Comparison between Volumetric Modulated arc Therapy based Coplanar and Noncoplanar Planning for Stereotactic Body Radiation Therapy of Liver

BACKGROUND: The study aims to investigate potential dosimetric benefits between non-coplanar and coplanar beam arrangements of Volumetric-Modulated Arc Therapy (VMAT) plans for liver stereotactic body radiotherapy (SBRT). METHODS: Thirteen patients who had undergone liver SBRT treatment in our department were chosen retrospectively for the study. Two sets of SBRT-VMAT plans namely, non-coplanar (NC-VMAT) and Coplanar (C-VMAT) were generated in Monaco(v5.11) planning system for Elekta Versa HD Linac using unflatten 6MV photon. The NC-VMAT plans were created by two/three non-coplanar partial arcs with couch rotation of ±150 and had an arc span of 1300 to 1600 whereas the C-VMAT plans consisted of a full arc. Both plans were compared by statistically analyzing various dosimetric and technical parameters. RESULTS: There is no statistically significant difference observed between the C-VMAT and NC-VMAT plans for planning target volume (PTV) coverage. However, the spine dose (D1cc) was much less in the NC-VMAT plan compared to the C-VMAT plan, with mean values of 6.127 ± 3.08Gy and 9.058 ± 4.76Gy, respectively (p-value=0.002). The low dose spillage to the healthy tissue was compared by the volume receiving 5Gy (V5Gy) and 10Gy (V10Gy). V5Gy of the NC-VMAT plan was 2399.23±1870.76cc while that of C-VMAT plans was 2835.36±1930.20cc with the p-value <0.001. Moreover, the monitor units(MU) were less with NC-VMAT than with C-VMAT SBRT plans (p=0.015). CONCLUSION: The plan quality of NC-VMAT plans was favorable compared to C-VMAT plans for liver SBRT especially in reducing spine dose, low dose spillage to healthy tissue, and MU.

Effective cataract surgical coverage in India: Evidence from 31 districts.

BACKGROUND: Effective Cataract Surgical Coverage (eCSC) is a core outcomes domain indicator to assess accessibility and quality of eye care services with limited available information. PURPOSE: To generate baseline estimates of eCSC for India. METHODS: We performed the analysis of data pooled from Rapid Assessment of Avoidable Blindness surveys conducted in 31 districts of India during 2015-2019 among persons aged 50+ years. eCSC was calculated at various thresholds, the primary being operable cataract at best corrected visual acuity <6/12, good outcome at presenting visual acuity of 6/12. RESULTS: Age-sex standardized and weighed eCSC in India was 36.7% (95% CI: 33.6, 39.9), and cataract surgical coverage (CSC) was 57.3% (95% CI: 53.3, 61.2), a relative quality gap in cataract surgery being 36.0%. eCSC in males was higher at 38.0% than females (35.6%). eCSC increased with education from 31.0% in illiterate participants to 59.7% in class 10 educated. On multivariate analysis, rural setting, increasing age, and residence in eastern or northeastern zones of India continued to be associated with poor/worse eCSC, while female gender was associated with higher eCSC. District-wide variations in eCSC were observed. CONCLUSION: Developmental factors have an important bearing on eCSC in India. Geographical variations point toward the need for targeted, locally relevant strategies.

Mandibular Osteoblastoma: A Case Report of a Rare Entity.

Osteoblastoma, an uncommon bone neoplasm characterized by the formation of osteoid tissue, constitutes a rare subset of bone tumors, representing only a negligible percentage of cases. While extensive research on the condition has identified a predilection for long bones and vertebrae, occurrences in facial bones are infrequent. This case report discusses a unique presentation in a nine-year-old female diagnosed with a tumor located in the mandibular parasymphysis region. Radiological examination revealed distinctive irregular contours surrounding the lesion, prompting a comprehensive investigation involving biopsy and subsequent histological analysis. The ensuing evaluation definitively confirmed the diagnosis of a typical benign osteoblastoma. This report highlights the novelty of an unresected benign osteoblastoma situated in the mandible, currently undergoing periodic review, with the option of surgery also on the table.

Environmental and human facets of the waterweed proliferation in a Vast Tropical Ramsar Wetland-Vembanad Lake System.

The Vembanad Lake and its associated low-lying areas and network of canals (hereafter VBL) form the major part of India's second-largest Ramsar wetland (1512 km2) located in Kerala State along India's southwest coast. The extensive VBL has a large fishery, inland waterways, and popular tourist attractions that support the livelihoods of thousands of people. Over the last several decades, the proliferation of water weeds in the VBL has alarmingly increased, causing many adverse ecological and socioeconomic effects. This study based on a review and synthesis of long-term data introduced the environmental and human dimensions of water weed proliferation in the VBL. Eichhornia (= Pontederia) crassipes, Monochoria vaginalis, Salvinia molesta, Limnocharis flava, Pistia stratiotes, and Hydrilla verticillata are the most troublesome water weeds in the VBL, with the first three being the most widespread. They were mostly imported to India long ago before becoming a part of the VBL. These weeds harmed water quality, waterways, agriculture, fisheries, disease vector management, as well as the vertical and horizontal shrinkage of the VBL through increased siltation and faster ecological succession. The inherently fragile VBL was harmed by extensive and long-term reclamation, the construction of saltwater barrages, and many landfill roads that crisscross water bodies serving as coastal dams, creating water stagnation by blocking natural flushing/ventilation by periodic tides from the adjacent southeastern Arabian Sea. These ecological imbalances were exacerbated by excessive fertiliser use in agricultural areas, as well as the addition of nutrient-rich domestic and municipal sewage, which provided an adequate supply of nutrients and a favourable habitat for the expansion of water weeds. Furthermore, because of recurrent floods and a changing ecology in the VBL, the water weed proliferation has become a more significant problem, with the potential to disrupt their current distribution pattern and spread in the future.

Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples.

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.

Experimental investigation on effect of accelerated speed and rotor material on life of implantable micro-infusion pump tubing.

Peristaltic pumps have been put to use in various biomedical applications like devices for the transfer of body fluids as well as devices for controlled release of medication, including implantable infusion pumps. Out of the various components of a peristaltic pump, tubing is considered the most vulnerable part. This study focuses on the performance of Silicone micro-pump tubing used in such an implantable drug delivery device. Long-term implantable medical devices are expected to be operational for about 10 years. But experimental testing of the reliability of components under normal working speeds are time-consuming and thus delays the product development cycle. While simulating the conditions in the laboratory under accelerated speeds, the effect of increasing the speed must be accounted. In this study, the effect of accelerated speed and rotor material on pump tubing life is investigated. A test jig is developed which simulates the running conditions of the infusion pump for long-duration operation. Different rotor speeds and material configurations are investigated to obtain their effect on long-duration performance. Thermal effects on the roller junctions are studied and found that the Delrin silicone combination has twice the rise in junction temperature than the titanium silicone combination. The failure modes are inspected using microstructure analysis and the best configuration is identified.

Alarming waterweeds proliferation in the Vembanad Lake System might significantly increase water loss through transpiration.

Eichhornia crassipes and Monochoria vaginalis are waterweeds, and their uncontrolled proliferation in fresh and brackish water habitats is a serious ecological problem in many parts of the world. These weeds are quite common in the Vembanad Lake System (VLS), India's second-largest Ramsar wetland. During the non-monsoon season, the Thannermukkom saltwater barrage divides the VLS into two zones: saline water downstream and freshwater upstream. The field sampling of the current study was carried out in the upstream zone of the VLS during the Pre-Monsoon (March 2017). Fresh Eichhornia and Monochoria samples were collected, transported to the lab, and experiments were conducted under natural light conditions to determine how much extra water they transpire into the atmosphere. The results showed that the water loss in experimental tanks with Eichhornia (evapotranspiration) is roughly twice that in control tanks without them (only evaporation). Monochoria transpires fairly more water to the atmosphere than Eichhornia. These results reveal that the proliferation of waterweeds has a significant adverse effect in conserving water in all freshwater bodies infested with them. The current study also points out that the expansion of waterweeds has the potential to worsen drought conditions as they cause excess water loss into the atmosphere and a faster drying up of freshwater reservoirs. Two possible approaches for managing the waterweeds in the VLS include reducing nutrient loading upstream and more frequent opening of the Thannermukkom saltwater barrage to allow saltwater intrusion, which could inhibit the growing waterweeds.

Microplastics in copepods reflects the manmade flow restrictions in the Kochi backwaters, along the southwest coast of India.

This baseline study on microplastics (MPs) in calanoid copepods in the Kochi backwaters (KBW), India's largest estuary system on the west coast, focuses on (a) the spatiotemporal variations of MPs with the seasonal hydrography setting, and (b) how man-made flow restrictions of a large saltwater barrage contribute to MPs in copepods and their potential to transfer to higher trophic levels. This study found that MPs in copepods in the KBW ranged from av. 0.01 ± 0.014 to 0.11 ± 0.03 no./ind. seasonally. When the saltwater barrage shutters were fully/partially closed during the Pre-monsoon/Northeast Monsoon, MPs in copepods were considerably larger (av. 0.11 ± 0.03 no./ind., and av. 0.075 ± 0.02 no./ind., respectively) as compared to the Southwest Monsoon (av. 0.03 ± 0.01 no./ind.), when the barrage shutters were fully open. This shows the potential of man-made flow restrictions to increase the bioconcentration of MPs in copepods and their possible transfer to higher trophic levels through the food chain, adding to the region's previous discovery that much higher trophic level resources are polluted with a high concentration of MPs.

Pathophysiological basis in the management of myasthenia gravis: a mini review.

Myasthenia gravis is an autoimmune disorder characterized by the presence of autoantibodies against the acetylcholine receptor present in the post-synaptic membrane of the neuromuscular junction impairing the muscle contraction and causing the patient suffering from the disorder to develop a myriad of muscular defects ranging from drooping of eyelids, blurred or double vision, shortness of breath, difficulty in swallowing, as well as weakness of limbs and arms. Myasthenia gravis is known as the disease of old men and young women but in contrast to the global scenario, in India, myasthenia gravis was found to be predominant in males with the ratio of 2.70:1. Though the disorder has been studied for centuries, the true reason for disease and its pathophysiology still eludes us. But recent advancement in molecular biology and diagnostic tools has enabled us to identify many targets for pharmacotherapy as well as for early diagnosis. Thus, improving the patient's morbidity and quality of life. In this article, we are discussing the recent advancements made in diagnosis and therapy of the disease.

Mucus targeting as a plausible approach to improve lung function in COVID-19 patients.

COVID-19 (SARS-CoV-2) has emerged as one of the worst pandemics that have tormented the globe due to its highly contagious nature. Even if the disease manifests fever-like symptoms mostly, the disease may progress to the pulmonary-hyper inflammatory phase, with severe pneumonia, hypoxia and subsequent multiple organ infection. This subsequently creates a huge burden to the health care systems across the globe for an immediate arrangement of ventilator facilities, oxygen supply and advanced health care. We evaluated the pathological similarity of COVID-19 with other airway obstructive disorders such as COPD and asthma and found typical mucus hypersecretion and mucus plugging in COVID-19 subjects. From several bronchoscopy and clinical autopsy carried out in COVID-19 patients, the overexpression of mucin gene was evident which play a significant role in mucus hypersecretion and accumulation, leading to airway obstruction and further to respiratory distress. In the present work, we highlight the need for intense research inputs to elucidate the exact role the mucus plays in worsening COVID-19 symptoms. This will further help to find a proper approach to quantify the airway mucus plugging in each patient and to develop an appropriate therapy either to inhibit mucus secretion or to improve mucus clearance through well-designed clinical trials.

Warming of blood and intravenous fluids using low-power infra-red light-emitting diodes.

Non-contact warming of blood and intravenous (IV) fluids with temperature drop compensation is an unmet clinical need till now, for management of hypothermia in patients with urgent requirement of blood. Currently available technologies provide wet warming or dry warming with direct contact using hot water or with a hot plate, respectively. These conventional technologies need disposable cartridges to be used in conjunction with the warmer. The warmed fluids lose their temperature when passing through long IV lines and fails in its purpose at low flow rates. In this paper, a distributed non-contact warming method is introduced using infra-red radiations. The method incorporates a bag warming unit and an inline cartridge unit. Bag warming unit provides uniform distribution of infra-red thermal energy liberated from low cost infra-red light emitting diodes (IR LEDs) in horizontal and vertical planes of the fluid carrying bag. An inline cartridge, through which the IV line passes, reduces the drop in temperature just before the transfusion site using a cluster of IR LEDs. As per the In Vitro tests are carried out in to establish the safety and efficacy, the bag warming unit steadily rises the temperature to attain the cut off value with a temperature rise coefficient of 0.7 °C/min and the inline cartridge warms the fluid within 10 min at a thermal transfer rate of more than 1.5 °C/min. The fluid temperature is uniformly distributed within a narrow range of 36-38 °C. When the inline warmer is powered on, the drop-in temperature is reduced to zero for flow up to 5 ml/min. For flow rates more than 8 ml/min, the temperature drop is reduced more than half. For massive transfusion range, the temperature of the fluid remains within 38.5 ± 1.2 °C for flow rates in the range of 100-1500 ml/min.

Trace metals concentration in water hyacinth implicates the saltwater barrage altered hydrography of Kochi backwaters, southwest Coast of India.

This study in the Kochi backwaters (KBW) presents the distribution of 9 trace metals (Fe, Zn, Cu, Mn, Ni, Co, Cr, Cd, Pb) in different parts (root, stolon and leaf) of the common water hyacinth Eichhornia crassipes during three different seasons [Pre-Monsoon (PRM), Southwest Monsoon (SWM), and Northeast Monsoon (NEM)]. The hyacinth was collected from 4 sections upstream of the KBW where a saltwater barrage [Thannermukkom Barrage (TB)] prevents saltwater intrusion. Results showed that regardless of seasons, all the trace metals concentration in different parts of Eichhornia varied in the following order: roots > stolon > leaves. All the trace metals except Fe showed their highest concentration during the PRM when TB introduces stagnancy of the water upstream through flow restrictions. Instead, Fe was high during the SWM associated with increased river influx at that time. Overall results showed that the hydrographical alterations of TB upstream of KBW have clear imprints on the trace metals concentrated in the hyacinth Eichhornia crassipes.

Dosimetric analysis and clinical outcomes of brachial plexus as an organ-at-risk in head-and-neck cancer patients treated with intensity-modulated radiotherapy.

OBJECTIVES: To document the dose received by brachial plexus (BP) in patients treated with intensity-modulated radiotherapy (IMRT) for head-and-neck squamous cell carcinoma (HNSCC) and report the incidence of brachial plexopathy. METHODS: Newly diagnosed patients of HNSCC treated with radical or adjuvant IMRT were included in this retrospective study. No dosimetric constraints were applied for BP maximum dose equivalent dose (EQD2 α/ß = 3). Patients with minimum 6-month follow-up were included and patients with suspicion of plexopathy were evaluated further. RESULTS: Sixty-seven patients were eligible and 127 BP were analyzed. The mean BP maximum dose (BPmax) was 62.4 Gy (+6.9), while mean BP volume was 28.1 cc (+4.1). Proportion of patients receiving BPmax >66 and >70 Gy were 34.7% and 14.2%. The mean BPmax for T4 tumors was significantly higher than T1 tumors (65 vs. 57.5 Gy, P = 0.005) but when adjusted for N-category, T-category was not independently significant in accounting for BPmax >66 or >70 Gy. Mean BPmax for N0 versus N2+ was 59.8 versus 65.6 Gy (P = 0.0001) and N1 versus N2+ was 61.6 versus 65.6 Gy (P = 0.018). After adjusting for T-category, patients with N2+ had a mean 4.2 Gy higher BPmax than N0-N1 (P = 0.0001). Stage III-IV patients had a mean six Gy higher BPmax doses than Stage I-II disease (P = 0.0001). With a median follow-up of 28 months (interquartile range 16-42), no patient had brachial plexopathy. CONCLUSION: Clinically significant plexopathy was not seen in spite of majority having over 2-years follow-up and a third of patients having dose above the recommended tolerance. Only nodal category independently influenced dose to the brachial plexii.

Rotating permanent magnet excitation for blood flow measurement.

A compact, portable and improved blood flow measurement system for an extracorporeal circuit having a rotating permanent magnetic excitation scheme is described in this paper. The system consists of a set of permanent magnets rotating near blood or any conductive fluid to create high-intensity alternating magnetic field in it and inducing a sinusoidal varying voltage across the column of fluid. The induced voltage signal is acquired, conditioned and processed to determine its flow rate. Performance analysis shows that a sensitivity of more than 250 mV/lpm can be obtained, which is more than five times higher than conventional flow measurement systems. Choice of rotating permanent magnet instead of an electromagnetic core generates alternate magnetic field of smooth sinusoidal nature which in turn reduces switching and interference noises. These results in reduction in complex electronic circuitry required for processing the signal to a great extent and enable the flow measuring device to be much less costlier, portable and light weight. The signal remains steady even with changes in environmental conditions and has an accuracy of greater than 95%. This paper also describes the construction details of the prototype, the factors affecting sensitivity and detailed performance analysis at various operating conditions.

Local excision inadequate in the treatment of anal canal leiomyosarcoma.

Leiomyosarcoma of the anal canal is an uncommon neoplasm of the gastrointestinal tract. We report a 45-year-old lady with anal canal leiomyosarcoma. In view of its rarity, we report its presentation and management. In the setting of a recurrent tumor with high-grade histological appearance, local excision would be deemed unsafe.