Evaluating the possible role of 68Ga-citrate PET/CT in the characterization of indeterminate lung lesions

We sought to determine whether PET/CT imaging with 68Ga-citrate could be of value in distinguishing benign from malignant lung pathology in a setting with a high prevalence of granulomatous diseases. METHODS : Thirty-six consecutive patients with indeterminate lung lesions prospectively underwent dual time point (60 and 120 min) 68Ga-citrate PET/CT study prior to lung biopsy. Qualitative and semi-quantitative measures of tracer uptake in the lung lesions (SUVmax) were compared to the histopathology in order to establish an imaging pattern to distinguish benign from malignant lesions. RESULTS : Fourteen patients (38.9 %) were diagnosed with a malignant lesion, 12 (33.3 %) with tuberculosis (TB), and 10 participants (27.8 %) with other benign lung lesions. At 60-min post-injection, patients who were diagnosed with a malignant lesion (n = 14) demonstrated a mean SUVmax of 3.36 ± 1.14, with a median value of 3.04 (min = 1.56, max = 4.65).Those with TB (n = 12) demonstrated a SUVmax of 3.99 ± 2.28, and a median value of 3.71 (pct25 = 2.19, pct75 = 4.95). In patients with other benign lesions (n = 10), the following values were observed: a SUVmax of 2.70 ± 1.31, a median value of 2.50 (pct25 = 1.76, pct75 = 3.59). The mean values of these three types of pathology were not statistically significant (p = 0.1919), and therefore the SUVmax could not be used to accurately distinguish between these lesions using both early and delayed imaging. CONCLUSION : This study, as the first 68Ga-citrate PET/CT in humans for the in vivo imaging of lung pathology, demonstrated its potential for the detection of both malignancy and TB. However, 68Ga-citrate seemed incapable of providing a clear distinction between malignant and benign lung lesions in a setting with a high prevalence of granulomatous diseases such as TB.http://link.springer.com/journal/12149hb201

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

Please read abstract in the article.https://www.thieme.de/de/nuklearmedizin/profil-120323.htm2020-09-04hj2020Nuclear Medicin

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

(18) F-FDG and (68) Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of (18) F-FDG- and (68) Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both (18) F-FDG and (68) Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 +/- 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. (18) F-FDG detected more lesions than (68) Ga-citrate (261 vs. 166, p <0.0001). (68) Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for (18) F-FDG compared to (68) Ga-citrate (5.73 vs. 3.01, p <0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p <0.0001). Conclusion Preliminary data shows (18) F-FDG-PET detects more abnormal lesions in TB compared to (68) Ga-citrate. However, (68) Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected

Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Home and In-Center Dialysis Guidance

Purpose of the program: This article provides guidance on optimizing the management of pediatric patients with end-stage kidney disease (ESKD) who will be or are being treated with any form of home or in-center dialysis during the COVID-19 pandemic. The goals are to provide the best possible care for pediatric patients with ESKD during the pandemic and ensure the health care team’s safety. Sources of information: The core of these rapid guidelines is derived from the Canadian Society of Nephrology (CSN) consensus recommendations for adult patients recently published in the Canadian Journal of Kidney Health and Disease (CJKHD). We also consulted specific documents from other national and international agencies focused on pediatric kidney health. Additional information was obtained by formal review of the published academic literature relevant to pediatric home or in-center hemodialysis. Methods: The Leadership of the Canadian Association of Paediatric Nephrologists (CAPN), which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric home and in-center dialysis. The goal was to adapt the guidelines recently adopted for Canadian adult dialysis patients for pediatric-specific settings. These included specific COVID-19-related themes that apply to dialysis in a Canadian environment, as determined by a group of senior renal leaders. Expert clinicians and nurses with deep expertise in pediatric home and in-center dialysis reviewed the revised pediatric guidelines. Key findings: We identified 7 broad areas of home dialysis practice management that may be affected by the COVID-19 pandemic: (1) peritoneal dialysis catheter placement, (2) home dialysis training, (3) home dialysis management, (4) personal protective equipment, (5) product delivery, (6) minimizing direct health care providers and patient contact, and (7) caregivers support in the community. In addition, we identified 8 broad areas of in-center dialysis practice management that may be affected by the COVID-19 pandemic: (1) identification of patients with COVID-19, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) management of visitors to the dialysis unit, (5) handling COVID-19 testing of patients and staff, (6) safe practices during resuscitation procedures in a pandemic, (7) routine hemodialysis care, and (8) hemodialysis care under fixed dialysis resources. We make specific suggestions and recommendations for each of these areas. Limitations: At the time when we started this work, we knew that evidence on the topic of pediatric dialysis and COVID-19 would be severely limited, and our resources were also limited. We did not, therefore, do formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Thus, this article’s advice and recommendations are primarily expert opinions and subject to the biases associated with this level of evidence. To expedite the publication of this work, we created a parallel review process that may not be as robust as standard arms’ length peer-review processes. Implications: We intend these recommendations to help provide the best care possible for pediatric patients prescribed in-center or home dialysis during the COVID-19 pandemic, a time of altered priorities and reduced resources

Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018.

Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials

Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018.

Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials