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PurposeNumerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study.Methods and materialsBased on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios.ResultsFrom January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications.ConclusionsA large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.

Background: In current clinical practice, intensity-modulated proton therapy (IMPT) head and neck cancer (HNC) plans are generated using a constant relative biological effectiveness (cRBE) of 1.1. The primary goal of this study was to explore the dosimetric impact of proton range uncertainties on RBE-weighted dose (RWD) distributions using a variable RBE (vRBE) model in the context of bilateral HNC IMPT plans. Methods: The current study included the computed tomography (CT) datasets of ten bilateral HNC patients who had undergone photon therapy. Each patient's plan was generated using three IMPT beams to deliver doses to the CTV_High and CTV_Low for doses of 70 Gy(RBE) and 54 Gy(RBE), respectively, in 35 fractions through a simultaneous integrated boost (SIB) technique. Each nominal plan calculated with a cRBE of 1.1 was subjected to the range uncertainties of ±3%. The McNamara vRBE model was used for RWD calculations. For each patient, the differences in dosimetric metrices between the RWD and nominal dose distributions were compared. Results: The constrictor muscles, oral cavity, parotids, larynx, thyroid, and esophagus showed average differences in mean dose (Dmean) values up to 6.91 Gy(RBE), indicating the impact of proton range uncertainties on RWD distributions. Similarly, the brachial plexus, brain, brainstem, spinal cord, and mandible showed varying degrees of the average differences in maximum dose (Dmax) values (2.78–10.75 Gy(RBE)). The Dmean and Dmax to the CTV from RWD distributions were within ±2% of the dosimetric results in nominal plans. Conclusion: The consistent trend of higher mean and maximum doses to the OARs with the McNamara vRBE model compared to cRBE model highlighted the need for consideration of proton range uncertainties while evaluating OAR doses in bilateral HNC IMPT plans. [ABSTRACT FROM AUTHOR]

Eyelid imbrication syndrome is an idiopathic acquired eyelid disorder characterized by upper eyelids overriding the lower eyelids. Congenital eyelid imbrications syndrome is extremely rare and thorough review of literature revealed only two previously reported cases and one congenital combined eyelid imbrications and floppy eyelid syndrome. We report a third case of bilateral asymmetric congenital eyelid imbrication syndrome and a second case of congenital combined eyelid imbrication and floppy eyelid syndrome that resolved with conservative treatment.

The growing number of cancer survivors and the high prevalence of cancer-related physical and psychosocial effects pose important and pressing challenges to health systems. The coronavirus disease 2019 (COVID-19) pandemic has led to further stressors on cancer survivors and health care systems. As the pandemic continues to have substantial impact on the world, it is critical to focus attention on the health care needs of cancer survivors. In this commentary, we propose an adoption of essential steps that should be part of a continuous adaptive approach to promote effective cancer survivorship care during ongoing COVID-19 waves and beyond. [ABSTRACT FROM AUTHOR]

The most dangerous pollution in the environment are the unwanted hydrocarbon in form of oil and petroleum which is the result of leak from the coastal oil refiners and to overcomes these situations use of microbes are the only ecofriendly method and they are the main contributor to maintain a safer environment. Current study aimed to evaluate the fungi and bacteria as a bio-degrader of hydrocarbon, for his bacteria and fungi were first isolate and identify from the oil contaminated soil collected from the different workshops of Sargodha city. Result reveled that upper layer (0-2m) contain diverse and large number of bacteria and fungi specie (bacteria 50%; fungi 50%), while lowest layer (3-4m) contain less diverse and low number of bacterial and fungi species (bacteria 6.66%; fungi 13.6%). After identification it was found that total 4 strains of fungi were isolate in which Aspergillustubingensis and Alternariatenuissima were dominantIn case of bacteria 7 strains were identified. Among which E. coli were dominant. Followed by the Pseudomonas spp. after biodegradation test it was found that fungal strain Aspergillustubingensis was the excellent bio-degrader (1.69x109) followed by the Aspergillums niger (1.40x108). On the other hands among the bacterial strains Staphylococcus aureus utilizes high amount of the hydrocarbon as energy source (1.76x107) followed by the Pseudomonas aeruginosa (1.67x109). in conclusion Introducing these microbes to the oil contaminated environment can solve the problems of hydrocarbon pollution. But future research should be conducted to better understand the molecular mechanism of hydrocarbon degradation in order to better utilize these microorganisms for the welfare of human beings. [ABSTRACT FROM AUTHOR]