Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic nonspecific low back pain: a randomized controlled clinical trial

Background GtObjective: Low back pain is a frequent problem faced by the majority of people at some point in their lifetime. Exercise therapy has been advocated an effective treatment for chronic low back pain

However, there is lack of consensus on the best exercise treatment and numerous studies are underway

Conclusive studies are tacking especially in this part of the world. This study was designed to compare the effectiveness of specific stabilization exercises with routine physical therapy exercise provided in patients with nonspecific chronic mechanical low back pain

Methods: This is single blinded randomized control trial that was conducted at the department of physical therapy Orthopedic and Spine institute, Johar Town, Lahore in which 120 subjects with nonspecific chronic low back pain participated. Subjects with the age between 20 to 60 years and primary complaint of chronic low back pain were recruited after giving an informed consent. Participants were randomly assigned to two treatment groups A and B which were treated with core stabilization exercise and routine physical therapy exercise respectively. TENS and ultrasound were given as therapeutic modalities to both treatment groups. Outcomes of the treatment were recorded using Visual Analogue Scale [VAS] pretreatment, at 2[nd], 4[th] and 6[th] week post treatment

Results: The results of this study illustrate that clinical and therapeutic effects of core stabilization exercise program over the period of six weeks are more effective in terms of reduction in pain, compared to routine physical therapy exercise for similar duration. This study found significant reduction in pain across the two groups at 2[nd], 4[th] and 6[th] week of treatment with p value less than 0.05. There was a mean reduction of 3.08 and 1.71 on VAS across the core stabilization group and routine physical therapy exercise group respectively

Conclusion: Core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain

Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage

To compare the efficacy of polyvinyl alcohol [PVA] particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage. This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi [chi[2]] square and Fisher's exact tests were applied and a P-value of less than 0.05 was considered statistically significant. Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% [36/57] and 35% [20/57] cases respectively. Technical success was achieved in all cases [100%]. Clinical success rate was higher in microcoils group [92%] than PVA particles group [75%] with statistically significant P value [p=0.048]. Ischemic complication was seen in one case [3%] in the microcoil group, while no such complications were seen in the PVA particles group. In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates

Haplotypes and genotypes; the frequency of rhesus alleles, haplotypes and genotypes in major Sakak city population, Aljouf region, Saudi Arabia

Rh-D distribution varies worldwide. The aim of.this study was to document the frequency of Rhesus alleles, haplotypes and genotypes in Aljouf region, Sakaka. The EE genotype is not generally represented in the Aljouf province, and DcE/Ce genotypes are the shared [30.8%], while Dce/Dce and Dce/ce genotypes are less familiar [1.4%]. The frequency distribution of Rh haplotypes among Aljouf population in the present study CDE [0.701] has the highest observed frequency followed by Cde [0.250], cDe [0.116] and CDe [0.040], cDE [0.028], cde[0.021] and cdE[0.008]. The data generated during this study would be important, a base line for advance to be catalogued by molecular rather than serological criteria, and of polymorphisms between RHD and RHCE, which will be a useful for DNA typing and to provide the development of suitable DNA techniques

Patient communication in radiology: current status of breaking bad news among radiologists and radiology trainees in Pakistan

Breaking bad news can be an intimidating task for any physician. The aim of this study was to record the practices of breaking bad news to the patients by Pakistani radiologists and trainees. The radiologists and trainees attending the 26[th] National Radiological Conference in October 2010 in Karachi, Pakistan, were surveyed. The response rate was 76%. The respondents included residents [51%], private practicing radiologists [28%], academic radiologists [13%], and other trainees [8%]. Most of the academic radiologists communicated with their patients. The daily frequency of breaking bad news by residents was noted, which was highest in the public teaching hospitals [71%]. For severe abnormalities such as malignancy, 50% residents, 55% of the academic radiologists and 74% of the private practicing radiologists were very malignancy, 50% residents, 55% of the academic radiologists and 74% of the private practicing radiologists were very uncomfortable in disclosure of results. Differences in frequency of communication with patients were noticed with both different training levels, and different settings of practice in a developing country

Diffusion weighted MR imaging of ring enhancing brain lesions

To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions. Analytical, descriptive study. Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Diffusion weighted imaging [DWI] was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of DWI were calculated. Comparisons of mean ADC values of abscess and neoplastic lesions were also done using t-test. DWI had a sensitivity of 94.73%, specificity of 94.44%, positive predictive value of 94.73%, and negative predictive value of 94.44% and diagnostic accuracy of 94.5% in differentiating brain abscess from neoplastic brain lesions. Mean ADC value in central cavity and wall of neoplastic lesions and brain abscesses were calculated with significant p-value of 0.001 and 0.025 respectively. Diffusion weighted imaging is non-invasive method with high sensitivity and specificity which can help in differentiation of ring enhancing neoplastic lesions and brain abscesses. This modality should be read in conjunction with conventional imaging

Interventions for improving research productivity in clinical radiology

The purpose of this study was to evaluate the effects of research promotion activities on overall quality and quantity of research output in a clinical department of a teaching tertiary care hospital. Simple research enhancing strategies including regular journal club, research hour, basic research skills training, hiring of research faculty, research awards, and annual research retreat and research board to increase research production were implemented in the Department of Radiology of a teaching hospital in Pakistan. A total of 77 papers were produced by the Department of Radiology before the intervention, which increased to 92 after the introduction of research initiatives. There was a significant increase in the overall proportion of publications in the international journals after the intervention [p < 0.001] with an increasing trend towards indexed journals [p < 0.001]. The research enhancing interventions had a positive effect on increasing clinical research output by the Department of Radiology. Such interventions can also be replicated in other clinical departments to increase their research productivity

Uterine artery embolization for the treatment of uterine fibroids: Initial experience

To evaluate the initial results of uterine artery embolization for the treatment of symptomatic uterine fibroids in our local population. Medical records and radiological images of all patients undergoing uterine artery embolization [UAE] in Aga Khan University Hospital [AKUH] between January 2003 and December 2009 were retrospectively analyzed. Fourteen patients [Age range: 19-50 years] with sonographic diagnosis of uterine fibroids associated with menorrhagia and/or pelvic pain underwent uterine artery embolization with use of polyvinyl alcohol [PVA] particles. Single femoral access technique was used in all patients. Clinical improvement was assessed by detailed questionnaire for symptomatic improvement and follow up ultrasounds. All 14 patients underwent technically successful embolization. Five patients were lost to follow up and were not included in the final analysis. Out of remaining 9 patients, eight patients had initially presented with menorrhagia with pelvic pain while one patient had presented with menorrhagia alone. On follow up after one year menorrhagia was significantly reduced in 7 out of 9 patients [77%]. Pelvic pain was improved in 7 out of 8 patients [89%]. Majority of patients experienced post procedure pain of various intensities which was treated conservatively. One patient developed scanty periods, a known complication of this procedure. No other procedure related significant complications were seen. Uterine fibroid embolization represents a promising method of treating fibroid-related menorrhagia and pelvic pain. Further studies with larger patient population will be required for definitive results

Magnetic resonance imaging findings in patients with schizophrenia

To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging [MRI]. Comparative study. The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008. Thirty-three cases of schizophrenia [n=33] and thirty-three age-matched controls, [n=33] were enrolled for this study. Screening Magnetic Resonance Imaging [MRI] of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p <0.05. Among the total of 66 [n=66] MRI films studied for brain abnormalities, brain atrophy, presence of septum pellicudum and enlarged Virchow-Robins spaces were significantly associated with schizophrenia [p<0.001]. There was no significant difference between cases and controls for ventricular dilatation [p=0.5]. Sinusitis was mostly associated with controls and well correlated with their symptoms [p<0.001]. Brain atrophy was the most commonly seen brain change in the studied sample of patients with schizophrenia. MRI brain can be used to identify structural abnormalities in patients with schizophrenia

MRI characterization and histopathological correlation of primary intra-axial brain glioma

Objective: To determine the diagnostic accuracy of magnetic resonance imaging [MRI] in preoperative diagnosis and grading of intra-axial gliomas compared with histopathology

Study Design: Prospective, comparative, study

Place and Duration of Study: Radiology Department, Aga Khan University Hospital, Karachi from July 2004 to June 2006

Methods: Fifty-three patients having different neurological symptoms referred to Radiology Department Aga Khan University Hospital for MRI examination were included in the study. These patients were provisionally diagnosed radiologically having intra-axial brain tumor or subsequently found to have pathologically proven primary intra-axial brain tumors. MRI scans were evaluated for location, consistency, hemorrhage, necrosis, margins, edema, MRI signals contrast enhancement and any additional features for staging the tumor. Preoperative diagnosis was compared with postoperative pathological diagnosis by using Pearson's Chi square test. Accuracy of magnetic resonance imaging in diagnosing and staging the brain tumors was determined. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in characterizing the lesion was also calculated

Results: The study included 53 patients with age ranging from 1-year 10-months to 60 years [mean 32.7 years]. Twenty-eight patients had supratentorial tumors [52%] and 25 had infratentorial tumors [47%]. Twenty-eight patients had Astrocytoma [52%], 10 had Oligodendroglioma [19%], 6 had Medulloblastoma [11%], 5 had Lymphoma [9%], and 4 had Hemangioblastoma [7%]. Preoperative MRI diagnosis was correct in 50 patients with accuracy of 94%. No significant difference was found between preoperative MRI grading and postoperative histopathological grade of intra-axial tumor [p-value>0.05]. Sensitivity, specificity, positive predictive value and negative predictive value of MRI in detecting tumor necrosis were 93%, 77%, 80% and 90% while for detecting tumor hemorrhage were 57%, 93%, 57%, and 93% respectively

Conclusion: MRI is very accurate in preoperative diagnosis, staging and assessing the tumor characteristics of primary intra-axial brain tumors. It can be used reliably in our usual clinical practice

Carotid artery disease in patients undergoing elective coronary artery bypass surgery

To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting [CABG] using Doppler sonography. Observational study. Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008. Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. Data was entered and analyzed in SPSS version 15. Pearson chi-square for categorical and independent "t" test was applied for continuous variables at 95% confidence level. P-value of less than 0.05 were considered significant. A total of 176 patients [85% male, mean age=65 years] undergoing elective coronary artery bypass grafting were evaluated preoperatively for carotid artery disease by neck color Doppler sonography. Twenty percent of patients were found to have advanced carotid artery disease [> 50% stenosis], 6% had critical stenosis [> 75% stenosis] and 3% had complete stenosis. Frequency of atherosclerotic plaques was 50%, more common on right side and more prevalent in common carotid artery. Family background of carotid or coronary artery disease and history of smoking were significantly associated with presence of carotid artery disease [p < 0.05]. A sizeable proportion of patients undergoing elective coronary artery bypass grafting surgery for coronary artery disease were found to have coexistant carotid artery disease

Non-fatal limb injuries in motorbike accidents

To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims. Cross-sectional observational study. Study was conducted at Jinnah Postgraduate Medical Centre [JPMC], Karachi, from October 2006 to March 2007. Trained data collectors prospectively collected data from the emergency department of JPMC, Karachi using structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with single or multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgery department were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chi-square test was applied to find out statistical significance at 95% confidence level. P-value <0.05 was considered as significant. A total of 137 [39%] patients presented with tibial injury among the study sample of 348 patients, which was significantly higher than the bone injuries of the body part [p<0.001]. Out of those, in 26% of patients, fibula was also involved along with tibia fracture. Other bone injuries included femur [16%], radius [9.2%], humerus [8.3%] and others. Radius was the commonest injured bone and in highest proportion among upper limb injuries [p<0.001]. Overall, 66% of the injuries in motorbike involved lower limb fractures. The highest proportion of motorbike accidents were observed on Saturdays [31%]. Majority of the accident victims were in the age group between 16 and 30 years [41% accident cases], 27% in age group 30 to 45 years, 15% in 45 to 60 years and 5% in >60 years. Those with less than 15 years accounted for 12% of cases. Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposed position while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lower limb involvement in motorbike accidents

Cleaning methods for ultrasound probes

To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Experimental study. Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A [n = 25], group B [n = 25] and group C [n = 25] respectively. Number of Colony Forming Unit [CFU] of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning [p < 0.001], however, soap cleaning method was the most effective in decreasing bacterial count to the minimum level in comparison to other two methods [p < 0.001]. The overall reduction in pathogenic bacterial count after performing each cleaning method was 45%, 76% and 98% for paper cleaning, normal saline and soap cleaning method respectively. Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients' body contact with the ultrasound probes

Film retakes in digital and conventional radiography

To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method. Comparative study. Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006. X-rays of different body parts, conducted during the year 2004, with conventional radiography [n=170300], and in 2006 with digital radiography [n=174550], were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, grid cut-off, and others [i.e. equipment related] due to which X-ray quality was questionable. Results were expressed in percentages. A total of 9423 X-rays [5.5%] were repeated in conventional radiography [n=170300] due to underexposure [38%], overexposure [28.5%], positioning errors [25%], portable procedures [4%], patient movement [2%], grid cut-off [0.5%], and others [2%]. Underexposure was the most frequently responsible factor for the X-ray repetition as compared to other factors [p<0.001]. In digital radiography [n=174550], 1464 X-rays [1%] needed to be repeated, which was significantly less in comparison to X-ray repetition in conventional method of radiography [5.5%] [p<0.001]. In digital radiography, the most frequent factor for X-ray re-take was positioning error [435, 30%]. Digital radiography is associated with significantly lesser number of re-take X-rays as compared to conventional radiography, hence minimizes the exposure of the patients to unnecessary radiations due to re-take X-rays. Positioning error remains a problem even in digital radiography, emphasizing training need for technologists

Non-B, Non-C Hepatitis as a cause of advanced chronic liver disease requiring medical admission at a rural centre in Pakistan

To study the frequency and mortality of hepatitis B and C negative chronic liver disease [CLD] at a rural tertiary centre in Pakistan. Data was collected retrospectively from the case notes of all the 176 patients consecutively admitted with advanced CLD in our medical ward during one year period. Patients, who were seropositive for hepatitis B and / or C, were separated from those who were negative for them, and the data was analysed. Thirty five patients [20%] were negative for both viral markers. They were more likely to die during the admission than those who were seropositive [11% VS 25% - p = 0.029]. A significant proportion of patients with CLD are negative for viral markers. These patients are at higher risk of mortality, and need testing for other causes of CLD as some of them may benefit from curative treatments available

Acute respiratory failure in Pakistani patients: Risk factors associated with mortality

To assess the outcome and risk factors associated with mortality in patients with acute respiratory failure [ARF]. Observational study. The Aga Khan University Hospital, Karachi, between January 1997 and June 2001. All adult patients admitted with a medical cause of acute respiratory failure were reviewed. The primary outcome measure was mortality and secondary outcome measures were factors associated with mortality in ARF. Multiple logistic regression analysis was used to identify the independent risk factors for mortality. A total of 270 patients were admitted with ARF. Hypercapnic respiratory failure was seen in 186 [69%] and hypoxemic in 84 [31%] cases. Pneumonia and COPD exacerbation were the most common underlying causes of ARF. Ventilator support was required in 93 [34.4%] patients. Hospital mortality was 28%. Chronic renal failure, malignancy, hypokalemia, severe acidosis [pH <7.25], septicemia and ARDS independently correlated with mortality. Mortality rate increased sharply [84%] with the presence of three or more risk factors. Acute respiratory failure has a high mortality rate [28%]. Development of ARDS or septicemia was associated with high mortality. Presence of more than one risk factor significantly increased the mortality rate

Primary lymphoma of the cervix

A 62-years old female presented with postmenopausal vaginal bleeding for one month. On vaginal examination soft fungated mass was palpated in cervix that bled to touch. Ultrasound, CT scan and MRI showed well-defined mass in cervix. On biopsy it was proved to be a primary non-Hodgkin's lymphoma