Epithelioid angiosarcoma of the pericardium: Case report of the challenges in the management of a rare malignancy with poor prognosis.

ABSTRACT: A primary epithelioid angiosarcoma of the pericardium is a rare soft tissue malignancy. This report describes a young adult woman who presented with progressive dyspnea and pericardial effusion. She was found to have pericardial mass on imaging along with extensive myocardial infiltration. The biopsy of the mass revealed epithelioid angiosarcoma, which was CD34 and CD31-immuno-positive. Due to unresectable disease, she was given a trial of immunotherapy followed by conventional chemotherapy. She showed partial response on interim assessment, but progressed soon after the completion of six cycles and succumbed to her rapidly progressive illness within nine months of diagnosis. This report discusses the diagnostic and therapeutic challenges faced while managing this disease of aggressive tumor biology.

A Prospective Comparative Study between 99mTc MIBI Myocardial Perfusion Single-Photon Emission Computed Tomography and Dobutamine Stress Echocardiography to Detect Viable Myocardium in Patients with Coronary Artery Disease.

Introduction: The objective of this study was to compare 99mTc MIBI myocardial perfusion SPECT and Dobutamine Stress Echocardiography (DSE) in detecting viable myocardium in patients with Coronary Artery Disease. Materials and Methods: Total of 50 patients who with CAD and poor LV function were idenitifed on 2D Echo using 16 segment cardiac model. These patients underwent 99mTc MIBI myocardial perfusion SPECT and Dobutamine Stress Echocardiography and the results were compared with the gold standard 18F-FDG PET-CT findings. Results: A Total of 550 dysfunctional segments were identified in datasets of 50 patients on 2D echo. No significant difference was noted between the pairwise positive outcome of viable segment between MIBI SPECT and DSE (p=0.875). MIBI SPECT showed a sensitivity of 86.5% and specificity of 90.0% when compared with 18F-FDG PET-CT which was comparable with DSE having a sensitivity of 87.6% and specificity of 90.7%. Conclusion: 99mTc MIBI SPECT is an effective good alternative for evaluation of viable myocardial segments in patients with dysfunctional myocardium and can be considered especially in elderly or obese patients and patients with lung disease having poor echocardiographic imaging window due to lack of an optimal acoustic window.

An Unusual Cause of Fever, Bilateral Ear Discharge, Lung Nodules, and Polyuria in a Young Male Post Coronavirus Disease 19.

We present a case of a young male with pyrexia of unknown origin, bilateral ear discharge, lung nodules and polyuria within four weeks of recovering from a moderate Coronavirus disease-19 infection. To the best of our knowledge, this is the first case of post- Coronavirus disease-19 Granulomatosis with Polyangiitis with overlapping large vessel vasculitis with a favorable outcome.

Role of 18 F-FDG PET-CT in Urethral Malignant Melanoma and Analysis of the UK Guidelines on Ano-uro-genital Melanomas.

Urethral melanomas are a rare subtype of noncutaneous melanomas. The disease has a tendency to have skip lesions and early metastases as compared with cutaneous melanomas. The role of fluorine-18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography computed tomography (PET-CT) is well established in cases of cutaneous melanomas and is recommended by the National Comprehensive Cancer Network (NCCN) for stage IIB to IV cancer. There are no established guidelines on the management of noncutaneous melanomas; however, a recently published United Kingdom national guideline aims to streamline the management of ano-uro-genital melanomas. The guideline describes a very limited role in the use of 18 F-FDG PET-CT in this case scenario. The tendency to skip lesions, early metastases, involvement of brain parenchyma, and finally the usage of anti-PD-1 medications are key areas where 18 F-FDG PET-CT has shown superiority over CT scan. With this case report, we aim to highlight the strength of 18 F-FDG PET-CT in the management of urethral melanomas, which can be extrapolated to other ano-uro-genital melanomas.

Use of Oral Empagliflozin to Obtain Optimal Blood Sugar Levels for Conducting 18 F-FDG PET-CT in Patients with Hyperglycemia-A Pilot Study.

Background Flourine-18 fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET-CT) is a well-established imaging modality for the evaluation of patients with oncological and nononcological conditions. The underlying principle of imaging is the preferentially increased glucose consumption by cancer cells, due to overexpression of glucose type 1 receptors that are insulin independent. Thus, one of the factors that leads to decreased sensitivity of an 18 F-FDG PET-CT is elevated blood sugar levels, leading to decreased glucose uptake by cancer cells due to competitive inhibition. A significant percentage of patients scheduled for PET-CT scan has diabetes mellitus type II as a comorbid condition and often has elevated random blood sugar (RBS) precluding an upfront PET-CT evaluation. Such cases must be rescheduled. This causes delay in the evaluation and management of such patients. Empagliflozin is a novel sodium glucose type 2 inhibitor that prevents tubular reabsorption of glucose and increases renal glycosuria resulting in decreased blood sugar. This drug does not cause significant hypoglycemia or increase endogenous insulin secretion. This study was undertaken to evaluate a potential role for empagliflozin in facilitating optimal blood sugar control in patients with hyperglycemia on the day of the scheduled PET scan. Methods This is an interventional prospective study and patients detected to have RBS more than 200 mg/dL on the day of the scheduled scan were included in the study. The patients were administered two tablets of 10 mg empagliflozin and kept under observation. Samples for RBS were taken at approximately 2nd and 4th hour post administration by bedside method. These patients underwent scan on the same day after adequate sugar control and when an RBS of less than 200 mg/dL was achieved. The primary outcome studied was change in RBS values in the patient cohort and evaluation of PET SUV (standardized uptake value) compared with the rest of the patients scheduled on the same day. Secondary outcome was assessment of any side effects in the patients. Results Total of 10 patients were found to have elevated blood sugar (RBS > 200 mg/dL; irrespective of being on medication) and did not meet the evaluation criteria for a PET-CT scan on the scheduled day. Following administration of the drug, all 10 patients were able to attain blood sugar levels and fulfill the criteria for undergoing a PET-CT scan. No obvious side effect was noted in any of the patient. The SUV values of the patient cohort were comparable with the rest of the patient scanned on the day. Conclusion In this pilot study, 20 mg of empagliflozin (2 tablets of 10 mg) appears to be a safe and effective method for achieving optimal decrease in the RBS without causing hypoglycemia or hyperinsulinemia. It can be safely employed in the subset of population with RBS between 201 and 300 mg/dL to adequately bring the sugar levels at acceptable levels RBS less than 200 mg/dl and fulfill the FDG PET-CT criteria as per European Association of Nuclear Medicine (EANM) norms.

18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan Findings in a Rare Case of Subcutaneous Panniculitis-Like T-Cell Lymphoma.

Skin lymphomas are less common and subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a fairly rare subtype of primary cutaneous lymphoma. Skin lymphomas involve subcutaneous adipose tissues with no involvement of lymph nodes. Diagnosis of these cases is generally a challenge to clinicians. These cases present with fever, weight loss, and local discomfort in the region of involvement of subcutaneous tissues and sometime with skin eczema and rashes. Positron emission tomography/computed tomography (PET/CT) scan can guide in determining the extent of involvement being whole-body imaging and can guide the site of biopsy and can help to prevent misdiagnosis. It also helps in correct and early diagnosis and successful treatment. We report a case of a young adult who presented with pyrexia of unknown origin in which PET/CT scan revealed mildly fluorodeoxyglucose-avid diffuse subcutaneous panniculitis involving the whole body, trunk, and extremities. Biopsy was taken from the most appropriate site according to the PET/CT scan report and reported as SPTCL.

COVID-19 Bivalent Booster Vaccination Coverage and Intent to Receive Booster Vaccination Among Adolescents and Adults - United States, November-December 2022.

COVID-19 vaccine booster doses are safe and maintain protection after receipt of a primary vaccination series and reduce the risk for serious COVID-19-related outcomes, including emergency department visits, hospitalization, and death (1,2). CDC recommended an updated (bivalent) booster for adolescents aged 12-17 years and adults aged ≥18 years on September 1, 2022 (3). The bivalent booster is formulated to protect against the Omicron BA.4 and BA.5 subvariants of SARS-CoV-2 as well as the original (ancestral) strain (3). Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Child COVID Module (NIS-CCM) (4), among all adolescents aged 12-17 years who completed a primary series, 18.5% had received a bivalent booster dose, 52.0% had not yet received a bivalent booster but had parents open to booster vaccination for their child, 15.1% had not received a bivalent booster and had parents who were unsure about getting a booster vaccination for their child, and 14.4% had parents who were reluctant to seek booster vaccination for their child. Based on data collected during October 30-December 31, 2022, from the National Immunization Survey-Adult COVID Module (NIS-ACM) (4), 27.1% of adults who had completed a COVID-19 primary series had received a bivalent booster, 39.4% had not yet received a bivalent booster but were open to receiving booster vaccination, 12.4% had not yet received a bivalent booster and were unsure about getting a booster vaccination, and 21.1% were reluctant to receive a booster. Adolescents and adults in rural areas had a much lower primary series completion rate and up-to-date vaccination coverage. Bivalent booster coverage was lower among non-Hispanic Black or African American (Black) and Hispanic or Latino (Hispanic) adolescents and adults compared with non-Hispanic White (White) adolescents and adults. Among adults who were open to receiving booster vaccination, 58.9% reported not having received a provider recommendation for booster vaccination, 16.9% had safety concerns, and 4.4% reported difficulty getting a booster vaccine. Among adolescents with parents who were open to getting a booster vaccination for their child, 32.4% had not received a provider recommendation for any COVID-19 vaccination, and 11.8% had parents who reported safety concerns. Although bivalent booster vaccination coverage among adults differed by factors such as income, health insurance status, and social vulnerability index (SVI), these factors were not associated with differences in reluctance to seek booster vaccination. Health care provider recommendations for COVID-19 vaccination; dissemination of information by trusted messengers about the continued risk for COVID-19-related illness and the benefits and safety of bivalent booster vaccination; and reducing barriers to vaccination could improve COVID-19 bivalent booster coverage among adolescents and adults.

A lightweight capsule network architecture for detection of COVID-19 from lung CT scans.

COVID-19, a novel coronavirus, has spread quickly and produced a worldwide respiratory ailment outbreak. There is a need for large-scale screening to prevent the spreading of the disease. When compared with the reverse transcription polymerase chain reaction (RT-PCR) test, computed tomography (CT) is far more consistent, concrete, and precise in detecting COVID-19 patients through clinical diagnosis. An architecture based on deep learning has been proposed by integrating a capsule network with different variants of convolution neural networks. DenseNet, ResNet, VGGNet, and MobileNet are utilized with CapsNet to detect COVID-19 cases using lung computed tomography scans. It has found that all the four models are providing adequate accuracy, among which the VGGCapsNet, DenseCapsNet, and MobileCapsNet models have gained the highest accuracy of 99%. An Android-based app can be deployed using MobileCapsNet model to detect COVID-19 as it is a lightweight model and best suited for handheld devices like a mobile.

Personalized Liver Cancer Risk Prediction Using Big Data Analytics Techniques with Image Processing Segmentation.

A technology known as data analytics is a massively parallel processing approach that may be used to forecast a wide range of illnesses. Many scientific research methodologies have the problem of requiring a significant amount of time and processing effort, which has a negative impact on the overall performance of the system. Virtual screening (VS) is a drug discovery approach that makes use of big data techniques and is based on the concept of virtual screening. This approach is utilised for the development of novel drugs, and it is a time-consuming procedure that includes the docking of ligands in several databases in order to build the protein receptor. The proposed work is divided into two modules: image processing-based cancer segmentation and analysis using extracted features using big data analytics, and cancer segmentation and analysis using extracted features using image processing. This statistical approach is critical in the development of new drugs for the treatment of liver cancer. Machine learning methods were utilised in the prediction of liver cancer, including the MapReduce and Mahout algorithms, which were used to prefilter the set of ligand filaments before they were used in the prediction of liver cancer. This work proposes the SMRF algorithm, an improved scalable random forest algorithm built on the MapReduce foundation. Using a computer cluster or cloud computing environment, this new method categorises massive datasets. With SMRF, small amounts of data are processed and optimised over a large number of computers, allowing for the highest possible throughput. When compared to the standard random forest method, the testing findings reveal that the SMRF algorithm exhibits the same level of accuracy deterioration but exhibits superior overall performance. The accuracy range of 80 percent using the performance metrics analysis is included in the actual formulation of the medicine that is utilised for liver cancer prediction in this study.

Synchronous Detection of Extra-Adrenal Paraganglioma in a Follow-Up Case of High-Grade Gastrointestinal Stromal Tumor.

Extraadrenal paragalionoma at multiple sites and its association with GIST is a rare finding. Although 18F-FDG PET-CT is not a modality of choice for primary diagnosis of paraganglioma, and its use is restricted for detection of metastases/multiple sites and disease staging. However, in this case that we describe here, its role in an already-proven/recurrent case of paraganglioma is emphasized by its simultaneous assessment of disease at several different sites.

Convolutional capsule network for COVID-19 detection using radiography images.

Novel corona virus COVID-19 has spread rapidly all over the world. Due to increasing COVID-19 cases, there is a dearth of testing kits. Therefore, there is a severe need for an automatic recognition system as a solution to reduce the spreading of the COVID-19 virus. This work offers a decision support system based on the X-ray image to diagnose the presence of the COVID-19 virus. A deep learning-based computer-aided decision support system will be capable to differentiate between COVID-19 and pneumonia. Recently, convolutional neural network (CNN) is designed for the diagnosis of COVID-19 patients through chest radiography (or chest X-ray, CXR) images. However, due to the usage of CNN, there are some limitations with these decision support systems. These systems suffer with the problem of view-invariance and loss of information due to down-sampling. In this paper, the capsule network (CapsNet)-based system named visual geometry group capsule network (VGG-CapsNet) for the diagnosis of COVID-19 is proposed. Due to the usage of capsule network (CapsNet), the authors have succeeded in removing the drawbacks found in the CNN-based decision support system for the detection of COVID-19. Through simulation results, it is found that VGG-CapsNet has performed better than the CNN-CapsNet model for the diagnosis of COVID-19. The proposed VGG-CapsNet-based system has shown 97% accuracy for COVID-19 versus non-COVID-19 classification, and 92% accuracy for COVID-19 versus normal versus viral pneumonia classification. Proposed VGG-CapsNet-based system available at https://github.com/shamiktiwari/COVID19_Xray can be used to detect the existence of COVID-19 virus in the human body through chest radiographic images.

Anaesthetic implications of free-flap microvascular surgery for head and neck malignancies - A relook.

Head and neck free-flap microvascular surgery is a type of surgery where multiple anaesthetic factors play a very important role in the outcome of the surgery while the conduct of anaesthesia itself may be quite challenging for the anaesthesiologist. In microvascular reconstruction of head and neck malignancies, flaps are used to reconstruct a primary defect formed by wide local excision. A free flap is raised after removing the neurovascular pedicle from the donor site and transplanting it by microvascular anastomosis to the new location. This gives rise to a secondary defect which is then repaired by direct suture or skin graft. The anaesthesiologist's role includes optimizing the physiological conditions for the survival of the flap while decreasing morbidity at the same time. Failure of the free flap is attributed to numerous causes. This is an attempt to highlight them along with discussion of the anaesthesia-related issues that are faced during this type of surgery. The various pre-, intra- and postoperative factors affecting flap survival and overall postoperative outcome in the patient are discussed here.

F-18 fluorodeoxyglucose positron emission tomography/computed tomography in conjunctival melanoma with recurrence.

Ocular melanoma is classified under the category of noncutaneous melanomas. Noncutaneous melanomas are relatively rare. Ocular melanoma commonly arises from choroid. Conjunctival melanoma is a rare but potentially lethal form of ocular melanoma. It can invade locally. Systemic spread is seen in up to 25% of cases, often associated with lymph node involvement. Metastatic sites include the lungs, liver, gastrointestinal tract, and the central nervous system. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET-CT) scanning is indicated for staging cutaneous melanoma patients. However, few studies have evaluated its role in the management of conjunctival melanoma. This case highlights the use of F-18 FDG PET/CT for imaging, preoperative staging, and evaluation for metastasis in conjunctival melanoma.

Tumor Thrombi in Multiple Tributaries of the Mesenteric Vein in a Case of Carcinoma Rectosigmoid: A Rare Entity.

Treatment for tumor thrombus in multiple blood vessels can be a challenge for management and thus FDG PET CT is a potent tool in evaluation of such cases in differentiating between bland and tumor thrombus and commenting on the extent of the involvement.

Knowledge, attitudes and practice preference regarding drug prescriptions of resident dental doctors: A quantitative study.

BACKGROUND: There has been an increasing need to examine undergraduate dental education in prescribing to confirm whether it is establishing the goal of producing safe and rational prescribers. Prescribing by dental doctors after graduation is influenced by a variety of factors: the different teaching approaches of the professors at the clinics and in the pharmacology course, fellow colleagues and even the information provided by the pharmaceutical industry. OBJECTIVE: The aim of this study was to assess the prescription knowledge, attitude, preference and common errors made by junior resident dental doctors in the dental department of two medical colleges and hospitals in India. METHODS: Dental graduates (n = 70) who served as junior resident doctors at dental departments and graduated from various dental colleges in India, participated in the study. A survey was conducted among 70 junior resident dental doctors in the dental department, applying a previously validated questionnaire consisting of open-ended questions. The knowledge, attitude and practice preference of resident doctors regarding drug prescription and common errors made by them were analyzed and reviewed. RESULTS: The most frequent response to each question was considered the most significant. The most common reason for prescribing medication was infection (n = 33, 47.14%) and the most widely prescribed antibiotic was amoxicillin (n = 29, 41.42%). The most frequent error reported by resident doctors was lack of knowledge about drug posology (n = 31, 44.28%). Maximum number of junior doctors acquired the information for prescribing drugs from their faculty (n = 33, 47.14%). Around 45.71% dental doctors had no knowledge about the WHO Guide to Good Prescribing. About 50- 60% doctors had knowledge about the dose, frequency, duration and route of administration of the drug prescribed. While prescribing drugs to the patient, 25.71% doctors explain the disease and treatment properly to the patient; 24.28% doctors do not criticize other doctors, and 10% doctors address the patient by name. CONCLUSION: The results of this study indicate that resident dental doctors' knowledge, attitudes and behavior about the drug prescription need to be improved. More studies are needed to determine whether this issue affects the quality of patient care and the effectiveness and safety of treatments.

Overdenture Prostheses with Metal Copings: A Retrospective Analysis of Survival and Prosthodontic Complications.

PURPOSE: To retrospectively evaluate complications associated with overdentures and abutment teeth restored with metal copings, including post-procedural and prosthetic problems; also to analyze the frequency and influencing factors associated with these problems. MATERIALS AND METHODS: A total of 80 subjects (48 females, 32 males, mean age 62 years) wearing root-supported overdentures were enrolled in the study. All participants were thoroughly examined by a single examiner, and appropriate maintenance care was performed. The 80 subjects had 270 abutments, which were endodontically treated teeth. All 80 subjects were carefully interviewed, inspected, and evaluated for post-procedural and clinical problems with their overdentures for an observation period of up to 5 years. RESULTS: Of the post-procedural problems evaluated, the most common problems were gingival inflammation (69%) and root caries (36%) because of poor oral hygiene (41%) and loss of metal copings (34%), followed by overdenture base fracture over abutment teeth (34%). Other post-procedural problems reported were loss of overdenture stability (23%), incidence of overdenture repair (20%), poor retention (18%), incidental finding of root fragments (unplanned) in the jaws (15%), and up to two grade net change in the mobility of overdenture abutments (8%). All prostheses were in use at the time of data collection and observation up to 5 years. CONCLUSIONS: Overdenture therapy was satisfactory; however, post-procedural and prosthetic complications and aftercare maintenance must not be underestimated.

Hematoma in Urinary Bladder Masquerading as Neoplastic Mass.

The most common reason for intraluminal urinary bladder hematoma is trauma. However in gynecological and pelvic malignancies, the pelvic irradiation can affect non targeted organs resulting in urogenital complications like hematoma. Small size hematoma can be easily diagnosed in ultrasound. Large hematoma can mimic as neoplastic mass in imaging modalities. We present here an intresting image of intraluminal urinary bladder mass, where FDG PET CT was helpful to diagnose it as a non neoplastic mass.

Dacroscintigraphy by Pediatric Dropper Technique: A User-friendly Instillation Procedure of Radiotracer.

CONTEXT: Instillation or application of the radiotracer over the tear film is one of the important parts of dacroscintigraphy. Our study explains the value of an improvised dropper technique so that desired amount of radioactivity in desired volume can be instilled over the tear film. AIM: The aim of the study is to introduce a simple and convenient instillation method based on dropper technique for performing dacroscintigraphy. This improvised dropper technique can be used so that desired amount of radioactivity in desired volume can be instilled over the tear film. The objectives of this experiment are to measure the volume and activity of each drop from the dropper. SETTINGS AND DESIGN: Experiment of volume and activity measurement standardization was carried out in two parts. In the first part, we calculated the volume of each drop indirectly to standardize the volume of drop. In the second part, we standardized the activity in each drop by measuring it in a dose calibrator. SUBJECTS AND METHODS: In this study, we used a common pediatric dropper of approximately 1 ml capacity, radioactivity (99mTcO4 pertechnetate), sample vial (container), vial holder, a pair of nonsterile gloves, dose calibrator, etc., Experiments of volume and radioactivity standardization were carried out in two parts. The first part of experiment calculated volume of each drop indirectly, and in the second, we standardized the activity in each drop by measuring it in dose calibrator. Statistical analysis used: Analysis of variance test was used to calculate the correlation of readings by same individual as well as among the three individuals. RESULTS: After analysis of result obtained, it was understood that there was no significant difference found in volume and activity of each drop in the readings recorded by same individual as well as among the three individuals. The calculated activity and observed activity were 86.64 and 79.16 µCi, respectively. The difference was only 8.63% lying within acceptable limits.

Non-Hodgkin's Lymphoma with Pelvic Skeletal Muscle Involvement Presenting as Low Back Ache: An Uncommon Presentation of a Rather Common Malignancy.

Lymphoma with skeletal muscle involvement is a rare clinical presentation. They may occur as primary skeletal muscle lymphoma, contiguous spread from bones or by metastatic spread. We present a rare case of non-Hodgkin's lymphoma with pelvic skeletal muscle involvement presenting as low back ache. Lymphoma as the first differential diagnosis in this case was clinched after an 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and confirmed as diffuse large B-cell lymphoma on histopathology. We seek to present an uncommon manifestation of lymphoma and highlight the role of 18F-FDG PET CT in the diagnosis, staging, and management of lymphoma.