Safety of percutaneous transhepatic biliary stenting in patients with obstructive jaundice

Objective: To determine the safety of percutaneous transhepatic biliary stenting [PTBS] in patients with obstructive jaundice

Study Design: A case series

Place and Duration Of Study: Department of Radiology, The Aga Khan University Hospital Karachi, Pakistan, from February 2012 to April 2013

Methodology: Patients with obstructive jaundice due to any cause referred for percutaneous transhepatic biliary stenting were included in the study. Patients were excluded if they had undergone previous ERCP, had guided transhepatic biliary stenting, previous percutaneous transhepatic biliary stenting and were lost to follow-up. Follow-up was taken at a 2, 4 and 6 week interval and clinical outcome was assessed as the difference between the bilirubin levels at base line and 6 weeks after PTBS, which was measured using Freidman's test

Results: A total of 102 patients were included; 59 [58%] were males and 43 [42%] were females. The age ranged from 21 to 89 years. A total of 30 patients experienced complications making an overall complication rate of 29.4%; 20 experienced minor and 10 experienced major complications. Pain was the most frequent minor complication [n=15 patients, 14.7%] followed by biliary leakage, fever and cholangitis. Major complications included death in 10 [10%] patients followed by biliary peritonitis and septicemia

Conclusion: PTBS achieved satisfactory palliation with a low complication rate in patients with obstructive jaundice

Negative predictive value of ultrasound in predicting tumor-free margins in specimen sonography

Objective: To evaluate the success of ultrasound in post-excision specimen visualization, and negative predictive value of ultrasound for estimation of tumor-free margins using histopathology as the gold standard

Study Design: Cross-sectional analytical study

Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from May 2010 till January 2013

Methodology: Sonography of all breast nodules was done before and after exicision by two female radiologists with at least five years clinical experience. All surgeries were performed by the same referring breast surgeons. All nodules were non-palpable and had histopathology as well as specimen sonography performed at AKUH. Subjects were excluded, if histopathology was not available, post-procedure sonogram not done or done in another hospital and nodules that were not seen on ultrasound. After needle localization in 47 patients using ultrasound and in 7 patients using mammogram was done, sonogram was conducted in all 54 lesions. These were then assessed by ultrasound for detection of lesion and tumor-free margins in malignant lesion. Post-excision ultrasound was performed for the evaluation of lesion whether visualized or absent with localizing needle in situ, lesion dimensions, depth measurement between the superior margin of the lesion and its edge

Results: All 54 lesions were present on post-exicison scan, out of which 28 were documented as malignant and 26 as benign. Ultrasound declared all specimens as tumor-free. On histopathology, two lesions were documented as having tumor-positive margins and were proven to be invasive lobular carcinoma. Therefore, the negative predictive value of the specimen sonography for margin detection was 26/28 [92.8%]

Conclusion: Ultrasound of the excised breast tumor specimen is a simple and reliable technique for confirmation of the tumor-free margins in non-palpable breast lesions

Diagnostic accuracy of diffusion weighted magnetic resonance imaging in the detection of myometrial invasion in endometrial carcinoma

Objective: To determine the diagnostic accuracy of Diffusion-Weighted Magnetic Resonance Imaging [DWMRI] in the detection of myometrial invasion in endometrial cancer taking histopathology as gold standard

Study Design: Cross-sectional validation study

Place and Duration of Study: Department of Radiology, The Aga Khan University Hospital, Karachi, from January to December 2012

Methodology: DWMRI [b-value = 50,400 and 800 s/mm[2]] was performed in 85 patients of biopsy-proven endometrial carcinoma before hysterectomy using body and spine coil at 1.5 Tesla. DWI was evaluated for presence of myometrial invasion by tumor with histopathology as gold standard. Sensitivity, specificity, the negative predictive value and positive predictive value and accuracy of DWI were assessed against the gold standard

Results: On DWI, superficial myometrial invasion was found in 42 patients and deep myometrial invasion in 43. On histopathology, superficial myometrial invasion was found in 53 patients and deep myometrial invasion in 32. Hence sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the assessment of myometrial invasion by endometrial tumor on DW images was 90%, 73%, 67%, 92% and 80%, respectively. Diagnostic accuracy of diffusion-weighted magnetic resonance imaging in detection of myometrial invasion in endometrial cancer was 80%

Conclusion: DWI is highly accurate in assessing myometrial invasion and can be used as an adjunct to routine MRI for pre-operative evaluation of myometrial invasion of endometrial cancer

Potential risk of cross-infection by tourniquets: a need for effective control practices in Pakistan

Tourniquets used repeatedly on patients for blood sampling are a potential source of nosocomial infections. They harbor numerous microorganisms, including methicillin-resistant Stapbylocoecus aureus [MRSA]. The aim of this study was to investigate tourniquets for the presence of microorganisms and to ascertain the infection control practices of health care workers. A cross-sectional study was carried out in 2012 on 100 samples of tourniquets collected from public and private sector hospitals in Karachi, Pakistan. The samples were cultured, and pathogenic microorganisms were identified and tested for methicillin resistance. A questionnaire was administered simultaneously to 100 health care workers who had used the tourniquets. Descriptive data are represented as frequencies and percentages. Ethical considerations were taken into account. The total colonization rate was 51%, with no bacterial growth in 17/40 and 32/60 samples from public and private sector hospitals, respectively. S. aureus was isolated from 12 [42%] private sector hospital samples and 10 [43%] public sector hospital samples. Although MRSA was found in more samples from public than private sector hospitals, the difference was not statistically significant. Nevertheless, 90% of all elastic and 41% of all rubber tourniquets harbored microorganisms [P < 0.001]. Although 96% of health care workers agreed that hospital staff and fomites can transmit infection, none identified tourniquets as a potential source. When asked whether tourniquets appeared clean before use, 66% agreed, and only 25% considered that tourniquets should be washed or cleaned before use. Tourniquets are a potential reservoir and vehicle for the spread of nosocomial infections, including MRSA. Health care workers have inadequate knowledge about infection control procedures and personal hygiene for disinfecting reusable items

Reduction in dysfunctional thought processes by the use of cognitive behavioral interventions among Pakistani couples with marital dissatisfaction

Marital dissatisfaction is one of the major issues of our times. The purpose of the study is to assess reduction in this dysfunction by the use of cognitive behavioral interventions. When these interventions are employed to decrease dissatisfaction in marriage the focus is to bring about a change in thinking patterns, cognitive features and style of information processing along with the employment of effective strategies to resolve problems in marriage. It was hypothesized that couples who received cognitive behavioral interventions would be able to reduce the frequency of their dysfunctional thinking [Cognitive Distortions] as compared to couples who did not receive the interventions. For the study 50 married couples were randomly allocated into two equal groups: the experimental group [the couples who received the treatment] and the control group [waited for the treatment to be given]. Demographic information relating to age, gender, educational qualification, number of years of marriage, number of children and the socioeconomic status, was obtained from participants in both experimental and control groups. The mean age of the males in the experimental group was 39.24, and mean age of their spouses was 35.20. Whereas the mean age of males in the control group was 41.64 and the mean age of their spouses was 36.72. Descriptive statistics were used to analyze the data. Findings of the study demonstrated that couples who received cognitive behavioral interventions showed marked reduction in distorted thought patterns compared to couples who did not receive the interventions. The study findings have significant implications for clinicians who are dealing with marital issues

Differences of coping responses between genders

Current research intended to find out the differences of coping responses between genders. Hence for the present research it was hypothesized that there would be a significant difference between scaled scores of focus of coping [approach and avoidance] responses of males and females Quantitative study. Karachi Pakistan. The total sample consisted of 150 volunteer students [75 males and 75 females from different universities of Karachi Sample age range was between 18 to 26 years Mean age of total sample was 21.32 years. Moreover mean age of males and females were 20.97 and 21.67 respectively First a consent form was signed by the students, then a demographic form was administered to record the basic information like age, gender, family income, residential area, educational institute etc. Coping Responses Inventory adult[1] was administered to find out the coping responses The CRI-A has two types of coping responses i.e. focus and method for the present research only focus of coping was considered. t-test was calculated to analyze the results. Results showed difference in only Emotional Discharge [avoidance focus of coping] between males and females at t [2.05=144 p<0.042 level. Thus the hypothesj5 is partially verified. It is concluded that there is no significant difference between coping responses of males and females except in one of the components of avoidance focus of coping [i.e. emotional discharge]

Goldston syndrome

Goldston syndrome is a rare entity describing the association of polycystic kidneys and Dandy Walker malformation with or without hepatic fibrosis. A 28 years old pregnant woman came to radiology department for the first antenatal scan. Ultrasound showed a single fetus corresponding to 27 week of gestation. The fetal brain revealed deficient vermis with a posterior fossa cyst communicating with the 4th ventricle suggestive of Dandy-Walker malformation [DWM]. The kidneys were enlarged, and echogenic containing small cysts with associated amniotic fluid index of 5 cm suggestive of Oligohydramnios. A diagnosis of Goldston syndrome was suggested. These findings were confirmed on post natal head and renal ultrasound

Perception of parenting styles and vulnerability to depression in adulthood

The present study is an attempt to investigate the effects of perceived parental styles on the psychological health of adults. Researches reveal that rejection and overprotection specially play a significant role in developing their perception for parental styles as adaptive or maladaptive. In the light of the research review, it has been hypothesized that individuals who perceive their parental styles as maladaptive are more vulnerable to psychological problems like depression than individuals who perceive their parental styles as adaptive. Perceived parental styles and the psychological problems were measured by the Egna Minnen Betraffande Uppforstran [EMBU, Swedish acronym for "My Memories of Upbringing] and Symptom Assessment-45 [SA-45] questionnaire's respectively. The sample comprised one hundred and sixty one [161] students, i.e. 81 male and 80 female students participated in this research. Initially they filled the demographic information form and then EMBU and SA-45 questionnaires were administered. The scores of EMBU questionnaire of the students were statistically evaluated by 95% Confidence Interval. Furthermore one-way analysis of variance [ANOVA] and t-test were applied on the data in order to get statistical significance of results. Results reveal that high parental rejection and high parental overprotection groups had significantly higher depression scores as compared to low parental rejection and low overprotection groups