Congenital Mediastinal Neuroenteric Cyst as a cause of respiratory distress since birth.

Mediastinal Neuroenteric Cyst is a rare congenital presentation in infants and is associated with a high mortality rate. It is a very uncommon benign lesion and usually develops from abnormal embryological development of the foregut. Till now, only 106 cases have been reported worldwide. In Pakistan only three cases have been published, with varying presentations. The clinical presentation and age at presentation vary from asymptomatic and coincidental finding on chest x-ray, to limb numbness or early presentation with severe symptoms like those in our case. In fact, it poses an important challenge for paediatricians. We present a rare case with emphasis on clinical presentation and diagnostic criteria.

Paediatrics Brain Imaging In Epilepsy: Common Presenting Symptoms And Spectrum Of Abnormalities Detected On MRI.

BACKGROUND: Epilepsy, a common neurological disorder can present at any age and has a number of aetiologies with underlying brain disease being the most common aetiology. Brain imaging becomes important and mandatory in the work up for epilepsy in localization and lateralization of the seizure focus. METHODS: This cross-sectional study was conducted in the department of Radiology Ayub Medical Teaching Institution Abbottabad from 1st March 2015 to 31st March 2016. A total of 209 children aged 28 days to 14 years were included in the study who presented with seizures to clinicians. Information obtained from history, clinical examination and investigations especially MRI brains were recorded in a prescribed pro forma. The data was analysed in SPSS 20. RESULTS: MRI examination was unremarkable in 44.01% (n=92) and mild generalized brain atrophy was noted in 12.91% (n=27). Arachnoid cysts, mild unilateral brain atrophy and hydrocephalous due to aqueduct stenosis were recorded in 3.82% (n=8) of each group. Neoplastic lesions were the second most common abnormal MRI finding and constituted 5.74% (n=12). Leukodystrophy was diagnosed in 4.78% (n=10). MRI examination showed ring enhancing lesions (tuberculomas) and AVM in 1.43% (n=3) of each group. Perinatal ischemia and intracranial infection, (focal or generalized) were recorded in 2.87% (n=6) of each group. A 0.95% (n=2) of children in each group had agenesis of corpus callosum and cavernoma. The radiological MRI diagnosis of Raussmussen encephalitis was made in 3.34% (n=7). Single case, each of mesial temporal sclerosis, subdural haemorrhage, infarct and craniopharyngioma was recorded making 0.47% of the total patients in each case. CONCLUSIONS: MRI examination was abnormal in significant number of patients (55.86%), so therefore if properly utilized, in a good clinical context, this can identify most of the structural brain abnormalities in paediatric patients presenting with seizures.

Comparison of perinatal outcome of growth restricted fetuses with normal and abnormal umbilical artery Doppler waveforms.

BACKGROUND: Intrauterine growth restridtion (IUGR) is a complex problem. It is notorious but a difficult diagnosis. The perinatal mortality can be reduced when the results of umbilical artery Doppler are made available to clinicians to help them intervene more timely and appropriately. This study aimed to compare perinatal outcome of growth restricted foetuses with normal and abnormal umbilical artery doppler waveforms. METHODS: This cross-sectional descriptive study was conducted in the radiology department of Mother and Child Health (MCH), Pakistan Institute of Medical Sciences (PIMS), Islamabad from March 2007 to March 2008. A total of 100 pregnant women -with growth restricted foetuses were studied with umbilical artery Doppler ultrasound. Fifty women had normail umbilical artery Doppler waveform and the umbilical artery Doppler wave-form was compromised (either absent or reversed) in the 50 pregnancies. These patients were followed up and the perinatal outcomes were recorded and compared. RESULTS: Premature delivery was recorded in 14% in the normal group and 96% in the abnormal group. The number of babies with low birth weight was more in the abnormal group. The neonatal intensive care (NICU) admissions were significantly increased in the abnormal group (82%). The incidence of intra-ventricular haemorrhage was more (18%) in the abnormal umbilical artery Doppler group as compared to normal group (06%). Perinatal deaths were three times more in the abnormal umbilical artery Doppler group as compared to normal. The difference in the perinatal outcome of both group is statistically significant (p=.0001). CONCLUSION: There is a strong relationship between pregnancy outcome in IUGR babies and abnormal uterine artery doppler waveform (Absent or reversed).

Role of cranial computed tomography in predicting clinical outcome in patients with minor head injury.

BACKGROUND: Optimal management of patients with mild head injury in the emergency department is still under debate. The objective of this study was to determine the diagnostic efficacy of computed tomography in patients with minor head injury. METHODS: A cross-sectional comparative study was conducted in the Radiology department of PIMS, Islamabad in collaboration with neurosurgery department from 14 February to 13 August 2008. One hundred and sixty patients coming to accident and emergency department with minor head injury with GCS of 13-15 were included. The patients then underwent non contrast enhanced CT of brain within 6 hours and results of computed tomography were compared with clinical outcome determined at 24 hours. RESULTS: Twenty-two patients were CT positive for intracranial injury. Out of these 18 patients had an adverse clinical outcome and were considered true positive, while 4 patients were false positive and had normal clinical course with observation only. Ninety-four patients were CT negative for intracranial injury. Out of these 93 were true negative while I was false negative, as confirmed subsequently by adverse clinical outcome. The sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of CT for intracranial injury in patients of minor head injury was 94%, 96%, 81%, 99% and 95.7% respectively. CONCLUSION: CT should be used as a primary screening investigation in all patients with minor head injury as patients with normal neurological examination and normal CT scan can be safely discharged without need for inpatient or patient observation, thereby making the hospital resources available for more serious patients.

Diagnostic Accuracy Of Contrast Enhanced Ct For Detection Of Renal Cell Carcinoma Taking Histopathology As Gold Standard.

BACKGROUND: Renal cell carcinoma being the commonest primary renal malignancy of adulthood accounts for approximately 80-90% renal malignant lesions. The purpose of radiological imaging modalities when devising the treatment options for renal masses is crucial as it significantly influence the clinical outcome and prognosis of the disease. Subjective impression by a radiologist for diagnosing a mass lesion is known to be critical and its precision is improved by contrast enhanced CT as demonstrated by certain retrospective analyses. We aimed to ascertain the diagnostic accuracy of contrast enhanced computed tomography to diagnose renal cell cancers by verifying through histopathology reported diagnoses. METHODS: This Cross-sectional (validation) study was carried out in Radiology and Urology departments of Ayub Teaching Hospital; Abbottabad, from 1st November 2020 to 30th April 2022. The study population included all admitted symptomatic patients with age range 18-70 years of either gender. The patients were subjected to detailed clinical examination and history and an ultrasound and contrast enhanced CT abdomen and pelvis. CT scans were reported under supervision of single consultant radiologist. Data was analysed in SPSS version 20.0. RESULTS: Mean age of the patients was 38.88±11.62 years ranging from 18-70 years and mean duration of symptoms was 54.64±49.171 ranging from 3-180 days. All of the total 113 patients underwent contrast enhanced CT scan and later operated to confirm the diagnoses by histopathology. The comparison yielded true positive (TP) cases to be 67, True Negative (TN) 16, False Positive (FP) 26, and 4 False Negative (FN) as per CT scan diagnoses. CT scan had a diagnostic Accuracy of 73.45% with 94.37% sensitivity and 38.10% specificity. CONCLUSIONS: Contrast-enhanced CT has a high sensitivity for making the diagnosis of renal cell carcinoma; however, its specificity is low. A multidisciplinary approach is necessary to overcome the low specificity. Therefore, collaboration between radiologists and urologic oncologists should be considered while devising treatment plan for patients.

Impact Of Media On Ocular Trauma In Our Setup.

Background: Ocular injuries are one of the most common causes of monocular visual impairment and blindness worldwide. However, surveys done in only hospitals underestimate the incidence of oculars trauma. Aim of the study was to draw the attention towards significant increase in eye injuries amongst, or by, the children in few months in our setup following the start of airing of the drama series Ertughral Ghazi on television. It is the need of the day to plan safety strategies for prevention of ocular injuries in children or by the children who view the drama series. Method: Case series study was done in Department of Ophthalmology, Ayub Medical and Teaching Institution, Abbottabad from 16thApril to 7th June 2021. Results: We had 10 patients with similar type of injuries but with different severity and extent due to wooden arrows while playing out the role of protagonists shown in the Ertughral Ghazi television series. Out of 10 eyes, 2 eyes got blind, 6 eyes were significantly damaged with profound visual loss and 1 eye had only lid laceration while1 eye had just conjunctival laceration near limbus. Conclusion: The current burden of several ocular traumas connected to the playacting by the children mimicking the TV drama has increased. Health education, information dissemination of and safety strategies should be planned and executed to prevent such injuries.

Diagnostic Accuracy Of Chest Radiograph In Interstitial Lung Disease As Confirmed By High Resolution Computed Tomography (HRCT) Chest.

Background: Interstitial Lung Disease (ILD) - an umbrella term encompassing about 100 different pathophysiological entities are usually defined as an irreversible, progressive fibrotic changes in the lung parenchyma that leads to difficult breathing and reduced gaseous exchange at the alveolar level. We aimed to quantify the validity of CXR for the diagnosis of ILD taking HRCT as gold standard in the population of Hazara division. Methods: This validation study was conducted during 11 June till 12 Dec 2019 in the radiology department of Ayub Teaching Hospital, Abbottabad on 60 adult patients aged 30-60 years who presented with progressive exertional dyspnoea. The patients were enrolled into the study via non probability, consecutive sampling technique. All the data was recorded on a self-developed structured questionnaire. Data was analyzed using SPSS version 20. Results: The mean age of study participants was 47.18±6.90 years SD with a range of 36-60years. The mean of time duration of symptoms was 9.66±1.7 years with a range of 7-12 years. There were 40 (66.7%) males and 20 (33.3%) females with a male to female ratio of 2:1. The sensitivity, specificity, PPV, NPV and Diagnostic Accuracy of CXR for the diagnosis of ILD as compared to HRCT was calculated to be 65.5%, 20%, 90%, 5% and 61.66% respectively. A chi square test of significance yielded a value of 0.51 for the diagnostic accuracy of CXR for ILD as compared to HRCT. Diagnostic ODDs ratio and Youden's Index yielded values of 47.37% and 0.145 respectively. All these parameters' points towards a lower utility of CXR for the diagnostic purpose in patients suspected with ILD. Conclusion: Chest x-ray is simple, non-invasive, economical and readily available alternative to HRCT but its specificity and diagnostic accuracy are questionable. CXR is a recommendable first line investigation for chest pathology workup but for a definitive diagnosis, one should not depend on CXR as it can miss the diagnosis.

Use Of Radiological Diagnostic Modalities In Tertiary Care Hospital - How Do The Clinicians Decide About Type Of Modality And Clinician Perception Regarding Hazards Associated With Radiological Imaging Modalities?

BACKGROUND: In the past few decades there is rapid advancement in technology and hence tremendous innovations in diagnostic imaging. This has increased our ability to diagnose illness and monitor response to treatment in a manner which was not previously possible. As compared to previous times, there is also more easy availability of these diagnostic imaging modalities in our hospitals. Therefore, easy and frequent availability harbour the risk of injudicious use of these tests as well. This study is conducted to know the views of consultants about it. METHODS: This cross-sectional descriptive study was conducted in Ayub Medical Institute MTI from March 2021 to July 2021. The data was collected through a self-administered anonymous questionnaire. RESULTS: A total of 250 clinicians participated in the study with 54% males. Majority of them (n=140) 56% answered that consultants on round and on duty in OPD decide special radiological investigations for the patients. Most of them (90%, n=225) were aware of radiation hazards in CT, X-rays and fluoroscopy . CONCLUSION: The referring physicians working at MTI ATH Abbottabad have enough basic knowledge regarding the practice of radiological modalities but were unaware of specific health hazards and radiation doses to the patients associated with the use of these imaging modalities.

Trustworthy Intrusion Detection in E-Healthcare Systems.

In Internet of Things (IoT)-based network systems (IoT-net), intrusion detection systems (IDS) play a significant role to maintain patient health records (PHR) in e-healthcare. IoT-net is a massive technology with security threats on the network layer, as it is considered the most common source for communication and data storage platforms. The security of data servers in all sectors (mainly healthcare) has become one of the most crucial challenges for researchers. This paper proposes an approach for effective intrusion detection in the e-healthcare environment to maintain PHR in a safe IoT-net using an adaptive neuro-fuzzy inference system (ANFIS). In the proposed security model, the experiments present a security tool that helps to detect malicious network traffic. The practical implementation of the ANFIS model on the MATLAB framework with testing and training results compares the accuracy rate from the previous research in security.

Validity Of Grayscale Ultrasound And Resistive Index In The Detection Of Nature Of Ovarian Neoplasms By Taking Histopathology As A Gold Standard.

BACKGROUND: The utility of ultrasound has long been established in the diagnosis of benign and malignant ovarian neoplasms. Ultrasound is a safe and non-invasive imaging modality that has a high sensitivity and specificity. The objective was to determine the validity of grayscale ultrasound and resistive index in the detection of nature of ovarian neoplasms by taking histopathology as a gold standard. METHODS: It was Cross-sectional study conducted in department of Radiology, Ayub Teaching Hospital Abbottabad from May 16 to November 30, 2014. Twohundred- twenty-one female patients in whom an adnexal mass was noted on pelvic ultrasound were included in the study. RESULTS: Out of these 221 patients, malignant ovarian masses were present in 50 (22.62%) patients on grayscale ultrasound. While a resistive index ≤0.6 was found in 56 (25.34%) patients. Over all the sensitivity of grayscale ultrasound was 95% and the specificity was 93.37%. Likewise, the sensitivity and specificity of resistive index were 95% and 90.06% respectively. CONCLUSIONS: This study showed the grayscale ultrasound is a sensitive imaging modality for differentiation of benign and malignant ovarian masses.

Validity Of Transabdominal Ultrasound Scan In The Prediction Of Uterine Scar Thickness.

BACKGROUND: Caesarean section rate is increasing throughout the world, which increases the risk of complications in subsequent pregnancy with increased maternal and foetal morbidity and mortality. There is risk of uterine rupture in subsequent pregnancy with trial of labour after caesarean section (TOLAC). Therefore, accurate prediction of uterine rupture can be of significant value during the management of subsequent pregnancies after previous caesarean delivery. The aim of this study was to evaluate the accuracy of prenatal transabdominal sonography in determining the lower uterine segment thickness in women with previous caesarean section, to document relevant risk factors in the obstetric history of subjects predisposing to uterine scar rupture and to define a cut-off value of uterine thickness for prediction of uterine rupture. METHODS: This cross-sectional validation study was conducted in the Department of Obstetrics and Gynaecology, Ayub Teaching Hospital, Abbottabad from May to October 2017.Transabdominal ultrasound was carried out in all patients before labour for the measurement of uterine scar thickness. Patients were followed till caesarean section and intraoperative findings were recorded. RESULTS: A total of 117 patients were enrolled. Out of these 33% had thin or dehiscence/rupture scar. At the cut-off value of ≤5 mm the sensitivity was 76.9%, specificity 48.7% and accuracy was 58.12%. No significant association was found between clinical features and scar dehiscence/rupture. CONCLUSIONS: No definite USG cut-off limit could be established to provide guidance regarding the clinical decision of opting for VBAC or repeat caesarean/section; scar thicknesses ≤5.0 mm should be judged cautiously.

Non-Contrast Enhanced Multi-Slice Ct-Kub In Renal Colic: Spectrum Of Abnormalities Detected On Ct Kub And Assessment Of Referral Patterns.

BACKGROUND: Renal colic is a common problem and significant number of patients presenting to ER, ED are suffering from acute or chronic renal colic. The conventional methods of investigating patients with renal colic are urine routine examination, plain radiograph for KUB (kidneys, ureters and bladder) and ultrasound followed by intravenous urography. Now a days non contrast enhanced computed tomography of kidneys, ureters and bladder is the first line investigation in suspected upper urinary tract obstruction. Radiation dose is one of the major limitations of CT KUB. Other limitations are cost and availability. The sensitivity and specificity of CT KUB is extremely high in the diagnosis of stones. METHODS: This cross-sectional descriptive study was conducted in the department of Radiology Ayub Medical Teaching Institution Abbottabad from 1st July 2017 to 30th May 2018. Information obtained from history, clinical examination and CT KUB, ultrasound were recorded in an approved and prescribed pro forma. RESULTS: Among total 350 patients, majority were male 66% and the age of study population ranged from 20 to 60 years. Most of the patients presented with flank pain and microscopic hematuria. Calculi were detected in 52 %. Patients with non obstructing stones were 63 %, ureteric stones and hydronephrosis were 22 %, ureterovesicle junction stone 4%. Patients with stones and incidental findings made 12.8% of the study population having abnormal CT KUB.. CONCLUSIONS: Non contrast enhanced CT KUB, performed in a suitable clinical scenario, is an excellent imaging investigation for patients having renal colic and the initial ultrasound is inconclusive. In majority of cases it identifies the cause of lumbar or pelvic pain. This modality has the added advantage of showing alternate causes for pain other than stones..

Obesity And Diabetes As Determinants Of Vitamin D Deficiency.

BACKGROUND: Vitamin D has been the focus of attention in the recent past owing to its multitude of effects on various organ systems including immune system, endocrine, cardiovascular etc. Diabetes mellitus and obesity are widely prevalent in our region. The present study was designed with an objective to determine the vitamin D status in relation to diabetes mellitus and obesity in our area. METHODS: This cross-sectional study was conducted at the Medical C Unit of Department of Medicine, Ayub Teaching Hospital from January to December 2017. Approval of ethical committee was taken. A total of 117 patients were enrolled in this study of which 109 were finalized for analysis owing to incomplete data in 8 cases. Patients' characteristics were recorded on a structured proforma. Type 2 diabetes was confirmed using HbA1C Levels. Using ADA 2016 criteria. Vitamin D status was assessed using 25-OH-Vit D levels from the same laboratory. Height and weight of the patients were recorded to obtain BMI. Data was entered and analysed using SPSS version 20. RESULTS: Of the total sample, 69 (63.3%) were females and 40 (36.7%) were males. Mean age of the participants was 44.13±15.777. Mean vitamin D levels were 26.35±18.72. A total of 83 (76.14%) patients were either vitamin D deficient 66 (60.6%) or insufficient 17 (15.6%) while 26 (23.9%) were sufficient in vitamin D. There was statistically significant difference in vitamin D status in diabetic versus non diabetic patients (p=0.015). As regards BMI and vitamin D status, the difference was also statistically significant (p=0.018). CONCLUSIONS: Vitamin D deficiency is widely prevalent in our region. There is also a high prevalence of obesity and diabetes mellitus and they are inversely related to low vitamin D levels.

Genetic Variation and Its Reflection on Posttranslational Modifications in Frequency Clock and Mating Type a-1 Proteins in Sordaria fimicola.

Posttranslational modifications (PTMs) occur in all essential proteins taking command of their functions. There are many domains inside proteins where modifications take place on side-chains of amino acids through various enzymes to generate different species of proteins. In this manuscript we have, for the first time, predicted posttranslational modifications of frequency clock and mating type a-1 proteins in Sordaria fimicola collected from different sites to see the effect of environment on proteins or various amino acids pickings and their ultimate impact on consensus sequences present in mating type proteins using bioinformatics tools. Furthermore, we have also measured and walked through genomic DNA of various Sordaria strains to determine genetic diversity by genotyping the short sequence repeats (SSRs) of wild strains of S. fimicola collected from contrasting environments of two opposing slopes (harsh and xeric south facing slope and mild north facing slope) of Evolution Canyon (EC), Israel. Based on the whole genome sequence of S. macrospora, we targeted 20 genomic regions in S. fimicola which contain short sequence repeats (SSRs). Our data revealed genetic variations in strains from south facing slope and these findings assist in the hypothesis that genetic variations caused by stressful environments lead to evolution.