Prime Modality Research Articles

Pediatric hemoptysis: diagnostic and interventional challenges.

Hemoptysis in the pediatric population, while infrequent, poses significant challenges for both the family and healthcare practitioners. The severity of hemoptysis dictates management decisions. Most cases being mild and self-limiting are treated conservatively. However, "life-threatening hemoptysis" may occur, and is defined as any degree of blood loss that endangers the airway and is arbitrarily considered to be > 8ml/kg in 24h in children. It requires prompt airway management and resuscitation followed by a tailored approach consisting of bronchoscopy, computed tomography (CT), interventional radiology, and/or surgery depending on the patient 's clinical status and cardiopulmonary comorbidities. Bronchial arteries are hypertrophied in myriad conditions and account for 90-95% cases of hemoptysis due to their systemic pressure levels; the rest being contributed by pulmonary artery pathologies. Despite similar pathogenic mechanisms, the etiologies of pediatric hemoptysis differ from those in adults, with acute lower respiratory tract infections being the predominant cause. Imaging plays a crucial role in identifying the source and cause of hemorrhage. Multidetector computed tomography (MDCT) has emerged as a prime modality in the diagnostic evaluation of hemoptysis and provides a roadmap for potential interventional procedures. This article discusses the etiopathogenesis of hemoptysis along with a brief mention of the diagnostic modalities. It provides a structured reporting format and uses it to illustrate the imaging features in hemoptysis, with emphasis on CT angiography. The key findings in the lung parenchyma, airways, bronchial and non-bronchial systemic collaterals, and pulmonary arteries are elaborated upon. It further addresses the nuances of interventional management, particularly emphasizing the applications of bronchial artery embolization and pulmonary artery embolization in the pediatric population. The article also underscores the potential complications and factors influencing recurrence rates.

Blood-Brain Barrier Disruption for the Treatment of Primary Brain Tumors: Advances in the Past Half-Decade.

To review relevant advances in the past half-decade in the treatment of primary brain tumors via modification of blood-brain barrier (BBB) permeability. BBB disruption is becoming increasingly common in the treatment of primary brain tumors. Use of mannitol in BBB disruption for targeted delivery of chemotherapeutics via superselective intra-arterial cerebral infusion (SIACI) is the most utilized strategy to modify the BBB. Mannitol is used in conjunction with chemotherapeutics, oligonucleotides, and other active agents. Convection-enhanced delivery has become an attractive option for therapeutic delivery while bypassing the BBB. Other technologic innovations include laser interstitial thermal therapy (LITT) and focused ultrasound (FUS) which have emerged as prime modalities to directly target tumors and cause significant local BBB disruption. In the past 5years, interest has significantly increased in studying modalities to disrupt the BBB in primary brain tumors to enhance treatment responses and improve clinical outcomes.

Peer-assisted Virtual Learning in Basic Surgical Skills for Medical Students in Malaysia during the COVID-19 Pandemic

Abstract Introduction: During the coronavirus disease 2019 pandemic, all in-person teachings were suspended. This includes opportunities to learn surgical skills among undergraduate medical students in Malaysia. Virtual learning became the prime modality of medical education for all Malaysian universities. InciSioN Malaysia designed and conducted an online suturing workshop to increase medical students’ exposure to surgical skills. This workshop aimed to evaluate the feasibility and the reception of such workshops for undergraduate medical students in Malaysia. Methods: All participants received a preworkshop handbook covering the basic techniques of knotting and suturing. The online workshop was 2 h and peer-led. We conducted the suturing workshop through Zoom and using a unique set-up to provide real-time skills sharing with immediate feedback. This involved connecting on Zoom with two devices from both the tutor and the participant. A smartphone to show the suturing and knotting skills and a laptop to provide tutor-to-participant feedback. Participants were divided into small peer-to-peer (PTP) teaching groups where tutors demonstrated the basic surgical skills according to the handbook. Results: All tutors’ reported challenges in orientating their equipment set-up to ensuring that their technique was visible to the participants. Few participants faced difficulties understanding the tutor’s instruction on the knotting technique. Variations in the participants’ and tutors’ camera angles and Internet connectivity issues hindered effective real-time feedback. All participants were satisfied with the knotting and suturing skills session and 80% of participants rated a score of higher than 4/5 on the overall workshop and the quality of the lecture. In the perspective of long-term outcome, participants were motivated to practice more on the knotting and suturing technique which was taught on the event day. Discussion: Online PTP surgical skills workshops can reduce the time, travel, and costs to deliver and receive surgical skills teachings. This increases the learning opportunities for medical students, especially within social distancing limitations. This can provide workshops to upskill health-care providers in remote areas. However, Internet connectivity, technical issues with meeting platforms, and camera angles limited the effectiveness of online suturing workshops. These issues can be tackled by prior testing of the orientation of the phone and checking for the speed of Internet connectivity. Participants enjoyed the small group PTP teaching as it provided a comfortable environment for immediate questions and feedback. Conclusion: Virtual skills workshop has the potential to continue surgical education and can develop an interest in surgery. More importantly, this model has the potential to reach remote areas where workshops like this are usually conducted in the cities.

Computed tomography as a prime modality for early detection of nasopharyngeal carcinoma.

Objective: To determine the diagnostic accuracy of computed tomographic scan for the diagnosis of nasopharyngeal carcinoma, taking histopathology as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology, Allied Hospital, Faisalabad. Period: 5th December 2020 to 4th June 2021. Material & Methods: Total 170 people between the ages of 20 and 60, of either gender, who were thought to have nasopharyngeal cancer were included. Patients with previous operation on the neck, previous radiotherapy to the neck, or patients with congenital lesions, claustrophobic and CRF were excluded. Then patients were undergone CT evaluation. Patients were labeled as positive or negative. Then patients were undergone biopsy and biopsy samples were evaluated from the Histopathology Department of Allied hospital Faisalabad. Biopsy results were followed and patients were confirmed as positive or negative. Results: Using histology as gold standard, computed tomographic scan has a sensitivity of 95.10%, specificity of 91.18%, positive predictive value of 94.17%, negative predictive value of 92.54%, and diagnostic accuracy of 93.53% for detecting NPC. Conclusion: This study proved computed tomography as a highly sensitive and accurate non-invasive modality for the detection of intracranial extension of NPC.

An updated meta-analysis of the primed goal-organizational behaviour relationship.

Environmental cues (e.g. achievement-related words and pictures) can prime/activate, in the absence of awareness, a mental representation of importance stored in memory. Chen et al.'s 2021 Applied Psychology: An International Review 70, 216-253. (doi:10.1111/apps.12239) meta-analysis revealed a moderate, significant overall effect for the goal priming-organizational behaviour relationship, with three moderators identified: context-specific versus a general prime, prime modality (i.e. visual versus linguistic) and experimental setting (field versus laboratory). An independent researcher found that their finding was negligibly affected by a publication bias. Shanks & Vadillo (2021), Royal Society Open Science 8, 210544. (doi:10.1098/rsos.210544) (field: k = 13, N = 683, d = 0.64), questioned Chen et al.'s conclusion regarding the effect size found in field studies (field: k = 8, N = 357, d = 0.68). In this paper, we discussed Shanks & Vadillo's selection of additional field experiments that led to their conclusion of a publication bias. We updated Chen et al.'s meta-analysis to include relevant studies conducted since that study's publication. The present meta-analysis reproduced the original findings in Chen et al. (field: k = 11, N = 534, d = 0.67). The updated findings are consistent with: (i) laboratory findings, (ii) the findings obtained in field experiments on consciously set goals and (iii) goal setting theory (Latham & Locke, 2018 In Handbook of industrial, work & organizational Psychology, vol. 1 (eds D Ones, N Anderson, C Viswesvaran, H Sinangil), pp. 103-124).

Renal Resistive Index: Revisited.

Introduction Chronic kidney disease (CKD) is universally considered a public health burden and the majority of cases are found to be diabetic at the time of diagnosis. Renal biopsy is the prime modality for the complete evaluation of renal injuriesbut is invasive. Duplex Doppler sonography can help to determine renal resistive index (RRI), which is an excellent marker for demonstrating dynamic or structural changes of intrarenal vessels. In this study, we evaluated the intrarenal hemodynamic abnormalities with RRI in diabetic and non-diabetic kidney disease patients. Also, RRI was correlated with the established parameters of renal dysfunction, i.e., estimated glomerular filtration rate (eGFR) and other biochemical parameters. Results There was a significant correlation of RRI with eGFR and serum creatinine indicating its role as a Doppler parameter, which can be used as complementary to biochemical parameters. A remarkable difference was noted in the RRI values between diabetic and non-diabetic groups in the early stages of CKD, revealing its ability to arrive at etiopathogenesis in the early stages. The renal resistive index increases in a sequential pattern and is an indicator of declining renal function. Conclusions The addition of sonographic parameters like renal resistive index could help in the complete evaluation of chronic kidney disease in diabetic and non-diabetic groups. A sequential increase in renal resistive index is a better indicator of the progressive worsening of renal function as opposed to an absolute cut-off value.

A descriptive longitudinal study of functional outcome in intra-articular distal end radius fracture with volar displacement treated by locking compression plate

Background: The distal radius metaphysis is composed mainly of cancellous bone. On articular surface there is a biconcave articulating surface with the proximally placed carpal row (scaphoid and lunate fossae) and also a notch for articulation with the ulna. Objective of the research was to study the functional outcome in distal end radius fracture with volar displacement treated by locking compression plate. Methods: A hospital based descriptive, longitudinal study was conducted with 114 patients aged between 20-60 years to assess functional outcome in patients of distal end radius fracture with volar displacement treated by locking compression plate. Results: According to demerit point score system of Gartland and Werley, 75 (69.4%) patients had excellent score while 24 (17.5%) and 15 (13.1%) patients had good and fair score respectively. No patient had poor score. 6 (5.3%) and 2 (1.8%) patients had superficial infection and hypertrophic scar respectively while 1 (0.9%) patient had developed malunion. Conclusions: Volar plating has excellent functional outcome with minimal complications thus proving that it is the prime modality of treatment for distal radius fractures.

Role of Multi-Detector Computed Tomography in the Diagnosis of Intestinal Obstruction.

There is a need to identify patients whose small bowel obstruction (SBO) can resolve spontaneously so that unnecessary surgical interventions are avoided. This study aimed to evaluate the diagnostic accuracy of multi-detector computed tomography (MDCT) in intestinal obstruction and find out the presence, level, causes, and degree of intestinal obstruction taking intraoperative findings as gold standard. This cross-sectional study was conducted analyzing 147 patients that were referred from emergency with abdominal pain, abdominal distension, inability to pass flatus, and aged 18-70 years from both genders. Computed tomography (CT) examinations were done and findings like intestinal dilatation, evidence of mesenteric fat stranding, and area of transition between the dilated and collapsed loops were noted. The final report was made by the radiologist while the operative findings were reviewed from the operative notes written by operative surgeons of the same patient. In a total of 147 patients, mean age was 52.38±16.01 years. There were 76 (51.70%) males and 71 (48.30%) females. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of multi-detector computed tomography scan in diagnosing intestinal obstruction, taking operative findings as gold standard, were 98.39%, 65.22%, 93.85%, 88.24%, and 93.20%, respectively. The multi-detector CT can be used routinely as a prime modality for detecting intestinal obstruction which will result in proper and timely management for reducing the morbidity and mortality of these particular patients.

P269 Spaciotemporal machine learning analysis of complete small bowel capsule endoscopy videos for prediction of outcomes in Crohn’s disease

Abstract Background Capsule endoscopy (CE) is a prime modality for diagnosis and monitoring of Crohn’s disease (CD). However utilization of CE for monitoring of CE is hampered by prolonged reading time and interobserver variability. Machine learning (ML) techniques such as convolutional neural networks (CNN) are capable of accurate detection and grading of inflammatory findings on isolated images from CE in CD patients, with accuracy above 95%. However, ML-based analysis of complete CE films have not yet been reported; moreover, the predictive utility of ML of CE in CD for disease outcomes has not been examined so far. Methods The study cohort included treatment-naïve CD patients that have performed CE (SBIII, Medtronic) within 6 months of diagnosis of CD and had a minimal follow-up of 6 months. Complete small bowel videos (first duodenal to first cecal image) were extracted using the RAPID reader software, V9.0. Prior to extraction, CE videos were scored using the Lewis score (LS). Clinical, endoscopic and laboratory data were extracted from the electronic medical records. All patients were classified as per start of biological therapy during follow-up. Machine learning analysis was performed by Intel Inc. using TimeSformer computer vision algorithm developed by Facebook. Timesformer algorithm utilizes spaciotemporal Results The patient cohort included 103 patients (54 (52%) female, median age- 25 years, interquartile ratio (IQR) 21–40). The median duration of follow-up was 941 (363–1644) days. The median LS was 450 (IQR-225–900). Biological therapy was initiated by 41(39.8%) of the patients (adalimumab -20 (48.7%), infliximab-14 (34,1%), vedolizumab- 7 (17%) patients, respectively). TimeSformer algorithm achieved training and testing accuracy of 91% and 79% respectively, with area under the curve (AUC) of 0.79 for prediction of the need for biologic therapy. In comparison, the AUC for LS was 0.69. The required time for analysis per complete video was 440ms on a single GPU. Conclusion Spaciotemporal analysis of complete small bowel CE videos of newly diagnosed CD patients achieved accurate prediction of the need for biological therapy. The accuracy was superior to that of human reader index. Following future validation, this approach will allow for fast and accurate personalization of treatment decisions in CD.

P160 Pan-enteric mucosal inflammation in CD patients treated with vedolizumab – interim results of a prospective observational study using a panenteric capsule (PiilCam CD)

Abstract Background Mucosal healing is associated with improved short- and long-term outcomes in Crohn’s disease (CD). However, the likelihood of reaching mucosal healing differs between segments of the mucosal tract. The prevalence of panenteric mucosal healing is scarcely described. Capsule endoscopy is the prime modality for evaluation of the entire small bowel. Recently, a combined pan-enteric capsule (PillCam Crohn’s capsule (PCCD) that enables evaluation of mucosal inflammation in the entire digestive tract in a single procedure, has been developed. The main aim of our study was to evaluate the rate of panenteric mucosal healing in Crohn’s disease patients treated with vedolizumab (VDZ) after 52 weeks of therapy. The current interim report focuses on the rates of mucosal improvement after 14 weeks of VDZ treatment. Methods This was a prospective open- label observational study. Patients starting vedolizumab (VDZ) for Crohn’s disease underwent a patency capsule (PC) and if it was excreted within 30 hours, enrolled in the study. The patients were evaluated with PCCD at week 0, 14 and 52 of VDZ treatment. Mucosal inflammation was quantified using the Lewis score (LS) and the panenteric Pillcam score (PS). In addition, fecal calprotectin (FC) and CRP levels were measured at each visit. Patients without active mucosal inflammation on week 0 PCCD were excluded from further participation Results We enrolled 30 patients; 5/30 failed PC and were dropped out of the study.Twenty five patients underwent PCCD at week 0 and 19/25 (78%)% -at week14 (six patients were dropped out for either absence of active mucosal inflammation at week 0 (1 patient), treatment discontinuation before week 14 (2 patients) endoscopic activity – 1, withdrawal of consent (1 patient) or loss to follow-up (1 patient)). After 14 weeks of VDZ treatment, there was a significant improvement in LS (median of 900 (interquartile ration (IQR)- 1143)), vs 450 (IQR-750), p=0.013), ES (15 (IQR-18) vs 10 (IQR-11), p=0.012) and FC (996 (IQR-455) vs 742 (IQR -740), p=0.012), while CRP levels were not significantly different. Conclusion VDZ induces significant improvement in mucosal inflammation evaluated by panenteric capsule endoscopy, in addition to a significant improvement in FC levels, after 14 weeks of therapy *The study was supported by IIR grant from Takeda and Medtronic

Role of Nasya Karma (nasal instillation therapy) in Apabahuka (frozen shoulder)– A qualitative systematic review

Background: With an incidence of 3%-5% in the general population and up to 20% in people with diabetes, peak incidence of frozen shoulder is more common in women and in manual workers between the age of 40 and 60yrs. Though multiple interventions have been studied on the frozen shoulder, the complete and the effective treatment is indefinite. Nasya karma is one among the panchakarma therapies of Ayurvedic system of medicine which can deliver the potential effects to the patients of frozen shoulder or apabahuka. Purpose: The objective of this study was to review the case reports and case series that are published on nasya karma and apabahuka or frozen shoulder. Design: Systematic review. Methods: PubMed/MEDLINE, Cochrane (CENTRAL), EMBASE, Google Scholar, TKDL, AYUSH and DHARA databases were screened from inception until March 8th, 2020. References of the full text articles were screened and selected articles by searching manually as a next step. Based on the pre-specified inclusion criteria articles were screened and finally 5 case reports and 0 case series were included for the study. Results: All the 5 studies included in the review administered nasya karma to the patients suffering from apabahuka or frozen shoulder and assessed pain, severity of the pain, VAS (visual analogue scale), stiffness, ROM (Range of movements) like flexion, extension, abduction, adduction, internal rotation and external rotation, forward elevation, lateral elevation, restricted movements and constant assessment scale of shoulder joint before and after the treatment which showed significant improvement in all the parameters. Conclusions: Nasya karma, one of the panchakarma therapies in Ayurvedic system of medicine constitutes the prime modality of treatment in the management of jatru-urdhwagata rogas mainly apabahuka or the frozen shoulder. Though present review showed significant changes in all the parameters, there are several limitations besides the quality of reporting, that is generally low in the included case reports. In addition, this review provides a comprehensive knowledge that may assist the researcher as a supplementary by giving an intuition for the execution of RCT’s and clinical studies further on the domain studied. Having negligible number of systematic reviews in Ayurveda and absence of systematic reviews on case studies or reports and series, this review may serve as a preliminary step towards conducting more systematic reviews in Ayurvedic system of medicine which is the need of hour..

A Review on Computer Aided Diagnosis of Acute Brain Stroke.

Amongst the most common causes of death globally, stroke is one of top three affecting over 100 million people worldwide annually. There are two classes of stroke, namely ischemic stroke (due to impairment of blood supply, accounting for ~70% of all strokes) and hemorrhagic stroke (due to bleeding), both of which can result, if untreated, in permanently damaged brain tissue. The discovery that the affected brain tissue (i.e., ‘ischemic penumbra’) can be salvaged from permanent damage and the bourgeoning growth in computer aided diagnosis has led to major advances in stroke management. Abiding to the Preferred Reporting Items for Systematic Review and Meta–Analyses (PRISMA) guidelines, we have surveyed a total of 177 research papers published between 2010 and 2021 to highlight the current status and challenges faced by computer aided diagnosis (CAD), machine learning (ML) and deep learning (DL) based techniques for CT and MRI as prime modalities for stroke detection and lesion region segmentation. This work concludes by showcasing the current requirement of this domain, the preferred modality, and prospective research areas.

The prime modality effect on the time course of Chinese spoken word recognition: Evidence from lexical decision task

In the present study, two experiments were carried out to investigate how the time course of spoken word recognition in Mandarin Chinese was modulated by prime modality with the unimodal auditory priming and cross-modal priming designs respectively. Spoken word primes were used in the first experiment, and written primes in the second. The phonological relation between primes and targets was manipulated, with the same disyllabic target word preceded by identical, unrelated, or cohort primes (i.e., sharing phonologically similar word-initial syllables as the targets, but with different meanings). Participants performed a lexical decision task in both experiments. An enhanced P2, indexing early phonological processing between 200 and 300 ms was elicited by word-initial phonological mismatches in the unimodal priming design, but not in the cross-modal priming design. Centro-parietal Early N400 and Late N400 effects, indexing semantic processing were elicited in both designs, but with more negative amplitude in the cross-modal design. These results demonstrate that both the phonological processing and semantic processing in Chinese spoken word recognition are modulated by the modality of the primes, but qualitatively for the former and quantitatively for the later.

ULTRASOUND AS PRIME MODALITY OF CHOICE FOR EVALUATION OF BREAST LESIONS.

INTRODUCTION: The four main roles of ultrasound in Breast imaging are-primary screening, supplemental screening, diagnosis and Interventional procedures. Palpable masses, abnormal nipple discharge and mammographic abnormalities constitute the most common indication for targeted Breast Ultrasound. AIM: To study the role of Ultrasound in evaluating Breast lesions and characterising them as Benign or Malignant. MATERIAL AND METHODS:This is a Retrospective analysis conducted in Department of Radiology, MGM Medical College and Hospital, Kamothey, Navi Mumbai from February 2021 to June 2021. A total of 136 patients with signs and symptoms related to breast lesions were screened. CONCLUSION: The advent of high frequency probe, easy accessibility, cost effectiveness, reliability and relatively easy to perform makes ultrasound as the prime modality of choice for screening breast lesions.

Retroperitoneal unicentric Castleman's disease—A case report and review of literature

Introduction and importanceCastleman's disease is not so commonly diagnosed worldwide due to non-specific symptoms Clinical findings are variable.No definite blood investigation or any biomarkers are established to diagnose this disease. Radiological investigations do not play much role in diagnosing. It can be unicentric or multicentric. Etiological factors are not well understood except predilection of this disease towards immune-compromised persons. Surgery is considered as a prime modality to treat, if resectable.Case presentationPatient had recurrent abdominal pain in left lumbar region which was intermittent for last 6 months, dull aching with no aggravating and relieving factors. There was no history of abnormal bowel habits, urinary complaints, fever, night sweats, weight loss, rashes in body, joint pains and loss of appetite. On examination, there was a single, firm, non-tender, intra-abdominal, retroperitoneal mass of approximately size 10 ∗ 7 cm in left lumbar region encroaching inferiorly towards left inguinal region. Digital rectal examination (DRE) and external genitalia were normal.Clinical discussionAll routine blood investigations along with relevant tumour markers were normal. Magnetic Resonance Imaging (MRI) abdomen showed a well-defined mass suggestive of stromal tumour or retroperitoneal sarcoma. Patient underwent surgery in which complete excision of the mass was done. Postoperative event was uneventful and currently doing well.ConclusionTake away lesson in this case report is that we should not presume all retroperitoneal mass as cancer or sarcoma, we have to think about other rare causes like Castleman's disease, if clinical picture, blood and radiological investigation are discordant.

Exchange Transfusion in Neonatal Sepsis- An Old Wine in New Bottle

Neonatal Sepsis, second major cause of mortality, is killing more than one million neonates annually worldwide [1]. Globally, of three million annual neonatal sepsis cases India has the highest incidence of clinical sepsis (17,000/ 1, 00,000 live births) [2]. In the 1980s and 90s, exchange transfusion (ET) was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock [3]. The main aim of this study was to assess the efficacy of exchange transfusion in neonatal sepsis as compared to standard therapy. Neonates with septic shock (Sclerema) admitted to our NICU from dec 2017 to dec 2018 were included in the study. 43 neonates who received ETs were compared with 43 neonates who received of standard care therapy. The mortality rate was 27.9% in the ET group and 30.1% in the ScT group statistically insignificant. The duration of hospital stay in exchange transfusion babies was less(14.9 days) as compared to control group(22.7days) which was statistically significant(p<0.05). In the era of increasing antibiotic resistance, the need of hour is to find alternative measures in sepsis. Exchange transfusion can be one of the prime modality in treatment of severe neonatal sepsis, which is one of the major cause of deaths worldwide. Exchange transfusion being cheaper as compared to other modalities of treatment (eg; IVIG) needs further research on use and long term complications in neonatal sepsis.

Dose–volume analysis of acute gastrointestinal complications in cervical cancer undergoing definitive concurrent chemoradiation

Definitive concurrent chemoradiation with brachytherapy is the prime modality of treatment of cervical cancer. The small bowel is one of the critical organs responsible for gastrointestinal complications. This study aims to analyze the relation of small bowel dosimetric parameters with the incidence of acute gastrointestinal complications. The study analyzed 40 patients of stage IIB-IVA who underwent concurrent chemoradiation with three-dimensional conformal radiotherapy and weekly cisplatin from June 2017 to June 2018. The small bowel was contoured as the organ of risk. Dose-volume histogram parameters of the small bowel subjected to analysis were mean dose, maximum dose, the total volume of organ receiving 20 Gy, 40 Gy, and 45 Gy (V20-45), and the volume of V20-45 to total volume (V20-45 ratio). Gastrointestinal toxicity was graded using CTCAE version 5.0 criteria. Association between dosimetric parameters and incidence of 1-2 gastrointestinal complications were evaluated. A total of forty patients treated with concurrent chemoradiation were analyzed. Seven patients reported Grade 1, whereas three patients reported Grade 2 gastrointestinal complications. None of the patients reported Grade 3 or higher gastrointestinal complication. Patients with gastrointestinal complications had greater V30-45 and mean dose as compared to those without gastrointestinal complication. Dosimetric parameters of small bowel should be evaluated to reduce the incidence of gastrointestinal complications.

Dosimetric analysis of normal tissue toxicity in 3D conformal radiotherapy planning with fused PET-CT imaging in non-small cell lung carcinoma

Introduction: The prime modality for inoperable NSCLC is radiation therapy and or chemo-radiation and better results can be achieved by a higher dose of radiation. However dose escalation is difficult due to presence of critical and dose limiting sensitive structures in the vicinity of lung. Therefore success of radiotherapy in such tumors solely depends on the selective delivery of adequate dose to target with minimal irradiation of surrounding structures. The precision in target and normal tissue delineation needs to be achieved. So the aim of this study is to explore the possibility of using fused PET-CT images for accurate target and normal tissue delineation in 3D-conformal radiotherapy planning in patients of carcinoma lung (NSCLC) who are referred to us for radical radiotherapy. Materials and Methods: It’s a hospital based prospective study in which 14(n) cancer patients who had biopsy proven NSCLC and were referred to us for radical radiotherapy. After CT simulation and FDG-hybrid PET data sets were transferred to CMS planning system. The co-registration was done in Focal Pro using an auto fusion, 3D rotation and translation rigid body program, and the fiducial markers. The gross tumor volume (GTV), planning target volume (PTV) and normal tissue parameters were defined using the CT data and PET-CT data. 3D-CRT plans were generated for both CT data and PET-CT data sets and dosimetric analysis was done for same. Results: The mean age was 65 yrs, 78.5% (11) patients are male and 21.5 % (3) are female. The registration of fused images of PET with planning CT scan decreased the gross tumor volume (GTV) in 10 patients (71.42%), decreased volume in 4 patients (28.58%). The 3D-CRT planes were modified in 5patients (35%). CT-PET planning did not reduce the radiation fields in all patients. When all constraints of the lung, esophagus, and spinal cord were taken into account, normal tissue exposure was reduced with use of CT-PET. V20 decreased from 31.86% ± 4.17% to

Cerebral Vasculopathy in Sickle Cell Anemia: Diagnostic Contribution of Positron Emission Tomography

AbstractChildren with sickle cell anemia (SS) have an increased risk for cerebral vasculopathy with stroke (CVA) and cognitive impairment. The present study examines the extent to which adding positron emission tomography (PET) to magnetic resonance imaging (MRI) can improve the detection of cerebral vasculopathy. Whereas MRI has been the prime modality for showing anatomical lesions, PET excels at assessing the functional metabolic state through glucose utilization 2-deoxy-2 [18F] fluoro-D-glucose (FDG) and microvascular blood flow ([15O]H2O). Forty-nine SS children were studied. Among them, 19 had clinically overt CVA, 20 had life-threatening hypoxic episodes or soft neurologic signs, and 10 were normal based on neurological history and examination. For the entire sample of 49 subjects, 30 (61%) had abnormal MRI findings, 36 (73%) had abnormal PET findings, and 44 (90%) showed abnormalities on either the MRI or the PET or both. Of the 19 subjects with overt CVA, 17 had abnormal MRI (89%), 17 had abnormal PET (89%), and 19 (100%) had either abnormal MRI or PET or both. Among the 20 subjects with soft neurologic signs, 10 (50%) had abnormal MRI, 13 (65%) had abnormal PET, and 17 (85%) had abnormal MRI and/or PET. Six (60%) of the 10 neurologically normal subjects had abnormal PET. Among the 30 subjects with no overt CVA, 25 (83%) demonstrated imaging abnormalities based on either MRI or PET or both, thus, silent ischemia. Lower than average full-scale intelligence quotient (FSIQ) was associated with either overt CVA or silent ischemic lesions. Four subjects who received chronic red blood cell transfusion showed improved metabolic and perfusion status on repeat PET scans. In conclusion, (1) the addition of PET to MRI identified a much greater proportion of SS children with neuroimaging abnormalities, particularly in those who had no history of overt neurologic events. (2) PET lesions are more extensive, often bihemispheric, as compared with MRI abnormalities. (3) PET may be useful in management as a tool to evaluate metabolic improvement after therapeutic interventions, and (4) the correlation of PET abnormalities to subsequent stroke or progressive neurologic dysfunction requires further study.

Physical Activity, Immune Function and Risk of Community Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis

Background: Regular physical activity is prime modality for the prevention of numerous non-communicable diseases and has also been advocated for resilience against COVID-19 and other infectious diseases. However, there is currently no systematic and quantitative evidence synthesis of the association between habitual physical activity and the strength of human immune system. Methods: We conducted systemic review and meta-analysis according to PRISMA guidelines and following a pre-registered protocol (PROSPERO CRD42020178825 ). We searched seven databases (MEDLINE, Embase, Cochrane CENTRAL, Web of Science, CINAHL, PsycINFO, and SportDiscus) up to April 2020 for randomised control trials and prospective observational studies were included if they compared groups of adults with different levels of physical activity and reported immune system cell count, concentration of antibody, risk of clinically diagnosed infections, risk of hospitalisation and mortality due to infectious disease. Studies involving elite athletes were excluded. The quality of the selected studies was critically examined following the Cochrane guidelines using ROB2 and ROBINS_E. Data were pooled using a random-effects model. Findings: A total of 16833 abstract were screened to identify 55 studies including seven prospective studies and 48 randomised control trials. The meta-analysis showed that higher level of habitual physical activity is associated with a 31% risk reduction (HR= 0.69 CI [0.61 – 0.78]) of community acquired infectious disease and 37% risk reduction (HR= 0.64 CI [0.59 – 0.70]) of infectious disease mortality. Randomised control trials showed that physical activity interventions resulted in increased immunosurveillance cell counts (CD4+, 32 cells/µL, 95% CI 7 to 56 cells/µL), increased immunoglobulin IgA concentration (standardised mean difference 0.311, 95% CI 0.131 to 0.484) and decreased neutrophil counts (704 cells/µL, 95% CI 68 to 1340) compared to inactive controls. Physical activity increased antibody concentration after vaccination compared to vaccination without adjunct physical activity (standardised mean difference 0.210, 95% CI 0.015 to 0.406). Results differed between healthy adults, obese adults, clinical population and older adults. There appear to be no moderating effects of physical activity volume, intensity or type.Interpretation: The practice of any type of regular, moderate to vigorous physical activity appears to be associated with enhanced immunosurveillance and mucosal immune responses. This is likely to explain the significant risk reduction of community acquired infectious diseases and infectious disease mortality, as well as an increase in the potency of vaccination.Funding Statement: None.Declaration of Interests: None.