Using the 2014 IBM MarketScan Commercial Database, we compared antibiotic selection for pharyngitis, sinusitis, and acute otitis media in retail clinics, emergency departments, urgent cares, and offices. Only 50% of visits for these conditions received recommended first-line antibiotics. Improving antibiotic selection for common outpatient conditions is an important stewardship target.
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Doravirine is a non-nucleoside reverse transcriptase inhibitor approved for the treatment of HIV-1. In a phase 1 trial, doravirine exposure was transiently decreased when treatment was started immediately after stopping efavirenz. In a post-hoc subgroup analysis of participants who switched from an efavirenz-based regimen to doravirine/lamivudine/tenofovir disoproxil fumarate in the phase 3 DRIVE-SHIFT trial, doravirine plasma levels at week 4 were similar to non-induced levels, and HIV-1 suppression...
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Burkholderia pseudomallei (B. pseudomallei), the etiological agent of melioidosis, is a Gram-negative bacterium with additional concern as a biothreat pathogen. The mortality rate from B. pseudomallei varies depending on the type of infection and extent of available health care, but in the case of septicemia left untreated it can range from 50 – 90%. Current therapy for melioidosis is biphasic, consisting of parenteral acute-phase treatment for two weeks or longer, followed by oral eradication-phase...
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Abbas Yousefi-Koma, Yaser Shiravand, Mohsen QutbiIndian Journal of Nuclear Medicine 2019 34(4):326-328 A 65-year-old patient with acute lymphoblastic leukemia presented for an 18fluoro-2-deoxy-d-glucose positron emission tomography computed tomography (18FDG PET) after several courses of chemotherapy for metastatic evaluation. Unexpectedly, on 18FDG PET scan, no discernible uptake was observed in the visceral organs, but instead, the skeleton/bone marrow showed homogenously intense metabolic...
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Nitin Gupta, Ritu Verma, Ethel Shangne BelhoIndian Journal of Nuclear Medicine 2019 34(4):349-350 Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare clinical entity involving musculoskeletal and dermatologic systems. Its main features are prominent inflammatory cutaneous and articular manifestations. Anterior chest wall pain, more commonly at sternoclavicular and sternocostal joints, along with palmoplantar pustulosis and acne can point to this uncommon syndrome....
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Esraa El-Kholy, Lobna KhaledIndian Journal of Nuclear Medicine 2019 34(4):271-277 Purpose: The aim of this study was to evaluate the accuracy of dual-time point in differentiating benign from malignant local recurrent lesions in pancreatic cancer. Patients and Methods: Thirty-four patients with pancreatic cancer (22 males and 12 females, mean age: 58.3 ± 10.3) who presented with soft-tissue lesions at the operative bed. Early whole-body positron emission tomography/computed tomography (PET/CT)...
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Saurabh Arora, Nishikant Avinash Damle, Rachna Meel, Kanak Lata, Nikhil Tandon, Sanjay Sharma, Chandrasekhar BalIndian Journal of Nuclear Medicine 2019 34(4):338-340 Graves' ophthalmopathy (GO) involves autoimmune activation of fibroblasts, resulting in chronic inflammatory reaction. Somatostatin receptors are expressed in the cells associated with chronic inflammation. We hereby present patients with active GO, with delayed response to the standard treatment regimen, in whom68Ga-DOTANOC positron...
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Maciej J Pelak, Andrea d'AmicoIndian Journal of Nuclear Medicine 2019 34(4):278-283 Purpose of the study: The purpose of this study was to evaluate the potential value of gallium-68 (Ga-68)-DOTATATE positron emission tomography/computed tomography (PET/CT) in predicting the risk of progression in nonbenign meningioma after definite irradiation. We retrospectively reviewed our patients with meningiomas who had the highest risk of progression: WHO histological Grade II and III tumors and with macroscopic...
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Manish Ora, Sanjay GambhirIndian Journal of Nuclear Medicine 2019 34(4):263-270 Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Invasive coronary angiography (ICA) is the gold standard for the evaluation of epicardial CAD. In the pathogenesis of the CAD, myocardial perfusion abnormalities are the first changes that appear followed by wall motion abnormalities, electrocardiogram changes, and angina. Myocardial perfusion imaging (MPI) demonstrates the cumulative...
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Ranadheer Gupta Manthri, Sai Moulika Jeepalem, VS Krishna Mohan, D Bhargavi, Narendra Hulikal, Tekchand KalawatIndian Journal of Nuclear Medicine 2019 34(4):284-289 Introduction: Breast cancer is the most common malignancy among women all over the world, which accounts to 25% of all cancers. In known cases of breast cancer, the risk of developing another denovo malignancy is more when compared to low risk groups, which might be due to common environmental risk factors, treatment induced risk...
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Anuja Anand, Amish Choudhary, Pankaj Dougall, Bhavna Bansal, Madhavi ChawlaIndian Journal of Nuclear Medicine 2019 34(4):332-334 This case is a very good example of how a multimodality approach was taken in diagnosis and management of patient with suspected uterine sarcoma, which turned out to be uterine leiomyoma with parasitic leiomyoma mimicking the pararenal deposit. There has been an increased use of fluorodeoxyglucose avid positron emission tomography-computed tomography in pelvic malignancies,...
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Arvind Krishnamurthy, Saket Mittal, Krishna Kumar RamachandranIndian Journal of Nuclear Medicine 2019 34(4):290-294 Background: The present study aims to explore the role of sentinel lymph node biopsy (SLNB) with intraoperative frozen section in the management of early-staged oral tongue cancers. Materials and Methods: Fifty-two patients with clinical stages cT1/2N0 oral tongue cancers were included in the present study. The curative surgery was preceded by the performance of an SLNB using a...
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Nikhil Seniaray, Anuj JainIndian Journal of Nuclear Medicine 2019 34(4):344-346 A 41-year-old lady presented with headache and ophthalmoplegia of the left eye for 1 week and underwent magnetic resonance imaging (MRI) of the brain, which showed homogeneously enhancing nodular thickening of meninges in the left anterior and middle cranial fossa with perilesional white matter edema of the left fronto-temporal lobes which appeared suspicious for neurosarcoidosis. She subsequently underwent 18F-fluorodeoxyglucose...
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Boon Mathew, Nilendu C Purandare, Sneha Shah, Ameya Puranik, Archi Agrawal, Venkatesh RangarajanIndian Journal of Nuclear Medicine 2019 34(4):295-301 18F flurodeoxyglucose positron emission tomography-computed tomography (18F FDG PET-CT) is widely used in the evaluation of patients with lung mass suspicious for malignancy. In addition to malignancy, a variety of benign neoplasms and inflammatory lesions can arise in the lungs, many of which show increased FDG concentration, thereby mimicking...
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VNSSVAMS D Mahalakshmi, Sapana Bothra, Aromal Chekavar, Mallika Dhanda, Sabaretnam MayilvagananIndian Journal of Nuclear Medicine 2019 34(4):353-353
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Kasturi Rangan, Manish Ora, Amrin Israrahmed, Sanjay GambhirIndian Journal of Nuclear Medicine 2019 34(4):302-306 Krukenberg tumors described by Friedrich Ernst Krukenberg are still fascinating for their mysterious origin. It is known to be a rare entity and commonly originates from adenocarcinoma of stomach. We present three interestingly rare cases of this entity, revealed by 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG-PET/CT) scan and discuss how F-18...
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Varvara Valotassiou, George Angelidis, Sotiria Alexiou, Dimitrios Psimadas, Ioannis Tsougos, Panagiotis GeorgouliasIndian Journal of Nuclear Medicine 2019 34(4):324-325 A 50-year-old man with beta-thalassemia major underwent Tc-99m sestamibi parathyroid scintigraphy due to elevated parathyroid hormone and calcium serum levels. Single-photon emission computed tomography imaging of neck and thorax revealed a parathyroid adenoma, as well as increased tracer uptake in a paraspinal region in the right...
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Rashmi Ranjan Mohanty, Kanhaiyalal Agrawal, Bikash Ranjan MeherIndian Journal of Nuclear Medicine 2019 34(4):307-308 Thyroiditis is a very rare cause of fever of unknown origin (FUO). Thyroiditis presenting as only fever and weight loss is very rare. We present a case of FUO, which was later on confirmed as thyroiditis on thyroid scintigraphy.
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Luca Filippi, Barbara Sardella, Orazio Schillaci, Oreste BagniIndian Journal of Nuclear Medicine 2019 34(4):329-331 Lymphadenitis, due to typical or atypical Mycobacterium, is a clinical condition frequently associated with human immunodeficiency virus (HIV) infection. Differential diagnosis between benign and malignant causes may be a challenge for clinicians. In this regard, the role of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) has still not been fully explored....
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S Chandra Teja Reddy, V Venkatrami Reddy, D Bhargavi, B Deepthi, Suma Tammineni, Ranadheer Manthri, Tekchand KalawatIndian Journal of Nuclear Medicine 2019 34(4):309-312 Solid pseudopapillary neoplasm (SPN) is a rare histopathologic variant of pancreatic tumors. Franz first described this tumor as a “papillary tumor of the pancreas, benign or malignant.” In 1996, the World Health Organization named this tumor as SPN of the pancreas. It has a female preponderance with a male-to-female ratio of...
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Piyush Chandra, Satish Nath, Deepti JainIndian Journal of Nuclear Medicine 2019 34(4):335-337 Immunoglobulin G4-related disease (IgG4) is an immune-mediated fibro-inflammatory entity which affects multiple organs, most frequently the pancreas. Although extrapancreatic inflammations are commonly seen in 18F-fluorodeoxyglucose positron emission tomography/computed tomography of majority of these patients at follow-up, simultaneous involvement of the gastric/biliary tract at presentation is rare....
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Ravishankar Pillenahalli Maheshwarappa, Islam Ahmed Shehata Elhelf, Parren McNeelyIndian Journal of Nuclear Medicine 2019 34(4):313-316 Bone scans are the most commonly used imaging technique to rule out local recurrence or metastasis during surveillance of malignant bone tumors after treatment. Although bone scans are very sensitive in detecting recurrence or metastasis, they are less specific. There are many nonmalignant conditions which can mimic either recurrence or metastasis on a Tc-99m...
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Nestor Martinez-Amador, Remedios Quirce, Isabel MartÍnez-RodrÍguez, Blanca Lucas-Velázquez, Cristina Fernández-MartÍnez, Ignacio BanzoIndian Journal of Nuclear Medicine 2019 34(4):341-343 Extramedullary plasmacytoma is an unusual manifestation in multiple myeloma (MM). It can present as a solitary bone lesion and/or soft-tissue mass. Plasmacytoma can be presented at any location, but it is more common in the head and neck, usually without systemic involvement. The presence of plasmacytoma in...
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Madhur Kumar Srivastava, Kavitha Nallapareddy, Ram Manohar Pagala, Vinodh Kumar KendarlaIndian Journal of Nuclear Medicine 2019 34(4):317-318 Pelvic insufficiency fractures (IFs) are frequently diagnosed on technetium-99m methylene diphosphonate bone scan (BS), where it remains an important diagnostic imaging modality. Involvement of iliac bone in pelvic IFs is very rare. Differentiation from metastases is crucial where BS shows characteristic appearance obviating the need for further investigations...
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Jose Rafael Infante, Manuel Moreno, Andrés Martínez, Juan Ignacio Rayo, Justo Serrano, Amparo Cobo, Pedro JimenezIndian Journal of Nuclear Medicine 2019 34(4):347-348 Syringomyelia is a rare degenerative disease affecting the spinal cord and brain stem causing progressive neurological dysfunction. The presence of gastrointestinal symptoms in these patients is common, although references related to nuclear medicine imaging procedures in this pathology are limited, focusing on the study of gastric...
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Nitin Gupta, Ritu Verma, Ethel Shangne Belho, Anisha ManochaIndian Journal of Nuclear Medicine 2019 34(4):319-320 Rosai–Dorfman disease (RDD) is an uncommon proliferative histiocytic disorder. Patients usually present with painless massive cervical lymphadenopathy with fever and leukocytosis. Isolated extranodal disease is rare and more severe fibrosis, fewer histiocytosis in lesions make diagnosis more difficult as compared to nodal disease. Here, we report a case of isolated extranodal RDD...
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Vishnukumar Rajaraman, Madhusudhanan PonnusamyIndian Journal of Nuclear Medicine 2019 34(4):351-352 Abnormal Pertechnetate distribution can occur due to many reasons such as retrosternal extension of eutopic thyroid gland, ectopic functioning thyroid gland, physiological uptake in esophagus, teratoma having functioning thyroid tissue component, metastatic lymph nodes and sequestered thyroid nodule. We present a case of thyrotoxicosis with hyper functioning thyroid gland and two abnormal foci...
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Nikhil Seniaray, Ritu Verma, Rajeev Ranjan, Ethel Belho, Dharmender Malik, Vanshika Gupta, Abhinav Jaimini, Harsh MahajanIndian Journal of Nuclear Medicine 2019 34(4):321-323 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...
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Key PointsInteraction of RV with TLR2 regulates RV-induced IFN expression via SIRT-1.SIRT-1 regulates RV-induced IFN expression via inhibition of JAK-STAT pathway.RV-induced excessive IFNs in COPD is associated with defective TLR2 signaling.
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Key PointsDUOX2 mRNA expression is associated with poor prognosis in pancreatic cancer.IL-4 and IL-17A synergize to upregulate DUOX2 in pancreatic and colon cancer lines.DUOX2 upregulation increases the production of H2O2 and DNA damage.
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Key PointsTCR- tetramer identified ligand expression by flow cytometry.TCR- ligands were induced on activated monocytes or T cells.Bioinformatics combined with mass spectrometry produced an overlapping list of 16 candidate ligands.
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Key PointsMice lacking Grk2 B cell expression develop a severe immune phenotype.Grk2 expression in B cells limits S1PR1 signaling but augments CXCR5 signaling.An S1PR1 antagonist partially normalizes the signaling defects and immune phenotypes.
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Key PointsFlot1–/– CD8+ T cells have altered cell morphology and speeds in vivo.Flot1–/– CD8+ T cells show robust expansion and infiltration of peripheral tissues.
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Molecular events activating the phosphoinositide-3 kinase (PI3K) pathway are frequently detected in human tumors and the activation of PI3K signaling alters numerous cellular processes including tumor cell proliferation, survival, and motility. More recent studies have highlighted the impact of PI3K signaling on the cellular response to interferons and other immunologic processes relevant to anti-tumor immunity. Given the ability of interferon (IFN)- to regulate antigen processing and presentation...
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