Search

Objective: To determine diagnostic accuracy of MRS for diagnosis of malignant brain lesions taking histopathology as gold standard. Study Design: Cross Sectional Validation study. Setting: Department of Radiology, Lahore General Hospital, Lahore. Material & Methods: A total number of 127 patients who were referred for the diagnosis of focal brain lesions were included. In all patients, MRS was done by consultant radiologist to diagnose malignancy. All patients underwent surgery in the neurosurgery department and after surgery biopsy specimen were taken for diagnosis of malignancy using histopathology findings. Results: Mean age of patients was 40.88±11.37 years. There were 88 (69.29%) males and 39 (30.71%) female patients. On MRS, malignancy was diagnosed in 99 (77.95%) patients and on histopathology malignancy was diagnosed in 102 (80.31%) patients. Regarding diagnostic accuracy, MRS was 97.00% sensitive, 94.10% specific, with PPV of 78.60% and NPV of 88.00%. Conclusion: Magnetic resonance spectroscopy (MRS) has good sensitivity and specificity in differentiating neoplasm from non-neoplastic focal brain lesions.

Preocclusive stenosis of the common carotid artery is a rare and potentially life-threatening entity, and the early recognition of associated internal and external carotid artery patency is important for the management plan. The patient in this case report was sent for a thyroid ultrasound for complaints of neck pain, voice change, and dysphagia, and a preocclusive stenosis of the left common carotid artery was found. Multiple collateral pathways had developed to supply blood flow to the left internal carotid artery, and there was retrograde flow in the external carotid artery and antegrade flow in the internal carotid artery. Collaterals from the left thyrocervical trunk were supplying the superior thyroid artery which supplied the external carotid artery and finally the internal carotid artery through the carotid bulb. Doppler ultrasound is valuable in the identification of preocclusive common carotid artery stenosis and mapping of collateral pathways.

Obesity is a disease and acts to develop myriad of clinical condition. Along with causing other diseases it renders difficulties in some physical and imaging examination of obese patients as a challenge. Therefore, the consistency of results has a great deal of variation for sonographer. Objective: Study was aimed to evaluate the interobserver agreement in the fetal biometry among normal and obese mothers. Methods: The study includes obese and normal pregnant females with single alive without any anomaly or growth retardation fetus. Low frequency convex array transducer is used. Total 140 Patients were included and categorized according to BMI. Inter item correlation, ICC and CRC were calculated for all variables. Bland-Altman plots were constructed. T-test was applied p-value 0.05 considered significant. Results: It was observed that the variation in normal and obese pregnant ladies in third trimester is not significant and a strong agreement between the observers in both normal and obese. Conclusion: Obesity causes many problems in sonographic fetal biometry. It was observed that the variation in normal and obese pregnant ladies in third trimester is not significant and a strong agreement between the observers in both normal and obese categories.

Recognizing the emerging significance of the English Language as an International Link Language and its possibility to remain so, this paper traces the history of the dissemination of the English language in all through the British colonialism and make an assessment of its current status at the global level. The paper presumes the language’s bright future on the basis of its macroscopic usage and scope for neologisms. An answer to the questions like, How English language emerged as an International link language? and What were the causes that lead to the emergence of English as an International Link Language?, will be provided with an intricate analysis of the scope and importance of English as an International Link Language in the present scenario. An enlightening discussion regarding the paramount position of the English language as an internal link language of India and its influence on other languages of India will be made on the basis of the questions like, How English was introduced in India by the East India Company? How did it continue to remain the official language of India (along with Hindi) even after independence?, and Why is it widely spoken and taught as the most important foreign language? The contribution of some Indian, Pakistani and Bangladeshi writers will be scrutinized to suit the theme of the current research work.

Renal cysts are a common finding on routine ultrasound scans. Renal cysts are easily detected with ultrasound, with its low cost, non-invasiveness and no exposure to radiation, ultrasound is an exceptional method for primary evaluation of patients with cystic lesions. Most cysts detected by chance and are benign, but they can become complex if infection, bleeding, or ischemia occur. Objective: To assess the prevalence of renal cysts and find relationship with age and sex in the study group and to outline the differential diagnosis of renal cyst by ultrasonography. Methods: This was a cross-sectional descriptive study. An ultrasound examination was performed on 109 patients who were diagnosed with renal cysts. Cystic wall thickness, form, number of cysts, and acoustic enhancement were employed as sonographic criteria for evaluating renal cysts. Results: The incidence of renal cysts were more in females than in male s(52.3% vs. 47.7%). The majority of the cysts were solitary than multiple (69.7% vs. 30.3%). Most of the cysts were at lower pole cortical cysts (22.9%). Simple cyst was the most common type (90.8%), autosomal-dominant polycystic kidney disease (ADPKD) was 6.4%. 59 patients were asymptomatic and 50 patients were symptomatic with flank pain as the most common symptom. Conclusions: Simple cysts are the most frequently found kidney cysts on ultrasound. Aging and hypertension were common risk factors related with renal cysts. End-stage renal failure is caused by ADPKD, which is the most prevalent genetic cause. Diagnosis and early detection of renal cyst is important, routine ultrasound scans for adults is advisable prior to getting any serious complication.

Knee joint is among the all the body's joints that are much prone to sustains injuries. Injury to the knee ligaments followed by instability can lead to serious deformity. The diagnosis of ligament injuries is frequently performed by using magnetic resonance imaging (MRI), but the use of ultrasonography remains controversial. This article reviews the current literature regarding the viability of point-of-care knee ultrasonography (POCUS) in comparison to knee magnetic resonance imaging (MRI) for the diagnosis of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries in those individuals who have experienced sudden knee trauma. The data span from 2000 to 2022 was used for the electronic database search (PubMed, Science Direct, Google Scholar). The systematic review included all studies that evaluated the diagnostic efficacy of ultrasound (U/S) compared to MRI as the gold standard and were completely available in English. The meta-analysis reviewing the efficacy of MSK-POCUS for anterior and posterior cruciate ligament injuries includes 30 papers. The overall ultrasonography sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 76.02%, 92.77%, 92.25%, and 81.91% (95% CI), respectively. By assuring MRI as the gold standard in the diagnosis of ACL and PCL injuries, Point-of-care ultrasound (POCUS) reveals high accuracy. In individuals who have sustained acute knee injuries, the results of POCUS imaging might be serve to provide an initial diagnosis for additional pre-operative work-up.

Background: Hepatitis C is a diverse illness that causes significant death and morbidity. The hepatitis C virus infects hundreds of millions of individuals globally (HCV). More than 80% of those infected develop chronic infection; the remaining 10–20% recover spontaneously through natural immunity. Acute hepatitis is only icteric in 20% of individuals and is seldom severe. Methods: A pilot study was conducted at INOR hospital Abbottabad. Eleven hepatitis C positive and 10 hepatitis C negative participants were included in the study. Results: A significant difference correlation was found between viral load and SWE quantification for fibrosis stage in Kilo-Pascal, r= 0.904 (p-value=0.000

Background: All disturbed pattern of bleeding which arises due to different reasons such as anovulation, pregnancy, uterine abnormalities and coagulopathies is termed as abnormal uterine bleeding (AUB). Abnormal uterine bleeding is present in many forms such as heavy bleeding, short menstrual cycle, excessive and heavy menstruation, uterine bleeding at irregular period, excessive and prolonged uterine bleeding. Abnormal uterine bleeding is mostly caused by benign findings such as endometrial hyperplasia or atrophy or benign polyps. Around 5–12% of Abnormal uterine bleeding results from Endometrial Cancer. Objective: Uterine artery Doppler indices in various causes of abnormal uterine bleeding confirmed with histopathology. Methodology: A Cross-sectional Analytical study was conducted at Shireen Ultrasound Clinic Peshawar, Pakistan. This study enrolled a purposive sample of 162 patients presenting with abnormal uterine bleeding with the age between 18 to 80 years. The examination was performed with Toshiba Nemio 20(Xario Prime with TVS Probe frequency range 7-14MHz) .The Resistive index(RI), Pulsatility index(PI), mean and standard deviation were calculated for the continuous variables. Results: A total of 162 patients were enrolled in our study. The mean age of patients was recorded 38±5 years. In this study, the histopathological findings were as follow, 8.6% adenomyosis,12.3% endometrial hyperplasia, 43.3% leiomyoma’s, 17.3% polyp, 2.5% endometrial carcinoma and 16% non-specific findings so the most common cause of abnormal uterine bleeding was leiomyoma’s with mean of Right Uterine artery (U-A) PI and RI was 3.33±1.23 and 0.83±0.03 respectively and left U-A PI and RI was 2.95±1.17 and 0.84±0.03 respectively while the least common cause was endometrial carcinoma with mean of Right U-A PI and RI was 2.54±1.08 and 0.52±0.01 respectively and of Left U-A PI and RI was 1.62±0.00 and 0.52±0.00 respectively. Conclusion: From our study we concluded that the uterine artery RI in endometrial carcinoma causing abnormal uterine bleeding is low and in benign condition like polyp, hyperplasia and fibroids is high. Keywords: Uterine bleeding, Carcinoma, Fibroids, Hyperplasia, Trans-vaginal ultrasound

In her two major novels The Namesake and The Lowland Jhumpa Lahiri, a seminal South Asian Diaspora writer, traces the journey of three students (Ashoke, Subhash and Gauri) in diaspora. Ashoke and Subhash migrate to America in order to accomplish their academic goals and to have a better life opportunity, and Gauri accompanies her second husband Subhash to America and decides to continue her education. The present research work will analyse both the novels The Namesake and The Lowland to assert this argument that the journey and struggle of Ashoke and Subhash as students in diaspora is different from that of Gauri i.e. the journey of a female student diaspora is far more complicated and arduous than that of a male student diaspora. Ashoke and Subhash migrate to America at their will and with the consent of their parents who somehow take pride in the fact that their children are studying in America while the migration of Gauri to America follows a different trajectory. She is able to migrate to America only after marrying Subhash and has to topple down many patriarchal structures to secure her academic career

Shoulder impingement is the painful entrapment of the soft tissues in the shoulder outlet. Currently, dynamic sonography of the shoulder is the modality of choice for the evaluation of shoulder impingement syndrome. However, the current sonographic criteria for the evaluation of shoulder impingement is more subjective (operator dependent). And it is rather difficult for a novice observer to diagnose it. The measurable distance between acromion and greater tuberosity is during shoulder abduction is considered for shoulder impingement syndrome. Objective: To estimate the accuracy of the acromion to greater tuberosity distance in shoulder abduction as a sonographic diagnostic parameter for the shoulder impingement syndrome. Methods: Seven hundred and seventy-two shoulders were observed in this study. All the shoulders were evaluated with Toshiba Xario Prime ultrasound Unit with linear transducer 7-14MHz. Acromion to greater tuberosity distance was measured during the abducted arm. All the shoulders with measurable distance during abduction were declared as positive for impingement while unmeasurable distance due to disappearance of the greater tuberosity underneath the acromion was normal. Results: At 95% confidence interval, the sensitivity, and specificity with lower and upper limits, of the acromion to greater tuberosity distance during abduction for the diagnosis of shoulder impingement syndrome were 0.9731% (95.25 to 98.49%) and 100% (98.49 to 100%) respectively. While the positive-predictive and negative-predictive value were 100% (98.22% to 100%) and 97.12% (94.96% to 98.37%) respectively. However, the overall Accuracy at 95% confidence interval was 98.45% (97.30% to 99.20%). There was a high-grade interobserver (novice and expert) agreement in the diagnosis of shoulder impingement through this criteria with a Kappa value of 0.96. Conclusion: Sonographically measurable acromion to greater tuberosity distance in abduction is a more accurate, reliable, and objective technique for the diagnosis of shoulder impingement syndrome.

Objective: To determine the reliability of knee joint sonography in the evaluation of gouty arthritis. Methodology: A search of Google Scholar, PubMed, NCBI, MEDLINE, and Medscape databases, from 1988 up to 2020. The key search terms used were knee joint; knee joint ultrasound; gout; gouty arthritis, knee joint pain; sensitivity; specificity. The reviewer independently screened the titles and abstracts of the relevant articles and full text downloads to determine whether the inclusion or exclusion criteria were met. Results: In total, 103 articles were identified through the database search. In addition, 11 articles were identified through other sources. Then, screening was performed, and 9 articles were removed due to duplication. Further screening was done for 105 articles, and 27 articles were excluded due to insufficient information. Seventy-eight full-text articles were assessed for eligibility. A total of 13 full-text articles were excluded due to research performed on animals, as the study had been designed as a review of only human studies. Sixty-three studies were included that had a qualitative synthesis. Conclusion: The knee is a weight bearing joint and may be affected by a myriad of different pathological conditions, therefore a proper diagnosis is of prime importance for a proper management plan. Ultrasound is a non-invasive, radiation-free, and readily available modality that has high sensitivity and specificity in the evaluation of gouty arthritis.

Objective: The objective of this study was to determine the hemodynamic changes in the umbilical artery (UA) and middle cerebral artery (MCA) with oligohydramnios, during third trimester of pregnancy. Materials and Methods: A cross-sectional descriptive study was done in a perinatal ultrasound center, over a 9-month period. The participant sample size was 64, and all of the women were conveniently consented and selected for the study. All individuals were referred for obstetrical sonography in the third trimester, with oligohydramnios. All fetal anomalies, such as a neural tube defect, dwarfism, an abdominal wall defect, were excluded from the study. Results: The mean systolic to diastolic (S/D) ratio for the UA was 3.01, within a range of 1.49 to 5.60 (± 0.79 SD). The mean pulsatility index (PI), of the UA, was 1.11, within a range of 0.41 to 5.51 cm (± 0.64 SD). The mean resistive index (RI) of the UA was 0.66, within a range of 0.33 to 1.25 cm (± 0.13 SD). The mean S/D ratio of the MCA was 5.68, within a range of 2.05 to 26.10 (± 3.10 SD). The mean PI of the MCA was 1.67 within a range of 0.75 to 2.55 cm (± 0.45 SD). The mean resistive index (RI), of the UA, was 0.82 within a range of 0.51 to 1.77 cm (± 0.82 SD). Conclusion: The Doppler indices may rise as pregnancy advances, especially in fetuses with oligohydramnios. In these types of patients, the flow within the MCA may decrease, with an increase in the gestational age. Consequently, it appears that oligohydramnios may lead to vascular remodeling of the UA and MCA.

Objective: Focused assessment with sonography for trauma (FAST) is a widely used imaging technique for the diagnosis of blunt abdominal trauma and has its limitations and advantages. A meta-analysis was completed to evaluate the reliability of FAST, in the diagnosis of blunt torso trauma. Materials and Methods: A search was completed with Google Scholar, PubMed, National Center for Biotechnology Information (NCBI), MEDLINE, and Medscape databases, from 1993 up to 2020. Eligible studies were included for information about FAST examination of abdominal trauma. The animal research was excluded from this review process. The eligible studies were first categorized and then data analysis was performed, according to specific pathologic conditions. This literature review retrieved studies’ sample size, application, sensitivity, and a specificity of diagnosis using FAST for abdominal trauma. Results: In total, 100 articles were identified through the database search. Besides, five articles were identified through other sources. Then, screening was performed, and as such, 46 published studies were included that had a qualitative synthesis. Conclusion: FAST has a high sensitivity and specificity in the diagnosis of blunt abdominal trauma. However, a large range of sensitivity and specificity of FAST in the evaluation of torso trauma reveal that sonography is operator, technique, and equipment dependent.

Objective: Diabetes can lead to diabetic retinopathy, which damages the retina due to blood flow remodeling of occular vessels. Early stages of diabetic retinopathy may not present with patient symptoms. Doppler indices, of the ophthalmic arteries, could help in determining the effect of diabetic vascular remodeling. This research was designed to compare the Doppler indices, in the ophthalmic artery and central retinal artery, in both diabetic and nondiabetic patients. Materials and Methods: This was a cross-sectional observational study of 72 total patients. Sonography was performed on the ophthalmic arteries of 36 diabetics and 36 nondiabetics, to compare Doppler indices. All patients were voluntarily consented to this research that was approved by the university’s Institutional Review Board (IRB). Doppler parameters recorded were peak systolic velocity, end dystopic velocity, resistive index, and pulsatility index, which were taken in both patient groups and compared. Results: A significant difference was noted in the ophthalmic artery peak systolic velocity, end-diastolic velocity, pulsatility index, and resistive index for diabetic and nondiabetic individuals, with a statistically significant set at .01. Conclusions: There was a significant difference between diabetic and nondiabetic ophthalmic Doppler indices in this cohort of patients. This cohort demonstrated vascular remodeling of the ophthalmic arteries, caused by diabetes; therefore, blood flow resistance was increased due to diabetes.

Aim: To evaluate the sonographic association of polycystic ovaries with ovarian arterial pulsatility and resistive index. Methodology: In Al Mustafa Trust Medical Centre Lahore, a comparative analytic study was conducted. 140 patients of age group 17 to 50 were included in this study with convenient sampling technique. All patients were females and 70 were with the history of PCOs and normal. Gray scale Ultrasound and Doppler was used to diagnose the PI and RI in normal and subject. Duration of study: 02- Aug-2021 to 14- Dec-2021 Results: 70 PCOs patients have hyperechoic ovarian stroma and other 70 shows normal echogenicity. In this study different age groups were selected with minimum age was 17 years and maximum age was 50 years. In PCO females the mean RI was 0.7333 and PI was 1.6303 and in normal females the mean RI was 0.8889 and PI was 2.7251. Out of 140 patients the mean volume of right ovary is 9.6557 cm3 and of left ovary is 9.7943 cm3. Our Study was significant at point 0.0001. Conclusion: It is concluded that ovarian Doppler ultrasound is a basic tool in the diagnosis of the PCOS and provide an insight into the pathophysiological state and degree of progression in the affected ovary. Keywords: Polycystic ovary syndrome, Doppler ultrasound

Objective: The purpose of this literature search was to review the benefits of high-intensity focused ultrasound (HIFU) and its application for different pathologies. Methods: This review summarizes the implementation of HIFU for different pathologic conditions. An National Center for Biotechnology Information, PubMed, MEDLINE, Medscape, and Google Scholar database search (1992–2016) was done with the following keywords: high-intensity focused ultrasound; uses of HIFU; and applications of HIFU in the liver, bones, uterine fibroids, prostate, breast, thyroid, pancreas, kidneys, brain, urinary bladder, and so on. Tables and graphs were created for all the variables included in the study, and descriptive statistics were applied. Results: In total, 110 records were identified, through database search. In addition, 20 articles were identified through other sources. Screening of the articles was performed, and 20 were removed due to duplication; further screening was performed for 110 articles, and 30 records were further excluded. Full-text articles were assessed for eligibility and 30 were retained. Full-text articles were excluded (N = 36) on the basis that research was performed on animals, and this review article was performed solely for human application. There were 42 qualitative syntheses that researches added to the review. In addition, 42 quantitative synthesis (meta-analysis) were added to the review. Conclusion: The conclusion of this narrative review indicates that HIFU is noninvasive, nonharmful, and effective in treating diseases and tumors of the brain, breast, bone, hepatic, renal, pancreas, and prostate; uterine fibroids; and many other solid tumors. Recent technological development suggests that HIFU is likely to play a significant role in future surgical practices. Further research works should be conducted on a large sample size to obtain more accurate results in the application of HIFU.

Objective: To determine the use of sonography and test-feeding in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS). Methodology: A total of 79 infants from 2 weeks up to 12 weeks presenting with clinical signs (projectile vomiting) of IHPS were included in the study while sent to sonography. The study duration was February 2014 to December 2019. Results: The mean age of patients was 5.18 ± 2.69 weeks ranging from 1 to 12 weeks. Male gender was predominant with 62 (78.5%) cases. Of the total 79 cases, 36 (54.6%) were suggested as positive cases of IHPS and 43 (54.4%) were as normal with sonography. Most of the cases of IHPS (23; 29.1%) were observed in firstborn babies. Mean pyloric length in normal and IHPS was 12.69 ± 0.87 and 20.78 ± 2.28 mm, respectively, and mean pyloric muscle thickness in the normal and IHPS was 2.24 ± 0.36 and 5.27 ± 0.82 mm, respectively, while mean pyloric diameter in normal and IHPS was 12.69 ±0.87 and 15.01± 2.52 mm, respectively. Conclusion: The reliability of sonographic findings was better than test-feeding in the diagnosis of IHPS. Male infants, in this cohort, were five times more susceptible to develop IHPS, compared with females.

Prune belly syndrome is a rare disorder characterized by the absence of anterior abdominal wall muscles, bilateral cryptorchidism, and urinary tract malformations. The aim of this case study was to illustrate the developmental sequelae of prune belly syndrome, acquired through a series of antenatal sonography. A 20-year-old woman visited a diagnostic medical sonography center for an obstetrical sonogram. Her fetus was diagnosed with megacystis at 15 weeks’ gestation. The mother returned for repeated appointment and to observe fetal changes during the development of prune belly syndrome. First, the megacystis, hydroureter, and hydronephrosis were noted followed by hazy ascitic and amniotic fluid. The hemodynamics were altered in the umbilical artery, middle cerebral artery, and ductus venosus. Subsequently, the pressure was neutralized, but it was observed after birth that the newborn had cryptorchidism, a distended abdomen with wrinkled wall, and absent right kidney. In conclusion, prune belly syndrome could be caused by megacystis due to bladder outlet obstruction in otherwise normal karyotype fetuses. Megacystis leads to hydroureter, hydronephrosis, and abdominal distention. The persistent abdominal distention gives rise to the underdevelopment of anterior abdominal wall muscles and cryptorchidism.

Objective: To determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. Material and methods: A cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study. Results: Out of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation. Conclusion: A correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation. Objective: To determine the association between spectral Doppler cardiac activity in the lower limb veins and echocardiographic findings in patients with tricuspid regurgitation. Material and methods: A cross-sectional analysis was performed in the Gilani Ultrasound Center over a period of 13 months. The total study sample comprised 400 subjects. All individuals referred for abdominal ultrasound having cardiac activities in external iliac vein, popliteal and posterior tibial vein, individuals having normal venous Doppler ultrasound, both genders and all ages, were included, and unwilling and non-cooperative patients were excluded from the study. Results: Out of 400 individuals, 200 showed cardiac activity in the lower limb veins on Doppler vascular ultrasound, while 200 did not show cardiac activity. On echocardiography, 204 individuals were diagnosed with tricuspid regurgitation, and 196 individuals had a competent tricuspid valve. According to the independent sample t-test the mean difference in the posterior tibial vein was 25.54 (95% CI: 24.09; 26.98), while the mean difference in the iliac vein was 2.34 (95% CI: 0.64; 4.03) among normal and tricuspid regurgitation. Conclusion: A correlation was found between the cardiac activities in the lower limb veins and tricuspid regurgitation.

Purpose: The aim of our study was to determine the incidence and extent of deep venous thrombosis in hospitalized patient of tertiary care hospital.Methodology: This was observational cross sectional study. The data of patients had been collected from Jinnah hospital Lahore, Pakistan. After taking informed consent, data was collected through the Doppler ultrasound which was performed for lower limb in symptomatic patients. Equipment used was TOSHIBA Xario (200) with linear probe frequency ranging from 7-10 MHz. The data analysis was performed with the help of SPSS version 24.Findings: Total 124 patients were included in this study in which the mean age of the patient was 45.38 ± 16.846 with a range of 14-90 years. The Mean weight of patients was = 70.31±9.285 with the range 48­-90kg. The females were 56 and males were 68 in number included in this study. Out of 124 patients, right leg DVT present in 44(35.5%), and left leg DVT present in 74(59.7%), and bilateral DVT present in 6(4.8%) of patients. Unique contribution to theory, practice and policy: It was concluded that age plays a significant role in the development of DVT. Patients with acute DVT have hypoechoic thrombus while the chronic DVT have hyperechoic echogenicity. DVT was most commonly seen in the left leg in comparison with right leg. Ultrasound is the best modality in the detection of DVT.

Objective To determine the correlation between portal vein diameter and spleen size (craniocaudal). Methodology The study was conducted at the University Ultrasound Clinic, The University of Lahore, Lahore Pakistan from 1st January to 1st July 2013. All the individuals who referred for abdominal sonographic examination, including male, female, older and younger were conveniently included in the study, voluntarily, irrespective of the disease state. Ultrasonographic measurements of the caudocranial length of the spleen and portal vein were carried out on all of the one thousand subjects. The subject position for spleen was supine or right posterior oblique during suspended inspiration and right anterior oblique position for portal vein diameter with quiet respiration. The correlation between the splenic length and portal vein diameter was evaluated. Result A total of 1000 subjects; 36.9% females and 63.1% males aged from 4 to 79 years. The mean splenic length was 10.29 ± 1.89 cm. The mean portal vein diameter was 10.27 ± 1.78 mm. A statistically significant correlation was found between the spleen size and portal vein diameter; the Pearson correlation was significant at the 0.01 level. Conclusion Portal vein diameter is directly correlated to splenic caudocranial length. A regression formula was developed to measure the splenic length from the calculation of portal vein diameter.

Cancer chemotherapy can lead to the mycobacterial infections. Tuberculosis has been reported a serious complication in leukemia patients who undergo chemotherapy. The study was focused to find mutations in hupB gene of M. tuberculosis in 50 acute lymphoblastic leukemia (ALL) patients through semi multi complex PCR. A column based DNA isolation method was adopted for DNA isolation. The gene for histone-like protein (hupB [Rv2986c]) of M tuberculosis was amplified to detect two closely related mycobacterial species. Primers M and S (histone like protein HupB) were utilized to generate amplicons of 318 bp and 291 bp for M. tuberculosis and M. bovis, respectively. Out of fifty ALL patients, 21 (42%) were females and 29 (58%) were males. The prevalence of ALL was found higher in males as compared to females. The prevalence of ALL was higher in patients of age group 5-10 years. The results of the amplification showed that, the 318 bp fragment specific for M. tuberculosis was observed in seven samples (14%), while 291 bp fragment specific for M. bovis was not observed in any sample. Children with ALL were found at higher risk for tuberculosis. A risk evaluation of tuberculosis infection must be conducted before managing chemotherapy.

Glycated hemoglobin (glycohemoglobin, HbA1c, hemoglobin A1c, A1c, or less commonly HbA1c, HgbA1c, Hb1c, etc.) is a form of hemoglobin (Hb) that is chemically linked to a sugar. Most monosaccharides, including glucose, galactose and fructose, spontaneously (i.e. non-enzymatically) bond with hemoglobin, when present in the bloodstream of humans. This cross-sectional study was conducted among the patients presenting in the medical outdoor department of different hospitals. Name, age, gender and HbA1c levels were noted on a predefined proforma. All the data was entered and analyzed with SPSS Ver. 23.0. The quantitative variables were presented as mean and standard deviation. The qualitative variables were presented as frequency and percentages. A total of 60 patients were included in this study i.e., 30 males (50%) and 30 females (50%). The mean age of the patients was 34.32±5.50 years. Out of 60 patients, five patients had HbA1c values of >6.5% and the patients were labelled as diabetic.

C-reactive protein (CRP) is an annular (ring-shaped), pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells. This cross-sectional study was conducted among the patients presenting in the medical outdoor department of different hospitals. Name, age, gender and history of fever and levels of C-reactive protein were noted on a predefined proforma. All the data was entered and analyzed with SPSS Ver. 23.0. A total of 80 patients were included in this study i.e., 40 males (50%) and 40 females (50%). The mean age of the patients was 29.34±3.44 years. Out of 80 patients, fifteen patients had raised CRP levels with high grade fever. Thirty patients had high grade fever but CRP levels were not raised.

Background: Hydronephrosis is a major problem and colour doppler ultrasound is very useful to assess the hemodynamics of a diseased kidney, it is a therefore our research comprises sonographic analysis of segmental artery resistive index with the severity of hydronephrosis. Materials and Methods: This was a cross sectional analytical study carried out in Gilani Ultrasound center‑Afro‑Asian Institute, Lahore, Pakistan. Sixty patients of all ages were enrolled in this study with convenient sampling technique. A total of 60 individuals of all ages, both genders with calculus, masses, pregnant females, benign prostatic hyperplasia, (all the patients having hydronephrosis) were included in the study and individuals with Renal transplanted patients, nephrectomy, non-cooperative patients were excluded. The duration of the study was from December 2018 to October 2019. Toshiba (Xario 200) with convex transducer frequency range 2–5 MHz was used for this study. Age, gender, grade of hydronephrosis, pulsatility index and resistive index of segmental artery were the variables used in this study. Transabdominal scanning technique was used, Data were collected through data collection sheets and was tabulated and analyzed using Statistical Package for the Social Sciences (SPSS) version 24 (SPSS 24, IBM, Armonk, NY, United States of America), Microsoft Excel. Results: According to the results male patients with hydronephrosis (51%) were noted more than female hydronephrotic patients (48%). Mostly seen hydronephrosis grade in our study was mild (60%) while moderate hydronephrosis was (38.3) and severe was (1.7%). In our studies patients with left kidney hydronephrosis (56.7%) were more than that of right kidney hydronephrotic patients (43.3%). CONCLUSION(S): It is concluded that Doppler analysis is very helpful in the diagnosis of severity of hydronephrosis and to give detailed information about the pathophysiology of the hemodynamics of diseased kidney.

Background: FAST and CT scan are both widely used imaging techniques for diagnosing blunt torso trauma and have their limitaions and advantages. Objective: To evaluate the Accuracy of Focused Assessment with Sonography for Trauma (FAST) vs Computed Tomography for diagnosing Blunt Torso Trauma. Methodology: A cross sectional research which was done in Lahore in emergency department of Mayo hospital and Services hospital. Total 125 participants took part in the study who were victims of blunt torso trauma by road traffic accidents damaging mainly spleen, kidneys, liver, retroperitoneum, bladder and pancreas. FAST scan using Toshiba, Nemio model, Convex probe having a frequency of 3.75 MHz was carried out. Pictures were capture with different abdominal views. CT scan using Toshiba, 16 slice Hitachi and Scenaria, 128 slices was also done on the same population after giving contrast material. Results: Mean age of population under study was 37.87±11.678. FAST scan was administered on all patients and then CT scan was administered. Out of 125 scans 77 FAST positive scans were confirmed and 48 negative scans were confirmed by using CT scan. The values of sensitivity, specificity, ppv and npv of FAST scan were calculated to be 100%, 91.67, 100% and 85.42%. Conclusion: Although FAST is also a very valuable tool, some of the critical injuries that need immediate attention for the patient's life may be overlooked so CT scan is considered the best option for diagnostic accuracy of Blunt torso trauma.

Background: The purpose of the study is to evaluate and compare the changes associated with hepatosteatosis in diabetic obese versus diabetic normal-weight patients through ultrasonography. It is estimated that with the prevalence of about 30%–75% of obese individuals accordingto the body mass index (BMI) criteria are at increase risk of developing simple fatty live. Besides obesity, diabetes mellitus is also considered to be one of the important causes of hepatosteatosis. Methods: This prospective study was conducted in February 2015–December 2015 on a group of 181 diabetic patients, including 65 males and 116 females with an age range of 40–80 years. The patients were divided into two diabetic groups: those having a BMI ≥30 kg/m2 were included in the obese group (n = 116) and those with a BMI of 18.5–25 kg/m2 were included in the normal BMI group (n = 65). Ultrasound machine Esaote MyLab 50 equipped with a 3.5–5 MHz curvilinear multifrequency transducer was used to scan the liver. Independent samples t-test was performed to compare the liver span in the two groups. Chi-square tests were applied to compare the frequencies of fatty changes, border, and surface characteristics. Results: The presence of fatty changes among obese groups was statistically significant in the diabetic obese group compared to the normal-weight individuals with P < 0.0001. Similarly, hepatic spans were found to be significantly greater in the diabetic obese group than the diabetic normal BMI group on independent samples t-test with P < 0.0001. Females were seen to develop hepatosteatosis more frequently compared to males in all diabetic individuals with P = 0.02. Conclusion: It is concluded that diabetic obese patients are more prone to develop hepatosteatosis as compared to normal BMI diabetic individuals.

Introduction: Preeclampsia is a medical condition characterized by hypertension and proteinuria during pregnancy, with the symptoms generally manifesting in the 3rd trimester. Hypertension brings hemodynamic changes; it is therefore expected that arterial blood flow velocity waveforms will be different in the uterine and ophthalmic arteries in preeclampsia. Vascular changes do occur in preeclampsia, which in turn induces hemodynamic changes. Aim: To compare mean values of the resistive index of the ophthalmic and uterine arteries in patients with preeclampsia and normotensive individuals in Doppler US. Methods: In this cross-sectional observational study, ultrasound of the uterine and ophthalmic arteries was performed in 60 pregnant women in the 2nd and 3rd trimester of pregnancy to compare the resistive index of these arteries in preeclamptic and normotensive individuals. All the patients, i.e. 30 preeclamptic and 30 normotensive pregnant women, took part in this study voluntarily. The study was approved by the institutional review board (IRB) of the University of Lahore. Results: The mean resistive index of the uterine artery was 0.50 ± 0.08 in normotensive participants and 0.64 ± 0.09 in preeclamptic women, with the p-value

The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body.

Varicose veins could be clinically diagnosed with visual inspection but the use of Doppler ultrasound (US) in varicose veins is to identify the cause of varicose veins. Need for an extensive systematic review is therefore felt to itemize different causes of varicose veins. Relevant literature was searched and systematic analysis was performed with the aim to show the significance of US in the diagnosis of various causes of varicose veins. Various causes can be diagnosed with color and spectral Doppler US which can be usual causes and unusual causes as well including neovascularization, chronic venous ulceration, obesity, incompetency of the perforating veins, deep vein thrombosis, saphenofemoral junction incompetence, recurrence of the varicose veins after surgical treatment, vulvoperineal varicosities, intraosceous perforating vein incompetence, round ligament varicosity, persistent sciatic vein incompetence, congenital venous malformation and Klippel– Trenaunay syndrome, portosystemic collateral–related varicose veins, and pelvic congestion syndrome. It is concluded that duplex ultrasonography plays an important role in the diagnosis of the various causes of varicose veins.

For underdeveloped countries like Pakistan, education is very important to be at par with the developed countries. Education plays a vital role in the development and prosperity of the country. Cloud computing has been an essential part of education during the last few years. We have conducted a cost benefit analysis on cloud deployment in government institutions. Our focus is to evaluate the costs and benefits of moving educational institutions data to cloud. We intend to investigate the cost required to implement cloud based structure in an institution and what benefits it will bring to it. We will be considering some specific universities for each sector: public and private. We have compared the cost of traditional system being followed in institutions and SAAS system which will be helpful for educational sector. We conducted a survey to investigate barriers involved in implementing cloud facilities in public institutions. The comparison shows the benefits of implementing SAAS model in institutions.

Objective To ascertain that acrania can lead to anencephaly Materials and methods We commenced a cross-sectional study for a period of 41 months from 2013 to 2017. During routine ultrasound examination, we observed multiple cases of acrania in second trimester and third trimester. We followed 26 cases who failed to terminate their pregnancies and visited for reexamination. Changes in the brain matter, amniotic fluid volume, and echogenicity of the acrania fetuses were recorded and compared with the previous examination. Development of anencephaly was correlated with maternal age and advancement of gestational age. All the patients were examined transabdominally according to the American Institute of Ultrasound in Medicine (AIUM) guidelines for obstetrical ultrasound. Data were collected from the previous report and recent examination, by evaluating data with the help of IBM Statistical Package for the Social Sciences (SPSS) version 24 package, and the results were summarized. Results Pregnant women with diagnosed acrania fetus visited second time with a lapse of more than 4 weeks and were enrolled with mean age 25.73 ± 8.80. We observed 4 (15.4%) acrania patients developed into anencephaly. Development of anencephaly was observed to be correlated with the advancement of gestational age. It was observed that acrania is more common in below 20 and above 30 age groups. Haziness of amniotic fluid is also observed to be related with acrania. Conclusion Anencephaly could be caused by multiple factors but acrania can lead to anencephaly with continuous exposure of brain matter and meninges to mechanical trauma and chemical activities of the amniotic fluid. Clinical significance To test the hypothesis of acrania to anencephaly and make a roadmap for upcoming researches on association of acrania with physical, environmental, and genetical factors. How to cite this article Bacha R, Gilani SA, Manzoor I. Sonographic Transformation of Acrania to Anencephaly. Donald School J Ultrasound Obstet Gynecol 2017;11(3):189-196.

The twinkling artifact is a color Doppler artifact, but it could be used in the confirmation of urinary stones. Conventionally, gray-scale criteria (echogenic foci with acoustic shadowing) is used in the diagnosis of urinary stones, but unfortunately, its reliability is very low. If the color Doppler twinkling artifact is applied in conjunction with other provocative measures, then its overall reliability exceeds 95%. To determine the clinical significance of twinkling artifact in the diagnosis of urinary stones, this cross-sectional observational study was conducted at Gilani Ultrasound Center, Lahore, Pakistan. For the determination of clinical significance, 1350 patients were recruited for this study. All the patients had renal stones of variable size and location. All the patients were evaluated with gray-scale sonographic criteria, and then color Doppler was applied to look for the twinkling artifact. The findings were confirmed with other imaging modalities (i.e., plain X-ray, computed tomography scan, etc., or during patient follow up). Sensitivity and specificity of the gray-scale ultrasound criteria in the detection of urinary stones was 96.1% and 57.9%, respectively, while the sensitivity and specificity of the color Doppler twinkling artifact in the detection of urinary stones was 100.0% and 97.4%, respectively. It was concluded that the application of twinkling artifact is useful in the confirmation of urinary stones, but specifically, it is of great diagnostic value in the small (less than 5 mm) renal stones and stones adjacent to a strong reflector (i.e., ureteric stones or stones in the prostatic urethra).

The aim of the research is to know the sonographic association of polycystic ovaries with intraovarian arterial pulsatility index (PI) and resistive index (RI).We observed the PI and resistive index (RI) of 50 polycystic ovarian syndrome (PCOS) and 50 normal individuals. Polycystic ovary was seen with gray scale transabdominal and endo-vaginal sonography and labeled according to the developed sonographic criteria. The results were correlated and cross tabulated with independent sample t-test to determine the existing relationship among them. According to the results, PI and RI of the intraovarian artery were seen to decreases during PCOS as compared with the PI and RI of normal group women at the follicular phase. In case of polycystic ovary, the stroma undergoes hyperstimulation as a result of vascular remodeling and hypervascularity. It is concluded that Doppler analysis is very helpful in the diagnosis of PCOS and to give detailed information about the pathophysiology of the hemodynamics of diseased ovary.

Smallholder farmers are threatened by various vulnerable risks which include hostile weather conditions, rainfall at odd times, disease outbreaks and the market shocks. Crop insurance is the only solution to mitigate these risks. Crop yield records are of great importance to predict the crop yield/area into a region but the developing countries like Pakistan, have limited availability of crop yield records. Crop Reporting Service (CRS) in Punjab province of Pakistan has taken this initiative to save crop related data. We obtained the CRS based datasets of rice crop from (2008-2018) to predict the rice yield/area for the fiscal year 2019. The CRS based datasets were incorporated in collaboration with remotely sensed dataset to obtain more accurate results. The spectral responses of rice crop were taken as input to compute NDVI/RVI values of each year. We applied linear regression to NDVI/RVI and the CRS based yield to generate regression equations for prediction of rice yield for the year 2019 which was computed as 2.09 (ton/ha). The area under rice cultivation was estimated using supervised classification that was 139616 hectors. The net rice production was estimated as 219797 tons. Spectral responses of rice crop canopy proved efficient to determine the net productions.

Background: Pregnancy is considered as an important period in the women’s life. Not only environmental health condition influences the life quality of the mothers, but may also effects the fetus and cause hereditary disease. Millions of women do not have access to proper health services in future worldwide. The mains purpose of the rural pregnant women protection program is maintaining health and furnishing during the course of pregnancy by protecting the mother and fetus. The aim of the study here is to determine the sonographic signs leading to abortion. Objective: Determination of sonographic concerning signs leading to abortion. Methodology: HONDA HS2600 and HONDA GE p7 of 2.8-3.5 MHz Convex probe is used. AIUM procedures for obs and gyne are followed for the scanning procedures. The study was conducted at Indus Hospital, Manawan. Data of 60 patients was collected through convenient sampling. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: Out of 54 patients, 38 patients had vaginal bleeding and 16 patients came out without vaginal bleeding. In table 3, sonographic findings of the patients were illustrated. As the data was collected of 54 patients, among these, 11 patients (20.4%) had blighted ovum, 1 patient (1.9%) had CRL with negative FCA, 5 patients (9.3%) had haematoma, 3 patients (5.6) had fetal hydrops, 1 patient (1.9) had irregular low lying placenta, 19 patients (35.2%) had missed abortion. 6 patients (11.1%) had open internal os, 1 patient (1.9%) had previa type 3, 1 (1.9%) had previa type 1. 2 patients (3.7%) had recurrent abortion. 1 patient (1.9%) had scalping of bones and 3(5.6%) had scanty liquor. Conclusion: There are multiple sonographic concerning signs but missed abortion and blighted ovum were the most common amongst them.

A case of geyser sign with acromioclavicular (AC) joint cyst with underlying rotator cuff tear is presented. Ultrasound modality is used to diagnose the clinical case of the AC cyst with positive geyser sign. A 91-year-old male patient presented with a complaint of right-sided shoulder and neck pain. The physical examination revealed a large lump on his right shoulder with restricted shoulder movements. During ultrasound examination, a chronic supraspinatus tendon (ST) tear and AC joint cyst with a positive geyser sign was observed. The ultrasound diagnosis was also confirmed with magnetic resonance imaging (MRI). AC joint cyst with geyser sign is a rare condition. Few cases have been published with this type of pathology. To our knowledge, this is the first report of its kind from Pakistani population.

Background Fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences are previously described for the evaluation of acute subarachnoid hemorrhage (SAH) and demonstrated good sensitivity. This study was designed to find the diagnostic accuracy of FLAIR in detection of acute SAH in patients presenting with severe headache considering the fact that controversy has been observed in previous studies. Objective To determine diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache using lumber puncture as gold standard. Methodology A total of 245 patients fulfilling selection criteria were enrolled in the study through the emergency department of Combined Military Hospital, Lahore. MRI was performed by Philips Intera Achieva 1.5 T super conducting MR unit (Philips Medical Systems, the Netherlands), with the use of a head coil. FLAIR examination was performed at 6700/150 (TR/TE) with an inversion time (TI) of 2200 ms, a field of view 230 mm, matrix 189 × 256, scan time of 3 min 50s and section thickness 5 mm in axial plane. Following MRI, patients underwent lumbar puncture for cerebrospinal fluid (CSF) examination after 8–12 h from the onset of event. MRI and CSF analysis results were then compared. Results Out of 245 cases, 49.39% (n = 121) were between 20–55 years of age while 50.61% (n = 124) were between 56–70 years of age, mean ± sd was calculated as 52.13 ± 10.45 years, 53.88% (n = 132) were male while 46.12% (n = 113) were females, frequency of acute subarachnoid hemorrhage in patients presenting with severe headache was recorded as 5.71%(n = 14), diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache taking lumbar puncture as gold standard as 78.57% sensitivity, 96.53% specificity, 57.89% positive predictive value, 98.67% negative predictive value and accuracy rate was calculated as 95.29%. Conclusion Diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache taking lumbar puncture as gold standard is higher and reliable.