Unenhanced helical CT of ureterolithiasis: incidence of secondary urinary tract findings

Objective: To determine the incidence of secondary signs of obstruction in patients with ureteral stones on unenhanced helical CT scans.MATERIAL AND Methods: Three hundred consecutive patients with suspected renal colic referred by the emergency department for an unenhanced helical CT scan were evaluated. One hundred and thirty two patients with ureteric calculi were viewed prospectively for the secondary signs of obstruction, which include hydronephrosis, hydroureter, perinephric stranding, nephromegaly, periureteral edema and difference in attenuation between acutely obstructed kidney and unobstructed kidney.Results: In the evaluated 132 patients, calculi were present in the proximal, mid and distal ureter in 12, 18 and 112 patients respectively. Four patients had a contralateral ureteric calculus while none had more than one ureteric calculus on the same site. Concurrent renal parenchymal calculi were seen in 40 patients with ureteric stones, hydronephrosis in 69, hydroureter in 93 and perinephric strandings in 66 patients. Nephromegaly was seen in 15 and periureteral edema in 42 patients. In 87% patients with acute renal obstruction, the affected kidney was less dense than the unobstructed kidney. Only 5 of 132 patients had no associated findings.CONCLUSION: Unenhanced helical CT has rapidly become the imaging technique of choice in evaluating patients with acute ureteric colic. The secondary signs of obstruction provide supportive evidence of acute obstructive process

The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice

Objective: To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001.Methods: Forty nine consecutive patients included 19 men and 30 women, suspected of obstructive jaundice. Patients underwent ultrasound (n = 49), CT (n = 11), ERCP (n = 25) and biliary surgery (n = 17). Final diagnosis was established by surgical exploration, endoscopic sphincterectomy, cytology and clinical follow up.Results: Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive (88%) and specific (96.8%) in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture.CONCLUSION: Our prospective study confirms that MRCP, a noninvasive and well tolerated imaging technique is of value in the diagnosis of obstructive jaundice

Fabrication and Evaluation of Rosuvastatin Calcium Fast- Disintegrating Tablets Using β-Cyclodextrin and Superdisintegrants

Purpose: To formulate fast-disintegrating tablets (FDT) of rosuvastatin calcium (RST) using β- cyclodextrin (CD) and different superdisintegrants to enhance their solubility.Methods: A total of 15 FDT formulations of RST were prepared using three different techniques. The FDTs were evaluated for micromeritic properties, as well as by Fourier transform infrared spectroscopy (FTIR), thermal analysis, disintegration time (DT), dissolution rate, powder x-ray diffraction (XRDP), scanning electron microscopy (SEM) and stability studies.Results: XRDP showed that RST was changed from crystalline to amorphous form. SEM images revealed the presence of small microscopic pores that enhanced water penetration and provided rapid dissolution rate compared with the pure drug. There was maximum release of drug (99 %) from F4 formulation containing solid dispersion of RST, CD and superdisintegrants. DT and wetting time were 25 s (p = 0.032) and 33 s (p = 0.023), respectively, for F4 formulation. In vitro dispersion time was also lowest for F4 at 23 s (p = 0.023). FTIR and DSC studies also confirmed complex formation of drug with CD and superdisintegrants.Conclusion: FDT is a suitable strategy to enhance the dissolution rate of RST and thus is an effective tool to improve bioavailability of poorly water soluble drugs.Keywords: Solubility, β-cyclodextrin, Kyron, Polymer, Rosuvastatin, Fast-disintegrating tablet

Significant Analysis for Financial Statements: An Empirical Study of National and Unilever Foods

Choosing vital, reliable and hustle free analysis is a bit difficult situation for most of the financiers and managers as there are so many analyses. This study focuses on most significant analyses to perform on financial statements. To accomplish this study, financial statements of two companies, Unilever foods and National foods has selected to perform analysis. Results show that vertical analysis can be a suspicious analysis as it total assets and sales fluctuate gradually. Horizontal analysis is somehow better analysis than vertical analysis as it shows negative or positive trend of variables. DuPont analysis is a reliable analysis but it taken into consideration only two years. However, ratio analysis is seems to be best analysis as it gives concise and paramount review of firm’s performance. According to these analyses, Unilever Foods is better corporate than National Foods. Further results are discussed in the light of these analyses. Keywords: Vertical analysis, Horizontal analysis, DuPont analysis, Ratio analysi

The evaluation of hepatocellular carcinoma with biphasic contrast enhanced helical CT scan

Objective: To evaluate the role of biphasic contrast-enhanced helical CT including Hepatic Arterial Phase (HAP) imaging with Portal Venous Phase (PVP) imaging, in the detection and characterization of hepatocellular carcinomas.Methods: The study included 40 patients (M = 26, F = 14) with histopathologically proven HCC. Age range was between 30-85 years (mean = 55) by following consecutive patients with cirrhosis in whom Hepatocellular carcinoma was diagnosed or suspected either by raised serum a (alpha)-fetoprotein level or Ultrasound.Results: Biphasic contrast-enhanced examination revealed a total of 85 lesions in these 40 patients, out of which 13 were unifocal, 12 showed a dominant mass with satellite lesions, 2 showed cluster of contiguous nodules and 13 were multifocal HCCs. Mean diameter was 3.1 cm, ranging from 0.8 to 14 cm. On HAP imaging 85% were detected. (hyperattenuating = 69, hypoattenuating = 3) while on PVP imaging detectibility was only 48% (hyperattenuating = 2, hypoattenuating = 39). Hence detectibility was significantly (p = 0.008) superior in HAP as compared to PVP imaging. In 7 patients (17%) tumor was visible only on HAP images. Venous invasion was present in 12 patients (30%) while arterio-portal shunting was seen in 5 patients (13%).CONCLUSION: Biphasic contrast enhanced helical CT is a useful method in detection and characterization of HCC

Radiologic feeding gastrostomy placement: experience in 23 patients

Objective: To evaluate the safety, efficacy and complications of percutaneous gastrostomy catheter placementunder flouro guidance for long-term enteral feeding.MATERIALS AND Methods: Between April 1998 to May 2002, 23 patients who had percutaneous gastrostomy catheter placement were retrospectively reviewed. Clinical indications for catheter placement included patients with neurologic disease, head and neck malignancy, and pulmonary disease patients. Placement of 12 - 14 Fr gastrostomy catheter was then accomplished with the Seldinger technique. The technical success, procedural complications were recorded.Results: Twenty seven procedures, including revisions, were performed. The success rate for catheter placement was 100%. Revision was necessary in 7 (30%) instances in 7 patients. There was one (3.8%) major and 4 (14.8%) minor complications.CONCLUSION: Fluoroscopically directed percutaneous placement of gastrostomy catheters is a safe and effective procedure

Immature Platelet Fraction in Patients with Chronic Liver Disease, A Marker for Evaluating Cirrhotic Changes.

Objective: To evaluate the role of Immature platelet fraction in patients with chronic liver disease, a marker for evaluating cirrhotic changes. Methodology: This case control study was conducted at department of Pathology, Aziz Fatima Medical and Dental College, Faisalabad, over a period of Seven months from June 2020 to January 2021. A total of 126 participants were included in the study consisting of 63 patients with chronic liver disease in group A and 63 participants without any known disease in group B as control. The IPF master program in combination with XE-2100 multiparameter automatic hematology analyzer was used to measure the immature platelet fraction. Ethylene diamine tetraacetic acid was used to collect the blood sample for IPF measurement and was maintained till analysis on room temperature. Ten repeated analyses, immediately and after 24 hours were done for reproducibility of IPF%. Results: The mean age of liver disease patients was 52.35 ± 13.64 years and in control group the mean age was 51.62 ± 11.27 years. There was no significant (p-value > 0.05) difference between both groups based on age and gender. The hemoglobin level and red cell count was found to be significantly (p-value < 0.05) reduced in cases group. While white blood cells count was comparable in both groups. The mean platelet count was significantly (p-value < 0.05) less in cases group (163.5 ± 90.4 vs 233.4 ± 54.5 (x10*3/µl). The mean value of immature platelet fraction (IPF%) was significantly (p-value < 0.05) raised in cases group (5.62 ± 2.92 vs 3.06 ± 1.87). The multivariate discriminant analysis (MDA) score showed a significant (p-value < 0.05) association with chronic hepatis as compared to other liver related diseases. Conclusions: In chronic liver disease patients, there is an inverse relationship between platelet count and IPF% with decreased platelet count and increased IPF%. The proposed MDA function can be used to identify the cirrhotic changes in liver disease patients

Surveillance of molecular markers of antimalarial drug resistance in Plasmodium falciparum and Plasmodium vivax in Federally Administered Tribal Area (FATA), Pakistan

This molecular epidemiological study was designed to determine the antimalarial drug resistance pattern, and the genetic diversity of malaria isolates collected from a war-altered Federally Administered Tribal Area (FATA), in Pakistan. Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai and Kurram agencies of FATA region between May 2017 and May 2018, and they underwent DNA extraction and amplification. The investigation of gene polymorphisms in drug resistance genes (dhfr, dhps, crt, and mdr1) of Plasmodium falciparum and Plasmodium vivax was carried out by pyrosequencing and Sanger sequencing, respectively. Out of 679 PCR-confirmed malaria samples, 523 (77%) were P. vivax, 121 (18%) P. falciparum, and 35 (5%) had mixed-species infections. All P. falciparum isolates had pfdhfr double mutants (C59R+S108N), while pfdhfr/pfdhps triple mutants (C59R+S108N+A437G) were detected in 11.5% of the samples. About 97.4% of P. falciparum isolates contained pfcrt K76T mutation, while pfmdr1 N86Y and Y184F mutations were present in 18.2% and 10.2% of the samples. P. vivax pvdhfr S58R mutation was present in 24.9% of isolates and the S117N mutation in 36.2%, while no mutation in the pvdhps gene was found. Pvmdr1 F1076L mutation was found in nearly all samples, as it was observed in 98.9% of isolates. No significant anti-folate and chloroquine resistance was observed in P. vivax; however, mutations associated with antifolate-resistance were found, and the chloroquine-resistant gene has been observed in 100% of P. falciparum isolates. Chloroquine and sulphadoxine-pyrimethamine resistance were found to be high in P. falciparum and low in P. vivax. Chloroquine could still be used for P. vivax infection but need to be tested in vivo, whereas a replacement of the artemisinin combination therapy for P. falciparum appears to be justified