Predicting Gestational Age of Fetus with the Reference of Humerus and Foot Length by Ultrasonography

Objective: The objective of the study is to predict the gestational age of fetus with the reference of humerus and foot length by ultrasonography. Methodology: A cross sectional analytical study was perform in which 131 pregnant women with a singleton fetus were taken to get the required results. All data of the ultrasonographical reports has been collected from The Department of Radiology, Sheikh Zaid Hospital, Lahore. All pregnant women, from the second trimester to full term, are examined by ultrasound measurement of the full HL and FFL were taken by using a curve array transducer. Results: 36 women (27.5%) out of 131 had gestational age by LMP was 17-20 weeks and only 2 women (1.5%) having gestational age by LMP of 37-40 weeks while out of 37 women (28.2%) out of 131 had gestational age by foot length was 17-20 weeks and 8 women(6.1%) having gestational age by foot length of 25-28 weeks. 41 women (31.3%) out of 131 had gestational age by humerus length was17-20 weeks and 3 women (2.3%) having gestational age by foot length of 37-40 weeks.GA was almost similar from these different parameters i.e. LMP, Foot Length and Humerus Length. Conclusion: The fetal foot length and humerus length developed with gestational age in a healthily developing fetus. During the late second and third trimesters of pregnancy, the length of a fetus's foot and humerus length could be considered as an exploratory approach to determine the gestation of the fetus. When other parameters failed to reliably estimate gestational age, the length of the fetal foot and humerus length proved effective. Keywords: Gestational age, Humerus Length, Foot length DOI: 10.7176/JHMN/91-05 Publication date:July 31st 202

Sonographic Association Between Fatty Liver and Gall Baldder Stone

Background: Fatty liver (chronic liver disease) was most frequently found associated with gall stones. It arises due to accumulation of lipid in hepatocytes mainly triglyceride. Due to high existence of obesity in the population, the risk of fatty liver and gall stones also increases. In Pakistan the prevalence of fatty liver was 15-20 %. Fatty liver and gall stones could easily be observed on ultrasound. Objective: To evaluate the sonographic association between fatty liver and gall bladder Stone. Study Design: Descriptive Study was conducted Settings: Sanabil health services. Lahore Period: Four months Material & Methods: In our study patients presents with epigastric pain high cholesterol level and previous history of gall stones.While patient with the history of cholecystectomy were excluded. All the data had been composed from Sanabil Health Services Lahore. After informed consent, data was composed through ultrasound machine GE LOGIQ P7 with convex probe (frequency 2.5- 5MHZ) Results: According to results total volume of patient was 220. Now we were comparing between cholelithiasis and grading of fatty liver. Total no of GRADE 1 fatty liver patients were 63 out of 220 in which 13 patients were showing absence of GS while 50 patients showed GS. Total no of GRADE II fatty liver patients were 89 out of 220 in which 36 patients were showing absence of GS while 53 patients showed GS. Total no of GRADE III fatty liver patients were 68 out of 250 in which 20 patients were showing absence of GS while 48 patients showed GS. Total no of 69 out of 220 patients showed absence of GS while 151 patients out of 220 showed with GS. Conclusion: We concluded that the patients who had high cholesterol level, gall stones are associated with fatty liver disease. Moreover fatty liver disease was more common in females than males. Keywords: Nonalcoholic fatty liver, chronic liver disease, Gallbladder, Gall stones, Ultrasound and cholecystokinin. DOI: 10.7176/JHMN/91-09 Publication date:July 31st 202

Fetal Transverse Cerebellar Diameter (TCD) Measurement for Gestational Age Prediction in the Second and Third Trimesters of Pregnancy

Background: The purpose of this study was to see how accurate transverse cerebellar diameter (TCD) measurement is at predicting gestational age in normal fetuses. In the 2nd & 3rd trimesters of pregnancy a range of sonographics fetal biometric characteristics can be utilized to determine gestational age. Other parameters, such as bi-parietal diameter and fetal length, are used to determine transcerebellar diameter. Objective(s): To determine the predictability of GA estimated from fetal TCD assessed on ultrasonography in the 2nd and 3rd trimesters of pregnancy. Methodology: This was a cross-sectional study conducted at the Ch. Mohammad Akram teaching and research hospital on 84 pregnant healthy ladies with fetuses ranging in age from 18 to 45 years old. During the 2nd and 3rd trimesters of pregnancy a routine ultrasound scan was done. In additions to the standard biometric parameter the transcerebellar diameter was estimated. Results: The TCD of 84 patients as a measure of gestational age in weeks. These were generated from data collected during the study and include mean and standard deviation TCD measurements of 84 participants ranging in gestational age from 14 to 40 weeks. The current research found a significant link between the GA of TCD and the GA of BPD and fetal length.  The TCD(mm) mean and standard deviations were 33.74 ± 11.762 respectively. The TCD gestational age mean and standard deviations were 28.160 ± 6.7942 respectively. Bi-parietal diameter (mm) has a mean and standard deviation of 68.24 ± 18.503. Bi-parietal diameter had a mean and standard deviation of 27.996 ± 6.9099 gestational age. The standard deviation and mean  50.32 ± 16.265 mm Fetal length The mean and standard deviation of fetal length gestational age are 27.423 ± 6.7625. Different criteria such as transcerebellar diameter, biparietal diameter, and femur length, are used to establish the gestational age of the fetus in this cross-sectional analysis. Conclusion(s): The TCD is a set of accurate variables for assessing GA in pregnant women in the 2nd and 3rd trimesters. Key words: Transcerebellar diameter; Gestational age;  Fetal length ; Bi-parietal diameter. DOI: 10.7176/JHMN/93-08 Publication date:September 30th 202

Diagnostic Interstitial Lung Diseases in Patients Having Normal Chest Radiograph through High Resolution Computed Tomography

Background: In Pakistan, the main cause of death is interstitial lung disease (ILD) i.e., 4.75%. In interstitial lung disease majority of the patients is about the age of 57.5 years. The age group maybe varying between the ages of 46 and 65 year. Female gender is more predominantly i.e., 65.6% in all types of ILD except the interstitial pulmonary fibrosis (P< 0.001). Objective: The aim of our study is to diagnose interstitial lung diseases in patients having normal chest radiograph through high resolution computed tomography. Study design: Our study design was cross-sectional descriptive study. Material and method: The descriptive cross-sectional study was conducted in which data of 100 patients were taken. The data was collected from the Radiology department of Sheikh Zayed Hospital Rahim Yar Khan. After informed consent, data was collected through CT Toshiba 164 slices. Result: 100 patients were included in our study out of which 61 were females and 39 were male’s with the mean age of 49.32 years. The chest radiograph of the patients having ILD shows the patchy ground glass opacities (39.0%), consolidation of the lungs (21.0%), reticular shadowing (16.0%) and the pleural effusion (24.0%) while on the high-resolution computed tomography the patients were represented with ground glass haze (42.0%), calcific foci (21.0%), nodular lesion (16.0%), consolidation of the lungs (30.0%) and pleural effusion (22.0%). Conclusion: Chest radiograph nearly misses common radiographical features which are suggestive of interstitial lung disease but can be seen on High Resolution Computed Tomography (HRCT) due to its high resolution. So, it can be concluded that the HRCT is more efficient and authentic diagnostic equipment in assessing the Interstitial Lung Disease as compared to the chest radiograph. Keywords: Interstitial lung disease, Chest radiograph, Computed tomography, High resolution computed tomography. DOI: 10.7176/JHMN/91-04 Publication date:July 31st 202

SONOGRAPHIC EVALUATION OF ESTIMATED FETAL WEIGHT BY DIFFERENT METHOD AT TERM AND POST TERM

Objective: To determine fetal weight estimation by different method on ultrasound at term & to determine actual baby weight after birth Methodology: The research is conducted in Meer Children and Family Clinic Tajpura Lahore. 121 women participate in this study over a 4 month period from January 2021 to April 2021. Systematic random sampling was used to make the selection. The scanner has Hadlock, Shepard, shibozuka and warsof formula.  Results: Out of 70 pregnant women in which 36 (51.5%) nulliparous women and 34(48.5%) multiparous women. A total of 45(64.3%) by vaginal delivery while 25(35.7%) deliver by C – Section. The minimum maternal age for nulliparous women is 21 years and maximum maternal age for multiparous is 39 years. The minimum Actual birth weight i.e. 2.40 correlate with estimated fetal weight. The maximum Actual birth weight i.e. 4.00 correlate with estimated fetal weight. The mean Actual birth weight   is significantly increase with increase in both parity and maternal age at delivery Conclusion: For most pregnant women, estimated fetal weight based on multiple fetal parameters provides reliable and clinically useful information. Despite the fact that there is still an acceptable difference between the actual birth weight and the sonographically EFW. Keywords: Fetal Macrosomia, Term Pregnancy, Hadlocks Formula , Actual birth weight DOI: 10.7176/JHMN/91-11 Publication date:July 31st 202

Estimation of Nonalcoholic Fatty Liver Disease in Patients with Normal BMI on Ultrasound

Background: Non-Alcoholic fatty liver disease is common in adults and it is increasing in patients with normal BMI in Asian countries. Non-alcoholic fatty liver disease (NAFLD) occurs not only in obese individuals but also in non-obese ones. The association between NAFLD and metabolic events in a non-obese population is also evident.. Objective: To estimate nonalcoholic fatty liver disease in patients with normal BMI on ultrasound. Methodology: Analytical Cross-sectional prospective study in which 59 patients were enrolled in the research. All the patient’s data had been composed from indoor of hospital, outdoor of hospital, DHA Medical Center, Lahore. After well-versed consent, data was composed through ultrasound machine. The data, such as patient characteristics, hypertension, impaired fasting glucose, were extracted from medical records, and statistical analysis was performed. Results: The present study is retrospective cross sectional observational study.60 patients (29males 49.2% 31 female 50.8%) were enrolled in this study. According to abdominal ultrasonography, 72.9% of patients with normal BMI were diagnosed to have Non-alcoholic fatty liver disease and identified to have fatty changes in the liver. Conclusion: In our study we estimated that nonalcoholic fatty liver disease was present in patients with normal body mass index by imaging the echotexture of liver on ultrasound. Having increased echogenicity, due to poor diet and other associated diseases such as high blood pressure, impaired fasting glucose and low HDL cholesterol patients were getting NAFLD. Keywords: Nonalcoholic fatty liver disease (NAFLD), Body Mass Index (BMI), Ultrasonography (USG). DOI: 10.7176/JHMN/92-03 Publication date:August 31st 202

Frequency of Disc Degeneration at Different Levels of Lumbar Vertebrae in Adult Patients with Backache on Magnetic Resonance Imaging

Objective:To Determine the Frequency of Disc Degeneration at Different Levels of lumbar Vertebrae in Adult Patients with lower back Pain on Magnetic Resonance Imaging. Study Design: An analytical cross-sectional descriptive study was performed. Settings: The study was performed in Bashir Neurospine Institute and Al-Razi Healthcare center, Lahore. Period: An Analytical cross sectional study was conducted from 15 October,2020 to 15 January 2021. Material and Methods: In our study, all those adult patients with lower back pain, obese, dull ache, numbness, tingling, pins and needle sensations, muscles spasms were included. And those patients who were not giving consent, spondylosis, lumbar spine stenosis, cervical and thoracic abnormalities, paedes, and those who were uncooperative were excluded. Data was tabulated and analyze with the help of statistical package for the social science (SPSS version 24). The data was reported using cross sectional descriptive statistics. Results: In our research out of 160 patients 89 females and 51 males were those who  diagnosed with disc degeneration and 10 females and 10 male in which disc degeneration was absent. 10 patients out of 160 patients were those who diagnosed with disc degeneration at the level of L1 - L2 between the age of 24 to 87, 8 patients were those in which disc degeneration present at the level of L2- L3 between the age of 43 to 87, 31 patients were those in which disc degeneration present at the level of L3-L4 and  96 patients diagnosed with  disc degeneration present at the level of L4- L5 which is the lowest lumbar vertebra between the age of 55 to 80 years. Overall out of 160 patients only 3 patients were those who represent with mild pain (25yrs) and 102 were those who came with moderate pain (27-90yrs) and 55 patients who represent with severe backache (30 to 89yrs). In this research out of 160(100%) patients only 102  patients (63%) are those who present with moderate pain and 55 patients (34%)with severe pain .At L1-L2   disc degeneration only 5 patients (50%) were those who came with moderate and 5( 50% )with severe pain. At L2-L3 disc degeneration two patients (25%) with moderate and six patients (75%)with severe pain .At L3-L4 disc degeneration 11 patients (35.4%) with moderate and 20(64.5%) with severe pain. At L4-L5 disc degeneration 51 patients (53%) with moderate pain and 45 patients (46.8%) with severe pain. Our study also revealed that elevated BMI patients had high frequency of disc degeneration. Conclusion: This study conclude that lumbar disc degeneration was approximately in women than men who were represented with lower back pain. Minority of patients had normal lumbar MRI findings. Most of the degeneration occurs at the lowest lumbar vertebrae i.e. L4- L5 and patients who were presented with elevated BMI have increased risk of disc degeneration. Keywords: Lumbar vertebrae, Magnetic resonance imaging, lower back pain. Degenerative disc disease. DOI: 10.7176/JHMN/90-17 Publication date:June 30th 2021

Sonographic Evaluation of Causes of Right Hypochondriac Pain

Background: Right hypochondriac pain or right upper abdominal quadrant (RUQ) pain is the most common type of pain, reason of 7.9% patients presenting at the OPD and ET departments of hospitals. RUQ main has multiple recorded causes with different frequencies of presentation. Ultrasound is the essential imaging methodology of decision for introductory evaluation and fills in as a practical and dynamic methodology to give a conclusive finding. Various systems of organs are incorporated at standard RUQ US, and an assortment of ultrasonographically diagnosable infection cycles can be recognized, including states of hepatic, pancreatic, adrenal, renal, gastrointestinal, vascular, and thoracic, all of which may bring about RUQ torment and pain. Most common causes, however, incorporate acute hepatitis and issues with gall bladder such as cholelithiasis as reported in existing literature The present study was thus conducted to evaluate the causes of right hypochondriac pain adopting ultrasound as the modality of choice. All the patients were scanned using SIMENS Grey scale/doppler ultrasound machine. Scanning was done in both transverse, longitudinal and any other plane deemed necessary to adequately visualize the right upper quadrant. Patients of either sex suffering from right hypochondrium pain were included in the study. They were referred from surgical OPD/ward of Chaudhary Muhammad Akram Teaching and Research Hospital. Duration of study was 4 months, during this period 154 patients were selected on the basis of  age, gender and  radiological findings,  informed, verbal consent was taken and ultrasonographic reports were collected  from radiologist office. It was found that out of 154 recorded cases, 93 were females and 61 males. Patients presented with a mixed frequencies of pain, highest being generalized abdominal pain. For the causes of RUQ pain, hepatic cyst was found to be the major cause present in 38.3% study participants followed by cholelithiasis (13.6%), hepatic hemangioma (10.4%), and right renal cyst (6.5%). Other findings included conditions like fatty liver (5.8%), gallbladder polyp (5.8%), right renal stones and hepatocellular carcinoma (3.9%). It was concluded that hepatic cysts and gall bladder stones are the major cause of RUQ pain in the present study sample. Although in some cases  non-significant causes included hepatic calcification, focal nodular hyperplasia and lipomas are causes pain. As in our cases, US seems to be an important diagnostic modelity in both the diagnosis and follow-up of Right hypochondriac pain and it may provide a faster, easier method of diagnosis. Keywords: Right Hypochondriac Region, Cholelithiasis, Acute Hepatitis, Ultrasound, Inflammation. DOI: 10.7176/JHMN/91-06 Publication date:July 31st 202

Ultrasound Evaluation of Liver in Patients Who Had History of Hepatitis C

Background: Hepatitis is an infection of liver. The disorder can be self-limiting or lead to fibrosis(scarring), cirrhosis, or liver cancer. Both acute infection and chronic sequelae, such as hepatitis C, cause significance morbidity and mortality in the hum of population. Hepatitis can be very high in general population. Our study evaluate the liver parenchyma in patients with history of Hepatitis C and provide descriptive to prevent future liver pathologies.The primary goal of our research is to delay or perhaps stop the progression of liver fibrosis, as well as to prevent liver disease.Grey scale ultrasonography has been reported to detect Ultrasonographic features of chronic disease resulting in decreased liver function and ultimately, liver failure and to help the patients with cured hepatitis C to check out the parenchymal damage and to give healthy lifestyle. Objective: To evaluate the ultrasonographic features of the liver in the patients who had history of hepatitis C. Study design: ur study design was retro prospective. Material and method: The retro prospective study was conducted in which data of 56 patients were taken. The data was collected from the radiology department of al-Razi health care and Jinnah hospital. After informed consent, data was collected through ultrasound machine. Out of 56 patients 27 were females and 29 were males. study duration was 4 months. Inclusion criteria includes patients with history of liver hepatitis C. Exclusion criteria was patients with other causes of liver disease, primary biliary cirrhosis, metabolic liver disease and liver transplant recipients except hepatitis C. Result: 56 patients were included in our study out of which 27 were females and 29 were males. The ultrasonographic findings of the patients having liver hepatitis C shows the cirrhosis in 44.6%, change in liver contour in 37.5%, nodularity in 42.9% and vascular changes in 58.9%. Conclusion: Some extent of hepatitis C diseases cannot be seen on CT or MRI but can be seen on grey scale ultrasonography due to its high resolution .so, it can be concluded that the grey scale ultrasonography is more efficient and authentic diagnostic equipment in assessing the liver hepatitis C as compared to the CT. Keywords: hepatitis C, cirrhosis, liver abnormalities, ultrasound. DOI: 10.7176/JHMN/91-08 Publication date:July 31st 202

FETAL HEART RATE WITH HYPERTENSIVE AND NON-HYPERTENSIVE MOTHERS ON ULTRASONOGRAPHY IN THIRD TRIMESTER- A SYSTEMATIC REVIEW

Background: Preeclampsia throughout pregnancy increase a women’s chance of developing cardiovascular disease. Women that develop preeclampsia are at higher risk for development of hypertension and cardiac disease. Objective: To evaluate the relationship between maternal health (blood pressure} and fetal heart rate (FHR) during third trimester, and differentiate FHR in male and female fetuses. Material & Methods: An electronic study including the articles of nearly a decade and half. The studies were added by means of Google Scholar, Research gate, NCBI and PubMed to name a few. All the articles were included in the official language English. Articles were included having sonographic relation between the hypertensive and non-hypertensive mothers with fetal heart rate. Results: Analyzing the topic, 14 articles were added to determine the exact correlation between fetal cardiac output and hypertensive mothers. 25 articles were added in introduction and technique while 4 articles were included to link pre-eclamptic mothers with adolescent offspring regarding their growth and cardiac output. Conclusion: Gestational hypertension has adverse effect on fetal heart rate and studies have proved the difference by comparing them with normotensive pregnancies. Keywords: Fetal, Heart, Maternal, Blood pressure. DOI: 10.7176/JHMN/90-16 Publication date:June 30th 202