This is a case of a 66-year-old, Filipina, who presented with persistent proteinuria diagnosed with renal amyloidosis. In the presented case, the equivocal cardiac and incidental extracardiac findings in the Tc-99m pyrophosphate (Tc-99m PYP) scan aided in the diagnosis of primary systemic light chain amyloidosis (AL amyloidosis). Tc-99m PYP scan with single photon emission computed tomography (SPECT) is currently used as a non-invasive imaging modality to diagnose Transthyretin amyloidosis (ATTR amyloidosis) however its role in diagnosing AL amyloidosis is not well documented. The case highlights its role in detecting extracardiac amyloid burden and suggests possible biopsy sites. The researchers recommend an additional whole-body planar scan with possible SPECT/CT on the 3rd hour delay to survey other areas with possible amyloid protein deposit.
Philippines

: The parathyroid glands play a crucial role in calcium regulation through parathyroid hormone (PTH) production. Indicators for those with hyperparathyroidism would be elevated serum calcium and PTH levels with further evaluation followed by imaging with neck ultrasonography and parathyroid scintigraphy. Limitations in the initial imaging modalities include operator-dependent sensitivity in neck ultrasonography, and poor spatial resolution, and poor sensitivity for smaller-sized adenomas in parathyroid scintigraphy. : This case report describes a 24-year-old female with elevated parathyroid hormone, and borderline elevated calcium levels with an initial diagnosis of primary hyperparathyroidism secondary to a suspected parathyroid adenoma. The dual tracer dual-phase scintigraphy accompanied by SPECT/CT and subtraction method was negative for a parathyroid adenoma, however, ultrasonography of the neck showed a suspicious nodular structure. Due to the high clinical suspicion, a subsequent 18F-Choline PET/CT was done and identified an 18F-Choline-avid lesion, highly suggestive of a parathyroid adenoma. This prompted parathyroidectomy in which histopathology as well as intraoperative reduction in parathyroid hormone levels, confirmed the presence of a parathyroid adenoma. This is the first recorded 18F-Choline PET/CT usage for a parathyroid adenoma in the country and highlights the potential of its usage as a sensitive and specific imaging modality in cases where conventional imaging is inconclusive.
Human ; Female ; Young Adult: 19-24 yrs old ; parathyroid adenoma ; parathyroid neoplasms ; hyperparathyroidism

Introduction: COVID-19 emerged as a new disease during the early period of 2020. Given that our institution is a cardiac specialty center and our patients have numerous co-morbidities compared to the general population, we wanted to determine the clinical profiles and in-hospital short-term outcomes of suspect, probable and confirmed adult COVID-19 patients seen at our institution. Methodology: We prospectively enrolled 323 adult (115 health care workers) suspect, probable and confirmed COVID- 19 patients admitted from March to June 2020. We described and analyzed their clinical presentation, and in-hospital outcomes. Results: There were 117 (36.22%) RT-PCR positive patients with 36.53% confirmed, 13.00% probable and 50.46% suspect patients. For probable and confirmed patients, 25%, 21.25%, 23.13% 16.25% had no, mild, moderate, and severe symptoms, respectively with 14.28% critical cases. Over-all mortality rate for probable and confirmed cases was 25.54% with 91.3% mortality rate for critical cases. Co-morbidities with statistically significant association with severity of disease were as follows: hypertension, heart disease, cerebrovascular disease, diabetes mellitus and COPD. Conclusion During the early period of the COVID-19 pandemic, only 36.53% of cases admitted at our institution were COVID-19 confirmed by RT-PCR. One-third of the cases were severe and critical, with more clinical instability, increased inflammatory markers, and higher in-hospital morbidity and mortality.
COVID-19 ; Pandemics ; Philippines

Introduction: Prostate cancer is the third most common cancer among Filipino males. Ga-68 PSMA PET-CT and Lu-177 PRLT have been introduced in the Philippines for the diagnostics and therapy of prostate cancer. Objective: The aim of this study is to compare treatment outcomes of standard therapy plus Lu-177 PSMA radioligand therapy and standard therapy alone among patients with prostatic cancer status-post castration using Ga-68 PET-CT as an outcome indicator. Methodology: This is an ambispective cohort study on Ga-68 PSMA PET-CT scans performed between January 1, 2018 and July 31, 2021. Serum PSA data taken within one month of the PET-CT scans were also collected when available. The PET-CT images were reviewed by a radiologist for RECIST response, and by a nuclear medicine physician for PERCIST response . Results: A total of 11 participants were included in the study. Six participants (55.5%) received standard therapy, while five participants (45.5%) received Lu-177 PSMA radioligand therapy plus standard therapy. There was no significant difference in the baseline and follow-up CT as shown by all p values > 0.05. A trend towards higher number of participants with non-complete/non-progressive RECIST response was noted in the control group than the treatment group, as well as higher number of participants with progressive or stable disease using the PERCIST response. Conclusion There were no significant differences noted in the clinical outcomes of participants who received Lu-177 PRLT and those with standard therapy alone. A trend towards decreasing serum PSA, CT and PET measurements were noted among patients given Lu-177 PRLT than those with standard therapy.
Prostatic Neoplasms

The introduction of peptide receptor radionuclide therapy (PRRT) to the Philippines has allowed for novel approaches in the management of neuroendocrine tumors (NETs). This case report details the management of a 66-year-old Filipino man diagnosed with metastatic pancreatic NET after biopsy and staging with Ga-68 DOTATATE PET-CT. After poor response to somatostatin analogue therapy, the patient was advised to undergo PRRT. Upon completing four cycles of PRRT with Lu-177 DOTATATE, the metastatic hepatic lesions showed resolution and the pancreatic tail tumor exhibited regression, allowing the patient to undergo surgical resection of the primary tumor. On follow-up, he was declared to be in remission with good quality of life and no imaging evidence of recurrence. The case underscores the diagnostic and therapeutic utility of radiolabeled somatostatin analogues along with the importance of a multidisciplinary approach in the management of an initially unresectable metastatic pancreatic NET
Receptors, Peptide ; Pancreatic Neoplasms ; Neuroendocrine Tumors

INTRODUCTION AND OBJECTIVES: Differences in ethnicity and geographical factors may have an effect in the characteristics of the prostate in men. To date, there is no demographical data regarding the average prostate volume among Filipino males stratified per age. METHODS: Retrospectively collected data from 3568 consecutive patients who had an ultrasound of the prostate from January 1, 2015 to December 31, 2016. Age and prostate volume by ultrasound were collected. Patients who had previous prostate surgery were excluded, and for uniformity of results, only patients who underwent transabdominal prostate ultrasound were included. RESULTS: Patients were stratified into the following age groups: 29 and below, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and 80 and above, and present results showed that the mean values of prostate volume were 15.8 ± SD 5.4, 19.6 ± SD 5.7, 22.1 ± SD 7.3, 28.0 ± SD 11.0, 34.0 ± SD 17.9, 39.6 ± SD 28.13, 39.2 ± SD 23.3, respectively. CONCLUSION The mean prostate volume among Filipino males increases with age and the threshold for an enlarged prostate might need an adjustment in dealing with Filipino patients.

Background: Parathyroid carcinoma is an uncommon, aggressive, endocrine malignant neoplasm and subsequent parathyroidectomy of such cases may lead to the life-threatening hypocalcemic condition called Hungry Bone Syndrome. We present a very rare case of parathyroid carcinoma with concomitant thyroid microcarcinoma with Hungry Bone Syndrome as its sequalae. Case Presentation: A 54/F initially presenting with hypogastric pain was showed to have nephrolithiasis. Subsequent Endocrinology referral revealed hypercalcemia and osteoporosis – and with a working impression of hypercalcemia secondary to a parathyroid adenoma. Sestamibi parathyroid scan showed persistently avid uptake in the left thyroid lobe highly suspicious for a parathyroid adenoma, but a concomitant thyroid nodule was not ruled out. Bone scan showed intense and diffuse tracer uptake in the skull and irregular tracer activity in the ribs, suggestive of metabolic bone disease, with no evidence of metastatic-looking bone lesions. She underwent left thyroid lobectomy with isthmusectomy and Sestamibi-guided left parathyroidectomy. Histopathology report showed a parathyroid gland carcinoma with papillary thyroid microcarcinoma. Two weeks post-surgery, hypocalcemic signs developed and ionized calcium was low. Hungry Bone Syndrome was considered and was treated with calcium gluconate and Zoledronic acid. Conclusion Nuclear imaging techniques and radioguided surgery are helpful in the diagnosis and management of both parathyroid and thyroid lesions – especially in difficult cases.
Parathyroid Neoplasms

Introduction: Among older populations, osteoarthritis (OA) is one of the most common chronic joint disorders and is a leading cause of disability, while osteoporosis is the most common metabolic bone disease, conferring fragility and significant risk of fracture. The relationship between OA and osteoporosis remains controversial. Although earlier studies reported an inverse association between the two diseases, more recent literature found a complex relationship mediated by various factors. Objective: The investigators sought to determine the association of osteoporosis with radiologic grading of the hip among older Filipino patients with suspected hip osteoarthritis. Methodology: A cross-sectional analytical study was conducted involving 256 patients with suspected hip OA who underwent radiography of the hips and central dual energy x-ray absorptiometry (DXA). Radiographs of the hips were evaluated by a radiologist using the Kellgren-Lawrence (KL) grading scale, while central DXA images were processed and evaluated by a nuclear medicine physician using the World Health Organization criteria for the diagnosis of osteoporosis and the 2019 International Society for Clinical Densitometry guidelines. The primary outcome measures were the prevalence of osteoporosis in patients with suspected hip OA, and the association of osteoporosis with radiologic KL grading of the hips. The secondary outcome measure was the association of osteoporosis with sex and BMI. Results: The study found that osteoporosis was present in 136 (53.1%) of the 256 patients who all presented with radiologic evidence of hip OA. There was a positive association between the presence of osteoporosis and the radiologic grade of hip OA (p-value: 0.006 on the right hip and 0.036 on the left). Osteoporosis was more prevalent in women compared to men (p-value: 0.031). Likewise, osteoporosis had a direct relationship with BMI (p-value: <0.001). Conclusion Osteoporosis was prevalent in a significant proportion of older Filipino patients with clinical and radiologic evidence of hip OA, particularly among women, and was positively associated with increasing severity of OA. The study suggests that obesity may not necessarily protect against osteoporosis in this population, possibly relating to increased adiposity and decreased lean muscle mass.
Osteoporosis ; Osteoarthritis ; Osteoarthritis, Hip ; Absorptiometry, Photon

Background/Objective: Papillary thyroid carcinoma is the most common type of thyroid cancer. Treatment includes surgery and remnant ablation with radioactive iodine theraphy while follow-up monitoring includes I- 131 whole body scans land thyroglobulin monitoring. Lymphovascular invasion (LVI) has been used as a predictor of metastasis in different cancers. Therefore, it might be useful in predicting metastasis in patients with papillary thyroid carcinoma since metastasis in this type of carcinoma travels via the lymphatic route. The purpose of this study was to determine the association of LVI with metastasis among patients with papillary thyroid carcinoma Methodology: Records of patients with papillary thyroid carcinoma (histopathologic reports, thyroglobulin levevls and I-131 whole body scans) were reviewed. Univariate and multivariate anlyses were performed. Results: A total of 108 subjects were recruited for this study, 47 (43.5%) of which had LVI. There was no association found between LVI and metastasis on baseline (p=0.72) and follow-up scans (p=0.07). However, there was an association between metastasis resolution on follow-up scans and high-dose radioactive treatment (p=0.02) regarless of presence or absence of LVI. Conclusion There was a significant association of the presence of LVI with elevated thyroglobulin levels (p-value<0.0001). A significant association was also seen with LVI and dose of activity with resolution of thyroid remnant, locoregional lymph node and distant metastasis (p=0.02). Even though no association jwas seen between LVI and metastasis, a robust percentage of patients with LVI were positive for metastasis on whole body scans.
Thyroid Cancer, Papillary

The use of high- or low-dose radio-iodine therapy (RAIT) for initial thyroid remnant ablation in post-thyroidectomised patients diagnosed with differentiated thyroid cancer (DTC) with no distant metastases has long been a subject of much debate. Meta-analyses and systematic reviews have been previously made using both randomised control trials (RCTs) and observational studies without due regard to differences in study design. Hence, amore focused meta-analysis of available RCTs alone was conducted to determine the presence of a compelling difference between the initial remnant ablation success rates of high- and low-dose RAIT in post-thyroidectomised DTC patient without distant demtastases. An extensive search of PubMed and Cochrane Central register of RCTs (up to August 2013) was performed by two reviewers, which was completed by hand search of referencesfrom releveangt articles and review papers published from 1996 to 2012. The two reviewers independtly selected eligible studies, with disagreement resolved by consensus. The inclusion criteria were as follows: (a) randomised controlled trials, (b) post-thyroidectomised adult subjects diagnosed with well differentiated thyroid cancer and no evidence of distant metastases, and (c) subject randomisation into 30-50 mCi or 100 mCi 131I treatment groups. Studies were exluded if (a) the full text of the study is not available, (b) the study is in another language other than English, and (c) if the data on relative risk was not available or could not be derived from the study. Of eight published RCTs on radio-iodine therapy as of August 2013, only 5 were eligible for this meta-analysis; namely those by JOhansen et al. (1991), Bal et al. (1996), Zaman et al. (2006), Maenpaa et al. (2008) and Caglar et al. (2012). The same two reviewers independenty extracted data from the full text of the selected five studies. Two-by-two tables comparing frequencies of successful and failed remnant ablation using low-dose (30-60 mCi) and high-dise (100 mCi) RAIT were derived from the published results of the included studies, and the weighted and pooled relative risks for successful remnant ablation were computed via the Mantel-Haenszel method using a fixed effects model (cx = 5%). Subgroup analyses were performed based on different definitions of a successful remnant ablation. The pooled relative risk (-0.03) was statistically insignificant (p=0.54) and had poor precision (95% confidence interval of {-0.12,0.06}) even when adjustments to the varied definitions of a successful ablation were performed. Thus, using available RCTs that compare high- and low-dose RAIT for remnant ablation of DTC, there is an apparent trend favoring higher success rates using high-dose RAIT. However, the lack of well designed RCTs precludes recommending high-dose initial RAI ablation, and encourages the present practice of individualized.
Meta-Analysis ; Thyroid Neoplasms ; Iodine Radioisotopes