Predictors of acute muscle loss in the intensive care unit: A secondary analysis of an in-bed cycling trial for critically ill patients.

PURPOSE: The purpose of this study was to assist clinicians to identify critically ill patients at greatest risk of acute muscle loss and to analyse the associations between protein intake and exercise on acute muscle loss. MATERIALS AND METHODS: Secondary analysis of a single-centre randomised clinical trial of in-bed cycling using a mixed effects model was undertaken to examine the association between key variables and rectus femoris cross-sectional area (RFCSA). Groups were combined, and key variables for the cohort were modified Nutrition Risk in the Critically Ill (mNUTRIC) scores within the first days following intensive care unit admission, longitudinal RFCSA measurements, percent of daily recommended protein intake, and group allocation (usual care, in-bed cycling). RFCSA ultrasound measurements were taken at baseline and days 3, 7, and 10 to quantify acute muscle loss. All patients received usual care nutritional intake while in the intensive care unit. Patients allocated to the cycling group commenced in-bed cycling once safety criteria were met. RESULTS: Analysis included all 72 participants, of which 69% were male, with a mean (standard deviation) age of 56 (17) years. Patients received a mean (standard deviation) of 59% (26%) of the minimum protein dose recommended for critically ill patients. Mixed-effects model results indicated that patients with higher mNUTRIC scores experienced greater RFCSA loss (estimate = -0.41; 95% confidence interval [CI] = -0.59 to -0.23). RFCSA did not share a statistically significant association with cycling group allocation (estimate = -0.59, 95% CI = -1.53 to 0.34), the percentage of protein requirements received (estimate = -0.48; 95% CI = -1.16 to 0.19), or a combination of cycling group allocation and higher protein intake (estimate = 0.33, 95% CI = -0.76 to 1.43). CONCLUSIONS AND RELEVANCE: We found that a higher mNUTRIC score was associated with greater muscle loss, but we did not observe a relationship between combined protein delivery and in-bed cycling and muscle loss. The low protein doses achieved may have impacted the potential for exercise or nutrition strategies to reduce acute muscle loss. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry (ACTRN 12616000948493).

The inter- and intrarater reliability and feasibility of dietetic assessment of sarcopenia and frailty in potential liver transplant recipients: A mixed-methods study.

Sarcopenia and frailty are associated with poorer outcomes in potential liver transplant (LT) recipients. We examined the reliability and feasibility of dietitians assessing sarcopenia and frailty. Seventy-five adults referred for LT underwent assessments of muscle mass (abdominal CTs), physical function (handgrip strength; HGS, short physical performance battery; SPPB), and frailty (Liver Frailty Index; LFI). Inter- and intrarater reliability and agreement were assessed in subsets of patients using intraclass correlation coefficients (ICCs) and Bland-Altman plots. CTs were analyzed by a dietitian and two independent experts, two dietitians assessed function and frailty. Feasibility assessed system, patient, and profession factors (staff survey). Inter- and intrarater reliability for CT-defined low muscle were excellent (ICCs > 0.97). Reliability between dietitians was excellent for HGS (0.968, 95% CI, 0.928-0.986), SPPB (0.932, 95% CI, 0.798-0.973), and LFI (0.938, 95% CI 0.861-0.973). Bland-Altman analysis indicated excellent agreement for HGS. All transplant clinicians valued sarcopenia and frailty in LT assessments and considered the dietitian appropriate to perform them. Seven saw no barriers to implementation into practice, while five queried test standardization, learning from repeat testing, and resource cost. Dietetic assessments of sarcopenia and frailty are reliable, feasible, and valued measures in the assessment of potential LT recipients.

A framework to support quality of care for patients with chronic intestinal failure requiring home parenteral nutrition.

BACKGROUND AND AIM: Chronic intestinal failure requiring home parenteral nutrition (HPN) is a disabling condition that is best facilitated by a multidisciplinary approach to care. Variation in care has been identified as a key barrier to achieving quality of care for patients on HPN and requires appropriate strategies to help standardize management. METHOD: The Australasian Society for Parenteral and Enteral Nutrition (AuSPEN) assembled a multidisciplinary working group of 15 clinicians to develop a quality framework to assist with the standardization of HPN care in Australia. Obstacles to quality care specific to Australia were identified by consensus. Drafts of the framework documents were based on the available literature and refined by two Delphi rounds with the clinician work group, followed by a further two involving HPN consumers. The Oxford Centre for Evidence-Based Medicine Levels of Evidence was used to assess the strength of evidence underpinning each concept within the framework documents. RESULTS: Quality indicators, standards of care, and position statements have been developed to progress the delivery of quality care to HPN patients. CONCLUSION: The quality framework proposed by AuSPEN is intended to provide a practical structure for clinical and organizational aspects of HPN service delivery to reduce variation in care and improve quality of care and represents the initial step towards development of a national model of care for HPN patients in Australia. While developed for implementation in Australia, the evidence-based framework also has relevance to the international HPN community.

ZnO:Ga-graded ITO electrodes to control interface between PCBM and ITO in planar perovskite solar cells.

Ga-doped ZnO (GZO)-graded layer, facilitating electron extraction from electron transport layer, was integrated on the surface of transparent indium tin oxide (ITO) cathode by using graded sputtering technique to improve the performance of planar n-i-p perovskite solar cells (PSCs). The thickness of graded GZO layer was controlled to optimize GZO-indium tin oxide (ITO) combined electrode for planar n-i-p PSCs. At optimized graded thickness of 15 nm, the GZO-ITO combined electrode showed an optical transmittance of 95%, a resistivity of 2.3 × 10-4 Ohm cm, a sheet resistance of 15.6 Ohm/square, and work function of 4.23 eV, which is well matched with the 4.0-eV lowest unoccupied molecular orbital of [6,6]-phenyl-C61-butyric acid methyl ester. Owing to enhanced extraction of electron by the graded GZO, the n-i-p PSC with GZO-ITO combined electrode showed higher power conversion efficiency (PCE) of 9.67% than the PCE (5.25%) of PSC with only ITO electrode without GZO-graded layer. In addition, the GZO integrated-ITO electrode acts as transparent electrode and electron extraction layer simultaneously due to graded mixing of the GZO at the surface region of ITO electrode.

Pattern of antimicrobial drug resistance of Salmonella Typhi and Paratyphi A in a Teaching Hospital in Islamabad.

OBJECTIVE: To see the pattern of antimicrobial drug resistance among Salmonella serovars. METHODS: This longitudinal, observational study was conducted at Khan Research Laboratories Hospital, Islamabad, Pakistan, from May 2012 to December 2014. All patients presenting with typhoid fever with positive blood culture were included. Age, gender, salmonella serovar and sensitivity to 9 antimicrobial drugs were taken into account. The tested antimicrobial drugs were ampicillin, trimethoprim/sulphamethoxazole, chloramphenicol, nalidixic acid, ciprofloxacin, ofloxacin, levofloxacin, ceftriaxone and cefixime. SPSS 22 was used for analysis. RESULTS: Of the 197 patients, 118(59.9%) were males and 79(40.1%) were females. Moreover, there were 78(39.6%) children and 119(60.4%) adults. The overall mean age was 19.58±13.82 years. Patients with positive culture for salmonella typhi were 155(78.7%) while patients with positive cultures for salmonella paratyphi A were 42(21.3%). No other serovar was found in this study. Overall percentage of multidrug resistance for both salmonella typhi and paratyphi was 74(37.5%). CONCLUSIONS: The prevalence of multidrug resistance and quinolone resistance among salmonella serovars was high.

Outcomes Of Intensive Care Patients Having Septic Shock At A Tertiary Care Hospital Of Islamabad.

BACKGROUND: Septic shock is defined as sepsis with circulatory, cellular and metabolic abnormalities which are associated with greater mortality more than 40%. The objective of this study was to identify shortcomings and act promptly and adequately. METHODS: This case series included 32 patients over a period of 03 months, September to November 2016 done at ICU of KRL Hospital Islamabad. RESULTS: The study only enrolled patients who fulfilled the criteria of septic shock. Mortality was as high as 50%. (UTI) was the most common infection (43.75%). In patients who died Pneumonia was commonest infection (43.75%). Mean TLC, CRP and lactate was 17.48×109/l, 29.28 mg/L and 6.81mmom/L respectively. Escherichia Coli (E. coli) was the most common isolated pathogen (31.25%) followed by Staphylococcus Aureus (12.5%). Mean initial MAP was 49.7 mmHg and mean MAP at end of 3-day period was 71.4 mmHg. Mean norepinephrine dose given on day 1, 2 & 3 was 0.90 µg/kg/min, 1.01 µg/kg/min & 1.28 µg/kg/min respectively. Mean hospital stay was 7.1 days. Six out of 08 (75%) patients who needed ventilator support died while 02 out of 08 (25%) patients survived. Acute Kidney Injury (AKI) was the most common End Organ Damage (EOD). CONCLUSIONS: Mortality remains high in septic shock despite maximum efforts. In current study MAP, serum lactate level, hospital stay, need for ventilator support, comorbidities, need for newer generation antimicrobials were the important cofounders in differentiating patients who died and those who survived with significant p-values in the 1st four conditions.

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).

Attenuation of haemodynamic response to laryngoscopy and oral endotracheal intubation in coronary artery bypass surgery patients: intravenous morphine and lidocaine versus intravenous morphine and lidocaine spray.

BACKGROUND: Sympathetic response associated with laryngoscopy and endotracheal intubation is recognized as a potential cause for a number of complications especially in coronary bypass surgery patients. Various methods have been used to attenuate these hemodynamic responses, The aim of our study was to compare lidocaine spray in addition to intravenous morphine on attenuating the hemodynamic response to laryngoscopy and endotracheal intubation with intravenous lidocaine and morphine in coronary artery bypass surgery patients. METHOD: Sixty patients, scheduled for elective coronary bypass grafting surgery were included in this randomized controlled trial. The patients randomly divided in group-A (Intravenous Morphine 0.1mg/kg and Intravenous lidocaine 1.5 mg/kg) and group-B (Intravenous Morphine 0.1mg/kg and lidocaine spray 1.5 mg/kg). RESULTS: Demographic data was comparable in both groups. There was no statistically significant difference between two groups in the duration of laryngoscopy and intubation. There was statistically insignificant attenuation in heart rate in both groups (p=0.134), the trends of attenuation of systolic blood pressure, diastolic blood pressure and mean arterial pressure in group-A compared to group-B (p=0.933), (p=0.768) and (p=0.136) respectively were statistically insignificant. CONCLUSIONS: Under the present study design, lidocaine spray in addition to intravenous morphine had no better effect on attenuating the hemodynamic response to laryngoscopy and endotracheal intubation as compared to intravenous lidocaine and morphine in coronary artery bypass surgery patients.

The Electronic Impact of Light-Induced Degradation in CsPbBr3 Perovskite Nanocrystals at Gold Interfaces.

The understanding of the interfacial properties in perovskite devices under irradiation is crucial for their engineering. In this study we show how the electronic structure of the interface between CsPbBr3 perovskite nanocrystals (PNCs) and Au is affected by irradiation of X-rays, near-infrared (NIR), and ultraviolet (UV) light. The effects of X-ray and light exposure could be differentiated by employing low-dose X-ray photoelectron spectroscopy (XPS). Apart from the common degradation product of metallic lead (Pb0), a new intermediate component (Pbint) was identified in the Pb 4f XPS spectra after exposure to high intensity X-rays or UV light. The Pbint component is determined to be monolayer metallic Pb on-top of the Au substrate from underpotential deposition (UPD) of Pb induced from the breaking of the perovskite structure allowing for migration of Pb2+.

Justification for hysterectomies and frequency of histopathological lesions of hysterectomy at a Teaching Hospital in Peshawar, Pakistan.

OBJECTIVE: To determine the justification for hysterectomies and the frequencies of histopathological lesions and complications in hystrectomised patients. METHODOLOGY: As a part of a quality assurance process at the Mercy Teaching Hospital, hysterectomies performed between 1(st) January, 2010 and 1(st) Jan 2012 were retrospectively analyzed for presenting complaints, surgical indication, histologic findings, and postoperative complications. The hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report or if significant alternate pathology was present. RESULTS: A total of 123 hysterectomies were performed during this period. Eleven (8.9%) patients' results could not be traced. The other 91.1% had some pathology found. Histologic findings reconfirmed the clinical diagnoses. The hysterectomies were considered justified if p=0.000. Hysterectomy was performed abdominally in 88 (71.5%) patients, vaginally in 35 patients (28.4%). The most common indication for hysterectomy was fibroid related menorrhagia n=40(32.5%), followed by third degree uterovaginal prolapse n=30(24.4%), and dysfunctional uterine bleeding 29(23.6%) patients. Fever was the most common 7(5.7%) post operative complication followed by urinary tract infection 5(4.9%) The incidence of postoperative fever was greater following abdominal surgery, while urinary tract infection was greater following vaginal hysterectomy (P=0.370). CONCLUSION: Almost 91.1% of all hysterectomies in this study were justified. Clinical diagnoses were related to presenting complaints (p=0.000) and were confirmed by histopathogic findings (p=0.000). Most of the hysterectomies were carried out abdominally in part because fewer patients presented with prolapse.

Characterization of a thermostable lipase showing loss of secondary structure at ambient temperature.

A gene encoding extracellular lipase was cloned and characterized from metagenomic DNA extracted from hot spring soil. The recombinant gene was expressed in E. coli and expressed protein was purified to homogeneity using hydrophobic interactions chromatography. The mature polypeptide consists of 388 amino acids with apparent molecular weight of 43 kDa. The enzyme displayed maximum activity at 50 °C and pH 9.0. It showed thermal stability up to 40 °C without any loss of enzyme activity. Nearly 80% enzyme activity was retained at 50 °C even after incubation for 75 min. However above 50 °C the enzyme displayed thermal instability. The half life of the enzyme was determined to be 5 min at 60 °C. Interestingly the CD spectroscopic study carried out in the temperature range of 25-95 °C revealed distortion in solution structure above 35 °C. However the intrinsic tryptophan fluorescence spectroscopic study revealed that even with the loss of secondary structure at 35 °C and above the tertiary structure was retained. With p-nitrophenyl laurate as a substrate, the enzyme exhibited a K ( m ), V ( max ) and K ( cat ) of 0.73 ± 0.18 µM, 239 ± 16 µmol/ml/min and 569 s(-1) respectively. Enzyme activity was strongly inhibited by CuCl(2), HgCl(2) and DEPC but not by PMSF, eserine and SDS. The protein retained significant activity (~70%) with Triton X-100. The enzyme displayed 100% activity in presence of 30% n-Hexane and acetone.

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.

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.

The Outcome Of Closed Reduction And Cast Immobilization Of Colle's Fractures Using Radiological Parameters In The Emergency Department.

BACKGROUND: Distal radius fractures account for most of the injuries presenting in trauma centers. Colle's fractures are defined as fractures within 2.5 cm of the wrist with dorsal angulation of the distal fragment. The cornerstone of treatment remains immobilization of the wrist in a cast. The objective of the study was to determine the outcome of closed reduction and plaster cast immobilization of Colle's fractures in adults using Radiological parameters. It was a descriptive case series study, conducted at the Department of Orthopaedics Sheikh Khalifa Bin Zayed Al Nahyan /CMH Muzaffarabad Azad Kashmir from June 2018 to June 2019. METHODS: Patients with distal radius fractures fulfilling the criteria of Colle's fractures presenting in the Emergency Department were selected through non-probability consecutive sampling. They were managed as per stated protocols and followed up for 06 months. RESULTS: A total of 106 patients of either gender were included in this study. The average age of patients was 30.36±4.12. Fall on an outstretched hand is the major cause of Colle's fracture. In the older age group, most of the fractures are caused by falls while trauma was responsible for the younger age group. Normal post reduction radial inclination was seen in 72% cases; dorsal angulation was normal in 75% while post reduction height was normal in 91% cases. Post reduction radiological parameters were excellent in 49% and good results were seen in 40%. Poor post reduction anatomical results were found in 11% of cases. Overall, the Stewart Anatomical score was 84/100 (p<0.01). CONCLUSIONS: A large majority of Colle's fractures achieved excellent Radiological results after treatment by closed reduction and cast immobilization.

Integration of radiology in the modular system at the undergraduate level.

BACKGROUND: Integration of Radiology is challenging because in the traditional system it is introduced with a clinical subject while in an integrated curriculum, vertical integration of Radiology is done with anatomy in the first year and with pathology, forensic medicine, ophthalmology, ENT, gynaecology surgery, and medicine till the final year. This study was done with the purpose to evaluate Radiology teaching in an integrated curriculum in undergraduate students of Azad Jammu Kashmir Medical College/Sheikh Khalifa Bin Zaid Hospital Muzaffarabad. METHODS: This study was done to determine student's perceptions regarding Radiology teaching at Azad Jammu Kashmir Medical College (AJKMC), starting from the foundation module of the first year till the final year. It was a descriptive cross-sectional type conducted in the Radiology department of AJKMC. The study duration was six months. Students of final year and recent graduates were included in the study. All the information was collected on pro forma. Pro forma included 11 structured, close-ended, quantitative types of questions. Five points Likert scale was given starting from strongly agree to strongly disagree. Data was analysed by descriptive statistics. RESULTS: In 100 students who gave feedback, the age range was from 23 to 26 year. Male students were 32 (32%) and female 68(68 %). 70% of students agreed and 14% strongly agreed for the integration of Radiology at the undergraduate level. Six percent students disagreed with the integration of radiology at the undergraduate level. CONCLUSION: Integration of Radiology in a modular system for undergraduate students at AJKMC was supported by the majority of participants.

Erythrocyte Sedimentation Rate And C-Reactive Protein As Marker Of Acute Versus Chronic Medical Conditions.

BACKGROUND: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are frequently requested investigations that aid health professionals in precisely diagnosing and following a number of complicated disease conditions. The aim of this study is to ascertain whether a rise in any of these acute phase reactants has predilection for an acute illness versus chronic disease.. METHODS: Current study includes 144 patients admitted to Medical ward and Intensive care unit of Khan Research Laboratory (KRL) Hospital Islamabad from January to April 2017. ESR was measured using conventional Westergren method. CRP level (mg/L) was measured from venous or capillary blood using a point of care testing (POCT) device. SPSS version 20 was used for data analysis. RESULTS: Out of 144 patients who participated in this study 60.5% (n=87) were males while 39.6% (n=57) were females. Mean age was 53.4±18.9 years. Among acute medical conditions, Pneumonia and Enteric fever were common 13.2% (n=12) each. Diabetes Mellitus (DM) with complications was the commonest chronic medical condition 22.6% (n=12). Thirty-two patients had ESR <15 mm/Hour; out of them 71.8% (n=23) had acute while 28.2% (n=9) had chronic medical conditions. Thirty-four patients had ESR ≥15 & <30 mm/Hour; out of them 52.9% (n=18) had acute while 47.1% (n=16) had chronic medical conditions. Seventy-eight patients had ESR ≥30 mm/Hour; out of them 64.1% (n=50) had acute while 35.9% (n=28) had chronic medical conditions. All results were statistically significant with p-value ≤0.05. 75 patients had CRP <10 mg/L; out of them 66.7% (n=50) had acute while 33.3% (n=25) had chronic medical conditions. Sixty-nine patients had CRP ≥10 & <100 mg/L; out of them 59.4% (n=41) had acute while 40.6% (n=28) had chronic medical conditions. All results were statistically significant with p-value ≤0.05. In acute medical conditions mean CRP was 16.8±17.7 mg/L and average ESR was 35.9±25.6 mm/Hour. In chronic medical conditions mean CRP was 16.3±17.2 mg/L and mean ESR was 40.8±32.5 mm/Hour. CONCLUSIONS: No difference was found between CRP and ESR as markers of acute versus chronic medical conditions. Both CRP and ESR have positive association with acute as well as chronic medical conditions. Elevated ESR was seen more frequently in acute medical conditions as compared to CRP..

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..

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper.

BACKGROUND: Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS: Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS: The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION: Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.