Age at autism spectrum disorder diagnosis and its association with child and family characteristics in a tertiary care hospital in Malaysia.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Despite the absence of a cure, early diagnosis and intensive early intervention can improve the outcomes. However, little is known about the median age at ASD diagnosis in Malaysia or the child/family characteristics associated with early diagnosis. Therefore, this study aimed to determine the median age at ASD diagnosis among Malaysian children presenting to the country's largest public tertiary neurodevelopmental center and to investigate the possible demographic, child, and family characteristics associated with an early age at diagnosis. Data were collected between February 2017 and February 2019 from a database maintained by the child development unit of the country's largest publicly funded tertiary hospital, containing data from an ethnically diverse population. Among Malaysian children attending the clinic, the median age at ASD diagnosis was 48 months. Early autism diagnosis (<36 months of age) was associated with increased severity of social communication and interaction impairments, coexisting intellectual impairment, children from high socioeconomic status families, and children who receive joint care from their families and a maid or babysitter. The study findings highlight the socioeconomic inequalities in the country, a lack of parental awareness of early ASD signs, and the presence of cultural influences on the age at diagnosis of ASD.

Influence of ozonation and roasting on functional, microstructural, textural characteristics, and aflatoxin content of groundnut kernels.

The present study was conducted to evaluate the influence of ozonation, roasting and their combination on the moisture content, color, functional, structural, textural components, and aflatoxins in groundnut kernels. Samples were subjected to three treatments namely, dry roasting (R): 166°C for 7 min; gaseous ozone treatment (O): 6 mg/L for 30 min; combined ozonation-roasting (OR): gaseous ozonation at 6 mg/L for 30 min followed by dry roasting at 166°C for 7 min. The ozonated-roasted samples had the lowest moisture content (3.45%), the highest total phenolic content (4.18 mg gallic acid equivalents/100 g), and antioxidants capacity (69.59%). The treatments did not induce significant changes in color of kernels (p < .05). Scanning electron microscopy indicated cracking of granules in roasted and swelling in ozonated kernels whereas more uniform orientation of granules was observed in ozonated-roasted kernels. Roasted and ozonated kernels indicated a significant reduction of fracturability force to 54.60 and 14.11%, respectively, whereas ozonated-roasted samples demonstrated a nonsignificant increase (4.37%). An increase in wave number of ozonated samples to 3,289.37 cm-1 in Fourier transform infrared (FTIR) spectrum (FTIR) indicated stretching in OH groups. FTIR spectrum of ozonated-roasted kernels suggested the formation of a new compound with CC and CC groups. The major aflatoxin B1 was reduced to maximum, that is, 100% in ozonated-roasted kernels followed by ozonated (80.95%) and roasted (57.14%) samples. The findings indicate that the ozonation-roasting treatment had a prominent role in the enhancement of functional compounds, structural and textural attributes along with the considerable reduction in aflatoxin content.

Copper(II) Ion Promoted Reverse Solvatochromic Response of the Silatrane Probe to Spectral Shifts: Preferential Solvation and Computational Approach.

The unique solvatochromic attitude of an analyte owing to its coordination with metal ions in solvents of different polarities is challenging. Herein, we introduce two new solvatochromic 4-(pentan-3-yl) benzaldehyde-based triazolyl silatrane probes (5 and 6). The solvatochromic behavior of both probes 5 and 6 was studied using Reichardt's E (30) and the Kamlet-Taft empirical scale by UV-visible spectra in 14 solvents (hydrogen-bond donor (HBD) and non-HBD), and the results show that probes 5 and 6 exhibit reverse solvatochromism. Probe 5 witnessed an enhancement in this behavior upon coordination with the Cu2+ ion in MeCN/MeOH solvents due to the intramolecular charge transfer (ICT) process. Interestingly, the binding of probe 5 with Cu2+ ions resulted in an instant color change in MeCN and MeOH from pale yellow to light blue and brown-red, respectively, which can be easily detected by the "naked eye". A solvatochromic study of the complex 5-Cu2+ in binary mixtures of polar aprotic and polar protic solvents (MeCN/MeOH) discloses that the latter are more preferred over polar aprotic solvents in the solvation microsphere. The entire metal coordination process of probe 5 toward the Cu2+ ion can be visualized and was further evaluated by UV-vis/fluorescence spectral titrations, Fourier transform infrared (FT-IR) spectroscopy, and theoretical calculations employing density functional theory (DFT) and time-dependent-DFT (TD-DFT). The proposed analytical approach is believed to play a crucial role in the solvatochromic study of higher coordinated silicon compounds, which may be utilized to develop a solvent-dependent sensor.

Design of new bis-triazolyl structure for identification of inhibitory activity on COVID-19 main protease by molecular docking approach.

In the rapidly growing COVID-19 pandemic, designing of new drugs and evaluating their inhibitory action against main targets of corona virus could be an effective strategy to accelerate the drug discovery process and their efficacy towards corona virus disease. Herein, we design new bis-triazolyl probe for an investigation of inhibitory activity towards COVID-19 main protease by Molecular docking approach. The formulated compound has been thoroughly characterized by elemental analysis, NMR (1H and 13C) and complete structure elucidation was achieved via X-ray crystallography. Docking study reveals that newly synthesized compound confers good inhibitory response to COVID-19 main protease as supported by calculated docking score and binding energy. Strong hydrogen bonding and hydrophobic interactions of the newly synthesized compound with several important amino acids of the main protease also helps to explain the potency of the compound to inhibit the main protease. We hope that the present study would help the researcher in the field of Medicinal chemistry and to develop potential drug against the novel corona virus.

Diagnostic value of galactomannan antigen test in serum and bronchoalveolar lavage fluid sample from suspected patients of invasive pulmonary aspergillosis.

Invasive pulmonary aspergillosis (IPA) is mainly caused by Aspergillus fumigatus and other Aspergillus species. Galactomannan (GM) is a polysaccharide antigen that exists primarily in the cell walls of Aspergillus species. GM may be released into the blood and other body fluids even in the early stages of Aspergillus invasion; therefore, detection of the GM antigen level can be useful in making an early diagnosis of IPA.

Selenium attenuates venlafaxine hydrochloride-induced testicular damage in mice via modulating oxidative stress and apoptosis.

The present study assessed the effect of selenium (Se) supplementation on Venlafaxine hydrochloride (VH)-induced testicular toxicity. Mice were segregated into Group I (C), Group II (0.5 ppm Se), Group III (VH at a dose 60 mg/kg b.w.) and Group IV (Se was given as per Group II, and VH was given as per Group III). After 10 weeks, sperm parameters, histology, sperm cell counts, antioxidants activities, apoptotic proteins and molecular analysis of testicular tissue were evaluated. Group III had significantly lower sperm concentration (from 2.17 ± 0.28 to 1.04 ± 0.22) and sperm motility (from 68.04 ± 5.5 to 21.47 ± 5.21), and showed an extensive vacuolisation in the germinal epithelium, abnormal basement membrane, and reduced germ cell number as compared to Group I. However, selenium supplementation in Group IV substantially increased sperm concentration (1.47 ± 0.48) and motility (33.27 ± 8.66), improved the histoarchitecture and repopulated the germ cells as observed by raised numbers of spermatogonia, spermatocytes, round spermatids and elongated spermatids contrasted to Group III. Group IV also showed a noteworthy decreased ROS, LPO levels, as well as expressions of Bax, caspase-9, and caspase-3 and increased the SOD, CAT, GPx, and GSH activities as well the expression of Bcl-2 as compared to Group III. This effect was further supported by FTIR analysis for nucleic acids. Thus, selenium supplementation showed significant protection against VH-induced testicular toxicity.

Therapeutic Efficacy of Plasma Exchange in Neuromyelitis Optica.

BACKGROUND: Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that selectively affects the optic nerves and spinal cord and generally follows a relapsing course. Therapeutic plasma exchange (TPE) appears to be effective in patients with central nervous system inflammatory demyelinating disease who do not respond to first-line corticosteroid treatment. OBJECTIVE: We represent a retrospective review of the use of TPE in the treatment of an acute attack of NMO in five patients who failed to respond to initial immunomodulatory treatment. MATERIALS AND METHODS: We evaluated the effect of TPE on the degree of recovery from NMO. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics Mobile Collection System plus) by femoral or central line access and scheduled preferably on alternate-day intervals from 8 to 10 days. Both subjective and objective clinical response to TPE was estimated, and final assessment of response was made at the time of the last TPE in the series. RESULTS: All patients were severely disabled before the initiation of TPE and they were female; with the mean age of these patients was 52.5 years (range = 36-69 years), the median age of NMO diagnosis was 49.4 years (range = 35-65 years), and the median duration of disease was 2.6 years (range = 0-5 years). Out of five patients, three had a history of bilateral optic neuritis, and all patients were anti-against protein aquaporin-4antibody positive. Totally 24 TPE procedures were performed on five patients, the mean time of start of TPE in the acute attack was 18.6 days. Patients were severely disabled at the initiation of TPE (range = expanded disability status scale 6.5-9), and improvement was observed early in the course of TPE treatment in most patients. CONCLUSION: The present study provides clinical support for the importance of TPE in refractory acute attack in NMO. However, with new diagnostic technologies and increasing clinical awareness, we may see a more improved ways of TPE in these patients in the future; hence, TPE is more effective modality of treatment as it also removed the antibodies.

Evaluation of IOTA Simple Ultrasound Rules to Distinguish Benign and Malignant Ovarian Tumours.

INTRODUCTION: IOTA stands for International Ovarian Tumour Analysis group. Ovarian cancer is one of the common cancers in women and is diagnosed at later stage in majority. The limiting factor for early diagnosis is lack of standardized terms and procedures in gynaecological sonography. Introduction of IOTA rules has provided some consistency in defining morphological features of ovarian masses through a standardized examination technique. AIM: To evaluate the efficacy of IOTA simple ultrasound rules in distinguishing benign and malignant ovarian tumours and establishing their use as a tool in early diagnosis of ovarian malignancy. MATERIALS AND METHODS: A hospital based case control prospective study was conducted. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analysed using chi-square test and kappa statistical method. RESULTS: Out of initial 55 patients, 50 patients were included in the final analysis who underwent surgery. IOTA simple rules were applicable in 45 out of these 50 patients (90%). The sensitivity for the detection of malignancy in cases where IOTA simple rules were applicable was 91.66% and the specificity was 84.84%. Accuracy was 86.66%. Classifying inconclusive cases as malignant, the sensitivity and specificity was 93% and 80% respectively. High level of agreement was found between USG and histopathological diagnosis with Kappa value as 0.323. CONCLUSION: IOTA simple ultrasound rules were highly sensitive and specific in predicting ovarian malignancy preoperatively yet being reproducible, easy to train and use.

Psychosis in a 15-Year-Old Female with Herpes Simplex Encephalitis in a Background of Mannose-Binding Lecithin Deficiency.

Historically, psychotic disorder has been associated with viral infection. Herpes simplex infections and Epstein-Barr virus (EBV) among other viral infections have been implicated in psychotic disorder. Of note in this case report is psychotic disorder that occurred following reactivation of herpes simplex infection in a background of mannose-binding lecithin (MBL) deficiency, childhood EBV infection, and severe psychosocial stress. Herpes simplex encephalitis (HSE) remains a significant cause of morbidity and mortality despite advancement in its treatment with intravenous acyclovir. Many studies have reported psychiatric and neurological manifestation of herpes simplex infection following primary or reactivated infection, while others suggest milder clinical course of herpes simplex encephalitis in a background of immunosuppression. Another contributory factor to psychotic disorder in this case is childhood EBV exposure which has been reported to increase the risk of psychosis in adolescence and adulthood. This case report describes a 15-year-old female with MBL deficiency who presented with psychosis caused by reactivated herpes simplex infection and had good clinical recovery. Based on childhood Epstein-Barr virus exposure and psychosis in adolescence (current case), she is at increased risk of psychotic disorder in adulthood, which underscores the importance of long-term monitoring.

Superior Mesentric Artery Syndrome in a Patient with Subacute Intestinal Obstruction: A Case Report.

Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial. There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.

Individual donor-nucleic acid testing for human immunodeficiency virus-1, hepatitis C virus and hepatitis B virus and its role in blood safety.

BACKGROUND: Transfusion-transmitted infections (TTIs) are one of the biggest threats to blood transfusion safety. Nucleic acid testing (NAT) in blood donor screening has been implemented in many countries to reduce the risk of TTIs. NAT shortens this window period, thereby offering blood centers a much higher sensitivity for detecting viral infections. AIMS: The objective was to assess the role of individual donor-NAT (ID-NAT) for human immunodeficiency virus-1 (HIV-1), hepatitis C virus (HCV) and hepatitis B virus (HBV) and its role in blood safety. MATERIALS AND METHODS: A total of 32978 donations were tested for all three viruses using enzyme-linked immuno-sorbent assay (Vironostika(®) HIV Ag-Ab, Hepanostika(®) HCV ultra and hepatitis B surface antigen ultra by Biomerieux) and ID-NAT using Procleix Ultrio plus(®) Assay (Novartis Diagnostic, USA). All initial NAT reactive samples and serology nonreactive were retested in triplicate and NAT discriminatory assay for HIV-1, HCV and HBV were performed. RESULTS: Of the 32978 samples, 43 (0.13%) were found to be ID-NAT reactive but seronegative. Out of 43, one for HIV-1, 13 for HCV and 27 for HBV were reactive by discriminatory assays. There were two samples that were reactive for both HCV-HBV and counted as HCV-HBV co-infection NAT yield. The prevalence of these viruses in our sample, tested by ID-NAT is 0.06%, 0.71%, and 0.63% for HIV-1, HCV and HBV respectively. The combined NAT yield among blood donors was 1 in 753. CONCLUSION: ID-NAT testing for HIV-1, HCV and HBV can tremendously improve the efficacy of screening for protecting blood recipient from TTIs. It enables detection of these viruses that were undetected by serological test and thus helped in providing safe blood to the patients.

Therapeutic Plasma Exchange-A New Dawn in the Treatment of Pemphigus Vulgaris.

Pemphigus vulgaris is an autoimmune disorder that involves intraepithelial blistering and sores of skin and mucous membrane. It generally correlates with the levels of circulating autoantibodies; their removal seems a reasonable therapeutic approach. Therapeutic plasma exchange is hypothesized to remove pathogenic autoantibodies and has been used in refractory or severe cases. It may be considered for rapid control of severe or recalcitrant pemphigus vulgaris and should be combined with use of concomitant immuno-suppressive.

Acute transfusion reactions encountered in patients at a tertiary care centre in Punjab.

BACKGROUND: Blood transfusion is a life-saving procedure, which can occasionally be unsafe and result in a spectrum of adverse events. We aimed to determine the characteristics and type of acute transfusion reactions occurring in patients at a tertiary care centre. METHODS: A retrospective study was conducted at the Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab. All acute transfusion reactions reported to the department from 1 Jan 2012 to 31 March 2013 were evaluated. All the adverse reactions were recorded, analysed and classified on the basis of their clinical features and laboratory tests. RESULTS: During the study period, 45 092 blood components were issued from the department and 190 transfusion reactions (0.42%) were reported. The most frequent were febrile non-haemolytic transfusion reactions (54.2%) followed by allergic reactions (36.3%), haemolytic reactions (1%) and non-specific reactions (8.5%). CONCLUSION: Each transfusion has to be monitored carefully with prompt recognition and treatment of acute transfusion reactions to decrease transfusion-related morbidity and mortality. Data from a well-functioning haemovigilance system can be used as a quality indicator for monitoring blood transfusion safety and contribute to evidence-based transfusion medicine.

Diagnosis of frontal meningioma presenting with psychiatric symptoms.

The frontal lobes of the brain are notoriously "silent": Benign tumors such as meningiomas that compress the frontal lobes from the outside may not produce any symptoms other than progressive change of personality and intellect until they are large. We present two cases with symptoms suggestive of depressive episodes, which on further investigations showed space occupying lesions suggestive of frontal meningiomas.

Therapeutic plasma exchange in the treatment of myasthenia gravis.

AIM: The aim of this study was to analyze the retrospective experience related to the indication, complication and outcome of Therapeutic Plasma Exchange (TPE) in Myasthenia gravis (MG). It is a well known autoimmune disease characterized by antibodies against the acetylcholine receptor (anti-ACHR) on the post synaptic surface of the motor end plate. Plasma exchange is the therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence. MATERIALS AND METHODS: A total of 35 patients of MG were submitted to a total of 41 cycles and 171 session of TPE. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics) by Femoral or central line access and schedule preferably on alternate day interval. Immediate outcome was assessed shortly after each session and overall outcome at discharge. RESULTS: Total of 110 patients of MG who were admitted to our hospital during the study period of two years. 35 (31.8%) patients had TPE performed with mean age of 32 years (M:F = 2:1). The mean number of TPE session was 4.2 (SD±1.2), volume exchange was 2215 ml (SD±435); overall incidence of adverse reaction was 21.7%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 78.3% of patients. CONCLUSION: TPE may be considered as one of the treatment options especially in developing countries like ours as it is relatively less costly but as effective for myasthenic crisis as other modalities.

Acute Transfusion Reactions (ATRs) in Intensive Care Unit (ICU): A Retrospective Study.

BACKGROUND: Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. AIM: To analyze the incidence and spectrum of ATRs occuring in critically ill patients. MATERIALS AND METHODS: This was a retrospective review conducted from 1(st) April 2011 till 31(st) March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. RESULTS: During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. CONCLUSIONS: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.

Synthesis of the C(7)-C(22) sector of (+)-acutiphycin via O-directed double free radical alkyne hydrostannation with Ph3SnH/Et3B, double I-Sn exchange, and double Stille coupling.

Herein a new double O-directed free radical hydrostannation reaction is reported on the structurally complex dialkyldiyne 11. Through our use of a conformation-restraining acetal to help prevent stereocenter-compromising 1,5-H-atom abstraction reactions by vinyl radical intermediates, the two vinylstannanes of 10 were concurrently constructed with high stereocontrol using Ph3SnH/Et3B/O2. Distannane 10 was thereafter elaborated into the bis-vinyl iodide 9 via O-silylation and double I-Sn exchange; double Stille coupling of 9, O-desilylation, and oxidation thereafter furnished 8.

Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography.

OBJECTIVES: Examination of pregnant women in the first trimester with transvaginal ultrasonography with the aim to study various fetal development markers, e.g., gestation sac, yolk sac, fetal heart motion, CRL length, and fetal anatomy in both normal and abnormal pregnancies. Comparative evaluation of transvaginal ultrasonography vis-à-vis transabdominal scanning in the study of first trimester of pregnancy and its complications. To assess the relative merits and demerits of transvaginal ultrasonography in comparison with the transabdominal technique. MATERIALS AND METHODS: The study will be conducted on 50 females patients during the first trimester of pregnancy. The study population will consist of both normal and abnormal pregnancies. These patients will be included on the basis of suspicion of or proven pregnancy of duration up to 12 weeks from LMP. The evaluation of the patients will include the following: Record of patients obstetrical history and clinical examination, record of pregnancy test and relevant investigations, ultrasonic examination of pregnancy. (a) Transabdominal ultrasound scanning will be done with moderately distended bladder by using real time scanners with low frequency probe (3/3.5 MHz); (b) transvaginal sonography will be done with the real-time sector scanner using high-frequency endovaginal probe (5/7.5 MHz), after the patient voids urine. Relevant images will be taken by using the multiformat automatic camera. RESULTS AND CONCLUSIONS: In the study of 46 normal intrauterine pregnancies, TVS showed additional information in 36 patients (78.3%) as compared to TAS, in detection of gestation sac, yolk sac, double bleb sign, or better visualization of embryonic anatomy. In the abnormal pregnancy (n=17), TVS provided more information in 11 cases (64.9%), which included detection of embryonic demise, yolk sac, double bleb sign, or subchorionic hemorrhage. Regarding ectopic gestations (n=7), TVS gave additional information in 5 cases (71.4%) which included detection of ectopic fetal pole, yolk sac, decidual cast, adnexal mass, and fluid in cul de sac. In two cases, both TAS and TVS gave equal information. However, in 2 cases TAS demonstrated the extent of intraabdominal fluid better than TVS. The other advantages of TVS over TAS are that there is no need for the patient to have uncomfortably full bladder and time is saved from having to wait for bladder to fill. Thus, the potential preoperative patient can be kept fasting. TVS is also superior in obese patients, in patients with retroverted uterus and it also bypasses obstacles such as bone, gas filled bowel, and extensive pelvic adhesions. The limitations encountered with TVS were limited manoveuribility of probe and because of the unorthodox position and angle of the transducer, correct orientation was difficult initially.

An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy.

BACKGROUND: To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients. METHODS: Patients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast. RESULTS: The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p < 0.05) and left irradiated chest wall p = 0.025 (p < 0.025) in comparison to the non-irradiated skin thickness investigating chronic skin reactions. Patients with grade 2 acute skin toxicity presented with thinner skin as compared to patients with grade 1 (p = 0.006). CONCLUSIONS: This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.