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OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one-month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p < 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age.

Background: The carrying angle (CA) of elbow is an angulation of forearm with that of arm when the forearm is kept in supinated, and elbow in extended position. As there are different techniques of its measurement like goniometer and X-rays, it is not clearly known which one is better. This study is therefore designed to compare the two methods of its measurements. Study type, settings & duration: This cross-sectional study was carried out at CMH Malir from March to October 2020. Methodology: In the study, 80 adult males were included, with age group 18-22 years. Carrying angle of both elbows were measured by goniometric and on X-rays, the data was analyzed statistically, spearmen’s correlation was used to compare the mean values. Results: The mean age of study participants was 19.06±1.11years, the mean height was 179.46±3.10cm and the mean of weight was 61.83±1.88kg. The mean of CA by goniometer was 17.91±2.15 in right elbow while in the left elbow it was 16.53±2.33. The mean CA on X-ray was 18.06±2.14 in right elbow and 16.56±1.94 in the left. The mean values of CA by goniometer and on X-ray were when compared the ‘p’ value was 0.71 in right elbow which is non-significant; similarly, when the mean values of CA in left elbow by goniometer and on X-ray were compared the p value comes out 0.66 which is also non-significant. Conclusion: The present study provides evidence that any of the method of measurement among goniometric and radiographic can be used for the estimation of CA elbow with similar results.

OBJECTIVE: To determine the frequency of cardiomyopathy and its manifestations in patients with liver cirrhosis presenting at Tertiary Care Hospital, Karachi. METHODOLOGY: This cross-sectional study was carried out in Medical unit I of Jinnah Postgraduate Medical Center, Karachi, from July-December 2017. The sampling technique employed was nonprobability consecutive samplings. 95 patients with liver cirrhosis diagnosed earlier on clinical and investigations were included. Systolic dysfunction of the heart on Echocardiography was considered at EF0.44 was in 47.4% cases and heart rate >100 was in 33.7% cases. The proBNP >93 pg/ml was observed in 77.4% male patients and >144 pg/ml in 87.5% female patients. Cirrhotic cardiomyopathy was observed in 69.5% of patients and was not significantly associated with gender, age, duration of disease, and child Pugh class. CONCLUSION: Although there is a considerably high frequency of cardiomyopathy in cirrhotic patients, its presence, generally, is not realized and, thus, due attention is not given. Highlighting its high frequency, its need for workup and treatment may improve the quality of life of these patients.

Background: Patients with cirrhosis may have either a chronic neuropsychiatric state due to portal-systematic shunting or have an acute episode with some precipitating factor labeled as hepatic encephalopathy. In patients with encephalopathy, hypokalemic alkalosis leads to an increase in the amount of nonionic ammonia that readily crosses the blood brain barrier and accumulates in the CNS that can worsen the disease. Objective: The purpose of the study was to determine the frequency of hypokalemia in patients with hepatic encephalopathy and to compare the length of the hospital stay in hepatic encephalopathy patients with and without hypokalemia. Study type, settings & duration: This cross sectional study was conducted at Jinnah Postgraduate Medical Centre, Karachi from February to July 2021. Methodology: The sample was calculated by using WHO sample size calculator at 95% confidence interval and absolute precision of 8% with anticipated population proportion of 35%. The sample was recruited by using non-probability consecutive sampling technique. Hepatic encephalopathy was diagnosed on basis of clinical examination by West Haven Classification grades. Patients were diagnosed for hypokalemia by hospital lab as having potassium levels

Objective: To determine the frequency of cerebral aneurysm in patients with subarachnoid haemorrhage on CT cerebral angiography., Methods: This prospective cross-sectional study was conducted at Department of Radiology, JPMC, Karachi from 5 th June 2022 to 30 th January 2023. Total 176 patients with subarachnoid haemorrhage irrespective of gender were selected. CT angiography of cerebral vessels was performed. Cerebral aneurysm was noted as per operational definition and recorded., Results: Age range was from 18 to 60 years. Mean age was 39.516±6.77 years, Mean BMI 29.630±3.08 Kg/m2. and mean duration of symptoms was 7.721±2.40 days. Male patients were 80.1% and females were 19.9%. Cerebral aneurysm was observed in 91.4% female and 78.7% male patients. Aneurysmal percentage was slightly higher in younger (18-40 years) age group (84.2% vs 80.4%) as compared to older (40-60) age group but statistically not significant. Although total percentage of female was quite less 19.9% (n=35 vs n=141 male), in this lesser female percentage, aneurysmal detection was higher as compared to male gender (91.4% vs 78.7%). Distribution of aneurysms according to vessel involved was; 28.7% along anterior communicating artery, 28.3% related to middle cerebral artery and, 22.9% were along posterior communicating vessel. Rest was distributed among other vessels including tip of basilar artery., Conclusion: In Our study aneurysms was seen 81.3% in patients of subarachnoid hemorrhage having CT angiography at our center in Karachi Pakistan., (Copyright: © Pakistan Journal of Medical Sciences.)

Objective: To determine the diagnostic accuracy of Diffusion Weighted MRI in differentiating malignant from benign liver lesions taking histopathology as gold standard., Methods: This Cross-sectional study was conducted at Departments of Radiology and Medicine, JPMC, Karachi from February 23, 2019 till September 25, 2019. Data was prospectively collected from patients after taking consent. One hundred twenty five patients presenting with hepatic mass who met the inclusion criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables as frequency and percentages. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated. P-value of ≤0.05 was considered as significant., Results: Mean age in our study was 59.75±8.57 years. Total 71 (56.8%) were male and 54 (43.2%) were female. Out of 125 patients, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW MRI for the diagnosis of malignant focal liver lesion by taking histopathology as gold standard was found to be 92.3%, 93.6%, 96%, 88% and 92.8% respectively., Conclusion: DW MRI scan has high diagnostic accuracy and being accurate in making a diagnosis and differentiation of benign from malignant focal liver lesion would decrease need of invasive modality of histopathology., (Copyright: © Pakistan Journal of Medical Sciences.)

Objectives: The Dutch Radiological Society developed CO-RADS classification, a system for the classification of CT scan chest findings among suspected COVID-19 patients. However due to some important issues it was modified by authors and then applied on our study population. The objective was to study the spectrum of lungs involvement as concluded by HRCT scan chest finding and classifying it using the "Modified CO-RADS classification"., Methods: This cross-sectional study was conducted jointly by the departments of Medicine and Radiology, JPMC from January 16, 2021 to April 30, 2021. This study includes suspected cases of COVID-19 patients aged between 18-80 years who came for HRCT chest. Their data variables were recorded. HRCT findings were classified using "Modified CO-RADS classification". Patients' results of real time PCR for COVID-19 were also followed., Results: A total of 78 patients presented to the study department during this study period. Of them 85.8% were male (n=67) and 14.2% were female (n=11). Out of the 78 patients, 58 were tested positive for COVID-19 on first RT-PCR on follow up. Among positive two patients (3.4%) had CO-RADS-1, 4 patients (7%) had CO-RADS-2, 19 patients (32.75%) had CO-RADS-3, 21 patients (36.2%) had CO-RADS-4 while 12 patients (20.7%) had CO-RADS-5 category. (CO-RAD-6 category was omitted). Of the patient who had negative results on RT-PCR, five patients had CO-RADS-4 while three patients had CO-RADS-5. On repeat RT-PCR all (8/8) patients of category IV and V proved Covid-19 positive., Conclusion: HRCT scan chest can be used for quicker diagnosis of COVID-19 patients in patients with respiratory complaints in whom prompt diagnosis is required and when RT-PCR investigation process would be taking prolonged time due to over burden during pandemic situation. "CO-RADS classification after modification" proved more effective communicative tool to label and understand the severity of lung involvement in Covid-19 disease., (Copyright: © Pakistan Journal of Medical Sciences.)

Objective: To estimate the effect of portal pressure lowering drug 'octreotide', by observing the Doppler waveform before and after the administration of intravenous bolus of octreotide and thus to assess indirectly its efficacy to lower the portal pressure., Methods: This quassi experimental study was carried out in Medical Department in collaboration with Radiology Department of Jinnah Postgraduate Medical Center Karachi Pakistan from September 10, 2015 to February 5, 2016. Cases were selected from patients admitted in Medical Wards and those attending Medical OPD. Diagnosis of cirrhosis was confirmed by Clinical Examination and Lab & Imaging investigation in Medical Department. Doppler waveform study was done by experienced radiologist in Radiology Department before and after administration of octreotide. Doppler signals were obtained from the right hepatic vein. Waveform tracings were recorded for five seconds and categorized as 'monophasic', 'biphasic' and 'triphasic'. Waveform changes from one waveform to other were noted and analyzed., Results: Significant change i.e. from 'monophasic' to 'biphasic' or 'biphasic' to 'triphasic' was seen in 56% cases while 'monophasic' to 'triphasic' was seen in 20% cases. No change was seen in 24% cases. Improvement in waveform reflects lowering of portal vein pressure., Conclusion: Non invasive Hepatic vein Doppler waveform study showed improvement in Doppler waveform after administration of octreotide in 76% cases. Doppler waveform study has the potential of becoming non invasive 'follow up tool' of choice for assessing portal pressure in patients having variceal bleed due to portal hypertension.

Objective: To determine frequencies of different MRI patterns of tuberculous spondylitisin a public sector hospital in Karachi., Methods: This descriptive multidisciplinary case series study was done from October 25, 2011 to May 28, 2012 in Radiology Department and Department of Medicine in the Jinnah Postgraduate Medical Center Karachi. MRI scans (dorsal / lumbosacral spine) of the Patients presenting with backache in Medical OPD, were performed in Radiology Department. Axial and sagittal images of T1 weighted, T2 weighted and STIR sequences of the affected region were taken. A total of 140 patients who were diagnosed as having tuberculous spondylitis were further evaluated and analyzed for having different patterns of involvement of the spine and compared with similar studies., Results: Among frequencies of different MRI pattern of tuberculous spondylitis, contiguous vertebral involvement was 100%, discal involvement 98.6%, paravertebral abscess 92.1% cases, epidural abscess 91.4%, spinal cord / thecal sac compression 89.3%, vertebral collapse 72.9%, gibbus deformity 42.9% and psoas abscess 36.4%., Conclusion: Contiguous vertebral involvement was commonest MRI pattern, followed by disk involvement, paravertebral & epidural abscesses, thecal sac compression and vertebral collapse.