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For the onchocerciasis data, our model is log odds fi Baseline fi [Agegrp] Example 19. Age group Logistic regression equation Predicted logodds 0 log odds fi constant fi 0 A age group A1:115 fi 0:930 A 0 fiA1:115 1 log odds fi constant fi 1 A age group A1:115 fi 0:930 A 1 fiA0:185 2 log odds fi constant fi 2 A age group A1:115 fi 0:930 A 2 fi 0:745 3 log odds fi constant fi 3 A age group A1:115 fi 0:930 A 3 fi 1:674 regression equation when age is included as a categorical variable, as described in Section 19. Substitution of the estimated regression coefficients into the logistic regression equation gives the predicted log odds in each age group. This shows that the linear assumption gives a good approximation to the observed log odds in each group. We now describe how these models can be extended to control for the confounding effects of one or more additional variables. In addition, we briefly cover regression modelling for risk ratios, rather than odds ratios, and for outcomes with more than two levels. We also explained how this approach assumes that effect modification (interaction) is not present, i. We now see how making the same assumption allows us to control for confounding using logistic regression. We will explain this in the context of the onchocerciasis dataset used throughout Chapter 19. Recall that we found strong associations of both area of residence and of age group with the odds of microfilarial (mf) infection. If the age distributions differ in the two types of area, then it is possible that age is a confounding variable for the association between area and mf infection. We will control for this possible confounding by fitting a logistic regression model, which includes the effects of both area and age group. We will start with hypothetical data, constructed so that it is easy to see how this logistic regression model works. We will then explain how to interpret the output when we apply the model to the real data. For example, the odds ratio comparing age group 1 with age group 0 in the savannah areas is 0. Similarly, the odds ratio comparing age group 2 with age group 0 are 10 in each area, and the odds ratios comparing age group 3 with age group 0 are 15 in each area. Savannah areas (Unexposed) Rainforest areas (Exposed) Odds ratio for Age group d/h Odds d/h Odds area effect 0 20/100 0. These equations define the logistic regression model for the effects of area and age group on the odds of mf infection. As described in Chapter 19, such a logistic regression model can be abbreviated to: Odds fi Baseline A Area A Agegrp As explained in Section 19.
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They also do not remove the need to follow the Local Rules and Work Instructions that have been developed at individual radiotherapy departments 2. Any liver / bone marrow disease X Bulk disease>10cm A =absence of B symptoms B =presence of either unexplained fever>380C; drenching night sweats; weight loss>10% in the 6 months prior to diagnosis 2. Following chemotherapy recommended starts at maximum within 3 months of completing chemotherapy. Follicular Lymphoma) 24-30 Gy / 12-15 fractions 2 Examples of Palliative Schedules: fi 20-30Gy / 5-10 fractions fi 12Gy / 4 fractions fi 8Gy / single fraction fi 4Gy / 2 fractions 5. Consent is to be taken by a practitioner who is familiar with lymphoma radiotherapy planning and administration. With common treatment planning systems, dosimetric calculations should not be influenced, except in sites such as mediastinum and para-aortic region where blood, volume is relatively large. It is recommended that each centre carry out a dosimetric analysis of the effects of contrast on the treatment planning calculations for individual anatomical sites. Pre-chemotherapy imaging is used to define the superior and inferior extent of the original disease. Orbit Conjunctival tumours: electrons or superficial X-rays with corneal shielding. T-Cell lymphoma: Outlining is same as for low-grade lymphoma but to a different dose. V30 <46%; V33 <60%; V38 <33%; V42 < 20% Kidney Single kidney irradiated: V15 65-70% Both kidneys irradiated: V15 20-25% for each kidney; mean dose < 18 Gy Partial kidney irradiation (all constraints are for combined kidneys): mean doses < 18Gy, V28 <20%; V23 <30%; V20 <32%; V12 <55%. For neck + mediastinum field D max < or = 42Gy Testis Maximum dose of 2Gy to any part of the volume Thyroid D100<45 Gy 9. A parallel-opposed field arrangement often remains the preferred beam arrangement. Inspiratory breath-hold techniques and image guided radiotherapy may offer advantage in certain scenarios and to be considered. Mapping pelvic Lymph nodes: guidelines for delineation in intensity modulated radiotherapy. Role of salvage radiation therapy for patients with relapsed or refractory Hodgkin lymphoma who failed autologous stem cell transplant.
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Use with caution in cases of hypertension, ethmoidal, frontal, sphenoidal, multisinusitis (involvement of >1 ischemic heart disease, glaucoma, prostatic hypersinus), unilateral, bilateral and pansinusitis (involvement of all trophy, diabetes mellitus and geriatric patients. The commonly involved sinuses are maxillary and contraindicated in patients using monoamine oxidase ethmoid. Topical decongestants: for nasal congestion, use should Acute rs, which is primarily an infectious disease, can range be limited to 3 days. Analgesics: Non-aspirin containing analgesics should be preferred because aspirin causes increased shedding of Etiology viruses. These have many course serotypes, which vary in potency and severity of infection. The infection is usually contracted through airborne dropless of bacterial colonization (Streptococcus pneumoniae, lets. Complications are occasional and include sinusitis, pharyndays and then followed by cough and nasal discharge. In infuenzal rhinitis (infuenza viruses A, B or C) complicaof nose, nasal stufness, rhinorrhea and sneezing. Nasal watery discharge is profuse and may become mucochicken pox) secondary infection and complications are purulent due to secondary bacterial invasion (Streptococcus more frequent and severe. Antihistamines: Symptoms can be easily controlled with antihistaminics and nasal decongestants. Most common bacteria: the three bacteria, which account often without sedation or other noticeable symptoms. Other: They include anaerobes, Streptococcal species and As the rhinorrhea is diminished due to anticholinergic Staphylococcus aureus. Halitosis, periorbital edema and nasal congestion may be They are following: present. Allergic rhinosinusitis dental and gum pain (especially in maxillary sinus involve3. The most specific feature is purulent exudates in pools causes chemical infammation. Postural test is done if no frank pus is seen in the middle premolars: They involve maxillary sinus. The root of a tooth, during extraction, may be pushed of cotton soaked in topical decongestant. Acute infammation of mucosa causes hyperemia, exudamaxillary sinuses light is placed in oral cavity and light tion of fuid, outpouring of polymorphonuclear cells and transmission is compared over maxillary sinuses. Symptoms may include obstruction of osteomeatal complex, polypoid of upper respiratory tract infection which last for more than 10 changes and bony abnormalities.
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International measures: Control of fish or fish products imported from endemic areas. Opisthorchis felineus occurs in Europe and Asia, and has infected 2 million people in the former Soviet Union; O. These worms are the leading cause of cholangiocarcinoma throughout the world; in northern Thailand, rates for the latter are as high as 85/10 000 population. The biology of these fiatworms, the characteristics of the disease and methods of control are essentially the same as those for clonorchiasis. The primary infection may be entirely asymptomatic or resemble an acute infiuenzal illness with fever, chills, cough and (rarely) pleuritic pain. About 1 in 5 clinically recognized cases (an estimated 5% of all primary infections) develops erythema nodosum, most common in Caucasian females and rarest in American males of African origin. Primary infection may heal completely without detectable sequelae; may leave fibrosis, a pulmonary nodule that may or may not have calcified areas; may leave a persistent thin-walled cavity; or most rarely, may progress to the disseminated form of the disease. An estimated 1 out of every 1000 cases of symptomatic coccidioidomycosis becomes disseminated. Coccidioidal meningitis resembles tuberculous meningitis but runs a more chronic course. Serial skin and serological tests may be necessary to confirm a recent infection or indicate dissemination; skin tests are often negative in disseminated disease, and serological tests may be negative in the immunocompromised. It grows in soil and culture media as a saprophytic mould that reproduces by arthroconidia; in tissues and under special conditions, the parasitic form grows as spherical cells (spherules) that reproduce by endospore formation. Elsewhere, dusty fomites from endemic areas can transmit infection; disease has occurred in people who have merely travelled through endemic areas. More than half the patients with symptomatic infection are between 15 and 25; men are affected more frequently than women, probably because of occupational exposure. Infection is most frequent in summers following a rainy winter or spring, especially after wind and dust storms. It is an important disease among migrant workers, archaeologists and military personnel from nonendemic areas who move into endemic areas. Since 1991, a marked increase of coccidioidomycosis has been reported in California. While the parasitic form is normally not infective, accidental inoculation of infected pus or culture suspension into the skin or bone can result in granuloma formation.
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