Positron emission tomography imaging in nonmalignant thoracic disorders.

A case of gross skeletal muscle uptake of 18F-FDG during PET is described. The clinical context of immunosuppression after heart and lung transplantation and the absence of any other known association make the former a likely etiologic factor.

https://tech.snmjournals.org/content/jnmt/32/4/206.full.pdf

Extensive Skeletal Muscle Uptake of 18F-FDG: Relation to Immunosuppressants?

The authors describe various patterns of F-18 fluorodeoxyglucose (FDG) accumulation in the diaphragm and crura. They present 6 patients in whom incidental diaphragmatic and crural uptake of FDG was observed during positron emission tomography (PET). Hyperventilation is thought to be the potential underlying mechanism of this condition.

Diaphragmatic and crural FDG uptake in hyperventilating patients: a rare pattern important to recognize.

A patient with nonsmall cell lung carcinoma had a PET scan done for restaging, which showed very high FDG uptake in the tongue (SUV of 24). Physical examination of the tongue was normal. CT scan did not reveal any abnormality in the tongue. On questioning, the patient recollected that he was chewing gum before injection of FDG. A repeat PET scan 9 days later showed no tongue uptake. It is important to tell the patients not to chew gum for at least 4 hours before the PET study.

Chewing gum causing a very high FDG uptake of the tongue on PET scan.

The normal uptake and biodistribution patterns of F-18 fluorodeoxyglucose (FDG), as well as the physiological variants and benign pathologic conditions of FDG accumulation, should be recognized to identify malignant neoplasms or metastatic diseases. The authors describe the incidental uptake of FDG in the diaphragm, the crura, the tongue base, and the vocal cords using dual-modality PET/CT imaging in a crying child. Hyperventilation and hyperactivity of the associated muscles are thought to be the potential underlying mechanism of this condition.

FDG uptake in the diaphragm and crura, vocal cords, and base of tongue in a crying child.

A 65-year-old man with squamous cell carcinoma of the lung metastatic to the left pleura underwent an F-18 fluorodeoxglucose (FDG) positron emission tomographic (PET) scan. The PET scan revealed an unusual pattern of FDG uptake in the crus of the right hemidiaphragm only. This is particularly unusual because diaphragmatic crus uptake is usually bilateral. The unilateral right crus uptake is hypothesized to be secondary to increased work of breathing of the right lung compared with the left (as a result of the restriction of motion from the left pleural metastatic disease).

Unilateral diaphragmatic crus uptake on FDG positron emission tomographic imaging.

Autoimmune cytopenias may be the initial presentation in patients with HIV infection or can develop while on treatment with antiretroviral therapy (ART). These cytopenias usually resolve after initiation of ART. We report a rare case of HIV who presented with Evans syndrome on ART, being refractory to steroids and rituximab but with response to splenectomy.

An event of Evans even in HIV

Introduction: Fine-needle aspiration (FNA) cytology is a reliable method to diagnose thyroid lesions. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is universally followed for thyroid cytology reporting. Out of the six categories described, Category III, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous one. Materials and Methods: In this study conducted in a tertiary health care center in Eastern India over 2 ½-year period, 868 thyroid FNAs were performed and the cytology smears were interpreted using the TBSRTC. There were 32 FNAs in Category III. Histopathology report was available in nine cases. Results: The risk of malignancy (ROM) considering noninvasive follicular thyroid carcinoma with papillary nuclear features (NIFTP) as benign was 9.3% and by considering NIFTP as malignant was 21.8%. Conclusion: The ROM for AUS/FLUS in our study was within the revised ROM criteria. In Category III, surgery is preferable in nodules which harbor suspicious features either clinically or according to ultrasound findings. 

Atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda Category - III) in thyroid cytology: Experience from a tertiary health care center from Eastern India

Multidrug resistance episodes in malaria increased from 3.9% to 20% from 2015 to 2019. Synchronizing the clinical manifestation in chronological sequence led to a unique impression on glucose demand (increased up to 100-fold) by the parasite-infected RBCs. Hence, restriction in the glucose uptake to parasite-infected RBCs could be an alternative approach to conquer the global burden of malaria to a greater extent. A C28 steroidal lactone Withaferin A (WS-3) isolated from Withania somnifera leave extract shows better thermodynamically stable interactions with the glucose transporters (GLUT-1 and PfHT) to standard drugs metformin and lopinavir. MD simulations for a trajectory period of 100 ns reflect stable interactions with the interactive amino acid residues such as Pro141, Gln161, Gln282, Gln283, Trp388, Phe389, and Phe40, Asn48, Phe85, His168, Gln169, Asn311 which potentiating inhibitory activity of WS-3 against GLUT-1 and PfHT respectively. WS-3 was non-hemotoxic (%hemolysis <5%) for a high concentration of up to 1 mg/ml in the physiological milieu. However, the %hemolysis significantly increased up to 30.55 ± 0.929% in a parasitophorous simulated environment (pH 5.0). Increased hemolysis of WS-3 could be due to the production of ROS in an acidic environment. Further, the inhibitory activity of WS-3 against both glucose transporters was supported with flow cytometry-based analysis of parasite-infected RBCs. Results show that WS-3 has low mean fluorescence intensities for both target proteins compared to conventional drugs, suggesting a potential sugar transporter inhibitor against GLUT-1 and PfHT for managing malaria.Communicated by Ramaswamy H. Sarma.

Identification of starvation-mimetic bioactive phytocomponent from Withania somnifera using in-silico molecular modelling and flow cytometry-based analysis for the management of malaria.

Psoriasis is a chronic autoimmune pathological condition characterized by hyperactivation of proinflammatory cytokines (IL-6, TNF-α, IL-17, IL-23, etc.). Severe drug-associated toxicities like hepatotoxicity and nephrotoxicity (Methotrexate), teratogenicity (Tazarotene), hypercholesterolemia (Cyclosporine) and hypercalcemia (tacalcitol), are the forefront challenges that demand an alternative approach for the treatment of psoriasis. In the present study, a natural lead molecule 'Betulin' (BE, lup-20(29)-ene-3b,28-diol) was isolated from Betula utilis and subsequently, structure-based molecular docking was employed to identify the molecular target for psoriasis. The computational analysis reflects better affinity of BE towards pro-inflammatory cytokine as compared to standard drugs. Apart from this BE shows a greater affinity towards the overexpressed Glut-1 receptor in comparison to standard drug Metformin (Met). Based on the in silico screening the isolated lead compound was further processed for the evaluation of anti-psoriatic activity via imiquimod (IMQ 5%) induced psoriasis-like skin inflammation model. In vivo screening models were characterized by different parameters (psoriasis area and severity index (PASI) scores, macroscopically and behavioral evaluation, splenomegaly, cytokine levels and histological changes) and compared among the experimental groups. The experimental finding reflects comparable results of PASI score, i.e., 57.14% and 61.9% recovery of test BE-solution (180 mg/kg) and standard Betamethasone di-propionate ointment (BD-oint.0.5 mg/g), respectively. Focusing on other parameters, BE shows relative results such as an enhanced macroscopically with behavioral conditions, reducing the expression of proinflammatory cytokine as well as restoring histological changes with that of BD. These findings suggest that BE-isolated phytoconstituents from Betula utilis could be a potential agent and a step closer to psoriasis treatment. HIGHLIGHTPsoriasis is a multifaceted, immunologically mediated disease consequences production of high levels of proinflammatory mediators and overexpression of Glut-1 transporters that trigger keratinocyte proliferation and inflammatory cascades.A Himalayan silver birch, Betula utilis (Bhojpatra) contains many steroidal terpenes which are responsible for various pharmacological activities that could be exploited in drug development in psoriasis.The computational analysis of BE reflects a better affinity toward the proinflammatory cytokines with their target receptors and indicates a satisfactory range with a slight deviation from Jorgensen and Lipinski's rule and possesses a significant drug choice for psoriasis.Preclinical findings of BE-solution (BE-sol) give a positive response towards IMQ-induced psoriasis-like skin inflammation model.Communicated by Ramaswamy H. Sarma.

Rajesh Bhola

Papers

Unilateral diaphragmatic crus uptake on FDG positron emission tomographic imaging.

An event of Evans even in HIV

Atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda Category - III) in thyroid cytology: Experience from a tertiary health care center from Eastern India

Identification of starvation-mimetic bioactive phytocomponent from Withania somnifera using in-silico molecular modelling and flow cytometry-based analysis for the management of malaria.

Phytochemical investigation, structural elucidation, in silico study and anti-psoriatic activity of potent bioactive from Betula utilis.