Quantitative Investigation of Acoustic Emission Waveform Parameters from Crack Opening in a Rail Section Using Clustering Algorithms and Advanced Signal Processing.

Acoustic emission (AE) is an emerging technology for real-time non-destructive testing of structures. While research on a simulated AE source in rail and testing on rail material using small beam samples have been conducted, a study is required in lab environment to investigate AE waveform characteristics generated by crack in rail. In this paper, a three-point bending test is conducted on an actual rail section of 1500 mm with transverse damage of 38% head area to simulate AE source due to crack opening in the rail. AE signals are recorded for three different loads. For data analysis, unsupervised machine learning algorithms such as k-means, fuzzy-C mean and gaussian mixture model are used to cluster and filter out usable signals from the whole dataset corrupted by noisy signals from various sources. k-mean with principal component was observed to be best technique based on silhouette score. The frequency and amplitude of waveform have been discussed in relation to load and crack opening displacement. This study establishes a baseline for linking load, crack opening, and AE wave characteristics. This work can ultimately aid in the development of robust denoising, and damage analysis algorithms based on the frequency content and dispersion of the AE waveform.

Analysis of Denture Base Displacement between Conventional Acrylic Removable Partial Dentures and Click Fit Partials for Kennedy's Class I and II Situations: An In Vitro Study.

AIM/OBJECTIVE: The aim of this study was to evaluate the displacement of the denture base of conventional acrylic dentures and Click Fit partials in Kennedy's class I and II situations in the mandibular arch. MATERIALS AND METHODS: Four removable partial dentures-two conventional clasp dentures and two attachment dentures (Click Fit)-were designed. The two conventional clasp dentures were retained by C (conventional) clasps, and the two attachment dentures were retained by rigid precision attachments. The displacement of denture bases and the movements of denture bases were investigated, and the influences of denture design were studied. RESULT: The values obtained were statistically analyzed by using independent t-tests. For all statistical purposes, a p-value of ≤0.001 was considered significant. The results showed that mean vertical displacements (mm) of the conventional acrylic removable partial denture base for Kennedy's class I mandibular arch under 50, 75, and 100 N forces were 0.0317, 0.04377, and 0.06392, respectively, and those for Kennedy's class II mandibular arch under 50, 75, and 100 N forces were 0.04922, 0.09849, and 0.1522, respectively. Vertical displacements (mm) of the Click Fit removable partial denture base for Kennedy's class I mandibular arch under 50, 75, and 100 N forces were 0.02185, 0.03436, and 0.005365, respectively, and those for Kennedy's class II mandibular arch under 50N, 75N, and 100N forces were 0.0445, 0.07851, and 0.14457, respectively. The difference between the groups was statistically significant (p ≤0.001). CONCLUSION: The vertical displacement of the denture base retained by conventional C clasps was more than that of the denture base retained by rigid precision attachment. The displacement of the denture base tended to be less when the denture was designed with a rigid connection for the retainer and with cross-arch stabilization as in Kennedy's class I case. CLINICAL IMPLICATIONS: This research evaluated the vertical denture base displacement using different designs and retention types. Hence, it helped predict the prognosis of different removable partial denture base designs in various clinical conditions.

Comparison of Stress Distribution in Fixed Partial Prosthesis Restored with Different Combination of Support: A Finite Element Study.

AIM: This study was conducted to evaluate the distribution of stress in the bone around the natural tooth, endodontically treated tooth having post and core, and implant as an abutment in different combinations in fixed partial prosthesis using two-dimensional finite element analysis (FEA). MATERIALS AND METHODS: Six models were simulated using ANSYS Modeller19. All six models were divided into 12 zones and 4 lines, and stress values were calculated and compared. The study combinations were - tooth supported fixed partial prosthesis, fixed partial prosthesis having the combination of tooth and post- and core-treated tooth, fixed partial prosthesis with the combination of tooth and implant, fixed partial prosthesis having the combination of implant and post- and core-treated tooth, fixed partial prosthesis with the combination of post- and core-treated tooth on both sides, and fixed partial prosthesis having the combination of implant on both sides. RESULT: On comparing the stress values, the maximum stress value was observed in fixed partial prosthesis having the combination of implant on both sides (306.2434 MPa) followed by Model 4 (223.1255 MPa), Model 3 (154.3952 MPa), Model 5 (136.9041 MPa), Model 2 (116.2034 MPa), and least stress seen in Model 1 (99.6209 MPa), and minimum in tooth supported fixed partial prosthesis (99.6209 MPa). CONCLUSION: This study concluded that stress concentration in bone was maximum when the implant was used as an abutment in fixed partial prosthesis. The least stress was seen in bone around the natural tooth due to the dampening effect of the periodontal ligament. Further, the modulus of elasticity of a post acts as a vital parameter in the distribution of stress in post- and core-treated tooth. CLINICAL SIGNIFICANCE: The stress concentration in the bone around the abutments affects the longevity of the prosthesis, hence, the clinically appropriate combination of the abutments should be considered for a fixed partial prosthesis.

Localization and restaging of carcinoma prostate by 68Gallium prostate-specific membrane antigen positron emission tomography computed tomography in patients with biochemical recurrence.

INTRODUCTION: Radical prostatectomy (RP) and radical radiotherapy (RT) are well established primary curative options for localized prostate cancer. Despite technical improvements, prostate-specific antigen (PSA)-recurrence after RP and RT is a common clinical scenario. We aimed to assess the role of 68Gallium (68Ga) prostate-specific membrane antigen positron emission tomography computed tomography (PSMA PET/CT) in patients with biochemical recurrence of prostate cancer after RP or RT for the detection and localization recurrent and metastatic disease. MATERIALS AND METHODS: We ambispectively (70 retrospective and 100 prospective) analyzed the data of men with biochemical recurrence post-RP and post-RT who were evaluated by 68Ga PSMA PET/CT at our institute. We aimed to assess the relationship between serum PSA levels and the probability of having a positive scan in patients with recurrent prostate cancer. RESULTS: The study included 170 men, all had adenocarcinoma of the prostate, 124/170 had previous RP and 46/170 had prior RT. The median serum PSA in the RP group was 1.8 ng/ml and 5.2 ng/ml in the RT group. In the post-RP cohort, the detection rate of 68Ga PSMA PET/CT was 39.3% for PSA 0.2 to <0.5 ng/ml, 47.3% for PSA 0.5 to <1 ng/ml, 68.4% for PSA 1 to <2 ng/ml and 93.1% for PSA ≥2 ng/ml. In the post-RT group, the detection rate was 88.8% for PSA 2 to <4 ng/ml and 100% for PSA ≥4 ng/ml. CONCLUSIONS: 68Ga PSMA PET/CT provides a novel imaging modality for the detection of prostate cancer recurrence and metastases at low posttreatment PSA levels, which may help in directing appropriate salvage treatments.

Giant appendicolith: Rare finding in a common ailment.

Acute appendicitis is one of the commonest surgical emergencies worldwide. There is considerable variation in prevalence of appendicoliths with appendicitis. Most of the patients with appendicoliths are asymptomatic and they are not pathognomic for acute appendicitis. However, appendicoliths show increased association with perforation and abscess formation. Appendicolith are quite common, being present in 3% of general population and in nearly 10% cases of appendicitis. However, giant appendicoliths measuring over 2 centimeters (cms) are extremely rare. Computed Tomography (CT) has increased their pre-operative diagnosis considerably. Use of spectral analysis can give us the details of composition of the stone pre-operatively. We present a young male diagnosed pre-operatively on Non-Contrast Computed Tomography (NCCT) to have a giant calcium struvite appendicolith. On laparoscopy he had a 3 cm stone and an incidental Meckel's diverticulum and underwent appendectomy. The case is presented for the unique size of the appendicolith alongwith review of literature.

Reproductive healthcare seeking behaviour of women of the reproductive age group in an urban resettlement area of district Gautam Buddh Nagar in Uttar Pradesh, India.

Background: Reproductive tract infections (RTIs) and gynaecological morbidities constitute a significant proportion of morbidities in women of the reproductive age group. Objective: To find out the proportion of reproductive age group women in an urban resettlement colony having the symptoms of gynaecological morbidities and RTI/sexually transmitted infection (STI) and to explore the healthcare seeking behaviour of the women during such ailments. Materials and Methods: A community-based cross-sectional study was conducted from January to June 2023 among 317 females aged 15 to 49 years in an urban resettlement area of Gautam Buddh Nagar district in Uttar Pradesh. Statistical analysis used included descriptive statistics and Chi-square test. SPSS 23 was used for data analysis. Results: There was a prevalence of 65.3% of at least one self-reported symptom suggestive of RTI/STI or gynaecological morbidity among the respondents. Among the symptomatic respondents, 54.1% were found to seek treatment. Among the reasons given for not seeking treatment in any health facility, the majority (83.1%) responded 'lack of awareness that the problem needed medical treatment' and 'stigma related with the problem' to be the main reasons. Conclusion: The reproductive healthcare seeking behaviour was found to be inadequate, with only 54.1% of symptomatic respondents seeking treatment. Enhanced health awareness sessions can be planned in the short term, and skilled communicators within or outside of the health system in the long term may be deployed to disseminate information in the community regarding sexual and gynaecological morbidities in reproductive age group women and their timely intervention.

Quality of life and its determinants among hypertensive patients in a rural area of district Gautam Buddha Nagar, Uttar Pradesh - A community-based cross-sectional study.

Context: Hypertension is the leading cause of mortality and disability-adjusted life year (DALY) all over the world. World Health Organization defines quality of life (QOL) as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. Aims: The study was aimed to compare the the QOL of adult hypertensive patients with healthy study subjects and to determine the factors associated with poor QOL among the hypertensive subjects. Materials and Methods: A community-based cross-sectional study was conducted from January 2021 to June 2022 in Gautam Budh Nagar District. The study was carried out among 250 hypertensive patients and 50 healthy persons based on World Health Organization-Quality of Life-BREF questionnaire Manual. Statistical Analysis Used: Data collected were entered and statistically analyzed using statistical software (SPSS-22). Results: Overall QOL and general health scores were significantly lower among hypertensive subjects showing worsening of QOL among diseased persons (P value <0.001). Factors significantly associated with poor overall QOL were low educational status (P value <0.001), home makers (P value <0.001), lower socio-economic class (P value < 0.001), and subjects with co-morbidities (P value <0.001). Conclusion: The findings revealed that QOL was poor among the hypertensive subjects as compared to healthy subjects.

A cross-sectional study to assess the under-nutrition amongst the elderly population in a rural area of district Gautam Buddha Nagar, Uttar Pradesh.

Background: Ageing is a universal process. It is influenced by a person's genetic makeup, lifestyle, and environmental factors. Nutrition plays a significant role in modulation of ageing. In developing countries like India, the health and nutritional status of the elderly population is not satisfactory. Objectives: The current study was done to assess undernutrition amongst the elderly population and to find the various associations with sociodemographic factors and social determinants. Materials and Methods: This cross-sectional study was done from February 2023 to July 2023 in rural area of District Gautam Buddha Nagar, Uttar Pradesh. The elderly participants who were 60 years of age and more and who met the inclusion criteria were selected by simple random sampling technique for the study. Undernutrition was assessed by Mini Nutritional Assessment Tool (MNA). Result: Out of the total of 400 elderly persons, 18% were found to be undernourished and 38% were at risk of undernutrition. The association between undernutrition and age group, gender, occupation, family type, living arrangements that is staying with family or not, financial dependence, any co-morbid illness, smoking, and physical activity was found to be significant. Conclusion: The present findings reveal that undernutrition is not an uncommon problem in the elderly, and further studies are needed in this regard.

Age-stratified Assessment of Brain Volumetric Segmentation on the Indian Population Using Quantitative Magnetic Resonance Imaging.

BACKGROUND AND PURPOSE: Automated methods for quantifying brain tissue volumes have gained clinical interest for their objective assessment of neurological diseases. This study aimed to establish reference curves for brain volumes and fractions in the Indian population using Synthetic MRI (SyMRI), a quantitative imaging technique providing multiple contrast-weighted images through fast postprocessing. METHODS: The study included a cohort of 314 healthy individuals aged 15-65 years from multiple hospitals/centers across India. The SyMRI-quantified brain volumes and fractions, including brain parenchymal fraction (BPF), gray matter fraction (GMF), white matter fraction (WMF), and myelin. RESULTS: Normative age-stratified quantification curves were created based on the obtained data. The results showed significant differences in brain volumes between the sexes, but not after normalization by intracranial volume. CONCLUSION: The findings provide normative data for the Indian population and can be used for comparative analysis of brain structure values. Furthermore, our data indicate that the use of fractions rather than absolute volumes in normative curves, such as BPF, GMF, and WMF, can mitigate sex and population differences as they account for individual differences in head size or brain volume.

Comparative evaluation of osteogenic cell growth on titanium surface and titanium coated with boron nitride surface: An in vitro study.

Context: To promote better biological response and osseointegration continuous research is going on to modify the titanium (Ti) implant surface for successful implant treatment modality. Aims: This study aims to evaluate the osteogenic cell growth upon the uncoated Ti discs and boron nitride (BN) coated Ti to assess osseointegration and clinical success of dental implants. Settings and Design: This is an descriptive experimental study which includes coating of uncoated titanium alloy suraface with boron nitride in the form of hexagonal boron nitride sheets. Than comparative evaluation of osteogenic cell growth upon both coated and uncoated titanium surfaces was done using specific cell growth determinants. Materials and Methods: In this descriptive experimental study, both BN-coated and uncoated Ti discs were assessed for osteogenic cell growth using 3-(4, 5-dimethyl thiazolyl-2)-2, 5-diphenyltetrazolium bromide assay, 4',6-diamidino-2-phenylindole, is a fluorescent stain assay, and cell adhesion assay. Statistical Analysis Used: As this study is a descriptive experimental analysis between two variables only so there is no need of statistical analysis or p-value. Results: Overall good cell adhesion, cell differentiation, and cell proliferation occurred in the BN-coated Ti discs as compared to uncoated Ti discs. Conclusions: To promote osseointegration of dental implants, surface coating with BN proved to be an effective approach toward better osseointegration and long-duration success of dental implants as a single unit or implant-supported prosthesis BN which is a biocompatible graphene material with advantages in chemical and thermal stability. BN promoted better osteogenic cell adhesion, differentiation, and proliferation. Hence, it can be used as a new promising Ti implant surface-coating material.

Estimation of white matter hyperintensities with synthetic MRI myelin volume fraction in patients with multiple sclerosis and non-multiple-sclerosis white matter hyperintensities: A pilot study among the Indian population.

AIM: Synthetic MRI (SyMRI) works on the MDME sequence, which acquires the relaxation properties of the brain and helps to measure the accurate tissue properties in 6 minutes. The aim of this study was to evaluate the synthetic MRI (SyMRI)-generated myelin (MyC) to white matter (WM) ratio, the WM fraction (WMF), MyC partial maps performing normative brain volumetry to investigate MyC loss in multiple sclerosis (MS) patients with white-matter hyperintensites (WMHs) and non-MS patients with WMHs in a clinical setting. MATERIALS and METHODS: Synthetic MRI images were acquired from 15 patients with MS, and from 15 non-MS patients on a 3T MRI scanner (Discovery MR750w; GE Healthcare; Milwaukee, USA) using MAGiC, a customized version of SyntheticMR's SyMRI® IMAGE software marketed by GE Healthcare under a license agreement. Fast multi-delay multi-echo acquisition was performed with a 2D axial pulse sequence with different combinations of echo time (TEs) and saturation delay times. The total image acquisition time was 6 minutes. SyMRI image analysis was done using SyMRI software (SyMRI Version: 11.3.6; Synthetic MR, Linköping, Sweden). SyMRI data were used to generate the MyC partial maps and WMFs to quantify the signal intensities of test group and control group, andcontrol group , and their mean values were recorded. All patients also underwent conventional diffusion-weighted imaging, i.e., T1w and T2w imaging. RESULTS: The results showed that the WMF was significantly lower in the test group than in the control group (38.8% vs 33.2%, p < 0.001). The Mann-Whitney U nonparametric t-test revealed a significant difference in the mean myelin volume between the test group and the control group (158.66 ± 32.31 vs. 138.29 ± 29.28, p = 0.044). Also, there were no significant differences in the gray matter fraction and intracranial volume between the test group and the control group. CONCLUSIONS: We observed MyC loss in test group using quantitative SyMRI. Thus, myelin loss in MS patients can be quantitatively evaluated using SyMRI.

Role of diffusion tensor imaging and tractography in spinal cord injury.

Spinal cord injuries pose grave medical and socioeconomic burdens warranting measures for early diagnosis, triaging, prognostication and therapeutics. Imaging has since long played a pivotal role in this regard, with continuing research and technological advancements opening newer frontiers. One such advanced Magnetic resonance (MR) technique is Diffusion tensor imaging (DTI) which assesses cord microstructure by tracking the movement of water molecules in biological tissues. DTI utilizes the principle of anisotropy exhibited by the normal compact white matter (WM) tracts of the cord, in which direction-dependent water molecular motion is seen along the axonal axis. Disruption of this complex structure in response to injury alters the movement of these molecules, interrupting anisotropy and thereby DTI metrics. Evaluation of DTI images can be done both by quantitative indices, of which fractional anisotropy (FA) and mean diffusivity (MD) are the most commonly used and by qualitative fiber tracking (tractography) methods in which three-dimensional WM tracts are reconstructed by algorithmic post-processing. Reduced FA is consistently seen at injury sites as a direct consequence of disturbance of anisotropy. Diffusivity values are however more variable with both high and low values recorded across studies. 3D tractography images allow visual assessment of cord integrity, morphology, and orientation. Significant correlation is found between DTI parameters and various spinal injury scores. Furthermore, DTI also helps in accurate lesion mapping and in assessing cord changes distant from injury epicenter providing a holistic evaluation. From its inception, consistent progress in the understanding and application of DTI has effectuated its clinical utility and impact. Incorporation into day-to-day diagnostics is however still challenging, due to suboptimal image acquisition, difficult post-processing, and lack of standardized protocols & image interpretation guidelines. Further research with technical validation, development of normative and disease data sets, and histological confirmation will help establish this novel technique in routine diagnostics.

18F-FDG PET/CT and 99mTc-TRODAT Scan Findings in the Variants of Progressive Supranuclear Palsy and Correlation With Clinical Findings.

Aim: The aim of this study is to elucidate the patterns of characteristic hypometabolism on 18F-Fluoro Deoxy-glucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in the variants of Progressive supranuclear palsy (PSP) and its correlation with their core clinical features. Material and Methods: A retrospective analysis of 88 subjects with clinically suspected PSP was done. An institutional informed consent to participate in the study was taken from all the subjects. All the subjects had undergone a prior 99mTechnetium labeled Tropane derivative of dopamine transporter Single Photon Emission Computed Tomography (99mTc TRODAT-1 SPECT) study and had abnormal scans to confirm degenerative parkinsonism. The subjects were clinically examined by the neurologists using the Progressive Supranuclear Palsy Rating Scale proposed by the Movement Disorder Society and were further clinically segregated into eight subtypes. All the included subjects further underwent a detailed clinical analysis to obtain their individual Schwab and England activities of daily living scale and Modified Hoehn and Yahr staging by a neurologist. All the subjects underwent 18F-FDG PET/CT scan after adequate preparation. The scans were analyzed both qualitatively (visually) and quantitatively using Statistical Parametric Mapping. Results: The frontal, limbic, and sensorimotor cortices represented the common areas of hypometabolism among all the subtypes of PSP. The subcortical regions showing the most significant hypometabolism were the thalami, mid-brain, nucleus accumbens, caudate, globus pallidus, and putamen in descending order. Multiple cortical and subcortical regions of hypometabolism were identified in different subtypes of PSP. Conclusion: The characteristic patterns of hypometabolism observed in the different subgroups were more apparent on quantification and based on visual analysis alone, it may not be possible to differentiate the different subtypes of PSP. A good correlation was seen between some of the core clinical features and hypometabolic clusters.

Lewy Body Dementia Associated with Anti-IgLON 5 Encephalitis Detected on 18F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and 99mTc-TRODAT Single-Photon Emission Computed Tomography/Computed Tomography.

We present a case of Anti-IgLON 5 encephalitis with Lewy body dementia. 18F fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan and 99 mTc-TRODAT-1 SPECT/CT scan were done. 99 mTc-TRODAT-1 scan findings revealed severely reduced concentration of dopamine transporter in bilateral basal ganglia, suggestive of a degenerative parkinsonian disorder. 18F-FDG PET scan findings were suggestive of moderate-to-severe hypometabolism in the bilateral parieto-temporal and bilateral occipital cortices including the primary visual cortices, supporting Lewy body spectrum disease with associated hypermetabolism in the bilateral sensorimotor cortices, bilateral basal ganglia, thalami, brain stem, and bilateral cerebellar hemispheres suggestive of inflammatory pathology.

Prevalence of usage of Tobacco and its various correlates in District Gautam-Budh Nagar, Uttar Pradesh.

Context: Tobacco use is the leading single preventable cause of deaths worldwide. India is the second largest consumer of tobacco in the world. Aims: To study the prevalence of tobacco use among the adult population >15 years age of District Gautam-Budh Nagar and find the association of various socio-demographic factors with the tobacco usage. Settings and Design: Cross-sectional community-based study conducted in urban and rural areas of District Gautam-Budh Nagar, Uttar-Pradesh. Subjects and Methods: The study was conducted among 1461 adults aged 15 years and above in the District Gautam-Budh Nagar. Multistage sampling was used to select the study subjects. The questionnaire used for the interview consisted of questions related to socio-demographic profile, smoking habits and smokeless tobacco use, intention to quit and exposure to second-hand smoke. Statistical Analysis: The data were entered and analyzed in SPSS Software version 20.0. The prevalence of tobacco use was expressed in percentages. The association between various socio-demographic factors and tobacco use was assessed by Chi-square test. P value < 0.05 was taken as significant. Results: Prevalence of tobacco usage in this study was found to be 50.4% (65% among males and 28.8% among females). The prevalence of smoking and smokeless tobacco use in our study was 37.2% and 21.3%, respectively. Increasing age, male gender, and lower educational status were found to be significant risk factors for tobacco use in our study. Conclusions: India needs to gear up the efforts more and can still do more to make the proven tobacco control tools work for its citizens' well-being.

A review on investigation of the basic contrast mechanism underlying multidimensional diffusion MRI in assessment of neurological disorders.

INTRODUCTION: Multidimensional diffusion MRI (MDD MRI) is a novel diffusion technique that uses advanced gradient waveforms for microstructural tissue characterization to provide information about average rate, anisotropy and orientation of the diffusion and to disentangle the signal fraction from specific cell types i.e., elongated cells, isotropic cells and free water. AIM: To review the diagnostic potential of MDD MRI in the clinical setting for microstructural tissue characterization in patients with neurological disorders to aid in patient care and treatment. METHOD: A scoping review on the clinical applications of MDD MRI was conducted from original articles published in PubMed and Scopus from 2015 to 2021 using the keywords "Multidimensional diffusion MRI" OR "diffusion tensor distribution" OR "Tensor-Valued Diffusion" OR "b-tensor encoding" OR "microscopic diffusion anisotropy" OR "microscopic anisotropy" OR "microscopic fractional anisotropy" OR "double diffusion encoding" OR "triple diffusion encoding" OR "double pulsed field gradients" OR "double wave vector" OR "correlation tensor imaging" AND "brain" OR "axons". RESULTS: Initially 145 articles were screened and after applying inclusion and exclusion criteria, nine articles were included in the final analysis. In most of these studies, microscopic diffusion anisotropy within the lesion showed deviation from the normal-appearing tissue. CONCLUSION: Multidimensional diffusion MRI can provide better quantification and visualization of tissue microstructure than conventional diffusion MRI and can be used in the clinical setting for diagnosis of neurological disorders.

Dapagliflozin Improves Body Fat Patterning, and Hepatic and Pancreatic Fat in Patients With Type 2 Diabetes in North India.

CONTEXT: Excess hepatic and pancreatic fat may contribute to hyperglycemia. OBJECTIVE: The objective of this study was to examine the effect of dapagliflozin (an SGLT2 inhibitor) on anthropometric profile, liver, and pancreatic fat in patients with type 2 diabetes mellitus (T2DM). METHODS: This is an observational interventional paired study design without a control group. Patients (n = 30) were given dapagliflozin 10 mg/day (on top of stable dose of metformin and/or sulfonylureas) for 120 days. Changes in anthropometry (circumferences and skinfold thickness), surrogate markers of insulin resistance, body composition, liver, and pancreatic fat (as measured by magnetic resonance imaging (MRI)-derived proton density fat fraction [FF]) were evaluated. RESULTS: After 120 days of treatment with dapagliflozin, a statistically significant reduction in weight, body mass index (BMI), body fat, circumferences, and all skinfold thickness was seen. A statistically significant reduction in blood glucose, glycated hemoglobin A1c, hepatic transaminases, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and postprandial C-peptide was noted, while HOMA-ß, postprandial insulin sensitivity, and fasting adiponectin were statistically significantly increased. There was no change in lean body mass. Compared to baseline there was a statistically significant decrease in mean liver FF (from 15.2% to 10.1%, P < .0001) and mean pancreatic FF (from 7.5% to 5.99%, P < .0083). Reduction in liver fat was statistically significant after adjustment for change in body weight. CONCLUSION: Dapagliflozin, after 120 days of use, reduced pancreatic and liver fat and increased insulin sensitivity in Asian Indian patients with T2DM.

Use of rapid cardiac magnetic resonance imaging to guide chelation therapy in patients with transfusion-dependent thalassaemia in India: UMIMI study.

AIMS: To explore the impact of incorporating a faster cardiac magnetic resonance (CMR) imaging protocol in a low-middle-income country (LMIC) and using the result to guide chelation in transfusion-dependent patients. METHODS AND RESULTS: A prospective UK-India collaborative cohort study was conducted in two cities in India. Two visits 13 months apart included clinical assessment and chelation therapy recommendations based on rapid CMR results. Participants were recruited by the local patient advocate charity, who organized the patient medical camps. The average scanning time was 11.3 ± 2.5 min at the baseline and 9.8 ± 2.4 min (P < 0.001) at follow-up. The baseline visit was attended by 103 patients (mean age 25 years) and 83% attended the second assessment. At baseline, 29% had a cardiac T2* < 20 ms, which represents significant iron loading, and 12% had left ventricular ejection fraction <60%, the accepted lower limit in this population. Only 3% were free of liver iron (T2* ≥ 17 ms). At 13 months, more patients were taking intensified dual chelation therapy (43% vs. 55%, P = 0.002). In those with cardiac siderosis (baseline T2* < 20 ms), there was an improvement in T2*-10.9 ± 5.9 to 13.5 ± 8.7 ms, P = 0.005-and fewer were classified as having clinically important cardiac iron loading (T2* < 20 ms, 24% vs. 16%, P < 0.001). This is the first illustration in an LMIC that incorporating CMR results into patient management plans can improve cardiac iron loading. CONCLUSION: For thalassaemia patients in an LMIC, a simplified CMR protocol linked to therapeutic recommendation via the patient camp model led to enhanced chelation therapy and a reduction in cardiac iron in 1 year.

Comprehensive Functional Evaluation of the Spectrum of Multi-System Atrophy with 18F-FDG PET/CT and 99mTc TRODAT-1 SPECT: 5 Year's Experience from a Tertiary Care Center.

AIM: To elucidate the patterns of characteristic hypometabolism on 18F- fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in multisystem atrophy (MSA) and their correlation with the patterns of uptake on dopamine transporter imaging with 99mTc TRODAT-1 SPECT. MATERIAL AND METHODS: A retrospective analysis of 67 patients with clinically diagnosed MSA was performed. All the subjects underwent 99mTc TRODAT-1 SPECT and 18F-FDG PET/CT scanning on two separate days. The 99mTc-TRODAT-1 scans were analyzed visually for asymmetry and rostro-caudal gradient. The FDG uptake patterns were recorded, and areas of hypometabolism that were two standard deviations from the mean were considered abnormal. RESULTS: All the subjects had an abnormal pattern of FDG uptake on PET scan, both on a visual inspection and semiquantitative analysis. In MSA-P subjects (n = 29), diffuse predominant hypometabolism of the globus pallidus-putamen complex was noted, with relative sparing of the caudate nuclei. In MSA-C subjects (n = 25), characteristic hypometabolism was noted in the cerebellum and brainstem. In mixed subtypes (n = 13), variable involvement of the basal ganglia, cerebellum, and brainstem was noted with frontoparietal hypometabolism. A statistically significant difference between MSA-P and MSA-C for gradient reduction and asymmetry with gradient reduction was observed. CONCLUSION: Dopamine transporter imaging with 99mTc TRODAT-1 SPECT not only helps in confirmation of parkinsonian disorders but also demonstrates varying patterns of distribution in different subtypes of MSA. Characteristic patterns of hypometabolism in 18F-FDG PET may help in the differentiation of the subtypes of MSA in the presence of clinically overlapping symptoms.

Metabolic Imaging Patterns on 18F-FDG PET in Acute and Subacute LGI1 Autoimmune Limbic Encephalitis.

Autoimmune encephalitis is a diverse group of neuropsychiatric disorders, which are difficult to diagnose clinically. The disorder presents acutely or subacutely with alteration of consciousness, cognitive decline, seizures, and abnormal movements. Autoantibodies are directed against intracellular antigens or extracellular domains of cell surface proteins, critical for neuronal excitability. F-FDG PET/CT has been used to diagnose the metabolic derangement in the brain due to various antibodies. Here we describe a case where acute and subacute phase of disease was visualized on serial F-FDG PET/CT.