Search

Abstract Posterior reversible encephalopathy syndrome (PRES) is a disorder of reversible subcortical vasogenic brain oedema in patients with acute neurological symptoms. Drug‐induced PRES has been described with the usage of drugs that target receptors regulating vascular permeability or altering immune response. Lenvatinib is a receptor tyrosine kinase inhibitor that inhibits the kinase activities of vascular endothelial growth factor receptors implicated in cancer progression in addition to their normal cellular functions. The oedema associated with PRES is a consequence of disruption of cerebral blood flow autoregulation. Herein, we present a case of a 77‐year‐old lady who was on treatment with Lenvatinib for metastatic thyroid cancer who subsequently developed PRES. Her clinical and radiological findings improved after discontinuing Lenvatinib and the patient was switched to a different drug and remains asymptomatic on the same. This is the first such report of atypical findings of PRES in a patient on Lenvatinib therapy. Recognition of this entity is crucial for timely withdrawal of the drug and prevent further morbidity and mortality.

Background: Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem. Objective: This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof. Materials and Methods: All birth records of a private rural hospital spanning two decades (1989-2007) were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies. Results: No change was observed in the average birth weights (average 2.71 kg) over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby′s birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998. Conclusion: The birth weights have hardly changed in this population in the two decades.

Background and Objective: Extrathyroidal extension (ETE) is the term used to describe the growth of the primary thyroid tumor beyond the thyroid capsule. ETE is a critical prognostic marker for thyroid tumors, necessitating accurate preoperative assessment. This study aims to evaluate the diagnostic performance of computed tomography (CT)-based grading for ETE and tracheal invasion (TI) for preoperative prediction in patients with differentiated papillary thyroid carcinoma (PTC) and compare the diagnostic accuracy with ultrasound (US)., Materials and Methods: This retrospective study was approved by our institutional review board. Preoperative US and CT were performed for 83 patients who underwent surgery for PTC between 1 January 2010 and 31 December 2020. The US and CT features of ETE and TI of each case were retrospectively and independently investigated by two radiologists. The diagnostic performances of US and CT, including their specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for ETE, and their accuracy in predicting ETE and TI were analyzed. As per the grading for ETE on USG and CT, lesions were graded into three grades and Mahajan grading was also devised on CT to predict the TI and graded into four grades., Results: The accuracy and specificity of CT are relatively good for identifying tumor infiltration into the adjacent structures and range from 82% to 87% and 95% to 98%, respectively. It, however, has a low sensitivity, between 14.3% and 77.78%, when compared to US, which suggests that in case of any doubt regarding CT evidence of tumor infiltration into surrounding structures, additional clinical examination must be performed. CT showed better sensitivity (78%) and specificity (75%) in detecting TI compared to previous studies. The diagnostic accuracy of CT Mahajan grading was 91.5% with p < 0.005 in the prediction of TI., Conclusion: Preoperative US should be regarded as a first-line imaging modality for predicting minimal ETE, and CT should be additionally performed for the evaluation of maximal ETE. The specificity and PPV of CT are higher than those of US in detecting overall ETE and TI of PTC. The US- and CT-based grading systems have the potential to optimize preoperative surgical planning., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Mahajan, Rastogi, Shukla, Agarwal, Vaish, Chakrabarty, Ashtekar, Deokar, Shaikh, Pai, Chaturvedi, Ghosh Laskar, Smriti, Rane, Bal, Patil, Mittal, Noronha, Patil, Prabhash and Dcruz.)

Purpose: The authors aimed to develop and validate deep-learning-based radiogenomic (DLR) models and radiomic signatures to predict the EGFR mutation in patients with NSCLC, and to assess the semantic and clinical features that can contribute to detecting EGFR mutations., Methods: Using 990 patients from two NSCLC trials, we employed an end-to-end pipeline analyzing CT images without precise segmentation. Two 3D convolutional neural networks segmented lung masses and nodules., Results: The combined radiomics and DLR model achieved an AUC of 0.88 ± 0.03 in predicting EGFR mutation status, outperforming individual models. Semantic features further improved the model's accuracy, with an AUC of 0.88 ± 0.05. CT semantic features that were found to be significantly associated with EGFR mutations were pure solid tumours with no associated ground glass component ( p < 0.03), the absence of peripheral emphysema ( p < 0.03), the presence of pleural retraction ( p = 0.004), the presence of fissure attachment ( p = 0.001), the presence of metastatic nodules in both the tumour-containing lobe ( p = 0.001) and the non-tumour-containing lobe ( p = 0.001), the presence of ipsilateral pleural effusion ( p = 0.04), and average enhancement of the tumour mass above 54 HU ( p < 0.001)., Conclusions: This AI-based radiomics and DLR model demonstrated high accuracy in predicting EGFR mutation, serving as a non-invasive and user-friendly imaging biomarker for EGFR mutation status prediction.

Introduction: Conventional magnetic resonance imaging (MRI) has limitations in differentiating tumor recurrence (TR) from radionecrosis (RN) in high-grade gliomas (HGG), which can present with morphologically similar appearances. Multiparametric advanced MR sequences and Positron Emission Tomography (PET) with amino acid tracers can aid in diagnosing tumor metabolism. The role of both modalities on an individual basis and combined performances were investigated in the current study., Materials and Methods: Patients with HGG with MRI and PET within three weeks were included in the retrospective analysis. The multiparametric MRI included T1-contrast, T2-weighted sequences, perfusion, diffusion, and spectroscopy. MRI was interpreted by a neuroradiologist without using information from PET imaging. 18F-Fluoroethyl-Tyrosine (FET) uptake was calculated from the areas of maximum enhancement/suspicion, which was assessed by a nuclear medicine physician (having access to MRI to determine tumor-to-white matter ratio over a specific region). A definitive diagnosis of TR or RN was made based on the combination of multidisciplinary joint clinic decisions, histopathological examination, and clinic-radiological follow-up as applicable., Results: 62 patients were included in the study between July 2018 and August 2021. The histology during initial diagnosis was glioblastoma, oligodendroglioma, and astrocytoma in 43, 7, and 6 patients, respectively, while in 6, no definitive histological characterization was available. The median time from radiation (RT) was 23 months. 46 and 16 patients had TR and RN recurrence, respectively. Sensitivity, specificity, and accuracy using MRI were 98, 77, and 94%, respectively. Using PET imaging with T/W cut-off of 2.65, sensitivity, specificity, and accuracy were 79, 84, and 80%, respectively. The best results were obtained using both imaging combined with sensitivity, specificity, and accuracy of 98, 100, and 98%, respectively., Conclusion: Combined imaging with MRI and FET-PET offers multiparametric assessment of glioma recurrence that is correlative and complimentary, with higher accuracy and clinical value., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Sahu, Mathew, Ashtekar, Dasgupta, Puranik, Mahajan, Janu, Choudhari, Desai, Patnam, Chatterjee, Patil, Menon, Jain, Rangarajan, Dev, Epari, Sahay, Shetty, Goda, Moiyadi and Gupta.)

Background: Rising prevalence and poor outcomes make the twin challenges of diabetes epidemiology. This study evaluates effect of 2-only-daily-meals with exercise (2-OMEX) for its effect on HbA1c, oral hypoglycaemic agents (OHA) usage, body-weight among type-2-diabetes (T2DM) subjects, compared with conventional management., Material and Methods: A quasi-experimental, multicentre study in 2-OMEX arm, and HbA1c by HPLC method. HbA1c and body-weight changes were analyzed by 'Difference in Difference' (DID) method. Meal frequency, exercise, energy intakes were based on recall. The required sample size was 20X2 for 1.1 difference in HbA1c with 95% CL and 80% power., Results: Socio-demographic and risk profile of analysed and omitted subjects were similar. Studied arms were also similar in baseline features. The results in 2-OMEX and conventional arm are: complete records analyzed 201 and 120. Mean (sd) values as follows: observation days 234 and 236, age 52.03(8.84) and 52.45(9.48) years ( P =0.6977), diabetes duration 4.6(3.05) and 4.9(2.97) years, BMI 27.28(5.27), 26.90(3.74) ( P = 0.1859), baseline HbA1c gm% 7.46(1.52) and 7.55(1.58), end-line proportion of subjects attaining HbA1c ≤6.5gm% was 35.3% and 19.2% ( P =0.002), bodyweight loss 2.57% and 1.26%. OHA count 1.6 (1.23) and 2.7(1.06), ( P =0.0003). In 2-OMEX arm log-normal HbA1c declined significantly by 0.94 (95%CI: 1.60 to - 0.56, p=0.0333), weight loss difference 0.96 kg, and statistically not significant ( P =0.595). Two subjects in 2-OMEX arm showed partial remission. Mean baseline Kcal intakes in 2-OMEX arm, were 1200.4(F) and 1437.3(M) were significantly higher than conventional arm (F) and 1430 (M)., Conclusion: The 2-OMEX showed a sizeable and significant reduction in HbA1c and OHA use, in 7-months, with moderate intakes, compared to the conventional arm, possibly attributable to fewer insulin surges. More studies are required for its impact and pathways., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Community Medicine.)