Perception of students and teachers regarding the attributes of an effective clinical teacher in dentistry: A cross-sectional analytical study.

Objective: To compare the perception of dental students and faculty members regarding the attributes of effective clinical teachers. METHODS: This cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, from August 2021 to November 2021, and comprised of third and final year dental students and associated clinical faculty members from three dental colleges in the city. Data was collected using the modified version of a pre-validated questionnaire. Data was analysed using SPSS 25. RESULTS: Of the 200 students approached, 169(84.5%) responded; 135(79.9%) females and 34(20.1%) males with mean age 21.78±1.099 years (range: 19-26 years). Of the 59 teachers approached, 49(83%) responded; 33(67.3%) females and 16(32.7%) males with mean age 31.59±5.041 years (range: 23-49 years). The students found record-keeping a tiresome task 69(42%), while teachers regarded it essential for clinical development. Unlike teachers, the students were unable to identify the relevance of clinical objectives and they also did not appreciate teachers' involvement in clinical procedures. For other domains regarding personal traits, teaching methods and clinical skills, both groups had similar responses. Conclusion: There was generally a similarity of opinions among students and teachers regarding the essential qualities of effective dental clinical teaching.

Utility of instant messaging application, WhatsApp, as a tool to augment post-graduate radiology education.

BACKGROUND: Smart phone technology including different instant messaging applications like, WhatsApp, can be used for the development of radiological skills, reporting, and performance. To determine the utility, attitude, and outcome of WhatsApp for augmenting education in FCPS radiology residency program. To assess the opinion of radiology residents regarding WhatsApp as a tool to enhance postgraduate training. METHODOLOGY: A mixed method (qualitative and quantitative) was conducted at Dow Institute of Radiology, Karachi, Pakistan. All FCPS Radiology residents were given a radiological case by principal investigator followed by residents' response in 24 h. Key findings were shared by the mentor. Before and after the intervention of WhatsApp, all residents were evaluated with written and radiological imaging reporting exam. For quantitative analysis, a closed ended questionnaire was used containing information about total number of messages, images, webpage links shared, level of contribution (active/non-active), and utility (contribution in education related topic only). A feedback form with Likert scale was also got filled by all residents. For qualitative research, semi structured interviews (SSIs) were conducted. RESULTS: Median number of total images shared were 293 (IQR 1002 images), messages shared 110 (IQR), webpages shared were 54 webpages (61 webpages) and total contents shared by participants was 243 (544 contents). Active contributors showed better performance in utility, competency of contents and attitude towards using social media as a medium for learning. Comparison of written and OSCE results showed better performance after the intervention. Feedback form with Likert scale revealed that students responded positively regarding the shared learning content. Thematic analysis showed 52 codes and 16 themes. CONCLUSION: In this research we have observed that WhatsApp is highly efficient and productive academic tool which can amplify postgraduate radiology education. Student's narrative reflects that residents have found the missing link which can take them to radiological professional excellence through targeted high-profile learning outside lecture hall in time and place convenient motivational environment. Once it will be blended with existing teaching strategy, it can prove to be a game changer.

Utility of the serial portable chest x-ray for the diagnosis and quantification of COVID-19 patients.

Objective: To determine the role of the serial portable chest X-ray in the diagnosis and quantification of patients with confirmed COVID-19 admitted to a tertiary care hospital. Methods: A retrospective study was conducted at Dow Institute of Radiology, Dow University of Health Sciences. Confirmed positive cases of COVID-19 from November 2020 to January 2021 were retrospectively studied. Patients' demographics and clinical characteristics, chest X-ray findings, and outcomes were retrieved through electronic medical records. Baseline and final follow-up chest X-rays findings were compared by using chest X-ray severity score. Multivariable logistic regression was used to evaluate the relationship between patients' characteristics and patient outcomes. Results: The study included 329 patients with a mean age of 56.43 ± 13.10 years (range 16-85 years). Peripheral consolidation and ground glass opacities (89.4%) were the most common X-ray findings followed by bilateral lung involvement (79.0%) and perihilar consolidation/ground glass opacities (69.9%). Among the patients who were admitted, 61.4% were discharged, 49.5% had prolonged length of stay ≥10 days, and 37.7% died. After adjustment of all patients' characteristics, the multivariate model showed no significant difference in chest X-ray severity score in relation to the patient's outcome. Patients who were admitted to the intensive care unit, and received oxygen support, bilevel positive airway pressure, and a ventilator were significantly associated with the outcome of being discharged, prolonged hospital stay, and death. Conclusion: Peripheral consolidation and ground glass opacities were the most common chest X-ray findings in admitted COVID-19 patients. No significant difference in chest X-ray severity score was noted in the primary outcome of being discharged, prolonged hospital stay, and death. There is no requirement for daily chest X-rays in hospitalized patients until required in the condition of worsening symptoms or significant intervention such as endotracheal intubation.

Positive predictive value of Birads IV Lesions on mammogram in detection of breast carcinoma.

OBJECTIVE: To determine the positive predictive value of Breast Imaging Reporting and Data System category IV lesions, and to evaluate interobserver agreement among radiologists in interpreting the subcategories. Method: The cross-sectional study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 2018 to February 2019, and comprised adult females aged 30-60 years diagnosed with Breast Imaging Reporting and Data System IV. Already diagnosed breast carcinoma patients were excluded. The positive predictive value of Breast Imaging Reporting and Data System category IV was calculated using histopathology findings as the gold standard. Data was analysed using SPSS 22. RESULTS: There were 191 patients with a mean age of 49.01±11.79 years. Positive family history of breast cancer was found in 33(17.3%) subjects. Category IV-A was noted in 53(28.0%) subjects, IV-B in 45(23.6%) and IV-C in 93(48.7%). The overall positive predictive value of category IV was 151(79.1%), IV-A 27(50.9%), IV-B 35(77.7%) and IV-C 89(95.6%). Malignant disease was significantly associated with architectural distortion and suspicious microcalcifications (p<0.001). A good agreement was observed in the categorisation of Breast Imaging Reporting and Data System category IV between observers 1 and 2 (kappa 0.85, 95% confidence interval: 0.70-0.99), between observers 1 and 3 (kappa 0.77, 95% confidence interval: 0.61-0.94), and between observers 2 and 3 (kappa 0.63, 95% confidence interval: 0.43-0.83). CONCLUSIONS: Breast Imaging Reporting and Data System BI-RADS IV was found to have a high positive predictive value in the diagnosis of breast cancer. Besides the interobserver agreement in terms of identifying BI-RADS IV subcategories was good.

Radiological profile of patients undergoing Chest X-ray and computed tomography scans during COVID-19 outbreak.

BACKGROUND & OBJECTIVE: Radiology has played a significant role in the diagnosis and quantifying the severity of COVID 19 pulmonary disease. This study was conducted to assess patterns and severity of COVID-19 pulmonary disease based on radiological imaging. METHODS: A prospective observational study was conducted in a large tertiary care public sector teaching hospital of Karachi, Pakistan from June 2020 till August 2020. All confirmed and suspected COVID-19 patients referred for chest X-rays and computed tomography (CT) scans were evaluated along with RT-PCR results. Suspected patients were followed for RT-PCR. Radiological features and severity of imaging studies were determined. RESULTS: Of 533 patients in whom X-rays were performed, majority had severe/critical findings, i.e., 304 (57.03%). Of 97 patients in whom CT scan was performed, mild/moderate findings were observed in 63 (64.94%) patients. Of 472 patients with abnormal X-rays, majority presented with alveolar pattern 459 (97.2%), bilateral lung involvement 453 (89.6%), and consolidation 356 (75.4%). Moreover, lobar predominance showed lower zone preponderance in 446 (94.5%) patients. Of 88 patients with abnormal CT findings, ground-glass opacity (GGO) 87 (98.9%) and crazy paving 69 (78.4%) were the most common findings. An insignificantly higher association of PCR positive cases was observed with severe/critical X-rays (p-value 0.076) and CT scan findings (p-value 0.431). CONCLUSION: Most common patterns on CT scans were GGO and crazy paving. While on chest radiographs, bilateral lung involvement with alveolar pattern and consolidation were most common findings. On X-rays, majority had severe/critical whereas CT scan had mild/moderate findings.

Analysing the impact of global demographic characteristics over the COVID-19 spread using class rule mining and pattern matching.

Since the coronavirus disease (COVID-19) outbreak in December 2019, studies have been addressing diverse aspects in relation to COVID-19 and Variant of Concern 202012/01 (VOC 202012/01) such as potential symptoms and predictive tools. However, limited work has been performed towards the modelling of complex associations between the combined demographic attributes and varying nature of the COVID-19 infections across the globe. This study presents an intelligent approach to investigate the multi-dimensional associations between demographic attributes and COVID-19 global variations. We gather multiple demographic attributes and COVID-19 infection data (by 8 January 2021) from reliable sources, which are then processed by intelligent algorithms to identify the significant associations and patterns within the data. Statistical results and experts' reports indicate strong associations between COVID-19 severity levels across the globe and certain demographic attributes, e.g. female smokers, when combined together with other attributes. The outcomes will aid the understanding of the dynamics of disease spread and its progression, which in turn may support policy makers, medical specialists and society, in better understanding and effective management of the disease.

Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas.

OBJECTIVE: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detection of intra-axial gliomas in suspected cases keeping histopathology as gold standard. METHODS: This cross-sectional study was conducted at Dow Institute of Radiology, DUHS from October 2017 - April 2018. Patients of either gender aged 30-70 years presenting with headache were included. Patients already diagnosed and referred for follow up were excluded. MRI was performed on 1.5T scanner by a trained MRI technician. T1, T2, FLAIR, diffusion weighted and T1 post contrast images were acquired and reviewed by two radiologists having more than five years post fellowship experience. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI for intraaxial gliomas was calculated taking histopathology findings as gold standard. RESULTS: Mean age of the patient`s was 51.71 ±10.85 years. Positive intraaxial gliomas on MRI were observed in 123 (79.90%) patients while on histopathology, positive intraaxial gliomas were observed in 131 (85.10%) patients. Diagnostic accuracy of MRI in detection of intra-axial gliomas taking histopathology findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 89.31%, 73.91%, 95.12%, 54.84% and 87.01%. CONCLUSIONS: MRI has high sensitivity, moderate specificity and high diagnostic accuracy in detection of intraaxial gliomas.

Diagnostic accuracy of ultrasound in evaluation of obstructive jaundice with MRCP as gold standard.

OBJECTIVE: To evaluate the diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP as gold standard. METHODS: This cross-sectional study was conducted at Dow Institute of Radiology (DIR), Dow University of Health Sciences (DUHS), Karachi from 2nd May 2018 till 2nd November 2018. Both male and female patients aged 30 to 80 years with suspected obstructive jaundice were included. Patients already diagnosed with obstructive jaundice were excluded. MRCP and ultrasound were performed in suspected patients. Diagnostic accuracy including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of obstructive jaundice were calculated using contingency tables using MRCP findings as gold standard. RESULTS: Mean age of the patients was 54.73 ± 12.65 years. In causes of obstruction, choledocholothiasis was responsible for 85 (35.1%), stricture 61 (25.2%), carcinoma of head of pancreas 39 (16.1%), periampullary carcinoma 21 (8.7%), cholangiocarcinoma 10 (4.1%) and gallbladder carcinoma 26 (10.7%) of the cases. Diagnostic accuracy of ultrasound in obstructive jaundice taking MRCP findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 84.57%, 79.10%, 91.36%, 66.25% and 83.06%. CONCLUSION: Ultrasound has a high sensitivity, moderate specificity, and high diagnostic accuracy in diagnosis of obstructive jaundice.

CT-Based Evaluation of Diffuse Idiopathic Skeletal Hyperostosis in Adult Population; Prevalence, Associations and Interobserver Agreement.

Diffuse idiopathic skeletal hyperostosis (DISH), being an asymptomatic condition, is generally discovered incidentally on imaging and it has not received much attention for research on clinical grounds. We assessed the prevalence of DISH, its associated factors, and interobserver agreement for computed tomography (CT)-based diagnosis of DISH. CT scans of chest, abdomen, and pelvis performed for various clinical indications were retrospectively reviewed. Resnick criteria were used for the diagnosis of DISH. Moreover, enthesopathy along with comorbidities was assessed. CT scans were observed by 3 observers having different experience levels. Out of total 416 patients, the prevalence of DISH was 30.8%. Strong positive agreement was observed between observer 1 and 2 (k = 0.89), observer 1 and 3 (k = 0.91), and observer 2 and 3 (k = 0.94). Reporting rate of DISH was 59.3%. Regression analyses showed that enthesopathy was 2.45 times (adjusted odds ratio [AOR]: 2.45, 95% confidence intervals [CI]: 1.48-4.05), diabetic patients were 4.74 times (AOR: 4.74, 95% CI: 2.89-7.78) while hypertensive patients were 2.17 times (AOR: 2.17, 95% CI: 1.30-3.62) more likely to have DISH in comparison to those who do not have DISH. A high prevalence of DISH was observed in our cohort. Enthesopathy and comorbidities like diabetes and hypertension were significant factors associated with DISH. Moreover, excellent agreement was observed in defining DISH on CT according to Resnick criteria.

Diagnostic accuracy and associated complications of percutaneous computed tomography guided core needle biopsy of pulmonary lesions using coaxial technique.

This study was conducted to determine the diagnostic accuracy of CT-guided core needle biopsy (CNB) using coaxial technique of pulmonary lesions, its complications and factors affecting them. A total of 122 patients with suspected lung malignancy underwent CT-guided CNB. Final diagnosis was confirmed by histopathology. There were 84 (89.4%) true positive while 26 (92.9%) true negative cases. Diagnostic accuracy, sensitivity, specificity, PPV, NPV, and overall diagnostic accuracy were 97.67%, 72.22%, 89.36%, 92.86% and 90.16% respectively. Pneumothorax was the only complication observed in 10 (8.2%) patients. The odds of pneumothorax was found to be 10.72 times higher among patients with 2.5cm of size of lesions (AOR 10.72, 95% CI 1.49-76.77) while 86% lower among patients having prone position (AOR 0.14, 95% CI 0.021-0.96). Results indicate that percutaneous CT guided biopsy of pulmonary lesions using coaxial technique is a safe procedure with a high diagnostic accuracy and lesser risk of major complications.

Gastrointestinal and pancreatic neuroendocrine tumours and carcinomas; a review of rare tumour type.

Neuroendocrine tumours are a rare tumour type involving neuroectodermal cells. They are also termed carcinoids. Gastroenteropancreatic system is most commonly involved. They are classified as low, intermediate or high grade depending upon mitotic index and Ki-67 index. Their diagnosis involves measurement of chromogranin A levels. Ultrasound is the initial imaging modality for their evaluation. Endoscopic ultrasound allows close evaluation of the tumour. Staging is commonly undertaken by computed tomography scan. These tumours typically show hyper-enhancement on arterial phase. Their metastasis to the liver also shows arterial enhancement. Small bowel carcinoids tend to have hepatic and mesenteric spread. Mesenteric spread of disease gives a characteristic spoke wheel appearance. On magnetic resonance imaging, these tumours typically appear as hypointense on T1 weighted image, hyperintense on T2 weighted image and show avid enhancement on postcontrast scan. Surgical resection is appropriate treatment with follow-up at 6-month intervals during the first year. The current review was planned to cover the aetiology, diagnosis, staging, imaging techniques, imaging features and treatment of these rare tumours that need prompt diagnosis.

Sonographic Evaluation of Normal Liver, Spleen, and Renal Parameters in Adult Population: A Multicenter Study.

OBJECTIVE: To determine the normal liver, spleen, and renal parameters in adult patients with no comorbidities. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Dow Institute of Radiology, Ojha Campus, LEJ Campus, and Al-Mustafa Hospital Karachi, from October 2016 to March 2017. METHODOLOGY: A total of 3,136 study participants with more than 16 years of age of either gender underwent ultrasound examination. All individuals with morbid conditions like hypertension (HTN), diabetes mellitus (DM), liver cirrhosis, hydronephrosis, renal cyst, and liver mass were excluded. Ultrasound scan was performed and longitudinal and transverse sections were obtained of both kidneys (in full inspiration), spleen and liver. RESULTS: A significant positive correlation was observed between age and spleen size of the individuals (r=0.053, p=0.012). The correlation of BMI and liver size was also found significantly positive (r=0.237, p <0.001). The correlation of age and kidney size was found significantly negative in between age and right kidney (r=-0.074, p <0.001) and left kidney (r=-0.087, p <0.001). Similarly, the correlation of BMI and renal size was found significantly weak positive between BMI and right kidney (r=0.206, p <0.001) and BMI and left kidney (r=0.227, p <0.001). CONCLUSION: BMI was found significantly positively correlated with liver size and both kidneys in study participants. Moreover, spleen was found directly and renal size inversely correlated with age of the individuals.

Massive Osteolysis in Distal Shaft of Humerus: A Case Report on Vanishing Bone Disease.

Gorham-Stout disease is a rare disease characterised by endothelial proliferation of lymphatics and vessels. It is also known as vanishing bone disease. Increased vascularity and proliferation lead to progressive bony osteolysis. We report a case of a 17-year female diagnosed as having post traumatic Gorham-Stout disease. Being reported for the first time from our population, this will be an informative addition to the already available literature. On X-rays, initially there is osteopenia with patchy distribution followed by coalescence of osteopenic patches, erosion of cortex with soft tissue involvement, and finally bone resorption. MRI shows increased T2 signal with heterogeneous enhancement.

Appropriateness and clinical outcome of chest computed tomography without intravenous contrast: A study conducted in Pakistan.

BACKGROUND: Chest computed tomography (CT), including high-resolution CT (HRCT), has become an integral part of modern healthcare. It enables the physician to arrive at a diagnosis using a noninvasive approach. Our practice has shown that various chest CT scans without intravenous (IV) contrast, including HRCT, have no proper clinical indication. For the same reason, we have assessed the appropriateness of chest CT without IV contrast based on the evidence-based American College of Radiology (ACR) appropriateness criteria. METHODS: Chest CT scans without IV contrast were reviewed to evaluate if the examination was based upon the evidence-based ACR appropriateness criteria. All clinical indications, positive physical examination findings, laboratory test findings, and radiological records submitted at the time of chest CT were reviewed. RESULTS: Of 1205 CT scans, 538 (44.6%) were considered "inappropriate," 367 (30.4%) were considered "appropriate," and 300 (24.8%) were considered "may be appropriate." CT scans were performed on 241 (20.0%) patients with no clinical history, whereas 148 (12.3%) examinations in patients aged < 40 years were performed with no positive physical finding. Positive results that affected the management were 4.43 times more likely to be considered appropriate than inappropriate (adjusted odds ratio, 4.43; 95% confidence interval, 1.81-10.87). CONCLUSIONS: This study showed a high percentage of chest CT scans without IV contrast examinations not meeting the ACR appropriateness criteria. Chest CT is a valuable tool for evaluation of chest diseases only in the presence of adequate detailed history and physical examination.

Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging.

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases. OVERVIEW OF LITERATURE: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery. METHODS: All patients aged 11-90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation. RESULTS: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p<0.001). CONCLUSIONS: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.

Role of Multidetector Computed Tomography in Evaluation of Ovarian Lesions in Women Clinically Suspected of Malignancy

Objective: To determine the diagnostic accuracy of multidetector computed tomography (MDCT) in the evaluation of ovarian carcinoma using histopathology as the gold standard. Methods: This prospective cross-sectional study was conducted at Department of Radiology, Dow international medical college, DUHS, Karachi from December 2015 to April 2016. All patients of 30-60 years of age who were referred for CT a scan of the abdomen and pelvis with clinical suspicion of malignant ovarian cancer were included. A total of 158 cases were assessed with signs and symptoms of weight loss and an abdominal or pelvic mass detected on examination by a physician. Results: The mean age was 42.7 ±10.3 years (range 30-60). The largest group (46, 29.1%) presented with Stage 0 disease. The mean duration of symptoms was 4.06 ±1.39 months (range 1-6). Taking histopathology as the gold standard the sensitivity, specificity, NPV, PPV and overall diagnostic accuracy values for MDCT were 95.6%, 97.3%, 93.5%, 97.3% and 96.8%, respectively. Conclusion: MDCT showed high accuracy in differentiating benign and malignant lesions and as well as staging of malignant cases which should be very helpful in management of ovarian disease.

Facture of the Pars Interarticularis with or without Spondylolisthesis in an Adult Population in a Developing Country: Evaluation by Multidetector Computed Tomography.

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography. OVERVIEW OF LITERATURE: There is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries. METHODS: A retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis. RESULTS: Of 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p<0.001 and 53.01±15.31 vs. 42.44±15.88, p<0.001, respectively). Gender was significantly associated with spondylolisthesis (p=0.029) but not spondylolysis. Of patients who were >60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females. CONCLUSIONS: The prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.

Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan.

PURPOSE: In patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography. MATERIALS AND METHODS: A retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of <25 cm/s were considered to have arterial insufficiency, while an end diastolic velocity of >5 cm/s was considered to indicate venous incompetence. RESULTS: Out of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022). CONCLUSIONS: A majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.

Relationship of Oral Tumor Thickness with the rate of lymph node metastasis in Neck based on CT Scan.

OBJECTIVE: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan. METHODS: A total of 58 oral squamous cell carcinoma patients having the median age of 46 (39-55) years. with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test. RESULTS: Median age of the patients was 46 (39-55) years with preponderance of male gender, i.e. 48 (82.8%). Strong positive significant correlation was observed in between transverse dimension (TS) tumor size and stages of tumor (rho 0.673, p-value <0.001), Anterioposterior (AP) tumor size and stages of tumor (rho 0.675, p-value <0.001), and Craniocaudal (CC) tumor size and stages of tumor (rho 0.771, p-value <0.001). CONCLUSION: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm.