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Pulmonary hypertension (PH) is a threatening condition, and it is far more common than previously assumed, especially after the COVID pandemic. Its outcome is not good; if detected late, and can lead to right ventricular failure, which can be fatal. Our goal was to evaluate CT signs of PH, correlate them with echocardiography, and identify the cut-off values of these signs in our population. In this study, 160 patients having both CT and echocardiography with a maximum gap of one month were assessed from June to November 2021. The association between CT signs and echocardiography to diagnose PH was investigated. The Pearson and Spearman correlation and area under receiver operating curve (AUROC) tests were performed in the analysis. Receiver operating characteristic curve analysis was also used to assess CT's diagnostic capability and cut-off values. The correlation between main pulmonary artery (MPA) diameter and main pulmonary artery to aorta ratio (MPA/AO) with mean pulmonary artery pressure (mPAP) was weak but statistically significant (r = 0.316 and r = 0.321, p0.001). However, there was a very weak correlation between the right and left pulmonary artery and mPAP with correlation coefficients (r) of 0.155 and 0.138, respectively. For the first time in our population, we measured the cut-off values of MPA and MPA/AO ratios for PH which were 26 and 0.88 mm, respectively. The CT signs of PH correlate with echocardiography; however, should not be used solely; the cut-off values should be used according to race and population.

Background Non-alcoholic fatty liver disease (NAFLD) has been rising worldwide due to the rising public health threat of metabolic syndrome. Because non-alcoholic steatohepatitis can proceed to liver fibrosis and cirrhosis, early identification and monitoring are critical for management. For the examination of NAFLD, greyscale ultrasound has been frequently employed. A relatively new technique, attenuation imaging (ATI), can quantitatively evaluate and compute the attenuation coefficient (AC). Our goal was to evaluate the performance and cutoff values of attenuation imaging to identify hepatic steatosis. As a reference standard, greyscale ultrasound was employed. Method A total of 207 patients were assessed from June to November 2021 after getting informed consent. The association between ATI values and greyscale grading to diagnose hepatic steatosis was investigated, and the Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the data. In the analysis, the Spearman correlation and area under the receiver operating characteristic curve (AUROC) tests were performed. Receiver operating characteristic curve analysis was also used to assess ATI's diagnostic capability and cutoff values. Result The correlation between ATI values and hepatic steatosis grades on greyscale was statistically significant (p0.05). Greyscale grading and ATI levels have a correlation coefficient (r) of 0.85, indicating a strong association. Steatosis grades 1, 2, and 3 had threshold ATI values of 0.65, 0.73, and 0.96 dB/cm/MHz, respectively. According to greyscale, the diagnostic ability of ATI for steatosis grades 1, 2, and 3 were 0.948 (95% CI: 0.917-0.979), 0.978 (95% CI: 0.961-0.995), and 1.000 (95% CI: 1.000-1.000), respectively. Conclusions Attenuation imaging is a reliable method for identifying liver steatosis, with great performance and a strong association with the greyscale ultrasound.

Introduction Fine-needle aspiration (FNA) is a well-recognized procedure for the diagnosis of thyroid nodules, with the advantage of being safe and inexpensive. Fine-needle aspiration cytology (FNAC) is mainly performed for nodules showing suspicious sonographic features that may require thyroidectomy. Even when FNAC is performed under sonographic guidance, the cytological specimen obtained may be inadequate, leading to a non-diagnostic outcome. The aim of this study is to determine the sonographic and technical factors influencing the outcome of FNAC. Material and methods This cross-sectional study was conducted prospectively at the radiology department, Dr. Ziauddin Hospital, Karachi, from January 1, 2019, to December 31, 2020. This study was approved by the Ethical Review Committee (ERC) of Ziauddin University. All the patients undergoing ultrasound (US)-guided FNAC of thyroid nodules were included. Patients with a history of previous thyroid surgery, very large thyroid lesions (>5 cm), and those with adjacent soft tissue pathology obscuring the assessment of thyroid nodules were excluded from this study. Result Out of 176 nodules studied, 14 were non-diagnostic and 162 were diagnostic. A 22G needle was used in most of the patients, i.e. 102 (57.3%), which demonstrated no relationship with the non-diagnostic results. According to Bethesda, 136 (77.3%) patients were benign, 22 (12.5%) had lesions with atypia/follicular lesions of undetermined significance, 14 (8%) were non-diagnostic and four (2.3%) were suspicious for malignancy. A subset, including 76 nodules, was categorized according to Thyroid Imaging Reporting and Data System (TIRADS) as follows: 28 (36.8%) nodules were moderately suspicious, 24 (31.6%) were mildly suspicious, 20 (26.3%) were not suspicious, and four (5.3%) nodules were benign. It was also observed that none of the hypoechoic nodules yielded non-diagnostic cytology. Conclusion This study concludes that radiologists must be aware of the technical details, cytologic preparation, and procedure-related complications associated with US-guided FNA to optimize patient care and the diagnostic outcome.

The prediction of bony involvement of the mandible in oral Squamous Cell Carcinoma (SCC) by taking imaging scans prior to surgery is an important issue. The objective of our study was to determine the diagnostic accuracy of Multiple Detector Computed Tomography (MDCT) in detecting mandibular involvement in oral SCC, using histopathology, which is considered the gold standard in this field. A cross-sectional validation study was conducted in the Department of Radiology, Abbasi Shaheed Hospital (Karachi, Pakistan), from July 2017 to June 2018. Nonprobability consecutive sampling was used to select 75 patients with oral SCC who were referred to the Department of Radiology. MDCT was performed, and lesions were assessed for detection of mandibular invasion and confirmed by histopathology. Diagnostic validation [sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of MDCT] was carried out using histopathology. Data were analyzed using SPSS version 21.0 (SPSS Inc., IBM Corp., Armonk, NY, USA). Overall, 65.3% (49) of participants were males, whereas 34.7% (26) were females. MDCT correctly diagnosed 46 of 48 cases with mandibular involvement and correctly excluded mandibular invasion in 26 of 27 cases without invasion. The sensitivity and specificity of MDCT for detecting mandibular involvement were 95.83% and 96.42%, respectively, and the PPV and NPV of MDCT were 97.87% and 92.85%, respectively. Thus, MDCT proved to be a sound modality in early diagnosis of mandibular involvement in oral cavity SCC, paving the path for early detection and treatment.

Background and objectives The high cost of video-assisted transthoracic procedures precludes their use in the diagnostics of mediastinal masses in low- and middle-income countries (LMICs). This study aims to assess the technical success rate and diagnostic yield of ultrasound-guided transthoracic mediastinal biopsies at a tertiary care hospital. Methods This descriptive cross-sectional study was conducted in patients presenting with mediastinal masses referred to radiology services at Dr. Ziauddin University Hospital. Karachi, Pakistan. Ultrasonography was performed using Toshiba Xario 200 & Aplio 500 using convex and linear probes accordingly. Biopsy was performed using a combination of 18G semiautomatic trucut and 17G co-axial needles. Complications and overall diagnostic yields were determined. Results In all 70 patients referred, the procedure was completed successfully with an overall procedural yield of 95.7%. Inconclusive biopsies due to inadequate specimen were seen in two (4.2%) patients. No post-procedure major complication or mortality was observed. Minor complications were seen in three (4.2%) out of 70, including hematoma (

Introduction Hepatobiliary tree variant anatomy is crucial to understand the preoperative planning of hepatobiliary surgeries. Although the presence of variant anatomy is not an absolute contraindication for liver transplantation, inadvertent mapping can lead to postoperative biliary complications. These variants are also important to be recognized in various hepatobiliary surgeries and interventional procedures. Magnetic resonance cholangiopancreatography (MRCP) is an excellent non-invasive imaging tool that can identify biliary anatomy. The purpose of the current study is focused on determining anatomical variants of the biliary tree on MRCP in our population visiting a teaching hospital in Karachi. Methods This cross-sectional study was conducted on patients referred to Dr. Ziauddin Hospital for MRCP. MRCP was performed on MAGNETOM Avanto, SIEMENS, Belgium, Germany. Images were analyzed on a workstation by two radiologists and a postgraduate trainee. A senior radiologist reviewed equivocal cases. SPSS 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi-square test was used to see the link between anatomical variants of biliary tree and gender. P-value of ≤0.05 was considered as statistically significant. Results We recruited 369 patients undergoing MRCP consecutively for our study. Out of 369, 342 patients were eligible for analysis (139 males and 203 females). Standard anatomy was found to be prevalent in 65.8%. Type 3 was the leading variant. A statistically significant difference was recorded for the type 2 anatomic variant which was more frequent in males than females (p-value

Introduction: Portal vein (PV) is the principal blood vessel transporting blood from the alimentary tract and spleen to the liver. The aim of this study is to determine the prevalence of PV anatomical variations in our population using multidetector CT with maximum intensity projection (MIP) technique at a tertiary care hospital. Methods: This cross-sectional study was prospectively conducted from November 2018 to June 2019 in the Department of Radiology at a tertiary care hospital in Karachi. After informed consent, all the patients with no known hepatic pathology undergoing routine abdomen CT were included in this study. Patients with previous hepatic resection surgeries, undiagnosed large hepatic tumors/metastasis, and those with PV thrombosis were excluded. Results: A total of 500 patients (256 males and 244 females) were included in the study; the mean age of female patients was relatively higher as compared to the male patients (53.80 ± 18.44 vs. 44.15 ± 19.94 years; p = 0.000). Standard PV anatomy (type 1) was found in 438 patients (87.6%). Trifurcation (type 2) occurred in 18 patients (3.6%). Right posterior portal vein as the first branch of main PV (type 3) was found in 22 patients (4.4%). A separate branch of the right portal vein (RPV) to segment VII (type 4) and separate branch of the RPV to segment VI (type 5) were found in 6 (1.2%) and 16 (3.2%) patients, respectively. Conclusion: Our study displayed a relatively higher frequency of standard PV anatomy (type 1) compared to previous studies. We highlight the role of MIP in the analysis of hepatic venous anatomy with its utility demonstrating improved detection of variations.

Objective: To determine diagnostic accuracy of quadruple phase helical computed tomography scan in detection of hepatocellular carcinoma in individuals with hepatitis B and C, keeping histopathology as the gold standard. Methods: A cross-sectional study was performed in the Radiology and Imaging department of a tertiary care university hospital during 2014 to 2016. All serologically positive patients were included. Quadruple phase computed tomography scan was done and results were interrelated with histological diagnosis. Results: Hepatocellular carcinoma was accurately diagnosed in 76 out of 80 patients using Quadruple phase computed tomography scan (sensitivity, 95%). It was correctly excluded in 70 of 72 patients (specificity, 97.2%). The overall diagnostic accuracy of Quadruple phase computed tomography scan for diagnosing hepatocellular carcinoma was 96.05%. The positive and negative predictive values were 97.4% and 94.59% respectively. Conclusion: Quadruple phase computed tomography is more effective in evaluating hepatocellular carcinoma than conventional biphasic and triphasic computed tomography scans. We propose it as the technique of first preference for imaging workup in patients with Hepatitis B and C.

Waseem Mehmood Nizamani,1 Fatima Mubarak,1 Muhammad Danish Barakzai,1 Muhammad Saad Ahmed2 1Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan, 2Department of Radiology, Ziauddin University Hospital, Karachi, Pakistan Objective: The objective of the study was to assess magnetic resonance (MR) planimetric measurements and MR parkinsonism index (MRPI) in differentiating progressive supranuclear palsy (PSP) from Parkinson’s disease (PD) using 1.5 and 3 T MRI scanner. Subjects and methods: After ethical approval was obtained, analysis of 34 consecutive patients with PSP, 34 patients with PD and 34 healthy controls (HCs) was performed. HCs were age-matched adults without any history of neurodegenerative disease or movement disorders. Retrospective data from the past 10 years (from January 2006 to December 2015) were obtained from the Hospital Information Management System, and informed consent was obtained from all participants. The measurements of pons area–midbrain area ratio (P/M) and MCP width–superior cerebellar peduncle (SCP) width ratio (MCP/SCP) were used, and MRPI was calculated by the formula ([P/M]×[MCP/SCP]). Results: Midbrain area and SCP width in patients with PSP (19 males, 15 females; mean age =66.7 years) were significantly (P

Since the outbreak, COVID-19 (SARS-CoV-2) has affected more than 24 million people. COVID-19 pandemic appears to lack any effective antiviral drug or vaccine therapy. Previously, it has been reported that medicinal plants are effective against pneumonia caused by coronavirus (SARS-CoV). Secondary metabolites derived from medicinal plants also play pivotal role in strengthening the immune system as well as the killing of pathogens or viruses. The present review summarized the medicinal plants and their secondary metabolites that have antiviral potentials. Further studies are required to evaluate these medicinal plants and their secondary metabolites for possible treatment of COVID-19.

To assess normal venous anatomy of the cranium and its anatomical variants.This retrospective study was conducted at Radiology Department of Dr. Ziauddin Hospital, Karachi, and comprised data of patients aged 2-75 years and having undergone magnetic resonance imaging of brain from April 2015 to April 2016. Magnetic resonance venography was reviewed to evaluate the cerebral venous system. All magnetic resonance venography examinations were performed using a contiguous two-dimensional time-of-flight venography technique, and were reviewed by two consultant radiologists..Out of 204 patients, 96(47.05%) were males and 108(52.94%) were females. Overall Magnetic Resonance Venography examinations were found to be normal in 94(46.07%), patients, while 110(53.92%) had some of the normal anatomical variants. There was presence of superior sagittal sinus and straight sinus in 204(100%) cases. Inferior sagittal sinus was seen in 179(86.05%). Transverse sinus was hypoplastic in 8(3.92%) on the right and 80(39.2%) on the left side. Hypoplastic sigmoid sinus was present in 51(25%) patients and aplastic sigmoid sinus in 2(0.98%) patients. Flow gaps were also observed in 22(10.78%) patients. Occipital sinus was identified in 17(8.3%), vein of Trolard in 98(48.03%) and vein of Labbe in 105(51.47%).Two-dimensional time-of-flight magnetic resonance venography examination was found to be a useful imaging tool showing great sensitivity in determining the normal cerebral venous anatomy.

Unilateral renal agenesis (URA) is a rare condition with a reported incidence of 0.93–1.8 per 1000 autopsies. It is commonly diagnosed as an incidental finding on imaging.URA is frequently associated with other genitourinary anomalies. Different associations have been described in both males and females, however, to our knowledge, it has not been reported with subseptate uterus (SSU) and sacrococcygeal teratoma (SCT) in the same individual. Here, we present a unique case of URA with SSU and SCT.

Mycoplasma infections are of great concern in avian medicine, because they cause economic losses in commercial poultry production of Pakistan. Timely and efficient diagnosis of the mycoplasma is needed in order to practice prevention and control strategies. A duplex Polymerase Chain Reaction (PCR) was optimized for simultaneous detection of two pathogenic species of avian mycoplasmas. Two sets of oligonucleotide primers specific for Mycoplasma gallisepticum and Mycoplasma synoviae, were used in the test. The developed assay exhibited high sensitivity and 100% specificity for the simultaneous detection of mycoplasma species prevalence in Pakistan.

To assess the diagnostic accuracy of CTscan in detecting paranasal sinus fungal infections.Cross-sectional, observational study.Department of Radiology, Ziauddin University Hospital, Karachi, from April to September 2014.Patients with clinical suspicion of fungal sinusitis were included in this study. Patients with already diagnosed or history of recurrent fungal infections were excluded. All these patients underwent CTscan examination of paranasal sinuses. Findings were recorded. Final diagnosis was based on smear analysis for fungal culture. Accuracy analysis was conducted for CTdiagnosis using smear analysis as the gold standard. Kappa analysis was conducted to determine agreement.Out of the 120 patients, 71 (59%) were male. The sensitivity, specificity, positive predictive value and negative predictive value of CTwere 96.19%, 93.33%, 99.01%, 77.77%, respectively. The diagnostic accuracy was 95.83%. Kappa statistics showed 82% agreement beyond chance.CTscan is highly accurate in diagnosing and characterizing fungal infection of paranasal sinuses. It also determines the extent of disease which eventually aids in deciding the surgical approach to be used.

The Transporter Classification Database (TCDB), freely accessible at http://www.tcdb.org, is a relational database containing sequence, structural, functional and evolutionary information about transport systems from a variety of living organisms, based on the International Union of Biochemistry and Molecular Biology-approved transporter classification (TC) system. It is a curated repository for factual information compiled largely from published references. It uses a functional/phylogenetic system of classification, and currently encompasses about 5000 representative transporters and putative transporters in more than 500 families. We here describe novel software designed to support and extend the usefulness of TCDB. Our recent efforts render it more user friendly, incorporate machine learning to input novel data in a semiautomatic fashion, and allow analyses that are more accurate and less time consuming. The availability of these tools has resulted in recognition of distant phylogenetic relationships and tremendous expansion of the information available to TCDB users.