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

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

Sonographic Evaluation of Endometrial Thickness in Postmenopausal Women- A Systemic Review

Postmenopausal bleeding (PMB) is highly suspicious of being a sign for the presence of endometrial cancer (EC) and around 5–12% of PMB results from EC. Endometrial cancer is the most common gynecologic malignancy in developed countries. A thin endometrium (≤4 mm) has a very high negative predictive value (99%). A thickened endometrium has been regarded as an indication for an invasive evaluation. Endometrial sampling is recommended, with a cutoff value of 4 mm or 5 mm, for symptomatic postmenopausal women. However, different guidelines use different cut-off values of endometrial thickness, varying from 3 mm-5 mm, for excluding endometrial malignancy. The widespread use of sonography has also allowed the incidental finding of endometrial thickening in asymptomatic postmenopausal women. There are few data on the workup of these women, and the best cut-off value for the endometrial thickness that should warrant endometrial sampling is not known. However, it has been suggested that the 4‐ or 5‐mm limits generally used for excluding malignancy in symptomatic postmenopausal women are not transferable to asymptomatic patients. The objective of this study was to sonographic evaluation of endometrial thickness in postmenopausal women. About 9 studies were selected for this systemic review. We extracted the following information: Study design, Age of patient mean and range, Duration of menopause mean and range, Body mass index mean and range, and Endometrial thickness mean and range. From the above analysis we concluded that, the endometrial thickness with a recommended change in the cut-off to 3mm in routine ultrasound practice should be done in high risk women to detect malignancy earlier in postmenopausal women and ultrasound is proved to be a useful tool for the disgnostic purpose. Keywords: Postmenopausal bleeding, Endometrial  thickness, Endometrial Carcinoma. DOI: 10.7176/JHMN/82-04 Publication date: November 30th 202

ROLE OF MRI IN EVALUATION OF ANTERIOR CRUCIATE LIGAMENT TEAR

Magnetic resonance imaging being a most advanced and non-invasive imaging modality is a gold standard imaging modality in the diagnosis of soft tissue injuries including the injuries of ligament and tendons because of its three dimensional approach.  Almost there are 360 joints in human body with the help of which we can move from one place to other, among them knee joint is the largest joint. It is a synovial joint of hinge variety which mainly allows flexion and extension. Knee joint is supported by a huge network of ligaments and tendons which provide a great strength and flexibility to the knee joint. Anterior and posterior cruciate ligament are the important stabilizing ligaments of the knee joint these two ligaments connects the tibia with femur. Injury or torn to them can cause a critical clinical conditions to the patients suffering from that injury. Injury to anterior cruciate ligament is more frequent as compare to other ligamentous injuries of the knee. Injury to ACL occurs mostly by sudden change in direction so because of which it affects the people who take part in different types of sports like basketball, soccer, baseball skiing. Female athletes are at higher risk of having ACL tear as compare to males. ACL tear should be treated properly because injury to it can cause a serious clinical conditions like it can cause the immobilization of the subject until it is treated properly. For the accurate treatment there should be most advanced and highly sensitive diagnostic approach which aids in the addition of accurate information regarding the location, grading and the condition of ACL tear either there is  complete or partial tear. Magnetic resonance imaging modality can diagnosis ACL tears with a high accuracy with the help of specific protocols which are more sensitive to soft tissue injuries. Keywords: ANTERIOR CRUCIATE, LIGAMENT TEAR DOI: 10.7176/JHMN/93-10 Publication date:September 30th 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

Sonographic Evaluation of Chronic Kidney Disease Correlating with Serum Creatinine Level

Background: Chronic kidney disease is defined as abnormality of urinary system, there is persistent abnormality of structure and upward renal excretory function that is sign of irreversible damage to function of nephron. It is a public health problem world widely and it is 12th most common cause of mortality and morbidity, respectively. Objective: To evaluate chronic kidney disease (CKD) sonographically in addition correlating echogenicity with the level of serum creatinine. Study Design: An analytical Cross sectional prospective study. Settings: Life Care Hospital, Radiology department Lahore. Period: 20th December 2020 till 10th April 2021. Material & Methods: In our study all those patients with age above 18, patients suffering from chronic kidney disease, patient on hemodialysis, diabetic and hypertensive were included. While patient below 18 age, patients on peritoneal dialysis were excluded in which 71 patients were enrolled in the research. All the patient’s data had been composed from indoor of hospital, outdoor of hospital, and emergency department of Life Care Hospital, Lahore. After informed consent, data was composed through ultrasound machine Toshiba Xario Prime. Results: The findings revealed that there were 71 Chronic Renal Failure patients, 45 of whom were male and 26 of whom were female, with ages ranging from 20 to 73. Since the P value is > 0.05 of the relevance indicators, there is no important relationship between the two variables. Conclusion: The ideal sonographic parameter that can be used to correlate the level of serum creatinine with kidney parameter within ultrasound is kidney cortical echogenicity. As kidney cortical echogenicity does not reverses as the disease progress even after the treatment, so it is the most accurate parameter that can be used. Keywords: Chronic kidney disease, Echogenicity grade, Serum creatinine, Ultrasound, estimated Glomerular Filtration rate. DOI: 10.7176/JHMN/90-05 Publication date:June 30th 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

Evaluation of Ischemic and Hemorrhagic Stroke on Computed Tomography

The stroke is the 3rd leading cause of death in Pakistan, wherein back in 2009, stroke used to be the 4th leading cause of death in Pakistan, a 19.2% increase is alarming (IHME, 2019). Ischemic stroke occurs 75-80 percent of the time, while hemorrhagic stroke occurs 8-20 percent of the time. The objective of our study is to evaluate the frequency and ratio of ischemic and hemorrhagic stroke on computed tomography. A Descriptive study was performed using non-probability convenient sampling technique. The study was conducted in Lahore General Hospital, Lahore, Pakistan. The data was collected from November 15, 2020 to February 15, 2021. Informed consent was taken from all the participants. In our study patients with provisional diagnose of clot or thrombosis, History of Ischemic Stroke, History of Hemorrhagic Stroke, patients who came with clinical manifestation of stroke, traumatic or Road Traffic Accidents (RTA) patients, patients with cerebral Transient Ischemic Stroke. Arterial Puncture in Last 7 days, patients with Active bleeding, peroneal nerve injuryand patients who have been injected Botulinum Toxic Injection in last 3 months were included in our study. Patients who had a previous history of Parkinson disease, patients not having any apparent cause or chronic or acute symptoms of stroke, no history of internal bleeding, patients with chronic cerebral disease and patients with other neurological defects were excluded.A total of 85 patients with Stroke were included in our study. Most of the patients were 40 to 65 years of age. The average age of the patients was 59.5 ± 11.1 years. Out of 85 there were 38.8% (P=33) positive with H/O Infarction females (P=11) and males (P=22 ) 55 (62.5%) were males and 33 (37.5%) were females with 1.62: 1 male to female ratio as shown in Fig 5.2. Ischemic stroke was observed in 33 (36.2%) patients and 40 (47.3%) were suffered hemorrhagic stroke and 12 (14.4%) patients were affected with TIA.The conclusion to this study is that to assess early stroke with extreme clarity, computed tomography is the safest modality for evaluating stroke patients and allows radiologists to more accurately assess these patients on CT in terms of prognosis, frequency, morbidity, and legitimacy. Keywords: Stroke, Hemorrhagic Stroke, Ischemic Stroke, Cerebral Infarction, Computed Tomography DOI: 10.7176/JHMN/90-06 Publication date:June 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

Evaluation of Lumber Spine Stenosis on Magnetic Resonance Imaging Correlating with Its Clinical Manifestation

Lumber spine stenosis (LSS) is one of the major reasons of spinal surgery all over the globe. Despite using standard Diagnostic tools for LSS, the clinical and imaging findings often do not correlate. Over past years, the central spinal canal stenosis is assumed to be the diagnoses of lower back pain, while other anatomical stenosis (i.e lateral recess stenosis) not gaining as much attention. This fact assumed to be the reason for failed back surgery. In this context numerous studies in past have done. The aim of this study is to verify the clinical manifestation of LSS correlation to its Diagnostic find. To evaluate the lumbar spine stenosis on magnetic resonance imaging & correlating with its clinical manifestations. The duration of study was three months. Study was done at Lahore General Hospital, Pakistan. A cross-sectional analytical study included 120 patients. According our study the patients comes with lumber spine stenosis at different levels. At L4L5 presents 39 (32.5%) patients, 47(39.2%) patients reveal at the level of L5S1, 14 (11.7%) patients at L2L3, and only 3 (2.5%) patients appear at the level of L1L2, 19 (15.8%) patients show stenosis at L3L4 Then we correlate the pain intensity with all lumber spine levels and the results are 35 (29.2%) patients are absent and 85 (70.8%) presents at the level of L4L5. On the level of L5S1 pain intensity is absent in 81 (67.5%) patients, & present in 39 (32.5) patients. On the level of L2L3 106 (83.5%) absent and 14 (11.7%) patients are present pain intensity.  On the level of L1L2 117 (97.5%) absent of pain intensity and only 3 (2.5%) patients are present with pain intensity. The study concluded that the clinical manifestation of lumber spine stenosis to devise the management plan for the patient for better diagnoses in magnetic resonance imaging in LSS. Keywords: Lumber spine stenosis, manifestation, MRI DOI: 10.7176/JHMN/90-10 Publication date:June 30th 202