bluuebunny/crossref_metadata_2025 huggingface dataset:
Do Indian men have similar oncological outcomes with abiraterone plus androgen deprivation therapy in the setting of metastatic hormone-sensitive prostate cancer? A prospective observational study
Authors: Mandal Swarnendu , Tarigopula Vivek , Kumaraswamy Santosh , Das Manoj Kumar , Tripathy Sambit , Barik Kalandi , Nayak Prasant
Published: July 2024

Introduction:

Combination of abiraterone with androgen deprivation therapy (ADT) has better survival outcomes than ADT alone in metastatic Hormone-sensitive prostate cancer (mHSPC) in the Western population. In this prospective (Clinical Trials Registry-India [CTRI] registered) observational study, we present the comparative oncological outcomes of ADT alone and ADT + abiraterone in Indian patients, which is not available currently.

Methods:

This study (CTRI-number-CTRI/2020/07/026545) included newly diagnosed mHSPC patients from January 2020 to June 2023 in a tertiary care hospital, urology department. Patients fulfilling inclusion criteria were advised ADT with abiraterone (A + ADT), and those not affording received ADT monotherapy (ADT). The primary endpoint was overall survival (OS). Secondary outcomes included prostate-specific antigen (PSA) decline >90%, radiographic progression-free survival (rPFS), and PSA progression-free survival (pPFS).

Results:

Out of 278 patients with mHSPC, 163 patients were excluded and 115 were analyzed (ADT = 40 vs. A + ADT = 75). After a median follow-up of 20.3 months, 11 of 40 (27.5%) in ADT-only arm and 15 of 75 (20%) in ADT + abiraterone arm had died (Hazard-ratio of death 0.72; 95% confidence interval 0.68–0.88; P < 0.001). A PSA decline of >90% was seen in 85% in the ADT alone group and 93.3% in the ADT + abiraterone group. Significantly better outcomes of the ADT + abiraterone were seen in the secondary endpoints of rPFS (P < 0.001) and pPFS (P < 0.001). The OS benefit was 28% reduction in risk of death in our study versus 37% and 38% in STAMPEDE and LATITUDE, respectively. pPFS and rPFS were also poorer in Indian subsets.

Conclusions:

Abiraterone with ADT improves OS, PSA response, rPFS, and pPFS in the Indian population akin to the Western data but with poorer OS, rPFS, and PSA progression-free survival on comparison.
Glans cap-preserving dorsal inlay-free graft augmentation technique for reconstruction of meatal stenosis and fossa navicularis strictures: Analysis of short-term functional outcomes
Authors: Enganti Bhavatej , Nanavati Prashant , Madduri Vijay Kumar Sarma , Wani Amish , Chiruvella Mallikarjuna
Published: July 2024

Introduction:

Meatal stenosis and fossa navicularis strictures (FNSs) are commonly caused by lichen sclerosus and instrumentation. We present the technique and short-term functional outcomes of glans cap-preserving dorsal inlay-free graft augmentation for the reconstruction of meatal stenosis and FNS.

Methods:

This retrospective study analyzed patients with meatal stenosis and FNS who underwent glans cap-preserving dorsal inlay-free graft augmentation at our institute since 2019. The surgical technique included a ventral subcoronal approach, preservation and mobilization of the glans cap, a ventral midline urethrotomy incision over the stricture, and a dorsal midline meatotomy incision extending to the proximal normal urethral mucosa at the fossa navicularis, followed by dorsal inlay graft augmentation. During the follow-up, patients were periodically assessed for symptom scores, urinary flow rates (UFRs), and patient-reported outcomes.

Results:

A total of 26 patients with a mean age of 45 ± 15 years were assessed. The predominant cause of stricture was lichen sclerosus (n = 15; 58%). The mean stricture length was 3.8 ± 0.5 cm, 73% had a circumcised phallus, and an oral mucosa graft augmentation was performed in 22 (85%) patients. Notable postoperative complications included intractable meatal hemorrhage (n = 1) and glans suture granuloma (n = 1), which required intervention. At a mean follow-up of 40 months, there were four failures, of which one patient required redo-urethroplasty. The remaining patients (n = 22; 85%) showed improved symptom scores (P < 0.05), UFRs (P < 0.05), and satisfactory patient-reported outcomes.

Conclusion:

Glans cap-preserving dorsal inlay-free graft augmentation is a safe and feasible technique with satisfactory short-term functional outcomes for the management of meatal stenosis and FNS in carefully selected patients.
The Rate of Anti-measles Immunoglobulin M Positivity among Children with Skin Rash and Fever in Diyala Province
Authors: Hasan Abdulrazak SH. , Salman Raghad E. , Saleh Mohammad K. , Noaman Nadhim G. , Ali Alyaa Y. , Rashid Hiba H. , Zaidan Noor I.
Published: July 2024

Background:

Measles is an extremely contagious disease characterized by generalized maculopapular rash, fever, cough, coryza, and conjunctivitis. It is caused by the measles virus.

Objective:

The objective of this study was to explore the anti-measles immunoglobulin (Ig) M positivity rate among children with clinical suspicion of having measles.

Subjects and Methods:

This is a cross-sectional study carried out in Diyala Province, Iraq, from November/2020 to October/2021. A total of 425 blood samples were collected from children (≤14 years of age): 90 from patients who were clinically suspected as having measles (18 were vaccinated with measles vaccine and 72 were not); 270 from measles-vaccinated children, including those children who received all recommended vaccines in the Iraqi Expanded Program of Immunization (IEPI); and 65 from nonvaccinated children, including those children who received none of the vaccines in the IEPI. Enzyme-linked immunosorbent assay (ELISA) kits for the detection of anti-measles IgM were used.

Results:

The results found that 14 (15.6%) of clinically suspected children were positive for anti-measles IgM antibody versus 76 (84.4%) who were negative. Whereas, only one (1.5%) of the unvaccinated children was positive, and all vaccinated children were negative. Thus, clinically suspected patients had a significantly higher positivity rate compared to other study groups (P = 0.0001). Similarly, the mean ± standard deviation of anti-measles IgM concentration was significantly higher compared to other study groups (P = 0.0001).

Conclusion:

About one-sixth of patients clinically comparable to measles in Diyala Province actually had measles, most of them were unvaccinated, and the anti-measles IgM ELISA technique was a good marker for exploring measles cases.
Blood Lead Level among Chronic Kidney Diseases Patients Attended Medical City Hospital in Baghdad 2022
Authors: Fadhil Aseel Hussein , Al-Rubaey Mazin Ghazi
Published: July 2024

Background:

Lead is a highly toxic metal. Multiple lead exposures produce serious poisoning and sometimes fatality because lead builds up slowly in the exposed body. Signs of repeated exposure to lead are high blood pressure, numbness or tingling of the extremities, memory loss, anemia, and kidney dysfunction.

Methods:

A cross-sectional study was conducted involving patients with chronic kidney disease (CKD) who attended to medical city hospital. The study was conducted from January 2 to May 31, 2022. Inclusion criteria were by involved adults ≥30 years old with CKD of both genders. Glomerular filtration rate (GFR) was measured for all patients according to the Cockcroft-Gault equation. Whole blood samples were taken to measure lead levels in the Toxicology Center of Baghdad Medical City. The collection of data was done by interview using a special questionnaire. Verbal consent was taken as an ethical issue by each participant in the study.

Results:

A total of 315 CKD patients were involved. The mean blood lead level was 24.62 μg/dL, the range was between 15 μg/dL, and 33 μg/dL for both genders, which is higher than the cut point of 10 μg/dL depended in this study. About 38.4%, and 30.8% of patients had GFR (15–29 mL/min/1.73 m2), and (<15) mL/min/1.73 m2 and they were considered as stage 4 and 5 CKD patients, respectively.

Conclusions:

Lead level in blood and GFR had a significant association.
The Association between Refractive Errors and Congenital Ptosis
Authors: Khudhair Nadheer Hashim , Hasan Loay Mahmod
Published: July 2024

Background:

Children with congenital ptosis need to be carefully assessed for refractive errors and visual function to identify and treat amblyopia which occurs in 20% of congenital ptosis, small amount of which is attributed to ptotic eyelid occluding the pupil.

Objectives:

The objective is to determine the frequency of refractive errors and its associations among children with congenital ptosis.

Patients and Methods:

Case–control study of 60 patients with congenital ptosis (79 eyes) and 60 patients without ptosis (control group) (72 eyes). Conducted in Ibn Al-Haithem Eye Teaching Hospital in Baghdad from April 2020 to May 2021. The main outcome measures were relative congenital ptosis, presence, and types of refractive errors.

Results:

Significant association was obtained between children with ptosis and average spherical and cylinder refractory error. Among 60 cases (79 eyes) of congenital ptosis, refractive errors were present in 26 eyes (32.9%) with the astigmatisms as the most common refractive errors (18.9%), followed by hypermetropia (8.9%) and myopia (5.1%).

Conclusions:

Children with congenital ptosis in our environment have greater refractive errors, early ophthalmic evaluation and timely treatment of these conditions may help prevent the irreversible visual impairment in case of congenital ptosis.
Left Ventricle Myocardial Work Correlated with Functional Capacity in Severe Rheumatic Mitral Stenosis with Preserved Left Ventricular Ejection Fraction
Authors: Rudiktyo Estu , Cramer Maarten J. , Yonas Emir , Teske Arco J. , Siswanto Bambang Budi , Doevendans Pieter A. , Soesanto Amiliana M.
Published: July 2024

Background and Aims:

Functional capacity is reduced in mitral stenosis (MS) patients. Previous studies showed a correlation between left atrial strain and functional capacity in this population. However, currently, no left ventricle (LV) echocardiographic parameters were associated with functional capacity in patients with MS. Noninvasive LV pressure-strain loop analysis is a new echocardiographic method for evaluating LV function, integrating longitudinal strain from speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work (MW) that overcomes the preload-dependent characteristics conventional parameters by integrating afterload. This study aimed to evaluate the association between MW and functional capacity measured using exercise tests in patients with severe MS and preserved LV ejection fraction (LVEF).

Methods:

Adult patients with symptomatic severe rheumatic MS (mitral valve area <1.5 cm2), and preserved LVEF (>50%) and sinus rhythm who underwent echocardiography and exercise stress test in our hospital from 2019 to 2021 were included. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, significant mitral regurgitation or aortic valve lesions, coronary artery disease, intracardiac shunt, and atrial fibrillation. Standard echocardiographic parameters were measured, and all MW parameters were included. Exercise treadmill testing was performed using the modified Bruce protocol.

Results:

A total of 33 individuals with isolated severe rheumatic MS in sinus rhythm (age 39.8 ± 9.8 years) were included in the study. Patients with severe isolated MS showed significantly impaired LV-global longitudinal strain values compared to normal reference values. Furthermore, patients with severe MS showed significantly lower values of global work index, global constructive work, and efficiency compared to normal values and higher wasted work. Global work efficiency was significantly correlated to the duration of exercise (P = 0.025, Pearson’s r = 0.389).

Conclusions:

In stable patients with isolated severe mitral stenosis, MW efficiency significantly correlated with functional capacity measured objectively through exercise testing.
Potential Diagnostic and Prognostic Values of Left Atrial Strain in Valvular Heart Disease
Authors: Anwar Ashraf Mohammed
Published: July 2024

There has been increasing evidence supporting the importance of left atrial (LA) functional analysis and measurement in various physiologic and pathologic cardiovascular conditions due to its high diagnostic and prognostic values. Assessment of LA strain (LAS) has emerged as an early marker of subclinical LA dysfunction. Using speckle-tracking echocardiography, LAS can be measured in all phases of LA function (reservoir, conduit, and booster pump). In valvular heart disease (VHD), surgical and nonsurgical interventions should be performed before irreversible left ventricular (LV) and/or LA myocardial dysfunction. The current guidelines recommended using LV strain as a parameter for early detection and timely intervention. Currently, many published data have shown the diagnostic and prognostic values of LAS in VHD, which is encouraging to integrate LAS during echo assessment. In this review, we aim to collect the current data about the clinical utility of LAS changes in risk stratification, predicting outcome, and guiding the time of intervention in VHD. The review summarized these data according to the type of valve pathologies.
Exploring the Potential of Machine Learning Algorithms to Improve Diffusion Nuclear Magnetic Resonance Imaging Models Analysis
Authors: Prieto-González Leonar Steven , Agulles-Pedrós Luis
Published: July 2024

Purpose:

This paper explores different machine learning (ML) algorithms for analyzing diffusion nuclear magnetic resonance imaging (dMRI) models when analytical fitting shows restrictions. It reviews various ML techniques for dMRI analysis and evaluates their performance on different b-values range datasets, comparing them with analytical methods.

Materials and Methods:

After standard fitting for reference, four sets of diffusion-weighted nuclear magnetic resonance images were used to train/test various ML algorithms for prediction of diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), and kurtosis (K). ML classification algorithms, including extra-tree classifier (ETC), logistic regression, C-support vector, extra-gradient boost, and multilayer perceptron (MLP), were used to determine the existence of diffusion parameters (D, D*, f, and K) within single voxels. Regression algorithms, including linear regression, polynomial regression, ridge, lasso, random forest (RF), elastic-net, and support-vector machines, were used to estimate the value of the diffusion parameters. Performance was evaluated using accuracy (ACC), area under the curve (AUC) tests, and cross-validation root mean square error (RMSECV). Computational timing was also assessed.

Results:

ETC and MLP were the best classifiers, with 94.1% and 91.7%, respectively, for the ACC test and 98.7% and 96.3% for the AUC test. For parameter estimation, RF algorithm yielded the most accurate results The RMSECV percentages were: 8.39% for D, 3.57% for D*, 4.52% for f, and 3.53% for K. After the training phase, the ML methods demonstrated a substantial decrease in computational time, being approximately 232 times faster than the conventional methods.

Conclusions:

The findings suggest that ML algorithms can enhance the efficiency of dMRI model analysis and offer new perspectives on the microstructural and functional organization of biological tissues. This paper also discusses the limitations and future directions of ML-based dMRI analysis.
Investigating the Dosimetric Leaf Gap Correction Factor of Mobius3D Dose Calculation for Volumetric-modulated Arc Radiotherapy Plans
Authors: Sawapabmongkon Thitipong , Changkaew Pimolpun , Puttanawarut Chanon , Tangboonduangjit Puangpen , Khachonkham Suphalak
Published: July 2024

Aims:

The dosimetric leaf gap (DLG) is a parameter for correcting radiation transmission through the round leaf end of multileaf collimators. The purpose of this study was to determine and investigate the optimal DLG correction factor for 6 MV volumetric-modulated arc radiotherapy (VMAT) plan dose calculations in Mobius3D.

Materials and Methods:

Seventeen VMAT plans were selected for the DLG correction factor optimization process. The optimal DLG correction factor was defined as the minimum difference between the measured dose and the Mobius3D-calculated dose on the Mobius Verification Phantom™ with different DLG correction factors. Subsequently, the optimal DLG correction factor was applied for Mobius3D dose calculation, and accuracy was assessed by comparing the measured and calculated doses. For verification and validation, the 17 previous plans and 10 newly selected plans underwent Mobius3D calculations with the optimal DLG correction factor, and gamma analysis was performed to compare them to the treatment planning system (TPS). Gamma analysis was also performed between the electronic portal imaging device (EPID) and the TPS for cross-comparison between systems.

Results:

The DLG correction factor was optimized to −1.252, which reduced the average percentage differences between measured and Mobius3D-calculated doses from 2.23% ±1.21% to 0.03% ±1.82%. The cross-comparison between Mobius3D/TPS and EPID/TPS revealed a similar trend in gamma passing rate (>95%) in both the verification and validation plans.

Conclusion:

The DLG correction factor strongly influences the accuracy of Mobius3D-calculated doses. Applying the optimal DLG correction factor can increase dose agreement and gamma passing rate between calculation and delivered doses of VMAT plans, which emphasizes the importance of optimizing this factor during the commissioning process.
Determination of Critical Organ Doses with 177Lu Prostate-specific Membrane Antigen Dosimetry in Metastatic Prostate Cancer Treatment
Authors: Yilidir Gulcihan , Demir Mustafa
Published: July 2024

Aim:

This study aimed to perform dosimetry in patients with metastatic prostate cancer treated with 177Lutetium (Lu) prostate-specific membrane antigen (PSMA)-617 radiopharmaceutical, calculating organ blood clearance and consequently determining the maximum tolerable treatment activity.

Materials and Methods:

Eighteen patients with metastatic prostate cancer were enrolled in the study. Patients were administered 5.55 gigabecquerel (GBq) of 177Lu-PSMA-617 radiopharmaceutical per treatment cycle through infusion. Blood samples (2 mL each) were collected at 2, 4, 6, 8, 18, 24, 36, and 44 h postinjection to assess the bone marrow absorbed dose. Organ doses were calculated using the OLINDA/EXM software based on scintigraphic images of the 18 patients who received 177Lu-PSMA-617.

Results:

The blood clearance of 177Lu-PSMA-617 radiopharmaceutical was determined to be bi-exponential. The mean absorbed doses for the parotid glands, kidneys, bone marrow, and liver were found to be 1.18 ± 0.27, 1.05 ± 0.3, 0.07 ± 0.05, and 0.31 ± 0.2 Gy/GBq, respectively. The radiation dose to the bone marrow was significantly lower than that to the kidneys and parotid glands. No dose limitations were necessary for kidneys and bone marrow in any of the patients.

Conclusions:

Our dosimetry results indicate that 177Lu-PSMA-617 therapy is safe in terms of radiation toxicity.
Evaluation of Ion Recombination Correction for Indigenously Developed Farmer Ion Chamber in Flattening Filter-Free Photon Beams
Authors: Patwe Parimal T. , Deshpande Sudesh S. , Mahajan Gajanan R.
Published: July 2024

Purpose and Aim:

Modern generation linear accelerator (linac) either generates X-rays with a flattening filter (WFF beam) or without flattening filter free (FFF beam). The FFF beams are associated with a significantly higher dose per pulse compared to WFF beams due to the absence of a flattening filter and the corresponding attenuation caused by it. This results in increased ion recombination and a larger saturation correction factor (ks). In accordance with the IAEA TRS 398 dosimetry protocol, ks is necessary for the accurate measurement of absorbed dose at a point in water. The objective of this study was to evaluate the ks for the indigenous FAR 65-GB ion chamber (IC) for the FFF X-rays.

Materials and Methods:

The study was carried out on TrueBeam linac (Varian, A Siemens Healthineers company) which offers 6 MV WFF, 6 MV FFF, 10 MV WFF and 10 MV FFF beams. The two-voltage method was employed to measure ks in a solid water phantom at a depth of 10 cm for a FAR 65-GB and SNC 600c and 0.6cc PTW 30013 Farmer chambers at 100 cm and 150 cm source-to-chamber distances for a 10 cm × 10 cm field size.

Results:

The ks values for the FAR 65-GB, PTW 30,013, and SNC 600c were 1.0055 (1.0113), 1.0051 (1.0071), and 1.0033 (1.0066) for the 6 MV WFF (FFF) beams, respectively, and 1.0066 (1.0178), 1.0061 (1.0137), and 1.0035 (1.0119) for the 10MV WFF (FFF) beams, respectively. The ks values calculated by two-voltage method matches with ks values obtained from Jaffe’s plot. The chamber exhibited a linear dose-response up to 3000 cGy, beyond which a saturation effect was observed.

Conclusions:

Our study reveals that this chamber is suitable for the reference dosimetry for the FFF beams.
Evaluation of the Minimum Segment Width and Fluence Smoothing Tools for Intensity-modulated Techniques in Monaco Treatment Planning System
Authors: Jiménez-Puertas Sara , Rodríguez Andrea González , Cordero Sergio Lozares , González Tomás González , Chamarro Javier Díez , Hernández Mónica Hernández , Moreno Raquel Castro , Casi Marta Sánchez , Gazulla David Carlos Villa , Martínez Almudena Gandía , Bonel Arantxa Campos , Valiño Maria del Mar Puertas , Gómez José Antonio Font
Published: July 2024

Purpose:

This study aims to minimize monitor units (MUs) of intensity-modulated treatments in the Monaco treatment planning system while preserving plan quality by optimizing the “Minimum Segment Width” (MSW) and “Fluence Smoothing” parameters.

Materials and Methods:

We retrospectively analyzed 30 prostate, 30 gynecological, 15 breast cancer, 10 head and neck tumor, 11 radiosurgery, and 10 hypo-fractionated plans. Original prostate plans employed “Fluence Smoothing” = Off and were reoptimized with Low, Medium, and High settings. The remaining pathologies initially used MSW = 0.5 cm and were reoptimized with MSW = 1.0 cm. Plan quality, including total MU, delivery time, and dosimetric constraints, was statistically analyzed with a paired t-test.

Results:

Prostate plans exhibited the highest MU variation when changing “Fluence Smoothing” from Off to High (average ΔMU = −5.1%; P < 0.001). However, a High setting may increase overall MU when MSW = 0.5 cm. Gynecological plans changed substantially when MSW increased from 0.5 cm to 1.0 cm (average ΔMU = −29%; P < 0.001). Organs at risk sparing and planning target volumes remained within 1.2% differences. Replanning other pathologies with MSW = 1.0 cm affected breast and head and neck tumor plans (average ΔMU = −168.38, average Δt = −11.74 s, and average ΔMU = −256.56, average Δt = −15.05 s, respectively; all with P < 0.004). Radiosurgery and hypofractioned highly modulated plans did not yield statistically significant results.

Conclusions:

In breast, pelvis, head and neck, and prostate plans, starting with MSW = 1.0 cm optimally reduces MU and treatment time without compromising plan quality. MSW has a greater impact on MU than the “Fluence Smoothing” parameter. Plans with high modulation might present divergent behavior, requiring a case-specific analysis with MSW values higher than 0.5 cm.
Validation and Efficiency Evaluation of Automated Quality Assurance Software SunCHECK™ Machine for Mechanical and Dosimetric Quality Assurance
Authors: Dhoundiyal Mayank , Rasal Sachin , Gupte Ajinkya , Dandekar Prasad Raj , Jadhav Ananda , Awate Omkar
Published: July 2024

Recent decades have witnessed transformative advances in radiation physics and computer technology, revolutionizing the precision of radiation therapy. The adoption of intricate treatment techniques such as three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, volumetric-modulated arc therapy, and image-guided radiotherapy necessitates robust quality assurance (QA) programs. This study introduces the SunCHECK™ Machine (SCM), a web-based QA platform, presenting early results from its integration into a comprehensive QA program. linear accelerators (LINAC) demand QA programs to uphold machine characteristics within accepted tolerances. The increasing treatment complexity underscores the need for streamlined procedures. The selection of QA tools is vital, requiring efficiency, accuracy, and alignment with clinic needs, as per recommendations such as the AAPM task group 142 report. The materials and methods section details SCM implementation in various QA aspects, encompassing daily QA (DQA), imaging QA with Catphan, conventional output assessment with a water phantom, and LINAC isocenter verification through the Winston–Lutz test. Challenges in QA processes, such as manual data transcription and limited device integration, are highlighted. Early results demonstrate SCM’s significant reduction in QA time, ensuring accuracy and efficiency. Its automation eliminates interobserver variation and human errors, contributing to time savings and near-immediate result publication. SCM’s role in consolidating and storing DQA data within a single platform is emphasized, offering potential in resource optimization, especially in resource-limited settings. In conclusion, SCM shows promise for efficient and accurate mechanical and dosimetric QA in radiation therapy. The study underscores SCM’s potential to address contemporary QA challenges, contributing to improved resource utilization without compromising quality and safety standards.
Breast Cancer Subtype Prediction Model Employing Artificial Neural Network and 18F-Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography
Authors: Hossain Alamgir , Chowdhury Shariful Islam
Published: July 2024

Introduction:

Although positron emission tomography/computed tomography (PET/CT) is a common tool for measuring breast cancer (BC), subtypes are not automatically classified by it. Therefore, the purpose of this research is to use an artificial neural network (ANN) to evaluate the clinical subtypes of BC based on the value of the tumor marker.

Materials and Methods:

In our nuclear medical facility, 122 BC patients (training and testing) had 18F-fluoro-D-glucose (18F-FDG) PET/CT to identify the various subtypes of the disease. 18F-FDG-18 injections were administered to the patients before the scanning process. We carried out the scan according to protocol. Based on the tumor marker value, the ANN’s output layer uses the Softmax function with cross-entropy loss to detect different subtypes of BC.

Results:

With an accuracy of 95.77%, the result illustrates the ANN model for K-fold cross-validation. The mean values of specificity and sensitivity were 0.955 and 0.958, respectively. The area under the curve on average was 0.985.

Conclusion:

Subtypes of BC may be categorized using the suggested approach. The PET/CT may be updated to diagnose BC subtypes using the appropriate tumor maker value when the suggested model is clinically implemented.
Evaluation of the Treatment Planning and Delivery for Hip Implant Cases on Tomotherapy
Authors: Singh Pawan Kumar , Verma Rohit , Tripathi Deepak , Singh Sukhvir , Bhushan Manindra , Kumar Lalit , Barik Soumitra , Gairola Munish
Published: July 2024

Purpose:

The metal present in the implant creates artifacts during the treatment simulation, which impacts the treatment planning and delivery of the prescribed dose to the target and sparing normal tissues. This retrospective study evaluated the uncertainties in the planning and delivery of doses for prosthesis cases with dedicated phantom.

Materials and Methods:

In this retrospective study, 11 patients with a hip prosthesis having cervix carcinoma were selected. Two treatment plans were generated on treatment planning system (TPS) for each case. Plan_No_Res was without any beam restriction, and Plan_exit_only was the plan with restricted beam entry through the metallic implant. An indigenous phantom was utilized to verify the accuracy of the treatment. In the phantom, some groves were present, which could be filled by implants that mimic the patient’s geometries, like left, right and bilateral femur implants. The delivered doses were recorded using optically stimulated luminescence dosimeters (OSLDs), which were placed at different positions in the phantom. The plans were further calculated using megavoltage computed tomography (MVCT) scans acquired during treatment.

Results:

The patient data showed no significant dose changes between the two planning methods. The treatment time increases from 412.18 ± 86.65 to 427.36 ± 104.80 with P = 0.03 for Plan_No_Res and Plan_exit_only, respectively. The difference between planned and delivered doses of various points across phantom geometries was within ± 9.5% in each case as left, right, and bilateral implant. The variations between OSLDs and MVCT calculated doses were also within ± 10.8%.

Conclusion:

The study showed the competency of tomotherapy planning for hip prosthesis cases. The phantom measurements demonstrate the errors in dosimetry near the implant material, suggesting the need for precise methods to deal with artifact-related issues.
Analyzing Global Cancer Control: Progress of National Cancer Control Programs through Composite Indicators and Regression Modeling
Authors: Chauhan Rohit Singh , Munshi Anusheel , Pradhan Anirudh
Published: July 2024

Aim:

Cancer is a significant public health concern, and National Cancer Control Programs (NCCPs) are crucial for reducing its burden. However, assessing the progress of NCCPs is challenging due to the complexity of cancer control outcomes and the various factors that influence them. Composite indicators can provide a comprehensive and accurate assessment of NCCP progress.

Materials and Methods:

The dataset was compiled for 144 countries and comprised eight composite indices and two high-level comparative indicators (mortality-to-cancer incidence ratio [MIR] and 5-year cancer prevalence-to-incidence ratio [PCIR]) representing NCCP outcomes. Two large databases and six annual composite index reports were consulted. Linear regression analysis and Pearson correlation coefficients were used to establish a relationship between indicators and NCCP outcomes. A multiple regression machine learning model was generated to further improve the accuracy of NCCP outcome prediction.

Results:

High-income countries had the highest cancer incidence, whereas low-income countries had the highest MIR. Linear regression analysis indicated a negative trend between all composite indicators and MIR, whereas a positive trend was observed with PCIR. The Human Development Index and the Legatum Prosperity Index had the highest adjusted R
2 values for MIR (0.74 and 0.73) and PCIR (0.86 and 0.81), respectively. Multiple linear regression modeling was performed, and the results indicated a low mean squared error score (−0.02) and a high R
2 score (0.86), suggesting that the model accurately predicts NCCP outcomes.

Conclusions:

Overall, composite indicators can be an effective tool for evaluating NCCP, and the results of this study can aid in the development and keeping track of NCCP progress for better cancer control.
Effect of Magnetic Resonance Imaging on the Motion Accuracy of Magnetic Resonance Imaging-compatible Focused Ultrasound Robotic System
Authors: Antoniou Anastasia , Evripidou Nikolas , Chrysanthou Antreas , Georgiou Leonidas , Ioannides Cleanthis , Spanoudes Kyriakos , Damianou Christakis
Published: July 2024

Purpose:

The current study provides insights into the challenges of safely operating a magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) robotic system in a high-field MRI scanner in terms of robotic motion accuracy.

Materials and Methods:

Grid sonications were carried out in phantoms and excised porcine tissue in a 3T MRI scanner using an existing MRgFUS robotic system. Fast low-angle shot-based magnetic resonance thermometry was employed for the intraprocedural monitoring of thermal distribution.

Results:

Strong shifting of the heated spots from the intended points was observed owing to electromagnetic interference (EMI)-induced malfunctions in system’s operation. Increasing the slice thickness of the thermometry sequence to at least 8 mm was proven an efficient method for preserving the robotic motion accuracy.

Conclusions:

These findings raise awareness about EMI effects on the motion accuracy of MRgFUS robotic devices and how they can be mitigated by employing suitable thermometry parameters.
Validation of Microionization Chambers in Small-field Dosimetry
Authors: Kannan Mageshraja , Saminathan Sathiyan , Shwetha B. , Chandraraj Varatharaj , Raj D. Gowtham , Ganesh K. M.
Published: July 2024

Aim:

This study aims to validate the Razor Nano Chamber (RNC) and Razor Chamber (RC) dosimetric characteristics in a small field. The dosimetric parameters of the two chambers were compared.

Materials and Methods:

The chamber characteristics of leakage (pre and post), stability, energy dependency, dose linearity, dose rate effect, stem effect, angular dependency, ion recombination effect, and polarity effect were studied. Relative dose measurements of the percentage depth dose, profile measurement, and output factor (OF) measurements were performed for small fields. All measurements were performed in a Theratron 780E telecobalt unit and an Elekta Versa HD™ Linear Accelerator.

Results and Discussion:

The measured pre- and postirradiation leakage and energy dependency were within 0.5% of the acceptable limit. In the stability check, the standard error and standard error of mean were 0.047% and 0.068%, respectively, for both RNC and RC. The deviation in the angular responses of the RNC and RC ion chambers was negligible. In the ion recombination measurements, both the RNC and RC were overestimated for the 10 flattening filter-free photon beam. In small fields, there were no significant differences in the kpol values for either chamber. The RNC showed good agreement in the relative dose measurements compared to the RC.

Conclusion:

RNC and RC showed good agreement in small-field dosimetry. The RNC angular dependency and OF showed a superior response compared to the RC because of the small volume spherical shape and high spatial resolution, which gives a reduced penumbra and no volume averaging effect.
A young male with non-resolving consolidation and hepatosplenomegaly
Authors: Bajad Pradeep , Pahuja Sourabh , Agarwal Satyam , Khanna Gaurav , Khanna Arjun
Published: July 2024

Non-resolving consolidation refers to the persistence of radiographic abnormalities beyond the anticipated timeframe. Conditions such as infection, malignancy, inflammatory disorders, and connective tissue diseases can all manifest as non-resolving consolidation. We share a clinicopathological case study involving a 30-year-old male who exhibits non-resolving consolidation accompanied by hepatosplenomegaly.
Ventilator-associated pneumonia – What price does the public health system pay?
Authors: Thimmaiah Guruprasad , Pandey Navin , Prinja Shankar , Jain Kajal , Biswal Manisha , Agarwal Ritesh , Koushal Vipin , Sethi Saru
Published: July 2024

Background:

Ventilator-associated pneumonia (VAP) is the commonest healthcare-associated infection (HAI) in intensive care units (ICU), especially in trauma patients. VAP imposes a significant cost burden on the healthcare ecosystem. However, there are few data from the developing world.

Methodology:

We conducted this study in the trauma ICU (TICU) of PGIMER, Chandigarh, from October 2021 to December 2022. The incidence, incidence density, and average length of stay (ALOS) of both VAP and non-VAP patients were established. The health system cost was assessed using a mixed (top-down and bottom-up) micro-costing approach. We collected data for all the resources (direct and indirect costs) utilized during service delivery and estimated the health system cost per bed per day.

Results:

In this study, 494 patients were admitted to TICU, of which 484 received Mechanical Ventilation (MV) and 47 developed VAP. We included 41 and 44 patients with and without VAP. The VAP incidence rate was 9.7% and the VAP incidence density was 10.79/1000 MV days. The ALOS for VAP patients was 21 days, and for non- VAP patients was 8.2 days. Our study estimated a total health system cost of INR 25,927 per bed per day. The health system cost of treating a VAP patient was INR 544,467 compared to INR 207,416 for a non-VAP patient.

Conclusion:

Treatment of VAP poses substantial costs for the health system and patients. There is a need to focus on preventing VAP, which would eventually reduce the length of stay and the resultant financial impact on the health system and the patient.
Utility and safety of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC): A systematic review and meta-analysis
Authors: Chandragiri Pranay Sai , Tayal Anshula , Mittal Saurabh , Madan Neha Kawatra , Tiwari Pawan , Hadda Vijay , Mohan Anant , Madan Karan
Published: July 2024

Background:

Modalities to improve tissue acquisition during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been investigated. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) is a modality to obtain larger histological samples by inserting a cryoprobe into the mediastinal lesion. We aimed to study the diagnostic yield and safety of EBUS-TMC.

Methods:

We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yield of EBUS-TMC and compare it with EBUS-TBNA.

Results:

Following a systematic search, we identified 14 relevant studies (869 patients undergoing EBUS-TMC and EBUS-TBNA). We then performed a meta-analysis of the diagnostic yield of EBUS-TMC and EBUS-TBNA from studies wherein both procedures were performed. The pooled diagnostic yield of EBUS-TMC was 92% (95% confidence interval [CI], 89%–95%). The pooled diagnostic yield of EBUS-TBNA was 81% (95% CI, 77%–85%). The risk difference in yield was 11% (95% CI, 6%–15%, I
2 = 0%) when EBUS-TMC and EBUS-TBNA were compared. The only complication reported commonly with EBUS-TMC was minor bleeding. The complication rate was comparable with EBUS-TBNA.

Conclusion:

EBUS-TMC provides a greater diagnostic yield with a similar risk of adverse events compared to EBUS-TBNA. Future studies are required to clearly establish which patients are most likely to benefit from this modality.
Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024)
Authors: Koul Parvaiz A. , Vora Agam C. , Jindal Surinder K. , Ramasubramanian Venkatasubramanian , Narayanan Varsha , Tripathi Surya Kant , Bahera Digambar , Chandrashekhar Harway Bhaskar , Mehta Ravindra , Raval Narendra , Dorairaj Prabhakar , Chhajed Prashant , Balki Akash , Aurangabadwalla Rohan Ketan , Khandelwal Abhijeet , Kawedia Mahendra , Rai Satya Prakash , Grover Ashok , Sachdev Manish , Chatterjee Surajit , Ramanaprasad Velamuru V. , Das Aratrika , Modi Mahavir Madhavdas
Published: July 2024

Introduction:

Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing.

Methods:

Nation Against Pneumococcal Infections – Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake.

Outcome:

The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms.

Conclusion:

These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.
MRI Evaluation of Microstructural and Perfusion Changes in Patients with Hemsensory Neurological Syndromes
Authors: Pandey Saurabh , Jain Neeraj , Singh Anuradha , Paliwal Vimal Kumar , Kumar Sunil
Published: July 2024

Background:

Hemisensory syndrome is characterized by a nondermatomal sensory deficit involving one half of the body. With the conventional imaging techniques, researches find low diagnostic yield in this condition; however, with the advancements in MRI imaging, there is hope to find the pathophysiological basis of hemisensory symptoms.

Objective:

To evaluate microstructural and perfusion changes in brain parenchyma in patients with hemisensory syndrome on MRI with diffusion tensor imaging (DTI) and arterial spin labeling (ASL).

Material and Methods:

A total of 20 patients with hemisensory symptoms and 10 age-matched controls were enrolled and divided in two study groups – a) case vs. control and b) affected vs. nonaffected cerebral hemisphere in cases. Quantification of absolute cerebral blood flow (aCBF), fractional anisotropy (FA), and mean diffusivity (MD) was done in both groups.

Results:

On ASL, there was significantly increased aCBF in thalamus on the contralateral-affected side. DTI revealed significantly decreased FA in the thalamus and increased FA in corona radiata of the affected side. There was a significant difference for MD of corona radiata between affected and nonaffected hemisphere. The mean value of MD in corona radiata is decreased on the affected side.

Conclusion:

Changes in advanced neuroimaging techniques like ASL and DTI along the pain processing pathway suggest an alteration in neuronal density and activity at the microstructural level. These findings may provide an insight into the etiopathogenesis of pain syndromes.
Clinical, Laboratory and Radiological Correlates of Xpert MTB/RIF Assay Study in Cerebrospinal Fluid in CNS Tuberculosis
Authors: Anand R Pratheesh , Tandon Ruchika , Jha Sanjeev
Published: July 2024

Background:

Cerebrospinal fluid (CSF) Xpert MTB/RIF assay is an initial test for the diagnosis of tuberculous meningitis (TBM). Nevertheless, it is not very clear which of the factors govern CSF-Gene Xpert/MTB positivity.

Objective:

Hence, we aimed to assess the relationship, if any, between the clinical, laboratory and radiological parameters of the central nervous system (CNS) tuberculosis patients and the Gene Xpert study in CSF in such patients.

Methods and Material:

First, we studied 200 patients with CNS tuberculosis according to the case definition, and subsequently, we performed a Gene Xpert study on the CSF of these patients. Then, we correlated the clinical, radiological, and CSF criteria with the Gene Xpert positivity using the univariate binary logistic regression method via SPSS 20 (P-value <0.05).

Results:

Seventy-five (37.5%) patients (57.3% females) of median 24 years of age, were CSF-Gene Xpert/MTB-positive and 125 (62.5%) patients were negative. The mean duration of illness (P = 0.017), weight loss or failure to thrive (P < 0.001), loss of consciousness or seizure (P = 0.001), signs of meningeal irritation (P = 0.027), stage III of TBM (P < 0.001), evidence of dissemination (P = 0.003), basal exudates (P = 0.004), hydrocephalus (P = 0.018), CSF lymphocytic predominance (P < 0.001), and reduced CSF glucose (P = 0.011) correlated significantly with positive the Gene Xpert/MTB results. Also, Gene Xpert had a sensitivity of 80% and a specificity of 74.84% against culture Xpert.

Conclusions:

Xpert MTB/RIF might be more useful in the later stages of the disease and those with more severe disease.
Refractory Immune-Mediated Cysticercal Meningitis and Role of B Cell Depleting Therapy
Authors: Anadure Ravi K , Goel Jitesh , Saxena Rajeev , Mohimen Aneesh , Agrawal Palack
Published: July 2024

Background:

Extraparenchymal neurocysticercosis (NCC) commonly presents with symptoms of raised intracranial pressure such as headache, nausea, vomiting, or delirium. Intraventricular NCC is frequently associated with obstructive hydrocephalus as well as recurrent inflammatory cascade leading to chronic meningitis.

Objective:

The aim of this study was to report the novel use and benefit of B cell depleting therapy in a case of treatment-refractory cysticercal meningoencephalitis.

Case:

In this article, we report about a young male with intraventricular NCC, who had recurrent meningitis (with encephalitis) and kept relapsing despite multiple cerebrospinal fluid diversion procedures, cysticidal therapy, and high-dose steroids. He finally showed clinical and radiological resolution with pulsed rituximab therapy.

Conclusion:

This off-label use of a monoclonal antibody against CD20 may be considered as a rescue therapy in steroid-refractory immune-mediated cysticercal meningitis.
TREADS: Target Research for Anti-epileptic Drugs Using Data Science
Authors: Chintalapati Janaki , Kumar Arvind , Hosur MV , Pal Supriya N
Published: July 2024

Context:

Epilepsy is a common neurological disease and is classified into different types based on features such as the kind of seizure, age of onset, part of brain effected, etc. There are nearly 30 approved anti-epileptic drugs (AEDs) for treating different epilepsies and each drug targets proteins exhibiting a specific molecular mechanism of action. There are many genes, proteins, and microRNAs known to be associated with different epileptic disorders. This rich information on epilepsy-associated data is not available at one single location and is scattered across multiple publicly available repositories. There is a need to have a single platform integrated with the data, as well as tools required for epilepsy research.

Methods and Material:

Text mining approaches are used to extract data from multiple biological sources. The data is curated and populated within an in-house developed epilepsy database. Machine-learning based models are built in-house to know the probability of a protein being druggable based on the significant protein features. A web interface is provided for the access of the epilepsy database as well as the ML-based tool developed in-house.

Results:

The epilepsy-associated data is made accessible through a web browser. For a protein of interest, the platform provides all the feature values, and the results generated using different machine learning models are displayed as visualization plots.

Conclusions:

To meet these objectives, we present TREADS, a platform for epilepsy research community, having both database and an ML-based tool for the study of AED targets.

To access TREADS:

https://treads-aer.cdacb.in