Nevin Manimala

Eur Arch Otorhinolaryngol. 2022 May 22. doi: 10.1007/s00405-022-07452-1. Online ahead of print.

ABSTRACT

OBJECTIVE: A planning study was performed to evaluate dosimetric differences between intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for head and neck cancer (HNC) for sequential boost (Seq-boost) and simultaneous integrated boost techniques (SIB).

METHODS: 30 patients with HNC were included, 15 treated with SIB and 15 with Seq-Boost. For all patients both VMAT and IMRT plans were completed. The planning objective for PTV was 95% of dose covering minimum 95% of PTV; for spinal cord and brainstem Dmax was limited to 45 Gy and 54 Gy respectively. The parotids had a mean dose < 26 Gy limitation. The number of monitor units (MU) were scored for treatment delivery time efficiency.

RESULTS: Both techniques achieved the set objectives regarding PTV coverage and organ sparing. SIB plans presented a statistically significant better homogeneity for VMAT (p = 0.0096), while Seq-boost showed a statistically significant better conformity for VMAT (p = 0.0049). For parotids only SIB plans showed a lower Dmean value obtained with VMAT, while Seq-boost plans showed statistically insignificant differences. For SIB plans the MU was reduced by 33.4% with VMAT, whereas in Seq-boost plans the reduction was by 19.1%.

CONCLUSION: VMAT shows dosimetric superiority to IMRT in some cases, however an adequate coverage of the target volumes and a suitable OAR sparing can be achieved with both techniques. Though IMRT is still the standard in HNC radiotherapy, VMAT can be safely implemented, offering at least similar target coverage and organ sparing, with significantly reduced MU.

PMID:35598230 | DOI:10.1007/s00405-022-07452-1

Eur Arch Otorhinolaryngol. 2022 May 22. doi: 10.1007/s00405-022-07451-2. Online ahead of print.

ABSTRACT

PURPOSE: The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery.

MATERIALS AND METHODS: Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used.

RESULTS: Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft.

CONCLUSION: TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity.

PMID:35598229 | DOI:10.1007/s00405-022-07451-2

Bull Math Biol. 2022 May 22;84(7):69. doi: 10.1007/s11538-022-01022-6.

ABSTRACT

Model discovery methods offer a promising way to understand biology from data. We propose a method to learn biological dynamics from spatio-temporal data by Gaussian processes. This approach is essentially “equation free” and hence avoids model derivation, which is often difficult due to high complexity of biological processes. By exploiting the local nature of biological processes, dynamics can be learned with data sparse in time. When the length scales (hyperparameters) of the squared exponential covariance function are tuned, they reveal key insights of the underlying process. The squared exponential covariance function also simplifies propagation of uncertainty in multi-step forecasting. After evaluating the performance of the method on synthetic data, we demonstrate a case study on real image data of E. coli colony.

PMID:35598223 | DOI:10.1007/s11538-022-01022-6

Bull Math Biol. 2022 May 22;84(7):68. doi: 10.1007/s11538-022-01023-5.

ABSTRACT

Host diversification methods such as within-field mixtures (or field mosaics, depending on the spatial scale considered) are promising methods for agroecological plant disease control. We explore disease spread in host mixtures (or field mosaics) composed of two host genotypes (susceptible and resistant). The pathogen population is composed of two genotypes (wild-type and resistance-breaking). We show that for intermediate fractions of resistant hosts, the spatial spread of the disease may be split into two successive fronts. The first front is led by the wild-type pathogen and the disease spreads faster, but at a lower prevalence, than in a resistant pure stand (or landscape). The second front is led by the resistance-breaking type, which spreads slower than in a pure resistant stand (or landscape). The wild-type and the resistance-breaking genotypes coexist behind the invasion fronts, resulting in the same prevalence as in a resistant pure stand. This study shows that host diversification methods may have a twofold effect on pathogen spread compared to a resistant pure stand (or landscape): on the one hand, they accelerate disease spread, and on the other hand they slow down the spread of the resistance-breaking genotype. This work contributes to a better understanding of the multiple effects underlying the performance of host diversification methods in agroecology.

PMID:35598221 | DOI:10.1007/s11538-022-01023-5

Asian Pac J Allergy Immunol. 2022 May 22. doi: 10.12932/AP-071121-1267. Online ahead of print.

ABSTRACT

BACKGROUND: Nasal irrigation is an effective component of sino-nasal disease management. Nonetheless, bacterial contamination is worrisome.

OBJECTIVE: To study bacterial colonization incidence using squeeze-bottle nasal irrigation devices, after disinfection with soap or soap-plus-microwave technique, in pediatric acute rhinosinusitis.

METHODS: A randomized, prospective, controlled study was conducted on acute rhinosinusitis children, aged 2-15 years. Each participant was randomized into a soap-cleaning or soap-plus- microwave group. For a two-week period, participants irrigated their nostrils with NSS twice daily and cleaned the bottle after each use. In the end, bottles were sent to a microbiological laboratory for bacterial identification.

RESULTS: The mean 5S Score and satisfaction score gradually improved in both groups with no significant differences between groups. Bacterial identification frequency in the soap group was slightly higher than in the soap-plus-microwave one, without statistical significance. For safety and tolerability, all participants reported 100% adherence to nasal irrigation. The soap-plus-microwave group reported more minor adverse outcomes than the soap-cleaning one. No thermal deformation of irrigation bottles was observed.

CONCLUSIONS: Regular cleaning of nasal irrigation devices is needed to minimize bacterial contamination. Only soap or soap plus microwave disinfection appeared simple and safe for disinfection. Both techniques can equally minimize the rate of bacterial contamination. Although no gross thermal deformation at optimal power and duration, chemical irritants after high power or long microwave durations may be a concern.

PMID:35598187 | DOI:10.12932/AP-071121-1267

J Assoc Physicians India. 2022 May;70(5):11-12.

ABSTRACT

OBJECTIVES: To determine the association of eNOS (T786C and 27bp VNTR) gene polymorphism with the risk of type II diabetes mellitus and diabetic nephropathy in North India.

METHODS: The prospective case control study was conducted over a period of 18 months. A total of 100 patients of Type 2 Diabetes Mellitus (A1: 50 cases without Diabetic nephropathy-DN and 50 cases with DN) aged 18-75 years and 50 healthy adults as control (Group B) were included. The endothelial nitric oxide gene variant (T786C and 27bp VNTR) genotypes and alleles were studied. Odds ratio with 95% CI was calculated for genotype and alleles for the occurrence of diabetes and DN. p value of less than 0.05 was considered as significant.

RESULTS: With Bb as reference(27bp VNTR), the odds ratio for Ab in the three groups (A1,A2,B) was 2.243, 1.545 and 0.746 respectively; and for Aa was 3.043, 3.058 and 1.878 respectively; with TT as reference (T786C), it was 1.573, 1.55 and 1.055 respectively for TC; and for CC it was 2.121, 2.063 and 2.348 respectively. The OR was comparable among the study groups and control for all genotypes and alleles (p&gt;0.05).

CONCLUSION: In conclusion, there was a trend towards higher predilection of DN with aa genotype and a allele in 27 VNTR, CC genotype and C allele of -786T&gt;C polymorphism however it was not found to be statistically significant. Future large sample studies are required to account for the ethnic variation for a clearer association of the genes and their associated risk with Diabetes and its complications.

PMID:35598133

J Assoc Physicians India. 2022 May;70(5):11-12.

ABSTRACT

PURPOSE: It is rationale to predict fluid responsiveness for optimum hemodynamic management. Passive Leg Raising (PLR) causes reversible increase in cardiac output (CO) and changes in end-tidal CO2& pressure (ETCO2 ) can be considered surrogate for CO variations. We aimed to assess the variations in EtCO2 with PLR and fluid challenge (FC) and also compared it with systolic arterial pressure (SAP), mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP).

METHODOLOGY: This Prospective study was conducted in the ICU of a tertiary care teaching public hospital. PLR was performed before FC in patients of circulatory failure on mechanical ventilation. ETCO2 and hemodynamics were monitored and compared and correlated after PLR and FC. ROC curve of parameters, based on their Area under the Curve (AUC) was compared. MS Excel, PSPP version 1.0.1 was used for analysis.

RESULTS: Among hundred patients studied, 74 showed ETCO2 change≥ 2 mmHg (&gt;5%) and were fluid responders. Increase in Etco2 after PLR at 1minute and FC at 30 minutes was statistically significant (p=2.73×10-73) so is SAP(p=4.02×10-75) and MAP(p=1.75×10-75). AUC of predictive performance of parameters showed change in ETCO2 (AUC ROC 0.985 [0.938 to 0.999]) had significantly outperformed CVP (AUCROC 0.822 [0.733-0.892]), SAP (AUCROC 0.793 [0.701-0.868]), MAP (AUCROC 0.810 [0.719-0.881]), HR (AUCROC 0.574 [0.471-0.673]). <p>Conclusion: Variations in ETCO2 &gt;5% induced by PLR can predict fluid responsiveness and is a reliable, non-invasive, easy, quick, and reversible method. ETCO2 is better predictor than SAP, MAP, CVP, and HR during PLR and FC. We may recommend PLR-induced changes in ETCO2 to predict fluid responsiveness in mechanically ventilated patients.

PMID:35598132

J Assoc Physicians India. 2022 May;70(5):11-12.

ABSTRACT

AIMS AND OBJECTIVES: Patients with pulmonary thromboembolism (PTE) are commonly admitted to hospital and generally have a prolonged hospital stay in this part of the world. We aimed to determine different clinical and laboratory parameters that are associated with prolonged hospital stay in our set-up and to analyse effectiveness of Pulmonary Embolism Severity Index (PESI) score as a predictor of prolonged hospital stay in patients with PTE.

MATERIALS AND METHODS: It was a hospital based observational prospective study. Confirmed cases of PTE defined as patients with evidence of thrombus on CT pulmonary angiogram (CTPA) were included in this study. Depending on the length of hospital stay, patients were divided into two cohorts: Shorter Hospital stay (less than mean i.e., &lt; 10 Days) and Prolonged Hospital stay (longer than mean i.e., ≥ 10 Days). Logistic regression analysis was done to identify predictors of prolonged hospital stay.

RESULTS: 150 patients were included in the study with 67 patients (44.67%) having shorter hospital stay (&lt;10 days) and 83 patients (55.33%) having prolonged hospital stay (≥10 days). On multivariate regression analysis, parameters that were found to be statistically significant were hypotension at presentation, decreased level of consciousness, pco2 &lt; 30 mmHg, presence of S1Q3T3 pattern on electrocardiogram (ECG) and high risk PESI (class III-V).

CONCLUSION: PESI class can be effectively used to predict prolonged hospital stay in patients with pulmonary embolism. Patients with hypotension at presentation, decreased level of consciousness, pco2 less than 30 mmHg, and S1Q3T3 on ECG are more likely to have prolonged hospital stay in our healthcare setup.

PMID:35598131

J Assoc Physicians India. 2022 May;70(5):11-12.

ABSTRACT

BACKGROUND: Many studies found that only hypomagnesemia, but not hypermagnesemia is linked with increased mortality. However, reports of mortality due to magnesium dysregulation in the critical care setting are controversial.

OBJECTIVES: To study serum magnesium levels in critically ill patients on admission in intensive care unit (ICU) and its correlation with patient’s need and duration for ventilator support, duration of ICU stay, incidence of cardiac arrhythmias and mortality Methods: Two hundred forty six critically ill patients admitted in ICU with Acute Physiology and Chronic Health Evaluation (APACHE) II scores&gt;10, were included for this prospective observational study. Serum total magnesium level was measured at the time of admission to ICU. Primary outcome measure was ICU mortality whereas, secondary outcome measures were patient’s need and duration for ventilator support, duration of ICU stay, and incidence of cardiac arrhythmias. Categorical and continuous variables were tested using Chi-square/Fisher’s exact test and analysis of variance respectively. Multivariate logistic regression analysis was carried out to determine association of serum magnesium levels with ICU mortality.

RESULTS: Incidence of ICU mortality was significantly higher in group of patients with hypomagnesemia compared to those with normal magnesium levels. Hypomagnesemia was associated with need and longer duration of ventilator support, longer duration of ICU stay, higher APACHE II score, QTc prolongation, higher incidence of cardiac arrhythmias compared to patients with normal magnesium levels. Hypomagnesemia was an independent and statistically significant determinant of ICU mortality.

CONCLUSIONS: Hypomagnesemia was associated with higher mortality rate, longer duration of ventilator support and ICU stay, and higher APACHE II score in critically ill patients.

PMID:35598126

Clin Transplant. 2022 May 21:e14716. doi: 10.1111/ctr.14716. Online ahead of print.

ABSTRACT

The Scientific Registry of Transplant Recipients (SRTR) held a consensus conference in 2012 that examined methods used by SRTR for constructing performance metrics and made recommendations on how to improve program-specific reports. That consensus conference provided 25 recommendations categorized as follows: statistical methods, risk adjustment, and outcomes and data. During the subsequent decade, SRTR has implemented most of these recommendations; these are described in this article along with plans for another consensus conference in 2022. With the present article, SRTR aims to create transparency in the field of transplant metrics and guide discussion in the planning of the next consensus conference in 2022. The new conference will revisit the previous topics and have a broader focus to improve the metrics and information that SRTR provides. Readers can provide feedback on topics to be discussed at the next consensus conference as early as possible, by emailing [email protected] with the subject line “Task 5 Public Comment.” This article is protected by copyright. All rights reserved.

PMID:35598080 | DOI:10.1111/ctr.14716