Assessing the effectiveness and safety of transbronchial lung cryobiopsy utilizing a flexible bronchoscope with an endobronchial blocker in diffuse parenchymal lung lesions.

Transbronchial lung cryobiopsy (TBLC) with flexible bronchoscope represents an encouraging modality to obtain a larger size specimen without crush artifact, and a higher diagnostic yield in patients with diffuse parenchymal lung lesions/diseases as compared to conventional transbronchial lung biopsy, and fewer complications as opposed to surgical lung biopsy. Artificial airway is preferred as it provides better airway protection in cases of severe bleeding. Although various researchers have published data on different modalities, the data is not sufficient to standardize a single technique. This study describes the procedural technique, safety, and yield of TBLC using a flexible bronchoscope with an endobronchial blocker. We performed a retrospective analysis of 100 consecutive patients who underwent TBLC using flexible bronchoscopy from May 2018 to June 2022. TBLC samples were obtained under moderate sedation without the use of artificial airway or fluoroscopy. Among the 100 patients, the majority were male (63%). The mean age of the enrolled patients was 44.43±15.92 years. The predominant diagnoses in our study were hypersensitivity pneumonitis (27%), followed by sarcoidosis (12%) and tuberculosis (10%). We obtained alveolated lung tissue in 90 out of 100 cases with a median biopsy size of 5 mm (in greatest dimension, interquartile range 5-4 mm), resulting in a specific histopathological diagnosis in 82 cases. The most frequent complications were bleeding and pneumothorax (13%). Mild bleeding occurred in 58% of the patients, and moderate bleeding occurred in 20% of the patients. There was no episode of severe/life-threatening bleeding. None of the patients required intensive care unit admission or endotracheal intubation. In conclusion, the use of TBLC through flexible bronchoscopy with an endobronchial blocker emerges as a minimally invasive, secure, time-efficient, and readily reproducible technique. Significantly, this procedure can be seamlessly executed in the bronchoscopy suite, eliminating the requirement for an artificial airway or general anesthesia.

Safety and Efficacy of 25 mg/kg and 35 mg/kg vs 10 mg/kg Rifampicin in Pulmonary TB: A Phase IIb Randomized Controlled Trial.

Background: Globally, no trial data are available on head-to-head comparison between 10 mg/kg and 25/35 mg/kg rifampicin in treating pulmonary tuberculosis during study initiation. Methods: A multicentric, phase IIb randomized trial recruited 333 new culture-positive, drug-sensitive adult patients with pulmonary tuberculosis to compare safety and efficacy of high-dose rifampicin (R25/R35), against conventional dose (R10) given daily for 8 weeks followed by standard doses for 16 weeks. Main outcomes were treatment-emergent grade 3/4 adverse events (AEs) and time-to-culture conversion in liquid media, assessed by division of AIDS system for grading the severity of adverse events division of AIDS criteria and Kaplan-Meier methods. Results: In a modified intention-to-treat population of 323 patients (R10: 105/R25: 112/R35: 106), grade 3/4 AEs were reported in 34 patients (R10: 9.5% [10/105], R25: 9.8% [11/112], R35: 12.3% [13/106]) during the intensive phase. Among 23 patients (R10: 3.8% [4/105], R25: 6.3% [7/112], R35: 11.3% [12/106]) with grade 3/4 hepatotoxicity, 15 (R10: 1.9% [2/105], R25: 3.6% [4/112], R35: 8.5% [9/106]) had grade 3/4 hyperbilirubinemia and 9 patients (R10: 1.0% [1/105], R25: 0.9% [1/112], R35: 6.6% [7/106]) developed clinical jaundice. Significant differences observed only between R10 and R35 with hepatotoxicity (P = .039), hyperbilirubinemia (P = .031), clinical jaundice (P = .032), and treatment interruption (P = .039). Eighteen serious AEs and 6 deaths (R10: 3/R25: 1/R35: 2) occurred during study period. Time to stable culture conversion in liquid media was faster in R25 (adjusted hazard ratio, 1.71; 95% confidence interval [CI], 1.26-2.31 [solid: 1.97; 95% CI, 1.46-2.67]) and R35 (1.81; 95% CI, 1.33-2.48 [solid: 2.24; 95% CI, 1.64-3.06]), than R10 (34 vs 44 days). R25 had no failure/relapse. Conclusions: Hepatotoxicity, clinical jaundice, and treatment interruptions occurred significantly higher with R35 than R10. Because R25 was comparably safe as R10 and also highly efficacious than R10, it may be considered for implementation. Clinical Trials Registration. CTRI/2017/12/010951.

Air pollution and its effects on emergency room visits in tertiary respiratory care centers in Delhi, India.

Environmental pollution has harmful effects on human health, particularly the respiratory system. We aimed to study the impact of daily ambient air pollution on daily emergency room visits for acute respiratory symptoms. This study was conducted in two tertiary respiratory care centres in Delhi, India. Daily counts of emergency room visits were collected. All patients attending the emergency room were screened for acute onset (less than 2 weeks) of respiratory symptoms and were recruited if they were staying in Delhi continuously for at least 4 weeks and having onset (≤2 weeks) of respiratory symptoms. Daily average air pollution data for the study period was obtained from four continuous ambient air quality monitoring stations. A total of 61,285 patients were screened and 11,424 were enrolled from June 2017 to February 2019. Cough and difficulty in breathing were most common respiratory symptoms. Poor air quality was observed during the months of October to December. Emergency room visits with acute respiratory symptoms significantly increased per standard deviation increase in PM10 from lag days 2-7. Increase in wheezing was primarily seen with increase in NO2. Pollutant levels have effect on acute respiratory symptoms and thus influence emergency room visits. *************************************************************** *Appendix Authors list Kamal Singhal,1 Kana Ram Jat,2 Karan Madan,3 Mohan P. George,4 Kalaivani Mani,5 Randeep Guleria,3 Ravindra Mohan Pandey,5 Rupinder Singh Dhaliwal,6 Rakesh Lodha,2 Varinder Singh1 1Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India 2Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India 3Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India 4Department of Environment, Delhi Pollution Control Committee, Kashmere Gate, New Delhi, India 5Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India 6Department of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India.

Enhanced cellulosic ethanol production via fed-batch simultaneous saccharification and fermentation of sequential dilute acid-alkali pretreated sugarcane bagasse.

This study reports high gravity fed-batch simultaneous saccharification and fermentation (FB-SSF) of sequentially pretreated sugarcane bagasse (SCB) for enhanced bioethanol by employing multiple inhibitor tolerant Kluyveromyces marxianusJKH5 C60. FB-SSF with intermittent feeding of SCB (total 20 % solid loading) and enzyme (total dose of 20 FPU/g) at 6 and 12 h resulted in superior bioethanol production at42 °C. Under optimizedlab-scaleFB-SSF, the maximum ethanoltiter, efficiency and productivities were73.4 ± 1.2 g/L,78 % and 3.0 g/L/h, respectively, after 72 h in presence of inhibitors (acetic acid, furfural, and vanillin at 3, 1, and 1 g/L, respectively). Furthermore, pentose rich dilute acid hydrolysate of SCB was subjected to fermentation by Pichia stipitis NCIM 3499, resulting in ethanol titer of 6.8 g/L. Overall ethanol yield during the developed process was 260.1 g/kg native SCB, which proves industrial potential of the developed bioethanol conversion process.

Preparedness for establishing COVID-19 services during acute emergency of COVID-19 pandemic: Experience of a tertiary care TB and respiratory diseases hospital.

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) calls for setting up of well-equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. An ideal high-level isolation unit requires a high level of administrative commitment, availability of space, human resource and logistics. METHOD: The experience of setting up COVID-19 care facilities on a noticeably short period in a tertiary TB and respiratory diseases institute in wake of the COVID-19 pandemic is being shared here. RESULT: All the essential COVID-19 services were set up in record time of 8 days. A total of 115 COVID-19 patients were admitted. Out of these 89 patients were discharged in a satisfactory condition. There were 19 deaths, and 4 patients became critical and had to be referred to level 3 facility for ICU care. CONCLUSION: This experience will help other hospitals in planning out the strategies and solve the difficulties they may face while opening a COVID-19 care facility under limited resources on an urgent basis.

Valorization of Pineapple Leaves Waste for the Production of Bioethanol.

Being a lignocellulose-rich biomass, pineapple leaves waste (PL) could be a potential raw material for the production of biofuel, biochemicals, and other value-added products. The main aim of this study was to investigate the potential of pineapple leaves in the sustainable production of bioethanol via stepwise saccharification and fermentation. For this purpose, PL was subjected to hydrothermal pretreatment in a high-pressure reactor at 150 °C for 20 min without any catalyst, resulting in a maximum reducing sugar yield of 38.1 g/L in the liquid fraction after solid-liquid separation of the pretreated hydrolysate. Inhibitors (phenolics, furans) and oligomers production were also monitored during the pretreatment in the liquid fraction of pretreated PL. Enzymatic hydrolysis (EH) of both pretreated biomass slurry and cellulose-rich solid fraction maintained at a solid loading (dry basis) of 5% wt. was performed at 50 °C and 150 rpm using commercial cellulase at an enzyme dose of 10 FPU/gds. EH resulted in a glucose yield of 13.7 and 18.4 g/L from pretreated slurry and solid fractions, respectively. Fermentation of the sugar syrup obtained by EH of pretreated slurry and the solid fraction was performed at 30 °C for 72 h using Saccharomyces cerevisiae WLP300, resulting in significant ethanol production with more than 91% fermentation efficiency. This study reveals the potential of pineapple leaves waste for biorefinery application, and the role of inhibitors in the overall efficiency of the process when using whole biomass slurry as a substrate.

High-Dose Rifampicin Mediated Systemic Alterations of Cytokines, Chemokines, Growth Factors, Microbial Translocation Markers, and Acute-Phase Proteins in Pulmonary Tuberculosis.

High-dose rifampicin (HDR) is now undergoing clinical trials to improve the efficacy of anti-tuberculosis treatment (ATT). However, the influence of HDR in the modulation of different cytokines, chemokines/growth factors, microbial translocation markers (MTMs), and acute-phase proteins (APPs) in pulmonary tuberculosis (PTB) is not well known. PTB individuals were separated into three different arms (R10, R25, and R35) based on their rifampicin dosage. We examined the circulating levels of Type 1, Type 2, pro-inflammatory/regulatory cytokines, chemokines/growth factors, MTMs, and APPs at baseline and after completion of the second month of ATT by ELISA. The baseline levels of cytokines, chemokines/growth factors, MTMs, and APPs did not (except IL-5, IL-6, IL-17A, MCP-1, MIP-1ß, GCSF, SAA, ⍺2 MG, Hp) significantly differ between the study individuals. However, at the second month, the plasma levels of Type 1 (TNFα and IFNγ), Type 2 (IL-4, IL-5, and IL-13), pro-inflammatory/regulatory cytokines (IL-6, IL-17A, IL-10, and GMCSF), and APPs were significantly decreased in R35 regimen- compared to R25 and/or R10 regimen-treated PTB individuals. In contrast, the plasma levels of IL-2, IL-8, MCP-1, MIP-1ß, GSF, and MTMs were significantly increased in the R35 regimen compared to R25 and/or R10 regimen-treated PTB individuals. Overall, our data reveal that HDR could potentially be beneficial for host immunity by altering different immune and inflammatory markers.

Sleep-Disordered Breathing in Newly Diagnosed Patients of Lung Cancer.

Sleep-disordered breathing (SDB) is highly prevalent in patients with cancer and affects their prognosis. However, data on SDB in lung cancer patients are lacking, and few studies have conducted level I polysomnography (PSG) in this patient population. This study aimed to measure SDB in newly diagnosed lung cancer patients at the sleep clinic of a tertiary respiratory institute in New Delhi, India, for eight months. This study included 30 patients. Participants received a clinical examination, completed a sleep questionnaire, and then underwent overnight PSG. We scored sleep parameters according to the American Academy of Sleep Medicine guidelines. Both descriptive and inferential statistics were used to analyze the data. We used univariate analysis with chi-square testing, and p<0.05 was considered significant. SDB and obstructive sleep apnea (OSA) were found in 66.6% and 56.6% of patients, respectively. Mild, moderate, and severe OSA were seen in 26.6%, 16.6%, and 13.3% of patients, respectively. Nocturnal oxygen desaturation (NOD) or NOD90 (i.e., when >30% of sleep time was spent with oxygen saturation levels <90%) was seen in 13.3% of patients. Adenocarcinoma was the most common histological variant of cancer. Tumor-node-metastasis staging was significantly associated with the presence of OSA (p=0.045). Lung cancer patients should receive routine PSG to identify and manage patients with SDB, especially given that symptoms of SDB such as easy fatigability and non-refreshing sleep are overlooked as symptoms of lung cancer. Proper management of SDB or OSA would help improve patients' quality of life and improve their overall prognosis.

Millettia pinnata plant pod extract-mediated synthesis of Bi2O3 for degradation of water pollutants.

In this study, plant extract obtained from pods of Millettia pinnata plant species was employed for nanosynthesis of Bi2O3. The as-synthesized semiconductor metal oxide nanoparticles were analyzed using various characterization tools such as X-ray diffraction (XRD), Scanning electron microscope (SEM), ultra violet-visible (UV-Vis), Fourier transform infrared (FTIR), Zeta potential, Raman, and X-ray photoelectron spectroscopy (XPS). The characterization results designate the formation of α and ß forms of Bi2O3. FESEM images demonstrate rod and flake-like nanostructures ranging from 25 to 70 nm. The green synthesized nanomaterial was found efficient for reduction of 4-nitro phenol (4-NP) and 4-nitro aniline (4-NA). However, it showed better performance toward the reduction of 4-NA. Photocatalytic investigations demonstrated that the green synthesized nanophotocatalyst was capable in degrading Amido Black 10B (AB-10B) dye efficiently under visible light illumination. 98.83% degradation of AB-10B dye was achieved within 120 min of irradiation under optimum conditions of photocatalyst dose and dye concentration. Active species trapping experiments revealed prominent role of superoxide radicals (•O2-) while hydroxyl radicals (•OH) played considerable role in the AB-10B photocatalytic degradation process. Moreover, the photostability and reusability assessment study ascertained good performance of the catalyst after four runs of successive cycles.

Strategies to enhance enzymatic hydrolysis of lignocellulosic biomass for biorefinery applications: A review.

Global interest in lignocellulosic biorefineries has increased in the recent past due to technological advancements in sustainable and cost-effective production of numerous commodity and speciality chemicals and fuels from renewable lignocellulosic biomass (LCB). As a result, the market value of biorefinery products has also increased over the time, with an estimated worth of USD 867.7 billion by 2025. However, biorefinery operations, especially enzymatic hydrolysis, suffer from many challenges that limits the cost-effectiveness of conversion of LCB. Therefore, it is essential to understand and address these challenges in future biorefineries. The paper focuses on recent trends and challenges in enzymatic hydrolysis of LCB during lignocellulosic biorefinery operation for greener synthesis of energy, fuels, chemicals and other high-value products. Insights into the gaps in knowledge and technological challenges have also been addressed together with focus on future research needs and perspectives of enzymatic hydrolysis of LCB for biorefinery applications.

Morphologically favorable mutant of Trichoderma reesei for low viscosity cellulase production.

Metabolite production by filamentous fungi hampered because of high viscosity generated during growth. Low viscosity fermentation by mold is one of the preferred ways of large scale enzymes production. Cellulolytic enzymes play a key role during the process of lignocellulosic biomass conversion. In this study, a mutant RC-23-1 was isolated through mutagenesis (diethyl sulfate followed by UV) of Trichoderma reesei RUT-C30. RCRC-23-1 not only gave higher cellulase production but also generated lower viscosity during enzyme production. Viscosity of mutant growth was more than three times lower than parent strain. RC-23-1 shows unique, yeast-like colony morphology on solid media and small pellet-like growth in liquid media. This mutant did not spread like mold on solid media. This mutant produces cellulases constitutively when grown in sugars. Using only glucose, the cellulase production was 4.1 FPU/ml. Among polysaccharides (avicel, xylan, and pectin), avicel gave maximum of 6.2 FPU/ml and pretreated biomass (rice straw, wheat straw and sugarcane bagasse) produced 5.1-5.8 FPU/ml. At 7 L scale reactor, fed-batch process was designed for cellulase production using different carbon and nitrogen sources. Maximum yield of cellulases was 182 FPU/g of lactose consumed was observed in fed-batch process. The produced enzyme used for hydrolysis of acid pretreated rice straw (20% solid loading) and maximum of 60% glucan conversion was observed. RC-23-1 mutant is good candidate for large scale cellulase production and could be a model strain to study mold to yeast-like transformation.

Recent advancements in prebiotic oligomers synthesis via enzymatic hydrolysis of lignocellulosic biomass.

Interest in functional food, such as non-digestible prebiotic oligosaccharides is increasing day by day and their production is shifting toward sustainable manufacturing. Due to the presence of high carbohydrate content, lignocellulosic biomass (LCB) is the most-potential, cost-effective and sustainable substrate for production of many useful products, including lignocellulose-derived prebiotic oligosaccharides (LDOs). These have the same worthwhile properties as other common oligosaccharides, such as short chain carbohydrates digestible to the gut flora but not to humans mainly due to their resistance to the low pH and high temperature and their demand is constantly increasing mainly due to increased awareness about their potential health benefits. Despite several advantages over the thermo-chemical route of synthesis, comprehensive and updated information on the conversion of lignocellulosic biomass to prebiotic oligomers via controlled enzymatic saccharification is not available in the literature. Thus, the main objective of this review is to highlight recent advancements in enzymatic synthesis of LDOs, current challenges, and future prospects of sustainably producing prebiotic oligomers via enzymatic hydrolysis of LCB substrates. Enzyme reaction engineering practices, custom-made enzyme preparations, controlled enzymatic hydrolysis, and protein engineering approaches have been discussed with regard to their applications in sustainable synthesis of lignocellulose-derived oligosaccharide prebiotics. An overview of scale-up aspects and market potential of LDOs has also been provided.

Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019).

Background & objectives: Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach. Methods: The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software. Results: Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the 'moderately polluted' south-west region of Delhi with relatively lower PM2.5 concentrations. Interpretation & conclusions: Acute respiratory ER visits of patients were related to regional PM2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study provides support for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies.

Development of multiple inhibitor tolerant yeast via adaptive laboratory evolution for sustainable bioethanol production.

The present research work aimed at developing robust yeast cell factory via adaptive laboratory evolution (ALE) for improved cellulosic bioethanol production. Kluyveromyces marxianus JKH5, a newly isolated thermotolerant ethanologenic yeast, was engineered by serial passaging for 60 generations in medium supplemented with gradually higher concentration of inhibitors (acetic acid, furfural, and vanillin) that are generated during dilute acid pretreatment. The improved strain K. marxianus JKH5 C60, showed 3.3-fold higher specific growth rate, 56% reduced lag phase and 80% enhanced fermentation efficiency at 42 °C in comparison to parent strain in inhibitor cocktail comprising medium. Bioethanol production by simultaneous saccharification and fermentation of sequential dilute acid-alkali pretreated sugarcane bagasse in presence of inhibitors, resulted in ethanol titre and yield, respectively, 54.8 ± 0.9 g/L and 0.40 g/g. The adapted yeast can be used to ferment unwashed pretreated biomass, thereby, reducing overall cost, time, and wastewater generation, hence making bioethanol production sustainable.

Developments in bioprocess for bacterial cellulose production.

Bacterial cellulose (BC) represents a novel bio-origin nonomaterial with its unique properties having diverse applications. Increased market demand and low yield are the major reason for its higher cost. Bacteria belonging to Komagataeibacter sp are the most exploited ones for BC production. Development of a cost-effective bioprocess for higher BC production is desirable. Though static fermentation modes have been majorly employed for BC production using tray fermenters, agitated mode has also been employed successfully with air-lift fermenters as well as stirred tank reactors. Bioprocess advances in recent years has led BC production to an upper level; however, challenges of aeration requirement and labor cost towards the higher end is associated with static cultivation at large scale. We have discussed the bioprocess development for BC production in recent years along with the challenges associated and the path forward.

Facile synthesis of ZnO/CuO/Ag2O ternary metal oxide nanocomposite for effective photodegradation of organic water pollutants.

The current study is focused on fabrication of a ternary metal oxide nanocomposite (ZnO/CuO/Ag2O) as an efficient and superior photocatalyst by step-wise implanting of p-type CuO and Ag2O semiconductors onto an n-type semiconductor (ZnO) via a chemical method. The structural and textural characteristics of the manufactured samples were characterized by X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, field emission scanning electron microscopy combined with electron dispersive spectroscopy (FESEM-EDS) and UV-visible spectroscopy. The photocatalytic performance of the fabricated ternary nanocomposite was tested against the photocatalytic degradation of crystal violet (CV) and rhodamine B (RhB) organic dyes under solar light irradiation. The ternary nanocomposite demonstrated about 99.05% and 97.38% degradation efficiency toward CV and RhB dyes under solar light irradiation in a time period of 105 min. The calculated rate constants (k, min-1) for degradation under solar light over the ZnO/CuO/Ag2O nanocomposite were 4.26 and 3.61 times higher than the k value obtained over ZnO nanoparticles for CV and RhB dyes, respectively. The main reactive species taking part in the photodegradation processes were •OH and •O2- over ZnO/CuO/Ag2O photocatalysts under solar light illumination. Furthermore, the recycle experiments confirmed good reusability and photo-stability of the ZnO/CuO/Ag2O ternary nanocomposite.

Neurodegeneration with brain iron accumulation: Characterization of clinical, radiological, and genetic features of pediatric patients from Southern India.

BACKGROUND: Neurodegeneration with brain iron accumulation (NBIA) is a group of rare inherited neurodegenerative disorders. Ten types of NBIA are known. Studies reporting various NBIA subtypes together are few. This study was aimed at describing clinical features, neuroimaging findings, and genetic mutations of different NBIA group disorders. METHODS: Clinical, radiological, and genetic data of patients diagnosed with NBIA in a tertiary care centre in Southern India from 2014 to 2020 was retrospectively collected and analysed. RESULTS: In our cohort of 27 cases, PLA2G6-associated neurodegeneration (PLAN) was most common (n = 13) followed by Pantothenate kinase-associated neurodegeneration (PKAN) (n = 9). We had 2 cases each of Mitochondrial membrane-associated neurodegeneration (MPAN) and Beta-propeller protein- associated neurodegeneration (BPAN) and 1 case of Kufor-Rakeb Syndrome (KRS). Walking difficulty was the presenting complaint in all PKAN cases, whereas the presentation in PLAN was that of development regression with onset at a mean age of 2 years. Overall, 50% patients of them presented with development regression and one-third had epilepsy. Presence of pyramidal signs was most common examination feature (89%) followed by one or more eye findings (81%) and movement disorders (50%). Neuroimaging was abnormal in 24/27 cases and cerebellar atrophy was the commonest finding (52%) followed by globus pallidus hypointensities (44%). CONCLUSIONS: One should have a high index of clinical suspicion for the diagnosis of NBIA in children presenting with neuroregression and vision abnormalities in presence of pyramidal signs or movement disorders. Neuroimaging and ophthalmological evaluation provide important clues to diagnosis in NBIA syndromes.

Incremental Utility of Tc-99m Glucohepatonate Single-Photon Emission Computed Tomography over 18F-Flourodeoxyglucose Positron Emission Tomography in Diagnosis of Brain Tumor Recurrence - Old is Gold.

Detection of recurrence of a brain tumor after treatment is one of the most important and challenging diagnostic problems in neuro-oncological practice. In spite of technical advances in imaging modalities, sometimes, certain clinical presentations and manifestations can lead to a diagnostic dilemma even with the best of the technical know-how. We present a case of recurrence of anaplastic oligoastrocytoma (World Health Organization Grade III), where the patient's initial clinical presentation and the F-18 flourodeoxyglucose positron emission tomography (PET) magnetic resonance imaging findings were suggestive of stroke-like migraine attacks after radiation therapy syndrome. Due to a seizure episode before PET image acquisition, intense gyral uptake was noted in the left parietal lobe which made it difficult to ascertain the presence of a tumor recurrence. However, Tc-99m glucohepatonate single-photon emission computed tomography done after 1 week revealed radiotracer uptake within the site corresponding to the primary tumor, and a diagnosis of recurrence was made.