Frequency of severity of disability in patients with grade iII lumbar neural foraminal stenosis on magnetic resonance imaging

Background Low back pain is a common condition and carries substantial socioeconomic implications. Magnetic resonance imaging (MRI) is the imaging modality of choice with lumbar neural foraminal stenosis being one of the most common causes of lower back pain syndromes. Studies have shown a lack of correlation between patients\u27 severity of disability and radiologically determined nerve root constriction. Therefore, the goal of this study will be to determine the frequency of severity of disability in patients with severe (i.e., grade III) lumbar neural foraminal stenosis on MRI to ascertain the impact of MRI diagnosis on clinical outcomes. Materials and methods Two hundred fifty patients of either gender with a history of backache referred for MRI were included by purposive sampling. Of these 250 patients, 27 patients had grade II lumbar neural foraminal stenosis, and 21 had grade I neural foraminal stenosis on MRI and were excluded. Thirty-two patients had a spinal infection (e.g., tuberculosis), and 24 patients had a history of trauma. Further, 31 patients were having follow-up scans for previously diagnosed lumbar neural foraminal stenosis. Hence, after excluding these cases, 115 patients were enrolled in this cross-sectional study with grade III lumbar neural foraminal stenosis on MRI. Results The mean age was 51 years (range: 20 to 82 years). Most of the patients (55.6%) were older than 50 years. The most common site of grade III lumbar neural foraminal stenosis was L4-L5 (56.5%). According to the Oswestry disability index, 47 patients (40.9%) had a severe disability, 32 (27.8%) had a moderate disability, 16 (13.9%) were diabled, 14 (12.2%) had a mild disability, and six (5.2%) were bedridden. Conclusions While MRI is the imaging modality of choice in degenerative lumbar spinal stenosis, clinical disabilities can be more extensive than what radiological findings may indicate in approximately 40% of the cases. Therefore, lumbar spinal stenosis should be a neuro-radiological diagnosis, and surgical decisions should be based on clinical scenarios in addition to MRI findings

Portal biliopathy

Portal biliopathy (PB) is a rare disorder, which mostly presents as sub-clinically. It occurs most commonly due to idiopathic extrahepatic portal vein obstruction. We present three cases having features of portal biliopathy secondary to portal hypertension. Our first case did not have a prior history of chronic liver disease while next two patients had previous history of chronic liver disease resulting in portal hypertension. Cavernous transformation of the portal vein due to extrahepatic portal vein obstruction is not infrequent but biliary obstruction in association with this disorder is distinctly uncommon. Proper case management is very important as prolonged biliary duct obstruction can lead to the development of ascending cholangitis or later on secondary biliary cirrhosis

Diagnostic accuracy of digital mammography in the detection of breast cancer

Introduction Breast cancer has a high prevalence in the community and places very high demands on resources. Digital mammography provides a good quality image with reduced radiation dose and can detect breast carcinoma in its earlier stages, resulting in good prognosis and improved patient survival. Objective To calculate the diagnostic accuracy of digital mammography in the detection of breast cancer, using histopathology as a gold standard in women aged over 30 years, who are undergoing mammography for screening and diagnostic purposes. Materials and methods This was a cross-sectional analytical study, conducted in the department of radiology, for a total duration of 10 months. A total of 122 patients of age above 30 years, referred for digital mammography for the evaluation of different symptoms related to breast diseases, followed by biopsy/surgery and histopathology, were included in the study. Result Our data confirmed that digital mammography is a highly accurate tool for breast cancer detection having a sensitivity of 97%, a specificity of 64.5%, a positive predictive value of 89%, and a negative predictive value of 90.9%, with a diagnostic accuracy of 89.3%. Conclusion Considering our results, we recommend that digital mammography should replace screen-film mammography as a basic tool to detect breast cancer for both screening and diagnostic purpose

Assessment of Knowledge of Cardiopulmonary Resuscitation among Pharmacy Students of Mirpur, Azad Jammu & Kashmir

Introduction: Cardiopulmonary resuscitation (CPR) is the most important lifesaving technique in several emergency situations such as cardiac arrest. In future, being part of health care professionals, pharmacy students are deemed to possess basic skills and expertise which are required to perform CPR. Objective: To access the knowledge of cardiopulmonary among pharmacy students of Mirpur Azad Jammu & Kashmir. Methods: It was a questionnaire-based, descriptive cross-sectional study, conducted among 4th and 5th year students of two Pharmacy institutes of Mirpur AJ&K from November 2018 to January 2019. A pre-tested questionnaire from previous study was used to collect data. It comprised of 13 dichotomous questions with “Yes/No” options, regarding knowledge of CPR. Descriptive statistics was used to unfold the demographic characteristics. Inferential statistics (Kruskal Wallis and Man Whitney) tests were used for evaluating difference between dependent continuous variables and independent variables and Chi-square was applied to determine difference between grouped variables. P-value of less than 0.05 is considered significant. The data was analyzed using SPSS version 20. Result: Overall, 131 out of 150(response rate= 92%) students participated in current study. Gender distribution among the participants was almost equal with 66 males (50.4%) males and 65 (49.6%) females took part in current study. Participants of the age group 21-23 years (n=88, 67.2%) were dominant. Only few students (n=23, 17.6%) reported to have taken training in CPR previously. Eighty-eight (66.7%) had average knowledge of CPR. No significant differences among male and female, 4th and 5th year students of both the institutes were found. Conclusion: The study revealed that knowledge level of CPR is adequate in most of the students of pharmacy. However, further improvements are required to perform CPR in an efficient manner. Thus, training in CPR should be mandatory in the pharmacy curriculum

Utilization of Marble Wastes in Clay Bricks: A Step towards Lightweight Energy Efficient Construction Materials

Marble dust is one of the hazardous byproducts of marble-processing factories and requires planned disposal. Its beneficial use as a construction material will add to the sustainability, and most importantly, might overcome the burden of marble waste disposal. However, the use of marble dust in concrete has a negative impact. Therefore, this research examines various properties related to the utilization of such material in ceramic clay, and therefore its effects on the use of clay bricks are investigated. The research activity covers the categorization of marble dust powder from three different sources: Ziarat in Mohmand Agency, Buneer, and Mullagori (Pakistan). Its utilization in different proportions preparation of bricks is also addressed. Through the partial replacement of clay with marble dust from 0 to 30% by weight with amplification of 5%, seven mix designs are examined. The test result includes Bulk density, water absorption, porosity, thermal insulation, and strength. The partial replacement of clay with marble dust reduced its weight, strength and increased its porosity, water absorption, and thermal insulation. Furthermore, the utilization of marble powder in bricks minimizes soil erosion and reduces pollution to the environment. Doi: 10.28991/cej-2021-03091738 Full Text: PD

EVALUATION OF CYTOTOXIC ACTIVITY OF DICHOLOROMETHANE (DCM) AND METHANOL (MEOH) EXTRACT OF ROOT BARK OF CAPPARIS DECIDUA

The present study was conducted to evaluate the cytotoxic activity of different extracts of root bark of Capparis decidua (Capparidaceae). The root barks of Capparis decidua were collected from village Kirri khaisore Tehsil Pahar pur, Dera Ismail Khan; shade dried and ground into fine powder. The weighed plant material was then extracted with dichloromethane and methanol in triplicate for 72 hours by the process of successive maceration. The filtrate obtained was concentrated under reduced pressure at 30 °C using rotary evaporator. Brine shrimp lethality bioassays and MTT colorimetric assay were carried out on the extracts to assess the cytotoxic activity. Dichloromethane extract showed moderate brine shrimp lethality activity, while this activity was not shown by methanol extract. Both extract showed no cytotoxic activity. Keywords: Capparis decidua, cytotoxicity, Brine Shrim

Impact of diabetes mellitus on nerves

Background: Involvement of the peripheral and autonomic nervous systems is probably the most common complication of diabetes. The main symptoms of diabetic polyneuropathy include negative symptoms (those related to nerve fiber loss or dysfunction) such as numbness and weakness, and positive symptoms (those related to abnormal function of surviving nerve fibers) such as tingling and pain.Methods: This was a cross-sectional study held in diabetic clinic of Nishter hospital, Multan, Pakistan. The study included any diabetic patients showing symptoms of neuropathy.Results: There were total of 140 in this study. This study included 85% of male and 15% of female. Most common symptoms of diabetic neuropathy were pain (70%) and tingling (70%) followed by numbness in 65% of patients. There were 28 patients in 5 years duration of diabetes, 35 people in 6-10 years duration, 21 patients in 11-15 years duration, and 14 patients in 20+ years duration.Conclusions: Neuropathy due to diabetes is crippling especially when pain is the prominent symptoms. Autonomic symptoms like constipation and lightheadedness are discomforting for the patients. The most commonly used screening test is vibrating tuning fork test which is east to perform is clinical setting and is not time consuming. Diabetic patients need to take special care of

Types and clinical presentation of stroke

Background: Stroke is one of the leading causes of mortality and morbidity worldwide. In this study, authors worked on clinical presentation and types of stroke. The two main types of strokes are ischemic and haemorrhagic. Brain infarction is caused by decrease blood flow due to either narrowing of artery or complete obstruction to blood flow owing to embolism. While haemorrhage is caused by rupture of artery or aneurysms leading to accumulation of blood in the brain parenchyma.Methods: Cross sectional study of group of patients in Nishtar hospital Multan, Pakistan who presented with variety of neurological symptoms who were subsequently diagnosed as non-traumatic stroke. All patients were subjected to a detailed history and thorough clinical examination and investigations after obtaining informed consent.Results: Of 122 patient, 66 patients were male and 56 were female. Ischemic stroke was more common: present in 76 patients as compared to 46 patients with hemorrhagic stroke. Hypertension was present in 40.9% of ischemic stroke and 27.8% of hemorrhagic strokes. Most of the patients (67.2%) had altered sensorium at presentation followed by hemiplegia in 39.3 % of patients.Conclusions: Prevalence of ischemic strokes is higher than that of haemorrhagic stroke. Hypertension is associated with both types of these strokes. Moreover, hyperglycaemia and high blood pressure are common in early phase of stroke. Vomiting in stroke favors haemorrhagic stroke

Moyamoya Disease: A Rare Vascular Disease of the CNS

Moyamoya disease (MMD) is a rare disease affecting the cerebral vasculature of the central nervous system (CNS) with a reported incidence of 0.35–0.94 per 100,000 populations. It was first reported from Japan and later from other parts of the world. The pathology is narrowing of blood vessels supplying anterior circulation and rarely posterior circulation. It was believed that the disease is genetic in origin, but environmental factors also play a role. Patients with this rare disease may present with ischemic or hemorrhagic symptoms. Ischemic symptoms account for the disease in most of the pediatric patients, whereas in adults, hemorrhage is more common. Diagnostic imaging like CT angiogram and magnetic resonance angiogram helps in demonstrating the narrowing or the collateral vessels like “a puff of smoke” (moyamoya) formed at the base of the brain. Moyamoya disease is treated medically and/or surgically. Aspirin is the main medication used. Surgical options are direct or indirect revascularization techniques to bypass the stenosis. The disease is progressive in majority of the patients, but if treated early, they can have good prognosis especially children

Cerebral Arteriovenous Malformations (cAVMs): What Is New?

Cerebral arteriovenous malformations (cAVMs) are rare congenital anomalies of cerebral blood vessels that result from maldevelopment of the capillary bed, permitting direct communication between cerebral arteries and veins. It usually occurs in the supratentorial area of the brain; however, it can occur anywhere in the brain and spinal cord. Most of the patients with cAVMs present with a variety of complaints such as seizures, intracerebral hemorrhage, headache, and progressive focal neurological deficit. Imaging such as CT, MRI, and angiography plays a vital role in diagnosis, grading, risk assessment, and posttherapeutic follow-up. The multidisciplinary team use three therapeutic modalities in the treatment of cAVMs. This chapter reviews the clinical presentations, diagnosis, classification, and treatment of cAVMs