Usefulness of Hemodynamically Distribution of Intranodal Vessels in Differentiating Metastatic Neck Lymph Nodes - Value of Color Doppler and Spectral Wave Sonogram.

OBJECTIVE: To evaluate the diagnostic assessment of enlarged lymph nodes, based on its perfusion pattern by taking tissue diagnosis as gold standard. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Departments of Radiology and Pathology, PIMS Hospital, Islamabad, from February to May 2016. METHODOLOGY: Color sonography of patients with clinically, palpable cervical lymph nodes were carried by senior trainee under the supervision of senior radiologist. Ultrasound guided tissue diagnosis was obtained in all suspected malignant cases. Histopathology was taken as the gold standard for determining accuracy. RESULTS: Accuracy, sensitivity and specificity, positive and negative predictive values of color Doppler ultrasound in detecting malignant cervical lymphadenopathy was found to be 88.46%, 86.05%, 79.31% and 92.50%, respectively with diagnostic accuracy of 86.95%, when intranodal vascular pattern on color Doppler imaging was analyzed. Using spectral wave indexes, the same values were 92.31%, 90.70%, 85.71%, 95.12%, respectively with overall diagnostic accuracy of 91.30%. CONCLUSION: Color Doppler sonography is much sensitive borderline than grey scale findings alone. Furthermore, lymph nodes appearing in the detection of malignant nodes on grey scale images can be reliably diagnosed on Doppler scan.

Ultrasound And Supine Chest Radiograph In Road Traffic Accident Patients: A Reliable And Convenient Way To Diagnose Pleural Effusion.

BACKGROUND: Portable bed side ultrasound and supine chest radiograph of 80 traumatic patients excluding very clinically unstable patients who subsequently underwent CT scan chest was done for traumatic effusion showing that ultrasound had a higher sensitivity than CXR, 88.23% and 77.94%, respectively, and a similar specificity of 100% and 100%, respectively. Objective of the study is to compare the diagnostic accuracy of high resolution ultrasound and supine chest x-ray in detection of pleural effusion in road traffic accident patients keeping plain CT chest as gold standard. METHODS: This study was conducted in PIMS and PAEC General Hospital, Islamabad from 1st January to 15th December 2015. The current study examined total of 80 trauma (blunt and penetrating) patients coming to emergency departments of both hospitals specifically those who had road traffic accident history. Their portable bed side ultrasound and supine chest radiograph were performed for assessing pleural effusion and subsequently CT scan chest was done for confirmation as it's a gold standard. RESULTS: Using CT findings as gold standard the sensitivity, specificity, positive predictive value and negative predictive value was assessed for both ultrasonography and chest radiography and found to be 88.23%,100%, 100%, 40% and 77.94%, 100%, 100%, 55.55% respectively with diagnostic accuracy of ultrasound 90% as compared to 81.25% for supine chest x-rays when compared with gold standard. CONCLUSIONS: Ultrasound and chest x-ray can be used as a useful and suitable adjunct to CT in road traffic accident patients as these are easily available, non-invasive, no contrast required, can be performed on bed side and carries no or little radiation risk.

Bedside Ultrasonography: AUseful Tool for Traumatic Pneumothorax.

OBJECTIVE: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015. METHODOLOGY: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CTchest was done for confirmation as gold standard. RESULTS: Based on CTfindings, sensitivity for ultrasonography and chest radiography was found to be 83.33% and 54.76%, respectively and specificity of 100% for both modalities. CONCLUSION: Ultrasound can be used as a useful and suitable adjunct to CTin trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk.

The forgotten disease - Lemierres syndrome.

Lemierre's syndrome refers to septic thrombosis of deep veins of the neck, is a rare and often life threatening complication following upper respiratory tract infections. We present here a case of Lemierre's syndrome in a previously healthy 30 years old female who had a febrile illness for two weeks with associated dysphagia, hoarse voice and right sided neck swelling. She was investigated for retropharyngeal and parapharyngeal abscess, granulomatosis with polyangiitis, tuberculosis and thyroiditis but finally concluded as Lemierre's syndrome based on the findings of thrombosis of the deep neck veins following respiratory tract infection, septic pulmonary emboli and clinical recovery with antibiotics and supportive care. Lemierres syndrome can be fatal if diagnosis and treatment is delayed. Strong clinical suspicion leads to early diagnosis and may prevent life threatening organ dysfunction.

A system for automated, noninvasive, morphology-based evaluation of induced pluripotent stem cell cultures.

Due to the rapid adoption and use of human induced pluripotent stem cells (iPSCs) in recent years, there is a need for new technologies that standardize the evaluation of iPSCs to allow the objective comparison of results across different experiments and groups. In this article, we present a noninvasive, fully automated, and analytical system for morphology-based evaluation of iPSC cultures that consists of time-lapse microscopy and novel image analysis software. The presented system acquires low-light phase-contrast images of iPSC growth collected during a period of several days in culture, measures geometrical- and texture-based features of iPSC colonies throughout time, and derives a set of six biologically relevant features to automatically rank the quality of the cell culture. In a study of 94 iPSC cultures, we demonstrated the accuracy of the system by comparing the automated ranking with an independent expert evaluation based on visual review of the time-lapse movies. To our knowledge, this is the first demonstration of a fully automated and objective assessment of iPSC culture quality using noninvasive methods.

A cellular model for sporadic ALS using patient-derived induced pluripotent stem cells.

Development of therapeutics for genetically complex neurodegenerative diseases such as sporadic amyotrophic lateral sclerosis (ALS) has largely been hampered by lack of relevant disease models. Reprogramming of sporadic ALS patients' fibroblasts into induced pluripotent stem cells (iPSC) and differentiation into affected neurons that show a disease phenotype could provide a cellular model for disease mechanism studies and drug discovery. Here we report the reprogramming to pluripotency of fibroblasts from a large cohort of healthy controls and ALS patients and their differentiation into motor neurons. We demonstrate that motor neurons derived from three sALS patients show de novo TDP-43 aggregation and that the aggregates recapitulate pathology in postmortem tissue from one of the same patients from which the iPSC were derived. We configured a high-content chemical screen using the TDP-43 aggregate endpoint both in lower motor neurons and upper motor neuron like cells and identified FDA-approved small molecule modulators including Digoxin demonstrating the feasibility of patient-derived iPSC-based disease modeling for drug screening.

Formative research and development of an evidence-based communication strategy: the introduction of Vi typhoid fever vaccine among school-aged children in Karachi, Pakistan.

The authors conducted formative research (a) to identify stakeholders' concerns related to typhoid fever and the need for disease information and (b) to develop a communication strategy to inform stakeholders and address their concerns and motivate for support of a school-based vaccination program in Pakistan. Data were collected during interactive and semi-structured focus group discussions and interviews, followed by a qualitative analysis and multidisciplinary consultative process to identify an effective social mobilization strategy comprised of relevant media channels and messages. The authors conducted 14 focus group discussions with the parents of school-aged children and their teachers, and 13 individual interviews with school, religious, and political leaders. Parents thought that typhoid fever was a dangerous disease, but were unsure of their children's risk. They were interested in vaccination and were comfortable with a school-based vaccination if conducted under the supervision of trained and qualified staff. Teachers and leaders needed information on typhoid fever, the vaccine, procedures, and sponsors of the vaccination program. Meetings were considered the best form of information dissemination, followed by printed materials and mass media. This study shows how qualitative research findings can be translated into an effective social mobilization and communication approach. The findings of the research indicated the importance of increasing awareness of typhoid fever and the benefits of vaccination against the disease. Identification and dissemination of relevant, community-based disease and vaccination information will increase demand and use of vaccination.