Study of craniofacial skeletal patterns and body measurements in south Indians

Introduction:Craniofacial skeletal pattern and body measurements have been studied in anthropology, orthodontics, cosmetology and garment industries. The purpose of this study was to find the relationship between craniofacial skeletal pattern and body measurements, Ratios and BMI. Methods: Digital lateral cephalogram was recorded for all the two hundred subjects and were traced and analysed using six cephalometric measurements to identify craniofacial skeletal pattern. These two hundred subjects were divided into three groups Vertical, Horizontal and Average. Then twenty five subjects from each group were randomly selected for this study. Each subject’s height, weight, chest, waist and hip were measured and the ratios and BMI were derived. Data was tabulated and statistically analysed. Results: Waist measurement showed significant difference between Vertical and Horizontal groups.  The body mass index showed significant differences between Vertical and Average group. However, there were no significant differences in any measurements taken between Horizontal and Average. Conclusion: The data recorded by the present study shows that waist and BMI are significantly associated with each other between three groups. We would like to conclude by suggesting that these data can be used in identifying the craniofacial skeletal patterns in early age and preventive methods can be used in cardiovascular risk factors. Additionally these results can be used by forensic anthropologists as well as fashion designers to correlate the ratio and craniofacial skeletal patterns.  &nbsp

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Advances in Radiotherapy for Glioblastoma

External beam radiotherapy (RT) has long played a crucial role in the treatment of glioblastoma. Over the past several decades, significant advances in RT treatment and image-guidance technology have led to enormous improvements in the ability to optimize definitive and salvage treatments. This review highlights several of the latest developments and controversies related to RT, including the treatment of elderly patients, who continue to be a fragile and vulnerable population; potential salvage options for recurrent disease including reirradiation with chemotherapy; the latest imaging techniques allowing for more accurate and precise delineation of treatment volumes to maximize the therapeutic ratio of conformal RT; the ongoing preclinical and clinical data regarding the combination of immunotherapy with RT; and the increasing evidence of cancer stem-cell niches in the subventricular zone which may provide a potential target for local therapies. Finally, continued development on many fronts have allowed for modestly improved outcomes while at the same time limiting toxicity

Magnetic Resonance Spectroscopy, Positron Emission Tomography and Radiogenomics—Relevance to Glioma

Advances in metabolic imaging techniques have allowed for more precise characterization of gliomas, particularly as it relates to tumor recurrence or pseudoprogression. Furthermore, the emerging field of radiogenomics where radiographic features are systemically correlated with molecular markers has the potential to achieve the holy grail of neuro-oncologic neuro-radiology, namely molecular diagnosis without requiring tissue specimens. In this section, we will review the utility of metabolic imaging and discuss the current state of the art related to the radiogenomics of glioblastoma

Diffusion Weighted/Tensor Imaging, Functional MRI and Perfusion Weighted Imaging in Glioblastoma—Foundations and Future

In this article, we review the basics of diffusion tensor imaging and functional MRI, their current utility in preoperative neurosurgical mapping, and their limitations. We also discuss potential future applications, including implementation of resting state functional MRI. We then discuss perfusion and diffusion-weighted imaging and their application in advanced neuro-oncologic practice. We explain how these modalities can be helpful in guiding surgical biopsies and differentiating recurrent tumor from treatment related changes

RISK FACTORS FOR NON-COMMUNICABLE DISEASES AMONG RURAL ADOLESCENTS: A SCHOOL-BASED CROSS-SECTIONAL STUDY

 Objective: Non-communicable diseases (NCD) in recent times have attained a magnitude of epidemic proportion, with increasing number ofadolescence being reported as obese. The risk factors for NCD such as obesity, sedentary lifestyle, smoking, dietary habits, etc. are inculcated duringadolescence and continue to exist in adult life there by increasing the risk for hypertension, diabetes, and cardiovascular diseases. To assess theprevalence of risk factors for NCD among adolescents of a high school in rural Karnataka.Methods: In a school-based cross-sectional study 297 adolescents belonging to classes 8, 9 and 10 were assessed for the presence of risk factorsfor NCD using pretested questionnaire modified from NCD Risk Factor Survey Questionnaire, WHO-STEPS Questionnaire and Integrated DiseaseSurveillance Project Questionnaire.Results: The participants were aged between 12 and 17 years; mean age of the participants being 14.3 years. More than half (n=158, 53.2%) of theparticipants were boys, and a higher proportion (n=119, 40%) belonged to low socio-economic status class 5 according to B.G Prasad Scale. Based onInternational Physical Activity Questionnaire scoring protocol, 30.3% (n=90) participants were minimally active. The family history of hypertensionand diabetes was seen among 55 (18.5%) and 28 (9.5%) of the participants respectively. Based on CDC 2000 standards 7 (2.4%) of the participantswere overweight. The proportion of participants who were classified as having prehypertension, Stage I and Stage II hypertension was 20 (6.7%),16 (5.4%) and 1 (0.3%) respectively. Inadequate intake of fruits and vegetables was seen in 235 (80.1%) and inappropriate dietary intake (fried foods,salted items more than 3 times/week) was seen in 166 (55.9%) of the participants.Conclusion: Several risk factors, both modifiable and non-modifiable are prevalent among the adolescents. Early detection of the risk factors andtimely interventions are essential to reduce the burden of NCDs in future. Simple measures such as health education, nutritional education, andlifestyle modifications could go a long way in reducing the morbidity and mortality associated with NCD.Keywords: Adolescents, Non-communicable diseases, Risk factors, South India

Concurrent immunotherapy and re‐irradiation utilizing stereotactic body radiotherapy for recurrent high‐grade gliomas

Abstract Background Clinical trials evaluating immune checkpoint inhibition (ICI) in recurrent high‐grade gliomas (rHGG) report 7%–20% 6‐month progression‐free survival (PFS), while re‐irradiation demonstrates 28%–39% 6‐month PFS. Aims We evaluate outcomes of patients treated with ICI and concurrent re‐irradiation utilizing stereotactic body radiotherapy/fractionated stereotactic radiosurgery (SBRT) compared to ICI monotherapy. Methods and Results Patients ≥18‐years‐old with rHGG (WHO grade III and IV) receiving ICI + SBRT or ICI monotherapy between January 1, 2016 and January 1, 2019 were included. Adverse events, 6‐month PFS and overall survival (OS) were assessed. Log‐rank tests were used to evaluate PFS and OS. Histogram analyses of apparent diffusion coefficient maps and dynamic contrast‐enhanced magnetic resonance perfusion metrics were performed. Twenty‐one patients with rHGG (ICI + SBRT: 16; ICI: 5) were included. The ICI + SBRT and ICI groups received a mean 7.25 and 6.2 ICI cycles, respectively. There were five grade 1, one grade 2 and no grade 3–5 AEs in the ICI + SBRT group, and four grade 1 and no grade 2–5 AEs in the ICI group. Median PFS was 2.85 and 1 month for the ICI + SBRT and ICI groups; median OS was 7 and 6 months among ICI + SBRT and ICI groups, respectively. There were significant differences in pre and posttreatment tumor volume in the cohort (12.35 vs. 20.51; p = .03), but not between treatment groups. Conclusions In this heavily pretreated cohort, ICI with re‐irradiation utilizing SBRT was well tolerated. Prospective studies are warranted to evaluate potential therapeutic benefits to re‐irradiation with ICI + SBRT in rHGG

Left iliac artery injury during anterior lumbar spine surgery diagnosed by intraoperative neurophysiological monitoring

Serious vascular injury is a rare, but potentially devastating complication during anterior lumbar spinal surgery. The authors describe the first reported case where vascular injury was detected by multimodality neurophysiological monitoring during an L3–S1 anterior lumbar interbody fusion. The case demonstrates the need for multi-modality monitoring and the combined use of somatosensory-evoked potentials and motor-evoked potentials