Morphologic MRI features, diffusion tensor imaging and radiation dosimetric analysis to differentiate pseudo-progression from early tumor progression

Pseudo-progression (PsP) refers to the paradoxical increase of contrast enhancement within 12 weeks of chemo-radiation therapy in gliomas attributable to treatment effects rather than early tumor progression (ETP). This study was performed to evaluate the utility of morphologic imaging features, diffusion tensor imaging (DTI) and radiation dosimetric analysis of magnetic resonance imaging (MRI) changes in differentiating PsP from ETP. Serial MRI examinations of 163 patients treated for high-grade glioma were reviewed. 46 patients showed a recurrent or progressive enhancing lesion within 12 weeks of radiotherapy. We used an in-house modified scoring system based on 20 different morphologic features (modified VASARI features) to assess the MRI studies. DTI analyses were performed in 24 patients. MRI changes were defined as recurrent volume (V_rec) and registered with pretreatment computed tomography dataset, and the actual dose received by the V_rec during treatment was calculated using dose–volume histograms. Bidimensional product of T2-FLAIR signal abnormality and enhancing component was larger in the ETP group. DTI metrics revealed no significant difference between the two groups. There was no statistically significant difference in the location of V_rec between PsP and ETP groups. Morphologic MRI features and DTI have a limited role in differentiating between PsP and ETP. The larger sizes of the T2-FLAIR signal abnormality and the enhancing component of the lesion favor ETP. There was no correlation between the pattern of MRI changes and radiation dose distribution between PsP and ETP groups.     

Synthesis,Molecular Docking and Biological Evaluation of Diaryl Pyrimidine Derivatives as Urease Inhibitors

Pharmaceutical Chemistry Journal - Urease is a dinickel enzyme that is responsible for the hydrolysis of urea to ammonia and carbon dioxide. A series of bacteria like Helicobacter pylori produce...     

Cost of Comorbid Alcohol and Drug Problems

The authors measured the comorbid effect of alcohol and other drug (AOD) problems on medical, surgical, and psychiatric inpatient charges and length of stay (LOS) in an urban hospital by use of retrospective study of hospital clinical computer data comparing AOD-affected patients with non-AOD-affected patients in terms of cost, diagnostic, demographic, and utilization variables (N = 14,768). Patients were men and women with and without comorbid history of AOD problems, admitted for medical, surgical, and psychiatric reasons. For 10 of the 20 most frequent Diagnosis-Related Groups (DRGs), total hospital charges and LOS were significantly lower in patients with comorbid AOD problems (P < 0.001). Overall, for the most frequent 20 DRGs, total charges and LOS remained significantly lower for the AOD group. Most physicians believed that AOD-affected patients were often less ill than non-AOD patients within the same DRG. Alcohol/drug-affected patients had robustly lower costs and LOS. Fragmentation of psychosocial costs and addiction treatment from general health care and the fee-for-service DRG system appear to financially reward acute-care hospitals to repeatedly treat secondary AOD sequelae without providing any apparent incentives for the treatment of the primary alcohol/drug condition itself.     

Community-Based Assessment of Knowledge,Attitude, Practices and Risk Factors Regarding COVID-19 Among Pakistanis Residents During a Recent Outbreak: A Cross-Sectional Survey

Exceptional precautionary measures have been adopted to stop the transmission and control of COVID-19 through the world and Pakistan is facing lockdown in this scenario. Public loyalty to precautionary measures is affected by their knowledge, attitude, risk factors and practices (KAP) towards COVID-19. The present study was conducted among the Pakistani residents to observe the knowledge, attitude, practices and risk factors towards COVID-19 outbreak in Pakistan. A questionnaire was designed, and a cross-sectional survey was conducted among participants of the study area. Participants were asked the questions regarding knowledge, attitude, practices and risk factors towards COVID-19. Data were analyzed by SPSS and t/F test and correlation was applied among the knowledge, attitude, risk factors and practices. A total of 1060 questionnaires were received. 1004 were included while 56 were excluded. The highest representation was from Punjab province (65.6%), female (63%) and age group of 21–30 years (62.1%). Most participants were single (85%), Muslim (99.4%), Urdu speaking (45.6%) and were graduates (51.5%). Most of the participants were students (52.9%) and were from economically middle-class families (40.8%). The knowledge was positively correlated with attitude and practices whereas negatively correlated with risk factors (P?<?0.05). The attitude was negatively correlated with risk factor and positively correlated with practices. The risk factors and practices were positively correlated with each other. Health education program to improve the COVID-19 knowledge, attitude, practices and risk factors should be initiated to combat current health challenge.

     

Access to high-volume surgeons and the opportunity cost of performing radical prostatectomy by low-volume providers

Background

Evidence suggests that redirecting surgeries to high-volume providers may be associated with better outcomes and significant societal savings. Whether such referrals are feasible remains unanswered.

Potential use of drug carried-liposomes for cancer therapy via direct intratumoral injection

Liposomes have recognized advantages as nano-particle drug carriers for tumor therapy. In this study, the pharmacokinetics and distribution of intratumorally administered liposomes were investigated as drug carriers for treating solid tumors via direct intratumoral administration. 99mTc-liposomes were administered intratumorally to nude rats bearing human head and neck squamous cell carcinoma xenografts. Planar gamma camera images were analyzed to evaluate the local retention of the intratumorally administered liposomes. Co-registered pinhole micro-single photon emission computed tomography (SPECT)/computed tomography (CT) images were acquired of the whole animal as well as the dissected tumors to determine intratumoral distribution of the 99mTc-liposomes. For 99mTc-liposomes, there was an initial retention of 47.4 +/- 11.0% (n = 4) in tumors and surrounding tissues. At 20 h, 39.2 +/- 10.6% (n = 4) of 99mTc-activity still remained in the tumor. In contrast, only 18.7 +/- 3.3% (n = 3) of the intratumoral 99mTc-activity remained for unencapsulated 99mTc-complex at 20 h. Pinhole micro-SPECT images demonstrated that 99mTc-liposomes also have a superior intratumoral 99mTc-activity diffusion compared with unencapsulated 99mTc-complex. Higher intratumoral retention of 99mTc-liposomes accompanied by an improved intratumoral diffusion suggests that intratumorally administered liposomal drugs are potentially promising agents for solid tumor local therapy.     

Radiological analysis of the ethmoid roof in the Malaysian population

Objective

To ascertain the prevalence of the lateral lamella of the cribriform plate height according to Keros classification in the Malaysian population, and to find if there is any difference between the major ethnic groups in Malaysia (Malay, Chinese, Indian).

Methods

Retrospective analysis of 150 CT scan studies of the paranasal sinuses.

Results

The mean height of the lateral lamella of the cribriform plate (LLCP) in 300 sides was 2.64 mm. Keros type I was seen in 240 sides (80%), while, Keros type II was seen in 60 sides (20%). There was no significant difference in the distribution of Keros classification among the major ethnic groups of Malaysia (Malay, Chinese, Indian). Keros type I was seen in 103 sides in males and 137 sides in females. Significant difference was observed in type II between the male and female (47 sides in males and 13 sides in female; p-value <0.001). When comparing the difference in the height of the LLCP in the same individual, asymmetry was observed in 139 patients. The LLCP height was higher on the left side in 71 patients and higher on the right in 68.

Conclusion

The understanding of the anatomy of the ethmoid roof with its possible variation is crucial to give the surgeon the optimal information about the possible risk that one can face during the surgery.