ABSTRACT
Neuroleptic malignant syndrome (NMS), an iatrogenic form of malignant catatonia, carries high morbidity and mortality rates especially in the context of delayed recognition and standard intervention protocol of lorazepam trial. However, there is limited guidance available through literature for further management if benzodiazepine treatment is ineffective and electroconvulsive therapy (ECT) is not readily accessible. This case report describes a multimodal approach to address the diagnostic, treatment, and logistical system challenges in an acute medical hospital through the case of a 69-year-old man with schizophrenia who represented from a psychiatric ward with neuroleptic malignant syndrome. We educated our inpatient colleagues for timely recognition of hyperexcited subtype of catatonia to avoid iatrogenic progression to neuroleptic malignant syndrome and our medical colleagues on the clinical course of catatonic symptoms to avoid any further disagreements and delays in treatment. We advocated for timely electroconvulsive therapy in the setting of limited access and utilized creative pharmacologic strategies such as N-methyl-D-aspartate (NMDA) receptor antagonists and longer acting benzodiazepines while managing medical complications.
ABSTRACT
Development of antiviral therapy against acute viral diseases, such as dengue virus (DENV), suffers from the narrow window of viral load detection in serum during onset and clearance of infection and fever. We explored a biomarker approach using 18F-fluorodeoxyglucose (18F-FDG) PET in established mouse models for primary and antibody-dependent enhancement infection with DENV. 18F-FDG uptake was most prominent in the intestines and correlated with increased virus load and proinflammatory cytokines. Furthermore, a significant temporal trend in 18F-FDG uptake was seen in intestines and selected tissues over the time course of infection. Notably, 18F-FDG uptake and visualization by PET robustly differentiated treatment-naive groups from drug-treated groups as well as nonlethal from lethal infections with a clinical strain of DENV2. Thus, 18F-FDG may serve as a novel DENV infection-associated inflammation biomarker for assessing treatment response during therapeutic intervention trials.
ABSTRACT
The aim of this study on dopamine transporter binding by [18F]FE-PE2I and PET was to describe an image-derived approach using reference tissue models: the Logan DVR approach and simplified reference tissue model (SRTM), the features of which were simple to operate and precise in the measurements. Using the approach, the authors sought to obtain binding images and parameters. [18F]FE-PE2I and dynamic PET as well as an MRI was performed on three rhesus monkeys, and metabolite corrected arterial plasma inputs were obtained. After co-registering of PET to MR images, both image sets were resliced. The time-activity curve of the cerebellum was used as indirect input, and binding parametric images were computed voxel-by-voxel. Voxel-wise linear calculations were used for the Logan DVR approach, and nonlinear least squares fittings for the SRTM. To determine the best linear regression in the Logan DVR approach, the distribution volume ratio was obtained using the optimal starting frame analysis. The obtained binding parameters were compared with those obtained by the other independent ROI-based numerical approaches: two-tissue compartment model (2TCM), Logan DVR approach and SRTM using PMOD software. Binding potentials (BP) obtained by the present approach agreed well with those obtained by ROI-based numerical approaches, although reference tissue models tended to underestimate the BP value than 2TCM. Image-derived Logan approach provided a low-noise image, the computation time was short, and the error in the optimal starting frame analysis was small. The present approach provides a high-quality binding parametric image and reliable parameter value easily.
