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.
Objectives: To determine frequency of malignancy in solitary thyroid nodule. Design: Case-series study. Place and Duration of Study: The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi, from April 2002 till April 2003. Patients and Methods: Sixty patients with clinical solitary thyroid nodule fulfilled the selection criteria and were included in the study. Thyroid function tests, ultrasonography and thyroid scanning was done. Finally FNAC and histopathology were done in all the operated cases and record was evaluated. Results: Out of 60 cases studied, 8 (13.33%) were found to have malignant lesions. The remaining 52 (86.67%) cases had benign pathology. Male patients with solitary thyroid nodule showed a higher incidence of malignancy 17.65% as compared to females 11.63%. Maximum malignant cases (50%) were found between the ages of 31 to 40 years. Papillary carcinoma was the most common malignancy (50%)found in our study. Conclusions: The incidence of malignancy in solitary thyroid nodule is quite high (13.33%). So people should be educated to attend thyroid clinics for early diagnosis and adequate treatment.
Calcification of the auricular cartilage termed as "petrified ears" is a rare condition characterized by stiffness of auricular cartilages making them non-malleable and unable to get folded. Though appearing as an insignificant finding, it may be manifestation of an underlying systemic condition with masked systemic deteriorations. We present here report of a patient who presented with petrified ears and was found to have alkaptonuria.Our patient, a 40-year-old male, presented with three-years' history of progressive stiffness of ear pinna, two-years' history of off and on swelling of knees and one-year history of discoloration of skin over thumb, index, and middle fingers in both hands. He also had a lifelong history of darkening of urine. On examination, he had non-foldable, thickened, firm pinna with a few palpable hard papules and hyperpigmentation of overlying skin (Figure 1a, 1b). The ulnar borders of hands and fingers showed bluish-grey hyperkeratotic plaques of variable sizes (Figure 1c, 1d). He had wasted right leg with atrophy of overlying skin and right sided pes cavus (Figure 1e). Crepitus was positive in both knees and straight leg raising was normal. He had no tenderness over spine. His hemoglobin was 11.9 g/dL (normal: ≥13 mg/dL) and total leucocyte count was slightly low (3.5x10 9 /L; normal: 5-11x10 9 /L), however, platelet count, thyroid function tests, plasma glucose, serum calcium, parathyroid hormone, and vitamin D 3 levels, and urine routine examination were normal. On urine visual examination,
OBJECTIVE: To explore the prevalence of osteopenia and osteoporosis within a cohort of Pakistani postmenopausal women with respect to the lumbar spine and hip. METHODS: This cross-sectional study was conducted at Shifa International Hospital Islamabad, Pakistan from September 2019 to Feb 2020. Study comprised of 237 postmenopausal females who visited the outpatient department of the hospital. The T-scores of Bone Mineral density (BMD) data was collected and arranged in three groups: normal, osteopenia and osteoporosis. Data was analyzed to explore the distribution of the data and correlation analyses using R software version 3.6.3. RESULTS: Out of 237 females, majority were ranging in age from 61-70 years (n=110; 46.4%), followed by 51-60 years age group (n=60; 25.3%). Osteopenia was noted in 98 (41.4%) cases in lumber spine and hip area. Osteoporosis was found in 79 (33.3%) and 59 (24.9%) cases in lumber spine and hip region respectively. Mean T score was -1.775±-2.000 and median T score was -1.469 for lumber spine and hip. T-scores distribution of lumbar spine and hip indicated the highest proportion having a sore of -2 SD (n=60; 25.3% each), followed by -3 SD in 52 (21.9%) cases. Bone mass density was negatively correlated with age (p≤0.01). However, no significant difference was found among the BMD values of lumbar spine and hip region. CONCLUSION: Decreased bone density was a common occurrence affecting postmenopausal females and there is increase in degenerative bone loss with increasing age. Hip and lumbar spine region are equally affected by degenerative bone loss.
ABSTRACT: Reactive arthritis, formerly called Reiter’s syndrome is extra-articular oligoarthropathy, which can be due to bacterial infection or genetic predisposition. The infections are either urogenital (chlamydia being most notorious) or gastrointestinal (e.g. salmonella, yersinia, etc.). The human leukocyte antigen (HLA-B27) antigen has been implicated as the most common predisposing factor. Reactive arthritis often involves the joints of the lower limb. Bacterial enteric infections are a potential threat in a Pediatric population that can be due to an acute illness or its sequelae. Reactive arthritis following outbreaks of enteric infections with Salmonella is uncommon in the pediatric population. We report a rare case of a 6 years old boy who came to ER with high-grade fever and severe pain in the right iliac fossa. Clinical diagnosis of appendicitis was made by the physicians on physical exam but after radio-pathological investigation like CBC, ESR, CRP, Blood culture, USG abdomen, CT abdomen, and MRI, diagnosis of reactive arthritis secondary to salmonella enteritis was made and the patient underwent right hip arthrotomy after which he was discharged. Thus, imaging played a pivotal role in the right diagnosis of a patient with proper management guidelines. This also showed that salmonella enteritis can present atypically mimicking septic arthritis or acute appendicitis. Reactive arthritis after salmonella infection is a very rare and one of its kind case reported in Pakistan.
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