Tuberculosis prevalence and demographic characteristics of population in Azad Jammu and Kashmir (Pakistan): A retrospective study

Tuberculosis (TB) remains a serious problem for public health and a leading cause of death after COVID-19 and superior to even HIV/AIDS. It is a social health issue and can cause stigma and economic loss as the person cannot perform professionally due to lethargy caused by disease. It is a retrospective study done on data from National TB program Muzaffarabad chapter. The details were noted on SPSS and analysis was done to find important demographic characteristics. The total number of patients was 3441; among which 48.76% were males. Most of them (81.11%) belonged to the Muzaffarabad division of Azad Jammu and Kahmir (AJK). The microbiologically or culture positive cases were 440. Rifampicin resistance was present in 147 cases, further categorized as high (n = 143), very high (n = 3), or true positive (n = 1) resistance. Muti drug resistance was found in 19 cases. The microscopy culture is more sensitive (AUC = 0.511) than MTB/RIF or serology (AUC = 0.502) according to ROC. The rate of positive smear results is not very satisfactory in the present study as it cannot detect dormant or latent cases. There is a need to establish more sensitive tests for detection of cases and more research to combat the disease.

Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis

BACKGROUND

Acute heart failure (AHF) is one of the most common cardiovascular diseases. Early diagnosis and prognosis are essential, as they can eventually lead to a fatal condition. Recently, brain natriuretic peptide (BNP) has been recognized as one of the most popular biomarkers for AHF. Changes in glomerular filtration rate (GFR) are often observed in AHF.

METHODS

We searched PubMed, Google Scholar, and ScienceDirect between March and June 2023. Original case control studies written in English that assessed levels oh BNP in AHF were included. Systematic reviews, letters to editor, correspondence, comprehensive reviews, and duplicated studies were excluded. Funnel plots were constructed to assess publication bias.

RESULTS

A total of 9 studies were selected and we obtained the mean difference (MD) of BNP level to be 2.57 (95% CI: 1.35, 3.78), and GFR to be -15.52, (95% CI: -23.35, -7.70) in AHF patients. Sensitivity analyses supported the robustness of the outcome.

CONCLUSION

Results indicated that BNP was a promising prognostic biomarker of AHF, whereas GFR was found to be negatively correlated with AHF.

Diagnostic Accuracy of Ultrasound for Small Bowel Obstruction in Paediatric Population Undergoing Laparotomy Keeping Surgical Findings as the Gold Standard

Objective: To analyze the diagnostic accuracy of ultrasound in small bowel obstruction in the paediatric population and compare it with surgical findings. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan from Jun 2018 to Jun 2019. Methodology: This study enrolled 84 paediatric small bowel obstruction cases who underwent exploratory laparotomy at the Pakistan institute of medical sciences from Jun 2018 to Jun 2019. The clinically suspected cases of small bowel obstruction were referred by paediatric surgery to the Radiology department, where an ultrasound abdomen was performed by a senior resident, exclusively targeting the bowel. The clinical, sonological, and per-operative findings were recorded on a proforma. Results: The mean age in our study was 3.5±2.7 years. A male gender predominance was noted. The most consistent greyscale feature favouring bowel obstruction was dilated bowel loops, found among 98.7% (76 out of 77) of surgically confirmed cases of bowel obstruction. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasound were 98.7%, 71.4%, 97.4%, 83.4% and 94.6% respectively. The sonological cause of obstruction was readily demonstrated among 51 (67%) out of 76 true positive cases. The most common site of obstruction was the distal ileum, with intussusception being the leading cause found among 32% of true positive cases. Conclusion: The overall diagnostic accuracy of ultrasound in revealing small bowel obstruction is high among the paediatric population.

Monodisperse magnetic lecithin-PFP submicron bubbles as dual imaging contrast agents for ultrasound (US) and MRI

Multimodal imaging is a recent idea of combining two or more imaging methods synergistically to overcome the weakness of individual imaging modalities and utilizing complementary benefits. Ultrasound (US) and magnetic resonance imaging (MRI) are widely used imaging techniques in healthcare and to fully utilize the potential of fusion imaging, dual-modal contrast agents are necessary to improve disease diagnosis by enhancing contrast resolution and reducing health risks associated with the dual dosage of contrast agents. In this study, magnetic microbubbles were synthesized by incorporating oleic acid stabilized superparamagnetic iron oxide nanoparticles (OA-SPIONs) into lecithin microbubbles, encapsulating the perfluoropentane (PFP) core. The magnetic microbubbles were characterized by FTIR, SEM, MFM, zeta potential, in vitro MRI, and ultrasound. Upon in vitro MRI, magnetic microbubbles showed a negative contrast effect by producing darker T2 weighted images. Magnetic microbubbles showed concentration-dependent response with a decrease in signal intensity with an increase in the concentration of OA-IONP in microbubbles. However, a decrease in acoustic enhancement was also observed with an increase in OA-IONP concentration, therefore concentration was optimized to achieve the best effect on both modalities. The magnetic lecithin microbubble with 10 mg SPIONs provided the best contrast on both US and MR imaging. The hemocompatibility testing resulted in hemolysis less than 7% with plasma recalcification time and thrombin time of 240 s and 6 s corresponding to excellent hemocompatibility. Thus the magnetic microbubbles with a phase convertible PFP core encapsulated by a lecithin shell loaded with OA-SPIONs can serve as a potential bimodal contrast agent for both US and MRI imaging.

Diagnostic Accuracy of Different Computed Tomography Signs for Differentiating Between Malignant and Cirrhotic Ascites Keeping Ascitic Fluid Cytology as Gold Standard

Objective

The goal of this research was to define the diagnostic precision of CT signs to distinguish malignant ascites from cirrhotic ascites. Ascitic fluid cytology was kept as the gold standard.

Study design

This research was a prospective cross-sectional study.

Place and duration of the study

Participants’ recruitment started on July 15, 2021, and the whole study lasted about three months till October 15, 2021, at the Radiology Department of Pakistan Institute of Medical Sciences, Islamabad.

Patients and methods

A total of 80 patients were included in the research and divided into two groups grounded on the cirrhotic or malignant etiology of the ascites based on their fluid cytology. Ascites volume, relative spread between the lesser sac and greater peritoneal cavity, the wall thickness of gallbladder, density of ascites, parietal peritoneum thickness and degree of its enhancement, and presence of septa and loculations were some of the major CT signs studied.

Results

The average age of patients included in this study was 36.2 ± 6.67 years (range 29-49 years). Of the 80 patients, 50 (62.5 %) were men, and 30 (37.5 %) were women. CT signs associated with the malignant ascites reported in this study were fluid present in the lesser sac (p = 0.03), peritoneal thickening and degree of its enhancement (p = 0.05), increased ascites density (p= 0.001), and presence of septa and loculations (63.6 % of malignant ascites). However, gallbladder wall thickness did not show any variation between both groups.

Conclusion

We conclude that in the diagnosis of malignant ascites, CT scan imaging can play a vital role. This research approves and testifies the benefits of indirect signs such as the spread of ascites, increased density of ascites, thickening and enhancement of parietal peritoneum, and ascitic fluid complexity in pointing out malignancy as a cause of ascites.

Contrast enhanced sonothrombolysis using streptokinase loaded phase change nano-droplets for potential treatment of deep venous thrombosis

Current thrombolytic therapies for deep venous thrombosis are limited due to the wide side effect profile. Contrast mediated sonothrombolysis is a promising approach for thrombus treatment. The current study examines the effectiveness of in vitro streptokinase (SK) loaded phase-change nanodroplet (PCND) mediated sonothrombolysis at 7 MHz for the diagnosis of deep venous thrombosis. Lecithin shell and perfluorohexane core nanodroplets were prepared via the thin-film hydration method and morphologically characterized. Sonothrombolysis was performed at 7 MHz at different mechanical indexes of samples i.e., only sonothrombolysis, PCND mediated sonothrombolysis, sonothrombolysis with SK and SK loaded PCND mediated sonothrombolysis. Thrombolysis efficacy was assessed by measuring clot weight changes during 30 min US exposure, recording the mean gray intensity from the US images of the clot by computer software ImageJ, and spectrophotometric quantification of the hemoglobin in the clot lysate. In 15 minutes of sonothrombolysis performed at high mechanical index (0.9 and 1.2), SK loaded PCNDs showed a 48.61% and 74.29% reduction of mean gray intensity. At 0.9 and 1.2 MI, 86% and 92% weight loss was noted for SK-loaded PCNDs in confidence with spectrophotometric results. A significant difference (P < 0.05) was noted for SK-loaded PCND mediated sonothrombolysis compared to other groups. Loading of SK inside the PCNDs enhanced the efficacy of sonothrombolysis. An increase in MI and time also increased the efficacy of sonothrombolysis. This in vitro study showed the potential use of SK-loaded perfluorohexane core PCNDs as sonothrombolytic agents for deep venous thrombosis.

Contrast enhanced sonothrombolysis using streptokinase loaded phase change nano-droplets.

Breast Hemangioma: Unique Presentation In a Patient with Klippel-Trenaunay-Syndrome

BACKGROUND

Klippel-Trénaunay-Syndrome (KTS) is characterized by triad of varicose veins, port wine stain and soft tissue or bony hypertrophy and the diagnosis of KTS can be made if any two of these three features are present. Hemangiomas in various location e.g. skull, brain, epidural and vertebral hemangioma, mediastinal, colonic hemangioma, intraneural/intramuscular hemangiomas are reported with KTS.

CASE PRESENTATION

Benign vascular tumors may rarely develop malignant transformation as Bugarin-Estrada et al reported breast angiosarcoma in a patient diagnosed as Klippel-Trenaunay-Syndrome. We reported a case of a 40-year-old female with known case of Klipple-Trenaunay-Syndrome with left leg varicosities, cutaneous nevus as well as unfortunate development of deep venous thrombosis and markedly enlarged right breast hemangioma. Due to low incidence or lack of early detection of breast hemangioma, its diagnosis is challenging.

CONCLUSION

The history of patient and multi-modality imaging utilization can help in early and accurate diagnosis of diseases leading to better prognosis.

The Essential Role Of Conventional Radiography In Covid-19; Perspective Of A Developing Country

BACKGROUND

The Coronavirus disease (COVID-19) pandemic has shaken the world. So far, CT has emerged as main stay of imaging whereas the local data on radiographic features of COVID-19 is sparse.

METHODS

Prospective study includes 402 chest X rays (CXRs) of 105 patients presenting with symptoms of COVID-19. The nature of abnormality, distribution and lung zone involvement was documented. Following British Society of Thoracic Imaging (BSTI) guidelines, CXRs were grouped into classic/ probable COVID-19, indeterminate, non-COVID-19 and normal categories. The lung involvement was scored according to modified Radiographic Assessment of Lung Edema (RALE) scoring. The follow up radiographs were assessed for disease progression and improvement.

RESULTS

Seventy-six males and 29 females with mean age of 50 years were included in our study. 47 out of 105 baseline radiographs were categorized as classic/ probable COVID-19, 26 as indeterminate, 7 as Non-COVID-19 and 25 as normal. 75 patients were positive and 30 were negative on RT-PCR testing. The sensitivity of CXR in diagnosing COVID-19 is 84%. The worsening radiographic features and higher RALE score correlates with longer hospital stay, ICU admissions and mortality. The ground glass opacities and consolidations in peripheral distribution involving bilateral mid and lower zones are the predominant findings of COVID-19 in Pakistani population.

CONCLUSIONS

Combination of bilateral peripheral ground glass opacities and consolidations are the cardinal feature of COVID-19 on CXRs. The diagnostic categories described by BSTI correlates with PCR results in Pakistani population. The worsening radiographic findings correspond to poor prognosis; hence serial radiographs can be used for assessing disease course.

Novel heterozygous sequence variant in the GLI1 underlies postaxial polydactyly

Polydactyly is one of the most common congenital abnormal phenotype of autopod, which is characterized by extra supernumerary digit in hands/feet with or without well-developed bony structure within the digits. Preaxial polydactyly (PPD), postaxial polydactyly (PAP), and meso-axial (central) polydactyly are three different isoforms of polydactyly. Genetically, at least 10 genes have been identified causing nonsyndromic polydactyly. In the present study, we have investigated a large family segregating autosomal dominant form of nonsyndromic polydactyly. Whole exome sequencing followed by Sanger sequencing revealed a novel heterozygous missense variant (NM_005269.3; c.1064C>A; p.(Thr355Asn) in the gene GLI1 segregating with the disease phenotype within the family. This study presents first familial case of autosomal dominant form of polydactyly caused by the GLI1 variant.

Screening, diagnosis and genetic study of breast cancer patients in Pakistan

Objective: To determine the role of variants in BRCA1 gene in breast cancer development, women of Pakistani origin, diagnosed with breast cancer, were screened for variants in the BRCA1. Methods: The present study involved screening of 5000 women for breast cancer. 302 women were diagnosed with breast cancer. Using Sanger sequencing, DNA extracted from peripheral blood of 100 patients was screened for disease causing variants in the BRCA1. Results: Analysis of sequenced data revealed two frame shift (Gly312Trpfs*8, Ala322Glyfs*4), six missense (p.Glu362Lys, p.Lys651Arg, p.Asp693Asn, p.Pro871Leu, p.Glu1134Lys, p.Lys1183Arg), four synonymous (p.Thr327Thr, p.Ser694Ser, p.His771His, p.Gln1135Gln), and two intronic variants (g.75407T>C, g.75401_75401delT) in the patients. Conclusion: The present investigation showed that variations in BRCA1 made substantial contribution in causing hereditary/early-onset breast cancer in Pakistani women. doi: https://doi.org/10.12669/pjms.36.1.1059 How to cite this:Majeed AI, Ullah A, Jadoon M, Ahmad W, Riazuddin S. Screening, diagnosis and genetic study of breast cancer patients in Pakistan. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1059 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.