Clinico-epidemiological profiles & outcome of severe malaria in children under-five in the tribal area of Kalahandi, Odisha.

BACKGROUND OBJECTIVES: Severe malaria is a cause of excess mortality and morbidity in children in malaria-endemic areas where indigenous people live. Currently, available reports are all from secondary or tertiary care hospitals across India and some African countries. The objective of this study was to assess the clinical and epidemiological profiles of children under five years in two primary care health centres located in tribal-dominant Thuamul Rampur Block of Kalahandi district, Odisha. The outcome of management of severe malaria in these children was also assessed. METHODS: A retrospective review of case records of children under five years of age diagnosed and admitted with severe malaria in two non-governmental primary care facilities between 2017 and 2022, was undertaken. RESULTS: There was a declining trend in malaria cases documented in primary care health facilities between January 2017 and June 2022. Of the 4858 cases recorded, 242 (4.9%) had severe malaria, of whom 70.7 per cent (n=171) were children under 5 yr. The median age of the study children was 24 months (16-36). Children aged 1-2 yr had a significantly higher risk of malaria. The majority were tribals (87%), more than half the children presented with neurological manifestations (64.4%), and 49.6 per cent had respiratory manifestations, while 20.5 per cent had severe anaemia (Hb <5 g/dl). Most, 167 (97.7%) severe malaria was due to Plasmodium falciparum. Thirty-two percent of children were severely wasted (WHZ < -3 SD) and 28 per cent were moderately wasted (WHZ <-2 SD). There was no fatality among the 171 children who were managed for severe malaria in the two primary care facilities. INTERPRETATION CONCLUSIONS: In high endemic areas severe malaria is predominantly a disease of under-five children and is caused by P. falciparum. Clinical manifestations of severe malaria in children can be varied and life-threatening. Primary health facilities can manage severe malaria successfully, thereby reducing child mortality. Effective collaboration between malaria control and nutrition intervention programmes is essential for appropriate case management.

Triple-Barrel Ultramicroelectrodes for Multipurpose, Submilliliter Electroanalysis.

Here, we have developed and applied a triple-barrel microelectrode. This device incorporates a platinum disk working electrode, a platinum disk counter electrode, and a low-leakage Ag/AgCl reference electrode into a small probe. We demonstrate that the incorporated low-leakage reference electrode shows similar voltammetry, potentiometry, and drift when compared to a commercial reference electrode in bulk solution. We also demonstrate the versatility of such a small three-channel system via voltammetry in nanoliter droplets and through electroanalysis of captured aerosols. Finally, we demonstrate the probe's potential utility in single-cell electroanalysis by making measurements within salmon eggs.

Real-Time Intracellular Analysis of Kanamycin Using Microaptasensors.

With the emergence of multidrug-resistant bacteria, infection-related death toll is on the rise. Overuse of antibiotics and their leakage into waterways have transformed the environment into a sink, resulting in bacterial resistance permeating through all tiers of the food cycle. As one of the primary sources of food, fish and fish products such as fish eggs must be studied for their ability to accumulate relevant antibiotics. While the accumulation of these pharmaceuticals has previously been studied, there remains a need to analyze these processes in real time. Electrochemical aptamer-based sensor technology allows for selective, real-time monitoring of small molecules. Herein, we report the first use of miniaturized electrochemical aptamer-based sensors for the analysis of the passive uptake of the aminoglycoside antibiotic, kanamycin, in single salmon eggs. We use pulled platinum microelectrodes and increase the surface area at the electrode tip through dendritic gold deposition. These electrodes showed a 100-fold increase in DNA immobilization on the electrode surface as compared to bare microelectrodes. Additionally, the sensors showed improved stability in complex biological media over an extended period of time when compared to the more widely used macrosensors (r = 1 mm). The sensor range was determined to extend from nanomolar to micromolar concentrations of kanamycin in fish egg lysate and when used in a single salmon egg the µ-aptasensors were able to monitor the passive uptake of kanamycin over time. The accumulation kinetics were simulated using COMSOL Multiphysics software. This research presents the first reported record of passive uptake of a small molecule in a single cell in real-time using electrochemistry.

Risky Business: Increasing Risky Betting Through Rule-Governed Behavior.

The present study replicated and extended previous research by exploring the extent to which rules altered participants' engagement in risky betting in an electronic blackjack game. A multiple-baseline across-participants design with predetermined phase changes was used to assess 4 recreational gamblers' betting patterns in blackjack across 3 phases. During baseline, participants played blackjack with no exposure to rules. In the faulty rules phase, researchers gave participants a rule that suggested larger payouts would occur if gamblers played let-it-ride bets. Let-it-ride bets were placed after a winning hand and required participants to wager their entire winnings on the next hand. During the correct rules phase, researchers gave participants a rule that suggested that the let-it-ride bets did not result in larger payouts. Data on let-it-ride bets across each minute of play were collected. The results of the study demonstrated that the frequency of risky bets increased when participants were exposed to the incorrect rule. Following participants' exposure to correct rules, risky bets decreased, but most participants did not return to baseline rates.

Spectrum of Frontotemporal Lobar Degeneration on 18F-FDG PET/CT Scan.

FTLD (Frontotemporal lobar degeneration) is a clinically and pathologically heterogeneous group of degenerative disorders, characterized by predominantly asymmetric degeneration of frontal and temporal lobes with selective neuronal loss and gliosis. The disease presents with variable degrees of impairment in behavior, language, executive control, and motor symptoms with progressive loss of cognition. On the basis of presenting clinical symptoms, FTLD is further divided into behavioral variant, nonfluent/agrammatic variant primary progressive aphasia (PPA), semantic variant PPA, logopenic variant PPA, progressive supranuclear palsy, and corticobasal ganglionic degeneration. Here we illustrate the utility of FDG PET with statistical parametric analysis for evaluation of these patients.

Semiquantitative Interpretation Criteria for Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Large-Vessel Vasculitis: Pattern Recognition and Correlation with Polymyalgia Rheumatica.

BACKGROUND: Fluorine-18-fluorodeoxyglucose (18F-FDG)-positron emission tomography/computed tomography (PET/CT) is emerging as a useful imaging modality in suspected large-vessel vasculitis (LVV), owing to its ability to accumulate at the sites of inflammation within the arterial walls. However, there remains scope for standardization of reporting criteria to ensure reproducibility. Recently, a semiquantitative scoring system called "total vascular score" (TVS) has been suggested as a method to standardize and harmonize FDG PET/CT evaluation in LVV patients. The purpose of this study was to assess the clinical utility of the proposed semiquantitative grading scale in LVV patients. MATERIALS AND METHODS: Patients presenting with clinical symptoms of vasculitis, who had undergone a baseline FDG-PET/CT were evaluated. 18F-FDG uptake in the major vessels was quantified with standardized uptake values (SUVsmax) using four-point scale by three independent nuclear physicians. TVS was calculated based on the calculation of the vascular uptake values with respect to mediastinal blood pool and liver uptake and the number of vessels involved. RESULTS: A total of 106 PET-positive patients (74 males and 32 females) were evaluated. The most frequently involved vessels were thoracic aorta >abdominal aorta >subclavian arteries with mean SUVmax values of 4.05, 3.12, and 2.70, respectively. Mean TVS was 13.18 ± 3.4 (range 03-19) among 276 involved vessels. TVS showed significant positive correlation with erythrocyte sedimentation rate (r = 0.82; P < 0.005). 18 patients showed periarticular FDG uptake, with shoulder joint being the most commonly involved joint. CONCLUSION: The simplified visual and semiquantitative grading scale for interpretation and reporting classification provides better objectivity in diagnosis, communication with referring clinicians, and planning in patients of LVV.

FDG PET/CT with SPM Analysis in Early Diagnosis of Clinically Suspected Osmotic Demyelination Syndrome with Non-contributory MRI.

Early diagnosis is imperative for adequate management of patients with osmotic demyelination syndrome (ODS), which is usually a result of rapid shifts of osmolality secondary to rapid correction of hyponatremia. Magnetic resonance imaging (MRI) with its special sequences is the investigation of choice for early detection of the osmotic changes in the brain. We report a case of clinically suspected ODS with noncontributory MRI and positive fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) scan with statistical parametric mapping (SPM) analysis, which localized the focal hypermetabolism in the basal ganglia, thalamus, pons, and cerebellum.

Metabolic imaging patterns in posterior cortical atrophy and Lewy body dementia.

PURPOSE: To study the imaging patterns of Posterior cortical atrophy (PCA) and Dementia with Lewy bodies (DLB) on fluoro-deoxyglucose positron emission tomography computed tomography ([F]FDG PET/CT), identify areas of overlap and differences and to develop a prediction model to assist in diagnosis using univariate and multivariate analysis. METHODS: A retrospective analysis of 72 patients clinically suspected of having posterior dementia was done. All patients underwent [FF]FDG PET/CT of the brain and dopamine transporter imaging with [[Tc]TRODAT-1 SPECT scan on separate days. The patients were divided into PCA with normal TRODAT uptake (n=34) and DLB with abnormal TRODAT uptake (n=38). The FDG PET/CT uptake patterns were recorded and areas of significant hypometabolism by z score analysis were considered as abnormal. Receiver operator characteristics (ROC) curve analysis was used to determine cutoff z scores and binary logistic regression analysis was used to determine the Odds ratio of being in the predicted groups. RESULTS: Significantly hypometabolism was found in parieto-temporo-occipital association cortices and cingulate cortices in PCA patients. DLB patients showed significantly reduced uptake in the visual cortex. No significant difference was found between z score of occipital association cortex which showed hypometabolism in both groups. The cut-off z-score values derived from the ROC curve analysis were as follows- parietal association (cut-off-3, sensitivity-65.6%, specificity - 68.7%), temporal association (cut-off-2, sensitivity-78%, specificity-75%) and posterior cingulate (cut-off-0.5, sensitivity-93.7%, specificity-40.6%), their respective Odds ratio (with 95% confidence interval) for being in the PCA group as derived from univariate logistic regression were 3.66 (1.30-10.32), 10.71 (3.36-34.13) and 7.85 (1.57-39.17). The cut-off z score of primary visual cortex as derived from ROC curve was zero with sensitivity of 87.5%, specificity of 71.9%, and the Odds ratio for being the in the DLB group was 24.7 with 95% confidence interval of 5.99-101.85. CONCLUSION: [F]FDG PET may be useful as a non-invasive diagnostic modality in differentiating the two posterior cortical dementias, despite significant overlap. Primary visual cortical hypometabolism can serve as an independent diagnostic marker for DLB, even in the absence of TRODAT imaging.

Castleman Disease Masquerading as the Posterior Mediastinal Mass on 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.

A 28-year-old female presented with an incidentally detected mediastinal mass, found on routine chest X-ray. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was advised to plan course of further management. FDG-PET/CT findings were suggestive of an FDG-avid soft-tissue mass in the left posterior mediastinum in paravertebral location with left pleural effusion. Overall, PET/CT scan findings favored the possibility of a nerve sheath tumor. However, histopathology along with immunohistochemistry confirmed the diagnosis of Castleman disease.

Correlation of 99mTc-TRODAT-1 SPECT Imaging Findings and Clinical Staging of Parkinson Disease.

PURPOSE: The aims of this study were to evaluate Tc-TRODAT-1 SPECT imaging patterns and to assess their correlation with disease severity in clinically diagnosed patients of Parkinson disease (PD). METHODS: The study included 241 patients with clinically diagnosed idiopathic Parkinson disease who underwent Tc-TRODAT-1 SPECT/CT scan. Binding ratios were calculated for each striatum, caudate, and putamen individually, by drawing region of interest. Occipital cortex region of interest was taken for background correction. Correlation of binding ratio with increasing clinical stage was derived, as described by modified Hoehn and Yahr scale. RESULTS: Median binding ratio was least in the contralateral putamen for all stages of modified Hoehn and Yahr. A statistically significant negative correlation was found between increasing disease severity and binding ratio in all subregions of striatum. Patients were clinically categorized into postural instability and gait disorder group and tremor-dominant PD group. No significant asymmetry was found between the left and right striatum in patients belonging to postural instability and gait disorder group and in those with bilateral tremors without lateralization. CONCLUSIONS: Tc-TRODAT-1 SPECT is useful in early detection and in assessing disease severity of PD. A significant asymmetry with the contralateral side being affected more than the ipsilateral side can be attributed to tremor-dominant patients. The binding ratio of the ipsilateral striatum may serve useful as a marker of remaining functional dopaminergic neuronal reserve in the striatum.

Mediastinal Duplication Cyst on 99mTc Pertechnetate Scan.

A 3-year-old boy presented with intermittent abdominal pain, melena, and anemia since 2 months. Upper gastrointestinal endoscopy did not reveal any significant abnormality. The child was then referred for Tc-pertechnetate scan to rule out the presence of ectopic functioning gastric mucosa. Tc-pertechnetate scan revealed abnormal tracer accumulation in the thoracic region, which persisted in the delayed images, suspicious for being ectopic gastric mucosa. Subsequently, ultrasound and contrast-enhanced CT (CECT) scans of the chest revealed a large multiseptate cystic lesion in the retrocardiac region, corresponding to the site of increased tracer uptake on Tc-pertechnetate scan.