In not a few instances have nuclear medicine physicians encountered persistent neck lesions in 131I whole body scintigraphy despite giving repeated radioactive iodine therapy. Interpreting these lesions as still thyroid remnants served as a dilemma. This is a case of a 37-year-old female with papillary thyroid cancer. 131I whole body scans done before and one year after radioactive iodine therapy showed persistent and unchanged neck lesions. Further imaging with SPECT/CT showed laryngeal skeleton involvement. Rarity of vascular and lymphatic spread to the larynx has led to a small number of reported cases. Neck lesions should not always be immediately diagnosed as thyroid remnants.
Human ; Female ; Adult ; WHOLE BODY IMAGING ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC IMAGING

After cutaneous and neurological manifestations, bone and joint involvement are the most common manifestations in Hansen’s disease (HD). Sometimes, these are undiagnosed and rarely reported.

A 68-year-old Filipino, male, presented with an 8-month history of digital joint swelling on both hands. He was initially managed by Rheumatology for arthritis, partially responsive to Methotrexate and Prednisone. Immunology and lupus panel tests were unremarkable. Skin biopsy done on a solitary erythematous plaque on the back revealed granulomatous dermatitis, tuberculoid type. Fite-Faraco, AFB, PAS stains were negative. Four weeks later, he developed multiple erythematous papules and plaques on the face, ears, lower back, gluteal area, and lower extremities. Arthritis was persistent but hypoesthesia, hypohidrosis or alopecia were not reported. A repeat skin biopsy showed epithelioid to macrophagic cell granulomatous reaction compatible to HD. AFB stain and slit skin smear were positive. He was managed as a case of Borderline (BB) to Borderline Lepromatous (BL) leprosy and was started on multibacillary drug treatment (MDT) of Rifampicin, Clofazimine and Dapsone. One month later, the patient reported resolution of skin lesions and arthritis.

Approximately 75% of individuals with HD experience arthritis, which can be one of the early signs of disease. A high index of suspicion is required as it closely mimics other rheumatologic conditions.

To study the sand fly fauna, surveys were performed atfour different leishmaniasis-endemic areas of Ecuador, during February 2013 andApril 2014. The conventional Shannon trap was modified and simplified to anewly named mini-Shannon trap for its multiple uses at different study sites,such as limited, forested and narrow spaces. The mini-Shannon, CDC light trapsand the protected human landing method were employed for sand fly collection.The species identification of sand flies was performed mainly based on themorphology of spermathecae and cibarium, after dissection of freshsamples.  In this study, therefore, onlyfemale samples were used for analysis. A total of1,480 female sand flies belonging to 25 Lutzomyia species were collected. Numbers of the female sand fliescollected by each trap were 417 (28.2%) by the mini-Shannon trap, 259 (17.5%)by CDC light trap and 804 (54.3%) by human landing. The total number of sand flies per trap collected bydifferent methods was markedly affected by study sites, probably because ofdifferent species compositions at each locality. Further, as an additionalstudy, the attractiveness of sand flies against the mini-Shannon traps poweredwith LED White-light and LED Black-light, waspreliminary tested, together with CDC light trap and human landing. In the test,a total of 426 sand flies of nine Lutzomyia species, seven man-biting and two non-man-biting species, were collected by threecapture trials during May and June 2014 in an area endemic for leishmaniasis(La Ventura). The Black-light equipped trap was relatively superior in capturenumbers to the White-light equipped one, but no significant difference wasobserved statistically between the two traps.

Background & Objective: Chronic pain impacts the quality of life of patients, with neuropathic pain causing profound negative sequelae. Assessment of pain whether nociceptive or neuropathic is important to provide appropriate treatment. The objective of this study is to translate and validate the pain-DETECT Questionnaire (PDQ) to two widely spoken regional languages in Filipino. Methods: The PDQ, a self-administered questionnaire, was translated from English into the Filipino version, painDETECT Tagalog (PDQ-Tag) and painDETECT Cebuano (PDQ-Ceb). One hundred Filipino patients suffering from pain for at least three months were recruited in the out-patient clinics of a hospital and completed the questionnaire. The investigators, blinded to the subjects PDQ-Tag and PDQ-Ceb scores, examined the subjects using the standard clinical and neurological examination. The PDQ-Tag and PDQ-Ceb, scores were validated. Both questionnaires were administered to the same patient twice, two days apart by the same investigator. Results: Seventy subjects completed the (PDQ-Tag) and thirty subjects the (PDQ-Ceb). The sensitivity and specificity of PDQ-Tag were both 80% for an upper limit cut-off value of ≥ 17. The sensitivity and specificity of PDQ-Ceb were 62.5% and 80% respectively, for an upper limit cut-off value ≥ 18.0. Both questionnaires were reliable [Cronbach’s alpha coefficient: 0.78 (PDQ-Tag) and 0.70 (PDQ-Ceb), good test-retest stability with intra-class correlation coefficient: 0.93 for PDQ-Tag and 0.99 for PDQ-Ceb]. Cohen’s kappa were 0.64 and 0.61 for PDQ-Ceb and PDQ-Tag respectively, with P value<0.001 indicating a significant agreement on the assessment of neuropathic pain. Conclusion: PDQ-Tag and PDQ-Ceb are reliable and valid self-administered screening tools to detect neuropathic pain among Filipinos.

We found errors in our published article.

To study the sand fly fauna, surveys were performed at four different leishmaniasis-endemic sites in Ecuador from February 2013 to April 2014. A modified and simplified version of the conventional Shannon trap was named “mini-Shannon trap” and put to multiple uses at the different study sites in limited, forested and narrow spaces. The mini-Shannon, CDC light trap and protected human landing method were employed for sand fly collection. The species identification of sand flies was performed mainly based on the morphology of spermathecae and cibarium, after dissection of fresh samples. In this study, therefore, only female samples were used for analysis. A total of 1,480 female sand flies belonging to 25 Lutzomyia species were collected. The number of female sand flies collected was 417 (28.2%) using the mini-Shannon trap, 259 (17.5%) using the CDC light trap and 804 (54.3%) by human landing. The total number of sand flies per trap collected by the different methods was markedly affected by the study site, probably because of the various composition of species at each locality. Furthermore, as an additional study, the attraction of sand flies to mini-Shannon traps powered with LED white-light and LED black-light was investigated preliminarily, together with the CDC light trap and human landing. As a result, a total of 426 sand flies of nine Lutzomyia species, including seven man-biting and two non-biting species, were collected during three capture trials in May and June 2014 in an area endemic for leishmaniasis (La Ventura). The black-light proved relatively superior to the white-light with regard to capture numbers, but no significant statistical difference was observed between the two traps.

The zoonotic nematode, Trichinella papuae, was first discovered in wild and domestic pigs in the Bensbach area, Morehead District, Western Province of Papua New Guinea (PNG) in 1988. 15 years later, T. papuae was found in wild pigs and captive crocodiles (Crocodylus porosus) in the Kikori area, Gulf Province of PNG. An overall prevalence of anti-Trichinella IgG was detected in 10% (0.0%-36.7%) of 1536 villagers living in Morehead District by using an ELISA as screening test and a Western blot as confirmatory test. No anti-Trichinella IgG antibodies were detected in 313 villagers living in the Kikori District in spite of the fact that T. papuae was circulating in wild pigs in the district. These results may reflect the different methods of cooking in the two districts. Specific symptoms typical of trichinellosis were not reported by serologically positive persons living in Morehead District, although some non-pathognomonic symptoms, common to trichinellosis and other ailments, were noted. In Thailand, trichinellosis caused by T. papuae was attributed to the custom of eating large quantities of raw pig meat, a food behaviour not found in people living in Morehead and Kikori Districts. This fact probably accounts for the lack of pathognomonic symptoms of trichinellosis in serologically positive people of Morehead District, although they, as well as the Kikori people, occasionally eat tidbits of raw pork sufficient, in the case of the Morehead people, to develop an immune response. The importance of consumer education to eat only thoroughly cooked meat in the localities where T. papuae is circulating is emphasized.

Background: Non-specific focal uptake in the skeleton is a diagnostic pitfall on 18F-PSMA-1007 PET/CT, but adjunctive measures to aid interpretation of these lesions are currently lacking. We present two cases where dual time point imaging provided additional information. Case Presentation: The first patient had a PI-RADS 3 lesion on MRI. No PSMA-avid abnormality was seen on PET, save for focal uptake in the right pubis with no anatomic correlate. Additional imaging showed a decrease in lesion SUV, and this was interpreted as benign. Another patient, diagnosed with prostate cancer, had multiple PSMA-avid pelvic foci. Two suspiciously malignant bone lesions had increasing SUV trend after dual time point imaging despite only faint sclerosis on CT. In contrast, one faint PSMA-avid lesion with no anatomic abnormality was read as benign after a decrease in SUV. A decrease in lesion SUV may point to a benign etiology, while an increase would heighten suspicion for malignancy. One possible molecular explanation is that a true PSMA-overexpressing lesion would bind to the tracer for a longer period than a false positive. Conclusion Dual time point imaging provides additional information that may be useful in the interpretation of non-specificskeletal lesions with increased 18F-PSMA-1007 uptake.
PSMA-1007 ; Positron Emission Tomography Computed Tomography

Objective: The neutrophil to lymphocyte ratio (NLR) is a non-specific, easy-to-obtain marker of inflammation associated with morbidity and mortality in systemic, psychiatric, and age-related inflammatory conditions. Given the growing trend of substance use disorder (SUD) in older adults, and the relationship between inflammation and SUD elevated NLR may serve as a useful inflammatory biomarker of the combined burden of aging and SUD. The present study focused on cocaine use disorder (CUD) to examine if cocaine adds further inflammatory burden among older adults, by comparing NLR values between older adults with CUD and a non-cocaine using, aged-matched, nationally representative sample. Methods: The dataset included 107 (86% male) participants (aged 50−65 years) with cocaine use disorder. NLR was derived from complete blood count tests by dividing the absolute value of peripheral neutrophil concentration by lymphocyte concentration. For comparison, we extracted data from age-matched adults without CUD using the National Health and Nutrition Examination Survey. Individuals with immunocompromising conditions were excluded (e.g., rheumatoid arthritis and sexually transmitted infections such as HIV). A doubly-robust inverse probability-weighted regression adjustment (IPWRA) propensity score method was used to estimate group differences on NLR while controlling for potential confounding variables (age, gender, race, income, nicotine, marijuana and alcohol use). Results: The IPWRA model revealed that the CUD sample had significantly elevated NLR in comparison to non-cocaine users, with a moderate effect size ( weight = 0.67). Conclusion Although non-specific, NLR represents a readily obtainable inflammatory marker for SUD research. CUD may add further inflammatory burden to aging cocaine users.

We report a 50-year-old woman with no relevant clinical history who presented with headache and loss of memory. Magnetic resonance imaging showed a left parieto-temporal mass with annular enhancement after contrast media administration, rendering a radiological diagnosis of high-grade astrocytic neoplasm. Tumour sampling was performed but the patient ultimately died as a result of disease. Microscopically, the lesion had areas of glioblastoma mixed with a benign mesenchymal constituent; the former showed hypercellularity, endothelial proliferation, high mitotic activity and necrosis, while the latter showed fascicles of long spindle cells surrounded by collagen and reticulin fibers. With approximately 40 previously reported cases, gliofibroma is a rare neoplasm defined as either glio-desmoplastic or glial/benign mesenchymal. As shown in our case, its prognosis is apparently determined by the degree of anaplasia of the glial component.
Anaplasia ; Collagen ; Contrast Media ; Diagnosis ; Female ; Glioblastoma ; Headache ; Humans ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Necrosis ; Prognosis ; Reticulin