Objective: To determine a cut-off value of Chest CT severity score (CT-SS) in order to discriminate between the clinical types of COVID-19 pneumonia.

Background Acquired uterine arterial anomalies, including uterine artery pseudoaneurysms (UAP), arteriovenous malformations (AVMs) and arteriovenous fistulae (AFVs), are rare presenting causes of abnormal uterine bleeding. Timely diagnosis is essential for safe and effective treatment, avoiding life-threatening haemorrhage resulting from erroneous uterine curettage due to misdiagnosing these as other more common differentials. Main text This pictorial review discusses the ultrasound (USG), CT and MRI features of various acquired uterine vascular abnormalities with angiographic correlates. Conclusion Acquired uterine arteriovenous injuries are a fundamental cause of dysfunctional intractable bleeding recalcitrant to traditional conservative management. Endovascular transcatheter uterine artery embolisation is an increasingly popular and safe mode of treatment, especially in young patients desiring to have the option of future pregnancies, with lesser morbidity and in-hospital stay duration.

Objective: To evaluate the temporal changes on serial chest radiographs (CXRs)of hospitalised COVID-19 positive patients till their outcome(discharge/death); to determine the severity of CXR score and its correlation with clinical outcome (hospital stay, chest intubation and mortality). Study Design: Descriptive study. Place and Duration of Study: Shifa International Hospital (SIH), Islamabad from March to June 2020. Methodology: After IRB approval, 112 patients were consecutively enrolled, having laboratory-confirmed SARS-CoV-2 and hospitalised in SIH. Patients' demographics and clinical data were retrieved from Radiology Information System (RIS). Chest radiographs (CXR) were retrieved from picture archive and communication system (PACS). CXR severity scoring was determined by three radiologists, and results were analysed. Results: Lung opacities (98.2%), involvement of both lungs (96.4%), both peripheral and central region involvement (62.5%) and upper/mid/lower zone distribution (61.6%) were the most frequent findings. Males affected more than females with a mean age of 58.9 ± 13.1 years. Zonal involvement, density and extent of opacities peaked on 10-13 th day of illness. In the last CXR, opacities showed decrease in extent as well as density, reduction in zonal involvement, and few having mixed interstitial thickening/fibrosis. One hundred and five out of 112 (93.8%) patients had residual radiographic abnormalities on discharge. Conclusion: Serial chest radiography can be used to monitor disease progression and temporal changes after initial HRCT. Patients who have CXR severity score of 4 or more at the time of admission, is a red flag for prolonged hospital stay and possible intubation. Severity of CXR findings peaked at 10-13 days. It is recommended to repeat CXRs every 3-4 th day during hospital stay. Majority of the patients has residual radiographic abnormality on discharge.

Objective: To explore postoperative outcomes, particularly prolonged length of hospital stay, in radial arterycoronary artery bypass graft patients in a tertiary-care setting.Methods: The pilot prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, fromSeptember 2019 to September 2020, and comprised adult patients of either gender due to undergo coronary arterybypass grafting for coronary artery disease involving two or more vessels. The subjects approached for the use oftheir radial artery as a conduit. Prolonged length of hospital stay was defined as postoperative stay >9 days.Multivariable logistic regression was used to identify independent predictors of the length of hospital stay. Data wasanalysed using SPSS 21.Results: Of the 97 patients, 84(86.6%) were males. The overall mean age of the sample was 58.33±8.34 years. Meanlength of hospital stay was 8.10±2.37 days, and 23(23.7%) patients had prolonged stay. Higher age was a significantpredictor of prolonged hospital stay (p<0.05). Besides, 23(23.7%) patients developed acute kidney injury. There wasno incidence of wound, infection or deep venous thrombosis, while 1(1.03%) patient had to be reopened due toexcessive postoperative bleeding, and it represented the lone mortality.Conclusion: Patient age was found to be a significant predictor of prolonged hospital stay in patients undergoingradial artery coronary artery bypass graft, while almost a quarter of the sample was affected by acute kidney injury.Keywords: Coronary artery bypass graft, Radial artery, Prolonged length of stay, Acute kidney injury, Ejectionfraction. Continuous...

Objective: To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan. Methods: We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded. Results: In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower in DS patients compared to non-DS patients: 7.0 vs 23.0 months, 0.311 vs 0.487 m2, and 63 vs 82 cm, respectively. Bypass duration, aortic cross clamp time, post-operative ventilator hours, dose of inotropes, CICU stay, and total hospital stay were all significantly higher in the DS group. The odds ratio (95% CI) for mortality in DS babies was 6.2 (1.4, 27.1), p=0.015, after adjusting for age, weight, and height. The overall morbidity was comparable between the two groups, demonstrating no significant difference after adjusting for confounders. Conclusion: DS babies with AVSD and inlet VSD are at a greater risk of mortality compared to non-DS babies, particularly those with CAVSD. Furthermore, DS babies undergo surgery at a younger age and require more aggressive post-operative therapy and monitoring due to the development of complications. doi: https://doi.org/10.12669/pjms.36.5.1743 How to cite this:Aziz S, Ayub M, Masood L, Amanullah M, Hameed R, Hashmi S, et al. Major Septal Defects: Comparative study of Down Syndrome and Non-Down Syndrome Infants, before and after surgery. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1743 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.

Background: Acquired uterine vascular abnormalities are a rare cause of potentially life-threatening bleeding. These include uterine artery pseudoaneurysms (UAP)and acquired arteriovenous malformations. The objective of this study was to describe our experience with the diagnosis of acquired uterine vascular abnormalities and its treatment with uterine preservation. It was a retrospective cohort study. Methods: Eight patients were enrolled from the hospital database who presented to our Interventional Radiology department from April 2017 to March 2021 for uterine artery embolisation (UAE) with a history of iatrogenic/acquired uterine vascular abnormalities confirmed on imaging. These included two patients with uterine artery pseudoaneurysm (PA) concurrently with arteriovenous malformation (AVM), one with uterine artery PA and five having uterine AVMs. Embolisation agents used were histoacryl glue, lipiodol, PVA particles, and gelfoam slurry. Medical records, imaging studies, and telephonic contact with patients were assessed for patient presentation, intraprocedural details, and follow up to record treatment success. Statistical analysis was performed using descriptive statistics. Results: Bilateral UAE was performed in six patients, while two patients underwent unilateral UAE. Three of the patients presented with life-threatening bleeds requiring multiple transfusions. Clinical as well as angiographic success was achieved in all patients with immediate control of haemorrhage. No complications were observed during follow-up. Two of the patients were able to conceive normally within one year, though it resulted in a miscarriage. Conclusion: Acquired/iatrogenic uterine vascular abnormalities are a rare but important cause of life-threatening haemorrhage that can be expertly managed and successfully treated using UAE, which is rapid, safe, and minimally invasive, with the added advantage fertility preservation.

Colitis cystica profunda (CCP) is a rare benign disease characterised by mucin-filled cysts beneath the muscularis mucosae, which commonly involves the rectum and sigmoid colon. The disease process involving rectum is termed as proctitis cystica profunda. Trans-rectal ultrasound (TRUS) and magnetic resonance imaging (MRI) are an aid to diagnosis. However, histological analysis of deep biopsy is diagnostic. We report a case of 21-year male who presented with bleeding per rectum and was diagnosed as solitary ulcer of the rectum (SRUS) on superficial biopsies on sigmoidoscopy. Surgical intervention coupled with MRI findings and histopathological analysis formulated diagnosis of CCP. To our knowledge, we are second to report this entity with its MRI features.

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