Comparison between peak systolic velocity of the inferior thyroid artery and technetium-99m pertechnetate thyroid uptake in differentiating Graves' disease from thyroiditis

ABSTRACT Objectives The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake. Subjects and methods We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake. Results Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%. Conclusion Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults

Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm2 (±1.2). Arshed Hussain Parry, Abdul Haseeb Wani, Naseer Ahmad Choh, Tariq Ahmad Gojwari. High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults. IAIM, 2019; 6(4): 144-149. Page 145 Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm2 ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm2 ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm2 ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve

Level of vitamin d in Orthopaedic Trauma among adult patients

Background: The evidence on level of vitamin D in trauma patients is scarce in the developing countries

Objective: To determine the levels of vitamin D in trauma patients above 18 years of age

Methodology: This was a cross sectional study conducted on patients admitted in the Orthopedic department of Sheikh Zayed Medical College /Hospital, Rahim Yar Khan, patients included in this study were 340. The duration of study was 21st July to 16th March 2016. Vitamin D level were measured by using vitamin D kits [Roche]. Patients less than 18 years were not included in the study. Data was analyzed by using SPSS version 16

Results: A total of 340 patients admitted in orthopedic department were included in this study. Overall 92.6% patients have deficient or insufficient level of vitamin D. Most of the patients [68.8%] were less than 45 years of age. Majority of the patients were male [71.8%]. Most of the patients [72.4%] were not smokers. Majority belonged to rural areas [56%], and have no history of steroid intake

Conclusion: This study confirmed that majority of the trauma patients were vitamin D deficient or insufficient. This highlights that trauma surgeons should consider vitamin D in the armamentarium of orthopaedic treatment

Quantitative and qualitative changes in human Meissner’s corpuscle at different ages: a light microscopic analysis.

Background: Meissner’s corpuscle is the most complex sensory receptors of the skin; providing information about rapidly fluctuating mechanical forces acting on the hairless skin. Aim of current study was to study density and structural changes in human Meissner’s corpuscles at different ages Methods: Samples were obtained from finger tips of fifteen persons and divided into three groups according to age: group A <15years; group B: 16-45 years and group C: 46-72 years. 5 μm thick sections were prepared, impregnated with silver and observed under compound light microscope. Density of Meissner’s corpuscles (Mcs) was studied by calculating Meissner’s Index (MI). Results: In group A, the MI was 0.86-0.90, which increased to 0.96 in group B and dropped in group C to 0.4 (in the seventh decade). The analysis of variance showed significant difference (P = 0.019) in MIs of the three age groups. The size of the Mcs was largest in group B, followed by group C and smallest in group A. The analysis of variance showed that there was highly significant difference (P = 0.003) between the size of Mcs in all the three age groups. It was observed that morphology of Mcs alter with age. In children these consisted of rudimentary coil of nerve fibers around collection of cells. In adults the intra-corpuscular nerve fibers were compressed into a tight spiral and modifications of nerve fibers, like end bulbs, varicosities and networks, were well developed. In old age Mcs were attenuated consisting of tangled mass of nerve fibers. Conclusion: It can be concluded that in adults the Mcs are greater in number, larger in size and complicated in structure, compared to young and old people.

multi slice computed tomography coronary angiographic study of coronary artery disease in soldiers with chest pain

The study is sought to highlight the role and results of MSCT angiography in scenario of acute chest pain to determine or exclude significant coronary artery disease in patients who do not have high risk features for significant coronary disease. Descriptive study. Computed topography department, Armed Forces Institute of Cardiology, National Institute of Heart Diseases Rawalpindi from September 2013 to December 2013. A total of 150 patients [soldiers] who were referred to this hospital with chest pain and who did not have high risk features were evaluated by multi slice computed coronary angiography. One hundred and fifty patients who reported to this hospital with chest pain were evaluated by multi slice computed tomography [MSCT] angiography. Their age ranged from 20 to 53 years. Cases studied were those having low probability of coronary artery disease. Patients having high probability of coronary disease, acute coronary syndrome or definite coronary artery disease were excluded from this study and were evaluated by conventional coronary angiography, 114 [76%] patients showed normal coronary arteries. 6 [4%] had subcritical coronary disease, 5 [3.33%] had only minor irregularity in coronary arteries, 4 [2.66%] had significant coronary artery disease that necessitated coronary angiogram. 16 [10.66%] cases had muscle bridge in left anterior descending artery. One [0.66%] patient had patent graft after coronary artery bypass graft surgery. Three [2%] patient's had patent stents in coronary arteries. While 1[0.66%] patient had aberrant origin of coronary artery. There were no side effects observed during study. Patients presenting with chest pain with low risk features can be studied conveniently with MSCT angiography. Prevalence of significant coronary artery disease is low. MSCT angiography is a very useful, convenient and safe tool to screen low risk patients to rule out presence of significant coronary artery disease

Procedural outcome of primary PCI inst-segment elevation myocardial infarction at Afic and Nihd Rawalpindi - Pakistan

To determine the procedural outcome of primary percutaneous coronary interventions [PCI] in ST segment elevation myocardial infarction. A quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, a tertiary care cardiac institute from November 2011 to September 2013. Total 228 patients who underwent primary percutaneous intervention [primary PCI] were included in this study. A pre designed performa was prospectively filled which included demographic and procedural variables. Procedural success and in hospital mortality were recorded. The mean age was 59 +/- 10.88 years. There were 205 [89.9%] males, 80 [35.1%] patients were found to be diabetic, 47 [20.6%] hypertensive, and 90 [39.5%] patients were smokers. Family history of ischemic heart disease was positive in 51 [22.4] patients. Anterior, inferior and lateral myocardial infarction were present in 137 [60.1%], 90 [39.5%] and 1 [0.4%] patients respectively. The Median time from the onset of symptoms to the arrival in the hospital was 122.5 +/- 142.57 and median door to balloon time was 60 +/- 22.88 min. Left anterior descending [LAD] was the commonest infarct related artery accounting for culprit artery in 138 [60.5%] followed by right coronary artery [RCA] and left circumflex artery [LCX] in 72 [31.6%] and 18 [7.9%] cases respectively. Procedural success was achieved in 222 [97.4%] patients. Six [2.6%] patients died in the hospital. High success rate with low mortality rates can be achieved in our set up. However more studies and long term follow up is required to validate our results

Structural organization and pattern of innervations of human Meissner's corpuscle: a light microscopic study.

Background: Human glabrous skin has very rich nerve supply in the form of specialized nerve endings like Meissner’s corpuscles, Pacinian corpuscles, Krause end bulbs etc for carrying sensory information to brain. Aim of study: To study the structure, pattern of innervations and nerve terminations of human Meissner’s corpuscle. Methods: Skin samples from sixty human beings (age range 2 to 72 years) were taken, sections prepared and stained with a cytological (Haematoxylin – Eosin and Vongieson’s stains) and a neural stain (Silver Impregnation). Results: With cytological stain, Meissner’s corpuscles were seen in dermal papillae of glabrous skin, each consisting of a cellular structure having a peripheral capsule and central core of transversely arranged cells. With neural stain, each corpuscle was seen to be oval, globular or cylindrical structure, having a capsule surrounding the core of spirally arranged nerve fibers, sandwiched by Schwann cells. In between nerve fibers of the core were seen small bundles of collagen fibers. 2-6 nerve fibers innervated each Mc from the sub corial plexus of nerves and formed various patterns of nerve endings like networks, end bulbs and varicosities inside the Meissner’s corpuscle. Conclusion: Meissner’s corpuscle is a complex structure composed of capsule - consisting of spindle shaped capsular cells interspersed in collagen fibers, surrounding a core of helically arranged nerve fibers, Schwann cells and collagen fibers.

Self perception of malooclusion among dental and medical students

The purpose of this study was to assess the prevalence of malocclusion and its self-perception among medical and dental students of FMH College of Medicine and Dentistry and its correlation with understanding of treatment need. The total sample size was 385 [67% females, 23% males], aged from 18-25. Examination was conducted using a CPI probe according to DAI score and a questionnaire was filled by each participant. Chi-square and t-test were used to find relationship between malocclusion, its perception and treatment need with different independent variables. 60.3% of participants had no abnormality or minor malocclusion who needed no or minor treatment whereas, only 26.5%, 9.1% and 4.2% of subjects had definite, severe and very severe or handicapping malocclusion respectively to whom treatment was elective, highly desirable and mandatory. Out of there only 10.9% wanted to get treatment. It was concluded that there was adequate self-perception of malocclusion in the students but understanding for treatment need was very low

Parasitosis through the food-handlers and food samples of Lahore city

Parasitosis' means infection or infestation with parasites. Parasites are responsible for significant morbidity and mortality worldwide. Various epidemiological studies indicate that the prevalence of intestinal parasites is high especially in developing countries. To identify possible positive cases of intestinal parasitic infection among food handlers and also to determine the presence of intestinal parasitic cysts and ova in vegetables and meat. A co-relational descriptive study design. Study was conducted in two randomly selected markets of Lahore from January 2009 to June 2009. This study was designed to determine the association between various risk factors and the occurrence of intestinal parasites. Random sampling was done. Stool parasitological profile was done by direct smear and formaline-ethyl acetate sedimentation method. Both vegetables and meat samples were examined for the presence of intestinal parasitic cysts and ova by using centrifugal-flotation technique. 58% vegetables, 71.1% meat and 34.5% stool samples were found to be positive for intestinal parasites. Of the parasites detected, the most common parsites infecting the food handlers were Entamoeba histolytica and Ascaris lumbricoids. Whereas parasites were more in the meat samples that were not properly stored than those that were kept in refrigerator. This study revealed that risk of intestinal parasites is in direct proportion to the poor sanitary conditions

Non opaque foreign body aspiration in children: should we be more vigilant and proactive?

To study the frequency of symptoms, composition and complications of clinically suspected non radio-opaque foreign body aspiration; which is a difficult diagnostic challenge resulting in delayed referral for bronchoscopy. This descriptive analysis of 400 cases of foreign body aspiration was done in the department of ENT and Head and Neck surgery. Lady Reading Hospital Peshawar from 2003-2006. One hundred cases were selected with presumptive diagnosis of foreign bodies in tracheobronchial tree. The inclusion criteria were not witness and non radio-opaque foreign bodies. We reviewed their hospital record to ascertain history diagnosis and treatment. Age, sex, location in tracheobronchial tree, witnessed or un-witnessed events, symptoms, radio graphic findings, anatomical abnormalities noted at endoscopy and complications were recorded. Radio opaque foreign bodies were excluded from the study. A total of hundred cases were included. Age range was from 2-5 years. Males were 70% and females were 30%. Delay in presentation was from 10 days to 4 years. Common symptoms at presentation were cough 55% and asthma 20%. Radiological findings were abnormal in 90% of cases. Upon bronchoscopy 70% were positive for foreign body and 30% were negative. Peanuts [30%] and whistles [28%] were the commonest foreign bodies. No death occurred in this study and minor complications of the procedure were only 15%. Aspiration of foreign bodies in children can lead to serious morbidity if not recognized and treated in time; hence early referral is essential

Comparison of Jones JIG and distal jet molar distalizing appliances

The purpose of the present study was to evaluate and compare the effects of Jones jig and distal jet appliance during class-II molar correction with maxillary first molar distalization, its tipping, extrusion, rotation as well as anchorage loss at premolar-incisor unit. Sixty patients were selected from Orthodontics department de,Montmorency College of Dentistry, Lahore, Pakistan and pre and post distalization lateral cephalograms and study casts were used as evaluation tools. Distal jet group showed 3.88 mm space creation during 7.11 months, out of which 2.93 mm [75.52%] was molar distalization while 0.93 mm [24.48%] was premolar mesialization as anchorage loss. There was 3.41§ molar tipping with 0.20 mm extrusion and 7.33 § distal tipping with 0.90 mm second cuspid extrusion whereas incisors had 1.65 § labial tipping. Right and left upper molars showed 1.30° and 1.18° rotation respectively. In the Jones jig group, the maxillary first molars were distalized to 3.30 mm on each side and tipped 6.70° distally. The maxillary second premolars moved mesially 2.00 mm with tipping of 7.48°.Therefore a total space created between first molar and second premolar was 5.30 mm i.e. 62.26% from first molar distalization while 37.74% from second premolar mesialization. In addition maxillary first molar extruded 0.70 mm and second bicuspid extruded 1.58 mm. Both right and left first molars were also disto-palatally rotated by 2.00° and 2.55° respectively though upper incisors showed 2.25° proclination during distalization. Distal jet appliance was found to be a more effective and predictable method for themaxillary first molar distalization through bodily translation with minimum tipping, extrusion, and rotation as well as anchorage loss

Dental crowding and its relationship to arch dimensions - gender dimorphism

This study was conducted on a sample of 120 individuals [60 male and 60 female individuals] with dental Class I malocclusion selected from different dental institutions of Lahore, Pakistan. The patients were divided into crowed and non crowed groups with equal numbers of males and females. The sample age ranged from 12-18 years with mean age of 15.2 years. Arch width and arch length were measured in upper and lower arches at inter-canine, inter-premolar, inter-molar distances. All measurements were taken from study dental casts by a calibrated operator using vernier caliper. Data were analyzed by using SPSS 16 version for windows. The paired t-test was used to evaluate the differences between males and females and average values of the sample. The results showed that the average inter molar width in upper arch was 35.74mm to 36.95mm in females and males respectively in non crowded group. Average arch length was found 77.4mm to 82.7mm in upper arch with no crowding and 72.5mm to 76.1mm in crowded group. Males generally showed higher values in all dimensions but the differences were not statistically significant in comparison to females

Hepatic cirrhosis; its etiology and complications

To determine etiology and complications in the patients suffering from cirrhosis of liver in Railway Hospital. Descriptive study. At Medical Unit II, IIMC-T, Pakistan Railway Hospital, Rawalpindi from March 2004 to July 2007. Patients suffering from cirrhosis of liver on the basis of clinical and ultrasonographic findings were included in the study. All other patients of liver disease without evidence of cirrhosis were excluded. Data of the patients regarding the etiological factors and complications of cirrhosis were recorded onaproforma. Out of 141 patients, 56% were males and 44% were females. The mean age was 48.67 years. Most of the patients had HCV infection [61%] followed by HBV infection [20.56%]. Co-infection with HBV and HCV was 3.54%. 3.54% had alcoholic cirrhosis while 5% had post-surgical biliary cirrhosis. Only 2.12% had Wilson's disease and 4.25% were cryptogenic. Most common presentation was simple ascites [33.33%], next was variceal bleeding [27.65%]. Spontaneous bacterial peritonitis was present in 7.8%, hepatic encepha-lopathy in 15.6%, hepatorenal syndrome in 2.12%, generalized bleeding tendency in 3.54% and 5% of cases developed hepatocelluar carcinoma. HCV infection was most common etiology while simple ascites was most common presentation. Emphasis should be on prevention of hepatitis B and C infections through public awareness programmes

clinicomorphological study of lymphadenopathy

A total 238 lymph nod specimen were studied at various Hospitals of Lahore. The ages of these patients ranged from 2 years to 80 years. Maximum number of patients with lymphadenopathy [90 out of 238] 37.8% cases were in 10-19 years age group. Females [51.7%] presenting with lymph node enlargement were more affected than males [48.3%]. The commonest presenting complaint was fever [56.3%]. Cervical lymph nodes [80.3%] were the commonest site of involvement. On histopathological examination, seven morphological groups were highlighted; tuberculous lymphadenitis [42.5%], chronic nonspecific lymhadenitis [36.6%], viral lymphadenitis [3.4%] acute bacterial lymphadenitis [0.8%]. Fungal lymphadenitis [0.8%], Metastatic carcinoma [11.3%] and lymphomas [4.6%]

Effects of distal jet appliance in class-II molar correction

This study was conducted on a sample of thirty patients selected from Orthodontics department de'Montmorency College of dentistry/ Punjab dental Hospital, Lahore. The purpose of study was to evaluate treatment effects of Distal Jet Appliance during Class-II molar correction with a focus on the magnitude of Maxillary first molar distalization, its tipping, extrusion, rotation as well as anchorage loss at premolar-incisor unit. Pre and post distalization lateral cephalogram and study cast were used as evaluation tools. Results showed that there was 3.88 mm space created during 7.11 months; out of which 2.93 mm [75.52%] showed molar distalization while 0.93 mm [24.48%] premolar mesialization as anchorage loss. There was 3.41% molar tipping with 0.20 mm extrusion and second premolar showed 7.33% distal tipping, 0.90 mm extrusion whereas Incisors showed 1.65% labial tipping

Soft tissue morphology in bimaxillary proclination

The purpose of this study was to find the pattern of soft tissue morphology in a sample of Pakistani population with bimaxillary proclination. Lateral cephalograms of 100 patients [50 males and 50 females] exhibiting bimaxillary dental proclination were used to determine the skeletal, dental and soft tissue patterns among the subjects. Cephalometric parameters were evaluated and the database was developed in SPSS 10.0 for windows. The bimaxillary protrusion sample was skeletal class II due to mild mandibular deficiency and the mandibular plane inclination was within normal range. The soft tissue analysis showed the protrusion of both upper and lower lips

Upper lip strain in bimaxillary proclination

The purpose of this study was to determine the upper lip by Holdaway's method in individuals with bimaxillary proclination and to find out correlations of skeletal convexity at point A and maxillary incisor inclination with upper lip inclination and upper lipstrain. Lateral cephalograins of 100 patients [50 males and 50 female and exhibiting bimaxillary dental proclination were exposed in closed lip position. Cephalometric radiographs were traced manually and the database was developed in SPSS 10.0 for windows. The results showed a significant positive correlation with upper lip strain measured by Holdaway's method. Holdaway's method reveals lip strain in the sample. No statistical significant correlations of skeletal convexity at point A and maxillary incisor inclination with upper lip inclination were found. A-FP distance revealed a significant negative correlation with upper lip strain recorded by Holdaway's method. I-FH and I-SN plane angles are significantly positively correlated with upper lip inclination and upper lip strain measured by Holdaway's method

Immunoreactivity of proliferating cell nuclear antigen in transitional cell carcinoma of urinary bladder

This is a descriptive study designed to evaluate Proliferating cell nuclear antigen [PCNA] in transitional cell carcinoma. A total of fifty per urethra resected bladder tumour samples [TUR BT] were collected from Mayo Hospital and Services Hospital, Lahore and processed for H and E and PCNA stain. The grading of tumours were made on H and E stain. While Proliferating cell nuclear antigen labeling index was recorded for each case. The mean PCNA labeling index was significantly higher in grade III when compared with tumours of grade II. [p < 0.001] carcinoma. Similarly mean PCNA labeling index was significantly higher [p < 0.05] in patients having duration of symptoms up to 3 month when compared with the patients having longer duration of symptoms. The mean PCNA labeling index had significantly higher value in high grade tumours as compared to low grade tumours [p < 0.001]. Although determination of PCNA labeling index is costly yet it has significant role in tumour grading

Intracranial complications of chronic suppurative otitis media

To study the presentations of various intra cranial complications of chronic suppurative otitis media [SOM]. This prospective and descriptive study was conducted in the department of ENT, Lady Reading Hospital Peshawar from April 2006 to march 2007. All the cases with suspected intra cranial complications were admitted to the department and assessed clinically and radiologically. Audiological, and laboratory investigations were done as well. Out of 50 cases 36 were male and 14 female ranging from 10-40years in age. Complications like meningitis and brain abscesses were more common in males in the 2[nd] and 3[rd] decade of life [72%]. Most of the complications were from atticoantral diseases. The main presenting features were foul smelling otorrhea, headache, and fever, neck stiffness, chloestosteatoma and granulations in the ear. Meningitis [46%], temporal lobe abscess [36%] and extra dural abscess [14%] were the commonest complications. Burr hole aspiration, for intra cranial abscess and radical/modified radical mastoidecomy for SOM were the main surgical procedure carried out for these patients. Otogenic intra cranial complications like meningitis and brain abscesses are still common in spite of advances in the medical sciences. Complications are common in 2[nd] and 3[rd] decade of life. Meningitis is the commonest complication followed by brain abscess Burr whole aspiration with modified, radical mastoidectomy is the main stay of treatment along with parenteral antibiotics