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In occlusive vascular brain diseases, the structure of the circle of Willis is of immense importance. A high percentage of variations have been reported in the arteries forming circle of Willis. These have profound clinical implications. With
advances in interventional radiological procedures, the interventional radiologists and neurosurgeons need to have thorough knowledge of these variations. This article will help readers understand the significance of anatomical variations and their clinical effects
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Objective: To evaluate the efficacy of four risk assessment tools for identifying low Bone Mineral Density [BMD] in a sample of Pakistani females
Methodology: It was a cross sectional study including 200 females above 40 years. DXA scans were performed. Subjects were categorized into low risk and high risk categories for low BMD on the basis of T scores. Questionnaires were filled and risk indices were calculated for all subjects. Sensitivity, specificity, positive and negative predictive values were calculated, Receiver Operating characteristic [ROC] curves were plotted and Area Under Curve [AUC] were obtained
Results: A total of 200 females including 174[87%] postmenopausal, and 26[13%] premenopausal were included. Average age was 60.76+/-10.52 years with average age of menopause being 47.64+/-6.63 years. In terms of sensitivity, specificity and AUC, the WHO risk assessment tool FRAX showed the best performance with a sensitivity of 79%, specificity 94% and AUC of 0.869 for detecting low BMD
Conclusion: It is not cost effective to use DXA for screening purposes. We propose that risk assessment tools such as FRAX may be utilized to identify individuals with low BMD. This may prove beneficial in minimizing the medical and social burden that fragility fractures pose to developing health care systems
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Objective: To evaluate the olfactory fossa depth and to categorize it according to Keros classification
Methodology: It was a cross sectional study done on 270 adults , 160 males and 110 females at Ziauddin University Hospital, Clifton, Karachi using CT Para nasal sinuses. The depth of olfactory fossa was evaluated by measuring the height of lateral lamina of cribriform plate
Results: The mean and standard deviation[SD] of right olfactory fossa depth was greater than that of left 6.184+/-1.8237mm and 5.949 +/-1.8003mm [p value 0.006] respectively. Mean +/- [SD] for left olfactory fossa depth was greater in females [6.215+/-1.9271] than in males [5.766+/-1.6896] [p value 0.043]. Keros type II was found to be the most frequent on both right and left sides that is, in 69.26% and 72.96% individuals respectively followed by type III on right side in 18.15% and on left side in 15.19% subjects. Type I was found to be the least frequent in our population with a value of 12.59% on the right side and 11.85% on the left side
Conclusion: Our study shows that most of the population falls in the high risk categories of Keros that is type II and type III thus emphasizing the need of preoperative radiological assessment
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Objective: To determine the length and diameter of celiac trunk by using Multidetector computed Tomography Angiography [MDCTA] and to find its association with gender
Methodology: 160 individuals, 85 [53.1%] males and 75 [46.9%] females] without any vascular or upper abdominal visceral disease who presented to Radiology Department, Ziauddin University Hospital, Clifton, Karachi, for abdominal 3D MDCTA from March, 2017 to August, 2017 were recruited in this study. Length and diameter of both classical and non-classical celiac trunk was measured. Statistical analysis was done on SPSS version 20. All variables were presented as mean and standard deviation. Independent T test was applied. Correlation analysis by using Pearson.s correlation was applied to test the relationship between variables. P-value
Result: The difference between mean length of classical celiac trunk and non- classical celiac trunk was significant [P =0.005].The difference in mean length [P = 0.007], and mean diameter [P = 0.007] of classical celiac trunk between males and females was significant. A weak positive association [r = 0.247] was found between length and diameter of classical celiac trunk [P = 0.004]. A moderate positive association [r = 0.401] was found between length and diameter of non-classical celiac trunk [P = 0.043]
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Objective: To determine a reference range of renal artery measurements by using Multidetector Computed Tomography [MDCT] angiography and to find association of renal artery measurements with side of artery, gender and age
Method: Two hundred and fifty study participants without renal artery disease who were presented to Radiology Department, Ziauddin Hospital, Karachi, from November, 2016 to April, 2017 were included in this study. Main renal artery measurements were taken on Multidetector computed angiography and variation with side, gender and age were analyzed. Statistical analysis was done on Statistical Package for Social Sciences [SPSS] version 20. Independent sample T test, one way ANOVA and Pearson's correlation analysis were applied. P-value of < 0.05 was considered significant
Results: A significance difference [p=0.001] was seen between mean right renal artery [diameter 6.66 +/- 0.39 mm; length 44.69 +/- 2.48 mm] and left renal artery [diameter 6.79 +/- 0.36; length 35.10 +/- 2.86 mm]
Females found to have smaller mean diameter and length of renal arteries than males. However, a weak negative correlation was seen between mean renal artery diameter and age [right r= -0.158, p=0.0121; left r=-0.017, p= 0.708]
Conclusion: The mean diameter and mean length were found to be significantly different between right and left main renal artery and between males and females. A significant weak negative correlation was observed between renal artery diameter and age
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Computed Tomography Angiography , Analysis of Variance , Statistics, Nonparametric , Adult , Multidetector Computed TomographyABSTRACT
Objectives: To establish the local reference range of prostate volume according to our subset of population. To correlate prostate volume (PV) with age, body mass index (BMI) and waist circumference (WC). Methods: A cross-sectional study with 119 healthy adults aged 40-79 years without any prostatic pathology were recruited .The study population was categorized into 4 age groups (40 - <50 yrs, 50 -<60 yrs, 60-<70 yrs, 70-<80 yrs), 3 BMI groups (healthy, obese and overweight) and 2 WC groups (<90 cm and >90 cm). A p-value of <0.05 was considered significant. Results: The mean prostate volume was 21.7±2.2 mls, mean body mass index was 28±6 kg/m², whereas mean waist circumference was 95 cm. PV was found to be higher in obese and >90 cm waist circumference group. After applying multiple regression analysis, waist circumference correlated positively and significantly with prostate volume. Conclusion: Mean prostate volume in our studied population was smaller than that of many western populations. Our study has proved that central obesity is the most important factor influencing prostate volume.
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Objective: Large number of fetal weight formulae derived using different populations suggest that there is no fetal weight formula which is acceptable worldwide. Ethnicity and gender of the fetus are the well reported and recognized causes of inaccuracies in these fetal weight formulae. The aim of this study was to compare the accuracies of Schild's gender specific formula with Hadlock's, Shepard's and Aoki's formulae in Pakistani population
Study Design: Cross sectional study
Place and Duration of Study: This study was conducted at Ziauddin University Hospital, from May 2014 to May 2015
Material and Methods: This cross sectional study recruited 150 primary gravida with singleton pregnancy. Patients with hypertension, diabetes and smoking were excluded. Sonographic evaluation for fetal parameters was done during 36.39 +/- 0.684 weeks of gestation. Mean fetal weight was estimated from these formulae. Mean error, mean percentage error and the limit of agreement by Bland -Altman plot was determined. Anova was applied to compare the means of estimated fetal weight, error and percentage error. Gender and weight was noted after birth
Results: No significant difference was found between the means of estimated fetal weightobtained by these formulae. Statistically significant difference was found between mean error of these formulae [p -value = 0.012] ranging between -217.24 gram to - 310.93 gram. Insignificant difference in mean percentage errors was noted which was between - 6.74% to - 9.37%. The narrowest and widest limit of agreement was found with Schild's formula and Hadlock's formula respectively
Conclusion:In our population,for pregnancies with in normal range of fetal weight, Hadlock's, Shepard's, Aoki's and Schild's fetal weight formulae, all showed low values of mean errors and mean percentage errors which were within acceptable range
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Accurate fetal weight estimation is important in preventing and managing fetal and maternal complications. Many fetal weight formulae have been derived, but none seems to be accurate enough to be applied globally for all ranges of fetal weight. Major factors causing errors in fetal weight estimation include inappropriately derived equations not considering ethnic differences among populations, fetal gender difference and different ranges of fetal weight. Use of fetal thigh volume and arm volume for fetal weight estimation by 3D ultrasound may increase the precision of fetal weight formulae. However, the superiority of 3D ultrasound in fetal weight estimation over 2D ultrasound is debatable as greater expertise is required, time consumed is more and there is no substantial increase in accuracy. It is suggested that fetal gender specific, fetal weight range specific and community based formula should be derived and used for better accuracy. Further studies are recommended. Articles published between October 1993 to October 2015 were selected from PubMed and Google Scholar, for this review article
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It is an emerging concept now a day that epicardial adipose tissue [EAT] thickness has an essential character in the progression for cardiac risk profile. It is now consider as a new and consistent cardiovascular risk factor. EAT thickness is the indicator for cardiac adiposity. It modifies the cardiac morphology and function. It has close anatomical relation to myocardium. It causes local paracrine interactions between myocardial tissues. It causes enlargement of left ventricle with its diastolic dysfunction. Measurement and assessment of epicardial adipose tissue thickness is now done by new method echocardiography. It appraises visceral adiposity and inflammation. Association of EAT location and its physiological or pathological importance requires advance research. EAT in future may replace waist circumference, as a marker of abdominal obesity. This article briefly discussion the structure of epicardial adipose tissue and its function. It also describes the method for its assessment
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Optical coherence tomography [OCT] is a non-contact, non invasive imaging modality that helps diagnosing a variety of diseases involving the eye. It provides quantitative measurements of retinal nerve fiber layer [RNFL], optic nerve head and macular thickness parameters 1, 2 and can be used as a valuable tool in many intraocular surgeries. This article discusses the applications of different OCT systems available commercially for diagnosing and managing various ophthalmic conditions. Furthermore, future directions of OCT technology, clinical uses and benefits are also discussed. Different articles published till year 2014 majorly in between 2005 to 2014, obtained from online search engines Pubmed and Google Scholar were used in preparation of this review. Those articles were included that contained information regarding OCT and its uses in various ophthalmologic conditions and its future advancements. We excluded those articles that did not contain relevant information regarding OCT and its uses. Due to advancements in OCT technology, it is now possible to reveal the structural changes associated with retinal diseases that help in improving early analysis and monitoring of disease progression and response to treatment. Three generations of OCT have been introduced till date. Early versions of this technology i.e. OCT 1 and OCT 2 are relatively slow, limiting both the amount of data to be captured and the quality of image. The older versions required dilation of the pupil but the latest version, the Stratus OCT can be used without dilating the pupil.3 Commercially, OCT is employed in diverse applications including diagnostic medicine, interventional cardiology and art conservation. Ophthalmology is still the most important field of OCT application because of transparent ocular structures
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The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand and wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand and wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand and wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated. As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review
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The purpose was to study the impact of anthropometrical parameters on portal vein diameter and liver size by ultrasound in a subset of Karachi population. Four hundred and fifty nine apparently healthy subjects were included in this cross sectional study. After recording weight and height of each subject, Portal vein diameter and both liver lobes were measured by gray scale ultrasonography. Students T test and ANOVA were applied for statistical analyses. With increasing age, portal vein diameter and right lobe of liver increased significantly [p value < 0.001]. Increase in portal vein diameter was also observed with rise in body mass index [0.8 cm in underweight - 1.1 cm in obese subjects]. Sizes of right and left liver lobes also increased with a rise in body mass index [p value < 0.001 and 0.001]. Gender, however, did not have any effect on portal vein diameter and liver size. Age and body mass index are reliable parameters to consider for avoiding false positive diagnosis of hepatomegaly and portal hypertension. Knowing the right and left liver size with respect to anthropometrical measurements also assist a clinician in selecting a subject for liver transplantation
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To assess the degree of applicability of bone age calculated by Greulich and Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. Two Hundred and Twenty children [139 males, 81 females] between ages of 56 and 113 months [4.5 to 9.5 years] were randomly selected from 4 primary schools of Shireen Jinnah and Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich and Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. On average, the Greulich and Pyle Atlas underestimates chronological age by 6.65 +/- 13.47 months in females and 15.78 +/- 12.83 months in males [p-values < 0.001]. High correlation was found between chronological age and bone age in both genders [Females r=0.778; p-value < 0.001, Males r=0.816; p-value < 0.001]. Bone age calculated by Greulich and Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required [e.g. medicolegal cases]. However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children
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The aim of this study was to determine frequency of thyroid incidentalomas [TI] through ultrasound [US] and its association with age, gender and ethnicities. It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. Frequency of TI found was 21%. TI was detected in 25% of females and 16% males [P= 0.078]. 61% had thyroid nodules [TNs] in one lobe [right, left or isthmus] and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities [P= 0.758]. Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it's status as an iodine sufficient state
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Deaths from liver disease have doubled over the last fifteen years. Chronic liver disease and cirrhosis are still the twelfth leading cause of death in the United States. Till date no comprehensive data has been documented in our part of the world which can help a clinician in diagnosing organomegaly. Improved hardware and knowing the exact dimensions of an organ with respect to its anthropometrical measurements can be of great importance in a radiological clinical routine. This article review was the result of recent clinical studies relating to portal vein, liver and spleen normograms in different populations which can show a comparison in accordance with their anthropometrical factors. Data from survey reports, cross-sectional and prospective studies published between the years 2003-2012 on the topic were included. Data searches included both human and cadaveric studies. The data was extracted from online resources of statistic reports, Pub med, THE MEDLINE, Google, Medical and Radiological journals. Sonographical analysis of the effect of anthropometrical measurements on the dimensions of portal vein, liver and spleen can be important markers for evaluation, diagnoses and assessment of portal hypertension, organomegaly and liver transplantation
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Humans , Female , Male , Liver/anatomy & histology , Spleen/anatomy & histology , Anthropometry , Ultrasonography, DopplerABSTRACT
To study the effects of Tamoxifen on long bones, i.e. Femur, Tibia and Humerus of Postmenopausal Aged Female Albino Rats Setting: Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi Specimens: Ninety bones comprising humerus, femur and tibia [30 each] Methodology: Quantitative measurement of BMC [bone mineral content] and BMD [bone mineral density] carried out by DEXA [Dual Energy X ray Absorptiometry] Scanning Device; Qualitative changes mapped out through plain radiology. Bones, i.e. Femur, Tibia and Humerus of Tamoxifen treated group were found to have relatively increased levels of BMC and BMD. X-rays revealed that bones have greater cortical density in case of tamoxifen treated group. Tamoxifen helps preserving bone mass in bones of Aging Female Albino rats
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Animals, Laboratory , Osteoporosis, Postmenopausal/drug therapy , Rats , Absorptiometry, Photon , Bone DensityABSTRACT
To investigate the morphological differences in the pancreatic regions derived from dorsal and ventral primordia of non diabetic and diabetic rats. Light microscopic study of pancreatic islets in normal rats and in rats made diabetic by streptozotocin. Fourteen adult albino rats of JPMC strain were divided into two equal groups. A [non diabetic] and B [diabetic]. Diabetes was induced in group B ani mals by a single intraperitoneal injection of streptozotocin 32 mg/Kg body weight. The rats were killed by ether over dose and the pancreas were divided into four regions: lower duodenal derived from ventral lonbe and upper duodenal gastric and splenic derived from dorsal lobe. Sections from each region were stained with H and E and chrome alum haematoxylin and phloxin. In non diabetic rats the splenic region had more numerous and larger islets with greater number of cells while upper duodenal region had fewer and smaller islets. Mean number of cells was directly proportional to the islet diameter. In the lower duodenal region the islets were smaller than those in splenic and gastric regions but significantly larger than those in the upper duodenal region. In the diabetic rats the islets were reduced in size, number and cellular content in all the regions when compared with the corresponding regions of non diabetic rats. Mean number of B cells showed a highly significant decrease [P < 0.001] in all the four regions. Distinct regional differences exist in the pancreatic regions derived from dorsal and ventral lobes and also among the three regions derived from the dorsal lobe in non diabetic rats. In diabetic animals the same regional differences were observed but there was an overall decrease in number and size of the islets and their cellular content
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Animals, Laboratory , Islets of Langerhans , Diabetes Mellitus, Experimental , Rats , Animals, LaboratoryABSTRACT
The natural course of Insulin Dependent Diabetes Mellitus is characterized by progressive destruction of insulin producing Beta-cells of the pancreas resulting from an autoimmune process. The toxic effect of some Beta-cells toxins like streptozotocin [used to produce animal models of IDDM] has been associated with the oxidative stress due to enhanced DNA repair and NAD depletion in damaged Beta-cells. This activity of streptozotocin has been prevented with the use of nicotinamide. A light microscopic study was designed to determine the optimum dose of nicotinamide required for protection of pancreatic Beta cells against the toxicity of streptozotocin. 35 adult male albino rats were divided into five equal groups A, B, C, D and E. the duration of study was 14 days. The animals in experimental groups C, D and E received a single intraperitoneal injection of nicotinamide 250 mg/Kg, 350 mg/Kg and 500 mg/Kg respectively on day one. Animals in group A and B acted as normal control and diabetic control respectively. All the animals except those in group A received simultaneous injection of streptozotocin 32 mg /Kg body weight intraperitoneally in a single dose. Fasting blood glucose was assessed and the animals weighed before starting the treatment, after 48 hours and at the end of the experimental period. Histological studies were carried out at the end of the study period. The blood glucose level and the final body weight of the animals in group C matched the values in diabetic control. Histologically the pancreas had generally reduced Beta-cells mass [P < 0.001] with altered morphology. The animals in group D showed impaired glucose tolerance at 48 hours but were normoglycaemic at the end of the study period. There was some loss of Beta-cells but a significant number of these cells [P < 0.05] showing normal morphology were saved. The animals in group E had normal number of P-cells having normal morphological features. The final body weight and fasting blood glucose of these animals matched the values in normal control [group A]. Conclusions: These data suggest that the optimum dose of nicotinamide in regard to prevention against the Beta-cytotoxic effect of streptozotocin in albino rat is 500 mg/Kg body weight