JUXTAFACET CYST OF CERVICAL SPINE: A RARE NEURAL FORAMINAL LESION

Juxtafacet cysts (JFC) are well recognized entities occurring in the spine in relation to facet joints. These lesions include synovial cysts and ganglion cysts. Lumbar spine is more common location amongst other regions of the spine. Rarely these cysts can be seen in cervical spine. Only 29 cases of cervical synovial cysts has been reported so far to the best of our knowledge.2 The cervicothoracic junction is the preferential site of involvement. Usual location is in the dorsolateral spinal canal. Foraminal juxtafacet cyst, as seen in our case, are extremely rare

Association between lichen planus and dyslipidemia: an experience from North India

Association between lichen planus (LP) and dyslipidaemia and other cardiovascular risk factors has been reported in many studies in the past, with variable results between studies. The aim: this study was undertaken to study the association of lichen planus with dyslipidaemia. Methods: this was a prospective hospital-based case control study conducted over a period of three years, on 105 prospective newly diagnosed male patients of lichen planus and equal number of age and sex matched controls. Fasting serum lipid profile including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were measured, and comparison done between cases and controls. Results: dyslipidaemia was found in 44 (41.9 %) lichen planus patients (cases) as compared to 28 (26.7 %) controls, the difference being statistically significance (p 0.020). Triglycerides, total cholesterol, LDL cholesterol and VLDL cholesterol were significantly higher in cases than controls, whereas difference in the values of abdominal circumference and body mass index (BMI), although more in cases than controls was not statistically significant. Similarly, HDL-cholesterol values were less in cases than controls, but without statistical significance. Conclusion: dyslipidaemia was more common in lichen planus (LP) patients, as compared to controls, suggesting that LP patients are at a higher risk of developing derangements of serum lipids and should be routinely and regularly monitored for dyslipidaemia and other cardiovascular risk factors, to detect cardiovascular diseases well in time. The result of present study strengthens the evidence of association between LP and dyslipidaemia

Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Objective:  To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus. Material and Methods:  The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death. Results:  Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%). Conclusion:  Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes

Prevalence of Helicobacter pylori infections in patients visiting to gestroenterology department Rehman Medical Institute Khyber Pakhtunkhwa

Gastritis and peptic ulcer is common worldwide as well in Pakistan. H. pylori is causative agent and can survive in acidic medium like stomach. H. pylori is unique bacteria that capable to cause stomach cancer. The objective of present study was to report the prevalence of Helicobacter pylori infections in patients visiting to Rehman Medical Institute Peshawar. In the present descriptive cross-sectional study, a total number of 150 patients visiting to Gastroenterology Department Rehman Medical Institute Peshawar were gone through H. pylori screening test by Immunochromatography (BD ICT) method and test was performed to find out prevalence of Helicobacter pylori infection in patients visiting to Gastroenterology Department Rehman Medical Institute Peshawar. Data was recorded and analysed by SPSS-22 and shown here in the form of tables. Total number of patients was 150, out of them 44 (29.3%) patients were H. pylori positive and 106(70.7%) were H. pylori negative. The prevalence of H. pylori infection is higher in the patients visiting to gastroenterology department of Rehman Medical Institute Peshawar. It is more common in males as compared to female patients. We conclude here that patients of gastroenterology should be screened for H. pylori to cope with treatment & prevention from further complications

On the Utility of Parents\u27 Historical Data to Investigate the Causes of Autism Spectrum Disorder: A Data Mining-Based Framework

Objective: Autism Spectrum Disorder (ASD) is acknowledged as a challenge that influences the learning ability of adolescents and also negatively impacts their families. Autism may be caused due to environmental exposure or genetically inherited disorder, however, no definitive or universally customary reasons are known. This makes the issue fairly challenging. Material and methods: This work focuses on identifying the reasons of ASD utilizing computational methods. For this, data is collected that focuses on parental history for finding the trigged features by reviewing antenatal, perinatal, and infant hazard factors of ASD. Afterwards, ML techniques are applied on the collected instances to develop a predictive model and identify the reasons to ASD. While collecting the data, samples are obtained for ASD and non-ASD individuals both. A total of 115 features are obtained from each subject. The collected dataset has 47% samples of the subjects with ASD. Dimensionality reduction, and four feature selection methods are applied on the data to eliminate noise and least valued features. The data is verified using two clustering techniques, i.e., k-means and k-medoid. To validate the clustering results five clustering validation indices are used. Later, three classifiers, i.e. k-nearest neighbor (k-NN), Support Vector Machine (SVM), and Artificial Neural Network (ANN) are trained to predict cases with ASD. The frequent items mining technique and the descriptive analysis of the clustered data are utilized to identify the factors that may cause ASD. Results: The proposed framework enables to identify the features that may contribute towards ASD. Whereas, for the classification part, SVM classifier performs better than others do with an average accuracy of 98.34% in predicting the ASD cases. Conclusion: The results identified stress as the dominant feature and environmental factors, like frequent use of canned food and plastic/steel bottles during fertilization period that may contribute towards ASD

Rare co-occurrence of dural arteriovenous fistula and arteriovenous malformation with bilateral subcortical and basal ganglia calcification

The present study describes the imaging findings in a patient with dural arteriovenous fistula (AVR) and arteriovenous malformation (AVM) with bilateral subcortical and basal ganglia calcification. A 29 year old male patient presented with chief complaint of recent onset of generalized tonic clonic seizures and mild disorientation. The imaging studies on MCT demonstrated diffuse, symmetric calcification in the bilateral basal ganglia and subcortical white matter. MR imaging and angiography revealed AVM in parietooccipital region with supply predominantly from left posterior cerebral and middle cerebral arteries. Multiple dural feeders from meningeal branches of occipital and superficial temporal branches of bilateral external carotid and right internal carotid arteries. Calcification is proposed to be due to chronic reflux into the parenchymal veins or vascular steal phenomenon. This rare co-occurrence of subcortical calcification in a patient with a dural AVF and AVM is being reported

Triphasic computed tomography (CT) scan in focal tumoral liver lesions

OBJECTIVE: To assess the diagnostic accuracy of triphasic spiral CT in differentiating benign from malignant focal tumoral liver lesions. METHODS: The study was conducted in Department of Radiology of Aga Khan University Hospital and Sind Institute of Urology and Transplantation, Karachi from Feb 2006 to Feb 2007. By convenient sampling, 45 patients found to have focal tumoral liver lesions were recruited for one year period and their triphasic CT scans findings were evaluated and later correlated with histopathology. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of triphasic CT scan were calculated. RESULTS: Among 45 patients, 136 liver lesions (11 benign and 125 malignant) were detected with the help of different enhancement patterns. Out of these, 37(82.2%) patients had malignant while 8 (17.8%) had benign lesions. On later histopathological examination, 35 (77.8%) of the total 45 cases had malignant lesions while 10 (22.2%) were diagnosed as benign lesions. Based on these results, it could be assessed that triphasic CT Scan has a sensitivity of 100%, specificity of 80%, positive predictive value of 94.5%, negative predictive value of 100% and diagnostic accuracy of 95.5% in differentiating benign from malignant liver lesions. CONCLUSION: Triphasic CT Scan is a good non-invasive tool in characterizing and differentiating benign from malignant liver lesions

Diffusion Weighted MR Imaging of Ring Enhancing Brain Lesions

Objective: To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions. Study Design: Analytical, descriptive study. Place and Duration of Study: Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Methodology: Diffusion weighted imaging (DWI) was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of DWI were calculated. Comparisons of mean ADC values of abscess and neoplastic lesions were also done using t-test. Results: DWI had a sensitivity of 94.73%, specificity of 94.44%, positive predictive value of 94.73%, and negative predictive value of 94.44% and diagnostic accuracy of 94.5% in differentiating brain abscess from neoplastic brain lesions. Mean ADC value in central cavity and wall of neoplastic lesions and brain abscesses were calculated with significant p-value of 0.001 and 0.025 respectively. Conclusion: Diffusion weighted imaging is non-invasive method with high sensitivity and specificity which can help in differentiation of ring enhancing neoplastic lesions and brain abscesses. This modality should be read in conjunction with conventional imaging

Assessment of apparent diffusion coefficient values as predictor of aggressiveness in peripheral zone prostate cancer: comparison with Gleason score

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants were positive for malignancy. 89 lesions with proven malignancy showed diffusion restriction. The mean ADC value for disease with a Gleason score of 6 was 935mm(2)/s (SD = 248.4mm(2)/s); Gleason score of 7 was 837mm(2)/s (SD = 208.5mm(2)/s); Gleason score of 8 was 614mm(2)/s (SD = 108mm(2)/s); and Gleason score of 9 was 571mm(2)/s (SD = 82mm(2)/s). Inverse relationship was observed between Gleason score and mean ADC values. Conclusion. DWI and specifically quantitative ADC values may help differentiate between low-risk (Gleason score, 6), intermediate-risk (Gleason score, 7), and high-risk (Gleason score 8 and 9) prostate cancers, indirectly determining the aggressiveness of the disease

Multi-hazard groundwater risks to water supply from shallow depths: challenges to achieving the sustainable development goals in Bangladesh

Background: Groundwater currently provides 98% of all drinking-water supply in Bangladesh. Groundwater is found throughout Bangladesh but its quality (i.e. arsenic and salinity contamination) and quantity (i.e., water-storage depletion) vary across hydrological environments, posing unique challenges to certain geographical areas and population groups. Yet, no national-scale, multi-parameter groundwater hazard maps currently exist enabling water resources managers and policy makers to identify vulnerable areas to public health. Methods: We develop, for the first time, groundwater multi-hazard maps at the national scale of Bangladesh combining information on arsenic, salinity and water storage. We apply geospatial techniques in ‘R’ programming language and ArcGIS environment, linking hydrological indicators for water quality and quantity to construct risk maps. A range of socio-economic variables including access to drinking and irrigation water supplies and social vulnerability (i.e., poverty) are overlaid on these risk maps to estimate exposures. Results: Our multi-parameter groundwater hazard maps show that a considerable proportion of land area (5% to 24% under extremely-high to high risks) in Bangladesh is currently under combined risk of arsenic and salinity contamination, and groundwater-storage depletion. As small as 6.5 million (2.2 million poor) to 24.4 million (8.6 million poor) people are exposed to a combined risk of high arsenic, salinity and groundwater-storage depletion. Conclusions: Our groundwater hazard maps reveal areas and exposure of population groups to water risks posed by arsenic and salinity contamination and depletion of water storage. These geospatial hazard maps can potentially guide policymakers in prioritizing mitigation and adaptation measures in order to achieve the United Nation’s Sustainable Development Goals across the water, agriculture and public health sectors in Bangladesh