Salmonella Typhi is a Gram-negative pathogen that causes typhoid fever in humans. The use of antibiotics to treat typhoid has considerably mitigated its fatality risk, but rising multidrug-resistant (MDR) and extensively drug-resistant (XDR) resistance in Pakistan threatens effective treatment. This study determined the prevalence of MDR and XDR S. Typhi at a local hospital in Lahore. Blood samples (n = 3000) were obtained and processed for bacterial identification. Antibiotic susceptibility test was performed using VITEK® 2 Compound 30 System. Statistical data analysis was performed using a Mann–Whitney U and Kruskal–Wallis H test, respectively. The results revealed 600 positive cultures, of which the majority were found to be XDR S. Typhi (46.1%) and MDR S. Typhi (24.5%) strains. The disease burden of resistant Salmonella strains was greater in males (60.67%) than females (39.33%), with the most affected age group being 0–10 years old (70.4 %). In both the outpatient department (OPD) and general ward, the prevalence of XDR S. Typhi cases was found to be alarmingly high (48.24%), followed by MDR S. Typhi (25.04 %). The results of the statistical analysis demonstrated that the incidence of resistance in MDR and XDR S. Typhi strains was not affected by the age as well as the gender of patients (p > 0.05). The occurrence of resistant strains against four tested antibiotics (azithromycin, ciprofloxacin, imipenem, and meropenem) was found to be similar in different wards and among hospitalized and OPD patients (p > 0.05). Maximum resistance was observed against chloramphenicol and ampicillin in the OPD and pediatric ward. Piperacillin/Tazobactam was observed to be the most effective antibiotic, followed by co-amoxiclav (p < 0.001). This study is effective in validating the existence of MDR and XDR S. Typhi in Lahore, where stringent methods should be applied for controlling its spread.
Background: The COW shows vast variations in different individuals. The aim of this study was to evaluate and describe the prevalence and patterns of arterial variants and the different morphological variations of the COW on MRA in adult Pakistanis. Aim: To find the different anatomical variations of Circle of Willis in adult patients on magnetic resonance angiography. Methodology: In this descriptive study a total of 90 patients with ages 20-90 years, were selected for the study between July 2021 till October 2021. The adult patients were referred for screening MRA brain in the Department of Radiology. The protocol selected to visualize the COW was 3D-TOF MRA. Results: Data analysis demonstrates that out of total 90 patients, 51(56.7%) were males and 39(43.3%) were females. Overall, 66(79.5%) circles were complete in anatomical configuration and 24(20.5) were incomplete. The anterior circle was complete in 73(81.1%) subjects and incomplete in 17(18.9%) subjects. The posterior circle was complete in 83(92.2%) subjects and incomplete in 7(7.8%) subjects.The most common variation of COW was hypoplasia/absence of segments of Circle of Willis. ACA was the most frequent segment of Circle of Willis that was hypoplastic/absent followed by A1 segment of right ACA is absent in 6(7.2%) subjects and A1segment of right ACA is hypoplastic in 6(7.2%) subjects. Conclusion: The study concludes that mostly the COW is complete in Pakistani adults. There are variations particularly in anterior part as compared to the posterior part of the COW. The most common variants are of A1 segment of Right ACA as compared to other type of variants. Keywords: Circle of Willis, 3D-TOF-MRA, Anterior circulation, Posterior circulation, Complete circle, Incomplete circle,
Objective: To access the role of radial K-space sampling technique for the compensation of motion artifact in magnetic resonance imaging (MRI). Study Design: Systematic Literature Search. Setting: Department of Radiology, Shalimar Hospital, Lahore. Period: March 2019 to Oct 2019. Material & Methods: Was conducted with the help the of following search engines: Google scholar, PubMed, NCBI, Medline and Medscape databases from 1999 up to 2019 for names or acronyms of Radial K-space sampling, propeller sequence, management of motion artifact in MRI, RADAR sequence for motion compensation in MRI, k-space in clinic and multivane. Only those studies were included in this review study which shows the role of radial K-space sampling Technique for compensation of motion artifact. Total 104 studies were selected and after evaluation only 42 studies were included. Results: According to literature radial k-space sampling improved the quality of image and provided the scans with reduced motion artifact. Whereas in case of specificity (N= 16) the mean calculated value was 80.87 and Std. Deviation was 7.022. In case of radial k-space sampling technique (N=42) calculated mean was .26 and std. deviation was .701. The main disadvantage of radial k-space sampling is increased scan time. Conclusion: After reviewing literature of 42 studies, it was assessed that the use of radial K-space sampling technique or propeller sequence adjacent to the standard MRI sequences can reduce the motion artifact and will increase the image quality.
Neck pain considerably influences worldwide. Neck pain is a common finding of the cervical spine abnormality. Disc degeneration is associated with progressive age groups. Objective: To find the Magnetic Resonance Imaging findings in patients above 40 years of age, with neck pain. Methods: In Shalamar Hospital Lahore, a descriptive study was conducted on MRI Philips MULTIVA 1.5 Tesla. 200 patients of above 40 years age groups were enrolled in this study with convenient sampling technique. All patients referred by clinicians with neck pain. Both male and female were included. Prior Neck Surgery, Traumatic Spine Fractures, Metabolic Bone Disease Spinal Infection, Rheumatoid Arthritis, Active Malignancy, prosthesis inside the body or any contra-indication to MRI were excluded. Results: Among 200 patients of different age groups, MRI findings were noted that reduced vertebral height, disc height, signal changes T2 and disc bulge present in patient with neck pain. 1 male patient had reduced vertebral height at C6 (0.5%) in 40-60 age group. 105 patients (52.7% males) had reduced disc height at C5/C6 (45.8%) in 81-100 age group and six patients had reduced signal intensity T2 at C6/C7 (3%) in 81-100 age group most frequently in males. 57 patients (34.4% females) of 40-60 age group had reduced disc bulge at C5/C6 (22.4%) level. Conclusion: Signal intensity T2 of the intervertebral disc and disc height were reduced in eighty-one to hundred age group and others findings were reduced at forty to sixty age groups i.e., vertebral height and disc bulge.
Background: Coronary Artery Disease (CAD) was the contraction of coronary arteries that was frequently began through the atherosclerosis which primes to restraint of blood flowing to cardiac muscles. Atherosclerosis was an accumulation of plaque or fats deposition upon the internal walls of arteries. Aim: To correlate coronary artery disease with risk factors on Computed Tomography Angiography. Duration and place of study: This study was conduct from 17-July-2019 to 13-Oct-2020 at Punjab Institute of Cardiology Lahore. Methods: A cross sectional analytical study was conducted at Punjab Institute of Cardiology, Lahore. Data were collected according to the age, gender and risk factors such as diabetes mellitus, hypertension, hyperlipidemia; high cholesterol level, contrast with volume, vessels involved and extent of vessels involvement.132 participants including 103 males (78%) and 29 females (22%) were selected through convenient sampling technique. Results: Data examination exhibited that out of 132 patients, 101 patients (76.5%) had CAD and 31 patients (23.5%) had no CAD. Out of 29 females, 21 female patients (20.8%) had CAD whereas out of 103 males, 80 male patients (79.2%) had coronary artery disease. According to our study, as correlated the coronary artery disease with various risk factors on computed tomography angiography. The patient had one or more than one risk factors; out of 132 patients, 72 patients (54.5%) had diabetes mellitus, 102 patients (77.3%) had hypertension, 55 patients (41.7%) had hyperlipidemia, 56 patients (42.4%) familial hypercholesterolemia, and 30(22.7%) were smokers. Conclusions: We concluded from our study that patients with Diabetes Mellitus (DM) were more prone to develope coronary artery disease CAD. Males were more at risk (79.2%) than females (20.8%) for CAD. Diabetes mellitus and hypertension were stronger predictors of CAD than smoking, hyperlipidemia and familial hypercholesterolemia. Keywords: Coronary Artery disease, Computed Tomography Angiogrpahy, Diabetes Mellitus, Hypertension
Objective: To compare the diagnostic accuracy of color Doppler ultrasound with computed tomography angiography in patients with lower limb ischemia and to assess the severity of stenosis. Study Design: Cross Sectional Analytical study. Setting: Shalamar Hospital, Lahore. Period: May 2020 to October 2020. Material & Methods: Data were collected according to the Age, Height, Weight, BMI, Duration of diabetes, Total Cholesterol, LDL, HDL, Triglyceride, Gender, Socioeconomic status, Diabetes, Hypertension, Stenosis, Collateral, calcification. Sample size of46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%).Data entry and analysis will be done by using SPSS version-23. Results: Total numbers of 46 patients were included in this research comprising 32 males (69.6%) and 14 females (30.4%). According to the result analysis 34 patients had shown peripheral arterial disease at color Doppler and 12 patients had not shown peripheral arterial disease at color doppler. 38 patients had shown peripheral arterial disease at CTA and 8 patients had not shown peripheral arterial disease at CTA. Conclusion: This study concludes that computed tomography angiography for detection of peripheral arterial disease as the gold standard, MDCT angiography shows higher sensitivity (82.6%) than color-coded Doppler ultrasonography (73.9%) in the assessment of peripheral arterial disease.
The shoulder joint trauma after one to two years usually induces growth ofits traumatic separated articular cartilage pieces, which sometime further deteriorates intoan uncommon condition termed as SOC (Secondary synovial osteo-chondromatosis).Objectives: Is to determine the secondary osteochondromatosis of shoulder joint by itsspecific differentiating features in history, skiagram, sonogram, MRI and microscopic findingsof tissue of the affected joint. Methods: A male of 34 years with complaint of pain, stiffness anddecreased range of movement in left shoulder joint came to an adult orthopedic outdoor unit,Shalimar Hospital, Lahore, Pakistan and admitted in the orthopedic unit 3 for treatment. Afterphysical /clinical examination, Skiagram, sonogram and MRI of the patient’s affected shoulderjoint were performed by the Radiology department and diagnosed as secondary variety ofosteochondromatosis of the shoulder joint. Its nodules excised through arthroscopy wereexamined histopathologically and found to contain fragments of articular cartilage with ringof calcification. Conclusion: MRI imaging as compared to other medical imaging modalitiesis more precise in estimating diagnosis of secondary osteochondromatosis. However thediagnosis of this disorder is counter confirmed by presence of loose bodies of hyaline cartilageencircled by calcification lamellae on histopathological examination.
MRI findings are essential to diagnose the severity of ligament tears in knee injuries in footballers. By using Magnetic Imaging Resonance we can accurately make diagnose and can determine the extent of damage to tissues and ligaments by grading them according to injuries. Objective: The main objective of this study is to determine the MRI findings in patients of knee injuries in football players. MethodS: A multicenter descriptive study conducted at University of Lahore Teaching hospital and National hospital during 4 months period. All symptomatic football players of both genders and age ranging from 16-40 year are included in this study. Our calculated sample size is 80. 1.5T MRI machine used for scans. All images were Proton density and T2 weighted images. Results: This study includes 80 footballers complaining knee pain. Mean age of all subjects was 31.4 +, - 5.7 year. Among 80 patients who had knee injuries, 56 patients (70%) had ACL injuries, 14 patients (17.5%) had PCL injuries, 14 patients (17.5%) had LCL injuries, 8 patients (10%) had MCL injuries, 24 patients (30%) had LM injuries, and 31 patients (38.8%) had MM injuries. Conclusion: MRI is useful imaging modality for the detection of soft tissue injuries most commonly sports injuries. It gives more accurate and detailed information of ligaments and muscle tears than any other modalities. In our study most common injuries that are detected by MRI are ACL tear, bucket handle tear of medial meniscus and MCL injuries. PCL injuries are less common than ACL injuries.
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