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We present a case of an 18-year-old male athlete who presented with complaints of right lower leg pain for 10 days following intense exercise. The most likely diagnosis was a possible tibial stress fracture or a ''shin splint'' syndrome. The radiograph did not reveal any significant abnormality in the form of any fracture or a cortical break. We performed planar bone scintigraphy including single-photon emission computed tomography (CT)/CT that revealed the presence of the two concomitant pathologies in the form of a hot spot which corresponded with a bone lesion in the tibial stress fracture and subtle remodeling activity without evidence of significant cortical lesion in the shin splints in bilateral lower limbs (R>L).

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Molecular imaging has witnessed a great progress in the field of oncology over the past few decades. Radiolabeled amino acid (AA) tracers are particularly helpful in the areas where the utility of 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography imaging has been limited such as in evaluating brain tumors, neuroendocrine tumors (NETs), and prostate cancer. Radiolabeled AA tracers such as 6-[18F]-L-fluoro-L-3, 4-dihydroxyphenylalanine (18F-FDOPA), 18F-fluoro-ethyl-tyrosine (18F-FET), and 11C-methionine have found wide applications in brain tumors, which, unlike 18F-FDG, concentrate in the tumor tissue to a greater extent than that in normal brain tissue by providing accurate information about tumor volume and boundaries. 18F-FDOPA is also useful in evaluating NETs. Tracers such as 18F-FACBC (Fluciclovine) and anti-1-amino-2-[18F]fluorocyclopentyl-1-carboxylic acid (18F-FACPC) are used in imaging of prostate cancer and provide valuable information of locoregional, recurrent, and metastatic disease. This review highlights AA tracers and their major applications in imaging, viz., in evaluating brain tumors, NETs, and prostate cancer.

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PET/computed tomography (CT) with fluorodeoxyglucose and nonfluorodeoxyglucose PET tracers has established itself in the management of malignant disorders. Its role in the assessment of nonmalignant conditions, such as infectious and noninfectious inflammatory diseases and other benign conditions, has emerged independently and alongside its role being evaluated in malignancy and continues to evolve. It is evident that PET/CT has the potential to play a significant role in various nonmalignant disorders of the thorax. This review highlights current developments and areas where PET/CT has a potential to impact the clinical management of nonmalignant thoracic conditions with special focus on nonfluorodeoxyglucose tracers.

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Allogenic bone is the most commonly grafted tissue which provides only osteoconductive property, in which it acts as a scaffold to facilitate the ingrowth of the vessels and migration of host cells capable of osteogenesis. It can be used as a substitute for autografts as the latter is associated with morbidity and limited donor site availability. Its applications are expanding in all aspects of orthopedic surgery, notably in revision hip replacement or surgical treatment for bone tumors or benign conditions. The balance between osteolysis and osteogenesis must be maintained for graft incorporation to occur and thus postoperative imaging is essential for differentiation between grafts and recurrent disease or viability/nonviability. Here, we present three cases, in which bone allografting was done who underwent serial 99 mTc-methylene diphosphonate three-phase bone scintigraphy with single-photon emission computed tomography/computed tomography to assess the viability, integrity, and the incorporation of the graft.

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BACKGROUND: Soft tissue coverage plays a vital role in replacing the vascularity of the underlying bone in Gustilo type IIIB fractures. The aim of this article was to evaluate the feasibility of local pedicled flaps in type IIIB fractures at a tertiary care center. METHODS: We included all cases of open Gustilo-Anderson type IIIB fractures of the tibia treated with local flap coverage from January 2017 to February 2019. We carried out a retrospective analysis to investigate the relationships of complications, hospital stay, and cost-effectiveness with the choice of flap, infective foci, site and size of the defect, and type of fixation. RESULTS: Out of 138 Gustilo type IIIB fractures analyzed in our study, 27 cases had complications, of which 19 (13.76%) involved flap necrosis, four (2.89%) were infections, three (2.17%) involved partial necrosis, and one (0.72%) was related to bone spur development. Flap complications showed a statistically significant association with the perforator flap category (propeller flaps in particular) (P=0.001). Flap necrosis showed a significant positive correlation with cases treated within 3 weeks after trauma (P=0.046). A significant positive correlation was also found between defect size and the duration of hospital stay (P=0.03). CONCLUSIONS: Although local flaps are harvested from the same leg that underwent trauma, their success rate is at least as high as microvascular flaps as reported from other centers. Amidst the local flaps, complications were predominantly associated with perforator flaps.

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Background: Occupational health hazard pertaining to health care providers is one of the neglected areas that need serious attention. Any compromise in their safety would result in reduction in workforce, which may affect patient care, keeping in mind the wide gap between the required number and actual health care workers (HCWs) available in the world over. Aim: This study was undertaken to evaluate the change in knowledge through a sensitization training program on occupational health hazards and vaccination for HCWs. Materials and Methods: Participants of the study included nursing and allied HCWs of a tertiary care health institute in Uttarakhand, India. Multiple training sessions, each of around 180 min, were held periodically in small groups with 20-40 participants over 2 years. Participants were assessed with pretest and posttest questionnaires, and feedback was taken. Questionnaires comprised three categories: general safety and ergonomics, biological hazards, and chemical and radiation hazards. Data of incident reporting for needlestick injury from 2017 to 2019 were retrieved. All data were compiled in Excel sheet and analyzed. Results: A total of 352 participants were included in the study. Mean ± SD for pretest and posttest scores were 5.3 ± 2.13 and 11.22 ± 2.15, respectively. There was considerable improvement in knowledge, which was found to be statistically significant with p-value of 0.001 for all categories. Participants in their feedback suggested for inclusion of psychosocial aspect in further training programs. Conclusion: Low baseline knowledge prior to attending the course highlights a need for an intervention through such structured sensitization program to create awareness and educate HCWs on common occupational health hazards and vaccination. Statistically significant improvement in posttest knowledge highlights effectiveness of the training program. A drastic rise in incident reporting for needlestick injury reflects fairly good impact of training program. Regular and appropriate form of training can reduce injuries resulting from occupational hazards and ensure healthy workforce contributing toward a positive impact on national economy.

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Radiopharmaceutical injection is challenging as it poses radiation exposure to staff as well as patient. Infrared light-assisted devices have been available since many years and have garnered mixed reviews in the pediatric age group. However, there are no data on outcome of infrared assistance for radiopharmaceutical injection. We compared results of first-attempt intravenous access (in cubital veins) with and without infrared assistance device for injection of radiopharmaceuticals. All adult patients who underwent nuclear scan in the initial weeks of infrared device installation were injected utilizing infrared device assistance. These were compared with those who underwent injection without infrared assistance. Three hundred consecutive patients were studied for success of intravenous injection with and without infrared assistance. Of these, 150 were injected with and 150 without infrared assistance. A success rate of 72%/51.3% was noted with and without infrared assistance, respectively, on the first attempt which was statistically significant. In our initial experience, assistance with infrared device was found to improve the outcome of first-attempt intravenous access for injection of radiopharmaceuticals. This method has potential of improving outcome for radiopharmaceutical injection.

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BACKGROUND: Oral Squamous Cell Carcinoma (OSCC) results from a series of genetic alteration in squamous cells. This particular type of cancer considers one of the most aggressive malignancies to control because of its frequent local invasions to the regional lymph node. Although several biomarkers have been reported, the key marker used to predict the behavior of the disease is largely unknown. Here we report Long INterpersed Element-1 (LINE1 or L1) retrotransposon activity in post-operative oral cancer samples. L1 is the only active retrotransposon occupying around 17% of the human genome with an estimated 500,000 copies. An active L1 encodes two proteins (L1ORF1p and L1ORF2p); both of which are critical in the process of retrotransposition. Several studies report that the L1 retrotransposon is highly active in many cancers. L1 activity is generally determined by assaying L1ORF1p because of its high expression and availability of the antibody. However, due to its lower expression and unavailability of a robust antibody, detection of L1ORF2p has been limited. L1ORF2p is the crucial protein in the process of retrotransposition as it provides endonuclease and reverse transcriptase (RT) activity. METHODS: Immunohistochemistry and Western blotting were performed on the post-operative oral cancer samples and murine tissues. RESULTS: Using in house novel antibodies against both the L1 proteins (L1ORF1p and L1ORF2p), we found L1 retrotransposon is extremely active in post-operative oral cancer tissues. Here, we report a novel human L1ORF2p antibody generated using an 80-amino-acid stretch from the RT domain, which is highly conserved among different species. The antibody detects significant L1ORF2p expression in human oral squamous cell carcinoma (OSCC) samples and murine germ tissues. CONCLUSIONS: We report exceptionally high L1ORF1p and L1ORF2p expression in post-operative oral cancer samples. The novel L1ORF2p antibody reported in this study will serve as a useful tool to understand why L1 activity is deregulated in OSCC and how it contributes to the progression of this particular cancer. Cross-species reactivity of L1ORF2p antibody due to the conserved epitope will be useful to study the retrotransposon biology in mice and rat germ tissues.

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The aim of this study was to evaluate the effect of glycemic control as estimated by glycated hemoglobin A1c (HbA1c) on gastric emptying in patients with type 2 diabetes mellitus (DM) using gastric emptying scintigraphy (GES). This was a cross-sectional study conducted at a tertiary health care center in Northern India. The study included 44 patients who underwent GES using a radiolabeled solid Idli meal containing 1 mCi of Tc-99 m Sulfur Colloid. Patients were divided into three groups based on glycemic control as Group A, B, and C with HbA1c <7%, 7%-9%, and >9%. Statistical analysis was performed using the IBM® SPSS® Statistics Version 23.0 The comparison of proportions was done using the Chi-square test and Fisher's exact test. Means were compared using the independent t-test and one-way analysis of variance. P < 0.05 was considered statistically significant. No statistically significant correlation was found between delayed gastric emptying and glycemic control (P = 0.09), gender (P = 0.228), dietary patterns (P = 0.91), symptoms of gastroparesis (P = 0.06), body mass index (BMI) (P = 0.267), and duration of type 2 DM (P = 0.565). No statistically significant association was also found between glycemic control and time taken for half gastric emptying (t1/2) (P = 0.225). Scintigraphy using Tc-99m Sulfur Colloid radiolabeled Idli meal can be effectively used for the assessment of gastric emptying. There is no significant correlation of delayed gastric emptying with glycemic control, gender, BMI, type of diet, and duration of diabetes mellitus.

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OBJECTIVE: We describe and discuss the various medical, social and financial aspects of setting up, and optimizing, working conditions of a tertiary Nuclear Medicine Department. This department was established in a North Indian state which comprises 93% of hilly area. During the first three years after establishment we have developed infrastructure, cooperation with other departments, improved radiation safety and cost effectiveness of our work and designed future perspectives. The facility was established in a cancer center of a tertiary care hospital where a medical college infrastructure was developed. National guidelines formulated by the Atomic Energy Regulatory Board (AERB) were followed. Our department served a population area of 10.08 million inhabitants. Over the first three years 2,400 patients underwent diagnostic scans and 106 patients underwent low dose radioiodine treatment for thyrotoxicosis. To optimize resources and at the same time, enhance their effectivity, we procured our (99)Mo/ (99m)Tc generator every other week and arranged our daily programme accordingly. Fractionation of cold kits allowed us to perform low cost in-vivo procedures on a daily basis and to save the department's running costs by 30%-50%. We run continuing education nuclear medicine programmes for referring physicians, medical students and paramedical workers which were included in routine practice which led to a consistent growth in patients referral. The need for a positron emission tomography/computed tomography (PET/CT) scan and high dose treatment department for thyroid cancer was strongly felt. CONCLUSION: Our nuclear medicine department in a peripheral region of a developing country applied better logistics by procuring new generator every fortnight, fractionating the cold kits and by organizing complete teaching programmes.

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