This study aimed to assess the clinical impact of 68Ga-DOTATATE and 18F-FDG with respect to the management plan and to evaluate the prognostic value of both tracers. Methods: A total of 104 patients (55 male and 49 female; median age, 58 y; range, 20–90 y) with histologically proven neuroendocrine tumors (NETs) underwent both 68Ga-DOTATATE and 18F-FDG PET/CT. Twenty-eight patients (26.9%) had poorly differentiated tumors, and 76 (73.1%) had well-differentiated tumors. PET/CT results and SUVs were compared with prognostic factors such as histologic grade (G1, G2, or G3, for low-grade [well differentiated], intermediate-grade [moderately differentiated], and high-grade [poorly differentiated], respectively), chromogranin A, and proliferation index (Ki-67). Results: The 68Ga-DOTATATE and 18F-FDG PET/CT findings were discordant in 65 patients (62.5%) and concordant in 39 patients (37.5%). The results changed the therapeutic plan in 84 patients (80.8%). In 22 patients (21.1%), decision making was based on the 18F-FDG findings; in 32 (30.8%), on the findings with both radiotracers; and in 50 (48.1%), on the 68Ga-DOTATATE findings. The most frequent management decision based on 18F-FDG was initiation of chemotherapy (10 patients, 47.6%). The most common treatment decision due to 68Ga-DOTATATE was initiation of peptide receptor radionuclide therapy (14 patients, 27.4%). In 11 (39.2%) of 28 patients with poorly differentiated NETs, the management decision was based on only the 18F-FDG results. For 68Ga-DOTATATE, SUVmax was higher for G1 tumors and lower for G3 tumors (P = 0.012). However, no significant differences in 18F-FDG-derived SUVs were observed between different grades (P = 0.38). The Mann–Whitney test showed significant differences in 68Ga-DOTATATE SUVmax between tumors with a Ki-67 of less than 5% and tumors with a Ki-67 of more than 5% (P = 0.004), without significance differences in 18F-FDG SUVmax. Log-rank analysis showed statistically significant differences in survival for patients with bone metastasis versus soft-tissue or no metastasis for both 18F-FDG (P = 0.037) and 68Ga-DOTATATE (P = 0.047). Overall survival declined rapidly with increasing grade (P = 0.001), at an estimated 91 mo for G1, 59 mo for G2, and 48 mo for G3. Conclusion:18F-FDG PET/CT had no clinical impact on G1 NETs and a moderate impact on G2 NETs. However, in poorly differentiated NETs, 18F-FDG PET/CT plays a significant clinical role in combination with 68Ga-DOTATATE. 68Ga DOTATATE SUVmax relates to grade and Ki-67 and can be used prognostically.

https://jnm.snmjournals.org/content/jnumed/58/1/91.full.pdf

Comparison of the Impact of 68Ga-DOTATATE and 18F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors.

An estimated 3% of the world population is infected with Hepatitis C virus (HCV), a hepatotropic RNA virus, transmitted primarily via the blood route. The major modes of transmission of the virus include injection drug use, unsafe injection practices, blood transfusion etc. HCV causes chronic hepatitis in about 80% of those infected by it. The mainstay in diagnosing infection with HCV is to initially screen high risk groups for antibodies to HCV (anti-HCV). The inclusion of serum to cut-off ratio (S/CO) in recent guidelines is helpful in deciding the supplemental assay to be used to confirm initially reactive screening results. Nucleic acid amplification tests (NAT) are used as confirmatory tools, and also to determine viral load prior to initiating treatment. Quantitative NAT has replaced qualitative assays. Genotyping is an important tool in clinical management to predict the likelihood of response and determine the optimal duration of therapy. The impact of this infection has begun to emerge in India. The problem of professional blood donation despite an existing law against it, and flourishing unsafe injection practices, are potential sources for the spread of hepatitis C in our country. All health care practitioners need to understand how to establish or exclude a diagnosis of HCV infection and to interpret the tests correctly. In the absence of a preventive or therapeutic vaccine, and also of post-exposure prophylaxis against the virus, it is imperative to diagnose infection by HCV so as to prevent hepatic insult and the ensuing complications that follow, including primary hepatocellular carcinoma (HCC). This review aims to help blood bank staff regarding options for diagnosis and management of donors positive for HCV.

Hepatitis C virus: Screening, diagnosis, and interpretation of laboratory assays

Globally, approximately 240 people have been infected worldwide with hepatitis B Virus (HBV). India has approximately HBV carrier rate of 3.0% with a high prevalence rate in the tribal population. With a population of more than 1.25 billion, India has more than 37 million HBV carriers and contributes a large proportion of this HBV burden. While horizontal transmission in childhood appears to be a major route of transmission, the role of vertical transmission is probably underestimated. Blood transfusion and unsafe therapeutic injections continue to be important modes of transmission of HBV. There is a need for large field studies to better understand HBV epidemiology and identify high prevalence areas, and public health measures to prevent disease transmission and decrease the burden of the disease.

Tackling the Hepatitis B Disease Burden in India.

6-Fluoro-(18F)-L-3,4-dihydroxyphenylalanine (FDOPA) is an amino acid analogue for positron emission tomography (PET) imaging which has been registered since 2006 in several European Union (EU) countries and by several pharmaceutical firms. Neuroendocrine tumour (NET) imaging is part of its registered indications. NET functional imaging is a very competitive niche, competitors of FDOPA being two well-established radiopharmaceuticals for scintigraphy, 123I-metaiodobenzylguanidine (MIBG) and 111In-pentetreotide, and even more radiopharmaceuticals for PET, including fluorodeoxyglucose (FDG) and somatostatin analogues. Nevertheless, there is no universal single photon emission computed tomography (SPECT) or PET tracer for NET imaging, at least for the moment. FDOPA, as the other PET tracers, is superior in diagnostic performance in a limited number of precise NET types which are currently medullary thyroid cancer, catecholamine-producing tumours with a low aggressiveness and well-differentiated carcinoid tumours of the midgut, and in cases of congenital hyperinsulinism. This article reports on diagnostic performance and impact on management of FDOPA according to the NET type, emphasising the results of comparative studies with other radiopharmaceuticals. By pooling the results of the published studies with a defined standard of truth, patient-based sensitivity to detect recurrent medullary thyroid cancer was 70 % [95 % confidence interval (CI) 62.1–77.6] for FDOPA vs 44 % (95 % CI 35–53.4) for FDG; patient-based sensitivity to detect phaeochromocytoma/paraganglioma was 94 % (95 % CI 91.4–97.1) for FDOPA vs 69 % (95 % CI 60.2–77.1) for 123I-MIBG; and patient-based sensitivity to detect midgut NET was 89 % (95 % CI 80.3–95.3) for FDOPA vs 80 % (95 % CI 69.2–88.4) for somatostatin receptor scintigraphy with a larger gap in lesion-based sensitivity (97 vs 49 %). Previously unpublished FDOPA results from our team are reported in some rare NET, such as small cell prostate cancer, or in emerging indications, such as metastatic NET of unknown primary (CUP-NET) or adrenocorticotropic hormone (ACTH) ectopic production. An evidence-based strategy in NET functional imaging is as yet affected by a low number of comparative studies. Then the suggested diagnostic trees, being a consequence of the analysis of present data, could be modified, for some indications, by a wider experience mainly involving face-to-face studies comparing FDOPA and 68Ga-labelled peptides.

/pdf/18f-fluorodihydroxyphenylalanine-vs-other-spxv8phem3.pdf

18F-Fluorodihydroxyphenylalanine vs other radiopharmaceuticals for imaging neuroendocrine tumours according to their type

Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. Herein, we review the clinical signs and symptoms that can aid in the diagnosis and localization of a Horner syndrome as well as the causes of the condition. We emphasize that pharmacologic testing can confirm its presence and direct further testing and management.

/pdf/horner-syndrome-clinical-perspectives-28949z5z2g.pdf

Horner syndrome: clinical perspectives.

Prevalence of hepatitis B virus and hepatitis C virus among blood donors at a tertiary care hospital in India: a five-year study.

Pulmonary carcinoids are histologically classified into typical and atypical. It is important to identify these preoperatively for treatment planning and prognosis. Structural imaging cannot conclusively differentiate between them. The aim of this study was to assess the possibility of differentiating the 2 variants using [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) and [68Ga]1,4,7,10-tetraazacyclododecane-NI–IIII-tetraacetic acid-(d)-Phe1-Thy3-octreotide (DOTATOC)-PET/CT. The imaging results of 20 patients with pulmonary carcinoids (13 typical, 7 atypical) on [18F]FDG-PET/CT and [68Ga]DOTATOC-PET/CT were assessed retrospectively. Six typical carcinoids failed to reveal significant uptake on [18F]FDG-PET/CT. All the atypical carcinoids revealed significant uptake on the [18F]FDG-PET/CT that was higher than that in typical carcinoids (standardized uptake value (SUV)max, 2.9–8.4, P = 0.001). The SUVmax in typical carcinoids on [68Ga]DOTATOC-PET/CT was significantly higher (SUVmax, 8.8–66) compared with atypical carcinoids (SUVmax, 1.1–18.5, P = 0.002). Ratios of SUVmax on [68Ga]DOTATOC-PET/CT to that on [18F]FDG-PET/CT were significantly higher (P < 0.001) in typical carcinoids compared with atypical carcinoids. The different uptake patterns on [18F]FDG and [68Ga]DOTATOC-PET/CT. and the ratio of SUVmax may be helpful in differentiating between typical and atypical carcinoids.

Evaluation of the role of [18F]FDG-PET/CT and [68Ga]DOTATOC-PET/CT in differentiating typical and atypical pulmonary carcinoids

Introduction
Thyroid autoimmunity can have an adverse impact on the outcome of the pregnancy. Although the adverse effects of antithyroid antibodies have been well studied in hypothyroid women, their effects in euthyroid women are not well evaluated.

The Effect of Anti-Thyroid Peroxidase Antibodies on Pregnancy Outcomes in Euthyroid Women.

The availability of freshwater is limited for agriculture systems across the globe. A fast-growing population demands need to enhance the food grain production from a limited natural resources. Therefore, researchers and policymakers have been emphasized on the production potential of agricultural crops in a sustainable manner. On the challenging side, freshwater bodies are shrinking with the pace of time further limiting crop production. Poor-quality water may be a good alternative for fresh water in water scarce areas. It should not contain toxic pollutants beyond certain critical levels. Unfortunately, such critical limits for different pollutants as well as permissible quality parameters for different wastewater types are lacking or poorly addressed. Marginal quality water and industrial effluent used in crop production should be treated prior to application in crop field. Hence, safe reuse of wastewater for cultivation of food material is necessary to fulfil the demands of growing population across the globe in the changing scenario of climate. 

https://link.springer.com/content/pdf/10.1007/s10668-022-02365-9.pdf

Reuse of poor-quality water for sustainable crop production in the changing scenario of climate

A 14-year-old girl presented with complaints of painful oral ulcers involving entire buccal mucosa, palate, tongue and lips for 5 months. Biopsy of the lesions revealed ulceration of the epidermis along with necrosis and inflammation of superficial dermis (Fig. 1a,b). Direct immunofluorescence revealed IgG and complement at the basement membrane zone. She was diagnosed as having paraneoplastic pemphigus (PNP) and was put on medical treatment with oral prednisone at a dose of 1 mg/kg, which was slowly increased to 2 mg/kg over 6 weeks, however there was no clinical response. Her chest X-ray revealed a mass. Contrast-enhanced computed tomography (CT) of the chest revealed a 10 ¥ 7 ¥ 8-cm, intensely enhancing mass in the right paratracheal area. Lung fields were normal. A CT-guided biopsy of the mass was attempted but abandoned as the patient developed pneumothorax. As the mass was intensely enhancing on CT and due to its association with PNP, a presumptive diagnosis of Castleman’s disease (CD) was considered. Abdominal ultrasound, done to rule out multicentric tumor, was normal. There was no significant lymphadenopathy. Pulmonary function test (PFT) revealed severe airflow obstruction. The patient underwent complete excision of the mass. Histopathology confirmed CD of hyaline-vascular type. Postoperatively, she was electively ventilated considering the deranged PFT. On the second postoperative day, she developed fever, leukocytosis and renal shutdown. As the renal function did not improve, she was put on dialysis. She could not be weaned off the ventilator due to respiratory problems. Two months postoperatively, her renal parameters started improving, hence dialysis was stopped. The skin lesions also improved. As the patient could not be weaned off the ventilator, a high-resolution CT of the chest was done. It revealed diffuse ground glass opacities predominantly in the lower zones of the lungs along with areas of airtrapping and oligemia, especially on expiratory scans. The features were suggestive of bronchiolitis obliterans (BO). A

Monika Meena

Papers

Prevalence of hepatitis B virus and hepatitis C virus among blood donors at a tertiary care hospital in India: a five-year study.

Evaluation of the role of [18F]FDG-PET/CT and [68Ga]DOTATOC-PET/CT in differentiating typical and atypical pulmonary carcinoids

The Effect of Anti-Thyroid Peroxidase Antibodies on Pregnancy Outcomes in Euthyroid Women.

Reuse of poor-quality water for sustainable crop production in the changing scenario of climate

Paraneoplastic pemphigus with Castleman's disease and bronchiolitis obliterans.