Formulation and evaluation of a single vial lyophilized preparation of technetium-99m labeled ethylene dicysteine as a renal scintigraphic agent

Tc labeled N-N-ethylene-L, L-dicysteine [EC] was introduced in form of multiple-step kit as an alternate renal imaging radiopharmaceutical for commonly used [99m] Tc-MAG3. We developed a single component lyophilized kit of EC ready to be labeled with [99m]Tc

We present the optimization of the components of our formulation, its evaluation in animal models, normal human volunteers and patients of various renal diseases, in comparison with[99m] Tc-MAG3. Efficient labeling of EC was achieved with our preparation at pH 7 to 12. The formulation at pH 8 was used further for bio distribution studies in organs of sacrificed Sprague Dawley rats and a live rhesus monkey using scintigraphy

After satisfactory bio-distribution results, the kit was then evaluated in normal human volunteers through renography. But the renogram parameters of [99m] Tc-EC[pH 8] were statistically inferior to[99m] Tc-MAG3. Surrogate kit at pH 10 was therefore developed and re-evaluated in rats for organ bio distribution. After favorable results the kit was then assessed further in normal volunteers and a group of patients with various renal disorders via scintigraphy

The EC kit developed at pH 10 gave images better than and scintigraphic parameters comparable to [99m] Tc-MAG3. It was concluded that single vial kit we formulated easy to prepare than three-vial kit and can be used as an alternate to[99m] Tc-MAG3

Validation of modified estimated glomerular filtration rate in chronic kidney disease patients

To derive the ethnic factor and validate the modified estimated Glomerular Filtration Rate [eGFR] by Modification of Diet in Renal Disease [MDRD] equation for Chronic Kidney Disease [CKD] patients of Rawalpindi. Cross- sectional study. Armed Forces Institute of Pathology [AFIP], Rawalpindi, from July 2011 to July 2012. A total of 140 patients with CKD reporting to AFIP for GFR measurement by [99m] Technetium diethylenethiaminepenta-acetic acid [[99m]Tc-DTPA] renal scan were consecutively inducted. Serum creatinine was measured by the Jaffe's assay on Beckman DxC 600 Analyzer prior to the renal scan. Ethnic factor for population of Rawalpindi with CKD was derived for the MDRD eGFR equation using [99m]Tc-DTPA renal scan by Gates method as the reference method. MDRD equation was modified by inclusion of the ethnic factor in it. Agreement between the reference GFR [rGFR] and the modified MDRD eGFR [mGFR] was assessed by applying paired samples t-test. Out of 140 patients of CKD, 99 [71%] were males and 41 [29%] females, with mean age of 55 +/- 13.42 years. The mean values were 32.91 +/- 14.96, 34.89 +/- 16.45, 0.971 +/- 0.20 and 33.87 +/- 15.97 for rGFR, original eGFR, ethnic factor and mGFR respectively. The mGFR with new ethnic factor of 0.971 showed improved performance as compared to original eGFR and showed a significant level of correlation with rGFR [r[2] = 0.817], at a p-value of 0.000. This study validates the mGFR equation by inclusion of newly derived ethnic factor of 0.971 in the population of Rawalpindi with CKD and it was found to be not significantly different from the rGFR.

Cholescintigraphy of children with prolonged neonatal jaundice

To find the cause of neonatal jaundice in patients of up to 1 year of age, referred to Nuclear Medical Centre, AFIP Rawalpindi. Patients of jaundice up to 1 year of age referred by paediatricians from Military Hospitals were subjected to radionuclide cholescintigraphy at Nuclear Medical Centre, AFIP, Rawalpindi. The pattern noted was that 41% cases were scintigraphically positive for biliary atresia, 37% cases were found to be negative for it. Sixteen percent of the cases showed scintigraphic evidence of parenchymal liver disease and the possibility of biliary atresia could not be completely ruled out in these patients. Interestingly 6% of the cases were noted to be inconclusive though they were suffering from jaundice. The female to male ratio were 1:1.5, 1:6, and 1:1.6 for biliary atresia, negative for biliary atresia and parenchymal liver disease respectively. The cause of neonatal jaundice in most cases was biliary atresia and the frequency in males was higher as compared to female patients