Background & Objectives: Pakistan ranked fifth amongst 22 high-burden Tuberculosis countries, and it is  an epidemic in Pakistan, hence screening is performed nationally, as part of the ambitious ZERO TB drive. Our objective was to assess the diagnostic accuracy of Computer Aided Detection (CAD4TB) software on chest Xray in screening for pulmonary tuberculosis in comparison with gene-Xpert. Methods: The study was conducted by Radiology Department Lady Reading Hospital Peshawar in affiliation with Indus Hospital network over a period of one year. Screening was done by using mobile Xray unit equipped with CAD4TB software with scoring system. All of those having score of more than 70 and few selected cases with strong clinical suspicion but score of less than 70 were referred to dedicated TB clinic for Gene-Xpert analysis. Results: Among 26,997 individuals screened, 2617 (9.7%) individuals were found presumptive for pulmonary TB. Sputum samples for Gene-Xpert were obtained in 2100 (80.24%) individuals, out of which 1825 (86.9%) were presumptive for pulmonary TB on CAD4TB only. Gene-Xpert was positive in 159 (8.7%) patients and negative in 1,666(91.3%). Sensitivity and specificity of CAD4TB and symptomatology with threshold score of ≥70 was 83.2% and 12.7% respectively keeping Gene-Xpert as gold standard. Conclusion: Combination of chest X-ray analysis by CAD4TB and symptomatology is of immense value to screen a large population at risk in a developing high burden country. It is significantly a more effective tool for screening and early diagnosis of TB in individuals, who would otherwise go undiagnosed. Abbreviations: TB = Tuberculosis, WHO = World Health Organization, CAD4TB = Computer aided detection for tuberculosis, CXR = Chest X-Ray, CAR = Computer aided reading. doi: https://doi.org/10.12669/pjms.38.1.4531 How to cite this:Nishtar T, Burki S, Ahmad FS, Ahmad T. Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert. Pak J Med Sci. 2022;38(1):---------.   doi: https://doi.org/10.12669/pjms.38.1.4531 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.

Objective: To determine the pattern of COVID-19 on chest radiograph in patients presenting to Lady Reading Hospital, Peshawar, Pakistan. Methods: This prospective observational study was conducted on 178 consecutive swab positive COVID-19 patients presenting to Lady Reading Hospital, Peshawar, Pakistan from 15th March to 15th June 2020. Patients of all ages and both genders were included. Chest X-rays performed by portable radiography unit were viewed for different patterns by two consultant radiologists independently and results were analyzed using IBM SPSS 20. Results: Out of 178 patients 134 were male. Mean age was 55.67 years. Radiographic patterns observed were ground glass haze without or with reticulation and/or consolidation (45.5 % and 33.2% respectively) and predominant consolidation either alone or in combination with ground glass haze or other findings (27.1% collectively). Peripheral distribution pattern was seen in 69.1% of patients with bilateral findings in 84.3%. Further categorization was based on pulmonary zonal demarcation with changes most commonly involving four zones (33.1%) i.e., the lower and mid zones bilaterally. Conclusion: Portable chest radiography is an essential supporting tool for assessing different patterns in COVID-19 infection. The most common pattern observed is alveolar opacities with predominant peripheral distribution either unilateral or more frequently bilateral, starting from the lower and mid zones extending to the upper zones and becoming diffuse with disease progression. doi: https://doi.org/10.12669/pjms.37.1.3435 How to cite this:Nishtar T, Noor N, Khan SL. X-ray patterns of COVID -19 in patients presenting to Lady Reading Hospital, Peshawar, Pakistan. Pak J Med Sci. 2021;37(1):28-33. doi: https://doi.org/10.12669/pjms.37.1.3435 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.

Objective: To evaluate the radiographic patterns on Chest X-Ray (CXR) in accordance with Modified Brixia Scoring as supporting imaging tool in triaging of Corona Virus Disease (COVID-19) pneumonia. Methods: In this cross-sectional study, chest radiographs of suspected COVID patients at emergency triage, Lady Reading Hospital (LRH) from April 18th to July 22nd 2020 were evaluated for patterns of COVID pneumonia and scored in accordance with modified Brixia score. Each zone was categorized as score of “one” for interstitial pattern, “two” for mixed interstitial /alveolar pattern and “three” for alveolar pattern. Radiographic patterns consistent with COVID pneumonia or patients having strong clinical suspicion were advised Polymerase Chain Reaction (PCR) tests. Results: Total of 2,225 individuals were screened for patterns of COVID-19 pneumonia on chest radiograph. Out of these 1465(65.8%) had normal chest radiograph and 760(34.2%) had abnormal findings. Out of the total, 648 suspected COVID patients were selected for PCR. The radiographic patterns ranged from mixed interstitial/alveolar pattern in 261(40.3%) patients, alveolar pattern in 231(35.6%), interstitial pattern in 87(13.4%), pleural effusion in 12(1.9%), other findings in 5(0.8%) while 52(8%) suspected Covid patients had normal radiographs. The PCR was positive in 326(50.3%), negative in 100(15.4%) and inconclusive in 60(9.3%) while 162(25%) were lost to follow up. Amongst the 52 suspected Covid patients having normal chest radiographs, 10 were positive on PCR, 21 negative, seven suspected and two inconclusive, while 12 were lost to follow up. Conclusion: Chest radiograph is used for triaging of suspected COVID pneumonia patients in emergency settings. It assesses the severity of disease according to modified Brixia scoring for treatment plan. doi: https://doi.org/10.12669/pjms.38.6.5279 How to cite this:Nishtar T, Nadeem Ullah, Ahmad FS, Rahim S. Radiographic patterns on Chest X-ray as a supporting imaging tool in triaging of suspected Corona Virus Disease (COVID) patients. Pak J Med Sci. 2022;38(6):---------.  doi: https://doi.org/10.12669/pjms.38.6.5279 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.

Objective:: This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment of diaphragmatic injuries in our trauma patients. Design:: An observational descriptive study. Place and duration of study:: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from March 2001 to April 2005. Subjects and methods: In this retrospective study, 50 patients admitted to our department with diaphragmatic injury were evaluated according to the type of injury, diagnostic methods, associated organ injury, treatment, modality, morbidity and mortality. Results: The average age of patients was 32 years. There were 35 (70%) male and 15 (30%0 female patients, 38 (76%) of these patients sustained blunt and 12 (24%) had penetrating chest injury. The diaphragmatic injury was right sided in 4 and left sided in 46 patients. Thirty nine (78%) patients presented in respiratory distress within 48 hours of in jury while 11 (22%) presented with bowel obstructive symptoms months and years after injury. A chest x-ray on admission suggested the diagnosis in 70% of the cases while chest ultrasonography and contrast studies were required in others. Surgery was emergent in 35 (70%), semi-emergent in 9 (18%) and effective in 6 (12%) cases. Surgical approaches were left thoracotomy (40 patients), left thoracolaprotomy (6 patients) and right thoracotomy (4 patients). The diaphragmatic repair was achieved by direct suture in 45 cases while prolene Mesh was required in 5 cases. The mortality rate was 6% (n = 3). Recurrence occurred in one (2%), wound infection in 3 (6%), pleural, space, problem in 1 and chest infection in 2 (4%) patients. Conclusion: A high index of suspicion and early surgical treatment determine the successful management of traumatic diaphragmatic injury with or without the herniation of abdominal organs. The surgical approach is individualized. We prefer the thoracic approach adding laporotomy when necess ary.

Objective: To emphasize the rational use of Computed Tomography (CT) head in emergency department (ED) of a high volume tertiary care hospital. Methods: This retrospective observational study was conducted in Radiology Department of Medical Teaching Institute Lady Reading Hospital (MTI-LRH), Peshawar, Pakistan from November 1st 2017 to 31st January 2018. Patients of all ages and both genders presenting to the emergency department with post traumatic and non-traumatic indications for emergency CT head scan were included in the study. The imaging was performed on GE 16 multi slice Optima CT system. The imaging protocol included slice thickness of 3-5mm, non-contrast study for cases of head trauma or suspected stroke. Where needed intravenous contrast was administered e.g. to exclude meningitis in patients presenting with severe headache. Patients undergoing CT examination for regions of the body other than head and brain were excluded from the study as their number was insignificant. Reporting was done on PACS and results analyzed using latest SPSS version. Results: Out of 4284 CT scans performed in emergency department 90.8% were CT head (3893). Among 3893 CT scan head done in ED, 2581 cases were reported normal (66.29%), while 1312 cases had positive findings (33.7%), including post traumatic and non-traumatic. Conclusion: Misuse of CT head is common especially in an emergency setting. Emergency physicians should be encouraged to obtain a detailed history and perform a thorough physical examination with reference to internationally standardized guidelines, while ordering CT scan. How to cite this:Nishtar T, Ahmad T, Noor N, Muhammad F. Rational use of Computed Tomography Scan head in the Emergency Department of a high volume tertiary care public sector hospital. Pak J Med Sci. 2019;35(2):---------. doi: https://doi.org/10.12669/pjms.35.2.719 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.