Cancer Staging in Patients with Compromised Renal Function: Is PET/CT an Alternative to Contrast CT Scan?

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Standardised Uptake Value in Organ Confined Prostate Cancer in 68-Ga- Prostate-Specific Membrane Antigen Positron Emission Tomography-Computed Tomography Scan and its Correlation with Prostate Specific Antigen Level and Gleason Score.

Introduction: A positron emission tomography (PET) scan and a computed tomography (CT) scan are an integral part of oncological imaging and other modalities such as magnetic resonance imaging, CT or bone scintigraphy have some limitations in staging the workup of prostate carcinoma. Combined with tissue-specific markers like prostate-specific membrane antigen (PSMA), positron emitter-based functional imaging results have improved. Our study aimed to determine the Standardised Uptake Value (SUVmax) in prostate adenocarcinoma that is confined to the organ in Ga-68-PSMA PET-CT scans and how it correlates with prostate-specific antigen (PSA) levels and Gleason score (GS). Materials and Methods: This cross-sectional study was conducted at Sindh Institute of Urology and Transplantation (SIUT), Karachi, and includes subjects referred for a Ga68-PSMA PET-CT scan from September 2017 to January 2022. Histopathologic-proven adenocarcinoma prostate patients with organ-confined disease and PSA levels obtained within 6 weeks before the PSMA-PET-CT scan were included in the study. PET-CT images were semi-quantitatively analysed by measuring SUVmax and the result was interpreted using statistical software SPSS version 22.0. Results: A total of 154 patients were analysed. The mean age of patients was 66.57 ± 8.86 years. The GS of all patients ranges from 6 to 10. The mean and median PSA levels were 32.33 ng/mL (range: 0.004-306.00) and 14.20 ng/mL, respectively. The mean SUVmax of all prostatic lesions was 14.67 ± 12.58 and the median value was 10.76. SUVmax was higher in patients with a PSA level of more than ten than those with a <10. The correlation of SUVmax with PSA and GS showed a significant correlation. Conclusion: The SUVmax of organ-confined prostate cancer correlates well with PSA level and GS Median SUVmax and PSA directly relate to GS.

SONG: A Multi-Objective Evolutionary Algorithm for Delay and Energy Aware Facility Location in Vehicular Fog Networks.

With the emergence of delay- and energy-critical vehicular applications, forwarding sense-actuate data from vehicles to the cloud became practically infeasible. Therefore, a new computational model called Vehicular Fog Computing (VFC) was proposed. It offloads the computation workload from passenger devices (PDs) to transportation infrastructures such as roadside units (RSUs) and base stations (BSs), called static fog nodes. It can also exploit the underutilized computation resources of nearby vehicles that can act as vehicular fog nodes (VFNs) and provide delay- and energy-aware computing services. However, the capacity planning and dimensioning of VFC, which come under a class of facility location problems (FLPs), is a challenging issue. The complexity arises from the spatio-temporal dynamics of vehicular traffic, varying resource demand from PD applications, and the mobility of VFNs. This paper proposes a multi-objective optimization model to investigate the facility location in VFC networks. The solutions to this model generate optimal VFC topologies pertaining to an optimized trade-off (Pareto front) between the service delay and energy consumption. Thus, to solve this model, we propose a hybrid Evolutionary Multi-Objective (EMO) algorithm called Swarm Optimized Non-dominated sorting Genetic algorithm (SONG). It combines the convergence and search efficiency of two popular EMO algorithms: the Non-dominated Sorting Genetic Algorithm (NSGA-II) and Speed-constrained Particle Swarm Optimization (SMPSO). First, we solve an example problem using the SONG algorithm to illustrate the delay-energy solution frontiers and plotted the corresponding layout topology. Subsequently, we evaluate the evolutionary performance of the SONG algorithm on real-world vehicular traces against three quality indicators: Hyper-Volume (HV), Inverted Generational Distance (IGD) and CPU delay gap. The empirical results show that SONG exhibits improved solution quality over the NSGA-II and SMPSO algorithms and hence can be utilized as a potential tool by the service providers for the planning and design of VFC networks.

Bony lesion analysis in carcinoma prostate: methylene diphosphonate bone scan vs. Gallium-68 psma-11 pet/ct.

BACKGROUND: Prostate cancer is the cause of the highest cancer-related death in males, 5-year survival is 31% in metastatic disease, and bone is a common site of metastases. Bone scintigraphy is a routinely used imaging modality for detecting skeletal metastases. It has variable sensitivity of 52-100%, whereas PSMA PET/CT scans have better sensitivity approaching 100%, so we determined the diagnostic accuracy, sensitivity, and specificity of planar M.D.P. (Methylene diphosphonate) bone scintigraphy. METHODS: This analytical cross-sectional study was conducted at the N.M. & molecular imaging department of S.I.U.T. Karachi. Bone scans and PSMA-PET/CT scans of all patients who were visited from Janury-2018 to January 2023 were reviewed and interpreted by a nuclear physician& radiologist team. Inclusion criteria were histopathology-proven prostate cancer patients who had a bone scan and PSMA PET/CT scan within one month and had not received any treatment between scans. RESULTS: Among 70 scans, 38 (54.2%) were positive for bone lesions. A total of 18 (47%) patients had positive bony lesions on both PSMA-PET/CT and Bone scintigraphy. Among 38 bone lesions positive patients, in eleven patients, bone lesions were detected only on PET/CT scans, whereas nine were positive only on Bone scans. The mean S.U.V. max of all bony lesions was 19.15 (range 3.2-57.5). The bone scan's sensitivity, specificity, and accuracy were 62.07%, 78.05%, and 62.87%, respectively. CONCLUSIONS: PSMA-PET/CT is better than bone Scintigraphy for detecting skeletal metastases. However, outcomes of bone scintigraphy may be improved when Tc-PSMA receptor bone scintigraphy is used.

Characterizing Hypertension Specialist Care in Canada: A National Survey.

Background: The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists. Methods: Adult hypertension specialists across Canada were surveyed to describe hypertension centres and specialist practice in Canada, including the following: the patient population managed by hypertension specialists; details on how care is provided; practice pattern variations; and differences in access to specialized hypertension resources across the country. Results: The survey response rate was 73.5% from 25 hypertension centres. Most respondents were nephrologists and general internal medicine specialists. Hypertension centres saw between 50 and 2500 patients yearly. A mean of 17% (± 15%) of patients were referred from the emergency department and a mean of 52% (± 24%) were referred from primary care. Most centres had access to specialized testing (adrenal vein sampling, level 1 sleep studies, autonomic testing) and advanced therapies for resistant hypertension (renal denervation). Considerable heterogeneity was present in the target blood pressure in young people with low cardiovascular risk and in the diagnostic algorithms for investigating secondary causes of hypertension. Conclusions: These results summarize the current state of hypertension specialist care and highlight opportunities for further collaboration among hypertension specialists, including standardization of the approach to specialist care for patients with hypertension.

Contexte: Le spécialiste de l'hypertension reçoit souvent des patients orientés pour une hypertension sévère, d'apparition précoce et difficile à maîtriser, pour une urgence hypertensive ou pour des causes secondaires de l'hypertension. Les soins spécialisés de l'hypertension complètent les soins primaires pour ces cas complexes et font partie d'une stratégie globale de maîtrise de l'hypertension. Cette étude avait pour objectif de caractériser les centres de traitement de l'hypertension et les habitudes de pratique des spécialistes canadiens qui traitent l'hypertension. Méthodologie: Un sondage a été mené auprès de spécialistes de l'hypertension adulte de l'ensemble du Canada afin de décrire les centres de traitement de l'hypertension et la pratique des spécialistes au Canada, notamment les éléments suivants : la population de patients prise en charge par des spécialistes de l'hypertension, les renseignements sur la façon dont les soins sont prodigués, les variations dans les habitudes de pratique ainsi que les différences relatives à l'accès aux ressources spécialisées en hypertension à l'échelle du pays. Résultats: Le taux de réponse au sondage a été de 73,5 % dans 25 centres de l'hypertension. La plupart des répondants étaient des néphrologues et des spécialistes en médecine interne générale. Les centres de l'hypertension recevaient entre 50 et 2500 patients par année. En moyenne, 17 % (± 15 %) des patients provenaient du service des urgences et 52 % (± 24 %) provenaient d'une unité de soins primaires. La plupart des centres avaient accès à des tests spécialisés (prélèvements veineux surrénaliens, études du sommeil de niveau 1, tests autonomes) et à des traitements avancés pour l'hypertension résistante (dénervation rénale). Une hétérogénéité considérable a été constatée en ce qui concerne la pression artérielle cible chez les jeunes présentant un faible risque cardiovasculaire et les algorithmes diagnostiques pour étudier les causes secondaires de l'hypertension. Conclusions: Ces résultats résument la situation actuelle des soins spécialisés de l'hypertension et font ressortir des occasions d'accroître la collaboration entre les spécialistes de l'hypertension, notamment en ce qui concerne une normalisation de l'approche des soins spécialisés pour les patients hypertendus.

Disseminated Cysticercosis Masquerading as Mucocutaneous Nodules.

Cysticercus cellulosae is the larval form of the pork tapeworm, Taenia solium. It can be transmitted to humans through food and water contaminated with eggs. The cysticerci formed are spread through the intestinal wall and are carried by the blood stream to muscles, brain, and subcutaneous tissues, leading to clinical manifestations. Rarely, disseminated cysticercosis is observed. We present a case of an asymptomatic disseminated cysticercosis in a 55-year-old man who presented with multiple subcutaneous nodules over the body for 1 year. A nodule was also present over the dorsum of the tongue. No systemic symptoms were associated. The diagnosis was made based on histopathology which revealed cystic lesions with larvae. Ultrasonography showed a cystic cavity with a scolex. On further investigations, involvement of the brain and thyroid gland were revealed. A high index of suspicion with appropriate investigations is required in such cases in endemic areas. Also, this raises the importance of thorough investigations, which should be performed to rule out disseminated disease even in the absence of systemic symptoms.

Redesigning Kidney Care for the Anthropocene: A New Framework for Planetary Health in Nephrology.

Climate change is one of the greatest threats to human health in the 21st century. The human health impacts of climate change contribute to approximately 1 in 4 deaths worldwide. Health care itself is responsible for approximately 5% of annual global greenhouse gas (GHG) emissions. Canada is a recent signatory of the 26th United Nations Climate Change Conference (COP26) health agreement that is committed to developing low carbon and climate resilient health systems. Kidney care services have a substantial environmental impact and there is opportunity for the kidney care community to climate align clinical care. We introduce a framework of redesigned kidney care and describe examples of low carbon kidney disease management strategies to expand our duty of care to the environment which completes the triple bottom line of optimal patient outcomes and cost effectiveness in the Anthropocene.

Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system.

BACKGROUND: In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan's baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities. METHODS: To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles. RESULTS: A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public-private and metropolitan-rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks. CONCLUSION: Pakistan has an underdeveloped critical care network with significant inequity between public-private and metropolitan-rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

Ballodiolic Acid A and B: Two New ROS, (•OH), (ONOO-) Scavenging and Potent Antimicrobial Constituents Isolated from Ballota pseudodictamnus (L.) Benth.

Bioassays guided phytochemical investigations on the ethyl acetate-soluble fraction of the root material of Ballota pseudodictamnus (L.) Benth. led to the isolation of two new compounds, ballodiolic acid A (1) and ballodiolic acid B (2), along with three known compounds ballodiolic acid (3), ballotenic acid (4), and ß-amyrin (5), which were also isolated for the first time from this species by using multiple chromatographic techniques. The structures of the compounds (1-5) were determined by modern spectroscopic analysis including 1D and 2D NMR techniques and chemical studies. In three separate experiments, the isolated compounds (1-5) demonstrated potent antioxidant scavenging activity, with IC50 values ranging from 07.22-34.10 µM in the hydroxyl radical (•OH) inhibitory activity test, 58.10-148.55 µM in the total ROS (reactive oxygen species) inhibitory activity test, and 6.23-69.01 µM in the peroxynitrite (ONOO-) scavenging activity test. With IC50 values of (07.22 ± 0.03, 58.10 ± 0.07, 6.23 ± 0.04 µM) for •OH, total ROS, and scavenge ONOO-, respectively, ballodiolic acid B (2) showed the highest scavenging ability. Antibacterial and antifungal behaviors were also exposed to the pure compounds 1-5. In contrast to compounds 4 and 5, compounds 1-3 were active against all bacterial strains studied, with a good zone of inhibition proving these as a potent antibacterial agent. Similarly, compared to compounds 3-5, compounds 1 and 2 with a 47 percent and 45 percent respective inhibition zone were found to be more active against tested fungal strains.

Comparison of efficacy and safety of 30% hydrogen peroxide with 50% trichloroacetic acid in seborrheic keratosis: a randomized controlled study.

BACKGROUND: Seborrheic keratosis is a benign skin tumour. None of the common therapies is satisfactory. This study compared the efficacy of 30% hydrogen peroxide versus 50% trichloroacetic acid in treatment of seborrheic keratoses. METHODS: This unblinded, comparative interventional study was conducted on 85 patients of seborrheic keratosis. Lesions were graded using physician's lesion assessment (PLA) scale (0, clear; 1, nearly clear; 2≤1 mm thick; 3≥1 mm thick). Patients were randomly assigned into two groups: A and B. Five target seborrheic keratosis lesions with PLA score of three were selected in each patient. Group A was treated with 30% hydrogen peroxide and group B with 50% trichloroacetic acid. Both groups received treatment every week up to 5 weeks or till complete resolution of lesions. Clinical photographs of all patients were taken every 2 weeks. RESULTS: Both the groups were comparable in terms of age and sex. At the end of 6 weeks, lesions were cleared completely in 41.8% of patients in group A and in 23.8% in group B. Mean PLA score decreased significantly in group A from 3 to 1.79 (40.3%) at 2 weeks and to 0.63 (79%) at 6 weeks (P<0.001). The decrease in PLA score in group B was 2.41 (19.7%) and 1.13 (62.3%) at 2, and 6 weeks respectively (P<0.001). Hydrogen peroxide produced greater clearance of seborrheic keratosis (P=0.017) than trichloroacetic acid. Also, no major adverse effects were observed in the two groups. CONCLUSIONS: Application of 30% hydrogen peroxide appears to be more efficacious as compared to trichloroacetic acid (50%) for treatment of seborrheic keratosis.

Efficacy of Topical 5% 5-Fluorouracil with Needling versus 5% 5-Fluorouracil Alone in Stable Vitiligo: A Randomized Controlled Study.

BACKGROUND: Vitiligo is a chronic disease of great cosmetic concern presenting with depigmented macules and patches. It is often recalcitrant to medical treatment. AIM: The aim of the study was to study the efficacy and safety of topical 5% 5-fluorouracil with needling versus topical 5% 5-fluorouracil alone in stable vitiligo. MATERIALS AND METHODS: This interventional prospective study was conducted from July 2018 to June 2019. Total of 60 patients, with stable vitiligo of age older than 10 years, were randomly assigned into two groups of 30 patients each. Group A was treated with needling followed by topical 5% 5-fluorouracil over vitiligo patches. The procedure was performed every 2 weeks for 3 months. Group B was treated with topical 5% 5-fluorouracil alone. Clinical improvement was assessed monthly till 6 months by serial clinical photographs and grading score. RESULTS: Initiation of repigmentation started at 1 month in 76 patches (65%) in Group A, whereas in group B, it was seen in 45 patches (38.7%), which was statistically significant (P = 0.0001). Excellent improvement (>75% repigmentation) was noted in 55 patches (47%) in Group A as compared to 5 patches (4.3%) in group B at the end of 6 months (P = 0.03). CONCLUSION: Needling with 5% 5-fluorouracil appears to be simple, safe, and effective treatment in vitiligo. It can be used in poor responders to conventional therapy.

The Impact of Onychopathies on Quality of Life: A Hospital-based, Cross-sectional Study.

BACKGROUND: Onychopathies or nail disorders are associated with social stigma and causes limitation of daily activities by hampering the function of both fingers and toes. AIM: To evaluate the impact of onychopathies on quality of life (QoL) and compare the severity of impact on QoL in various nail disorders. MATERIALS AND METHODS: A hospital-based cross-sectional study consisting of 540 patients with onychopathies was conducted in the dermatology outpatient department. Patients were requested to complete a nail-specific QoL questionnaire consisting of 24 and 16 questions, respectively, for fingernails (group F) and toenails (group T) with five possible responses to each question. A score of 1-5 was given to each response. Statistical analysis was done to compare the impact of QoL on the different types of onychopathies. RESULTS: We found that onychopathies have a significant impact on QoL. QoL was significantly more affected when multiple nails were involved (P = 0.020 for group F and P = 0.001 for group T). QoL impact was statistically more significant in women (P = 0.038 for group F and P < 0.001 for group T) and in younger people aged <20 years in group F and 20-39 years in group T (P < 0.001 for both groups F and T). Patients with onychomycosis, structural nail defects, and psoriasis had a more significant impact than other diseases (P < 0.001 for both groups F and T). CONCLUSION: Onychopathies have a significant adverse effect on QoL because of their serious physical, psychological and social impact. Hence, clinicians should treat the nail disorders with utmost seriousness.

Renovascular hypertension from the BCR-ABL tyrosine kinase inhibitor ponatinib.

Drug-induced hypertension is one of the commonest causes of secondary hypertension. In the last few years, secondary hypertension due to tyrosine kinase inhibitors, from the vascular endothelial growth factor class, has been recognized to be an important cause of hypertension, as well as proteinuria, and occasionally kidney dysfunction in some cases. Less well-recognized is that BCR-ABL tyrosine kinase inhibitors also have adverse vascular effects. These manifest as vascular stenoses in large vessels, which may sometimes cause renal artery stenosis and subsequent hypertension. We describe a case report which presented as classical bilateral renal artery stenosis, and responded to revascularization. Increased awareness of these effects, as well as research into the pathogenesis, may provide more insight into vascular biology.