Journal of Islamabad Medical & Dental College
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Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease
Get PDFBackground: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomograph
Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions
Get PDFBackground: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions.
Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated.
Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively.
Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures
Comparison of TI-RADS classification with FNAC for the Diagnosis of Thyroid Nodules
Get PDFBackground: Thyroid nodules are very common and its prevalence is largely dependent on the identification techniques. Recently high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. This study aimed to determine the efficacy of TI-RADS classification and its association with FNAC findings in thyroid lesions.
Material and Methods: This prospective study was carried out in the Department of Radiology of Islamabad Diagnostic Centre, Islamabad for a period of 6 months from 6th January 2018 to 6th July, 2018. All male and female patients presenting with thyroid nodules were selected for the study. Ultrasound neck was performed with high frequency linear probes. Ultrasonography findings were classified according to Thyroid Imaging Reporting and Data System (TI-RADS) classification, as defined by Horvath et al. Patients with TI-RADS II-V were scheduled for US-guided Fine Needle Aspiration (FNA). All the specimens were sent to pathology laboratory for cytology (FNAC).
Results: Total 123 patients of thyroid nodules were studied. Mean age of the patients was 45.78 ± 13.11 years, with a female predominance (73.2%). A significant association was seen between TI-RADS classification of thyroid nodules and findings on cytology. Thyroid nodules with TI-RADS II, III and IV a classification showed benign cytological findings, while TI-RADS class V had a significant association with malignant findings on cytology (P=0.001).
Conclusions: TI-RADS classification is a reliable modality in differentiating benign thyroid nodules from malignant ones and circumvent the need for FNAC in every case with a thyroid nodule
Comparison of Auramine Phenol and ZN Staining in Diagnosis of Pulmonary Tuberculosis with GeneXpert MTB/RIF as Gold Standard
Get PDFBackground: Pakistan faces an immense burden of pulmonary tuberculosis (TB) due to large number of cases and limited resources. Despite the recent advancement in the diagnostic techniques for pulmonary TB, smear microscopy is still a useful technique for the diagnosis of this disease. This study was conducted in order to compare the diagnostic value of Auramine stain with the conventional Ziehl-Neelsen (ZN) stain on the sputum smear for the diagnosis of pulmonary TB, keeping GeneXpert MTB/RIF as the gold standard.
Method: This cross-sectional study was conducted on 356 suspected patients of pulmonary TB referred to the Pathology laboratory from TB ward and OPD of District Head Quarter (DHQ) teaching hospital Rawalpindi, Pakistan. Sputum specimen were collected and two smears were prepared from each sputum sample on which Auramine phenol and Ziehl-Neelsen staining were carried out as per WHO recommendations. All these samples were further tested using Gene Xpert MTB/RIF technique. The sensitivity, specificity, Positive predictive value (PPV) and Negative predictive values (NPV) of ZN and Auramine stain were calculated and compared with GeneXpert MTB/RIF technique.
Results: Out of the total 356 samples, 64(18%) were positive and 291(82%) were negative by GeneXpert which was taken as the gold standard. On comparison with GeneXpert, percentage of true positive was greater in case of Auramine than ZN stained samples (16.29% versus 12.92%), while the percentage of false positive was same for both staining techniques (0.28%). There were lesser false negative cases observed in samples stained by Auramine as compared to the ones stained by ZN (1.68% versus 5.05%). The sensitivity, specificity, positive predictive value and negative predictive values were 97.87%, 94.17%, 71.88 and 99.66%, respectively for the ZN staining and 98.31%, 97.98%, 90.63% and 99.66% respectively, for the Auramine phenol staining.
Conclusion: Smear microscopy using Auramine phenol stain is a useful technique for the diagnosis of pulmonary TB. The Auramine phenol staining with fluorescent microscopy is found to be superior to ZN staining because of higher sensitivity and specificity.
Keywords: Auramine phenol, Fluorescence microscopy, GeneXpert, Mycobacterium tuberculosis, Ziehl-Neelse
Saliva as a Diagnostic Tool for Detection of Coronavirus: A Review
Get PDFWe aimed in this literature review to demonstrate the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non-invasive diagnostic modality. The specimen can be easily obtained and tested from suspected individuals. Review of available literature in PubMed, Google Scholar, EBSCO, and Semantic Scholar was carried out using keywords and combination of “Coronavirus”, “saliva” and “diagnosis”. Of 1846 articles found, 110 were screened and included in this literature review. Currently, nasopharyngeal swab is the standard diagnostic tool as it has been reported to be accurate and sensitive towards detection of coronavirus. Testing of saliva specimens is now being considered to aid rapid detection, because saliva collection and its testing are relatively simple, cheap, and safe for both patients as well as healthcare professionals. Further research on this will be beneficial to control and contain the virus
Mucoepidermoid Carcinoma: A Demographic and Histopathological Profile
Get PDFBackground: Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands, with a variable prevalence (9.5%-25.6% in Pakistan) and clinicopathological presentation. The objective of this study was to find out the frequency and clinicopathological presentation of mucoepidermoid carcinoma at Armed Forces Institute of Pathology, Rawalpindi Pakistan.Material and Methods: This descriptive cross-sectional study was carried out at Armed Forces Institute of Pathology, Rawalpindi between June 2016 to September 2017. All the malignant salivary gland tumors fulfilling the diagnostic criteria for MEC were included and the frequency of mucoepidermoid carcinoma was calculated. Age, gender, histopathological grading and anatomical site of tumor were also evaluated.Results: A total of 30 patients of mucoepidermoid carcinomas, 23 (76.66%) males and 7 (23.33%) females, with a mean age of 44.9±19.2 years and age range of 6 to 88 years were reported. Regarding anatomical site, majority of the patients (73.3%) had tumor in the parotid gland, 13.3% in submandibular gland and 13.3% had tumor in palate, retromolar area and posterior one third of the tongue. According to histopathological grading, 26.6% MEC were high-grade, 26.6 % intermediate-grade and 36.6% were low-grade tumors.Conclusions: Mucoepidermoid carcinoma was more common in males, in the third decade with parotid gland as the most common site for this tumor. On histopathology, low grade MEC on Auclair et al. grading had the highest frequency in our study cohort
A Cadaveric Morphometric Study of Lumbar Vertebrae in Zimbabwean Adult Males
Get PDFBackground: Transpedicular screw fixation has been widely used for spinal reconstruction because of its good fusion results. However, pedicle walls can be damaged during fixation if diameter of the screw is too large or screw is misplaced. Knowledge of the morphometric dimensions of the pedicle is thus important for effective fixation and to avoid complications. The main objective of this study was to measure the Pedicle Transverse Diameter (PTD), Pedicle Vertical Diameter (PVD) and chord length of male adult cadavers from Zimbabwean population.Material and Methods: It was a descriptive cross-sectional study carried out at the Department of Anatomy, University of Zimbabwe College of Health Sciences, Harare Zimbabwe, from June 2019 to December 2019. The lumbar vertebrae from 15 adult male cadavers were dissected out and Pedicle Transverse Diameter (PTD), Pedicle Vertical Diameter (PVD) and chord length was measured and compared (on right and left sides), using a Vernier caliper. The statistical analysis was done using SPSS version 20.0., with data expressed as means, standard deviation and ranges. Student’s t-test was used to estimate the difference in pedicle dimensions of the right and left sides of the lumbar vertebrae.Results: There was an insignificant difference between pedicle dimensions (PTD and PVD) of the right and left sides (P > .05). PTD steadily increased from vertebral level L1 to L5 followed by an abrupt increase at L5. PVD gradually decreased from L1 to L5 level. The chord length increased from a minimum at L1 to reach a maximum at L3 and then again decreased to L5 level.Conclusions: Pedicle dimensions of the Zimbabwean population differ from those reported in previous studies for other population groups and can be useful while performing pedicle screw fixation for lumbar vertebral fractures. A screw length of 40-45 mm should be used for lumbar transpedicular screw fixation with minimal risk of implant failure in Zimbabwean population
Nephroprotective Effects of L-Arginine against Chemotherapy Induced Acute Kidney Injury in Wistar Rats
Get PDFBackground: L-arginine is a nitric oxide precursor that decreases oxidative stress and regulates the blood flow by modifying the tone of vessels and also prevent ischemic renal tissue injuries. The objective of this study was to evaluate the protective role of L-arginine in cisplatin-induced acute renal injury through assessment of renal, oxidative stress, and inflammatory markers in albino Wistar rats.Material and Methods: A quasi-experimental study was conducted at the Department of Physiology and Postgraduate Research Laboratory, Isra University, Hyderabad, Pakistan from April to September 2019. Thirty male Albino Wistar rats were selected through non-random purposive sampling and divided equally into three different groups: Group A (control group), Group B (cisplatin group), and Group C (cisplatin plus arginine group). Blood samples from rats were collected through cardiac puncture, followed by renal histopathological analysis under light microscope. The severity of tissue damage was observed using a graded scale from ‘0’ (no damage) to III (severe damage). Data was analyzed using SPSS version 24.0., with one-way ANOVA and Post hoc Tukey analysis used for comparison of different variables.Results: There was a statistically significant decline in the bodyweight and rise in absolute kidney weight of group B in comparison with the other two groups (P <.05). Moreover, a significant rise in serum renal markers was observed in group B (P <.05), with a statistically significant decline in these markers in group C compared with group B (P <.05). Marked histological alterations (glomerular and tubular damage) were observed in renal tissues of group B as compared to group C.Conclusions: The present study concludes that L-arginine exerts anti-oxidative, anti-inflammatory, and nephroprotective effects against renal tissue damage caused by Cisplatin
Giant Pulmonary Chondroid Hamartoma in Welder’s Lung: A Unique Case Report
Get PDFPulmonary Hamartomas are benign lung tumors, containing cartilage, connective tissue, fat and usually appear as peripheral lesions. They are 2-4 cm in size, frequently asymptomatic, comprising of 5–8% of all solitary pulmonary nodules. The peak incidence occurs in 40-70 years of age with a male preponderance. We describe a unique case of centrally located, giant chondroid hamartoma, in the background of pulmonary hemosiderosis. Patient presented with cough, shortness of breath and left sided chest pain, masquerading as pleural effusion, lung cancer and left sided chest pain mimicking myocardial disease. Chest x-ray raised the suspicion of pleural effusion but ultrasound and CT-scan indicated a benign calcified central mass. A presumptive diagnosis of cartilage-containing benign mass was made on ultrasound-guided percutaneous biopsy, while surgical resection followed by histopathology revealed a chondroid hamartoma. No recurrence was noted on follow-up. Chondroid hamartoma can be large, symptomatic and requires modern modalities for diagnosis while its association with pulmonary hemosiderosis, still requires to be investigated