Integrated scoring approach to assess radiotherapy plan quality for breast cancer treatment

Background: Proposal of an integrated scoring approach assessing the quality of different treatment techniques in a radiotherapy planning comparison. This scoring method incorporates all dosimetric indices of planning target volumes (PTVs) as well as organs at risk (OARs) and provides a single quantitative measure to select an ideal plan. Materials and methods: The radiotherapy planning techniques compared were field-in-field (FinF), intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), hybrid IMRT (H-IMRT), and hybrid VMAT (H-VMAT). These plans were generated for twenty-five locally advanced left-sided breast cancer patients. The PTVs were prescribed a hypofractionation dose of 40.5 Gy in 15 fractions. The integrated score for each planning technique was calculated using the proposed formula. Results: An integrated score value that is close to zero indicates a superior plan. The integrated score that incorporates all dosimetric indices (PTVs and OARs) were 1.37, 1.64, 1.72, 1.18, and 1.24 for FinF, IMRT, VMAT, H-IMRT, and H-VMAT plans, respectively. Conclusion: The proposed integrated scoring approach is scientific to select a better plan and flexible to incorporate the patient-specific clinical demands. This simple tool is useful to quantify the treatment techniques and able to differentiate the acceptable and unacceptable plans

Systematic Development of the ReWin Application: A Digital Therapeutic Rehabilitation Innovation for People With Stroke-related Disabilities in India

This is a viewpoint paper that aims to describe the systematic approach to the development of a technology-driven stroke rehabilitation innovation to manage disabilities following a stroke at home in India. This paper intends to sensitize public health innovators and intervention development experts about the important aspects that need to be considered to develop a culturally sensitive, patient-centered, scalable solution for stroke care using technology. Stroke has been the second-leading cause of death and the third-leading cause of disability globally for the past 3 decades. The emerging technological innovations for stroke care were predominantly designed and developed by digital technology experts as stand-alone products with very minimal efforts to explore their feasibility, acceptability, and, more importantly, scalability. Hence, a digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India was systematically developed and is being evaluated. ReWin is an innovation that is technologically driven and envisions digital therapeutics as a medium for the provision of rehabilitation to persons with disabilities. It is conceptualized and developed based on the International Classification of Functioning, Disability and Health. ReWin encompasses specific technological aspects to enable its scientific framework and conceptualization to suit the context and needs of stroke care providers and consumers. The framework is built with 2 separate applications, one for the providers and one for the patients and caregivers. Each of these applications has a specific inbuilt design to add data about the demographic details of the user, stroke severity using the National Institute of Health Stroke Scale, and self-assessment of disability measured by the modified Barthel Index. Users can communicate with each other and decide on their therapeutic goals, therapy training information, and progress remotely from where they are. The ultimate outcome expected from the ReWin innovation is a continuum of care for stroke survivors that is effective, safe, and of good quality. Systematic development cannot make the intervention scalable. The intervention needs to be evaluated for its feasibility, acceptability, and effectiveness. Currently, ReWin is being evaluated for its feasibility and acceptability. The evaluation of ReWin will provide an opportunity to develop a scalable solution for empowering therapists and persons with disabilities, in general, to objectively self-manage their treatment. Findings from this study will also provide valuable information about the resources required to deliver such interventions in resource-constrained settings like India

Evaluation of the feasibility and acceptability of ReWin—A digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India

Background: Developing culturally appropriate, scalable interventions to meet the growing needs for stroke rehabilitation is a significant problem of public health concern. Therefore, systematic development and evaluation of a scalable, inclusive, technology-driven solution for community-based stroke care are of immense public health importance in India. ReWin is a digital therapeutics platform that was developed systematically. This study aimed to evaluate its feasibility and acceptability in an Indian context. Objectives: Phase–1: To pilot the intervention for identifying operational issues and finalize the intervention. Phase–2: To assess the feasibility and acceptability of ReWin intervention in an Indian context. Methods: Design: Mixed-methods research design. Setting: Participant's home and rehabilitation centers. Participants were selected from rehabilitation centers in South India. Participants: Ten stroke survivors and their caregivers, as well as four rehabilitation service providers were recruited for phase 1. Thirty stroke survivors who were treated and discharged from the hospital, and their caregivers as well as 10 rehabilitation service providers were recruited for Phase 2. Intervention: ReWin a digital therapeutic platform with the provider and patient app for the rehabilitation of physical disabilities following stroke was piloted. Process: Evaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 10 stroke survivors and four rehabilitation service providers for 2 weeks. In the second phase, the finalized intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers as well as to 10 rehabilitation service providers for 4 weeks. Outcome measures: Primary outcomes: (1) operational difficulties in using the ReWin intervention; (2) feasibility and acceptability of the ReWin intervention in an Indian setting. Results: Field-testing identified operational difficulties related to 1. Therapeutic content; 2. Format; 3. Navigation; 4. Connectivity, 5. Video-streaming, 6. Language; and 7. Comprehensibility of the animated content. The intervention was reviewed, revised and finalized before pilot testing. Findings from the pilot testing showed that the ReWin intervention was feasible and acceptable. About 76% of the participants had used ReWin for more than half of the intervention period of 4 weeks. Ninety percentage of the stroke care providers and about 60% of the stroke survivors and caregivers felt that the content of ReWin was very relevant to the needs of the stroke survivors. Forty percentage of the stroke survivors and caregivers rated ReWin intervention as excellent. Another 45% of the stroke survivors and caregivers as well as 90% of the stroke care providers rated ReWin intervention as very good based on its overall credibility, usability, and user-friendliness. Conclusions: ReWin has all the essential components to connect care providers and consumers not just for stroke rehabilitation but for several other health conditions with the use of several other technological features that support rehabilitation of persons with disabilities and strengthen rehabilitation in health systems worldwide. It is critical to amalgamate ReWin and other evidence-based interventions for rehabilitation to innovate scalable solutions and promote universal health coverage for stroke care worldwide

Performance of little millet (Panicum flexuosum) based cropping system for rainfed agro ecosystems: A path to sustainable crop diversification

An experiment was conducted during 2019, 2020 and 2021 at Centre of Excellence in Millets, (Tamil Nadu Agricultural University, Coimbatore, Tamil Nadu), Athiyandal, Tiruvanamalai, Tamil Nadu. to study the performance of little millet (Panicum flexuosum Retz.) based cropping system for rainfed agro ecosystems for north-eastern part of Tamil Nadu. The experiment was laid out in randomized block design (RBD) comprised of 9 treatments, viz. T1, Little millet + Redgram [Cajanus cajan (L.) Millsp.] (4:1)-Moth bean [Vigna aconitifolia (Jacq.) Marechal]; T2, Little millet + Redgram (4:1)-Blackgram [Vigna mungo (L.) Hepper]; T3, Little millet + Redgram (4:1)-Horsegram [Macrotyloma uniflorum (Lam.) Verdc.]; T4, Little millet + Redgram (6:2)-Moth bean; T5, Little millet + Redgram (6:2)-Blackgram; T6, Little millet + Redgram (6:2)-Horsegram; T7, Little millet + Redgram (8:2)- Mothbean; T8, Little millet + Redgram (8:2)-Blackgram; T9, Little millet + Redgram (8:2)- Horsegram, with three replications. The good quality seeds of little millet (CO 4), redgram (Paiyur 2), horsegram (Paiyur 2), blackgram (VBN 3) and mothbean [TMV (Mb) 1] were used. The result shows that the higher yield for little millet and intercropped redgram was recorded in T9 (985 and 362 kg/ha) followed by T7 (853 and 356 kg/ha) and T8 (834 and 337 kg/ ha). The 8:2 row ratio exhibited the highest little millet equivalent yield when compared to 6:2 and 4:1 row ratio. The highest economic return and benefit cost (B:C) ratio was observed in T9 with gross return of ₹60,962/ha, net returns of ₹35,362/ha and B:C ratio (2.38). This was followed by T7 which had gross returns of ₹51,314/ha, net returns of ₹25,989/ha and B:C ratio (2.10)

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Physicochemical, phytochemical and antioxidant efficacy of the medicinal plant Coccinia Grandis

India contains seven thousand plant species. Plants are important for human health. (Coccinia grandis) is an edible food crop. (Coccinia grandis) (methanolic extract) alkaloids, flavonoids, cardiac glycosides, terpenoids, phenolics, proteins, carbohydrates, steroids and coumarins (phytochemical assay, physiochemical assay). Estimates were made using standard algorithms. The soxhlet extraction &nbsp;was used to extract the different extracts. This study reveals the presence of different types of phytochemicals, physicochemicals and antioxidants. (Coccinia grandis). The leaves of this plant contain excellent antioxidants. Methanolic and Ethanolic extract were used (plant leaf) for the Antioxidant assays (DPTH, Hydrogen peroxide scavenging activity, FRAP assay and Total Antioxidant capacity assay ). Antioxidants are very important, especially when getting rid of disease. (Louis 1989). Plant phytochemicals have protective functions (immunization). (Coccinia grandis). Extracts made from plant materials. It contains phenolics. It destroys the antioxidant breakdown of lipids. This increases the nutritional value of the food and the quality of the food. This study was done to reveal the medicinal properties and value of medicinal plants. Our study is important for foundation research and future pharmaceutical research

Dementia: A silent killer which kills millions in its wake: An overview

WHO defines dementia as a progressive chronic syndrome characterized by deterioration of cognitive function much beyond what is observed in the normal aging process. The impairment in various levels of cognitive functions such as short and long-term memory, abstract thinking, learning capability, orientation, comprehend various tasks, language, and judgment are commonly observed in patients with dementia. Further, the situation can get worsen by loss of emotional control, social behavior, motivation, etc., and this disability makes the dependency. A detailed literature review was performed through MEDLINE, Google, PubMed, Medline, Eric, Frontiers, and other online journals using the terms “Dementia”, “Risk factors of dementia”, “its types”, “prevalence”, and “available treatments of dementia”. The present article was based on these relevant terminologies. Progressive deterioration in cognition and motor functions is an undesired consequence of dementia, which has very limited diagnostic and therapeutic options. So, its quite mandatory to discover new diagnostic techniques as well as therapeutic strategies to conquer the challenge.&nbsp; Since pharmacological intervention only provides symptomatic relief, more and more non-pharmacological therapies should be invented in order to delay or prevent unhealthy aging

Comparison of Postoperative Analgesic Effect of Dexmedetomidine and Morphine as an Adjuvant to Intrathecal Bupivacaine in Infraumbilical Surgeries: A Randomised Clinical Trial

Introduction: Regional anaesthesia is the standard technique for lower limb infraumbilical procedures. To provide a better analgesic profile, adjuvants are added to local anaesthetics to enhance their action. Opioids have been used as an adjuvant for a long-time. With evolving pharmacology, various drugs satisfy the criteria of being an adjuvant. One such drug is Dexmedetomidine, a novel alpha-2 agonist. Aim: To compare the duration of analgesia of intrathecal Morphine and Dexmedetomidine as an adjuvant to bupivacaine in a subarachnoid block for lower limb infraumbilical surgeries. Materials and Methods: In this randomised clinical, double-blinded study conducted in a multispecialty hospital over the period of June 2020 to February 2021, 70 patients were randomly divided into two groups: Group M received Morphine 125 μg, and Group D received dexmedetomidine 5 μg as an adjuvant to 15 mg of 0.5% hyperbaric bupivacaine. The primary outcome was to compare the duration of postoperative analgesia. The secondary results assessed the block characteristics, haemodynamic parameters, rescue analgesic consumption, sedation score, and side-effects like bradycardia, hypotension, nausea, vomiting, pruritus, and respiratory depression. Data was spread in an Excel sheet and descriptive analysis done. Normally distributed continuous variables were compared using a Student’s t-test, and discrete variables were compared using a Chi-square test. A p-value of <0.05 was considered significant. Results: Both groups were similar with respect to age, sex, body mass index, American Society of Anaesthesiologists grading, and duration of surgery. The duration of analgesia was 956.97±120.043 minutes in group M and 392.83±50.354 minutes in group D (p-value <0.001). The total consumption of paracetamol was 1984.71±499.111 mg in group M and 3543.86±406.17 mg in group D. The onset and regression were significantly faster in group D. There was significant hypotension and bradycardia up to the 40th minute and an increase in heart rate, respiratory rate, and mean arterial pressure between 5-7 hours in group D. The sedation score was more in group D for the initial two hours. Postoperatively, the incidence of nausea, vomiting, and pruritus was more in group M. Conclusion: It can be concluded that 125 μg of intrathecal morphine is a better adjuvant to spinal bupivacaine, providing excellent postoperative analgesia compared to 5 μg of intrathecal dexmedetomidine. However, dexmedetomidine had more incidence of hypotension, bradycardia, and sedation when compared to morphine intrathecally

Analysis of physical parameters and determination of inflection point for Flattening Filter Free beams in medical linear accelerator

BackgroundMedical Linear accelerators manufactured without flattening filters are increasing popular in recent days. The removal of flattening filter results in increased dose rate, reduced mean energy, reduction in head leakage and lateral scattering, which have shown advantageous when used for special treatment procedures.AimThis study aims to analyze physical parameters of FFF beams and to determine the inflection point for standardizing the beam flatness and penumbra.Materials and methodsThe beam profiles and depth dose patterns were measured using Radiation Field Analyzer (RFA) with 0.13[[ce:hsp sp="0.25"/]]cc cylindrical ion chamber. The beam energy characteristics, head scatter factor (Sc) were obtained for 6FFF and 10FFF beams and compared with 6[[ce:hsp sp="0.25"/]]MV and 10[[ce:hsp sp="0.25"/]]MV photons, respectively. The symmetry and stability of unflattened regions were also analyzed. In addition, the study proposes a simple physical concept for obtaining inflection point for FFF beams and results were compared using the Akima spline interpolation method. The inflection point was used to determine the field size and penumbra of FFF beams.ResultsThe Sc varied from 0.922 to 1.044 for 6FFF and from 0.913 to 1.044 for 10FFF with field sizes from 3[[ce:hsp sp="0.25"/]]cm[[ce:hsp sp="0.25"/]]×[[ce:hsp sp="0.25"/]]3[[ce:hsp sp="0.25"/]]cm to 40[[ce:hsp sp="0.25"/]]cm[[ce:hsp sp="0.25"/]]×[[ce:hsp sp="0.25"/]]40[[ce:hsp sp="0.25"/]]cm which is much less than FF beams. The obtained value of field size and penumbra for both simple physical concept and Akima spline interpolation methods is within the ±1.0[[ce:hsp sp="0.25"/]]mm for the field size and ±2[[ce:hsp sp="0.25"/]]mm penumbra. The results indicate that FFF beams reduce Sc compared with FF beams due to the absence of a flattening filter.ConclusionThe proposed simple method to find field size and penumbra using inflection point can be accepted as it is closely approximated to mathematical results. Stability of these parameters was ascertained by repeated measurements and the study indicates good stability for FFF beam similar to that of FF beams

Re-irradiation after stereotactic body radiotherapy for spine metastases from hepatocellular carcinoma: a case report

Modern radiotherapy machines with refinements in planning software and image-guidance apparatuses have made stereotactic body radiotherapy (SBRT) more widely available as an effective tool in the management of spine metastases. In conventional palliative radiotherapy, the aim has traditionally been pain relief and short-term local control. In contrast, SBRT aims to deliver an ablative dose to enhance local control, with a smaller number of fractions while sparing the organs at risk (OAR), especially the spinal cord. Recently, trials have asserted the role of spine SBRT as an effective modality for durable local control, in addition to achieving pain relief. The quality of evidence for spine SBRT data is maturing, while prospective published trials on re-irradiation SBRT in spine remain sparse. The purpose of the present case report is to share the challenges faced while salvaging a dorsal spine metastasis and ablating a new right adrenal metastatic lesion in proximity of the transplanted liver