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Introduction The radiotherapy of left-sided breast cancers is challenging because of neighboring critical organs, posing an increased risk of complications. Various radiation delivery techniques have been used to deliver the desired dose of radiation to the target area while keeping the doses to nearby structures within constraints. The main aim of this study is to quantify doses delivered to the organs at risk (OARs) including heart, left lung, spinal cord, and contralateral breast, and to the planning target volume (PTV) using Field-in-Field (FIF) and Volumetric Modulated Arc Therapy (VMAT). Patients and methods A retrospective review of 15 left-sided breast cancer patients was done. All the patients underwent breast-conserving surgery and adjuvant radiation. For every patient, two different radiation treatment plans were formulated and compared for the PTV coverage and doses to OARs, including heart, ipsilateral lung, spinal cord, and contralateral breast. The radiation treatment techniques utilized for this purpose were FIF and VMAT. The homogeneity index (HI), and conformity index (CI) required for the treatment planning were also calculated. Data was analyzed using Statistical Package for the Social Sciences (IBM Corp., Armonk, USA). An Independent T-test was used for statistical analysis. Results The mean age was 41 years and the majority of them were stage II. Total nine patients were given 4005centi Gray (cGy) in 15 fractions (fr) followed by 10Gy boost, hence receiving a total dose of 5005cGy in 20fr. While remaining six patients were given a total dose 4005cGy in 15fr without any boost. All patients were hypofractionated and the dose was delivered at a rate of 267cGy per fr. The FIF technique utilized in breast cancer radiation significantly reduced the mean doses to OARs: mean heart dose (3.81cGy), ipsilateral lung dose (V16- 15cGy), mean contralateral breast dose (0.03cGy), and maximum spinal cord dose (0.18cGy); as compared to VMAT technique which delivered comparatively higher doses: mean heart dose (8.85cGy), ipsilateral lung dose (V16- 19.82cGy), mean contralateral breast dose (4.59cGy), and maximum spinal cord dose (7.14cGy). There was a significant mean difference between doses of OARs and all p-values were statistically significant (p<0.005). Moreover, the FIF technique also improves the dose distribution of PTV in terms of dose homogeneity. However, the conformity index is more enhanced with VMAT as opposed to FIF. Conclusion The FIF technique is more advantageous than the VMAT planning technique because it provides better dose distribution in terms of PTV coverage and significantly lower doses to OARs in radiotherapy to left-sided breast cancer.
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OBJECTIVE: To determine the patterns of maternal nutrition status by using mid upper arm circumference (MUAC) and to examine the association of maternal nutritional status with the nutritional status of malnourished children under two years of age. METHODS: Descriptive study conducted at the Department of Pediatric Medicine of the Children's Hospital, Lahore from January 2017 to March 2018. A total of 227 mother accompanying their children admitted for nutritional rehabilitation were included. Demographics of participants along with MUAC of every mother was taken. Data analysis was done by SPSS 22. RESULTS: Mean maternal age was 28.29±5.30 years and mean age of children was 9.22 ± 6.05 months. Mean maternal MUAC was 25.53±3.63 cm. Normal nutrition was present in only 70 (31%), 35 (15.4%) had moderate to severe under nutrition and 68 (30%) were overweight and 17 (7.5%) were obese. Maternal illiteracy was common 150 (66%) and 203 (89%) belong to poor social class. Majority 150 (75%) children had <-3SD WHZ score. Only 42 (18.5%) children were exclusively breast fed. Maternal malnutrition was significantly associated with severity of child's undernutrition (p=0.045) and low rates of exclusive breast feeding practices (p=0.049). CONCLUSION: Malnutrition, in the form of both under nutrition and obesity is prevalent in mothers of malnourished children belonging to lower social class. Maternal illiteracy and low income are the major contributor in maternal malnutrition which in turn has an impact on child nutrition and breast feeding practices.
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OBJECTIVE: To compare weight for height (WHZ) and mid upper arm circumference (MUAC) to diagnose malnutrition in children aged 6-59 months and to determine the association of various risk factors with the nutritional status of the children. METHODS: Descriptive study conducted at the Department of Paediatric Medicine of The Children's Hospital Lahore from May 2017 to April 2018. A total of 257 children 6 to 59 months of age having MUAC of <125mm were included. WHZ scoring was done and compared with MUAC. RESULTS: There was slight male predominance 135 (52.5%). Mean age of children was 13.43 + 8.81 months (95% CI: 12.34-14.51). Mean MUAC was 103±13.5 mm (95%CI: 101-105mm). Exclusive breast feeding was present in 82 (32%). Maternal illiteracy was common in SAM (p = was 0.001). More children (73.2%) were identified as SAM by MUAC of <115 mm as compared to WHZ of <-3SD (70%). The ROC curve analysis for MUAC (cut-off value:103, 95%CI; AUC: 101-107 mm) showed it as an excellent predictor (p=<0.001) for children having SAM and WHZ <-3SD, with (AUC= 0.786 [95%CI; 0.725-0.848]). CONCLUSION: Both MUAC and WHZ showed fair degree of agreement to diagnose moderate and severe acute malnutrition among children aged 6-59 months. At the community level of resource limited countries, MUAC can be used as an appropriate rapid diagnostic method to identify malnourished children to be managed in nutritional rehabilitation programs.
