bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of taurolidine–citrate–heparin lock solution on inflammatory response and hemodialysis adequacy in hemodialysis patients with tunneled catheters
Authors: El-Sharkawy Magdy M. , Abdelgawad Mostafa A. , Gad Omar E. , Emara Ahmad A.
Published: May 2024

Background

Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in hemodialysis (HD) patients using dialysis catheters. Short-term and long-term catheters are still being used as a vascular access in HD patients in our country. The aim of this study was to assess the effect of TauroLock-HEP500 as a lock solution on the incidence of CRBSIs, performance of HD permanent catheters, and HD adequacy.

Patients and methods

This was a randomized controlled trial carried out on 60 patients at Al-Zaitoun Specialized Hospital and Al-Demerdash Hospital – Ain Shams University. The patients were divided into two groups: taurolock group (group 1), which included 30 patients who received TauroLock-HEP500 (taurolidine, 4% citrate and 500 IU/ml heparin are combined in this solution), and heparin group (group 2), which included 30 patients who received unfractionated heparin (heparin sodium 5000 IU/ml) as a permanent catheter lock solution. Patients were followed up for 1 month for monitoring HD adequacy and incidence of CRBSI.

Result

At the end of the study, C-reactive protein was significantly higher in heparin group than the taurolock group (P=0.01). Moreover, urea reduction ratio significantly increased within group 1 (taurolock) (P≤0.001) and significantly decreased in group 2 (heparin) (P=0.034). Moreover, urea reduction ratio was significantly higher in group 1(taurolock) compared with group 2 (heparin) at the end of the study (P≤0.001). Regarding blood flow rate (BFR), there was a significant increase of BFR within group 1 (taurolock) after 1 month compared with the baseline (P≤0.001), whereas there was no significant change in group 2 (heparin) (P=0.387). Moreover, at the end of the study, there was a significant increase of BFR in group 1 (taurolock) than in group 2 (heparin) (P=0.056). One case with CRBSIs was demonstrated in the taurolock group compared with five cases in the heparin group (P=0.19).

Conclusion

The use of taurolidine–citrate–heparin lock solution in HD patients with dialysis catheters may be associated with better HD adequacy, lower incidence of CRBSI) and lower inflammatory markers in comparison with the use of heparin.
Assessment of physical activity in hemodialysis and factors associated with a sedentary lifestyle
Authors: Mbengue Mansour , Séne Abdoulaye , Om’ndus Carolyn K. , Diagne Seynabou , Faye Maria , Niang Abdou , Lemrabott Ahmed T.
Published: May 2024

Background

A sedentary lifestyle is an important risk factor for mortality, especially cardiovascular mortality. This risk is increased in hemodialysis patients owing to the presence of other comorbidities. The aims of this study were to assess physical activity in hemodialysis patients and to figure out factors associated with sedentary lifestyle.

Patients and methods

This was a cross-sectional, descriptive, analytical study. It was conducted over a 2-month period. The study included patients who had been on regular hemodialysis for at least 6 months. Patients with physical disability were not included. Physical activity was assessed using an accelerometer.

Results

There were 30 included patients, of whom 22 were male and eight female. The mean age of the patients was 43.40 ± 15.14 years. The average number of steps per day was 7464.32 ± 4166.82 steps/day. The average number of steps per dialysis day was 6605.41 ± 4251.27 steps/day. According to the number of steps per day, 26.7% of patients were sedentary, 26.7% of patients were less active, and 46.6% were active. Factors associated with sedentary behavior were the sex (P=0.028), the age (P=0.001), and the day of dialysis (P=0.0001).

Conclusion

Sedentary lifestyle was frequent in our study. This high frequency is explained by several factors related to chronic kidney disease and hemodialysis itself.
Transplanting highly sensitized patients
Authors: Habli Mohamed , Belal Dawlat , Sharma Ajay , Halawa Ahmed
Published: May 2024

Immunological barrier posed by preformed antibodies against donor's human leukocyte antigen (HLA) antigens compounds the situation of global shortage of kidney donors. Pretransplantation sensitization carries a high risk of acute rejection and allograft loss. Therefore, there is a need for careful evaluation of potential recipients, based on HLA typing, HLA match, and comprehensive screening of antibodies (is conceptual). Sensitization events include previous transplantations, blood transfusions, or pregnancies. Despite advances in molecular techniques and solid-phase assays used to identify at-risk patients, kidney transplantation continues to be challenging in patients with calculated panel reactive antibodies greater than 85%. The development of desensitization protocols has been used to overcome acute rejection risk; however, the associated further increase in the risk of infection and malignancy is of significant concern owing to enhanced immunosuppression. The introduction of rituximab, bortezomib, plasmapheresis, and intravenous immunoglobulins has improved the success rate of desensitization protocols. On the contrary, paired (pooled) exchange kidney program has been instrumental in widening access to allografts to highly sensitized patients by offering lesser HLA mismatches. Moreover, desensitization protocols are rather expensive, leading to a high economic burden in the pretransplantation and posttransplantation period. This review aims to discuss the scientific basis and practical issues of managing highly sensitized patients.
Feto-maternal outcome of pregnancy related acute kidney injury in a North Indian population
Authors: Sachan Rekha , Shukla Savita , Shyam Radhey , Sachan Pushp L. , Patel Munna L.
Published: May 2024

BACKGROUND:

Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal and fetal morbidity/mortality. The aim of this study was to evaluate the magnitude of pregnancy-related AKI (PRAKI) in a North Indian population, and its contributing factors.

MATERIALS AND METHODS:

This prospective study was carried out at the department of obstetrics and gynecology in collaboration with the nephrology unit and internal medicine department at King George Medical University from June 2019 to October 2020. After informed consent and ethical clearance, a total of 150 PRAKI women were enrolled, and 98 women were subjected to renal replacement therapy as per Kidney Disease Improving Global Outcomes 2012 guideline and were followed for 3 months for renal and fetomaternal outcome.

RESULTS:

There was a high incidence (1.02%) of AKI during pregnancy and puerperium. Majority (57.3%) of the women were aged 26–30 years, and 93.3% had institutional deliveries. About 49% of the women suffering from PRAKI were multipara, and most were identified in the postpartum period (82%). Hypertensive disorder of pregnancy (48%), puerperal sepsis (45%), and hemorrhage (34%) were the associated causes for PRAKI. Stillbirth/intrauterine death (IUD) was higher in Stage II (53.8%) and Stage III AKI (37.7%) (none in Stage I AKI). The majority of the neonates were born with a birth weight of ≤2500 g irrespective of the stages of AKI. Preterm deliveries were significantly higher in Stage II AKI (53.8%) than in Stage I (33.3%) and Stage III (20.0%). Thirty-seven cases of PRAKI were managed conservatively, while 98 required dialysis. Complete recovery occurred in 27.3% and partial renal recovery in 31.3%. However, 3.3% progressed to chronic kidney disease, 34% expired, and 4% were lost to follow-up. High maternal mortality of 30.1% was observed in those dialyzed.

CONCLUSION:

AKI is associated with fetal growth restriction and preterm deliveries. Stillbirth/IUD is higher in Stage II and Stage III AKI.
Stigmatization and discrimination against people living with HIV/AIDS: Knowledge, attitudes, and practices of healthcare workers in the primary healthcare centers in Madinah, Saudi Arabia, 2022
Authors: Alharbi Hani H. O. , Al-Dubai Sami A. R. , Almutairi Rami M. H. , Alharbi Mohammed H.
Published: May 2024

BACKGROUND:

There are very few studies in Saudi Arabia on stigmatization and discrimination against people living with HIV/AIDS (PLWHA), a critical step for the prevention and control of HIV. The aim of this study was to assess the level of stigmatization and discrimination against PLWHA by healthcare workers (HCWs) as well as their knowledge, attitude, and practices (KAP).

MATERIALS AND METHODS:

This cross-sectional study included 182 HCWs at primary healthcare centers in Medina, Saudi Arabia. The validated short version of the Healthcare Provider HIV/AIDS Stigma Scale and the AIDS Attitude Scale were used in this research. Student’s t-test and analysis of variance (ANOVA) were used to assess the differences in the mean knowledge, attitudes, and practices KAP scores by various sociodemographic factors. Multiple linear regression analysis was used to determine factors associated with KAP scores.

RESULTS:

Most participants were males (58.2%) and aged more than 30 years (60.4%). The tendency to stigmatizing behavior was present in 24.2%–68.17% of the participants, and discriminatory practice was present in 11.5%–50% of the participants. In multiple linear regression analysis, factors that independently predicted the knowledge score were being a doctor compared to nurses (P < 0.001), receiving in-service training for PLWHA (P < 0.001), and male gender (P = 0.002). Attitude was predicted by being female (P = 0.008) and a doctor (P = 0.005). Practice was predicted by the knowledge score (P < 0.001) and being married (P = 0.035).

CONCLUSION:

This study found that stigmatization and discrimination were less prevalent in HCWs who had good HIV-related knowledge and had received in-service training for PLWHA. The results highlight the significance of continuing education and training opportunities for HCWs to provide effective and appropriate treatment to PLWHA.
Factors related to treatment adherence among hypertensive patients: A cross-sectional study in primary healthcare centers in Taif city
Authors: Alsofyani Mohammed A. , Aloufi Adel O. , Al-Qhtani Nada S. , Bamansour Sarah O. , Almathkori Raghad S.
Published: May 2024

BACKGROUND:

Antihypertensive medications must be taken as prescribed since noncompliance can result in the lack of hypertension (HTN) control. The aim of this study was to determine the factors that influence adherence to treatment by HTN patients in Taif city.

MATERIALS AND METHODS:

A cross-sectional study was undertaken in basic healthcare centers in Taif city, Saudi Arabia. A simple random sampling method was used to select participants from primary healthcare centers. Data was obtained on patients’ demographic characteristics, smoking habits, anti-HTN drugs and treatment characteristics, barriers to medication compliance, systolic and diastolic blood pressure (BP), anthropometric measurements, and family history of HTN and diabetes mellitus (DM). We used the 4-item Morisky Medication Adherence Scale (MMAS-4™) as a valid questionnaire to assess medication adherence. Data were analyzed using SPSS. Qualitative data was presented as numbers and percentages, and Chi-squared test was applied to test the relationship between qualitative variables. For quantitative data, mean and standard deviation was calculated. Multiple logistic regression analysis were performed to determine correlates of treatment adherence, and results were presented as Odds Ratio (OR) and 95% confidence interval (CI) for OR.

RESULTS:

Of the 549 patients included, 36.8% did not have a regular check of their BP at home and the majority had a family history of HTN and diabetes. About 86% patients showed a high level of adherence. Income ≥5000 SAR, age ≥60 years, female gender, who were being married, having ≤10 family members, being unemployed, and never having smoked were associated with high adherence level. The most important factor that affected MMAS scores was the regular BP checks at home.

CONCLUSION:

When patients attend routine follow-up clinics, it is critical to strengthen reminder mechanisms and provide regular counseling.
Occupational stress in healthcare workers at a university hospital, Jeddah, Saudi Arabia
Authors: AlMuammar Sarah A. , Shahadah Dhiyaa M. , Shahadah Anas O.
Published: May 2024

BACKGROUND:

Occupational stress can be caused by a heavy workload, insecurity, or poor relationships with coworkers or supervisors. Previous research has showed a significant prevalence of stress in healthcare personnel. This study’s aim was to identify health-care professionals at risk of occupational stress and determine the factors that may cause it.

MATERIALS AND METHODS:

A cross-sectional study was conducted among healthcare workers at a university hospital, in Jeddah, Saudi Arabia. A questionnaire solicited information on participants’ demographic data including the Workplace Stress Scale, questions on their relationships with colleagues, lack of equipment, job insecurity at the workplace, changing shift patterns, job satisfaction, availability of time to rest and relax, social and family problems, responsibilities, social support, rational/cognitive coping, doctor–patient relationship, and role overload. SPSS was used for data analysis; initial analysis included descriptive statistics, and t-test chi-square test. Multiple linear regression analysis used to identify factors associated with workplace stress.

RESULTS:

About 78% of the participants were 25–35 years old, 54% were males, and 60% were physicians. Working a shift reduced the job stress index by a statistically significant amount. However, longer working hours, higher education, and having many children contributed to higher job stress; in terms of severity, a good educational level and having many children marginally increased the risk whereas having shifts decreased the job stress. In terms of the absence of organizational support, it was discovered that having many children, a high educational level, and long working hours per day boosted it, although working a shift had a negative correlation.

CONCLUSION:

There is a need for continued administrative assistance and appropriate training programs to deal with potentially stressful situations at health facilities.
Body mass index, eating habits, and various lifestyle changes in young adults during the two years of the coronavirus disease 2019 (COVID-19) pandemic
Authors: Rafique Nazish
Published: May 2024

BACKGROUND:

The aim of this study was to find out the perceived impact of 2 years of coronavirus disease 2019 (COVID-19) pandemic on various lifestyle behaviors (LSBs) and changes and their effect on body mass index (BMI) of young Saudi adults.

MATERIALS AND METHODS:

This was a descriptive exploratory study conducted in January 2022 on 1724 students (aged 16–21 years) from multiple colleges of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The main tools of the study were: BMI and an online 30-item LSB and changes structured questionnaire, which assessed LSB and perceived changes, 1 month immediately preceding and 2 years after the COVID-19 outbreak.

RESULTS:

Our study results showed that 48% of the subjects gained weight after the pandemic. Screen time (ST) increased from 6.8 h before pandemic to 9.2 h/24 h after pandemic outbreak (P < 0.0001). However, no significant association was observed between excessive ST and increased BMI. A significant decrease in physical activity was seen after the outbreak (P < 0.001), which was positively but insignificantly associated with increased BMI (P = 0.3). A significant increase in the frequency of food intake was observed; 18.7% of the subjects reported taking ≥ 4 meals/day before the epidemic compared to 32.1% during the pandemic (P = 0.001). Decreased intake of homemade food, increased intake of junk food, and increased number of the meals/day were significantly related with increased BMI (P < 0.05). The strongest risk factor for increased BMI after the outbreak of the pandemic was ≥4 meals/day (OR=1.6; P = 0.048).

CONCLUSION:

After 2 years of the pandemic, 48% of the young adults perceived they had gained weight, which was strongly associated with self-reported increase in the number of meals/day (≥4). These observations could aid the development of nutritional recommendations to maintain the health of young adults during and after the COVID-19 pandemic.
The Dynamic(s) of Adipose Stem Cell System, Their Survival, and Cessation under the Influence of Electromagnetic Fields
Authors: Trzyna Anna , Bądziul Dorota B. , Jakubczyk Paweł , Bocak Damian S. , Cholewa Marian , Banaś-Ząbczyk Agnieszka
Published: May 2024

Context

The electromagnetic field (EMF) is one of the external biophysical factors that can influence stem cells' structure and functionality. Depending on its frequency and magnetic flux density, EMF can have both a positive and negative effect on stem cell biology.

Aims:

The aim of the study is to define EMF conditions that support beneficial physiological processes and those that lead to pathophysiological phenomena. Understanding the changes and processes occurring in stem cells after exposure to EMFs of different parameters can be an important factor to be applied in stem cell-based therapies and regenerative medicine.

Materials and Methods:

In this study, using fluorescent microscopy and flow cytometry methods, the influence of EMF on adipose-derived stem cells proliferation, cell cycle, viability, and death were examined. EMF parameters were set in accordance with the ion cyclotron resonance (ICR) theory that influences Ca2+ and Mg2+ ions influx. Results were statistically developed using the ANOVA and effect size (Cohen's d) analyses.

Results

In this study, the continuous exposure of adipose-derived stem cells to EMF (ICR parameters: 76.6 Hz; 20 μT) causes a statistically significant increase in cell death through the enhancement of apoptotic, necrotic, and autophagic cell numbers. Apart from increased cell deaths after EMF exposure, increased proliferation after 24 h of EMF exposure has been also observed.

Conclusions

Results presented in this study show that EMF influences stem cell dynamics resulting in a significantly increased cell death, thus altering the stem cell fate. It is important to further establish EMF conditions that support ASCs functioning and beneficial physiological processes for future regenerative medical purposes.
Determination of Multileaf Collimator Positional Errors as a Function of Dose Rate, Speed, and Delivery Interruption for Volumetric-Modulated Arc Therapy Delivery
Authors: Roy Soumya , Sarkar Biplab , Pradhan Anirudh
Published: May 2024

Aim:

To determine the multileaf collimator positional error (MLC-PE) during volumetric modulated arc therapy (VMAT) delivery by studying the time-dependent MLC velocity in mathematically derivable trajectories such as straight line and conic sections.

Materials and Methods:

VMAT delivery is planned in a way that MLCs are moving in a locus which can be defined by mathematical functions such as linear, parabolic, or circular velocity (PV or CV). The VMAT delivery was interrupted either once or multiple times during the delivery and projection images of the same were acquired in electronic portal imaging device. MLC-PE was then analyzed as a function of dose rate (DR), and MLC speed (SP) and number of interruptions in treatment delivery. In VMAT delivery with linear MLC motion, the delivery was interrupted either once (linear motion single interruption) or multiple (three) times (linear motion multiple interruptions). For PV and CV MLC velocity, the MLC motions are interrupted multiple times.

Results:

The maximum individual error obtained (DR of 35 MU/min, SP of 2.0 cm/s) was 1.96 ± 0.1 mm. Only 4.4% of MLCs showed ≥ ±1 mm positional error. When the treatment delivery is interrupted multiple times in VMAT delivery, the influence of interruption in MLC-PE overwhelmed the influence by DR and SP. For a sub-group analysis of independent and dependent variables, the mean MLC-PE was 0.18 ± 0.4 mm 0.19 ± 0.42 mm, respectively.

Conclusion:

Determination of MLC-PEs using a mathematical function without approximation indicates that MLC-PE is not a function of MLC speed. In less than 5% of the studied scenarios, the MLC-PE exceeds its tolerance value (±1 mm). The MLC-PE is significantly less in modern machines due to advancements in the delivery mechanism.
Use of Multiple-Tube Phantom
Authors: Negi Pradeep Singh , Mehta Shashi Bhushan , Jena Amarnath
Published: May 2024

Background:

Native T1 relaxation time (T10) presents an important prerequisite to reliably quantify pharmacokinetic parameter like Ktrans (volume transfer constant). Native T1 value can be varied because of the inhomogeneity in the breast coil, thus influencing the Ktrans measurement.

Purpose:

The current study aims to design and use a phantom with multiple tubes for both breast cuffs to assess native T1 inhomogeneity across the dedicated molecular magnetic resonance (mMR) breast coil and adopt corrective method to spatially normalize T1 values to improve homogeneity.

Materials and Methods:

Two phantoms with multiple tubes (19 tubes) specially designed and filled with contrast medium with known T1 value were placed in each mMR breast coil cuff. Native T1 at various spatial locations was calculated applying dual flip angle sequence. Correction factors were derived at various spatial locations as a function of deviation of the native T1 value from phantom and applied to correct the native T1 relaxation time.

Results:

A statistically significant difference between native T1 values of the right and left anterior (P = 0.0095), middle (P = 0.0081), and posterior (P = 0.0004) parts of the breast coil. No significant difference was seen in the corrected T1 values between anterior (P = 0.402), middle (P = 0.305), and posterior (P = 0.349) aspects of both sides of the breast coil.

Conclusion:

Inhomogeneity in the native T1 value exists in dedicated mMR breast coil, and significant improvement can be achieved using specially designed external phantom with multiple tubes.
Assessment of Uncertainty Depending on Various Conditions in Modulation Transfer Function Calculation Using the Edge Method
Authors: Maruyama Sho
Published: May 2024

In medical X-ray imaging, to perform optimal operations, it is essential for the user to understand whether a required image quality level which depends on a diagnostic task can be achieved with the imaging system used. This study focuses on the effects of noise on the modulation transfer function (MTF) using the edge method, the most widely used to evaluate the task dependence property. The purpose is to verify the uncertainty of the MTF value at each spatial frequency and examine the conditions under which the accuracy is ensured. By using a Monte Carlo simulation, edge images with various contrast-to-noise ratio (CNR) are acquired. MTFs are then calculated with different edge spread function (ESF) lengths. The uncertainties for each spatial frequency are estimated based on the independent MTF calculations obtained from the five edge data. The uncertainty of the MTF is inversely proportional to the CNR. In the frequency range up to the Nyquist frequency, the uncertainty in five calculations is <0.01 when the CNR is more than 60. In addition, it is observed that the uncertainty increases as the ESF length increases. This relationship depends on the frequency range, but it is proportional to the 0.3–0.5 power of the ESF length. The results in which the uncertainty is most likely to be large in the MTF calculation are clearly shown. Therefore, it is expected to provide an important barometer and useful insights for a proper image quality measurement.
An Investigation of Multileaf Collimator Performance Dependence on Gantry Angle Using Machine Log Files
Authors: Hughes Jeremy L. , Ebert Martin A. , McGarry Conor K. , Agnew Christina E. , Sabet Mahsheed , Rowshanfarzad Pejman
Published: May 2024

Background:

Quality assurance of linear accelerators (linacs) is an important part of ensuring accurate radiotherapy treatment deliveries. The aim of this study is to investigate the role of gravity on the positional accuracy of multileaf collimator (MLC) leaves during complex radiotherapy treatments on linacs. This investigation is based on the analysis of the machine log files from five different linacs in multiple centers.

Materials and Methods:

Three main categories of deliveries were considered: Picket fence, volumetric modulated arc therapy (VMAT) (both delivering with continuous gantry rotation), and sliding gap tests delivered at cardinal gantry angles, to determine the error of the MLC in relation to the gantry angle.

Results:

Analysis of picket fence tests revealed a dependence of the error upon the gantry angle. For the majority of deliveries, the MLC showed greater error at gantry angles 270 and 90. The errors computed for the cardinal angles for sliding gap tests were all statistically different with greatest error arising at gantry angle 270 and least error at gantry 90. For picket fence, sliding gap, and VMAT cases, MLC errors were dependent on the gantry angle.

Conclusions:

The errors in leaf positioning were found to be dependent on the gantry angle. For sliding gap tests, the error was greater at gantry angle 270° and 90° and less when the leaf motion was perpendicular to the force of gravity.
Designing a "Near-Death Experience" Reality Testing System
Authors: Shakeri Ali Akbar , Ebrahimi Sedigheh , Jahromi Mohsen Faseleh , Tabei Seyed Ziaaddin
Published: May 2024

“Near-death experiences (NDEs)” are usually depicted with a vivid perception of departure from the physical body and being in a distinctive spatial and temporal area setting. There are challenges to whether consciousness during this phenomenon is cerebral or extracerebral? To investigate this subject further, the AWARE research projects were designed. It was a research milestone in this field. During the AWARE projects, images were put in the cardio pulmonary resuscitation (CPR) area. The person with experience of leaving the body was then asked about the nature of the images. In a recent project, a complementary system was designed that contains two main parts: a transmitter connected to the electroshock (as starter) and a receiver connected to the monitor. The laboratory experiment showed that the connection between the parts of the system was systematically and meticulously organized. This new system, such as the AWARE projects, is based on the perception of the visual and auditory elements, during the out-of-body experience component of the NDE but, unlike the AWAREs, it has three main differences in testing of visual elements: unfixed/dynamic images, “timed” movie's capacity, and the automatic activation. Also this system, records the ambient sounds. So, after the successful resuscitation, researchers will be asked about the ambient sounds specification. The new system records the ambient sounds. Consequently, it becomes feasible to study environmental and corporeal events in more detail, during the phenomenon.
Paradigm Shift in Radiation Treatment Planning Over Multiple Treatment Modalities
Authors: Insley Benjamin , Hsu I-Chow , Cunha J. Adam Martin
Published: May 2024

The inverse planning simulated annealing optimization engine was used to develop a new method of incorporating biological parameters into radiation treatment planning. This method integrates optimization of a radiation schedule over multiple types of delivery methods into a single algorithm. We demonstrate a general procedure of incorporating a functional biological dose model into the calculation of physical dose prescriptions. This paradigm differs from current practice in that it combines biology-informed dose constraints with a physical dose optimizer allowing for the comparison of treatment plans across multiple different radiation types and fractionation schemes.
Probability Distribution of Pixel Intensities of EBT3 Films and its Application in the Correction of Uncertainty Budget
Authors: Chaudhary Rahul Kumar , Pathan Munir , Kumar Rajesh , Sharma S. D. , Sapra B. K.
Published: May 2024

Background and Aim:

Modern radiotherapy modalities, such as Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy involve complex dose delivery. The dose delivery is complex as it involves beam modulation, hence, manual dose calculations for these techniques are not possible. Film dosimetry is commonly used method of dose verification for these modalities because of the advantages associated with it. The quantification of uncertainty associated with a film dosimetry system under clinical use becomes important for accurate dosimetry. The spread in the distribution of the pixel values (PV) of the irradiated film contributes to the uncertainty. The probability distribution (PD) of the PV was studied for the clinical photon beam energies of 6, 10, and 15 MV.

Methods and Materials:

Gafchromic EBT3 film and EPSON 10000XL flatbed scanner were used for this purpose and using the resulting PD, the uncertainty budgets for these energies in the red, green and blue color channels were estimated.

Results:

The PV of exposed films for the energies studied follows t-distribution, the sum of the squares of the deviation of the measured data from the fitted value was of the order of 10−7, this indicates the goodness of fit. The “t” value corrected combined standard uncertainty (CSU) at 1σ confidence level for exposed film and dose measurement at 200 cGy were 1.42%, 1.48%, and 1.63% and 1.99%, 3.23%, and 5.08% for 6, 10, and 15 MV energies, respectively, in the red colour channel.

Conclusion:

In the case of the limited number of measurements of a quantity, the SU values must be corrected using the “t” value to get the correct CSU.
A Feasibility Study of Stereotactic Radiosurgery/Stereotactic body Radiotherapy/Stereotactic Ablative Radiotherapy Practice using TomoEDGE in Helical TomoTherapy for Lung, Liver, and Spine Targets
Authors: Sresty N. V. N. Madhusudhana , Raju A. Krishnam , Kumar G. Deleep , Rohit S. , Reddy B. Nagarjuna , Sahithya V. C. , Reddy B. Devender , Mohd Yakub , Rushdi Tasneem , Bajwa Harjoth , Aparna S
Published: May 2024

The primary purpose of the study is to evaluate the implementation of Helical TomoTherapy (HT) for eligible stereotactic radiosurgery/stereotactic body radiotherapy/stereotactic ablative radiotherapy (SRS/SBRT/SABR) cases using TomoEDGE option. The study focuses on reduction of treatment time without compromise in plan quality using TomoEDGE. It is a mode in HT that uses a dynamic opening of the jaws during treatment delivery to reduce the dose penumbra which otherwise is not possible with fixed jaws option. Eligible SRS/SBRT/SABR cases of lung, liver, and spine were used in this study. All planning parameters such as dose prescription to target and critical organs, pitch, and modulation factor were same in all the plans of the same patient with modifications in the field width and jaw mode. First set of plans with 2.5 cm width and second set of plans with 5 cm width were done in dynamic TomoEDGE mode. Third set of plans created with 5 cm width fixed jaw mode and fourth set of plans with 2.5 cm fixed jaw mode for comparison purpose were done. Our observations achieved that a significant milestone with reduction of up to 34.3% in treatment time of liver cases, 35.2% in lung cases, and 28.7% in spine cases was observed using dynamic TomoEDGE mode with 5 cm width, while no significant variation in the planning results compared with plans using 2.5 cm dynamic TomoEDGE option. TomoEDGE is an efficient and useful mode in TomoTherapy to reduce the treatment time with bigger field width in SRS/SBRT/SABR cases without significant changes in the plan quality.
Comparison of Norepinephrine with Ephedrine Boluses for the Treatment of Maternal Hypotension during Cesarean Section Under Spinal Anesthesia: A Prospective Observational Study
Authors: Phogat Antima , Kavishvar Neeta
Published: May 2024

Spinal Induced Hypotension:

Hypotension is one of the most common side effects of spinal anesthesia for lower segment cesarean section (LSCS). The most commonly used vasopressors for the treatment of spinal-induced hypotension (SIH) are phenylephrine, ephedrine, and norepinephrine.

Aim:

This study aimed to compare the efficacy of boluses of ephedrine and norepinephrine for the treatment of SIH in cesarean section.

Methods and Material:

A prospective observational study was conducted on 160 women undergoing elective and emergency cesarean section receiving spinal anesthesia with injection of bupivacaine heavily. Whenever hypotension (fall in systolic blood pressure (SBP) <20% from baseline value or SBP <80 mm Hg, whichever is less) occurred, either ephedrine (6 mg) or noradrenaline (6 μg) was given intravenous (IV) bolus as per the availability. Primary outcomes were maternal hemodynamic parameters, number of episodes of hypotension, requirement of bolus vasopressors, and Apgar score. Other outcomes were episodes of tachycardia, bradycardia, hypertension, and maternal side effects such as nausea, vomiting, shivering, and arrhythmia. Data analysis was performed with the help of Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 25. A P- value of <0.05 was considered statistically significant.

Results:

The mean SBP of both groups was comparable (P < 0.05). The mean heart rate (HR) was significantly higher in group E than in group N at 8 minutes and after till 60 minutes (P < 0.001). No statistical difference was found between the two groups in the Apgar score (P > 0.05). The mean dose requirement of ephedrine in group E was 1.94 and in group N was 2.04.

Conclusions:

Ephedrine (6 mg) and norepinephrine (6 μg) boluses are efficacious in treating hypotension after spinal anesthesia in obstetric patients. Norepinephrine appears to be favorable in view of HR than ephedrine.
Acute Onset Budd-Chiari Syndrome in the Postpartum Period
Authors: Bhatia Unnati , Hulgur Mruthunjaya D. , Hannigan Jennifer , Nallapillai Arul
Published: May 2024

Budd-Chiari syndrome, though rare, can have devastating consequences during pregnancy. The presence of varied anatomical and physiological changes in pregnancy can worsen this condition. Owing to the rarity of this condition, the understanding of this disease process is limited and still evolving. Due to the acute clinical manifestations, it would be prudent to keep a close watch on women with hepatic vascular events in the peripartum period. We describe the anesthetic management of a primigravida who suddenly deteriorated in the immediate postpartum period following an uneventful forceps delivery with a high vaginal tear repair under spinal anesthesia. The challenges faced, including difficulty in establishing a diagnosis, have been discussed.
Airtraq as an Alternative Device for Airway Management for Emergency Cesarean Section in a Parturient with Kyphoscoliosis and Short Stature – A Case Report
Authors: Narayanan K Sathya , Bhandari Geeta , Nautiyal Abhishek , Tiwari Abha
Published: May 2024

Kyphoscoliosis is a spine abnormality identified by anterior flexion (kyphosis) and lateral curvature (scoliosis) and its causes can be multifactorial. A 24-year-old primigravida with short stature and severe thoracolumbar kyphoscoliosis was scheduled for emergency cesarean section due to non-progression of labor with fetal distress. After failed spinal and unsuccessful conventional laryngoscopy, the patient was intubated using an optical Airtraq (Prodol Meditec S.A., Vizcaya, Spain) laryngoscope and operated. The main purpose of an anesthesiologist is to perform safe and skilled anesthetic management to minimize risk to mother and baby. Kyphoscoliosis exacerbates an already compromised cardiopulmonary status due to pregnancy. The severity of pulmonary impairment depends upon the degree of Cobb’s angle. None of the anesthetic techniques is said to be perfect as each technique has its own merits and demerits. General anesthesia may be indicated because of maternal preference or maternal cardiopulmonary disease or technical difficulties related to the regional block. Airtraq can be an alternative option for airway management as it provides a direct view of the glottis in a neutral neck position.
To Study Maternal Hypotension, Side-Effects and Fetal Acid-Base Balance During Cesarean Delivery Under Spinal Anesthesia using Prophylactic Infusion Doses of 25 and 50 μg/Min Phenylephrine
Authors: Akshay R , Bajaj Jeetendra Kumar
Published: May 2024

Objectives:

To study maternal hypotension, side effects, and fetal acid-base balance during cesarean delivery under spinal anesthesia using prophylactic infusion doses of 25 and 50 μg/min phenylephrine.

Methods:

This prospective randomized study was carried out at a tertiary care hospital on 100 pregnant women who underwent caesarean section under subarachnoid block. The participants were randomized into: Group P1 (n = 50): who received phenylephrine 25 μg/min infusion prophylactically and Group P2 (n = 50) received phenylephrine 50 μg/min infusion prophylactically. The two groups were compared for heart rate, blood pressure, side effects, and fetal arterial and venous blood gas analysis. P value < 0.05 was considered statistically significant.

Results:

In group P1, 3 (6%) patients had episode of hypotension and in group P2, 1 (2%) patient had episode of hypotension. There was no incidence of hypertension in group P1 but in group P2, 5 (10%) patients had hypertension (p < 0.05). There was no episode of bradycardia or oxygen desaturation in any group. Side effects were Grade 1 in three patients each in both the groups, and Grade 2 in one patient of Group P1 and four patients in Group P2 (p = 0.842). Fetal acid-base balance was comparable in the two groups (p > 0.05).

Conclusion:

It can be concluded that 50 μg/min phenylephrine was able to better prevent maternal hypotension with comparable side-effects profile and fetal acid base balance.
Non - Invasive Hemodynamic Parameters as Predictors for Hypotension following Spinal Anesthesia in Parturients Undergoing Lower Segment Cesarean Section: A Prospective Observational Study
Authors: Singhal Neelam , Bansal Amol , Duggal Rashmi
Published: May 2024

Background:

In parturients undergoing lower segment cesarean section (LSCS) following spinal anesthesia hypotension is the most common side effect that may cause severe adverse effects in mothers such as nausea, vomiting, and dizziness. Very few studies have been done in the Indian population wherein multiple non-invasive hemodynamic parameters have been studied as predictors of hypotension following spinal anesthesia in parturients undergoing cesarean section. So we hypothesized that multiple non-invasive hemodynamic parameters like Perfusion Index (PI), Pleth Variability Index (PVI), and heart rate (HR) can predict hypotension following spinal anesthesia in parturients undergoing an elective cesarean section.

Methods:

We enrolled 40 parturients in this prospective observational study. Spinal anesthesia was performed with 10 mg of injection bupivacaine 0.5% (hyperbaric) at the L3–L4 or L2–L3 interspaces. Hypotension in parturient was defined as decrease in systolic blood pressure of greater than 20% from its baseline value. Baseline HR, PVI, and PI were recorded. Statistical analysis was performed using Unpaired t-test/Mann–Whitney test and Chi-Square test/Fisher’s exact tests. Area under the receiver operating characteristic (ROC) curve (AUC) was used to determine the sensitivity, specificity, and the cut-off value for the parameters.

Results:

Hypotension occurred in 57.5% of the parturients. It was observed that only PI could predict the development of post spinal hypotension in parturients undergoing LSCS (AUC = 0.835, 95% confidence interval [CI] 0.684–0.933, P = 0.001). The analysis of ROC curve was done and a new cut-off value of PI of >2.58 was found with 100% sensitivity and 70.6% specificity for predicting post-spinal hypotension, which was highly statistically significant, P value <0.001.

Conclusion:

The baseline PI is a useful predictor for hypotension in parturients undergoing spinal anesthesia. Other non-invasive hemodynamic parameters, that is baseline HR and PVI, however, could not anticipate hypotension in these parturients.
To Compare the Efficacy of Two Different Bolus Doses of Phenylephrine in Combination With Oxytocin in Preventing Oxytocin-Induced Hypotension during Cesarean Section Under Spinal Anesthesia: A Randomized Comparative Study
Authors: Kumari Snehalata , Barman Ratindra K. , Kalita Pranab , Engti Peter
Published: May 2024

Background:

A randomized comparative study was conducted to assess the effectiveness of two different bolus doses of phenylephrine to obtund the hypotensive effects of bolus oxytocin injection in patients undergoing cesarean section under spinal anesthesia.

Methods:

The study involved 180 parturients belonging to the ASAI and II, undergoing CS under SA were randomized into three groups, group A: oxytocin 3U and phenylephrine 50 μg; group B: oxytocin 3U and phenylephrine 75 μg; group C: oxytocin 3U and normal saline, administered intravenously over 5 min after delivery of anterior shoulder. The incidence of hypotension being the primary objective and hemodynamic changes, the incidence of nausea and vomiting, and other complications, such as total rescue vasopressor requirement, adequacy of uterine contraction, and the number of patients requiring additional uterotonics, were our secondary objectives.

Results:

The incidence of hypotension was highest in group C (83.3%) followed by group A (80%) and lowest in group B (11.6%). The total rescue doses of PE after T0 between the three groups showed that group A required (61.32 ± 41.19) μg, group B required (10.19 ± 29.75) μg, and group C required (113.21 ± 47.18) μg of PE. The uterine contraction was comparable between the groups. Incidence of nausea and vomiting and other complications were comparable between the groups.

Conclusion:

Co-administration of PE 75 mg with OT 3 IU after delivery reduces the incidence of OT-induced hypotension and rescue vasopressor requirement compared to co-administration of 50 μg PE during CS under spinal anesthesia.
Evaluation of Perfusion Index as a Screening Tool for Prediction of Hypotension and Shivering in Cesarean Section
Authors: Gandhi Parita , Kheskani Divya , Chhanwal Heena Sunil , Solanki Rekha Nilesh , Shah Meet , Singh Aayushi
Published: May 2024

Aim:

The aim of this study was to determine whether a baseline perfusion index (PI) can predict hypotension and shivering after spinal anesthesia for cesarean section.

Materials and Methods:

In this prospective, observational study, 100 parturients were divided into two groups on the basis of baseline PI. Group I included parturients with PI of <3.5, and Group II included parturients with PI values ≥3.5. Spinal anesthesia was performed with hyperbaric 2 ml of 0.75% ropivacaine at L3–L4 or L2–L3 interspace. Hypotension was defined as mean arterial pressure <65 mmHg. PI and blood pressure were monitored at baseline, every 2 min for 12 min, and every 10 min until 120 min. Shivering was observed until 120 min according to the Crossley and Mahajan scale. Statistical analysis was performed using Chi-square test, independent sample t-test, and Mann–Whitney U-test.

Results:

Baseline PI significantly correlated with the number of episodes of hypotension. The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) compared to those with PI <3.5 (33.33%), and parturients with preoperative PI <3.5 had a greater risk of post-anesthetic shivering.

Conclusions:

Perfusion Index serves as an excellent tool for predicting hypotension and shivering in pregnant patients.
Head Fixation in Head Frame in Surgeries of Unstable Craniovertebral Junction through Midline Posterior Approach
Authors: Jha Deepak Kumar , Jha Ashutosh , Garg Mayank , Gosal Jaskaran Singh , Agrawal Mohit , Sharma Raghavendra Kumar , Khera Pushpinder Singh
Published: May 2024

Intraoperative skeletal traction with Gardner-Wells tongs or Crutchfield tongs is often used during surgery for craniovertebral junction (CVJ) instability. During these posterior surgical procedures for CVJ instability, there is pressure on occiput/C1 while subperiosteal dissection, drilling, and insertion of screws. With cervical traction, there is a possibility of anterior movement of occiput/C1 due to pressure while performing the above steps. This may lead to undesirable compression of the cervicomedullary junction. The use of rigid head fixation during CVJ surgeries will prevent any such unwanted anterior movement of occiput/C1. Furthermore, the use of the reverse Trendelenburg position allows the body weight to provide counter traction while the rigid frame provides traction allowing reduction of atlantoaxial dislocation. Authors conclude that head fixation in the frame is safer than skeletal traction for CVJ surgeries, through midline posterior approach, for traumatic or congenital anomalies related instabilities.
Posterior Spinal Screw Fixation Techniques and Trajectories: General Overview and an Analysis of How Often They Are Used
Authors: Andermatten Joaquin , Chaurasia Bipin , Lopo Anne Fernandez , Puertas Garazi Marticorena , Samprón Nicolás
Published: May 2024

Background:

There is a great variety of techniques (translaminar, transfacet, and extrapedicular screws) apart from the traditional pedicle screw in posterior spinal instrumentation. The latter technique is the most widely used around the world (except from the cervical region) since it tends to obtain very good results with a simple approach with fewer complications.Therefore, other trajectories are usually reserved for more specific cases in which the insertion of these purely pedicle screws is not possible.

Objective:

The objective of this study was to review and analyze the use of different techniques and trajectories of posterior spinal instrumentation by different spinal surgeons around the world.

Material and Methods:

We developed a survey including posterior spinal screw techniques and trajectories. In this article, we present the data resulting from 122 answers from different spinal surgeons (neuro, orthopedic surgery).

Results:

Despite advances in the development of new technologies such as neuronavigation (17%) and robotic (1%) available on the market, nowadays, the gold-standard technique for spinal screw insertion is the fluoroscopy-assisted freehand approach (54%). The lumbar spine is the most instrumented spinal region (31%), with a clear preference for purely transpedicular screws. Thoracic and sacroiliac areas presented a greater diversity of screw trajectories. In the cervical spine, there is a clear tendency toward the insertion of lateral mass screws (85% in the atlantoaxial region and 70% in the subaxial region), as opposed to the use of pedicular screws. This is mainly due to the complexity of this area and the risk of damaging important neurovascular structures relatively close to the pedicles. Unexpectedly, two additional techniques were presented: cortical bone trajectory for lumbar screw fixation (for osteoporotic patients) and S2-alar-iliac screw fixation (more used than iliac screws alone).

Conclusions:

This survey demonstrates that the most used spinal trajectory in the thoracolumbar spinal region is the traditional pedicle screw insertion. Lateral mass was the most common place to insert screws in the subaxial cervical region. The use of robotic systems can improve the position of the screws of more complex techniques. We consider that the different techniques should be known since every surgery will be adapted to the patient’s anatomy and needs.