BackgroundHepatitis C virus (HCV) is highly infectious pathogen which is responsible for causing Hepatitis around 200 million individuals worldwide. In Pakistan, 4.7% of HCV prevalence has been reported and HCV genotype 3a has been found to be the major source of infection in Pakistan but still there is lack of information on distribution of HCV genotypes and viral load in various geographical regions of Pakistan. Therefore, current study was designed to determine distribution of HCV genotypes as well viral load in different areas of Punjab province of Pakistan.FindingsA total of 995 serum samples were taken from those individuals in which antibodies against HCV were detected through ELISA, from different regions of Punjab i.e. Lahore 317(31.85%), Faisalabad 70(7.03%), Gujranwala 129(12.96%), Gujrat 106(10.65%), Sialkot 94(9.44%), Sargodha 60(6.03%), Mandibaha-ud-din 135(13.56%), Jhang 86(8.64%). Qualitative PCR was performed to determine viral load and genotyping was performed using Nested PCR. Chi-square test was used to determine the age and sex-wise prevalence of HCV. Out of 995 samples, 888 samples were found positive for HCV RNA. In all regions, genotype 3a showed highest prevalence (82.81%) followed by genotype 1 (3.41%), mixed genotypes (2.41%), genotype 2 (0.50%), genotype 5 (0.1%) and unclassified genotypes (10.75%). Viral load in 29.5% patients infected with genotype 3a was less than 600,000 IU/mL, while it was between 600,000-800,000 IU/mL in 27.9% patients and 25.22% patients had more than 800,000 IU/mL viral load.ConclusionHCV genotype 3a is the most prevalent genotype in various regions of Punjab. Viral load of HCV patients in these different regions of Punjab are reported for the first time. Moreover, based upon these results the Patients having viral load below 800,000 IU/mL would be expected to show better response of anti-HCV therapy.

Abnormal placentation has raised the ratio of cesarean cases. In such obstetric complication the placenta lie at the lower segment of the uterus. These abnormal attachments of placenta to uterus and invasion to adjacent organs are the main cause of placenta previa. These are not only raising delivery challenges but also raising the mortality cases. Objective: For evaluation of the diagnostic efficacy of MRI to locate placentation abnormalities with high accuracy and sensitivity. This not only helps in preoperative delivery planning but also decreases the ratio of mortality. Study Setting: It was an observational study, conducted at radiology department of Mardan Medical Complex Mardan for the duration of six months from September 2021 to February 2022. Methods: The women suspicion of placentation abnormalities were recommended with MRI. The consecutive 185 pregnant women were included in the study. The results obtained from MRI were compared with the results obtained by C-section. Cesarean section results were considered as standard. The treatment strategy was decided in accordance with the MRI findings. The treatment strategies which opt during the CS were compared with the strategy created on the basis of MRI. Results: 115 women were diagnosed with abnormal placentation. The 70 women out of 185 were diagnosed with placenta previa. The percentage false results were seen in 18 patients. The false negative results of MRI were seen in three patients. After comparison between the findings of MRI and CS the sensitivity, positive predictive values and other parameters were calculated. The sensitivity was 97%, while the positive predictive value was 84%. The other parameters such as specificity were 79% and negative predictive value was 95%. The sensitivity, accuracy, and positive predictive values of the planning strategy created for treatment on the basis of MRI findings were calculated. There was significant correlation between the findings of MRI and CS. Conclusion: For the future planning of treatment strategy for the women suspected of abnormal placentation, MRI is highly suggested diagnostic tool with better efficacy and sensitivity. This imaging modality helps in proper and accurate diagnosis of abnormal placentation. Keywords: Abnormal placentation, obstetric complications, treatment strategy, placenta previa.

Objective: To assess the accuracy of application of diffusion weighted imaging in the diagnosis and evaluation of acute onset ischemic strokes. Study Design: Cross sectional validation study. Place and Duration: Department of Diagnostic Radiology, Mardan Medical Complex, Hospital, Mardan from 15th October 2020 to 15th April 2021. Methodology: Patients whose presentation was highly suggestive of acute stroke, were undergone a non-contrast Computed tomography scan of the brain immediately by Asteion VP single slice. Those found negative for acute hemorrhage on Computed tomography images were subjected to Magnetic resonance imaging on Achieva 1.5 Tesla. Diffusion-weighted imaging technique of MRI scan was done in addition to the conventional T1W, T2W, and FLAIR scans of MRI which were also done. DWI was performed as early as possible not later than 24 hours after symptoms onset. Both DWI imaging technique and conventional routine T1W, T2W and FLAIR scans of MRI were repeated after 7 days. Results: The mean age of the sample was 57.6 + 5.9 years. On Diffusion-weighted imaging, stroke was observed in 60.2% of patients. Later on follow-up conventional magnetic resonance imaging scans were done after 7 days, stroke was recorded in 69.9% of patients confirming the diagnostic accuracy of DWI imaging in sub-acute stroke in early diagnosis. Conclusion: Conventional MRI scans like T1W, T2W and FLAIR have diagnostic accuracy only after some days. It has poor diagnostic accuracy in early onset sub-acute ischemic strokes. On the other hand, DWI imaging scans of MRI can be a useful tool for early detection of ischemic strokes as it diagnosed stroke in 60.2% of patients which were later confirmed by conventional MRI scans done after 7 days. Conventional MRI scans have high accuracy of detection of strokes but only after some days. So DW1 imaging may be applied for early diagnosis of strokes in sub-acute onset strokes. Keywords: Ischemic stroke, Magnetic Resonance Imaging, Diffusion Weighted Imaging, Hemorrhage, Computed Tomography How to Cite This: Afridi SQ, Baig H, Janan Z, Begum T, Shuaib M. Accuracy of diffusion-weighted imaging in the diagnosis and Evaluation of acute ischemic strokes. Isra Med J. 2022; 14(3): 99-103. DOI: https://doi.org/10.55282/imj.oa1314