Nuclear Imaging in Pediatric Kidney Diseases

Renal scintigraphy is a useful tool in diagnosis and management of various nephro-urological conditions. Tc-99m dimercaptosuccinic acid renal scintigraphy (Tc-99m-DMSA), Tc-99m mercaptoacetyltriglycine (Tc-99m-MAG3) or Tc-99m diethylenetriaminepentaacetic acid (Tc-99m-DTPA) dynamic renal scintigraphy, and Radionuclide micturating cystography are the common scans used in children with kidney diseases. These studies are minimally invasive, easily available, and offer both anatomic details and functional information required for thorough evaluation. At the same time, it is essential to have appropriate knowledge to interpret these studies and be aware of their limitations and pitfalls. The advent of Positron emission tomography-computed tomography/magnetic resonance imaging (PETCT/MRI) has broadened the scope of nuclear medicine. This article focuses on the technique, interpretation, indication and recent practice guidelines of renal scintigraphy in children with kidney diseases.     

A case of bronchopericardial fistula with tension pneumopericardium closed successfully by transpericardial intervention: A novel procedure

A pneumopericardium is a collection of air or gas in the pericardial sac which may cause cardiac tamponade, known as tension pneumopericardium. Tension pneumopericardium is a rare and lethal presentation of bronchopericardial fistula. There are very few reports in the literature of patients surviving with this condition, although prompt diagnosis and early intervention are important. Treatment options are limited. We present a rare case of tension pneumopericardium with cardiogenic shock due to bronchopericardial fistula in a patient with bronchogenic carcinoma who was successfully treated with transpericardial intervention.     

Effects of a fixed-dose combination of sitagliptin and metformin versus respective monotherapies in newly diagnosed type 2 diabetic subjects

Metformin is considered as a backbone therapy for type 2 diabetes (T2DM) management. Many patients need treatment with combination therapy. In India, multiple fixed-dose combinations with metformin are available. The study was done to compare the efficacy and safety of sitagliptin plus metformin combination versus metformin and sitagliptin monotherapy in newly diagnosed T2DM subjects. This was an open-label, randomized, parallel group, prospective and single centre study, in 60 subjects with T2DM. The subjects received either metformin 500 mg, sitagliptin 50 mg or fixed-dose combination of metformin 500 mg plus sitagliptin 50 mg. All study medicines were given twice daily for 12 weeks. Glycaemic control (HbA1c, fasting and postprandial blood glucose) and body mass index (BMI) were evaluated as efficacy parameters while safety was evaluated by reporting adverse events. Significant reduction in HbA1C level was seen in all three groups (P?=?0.0001). HbA1C reduction was significantly higher in the combination group compared to metformin monotherapy (P?=?0.0072). Fasting blood glucose (FBG) level reduced significantly in all three groups (P?=?0.0001). The reduction in fasting blood glucose was significantly higher with combination compared to sitagliptin monotherapy (P?=?0.0060). Postprandial blood glucose (PPG) also reduced significantly in all three groups (P?=?0.0001). The reduction with sitagliptin was statistically higher compared to metformin (P?=?0.0155). The combination treatment resulted in significantly higher reduction of PPG compared to sitagliptin monotherapy (P?=?0.0160). Body mass index reduced significantly in all three groups (P?=?0.0001). Reduction in BMI was significant with combination treatment compared to sitagliptin monotherapy (P?<?0.05). Overall, study medications were well tolerated. The incidence of adverse event was 11.7 %. No serious adverse event was reported in the study. In newly diagnosed, drug naïve, type 2 diabetes mellitus management, fixed-dose combination of sitagliptin plus metformin is effective and well tolerated. Due to its multiple benefits, it can be used as a suitable option for selected subjects requiring combination therapy in type 2 diabetes mellitus.     

Novel Piperine Derivatives with Antidiabetic Effect as PPAR‐γ Agonists

Piperine is an alkaloid responsible for the pungency of black pepper. In this study, piperine isolated from Piper nigrum L. was hydrolyzed under basic condition to obtain piperic acid and was used as precursor to carry out the synthesis of twenty piperine derivatives containing benzothiazole moiety. All the benzothiazole derivatives were evaluated for their antidiabetic potential by OGT test followed by assessment of active derivatives on STZ‐induced diabetic model. It was observed that nine of twenty novel piperine analogues ( 5b, 6a‐h) , showed significantly higher antidiabetic activity in comparison with rosiglitazone (standard). Furthermore, these active derivatives were evaluated for their action as PPAR‐γ agonists demonstrating their mechanism of action. The effects on body weight, lipid peroxidation, and hepatotoxicity after administration with active derivatives were also studied to further establish these derivatives as lead molecules for treatment of diabetes with lesser side‐effects.     

Skin prick testing and immunotherapy in nasobronchial allergy: our experience

In the present study of 331 patients suffering from signs/symptoms of nasal allergy, 9 nasal polyps, allergic conjunctivitis and allergic asthma, who were referred by clinician, were taken up for diagnosis of allergy with skin prick test (Ten et al. Mayo Clin Proc 70(8):783-784, 1995) and subjective improvement of patients by immunotherapy. Out of 331 patients tested 321 patients showed significant positive results and rest of them tested negative for allergy. High incidences of positive results were noted in third and fourth decade age of patients. Dust and pollen allergens were positive in most of the patients compare to insect's antigens. Among the pollen antigens tested, those of Parthenium hysterophorus was found to be the most common (30%) followed by Prosopis julifora (25%). 75.22% patients were positive to house dust, 19.33% patients were positive to Aspergillusmoulds. D. farinae was the most common offender amongst the mites. Patients who attended, allergy clinic in Kamineni Hospitals during the last 4?years were referral patients, who had been on prolonged treatment without much relief. Immunotherapy was advised to patients who were having perineal allergy, in whom, medical treatment had become only palliative. Immunotherapy injections were administered subcutaneously, and their results were monitored.     

Multiomics Analysis and Systems Biology Integration Identifies the Roles of IL-9 in Keratinocyte Metabolic Reprogramming

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