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.

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.

Early oral feeding after colorectal surgery: A mixed methods study of knowledge translation.

AIM: Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within 24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement strategies to facilitate EOF uptake; and evaluate changes to practice. METHODS: A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework. Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews identified barriers to EOF implementation. Results from Phases 1 and 2 were fed back to inform Phase 3 strategies. Knowledge uptake was monitored in Audits 3 and 4. Phase 4 evaluated outcomes from Audit 5. RESULTS: In Phase 1, median time to commencement of full diet was postoperative Days 4 and 3 in Audits 1 and 2, respectively. Phase 2 identified EOF barriers, including disparities in diet upgrade practices and variable understanding of hospital diets. In Phase 3, planned strategies were implemented to improve EOF (i) educational session describing local hospital diets; (ii) consultant decision to prescribe a full diet on operation notes; and (iii) educational sessions with nursing staff describing changes to EOF practice. In Phase 4, median time to commencement of full diet improved to postoperative Day 0. Patients prescribed a full diet on operation notes increased from 0% to 82%. CONCLUSIONS: The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations.

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.

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.

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.

Magnetic resonance imaging and spectroscopy for monitoring liver steatosis.

PURPOSE: To compare noninvasive MRI and magnetic resonance spectroscopy (MRS) methods with liver biopsy to quantify liver fat content. MATERIALS AND METHODS: Quantification of liver fat was compared by liver biopsy, proton MRS, and MRI using in-phase/out-of-phase (IP/OP) and plus/minus fat saturation (+/-FS) techniques. The reproducibility of each MR measure was also determined. An additional group of overweight patients with steatosis underwent hepatic MRI and MRS before and after a six-month weight-loss program. RESULTS: A close correlation was demonstrated between histological assessment of steatosis and measurement of intrahepatocellular lipid (IHCL) by MRS (r(s) = 0.928, P < 0.0001) and MRI (IP/OP r(s) = 0.942, P < 0.0001; FS r(s) = 0.935, P < 0.0001). Following weight reduction, four of five patients with >5% weight loss had a decrease in IHCL of >or=50%. CONCLUSION: These findings suggest that standard MRI protocols provide a rapid, safe, and quantitative assessment of hepatic steatosis. This is important because MRS is not available on all clinical MRI systems. This will enable noninvasive monitoring of the effects of interventions such as weight loss or pharmacotherapy in patients with fatty liver diseases.

Steatosis is a cofactor in liver injury in hemochromatosis.

BACKGROUND & AIMS: Obesity-related steatosis is an increasingly common histologic finding and often coexists with other chronic liver diseases. Although obesity and steatosis are recognized risk factors for more advanced fibrosis in chronic hepatitis C and alcoholic liver disease, it has not been determined whether these factors influence the progression of other diseases in which steatosis is not a feature of the primary liver insult. METHODS: We studied 214 patients with hemochromatosis who were homozygous for the C282Y substitution in HFE and had undergone liver biopsy prior to phlebotomy. RESULTS: Steatosis was present in 41.1% of these patients, and 14.5% had moderate or severe steatosis. Median serum alanine aminotransferase (ALT) and ferritin levels were higher (P < .001), and median transferrin saturation (P = .01) and hepatic iron concentration (HIC) were lower (P = .003) in subjects with steatosis compared with subjects without steatosis. Bivariate analysis revealed a significant association between steatosis and fibrosis (P = .001). Following multiple logistic regression, steatosis was independently associated with fibrosis (odds ratio [OR] 4.3, 95% confidence interval [CI]: 2.1-8.8; P < .001) along with male sex (OR, 5.1; 95% CI: 2.0-12.5; P < .001), excess alcohol consumption (males > or = 50 g/day, females > or = 40 g/day) (OR, 3.9; 95% CI: 1.8-8.5; P = .001), and hepatic iron content (OR, 1.4; 95% CI: 1.2-1.6; P < .001). Both higher BMI (OR, 3.3; 95% CI: 1.8-6.3; P < .001) and alcohol consumption (males > or = 30 g/day, females > or = 10 g/day) (OR, 3.4; 95% CI: 1.2-10.0; P = .023) were independently associated with the presence of steatosis. CONCLUSIONS: These findings indicate that obesity-related steatosis may have a role as a cofactor in liver injury in hemochromatosis. This has important clinical implications and suggests that obesity should be actively addressed in the management of patients with hemochromatosis, as well as other liver diseases.