Diagnosis of Spinal Tuberculosis -A Computed Tomography Study

Introduction: Tuberculosis is an infectious disease, mainlycaused by Mycobacterium tuberculosis and its incidence haveincreased across the globe. Objective: This was a hospitalbased retrospective study and was used to determine the roleof CT in establishing the definitive diagnosis of spinal TB.Material and Methods: The patient data was retrievedfrom the digital database of the hospital. Out of 120 patients,14 patients were included in this study. Patients age, sex,symptoms and signs were noted down. CT scan with axial,coronal and sagittal sections were studied. Axial, coronal andsagittal sections of CT were reviewed by an expert radiologist.Results: Fourteen (11.4%) adults with spinal tuberculosiswere found among 120 patients during this study period. Themean age (± SD) in our cases was 46.5 (± 22.0) years. Out of14, 8 were males and 6 were females, with male: female ratioof 1.4. The mean duration was 1.25 years. The most commonfeature was rachialgia which was seen in 93% of cases,followed by segmental spinal stiffness (50%). The diagnosisin these cases was based on history, physical examination,vertebral radiographs, CT scan and response the medications.On vertebral imaging, lumbar lesions (57%) were seen inmost of the cases, followed by dorsal (36%) and cervical (7%)involvement. The prognosis was good in all these cases exceptin two patients with medullary compression.Conclusion: In the recent years, the incidence of spinal TB hasincreased in both the developed and developing nations andis difficult to diagnose as histopathology is not done straightaway in such cases. The presence of back pain associated withmajor radiological signs of spondylosis on CT can be used todiagnose this condition

Extracorporeal Shock-Wave Lithotripsy in Renal and Ureteric Calculi: Role in Resource Poor Developing Countries in Modern Era

Introduction: Extracorporeal shock-wave lithotripsy (ESWL)is an established non-invasive treatment modality for renaland ureteric stones. However, treatment outcome and efficacydepends on multiple factors like stone size, location and typeof machine used. We aimed to assess efficacy of ESWL asa primary treatment modality in renal and ureteric stones ina busy hospital setting having significant renal stone diseaseburden.Material and methods:1187 patients who underwent ESWLbetween January 2015 to December 2016 in our departmentwere included in the study. Patients with nephrolithiasis andureterolithiasis having functional kidney, without any absolutecontraindication to ESWL were included. Dornier Med TechCompact Delta 2 machines were used for all the patients.Stone localization was done using both fluoroscopic andultrasound- guided methods by same expert.Results: Out of 1187 patients,887 patients had solitary renalstones,170 had solitary ureteral calculus and 130 patients hadmultiple renal calculi. Stone size ranged from 8mm–20mm.Renal pelvic stones, upper calycial stones and proximalureteric stones had stone free rate of 84%,86% and 82.5%respectively. 89% and 84% of patients were stone free whensize of stone was between 8-12mm, it decreased to 77% and73% when size increased between 13-16mm for kidney andureteric stones respectively.Conclusions: ESWL is an effective primary treatmentmodality for appropriately selected patients with stone sizeless than 2 cm in favorable location with a normal functioningkidney. Use of both fluoroscopic and ultrasound imagingimproves localization of stones thus improving success. Itis an important modality in hands of urologist treating hugevolume of urolithiasis patients in busy hospitals with longwaiting list and with limited resources.

Minimally invasive procedures for urological disorders in pregnant patients: our experience

Background: Urological disorders like stone disease, pyonephrosis secondary to obstruction and trauma are common during pregnancy with global incidence of 1 in 250 to 1 in 3000. These diseases can complicate any pregnancy and timely diagnosis and management is of utmost importance for safety of the mother and fetus. Managing these cases entails morbidity and minimally invasive procedures avoiding anesthesia have definite advantage.Methods: It was an observational study. Pregnant patients with nephrolithiasis, pyonephrosis, complicated post-traumatic ureteropelvic junction (PUJ) obstruction (PUJO) and trauma were included in the study.Results: Out of total 84 cases, 45 required intervention. Percutaneous nephrostomy (PCN) for pyonephrosis secondary to PUJO and obstructed PUJ calculus was done in 11 and 14 cases respectively. Bilateral PCN for bilateral nephrolithiasis was done in 7 cases. Silicon double-J stenting for ureteric calculus was done in 13 cases. One case of spontaneous fornicial rupture of kidney without stone disease was managed conservatively as were 4 cases of trauma with concomitant renal injury, 18 cases of non-obstructive renal stones and 16 cases of pyelonephritis. Seven patients lost follow-up. One case each of pyonephrosis and polytrauma had fetal death at term unrelated to urological cause. In rest 75 patients, primary pathology was tackled after 6-8 weeks of delivery.Conclusions: Urological diseases during pregnancy are not an uncommon entity and can pose risk to both mother and fetus. With good clinical vigil, use of minimally invasive procedures, close monitoring and follow up, these patients can be safely managed without any adverse events to the fetus and mother.

Crimean-Congo hemorrhagic fever: Etiology, diagnosis, management and potential alternative therapy

Crimean-Congo hemorrhagic fever (CCHF) virus belongs to the genus Nairovirus and family Bunyaviridae. CCHF is a tickborne disease that has mostly been reported from Asia, Africa and Europe. Early diagnosis of CCHF is essential for patient care and preventing its spread to normal individuals. Treatment of CCHF is mostly limited to the use of ribavirin and palliative care. The practice of using interferon and vaccines has also been proved to be ineffective and unsafe. A search for an effective alternative treatment of the CCHF still continues. Therefore, the current review focusses on the cause, prevalence, mode of transmission, pathophysiology, signs, symptoms, diagnostic features and treatment options of CCHF. This review also highlights the possible alternative therapy in the form of antiviral medicinal plants which are effective against viral hemorrhagic fever. These medicinal plants have shown convincing evidence for their activities against different viral hemorrhagic fevers and may be used alone or in combination with existing therapies to achieve an optimum therapeutic response.

Crimean-Congo hemorrhagic fever: Etiology, diagnosis, management and potential alternative therapy

Crimean-Congo hemorrhagic fever (CCHF) virus belongs to the genus Nairovirus and family Bunyaviridae. CCHF is a tickborne disease that has mostly been reported from Asia, Africa and Europe. Early diagnosis of CCHF is essential for patient care and preventing its spread to normal individuals. Treatment of CCHF is mostly limited to the use of ribavirin and palliative care. The practice of using interferon and vaccines has also been proved to be ineffective and unsafe. A search for an effective alternative treatment of the CCHF still continues. Therefore, the current review focusses on the cause, prevalence, mode of transmission, pathophysiology, signs, symptoms, diagnostic features and treatment options of CCHF. This review also highlights the possible alternative therapy in the form of antiviral medicinal plants which are effective against viral hemorrhagic fever. These medicinal plants have shown convincing evidence for their activities against different viral hemorrhagic fevers and may be used alone or in combination with existing therapies to achieve an optimum therapeutic response.

Normative data of liver size in Kashmiri adult population using ultra-sonography, India

Background: A number of disorders are accompanied by altered size of various abdominal organs like liver including infective, infestation, infiltrative, immunological and malignant conditions. Medical imaging has played an important role in helping physicians for taking normal anatomical dimensions and establishing diagnosis. This study was carried out to determine the normal standards of liver size and its relationship with body weight, height and body mass index.Methods: A cross sectional study was done in GMC Srinagar, Jammu and Kashmir, India for a period of 18 months. 300 staff members in the age group of 19 to 55 years took part in this study.Results: The mean craniocaudal length of liver was 13.08±1.04cms. Authors found a significant correlation of liver size with body weight and body mass index.Conclusions: Body weight and BMI are important determining factors for liver size. Nomograms from this study can be beneficial for diagnosing pathological enlargement or reduction of liver in Kashmiri ethnic population.

Angiographic anatomy of the coronary sinus venous system in adult Kashmiri population

Background: Knowledge of the coronary sinus venous anatomy is an important factor because of its relevance in electrophysiological procedures such as chronic resynchronisation therapy, mapping and ablation of arrhythmias. The advent of advanced invasive and interventional cardiac treatment and management tools for common disorders like heart failure has made understanding of coronary sinus anatomy necessary. The aim was to study the angiographic anatomy of coronary sinus and its tributaries in adult Kashmiri population and provide anatomical basis for cannulation of coronary sinus and its tributaries.Methods: Authors analysed the levophase angiogram of 150 subjects undergoing routine coronary angiography in the right anterior oblique and left anterior oblique view with the necessary caudal or cranial angulations.Results: The coronary sinus was formed by the union of GCV+LMV in 93.3% of subjects and by the union of GCV+PLV in 6.7% of subjects. The GCV and the MCV were the most consistent tributaries present in all the subjects. The mean length of CS was 71.70±9.7 mm when it was formed by GCV+LMV and 70.18±14.98 mm in case of GCV+PLV. The diameter of the CS ostium was 8.48±1.21mm. The mean diameter of GCV was 2.90±1.24 mm, MCV was 2.76±1.08 mm, LMV was 2.23±0.51 mm and the PLV was 2.25±0.53 mm. The opening angle of GCV was obtuse in all the cases, MCV drained at an acute angle in 62% subjects and LMV draining angle was acute in 31.33% cases. The valve of the CS was present in 32.7% subjects and absent in 67.3% subjects. The tortuosity was absent in 75.3%. The distance between CS ostium and the ostium of the vein ideal for lead implantation was between 10-40 mm in 76% subjects.Conclusions: The basic knowledge of coronary sinus and its tributaries play a significant role during electrophysiological procedures. The data obtained from the study can be utilised by interventional cardiologist for cannulation of coronary sinus in Kashmiri population.

Spectrum of imaging findings in trans-gastric migration of accidently ingested metallic foreign bodies

Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.

Managing hot flushes in menopausal women: a review

Hot flushes during menopause are distressing for women and result in poor quality of life. Purpose of the current review was to evaluate the available treatment modalities that should be utilised for the management of hot flushes. Menopause refers to last menses of women life and can be declared after amenorrhea of 12 months. Vasomotor symptoms including hot flushes and night sweats are common after menopause, affecting almost 50 - 85% women older than 45 years. The mean increment in core body and skin temperature is 0.5 degree C and 0.25 - 3 degree C during a hot flush attack. Low level of estrogen during menopause and its association in triggering episodes of hot flushes, is still under debate. The most accepted hypothesis is a narrowing of the thermoneutral zone [TNZ] triggered by estrogen fluctuations. Although, hormone replacement therapy [HRT] remains the standard treatment for the alleviation of such symptoms, incidence of life threatening side effects restrained medical professionals from its use. Complications associated with the use of HRT can be avoided by appropriate evaluation of patients before initiating therapy. Several guidelines have also recommended HRT [estrogen and progesterone] to be safe for up to a period of seven years. Both hormonal and non-hormonal treatments are used for the management of hot flushes. Since hot flushes are the least appreciated and neglected complication of menopause, current review provides detailed information on its background, pathophysiology and management, and emphasises the need of its treatment

Significant impact of +105 A>C promoter polymorphism in IL-18 cytokine in patients with kidney stone disease.

Background: Inflammation may be one cause of nephrolithiasis and the interleukin-18 (IL-18) encoding gene polymorphisms at +105 A>C has been implicated in several inflammation related diseases. The aim of this study was to test whether IL-18+105 A>C polymorphisms could act as genetic marker for renal stone disease. A case-control study was conducted to observe the genotype distribution of IL-18+105 A>C, to elucidate the possible role of this SNP as risk factor in renal stone development and to examine its correlation with the clinico-pathologic variables. Methods: Using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique, we tested the genotype distribution of 160 nephrolithiasis patients in comparison with 200 disease free controls from the same geographical region. Results: We observed significant differences of IL-18+105 A to C between the controls and patients with odds ratio 5.4 (P = 0.001). The prevalence of the variant genotypes AC + CC in the patients was higher than that in the controls (45% v/s 30%) and showed a significant association (P = 0.003). Moreover, the frequency per copy of the C allele of IL-18+105 A>C was found to be implicated more in patient group 0.27 as against only 0.16 in controls (P = 0.0003). Further, males and subjects with <45 years of age in patient group were significantly associated with variant genotype (P <0.05). Conclusion: Thus, it is evident from our study that IL-18+105 A>C is implicated in renal stone disease, and that the rare, C related allele is connected with higher susceptibility to nephrolithiasis.

Microalbuminuria in diabetes mellitus type 2: association with age, sex, and body mass index: a cross sectional study

This study was aimed to determine the association of microalbuminuria with age gender, body mass index [BMI] and duration of type 2 diabetes mellitus [T2DM]. Prospective Cross sectional. This study was carried out at District Head Quarter Hospital Mirpur Azad Kashmir from July 2011and June 2012. This study included 300 patients [199 females and 101 females] with T2DM of duration of six months to 43 years. The evaluation included structured questionnaires clinical, neurological examinations and laboratory tests. Negative for albumin in urine by albustic method and micral tests were used for estimation and categorization of microalbuminuria. Chi square test revealed statistical significant association of microalbuminuria with age [<0.015] blood sugars random [p <0.015] but no statistical significant association with gender, weight, and old and new diabetics. One sample t test had shown statistical significant association of degree of microalbuminuria with BMI [p<0.001], cholesterol [p<0.001] and numbers of years of diabetes [p<0.050] In type 2 diabetic statistical significant associations has shown between degree of microalbuminuria, age, blood sugars, cholesterol, body mass index and duration of diabetes mellitus

C reactive protein concentrations can predict metabolic syndrome in adults

This study analysedthe correlations between C reactive protein [CRP] serum concentrations and demographics and anthropometric aspects of developing metabolic syndrome components in adults. A cross-sectional study. This study was carried out in Azad Kashmir Sheik Khalifa Bin Zyad Hospital Muzaffarabad from March 2012 to April 2013. Demographic, anthropometic parameters of MS such as body mass index [BMI] and waist hips ratio [WEE], biochemical and clinical data were collected from 115 adults of age ranged between 22- 55yearsold. Adults BMI had direct correlation with CRP concentrations. In our study CRP concentrations were statistical significant correlated with age [r = 0.282, p = <0.002], BMI [r = 0.787, p = <0.001], waist hips ratio [r = 0.850, p =< 0.001] and weight [r = 0.662, p =<0.001]. The height had poor correlation with CRP [r = 0.101, p = 0.825].Thecorrected CRP [r = 0.101, p =0.825] was also poorly correlated to CRP concentrations. Statistical analysis has shown there is direct correlation between BMI, WHR and CRP concentrations which suggests that inflammation might be an important event in the development of metabolic disorders in adults

Epigenetic therapy for cancer

Epigenetics means the study of alterations in the genetic material that affect the phenotype but does not affect the genotype. Epigenetics cause alterations in cell properties, which are inherited; but it does not cause alterations in DNA sequence. Epigenetic mediated silencing of gene is of four types, which are DNA methylation, histone deacetylation, RNA associated silencing and Genomic imprinting. Other factors [environmental and xenobiotics] can also cause gene silencing but DNA methytlation and changes in histones of chromatin are two important changes, which are responsible for malignant diseases. Two groups of drugs are under development, which corrects the epigenetic alterations. These are histone deacetylation [HDAC] inhibitors and DNA methytransferase [DNMT] inhibitors. These drugs may be used in cancer because in cancer, hypermethylation of cancer suppressor gene causes gene silencing. Epigenetic therapy scope is likely to increase in future.

Factors associated with tuberculosis treatment default

This study was carried out at Azad Kashmir Combined Military Hospital [AK CMH]/Sheik Khalifa Bin Zyad [SKBZ] Muzaffarabad [MZD] designed for patients defaulting from tuberculosis treatment from 1.1.2013 to 31.12.2013. This study included 110 adults with diagnosis of TB treatment default. The study protocol incorporated structured questionnaire, physical examinations, radiological, laboratory investigations and potential factors for TB treatment defaults. The statistical analysis was performed using SPSS-20, the chi square test was done and p<0.05 was considered as statistical significance. PLUM-Ordinal regression analysis revealed that many clinical variables have statistical significant association with tuberculosis treatment defaults. Factors identified to be associated with treatment default were male gender [p<0.007], distance from the health post [p<0.007], displacement [p<0.024], financial Constraints [p<0.00 1], no body at home to bring medicine or take patients to hospital [p = 0.001], route closed in winters [p = 0.001], improvement from symptoms [0.009] and went abroad [0.001]. Determinants of treatment defaults and associated factors should he considered in treatments plan and Policy actions to tuberculosis control programs. Information on disease, treatment plan and education of the individual along with population should be done in order to minimize treatment default and spread of multi drug resistance to anti-TB drugs

Frequency of category 1 and category 2 tuberculosis in district Kotli Azad Kashmir

To estimate the frequency of Category 1 and 2 Tuberculosis in area of research. Cross sectional study. This study was a conducted in District Kotli Azad Kashmir from January 2009 to December 2009. This study was conducted with a population of 750,000. Data was collected from all the eight national TB centres in the District Kotli. It included every patient registered there with the diagnosis of tuberculosis including pulmonary and extra pulmonary tuberculosis and sputum smear positive and negative patients. They were classified as category 1 and category 2 according to the standard definitions. Results were given in tabulated form. From a total of 752 patients, 579 [76.99%] were pulmonary and 173 [23%] were extra pulmonary. In pulmonary TB cases, 259 [44.78%] were sputum smear positive [235 [90.73%] of them were category 1 and 24 [9.24%] were category 2]. In 320 [55.26%] sputum smear negative patients, 300 [93.75%] were category 1 and 20 [6.25%] were category 2. All of the extra pulmonary TB cases were category 1 [100%]. As a whole 708 [94.15%] were category 1 and 44 [5.85%] were category 2. In our study frequency of category 2 patients was found to be relatively low. It indicates that the problem of drug resistant tuberculosis is probably low in the area. It also shows the effectiveness of local TB control programme

Hypertension as independent risk factors for acute stroke

The stroke is leading cause of death in world and many patients die of an acute stroke. This study was conducted to determine whether the hypertension is independent risk factor for acute stroke. Prospective cross sectional. This study was carried out at AK CMH/SKBZ Muzaffarabad from May 2012 to May 2013. In this study 220 patients having first ever acute stroke. Many clinical variables have been investigated as risks factors for stroke.The hypertension was investigated as a risk factor for stroke. The evaluation of patients included structured questionnaire, clinical, neurological examinations, laboratory tests, and computed tomogram scan [CT] brain. The follow-up at 14 days was done for all patients. Out of 220 cases of acute stroke, 171 [[77.73%] were hypertensive, and 49[22.27] % were normotensive. The statistical significant risk factors for stroke were: hypertension [p=0.04] and Hypercholesterolemia [p=0.05]; for cerebral infarction [CI]: [p=<0.001] and hypertension [p = 0.05] and Hypercholesterolemia [p=0.001]; for intracerebral hemorrhagic [ICH] stroke [p = 0.001]. The low Glasgow coma scale [GCS] score [p=0.05] on admission was associated with high mortality and worst outcome in hypertensive patients. Thus hypertension has statistical significant association for both CI and ICH stroke patients. This study confirms the statistical significant association of hypertension with acute stroke and emphasizes the need in preventing and controlling of hypertension in order to avoid stroke and its mortality

Prevalence of tuberculosis in Kotli, Azad Kashmir

Tuberculosis is highly prevalent in Pakistan. It is a contagious disease and causes a lot of morbidity and mortality. Its treatment is costly especially for poor countries like Pakistan. But fortunately it is a preventable disease. Objective of this study was to analyse various epidemiological features of tuberculosis in District Kotli, a remote area of Northern Pakistan. This cross sectional study was conducted in District Kotli, Azad Kashmir from January to December 2009. Data was collected from eight national TB centres of District Kotli. It included all the diagnosed cases of tuberculosis, registered there during the study period. Various epidemiological aspects of these patients were analysed. Total number patients registered during the study period were 752. Of these 579 [76.99%] were pulmonary and 173 [23%] were extra-pulmonary tuberculosis [EPT]. Total prevalence of tuberculosis was found to be 100.27 per 100,000. Prevalence of pulmonary TB was 77.2 while that of EPT was 23.07 per 100,000. There were 405 males [53.85%] and 347 females [46.14%]. Most patients were 61-75 years of age [220, 29.25%]. Overall 417 [55.44%] were 46-75 years. Housewives were affected most frequently [324, 43.08%]. Labourers were also commonly involved [40.82%]. All cause mortality was 29 [3.85%]. Mortality due to tuberculosis was 11 [1.04%]. Among pulmonary tuberculosis, 259 [44.78%] were sputum smear positive and 320 [55.26%] were sputum smear negative. In EPT, most frequent was pleural effusion [74, 42%] and least frequent was skin involvement [3, 1.73%]. Prevalence of tuberculosis in Kotli was lower than the overall prevalence in Pakistan. Male to female ratio was lower than that generally observed in Southeast Asia. It was more common in middle to old age population. Frequency was higher in housewives and labourers. Very significant proportion of pulmonary TB was sputum smear positive. Among EPT, pleural effusion was the most common mode of presentation

Endorectal coil MRI and MR-spectroscopic imaging in patients with elevated serum prostate specific antigen with negative trus transrectal ultrasound guided biopsy

The aim of this study was to see the efficacy of endorectal coil MRI and MR spectroscopic imaging in patients with elevated serum PSA and negative transrectal ultrasonography [TRUS]-guided biopsy. This study was conducted on 87 patients presented with: Elevated prostatic specific antigen levels >5 ng/ml. Symptoms and signs of prostatic carcinoma. Patients with negative TRUS-guided biopsy. Suspicious lesion on TRU. All the patients were subjected to TRUS and followed by TRUS-guided biopsy of the lesion identified on endorectal coil MRI and MR-Spectroscopy. TRUS-guided biopsy of prostate was done with a Siemens Sonoline Adana Scanner. The scanning was performed by mechanical probe 5-7.5 MHz. Out of 87 patients, 43 [49.4%] had hypointense lesion, 11 [12.6%] had hyperintense lesion. Out of 87 patients, MR-spectroscopy showed peak choline-creatine in 74 patients. Normal citrate peak was seen in 13 patients. Patients who had choline-creatine peak, among them 28 [37.8%] had peak in left peripheral zone, 23 [31.1%] had peak in the right peripheral zone, 2 [2.7%] had peak in the central zone, 17 had [23%] peak bilaterally. Four patients [5.4%] had peaks in right and central zones. The difference was statistically significant [P < 0.001]. Prostatic biopsy directed with endorectal coil MRI and MR-spectroscopic imaging findings in patients with elevated serum PSA and prior negative biopsy, improves the early diagnosis of prostatic carcinoma and accurate localization of prostate cancer within the gland.

Accident and emergency neuroimaging: is an optimization needed in ordered non-enhanced CT scans for brain imaging?

To determine and characterize ordering of computed tomography scans for neuroimaging and to identify the frequency of negative non-enhanced computed tomography [NECT] in a prospective series of patients presenting to medical, surgical and pediatric floors of Accident and Emergency Department, so as to manipulate ordering practice by the referring physicians. This study was conducted in Department of Radiology, Services Institute of Medical Sciences/ Services Hospital, Lahore, between January and June 2010. The study consecutively included all the cases from Accident and Emergency Department with neurological symptoms and signs undergoing CT head referred from medical, surgical and pediatric floors. The patients' medical records were reviewed. The study population consisted of 2570 patients, including 1611 men and 959 women, who were 1-75 years old [mean 42 years]. Interpretation of NECT heads was done for positive as well as negative cases. Of 2570 cases, 1155 cases [44.9%] were positive. The overall percentage of negative CT scans was high for medical emergencies, with only 481 cases [29.2%] out of 1647 revealing positive findings. The percentage of negative CT scans referred from surgical emergency was not as high as for medical emergencies, but the major head trauma was only productive for extra-axial bleed/ hematoma revealing 403 cases [44.6%]. Minor head trauma was more commonly scanned with most of the CT scans head remarkable only for skull vault non-depressed fractures. Pediatric referrals positive percentage was again low with only 6 [28.5%] out of 21 cases positive for any underlying pathology. Optimization in the neuroimaging should be encouraged for more thoughtful use of imaging modalities in Accidents and Emergency departments to ensure patients' benefit from continued imaging innovation. An urgent CT head scan is deemed appropriate if it leads to an immediate change in a patient's management. Unnecessary use of neuroimaging, in particular to CT scan, has long-term effects of accumulated diagnostic radiation. Appropriateness of the requests should be evaluated according to the various guidelines.

Serum enzyme activities in human thyroid diseases

The study enrolled a total of 76 patients with thyroid gland diseases, hyperthyroidism and hypothyroidism. The activities of the enzyme amylase, gamma glutamyltransferase and alkaline phosphatase were evaluated in these diseases state and were compared with normal healthy thyroid gland. The specimens were obtained from different hospitals in Baghdad and from routine clinical works. Diagnosis of patients with thyroid gland diseases hyper and hypothyroidism by evaluation of enzymes activity of amylase, GGT and ALP. Two groups of patients were used: The first consists of 38 patients with hyperthyroidism, the second consists of also 38 are patients with hypothyroidism. Twenty five of each group was investigated for amylase, GGT, ALP and were compared with third group of 25 normal healthy thyroid gland. The remaining 13 out of 38 patients of each group were tested for enzymes, amylase, GGT, ALP, GOT, GPT and evaluate the hormones, they were compared with third group of 10 normal healthy thyroid gland. There was a highly significant increase and decrease in the activity of amylase, GGT and ALP in hyper and hypothyroidism patients [P<0.001] when compared with third group normal. Diagnosis of patients with thyroid gland diseases can be confirmed by enzymes investigation in blood serum and hormonal assay