Journal of Islamabad Medical & Dental College
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The Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) For Detection of Spinal Tuberculosis (TB)
Get PDFBackground: Diagnosis of spinal tuberculosis is a major challenge. It is usually made using a blend of, laboratory , imaging investigations, clinical and none of these are 100% confirmatory. The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) for detection of spinal tuberculosis (TB)
Methodology: This cross-sectional study was conducted in the department of Radiology, Lahore General Hospital, on 150 patients, with suspicion of spinal TB from January,2020 to August,2020. Patients having Backache for >6 months, loss of appetite, loss of weight >10% in previous one month, raised ESR >15 mm/hour, and positive sputum results for AFB were included. The patients underwent full spinal MRI scan. MRI was done using 1.5 Tesla MR for diagnosis of spinal TB. The diagnosis of spinal TB was then confirmed on histopathologic reporting.
Results:Mean age of study participants was 47.83±9.65 years. There was male predominance with 93 (62.0%) males and 57 (38.0%) female patients. The mean duration of spinal TB symptoms was 11.52±3.12 months. On accuracy of MRI, there were 83 (55.3%) true positive cases, 10 (6.67%) false positive, 08 (5.33%) false negative and 49 (32.67%) true negative. The sensitivity of MRI was 91.2%, specificity 83.1%, positive predictive value (PPV) 89.2% and negative predictive value (NPV) 86.0%.
Conclusion: Sensitivity of MRI was 91.2% and specificity 83.1%.MRI is an ideal non-invasive imaging modality for the diagnosis of spinal TB.
Keywords: Magnetic resonance imaging, Spinal, Tuberculosis
Functional Outcome of Distal Femur Fracture Treated with Retrograde Nailing Technique
Get PDFBackground: Management of distal femur fractures is always challenging for the surgeons. Retrograde interlocking nailing is one of the effective methods with minimal complications for treatment of such fractures. The objective of the study was to evaluate the functional outcome of retrograde interlocking nailing technique in patients with distal femur fractures.
Methodology: This interventional study was conducted at the department of orthopedic surgery, Liaquat University Hospital, Hyderabad from March 2017 to December 2019. Patients of either gender, between 30 to 65 years age, who presented with acute fracture of distal femur, as a result of trauma within 12-96 hours, requiring surgical intervention were included. Lysholm Scoring System was used to evaluate the functional outcome of patients treated with retrograde interlocking nailing technique. Data was analyzed using SPSS version 24.
Results: Total 102 patients gave consent of participation. The mean age of study participants was 43.50±7.26 with the age range from 40-65 years. Male patients were 76.47% and female 23.53%. In majority (63.73%) of cases, mode of injury was road traffic accidents. Statistically significant difference in functional mobility score between the age groups and gender (p < 0.05) was found. Statistically significant (p < 0.05) decline in mean Lysholm score was observed in participants who had been bearing full weight for 3 months. Excellent functional outcome was achieved by 49.02% patients while 34.31% patients achieved good functional outcome.
Conclusion: Retrograde interlocking nailing for fracture of distal femur is an effective fixation surgical technique with minimal complications and excellent to good functional outcome.
Key words: Accidents, Femur Fractures, Fracture Fixation, Functional Performanc
Determination of Difficulty Index in End of Block Examinations of Preclinical Undergraduate Medical Students
Get PDFBackground: Multiple Choice Questions (MCQs) are considered a good choice for undergraduate formative assessment as they have higher reliability and are generally feasible. The objective of this study was to evaluate the difficulty index of Multiple-Choice Questions in the end of block examination of preclinical undergraduate medical students at Rawalpindi Medical University.
Methodology: This descriptive cross-sectional study was conducted at Rawalpindi Medical University. End of Block assessment data was collected from Department of Medical Education, RMU. A total of 60 MCQs scores were randomly selected and the difficulty index was calculated after entering data in MS Excel. Data was then entered in SPSS version 24. Means and standard deviations of Difficulty indices were calculated and compared between first-year and second-year students by independent samples students t-test and between subjects by ANOVA.
Results: Out of 120 Multiple Choice Items analyzed, in the first year MBBS block exam, 30% were easy, 65% were acceptable and 5% were difficult. In the second year MBBS block exam, 36.67% were easy, 56.67% were acceptable and 6.67% were difficult. There was no significant difference (p=0.986) between the mean difficulty index of first-year MBBS students and second-year MBBS students. However, the mean difficulty index was highest in physiology (66.53 ± 16.262) followed by biochemistry (64.36 ± 16.756) and anatomy (54.80 ± 17.665), and the mean difference between the subjects was statistically significant (p=0.005). The mean difficulty index in first-year MBBS students was highest for Biochemistry followed by Physiology and Anatomy. In second-year MBBS students, the mean difficulty index was highest in Physiology followed by Biochemistry and Anatomy.
Conclusion: The difficulty index of Anatomy MCQs was lower indicating that the students find them more difficult than the other two subjects i.e., Physiology and Biochemistry in the first two years of their undergraduate medical studies.
 
Outcome of Ultrasound Guided Trucut Biopsy of Adnexal Masses with Suspected Malignancy: Ultrasound Guided Trucut Biopsy of Adnexal Masses
No full textBackground: Ultrasound guided sampling techniques are frequently used in the tissue diagnosis of various tumours. Female patients commonly present with adnexal masses and require tissue diagnosis by trucut biopsy for initiation of the treatment. This study was done to determine the outcome of ultrasound guided trucut biopsy in patients presenting with suspected adnexal malignancy.
Methodology: This cross sectional study was done at the Department of Radiology, MCH Centre, PIMS hospital, Islamabad from October 2018 to September 2020. In this study, all female patients aged 18 years and above with suspected adnexal malignancy were included. Trucut biopsy was performed under ultrasound guidance, sample sent for histopathology and various histopathological outcomes were assessed. Patients were kept under observation for 2 hours following biopsy. The data was entered and assessed by using SPSS version 24.0. Frequencies and percentages were calculated for nominal data and mean and standard deviation for numerical data.
Results: Mean age of the subjects was 50.24±10.52 years and mean duration of symptoms was 2.97±1.23 months. Definitive diagnosis made in 59 (95.1%) out of 62 cases and only 3 (0.04%) cases were inconclusive; among which two showed inadequate sample and one showed normal tubo-ovarian tissue. 90% histopathological findings were conclusive and no complication was reported.
Conclusion: Trucut biopsy has high diagnostic yield with no complications and most common malignancy detected was serous cystadenocarcinoma followed by mucinous carcinoma.
Key words: Biopsy, Malignancy, Ultrasound
 
Histo-Pathological Effects of Raphanus Sativus Leaf Extract on Carbon Tetrachloride Induced Hepatotoxicity
Get PDFBackground: Raphanus sativus is a cruciferous plant which possesses free radical scavenging properties that defend the body against the deleterious effects of reactive oxygen species. The study objective was to assess the protective effect of Raphanus sativus in carbon tetrachloride induced hepatotoxicity in albino Wistar rats.
Methodology: This animal based experimental research was conducted from September 2019 to March 2020 at the Postgraduate Research Laboratory, Isra University, Hyderabad. Non-random purposive sampling technique was used for selection of study animals. Rats were distributed evenly in three different groups: Group 1 (control group), Group 2 (CCl4 induced experimental group), and Group 3 (CCl4 plus Raphanus sativus treatment group). Data was analyzed using SPSS version 24.
Results: Liver weight and serum markers of hepatic function were high in group 2 as compared to group 1 and C rats (p<0.05). Treatment with Raphanus Sativus significantly reduced serum levels of LFTs (p<0.05). There was a significant decline in the plasma levels of oxidative markers in group 2 while marked histo-pathological changes like necrosis, sinusoidal dilatation and congestion observed among animals of group 2.
Conclusion: Raphanus Sativus wields anti-oxidative as well as hepato-protective effect against carbon tetrachloride induced hepatotoxicity and tissue damage
Utility of Cell Block with p53 Immunostain in Diagnosing Urothelial Carcinoma
Get PDFBackground: Urine cytology is an initial noninvasive screening test done in patients with suspected urothelial carcinoma. The objective of this study was to compare the sensitivity of conventional smear cytology with cell block technique for the diagnosis of malignant cells in urine and to assess the efficacy of p53 immuno-marker in the diagnosis and prognosis of urinary bladder cancer.
Methodology: The study was carried out in the department of Histopathology, Pakistan Institute of Medical Sciences(PIMS), Islamabad. Cell blocks and cytology smears and were prepared from urine samples of 80 patients of urothelial carcinoma and p53 stain was applied. Data was analyzed using version 21. Sensitivity of conventional smear and cell block techniques were calculated for both low and high grade urothelial carcinomas.
Results:The sensitivity of detecting atypical cells using conventional smear was 31% and 70.6% for low grade and high grade urothelial tumors respectively. The sensitivity increased to 41.4% and 84.3% for low and high grade urothelial carcinomas respectively with cell block technique. Positive p53 stain was seen in 13.8% of cases with low grade tumors and 66.7% cases with high grade tumors. Chi-square test was used to find the association of cytology findings with the histologic grade.
Conclusion: Sensitivity of urine cell blocks is higher than the conventional smear method for detecting high grade lesions. It can be used as an efficient non-invasive technique and an adjunct tool for the determination of disease relapse and overall survival in patients.
Keywords: Carcinoma, Cytology, P53 Protein, Urin
Comparative Benefits of Tissue Marking by Poster Ink in Histopathology
Get PDFBackground: Tissue margin marking with India ink is important in decision making for surgeons. The present study was conducted to examine the reliability of different shades of locally available poster colours in tissue marking and to evaluate the colour perceptibility microscopically in comparison with similar tissues marked by India ink.
Methodology: This experimental study was conducted at Department of Pathology, HBS Medical & Dental College & Hospital, Islamabad from 27th February 2021 to 29th April 2021. Sample size was fifty, collected through convenient sampling technique. Five types of formalin fixed tissue specimens were selected for the study so as to evaluate the effectiveness of poster ink marking on different tissue surfaces. From each specimen, four sections were taken from the margins. Three shades of poster colour (black, blue and green) were used to ink three sections while one section from each tissue type was marked with India ink. After complete tissue processing and routine haematoxylin and eosin (H&E) staining, slides were examined microscopically. Scoring was done on a scale 0 to 3 on the basis of visibility.
Results: The present study showed that poster colours inking of the tissues was quite reliable as compared to India ink. Most consistent results were achieved with black and blue colours as compared to green colour.
Conclusion: Poster colours are reliable tool for tissue marking when India ink is not available. Their availability in a variety of colours provides them an edge over India ink.
Key words: Eosin, India ink, Resection Margin
A breakthrough in Alzheimer’s Disease
Get PDFAlzheimer's disease is among the most prevalent types of dementia worldwide. Studying mice models, Australian researchers discovered one of the possible origins of Alzheimer's disease. The discovery has been termed a "breakthrough" by some. Scientists have gained a better grasp of why and how Alzheimer's disease arises by researching the blood-brain barrier. Their findings point to possible therapy and preventive strategies for the neurodegenerative disorder
The Impact of Disease Severity and Treatment on Quality of Life in Patients of Psoriasis : Psoriasis severity and treatment modalities affecting quality of life
No full textBackground: Psoriasis is a common inflammatory dermatosis with significantly challenging clinical needs in patient management. Given its chronicity and social stigmatization, the burden on health-related life quality is substantial. The objective of this study was to assess psychosocial and financial impact of disease severity and treatment modalities on patients’ life quality.
Methodology: A total of 93 clinically diagnosed patients with Psoriasis were included in this cross-sectional study. Quality of life was assessed through Dermatology Life Quality Index (DLQI) scoring system and disease severity by Psoriasis area severity index (PASI) respectively. Treatment modalities were evaluated by filling out a brief questionnaire. Descriptive analyses were presented as mean ± SD for symmetrically distributed variables while median with interquartile range (IQR) were reported for non-symmetrically distributed variables. Association was determined by Chi-square test considering p-value ≤0.05 as significant.
Results: There were 47.3% male and 52.7% female patients. The Median DLQI score was 6.00 with an IQR of 7. Topical treatment was used in the majority of patients currently (60%). Quality of life ( QOL) for 41.9% of cases was mildly affected. Rest of the cases were affected more severely, consisting of 47.3% with moderate and 10.8% with severe impact on quality of life. Significant association of DLQI scores was found with disease severity and current treatment modalities.
Conclusion: Different therapies along with disease severity, remarkably affect QoL among psoriasis patients.
KEYWORDS
Disease Severity ,Impact, Psoriasis , Quality of Life, Treatmen