclusion While both the inverse planning modalities led to increased coverage, better CI, and better HI and decreased high dose volumes in OARs, there was increased low volume irradiation of heart, lungs, and body with VMAT faring marginally better than IMRT in coverage and decreasing lung irradiation with comparable heart irradiation.