Ahsen Farooq | Riphah International University (original) (raw)

Papers by Ahsen Farooq

Research paper thumbnail of Effects of Electromyographic Biofeedback on the Performance of Vastus Medialis Oblique Muscle in Knee Osteoarthritis: A Randomized Controlled Trial

The Rehabilitation Journal

Background: Knee osteoarthritis is a common musculoskeletal disorder, enhancing performance of Va... more Background: Knee osteoarthritis is a common musculoskeletal disorder, enhancing performance of Vastus Medialis Oblique (VMO) can reduce the symptoms. Objective: The study objective was to determine the effects of Electromyographic Biofeedback (EMG BF) on the performance of VMO in patients with knee osteoarthritis (OA). Methods: A Randomized Controlled Trial (RCT) was conducted at Pakistan Railway General Hospital, Rawalpindi from July to December 2019. In this study, n=30 patients with a diagnosis of knee OA were recruited with the age ranging from 50 to 65 years. The participants were randomly allocated to two groups. Group A has received isometric exercises with Electromyographic Biofeedback (EMG BF) training and Group B has received only isometric exercises for 6 weeks. The Assessments were taken at the baseline and after 6th week of intervention. The outcome measure of vastus medialis oblique (VMO) performance was maximum voluntary isometric contraction (MVIC), measured by an EM...

Research paper thumbnail of Effects of high-intensity multi-modal exercise training (HIT-MMEX) on bone mineral density and muscle performance in postmenopausal women. A Pilot randomized controlled trial

Journal of the Pakistan Medical Association

Objectives: To determine the effects of high-intensity multimodal exercise training on bone miner... more Objectives: To determine the effects of high-intensity multimodal exercise training on bone mineral density and muscle performance in postmenopausal women. Method: The two-armed, parallel, pilot randomised controlled trial was conducted from November 2020 to July 2021 at Riphah Rehabilitation Centre, Rawalpindi, Pakistan, and comprised women aged 45-70 having been in the post-menopause phase for at least 3 years, with body mass index <30, community ambulant and willing to have exercise therapy. The subjects were randomised into two equal groups. The experimental group A received supervised high-intensity resistance, weight-bearing, balance and mobility training twice weekly for 8 months. The control group B received low-to–moderate intensity exercises. Femoral neck and lumbar spine bone mineral density (g/cm2) were taken through a dual-energy X-ray absorptiometry scan. Muscle performance was measured using 1 repetition maximum for leg and trunk extensors, and 30 sec sit to stand ...

Research paper thumbnail of Normal values of liver and spleen sizes by ultrasonography in Pakistani children: a regional study

Rawal Medical Journal, 2021

Ultrasonography is commonly used to assess sizes of intra-abdominal organs. The liver is measured... more Ultrasonography is commonly used to assess sizes of intra-abdominal organs. The liver is measured in the mid clavicular line during quiet breathing in young children and during breath holding in older children. The upper and lower points of the 1 sonographic image are taken as the measurement. Splenic size is measured by obtaining a coronal view that included the hilum, in quietly breathing. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) is measured and correlated with age, height, and weight. Liver can also be palpated and percussed clinically in neonates and children but method is neither reliable not accurate with inter observer 7,8 differences. Ultrasound is a safe, accurate, reproducible, non-invasive and quick tool used for 9 measuring sizes of spleen and liver. The children are 10-13 grouped under age, gender, height and weight. The objective of this study was to determine the normal range of dimensions for the liver and spleen in healthy neonates, infants, and children. METHODOLOGY This study was conducted with 354 children with no acute or chronic hepatic or renal ailment, age range varying from one month old to twelve years from January to December 2019. The children visited OPD for immunization, came with family or were brought for ultrasound for other causes of illness. Children having viral hepatitis, typhoid, congestive cardiac failure, malaria, anemia or protein energy malnutrition were excluded. Informed consent was obtained from parents/ accompanying adults. Ethical approval of the study was obtained from the Ethics Review Committee of the Hospital. Detailed history was taken to ensure to rule out any m e t a b o l i c , c o l l a g e n v a s c u l a r, i n f e c t i v e / inflammatory, post-traumatic, neoplastic or blood related diseases. Age nearest to the completed month was entered. Measuring tools included an electronic weighing scale and a stadiometer mounted on wall. In each child, the pediatrician i d e n t i f i e d t h e s t e r n o c l a v i c u l a r a n d t h e acromioclavicular joints by palpation mid

Research paper thumbnail of Afghan Mutation of Ca-II Gene; Osteopetrosis and Carbonic Anhydrase II Deficiency with Craniofacial Disproportion in an Afghan Child

The professional medical journal, 2016

Carbonic anhydrase-II deficiency is an autosomal recessive disorder grounded on a triad of cerebr... more Carbonic anhydrase-II deficiency is an autosomal recessive disorder grounded on a triad of cerebral calcification, osteopetrosis and renal tubular acidosis away in which proximal tubules, distal collecting ducts or combined.1 Other features include growth and mental retardation along with the complications of osteopetrosis.2 The only treatment to cure the calcification is allogeneic bone marrow stem cell replacement; however it does not have any considerable effect on the renal lesions3 We report a case of a 3 week old male child of Afghan origin with all these features who was clinically diagnosed as having carbonic anhydrase type II deficiency however unfortunately the baby passed during cranioplasty and genetic testing for enzyme deficiency could not be done. Our aim to present this case of a male child of Afghan origin is to enhance the awareness about this rare syndrome in our medical community and inviting further research for a possible Afghan mutation of CA-II gene.

Research paper thumbnail of Noninvasive Ultrasound Assessment of the Normal Optic Nerve Sheath Diameter in Healthy Adults: an Islamabad-based Pakistani Population Study

Journal of Ophthalmology and Research

Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath di... more Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath diameter (ONSD) is becoming popular to monitor intracranial pressure (ICP). Different studies report varied values for normal ONSD. Our primary aim was to find the TOUmeasured normal ONSD in healthy adult Pakistanis living in Islamabad Capital Territory (ICT).

Research paper thumbnail of CT Evaluation of Mediastinal Masses : A Study of 80 Cases

Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were a... more Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were analyzed with regard to the ability of CT to demonstrate the masses, their location, their morphology, and their encroachment upon or displacement of adjacent mediastinal structures. CT images were compared with plain chest radiographs which were available in all cases. CT depicted all lesions successfully with good anatomic detail. Among the 80patients the largest number of cases (n =51) were found to be having lymphadenopathy with Hodgkin's lymphoma in 57% and non-Hodgkin's lymphoma in J5% of cases. CT is regarded as the best single radiological investigation for evaluating a mediastinal abnormality demonstrated on a high-kV chest radiograph or for detecting occult mediastinal disease.

Research paper thumbnail of Role of Ultrasonography in Infertility Management: Ovulation Monitoring and Assisted Conception

Infertility causes great stress to many couples. Most of those presenting with childlessness have... more Infertility causes great stress to many couples. Most of those presenting with childlessness have reduced fertility, rather than absolute sterility, and many are likely to conceive spontaneously. In this "ultrasonographic monitoring of growing follicles, in ovaries to determine the day of ovulation and its coordination with time of intercourse" has a well established role in the management of "unexplained infertility". This study was conducted to find out its efficacy in our setup. 86 female"s patients of unexplained infertility, with different post-marital time period, underwent ultrasonographic ovulation monitoring each with follow up for minimum of four menstrual cycles. Average follicular growth rate was 2 mm a day, which increased to 3 mm a day, two days prior to ovulation. Follicular diameter at the time of ovulation ranged from 22 mm to 27 mm with a mean of 24 mm. We observed ovulation in 79.2% of our patients. In 8.1% patient"s dominant follicle ceased to grow beyond 18 mm size and gradually become atretic. Leutinized unruptured follicle was documented in 12.7% of our patients in whom follicular size reached to periovulatory range but did not rupture. Uterine endometrial thickness at the time of ovulation varied from 7 mm to 13 mm and multilayered appearance (triple line sign) was observed in 57.3% of patients. Overall conception rate was 16.3% whereas it was much more encouraging to see in 23.5% of patients who were in less than 5 years of their marriage. Keeping in view of easy to workup as out patient basis in large numbers of patient, less time consuming, promising results, cost effectiveness and non invasive nature of technique; ultrasonographic monitoring of ovulation is recommended as a part of management in all patients of unexplained infertility.

Research paper thumbnail of Afghan Mutation of Ca-II Gene

The Professional Medical Journal

Carbonic anhydrase-II deficiency is an autosomal recessive disorder groundedon a triad of cerebra... more Carbonic anhydrase-II deficiency is an autosomal recessive disorder groundedon a triad of cerebral calcification, osteopetrosis and renal tubular acidosis away in whichproximal tubules, distal collecting ducts or combined.1 Other features include growth andmental retardation along with the complications of osteopetrosis.2 The only treatment to curethe calcification is allogeneic bone marrow stem cell replacement; however it does not have anyconsiderable effect on the renal lesions3 We report a case of a 3 week old male child of Afghanorigin with all these features who was clinically diagnosed as having carbonic anhydrase type IIdeficiency however unfortunately the baby passed during cranioplasty and genetic testing forenzyme deficiency could not be done. Our aim to present this case of a male child of Afghanorigin is to enhance the awareness about this rare syndrome in our medical community andinviting further research for a possible Afghan mutation of CA-II gene.

Research paper thumbnail of Frequency of Primary Headache Syndromes in Patients with a Major Depressive Disorder

Cureus Journal of Medical Science, Jun 5, 2018

Purpose: The primary objective of this study was to assess the overall frequency of primary heada... more Purpose: The primary objective of this study was to assess the overall frequency of primary headaches in subjects with a moderate to severe major depressive disorder. A further objective was to determine the frequency of primary headache sub-types in this population.
Materials and methods: This descriptive, cross-sectional study was conducted at the outpatients’ clinic of the department of psychiatry, Pakistan Railways Teaching Hospital, an affiliate of Islamic International Medical College, Rawalpindi. The duration of the study was from December 2016 to May 2017. One hundred and ten consecutive patients with a major depressive disorder (MDD) were assessed for a primary headache, according to the diagnostic criteria of International Classification of Headache Disorders second edition (ICHD-2). MDD patients with moderate to severe depression, according to the diagnostic and statistical manual of mental disorders (DSM-5) were enrolled in the study. A semi-structured proforma was designed to gather information on sociodemographic variables. The data was analyzed by utilizing the Statistical Package for Social Sciences, version 22 (IBM Corp., Armonk, NY, US).
Results: Of the 110 MDD patients enrolled, a primary headache was present in 45 (40.90%) cases. Additionally, five of these patients had a migraine with aura (11.11%), 12 had a migraine without aura (26.66%), and 28 had a tension-type headache (62.22%). In the females, migraines with or without aura was frequent (35.29%), while a tension-type headache was more common in males (72.72%).
Conclusion: More than one-third of the sample had a primary headache syndrome, which shows a high comorbidity between a migraine and its variants and MDD. There is a need to undertake further studies with larger samples to elucidate this relationship.

Research paper thumbnail of Association of Portal Vein Doppler Parameters with Chronic Liver Disease Child Pugh Classes: A Single Center Experience at Rawalpindi, Pakistan

Journal of Islamic International Medical College (JIIMC), Mar 7, 2019

Objective: To determine the association between Doppler Parameters of average peak portal vein ve... more Objective: To determine the association between Doppler Parameters of average peak portal vein velocity and flow direction and Child Pugh classes of patients suffering from the chronic liver disease.
Study Design: It was a descriptive study.
Place and Duration of Study: The study was conducted from December 2013 to January 2015 at the Radiology Department of Holy Family Hospital, Rawalpindi, Pakistan.
Materials and Methods: Selected chronic liver disease (CLD) patients were examined with gray scale and Doppler USG for assessment of portal vein (PV). Average peak portal venous velocity (PVV) and direction of flow in the main portal vein were recorded. Doppler findings were correlated with clinical features and laboratory findings in three classes (A, B & C) of patients using Child Pugh criteria to establish any probable association between them (appendix: I).
Results: Out of total 115 CLD patients studied, 47.8% were in Child Pugh class C. The main portal vein average PVV (cm/sec) in 24.34% patients with Child Pugh class A was 18.75 + 1.88, in 27.82% patients with Child Pugh class B was 14.25 + 0.98 and in 47.82% patients with Child Pugh class C was 8.15 + 1.84. This showed a significant fall in portal vein average PVV with advancing Child Pugh class of cirrhosis. Only 10.4% patients showed continuous hepatofugal flow and 4.3% showed bidirectional flow. It was recorded only in Child Pugh class C patients.
Conclusion: Doppler findings of average peak velocity in the main portal vein fall progressively with worsening of the Child Pugh class. In addition, the direction of flow is also reversed in cases of the Child Pugh class C cirrhosis.

Research paper thumbnail of Frequency of Primary Headache Syndromes in Patients with a Major Depressive Disorder

Cureus Journal of Medical Science, Jun 5, 2018

Purpose: The primary objective of this study was to assess the overall frequency of primary heada... more Purpose: The primary objective of this study was to assess the overall frequency of primary headaches in subjects with a moderate to severe major depressive disorder. A further objective was to determine the frequency of primary headache sub-types in this population.
Materials and methods: This descriptive, cross-sectional study was conducted at the outpatients’ clinic of the department of psychiatry, Pakistan Railways Teaching Hospital, an affiliate of Islamic International Medical College, Rawalpindi. The duration of the study was from December 2016 to May 2017. One hundred and ten consecutive patients with a major depressive disorder (MDD) were assessed for a primary headache, according to the diagnostic criteria of International Classification of Headache Disorders second edition (ICHD-2). MDD patients with moderate to severe depression, according to the diagnostic and statistical manual of mental disorders (DSM-5) were enrolled in the study. A semi-structured proforma was designed to gather information on sociodemographic variables. The data was analyzed by utilizing the Statistical Package for Social Sciences, version 22 (IBM Corp., Armonk, NY, US).
Results: Of the 110 MDD patients enrolled, a primary headache was present in 45 (40.90%) cases. Additionally, five of these patients had a migraine with aura (11.11%), 12 had a migraine without aura (26.66%), and 28 had a tension-type headache (62.22%). In the females, migraines with or without aura was frequent (35.29%), while a tension-type headache was more common in males (72.72%).
Conclusion: More than one-third of the sample had a primary headache syndrome, which shows a high comorbidity between a migraine and its variants and MDD. There is a need to undertake further studies with larger samples to elucidate this relationship.

Research paper thumbnail of Noninvasive Ultrasound Assessment of the Normal Optic Nerve Sheath Diameter in Healthy Adults: an Islamabad-based Pakistani Population Study

Journal of Ophthalmology and Research, Nov 24, 2020

Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath di... more Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath diameter (ONSD) is becoming popular to monitor intracranial pressure (ICP). Different studies report varied values for normal ONSD. Our primary aim was to find the TOU-measured normal ONSD in healthy adult Pakistanis living in Islamabad Capital Territory (ICT). Methodology: One hundred healthy adult volunteers participated in this cross-sectional study, conducted at the Pakistan Atomic Energy Commission (P.A.E.C.) General Hospital, Islamabad. Each eye was scanned for the optic nerve (ON) via TOU using a B-mode 7-15 MHz linear probe. The investigators measured ONSD in a transverse plane three millimeters behind the retina. They recorded an average of three readings as a mean ONSD value for both eyes. Results: The overall normal mean ONSD was 4.80±0.26 mm with a minimum of 4.25 mm and a maximum of 5.20 mm. The mean ONSD for the age group of 20-35 years was 4.79±0.27 mm and for 36-50 years, it was 4.81±0.24 mm (p = 0.7952), for the male eye it was 4.83±0.26 mm and for the female eye was 4.75±0.25 mm (p = 0.1238), and for the right eye was 4.79±0.27 mm and for the left eye was 4.80±0.26 mm with (p = 0.2434) and (r = 0.9455). There was no statistically significant difference in the mean ONSD of the four ethnic groups (p = 0.7141). Conclusion: The normal mean optic nerve sheath diameter in the studied healthy adult Pakistanis, as measured through noninvasive B-mode transorbital ultrasound is 4.80±0.26 mm.

articles by Ahsen Farooq

Research paper thumbnail of Effects of Electromyographic Biofeedback on the Performance of Vastus Medialis Oblique Muscle in Knee Osteoarthritis: A Randomized Controlled Trial.

The Rehabilitation Journal (2521-344X, 2521-3458), Jun 30, 2022

Background: Knee osteoarthritis is a common musculoskeletal disorder. Enhancing the performance o... more Background: Knee osteoarthritis is a common musculoskeletal disorder. Enhancing the performance of Vastus Medialis Oblique (VMO) can reduce the symptoms. Objective: The study objective was to determine the effects of Electromyographic Biofeedback (EMG BF) on the performance of VMO in patients with knee osteoarthritis (OA). Methods: A Randomized Controlled Trial (RCT) was conducted at Pakistan Railways General Hospital, Rawalpindi from July to December 2019. In this study, n = 30 patients with a diagnosis of knee OA were recruited, with an age range of 0 to 65 years. The participants were randomly allocated to two groups. Group A received isometric exercises with Electromyographic Biofeedback (EMG BF) training, and Group B received only isometric exercises for 6 weeks. The assessments were taken at the baseline and after the 6th week of intervention. The outcome measure of vastus medialis oblique (VMO) performance was maximum voluntary isometric contraction (MVIC), measured by an EMG BF device, and one-repetition maximum (1RM). The VMO muscle thickness was measured by musculoskeletal ultrasound. SPSS version 21 was used for data analysis. Results: The mean age of group A was 58.94±3.1 years, and that of group B was 59.44±2.9 years. There was a significant improvement (p<0.001) in VMO thickness and 1RM in the experimental group. But for MVIC, the between-group difference was not significant (p>0.05). Within-group analysis for all variables was statistically significant (p 0<.001) in both groups. Conclusion: VMO training with an EMG BF device is more effective in enhancing VMO thickness and strength in terms of 1RM in patients with knee osteoarthritis.

Keywords: Osteoarthritis, Electromyography Biofeedback, One repetition maximum

Research paper thumbnail of Effects of high-intensity multi-modal exercise training (HIT-MMEX) on bone mineral density and muscle performance in postmenopausal women. A pilot randomized controlled trial

The Journal of the Pakistan Medical Association (0030-9982), 2022

Objectives: To determine the effects of high-intensity multimodal exercise training on bone miner... more Objectives: To determine the effects of high-intensity multimodal exercise training on bone mineral density and muscle performance in postmenopausal women. Method: The two-armed, parallel, pilot randomized controlled trial was conducted from November 2020 to July 2021 at Riphah Rehabilitation Center, Rawalpindi, Pakistan, which comprised women aged 45–70 who had been in the post-menopause phase for at least 3 years, with a body mass index of 30, who were community ambulant and willing for exercise therapy. The subjects were randomized into two equal groups. Experimental group A received supervised high-intensity resistance, weight-bearing, balance, and mobility training twice-weekly for 8 months. Control group B received low-to–moderate-intensity exercises. Femoral neck and lumbar spine bone mineral density (g/cm2) was taken through a dual-energy X-ray absorptiometry scan. Muscle performance was measured using a 1 repetition maximum for leg and trunk extensors, and a 30-second sit-to-stand test. Data were analyzed using SPSS 21. Results: Out of the 101 women screened, 28 (27.7%) were enrolled; 14 (50%) in group A had a mean age of 53.366.28 years; and 14 (50%) in group B had a mean age of 51.714.82 years (p> 0.05). Group A showed significantly more improvement than group B, with respect to both lumbar spine bone mineral density and muscle performance (p<0.05). Conclusion: A supervised high-intensity multimodal exercise training protocol had a positive effect on the lumbar spine, bone mineral density, and muscle performance in postmenopausal women.

Research paper thumbnail of CT Evaluation of Mediastinal Masses: A Study of 80 Cases.

Journal of Abbottabad Medical College (JAMC), Feb 1996

Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were ... more Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were analyzed regarding the ability of CT to demonstrate the masses, their location, their morphology, and their encroachment upon or displacement of adjacent mediastinal structures. CT images were compared with plain chest radiographs which were available in all cases. CT depicted all lesions successfully with good anatomic detail. Among the 80 patients the largest number of cases (n =51) were found to be having lymphadenopathy with Hodgkin's lymphoma in 57% and non-Hodgkin's lymphoma in 33% of cases. CT is regarded as the best single radiological investigation for evaluating a mediastinal abnormality demonstrated on a high-kV chest radiograph or for detecting occult mediastinal disease.

Research paper thumbnail of The role of barium enema in the evaluation of morphologic and histopathologic characteristics of colorectal tumours

Journal of the College of Physicians and Surgeons Pakistan (JCPSP), Apr 1997

During a 9-month period (Sept 1991–Jun 1992), the clinical, radiographic, endoscopic, surgical, a... more During a 9-month period (Sept 1991–Jun 1992), the clinical, radiographic, endoscopic, surgical, and histopathologic findings of 25 patients with colorectal tumours were reviewed retrospectively. To assess the current status of barium enema examination as the initial diagnostic procedure for the detection of suspected colorectal tumours and to determine the relationship between their morphologic and histopathologic characteristics. Six patients (24%) had lesions proximal to the splenic flexure and 19 (76%) patients had more distal lesions predominantly (68%) in the rectosigmoid region. Large (> 4 cm) intraluminal fungating cancers [34.50% (9 of 25 patients)] and long (> 4 cm) rigid neoplastic strictures [30.75% (8 of 29 patients)] were among the commonest morphologic forms of colorectal tumours. Four patients [(out of 25) (15.40%)] had typical annular carcinoma; two patients [(out of 25) (7.70%)] had small (2-4 cm) polypoidal growths; and one patient [(out of 25) (3.85%)] had a flat marginal lesion. One patient had double lesions, so two polyps (7.70%) were also detected. The minimum size of the lesion noted was 1.8 cm, and the maximum was 16.2 cm. Histopathologic reports revealed 2 adenomatous polyps; 2 metastatic cancers; squamous cell carcinoma and 20 cases of primary colorectal adenocarcinomas; 2 (10%) were well-differentiated; 9 (45%) moderately differentiated; and 9 (45%) poorly differentiated. Three patients had Dukes stage A lesions; 10 had Dukes stage B lesions; 8 had Dukes stage C lesions; and 4 had Dukes stage D lesions. Long strictures and annular carcinomas were more likely to extend to the stroma and spread to the lymph nodes. The results showed that double contrast barium enema examination is an easy and valuable initial diagnostic procedure for the detection of suspected colorectal tumours and is also significantly helpful in predicting their morphologic and histopathologic characteristics.

Research paper thumbnail of Radiological Evaluation and Prevention of Tarsal Disintegration in Leprosy

Pakistan Journal of Medical Research (PJMR), Jun 1999

Tarsal disintegration [TD] is a known entity occurring exclusively in the neuropathic foot of lep... more Tarsal disintegration [TD] is a known entity occurring exclusively in the neuropathic foot of leprosy. It is a complex and less understood phenomenon influenced by many factors, among them the disease itself, and altered gait due to sensory and muscular paralysis resulting in repeated trauma. In this study, conducted in the Department of Radiology, C.M.H., Rawalpindi, in collaboration with Rawalpindi Leprosy Hospital, these factors were studied in detail radiologically. It was found that sensory loss and muscular paralysis due to disease result in changes in weight bearing and weight transmission in the feet during standing and propulsion, which constitute one of the major factors in the occurrence and progression of T.D. Early detection of bony changes that can lead to T.D. is very crucial. By performing periodic check x-rays of the feet for soft tissue and bones with and without weight bearing, the radiologist can help the treating doctor take preventive and curative measures. Fissuring in the fibro-fatty layers of the sole causes infection of soft tissue and may result in osteomyelitis of already compromised bones, which can result in the occurrence and progression of TD, if preventive and curative measures are not adopted and followed on a war footing along with health education.

Research paper thumbnail of Afghan Mutation of CA-II Gene: Osteopetrosis and Carbonic Anhydrase II Deficiency with Craniofacial Disproportion in an Afghan Child

The Professional Medical Journal (TPMJ), Jun 2016

Carbonic anhydrase (CA)-II deficiency is a rare autosomal recessive disorder grounded on the tria... more Carbonic anhydrase (CA)-II deficiency is a rare autosomal recessive disorder grounded on the triad of cerebral calcification, osteopetrosis and renal tubular acidosis in which proximal tubules, distal collecting ducts or combined.1 Other features include growth and mental retardation along with the complications of osteopetrosis.2 The only treatment to cure the calcification is allogeneic bone marrow stem cell replacement; however, it does not have any considerable effect on the renal lesions.3 We report a case of a 3-week old boy of Afghan origin with all these features who was clinically diagnosed as having carbonic anhydrase (CA)-II deficiency. Unfortunately, the baby passed away during cranioplasty and genetic testing for enzyme deficiency could not be done. Our aim to present this case is to enhance awareness about this rare syndrome in our medical community and inviting further research for a possible Afghan mutation of CA-II gene.

Research paper thumbnail of Diagnosing Pediatric Intussusception: Reliability of Sonographic Findings in Comparison to Operative Findings - A Short Term Analysis in Two Tertiary Care Hospitals

Diagnosing pediatric intussusception: Reliability of Sonographic Findings in Comparison to Operative Findings - A Short Term Analysis in Two Tertiary Care Hospitals, Jun 2017

Objective: To review the reliability of ultrasonography for the screening and diagnosis of intuss... more Objective: To review the reliability of ultrasonography for the screening and diagnosis of intussusception in clinically suspected children examined in radiology departments of two tertiary care hospitals in comparison to operative findings.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted collaboratively in the Departments of Radiology, Pakistan Railways General Hospital, Rawalpindi and Bhawal Victoria Hospital, Bahawalpur from January 2013 to December 2014.
Materials and Methods: A total of 113 children with ages ranging from 0 to 5 years of both genders having clinical features of suspected intussusception were included in the study. Patients with stomas, history of previous surgery, patients with known congenital intestinal anomalies and haemodynamically unstable patients were excluded. These patients had undergone ultrasound of abdomen and pelvis. The sonographic findings were recorded as positive and negative for intussusception. The criteria for positivity included the “target or doughnut sign” on transverse view and the “pseudo kidney sign” in longitudinal view, respectively. Subsequently, all these patients underwent exploratory laparotomy and intra-operative findings were recorded and correlated with sonographic findings to determine diagnostic reliability of ultrasonography.
Results: Ultrasonography supported the diagnosis of intussusception in 76 (67.26%) patients. Operative findings confirmed intussusception in 79 (69.91%) cases whereas 34 (30.01%) patients revealed no intussusception. There was one false positive and four false-negative results on ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of grey scale ultrasonography in intussusception in children were 94.94%, 97.06%, 98.68%, 89.19% and 95.57% respectively.
Conclusion: The sensitivity and specificity of sonographic findings for screening and diagnosing the intussusception as reported by the Radiology Departments of the two hospitals and confirmed with operative findings, were consistent with previous studies published locally and internationally.

Research paper thumbnail of CT scan verdicts: Hemorrhagic vs ischemic strokes

CT scan verdicts: Hemorrhagic vs ischemic strokes, Mar 2020

Aim: To find a relatively higher percentage of hemorrhagic strokes in our set up than ischemic st... more Aim: To find a relatively higher percentage of hemorrhagic strokes in our set up than ischemic stroke.
Methodology: This study was a retrospective review of one year data from January to December 2018 conducted
in all hospitalized patients of POF hospital Wah Cantt with computed tomography (CT) diagnosis of either hemorrhagic or ischemic stroke.
Results: Out of two hundred and twenty-nine patients included in the study,105(36 %) had intracranial bleed and 187(64%) had ischemic stroke.
Conclusion: Interestingly, the study outcome reveals a relatively higher prevalence of hemorrhagic stroke than the previously conducted epidemiologic studies. We believe that this was mainly attributed to widespread use of CT scanning facility. A higher percentage of patients unaware of hypertension or uncontrolled hypertension because of poor compliance might be a reason for increased intracranial bleeding. On the other hand,
a widespread use of anticoagulants and antiplatelet drugs are contributing to increased hemorrhagic strokes.

Research paper thumbnail of Effects of Electromyographic Biofeedback on the Performance of Vastus Medialis Oblique Muscle in Knee Osteoarthritis: A Randomized Controlled Trial

The Rehabilitation Journal

Background: Knee osteoarthritis is a common musculoskeletal disorder, enhancing performance of Va... more Background: Knee osteoarthritis is a common musculoskeletal disorder, enhancing performance of Vastus Medialis Oblique (VMO) can reduce the symptoms. Objective: The study objective was to determine the effects of Electromyographic Biofeedback (EMG BF) on the performance of VMO in patients with knee osteoarthritis (OA). Methods: A Randomized Controlled Trial (RCT) was conducted at Pakistan Railway General Hospital, Rawalpindi from July to December 2019. In this study, n=30 patients with a diagnosis of knee OA were recruited with the age ranging from 50 to 65 years. The participants were randomly allocated to two groups. Group A has received isometric exercises with Electromyographic Biofeedback (EMG BF) training and Group B has received only isometric exercises for 6 weeks. The Assessments were taken at the baseline and after 6th week of intervention. The outcome measure of vastus medialis oblique (VMO) performance was maximum voluntary isometric contraction (MVIC), measured by an EM...

Research paper thumbnail of Effects of high-intensity multi-modal exercise training (HIT-MMEX) on bone mineral density and muscle performance in postmenopausal women. A Pilot randomized controlled trial

Journal of the Pakistan Medical Association

Objectives: To determine the effects of high-intensity multimodal exercise training on bone miner... more Objectives: To determine the effects of high-intensity multimodal exercise training on bone mineral density and muscle performance in postmenopausal women. Method: The two-armed, parallel, pilot randomised controlled trial was conducted from November 2020 to July 2021 at Riphah Rehabilitation Centre, Rawalpindi, Pakistan, and comprised women aged 45-70 having been in the post-menopause phase for at least 3 years, with body mass index <30, community ambulant and willing to have exercise therapy. The subjects were randomised into two equal groups. The experimental group A received supervised high-intensity resistance, weight-bearing, balance and mobility training twice weekly for 8 months. The control group B received low-to–moderate intensity exercises. Femoral neck and lumbar spine bone mineral density (g/cm2) were taken through a dual-energy X-ray absorptiometry scan. Muscle performance was measured using 1 repetition maximum for leg and trunk extensors, and 30 sec sit to stand ...

Research paper thumbnail of Normal values of liver and spleen sizes by ultrasonography in Pakistani children: a regional study

Rawal Medical Journal, 2021

Ultrasonography is commonly used to assess sizes of intra-abdominal organs. The liver is measured... more Ultrasonography is commonly used to assess sizes of intra-abdominal organs. The liver is measured in the mid clavicular line during quiet breathing in young children and during breath holding in older children. The upper and lower points of the 1 sonographic image are taken as the measurement. Splenic size is measured by obtaining a coronal view that included the hilum, in quietly breathing. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) is measured and correlated with age, height, and weight. Liver can also be palpated and percussed clinically in neonates and children but method is neither reliable not accurate with inter observer 7,8 differences. Ultrasound is a safe, accurate, reproducible, non-invasive and quick tool used for 9 measuring sizes of spleen and liver. The children are 10-13 grouped under age, gender, height and weight. The objective of this study was to determine the normal range of dimensions for the liver and spleen in healthy neonates, infants, and children. METHODOLOGY This study was conducted with 354 children with no acute or chronic hepatic or renal ailment, age range varying from one month old to twelve years from January to December 2019. The children visited OPD for immunization, came with family or were brought for ultrasound for other causes of illness. Children having viral hepatitis, typhoid, congestive cardiac failure, malaria, anemia or protein energy malnutrition were excluded. Informed consent was obtained from parents/ accompanying adults. Ethical approval of the study was obtained from the Ethics Review Committee of the Hospital. Detailed history was taken to ensure to rule out any m e t a b o l i c , c o l l a g e n v a s c u l a r, i n f e c t i v e / inflammatory, post-traumatic, neoplastic or blood related diseases. Age nearest to the completed month was entered. Measuring tools included an electronic weighing scale and a stadiometer mounted on wall. In each child, the pediatrician i d e n t i f i e d t h e s t e r n o c l a v i c u l a r a n d t h e acromioclavicular joints by palpation mid

Research paper thumbnail of Afghan Mutation of Ca-II Gene; Osteopetrosis and Carbonic Anhydrase II Deficiency with Craniofacial Disproportion in an Afghan Child

The professional medical journal, 2016

Carbonic anhydrase-II deficiency is an autosomal recessive disorder grounded on a triad of cerebr... more Carbonic anhydrase-II deficiency is an autosomal recessive disorder grounded on a triad of cerebral calcification, osteopetrosis and renal tubular acidosis away in which proximal tubules, distal collecting ducts or combined.1 Other features include growth and mental retardation along with the complications of osteopetrosis.2 The only treatment to cure the calcification is allogeneic bone marrow stem cell replacement; however it does not have any considerable effect on the renal lesions3 We report a case of a 3 week old male child of Afghan origin with all these features who was clinically diagnosed as having carbonic anhydrase type II deficiency however unfortunately the baby passed during cranioplasty and genetic testing for enzyme deficiency could not be done. Our aim to present this case of a male child of Afghan origin is to enhance the awareness about this rare syndrome in our medical community and inviting further research for a possible Afghan mutation of CA-II gene.

Research paper thumbnail of Noninvasive Ultrasound Assessment of the Normal Optic Nerve Sheath Diameter in Healthy Adults: an Islamabad-based Pakistani Population Study

Journal of Ophthalmology and Research

Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath di... more Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath diameter (ONSD) is becoming popular to monitor intracranial pressure (ICP). Different studies report varied values for normal ONSD. Our primary aim was to find the TOUmeasured normal ONSD in healthy adult Pakistanis living in Islamabad Capital Territory (ICT).

Research paper thumbnail of CT Evaluation of Mediastinal Masses : A Study of 80 Cases

Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were a... more Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were analyzed with regard to the ability of CT to demonstrate the masses, their location, their morphology, and their encroachment upon or displacement of adjacent mediastinal structures. CT images were compared with plain chest radiographs which were available in all cases. CT depicted all lesions successfully with good anatomic detail. Among the 80patients the largest number of cases (n =51) were found to be having lymphadenopathy with Hodgkin's lymphoma in 57% and non-Hodgkin's lymphoma in J5% of cases. CT is regarded as the best single radiological investigation for evaluating a mediastinal abnormality demonstrated on a high-kV chest radiograph or for detecting occult mediastinal disease.

Research paper thumbnail of Role of Ultrasonography in Infertility Management: Ovulation Monitoring and Assisted Conception

Infertility causes great stress to many couples. Most of those presenting with childlessness have... more Infertility causes great stress to many couples. Most of those presenting with childlessness have reduced fertility, rather than absolute sterility, and many are likely to conceive spontaneously. In this "ultrasonographic monitoring of growing follicles, in ovaries to determine the day of ovulation and its coordination with time of intercourse" has a well established role in the management of "unexplained infertility". This study was conducted to find out its efficacy in our setup. 86 female"s patients of unexplained infertility, with different post-marital time period, underwent ultrasonographic ovulation monitoring each with follow up for minimum of four menstrual cycles. Average follicular growth rate was 2 mm a day, which increased to 3 mm a day, two days prior to ovulation. Follicular diameter at the time of ovulation ranged from 22 mm to 27 mm with a mean of 24 mm. We observed ovulation in 79.2% of our patients. In 8.1% patient"s dominant follicle ceased to grow beyond 18 mm size and gradually become atretic. Leutinized unruptured follicle was documented in 12.7% of our patients in whom follicular size reached to periovulatory range but did not rupture. Uterine endometrial thickness at the time of ovulation varied from 7 mm to 13 mm and multilayered appearance (triple line sign) was observed in 57.3% of patients. Overall conception rate was 16.3% whereas it was much more encouraging to see in 23.5% of patients who were in less than 5 years of their marriage. Keeping in view of easy to workup as out patient basis in large numbers of patient, less time consuming, promising results, cost effectiveness and non invasive nature of technique; ultrasonographic monitoring of ovulation is recommended as a part of management in all patients of unexplained infertility.

Research paper thumbnail of Afghan Mutation of Ca-II Gene

The Professional Medical Journal

Carbonic anhydrase-II deficiency is an autosomal recessive disorder groundedon a triad of cerebra... more Carbonic anhydrase-II deficiency is an autosomal recessive disorder groundedon a triad of cerebral calcification, osteopetrosis and renal tubular acidosis away in whichproximal tubules, distal collecting ducts or combined.1 Other features include growth andmental retardation along with the complications of osteopetrosis.2 The only treatment to curethe calcification is allogeneic bone marrow stem cell replacement; however it does not have anyconsiderable effect on the renal lesions3 We report a case of a 3 week old male child of Afghanorigin with all these features who was clinically diagnosed as having carbonic anhydrase type IIdeficiency however unfortunately the baby passed during cranioplasty and genetic testing forenzyme deficiency could not be done. Our aim to present this case of a male child of Afghanorigin is to enhance the awareness about this rare syndrome in our medical community andinviting further research for a possible Afghan mutation of CA-II gene.

Research paper thumbnail of Frequency of Primary Headache Syndromes in Patients with a Major Depressive Disorder

Cureus Journal of Medical Science, Jun 5, 2018

Purpose: The primary objective of this study was to assess the overall frequency of primary heada... more Purpose: The primary objective of this study was to assess the overall frequency of primary headaches in subjects with a moderate to severe major depressive disorder. A further objective was to determine the frequency of primary headache sub-types in this population.
Materials and methods: This descriptive, cross-sectional study was conducted at the outpatients’ clinic of the department of psychiatry, Pakistan Railways Teaching Hospital, an affiliate of Islamic International Medical College, Rawalpindi. The duration of the study was from December 2016 to May 2017. One hundred and ten consecutive patients with a major depressive disorder (MDD) were assessed for a primary headache, according to the diagnostic criteria of International Classification of Headache Disorders second edition (ICHD-2). MDD patients with moderate to severe depression, according to the diagnostic and statistical manual of mental disorders (DSM-5) were enrolled in the study. A semi-structured proforma was designed to gather information on sociodemographic variables. The data was analyzed by utilizing the Statistical Package for Social Sciences, version 22 (IBM Corp., Armonk, NY, US).
Results: Of the 110 MDD patients enrolled, a primary headache was present in 45 (40.90%) cases. Additionally, five of these patients had a migraine with aura (11.11%), 12 had a migraine without aura (26.66%), and 28 had a tension-type headache (62.22%). In the females, migraines with or without aura was frequent (35.29%), while a tension-type headache was more common in males (72.72%).
Conclusion: More than one-third of the sample had a primary headache syndrome, which shows a high comorbidity between a migraine and its variants and MDD. There is a need to undertake further studies with larger samples to elucidate this relationship.

Research paper thumbnail of Association of Portal Vein Doppler Parameters with Chronic Liver Disease Child Pugh Classes: A Single Center Experience at Rawalpindi, Pakistan

Journal of Islamic International Medical College (JIIMC), Mar 7, 2019

Objective: To determine the association between Doppler Parameters of average peak portal vein ve... more Objective: To determine the association between Doppler Parameters of average peak portal vein velocity and flow direction and Child Pugh classes of patients suffering from the chronic liver disease.
Study Design: It was a descriptive study.
Place and Duration of Study: The study was conducted from December 2013 to January 2015 at the Radiology Department of Holy Family Hospital, Rawalpindi, Pakistan.
Materials and Methods: Selected chronic liver disease (CLD) patients were examined with gray scale and Doppler USG for assessment of portal vein (PV). Average peak portal venous velocity (PVV) and direction of flow in the main portal vein were recorded. Doppler findings were correlated with clinical features and laboratory findings in three classes (A, B & C) of patients using Child Pugh criteria to establish any probable association between them (appendix: I).
Results: Out of total 115 CLD patients studied, 47.8% were in Child Pugh class C. The main portal vein average PVV (cm/sec) in 24.34% patients with Child Pugh class A was 18.75 + 1.88, in 27.82% patients with Child Pugh class B was 14.25 + 0.98 and in 47.82% patients with Child Pugh class C was 8.15 + 1.84. This showed a significant fall in portal vein average PVV with advancing Child Pugh class of cirrhosis. Only 10.4% patients showed continuous hepatofugal flow and 4.3% showed bidirectional flow. It was recorded only in Child Pugh class C patients.
Conclusion: Doppler findings of average peak velocity in the main portal vein fall progressively with worsening of the Child Pugh class. In addition, the direction of flow is also reversed in cases of the Child Pugh class C cirrhosis.

Research paper thumbnail of Frequency of Primary Headache Syndromes in Patients with a Major Depressive Disorder

Cureus Journal of Medical Science, Jun 5, 2018

Purpose: The primary objective of this study was to assess the overall frequency of primary heada... more Purpose: The primary objective of this study was to assess the overall frequency of primary headaches in subjects with a moderate to severe major depressive disorder. A further objective was to determine the frequency of primary headache sub-types in this population.
Materials and methods: This descriptive, cross-sectional study was conducted at the outpatients’ clinic of the department of psychiatry, Pakistan Railways Teaching Hospital, an affiliate of Islamic International Medical College, Rawalpindi. The duration of the study was from December 2016 to May 2017. One hundred and ten consecutive patients with a major depressive disorder (MDD) were assessed for a primary headache, according to the diagnostic criteria of International Classification of Headache Disorders second edition (ICHD-2). MDD patients with moderate to severe depression, according to the diagnostic and statistical manual of mental disorders (DSM-5) were enrolled in the study. A semi-structured proforma was designed to gather information on sociodemographic variables. The data was analyzed by utilizing the Statistical Package for Social Sciences, version 22 (IBM Corp., Armonk, NY, US).
Results: Of the 110 MDD patients enrolled, a primary headache was present in 45 (40.90%) cases. Additionally, five of these patients had a migraine with aura (11.11%), 12 had a migraine without aura (26.66%), and 28 had a tension-type headache (62.22%). In the females, migraines with or without aura was frequent (35.29%), while a tension-type headache was more common in males (72.72%).
Conclusion: More than one-third of the sample had a primary headache syndrome, which shows a high comorbidity between a migraine and its variants and MDD. There is a need to undertake further studies with larger samples to elucidate this relationship.

Research paper thumbnail of Noninvasive Ultrasound Assessment of the Normal Optic Nerve Sheath Diameter in Healthy Adults: an Islamabad-based Pakistani Population Study

Journal of Ophthalmology and Research, Nov 24, 2020

Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath di... more Aim: The noninvasive B-mode transocular ultrasound (TOU) measurement of the optic nerve sheath diameter (ONSD) is becoming popular to monitor intracranial pressure (ICP). Different studies report varied values for normal ONSD. Our primary aim was to find the TOU-measured normal ONSD in healthy adult Pakistanis living in Islamabad Capital Territory (ICT). Methodology: One hundred healthy adult volunteers participated in this cross-sectional study, conducted at the Pakistan Atomic Energy Commission (P.A.E.C.) General Hospital, Islamabad. Each eye was scanned for the optic nerve (ON) via TOU using a B-mode 7-15 MHz linear probe. The investigators measured ONSD in a transverse plane three millimeters behind the retina. They recorded an average of three readings as a mean ONSD value for both eyes. Results: The overall normal mean ONSD was 4.80±0.26 mm with a minimum of 4.25 mm and a maximum of 5.20 mm. The mean ONSD for the age group of 20-35 years was 4.79±0.27 mm and for 36-50 years, it was 4.81±0.24 mm (p = 0.7952), for the male eye it was 4.83±0.26 mm and for the female eye was 4.75±0.25 mm (p = 0.1238), and for the right eye was 4.79±0.27 mm and for the left eye was 4.80±0.26 mm with (p = 0.2434) and (r = 0.9455). There was no statistically significant difference in the mean ONSD of the four ethnic groups (p = 0.7141). Conclusion: The normal mean optic nerve sheath diameter in the studied healthy adult Pakistanis, as measured through noninvasive B-mode transorbital ultrasound is 4.80±0.26 mm.

Research paper thumbnail of Effects of Electromyographic Biofeedback on the Performance of Vastus Medialis Oblique Muscle in Knee Osteoarthritis: A Randomized Controlled Trial.

The Rehabilitation Journal (2521-344X, 2521-3458), Jun 30, 2022

Background: Knee osteoarthritis is a common musculoskeletal disorder. Enhancing the performance o... more Background: Knee osteoarthritis is a common musculoskeletal disorder. Enhancing the performance of Vastus Medialis Oblique (VMO) can reduce the symptoms. Objective: The study objective was to determine the effects of Electromyographic Biofeedback (EMG BF) on the performance of VMO in patients with knee osteoarthritis (OA). Methods: A Randomized Controlled Trial (RCT) was conducted at Pakistan Railways General Hospital, Rawalpindi from July to December 2019. In this study, n = 30 patients with a diagnosis of knee OA were recruited, with an age range of 0 to 65 years. The participants were randomly allocated to two groups. Group A received isometric exercises with Electromyographic Biofeedback (EMG BF) training, and Group B received only isometric exercises for 6 weeks. The assessments were taken at the baseline and after the 6th week of intervention. The outcome measure of vastus medialis oblique (VMO) performance was maximum voluntary isometric contraction (MVIC), measured by an EMG BF device, and one-repetition maximum (1RM). The VMO muscle thickness was measured by musculoskeletal ultrasound. SPSS version 21 was used for data analysis. Results: The mean age of group A was 58.94±3.1 years, and that of group B was 59.44±2.9 years. There was a significant improvement (p<0.001) in VMO thickness and 1RM in the experimental group. But for MVIC, the between-group difference was not significant (p>0.05). Within-group analysis for all variables was statistically significant (p 0<.001) in both groups. Conclusion: VMO training with an EMG BF device is more effective in enhancing VMO thickness and strength in terms of 1RM in patients with knee osteoarthritis.

Keywords: Osteoarthritis, Electromyography Biofeedback, One repetition maximum

Research paper thumbnail of Effects of high-intensity multi-modal exercise training (HIT-MMEX) on bone mineral density and muscle performance in postmenopausal women. A pilot randomized controlled trial

The Journal of the Pakistan Medical Association (0030-9982), 2022

Objectives: To determine the effects of high-intensity multimodal exercise training on bone miner... more Objectives: To determine the effects of high-intensity multimodal exercise training on bone mineral density and muscle performance in postmenopausal women. Method: The two-armed, parallel, pilot randomized controlled trial was conducted from November 2020 to July 2021 at Riphah Rehabilitation Center, Rawalpindi, Pakistan, which comprised women aged 45–70 who had been in the post-menopause phase for at least 3 years, with a body mass index of 30, who were community ambulant and willing for exercise therapy. The subjects were randomized into two equal groups. Experimental group A received supervised high-intensity resistance, weight-bearing, balance, and mobility training twice-weekly for 8 months. Control group B received low-to–moderate-intensity exercises. Femoral neck and lumbar spine bone mineral density (g/cm2) was taken through a dual-energy X-ray absorptiometry scan. Muscle performance was measured using a 1 repetition maximum for leg and trunk extensors, and a 30-second sit-to-stand test. Data were analyzed using SPSS 21. Results: Out of the 101 women screened, 28 (27.7%) were enrolled; 14 (50%) in group A had a mean age of 53.366.28 years; and 14 (50%) in group B had a mean age of 51.714.82 years (p> 0.05). Group A showed significantly more improvement than group B, with respect to both lumbar spine bone mineral density and muscle performance (p<0.05). Conclusion: A supervised high-intensity multimodal exercise training protocol had a positive effect on the lumbar spine, bone mineral density, and muscle performance in postmenopausal women.

Research paper thumbnail of CT Evaluation of Mediastinal Masses: A Study of 80 Cases.

Journal of Abbottabad Medical College (JAMC), Feb 1996

Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were ... more Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were analyzed regarding the ability of CT to demonstrate the masses, their location, their morphology, and their encroachment upon or displacement of adjacent mediastinal structures. CT images were compared with plain chest radiographs which were available in all cases. CT depicted all lesions successfully with good anatomic detail. Among the 80 patients the largest number of cases (n =51) were found to be having lymphadenopathy with Hodgkin's lymphoma in 57% and non-Hodgkin's lymphoma in 33% of cases. CT is regarded as the best single radiological investigation for evaluating a mediastinal abnormality demonstrated on a high-kV chest radiograph or for detecting occult mediastinal disease.

Research paper thumbnail of The role of barium enema in the evaluation of morphologic and histopathologic characteristics of colorectal tumours

Journal of the College of Physicians and Surgeons Pakistan (JCPSP), Apr 1997

During a 9-month period (Sept 1991–Jun 1992), the clinical, radiographic, endoscopic, surgical, a... more During a 9-month period (Sept 1991–Jun 1992), the clinical, radiographic, endoscopic, surgical, and histopathologic findings of 25 patients with colorectal tumours were reviewed retrospectively. To assess the current status of barium enema examination as the initial diagnostic procedure for the detection of suspected colorectal tumours and to determine the relationship between their morphologic and histopathologic characteristics. Six patients (24%) had lesions proximal to the splenic flexure and 19 (76%) patients had more distal lesions predominantly (68%) in the rectosigmoid region. Large (> 4 cm) intraluminal fungating cancers [34.50% (9 of 25 patients)] and long (> 4 cm) rigid neoplastic strictures [30.75% (8 of 29 patients)] were among the commonest morphologic forms of colorectal tumours. Four patients [(out of 25) (15.40%)] had typical annular carcinoma; two patients [(out of 25) (7.70%)] had small (2-4 cm) polypoidal growths; and one patient [(out of 25) (3.85%)] had a flat marginal lesion. One patient had double lesions, so two polyps (7.70%) were also detected. The minimum size of the lesion noted was 1.8 cm, and the maximum was 16.2 cm. Histopathologic reports revealed 2 adenomatous polyps; 2 metastatic cancers; squamous cell carcinoma and 20 cases of primary colorectal adenocarcinomas; 2 (10%) were well-differentiated; 9 (45%) moderately differentiated; and 9 (45%) poorly differentiated. Three patients had Dukes stage A lesions; 10 had Dukes stage B lesions; 8 had Dukes stage C lesions; and 4 had Dukes stage D lesions. Long strictures and annular carcinomas were more likely to extend to the stroma and spread to the lymph nodes. The results showed that double contrast barium enema examination is an easy and valuable initial diagnostic procedure for the detection of suspected colorectal tumours and is also significantly helpful in predicting their morphologic and histopathologic characteristics.

Research paper thumbnail of Radiological Evaluation and Prevention of Tarsal Disintegration in Leprosy

Pakistan Journal of Medical Research (PJMR), Jun 1999

Tarsal disintegration [TD] is a known entity occurring exclusively in the neuropathic foot of lep... more Tarsal disintegration [TD] is a known entity occurring exclusively in the neuropathic foot of leprosy. It is a complex and less understood phenomenon influenced by many factors, among them the disease itself, and altered gait due to sensory and muscular paralysis resulting in repeated trauma. In this study, conducted in the Department of Radiology, C.M.H., Rawalpindi, in collaboration with Rawalpindi Leprosy Hospital, these factors were studied in detail radiologically. It was found that sensory loss and muscular paralysis due to disease result in changes in weight bearing and weight transmission in the feet during standing and propulsion, which constitute one of the major factors in the occurrence and progression of T.D. Early detection of bony changes that can lead to T.D. is very crucial. By performing periodic check x-rays of the feet for soft tissue and bones with and without weight bearing, the radiologist can help the treating doctor take preventive and curative measures. Fissuring in the fibro-fatty layers of the sole causes infection of soft tissue and may result in osteomyelitis of already compromised bones, which can result in the occurrence and progression of TD, if preventive and curative measures are not adopted and followed on a war footing along with health education.

Research paper thumbnail of Afghan Mutation of CA-II Gene: Osteopetrosis and Carbonic Anhydrase II Deficiency with Craniofacial Disproportion in an Afghan Child

The Professional Medical Journal (TPMJ), Jun 2016

Carbonic anhydrase (CA)-II deficiency is a rare autosomal recessive disorder grounded on the tria... more Carbonic anhydrase (CA)-II deficiency is a rare autosomal recessive disorder grounded on the triad of cerebral calcification, osteopetrosis and renal tubular acidosis in which proximal tubules, distal collecting ducts or combined.1 Other features include growth and mental retardation along with the complications of osteopetrosis.2 The only treatment to cure the calcification is allogeneic bone marrow stem cell replacement; however, it does not have any considerable effect on the renal lesions.3 We report a case of a 3-week old boy of Afghan origin with all these features who was clinically diagnosed as having carbonic anhydrase (CA)-II deficiency. Unfortunately, the baby passed away during cranioplasty and genetic testing for enzyme deficiency could not be done. Our aim to present this case is to enhance awareness about this rare syndrome in our medical community and inviting further research for a possible Afghan mutation of CA-II gene.

Research paper thumbnail of Diagnosing Pediatric Intussusception: Reliability of Sonographic Findings in Comparison to Operative Findings - A Short Term Analysis in Two Tertiary Care Hospitals

Diagnosing pediatric intussusception: Reliability of Sonographic Findings in Comparison to Operative Findings - A Short Term Analysis in Two Tertiary Care Hospitals, Jun 2017

Objective: To review the reliability of ultrasonography for the screening and diagnosis of intuss... more Objective: To review the reliability of ultrasonography for the screening and diagnosis of intussusception in clinically suspected children examined in radiology departments of two tertiary care hospitals in comparison to operative findings.
Study Design: Cross-sectional study.
Place and Duration of Study: The study was conducted collaboratively in the Departments of Radiology, Pakistan Railways General Hospital, Rawalpindi and Bhawal Victoria Hospital, Bahawalpur from January 2013 to December 2014.
Materials and Methods: A total of 113 children with ages ranging from 0 to 5 years of both genders having clinical features of suspected intussusception were included in the study. Patients with stomas, history of previous surgery, patients with known congenital intestinal anomalies and haemodynamically unstable patients were excluded. These patients had undergone ultrasound of abdomen and pelvis. The sonographic findings were recorded as positive and negative for intussusception. The criteria for positivity included the “target or doughnut sign” on transverse view and the “pseudo kidney sign” in longitudinal view, respectively. Subsequently, all these patients underwent exploratory laparotomy and intra-operative findings were recorded and correlated with sonographic findings to determine diagnostic reliability of ultrasonography.
Results: Ultrasonography supported the diagnosis of intussusception in 76 (67.26%) patients. Operative findings confirmed intussusception in 79 (69.91%) cases whereas 34 (30.01%) patients revealed no intussusception. There was one false positive and four false-negative results on ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of grey scale ultrasonography in intussusception in children were 94.94%, 97.06%, 98.68%, 89.19% and 95.57% respectively.
Conclusion: The sensitivity and specificity of sonographic findings for screening and diagnosing the intussusception as reported by the Radiology Departments of the two hospitals and confirmed with operative findings, were consistent with previous studies published locally and internationally.

Research paper thumbnail of CT scan verdicts: Hemorrhagic vs ischemic strokes

CT scan verdicts: Hemorrhagic vs ischemic strokes, Mar 2020

Aim: To find a relatively higher percentage of hemorrhagic strokes in our set up than ischemic st... more Aim: To find a relatively higher percentage of hemorrhagic strokes in our set up than ischemic stroke.
Methodology: This study was a retrospective review of one year data from January to December 2018 conducted
in all hospitalized patients of POF hospital Wah Cantt with computed tomography (CT) diagnosis of either hemorrhagic or ischemic stroke.
Results: Out of two hundred and twenty-nine patients included in the study,105(36 %) had intracranial bleed and 187(64%) had ischemic stroke.
Conclusion: Interestingly, the study outcome reveals a relatively higher prevalence of hemorrhagic stroke than the previously conducted epidemiologic studies. We believe that this was mainly attributed to widespread use of CT scanning facility. A higher percentage of patients unaware of hypertension or uncontrolled hypertension because of poor compliance might be a reason for increased intracranial bleeding. On the other hand,
a widespread use of anticoagulants and antiplatelet drugs are contributing to increased hemorrhagic strokes.

Research paper thumbnail of Normal Values of Liver and Spleen Sizes by Ultrasonography in Pakistani Children: A Regional Study

Rawal Medical Journal (RMJ), Aug 2021

Objective: To establish normal reference data for the sonographic measurement of liver and spleen... more Objective: To establish normal reference data for the sonographic measurement of liver and spleen size in healthy Pakistani children.
Methodology: This cross-sectional, hospital-based study was conducted at the Radiology Department HIT Hospital, Taxila Cantt. It comprised 354 healthy children between the ages of 1 month and 12 years. Sonographic assessments of liver and spleen size were made further correlating with age, gender, height/length, and weight of the participants. Data were analysed using SPSS 23.
Results: The normal liver and spleen length organometric normative data is shown to correlate with the weight and height/length of the child.
Conclusion: The study provides normal values of liver and spleen size by Ultrasonography in healthy Pakistani children.