Drs. Vakhtang Tchantchaleishvili and Olugbenga Okusanya - Winter 2024, Volume 20, Number 2

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From Cure to Crisis: A Case of Severe Hypoxic Respiratory Failure Due to Daptomycin-Associated Eosinophilic Pneumonitis

Daptomycin is a cyclic lipopeptide antibiotic that commonly treats Gram-positive infections. Most frequently prescribed for osteoarticular infections.1 Daptomycin is associated with numerous side effects, including myopathy, rhabdomyolysis, eosinophilic pneumonia, and anaphylactic hypersensitivity reactions.1 Daptomycin-induced eosinophilic pneumonitis (DIEP) is a rare but potentially life-threatening adverse effect associated with prolonged use.2 There are several established criteria for diagnosing this medical condition. However, the variation in its clinical presentation, coupled with the favorable outcomes of early diagnosis and the severe consequences of delayed diagnosis, emphasizes the need for further discussions. This case highlights the importance of monitoring patients on prolonged daptomycin therapy for this serious complication. Furthermore, it emphasizes the value and limitations of standardized scoring tools as clinical aids in decision-making, early diagnosis, and timely treatment

Evaluating Artifact-Free Four-Dimensional Computer Tomography With 16 CM Detector Array

PURPOSE: To evaluate a 16 cm-array axial four-dimensional computer tomography (4DCT) in comparison with a 4 cm-array 4DCT in the presence of respiration irregularity. METHOD: Ten traces of lung tumor motion from CyberKnife treatments were imported to move the lung cylinder, containing a spherical target, of a phantom. Images were acquired for the lung that moved to each of the 10-positions/phases (1) step-wisely by nominal helical scan at each movement (ground truth), (2) continuously by 4D scan with the 16 cm array, and (3) the same with the 4 cm array, involving table shift. Irregularities, consisting of baseline shift and/or amplitude change of the traces in their second periods, affected #3 scan only in its second table position. The full-widths at half maximum of the target in the direction of the motion were determined on the average (Ave) CT, maximum-intensity (Mip) CT, and a phase (MP) CT that is associated with the maximum error, comparing #2 and 3 with #1. Three tumor-shaped targets were also imaged, and overlap ratios of them from #2 and 3 with the targets from #1 were inter-compared. Hounsfield unit (HU)s of the targets were also compared. RESULTS: The average difference in the spherical-target length between #2 and #1 was found to be 0.28 ± 0.15 cm on AveCT, 0.00 ± 0.18 cm on MipCT, and 0.07 ± 0.06 cm on MPCT, showing agreement. The average difference between #3 and #1 was 0.34 ± 0.23 cm on AveCT, 0.48 ± 0.31 cm on MipCT, and 0.56 ± 0.50 cm on MPCT, showing disagreement. The overlap ratios were better with #2 than with #3 for all tumor-shaped targets in each phase CT and MipCT, but they were not perfect for #2 due to motion averaging and phase sorting limitations. The differences in HUs were smaller with #2 than with #3, but not fully satisfactory with #2. CONCLUSION: 4DCT with the 16 cm array needs to be used to minimize the impact of the irregularity

The Advancement and Utility of Multimodal Imaging in the Diagnosis of Degenerative Disc Disease

Degenerative disc disease (DDD) is a common spinal condition characterized by the deterioration of intervertebral discs, leading to chronic back pain and reduced mobility. While magnetic resonance imaging (MRI) has long been the standard for late-stage DDD diagnosis, its limitations in early-stage detection prompt the exploration of advanced imaging methods. Positron emission tomography/computed tomography (PET/CT) using 18F- fluorodeoxyglucose (FDG) and 18F-sodium fluoride (NaF) has shown promise in identifying metabolic imbalances and age-related spinal degeneration, thereby complementing CT grading of the disease. The novel hybrid imaging modality PET/MRI provides new opportunities and are briefly discussed. The complex pathophysiology of DDD is dissected to highlight the role of genetic predisposition and lifestyle factors such as smoking and obesity. These etiological factors significantly impact the lumbosacral region, manifesting in chronic low back pain (LBP) and potential nerve compression. Traditional grading systems, like the Pfirrmann classification for MRI, are evaluated for their limitations in capturing the full spectrum of DDD. The potential to identify early disease processes and predict patient outcomes by the use of artificial intelligence (AI) is also briefly mentioned. Overall, the manuscript aims to spotlight advancements in imaging technologies for DDD, emphasizing their implications in refining both diagnosis and treatment strategies. The role of ongoing and future research is emphasized to validate these emerging techniques and overcome current limitations for more effective early detection and treatment

Case Report: Myeloid Neoplasms With the t(3;12)(q26.2;p13.1)/ MECOM-ETV6 Translocation: Report of Two New Cases and Review of the Literature

The MECOM (MDS1 and EVI1 complex locus) gene, located at 3q26.2, encodes an oncogenic transcription factor implicated in multiple signaling pathways. Rearrangements involving MECOM/3q26.2, including inversions, translocations, insertions and cryptic chromosomal changes, are observed in myeloid neoplasms and are associated with high-risk disease features and poor clinical outcomes. The translocation t(3;12)(q26.2;p13.1) is a rare genetic event, resulting in a fusion of the MECOM gene at 3q26.2 with the ETV6 gene at 12p13.1. To date, only 78 cases of hematologic neoplasms harboring t(3;12) have been reported in the English literature, primarily as case reports or case series. T(3;12) has been associated with abnormalities of chromosome 7, multiple hematopoietic lineage dysplasia, and poor prognosis. Given its rarity, studies on t(3;12) in myeloid neoplasms are limited. In this report, we present two additional cases exhibiting t(3;12), initially identified through routine karyotyping. The clinicopathological, cytogenetic and molecular genetic characteristics were summarized and discussed. A comprehensive review of partner genomic loci and genes mutated in myeloid neoplasms with MECOM rearrangement was conducted. The AF4 gene and the transcription elongation control pathways are proposed as potential therapeutic targets for MECOM-rearranged myeloid neoplasms

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Seizure Freedom and Reducing the Risk of Sudden Unexpected Death in Patients With Focal Epilepsy Treated With Cenobamate or Other Antiseizure Medications

People with epilepsy who have uncontrolled seizures are at increased risk of all-cause mortality, injuries, comorbidities, mood and psychosocial disorders, and diminished quality of life. For those with focal epilepsy, focal to bilateral tonic-clonic seizures (FBTCS) pose the greatest risk for sudden unexpected death in epilepsy (SUDEP), a leading cause of premature mortality in people with epilepsy. Cenobamate is a third-generation antiseizure medication with demonstrated efficacy in controlling focal seizures, including FBTCS, in people with drug-resistant epilepsy. Treatment with cenobamate in clinical trials was associated with a reduction in all-cause mortality to a rate statistically indistinguishable from that seen in the general population, and SUDEP rates were lower than expected. As FBTCS are associated with the highest risk of death, prevention of this seizure type is especially important, and physicians should continue to try new therapies to prevent these seizures. A shared decision-making model should be used when interacting with patients and their care providers to achieve and maintain seizure control and maximize treatment outcomes

Comparative Outcomes of Endovascular vs. Surgical Treatment in Craniocervical Junction Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis

BACKGROUND: Craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) are rare and complex vascular malformations that are challenging to diagnose and treat. This study aims to compare surgical and endovascular treatments for CCJ-DAVFs through a systematic review and meta-analysis. METHODS: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024. RESULTS: Fifteen studies involving 266 patients were included. Of these, 143 (53.8 %) patients underwent surgical treatment alone and 123 (46.2 %) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8 %. Retreatment rate was 6.2 %. Periprocedural complications occurred in 21.6 % of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6 %. Retreatment rate was 46.7 %. Periprocedural complications occurred in 18.8 % of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, p = 0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p = 0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, p \u3c 0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms. CONCLUSION: Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings

The Role of Anthropogenic Influences on a Tropical Lake Ecosystem and Its Surrounding Catchment: A Case Study of Lake Sentani

Lake Sentani is a tropical lake in Indonesia, consisting of four interconnected sub-basins of different water depths. While previous work has highlighted the impact of catchment composition on biogeochemical processes in Lake Sentani, little is currently known about the microbiological characteristics across this unique ecosystem. With recent population growth in this historically rural area, the anthropogenic impact on Lake Sentani and hence its microbial life is also increasing. Therefore, we aimed to explore the influence of environmental and anthropogenic factors on the microbial diversity of Lake Sentani. Here, we present a detailed microbiological evaluation of Lake Sentani, analyzing 49 different sites across the lake, its tributary rivers and their river mouths to assess diversity and community structure using 16S rRNA gene sequencing. Our results reveal distinct communities in lake and river sediments, supporting the observed geochemical differences. Taxonomic assessment showed the potential impact of anthropogenic pressure along the northern, urbanized shore, as river and river mouth samples revealed high abundances of Bacteroidota, Firmicutes, and Cyanobacteria, which could be attributed to pollution and eutrophication. In contrast, lake sediment communities were dominated by Thermodesulfovibrionia, Methanomethylicia, Bathyarchaeia, and Thermoplasmata, suggesting sulfate reducing, thermophilic, acidophilic bacteria and methanogenic archaea to play an important role in tropical lake systems. This study provides novel insights into ecological functions of tropical lakes and contributes to the optimization of management strategies of Lake Sentani, ensuring its holistic preservation in the future