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Background: Choledocholithiasis denotes to the presence of gallstones within the common bile duct. In patients with Gall stones, the precise incidence and prevalence of choledocholithiasis are not known, but it has been estimated that 5–20 percent of patients have choledocholithiasis at the time of cholecystectomy, with the incidence increasing with age. The transabdominal ultrasound examination (US) is the most commonly used modality for symptoms attributable to gallstone disease. US can provide important evidence for presence of stones in CBD. Methods: This was a descriptive cross-sectional validation study which was conducted at PAEC General Hospital, Islamabad from February to July 2015. Patients with suspected choledocholithiasis attending radiology department for ultrasound abdomen were included in the study. Findings for dilatation of common bile duct, intrahepatic biliary channel dilatation and direct visualization of calculus in CBD were noted. Ultrasound findings were compared with subsequent ERCP which was considered gold standard. Results: Diagnostic accuracy of trans abdominal ultrasound in detection of choledocholithiasis came out to be 76.9% with sensitivity of 76.2% and specificity of 81.3%. Conclusion: Ultrasound can be used as an initial and baseline tool for detection of CBD calculi as it is non-invasive, easily available, radiation free and cost effective. [ABSTRACT FROM AUTHOR]

The main objective of this paper is to understand and analyse the significance of sustainability and resilience in the recent development of Pakistan's Energy Sector. In addition to this, the paper aims to analyze what role the energy sector is playing in the economic development of the country. In contrast to quantitative research approach which mainly focuses on numbers and facts, this paper applies a qualitative research design on the said matter. Based on a proposed conceptual thematic framework, underlying the concept of climate change and adaptability (resilience), the contributions of the energy sector is explored. This included understanding the perception of some key stakeholders and how they expect global and national developments to the sector. More than fifteen stakeholders belonging to private investors, Government and Public were interviewed in the context of this study. Each of them represented senior management opinion and perspective on the issues faced by the sector and the future plans for them. [ABSTRACT FROM AUTHOR]

Gastroparesis being multifocal abnormality is characterized by objective feeling of prolong time of gastric retention without any evidence of anatomical blockage. The key symptoms include early satiety, feeling of fullness after meals, nausea, vomiting, bloating, and upper abdominal pain. Radio isotopic Gastric emptying study using radiolabelled test food is integrated clinically for evaluation of functional gastric motility disorders. We present a young female having abdominal pain and vomiting for two months. She was investigated for anatomical causes and no abnormality was uncovered. Gastric Emptying scintigraphy revealed delayed lag phase and half gastric emptying time consistent with the diagnosis of Gastroparesis.

Myocardial perfusion imaging (MPI) is a powerful diagnostic and prognostic tool for evaluating coronary artery disease (CAD). Gating myocardial perfusion gives important diagnostic and prognostic information. This 43 years old patient was referred for cardiac scan. Exercise stress test showed > 2 mm horizontal ST segment depression. Cardiac scan was normal except for left ventricular cavity dilatation on stress images. Gated images showed global hypokinesia and increased end-diastolic volume. Patient was suspected to have balanced ischemia and was referred for Angiography. Angiography showed total occlusion with no flow in proximal Left Anterior Descending Artery and distal circumflex artery. It is very important to evaluate symptomatic patients and patients with risk factors carefully with normal myocardial perfusion scan.

Primary Hyperparathyroidism (HPT) is an inappropriate hyper secretion of parathyroid hormone (PTH). Primary HPT is caused by parathyroid adenoma in 80-85% of patients. Clinical manifestations are kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. Ultrasonography is widely used in suspected cases for localization of parathyroid adenoma. There is considerable intra-observer variation and it is difficult for ultrasound alone to differentiate parathyroid lesion form that of thyroid. Dual phase Tc-99m MIBI scinitigraphy for detection of parathyroid adenomas has sensitivity and specificity values ranging from 82% to 100% and from 89% to 100%, respectively. Percutaneous ethanol injection for parathyroid glands can be applied effectively in selected cases when surgery is unadvisable either for technical reasons (e.g., recurrence ofhyperplastic glands in the neck after subtotal surgery or intrathyroideal parathyroid tumors or the poor clinical state of the patient.