Allopurinol-Induced Uncommon Dermatological Emergency of Toxic Epidermal Necrolysis (TEN).

Toxic epidermal necrolysis (TEN) is a life-threatening, blistering dermatitis. It is characterized by fever and the development of mucocutaneous lesions, which lead to necrosis and sloughing of the epidermis. It is commonly triggered by medications and infections. We present the case of a 75-year-old male who presented to the hospital with a fever and widespread exfoliating skin rash involving 41% of his body surface area (BSA). He has a past medical history of gout, hypertension, asthma, and depression. He was recently started on allopurinol by his general practitioner (GP) for hyperuricemia. The condition also involved oral, eye, and pharynx mucosae. He was diagnosed with toxic epidermal necrolysis and was managed with intravenous (IV) hydrocortisone, steroid and antibiotic eye drops, and steroid and antibiotic topical creams. Due to the weak available evidence supporting the use of ciclosporin and intravenous immunoglobulins, this patient was managed with steroid use only. His rash initially worsened, but ultimately, he made a full recovery without any sequelae. The patient was reviewed in the dermatology clinic four weeks post-discharge, and he did not have any residual disease.

Knowledge and Awareness of Colorectal Cancer among General Public of Kuwait

Colorectal cancer (CRC) is the third most common type of cancer and also the fourth most common cause of cancer related death in both men and women worldwide. The CRC is considered to be the second killer in Kuwait after breast cancer. Aim: to assess and identify the level of knowledge and awareness of colorectal cancer with regards to risk factors, symptoms and screening/imaging procedures among general public in the State of Kuwait. Method: A total of 1000 questionnaires were distributed and 675 questionnaires were completed, thus giving a response rate of 67.5%. The questionnaire was split into 4 categories representing demographic variables, risk factors, symptoms of CRC and awareness of diagnostic procedures. Statistical analysis was carried out using non-parametric test K-W. Results: It showed that 75% of the participants had heard about CRC. The most frequent risk factor that was chosen was the genetic factors and family history (73.5%) with P ˂ 0.05; however, the minimal risk factor was diabetes (31%). Most of the symptoms found to be related to colon rectal cancer were bloody stool, lower abdominal pain, obstructed intestine, and change in the nature of the exit but the least common symptom was due to anemia (33%). MRI was identified to be the most frequent diagnostic procedure (36%) followed by CT scan (31%). On the other hand, there were 187 (27.7%) of the participants who had limited knowledge about these different diagnostic procedures. Conclusion: The need for public awareness about diabetes as an important risk factor of CRC is necessary. Public seminars, school visits and social media will have important role in educating the public with regards to symptoms and diagnostic procedures of CRC.

Are women in Kuwait aware of breast cancer and its diagnostic procedures?

The aim of this study was to examine the knowledge and awareness of women in Kuwait with regard to risk factors, symptoms and diagnostic procedures of breast cancer. A total of 521 questionnaires were distributed among women in Kuwait. Results showed that 72% of respondents linked breast cancer factors to family history, while 69.7% scored abnormal breast enlargement as the most detectable symptom of the disease. Some 84% of participants had heard about self-examination, but knowledge about mammograms was limited to 48.6% and only 22.2% were familiar with diagnostic procedures. Some 22.9% of respondents identified the age over 40 years as the reasonable age to start mammogram screening. Risk factor awareness was independent on age groups (p>0.05), but both high education and family history increased the likelihood of postivie answers; the majority knew about a few factors such as aging, pregnancy after age 30, breast feeding for short time, menopause after age of 50, early puberty, and poor personal hygiene. In conclusion, 43.1% of participants had an overall good knowledge of breast cancer with regards to symptoms, risk factors and breast examination. Very highly significant associations (p<0.005) were evident for all groups except for respondents distributed by nationality (p=0.444). Early campaigns for screening the breast should be recommended to eliminate the confusion of wrong perceptions about malignant mammary disease.

Differential regional lung uptake analysis of the lung scan as an adjunct to interpretation of pulmonary embolism.

OBJECTIVE: Differential regional lung uptake (DRLU) analysis of a lung perfusion scan is used to provide information on diversion of the radiotracer from areas supplied by obstructed pulmonary artery branches to areas with patent vessels, which could assist in the diagnosis of pulmonary embolism (PE), especially the intermediate-probability studies. METHODS: Lung perfusion scans performed over 3 years (n=121) were analyzed using a computer overlay of six regions of interest per lung on the posterior view. DRLU was defined for neighboring region pairs as the ratio of the difference in the average count rate to the sum of the count rate in the region pair for a total of 18 region pairs per study. RESULTS: Comparison of the DRLU for high-probability studies (n=30) with normal scans (n=40) showed significant deviation in a least three region pairs per study. For low-probability scans (n=30), there was no significant deviation from the normal. For the intermediate category (n=21), a subgroup (n=7) showed significant deviation in at least three region pairs, which also had a positive computed tomography pulmonary angiography for PE, and another subgroup (n=14) had deviation in two or fewer region pairs with a negative computed tomography pulmonary angiography. CONCLUSION: Using DRLU analysis, intermediate scans for PE could be redefined as low or high probability, on the basis of the number of region pairs showing deviation of DRLU. This could lead to improved diagnostic performance of the study without recourse to additional maneuvers or specialized equipment and would obviate the need for more tests on the patient.

Effects of local curcumin on oxidative stress and total antioxidant capacity in vivo study.

Plants have been one of the important sources of medicine even since the-dawn of human civilization. Curcumin has been found to possess tremendous therapeutic potency as antiinflammatory, antioxidant and antimicrobial agent. The present study was designed to examine possible potential therapeutic and protective effect of curcumin from oxidative stress and on total antioxidant capacity in liver damage. The study was conducted using H2O2 as inducing agent of oxidative stress in vivo. Rats were randomly divided into five groups, where n = 20 for each group. Group 1 (G1) rats served as control group. Group 2 (G2) rats subjected to experimentally induced oxidative stress by the ad libitum supply of drinking water containing 0.5% H2O2(v/v) was prepared daily over entire 60 days. Group 3 (G3) rats received H2O2 for sixty days followed by giving 200 mg kg(-1) of curcumin for 30 days. Group 4 (G4) was simultaneously given curcumin (200 mg kg(-1)) for 15 days then followed by receiving H2O2 with curcumin for sixty days. Group 5 (G5) rats was received H2O2 for sixty days followed by giving 200 mg kg(-1) of N-acetyl 1-cystine as standard drug for 30 days. Levels of marker enzymes (ALT, AST and ALP), uric acid, Total Protein (TP) and tumor necrosis factor (α-TNF) were assessed in serum for all studied groups. Malondialdehyde (MDA), 8-hydroxy-2-deoxyguinosine, Total Antioxidant Capacity (TAC), reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) were assayed in liver homogenates for all studied groups. The results revealed significant increase (p < 0.05) in levels of ALT, AST, ALP, uric acid and α-TNF while there are significant decrease (p < 0.05) in levels of TP in G2 comparing to G1. Also there are significant differences (p < 0.05) between G3 and G4 comparing to G2 and between G3, G4 and G5 which curcumin elicited a significant hepatoprotective activity by lowering the levels of serum marker enzymes and lipid peroxidation. The results also revealed a significant increase (p < 0.05) in levels of MDA and 8-H-2-deoxy guinosine while there was significant reduction (p < 0.05) in TAC, GSH, SOD and catalase in G2 comparing to G1. Also there are significant differences (p < 0.05) between G3 and G4 comparing to G2 and between G3, G4 and G5. The conclusion could be drown from this study that the ability of curcumin as therapeutic agent and hepatoprotective against liver damage from oxidative damage and on TAC more than N-acetyl 1-cystine related to its antioxidant and free radical scavenger activity.

Issues affecting the motivation of nuclear medicine technologists in Kuwait.

UNLABELLED: The demand for nuclear medicine technologists (NMTs) in Kuwait has increased, especially with the introduction of multimodality imaging systems. In order to increase the number of NMTs in the workforce and retain the existing NMTs, there should be a better way to motivate them. AIM: To find out how satisfied NMTs are and the factors that motivate them. METHODS: An interview was conducted with 40 randomly selected NMTs to explore deep-seated emotions and attitudes that were related to motivation. Questions about the recognition NMTs receive from the general public, whether they are acknowledged as significant contributors to health services, ways to improve the standing of NMTs in society, and the clarity of the job description were included. A questionnaire survey was then conducted with 100 randomly selected NMTs. The questions were designed to elicit wider perspective of the information obtained from the interviews. RESULTS: The results show a need for attention in the Ministry of Health to NMTs for recognition, motivation, and improvement. Giving the NMTs their own identity and opportunities to be part of decision-making in the health team would influence more students to join nuclear medicine departments and give more self-confidence to the existing NMTs.

Ga-67 scintigraphic imaging: role of combined optimized energy photopeaks and scatter correction in improving lesion detectability.

BACKGROUND: The detection of lymphoma in gallium imaging is largely affected by image quality as Ga-67 emits three different energies with the highest contributing to septal penetration and image noise. Therefore, determining an optimal imaging protocol is crucial in the diagnosis and staging of lymphoma. The aim of this study was to further investigate the effect of using two energy windows rather than three (in improving signal-to-noise ratio, contrast, and resolution). In addition, application of the triple-energy-window (TEW) scatter correction method and its influence on lesion detectability have also been studied with emphasis placed on minimum detectable lesion and contrast. METHODS: An anthropomorphic torso phantom with chest lesion of different sizes and locations was used. Static planar and single-photon emission computed tomographic images for various lesion sizes and contrasts were acquired using the two different acquisition protocols. Contrast, resolution, and image noise were determined by the lesion-to-background ratio, full width at half maximum, and uniformity measurements, respectively. The TEW scatter compensation method was applied on two peaks-acquired images using two subwindows. RESULTS: Significant improvement (32%) in contrast was found in images acquired with two photopeaks in both planar and single-photon emission computed tomography (P<0.05). Observers' performance was significantly in favor of two photopeaks (P=0.003). The minimum detectable lesion was found to be 7 mm with an object ratio of 5 : 1 in two peaks images. This lesion, however, was not detectable in three photopeaks. Lesion detectability was significantly improved with the TEW scatter compensation method (P<0.01). CONCLUSION: Images acquired using two peaks were found to be superior to those normally used in clinical practice (i.e. three energies). The TEW scatter compensation method was found to be useful in improving Ga-67 image quality and lesion detectability. Thus, it is advised to reconsider using two photopeaks in gallium imaging with TEW scatter correction.

Improved delineation of parathyroid lesions in patients with chronic renal failure using magnified pinhole imaging.

UNLABELLED: (99m)Tc-sestamibi dual-phase scintigraphy is currently established for parathyroid localization. However, the imaging technique is not standardized, and the role of the pinhole collimator, especially, is not fully recognized in the imaging protocol. The aim of this study was to check whether the use of a pinhole collimator in parathyroid scintigraphy would enhance lesion detectability and delineation more than does a parallel-hole collimator or SPECT in patients with secondary hyperparathyroidism due to chronic renal failure with a mixed pattern of abnormalities. METHODS: Thirty-five patients referred for a parathyroid scan were included. Imaging was performed at 10 min and 2 h after injection of 925 MBq (25 mCi) of (99m)Tc-sestamibi using both a pinhole collimator and a high-resolution parallel-hole collimator fitted to a scintillation camera. SPECT was also performed at 1.5 h after injection. The images were reviewed by 2 experienced nuclear medicine physicians, and the results were analyzed. In addition, the contrast of visualized lesions was evaluated. RESULTS: Twenty-three patients (65.7%) had abnormal scan findings. The McNemar test revealed better detection of parathyroid lesions using pinhole imaging than with planar parallel-hole imaging and SPECT (P < 0.001 and P < 0.03, respectively). Both observers showed good agreement in evaluating different imaging techniques (κ = 0.76). Observers were in favor of pinhole imaging because SPECT suffered from noise. Lesion contrast was significantly higher in pinhole imaging than in parallel-hole imaging and SPECT (P < 0.05), with a 16% and 11% improvement in contrast, respectively. CONCLUSION: Pinhole imaging better delineates and detects lesions in parathyroid scintigraphy than does parallel-hole imaging and SPECT. Pinhole imaging increases confidence in image interpretation because of high lesion contrast and better magnification and resolution. The use of this technique is therefore recommended as part of the routine imaging protocol for (99m)Tc-sestamibi parathyroid scintigraphy.

Revisiting gallium-67 imaging: investigation of the energy photopeaks.

BACKGROUND: Ga-67 has multiple energy emissions of different abundances and the quality of images is affected by these inhomogeneous energy distributions. Thus the purpose of this study was to investigate whether two or three energy peaks of Ga-67 would be the most appropriate setting in terms of γ-camera performance and image quality measurements. MATERIALS AND METHODS: The physical performance of the γ-camera using Ga-67 has been tested; in particular, the effect of different gallium energy settings (two vs. three energy photopeaks) on the extrinsic and intrinsic uniformity and resolution of the γ-camera. The multicontrast/resolution phantom (OPRAXMEDICAL model 74-345) has been used to compare the two energy settings. The average contrast of the lesions and the contrast-to-noise ratio were measured and the significance of the result was determined using the paired Student's t-test. To test the effects of size and contrast on the detectability of defects, contrast detail curves have been generated for both the acquisition energy settings. For the optimization of the energy window, multiple static liver phantom images were acquired using the dual-energy photopeak acquisition method. However, each image was taken at different symmetric energy window combinations and the window settings were (5, 10, 15, and 20%) for 92 and 184 keV, respectively. RESULTS: For the two energy window acquisitions, the intrinsic uniformity calculated by the integral and differential equations for the useful field of view was 2.26 and 1.39%, respectively. However, for the three energy windows, the values were 3.04 and 1.81%, respectively. The integral and differential values for the dual-energy flood images were 10.97 and 3.75%, respectively, whereas the integral and differential values for the triple-energy flood images were 13.3 and 4.13%, respectively. A slight improvement in the system's intrinsic spatial resolution was observed in the dual-window setting with a full width at half maximum of 9.24 mm compared with 10.42 mm for the triple-energy acquisition. The full width at half maximum was not drastically increased in the three window acquisitions, but the full width at tenth maximum was found to be larger. The two energy acquisitions yielded a significant improvement by 20.5 and 22% in the mean contrast of the planar images of the phantom filled with 2 and 5 mCi of Ga-67, respectively (P value <0.01). Single-photon emission computed tomography images acquired for the liver phantom showed an improvement in the mean contrast by 29 and 27.6% using two windows (P<0.001) for 2 and 5 mCi activity concentration, respectively. Unlike planar imaging, single-photon emission computed tomography images yielded a 45% increase in the contrast-to-noise ratio using the two window acquisitions with a mean CNR of 5.24±3.47 and 2.9±2.23 for two and three windows respectively; P value less than 0.05. The contrast detail curves showed better detectibality for small-sized lesions and lower contrast when using dual-energy settings. The best contrast, on average, was achieved using 10% for 92 keV and 5, 10, 15, and 20% for 184 keV, respectively, and it was improved by 16, 24, and 35% compared with other settings. CONCLUSION: A significant improvement in image quality can be achieved by simply applying different window widths over the different photopeaks. Our results indicated that two photopeaks with optimized window widths can significantly outperform three windows in terms of spatial and contrast resolution and lesion detectability with a relatively negligible reduction of count sensitivity.