Institute of Radiotherapy and Nuclear Medicine

Abstract Background In external beam radiotherapy, over radiation dose results in severe side-effects, but under radiation dose decreases the probability of treatment for cancer patients. The purpose of the article was to verify treatment delivery in radiotherapy of the cancer patients using single point dose verification method. Methods Computed tomography (CT) simulation of intensity-modulated radiation therapy (IMRT) phantom with slot-in ion chamber was done. The IMRT phantom was set on the treatment table of LINAC (Siemens) with FC65-P Farmer type thimble chamber for radiation dose measurement. Different plans were prepared on prowess panther treatment planning system (TPS) using CT images of IMRT Phantom. The monitor units (MU) and doses were calculated for both photon algorithms i.e. Collapsed Cone Convolution Superposition (CCCS) and Fast Photon (FP) algorithms. The calculations for treatment verification were done for both 6MV and 15MV energies produced by LINAC (Siemens) at central axis as well as off axis beams. Results The percentage difference between the measured and calculated dose was less than 1% except for those plans which have greater number of posterior beams. These percentage errors were slightly greater than 1% but well within international recommended limits of ± 3%. Conclusion The percentage error in radiotherapy treatment delivery within limit confirms the best quality of radiotherapy treatment at the institute. The couch attenuation lessens the posterior beams’ dose slightly which can be reduced by incorporating the couch attenuation correction factor while calculating dose on treatment planning system.

We report an unusual case of an 11-year-old male with Ewing's sarcoma of the right fibula who presented 6years post-remission with progressive dyspnea, fever, and swelling of the right ankle. Imaging revealed multiple partially calcified "cannonball" pulmonary metastases and a large, partially ossified, pleura-based mediastinal mass-an atypical metastatic presentation for this tumor. Histopathological confirmation was essential due to the diagnostic challenge posed by the calcifications, which are typically associated with infection or other malignancies. This case highlights the importance of considering atypical metastatic presentations in Ewing's sarcoma and emphasizes a multimodal diagnostic approach. The findings contribute to the sparse literature on calcified metastases in Ewing's sarcoma, calling for further research to understand the mechanisms and clinical significance of such presentations.

BackgroundOral squamous cell carcinoma is the most common malignant neoplasm of the oral cavity, contributing significantly to cancer-related mortality worldwide. Circulating tumor DNA could be a promising biomarker for the early diagnosis and prognosis of oral cancer.ObjectiveThe aim of this systematic review was to consolidate the existing literature on the role of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) in the diagnosis and prognosis of oral cancer.MethodologyThe review protocol followed PRISMA guidelines. A systematic search was conducted across PubMed, Web of Science, Google Scholar and SCOPUS. Only English-language studies were included, while narrative reviews, HPV-positive OSCC, systematic reviews, meta-analyses, abstracts, and letters to the editor were excluded. Data were extracted on study design, country, sample size, participant characteristics, assessment methods, type of oral cancer and measured outcomes. Risk of bias was evaluated using Newcastle-Ottawa Scale (NOS).ResultsA total of 3,155 records were identified, out of which 17 studies met the inclusion criteria. These comprised eleven cohort studies, one was a case series, two were descriptive studies, and three were case-control studies. The studies primarily addressed oral squamous cell carcinoma (OSCC) and head and neck squamous cell carcinoma (HNSCC). Findings revealed that elevated cfDNA levels are associated with poor prognosis, lymph node metastasis, larger tumor size and advanced disease stages. ctDNA acts as a predictive tool for monitoring cancer progression, treatment response, recurrence risk, and overall survival. Among 12 studies evaluated using NOS, 8 were of good quality, while 4 were fair quality.ConclusionctDNA and cfDNA exhibit promising prognostic and diagnostic potential for OSCC and HNSCC. Elevated cfDNA levels correlate with poor prognosis, while ctDNA shows potential for monitoring cancer progression and treatment response.

Background: Malaria and anemia especially iron-deficiency anemia are two primary maternal health complications in areas where malaria is endemic. Objectives: To determine the impact of maternal iron levels on the risk of malaria infection in women of childbearing age residing in malaria-endemic areas. Methodology: This study conducted in the department of Community medicine department Khyber Medical College Peshawar from june 2023 to dec 2023. The study population of 200 pregnant women was obtained using non-probability sampling techniques. The study assessed the iron status of pregnant women which included checking their haemoglobin serum ferritin serum iron concentration and transferrin saturation levels. Malaria was diagnosed using peripheral smear and rapid diagnostic tests. The population was then analyzed to determine their iron sufficiency status and the respective group to which they belonged. The data were analyzed using SPSS version 24.0. Results: 80 of 200 patients. The patients had Mean age of 26.4 years with a standard deviation of 4.8 years. The results indicated that malaria was present in 58 of the 120 iron-deficient female patients which constituted 48.3% with a statistical significance of 0.003. In contrast only 22 of the 80 iron-sufficient females had malaria resulting in an infection rate of 27.5% with a statistical significance of 0.003. The mean hemoglobin concentration of patients with malarial infection was 9.1 ± 1.2 g/dL while that of infected patients without malarial infection was 10.6 ± 1.4 g/dL showing a statistically significant difference of less than 0.001. The analysis revealed a negative correlation between the amount of serum ferritin and the level of parasitemia with a correlation coefficient of r = -0.41 and a p-value of 0.01. Conclusion: During iron deficiency pregnant women have an elevated risk of malaria infection indicating that iron supplementation strategies must be developed and tailored accordingly. Antenatal care that monitors and corrects iron deficiency will reduce the complications of malaria particularly in areas with high malaria transmission.

This systematic review evaluated the efficacy and safety of photodynamic therapy (PDT) in the management of cutaneous leishmaniasis (CL). The electronic search for identification of relevant studies, adhered to the PICOS (Population, Intervention, Comparator, Outcomes and Study type) framework, was conducted through PubMed, Google scholar, Dimensions, X-mol, and Semantic Scholar till December 2023. All types of studies reporting PDT in the management of CL with no language restriction were included. Methodological quality appraised of the selected studies was performed using Jadad index. Of the 317 identified studies, 21 reported PDT for the treatment of CL lesions, consisting of two randomized controlled trials (RCTs), four single-center open study, one case series and 14 case reports. Collectively, these studies presented a total of 304 patients with ages ranging from 1 to 82years, undergoing varying number of PDT sessions (3-28) and follow-up durations spanning 4weeks to 24months. The CL lesions predominantly manifested on the exposed body areas, such as face, limbs, neck, ear and nose, and characterized with the use of clinical variables, such as plaques, papules, erythema and ulceration. PDT protocols differed in the photosensitizer type, incubation time, light source characteristics (e.g., wavelength, output power, and energy density), duration of light illumination, number of PDT sessions and their respective frequencies. Treatment response was assessed through the clinical presentation (i.e., at the baseline and after PDT completion) or by the absence of Leishmania parasites. Adverse effects comprised of pain, burning and tingling sensation experienced during PDT, followed by erythema, pigmentation changes and edema post-treatment. This systematic review revealed that PDT is an efficacious and safe modality for the treatment of CL, with mild and transient side effects.

This case study evaluates the impact of a multidisciplinary rehabilitation approach combining Dance/Movement Therapy (DMT) andpsychological motion therapy on an ovarian cancer patient having chemotherapy-induced peripheral neuropathy (CIPN). The patient, U.B, had a five-week intervention targeted at improving physical functioning, lowering neuropathic pain, and raising overall quality of life. Baseline assessments included tests of grip strength, knee and shoulder flexion, psychological well-being using the Hospital Anxiety and Depression Scale (HADS), neuropathic pain using the DN4 scale, and quality of life using the EORTC QLQ-C30. The intervention comprised weekly sessions integrating DMT and psychological approaches, followed by weekly examinations to track development. Results demonstrated considerable increases in physical functioning, with grip strength increasing by 4 kg in both hands and notable advances in knee and shoulder flexion. Psychological well-being showed great progress, with HADS ratings for anxiety and depression falling significantly. The DN4 neuropathic pain score reduced from 8 to 5, showing a considerable reduction in pain. Quality of life metrics improved across several areas, including physical activities, work and leisure, and general health. The overall health score climbed from 4 to 6, while the quality-of-life score improved from 3 to 5. This study illustrates the usefulness of a holistic rehabilitation approach in treating CIPN and enhancing the quality of life for ovarian cancer patients. The confluence of physical and psychological therapy offers a complete strategy for treating the numerous issues associated with CIPN. These findings imply that multidisciplinary therapies should be used in cancer rehabilitation programs to enhance patient outcomes. Further study with larger samples and randomized controlled trials is necessary to validate these results and explore the long-term advantages of such therapies.

This systematic review aims to compare the efficacy and safety of a novel immunotherapy with low-dose interleukin 2 (IL2) across two of the most prevalent autoimmune diseases i.e. systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Contemporary therapeutic practices have not been able to achieve complete remission from these autoimmune disorders. In contrast, low-dose IL2has shown promise in achieving this therapeutic goal via inducing self-tolerance in patients with autoimmune diseases; however, due to variable irregularities among autoimmune processes of variable diseases, the benefit of low-dose IL2 could not be determined among different autoimmune diseases. Therefore, we conducted a study to compare low-dose IL2 therapy effects on SLE and RA. We systematically screened four databases: PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), and Google Scholar. Inclusion and exclusion criteria were implemented. Quality appraisal of studies chosen for the review was done using the Cochrane Risk-of-Bias (RoB) assessment tool for randomized controlled trials, and the Newcastle-Ottawa Scale (NOS) and JBI critical appraisal tool for non-randomized clinical trials. Information was gathered from seven articles: three randomized controlled trials and four non-randomized clinical trials. Our review concluded that low-dose IL2 therapy in conjunction with respective standard therapies for SLE and RA has a higher efficacy and safety profile as compared to standard therapy alone and the therapeutic effects were comparable in both SLE and RA patients treated with low-dose IL2; however, this novel intervention does not seem to have a significant corrective effect on the biomarkers of RA as it does for SLE biomarkers.

RESUMO Objetivos: desenvolver e validar um plano de cuidado de enfermagem em Unidade de Terapia Intensiva Materna. Métodos: estudo metodológico, desenvolvido em etapas: revisão integrativa; construção do Histórico de Enfermagem; reestruturação do plano de cuidados; validação de aparência e conteúdo por juízes. Resultados: o histórico foi organizado em seções: Identificação; Necessidades Humanas Básicas; Exame Físico; e avaliação das Necessidades Humanas Básicas. O plano de cuidado foi reestruturado com 34 diagnósticos, organizados segundo as necessidades humanas básicas. Obteve-se nível satisfatório de validação de aparência do histórico e plano de cuidados (Índice de Concordância variando entre 86,3 e 100 para ambos os intrumentos), e validação de conteúdo com média dos índices de 90,8 e 92,8, respectivamente. Foram consolidados 34 diagnósticos, suas intervenções e ações de enfermagem. Conclusões: os instrumentos foram considerados relevantes e pertinentes quanto aparência e conteúdo, podendo ser recomendada sua utilização na instituição em estudo, bem como em outros serviços semelhantes.