Study of PRESAGE® dosimeter for end-to-end 3D radiotherapy verification using an anthropomorphic phantom with bespoke dosimeter insert.

Modern radiotherapy techniques have advanced and become more sophisticated. End-to-end 3D verification of the complex radiotherapy dose distribution in an anthropomorphic phantom can ensure the accuracy of the treatment delivery. The phantoms commonly used for dosimetry are homogeneous solid water phantom which lacks the capability to measure the 3D dose distribution for heterogeneous tissues necessary for advanced radiotherapy techniques. Therefore, we developed an end-to-end 3D radiotherapy dose verification system based on MAX-HD anthropomorphic phantom (Integrated Medical Technologies Inc., Troy, New York) with bespoke intracranial insert for PRESAGE® dosimeter. In this study, several advanced radiotherapy treatment techniques of various levels of complexity; 3D-CRT, IMRT and VMAT treatment, were planned for a 20 mm diameter of a spherical target in the brain region and delivered to the phantom. The dosimeters were read out using an in-house developed optical computed tomography (OCT) imaging system known as 3DmicroHD-OCT. It was found that the measured dose distribution of the PRESAGE® when compared with the measured dose distribution of EBT film and Monaco TPS has a maximum difference of less than 3% for 3D-CRT, IMRT and VMAT treatment plans. The gamma analysis results of PRESAGE® in comparison to EBT film and Monaco TPS show pass rates of more than 95% for the criteria of 3% dose difference and 3 mm distance-to-agreement. This study proves the capability of PRESAGE® and bespoke MAX-HD phantom in conjunction with the 3DmicroHD-OCT system to measure 3D dose distribution for end-to-end dosimetry verification.

The candle as an improvised anal dilator following surgery for anorectal malformation.

Introduction: Anal dilation with Hegar dilator is recommended as part of the post-operative management following surgical correction of anorectal malformation (ARM) in children to prevent strictures. Parents usually continue dilation at home with a personal set of dilators. However, in low-resource settings, many parents cannot afford the Hegar dilator. Devices that have been improvised as dilators include appropriately sized candles, spigot from Foley catheter, rounded ball pen ends and mothers' fingers. We aimed to report our preliminary experience with the use of candle as an improvised anal dilator following surgeries for ARM in our practice. Materials and Methods: A review of records of children who had surgery for ARMs and commenced on candle dilation between February 2018 and July 2019 at our centre was done. Relevant demographic information, type of anomaly, duration of dilation, availability of health insurance coverage, complications and parents' acceptance of improvised dilator (evaluated during scheduled follow up visits) were retrieved. The data were analysed using SPPSS version 21 (Chicago, Illinois). Results: Nineteen patients underwent anal dilation with improvised candles during the period. Rectobulbar and rectovestibular fistulas were most frequent anomaly in boys and girls, respectively. The median age at surgery was 6 months. The median duration of dilation (completed in 9 patients) was 7 months. Candle dilation was well tolerated, and all parents were comfortable using the device. Conclusion: The candle as an improvised anal dilator following anorectal surgeries in children is a useful alternative to the conventional dilator. It is more affordable and gives satisfactory results.

Accuracy of a time-of-flight (ToF) imaging system for monitoring deep-inspiration breath-hold radiotherapy (DIBH-RT) for left breast cancer patients.

Deep inspiration breath-hold radiotherapy (DIBH-RT) reduces cardiac dose by over 50%. However, poor breath-hold reproducibility could result in target miss which compromises the treatment success. This study aimed to benchmark the accuracy of a Time-of-Flight (ToF) imaging system for monitoring breath-hold during DIBH-RT. The accuracy of an Argos P330 3D ToF camera (Bluetechnix, Austria) was evaluated for patient setup verification and intra-fraction monitoring among 13 DIBH-RT left breast cancer patients. The ToF imaging was performed simultaneously with in-room cone beam computed tomography (CBCT) and electronic portal imaging device (EPID) imaging systems during patient setup and treatment delivery, respectively. Patient surface depths (PSD) during setup were extracted from the ToF and the CBCT images during free breathing and DIBH using MATLAB (MathWorks, Natick, MA) and the chest surface displacement were compared. The mean difference ± standard deviation, correlation coefficient, and limit of agreement between the CBCT and ToF were 2.88 ± 5.89 mm, 0.92, and - 7.36, 1.60 mm, respectively. The breath-hold stability and reproducibility were estimated using the central lung depth extracted from the EPID images during treatment and compared with the PSD from the ToF. The average correlation between ToF and EPID was - 0.84. The average intra-field reproducibility for all the fields was within 2.70 mm. The average intra-fraction reproducibility and stability were 3.74 mm, and 0.80 mm, respectively. The study demonstrated the feasibility of using ToF camera for monitoring breath-hold during DIBH-RT and shows good breath-hold reproducibility and stability during the treatment delivery.

Surgical management of traumatic perineal injury in female children: A report of two cases.

INTRODUCTION AND IMPORTANCE: Perineal trauma is uncommon in paediatric population,accounting for about 0.2 to 8 % of all paediatric trauma. The goal of surgical management is to ensure adequate anatomical reconstruction with good functional outcome and cosmesis. A novel surgical technique derived from posterior sagittal anorectoplasty (PSARP)was recently described for reconstruction of perineal injuries due to sexual assault in children. We report our experience with the utilization of this technique for perineal reconstruction in 2 girls with fourth-degree traumatic genito-anal injury. CASE PRESENTATION: The first patient is a 6 year old girl who presented 2 months post perineal injury following a fall.Previous multiple attempts at repair in peripheral hospital failed.She had Initial debridement,wound irrigation and divided sigmoid colostomy for stool diversion done.Definitive reconstruction was performed 5 months later.The second patient is a 14 year old girl that presented 6 days following perineal trauma sustained while riding a bicycle.Primary repair was also attempted before referral,with subsequent wound breakdown.Wound debridement and colostomy creation was done and surgical reconstruction carried out 6 months later.Following definitive repair,the colostomies in both patients were closed at 2 and 3 months respectively.Both patients are fully continent of stool and have excellent cosmetic outcome during postoperative follow up. CLINICAL DISCUSSION: The surgical technique allows for effective dissection and proper reconstruction of the perineal body and anorectal sphincters.It also avoids unnecessary dissection and tissue disruption as the intact posterior rectal wall and anal sphincters are left undisturbed. CONCLUSION: The Surgical technique derived from the principles of posterior sagittal anorectoplasty gives excellent functional outcome in perineal trauma.

Experience with the use of mohan's valvotome for posterior urethral valve ablation at a centre in North-Eastern Nigeria.

Introduction: Posterior urethral valve (PUV) is the most common congenital cause of lower urinary tract obstruction in boys. Management has remained challenging in our region, with features of renal impairment evident in some patients at the time of presentation. Endoscopic valve ablation is the gold standard of treatment, but this is not readily available in our setting. Mohan's valvotome has been described as an alternative device for valve ablation. This study aimed to highlight the clinical presentation, management and early outcomes following valve ablation using Mohan's valvotome. Methods: A retrospective study of boys with PUVs managed between September 2014 and June 2018 was done. The demographic characteristics, clinical features, investigations, treatment and initial outcomes were reviewed. The main outcome measures were improved post-ablation urinary stream, serial serum creatinine values at presentation, 4-5 days of initial catheter drainage and at follow-up. Results: There were ten boys with the median age at presentation of 4 months (mean: 23.9 months; range 10 days to 7 years). Four patients presented after 1 year. All the patients had features of bladder outlet obstruction with associated fever in seven patients and urinary tract infections in six patients. Nine patients (90%) had suprapubic masses, while 2 had ballotable kidneys with co-existing urinary ascites in one patient. Valve ablation was achieved with Mohan's valvotome. There was a significant improvement in the urine stream in all patients. The median duration of follow-up was 7.5 months. Median serum creatinine was 0.95 mg/dl (mean 0.94 mg/d ± 0.38 mg/dl) at follow-up, compared to a median of 4.03 mg/dl at presentation (P = 0.01). Conclusion: Initial drainage and definitive valve ablation with Mohan's valvotome is associated with improved serum creatinine and urinary stream.

Analysis of image quality and radiation dose in routine adult brain helical and wide-volume computed tomography procedures.

OBJECTIVES: To evaluate and compare image quality and radiation dose between the helical and wide-volume scans to determine the protocol that provides a lower radiation dose without loss in image quality. METHODS: The study was prospectively conducted on consented adult patients that presented for routine brain CT. Image quality and radiation dose were compared between the helical and wide-volume scans on the Toshiba 160-slice Aquilion Prime CT scanner. The volume computed tomography dose index (CTDIvol) and dose length product (DLP) for each scan mode were collected and compared. Image quality was quantitatively and qualitatively evaluated using the unenhanced brain CT images. The data were analysed using a statistical package for social sciences (SPSS) software version 20 for both the descriptive and inferential statistics. A significant difference in image quality and radiation dose between the helical and wide-volume scans was determined based on a p-value of <0.05. RESULTS: A total of 54 participants were included, with two groups of 27 participants. The CTDIvol and DLP values were significantly p < 0.05 higher in the helical scan (CTDIvol: 65 mGy; DLP: 1597 mGy.cm) compared to the wide-volume scan (CTDIvol: 54 mGy; DLP: 1133 mGy.cm). The grey and white matters show a better signal-to-noise ratio (SNR) for the helical scan. Meanwhile, the contrast-to-noise ratio (CNR) was significantly p < 0.05 higher in the wide-volume scan. The results from the visual grading methods were compared and showed superior image quality in helical over the wide-volume scan. CONCLUSION: Wide-volume provides a lower dose compared to helical and therefore, could be adopted as the routine protocol for brain CT for in house dose optimisation. Where clinical conditions warrant the need for a helical scan, the protocol should be optimised in line with the as low as reasonable achievable (ALARA) principle.

Typhoid perforation in children below 5 years: a 10-year review of cases managed and outcome.

INTRODUCTION: Typhoid perforation is still prevalent in children in developing countries. Hence, the need for a review of the morbidity and mortality from typhoid perforation in children from poor countries. AIM: We review the clinical features, morbidity, and mortality of typhoid perforation in children aged ≤ 5 years in a developing country. METHODS: A retrospective 10-year study of children aged ≤ 5 years with typhoid perforation in two tertiary hospitals in northeastern Nigeria. Data regarding clinical presentation, investigations, intra-operative findings, treatment, and outcome were reviewed. RESULTS: Out of 221 children aged ≤ 15 years with typhoid perforation, 45 (20.4%) were aged ≤ 5 years. Fever and abdominal distension were present in all 45 (100.0%), followed by abdominal pain 33 (73.3%), constipation 19 (42.2%), diarrhoea and vomiting 18 (40.0%) and vomiting 13 (28.8%). All patients presented in second week of infection. Plain abdominal radiograph showed pneumoperitoneum suggestive of bowel perforation in 39 (86.7%) patients. Forty-one (91.1%) patients had ileal perforations with various severities of peritonitis. Out of which, 30 (73.2%) were single and 11 (26.8%) were multiple perforations. Two (4.4%) patients had peritonitis without bowel perforation, while 2 (4.4%) others had caecal, gall bladder perforations, respectively. Serious post-operative wound complications occurred in patients with severe peritonitis, multiple perforations, prolonged pre-operative resuscitation, and operation beyond 2 h. Overall, mortality rate was about 26.7% mainly in patients who had multiple perforations, severe peritonitis, prolonged pre-operative resuscitation, and operation time more than 2 h. CONCLUSION: Multiple perforations, severe peritonitis, and operation time more than 2 h are poor post-operative factors that were associated with poor post-operative outcome in our patients.

Effect of food hygiene training on food handlers' knowledge in Sokoto Metropolis: a quasi-experimental study.

INTRODUCTION: training intervention for food handlers is necessary to increase their knowledge and awareness about food hygiene. Research in this area has been given low attention in Nigeria, especially in the Northern part of the country. Therefore, we assessed the effect of food hygiene training on the knowledge of food hygiene among food handlers in Sokoto metropolis. METHODS: we conducted a quasi-experimental study between January and July 2019. We used a multistage sampling technique to select 360 food handlers randomized into intervention and control groups. We conducted a training intervention after the baseline data collection. Post-intervention data collection was conducted six months after the intervention. We estimated the proportion of respondents with good knowledge at baseline and post-intervention. We assessed the difference in pre-and post-intervention proportions using McNemars Marginal Homogeneity test at 5% level of significance. RESULTS: in the intervention and control groups, 19 (10.6%) and 18 (10.0%) had primary education respectively, p = 0.231. At baseline, 23 (12.8%) and 22 (12.2%) in intervention and control groups respectively had good knowledge, p= 0.515. At post-intervention, the proportion of those with good knowledge in the intervention group increased to 56.7%, p < 0.001; while in the control group, there was no significant difference in the proportion of those with good knowledge, p = 0.248. CONCLUSION: the training intervention has significantly improved the knowledge of the food handlers. We recommend that the National Food and Drug Agency, in collaboration with restaurant owners, ensure regular on-the-job training of food handlers.

Knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria.

INTRODUCTION: psychoactive substance use (PSU) is a patterned use of a drug in which the user consumes the substance in amounts or methods which are harmful to themselves or others. Psychoactive substance use takes a considerable toll on financial status, academic achievement and health status of addicts. In Nigeria, PSU is on the increase, one of the most disturbing health-related problems and a leading cause of premature death among school aged population worldwide. We therefore, determined the knowledge of health effects and determinants of psychoactive substance use among secondary school students in Sokoto Metropolis, Nigeria. METHODS: we conducted a cross-sectional study among 430 secondary school students that were selected using multistage sampling in Sokoto, Northwestern, Nigeria from April to May 2019. We collected data using a semi-structured, interviewer-administered questionnaire. We calculated proportions and adjusted odds ratios (OR) with 95% confidence intervals (CI) in a binary logistic regression model. RESULTS: knowledge of health effects of PSU was good in 38.1% of the respondents with a mean score of 19.6 ± 10.0. The overall prevalence of PSU was high among current users (16.3%), male participants (78.6%) and those aged 17-years or more (68.6%). Independent predictors of current use of psychoactive substances were poor knowledge of health effects (aOR: 4.1, 95% CI: 1.7-10.0) and father´s use of psychoactive substances (aOR: 10.3, 95% CI= 1.9-57.1). CONCLUSION: knowledge of health effects of psychoactive substances was generally poor among the participants with an associated high prevalence among current users. Poor knowledge of its health effects determines the use of psychoactive substances. We conducted awareness campaigns and health talk on health effects of PSU to secondary school students in the State. The Federal Ministry of Education should ensure that PSU-related topics are incorporated in the secondary school curriculum.

Predictors of bullying perpetration among adolescents attending secondary schools in Sokoto Metropolis, Nigeria, 2019.

INTRODUCTION: bullying affects up to 85% of in-school adolescents in Nigeria. It presents a potentially serious threat to healthy adolescent development. Bullying has not been extensively studied in Nigeria and more so in northern Nigeria. Therefore, we investigated the types and predictors of bullying perpetration among adolescents in secondary schools. METHODS: we conducted a cross-sectional study between January and March 2019. Using a multistage sampling technique, we recruited 390 adolescents. We estimated the prevalence and types of bullying perpetration, and we examined the predictors of bullying among the participants using chi-square and binary logistic regression at a 5% level of significance. RESULTS: the mean age of adolescents was 15.2 ± 1.9 years. Majority of the participants 234 (60.0%) were in late adolescence (15-19 years), and 205 (52.6%) were males. The most prevalent type of bullying perpetrated was verbal [69.7%; 95% CI = 64.9-74.3%]. Overall, 307 [78.7%; 95% CI = 74.3-82.6%] had perpetrated at least one type of bullying. Male gender (adjusted Odds Ratio (aOR): 2.70; 95%CI = 1.43 - 5.10), attending a boarding school (aOR: 7.93, 95% CI = 2.91 - 21.58) and frequent parental conflicts (aOR: 5.23, 95% CI = 2.15 - 12.71) were independent predictors of bullying perpetration. CONCLUSION: there is a high prevalence of bullying perpetration among adolescents in Sokoto metropolis, especially among males, those in boarding schools and those who experience frequent parental conflicts. We recommend that school principals should pay close attention to this behaviour and parents should be sensitized on the consequences of their domestic actions on their children.

A Survey of Iranian Retracted Publications Indexed in PubMed.

BACKGROUND: Retraction is a mechanism for correcting the literature and a warning for readers in relation to publications that contain serious flaws or erroneous data. As a result of growth and development of Iranian publications in the last two decades, that brings unethical behavior of researchers led to retraction of their publications. We aimed to investigate Iranian retracted publications indexed in PubMed database. METHODS: All Iranian retracted publications published in PubMed up to Dec 2017 have been retrieved. Bibliographic information of retracted publications, retraction notice, time lag between article publication date and the date of retraction notice, reasons of retraction, Issuer of retraction and acknowledge information of retracted publication were recorded. Additionally, citation data of retracted publications before 2013 were analyzed. RESULTS: Overall, 164 Iranian retracted publications were identified. Meantime lag was 20.8 months. "Islamic Azad University" and "Tehran University of Medical Sciences (TUMS)" were two affiliations that have received highest number of retracted publications. The most issuer of retraction publications was editor-in-chief and the most mentioned reasons for retractions were authorship issues, plagiarism, and redundant publication. Thirty-three (20.12%) publications have received funds from various agencies. Citation study of retracted publications indicates that these publications have received 789 citations (Citation per publication=11.6). CONCLUSION: Although Iranian retracted publications represent small portion of all Iranian publications, but the number of retracted publications has increased. More than half of retracted publications have had authorship issues and plagiarism that requires more attention to research ethics authorities.

Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012-2019: a secondary data analysis.

BACKGROUND: Nigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. METHODS: This retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019. RESULTS: Cumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases. CONCLUSIONS: Sokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

Automated algorithm for calculation of setup corrections and planning target volume margins for offline image-guided radiotherapy protocols.

PURPOSE: Each radiotherapy center should have a site-specific planning target volume (PTV) margins and image-guided (IG) radiotherapy (IGRT) correction protocols to compensate for the geometric errors that can occur during treatment. This study developed an automated algorithm for the calculation and evaluation of these parameters from cone beam computed tomography (CBCT)-based IG-intensity modulated radiotherapy (IG-IMRT) treatment. METHODS AND MATERIALS: A MATLAB algorithm was developed to extract the setup errors in three translational directions (x, y, and z) from the data logged by the CBCT system during treatment delivery. The algorithm also calculates the resulted population setup error and PTV margin based on the van Herk margin recipe and subsequently estimates their respective values for no action level (NAL) and extended no action level (eNAL) offline correction protocols. The algorithm was tested on 25 head and neck cancer (HNC) patients treated using IG-IMRT. RESULTS: The algorithms calculated that the HNC patients require a PTV margin of 3.1, 2.7, and 3.2 mm in the x-, y-, and z-direction, respectively, without IGRT. The margin can be reduced to 2.0, 2.2, and 3.0 mm in the x-, y-, and z-direction, respectively, with NAL and 1.6, 1.7, and 2.2 mm in the x-, y-, and z-direction, respectively, with eNAL protocol. The results obtained were verified to be the same with the margins calculated using an Excel spreadsheet. The algorithm calculates the weekly offline setup error correction values automatically and reduces the risk of input data error observed in the spreadsheet. CONCLUSIONS: In conclusion, the algorithm provides an automated method for optimization and reduction of PTV margin using logged setup errors from CBCT-based IGRT.

Derivative-free HS-DY-type method for solving nonlinear equations and image restoration.

A derivative-free conjugate gradient algorithm for solving nonlinear equations and image restoration is proposed. The conjugate gradient (CG) parameter of the proposed algorithm is a convex combination of Hestenes-Stiefel (HS) and Dai-Yuan (DY) type CG parameters. The search direction is descent and bounded. Under suitable assumptions, the convergence of the proposed hybrid algorithm is obtained. Using some benchmark test problems, the proposed algorithm is shown to be efficient compared with existing algorithms. In addition, the proposed algorithm is effectively applied to solve image restoration problems.

A hybrid conjugate gradient algorithm for constrained monotone equations with application in compressive sensing.

Combining the projection method of Solodov and Svaiter with the Liu-Storey and Fletcher Reeves conjugate gradient algorithm of Djordjevic for unconstrained minimization problems, a hybrid conjugate gradient algorithm is proposed and extended to solve convex constrained nonlinear monotone equations. Under some suitable conditions, the global convergence result of the proposed method is established. Furthermore, the proposed method is applied to solve the ℓ 1 -norm regularized problems to restore sparse signal and image in compressive sensing. Numerical comparisons of the proposed algorithm versus some other conjugate gradient algorithms on a set of benchmark test problems, sparse signal reconstruction and image restoration in compressive sensing show that the proposed scheme is computationally more efficient and robust than the compared schemes.

Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria.

Introduction: Gastroschisis is a congenital anterior abdominal wall defect characterized by herniation of abdominal contents through a defect usually located to the right side of the umbilical cord. It occurs in about 1 in 2,000-4,000 live births and is slightly commoner in males. Management has remained challenging in the low and middle-income countries (LMICS), with high mortality rates. This study highlights the clinical presentation, treatment, outcomes, and challenges in the management of gastroschisis at a tertiary healthcare center in a resource-limited setting. Methods: This was a retrospective review of the records of all patients with gastroschisis managed over a period of 30 months (January 2016-June 2018). Data on patients' demographics, age, birth weight, clinical presentation, method of gastroschisis reduction and closure, complications, and outcomes were collated. Statistical analysis was performed using SPSS version 20. A p-value of >0.05 was considered significant. Results: Twenty-four patients with gastroschisis were managed. Of these, 18 patients had data available for analysis. There were 14 males, with a male-female ratio of 3.5:1. The median age at presentation was 11.0 h (range 1-36 h). Ten patients (55.6%) were delivered in a medical facility. One patient had type II jejunal atresia and transverse colonic atresia as associated anomalies. Improvised silos were applied by the bedside in 15 (83.3%) patients, while two patients (11.1%) had primary closure under general anesthesia. One patient died before definitive treatment could be done. Sterile urobags and female condoms were used for constructing improvised silos in 9 (60%) and 6 (40%) patients, respectively. Eight patients who had initial silo application had complete bowel reduction over a median time of 8.0 days (mean 10.0 ± 6.5 days, range 2-23 days). Total parenteral nutrition (TPN) was not available. The average time to commencement of feeding was 8.0 days ± 6.6 (median 6.0 days, range 2-22 days). Full feeding was achieved in five patients (two patients in the primary closure group and three from the silo group) over a mean time of 16.8 days ± 10.4 (median 14.0 days). Sepsis was the commonest complication. Four patients (22.2%) survived. Conclusion: Management of gastroschisis remains challenging in resource-limited regions.

Characterisation of Time-of-Flight (ToF) imaging system for application in monitoring deep inspiration breath-hold radiotherapy (DIBH-RT).

The purpose of this study is to develop a method for characterisation of time-of-flight (ToF) imaging system for application in deep inspiration breath-hold radiotherapy (DIBH-RT). The performance of an Argos 3D P330 ToF camera (Bluetechnix, Austria) was studied for patient surface monitoring during DIBH-RT using a phantom to simulate the intra-patient and inter-patient stability of the camera. Patient setup error was also simulated by positioning the phantom at predefined shift positions (2, 5 and 10 mm) from the isocentre. The localisation accuracy of the phantom was measured using ToF imaging system and repeated using CBCT imaging alone (CBCT) and simultaneously using ToF imaging during CBCT imaging (ToF-CBCT). The mean and SD of the setup errors obtained from each of the imaging methods were calculated. Student t-test was used to compare the mean setup errors. Correlation and Bland-Altman analysis were also performed. The intra-and inter-patient stability of the camera were within 0.31 mm and 0.74 mm, respectively. The localisation accuracy in terms of the mean ±SD of the measured setup errors were 0.34 ± 0.98 mm, 0.12 ± 0.34 mm, and -0.24 ± 1.42 mm for ToF, CBCT and ToF-CBCT imaging, respectively. A strong correlation was seen between the phantom position and the measured position using ToF (r = 0.96), CBCT (r = 0.99) as well as ToF-CBCT (r = 0.92) imaging. The limits of agreement from Bland Altman analysis between the phantom position and ToF, CBCT and ToF-CBCT measured positions were -1.52, 2.31 mm, -0.55, 0.78 mm; and -3.03, 2.55 mm, respectively. The sensor shows good stability and high accuracy comparable to similar sensors in the market. The method developed is useful for characterisation of an optical surface imaging system for application in monitoring DIBH-RT.

Wilms tumor in a left pelvic kidney: A case report.

INTRODUCTION: Wilms tumor(nephroblastoma) is the most common renal tumor in childhood.The most frequent anomalies and syndromes associated with this tumor involve the genitourinary tract. The occurrence of Wilms tumor with renal ectopia is rare.When present,Wilms tumor is usually found in association with other forms of renal ectopia like horseshoe kidneys or crossed fused renal ectopia. However, reports of the occurrence of Wilms tumor in unilateral pelvic renal ectopia is uncommon. We report a case of Wilms tumor in a pelvic left kidney. PRESENTATION OF CASE: A 10 year old girl presented to the out-patient department with a one year history of lower abdominal mass, pain and hematuria. Examination revealed a mass in the suprapubic region. Radiological investigations showed a tumor in a left pelvic kidney. She was managed with preoperative chemotherapy, surgery and adjuvant chemotherapy. Histopathologic examination of the nephrectomy specimen confirmed the diagnosis of nephroblastoma. DISCUSSION: The occurrence of Wilms tumor in association with renal ectopia is rare. There are few reports of tumors arising in unilateral pelvic ectopic kidneys. A multi-modal treatment approach involving the use of chemotherapy, surgery and radiotherapy (for high-risk tumors) in the management of Wilms tumor gives good outcome. CONCLUSION: Tumors arising from a pelvic kidney should be considered as part of the differential diagnosis of lower abdominal masses in children.

Challenges in the management of early versus late presenting congenital diaphragmatic hernia in a poor resource setting.

BACKGROUND: Despite the advances in management, congenital diaphragmatic hernia (CDH) has continued to pose a significant challenge to paediatric surgeons. This is amplified in a setting like ours where there is a dearth of facilities to cope with the problem of CDH. This study was undertaken to highlight the peculiarities of the management of CDH in a poor resource setting. METHODS: All confirmed cases of CDH were prospectively documented from 2003 till date. RESULTS: Seven children were treated from 2003 till date. The diaphragmatic defect was on the left side in six (83.8%) and on the right side in one (17.7%). All the patients had primary closure of the defect without patch via an abdominal approach. The three patients presenting at birth died while the remaining four patients survived. CONCLUSION: With inadequate neonatal intensive care facilities, the severe early presenting CDH has a dismal prognosis. In contrast, the late presenting CDH poses more diagnostic challenges; but once identified and appropriate treatment instituted, it has an excellent prognosis. We recommend that physicians should include CDH in the differential diagnosis of patients with birth asphyxia and in patients with chronic respiratory symptoms with failure to thrive.

The epigastric heteropagus conjoined twins.

Conjoined twins are rare and are classified as symmetrical or asymmetrical, in which a member, the host (autosite), is near normal and bears the parasite, which is incomplete, smaller, and fully dependent for growth on it. This form of conjoined twins is referred to as heteropagus and when attached to the epigastrium of the autosite is called epigastric heteropagus. Only 44 cases of epigastric heteropagus twins have been previously reported in the world literature. We hereby report the successful separation of a pair of heteropagus twins.