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Objective: To determine the diagnostic accuracy of contrast-enhanced MRI with conventional sequences and MR Spectroscopy in the diagnosis of Glioblastoma Multiforme, taking histopathology as the gold standard. We also determined the MR imaging appearance of GBM on conventional sequences. Methodology: This descriptive cross-sectional study was conducted at a tertiary care hospital from 19th August 2019 to 18th August 2020 on 165 adult patients suspected of having an intracranial space-occupying lesion. Informed consent was sought and a questionnaire was filled out for patient data, MRI imaging findings, and MRS results. Histopathology results were subsequently followed and recorded. The diagnostic accuracy of contrast enhanced MRI brain as well as MRS was determined in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy, taking histopathology as gold standard. Results: In a total of 165 patients selected for the study, the mean age was 56.34±10.04 years with a male to female ratio of 1:1 and the frontal lobe being the most common location (34.5%). In histopathological positive GBM cases, margins of the mass were ill-defined in 55.1%, intralesional low ADC values were observed in 63.3%, signal drop out on susceptibility imaging in 42.8%, and MRS with raised choline and reduced NAA in 75.5%. MRI had a sensitivity of 81.6% and  specificity of 94.8%, and MRS has a sensitivity of 75.5% and a specificity of 100%. Conclusion: Ill-defined margins, necrosis, and hemorrhage are important MRI features suggesting GBM. MRS combined with conventional MR sequences has high sensitivity and specificity in its diagnosis.

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Objectives: To evaluate the role of paracetamol in reducing pain and discomfort during the mammography procedure. Methods: This randomized double-blind placebo-controlled trial was conducted at DIR, Ojha and LEJ Campus of DUHS from November 2019 to May 2021. All females aged above 40 years undergoing first time mammogram (screening or diagnostic) were enrolled. Of 639 included participants, 321 were included in paracetamol and 318 in placebo group. Patients in both the groups took medication orally which was customized by the Dow Pharmacy. The degree of pain felt during the mammography procedure was the outcome variable that was measured using Visual Analogue Scale. Results: The overall pain was found in 506 (79.19%) women. Pain was significantly higher in women who were in placebo group as compared to patients who were in paracetamol group, i.e., 280 (55.3%) and 226 (44.7%) (p-value <0.001). After adjustment of other covariates, the odds of pain was 3.64 times significantly higher in women who were in placebo group than that of women in paracetamol group (OR 3.64, 95% CI 2.31-5.74). Moreover, >25kg/m2 BMI was 2.84 times, 22.6-25 kg/m2 BMI was 2.29 times, nulligravida was 3.56 times, menopausal status was 2.23 times, pre-menopausal status was 4.51 times, and family history of breast cancer was 2.33 times significantly more likely to have pain. No post-trial complications were observed in both the groups. Conclusion: The use of paracetamol prior to the mammography procedure was found to be an effective intervention to reduce the pain among women. Clinical Trials Identifier: NCT04381104. doi: https://doi.org/10.12669/pjms.39.5.7500 How to cite this: Rahim A, Rasheed B, Adil SO, Naz N, Aslam N. Effective strategy to cope the pain and discomfort among women undergoing mammography - A randomized controlled trial. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7500 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.

Oral cancer is a violent, 1 and devastating disease, which ranks second commonest malignancy in Pakistan. (Incidence rate, according to age standardised rates in the world, is 5.3 in males and 2.6 in females). Oral cancer is the great risk to public health of not only in Pakistan but all over the world, although a wide geographical variation noted in the occurrence and outcomes. 2 According to recent cancer registry record of Shaukat Khanum Memorial Hospital, Lahore, it is the eighth most common worldwide malignancy; but in the Pakistan, it is the second commonest malgnancy. It accounts for 15% of all new cancer cases in this region in comparison to 3% detected worldwide. 2 The prevalence of oral cancer is variable throughout the world. It is higher in Pakistan reaching the 10% of all cancers, and around 45% in India. A study conducted in Pakistan during 1995-2004 showed much higher incidence rate, 22.5% in males and 20.4% in females. 3 Over 300,000 new cases of oral and oropharyngeal cancer were diagnosed in 2004-2009 worldwide, and over 7,000 affected individuals died of these cancers. 4 It is estimated that more than 90% of all oral neoplasms are oral squamous cell carcinoma (OSCC), so this term tends to be used interchangeably with oral cancer. 4 Squamous cell carcinoma (SCC) comprises 90% of head and neck cancers; whereas, oral cavity squamous cell carcinoma (OCSCC) is the commonest. Subsites of oral cavity are lip, alveolar ridge, buccal mucosa, retromolar trigone, floor of mouth and tongue; 5 but buccal mucosa being the aggressive subsite. 6 Risk factors associated with SCC include betel quid chewing, tobacco and alcohol consumption. 7 Although there are rapid advancements in the diagnostic and therapeutic procedures in the past decades, but the five-year survival rate has showed none or only slight improvement at 65% between 2002-2008. 5 If disease is properly diagnosed and staging done at early phase, then treatment option is surgical (transoral

Objective: This study aimed to assess the efficiency of ultrasonography in the accurate diagnosis of benign ovarian lesions as compared to the gold standard Magnetic Resonance Imaging (MRI). Study Design: Prospective analytical cross-sectional study. Place and Duration of Study: Dow Institute of Radiology, Dow University of health sciences (DUHS), OJHA Campus, Karachi, Pakistan, from Jun 2018 to Nov 2019 Methodology: The consecutive sampling technique was used to recruit the patients. The frequency and percentage, and mean and standard deviation were calculated for qualitative and quantitative variables, respectively. The p-value <0.05 considered assignificant. Results: Majority of the patients were aged ≥20 years (49.06%) and were obese (13.21%). Majority of the participants (88.68%) were married where 69.81% had normal menstrual status and 11.32% had menopause. On cross-tabulation, tumor status (Benign) was found to have a very high significant association with age and BMI at p-value <0.001 and menstrual status at pvalue 0.000. Benign lesions were most prevalent (60.47%) among 20-29 years old and the PPV is 92.86%; Diagnostic accuracy for this age group is 95.35%. PPV, NPV, sensitivity, specificity, and diagnostic accuracy were 100 % for Underweight, premenopause patients with 16 to 30 days symptoms. Benign tumor was more prevalent among patients with normal BMI (93.48%), post-menopause (63.64%), symptoms’ duration of 1 to 3years (66.67%), single (37.06%) and cystic mass (49.52%). Conclusion: Ultrasonography showed excellent diagnostic accuracy in the detection of benign ovarian tumors.

Background: Magnetic Resonance Imaging (MRI) has a premier role in detecting rectal cancer and is considered superior for diagnosing tumour recurrences. It is the modality of choice by which patients with total abdominal perineal (AP) resection can be fully evaluated. This study aimed to evaluate the diagnostic accuracy of MRI in the detection of rectal carcinoma in suspected cases, keeping histopathology as a gold standard. Methodology: A descriptive cross-sectional study was conducted in the radiology department of Dow University of Health Sciences, Civil Hospital, Karachi, from 19th May to 18th November 2018. A total of 181 patients with a history of bleeding per rectum, altered bowel habits and abdominal pain were included. High-resolution 2D T2-weighted fast spin-echo sequences in the sagittal, axial and coronal planes were taken. Patients were followed for histopathology reports. The diagnostic accuracy of MRI for rectal carcinoma was calculated in terms of diagnostic accuracy, sensitivity, specificity, using histopathology as a gold standard. Results: There were 63% male and 37% female patients. The mean symptoms duration was 60.61 ± 7.18 weeks. 64.1% were presented with bleeding per rectum, 52.5% with altered bowel habits and 31.5% with abdominal pain. 35.4% of cases were diagnosed positive by MRI, and 43.6% cases through histopathology. Sensitivity, Specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 85.9%, 79.5%, 69.6%, 91.2%, and 81.76% respectively. Conclusion: It was concluded that MRI has 85.9% sensitivity, 79.5% specificity, and 81.76% diagnostic accuracy in detecting rectal cancers proving its reliability in detecting both early and recurrent rectal cancers.