Exploratory analysis of 64 CuCl 2 PET-CT imaging in carcinoma prostate and its comparison with 68 Ga-PSMA-11 and 18 F-FDG PET-CT.

AIM: Exploratory analysis of 64 CuCl 2 PET-CT imaging in patients of carcinoma prostate and its head-to-head comparison with 68 Ga-PSMA-11 and 18 F-FDG PET-CT. METHODS: In this prospective study, 50 patients of biopsy-proven carcinoma prostate belonging to the entire spectrum of disease were evaluated, out of which 21 patients were for initial staging and 29 were for restaging/response evaluation. Both 64 CuCl 2 (early and delayed) and 68 Ga-PSMA-11 PET-CT were undertaken in all patients and 18 F-FDG PET-CT was done in patients whenever possible. All scans were done within a period of 2 weeks, without any interim therapeutic intervention. 64 CuCl 2 PET-CT was acquired at 1 and 3 h. We evaluated the physiological uptake of 64 CuCl 2 , correlated the uptake in primary with disease parameters like Gleason score and serum PSA levels, and compared the detection rates for primary and metastatic disease with 68 Ga-PSMA-11 and 18 F-FDG PET-CT. RESULTS: The detection rates of primary disease were same for both 64 CuCl 2 and 68 Ga-PSMA-11 PET-CT and both agents performed similarly in detecting extra-prostatic disease. There was no statistically significant correlation observed between the uptake of 64 CuCl 2 in the primary lesion with disease parameters. With regard to the evaluation of metastatic disease, the detection rate of 64 CuCl 2 PET-CT was 86% for lymph nodes, 77.3% for skeletal metastases and 80.6% for soft tissue metastases while 68 Ga-PSMA-11 PET-CT performed better with detection rates were 98%, 99% and 85.4%, respectively. In 17 patients where 18 F-FDG PET-CT was available, 64 CuCl 2 PET-CT detected more metastatic disease than 18 F-FDG PET-CT. CONCLUSION: 64 CuCl 2 PET-CT did not show any additional advantage over 68 Ga-PSMA-11 PET-CT in evaluation of local disease or for the assessment of metastatic disease. When compared to 68 Ga-PSMA-11 PET-CT, the absence of urinary bladder and ureteric activity allows better contrast for evaluating local disease, but it does not translate into increased disease detection.

Angiogenesis Imaging of Adrenocortical Carcinoma with Ga-68-NODAGA-RGD Positron Emission Tomography: Opening New Horizons in Multimodality Imaging from Theranostic Perspective.

A 53-year-old female, with a known case of adrenocortical carcinoma (ACC), underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for initial staging, which revealed FDG avid large left suprarenal mass contiguous with hypermetabolic tumor thrombus in the inferior vena cava (IVC) through the left renal vein. Thereafter, she underwent angiogenesis imaging using Ga-68-NODAGA-RGD PET/CT, which showed similar avid tracer uptake in both primary and IVC thrombus. Demonstration of RGD avidity in ACC in this case opens a new horizon for targeted radionuclide therapy (e.g., Lu-177 RGD) in selected patients, who may have limited therapeutic options.

Relationship Between Ergonomic Awareness and Work-related Musculoskeletal Disorders Among Staff Nurses in Oman: An Observational Study.

Objectives: To detect the level of ergonomic awareness related to work-related musculoskeletal disorders among 200 staff nurses in a tertiary hospital. The additional objective was to study the relationship of such awareness with the prevalence of these disorders. Methods: A group of 25-45-year-old staff nurses and a body mass index of ≤ 30 kg/m2, with at least one year working experience were randomly selected from different wards of the Royal Hospital, Muscat. The study excluded nurses who were on leave and those who had sustained traffic accidents or sports injuries in the preceding year. Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to measure the work-related musculoskeletal disorders experienced by the nurses. A second questionnaire was administered to measure their ergonomic awareness. The data was statistically analyzed. Correlations were established by Spearman's rank correlation coefficient (ρ). Results: The participants were 200 staff nurses (male = 30 male, female = 170). Analysis of the ergonomics awareness construct indicated 'agreement' as an overall response with a mean of 3.2±0.6, indicating fair ergonomic awareness. For CMDQ, 50.3% reported discomfort in the low back region, 15.0% in the neck, and 6.9% in the right lower leg. The left wrist, left forearm, and right upper arm had the least reported discomfort (< 1.0%). The correlation between ergonomic awareness and working ability was weakly positive, yet statistically significant (ρ = 0.210; p = 0.003). Correlations were not statistically significant between ergonomic awareness and discomfort (ρ = -0.031; p = 0.664) and between ergonomic awareness and total frequency (ρ = 0.109; p = 0.123). Conclusions: There is a strong need to develop practical ergonomic awareness among nursing staff for a sustainable and safe work environment.

Frequency of Congenital Cardiac Disease in Various Divisions of Khyber Pakhtunkhwa (KPK) Based on a Six-Month Analysis of Inpatients at a Tertiary Care Hospital's Pediatric Cardiology Unit.

OBJECTIVE: To identify the frequency of congenital heart disease (CHD) in various Khyber Pakhtunkhwa (KPK) divisions. MATERIALS AND METHODS: To perform this research, we reviewed the medical records of pediatric cardiology patients hospitalized between January 2022 and July 2022. Data was taken from the cardiology department's computerized data system between January 1 and July 31, 2022. To prevent any errors in diagnosis and address them during input by the ward clerk, patients' addresses, diagnoses, and gender were verified with the computerized medical record. Data were analyzed, and frequency and percentages were calculated. Per the digital mapping of KPK districts, we stratified and examined the data among various KPK divisions. RESULTS: Out Of the 371 patients with CHD who were admitted, 36.98% (137) were from the Peshawar division, 28.84% (107) from the Malakand division, 16.71% (62) from the Mardan division, 6.1% (23) from the Kohat division, 4.3% (16) from the Bannu division, 3.5% (13) from the Dera Ismail Khan division, and 3.5% (13) from the Hazara division. A total of 371 had CHD, of which 234 (63.07%) were cyanotic and 137 (36.92%) were cyanotic. The most prevalent acynotic congenital heart defect was patent ductus arteriosus (PDA) at 36.32% (85), followed by a ventricular septal defect (VSD) at 35.04 (82). The most frequent acyanotic congenital cardiac abnormality was tetralogy of Fallot (TOF) at 49.63% (68), which was followed by transposition of the great arteries (TGA) at 33.57% (46). CONCLUSION: In KPK, congenital heart disease is most prevalent in the divisions of Peshawar and Malakand, while it is least prevalent in Hazara.

Effects of repeated volitional swallowing on the excitability of submental corticobulbar motor pathways.

The aim of this study was to examine the effects of repeated volitional saliva swallowing on corticobulbar excitability recorded during two muscle preactivation conditions of the submental muscle group. Motor-evoked potentials (MEPs), elicited by transcranial magnetic stimulation (TMS), were assessed in ten healthy volunteers prior to and at 5, 30, 60, and 90 min after 60 volitional saliva swallows (Protocol A). To control for intrinsic fluctuations in corticobulbar excitability during this assessment period, MEPs were also recorded, on a different day, at 30-min intervals across a 2-h period (Protocol B). At each assessment, 15 MEPs were recorded during two submental muscle preactivation conditions: volitional contraction and contraction associated with the pharyngeal phase of volitional swallowing. There were no significant effects of repetitive volitional swallowing or time on MEP measures (p>0.05). We conclude that volitional saliva swallowing does not have immediate effects on the excitability of corticobulbar projections to the submental musculature during volitionally initiated swallowing motor tasks. These results provide no evidence for use-dependent potentiation of corticobulbar excitability through repetitive saliva swallowing. The lack of effects of time on mean MEP measures supports previous reports of good intrasession reliability of MEPs as a measure of corticobulbar excitability.

Suture-Button Versus Syndesmotic Screw Fixation of Ankle Fractures: A Comparative Retrospective Review Over One Year.

Background Syndesmotic fixation is essential in the management of unstable ankle fractures with syndesmotic disruption. It can be achieved either by rigid fixation with screws or dynamic fixation with suture-button devices. Syndesmosis screws are considered the gold standard for the stabilisation and fixation of distal tibiofibular syndesmotic injuries. We use both types of devices in our unit for the stabilisation of syndesmotic injuries. In our department, Arthrex TightRope® (Arthrex, Naples, FL) is the preferred suture-button device for the dynamic fixation of distal tibiofibular syndesmosis. Some studies have reported better outcomes with the use of suture-button devices. In this study, we aim to compare the outcomes with the use of both these devices. Methodology This retrospective cohort study was conducted from 1 June 2019 until 31 May 2020 which included all patients who underwent syndesmotic fixation. Data were collected from the Northern Ireland Electronic Care Record and the Northern Ireland Picture Archiving and Communication System. Primary outcomes included reoperation rates due to failure of syndesmotic hardware. Secondary outcomes included the comparison of complications (e.g. infection, wound problems, or loss of reduction) radiographic fixation/stability, duration of follow-up, and significant ongoing symptoms at the time of discharge from the clinic. Results A total of 53 patients underwent syndesmotic stabilisation during this period. In total, 34 patients underwent fixation with TightRope and 19 underwent syndesmotic screw fixation. Three patients (9%) had reoperation due to any cause in the TightRope group compared to four patients (21%) in the syndesmotic screw group. All four patients in the syndesmotic screws group underwent implant removal due to failure or symptoms due to implant. Only one patient (3%) in the TightRope group underwent implant removal due to ongoing pain [the other two (6%) patients included one with lateral ankle abscess and one with long distal fibula screws, both unrelated to the use of TightRope and TightRope left in situ at reoperation]. Rediastasis was reported in one (5.2%) patient with syndesmotic screws. The median duration of follow-up was 82 days in the syndesmotic screw group compared to 77.5 days in the TightRope group. Conclusions Based on our data, we report a lower incidence of implant-related problems and the need for implant removal with the use of TightRope. Quicker return to weight-bearing and slightly better radiographic stabilisation were noted as well. Our study has its limitations in terms of a small number of patients and the absence of functional outcomes as these were not routinely recorded at the time of discharge from the clinic.

Mesenteric Castleman's disease mimicking neuroendocrine tumour.

INTRODUCTION: Castleman's disease is a rare entity and is a benign hyperplastic enlargement of lymph nodes. It can occur anywhere within the body but only approximately 50 cases of mesenteric Castleman's disease have been reported within the literature. CASE PRESENTATION: We report a female patient who was thought to have developed a neuroendocrine tumour within the small bowel and a large nodal mass within the mesentery based on nuclear scintigraphy imaging. Following surgical resection the nodal mass found confirmed to be Castleman's disease. DISCUSSION: Although rare complete resection of mesenteric Castleman's disease offer excellent long term outcome although the diagnosis may only be made after surgery. CONCLUSION: The diagnosis of mesenteric Castleman's disease is often made post-operatively but complete surgical resection offers excellent long-term survival.

Pharyngeal pressure differences between four types of swallowing in healthy participants.

PURPOSE: The aim of this observational study was to identify biomechanical differences, as measured by pharyngeal manometric pressure patterns, between discrete and continuous water swallowing, as well as volitionally initiated and reflexive swallowing. METHODS: Using pharyngeal manometry, swallowing-related pressures from 24 young healthy individuals were recorded at three locations: upper pharynx, mid-pharynx and upper oesophageal sphincter (UES) during four swallowing conditions: discrete saliva swallowing, discrete 10ml water swallowing, volitional continuous water swallowing, and reflexive continuous water swallowing. Measures of peak pressure and pressure duration at each level were compared across conditions using repeated-measures analysis of variance. RESULTS: UES nadir pressure during saliva swallowing was lower than during water swallowing conditions (p<0.05). In addition, nadir pressure during discrete 10ml water swallowing was lower than during reflexive and volitional continuous water swallowing conditions (p<0.05). Saliva swallowing produced longer pressure duration than water swallowing conditions at the upper pharynx (p<0.05). Saliva swallowing produced pressure of greater duration than reflexive continuous water swallowing at mid-pharynx (p<0.05). Further, discrete 10ml water swallowing produced longer UES opening duration and longer pharyngeal pressure generation (p<0.05) than reflexive continuous water swallowing or saliva swallowing. CONCLUSION: Pressure generation differs between swallowing types and bolus types at the level of the UES in particular. These physiological differences between swallowing and bolus types may support clinical decisions for individuals with impaired swallowing.

Seroprevalence of HBV, HCV and HIV infections among college going first time voluntary blood donors.

OBJECTIVE: College going first time voluntary blood donors were tested for HBV, HCV and HIV infections, to know the seroprevalence of these diseases among them. METHOD: Blood donation camps were organized at 18 colleges and universities of the city and a total of 612 samples from first time donors were tested for HbsAg, anti-HCV, anti-HIV1, 2 antibodies on Abbott Diagnostic systems. RESULTS: Thirteen voluntary blood donors (2.21% with 95% confidence limit 1.2-3.52%) were HbsAg and 3 (0.5% with 95% confidence limit 0.12-1.33%) were anti HCV positive. None of the donors was positive for HIV infection. CONCLUSION: Seroprevalence of HBV, HCV and HIV infections among college going students is significantly low (< 3.0%) than 30% seroprevalence among paid donors and 7% among family/replacement blood donors. There is a need to educate, motivate and recruit college going students to regularly donate blood to ensure relatively safe supply of blood for transfusion services.

To evaluate and compare the effects of first generation anti-histamine (chlorpheniramine maleate) and second generation anti-histamine (loratadine) on isolated trachea of rabbit.

OBJECTIVE: The incidence of respiratory allergy has increased gradually over the past several years and current estimates suggest that allergic rhinitis affects approximately 20% of the population. Large scales population surveys indicate that up to 38% of patients with rhinitis have asthma. The allergic response in the airways is an important pathogensis to cause bronchoconstriction owing to increased responsiveness of tracheo bronchial tree to various stimuli and also causes the release of histamine and other chemical mediators from mast cells. Histamine has been shown to be an important mediator of an allergic reaction in both the upper and lower respiratory airways. Chlorpheniramine maleate is a stable, most potent, sedative first generation anti-histamine and is effective in the treatment of allergic disorders. Loratadine is a highly potent, non-sedating, long acting tricyclic, second generation anti-histamine. It is indicated in allergic rhinits, chronic idiopathic urticaria and allergic bronchial asthma. The purpose of study was to evaluate the antagonistic effects of chlorpheniramine maleate and loratadine on histamine induced contractions in isolated trachea of rabbit and also to compare the effects of first generation anti-histamine (chlorpheniramine maleate and second generation anti-histamine loratadine). METHODS: In this study twenty-four experiments were performed on isolated trachea of rabbit, in the presence of selected standard concentration of histamine dihydrochloride, antagonistic effects of various concentrations of chlorpheniramine maleate (10-18 to 10(-3) gm/ml) and loratadine from concentrations 10(-18) to 10(-3) gm/ml were recorded by Polygraph Model 7B in terms of rate and amplitude. RESULTS: Chlorpheniramine maleate showed non-significant antagonistic effect from concentrations 10(-18) to 10(-3) gm/ml in case of rate and 10(-18) to 10(-8) gm/ml in case of amplitude. Significant response showed from concentrations 10(-8) to 10(-3) gm/ml in case of rate (P<0.001) and 10(-7) to 10(-3) gm/ml in case of amplitude (P<0.001) while, loratadine showed non-significant response from concentrations 10(-18) to 10(-12) gm/ml in case of rate and from concentration 10(-18) to 10(-14) gm/ml in case of amplitude. Significant response observed from concentrations 10(-11) to 10(-3) gm/ml in case of rate and 10(-13) to 10(-3) gm/ml in case of amplitude. CONCLUSION: It was concluded that chlorpheniramine maleate antagonized the histamine induced contractions 80.65% at concentration 10(-3) gm/ml in case of amplitude and 11.35% at concentration 10(-3) gm/ml in case of rate and loratadine 76.82% in case of amplitude and 10.59% in case of rate.

The effects of glibenclamide on serum lipids and lipoproteins in type II non-insulin dependent diabetes mellitus.

OBJECTIVE: To examine the effects of glibenclamide treatment on plasma lipids and lipoprotein levels. SETTINGS: Out patients of Type II diabetics from department of Baqai Diabetes and Endocrine Centre and two other diabetic clinics of Karachi. METHODS: The effects of glibenclamide on blood glucose and various aspects of lipoproteins has been studied in 26 (14 male, 12 female) Type II Diapetes patients before and after 12 weeks of glibenclamide therapy. Treatment was initiated with 5 mg oral glibenclamide with diet control. The initial dosage of glibenclamide was 5 mg/day taken half an hour before meal; this was increased to 5 mg per week and was adjusted according to the patient's tolerance to the drug and their glycemic control. RESULTS: The results demonstrated that fasting blood glucose declined from 221.53 + 7.84 to 165.02 + 5.12 mg/dl, (P < 0.001). There was a statistically significant increase in the plasma high-density lipoprotein cholesterol from 33.60 + 1.00 to 37.07 + 1.05 mg/dl, (P << 0.05). Total cholesterol, triglycerides, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol did not change significantly. CONCLUSION: Improved glycaemic control in patients treated with glibenclamide with Type II Diabetes was achieved which lead to changes in lipoprotein metabolism. There was no evidence of changes in lipoproteins in directions associated with an increased risk for atherosclerosis.