Search

Background: To have proper utilization of blood and its components adherence to established guidelines is essential. Hence, periodic review of blood components is necessary to improve transfusion practices and decrease the inappropriateness of blood components. Aims and Objectives: Our study aims to assess the utilization and appropriateness of blood and blood components in the Department of Clinical Hematology SKIMS, Soura, Srinagar. Materials and Methods: This prospective observational study was conducted in the Department of Blood Transfusion and Immunohematology, SKIMS, Soura, Srinagar, over a period of 1 year from August 2020 to July 2021 on patients admitted in Clinical Hematology requiring transfusion therapy. The number of all blood and blood component units supplied over a period of 1 year was assessed. The usage of different types of blood component was recorded and correlated with the patient’s diagnosis and indications for transfusion. Results: A total of 250 patients were transfused with 2099 blood and blood components, among them 64.32% (1350) units were used appropriately and 35.68% (749) units were used inappropriately. Transfusions of packed red blood cells were found to be inappropriate in patients with asymptomatic chronic anemia with Hemoglobin >7 g/dL. Fresh frozen plasma was given inappropriately in cases of bleeding without derangement of coagulation tests. Inappropriate use of platelets was seen in patients who had received platelets prophylactically with platelet count above 10,000/μL. Conclusion: Proper implementation of guidelines for the use of various blood components would help reduce their inappropriateness.

Objective: The recommended course of treatment for early-stage breast cancer is breast-conserving surgery followed by adjuvant whole-breast radiation. It is challenging to obtain homogeneous dose distribution using standard procedures because of breast irregularities. Currently, it is possible to use different breast irradiation techniques such as a field in field (FIF) which produces a more homogenous distribution of doses within the target volumes while sparing the organs at risk, leading to a better treatment outcome. Materials and Methods: The present study aimed to compare the conformal and the FIF techniques dosimetrically. In this retrospective dosimetric study, we evaluate 20 patients with early-stage breast cancer who underwent computed tomography. For each patient, two different treatment plans were created, three-dimensional conformal radiotherapy and a FIF plan. A dose of 50 Gy in 25 fractions was prescribed to the planning target volume (PTV). Results: The plans were compared with each other on volume coverage (conformity and homogeneity) and OAR sparing. The dosimetric parameters and monitor components were compared with paired sample t-test. The FIF technique obtained a significantly lower dose homogeneity index, lower maximum doses, and higher median doses in PTV (P < 0.05). In ipsilateral lungs, FIF significantly reduced the maximum and mean doses (P < 0.05). In patients with left-sided breast cancer, minimum and maximum doses and V40 of the heart were significantly decreased in FIF plans (P < 0.05). Doses to the contralateral lung differ to a little degree as well. Conclusion: The use of forward intensity-modulated radiation therapy (RT) technique for RT of high-risk node-positive breast cancer patients provides an efficient and reliable method for achieving superior dose uniformity, conformity, and homogeneity in the breast chest wall volume with minimal doses to the OAR. Monitor units were less in FIF, with less time on the machine and less machine consumption.

Aim and Objectives: The study was conducted to to compare the dosimetric superiority between the Field in Field and Box techniques. Meterials and Methods: We have taken 22 Patients of Ca esophagus for our study from our Institute database. Patients were already treated Box (4 fields) plan. Retrospectively additional Field in Field (FIF) plan was created with Planning target volume (PTV) prescription dose of 59.4Gy in 33 fractions. Prescription dose of 95% of PTV was chosen for the comparison between two treatment planning strategies. The Dose volume histogram (DVH) was used to analyze and compare various plan quality index and doses to the organs at risk (OARs). For each patient, two treatment plans were created: Box 4FB and FIF. The parameters compared included the conformity index (CI), homogeneity index (HI), Conformation number (CN), DMean, DMax, V20Gy and V30Gy of the heart and lungs, and monitor units per fraction (MU/fr). Results: A paired t-test analysis significant differences (P < 0.05) between the two techniques in terms of the CI, HI, and CN when the FIF was applied. The Dmax of the PTV, lung, and spinal cord were also significantly better with the FIF. Moreover, the V20Gy of the significantly reduced when the FIF was used and the MU/fr was significantly decreased. The FIF technique enables better dose distribution in the PTV and reduces dose to OARs in esophageal radiotherapy. Conclusion: Although all plans were within acceptable limits, dosimetric comparison of different planning techniques revealed that FIF had statistically significant differences from Box planning technique in terms of planned target volume (PTV) coverage, OAR protection, HI, CI, CN, MU and treatment duration. From the aspect of treatment duration and MU parameters, FIF technique can be considered as an alternative planning option.

Objective: This study analyzed different planning target dose–volume evaluation parameters, target mean dose, homogeneity index (HI), conformity index (CI), and Target Coverage Index (TCI) for different conformal techniques. The purpose of this article was to analyze these three parameters in the assessment of the treatment plans in ten patients undergoing postoperative conformal radiotherapy treatment. Materials and Methods: We retrospectively evaluated that the treatment plans of ten patients with a prescribed dose was 60 Gy delivered at 2.0 Gy per fraction using 6 MV photon energy. The dosimetric comparison was done by performing two plans for the same patient; prescription dose and normal tissue constraints were identical for both plans. A total of ten patients underwent computed tomography treatment planning in conjunction with magnetic resonance imaging fusion. Prescription dose and normal tissue constraints were identical for both conformal plans. The irradiated patients were retrieved and replanned with three-dimensional conformal radiation therapy (3DCRT) techniques, and a dosimetric comparison was done by performing two plans for the same patient. Results: The Student's t-test was used to perform statistical analysis to determine the differences between the dose–volume constraints used for planning. The cumulative dose–volume histogram of target volumes (TVs), target coverage, target homogeneity, target conformity, and normal tissue sparing with two different conformal planning was compared. The intensity-modulated radiation therapy (IMRT) plan yielded superior target coverage as compared with the 3D-CRT plan. Specifically, minimum and mean planning TV cone-down doses were 46.80 ± 4.16 Gy and 60.72 ± 1.00 Gy for IMRT and 49.06 ± 4.98 Gy and 61.04 ± 1.15 Gy for 3D-CRT P < 0.519, respectively. The CI was approximately equal in both the modalities with an average value of 0.962 ± 0.041 in IMRT compared to 0.969 ± 0.039 in 3DCRT (P < 0.481). The average HI in IMRT was 0.187 ± 0.176 and 0.099 ± 0.0500 in 3DCRT (P < 0.165). Therefore, IMRT achieved an improvement in HI. The target coverage index (TCI) in IMRT was 0.7213 ± 0.2050 and 0.5970 ± 0.194 in 3DCRT. Statistical analysis was performed to determine the differences. Conclusions: These indexes can all be objective tools for the evaluation of plan quality. The IMRT plan yielded superior target coverage and reduced radiation dose to the brain, brainstem, and optic chiasm. With the availability of new cancer imaging tools and more effective systemic agents, IMRT may be used to intensify tumor doses when minimizing toxicity, therefore potentially improving outcomes in patients.

Background: Millions of people have been impacted by COVID-19 pandemic globally. COVID-19 pandemic has descended people to the realms of uncertainty and isolation which surprisingly are associated with mental distress. Depression, anxiety and stress are one of the prominent psychological factors that might have been significantly impacted by the ongoing pandemic. Aims and Objectives: The present study was conducted predominantly with the aim of assessing psychological impact by COVID-19 in health-care professionals (HCPs) as well as in general population. Materials and Methods: The present study was an observational study conducted in Sher-i-Kashmir Institute of Medical Sciences, Soura, a tertiary level teaching hospital in Union territory of Jammu and Kashmir, India. A total of 250 participants comprising both HCPs and general population were included in the study. Depression, anxiety, stress-scale-21 questionnaire, a validated instrument, was used to assess the depression, anxiety, and stress levels among the participants. Informed consent was taken individually for volunteering in the study and participants were required to fill the questionnaire as per the directed instructions. Results: Out of 250 participants, 54.8%, 68%, and 34.4% were found to have depression, anxiety, and stress, respectively. The prevalence of severe and extremely severe depression corresponded to 9.9% and 6.8% of HCPs, respectively. Severe and extremely severe anxiety existed in 14.9% and 21.1% of HCPs, respectively, followed by 7.5% and 1.2% severe stress and extremely severe stress percentages. About 11.2% and 7.9% participants in community experienced severe and extremely severe depression, respectively. Although 19.1% and 21.3% values corresponded to severe and extremely severe anxiety in community, 5% participants were found to have severe stress, and 4 % had extremely severe stress. A significant positive correlation existed between the levels of depression, anxiety, and stress. No statistically significant association was found between DAS scores and demographic variables except anxiety scores which showed a statistically significant association with HCPs especially nurses, students, and doctors. Conclusion: The findings from this study highlight high prevalence of depression, anxiety and stress experienced during COVID-19 pandemic by all participants. Anxiety in comparison to depression and stress was found to be experienced by majority of participants. Anxiety levels were prominent in nurses, students, and doctors among HCPs.

Introduction: The purpose of the study was to determine forward-planned intensity-modulated radiotherapy which improves the sparing of organs at risk (OAR), heart, lungs, and contralateral breast, when compared with multi-field inverse-planned intensity-modulated radiation therapy (RT). The anatomy of the chest wall is curved, which makes it difficult to achieve a homogeneous dose; therefore, it is essential to know the technique by which we can render a better treatment. Methods: The three-dimensional field-in-field (FIF) technique for radiotherapy is an advanced state-of-the-art method that uses multileaf collimators to generate a homogeneous and conformal dose distribution through segmental subfields. The planning computer tomography (CT) scans of 30 women with left-sided breast cancer previously treated with whole breast RT on an inclined breast board with both arms supported above the head were retrieved. The whole-breast planning target volume (PTV) was defined by clinical markup and contoured on all relevant CT slices as were the OARs. For each patient, two plans were generated using FIF and five-field inverse-planned IMRT, with a prescription dose of 50 Gy in 25 fractions to the whole breast. The mean and maximum doses to the OARs, conformity index, and homogeneity index (HI) of the whole-breast PTV were compared. Results: The FIF technique significantly reduced the maximum dose of the PTV as well as the mean doses of the heart, ipsilateral lung, contralateral lung, esophagus, and contralateral breast (P < 0.001 for each). When the organ at risk volumes irradiated with 10, 20, 30, and 40 Gy were compared, the results were in favor of the FIF technique. The volume receiving

Purpose: The purpose of the current study is to determine whether patients diagnosed with glioblastoma multiforme (GBM) who underwent radiotherapy (RT) using intensity-modulated RT (IMRT) technique were benefitting from this highly conformal treatment in terms of doses received by planning target volume (PTV) and organs at risk (OARs) in comparison to three-dimensional conventional RT (3DCRT). Materials and Methods: Twelve patients treated with IMRT for GBM were selected for dosimetric comparison with 3DCRT. The prescribed dose was 60 Gy in 30 fractions and seven non-coplanner beams were used in IMRT to cover 95% of target volume. The irradiated patients of GBM were retrieved and replanned with 3DCRT techniques. Dosimetric comparison was done by performing two plans for the same patient; prescription dose and normal tissue constraints were identical for both plans. The dose–volume histograms of target volumes and OAR, dose conformity, and dose homogeneity with 3DCRT and IMRT planning were compared. Statistical analysis was performed to determine the differences. Results: The mean conformity index was 0.99 ± 0.001 for IMRT and 0.97 ± 0.002 for 3DCRT, P = 0.001. The mean homogeneity index was 1.03 ± 0.02 for IMRT and 1.06 ± 0.009 for 3DCRT, P = 0.003, which is statistically significant. The IMRT technique enables dose reduction of normal tissues including brainstem (Dmean by 33.78 ± 5.34 and Dmax 51.84 ± 4.43), optic chiasm (Dmean by 36.92 ± 1.99 and Dmax 44.61 ± 3.72), left optic nerve (Dmean by 28.97 ± 6.51 and Dmax 46.08 ± 10.58), right optic nerve (Dmean by 31.93 ± 11.68 and Dmax 44.63 ± 13.54), left eye (Dmean by 18.66 ± 8.92 and Dmax 37.43 ± 13.47), right eye (Dmean by 14.40 ± 4.87 and Dmax 40.37 ± 11.37), left lens (by Dmax 5.45 ± 1.85), and right lens (Dmax 5.07 ± 0.63). Conclusion: The IMRT provides a real dosimetric advantage, especially for normal brain tissue, and in terms of target coverage. It allows treatment of tumors while respecting OARs' dose constraints. The IMRT technique shows significant advantage in PTV coverage, dose homogeneity, and conformity. In IMRT, the coverage is better where PTV was overlapping with critical OARs.

Background: Drug therapy is an inevitable cause of cutaneous adverse reactions. Aims and Objectives: The primary aim was to identify the incidence and magnitude of various dermatological adverse reactions including Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Moreover, secondary aim was to quantify the risks associated with the use of specific medications. Materials and Methods: A prospective and hospital-based study was conducted in the department of dermatology SMHS hospital on hospitalized cases of cutaneous adverse drug reactions (CADRs). Informed consent was sought and reactions were reported on validated questionnaire based on adverse drug reaction (ADR) monitoring form provided by Central Drug Standard Control organization Ministry of Health and Family Welfare, Government of India. These dermatological reactions were assessed for the clinical pattern, causative agents, and prognosis. The WHO-Uppsala Monitoring centre system for standardized case was used for causality assessment of all cases identified. Results: A total of 101 hospitalized patients with varied dermatological ADRs were reported during the study period. Cases were found more in females (n=75, 74.25%) than in males (n=26, 25.75%). CADRs that were reported in our study were exanthematous rash, fixed drug eruptions, urticarial rashes, SJS, TEN, urticarial vasculitis, anticonvulsant hypersensitivity syndrome, erythema multiforme, contact dermatitis, exfoliative dermatitis, mucosal hyperpigmentation, and nail pigmentation, respectively. After a meticulous drug history, the drugs implicated in causing the cutaneous reactions were anticonvalscents such as phenytoin, carbamazepine, lamotrigine, and phenobarbitone. Other drugs identified were non-steroidal anti-inflammatory drugs such as oxicam, antibiotics such as sulfasalazine, cefixime, cefpodoxime, amoxicillin, fluoroquinolones such as levofloxacin and ciprofloxacin, chemotherapeutic agents such as cyclophosphamide, 5FU, and hydroxurea. Conclusion: The present study concluded that skin is most common target for ADRs. Drug-induced cutaneous reactions can be as simple as a mild rash to rare life-threatening SJS and TEN. Moreover, certain group of patients is at increased risk for developing CADR’s as women are more susceptible than men.

Introduction: Coronavirus Disease-19 (COVID-19) Pandemic affected healthcare delivery worldwide from all quarters be it routine or essential care, including cancer care. All aspects like screening, diagnosis, and treatment were affected regardless of the developmental status of countries. Aim: To find out the extent and magnitude of cancer care affected during pandemic by comparing the data during pandemic for outpatient visits, new registrations, admissions, and day-care chemotherapy sessions with prepandemic data. Materials and Methods: This retrospective study was conducted in the Department of Medical Oncology of State Cancer Institute in Srinagar, India. The parameters assessed were the number of outpatient visits, new registrations, admissions, and day care chemotherapy sessions from the department of Medical Oncology. Anonymised cumulative data of all the patients who availed these services was included. Data were collected for eight months, during pandemic in 2020 and were compared with the data from previous year 2019. The effect of lockdown was assessed by comparing these parameters with the non lockdown period. Statistical analysis was done by independent t-test. Results: The number of outpatient visits dropped from 15425 from non lockdown period to 12670 in lockdown period (p-value=0.019), number of new admissions from 1613 to 1418 (p-value=0.001), and chemotherapy sessions from 9374 to 8081, (p-value=0.004). The number of patient registrations also declined but the drop was not significant (p-value=0.171). All the parameters except in-patient admission improved during the non lockdown period with the highest improvement in registration, but inpatient admission revealed a similar reduction as in the lockdown period. Conclusion: There was a significant effect of lock down due to COVID-19 pandemic on the number of outpatient visits, new admissions and chemotherapy sessions. This infers that, the treatment protocols and chemotherapeutic management of cancer care were badly affected by the advent of the pandemic.

Image segmentation is one of the pivotal steps in image processing due to its enormous application potential in medical image analysis, data mining, and pattern recognition. In fact, image segmentation is the process of splitting an image into multiple parts in order to provide detailed information on different aspects of the image. Traditional image segmentation techniques suffer from local minima and premature convergence issues when exploring complex search spaces. Additionally, these techniques also take considerable runtime to find the optimal pixels as the threshold levels are increased. Therefore, in order to overcome the computational overhead and convergence problems of the multilevel thresholding process, a robust optimizer, namely the Levy flight and Chaos theory-based Gravitational Search Algorithm (LCGSA), is employed to perform the segmentation of the COVID-19 chest CT scan images. In LCGSA, exploration is carried out by Levy flight, while chaotic maps guarantee the exploitation of the search space. Meanwhile, Kapur’s entropy method is utilized for segmenting the image into various regions based on the pixel intensity values. To investigate the segmentation performance of ten chaotic versions of LCGSA, firstly, several benchmark images from the USC-SIPI database are considered for the numerical analysis. Secondly, the applicability of LCGSA for solving real-world image processing problems is examined by using various COVID-19 chest CT scan imaging datasets from the Kaggle database. Further, an ablation study is carried out on different chest CT scan images by considering ground truth images. Moreover, various qualitative and quantitative metrics are used for the performance evaluation. The overall analysis of the experimental results indicated the efficient performance of LCGSA over other peer algorithms in terms of taking less computational time and providing optimal values for image quality metrics.

This study was carried out to conduct the geographical discrimination of various types of honey, and their utilization in development of novel functional foods where in honey could be substituted in place of white sugar. Honey based apple spread and marmalade products were developed and evaluated for quality analysis. The results showed higher water activity (aw) and moisture content in Plectranthus rugosus (PR) honey based apple spread and marmalade while, TSS was highest (p < 0.05) in Multifloral (MF) honey based apple spread and marmalade. Hydroxymethylfurfural was found to be in the ranged of 6.77–7.05 (mg/kg) for honey based apple spread products and 3.09–3.46 (mg/kg) for honey based apple marmalade products. The lightness (L*) value was significantly highest in MF honey based apple spread and marmalades (p < 0.05). Redness (a*) and yellowness (b*) values were significantly highest in PR honey based apple spreads and marmalades and lowest in Robinia pseudo acacia (RSA) honey based apple spread and marmalades. In general, all MF honey based apple spreads and marmalades has the highest score for overall acceptability in comparison to RSA and PR honey based apple spreads. The values of gel strength (Fe), rupture force (FR), energy of penetration (E) and adhesiveness (A) in the given spread products were in the range of 1.50–1.54 N, 1.70–1.73 N, 17.00–17.05 Ns and −1.11–−1.08 Ns, respectively. The values of gel strength (Fe), rupture force (FR), energy of penetration (E) and adhesiveness (A) in the investigated marmalade products were in the range of 1.65–1.69 N, 2.08–2.13 N, 16.05–16.10 Ns and −1.14–−1.10 Ns, respectively.