Zafar Sajjad

Ultrasound Biosafety During Pregnancy: What Do Operators Know in the Developing World? National Survey Findings From Pakistan

The purpose of this study was to evaluate the knowledge and attitudes of ultrasound users toward safety aspects during routine obstetric examinations.

Frequency and Outcome of Carotid Atheromatous Disease in Patients With Stroke in Pakistan

Background and Purpose— Limited data exist on the frequency and outcome of carotid artery disease in Pakistan. Such information would help guide the usefulness of screening for the condition in this low-middle income health care setting. Methods— A prospective, descriptive study was conducted among 3 large teaching hospitals in Karachi, Pakistan. Patients referred for carotid Doppler ultrasound examination were included if they had experienced a stroke or TIA within the previous month. The severity and morphology of carotid disease were characterized by trained technicians using standardized criteria. Demographic and risk factor data were collected at baseline, and the outcome of patients was assessed at least 6 months later. Results— A total of 672 patients underwent bilateral carotid Doppler ultrasound (1344 carotid examinations). The findings revealed 0% to 50% stenosis in 526 (78%), 51% to 69% stenosis in 57 (8%), 70% to 99% stenosis in 82 (12%), and total occlusion in 7 patients (1%). Potentially surgically correctable disease, defined as 70% to 99% carotid artery stenosis, was present in only 79 (12%) patients, of whom 47 (60%) were ipsilateral symptomatic, 15 (20%) asymptomatic, and 17 (20%) had status unknown. Outcome information at ≥6 months follow-up was available for 36 of the 47 (76%) surgically correctable and only 4 of these patients (12%) had undergone surgical or radiological intervention (carotid endarterectomy in 3 patients and carotid stenting in 1 patient). Conclusion— The frequency of carotid artery disease of at least moderate severity is very low in patients with recent stroke or TIA and there is low utilization of high-cost, carotid intervention procedures in Pakistan. These data raise questions regarding the applicability and cost-effectiveness of routine carotid ultrasound screening in our country and similar population in Asia. The local socio-economic and clinical data do not support routine carotid Doppler ultrasound in every patient with stroke and TIA in Pakistan. Studies are warranted to determine predictors of significant carotid artery stenosis in stroke/TIA patients of our country to develop reliable stroke guidelines appropriate for local population.

Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis

BackgroundIntracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region.MethodsThe study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin–Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios.ResultsOf the 200 participants, ICAD was found in 34.5% (nu2009=u200969) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45xa0years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association.ConclusionICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD.Study Registration NumberNCT02072876 2/25/2014

The Role of Radiological Imaging

X-ray-based imaging modalities of plain films and computerized tomography (CT) are the common modalities used to detect urinary tract calculi. Plain films on their own have a low sensitivity and specificity for the detection of renal stones. Intravenous urograms (IVUs), which are obtained by intravenously injecting iodine-containing organic compounds prior to taking X-ray images, were the mainstay of radiological detection. Several problems were associated with the use of these iodinated compounds. The advent of helical CT has obviated their need in the majority of patients. CT scanning detects renal calculi with a high degree of accuracy. Exposure to ionizing radiation is a concern that needs to be addressed and dose-reduction measures should be employed whenever feasible.

Case Scenarios and Interesting Images in Urolithiasis

Figure 114.1 is a Doppler ultrasound (US) study of the neck, demonstrating a vascular well-circumscribed mass in a patient with recurrent, bilateral urolithiasis and a raised serum calcium level (>2.96 mmol/l). What does it represent?