Perforated appendicitis: accuracy of ct diagnosis and correlation of ct findings with the length of hospital stay

Objective: To determine the sensitivity and specificity of CT findings in the differentiation of perforated from nonperforated appendicitis and correlate CT diagnosis with the length of hospital stay.STUDY Design: An analytical study.PLACE AND DURATION OF STUDY: This study was conducted at Radiology Department of Aga Khan University Hospital, Karachi, from January 2004 to June 2005.PATIENTS AND Methods: The study included 70 patients who presented with right lower quadrant abdominal pain and underwent pre-operative CT scan followed by appendectomy. Patients were divided into two groups of having perforated and nonperforated appendicitis on the basis of CT scan findings. The surgical and pathological reports combined were considered the reference standard for the diagnosis of perforated appendicitis. Various CT scan findings and average duration of hospital stay in days was compared by t-test.Results: Twenty-six (37%) of 70 patients had perforated appendicitis. It was correctly identified on pre-operative CT scan in 18 patients. There were 18 true positive diagnoses, 43 true negative diagnoses, 1 false positive diagnosis and 8 false negative diagnoses which yielded a sensitivity of 69%, specificity of 97%, positive predictive value of 94% and negative predictive value of 84%. Mean length of hospital stay in perforated group was 6.3 days and 2.9 days in nonperforated group. Severe periappendiceal inflammation, periappendiceal and or abdominopelvic fluid and abscess were significantly associated with perforated appendicitis and with a significant longer hospital stay (p \u3c .001).CONCLUSION: CT scan is 69% sensitive and 97% specific for the diagnosis of perforated appendicitis and constellation of CT findings can be used to select patients with perforated appendicitis for initial non-operative management. Presence of CT signs of significant appendiceal inflammation is independent predictor of longer hospital stay

Building Consumer-Based Brand Equity in Retail Banks: A Quantitative Study On a Pakistani Star Bank

Firms are striving to increase their brand equity that ultimately leads to an increase in profitability. The purpose of the study is to identify the causal relationship of endorser's credibility with Brand credibility and its meditating role on consumer-based brand equity in the banking sector of Pakistan. 384 active HBC account holders taken as the sample and data collected through a comprehensive questionnaire. Correlation and regression analysis were conducted to test the factors of attractiveness, expertise, trustworthiness, and popularity on Brand credibility and further its effect on Brand equity. The results suggest that in banking sector firm Expertise of endorser is the most significant factor followed by trustworthiness and popularity that influence brand credibility and attractiveness does not have any impact on brand credibility. The study provides an understanding of brand building strategy, and it also highlights a clear brand differentiation strategy for bank brands.DOI: 10.15408/etk.v17i2.672

Polypoid adenomyoma of the uterus.

Polypoid adenomyoma is a rare uterine endometrial polypoid tumor of mixed epithelial and mesenchymal origin. Although the clinical and pathologic features of polypoid adenomyomas have been described extensively, imaging findings for these tumors have not been frequently reported in the literature. On imaging, their features may be confused with prolapsed leiomyomas or malignancy. Hemorrhagic cystic spaces in a prolapsed uterine tumor within the vagina should raise consideration of a diagnosis of polypoid adenomyoma. Such blood-containing cystic spaces would be unusual findings in leiomyomas and malignancy. Diagnosing polypoid adenomyoma is vital because it can potentially be managed by hysteroscopic resection, unlike an ordinary form of adenomyosi

Cesarean scar pregnancy: an experience of three cases with review of literature

Cesarean scar pregnancy (CSP), often considered the rarest form of ectopic pregnancy, is a result of implantation of the gestational sac into the fibrous tissue scar of a previous cesarean section. With an increase in the rate of cesarean sections, along with better awareness and improvement in sonographic diagnosis, the number and detection of scar pregnancies are on the rise. Because of its early invasion of the myometrium, usually in the first trimester, CSP is considered to be potentially lethal, leading to high risks of uterine rupture. We report a series of three cases of scar pregnancy that presented at different gestational ages and were managed by different methods. The aim of this case series is to share our experience with CSP, review previous literature, and emphasize on the radiological criteria to making a confident diagnosis. Diagnosis and management of CSP needs considerable expertise and a multidisciplinary approach to prevent complications. KEYWORDS

Variability of breast density assessment and the need for additional imaging: A comparison between computed mammography and digital mammography

Objective: To determine the variability of breast density assessment and the need for additional imaging using computed radiography (CR) mammography versus digital radiography (DR) mammography.Study design: Cohort study.Place and duration of study: Department of Radiology, The Aga Khan University Hospital, Karachi from March to June 2018.Methodology: Patients who underwent screening CR mammography, followed by DR mammography a year later, were selected. Only disease-free individuals were included in the study. Evaluation of breast density was done subjectively, using the breast imaging reporting and data system (BI-RADS) by two independent experienced radiologists. Statistical analysis was performed using the Wilcox Signed Rank-sum test to compare both modalities. Fisher Exact method was used to compare the need for ultrasound imaging.Results: A total of 295 patients were included in the study. The mean age of the patients was 52.76 ± 0.64 years. There was a significant difference in the change of breast density when comparing both modalities (Z= -11.839, p \u3c0.001). A statistically significant reduction in the need for further breast ultrasound was observed after DR mammography than with CR mammography (p \u3c0.001).Conclusion: Use of DR mammography, especially in patients with dense breast parenchyma, is a better screening tool overall. It translates to better feasibility for the radiologist and is more economical for the patient. DR mammography decreases unnecessary imaging and leads to better visualisation, thus providing a more accurate categorisation of breast density. Key Word: Computed radiography mammography, Breast density, Screening, Breast cancer, Digital mammography, Ultrasound

Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan

Objective:  The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Materials and Methods:  This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion. Results:  80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale. Conclusion:  Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern. 

Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain

Objective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement. Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ≤3) was considered after 12 months. Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value < 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement. Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF

Alzheimer Disease Detection Techniques and Methods: A Review

Brain pathological changes linked with Alzheimer's disease (AD) can be measured with Neuroimaging. In the past few years, these measures are rapidly integrated into the signatures of Alzheimer disease (AD) with the help of classification frameworks which are offering tools for diagnosis and prognosis. Here is the review study of Alzheimer's disease based on Neuroimaging and cognitive impairment classification. This work is a systematic review for the published work in the field of AD especially the computer-aided diagnosis. The imaging modalities include 1) Magnetic resonance imaging (MRI) 2) Functional MRI (fMRI) 3) Diffusion tensor imaging 4) Positron emission tomography (PET) and 5) amyloid-PET. The study revealed that the classification criterion based on the features shows promising results to diagnose the disease and helps in clinical progression. The most widely used machine learning classifiers for AD diagnosis include Support Vector Machine, Bayesian Classifiers, Linear Discriminant Analysis, and K-Nearest Neighbor along with Deep learning. The study revealed that the deep learning techniques and support vector machine give higher accuracies in the identification of Alzheimer’s disease. The possible challenges along with future directions are also discussed in the paper