Purpose: To validate a locally fabricated phantom of Imatrixx-2D Array by comparing its results with ArcCheck phantom and comparing portal dosimetry measurements with the two phantom studies. Materials and Methods: Electronic Portal Imaging Devices and Epiqa software were used for portal dosimetry. An Imatrixx-2D array with a locally fabricated phantom and ArcCheck cylindrical phantom were used for phantom studies. Eclipse-TPS with RapidArc treatment planning and portal dose prediction software was used for planar dose calculations. Three verification plans were created for each of the 15 patient plans of various sites, making a total of 45 plans to be delivered on 3 QA systems as above. Fifteen plans each with 2 arcs were delivered on the EPIDs of the Linacs, on Imatrixx-2D array phantom and on ArcCheck cylindrical phantom respectively. The planar dose matrices were analysed using global Gamma Index criteria of 3mm DTA and 3% dose difference. Results: The maximum deviations of percentage in dose points, in which γ>1, are 1.94, 1.89 and 1.5 in Imatrixx phantom, ArcCheck phantom and Portal dosimetry, respectively. Similarly, the mean deviations and SD values are less in portal dosimetry than that of phantom studies. The smaller deviations in portal dosimetry are attributed to closely embedded chambers in the EPID compared to the distance between the detectors placed in the phantom measurements. Conclusion: After carrying out the comparison of results, the locally fabricated phantom has been validated and accepted for the dosimetric studies. The conclusion is that all the three dosimetric QA systems are suitable for the patient-specific QA of RapidArc treatments.

Additional heads of the biceps brachii muscle of arm have the clinical importance, because they mislead the surgeon in arm surgical procedures. Existence of such variation is one of the reasons for neurovascular compression in the arm region. The present study was conducted to find out the incidence of third head of biceps brachii among 80 samples in South Indian population. The third head of biceps brachii was found in right side in one case which was 13.7 cm in length and arising from antero medial wall of lower part of shaft of humerus. Incidence of the study is 1.25% in South Indians. Occurrence of supernumerary third head of biceps is rare in Indian population.

A 28-year-old woman with mullerian agenesis presented with primary infertility and was considered for laparoscopic oocyte retrieval and in-vitro fertilisation. Her 27-year-old younger sister served as a gestational carrier. The patient underwent ovarian stimulation and 11 mature oocytes were retrieved by laparoscopy. After successful in-vitro fertilisation, two embryos were transferred to the gestational carrier. Two weeks after embryo transfer, the pregnancy was confirmed by serum human chorionic gonadotropin levels. Another two weeks later, an ongoing singleton pregnancy with foetal heartbeat was confirmed by transvaginal ultrasonography.
Adult ; Female ; Fertilization in Vitro ; methods ; Humans ; Infertility, Female ; genetics ; Mullerian Ducts ; abnormalities ; Oocytes ; Pregnancy ; Surrogate Mothers ; Syndrome ; Tissue and Organ Harvesting ; Urogenital Abnormalities

BACKGROUND: In this study, the measurement of job stress of electric overhead traveling crane operators and quantification of the effects of operator and workplace characteristics on job stress were assessed. METHODS: Job stress was measured on five subscales: employee empowerment, role overload, role ambiguity, rule violation, and job hazard. The characteristics of the operators that were studied were age, experience, body weight, and body height. The workplace characteristics considered were hours of exposure, cabin type, cabin feature, and crane height. The proposed methodology included administration of a questionnaire survey to 76 electric overhead traveling crane operators followed by analysis using analysis of variance and a classification and regression tree. RESULTS: The key findings were: (1) the five subscales can be used to measure job stress; (2) employee empowerment was the most significant factor followed by the role overload; (3) workplace characteristics contributed more towards job stress than operator's characteristics; and (4) of the workplace characteristics, crane height was the major contributor CONCLUSION: The issues related to crane height and cabin feature can be fixed by providing engineering or foolproof solutions than relying on interventions related to the demographic factors.
Body Height ; Body Weight ; Classification ; Demography ; Power (Psychology) ; Trees

Patients with Pierre Robin sequence exhibit varying degrees of airway obstruction and feeding difficulty. In some patients, airway obstruction may be profound, warranting surgical intervention to maintain a patent airway. The purpose of this article is to highlight the advantages of the tongue-lip adhesion procedure for the management of airway obstruction in such patients compared to the currently available options.
Airway Obstruction ; Humans ; Pierre Robin Syndrome*

A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained. The intravascular imaging demonstrated that the flow diverter had good wall apposition and concentric neointimal growth over the braid with exception to the areas that the PED was not in contact with the endothelial wall, such as at the right PICA ostium and at the vertebrobasilar junction. The entire procedure was safe, and the patient had no complications. In this article, we describe for the first time the assessment of the status of endothelial “healing” of the PED shield at 8-weeks.
Aneurysm ; Basilar Artery ; Cerebral Arteries ; Female ; Follow-Up Studies ; Humans* ; Middle Aged ; Pica ; Retreatment ; Tomography, Optical Coherence* ; Vertebral Artery

INTRODUCTIONThis study aimed to describe the patterns of sedative use among terminally ill cancer patients who were referred to a hospital-based specialist palliative care service for symptom management. It also aimed to examine whether sedative use among terminally ill cancer patients during the last two days of life had any impact on their survival.

METHODSA retrospective review of case notes was carried out for patients with a diagnosis of terminal cancer, who died in a 95-bedded oncology ward between September 2006 and September 2007. Data was collected on patient characteristics, duration of palliative care, indications and doses of sedatives used at 48 hours and 24 hours before death.

RESULTSA total of 238 patients died while receiving specialist palliative care, 132 of whom (55.5%) were female. At 48 hours and 24 hours before death, 22.6% and 24.8% of patients, respectively, were on sedatives like midazolam, haloperidol or both. The median dose of midazolam was 5 mg/day while the haloperidol dose at 48 hours and 24 hours before death was 3 mg/day and 4 mg/day, respectively. The indications for midazolam were anxiety, breathlessness and stiffness, while those for haloperidol were confusion agitation and nausea. Survival analysis showed no significant difference in survival between patients who were on sedatives and those who were not. The p-value for log-rank test was 0.78.

CONCLUSIONThe results showed that the doses and overall frequency of sedative use in this patient population tended to be low and that usage of sedatives had no deleterious influence on survival.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Analgesics, Opioid ; therapeutic use ; Female ; Haloperidol ; therapeutic use ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Neoplasms ; drug therapy ; mortality ; Palliative Care ; methods ; Retrospective Studies ; Terminal Care ; methods ; Terminally Ill ; Time Factors ; Treatment Outcome

Background/Aims: Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear. Methods: We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies. Results: Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively. Conclusions The clinical presentation of COVID-19 in IBD patients is similar to the general population.

PURPOSE: Diagnosis of extrapulmonary tuberculosis (EPTB) poses serious challenges. A careful selection of appropriate gene targets is essential for designing a multiplex-polymerase chain reaction (M-PCR) assay. MATERIALS AND METHODS: We compared several gene targets of Mycobacterium tuberculosis, including IS6110, devR, and genes encoding MPB-64 (mpb64), 38kDa (pstS1), 65kDa (hsp65), 30kDa (fbpB), ESAT-6 (esat6), and CFP-10 (cfp10) proteins, using PCR assays on 105 EPTB specimens. From these data, we chose the two best gene targets to design an M-PCR. RESULTS: Among all gene targets tested, mpb64 showed the highest sensitivity (84% in confirmed cases and 77.5% in clinically suspected cases), followed by IS6110, hsp65, 38kDa, 30kDa, esat6, cfp10, and devR. We used mpb64+IS6110 for designing an M-PCR assay. Our M-PCR assay demonstrated a high sensitivity of 96% in confirmed EPTB cases and 88.75% in clinically suspected EPTB cases with a high specificity of 100%, taking clinical diagnosis as the gold standard. CONCLUSION: These M-PCR results along with the clinical findings may facilitate an early diagnosis of EPTB patients and clinical management of disease.
Bacteriological Techniques/methods ; DNA Transposable Elements/genetics ; DNA, Bacterial/analysis/genetics ; Early Diagnosis ; Female ; Gene Amplification ; Humans ; Male ; Multiplex Polymerase Chain Reaction/*methods ; Mycobacterium tuberculosis/genetics/*isolation & purification ; Polymerase Chain Reaction/*methods/standards ; Sensitivity and Specificity ; Tuberculosis/*diagnosis

PURPOSE: Appendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors (TNET), goblet cell carcinoids (GCC), and atypical GCC. Atypical GCC are classified into signet-ring cell cancers (SRCC) and poorly differentiated appendiceal adenocarcinoids. The prognosis and management of these diseases is unclear because there are no prospective studies. The aim of this study is to assess the characteristics and outcome of appendiceal TNET, GCC, and SRCC patients. MATERIALS AND METHODS: Appendiceal TNET, GCC, and SRCC patients diagnosed between 1973 and 2011 were identified in the Surveillance Epidemiology and End Results (SEER) database. Demographics, type of surgery, and clinicopathologic characteristics were collected. Survival functions were estimated by the Kaplan-Meier method, and log-rank test was used to assess the difference in overall survival (OS) among the three histologies. RESULTS: The SEER database yielded 1,021 TNET patients, 1,582 with GCC, and 534 SRCC patients. TNET presented at a younger age (p < 0.001). Patients with SRCC presented with advanced stage disease (p < 0.001). The median OS (mOS) for GCC and TNET patients was not reached; mOS for SRCC was 24 months. Multivariate analysis stratified for stage revealed significantly longer survival for TNET and GCC than SRCC (p < 0.001). CONCLUSION: This is the largest report to date for appendiceal neuroendocrine tumor patients, suggesting a spectrum of diseases with different characteristics and outcomes. In this report, we present a treatment approach for this complex spectrum of disease, based on the experience of Ohio State and Emory Universities investigators.
Appendiceal Neoplasms ; Carcinoid Tumor ; Demography ; Disease Management ; Epidemiology ; Goblet Cells ; Humans ; Multivariate Analysis ; Neuroendocrine Tumors ; Ohio ; Prognosis ; Prospective Studies ; Research Personnel