Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Obstructive Jaundice in Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP).

This cross sectional study was carried out in the department of Radiology and Imaging in collaboration with Department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2014 to evaluate the efficacy of Magnetic resonance cholangiopancreatography (MRCP) and ERCP in the management of obstructive jaundice and also to determine diagnostic validity accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in evaluation of obstructive jaundice. For this purpose, a total of 60 patients with obstructive jaundice who underwent MRCP and Endoscopic retrograde cholangiopancreatography (ERCP) in the above mentioned hospital were enrolled. More than one third (35.0%) patients were in 5th decade and the mean age was 46.2±12.9 years. Male female ratio was 1.1:1. Most (45.0%) of the patients had filling defect, 28.3% had concentric stenosis and 26.7% eccentric stenosis. In MRCP findings more than one third (35.0%) patients had choledocholithiasis followed by 26.7% had cholangiocarcinoma, 10.0% benign CBD stricture and 8.3% had ascariasis. In ERCP findings 31.7% patients had choledocholithiasis followed by 16.7% had cholangiocarcinoma, 13.3% benign CBD stricture and 10.0% ascariasis. All patients had increased serum bilirubin.

Occupational exposure from external radiation used in medical practices in Pakistan by film badge dosimetry.

Occupational exposure data of workers due to external sources of radiation in various medical practices such as nuclear medicine (NM), radiotherapy and diagnostic radiology (DR) in Pakistan were collected and analysed. Whole-body doses of workers were measured by film badge dosimetry technique during 2003-2007. Annual average effective dose in NM, radiotherapy and DR varied in the range of 1.39-1.80, 1.05-1.45 and 1.22-1.71 mSv, respectively, during 2003-2007. These values are quite low and well below the annual limit of 20 mSv averaged over a period of 5 consecutive years. Nobody received the radiation dose >50 mSv in any single year over a period of 5 consecutive years; therefore, no overexposure case has been detected. Decreasing trend of annual average dose values in aforementioned categories of work during 2003-2007 indicates the improvement of radiation protection status in medical field in Pakistan.

Radiological impact of composite food served at PINSTECH.

To determine radiological impact of composite food served at Pakistan Institute of Nuclear Science and Technology (PINSTECH) on its worker, cooked meals were collected during 2000-2007 and analysed by gamma and beta radiometry techniques for naturally occurring radionuclides and fission fragments. The only measurable radionuclide was naturally occurring (40)K. Its activity range was 40+/-1.5 to 182.4+/-3.8 Bq kg(-1) with cumulative average value of 89.4+/-35.1 Bq kg(-1). Based on annual meals taken by the worker in cafeteria, the measured value gives committed effective dose of 74 microSv and estimated cancer risk factor of 1.5 x 10(-4) that is a minor fraction of the total risk of 5 x 10(-3). It depicts that food served at PINSTECH cafeteria is radiologically safe for consumption.

Environmental gamma radiation measurement in district Swat, Pakistan.

External exposure to environmental gamma ray sources is an important component of exposure to the public. A survey was carried out to determine activity concentration levels and associated doses from (226)Ra, (232)Th, (40)K and (137)Cs by means of high-resolution gamma ray spectrometry in the Swat district, famous for tourism. The mean concentrations for (226)Ra, (232)Th and (40)K were found to be 50.4 +/- 0.7, 34.8 +/- 0.7 and 434.5 +/- 7.4 Bq kg(-1), respectively, in soil samples, which are slightly more than the world average values. However, (137)Cs was only found in the soil sample of Barikot with an activity concentration of 34 +/- 1.2 Bq kg(-1). Only (40)K was determined in vegetation samples with an average activity of 172.2 +/- 1.7 Bq kg(-1), whereas in water samples, all radionuclides were found below lower limits of detection. The radium equivalent activity in all soil samples is lower than the limit set in the Organisation for Economic Cooperation and Development report (370 Bq kg(-1)). The value of the external exposure dose has been determined from the content of these radionuclides in soil. The average terrestrial gamma air absorbed dose rate was observed to be 62.4 nGy h(-1), which yields an annual effective dose of 0.08 mSv. The average value of the annual effective dose lies close to the global range of outdoor radiation exposure given in United Nations Scientific Committee on the Effects of Atomic Radiation. However, the main component of the radiation dose to the population residing in the study area arises from cosmic ray due to high altitude.

Introduction of an early pregnancy assessment unit: audit on the first 6 months of service.

BACKGROUND: Women experiencing bleeding in early pregnancy suffer considerable anxiety. Waiting for a considerable time for a diagnosis adds to their grievance. Early Pregnancy Assessment Unit (EPAU) is a dedicated service that provides quick and easy accessibility to diagnosis, treatment and support service. AIM: To monitor the first 6 months of the EPAU service in the Rotunda Hospital, to identify its shortcomings, so that we can ensure effective EPAU care in future. METHODS: A retrospective audit between July and December 2002 was performed. RESULTS: A majority of patients (83.4%) were self-referrals. All patients were seen between 1 and 3 h. In the miscarriage group, 218/278 (78.4%) was managed surgically by evacuation and a further 60/278 (21.6%) received conservative or medical treatment. Among 13 ectopic pregnancies, 5/13 (39%) had laparoscopic management. CONCLUSION: This clinic has enabled us to manage early pregnancy bleeding in an effective manner within a satisfactory time period. The high surgical intervention rate for miscarriages is highlighted to support the need for greater emphasis on medical and expectant management.

Radiological impact of dietary intakes of naturally occurring radionuclides on Pakistani adults.

Daily dietary intakes of three naturally occurring long-lived radionuclides (232)Th, (238)U and (40)K were estimated for the adult population of Pakistan using neutron activation analysis (NAA), inductively coupled plasma mass spectrometry (ICP-MS) and atomic absorption spectrometry (AAS), respectively. The daily intakes of (232)Th ranged from 4 to 29 mBq, (238)U ranged from 17 to 82 mBq and (40)K ranged from 51 to 128 Bq. The geometric means of these intakes were 10 mBqd(-1) for (232)Th, 33 mBqd(-1) for (238)U and 78.5 Bqd(-1) for (40)K. The measured values give annual committed effective doses of 0.80, 0.53 and 178.75 microSvyr(-1) for (232)Th, (238)U and (40)K, respectively to Pakistani population. The net radiological impact of these radionuclides is 180.08 microSvyr(-1). This value gives cancer risk factor of 4.5 x 10(-4) and loss of life expectancy of 0.87 days only. Whereas ICRP cancer risk factor for general public is 2.5 x 10(-3) and total risk involve from the all natural radiation sources based on global average annual radiation dose of 2.4 mSvyr(-1) is 6.0 x 10(-3). The estimated cancer risk shows that probability of increase of cancer risk from daily Pakistani diet is only a minor fraction of ICRP values. Therefore, the diet does not pose any significant health hazard and is considered radiologically safe for human consumption.

Thorium concentration in Pakistani diet.

To evaluate radiation doses due to ingestion of thorium activity by members of the public, baseline analytical data on thorium concentration in a typical Pakistani diet was generated. Food samples were collected from major districts/ cities of the country using the market basket method, and typical daily diets were prepared. Thorium concentration was determined by instrumental neutron activation analysis. It was found to vary from 1.6 ng g(-1) to 12 ng g(-1). The median value was 4.6 ng g(-1). This leads to median daily thorium intake of 2.7 microg d(-1). The geometric mean was 2.6 microg d(-1), which was 13% less than the ICRP value. Based on these measurements the average intake of 232Th activity was 10 mBq d(-1), and the average annual and committed effective doses for adults were estimated to be 8.8 x 10(-7) Sv y(-1) and 4.4 x 10(-5) Sv, respectively.

Intercomparison of INAA and ICP-MS results for thorium determination in Pakistani diet.

A pilot study on ingestion and organ content of trace elements of importance in radiological protection was to be carried out in Pakistan. Baseline analytical data on daily dietary intake of thorium was to be measured using Instrumental Neutron Activation Analysis (INAA) technique. To determine the accuracy and reliability of our technique, some samples were measured in Pakistan using INAA and in Japan using Inductively Coupled Plasma-Mass Spectrometry. For intercomparison of results overall mean Z-scores were calculated. The results showed validity of our technique. Mean value of 232Th concentration in Pakistani diet samples using INAA technique is 0.0062 +/- 0.0028 microg/g and with ICP-MS technique is 0.0069 +/- 0.0032 microg/g.

Plasma level of antioxidant nutrients (retinol and alphatocopherol) in cases with different grades of cervical carcinoma.

A study was conducted on 23 patients on various grades of cervical cancer, selected purposely from Dhaka Medical College Hospital. Vitamin A and E level of this histologically proved cases showed mean serum level of vitamin A was 0.41 +/- 0.19 and that vitamin E was 4.21 +/- 2.15, and these low level was constant in all Histopathological grading of cervical cancer. Contraceptive user and smoker had very low level of vitamin A and E. Majority (51%) of the cases, were from lower middle class and 49% were from lower class, seventy seven percent were illiterate, 97% were married before 18 years, 57% had more than 6 children, 71% did not use contraceptive. The availability of vitamin A rich food were within reach of lower income group, than the food source of vitamin E which are usually of animal origin. It is concluded that in cervical cancer had low level of antioxidant vitamins A and E. Further study is indicated for understanding detail antioxidant nutrients role in aetiopathology of cervical cancer in Bangladesh.