Adult Necrotising Enterocolitis: a Rare Entity

A case of Adult Necrotising Enterocolitis in an adult female whom diagnosed with intestinal obstruction was reported. On exploratory laparotomy, the mechanical caused was not found although major part of small bowel, caecum and proximal ascending colon were gangrenous along with intervening normal parts. Resection of affected bowel was performed followed by jejunostomy and transverse colostomy. Unfortunately, the patient not survive in the postoperative periods. Adult Necrotising Enterocolitis may mimic intestinal obstruction clinically or radiologically and prompt medical and surgical intervention is indicated in doubtful cases although it carries a poor prognosis. Key words: adult necrotizing Enterocolitis, non-occlusive mesenteric ischemia, gangrenous bowe

Duxorubicin-induced cardiotoxicity

The survival rate of cancer patients has greatly increased over the last 20 years. However, to achieve this result, a considerable price has been paid in terms of the side-effects associated with the intensive anticancer treatment. Cardiotoxicity of anticancer drugs is a serious problem. It is defined, by the National Cancer Institute, as the “toxicity that affects the heart.” This definition not only includes a direct effect of the drug on the heart, but also an indirect effect due to enhancement of hemodynamic flow alterations or due to thrombotic events. Cardiotoxicity can develop in a subacute, acute, or chronic manner. The risk for such effects depends upon: cumulative dose, rate of drug administration, mediastinal radiation, advanced age, younger age, female gender, pre-existing heart disease and hypertension. Anthracyclines, such as doxorubicin (DOX), cause serious cardiac side-effects. Acute tachyarrhythmias and acute heart failure (HF) may occur after high doses, but these reactions are now rare due to changed dosage schemes (e.g. slower infusion) with the aim to prevent this. However, the sub-acute or chronic cardiac effects of anthracyclines remain a clinical problem. Clinically, anthracycline induced cardiotoxicity manifests itself as left ventricular failure, which develops insidiously over months to years after completion of the anthracycline based chemotherapy and may result in congestive HF. The mechanism of anthracyclin induced cardiotoxicity is not totally unraveled. It is likely that the decline in myocardial function is related to apoptosis of cardiac myocytes that occurs apparently at random in the myocardium. Anthracyclin induced formation of reactive oxygen species (ROS) in the presence of intracellular iron, impaired homeostasis of intracellular iron and calcium (that may facilitate the apoptosis induced by the ROS) have been put forward as mechanisms. Cardiac protection can be achieved by limitation of the cumulative dose. Further, addition of the antioxidant and iron chelator dexrazoxane to anthracycline therapy has shown to be effective in lowering the incidence of anthracycline induced cardiotoxicity

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Background: To evaluate the feasibility and safety of totally tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.Methods: From August 2014 to January 2016, 66 patients underwent PCNL in our institute. Of this group, 35 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 31 patients. These  groups were compared with respect to age, stone burden, intraoperative events, postoperative pain, analgesic requirements, soakage, postoperative change in hemoglobin, hospitalization time and complication rates.Results: Two groups were comparable with respect to age, stone burden (2.03 cm Vs. 2.12 cm) and intraoperative events. The mean pain score (day2 - 4.95 vs. 2.95) (day3 - 4.33 vs. 1.44) and analgesic requirement (mg diclofenac) (day2 - 140.22 vs. 65.31) (day3 - 124.44 vs. 43.89) was significantly less for group 2 on day 2 and 3. There was significant problem of soakage from nephrostomy tract in group 1. Patients in group 2 returned faster to normal activities but there was no difference found in drop in hemoglobin, complication rates even in subset of patients with large stone burden. No patient required readmission in the follow-up for pain, obstruction or infection in group 2. One patient developed urinoma which resolved conservativelyConclusions: In selected cases totally tubeless PCNL is feasible and safe

INCIDENCE OF PRESENCE OF H. PYLORI IN CASES OF CHOLECYSTITIS AND CHOLELITHIASIS IN A RURAL MEDICAL COLLEGE & HOSPITAL

Cholecystitis is defined  as inflammation of the gallbladder. Ninety percent of cases involve stones in the cystic duct and gall bladder, (i.e., calculus cholecystitis) with the other 10% of cases representing acalculus cholecystitis.(1) The association of gallstones with Helicobacter pylori has been investigated but not clearly demonstrated. In this study, the presence of H. pylori in the gallbladder mucosa of patients with symptomatic cholecystitis and cholelithiasis was investigated.The study included 50 cases of  cholecystitis and cholelithiasis randomly selected who were admitted to the surgical wards of M.M.I.M.S.R, Mullana in last 2 years.  All patients underwent cholecystectomy and gall bladder mucosa was histopathologically examined by giemsa staining (silver slide test). We concluded that no gall bladder mucosa exhibits presence of H. Pylori. Keywords: Cholelithiasis; Cholecystitis; H. pylori; GiemsaÂ

Impact of patient positioning on radiotherapy dose distribution: An assessment in parotid tumor

Purpose: We intended to study the impact of patient positioning on the dose distribution within target volume and organs at risk in patients with parotid malignancies treated with 3D conformal radiotherapy (3D-CRT) with photon wedge pair (WP) or intensity modulated radiotherapy (IMRT).Methods: Three patients with a non-Hodgkin’s lymphoma of the right parotid gland were consecutively immobilized using thermoplastic cast in 2 positions: supine with head in neutral position (HN) and with head turned 90° to the left side (HT). Images for treatment planning purpose were acquired in both positions. For both positions, photon WP plans and 5 field IMRT plans were generated, after contouring clinical target volume (CTV), planning target volume (PTV= CTV + 5 mm margin) and organs at risk (OAR). All plans were evaluated for target coverage and dose to OARs.Results: Both CTV and PTV were apparently larger in HN compared with HT (31.76±8.89 cc, 30.31±7.83 cc and 62.49±19.01 cc, 58.89±15.33 cc) respectively. The CI value for PTV was slightly better for HT compared to HN position in both the WP and IMRT plans. The homogeneity was comparable in both the head positions in case of WP plan. The mean HI of PTV was increased in case of IMRT plan at HT versus HN position (1.108 vs. 1.097). A change in head position from HN to HT with wedge pair plan resulted in a reduction of brainstem Dmax and Dmean. Lesser dose was observed in HN position for contralateral parotid. A difference of 0.9 Gy in the average Dmax to spinal cord was seen. The values of Dmean to mandible, oral cavity, ipsilateral and contralateral cochlea were higher in the HT position. A change in head position from HN to HT with IMRT plan resulted in a dose reduction in average Dmax to brainstem. The spinal cord Dmax increased at the HT position by 1.2 Gy. The dose to contralateral parotid and cochlea was comparable in both the positions. However, the Dmean to oral cavity was reduced at HT position. Whereas for IMRT versus wedge pair plan at head neutral position average Dmean to the contralateral parotid was reduced with the IMRT plan. A considerable reduction in Dmax to spinal cord and Dmean to ipsilateral cochlea was observed. A slight increase in average Dmax to brainstem and was observed with the IMRT plan. The doses to the remaining OARs were lesser in case of IMRT plan. For IMRT versus wedge pair plan at head tilt position slight increase in average Dmax to brainstem was observed in case of IMRT plan. A considerable reduction in Dmax to spinal cord and Dmean to ipsilateral cochlea was observed. The doses to the remaining OARs were reduced with IMRT plan.Conclusion: Change in head position from neutral to 90° contralateral tilt for wedge pair plan in parotid tumor may considerably reduce dose to the brainstem and spinal cord with a modest increase in dose to mandible, oral cavity, contralateral parotid, and bilateral cochlea. The alteration in head position has minimal impact on IMRT planning

Influence of collimator rotation on dose distribution and delivery in intensity modulated radiation therapy for parotid cancer

Purpose: To evaluate the influence of collimator rotation in IMRT planning with respect to the target coverage and dose to critical structures. In addition, the delivery efficiency of desired fluence with collimator rotation is assessed.Methods: The computed tomography (CT) datasets of 5 patients with parotid cancer were employed for this study. Dynamic IMRT plans were generated with a dose prescription of 60 Gy in 30 fractions. IMRT plans were generated with five unilateral fields using 6MV X-rays. Four different plans were generated for each patient by keeping the collimator angle at 0, 30, 60, and 90 degree. All plans were analyzed using dose volume histogram. Conformity index (CI) and heterogeneity index (HI) were calculated. The total monitor units (MU) required to deliver one fraction were noted and compared. To verify the delivery efficiency; the measured fluence on IBA I’mRT MatriXX ionization chamber array detector was compared with the TPS dose plan with 2D gamma evaluation.Results: There is not much difference in the PTV Dmax and Dmean with respect to the different collimator angles. The PTV coverage is best at collimator angle of 0 degree. A slight reduction in CI was observed with plans at other collimator angles as compared to 0 degree. The HI values were almost similar for plans with collimator angle 0, 30, and 60 degree. The plan with 90 degree collimator showed a slightly higher heterogeneity for the PTV. A slight reduction in the average Dmax to spinal cord was observed for the plan with collimator angle 30 degree as compared to other angles whereas maximum value of Dmax to spinal cord was at collimator angle 60 degree. No clinically relevant difference was observed among the plans with respect to brainstem and mandible Dmax. An increase in average of oral cavity Dmax and Dmean was observed for collimator angle 60 and 90 degree as compared to collimator angle 0 and 30 degree. Not much difference was observed with respect to Dmax and Dmean for contralateral parotid and cochlea with plans at different collimator angles. A decrease in MU required to deliver a fraction was observed for the plan with collimator angle 30 degree as compared to other angles. The plan with 90 degree collimator required maximum MU. The 2D γ index evaluation of planned and delivered fluence showed almost similar results for plans with different collimator angles.Conclusion: An individual case-specific collimator rotation may aid in achieving the desired dose distribution and relative sparing of critical structures in IMRT.  

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency–Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe