Reviewers' responses to medical research articles

Objective: To document the reviewers' responses in terms of reviewers' demographic and professional characteristics, promptness of reply, and duration of reply to the request to review medical research articles for a general biomedical research journal

Study Design: Cross-sectional, observational study

Place and Duration Of Study: Department of Publications, College of Physicians and Surgeons Pakistan [CPSP], from October to December 2015

Methodology: Peer reviewed articles edited by a single staff editor were included. Editorials and correspondence were excluded. Manuscript category, discipline, and the total number of reviewers per manuscript were noted. Responses were divided into no response, regrets, and responded, i.e. provided with the review comments; and further sub-divided into timely response, i.e. within 21 days, or later. Total duration of response was counted in days from the date of dispatch to the date of receiving. Among those who provided a review, reviewers' characteristics were noted as designation, institute affiliation, qualification, and gender. Number and percentages of the studied variables were determined. Chi-square test of proportions was used for comparing the proportions with significance at p<0.05

Results: Reviewers for 50 articles including 28 original articles, 15 case reports, three letters to the editor, two short communications, and two new techniques, were evaluated. A total of 598 reviewers were contacted for those 50 articles; forming an average of 11.96 reviewers contacted and 2.2 responded per manuscript. Four hundred and seventy [78.59%] did not reply at all, 18 [3.01%] regretted, and 110 [18.39%] responded [79/110=71.81% timely, and 31/110=28.18% late]. Earliest reply was received in one day and the delayed reply in 87 days. Maximum number of reviewers was 24 for a single original article [internal medicine] and 22 for a case report [cardiology]. Significantly, more fellows, professors and females [p=0.004, p=0.002, and p=0.017, respectively] provided timely response

Conclusion: An overwhelming majority of the reviewers did not reply at all despite the incentives of CME credits and honorarium, adversely affecting the processing time. Majority of those who replied, were on time. Reasons for those who did not reply need to be explored

Aneurysmal bone cyst of ischiopubic ramus: a rare location with literature review

Aneurysmal bone cyst [ABC] is a locally destructive lesion of the bone rather than a true neoplasm. The pelvis is not an unusual site for an ABC; approximately 12% of cases occur in this location. We present a case of aneurysmal bone cyst [ABC] in ischiopubic ramus in a 22 years old male who presented with right inguinal swelling and pain. He was evaluated with X-ray and Magnetic Resonance Imaging MRI of pelvis. A review of literature regarding this rare site of ABC with radiological features is also described in this case report. ABC of ischiopubic ramus is an uncommon entity hence diagnosis of such a case requires proper clinical, radiological and histopathological evaluation to rule out other differential diagnoses of an expansile, osteolytic lesion. This will help in selecting a proper treatment plan

Pseudoaneurysm of left proximal common carotid artery following penetrating trauma

A 33-year male with history of penetrating trauma to left upper chest in 2006, presented through Medical unit to Radiology Department with complain of hemoptysis. Chest X-ray showed a soft tissue lesion in left upper lobe with a linear metallic foreign body. Contrast enhanced CT scan of chest and later CTA was performed which showed a saccular aneurysm arising from mediastinal part of left common aortic artery surrounded by thrombosis with a cylindrical linear metallic foreign body. He was planned for endovascular repair with stenting which he could not afford due to financial constraints. He is currently on conservative follow up. Vascular lesions can be serious complications resulting from blunt or penetrating trauma, when presenting with hemoptysis due to pseudaoneurysms formation even after so many years of trauma

Targeted ultrasound of an indeterminate breast lesion on mammography: when does it influence management?

To determine the change over mammographic diagnosis, BI-RADS category and management following targeted ultrasound of an indeterminate lesion seen on mammography and associated factors, if any. Descriptive, analytical study. Radiology Department, The Aga Khan University Hospital and Clifton Medical Services, Karachi, from April 2010 to May 2011. Patients referred for targeted breast ultrasound following X-ray mammography were selected regardless of age. Targeted Ultrasound [TUS] was defined as a limited ultrasound of a specific lesion or breast part as indicated by the referring source. Comparison was made between the post mammography and post TUS lesion characterization, diagnosis and BI-RADS category [0-5] which was taken as a measure of management change. Those were evaluated to determine significance of age, marital status, parity, breast parenchymal pattern [dense, fatty, heterogeneous], referring source for the TUS [radiology resident, radiologist or surgeon], lesion characteristics [density, echogenecity, shape, location, margins, size, depth-to-width ratio, enhancement or shadowing], presenting symptoms or signs and reason for TUS. A p-value of 0.05 or less was taken as significant. There were a total of 342 patients with mean age of 49.7 +/- 13.5 years. It assigned a definite category in 232 patients with an indefinite category [0] on mammography requiring further investigation. It decreased the suspicion for malignancy in 180 [77.58%] by assigning a low BI-RADS category and increased the suspicion in 52 [22.41%]. The factors significantly associated with this changes included clinical indication being diagnostic [p < 0.001], lesion characteristics on imaging [p < 0.001], heterogenous breast parenchymal pattern [p < 0.001] and presence of known risk factors [p=0.049]. TUS served as a problem solving tool in the evaluation and management of an indeterminate breast lesion in a high number of patients, particularly when there was a lump as indication for imaging in the presence of risk factors in a patient with otherwise heterogeneously dense breast parenchyma

Ultrasound based evaluation of hepatic steatosis and fibrosis in hepatitis c non-responders

To determine the accuracy of ultrasound in the diagnosis and grading of steatosis and fibrosis in Hepatitis C [HCV] patients not responding to ribavarin-interferon therapy. A cross-sectional, analytical study. Radiology Department, Civil Hospital, Karachi, from March 2008 to August 2010. Patients with positive HCV RNA despite 24 weeks ribavarin-interferon therapy [non-responders] were subjected to ultrasound and biopsy prior to institution of pegylated interferon therapy for detection and grading of steatosis and fibrosis. Using histopathology as the gold standard, sensitivity, specificity, negative and positive predictive values for ultrasound were determined. The sensitivity of ultrasound for hepatic steatosis was 90.9% for no steatosis [NS], 100% for moderate and gross steatosis and 84.4% for mild steatosis with 100% specificity. The senitivity for fibrosis was 25% for no fibrosis, 100% for mild fibrosis, 89.74% for moderate fibrosis and 100% for gross fibrosis. The overall accuracy for detection of steatosis was 95.39% and that for fibrosis was 98.02%. Hepatic vein showed increased dampening of flow with advancing grades of steatosis and fibrosis. Ultrasound has a high accuracy in the diagnosis and grading of steatosis and fibrosis in HCV non-responders. Mild fibrosis may confound the diagnosis of mild steatosis

MRI features of spinal fluorosis: results of an endemic community screening

Fluorosis is endemic in many parts of the world. However community studies on MRI features of fluorosis are lacking. The aim of this study was to determine MRI features of spinal changes in a community with endemic fluorosis in the Thar Desert Pakistan. Randomly selected adults from the Village Samorindh, district Thar parker, Sindh, Pakistan, with spinal fluorosis diagnosed on plain x-rays and raised serum fluoride levels were studied from June 2008 to January 2009. MRI was carried out on 0.5 T open magnet MRI system. Features of vertebral body, spinal ligaments, intervertebral disc, facet joints, iliac wings and other incidental findings were noted. Sclerosis was defined as low signal intensity on both T1 and T2 weighted images. Results were described as mean and percentage values. All the studied 27 subjects complained of back ache without neurological signs. The average age was 43.33 +/- 10.45 years; 21 being male [77.8%]. The most frequent findings included generalized vertebral sclerosis [24, 88.8%], ligamentum flavum hypertrophy [23, 85%], anterior [20, 74%] and lateral [17, 62.9%] disc herniation, thickened longitudinal ligaments, and narrowing of spinal foramina. Hemangioma was seen in 04[14.8%]. The most commonly involved level was L1-2, L4-5 and lower dorsal spine. Vertebral sclerosis, a combination of premature degeneration with anterior disc herniation and an unusually high frequency of vertebral hemangioma formed the spectrum of MRI findings in subjects with spinal fluorosis having back ache but no neurological findings

Comparison of suprascapular nerve block and intra-articular injection in the treatment of frozen shoulder

The objective of this study was to compare the effect of supra scapular nerve block and intra articular injection to relieve pain and reduce disability in the patients of frozen shoulder. It was a quasi experimental study. The study was conducted at the department of Orthopedics, Pakistan Railway Hospital, Rawalpindi, fromAugust 2011 toSeptember 2012. Patients diagnosed as the cases of frozen shoulder in outpatient department of Orthopedics irrespective of their gender were included in the study. Forty patients and 50 shoulders were divided into two groups by randomization, one group received single suprascapular nerve block and second group received single intra-articular steroid injection. Both groups were advised for physiotherapy after injection. Patients' pain levels and ranges of movement were assessed over a period of twelve weeks. The study included 40 patients and 50 shoulders to a single suprascapular nerve block and intra articular steroid injection. The mean age of the patients was 49.4 + 9.97 and the range was 40-60 years. There were 16 females and 24 male patients. Post injection assessment of patients was done at two, six, eight and twelve weeks. There was a significant decrease in pain and marked improvement in range of movement with supra scapular nerve block than with intra articular injection. Patients' pain levels and ranges of movement were assessed over a twelve week period. Suprascapular nerve block produced a faster and more complete resolution of pain and restoration of range of movement than intra articular injection

Treatment of colle's fracture with wrist immobilization in palmar flexed and dorsiflexed position

To evaluate and compare the radiological and functional results of immobilization of Colle's fracture treated conservatively in two different positions of wrist i.e. palmarflexion [PF] and dorsiflexion [DF]. A Descriptive Cross Sectional Study. Sixty patients with closed Colle's fracture who were treated conservatively by close reduction and below elbow cast application were included in this study. The study was conducted at Department of Orthopedics, Railway Hospital, Westridge, Rawalpindi from November 2008 to May 2011. The patients were alternately allocated to dorsal or palmar flexed immobilized position of wrist. Patients were followed up for a minimum six-month period. The radial tilt, palmar tilt and ulnar variance were measured at 6 month follow up. The results were scored by Demerit Scoring System of Saito. All fractures were united. Individual movement of dorsiflexion, palmar flexion, supination, and radial-ulnar deviation [except pronation] were all significantly better in the dorsiflexed-immobilized group as compared with the palmar flexed immobilized group. Grip strength recovery with subjective assessment was better in the dorsiflexed group as compared to the PF group. Radiological parameters were markedly better in the dorsiflexed group. 100% of patients in the dorsiflexed group had overall excellent results as compared to 23.3% in the palmar flexed group in terms of radiological and functional outcome. Functional and radiological results of Colle's fractures are superior if the fractures after reduction are immobilized in dorsiflexion of wrist ratherthan in conventional palmarflexion position

Clinician's views on reporting by the radiology department of a tertiary care hospital in Karachi

There are no standard radiological reporting formats therefore reporting varies from person to person. Clinicians are the users of these reports and their satisfaction on reporting can improve the credibility of the radiology department. To obtain clinician's views and assess their satisfaction regarding the current reporting service by the radiology department and to determine ways of improving it. This was a cross sectional study consisting of two main sections. The first section dealt with the existing reporting style while, the second was about the clinician's preferences on the format of reporting. It was a questionnaire based study where senior physicians representing all departments utilizing the services of the radiology department who consented to participate in the study were included. The results were described as frequencies while, percentages and significance was tested using chi square test. Clinicians were unsatisfied with the detail, timeliness and print quality of the reports. However, clarity and correctness were rated high. Computed Tomography scan was the most satisfactory service offered by the radiology department. Substandard film quality was the most common reason given for requesting a repeat investigation. Clinicians supported the idea that radiologists should give recommendations not only for further radiological investigations but also for non-radiological investigation and further referrals. Most clinicians were unaware of normal size of common body organs. There is a need to enhance communication between the clinician and the radiologist to ensure high quality reporting standards

Utility of breast imaging in Mastalgia

Objective: To determine the use of breast imaging in patients with localised or diffuse pain in the breast, in the absence of palpable lump or nipple discharge

Design: Descriptive study

Setting: This study was conducted at Radiology Department of Civil Hospital and Dow University of Health Sciences Karachi from October 2007 to September 2008

Patients and Methods: Patients referred for radiological examination of breast[s] in which either mammography or ultrasound or both done were included. Inclusion criteria was pain in the breast present in women between the ages of 15-65 years. Exclusion criteria included palpable lump, and nipple discharge, patients with a history of breast cancer, or breast augmentation. Mammography was done in those who were above 35 years whereas the ultrasound was carried out in every patient with mastalgia. Main outcome measure was presence of the abnormal radiological findings. Findings were categorized in BIRADS terms. Statistical analysis was done for descriptive statistics. Mean +/- SD of age, numbers and percentage calculation for normal and abnormal findings were carried out

Results: Among the 175 subjects, pain was unilateral in 136 [77.5%] and bilateral in 39 [22.8%] patients. The mean age was 40 +/- 5 years [range 15-65 years]. Ninety-five [54.2%] women belonged to premenopausal or perimenopausal age group. The imaging findings were normal/negative in 114 [65.1%], benign in 43 [24.5%], probably benign in 12 [6.8%], suspicious in 04 [2.2%], and malignant in 02 [1.1%]

Conclusions: No abnormality was found in the painful area in majority of patients. A marked number of patients with benign or probably benign had pain in breast while probable or definite malignant disease was uncommon. Breast imaging in women who present with pain alone provides reassurance

Radiological appraisal of moderate to severe head injury - medicolegal implications

Objective: To compare the diagnosis of X-ray and CT scan of skull in assigning the correct kind of moderate to severe head injury [Shajjah] for medicolegal [ML] certification, and also the clinical severity of head injury against the medicolegal severity

Study Design: Comparative study

Duration and Setting: Medicolegal Section of Accidents and Emergency Department, Civil Hospital Karachi [CHK] and Radiology Department, Dow University of Health Sciences CHK, From June 2008 to May 2009

Methods: One hundred cases of moderate to severe head injury based on Glasgow Coma score [GCS] of 12 or less, with fractured skull reported for medicolegal certification were included. Those with mild injury [GCS 12 or greater], without fracture of skull, with additional face injury, or non medicolegal cases were excluded. Plain X-rays and CT scan of skull and brain were performed in every case. Radiological findings, GCS, and demographics were noted. Shajjah injury types were assigned according to Qisas and Diyat Act terms. Findings of both modalities were compared for medicolegal and clinical severity of injuries and expressed in numbers and percentages

Results: There were 54 cases of moderate and 46 cases of severe head injury. As against CT scan, plain X rays failed to reveal any injury in 21 cases later diagnosed on CT scan Hashimah [n=4], Munaqillah [n=04], Ammah [09] and Damighah [n=04] hurts. Additionally, X rays under diagnosed 60 cases of Shajjah hurts. Nine cases of Shajjah-i-Damighah were similarly diagnosed on X-ray and CT scan. The mean GCS score was 11.3 +/- 4.1 in Hashimah, 9.4 +/- 3.1 in Munaqillah, 7.8 +/- 4.1 in Ammah and 8.6 +/- 3.3 in Damighah hurt

Conclusion: In comparison with plain X rays, CT scan had superior performance in correctly assigning the ML grade of head injury in the moderate to severely injured case. The cases with higher clinical severity [lower GCS core] did not necessarily have a higher medicolegal grade of injury