Does Helical Tomotherapy Improve Dose Conformity and Normal Tissue Sparing Compared to Conventional IMRT? A Dosimetric Comparison in High Risk Prostate Cancer

The study was designed to compare Helical Tomotherapy (HT) based IMRT and conventional sliding window (SW IMRT) in patients with high risk prostate cancer. Complementary plans with HT and SWIMRT were compared using DVH parameters. The PTV Prostate was prescribed 74 Gy in 37 fractions and the nodal PTV received 55 Gy in 37 fractions by simultaneous integrated boost. Conformity Index, Homogeneity Index and dose-volume parameters were compared. The conformity index (CI) of HT (0.77, SD = 0.54) plans tended to be better (p = 0.069) compared to SWIMRT (0.70, SD = 0.01) for prostate PTV. CI for nodal PTV was similar. Helical tomotherapy plans were more homogeneous, with homogeneity index (HI) of 0.04 compared to 0.06 in SWIMRT (p = 0.018) for PTV prostate and HI of 0.06 and 0.15 (p = 0.025) for PTV nodes respectively. Median dose to bladder (p = 0.025) and rectum (p = 0.012) were less with HT. However, HT delivered a higher D10Gy and D1Gy to rectum and bladder overlap volumes as a consequence of achieving better homogeneity. Femoral heads were better spared with HT plans (p = 0.012). HT improves dose homogeneity, target coverage and conformity as compared to SWIMRT, with overall improvement in critical organ sparing.

Assessing cold chain status in a metro city of India: an intervention study

BACKGROUND

Cold chain maintenance is an essential activity to maintain the potency of vaccines and to prevent adverse events following immunization. One baseline study highlighted the unsatisfactory cold chain status in city of Kolkata in India.

OBJECTIVES

To assess the changes which occurred in the cold chain status after the intervention undertaken to improve the status and also to assess the awareness of the cold chain handlers regarding cold chain maintenance.

METHODS

Intervention consisted of reorganization of cold chain points and training of health manpower in Kolkata Municipal area regarding immunization and cold chain following the guidelines as laid by Govt of India. Reevaluation of cold chain status was done at 20 institutions selected by stratified systematic random sampling after the intervention. The results were compared with baseline survey.

RESULTS

Significant improvement had been observed in correct placing of cold chain equipment, maintenance of stock security, orderly placing of ice packs, diluents and vaccines inside the equipment, temperature recording and maintenance. But awareness and skill of cold chain handlers regarding basics of cold chain maintenance was not satisfactory.

CONCLUSIONS

The success of intervention included significant improvement of cold chain status including creation of a designated cold chain handler. The gaps lay in non-availability of non-electrical cold chain equipment and separate cold chain room, policy makers should stress. Cold chain handlers need reorientation training regarding heat & cold sensitive vaccines, preventive maintenance and correct contingency plan.

Brain-sparing holo-cranial radiotherapy: a unique application of helical tomotherapy

AIMS

Diffuse and extensive involvement of the scalp/skull by malignancy mandates holo-cranial radiotherapy with the aim to deliver homogeneous doses to the planning target volume (PTV) while minimising the dose to surrounding organs at risk (OARs). Previously described techniques result in significant heterogeneity, suboptimal coverage or poor conformity and need complicated beam matching. Here we report our preliminary experience of planning and delivery of brain-sparing holo-cranial radiotherapy with helical tomotherapy.

MATERIALS AND METHODS

Three patients with extensive involvement of the scalp/skull by malignancy were planned and treated with image-guided intensity-modulated radiation therapy on helical tomotherapy. The plan evaluation was carried out using standardised dose metrics.

RESULTS

Helical tomotherapy achieved highly conformal and homogeneous dose distributions with substantial OAR sparing in all three patients. The volume of PTV receiving ≥95% of prescribed dose (V(95%)) was ≥98% in all three patients. The mean (standard deviation) homogeneity index and conformity index was 0.046 (0.006) and 0.783 (0.035), respectively. The mean dose to the brain parenchyma outside the PTV was 17.32 Gy (74%), 28.76 Gy (63.9%) and 26.7 Gy (59.3%) for the three patients. The mean (standard deviation) monitor units and beam-on time was 6939 (985) and 8.10 (1.137) min, respectively. Overall the treatment was very well tolerated with no significant acute toxicity. Early follow-up evaluation revealed a good clinicoradiological response and the absence of local disease progression with no significant sequelae, implying successful application of the treatment paradigm.

CONCLUSION

Helical tomotherapy is ideally suited for brain-sparing holo-cranial radiotherapy with its exceptional ability of tangential beam delivery resulting in highly conformal and homogenous dose distribution across large, complex target volumes with substantial OAR sparing.

Early experiences of abuse and current depressive disorders in Iranian women

Early experience of abuse may be viewed as a risk factor for mental disorders in women later in life. This case-control study in Isfahan screened 709 women aged 20-45 years using the Beck Depression Inventory and structured clinical interviews for Diagnostic Statistical Manual-IV criteria. Lifetime history of abuse was determined using a standard questionnaire. Among the women 35.1% had experienced fear of or actual abuse (physical, sexual or both) in childhood or adolescence. The risk of having major depression in adult life was significantly higher in women who experienced abuse in childhood and adolescence (OR 4.3), severe degrees of abuse (OR 3.9) or multiple forms of abuse (OR 3.8).

Psychometric properties of the WHOQOL-BREF in an Iranian adult sample

To evaluate discriminant validity, reliability, internal consistency, and dimensional structure of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) in a heterogeneous Iranian population. A clustered randomized sample of 2,956 healthy with 2,936 unhealthy rural and urban inhabitants aged 30 and above from two dissimilar Iranian provinces during 2006 completed the Persian version of the WHOQOL-BREF. We performed descriptive and analytical analysis including t-student, correlation matrix, Cronbach's Alpha, and factor analysis with principal components method and Varimax rotation with SPSS.15. The mean age of the participants was 42.2 +/- 12.1 years and the mean years of education was 9.3 +/- 3.8. The Iranian version of the WHOQOL-BREF domain scores demonstrated good internal consistency, criterion validity, and discriminant validity. The physical health domain contributed most in overall quality of life, while the environment domain made the least contribution. Factor analysis provided evidence for construct validity for four-factor model of the instrument. The scores of all domains discriminated between healthy persons and the patients. The WHOQOL-BREF has adequate psychometric properties and is, therefore, an adequate measure for assessing quality of life at the domain level in an adult Iranian population.

Expenditure to treat thalassaemia: an experience at a tertiary care hospital in India

BACKGROUND

The medical and economic problem of thalassaemia are considered to be a vast public health problem in the thalassaemia belt countries, emphasizing more on prenatal diagnosis as the solution of the problem.

METHODS

A cross-sectional descriptive study was conducted in the Institute of Haematology & Transfusion Medicine located in Medical College, Kolkata, India to assess the socio-demographic profile, clinical presentation, expenditure for treatment of thalassaemia patients and awareness about cause and prevention of the disease.

RESULTS

Thalassaemia patients attended the Govt. setting were mostly from lower socioeconomic status with low level of literacy. Annual expenditure for treatment of thalassaemia ranged from $ 108 to 432; depending on type of treatment with average cost per transfusion was $ 5.2±2.2. Average 18.5%±14.3 of the total annual income was spent on the treatment for thalassaemia. Average man days or school days lost for the patients was 29.87±18.5 and 19.07±12.7 for the accompanying persons.

CONCLUSION

Blood transfusion and carrier screening facilities should be decentralized to decrease the expenditure for treatment and alleviate the harassment of the families. Folate and calcium tablets, hepatitis B vaccination can be made available at government setting free of cost.

What are the predictors of work impairment in Iranian patients with depressive disorders?

The purpose of this study is to estimate the predictors of working ability in depressed patients. Two hundred and twenty-six patients with depression consecutively admitted on outpatient basis from March 2003 to May 2006 were classified into working and non working groups. Severity of depression was measured by the Beck Depression Inventory and their occupational adjustment 2 months prior to the last episode was determined by Occupational Adjustment Scale, a subscale of Social Adjustment Scale. The groups were almost similar in terms of age, sex, education, and marital status. There were significant differences between them in terms of family history of depression, episodes of depression, history of suicide attempts, duration of illness and severity of depression (P < 0.01). The working depressed group differed significantly from the impaired depressed group in terms of work experience, job turnover, and overall occupational adjustment (P < 0.01). History of suicide attempt, family history of depression, time lost, severity of depression, pre-morbid occupational adjustment, age, and illness duration emerged as the most important predictors, explaining 64% of the patients' working ability. Our observations are on line with robust literature across the globe. Nature of illness condition as well as societal attitude can explain the impairment condition in depressed patients. Presence of a comprehensive integrated approach to their treatment and rehabilitation is imperative.

A novel PRNP-P105S mutation associated with atypical prion disease and a rare PrPSc conformation

OBJECTIVE

To define the clinicopathologic, genetic, and pathogenic prion protein (PrP(Sc)) characteristics associated with a novel mutation of the prion protein gene (PRNP).

METHODS

The coding segment of PRNP from the proband and family members was sequenced and the brain of the proband was histologically studied. The Western blot profile of the proteinase K (PK) resistant fraction of PrP(Sc), an approximation of its conformation, or "PrP(Sc)-type," was determined.

RESULTS

We detected a novel mutation at codon 105 of PRNP that results in a serine (S) substitution of proline (P) (P105S), in a young woman who developed progressive aphasia, behavioral changes, dementia, and parkinsonism, lasting 10 years to her death. Histopathologic findings included an intense focus of multicentric PrP-plaques within the hippocampus, punctate plaques scattered throughout the cerebellum, and intense spongiform degeneration focally within the putamen, suggesting a variant of Gerstmann-Sträussler-Scheinker syndrome (GSS). However, PrP(Sc)-typing revealed two PK-resistant PrP(Sc) fragments (approximately 21 and 26 kDa), a pattern not previously detected in GSS.

CONCLUSIONS

This mutation is the third sequence variation at codon 105 of PRNP. The unusual phenotype and PrP(Sc)-type distinguishes this genetic prion disease from typical Gerstmann-Sträussler-Scheinker syndrome and other codon 105 substitutions, suggesting that, in addition to the loss of proline at this position, the PrP(Sc) conformation and phenotype is dependent on the specific amino acid substitution.

Pattern of adverse drug reactions due to cancer chemotherapy in a tertiary care teaching hospital in Nepal

Use of cancer chemotherapeutic drugs is associated with several adverse drug reactions (ADRs) ranging from mild nausea to fatal myelosuppression. Data regarding safety profile of cancer chemotherapy is lacking in Nepal. To study the pattern of ADRs caused by cancer chemotherapeutic drugs in Manipal Teaching Hospital (MTH), Pokhara, Nepal. Hospitalized patients treated with cancer chemotherapy drugs from 1st January to 30th June 2006, was studied retrospectively. Necessary information was collected from the patients' hospital records. Total 60 patients underwent chemotherapy among which 25 (41.67%) developed ADRs. More than half (60 %) were male and 40 % were of age group 61-70 years. The mean SD age was 57.8 +/- 11.54 years. More than half of the patients (56%) who developed ADRs were on adjuvant chemotherapy. Alkylating agents were responsible for the ADRs in nearly half of the patients (52%) followed by antimetabolites (20%). Cisplatin was the individual drug responsible for 44% of the ADRs. The onset of the ADR was within a day in 44% of the patients. Thirty six percent of patients developing ADRs stayed in the hospital for 1-4 days. Hematological system was affected primarily (40.47% of the patients), followed by the gastrointestinal tract (33.33%). Grade I neutropenia was the most common ADR affecting 28.6% of the patients, followed by emesis (21.4%). Increased dose of antiemetics was needed in 38.5% of the patients to manage the ADRs. Levamisole was the drug used primarily (30.43%) for managing ADRs. Male patients and age group 61-70 years were highly predisposed to ADRs. Cisplatin was the common drug responsible for ADRs. Levamisole was commonly used in managing the ADRs. Similar studies covering more patients form different regions are needed to validate our findings.

Psychological profile of Iranian patients with low-back pain

A hospital case-control study in Isfahan, Islamic Republic of Iran, compared the psychological features of 200 patients with low-back pain with 350 matched controls. The control group scored lower than patients in all dimensions of the Symptom Checklist-90 checklist. Female patients were more psychologically affected by low-back pain than males. In both groups, grudge, general complaints, anxiety, depression, obsessive-compulsive behaviours, somatization and phobia varied with level of education. Patients' levels of depression and anxiety were related to occupational background. Longer duration of illness was accompanied by higher levels of anxiety, depression, obsessive-compulsive behaviours and somatization.

Studies on manganese nodule leached residue 4. Physicochemical characterization and catalytic activity of acetic acid treated manganese nodule leached residue

The catalytic activity of water-washed manganese nodule leached residue (WMNLR) samples improved by treating with acetic acid. The effects of acetic acid treatment on the physicochemical properties and catalytic activity of manganese nodule leached residue have been studied. The surface area, surface oxygen, surface hydroxyl groups, surface acidity, electron donating properties, etc., increase gradually with acid treatment up to 0.5 M and thereafter show a decreasing trend. The rate constant of H2O2 decomposition, catalytic activity of CO oxidation, and esterification of acetic acid also show a similar trend to that of surface properties.

Effect of heat treatment on the physico-chemical properties and catalytic activity of manganese nodules leached residue towards decomposition of hydrogen peroxide

The effect of calcination temperature on the physico-chemical characterization of manganese nodule leached residue (MNLR) and water-washed manganese nodule leached residue (WMNLR) has been investigated on the basis of chemical analysis, XRD, TG-DTA, FTIR, surface hydroxyl groups, surface oxygen, reducing and oxidizing sites, surface area. XRD and IR confirm the presence of amorphous iron oxyhydroxides, delta-MnO2, which are converted to alpha-Fe2O3 and gamma-Mn2O3 phases above 400 degrees C of calcination, respectively. A solid solution of Fe2O3 and Mn2O3 is formed above 700 degrees C. The surface area, surface hydroxyl group, surface oxygen, reducing and oxidizing sites increase with the increase in calcination temperature up to 400 degrees C and then decrease with further rise in calcination temperature up to 700 degrees C. The catalytic activity of the sample towards H2O2 decomposition shows the similar trend as surface properties. A suitable Mn(3+)Mn4+ couple favours H2O2 decomposition reaction. The activity has been correlated with various physico-chemical properties.

Routine primary immunization: status in two district of West Bengal

The study was conducted at Birbhum and Purba Medinipur districts of West Bengal to assess the routine primary immunization coverage following 40 cluster sampling technique was used to study 320 children in each of the districts. BCG coverage was found to be 79.69% at Birbhum and 84.38% at Purba Medinipur. Only 62.81% children at Birbhum and 67.81% children at Purba Medinipur received all the three primary doses of DPT. Regarding OPV, coverage with three primary doses were only 65% and 66.88% at Birbhum and Purba Medinipur respectively. Measles vaccine coverage was very poor at both the districts, 55.94% at Birbhum and 62.5% at Purba Medinipur. Full primary immunization was observed 53.13% and 61.56% in Birbhum and Purba Medinipur respectively. High drop-out rate was identified as a major deficiency in both the districts. Of the children who received at least one routine vaccine, more than 1/3rd at Birbhum and more than 1/4 th at Purba Medinipur did not turn up later for completion of their primary vaccine doses. It is evident that routine immunization coverage was poor in both the districts and it seems there has been no improvement in situation for last few years. It will influence not only the child morbidity and mortality situation but also will jeopardize the paralytic polio eradication programme. Urgent intervention should be undertaken to address the large number of non-immunized children as well as high proportion of drop-outs.

Surface recognition of a protein using designed transition metal complexes

Each protein has a unique pattern of histidine residues on the surface. This paper describes the design, synthesis, and binding studies of transition metal complexes to target the surface histidine pattern of carbonic anhydrase (bovine erythrocyte). When the pattern of cupric ions on a complex matches the surface pattern of histidines of the protein, strong and selective binding can be achieved in aqueous buffer (pH = 7.0). The described method of protein recognition is applicable to proteins of known structures. With rapidly increasing number of solved protein structures, the method has wide applicability in purification, targeting, and sensing of proteins.

Synthesis of conjugated diacetylene, metal-chelating monomers for polymerizable monolayer assemblies

[see structure]. Self-assembled monolayers (SAMs) of thiols on gold have been used for numerous applications. For protein targeting applications, one successful strategy is to use a metal-chelating SAM. It has also been demonstrated that polymerized SAMs are much more stable than non-polymerized counterparts. We report herein, the synthesis of several polymerizable, metal-chelating thiols capable of complexing luminescent lanthanide ions.