bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of octreotide on the duration of postmastectomy wound drainage: A randomized controlled trial
Authors: Ayandipo Omobolaji Oladayo , Ulasi Ikechukwu Bartholomew , Afuwape Oladolapo Olawunmi
Published: May 2024

Background:

Following mastectomy, prolonged wound drainage delays adjuvant therapy and also prolongs hospitalization in an otherwise fit patient. This study determined the effect of octreotide on the duration of postmastectomy wound drainage.

Methods:

Patients scheduled for modified radical mastectomy were randomized into a treatment group that received 100 µg of octreotide and a control group that received 1 mL of sterile water intravenously 8 hourly for 5 days from the first postoperative day. Sociodemographic data, time to drain removal, total drain volume, and incidence of seroma were obtained. The groups were compared for the time to drain removal, total drain output, average drain output per day, and incidence of seroma. Statistical significance was set at P < 0.05.

Results:

Forty-one female breast cancer patients were recruited. The mean age was 53.1 ± 13.0 years. The most common histologic variant was invasive carcinoma of no special type (n = 27; 65.9%). Although not statistically significant, patients in the intervention group had a lower median time to drain removal of 11 days (interquartile range [IQR] = 3) compared with 13 days (IQR = 3) in the control group (P = 0.106) and similarly had a lower median total drain output compared with controls (892.0 mL vs. 1182.8 mL; P = 0.095). Both groups were comparable in terms of postoperative complications and these occurred in 13 patients (31.7%), the most common being seroma (n = 11; 50.0%).

Conclusion:

Octreotide had no statistically significant effect on either the total drain output or the duration of postmastectomy wound drainage among breast cancer patients.
A protocol for the study of environmental risk factors and candidate gene–environment interactions in neurodegenerative disorders in Nigeria (SERGEND): A cross-sectional descriptive study
Authors: Ojo Oluwadamilola Omolara , Agabi Osigwe P , Ishola Ismail O , Oshinaike Olajumoke O , Abubakar Sani A , Wahab Kolawole W , Bello Abiodun H , Akinyemi Rufus O , Williams Uduak , Ozomma Simon I , Ekenze Oluchi , Iwuozo Emmanuel , Nyandaiti Yakub W , Ojini Francis I , Houlden Henry , Hardy John , Okubadejo Njideka Ulunma
Published: May 2024

Introduction:

The risk of developing neurodegenerative disorders (NDDs) such as Alzheimer’s disease and related dementias (ADRD) and Parkinson’s disease and atypical parkinsonism (PDAP), has been alluded to arise predominantly from the interplay between environmental exposures and genetic variability. The contributions of these factors to NDD in Black sub-Saharan Africans are largely unknown. The broad aim of SERGEND is to investigate the effect of specific environmental exposures and genetic variability on the risk of developing ADRD and PDAP in our population.

Methods:

The SERGEND, a national, multi-center, cross-sectional, descriptive study, will be conducted in Nigeria, within academic hospitals located in all six geopolitical zones of the country. The study population will comprise 3000 consenting adult Nigerians aged 18 years and above, residing within the recruiting geopolitical zone in the preceding 12 months. Cases will be persons with ADRD or PDAP and age-matched healthy controls. Assessments will include dementia and parkinsonism-specific case ascertainment, disease severity, functional status, and environmental risk factors assessment. Genotyping for APOE and SNCA REP1 polymorphic variability will be conducted. Future analyses will be performed on biobanked samples.

Ethics and Dissemination:

The study protocol was approved by the National Health Research Ethics Committee in Nigeria, with institutional HREC concordant approval for all participating sites before enrollment of the study participants. Written informed consent was obtained from all study participants or identified proxies. The study results will be published in peer-reviewed journals and as conference abstracts.

Trial Registration:

International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry (www.isrctn.com). Trial registration number: ISRCTN10548575. Locator ID: https://doi.org/10.1186/ISRCTN10548575.
Rapidly progressive glomerulonephritis in a tertiary health facility in northeastern Nigeria
Authors: Mohammad Sulaiman M. , Jummai Shettima , Mustapha Lawan , Umar Loskurima , Ibrahim Ummate
Published: May 2024

Background

Rapidly progressive glomerulonephritis (RPGN) is a syndrome that is characterized by the rapid decline of kidney function associated with proteinuria and hematuria and often leads to irreversible kidney failure if diagnosis and subsequent institution of appropriate treatment are not made early. It is thought to be rare in Africa due to late presentation and/or diagnosis of the condition, resulting in many of them labeled as chronic glomerulonephritis. This study aims to determine the prevalence of RPGN among patients admitted with kidney disease in a tertiary health facility in northeastern Nigeria.

Patients and methods

This cross-sectional hospital-based study was conducted at the University of Maiduguri Teaching Hospital, Maiduguri, Northeast Nigeria, between the periods January 2020 and December 2021. Included in the study were patients admitted into the renal unit who had features of rapidly deteriorating kidney function, normal-sized kidneys more than 8.5 cm, proteinuria, and/or hematuria. Kidney biopsy was done for consenting patients who had normal kidney sizes. The biopsy specimen was fixed in formalin, cut, and stained using hematoxylin and eosin stain.

Results

A total of 1440 patients were admitted into the renal unit of University of Maiduguri Teaching Hospital, out of whom 28 (1.9%) were diagnosed with RPGN. The ages of the study participants ranged from 17 to 40 years and had a mean of 31.14 ± 7.81 years. Their mean serum creatinine was 1203 ± 495.78 µmol/l and urea 32.67 ± 12.58 moml/l. Proteinuria was present in all patients with RPGN, whereas hematuria was seen in 78.6%. Kidney biopsy was done in 42.9% of patients, 83.3% of them had crescents in more than 50% of glomeruli. Antineutrophil cytoplasmic antibody, complements C3 and C4 were not assayed in any of the study participants.

Conclusion

RPGN contributes to the burden of kidney disease in northeastern Nigeria. Due to lack of proper investigative tools in our institution, many patients are not diagnosed and those who were identified are not adequately characterized.
Prevalence of thyroid disorder in patients with systemic lupus erythematosus and patients with lupus nephritis
Authors: Elshair Heba S. , Zeid Montasser H. , Deghady Akram A. , Essa Bassant Y. , Bondok Maha E.
Published: May 2024

Background

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect many organs. Lupus nephritis (LN) is a major cause of morbidity and mortality in patients with SLE. The interaction between kidney and the thyroid-gland functions has been known for a long time. Thyroid hormones (TH) are necessary for growth and development of the kidney, and for the maintenance of water and electrolyte homeostasis. On the other hand, kidney is involved in the metabolism and elimination of TH. Thyroid disease appears to be more frequent in SLE patients than in the general population. Therefore, screening of thyroid dysfunction in patients with SLE, especially in those with evidence of LN, is recommended. The aim of this work is to study morphological (thyromegaly and thyroid nodules) and functional (hypothyroidism or hyperthyroidism) thyroid disorders in patients with SLE with or without renal affection, and whether LN acts as an independent risk factor of thyroid abnormalities.

Patients and methods

In total, 60 participants were divided into three groups: group I: 20 patients diagnosed with SLE without evidence of renal affection, group II: 20 patients diagnosed with SLE with evidence of LN, and group III: 20 healthy participants. All were subjected to full history taking, thorough physical examination, laboratory investigations (urea and creatinine), thyroid function, and serological marker serum [antithyroid peroxidase antibody (anti-TPO Ab)]. Ultrasound examination of the thyroid gland was done.

Results

There was a direct significant relationship between renal function tests, namely urea and creatinine and anti-TPO among cases with SLE, both without and with LN, and an inverse significant relationship between estimated glomerular filtration rate and anti-TPO among both the SLE group and the LN group.

Conclusion

Screening of thyroid dysfunction in patients with SLE, especially in those with evidence of LN by estimation of thyroid function tests, thyroid autoantibodies, and by ultrasonography, is recommended.
Internet gaming disorder and its correlates among university students, Saudi Arabia
Authors: Alsunni Ahmed A. , Latif Rabia
Published: May 2024

BACKGROUND:

Over-indulgence in online/offline video games could result in the development of internet gaming disorder (IGD). Knowledge of the prevalence and correlates of IGD may help to understand its etiology. The aim of the present study was to estimate IGD and its psychological/game-related correlates in Saudi university students.

MATERIALS AND METHODS:

For this cross-sectional study, 843 students registered in a university in Saudi Arabia filled an online survey comprising diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hospital anxiety and depression scale, Rosenberg self-esteem scale, social phobia inventory scale, satisfaction with life scale, and subjective happiness (SH) scale. For data analysis, an independent sample t-test, Pearson correlation coefficient/Chi-square test, and multiple linear regression followed by hierarchical regressions were used.

RESULTS:

The frequency of IGD was 21.5%. Total game time/day, years of playing games, and social phobia were significantly higher in subjects with IGD (P = 0.001, <0.001, and <0.001, respectively), whereas SH was significantly lower (P < 0.001). Tendency to IGD had a significant positive correlation with social phobia, total game time/day, and years of playing games and a negative correlation with SH. Total game time/day, years of playing games, and social phobia were significant positive predictors of tendency to IGD, whereas SH was a negative predictor. The rest of all variables were insignificant predictors.

CONCLUSION:

The frequency of IGD in Saudi university students identified by DSM-5 criteria was relatively high (21.5%). The prediction of the severity of IGD could be based on social phobia, total game time/day, number of years of playing games, and SH.
Resilience and its correlates among medical students in the Eastern part of India during the coronavirus disease 2019 (COVID-19) pandemic
Authors: Golui Poulomi , Roy Saptarshi , Dey Indira , Burman Jayeeta , Sembiah Sembagamuthu
Published: May 2024

BACKGROUND:

There is a great deal of psychological pressure on medical students, which results in depression, addiction, and suicide. Resilience plays a significant role in coping with psychological distress. The study aimed to determine the resilience level of medical students in Kolkata and factors related to it.

MATERIALS AND METHODS:

A cross-sectional study was conducted among undergraduate students of a medical college in the eastern part of India during October 2020. Resilience was assessed using the validated “Adult Resilience Measure-R.” Data were collected on Google Forms and analyzed using SPSS (version 16.0). Logistic regression analysis was performed to find factors associated with low resilience.

RESULTS:

The study revealed that one-fourth (25.2%) of the participants had low-level resilience. Nearly half (44.9%) of them perceived their mental health status as having worsened during the lockdown. Students who did not enjoy staying at home during the lockdown and who spent <10 h of their time with their family members had higher odds of low resilience. In multivariable analysis, not enjoying staying at home during the lockdown remained the only significant predictor of low resilience.

CONCLUSION:

Students should spend more time with their parents and family members and learn coping skills. Appropriate resilience training programs have to be integrated into the medical curriculum to help in coping with future challenges.
Use of a Checklist Approach on a Telecobalt in an Attempt to Reduce Human Errors in Radiotherapy Delivery and Improve Therapeutic Ratio
Authors: Mukundan Hari , Singh Sankalp , Lohia Nishant , Semwal Manoj Kumar , Kumar Vijendra , Bhatnagar Sharad , Sarin Arti , Trivedi Gaurav
Published: May 2024

Background:

The process of radiotherapy treatment planning and delivery involves multiple steps and professionals causing it to be prone to errors. Radiotherapy centers equipped with old telecobalt machines have certain peculiar challenges to workflow. We designed and tested a checklist for radiotherapy technicians (RTTs) to reduce chances of error during treatment delivery on a telecobalt machine.

Materials and Methods:

A physical checklist was designed for RTTs to use in the pretreatment pause using a template advocated by the American Association of Physicists in Medicine. It was tested on 4 RTTs over 1000 radiotherapy delivery sittings.

Results:

The checklist helped to rectify 41 documentary lapses and 28 errors in radiotherapy treatment parameters while also identifying 12 instances where treatment plan modifications were due and 30 where the patient was due for review by the radiation oncologist. The average time to go through the checklist was between 2.5 and 3 min.

Conclusions:

The development and use of the checklist has helped in reducing errors and also improving workflow in our department. It is recommended to utilize such physical checklists in all radiotherapy centers with telecobalt machines. The success of the checklist depends upon leadership, teamwork, acceptance of a need to inculcate a “safety culture,” with voluntary error-reporting and a willingness to learn from such errors.
Implementation and Challenges of International Atomic Energy Agency/American Association of Physicists in Medicine TRS 483 Formalism for Field Output Factors and Involved Uncertainties Determination in Small Fields for TomoTherapy
Authors: Kinhikar Rajesh , Kaushik Suryakant , Tambe Chandrashekhar , Kadam Sudarshan , Kale Shrikant , Upreti Rituraj
Published: May 2024

Purpose

International Atomic Energy Agency published TRS-483 to address the issues of small field dosimetry. Our study calculates the output factor in the small fields of TomoTherapy using different detectors and dosimetric conditions. Furthermore, it estimates the various components of uncertainty and presents challenges faced during implementation.

Materials and Methods

Beam quality TPR20,10(10) at the hypothetical field size of 10 cm × 10 cm was calculated from TPR20,10(S). Two ionization chambers based on the minimum field width required to satisfy the lateral charge particle equilibrium and one unshielded electron field diode (EFD) were selected. Output factor measurements were performed in various dosimetric conditions.

Results

Beam quality TPR20,10(10) has a mean value of 0.627 ± 0.001. The maximum variation of output factor between CC01 chamber and EFD diode at the smallest field size was 11.80%. In source to surface setup, the difference between water and virtual water was up to 9.68% and 8.13%, respectively, for the CC01 chamber and EFD diode. The total uncertainty in the ionization chamber was 2.43 times higher compared to the unshielded EFD diode at the smallest field size.

Conclusions

Beam quality measurements, chamber selection procedure, and output factors were successfully carried out. A difference of up to 10% in output factor can occur if density scaling for electron density in virtual water is not considered. The uncertainty in output correction factors dominates, while positional and meter reading uncertainty makes a minor contribution to total uncertainty. An unshielded EFD diode is a preferred detector in small fields because of lower uncertainty in measurements compared to ionization chambers.
Investigation of tube voltage dependence on CT number and its effect on dose calculation algorithms using thorax phantom in Monaco treatment planning system for external beam radiation therapy
Authors: Saini Amit , Pandey V P , Kumar Pankaj , Singh Avtar , Pasricha Rajesh
Published: May 2024

Introduction:

The accuracy of dose calculation algorithms depends on the electron density and computed tomography (CT) number of medium scanned. Our study aimed to verify the impact of different CT scanning protocols on Hounsfield unit (HU) and effect on dose calculation algorithms.

Materials and Methods:

CIRS thorax phantom with different density material plugs was scanned at varying tube voltages from CT scanner and HU values were measured in treatment planning system (TPS). Calibration curves of electron density at different tube voltages were plotted and used for dose calculation with different calculation algorithms at varying high energy megavoltage photon energies.

Results:

Insignificant difference is obtained in electron density curves plotted at different tube voltages. The mean variation in HU values was found at different tube voltages for bone, lung, and water are 896.75 (standard deviation [SD] 122.88), −799.25 (SD 5.74), and −17.5 (SD 0.57), respectively. The estimated P values for change in HU values were 0.089, 0.258, and 0.121 for bone, lung, and water, respectively. Pencil beam (PB) convolution and collapsed cone algorithms show no significant dose difference, i.e., <1% variation and Monte Carlo (MC) shows maximum dose difference up to 1.4%.

Conclusion:

Third-generation algorithms such as MC shows dependence on varying tube voltages in dose calculation. Calibration curves plotted at different kVp in TPS advised to be chosen wisely to avoid any dosimetric errors in different medium.
Magnetic Resonance Neurography of the Brachial Plexus Using 3D SHINKEI
Authors: Nair Prashant Prabhakaran , Mariappan Yogesh K. , Paruthikunnan Samir M. , Kamath Asha , Rolla Narayana K. , Saha Indrajit , Kadavigere Rajagopal
Published: May 2024

Background and Purpose:

This work aims at optimizing and studying the feasibility of imaging the brachial plexus at 1.5T using 3D nerve-SHeath signal increased with INKed rest-tissue RARE imaging (3D SHINKEI) neurography sequence by comparing with routine sequences.

Materials and Methods:

The study was performed on a 1.5T Achieva scanner. It was designed in two parts: (a) Optimization of SHINKEI sequence at 1.5T; and (b) Feasibility study of the optimized SHINKEI sequence for generating clinical quality magnetic resonance neurography images at 1.5T. Simulations and volunteer experiments were conducted to optimize the T2 preparation duration for optimum nerve-muscle contrast at 1.5T. Images from the sequence under study and other routine sequences from 24 patients clinically referred for brachial plexus imaging were scored by a panel of radiologists for diagnostic quality. Injury detection efficacy of these sequences were evaluated against the surgical information available from seven patients.

Results:

T2 preparation duration of 50 ms gives the best contrast to noise between nerve and muscle. The images of 3D SHINKEI and short-term inversion recovery turbo spin-echo sequences are of similar diagnostic quality but significantly better than diffusion weighted imaging with background signal suppression. In comparison with the surgical findings, 3D SHINKEI has the lowest specificity; however, it had the highest sensitivity and predictive efficacy compared to other routine sequences.

Conclusion:

3D SHINKEI sequence provides a good nerve–muscle contrast and has high predictive efficacy of nerve injury, indicating that it is a potential screening sequence candidate for brachial plexus scans at 1.5T also.
Use of Poly (Ethylene Glycol) Coated Superparamagnetic Iron Oxide Nanoparticles as Radio Sensitizer in Enhancing Colorectal Cancer Radiation Efficacy
Authors: Anuje Madhuri , Pawaskar Padamaja , Sivan Ajay , Lokhande Chandrakant , Ahmed Imtiaz , Patil Dhanashree
Published: May 2024

Backgorund:

The aim of the radiotherapy is to deliver a lethal dose to tumor while reducing the impact on the normal tissue. This reduction in impact can be achieved to have a greater therapeutic ratio by using nanoparticles as radiosensitizer.

Materials and Methods:

In this article, the potential role of superparamagnetic iron oxide nanoparticles (SPIONs) as radiosensitization enhancer on HT 29 cell lines for different concentrations (0.007to 0.25 mg/ml) and different radiation doses (0.5to 2 Gy) of 6MV photon beam is presented.

Results:

The highest sensitization enhancement ratio (SER) value was observed with 2 Gy for 0.25 mg/ml concentration. Radio sensitization increases with increase in the concentration of nanoparticles. Combination of 6MV energy radiation and polyethylene glycol (PEG) coated SPIONs results in increasing cell killing of HT 29 as compared to cell killing with radiation therapy alone.

Conclusion:

The results reveal that PEG coated nanoparticle might be a potential candidate to work as radiotherapy sensitizer in colorectal cancer.
Validation of American Association of Physicists in Medicine TG 43 Dosimetry Data in Commercial Treatment Planning System
Authors: Saminathan Sathiyan , Maheshraja K. , Ganesh K. M.
Published: May 2024

Aims

This study aimed to validate the dosimetric data of low-energy photon-emitting low-dose rate (LE-LDR) brachytherapy seed sources in commercial treatment planning system (TPS).

Materials and Methods

The LE-LDR seed sources dosimetric data were published in the American Association of Physicists in Medicine (AAPM) Task Group reports TG-43 (1995), TG-43U1 (2004), TG-43U1S1 (2007), and TG-43U1S2. The Bhabha Atomic Research centre (BARC) 125I Ocu-Prosta seed dosimetry data are also available in the literature. The commercially available TPSs are using both two-dimensional (cylindrically symmetric line-source) and one-dimensional (1D) (point source) dose-calculation formalisms. TPS used in this study uses only 1D dose-calculation formalism for permanent implant dosimetry. The point-dose calculation, dose summation, isodose representation, and dose–volume histogram quality assurance tests were performed in this study. The point-source dose-calculation tests were performed for all the available sources in the literature. The others tests were performed for the I-125 BARC Ocu-Prosta seeds. The TPS-calculated doses were validated using manual calculation.

Results and Discussion

In point-source calculation test, the TPS-calculated point-dose values are within ±2% agreement with manually calculated dose for all the seeds studied. The agreement between the TPS and manually calculated dose is 0.5% for the dose summation test. The isodose line pass through the grid points at an equal distance was verified visually on the computer screen for seed used clinically. In dose–volume histogram test, the TPS-determined volume was compared with the real volume.

Conclusion

Misinterpretation of the TPS test and/or misunderstanding of the TG-43 dose-calculation formalism may cause large errors. It is very important to validate the TPS using literature provided dosimetric data. The dosimetric data of BARC 125I Ocu-Prosta Seed are validated with other AAPM TG-43-recommended seeds. The dose calculation of Best® NOMOS permanent implant TPS is accurate for all permanent implant seeds studied.
Automation of DVH Constraint Checks and Physics Quality Control Review Improves Patient Safety in Radiotherapy
Authors: Wahlstedt Isak , Jensen Nikolaj
Published: May 2024

This study investigates whether patient safety can be enhanced by the implementation of an automated electronic checklist (PlanCheck) for physics quality control review (QCR) of radiotherapy photon plans. PlanCheck evaluates both technical aspects and DVH constraints. Three hundred and thirty-one consecutively approved radiotherapy plans previously reviewed with manual QCR were retrospectively checked with PlanCheck. Four hundred and thirty-three (3.4%) of the 12783 automated technical checks executed in the 331 plans yielded an error. All errors were scored using the severity rating from the American Association of Physicists in Medicine TG-100 report. Nineteen of these errors (4%) either could have affected or affected target dose (severity 5+) implicating a maximum dose difference to the target or a critical organ at risk of 0.5% to 10% and 3 errors could have resulted in stereotactic brain treatments being delivered to the wrong location (severity 10). Forty-seven breast cancer plans were retrospectively subjected to automated DVH check, 10 undocumented dose constraint violations were found. PlanCheck has been shown to reduce errors in manually reviewed radiotherapy plans and thus to enhance patient safety.
Evolution of Brachytherapy Applicators for the Treatment of Cervical Cancer
Authors: Mourya Ankur , Aggarwal Lalit Mohan , Choudhary Sunil
Published: May 2024

Brachytherapy applicators have come a long way since Danlos developed early intracavitary applicators to treat cervical cancer patients. Therefore, this review will help in the neoteric designs of intracavitary applicators. A detailed literature survey of the gynecological brachytherapy applicators from the era of preloading to conceptual intensity-modulated brachytherapy applicators has been carried out. Depending on the extent of the disease and patient anatomy, the selection of brachytherapy applicators plays a pivotal role in the treatment of cervical cancer. Furthermore, the selection of the applicators is also based on the imaging modalities to be used for applicator reconstruction and treatment planning. Dose acceleration in the target and reduction in nearby organs at risk can be optimized using an applicator having the capabilities of intensity-modulated brachytherapy. Now, three-dimensional printed applicators are used for patient-specific tailor-made treatment and they are fast replacing the old conventional applicators. Newer advancements in technology have greatly influenced the neoteric designs of intracavitary brachytherapy applicators.
Dosimetric Evaluation of Simplified Knowledge-Based Plan with an Extensive Stepping Validation Approach in Volumetric-Modulated Arc Therapy-Stereotactic Body Radiotherapy for Lung Cancer
Authors: Wada Yutaro , Monzen Hajime , Tamura Mikoto , Otsuka Masakazu , Inada Masahiro , Ishikawa Kazuki , Doi Hiroshi , Nakamatsu Kiyoshi , Nishimura Yasumasa
Published: May 2024

Purpose:

We investigated the performance of the simplified knowledge-based plans (KBPs) in stereotactic body radiotherapy (SBRT) with volumetric-modulated arc therapy (VMAT) for lung cancer.

Materials and Methods:

For 50 cases who underwent SBRT, only three structures were registered into knowledge-based model: total lung, spinal cord, and planning target volume. We performed single auto-optimization on VMAT plans in two steps: 19 cases used for the model training (closed-loop validation) and 16 new cases outside of training set (open-loop validation) for TrueBeam (TB) and Halcyon (Hal) linacs. The dosimetric parameters were compared between clinical plans (CLPs) and KBPs: CLPclosed, KBPclosed-TB and KBPclosed-Hal in closed-loop validation, CLPopen, KBPopen-TB and KBPopen-Hal in open-loop validation.

Results:

All organs at risk were comparable between CLPs and KBPs except for contralateral lung: V5 of KBPs was approximately 3%–7% higher than that of CLPs. V20 of total lung for KBPs showed comparable to CLPs; CLPclosed vs. KBPclosed-TB and CLPclosed vs. KBPclosed-Hal: 4.36% ± 2.87% vs. 3.54% ± 1.95% and 4.36 ± 2.87% vs. 3.54% ± 1.94% (P = 0.54 and 0.54); CLPopen vs. KBPopen-TB and CLPopen vs. KBPopen-Hal: 4.18% ± 1.57% vs. 3.55% ± 1.27% and 4.18% ± 1.57% vs. 3.67% ± 1.26% (P = 0.19 and 0.27). CI95 of KBPs with both linacs was superior to that of the CLP in closed-loop validation: CLPclosed vs. KBPclosed-TB vs. KBPclosed-Hal: 1.32% ± 0.12% vs. 1.18% ± 0.09% vs. 1.17% ± 0.06% (P < 0.01); and open-loop validation: CLPopen vs. KBPopen-TB vs. KBPopen-Hal: 1.22% ± 0.09% vs. 1.14% ± 0.04% vs. 1.16% ± 0.05% (P ≤ 0.01).

Conclusions:

The simplified KBPs with limited number of structures and without planner intervention were clinically acceptable in the dosimetric parameters for lung VMAT-SBRT planning.
Framework for Machine Learning of CT and PET Radiomics to Predict Local Failure after Radiotherapy in Locally Advanced Head and Neck Cancers
Authors: Devakumar Devadhas , Sunny Goutham , Sasidharan Balu Krishna , Bowen Stephen R. , Nadaraj Ambily , Jeyseelan L. , Mathew Manu , Irodi Aparna , Isiah Rajesh , Pavamani Simon , John Subhashini , T. Thomas Hannah Mary
Published: May 2024

Context:

Cancer Radiomics is an emerging field in medical imaging and refers to the process of converting routine radiological images that are typically qualitatively interpreted to quantifiable descriptions of the tumor phenotypes and when combined with statistical analytics can improve the accuracy of clinical outcome prediction models. However, to understand the radiomic features and their correlation to molecular changes in the tumor, first, there is a need for the development of robust image analysis methods, software tools and statistical prediction models which is often limited in low- and middle-income countries (LMIC).

Aims:

The aim is to build a framework for machine learning of radiomic features of planning computed tomography (CT) and positron emission tomography (PET) using open source radiomics and data analytics platforms to make it widely accessible to clinical groups. The framework is tested in a small cohort to predict local disease failure following radiation treatment for head-and-neck cancer (HNC). The predictors were also compared with the existing Aerts HNC radiomics signature.

Settings and Design:

Retrospective analysis of patients with locally advanced HNC between 2017 and 2018 and 31 patients with both pre- and post-radiation CT and evaluation PET were selected.

Subjects and Methods:

Tumor volumes were delineated on baseline PET using the semi-automatic adaptive-threshold algorithm and propagated to CT; PyRadiomics features (total of 110 under shape/intensity/texture classes) were extracted. Two feature-selection methods were tested for model stability. Models were built based on least absolute shrinkage and selection operator-logistic and Ridge regression of the top pretreatment radiomic features and compared to Aerts' HNC-signature. Average model performance across all internal validation test folds was summarized by the area under the receiver operator curve (ROC).

Results:

Both feature selection methods selected CT features MCC (GLCM), SumEntropy (GLCM) and Sphericity (Shape) that could predict the binary failure status in the cross-validated group and achieved an AUC >0.7. However, models using Aerts' signature features (Energy, Compactness, GLRLM-GrayLevelNonUniformity and GrayLevelNonUniformity-HLH wavelet) could not achieve a clear separation between outcomes (AUC = 0.51–0.54).

Conclusions:

Radiomics pipeline included open-source workflows which makes it adoptable in LMIC countries. Additional independent validation of data is crucial for the implementation of radiomic models for clinical risk stratification.
Amniotic Fluid Embolism: A Narrative Review
Authors: Baxter Frederick J.
Published: May 2024

Amniotic fluid embolism (AFE) is a rare but deadly complication of pregnancy. First described in 1926, it remains a diagnosis of exclusion, without clear etiology or a specific test to confirm the diagnosis. Mortality remains high and neurological injury is common among survivors, although reported case fatality rates are decreasing over time. Hemodynamic instability appears to be caused by severe pulmonary vasospasm and subsequent right heart failure, followed by severe left ventricular failure. Presentation is often sudden with loss of consciousness and circulatory arrest, requiring immediate cardiopulmonary resuscitation, vasopressor and inotropic support, and endotracheal intubation. Disseminated intravascular coagulation commonly follows with severe coagulopathy and postpartum hemorrhage and may in some cases be the primary presenting feature. Management remains largely supportive, with the use of extracorporeal membrane oxygenation and inhaled pulmonary vasodilators assuming an increased role, in addition to advanced life support methods. Blood products and coagulation factor replacement are frequently required, sometimes in the form of a massive transfusion. This narrative review summarizes the past and current literature, emphasizing rapid identification of AFE and therapeutic options for its immediate management.
Comparison of Haemodynamic Effects of Intravenous Carbetocin and Oxytocin during Caesarean Section Under Subarchanoid Block
Authors: Jannu Vinayaka , Hanagandi Meghana P. , Kalal Raghavendra , Sabari C. G. S.
Published: May 2024

Context:

Uterine atony is the commonest cause for postpartum haemorrhage in majority of cases. Oxytocin remains the first-line uterotonic agent but, is associated with significant cardiovascular effects like hypotension and tachycardia after intravenous administration. Carbetocin, a synthetic heat-stable oxytocin analogue combines the safety and efficacy profile of oxytocin with the sustained uterotonic activity.

Aims:

The aim of this study was to compare intravenous oxytocin and carbetocin for haemodynamic responses during caesarean section under subarachnoid block.

Settings and Design:

Randomized controlled trial.

Methods and Material:

We performed a prospective randomized, controlled study on 142 pregnant patients undergoing elective cesarean section under subarachnoid block. Patients were randomly assigned to receive either 3U of intravenous oxytocin followed by infusion of 10U/hour for 4 hours or 100 μg intravenous carbetocin after the delivery of anterior shoulder. Heart rate and mean intra-arterial blood pressures were recorded at every 15 s during the study period of 5 min.

Statistical Analysis Used:

Data were analyzed using Student’s unpaired test, Chi-squared test, and Fischer’s exact test. A P < 0.05 was considered statistically significant.

Results:

Oxytocin produced clinically significant tachycardia (>20%) with peak effects over 180 s after injection (P < 0.0001). It also demonstrated a significant decrease in mean arterial pressure within 30 s of bolus injection and hypotension persisted throughout the study period (P < 0.0001). Carbetocin produced no significant changes in heart rate and mean blood pressure responses. The requirement of additional uterotonics and total intraoperative blood loss were similar among both the groups.

Conclusions:

Intravenous carbetocin is better tolerated without significant haemodynamic adverse effects in comparison to oxytocin during cesarean section.
Takotsubo Cardiomyopathy in Pregnancy: A Focused Review
Authors: Garg Heena , Singh Shashi , Ramachandran Rashmi , Trikha Anjan
Published: May 2024

Takotsubo cardiomyopathy (TTCM) has been described as a new entity of cardiomyopathy at the turn of the century. Takotsubo, a Japanese word, denotes an “octopus pot,” a fishing jar that has a narrow neck and wide base for trapping an octopus. This correlates with the shape of the heart on left ventriculography with apical ballooning and basal hypokinesia. The first case was defined in 1990 by Sato et al. and a plethora of literature exists about TTCM ever since. While believed to be an occurrence in elderly postmenopausal females, various reports have been found in recent literature highlighting its occurrence during the antenatal, perinatal, and postpartum periods. It is high time that TTCM is kept in the purview of diagnosing acute cardiopulmonary symptoms in pregnancy. Only an accurate and timely diagnosis of TTCM in pregnancy can lead to an early intervention and prevent countless morbidities and mortalities. A multidisciplinary approach with psychological rehabilitation is recommended to prevent recurrence. We present a concise review of the diagnosis, clinical features and management of this condition and the salient differentiating features from peripartum cardiomyopathy (PPCM). We found 26 cases of TTCM and 16 cases of reverse TTCM. There is a void in knowledge about estrogen levels and the corresponding levels of catecholamines in due course of pregnancy. Future studies to correlate between declining estrogen levels and catecholamine levels at the onset of symptoms of TTCM need to be done to get more insights into this phenomenon.
Comparison of Fractionated Versus Bolus Dose of Bupivacaine Heavy (0.5%) in Spinal Anesthesia for Elective Caesarean Section—A Prospective, Randomized, Single Blind, and Clinical Trial
Authors: Patel Darshna D. , Patel Chintan
Published: May 2024

Context:

Spinal anesthesia using bolus dose of bupivacaine has rapid onset of action but it may precipitate hypotension, whereas fractionated dose will provide hemodynamic stability as well as prolong the duration of analgesia.

Aims:

We aimed to compare the hemodynamic stability as our primary objective and block characteristics and duration of effective analgesia as our secondary objectives.

Methods:

The study was carried out in eighty patients with ASA I or II undergoing elective lower segment caesarean section (LSCS) under spinal anesthesia after institutional ethical clearance. Patients were divided into two groups. Group B patients received spinal anesthesia with single bolus dose of bupivacaine heavy (0.5%) and Group F patients received fractionated dose with two-third of the total dose of bupivacaine heavy (0.5%) given initially followed by one-third dose after 90 seconds.

Statistical Analysis Used:

Time of onset and regression of sensory and motor blockage, intraoperative hemodynamics, and duration of analgesia were recorded and analyzed using student’s t test.

Results:

Six patients in group F developed hypotension as compared to 16 patients in group B which were statistically significant (p < 0.05). There was statistically highly significant difference in duration of effective analgesia. It was longer for group F (338.25 ± 19.824 minutes), in comparison with group B (266.875 ± 19.861 minutes). Duration of sensory and motor block were also longer in group F as compared to group B (p < 0.0001).

Conclusions:

Fractionated dose of spinal anesthesia provides greater stability in terms of hemodynamic parameters and prolonged duration of analgesia as compared to bolus dose.
Anesthetic Management of Cesarean Section in a Patient with Léri-Weill Dyschondrosteosis – A Case Report
Authors: Hussain Muizz , Nair Nikhil , Foss Matthew , Paul James
Published: May 2024

When providing spinal anesthesia for patients with achondroplasia, a dose reduction is often recommended to prevent respiratory arrest and total spinal blocks as patients with achondroplasia present with spinal complications such as spinal cord stenosis, kyphoscoliosis, and lumbar lordosis. This case report describes why this dose reduction is unnecessary in patients with Léri–Weill dyschondrosteosis (LWD) dwarfism and how a regular spinal neuraxial approach is safe and efficacious. A 38-year-old pregnant woman with physical findings consistent with LWD and unremarkable past medical history presented for a repeat elective cesarean section. On examination, the patient was noted to have conserved spinal length and anatomy. In accordance with current recommendations, this patient received a 20% reduced spinal anesthetic dose for her cesarean section based on her height. The cesarean was uneventful. Additional dose reduction was found to be unnecessary due to normal spinal length and anatomy. This characteristic of LWD warrants a review of the clinical recommendations surrounding the anesthetic management of patients with LWD.
Intradural Disc Herniation Presented as Cauda Equina Syndrome: Brief Review Addressing Underlying Pathogenesis, Neuroimaging Features, and Surgical Outcome
Authors: Ahmed Nazmin , Khan Md. Shahidul Islam , Obaida Abu Saleh Mohammad Abu , Ahsan Md. Kamrul , Sardar Mithun , Chaurasia Bipin
Published: May 2024

Intradural disc herniations (IDHs) are rare clinical events, and there have been few literature reports addressing their pathogenesis, neuroimaging features, operative tenets, and surgical outcome. A 45-year-old male presented with features of cauda equina syndrome for 2 days with an antecedent history of low-back pain and bilateral sciatica for 6 months. Magnetic resonance imaging demonstrated a huge compressing lesion, obliterating the dural sac at the L5-S1 level with marked caudal migration of the extruded disc fragments. He underwent surgery and recovered well. Our case demonstrates a unique presentation of IDH having both intradural and postdural components.
The Superiority of Fine-tuning over Full-training for the Efficient Diagnosis of COPD from CXR Images
Authors: Agughasi Victor Ikechukwu
Published: May 2024

This research investigates the use of deep learning for diagnosing lung diseases like Chronic Obstructive Pulmonary Disease (COPD) using Chest X-rays (CXR). The study compares the impact of deep learning on improving these diagnoses by comparing the performance of models trained from the scratch with those enhanced through fine-tuning established architectures like InceptionV3, ResNet50, and VGG-19. The study revealed that fine-tuning pre-trained models offers significant benefits: faster convergence, improved stability, and increased accuracy. Data augmentation techniques were found to be particularly useful when dealing with limited or unbalanced datasets. A custom CNN model, Iyke-Net, showed promising results when fine-tuned. Interestingly, it was observed that models using grayscale images outperformed those using colour images in disease classification, suggesting that colour information might be less critical than previously thought for certain diagnostic procedures. The study emphasizes the importance of balancing model complexity with computational efficiency and diagnostic accuracy. It advocates for refining existing deep learning models for COPD diagnosis from CXR images, paving the way for further innovations in AI-enhanced medical diagnostics.
Trazodone-induced parkinsonism in a middle-aged male: A case report
Authors: Tharwat Ali Hossam , Ashraf Soliman Ziad , Aborigiba Firas , Leticia Fornari Caprara Ana , Pitton Rissardo Jamir
Published: May 2024

Introduction: Trazodone is an antidepressant agent approved for treating major depressive disorders and is also prescribed forinsomnia due to its sedative effect. In a few cases, trazodone was associated with parkinsonism. Herein, we describe a case ofparkinsonism after a brief exposure to a moderate dose of trazodone.
Objective: To describe a case of a patient with trazodone-induced parkinsonism in which the diagnosis was suspected after theexclusion of other common and serious causes.
Methods: A case report of trazodone-induced parkinsonism.
Clinical Case: A 58-year-old male with sleeping problems was prescribed trazodone 50 mg daily at bedtime. The subject doubledthe dosage without medical advice a week later. After 14 days of trazodone treatment, he started to experience difficulty inmoving his upper limbs and recurrent falling. Neuroimaging, electrodiagnostic studies, and laboratory exams were unremarkable.Trazodone was discontinued, and the patient fully recovered. Noteworthy, the patient developed a recurrence of the motorsymptoms with trazodone-rechallenge.
Conclusion: Our case showed reversibly induced parkinsonism after a short intake of a moderate dose of trazodone which wasprescribed for insomnia. The patient had a complete recovery after trazodone withdrawal. Noteworthy, the symptoms recurredupon trazodone-rechallenge.
Keywords: Trazodone; triazolopyridine; parkinsonism; movement disorder; drug-induced.
Tourists’ Assessment of Sustainable Ecotourism Development: A Case Study of National Children’s Park and Zoo, Abuja, Nigeria
Authors: Dododawa Z. , Igwebuike E. E.
Published: May 2024

The study of tourists’ assessment of sustainable ecotourism development was carried out in National Children’s Park and Zoo, Abuja, Nigeria. Purposive sampling technique was used to select one hundred and ten (110) tourists over 18 years which made up the respondents for the study. One hundred and ten (110) copies of questionnaire were administered to the respondents. Data collected was analyzed using descriptive statistics of frequency, percentage, mean and presented as tables, graphs and charts. The results revealed that the highest number of respondents (64.55%) got to know about the zoo from family and friends while the least (1.82%) from television and radio each. The majority of the respondents (36.36%) are visiting the Zoo for the first time, 28.18% are visiting for the second time while the least number of respondents (2.73%) are visiting for the sixth time. The highest number of respondents (56.36%) visited the Zoo for the purpose of Leisure/Recreation, 27.27% visited for the purpose of meetings, 10% for holiday, and 6.36% for Research/Education. The results also revealed that 67.27% of the respondents were satisfied with their visit to the Zoo, 19.09% were indifferent, and 13.64% were not satisfied. Majority of the respondents (70.91%) would visit the Zoo again and a very high proportion of the respondents (90%) would recommend the Zoo to others. It is therefore recommended that more funds should be allocated to the National Children’s park and zoo to help get new facilities to attract more tourists and employ more skilled staff.
Traffic Congestion Analysis of Asaba Road Using Volume to Capacity Ratio and Speed Performance Index
Authors: Odiakose U. C. , Iyeke S. D.
Published: May 2024

With Nnebisi Road acting as a case study, this study focuses on the investigation of traffic congestion on Asaba Road. The study aims to examine the relationship between vehicle volume and road capacity, enabling transportation authorities to assess congestion levels and make informed decisions to alleviate traffic issues. Peak traffic counts were conducted, revealing the highest traffic flow on specific road sections on different days. The Ibusa – Stadium junction saw the highest volume on Monday, reaching 3,056 vehicles, while Ibusa – Ofili-Ilukwu junction peaked at 3,128 vehicles, also on Monday, and Ibusa – Ogbeogonogo junction hit 3,151 vehicles on Tuesday. Speed performance index varied across junctions and days, generally exceeding 60%. For instance, Ibusa – Stadium Junction ranged from 69.57% to 71.82% from Monday to Friday, Ibusa – Ofili-Ilukwu junction showed values between 63.59% and 68.95%, and Ibusa – Ogbeogonogo Junction ranged from 61.57% to 70.11%. These findings suggest a better road traffic state with higher average speeds. Moreover, the volume to capacity ratio, indicates the level of congestion and delays experienced. The ratio values along the studied road sections ranged from 0.61 to 0.70. These ratios, along with the speed performance index, classify the level of service as class B, indicating moderate congestion and delays with slightly longer travel times, yet still acceptable to users.