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Using age- and height-adjusted total kidney volume, the Mayo Clinic Imaging Classification provides a validated approach to assess the risk of chronic kidney disease (CKD) progression in autosomal dominant polycystic kidney disease (ADPKD), but requires excluding patients with atypical imaging patterns, whose clinical characteristics have been poorly defined. We report an analysis of the prevalence, clinical and genetic characteristics of patients with atypical polycystic kidney disease by imaging. Patients from the extended Toronto Genetic Epidemiology Study of Polycystic Kidney Disease recruited between 2016 and 2018 completed a standardized clinical questionnaire, kidney function assessment, genetic testing, and kidney imaging by magnetic resonance or computed tomography. We compared the prevalence, clinical features, genetics, and renal prognosis of atypical versus typical polycystic kidney disease by imaging. Forty-six of the 523 (8.8%) patients displayed atypical polycystic kidney disease by imaging; they were older (55 vs. 43 years; P PKD1 or PKD2 mutation (9.2% vs. 80.4%; P

There is a raising demand for unscheduled care in the United Kingdom. Minor Ailments Schemes (MAS) were introduced to reduce the burden of minor ailments on higher cost settings such as general practices and emergency departments. The number of visits for minor ailments at GPs often declined following the implementation of MAS. Retail clinics in America employ nurse practitioners (NPs) and physician assistants (PAs) who can diagnose and treat minor illness, and minor injuries. Similar to the retail clinics, MAS can merge with walk-in centres. PAs and NPs can take over some primary care workload from pharmacists to prevent the pharmacists from being overwhelmed with all their current duties. MAS can also initiate the development of telehealth service to accommodate the home-bound patients. MAS must continue to change and evolve to meet the current and future demands of health care.

Positron emission tomography (PET) is currently the most advanced technique of metabolic imaging available for tumor diagnosis and follow-up. The aim of this study was to examine the versatility and accuracy of fluorodeoxyglucose (FDG) PET/computed tomography (CT) in the metastasis detection of renal cell carcinoma (RCC). We also compared our findings to other similar studies from the literature. This is the biggest study so far to examine the sensitivity and specificity of FDG PET/CT in the management of RCC. A retrospective review was carried out on all the FDG PET/CT studies done from January 1999 to January 2014 at our institution. Biopsy results were considered the gold standard. For our patients (n = 315) with biopsy results, FDG PET/CT studies exhibited 100% sensitivity, 100% specificity. Our results were better than results achieved by other studies. The use of FDG PET/CT in restaging and metastasis detection of RCC has many advantages, in addition to high accuracy. This imaging technique has great potential in influencing treatment decisions. We recommend the incorporation of FDG PET/CT in routine standard protocols for RCC.

Elderly Veterans enrolled in VA Home Based Primary Care (HBPC) programs suffer from many diseases including malnutrition. Nutrition screening tools exist in the VA system but they are inconsistently utilized across ambulatory care programs and are neither research validated nor comparable with non-VA populations. The Mini-Nutritional Assessment short-form (MNA-SF) has been validated in international studies in a variety of settings. The primary aim of this study was to find the prevalence of malnutrition among Veterans enrolled in HBPC programs. The secondary objective was to determine the feasibility of adopting a validated nutrition screening tool (Mini-Nutritional Assessment short-form (MNA-SF)). 2252 veterans age 65 and older from 18 HBPC programs from across the country participated in the study. The study period was between April and September 2012. WinPepi (version 11.25) was used for descriptive analysis. We found that the prevalence of malnutrition was 15% (344/2252) and the prevalence of at risk for malnutrition was 40.3% (909/2252). The MNA-SF is an efficient nutrition screening tool and it can be successfully used for the elderly veterans. The prevalence of malnutrition among veterans was high compared to the community dwelling U.S. civilian elderly population. By preventing and treating malnutrition, health care systems should be able to reduce overall health care costs.

Background : The primary aim of this study was to examine if factors such as renal function, height, weight and age could affect the uptake of sodium fluoride-18 (NaF-18) by the normal bone. This is the first study to examine the possible factors that can influence NaF-18 uptake in the normal bone. Methods: A retrospective study was done on NaF - 18 PET/CT bone scans from January 2010 to May 2012 at our institution. All NaF - 18 PET/CT studies used the same clinical protocol. Our excluding criteria w ere patients with abnormal renal function and patients with past history of cancer and metabolic bone diseases. Spearman ’ s correlation was used to analyze the data. Results: From our study (n = 11 patients), no correlation was found between SUV max and serum creatinine and between SUV max and age. However, significant correlations were found between SUV max and height (cm) and between SUV max and weight (kg) for thoracic 5, 7, 12 and lumbar 2 vertebral levels. Conclusion: Based on our findings, SUV max values in NaF-18 PET/CT bone scans can vary depending on the patient’s height, weight and bone region. This information can be helpful in diagnosing and monitoring bone pathologies and can help explain the clinical findings. J Clin Med Res. 2014;6(6):435-442 doi: http://dx.doi.org/10.14740/jocmr1901w

Our patient is a female who was first diagnosed with breast cancer at the age of 23. A follow-up fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) at age 44 revealed diffuse high FDG uptake in an enlarged thyroid gland. Fine-needle aspiration (FNA) of the thyroid mass revealed estrogen receptor/progesterone receptor negative, human epidermal growth factor receptor 2+ breast cancer. To the best of our knowledge, this is the first case to report breast cancer metastasis to the thyroid in a diffuse pattern on FDG-PET/CT. Bilateral diffuse uptake of FDG in thyroid is the most commonly associated with benign conditions. However, FNA biopsies need to be done to rule out metastatic disease in thyroid lesions with diffuse high FDG uptake, especially for patients with history of cancer.

Transjugular intrahepatic portosystemic shunt (TIPS) is a difficult procedure to perform and accessing the portal vein is a very challenging step. There are three broad categories of image guided TIPS creation techniques. Each technique has its advantages and disadvantages. TIPS procedure carries some risk of complications regardless of the guidance technique employed. The technology for TIPS has evolved in parallel with the expanding indications for TIPS. Ultrasound guidance technique offers a safe option, particularly for patients with challenging anatomy. Patient safety should always come first and the US guided technique should be more routinely used. Experience is the main factor in the success of TIPS. Other factors to consider in reducing the all-cause morbidity and mortality are patient selection, patient management and the clinical setting.

Objectives. To determine the prevalence of incidentalomas in a patient population with no known thyroid malignancy who underwent whole body FDG-PET/CT for staging or restaging of neoplasia. The additional aim of the study was to evaluate the feasibility of using PETCT as a screening tool for malignant thyroid incidentalomas. Methods. Retrospective review of medical records of all the thyroid exams done at our institution between January 1, 2000 and August 20, 2008. We made a criterion of PET/CT as the primary method of detection of incidentalomas. Results. From a total of 8464 thyroid exams, 156 incidentalomas were found and 40 incidentalomas underwent anatomopathology analysis, which was used as gold standard. Chi-square analysis was used to analyze the data. There is no significant association between SUV value and the prevalence of incidentalomas. Discussion. From January 1, 2000 to August 20, 2008, incidentalomas have a prevalence of 1.84% at our institution. 38% of the incidentalomas that were biopsied were characterized as representing malignant tumors. Conclusion. Focal, abnormal FDG uptake representing incidentalomas must be followed up with biopsies. It is impractical to use PET/CT as a screening tool to detect incidentalomas for the general population but it must be done in patients with history of any type of cancer.

We present a case of a 60-year-old white male with a history of papillary renal cell carcinoma (PRCC) status postpartial nepherectomy. He was followed-up annually with abdominal computed tomography (CT) scans to monitor for tumor recurrence. A solitary metastatic bony lesion was detected by CT 4 years after partial nephrectomy and it was confirmed by NaF-positron emission tomography (PET)/CT and magnetic resonance imaging. He underwent external beam radiation therapy (XRT) for solitary metastasis to L1 vertebra. The L1 lesion was treated with XRT, which exhibited no fluorodeoxyglucose activity after the treatment. This is the first case report to mention the use of NaF-18-PET/CT in the detection of bone metastasis from PRCC. Our case once again emphasizes the usefulness of NaF-18-PET/CT in RCC follow-up.

The article discusses the U.S. sociologist and photographer Lewis Wickes Hine, and his use of photography to expose the evils of child labor in the twentieth century. Topics include the use of art as a tool for social reform by U.S. artists, writers, and journalists in the twentieth century, the educational deficiencies and health and safety hazards of child labor, and Hine's work as the photographer for the National Child Labor Committee.

Myanmar (Burma) is a developing country in South East Asia. While Myanmar is among the 20 countries where 80% of the world's malnourished children live, its military consumes the majority of the national budget. Children who are malnourished between conception and age two are at high risk for impaired physical and mental development, which adversely affects the country's productivity and growth. Myanmar is facing three major micronutrient deficiencies which are iodine, iron and vitamin A deficiencies. The three micronutrient deficiencies can cost about 2.4% of the country's GDP. Children are the future of Myanmar and persistent micronutrient deficiencies will hamper its economic growth and lower its GDP.

The National Association of Boards of Pharmacy (NABP) has defined the practice of telepharmacy as “the provision of pharmacist care by registered pharmacies and pharmacists through the use of telecommunications to patients located at a distance.” Rural communities in America cannot support a full-time pharmacist or cannot easily recruit a pharmacist to reside in their region. Telepharmacy expands access to quality health care to communities nationwide, primarily in rural, medically-underserved areas. Telepharmacy has the potential to improve the quality of pharmaceutical care and to decrease medication errors and adverse drug events. Additional advantages of telepharmacy include cost-effectiveness, improved access to care, higher productivity, after hours availability and reduced travel time. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities. Two large health systems–the Veterans Affairs (VA) and the U.S. Navy – that employ telepharmacy can be used as case studies. The Veterans Health Administration (VHA) is America’s largest integrated health care system. Telepharmacy is among the 44 telehealth subspecialties offered by the VA. The telepharmacy services offered by the VA include videoconference consultations on medication therapy management (MTM), and other e-consult services to answer medication-related questions. The VA telepharmacy provides services for medical conditions such as heart failure, diabetes mellitus, hypertension, hyperlipidemia, thyroid abnormalities, chronic obstructive pulmonary disease, and asthma. Moreover, telepharmacy services have expanded outside primary care to include other

Immigrant workers are a vulnerable and underserved population. The average life expectancy of the migrant worker is 49 years, compared to 77.2 years for most Americans. Immigrant workers have a higher disease burden than other populations and work in occupations with high hazard levels. In addition, they have low socioeconomic levels and face many barriers to accessing healthcare services. Undocumented immigrant workers are excluded in the Affordable Care Act. Health professionals must be attuned to the health issues of new immigrants so that they can provide better services. In order to raise the health standards of America, health professionals must provide healthcare for all, including immigrant workers.

Introduction Nutrition counseling is important for veterans undergoing gastric bypass surgery. The aim of this study was to explore the relationship between the number of nutrition visits a patient attended and change in body mass index (BMI) after gastric bypass surgery for the veteran population. Methods A retrospective study examined veterans (N = 79) who underwent Roux-en-Y gastric bypass surgery from June 2004 through July 2010. Spearman’s correlation and multivariate regression analysis were used to analyze data. Results A significant correlation was found between the number of postoperative nutrition visits and the change in postsurgery BMI at 2 years (Spearman’s ρ = 0.21; P = .017). After adjusting for age, sex, and race, the association between postsurgery nutrition visits and BMI change persisted (β = 0.255; 95% confidence interval, 0.015–0.581; P = .039). Conclusion Veterans with more nutrition visits following Roux-en-Y gastric bypass surgery experienced greater declines in BMI. This finding underscores the importance of the dietitian on the bariatric surgery team.

We present two cases of head and neck squamous cell carcinoma (SCC) metastasizing to the thyroid gland. This is the first report that shows (18) F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) images of tonsillar and supraglottic SCCs invading the thyroid gland. Alcohol and tobacco use are the two most important risk factors for head and neck cancers, but recently human papilloma virus (HPV) infection has become a significant risk factor in the United States. FDG-PET/CT is very useful for SCC staging/restaging and follow-up.

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Femoral head avascular necrosis (AVN) is bone destruction due to subchondral oxygen deficiency and necrosis.1 Our patient is a 63-year-old man with Gleason score 5+4 prostate cancer. He received external beam radiation therapy (7200 cGy) along with combined androgen blockade therapy of lupon/casodex. The patient was …

We present the case of a 69-year-old male with chromophobe renal cell carcinoma (RCC). Chromophobe RCC accounts for only 4% of renal cancers and it is the least aggressive type. Omental nodular deposits due to RCC metastasis are very rare and it is reported only in more aggressive forms of RCC. This is the first report that shows FluoroDeoxyGlucose – Positron Emission Tomography/Computed Tomgraphy (FDG-PET/CT) images of omental nodular deposits from chromophobe RCC. FDG-PET/CT is becoming very useful in restaging RCC with distant metastases.

Benign skull lesions are routinely encountered in clinical practice. The aim of this review is to describe the Computed tomography (CT) findings of solitary benign parietal lesions. Benign parietal bone lesions can exist in patients with history of cancer. Metastasis to the calvarium is rare compared to other sites in the body and primary skull tumors are even rarer. This is the second report of solitary cholesteatoma occurring in the parietal bone. All the clinical cases in this study were histologically proven. Benign solitary parietal lesions can have non-specific features on CT and in some cases, only biopsy can give a definite diagnosis.

In 1995, Total started its oil and gas activities in Myanmar as the operator of Yadana consortium, which comprises Total Exploration & Production Myanmar (TEPM), Thai National Petroleum Exploration & Production Company (PTTEP), UNOCAL, and the national energy corporation Myanmar Oil and Gas Enterprise (MOGE). Among the facilities it has developed, a 65km long onshore gas pipeline in remote southern Myanmar (Tanintharyi Division) is the crucial asset. Together with the company’s operations, a CSR program called Yadana Socio Economic Development program is implemented under direct management of the company’s employees and contractors. This community development program covers 33 villages located within a 10km strip of "corridor" along the gas pipeline, from sea shore to Thai border. "Through our operations, we contribute to the social and economic development in countries where we operate, particularly local communities" – code of conduct

It is very important to accurately characterize skull lesions so that appropriate treatment decisions can be made. False positive readings may lead to unnecessary surgical intervention or radiation. We present a case of a parietal lesion seen on Diffusion weighted (DW) MRI, and further characterized with NaF18-PET/CT and CT in a 69 year old male. This is the first case to report the use of DW MRI, NaF18-PET/CT bone scan and CT in the diagnosis of a skull lesion. DW MRI is known to have high specificity to detect malignant lesions in the skull. If a similar case such as ours in encountered in everyday clinical practice, a differential diagnosis of a benign etiology should be considered.

The most common site of metastasis in gallbladder cancer is the liver. To our knowledge, there are no reports in the literature of gallbladder cancer metastasizing to both the brain parenchyma and the bone. There are only 5 prior reports of gallbladder cancer metastasis to the bone in the English Language literature. Likewise, gallbladder neoplasm metastasizing into the brain parenchyma is extremely rare. We present a rare case of gallbladder cancer presenting with metastases to both the brain parenchyma and the bone in a 71 year old African American male. This patient had early bone metastasis evidenced by hypermetabolic lesions on FDG PET/CT imaging, without density abnormalities of the bone tissue. Gastrointestinal (GI) tumors are commonly detected by CT but for metastasis, F18-FDG PET/CT has higher sensitivity and higher positive predictive value than CT. Since at the initial presentation, most patients suffering from gallbladder cancer tend to have metastatic disease, we raise a question as to whether F18-FDG PET/CT scans should be included in the routine work-up protocol.

We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results.

We present the case of a 54 year old white male with a history of lumbar spondylolisthesis and hip arthralgia, which prompted a hip X-ray. The X-ray showed hip arthritis as well as a sclerotic lesion in the right femur concerning for possible metastasis. He was then referred for a NaF18-PET/CT bone scan to exclude metastatic bone disease. The NaF18-PET/CT study did not show evidence of osteoblastic activity in the sclerotic right femoral lesion, but showed an incidental finding of an ill-defined intense and heterogeneous osteoblastic activity affecting the entire right ischium concerning for malignancy due to the level of activity and heterogeneity. This lesion was followed up with MRI imaging. MRI imaging has been stable and the final diagnosis is favored to be chronic avulsion injury. If a case such as ours is encountered in everyday practice, the possibility of a benign traumatic etiology should be given high consideration.