Fetal biometry in the population of Southern Punjab, Pakistan

Background: Ultrasound estimation of fetal parameters is one of the most important examinations. Hadlock and other foreign fetal biometry curves are used in Pakistan as there are no national normative data derived from local population

Objectives: To construct local reference charts and equations for fetal biometric measurements and amniotic fluid index [AFI] using a large sample of fetuses examined at 14 - 40 weeks in the population of southern Punjab

Study design, settings and duration: The prospective, cross sectional study conducted at the Multan Institute of Nuclear Medicine and Radiotherapy [MINAR] over a one year period from December 2010 to November 2011

Subjects and Methods: A total of 566 randomly selected pregnant females, who fulfilled the inclusion criteria were included in the study after informed consent. Each woman was scanned once only, between 14 and 40 weeks of gestation, and her fetal measurements were also recorded simultaneously. Regression models were used to estimate the mean and standard deviation at each week of gestation. Fetal biometric parameters of local population were compared with those of Hadlock and Singaporean Asian population. Results were statistically analyzed and also presented graphically across the different gestational ages to allow visual comparison

Results: Biometric measurements were obtained for 566 fetuses. There was no significant difference between fetal parameters of local population and those of Hadlock. When compared with those of the Singaporean Asian population, femur length and head circumference were larger while biparietal diameter was smaller in our population

Conclusion: We have constructed local reference centiles for fetal measurements and equations for dating of pregnancy for Southern Punjab. The biometric measurements are slightly different from Singaporean Asian population, but there was no statistically significant difference between these measurements and those by Hadlock

Attitude of medical students towards AIDS and leukemia patients

To examine the attitudes of undergraduate medical students' towards patients with AIDS vs. patients with Leukemia. A cross sectional survey with a purposive non probability sample on 205 undergraduate medical students was conducted from July 2011 to October 2011. Prejudicial attitudes and willingness to interact were measured based on four case vignettes using the Prejudicial Evaluation Scale [PES] and Social Interaction Scale [SIS]. SPSS 17 was used for the data analysis and independent sample t test was used to calculate the significant difference among the mean scores of the inventories and each item of the inventory. Paired t test was used to analyze the difference in the attitude of the medical students before and after attending the medical school. Highly significant differences were observed in the attitude of medical students determined by the overall mean scores of their responses towards patient with AIDS [44.45 +/- 9.32] and [24.22 +/- 11.69] versus Leukemic patient [49.65 +/- 10.73] and [20.67 +/- 7.84] of PES [p < 0.001] and SIS [p < 0.01] inventories respectively. Comparison of individual item on these scale revealed several items to be significantly different for patient with AIDS vs. Leukemic patient showing negative biasness towards this stigmatized group. Undergraduate medical students revealed negative biases against patients with AIDS and reported much less willingness to interact with these patients than with leukemic patients

Laparoscopic cholecystectomy fate of spilled bile with gallstones during laproscopic cholecystectomy

There is a continued debate on fate of spilled bile with gallstones during laparoscopic cholecystectomy, so we felt that the outcome needs further evaluation in detail. Although laparoscopic cholecystectomy become increasingly popular, but it is associated with a slightly higher chances of injury to biliary tree and perforation of gallbladder with spillage of bile only or with gallstones. [1] To evaluate fate of spilled bile with gallstones during laparoscopic cholecystectomy. [2] To assess various possible outcomes. [3] Suggestions to prevent these and their management. Prospective study. Surgical unit of Muhammad Medical College Hospital, Mirpurkhas. February 2008 to April 2011. Data source: Total 100 patients who underwent elective laparoscopic cholecystectomy were included. Age, sex, duration of operation, operative findings, duration of hospital stay and post-op complications were recorded in proforma and analyzed on SSP version 10. The patients who underwent cholecystectomy, and had intra-operative spillage were shortlisted, included in this study and followed up. Short-term follow-up was based on OPD visits for 2 to 3 weeks postoperatively, and long-term follow-up was achieved by regular OPD visits or telephone conversation in patients at a mean of 1.4 years [range 2 to 39 months].all minor or major complications were recorded in preformed proforma. A total of 100 patients underwent laparoscopic cholecystectomy. Among the patients who underwent elective laparoscopic cholecystectomy the incidence of Iatrogenic perforation of the gallbladder is around 40%, of whom about 22% had spillage of only bile and 18% in whom spillage of both bile and gallstones. It is concluded that laparoscopic cholecystectomy with gall bladder perforation along and spillage of bile and stones took longer operative time than intact gall bladder. We suggest that attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure. In our study, we revealed that no harm is caused by retained gallstones during laparoscopic cholecystectomy after long term followup by evaluation

Uptake of Tc-99m MIBI for assessment of cold thyroid nodule

Presence of nodule in the thyroid is a common problem throughout the world, incidence of which varies from region to region. This study was designed to appraise the diagnostic strategy to differentiate between malignant and benign lesions in solitary cold thyroid nodules using technetium-99m MIBI scintigraphy. Forty-nine patients were included in the study. All had cold nodule based on Tc-99m pertechnetate scan.Tc-99m MIBI thyroid scan and FNAC were performed in all the patients. Tc-99m MIBI thyroid scan was performed 20-40 min after intravenous injection of 185-370 MBq of Tc-99m MIBI. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue and designation of YY, YN and NN were assigned to each nodule .YY means Intense uptake or uptake more than surrounding normal Thyroid tissue, YN means Uptake is equal or nearly equal to surrounding normal Thyroid tissue and NN means no uptake. FNAC revealed nodular goitre in 29 cases, follicular lesion in 8, cysts and hemorrhage in 10, pleomorph in 2. None of the cystic nodules were YY on MIBI scan, while the follicular lesions showed a variety of MIBI imaging patterns most frequently the YY pattern. None of the follicular lesion showed NN uptake on MIBI scan. In the diagnosis of follicular lesion the sensitivities of YY and YY+YN MIBI uptake patterns were 80% and 100% respectively. The YY+YN MIBI uptake patterns had a negative predictive value of 100% and positive predictive value of 36%, whereas a specificity of 54% was observed. After a cold nodule had been detected using Tc-99m pertechnetate, a second scan with YY or YN MIBI uptake increases the probability that this nodule would be suspicious for malignancy. Having no uptake of Tc-99m MIBI in such nodules very safely excludes the possibility of malignancy. Tc-99m MIBI scintigraphy is a useful method in the differential diagnosis of cold thyroid nodules. High MIBI uptake considerably increases the probability of malignancy and facilitates immediate surgical removal while NN or no uptake actually excludes it. We suggest MIBI scan as a routine diagnostic approach to cold thyroid nodules before fine-needle aspiration cytology