Assessment of menisci and ligamentous injuries of the knee on magnetic resonance imaging: correlation with arthroscopy

OBJECTIVE: To evaluate the validity of MRI, in the assessment of the meniscal and cruciate ligamenteous injuries of the knee joint and comparison with arthroscopic findings. METHODS: A one year prospective cross-sectional study from January 2006 to January 2007, was performed on 50 patients (32 males & 18 females) with knee injury presenting at the orthopedic unit of AKUH. The patients were referred to radiology department for MRI evaluation and arthroscopy. RESULTS: The sensitivity, specificity and accuracy for MRI of the menisci and ligaments were as follows: medial meniscus resulted in 100% sensitivity, 69.27% specificity, 90% PPV, 100% NPV and 92% accuracy: lateral meniscus resulted in 87.5% sensitivity, 88.23% specificity, 77% PPV, 93% NPV and 88% accuracy: anterior cruciate ligament resulted in 86.67% sensitivity, 91.43% specificity, 81% PPV, 94% NPV and 88% accuracy; posterior cruciate ligament resulted in 100% sensitivity, 95.83% specificity,50% PPV, 100 NPV and 96% accuracy. CONCLUSION: Magnetic resonance imaging is a good, accurate and non invasive modality for the assessment of menisci and ligamenteous injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee

The nature, sources and the socio-economic effects of terrorism in Balochistan

Terrorism has badly affected Pakistan and Balochistan is one of its worst – hit provinces. There is no research that accounts for the nature, sources and effects of terrorism on Balochistan; this study, thus, tried to explore the same. A sample size of 250 respondents was chosen to cast their opinion about the problem using a questionnaire through a stratified sample of Quetta city. The results indicated that the nature of terrorism in Balochistan is, at first, Political and is caused by the prevailing social injustice and lack of economic activity, cross-border activities and religious and ethnic extremism. Terrorism has negatively affected business optimism, foreign investment and economic life in Balochistan. As far as the social life is concerned, a sense of fear prevails in the province that has reduced social activities in the province. One of the worst – hit areas by terrorism is education and religious practices. In order to correct the current situation prevailing in Balochistan the government has to play an intelligent, planned and effective role in Balochistan.Socio-economic effects, Terrorism, Balochistan

Contamination of Water Resources by Food Dyes and Its Removal Technologies

Food dyes comprise different groups which impart color to a wide range of food products. Food products are mainly purchased and consumed by people because they are nutritive and flavorsome and have an attractive color. Food color stimulates appetite and enhances its esthetic appeal of food on table for customer. With sky rocketing industrialization and modernization, the worldwide production of dyes in 2010 was forecasted to be 2.1 metric tons. It has been estimated that 15% of total dyes produced worldwide are discharged to water bodies which adversely affect aquatic ecosystem. Dyes in water reduces its transparency, thereby declining light penetration in the water, hence influencing photosynthesis which consequently reduces dissolved oxygen which is an alarming situation for both aquatic flora and fauna. Dyes wastewater discharged from huge number of industries like textile, leathers, paint, food, pharmaceutical etc. and deteriorating the aquatic environment and pose threat to living organism. The presence of dye molecules in water channels is an emerging alarm to an environmental scientist. An environmental friendly and self-sustainable treatment method should be explored to address this problem. Therefore, this work elaborates the various methods used for removal and degradation of dyes in water, although some processes have a common shortcoming like production of secondary pollution to the environment. This chapter have tried to highlight the important application of food dyes, their contamination and their toxic effect. Herein we also focus on remediation techniques like separation (adsorption, filtration, etc.) and degradation (chemical, biological and electrochemical oxidation) of dyes in aqueous solution. The mechanism and pros and cons of different methods are explored and discussed briefly

Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Background: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis. Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy. Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of –removed for blind review---from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values.  Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy. Key words: Extra pulmonary tuberculosis; GeneXpert; Pleural biopsy; Tuberculosis

Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Background: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis. Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy. Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of –removed for blind review---from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values.  Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy. Key words: Extra pulmonary tuberculosis; GeneXpert; Pleural biopsy; Tuberculosis

Outcome of Kangaroo Mother Care in Preterm, Low Birth Weight Neonates; A Randomized Control Trial

In a recent meta-analysis, based on 13 randomized control trials, the researchers concluded that the neonates care with KMC at least 6 hours per day got significant weight gain as compared to the Non-KMC group with a mean difference 8.99 gm per day. They also concluded that the infants received KMC for less or equal to 02 hours per day not showed a significant difference in weight gain as compared to controls.1

The nature, sources and the socio-economic effects of terrorism in Balochistan

Terrorism has badly affected Pakistan and Balochistan is one of its worst – hit provinces. There is no research that accounts for the nature, sources and effects of terrorism on Balochistan; this study, thus, tried to explore the same. A sample size of 250 respondents was chosen to cast their opinion about the problem using a questionnaire through a stratified sample of Quetta city. The results indicated that the nature of terrorism in Balochistan is, at first, Political and is caused by the prevailing social injustice and lack of economic activity, cross-border activities and religious and ethnic extremism. Terrorism has negatively affected business optimism, foreign investment and economic life in Balochistan. As far as the social life is concerned, a sense of fear prevails in the province that has reduced social activities in the province. One of the worst – hit areas by terrorism is education and religious practices. In order to correct the current situation prevailing in Balochistan the government has to play an intelligent, planned and effective role in Balochistan

The nature, sources and the socio-economic effects of terrorism in Balochistan

Terrorism has badly affected Pakistan and Balochistan is one of its worst – hit provinces. There is no research that accounts for the nature, sources and effects of terrorism on Balochistan; this study, thus, tried to explore the same. A sample size of 250 respondents was chosen to cast their opinion about the problem using a questionnaire through a stratified sample of Quetta city. The results indicated that the nature of terrorism in Balochistan is, at first, Political and is caused by the prevailing social injustice and lack of economic activity, cross-border activities and religious and ethnic extremism. Terrorism has negatively affected business optimism, foreign investment and economic life in Balochistan. As far as the social life is concerned, a sense of fear prevails in the province that has reduced social activities in the province. One of the worst – hit areas by terrorism is education and religious practices. In order to correct the current situation prevailing in Balochistan the government has to play an intelligent, planned and effective role in Balochistan

Catatonia in The General Hospital: A Case Series Wading Through Diagnostic & Management Challenges

ABSTRACT Catatonia is a cluster of affective, behavioral, and motor symptoms. Its causes are multifactorial ranging from severe and untreated psychiatric illnesses to neurological diseases and other general medical conditions. It is estimated that 20% of catatonia causes are due to medical conditions out of which two thirds are due to an underlying neurological condition which might include encephalitis, neural injury, developmental disorders, structural brain pathology, or seizures. Symptoms of catatonia can wax and wane, fluctuating between the retarded and the excited type within hours making it more difficult to identify and diagnose. If left untreated, catatonia can lead to multiple medical complications which can lead to significant long-term morbidity and mortality. The initial complications include dehydration, malnourishment, electrolyte imbalance, deep venous thrombosis, pulmonary embolism, pneumonia, urinary tract infection, and retention. In the long run, patients can have sepsis, rhabdomyolysis, DIC, decubitus ulcers, arrhythmia, renal failure, and liver dysfunction. This article will describe three patients (adolescent & adult) that presented to Aga Khan University Hospital (AKUH), Karachi with challenging presentations of catatonia. Their diagnostic and management difficulties will be discussed