Worldwide, tuberculosis (TB) is one of the top 10 causes of death, and the leading cause from a single infectious agent. Pakistan has an overwhelming burden of TB and it is a major health hazard for the majority of the rural population. The lung continues to be the most common site of involvement and even after completion of treatment residual changes remain which may affect quality of life.Complications of TB after treatment completion can often be misinterpreted for other active diseases so it is important to recognize and understand the radiologic manifestations of the thoracic sequelae. Post TB sequelae can be categorized into parenchymal, airway disease, pleural/chest wall, vascular and mediastinal. These residual changes can be minor however, some can be debilitating and even fatal.The purpose of this pictorial review is to show the spectrum of residual changes seen on chest radiography and/or computed tomography that persist after treatment completion and bacteriological cure. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1722 How to cite this:Khan R, Malik NI, Razaque A. Imaging of Pulmonary Post-Tuberculosis Sequelae . Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S75-S82. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1722 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.
Purpose: To report the therapeutic outcome of ultrasound-guided intralesional injection of bleomycin in the treatment of cutaneous hemangiomas and vascular malformations. Material & Methods:The medical records of patients with cutaneous hemangiomas and vascular malformations treated with the intralesional injection of bleomycin under ultrasound guidance between August 2009 and June 2013 at the Indus Hospital, Karachi were reviewed retrospectively using a computerized medical record information management system. Data were extracted using a pre-coded performa that included patient demographics, type and location of lesion, number of treatments, presenting/pre-and post-treatment clinical symptoms (pain, swelling, heaviness, size, discoloration), ultrasound appearance and vascularity, and post-treatment side effects. The dose range of bleomycin was 0.5-1.0 mg/kg, but not exceeding 15 mg in a single session. A maximum of four treatments were given in any given patient except for one, who presented with recurrence after a year of complete resolution. Therapeutic outcome was determined using review of ultrasound images and recorded clinical assessment. Treatment response was categorized as: (i) complete resolution [more than 90% reduction]; (ii) substantial reduction [more than 50% reduction]; (iii) mild reduction [25% reduction]; or, (iv) no improvement [<10% reduction].Results: A total of 30 patients (16 female, 14 male), ranging in age from 8 months to 48 years (mean age 10.2 years), were treated from 2009 to 2013. There were 23 hemangiomas. Seven were vascular malformations, of which five were lymphatic malformations and two were venous malformations. Twenty-eight lesions were located in the head and neck region, and two were peripheral. In 24 of the 30 patients (76%), treatment had been completed. In six patients (21%) treatment was ongoing at the time of this report. Seventeen of the 23 hemangiomas (74%) were completely resolved clinically and on ultrasound, five (22%) showed substantial improvement and one (4%) showed mild improvement. In five of the seven vascular malformations (71%) lymphatic malformations resolved completely, and two (29%) venous malformations showed substantial improvement. Of the 13 patients presenting with discoloration, there was complete resolution in one (7.7%), marked reduction in 11 (84.6%) and mild reduction in one (7.7%). Of seven patients presenting with pain, there was complete resolution in two (28.6%), marked reduction in two (28.6%), mild reduction in two (28.6%), and no improvement in one (14.3%). There were no pulmonary complications. Conclusion:Ultrasound-guided intralesional injection of bleomycin is an option to consider for the treatment of certain types of cutaneous hemangiomas and vascular malformations. Prospective studies should be undertaken to understand the various factors contributing to therapeutic success. Ultrasound-guided Intralesional Bleomycin Injection (IBI) for Treatment of Cutaneous Hemangiomas and Vascular Malformations
Covid 19 pandemic brought many challenges for public and healthcare workers. Healthcare workers all around the world are at the heart of this dreadful situation. While providing critical care to Covid 19 patients, they have faced many clinical as well as ethical dilemmas. The novelty and profound uncertainty associated with the clinical course of the disease introduced a dimension to the context of ethical dilemmas faced in clinical practice.
Objective: To determine contraceptive knowledge and practices among multiparous women. Study Design: Cross Sectional, Multicenter study. Setting: Gynae Unit I of Sir Ganga Ram Hospital, Lahore and Gynecology Department of Government Teaching Hospital, Shahdara. Period: 1st July 2019 to 31st December, 2019. Material & Methods: A total of 448 multiparous women were randomly selected from 2 tertiary care hospitals. A structured questionnaire was used to assess the knowledge of women attending antenatal and gynaecology clinics and indoor. Results: Out of 448 women, all were aware of at least one method of contraception and 272 (65%) had used one. The most commonly employed method was male condom (33%) followed by IUCD (24%), oral contraceptive pill (22%) and hormone based injectables (13%). In upper socioeconomic class, 95% were using birth control methods whereas 71% of middle class and 48% of lower class subjects had used any one method of birth control. In the highly educated subjects, 67% had employed a contraceptive method and among the illiterate, only 39% has used any method. Disapproval on part of the husband was the most common (28%) reason of refusing contraceptive services, followed by desire for more children (16%). Health care workers were the most common source of knowledge of contraception (69%) followed by family members (31%) and media (17%). Conclusion: All the subjects were aware of contraceptive methods. The most common used method is condoms followed by IUCD but practices were limited due to high illetracy, lower socioeconomic status, partener refusal, desire for more issues and fear of side effects.
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