The development of prostate-specific membrane antigen (PSMA) ligands labeled with radionuclides is a ground-breaking achievement in the management of prostate cancer. With the increasing use of 68 Gallium-PSMA and 18 F-DCFPyL (Pylarify) and their approval by the Food and Drug Administration (FDA), other PSMA agents and their unique characteristics are also being studied. Two other PSMA agents, namely 177 Lutetium-PSMA ( 177 Lu-PSMA) and 225 Actinium-PSMA ( 225 Ac-PSMA), are currently drawing the researcher's attention mainly due to their theranostic importance. Studies focusing on the essential characteristics of these two emerging radiotracers are relatively lacking. Hence, this review article, beginning with a brief introduction, intends to provide insights on the mechanism, efficacy, adverse effects, usefulness, including theranostic implications, and limitations of these two emerging PSMA agents. The 177 Lu-PSMA is commercially accessible, is well tolerated, and has been found to lower prostate-specific antigen (PSA) levels while improving patients' quality of life. It also reduces pain and the requirement for analgesics and is safe for advanced diseases. However, despite its potential advantages, around one-third of patients do not respond satisfactorily to this costly treatment; it is still challenging to personalize this therapy and predict its outcome. Similarly, 225 Ac is compatible with antibody-based targeting vectors, releasing four extremely hazardous high-energy emissions with a longer half-life of 10 days. It has made 225 Ac-PSMA therapy useful for tumors resistant to standard treatments, with a better response than 177 Lu-PSMA. Dosimetry studies show a good biochemical response without toxicity in patients with advanced metastatic castration-resistant prostate cancer (mCRPC). However, it can potentially cause significant damage to healthy tissues if not retained at the tumor site. Encapsulating radionuclides in a nano-carrier, hastening the absorption by tumor cells, and local delivery might all help reduce the harmful consequences. Both have advantages and disadvantages. The choice of PSMA agents may rely on desired qualities, cost, and convenience, among other factors. Further research is warranted in order to better understand their ideal use in clinical settings.
Congenital adrenal hyperplasia (CAH) is a set of autosomal recessive disorders characterized by enzyme abnormalities in the adrenal steroidogenesis pathway, which cause impaired cortisol biosynthesis. Glucocorticoid, mineralocorticoid, and sex steroid production can all be altered in individuals, necessitating hormone replacement therapy. The symptoms might range from prenatal salt loss and abnormal genitalia to adult hirsutism and irregular menses. We present the case of a girl who presented with a seizure initially at the age of three months. Laboratory results revealed hypoglycemia, hyponatremia, and hyperkalemia with increased renin activity, increased adrenocorticotropic hormone (ACTH), low aldosterone, low cortisol, high dehydroepiandrosterone sulfate (DHEAS), and high 17 hydroxyprogesterone levels. Imaging findings were normal. The patient was managed with hydrocortisone and fludrocortisone. She is currently on regular follow-up and is doing well with dexamethasone therapy.
Background: Choledochal cysts are dilated portions of the biliary tract that account for 1% of all benign biliary diseases. It is prevalent among Asian and female populations and the incidence is 1:100,000–150,000. Among the different types, only 15–35% of all choledochal cysts are type IV cysts, with type I being the most common representing 50–80%. Clinical presentation and therapy of biliary cysts (BC) differ depending on the type. Case: We present a case of a 2-year-old male who presented with non-specific symptoms of multiple episodes of vomiting. Laboratory investigations revealed raised alkaline phosphatase and gamma-glutamyl transpeptidase. His symptoms of acute pancreatitis were resolved with conventional therapy. Ultrasonography of the abdomen showed intra and extra-hepatic cystic biliary tree dilatation suggestive of choledochal cyst Type IV A. Conclusions: Choledochal cysts present with clinical features varying with age and anatomical variants and can pose challenges in management that can be addressed by surgery to avoid further complications.
Introduction: The World Health Organization recommends mass vaccination campaigns in children under 15 years before introducing the Japanese Encephalitis (JE) vaccine into the routine immunization program as the most effective immunization strategy in JE disease-endemic countries. The study was conducted to assess the JE vaccine coverage during the recent mass vaccination campaign in five districts of Nepal in 2016. Methods: A stratified three-stage cluster design was used for this cross-sectional sample survey. The JE mass vaccination campaign of 2016 targeted children aged between 1-14 years, and the interview was conducted among systematically sampled households’ mothers and guardians of children aged between 2-15 years in 2017. Results: The coverage of the JE mass vaccination campaign in the year 2016 was 96.9%; the males had slightly higher coverage (97.4%) than females (96.6%). The vaccine utilization increased with an increase in age, 94.0%, 98.1%, and 99.1% coverage among children aged 2-5 years, 6-10 years, and 10-15 years, respectively. The school enrolled children were four-times (OR: 4.016, CI: 2.595–6.216) likely to be vaccinated than out-of-school children and association was statistically significant. Among 86 children who were not vaccinated, 45.3% were ill during the campaign. Besides, 6.6% of out of school children also didn’t get the vaccination. Only three in ten (30.4%) respondents knew that the JE vaccine was given to protect against JE disease or brain fever. More than one-third (36.3%) of respondents reported that the recommendation from the health workers was main reason for vaccinating their children. Only 1.1% of vaccinated children had minor issues following vaccination. Conclusion: Despite low awareness about the specific protection of the JE vaccine, the vaccination coverage was high during the JE mass vaccination campaign. Increasing awareness about the particular vaccine and including activities to vaccinate out-of-school children could help achieve universal coverage in future mass vaccination campaigns
Congenital upper limb deficiency care and management have undergone drastic changes over the past 50 years. Given the low incidence of this defect nationwide, this case report adds to the existing database to analyze the etiological investigations, descriptive epidemiology, and trend detection. We present a case of a 2-month-old male child with congenital upper limb deficiency and explore the possible etiologies and difficulties during early diagnosis of such rare disorders in a low and middle-income countrries and present implications at the primary health care level to improve the prognosis. Poor nutrition during pregnancy due to an unplanned pregnancy is a possible cause. The prognosis is unfavourable due to sociocultural barriers. To address these limitations, it is pertinent to address disability-adequate knowledge among communities, promote early diagnosis, and timely rehabilitation using a multidisciplinary approach. Further, we provide a framework to optimize care.
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