'I thought we would be cherished and safe here': understanding the multi-faceted nature of mental health among Arab immigrants/refugees in Ontario, Canada- the CAN-HEAL study.

PURPOSE: Mental health (MH) is a critical public health issue. Arab immigrants/refugees (AIR) may be at high risk for MH problems owing to various unique stressors, such as post-September/11 demonization. Despite the growing AIR population in Western countries, there is a lack of AIR-MH research in these nations. The CAN-HEAL study examined MH experiences and needs among AIR in Ontario, Canada. METHODS: This study employed a cooperative community-based participatory research and integrated knowledge translation approach. The study used photovoice, qualitative interviews and a questionnaire survey. Sixty socio-demographically diverse AIR adults partook in this study. The research was informed by the "social determinants of health" framework and the "years since immigration effect" (YSIE) theory. RESULTS: The term "mental health" was deemed offensive for participants aged > 30 years. Participants proposed other culturally-appropriate words including "well-being" and "emotional state". The prevalence of poor mental well-being in the sample was alarming (55%). Of first-generation immigrant participants, 86.8% reported negative changes in MH since migration. The negative changes are not straightforward; they are complex and dynamic, and mainly related to micro/macro-aggression, cross-cultural pressures, dissatisfaction with the health and social care system, and poor living conditions. Intersections between different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion) amplified the negative changes in MH and exacerbated inequities. CONCLUSIONS: MH needs among AIR are distinct and intersectionality aggravated inequities. Culturally and structurally competent healthcare and structural/policy reformation are required to tackle MH inequities. This can be fulfilled through intersectoral cooperation and including AIR in decision-making.

'I thought we would be nourished here': The complexity of nutrition/food and its relationship to mental health among Arab immigrants/refugees in Canada: The CAN-HEAL study.

Nutritional psychiatry suggests that diet quality impacts one's mental health (MH). The relationship between food/nutrition and MH may be particularly salient for immigrants/refugees who often experience high risk for household food insecurity and MH challenges. An innovative collaborative community-based participatory research and integrated knowledge translation approach was adopted to explore food/nutrition needs as they relate to MH among Arab immigrants/refuges (AIR) in Ontario, Canada. The goal was to co-identify areas that require social change and co-produce applicable knowledge for service improvement. The CAN-HEAL study used a multi-methodological approach, employing qualitative interviews, photovoice and a questionnaire survey. A combination of three sampling approaches (convenience, snowball and purposive) was used to recruit sixty socio-demographically-diverse adult AIR participants. The research was guided by an integrated bio-psycho-socio-cultural framework. Participants reported various socio-economic and structural barriers to nutritious eating. Food quality/safety was a significant concern and source of anxiety among AIR; food mislabeling, the widespread presence of genetically/chemically modified foods and expired/rotten food products were associated with negative MH. Participants experienced an alarming prevalence of food insecurity (65%), which was associated with negative MH. Intersections among age, gender, religion, socio-economic status, parenthood, disability, and place of residence played a considerable role in how nutrition, food security, and dietary intake impacted AIR's MH and caused substantial disparities within the AIR community. The food/nutrition-MH relationship among AIR is multi-faceted, and various psycho-socio-cultural pathways/processes were found to shape MH. Intersectoral collaboration between health and non-health sectors is needed to implement a co-proposed socio-political and community-level action plan to achieve nutrition and health equity for AIR and other similar marginalized groups.

A case report of differentiated thyroid cancer presenting as a renal mass.

The kidney is an unconventional site for thyroid metastasis. As of the writing of this article, only about 30 cases have been reported. It presents like a renal mass. We are reporting a man with thyroid carcinoma presenting with distant metastasis to the kidney. He had complaints of abdominal pain and haematuria. Initial imaging suggested a left renal mass. A diagnosis of renal cell carcinoma was made and a nephrectomy was performed. Histopathology revealed it to be a metastasis from cancer of the thyroid gland. Subsequently, an ultrasound of the thyroid gland was performed, which showed a malignant appearing thyroid nodule. Correlative bone scan showed uptake at multiple skeletal sites. Total thyroidectomy was done and it was found to be papillary thyroid cancer. Subsequently, high dose radioactive iodine was administered. The patient was followed up and has recently found to have metastasis to the brain and is undergoing radiotherapy.

Re-Modelling 99m-Technetium Pertechnetate Thyroid Uptake; Statistical, Machine Learning and Deep Learning Approaches.

Background: While normal ranges for 99mTc thyroid percentage uptake vary, the seemingly intuitive evaluation of thyroid function does not reflect the complexity of thyroid pathology and biochemical status. The emergence of artificial intelligence (AI) in nuclear medicine has driven problem solving associated with logic and reasoning that warrant re-examination of established benchmarks in thyroid functional assessment. Methods: There were 123 patients retrospectively analysed in the study sample comparing scintigraphic findings to grounded truth established through biochemistry status. Conventional statistical approaches were used in conjunction with an artificial neural network (ANN) to determine predictors of thyroid function from data features. A convolutional neural network (CNN) was also used to extract features from the input tensor (images). Results: Analysis was confounded by sub-clinical hyperthyroidism, primary hypothyroidism, sub-clinical hypothyroidism and T3 toxicosis. Binary accuracy for identifying hyperthyroidism was highest for thyroid uptake classification using a threshold of 4.5% (82.6%), followed by pooled physician 6interpretation with the aid of uptake values (82.3%). Visual evaluation without quantitative values reduced accuracy to 61.0% for pooled physician determinations and 61.4% classifying on the basis of thyroid gland intensity relative to salivary glands. The machine learning (ML) algorithm produced 84.6% accuracy, however, this included biochemistry features not available to the semantic analysis. The deep learning (DL) algorithm had an accuracy of 80.5% based on image inputs alone. Conclusion: Thyroid scintigraphy is useful in identifying hyperthyroid patients suitable for radioiodine therapy when using an appropriately validated cut-off for the patient population (4.5% in this population). ML ANN algorithms can be developed to improve accuracy as second readers systems when biochemistry results are available. DL CNN algorithms can be developed to improve accuracy in the absence of biochemistry results. ML and DL do not displace the role of the physician in thyroid scintigraphy but could be used as second reader systems to minimize errors and increase confidence.

Intelligent Imaging: Radiomics and Artificial Neural Networks in Heart Failure.

BACKGROUND: Our previous work with 123iodine meta-iodobenzylguanidine (123I-mIBG) radionuclide imaging among patients with cardiomyopathy reported limitations associated with the prognostic power of global parameters derived from planar imaging [1]. Employing multivariate analysis, we further showed the regional washout associated with territories adjacent to infarcted myocardium obtained from single-photon emission computed tomography imaging (SPECT) yielded superior prognostic power over the other planar and SPECT indices in predicting future cardiac events [1]. The aim of this study was to apply an artificial neural network (Neural Analyser version 2.9.5) to the original data from the same patient cohort to evaluate the most potent prognostic index for future cardiac events among patient with cardiomyopathy. METHODS: The original data were reevaluated using an artificial neural network (Neural Analyser version 2.9.5). There were 84 input variables in the original 22 patients from clinical data, electrocardiogram (rest, stress, and continuous ambulatory electrocardiogram recording), transthoracic echocardiography, coronary angiogram, sestamibi myocardial perfusion SPECT, planar and SPECT 123I-mIBG, and genetic and biomarkers, detailed in the previous work. A single binary output was a cardiac event or no cardiac event in the follow-up period. RESULTS: Following training and validation phases, the optimal number of inputs was determined to be two with a training loss of 0.025 and selection loss <0.001. The final architecture had inputs of a change in left ventricular ejection fraction (Δ > -10%) and 123I-mIBG planar global washout (>30%), two hidden layers of 6 and 1 node, respectively, and a binary output. Using receiver operator characteristics analysis demonstrated an area under the curve of 0.75 correlating to a sensitivity of 100% and specificity of 50%. CONCLUSION: The premise that regional washout of 123I-mIBG SPECT from noninfarcted tissue is the best predictor of cardiac events was built on has a sound and logical foundation. By artificial neural network analysis; however, 123I-mIBG planar global washout of >30% was shown to be the best indicator for risk of cardiac event when accompanied by a decline in left ventricular ejection fraction of >10%. Further investigation should be undertaken assessing assimilation into big data and the potential for automated feature extraction from raw image datasets with convolutional neural networks.

Regional Cardiac Sympathetic Nervous System Evaluation Using 123I-mIBG SPECT in Patients with Heart Failure.

BACKGROUND: Heart failure (HF) involves both mechanical and autonomic nervous system dysfunction that can lead to sudden cardiac death. In the failing human heart, there is increased release of norepinephrine from neurons and reduced uptake. Iodine-123-labeled metaiodobenzylguanidine (123I-mIBG) demonstrates reduced global uptake and increased washout associated with increased mortality in HF. This research examined the potential benefits of single-photon emission computed tomography (SPECT) regional quantitation in risk stratification of HF patients and its role in prediction of cardiac morbidity and mortality. METHODS: Twenty-two clinically diagnosed HF patients were recruited into this study. The subjects underwent myocardial perfusion SPECT and cardiac sympathetic imaging with 123I-mIBG. Early (at 15 min after injection) and delayed (four hours after injection) planar and SPECT were performed. Visual and semiquantitative analysis was conducted, and global (from planar imaging) and regional (from SPECT imaging) uptake and washout indices determined. The patients were clinically followed for up to two years, and the cardiac events (CEs) in these patients were recorded and correlated with the various parameters. RESULTS: The occurrence of a CE in HF was independent of the patients' demographics or the cause of HF. Genetic biomarkers were unable to reliably predict CEs. Global or regional uptake had limited ability to predict a CE, whereas regional washout from the inferior wall (P = .005) was a statistically significant predictor of CEs. Similarly, a high washout of 40% or more from the peri-infarcted and noninfarcted segments on myocardial perfusion scintigraphy was also a significant predictor of CEs (P = .035). CONCLUSION: HF is a complex, multifactorial, progressive disease that appears to begin regionally. 123I-mIBG provides a valuable tool in imaging the global and regional sympathetic nervous system innervation of the heart. This may allow early identification and stratification of patients at risk of sudden cardiac death.

Novel Radiopharmaceuticals in Cardiovascular Medicine: Present and Future.

Advancements in molecular medicine technology have allowed the development of innovative and better radiopharmaceuticals to augment or replace the existing ones, allowing the acquisition of higher-quality and detailed diagnostic information and accuracy. They build on the strengths of the existing radiotracers or remove their shortcomings, thus bringing them closer to the ideal. Given the discovery of more novel molecules, it is now possible that processes in the human body indicative of predisease stage can be imaged, allowing for appropriate interventions earlier-preventing the development of late stage disease, preventing morbidity and mortality, and reducing the burden on the national health care system. Both positron emission tomography and single-photon emission computed tomography are developing in the fields of perfusion, metabolic, and innervation imaging of the heart. Newer radiotracers can yield higher-quality images with a greater diagnostic potential that are more convenient to use in the daily practice, and at a lower cost. In addition, tracers have been developed for imaging processes like cardiac apoptosis, angiogenesis, and the development of coronary atherosclerosis, enabling physicians to minimize the pathological changes at the reversible stage by promoting appropriate lifestyle changes and pharmaceutical interventions. In this article, we overview the most promising radiotracers that in the future have the potential to become established imaging agents in the field of cardiac nuclear medicine.

Tampon Appearance on Bone Scan Imaging: Case Report.

The role of a nuclear medicine diagnostic bone scan is well established and the influence of potential artifacts well documented. This case provides an insight into an unusual artifact associated with a tampon in situ and highlights the clinical relevance of single-photon emission computed tomography/computed tomography imaging in differentiating uncommon artifacts from potential pelvic pathology.

Risk stratification in heart failure using ¹²³I-MIBG.

Heart failure is a progressive, heterogeneous form of cardiovascular disease that requires treatment to be individualized depending on the presenting symptoms. A decision to use an implantable cardioverter-defibrillator (ICD) is based on chronic heart failure patients presenting with a New York Heart Association classification of II or III and a left ventricular ejection fraction (LVEF) less than or equal to 30%-35%. A large percentage of ICD devices, however, never deliver therapy during their lifetime, and as many as 33% of patients ineligible for an ICD (LVEF > 35%) die of sudden cardiac death. (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy identifies sympathetic nervous system dysfunction and has been shown to lead to better patient stratification. This article reviews the role of planar (123)I-MIBG global quantitation in improving differentiation of heart failure, regardless of the LVEF, to better identify those in whom an ICD is more likely to reap benefits. It goes on to explore the potential incremental benefit of SPECT-based regional quantitation to risk stratification and provides a case example in which (123)I-MIBG SPECT was used to inform a decision to not use an ICD in a patient eligible under the standard criteria.

The incremental value of SPECT/CT in characterizing solitary spine lesions.

UNLABELLED: The purpose of this study was to investigate the incremental value and diagnostic impact of SPECT/CT in patients who had a solitary spinal lesion on a bone scan. METHODS: A prospective study was performed on 80 patients (50 with known cancer) who underwent (99m)Tc-methylene diphosphonate whole-body planar bone scintigraphy and had a solitary spinal lesion. These lesions were then further evaluated using SPECT/CT. RESULTS: Lesions were localized to the vertebral body in 38 patients (47.5%), pedicle in 15 (18.8%), facet joint in 15 (18.8%), transverse process in 2 (2.5%), spinous process in 2 (2.5%), lamina in 3 (3.8%), and end plates in 5 (6.2%). Although the specificity of planar bone scans was excellent (100%), sensitivity was only 6.1% but increased to 78.8% after the addition of SPECT/CT. The results provide evidence of a substantial incremental increase in diagnostic accuracy using SPECT/CT over planar imaging alone for patients in whom a solitary spinal lesion is noted. CONCLUSION: The addition of SPECT/CT significantly reduced the number of false-negative results and increased the number of true-positive results. SPECT/CT also reduced the number of equivocal reports. A definitive diagnosis was given for most patients, indicating improved diagnostic confidence with the addition of SPECT/CT, compared with planar imaging alone, in patients with solitary spinal lesions.