Background: The purpose of the research is to know the sonographic evaluation of urolithiasis formation with positive family history in population of Lahore because urolithiasis is a major problem in Pakistan. According to a survey in 1985–1987 the incidence rate reaches to 8.3/100,000 individuals in the Punjab. In Pakistan, urolithiasis is the sixth major cause of surgery. The study was conducted to rule out the role of positive family history in people suffering from urolithiasis. Materials and Methods: This was an observational cross-sectional study conducted at the Radiology department of the University of Lahore teaching hospital and Gilani Ultrasound center-Afro-Asian Institute, Lahore, Pakistan. A total of 125 patients were included in the study which were diagnosed with urolithiasis and individuals with any other abnormality were excluded from the study. The duration of the study was from January 2017 to April 2017. Data were tabulated and analyzed using SPSS version 24. The data were reported using descriptive and inferential statistics. The quantitative variable like age was assessed using mean standard deviation and standard errors. The qualitative variables like gender were reported using percentages and frequencies. Results: Urolithiasis is commonly seen in the males (77 individuals out of 125) as compared to females (48 individuals out of 125) and mid pole of right kidney is the most common site of the renal stones deposition (13.6%), and the relationship of father is mostly seen as familial history (39.2%). Conclusion: It is concluded that positive family history is the major predisposing factor in urolithiasis and one of the cause in the development of stones in the urinary tract or in other words people who have a history of urolithiasis in blood relations have more tendency of stone formation in any part of their lives. Its positive aspect is that we can do a screening in blood relations, especially whose parents or family members diagnosed with stones and can do preventive measures for that. Moreover, its negative aspect is that there are several causes of the stone formation in the urinary tract.
The contributions of arterial cross-sectional area and time-averaged flow velocity to arterial blood flow
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Ethan C Hill, Terry J Housh, Cory M Smith, Joshua L Keller, Richard J Schmidt, Glen O Johnson DOI:10.4103/JMU.JMU_20_18
Background: Ultrasound has been used for noninvasive assessments of endothelial function in both clinical and athletic settings and to identify changes in muscle blood flow in response to exercise, nutritional supplementation, and occlusion. The purposes of the present study were to examine the reliability and relative contributions of arterial cross-sectional area and time-averaged flow velocity to predict muscle blood flow as a result of fatiguing exercise in men and women. Methods: Eighteen healthy men and 18 healthy women performed 50 consecutive eccentric repetitions of the elbow flexors at 60% of their pretest eccentric peak torque at a velocity of 180° s−1. Test-retest reliability and stepwise linear regression analyses were performed to determine the ability of arterial cross-sectional area and time-averaged flow velocity to predict brachial artery muscle blood flow for the men, women, and combined sample. Results: There was no systematic test versus retest mean differences (P > 0.05) for any of the ultrasound determined variables. The two-variable regression models significantly improved the ability to predict muscle blood flow and were associated with smaller standard error of the estimates (3.7%–10.1% vs. 16.8%–37.0% of the mean baseline muscle blood flow values) compared to the one-variable models. Conclusions: The findings of the present study supported the use of ultrasound for reliable assessments of arterial diameter, arterial cross-sectional area, time-averaged flow velocity, and muscle blood flow from the brachial artery in men and women. Furthermore, time-averaged flow velocity was a more powerful predictor of muscle blood flow than arterial cross-sectional area.
Objective: A double-blind placebo-controlled randomized study was conducted to assess the effectiveness of therapeutic ultrasound (US) in knee OA. Patients and Methods: Thirty-three patients (mean age 54.7 ± 14.7) were randomized to receive either continuous US (n = 15) or sham US (n = 18) as a placebo. Continuous ultrasonic waves with 1 MHZ frequency and 1 watt/cm2 power were applied for 5 min for 10 sessions. The primary outcome was pain on movement assessed by visual analog scale (VAS). The secondary outcomes were WOMAC scores and measurements of distal femoral cartilage thickness by imaging US. Results: Both groups showed reduced knee pain on movement following intervention. The VAS measurements improved significantly both in the treatment and the placebo group patients (P < 0.05 and P < 0.05). WOMAC scores improved statistically significant in all domains (pain, stiffness, physical function, and total score) in the treatment group (P< 0.05). All domains of WOMAC score showed statistically significant change when compared with the placebo group (P < 0.05). There was no change in the cartilage thickness measurements of medial femoral condyle, lateral femoral condyle, and intercondylar area in both groups after intervention. Conclusion: Results suggest that US is effective treatment modality in pain relief and improvement of function in patients with knee OA; however, US had no effect on cartilage repair.
Purpose: This study sought to determine the association between twinkling artifacts on color Doppler ultrasound and different types of guidewires. Materials and Methods: Twenty-two commonly used guidewires were classified into three groups according to decreasing diameter (Group 1, 0.035"; Group 2, 0.018"; and Group 3, 0.014") and tested in vitro. Severity of twinkling was visually graded into four categories (0–3, from weak to strong). Results: The percentages (tips/shafts) of twinkling artifacts were 100%/100% for Group 1; 0%/33.3% for Group 2; and 18.8%/31% for Group 3. The mean scores (tips/shafts) were 2.3/2.7 for Group 1; 0/0.3 for Group 2; and 0.3/0.4 for Group 3. Among them, both two guidewires with strong twinkling artifacts (score = 3) exhibited extensive rough surfaces on microscopic pictures. Conclusion: The twinkling artifacts were more likely to present in guidewires with larger diameters (from 0.014" to 0.035") in our study settings. The surface roughness may be the contribution to the twinkling artifact. Internal heterogeneities, such as types of material, types of coating, tip loading, and spring coil length, do not show influence on the twinkling artifact.
Correlation of subcutaneous fat measured on ultrasound with Body Mass Index
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Baby Nadeem, Raham Bacha, Syed Amir Gilani DOI:10.4103/JMU.JMU_34_18
Background: Body mass index (BMI) is used for the assessment of obesity and overweight worldwide. When body fat is increased BMI is also increased. Ultrasound is a reliable method to assess body fat. We have selected only one suprapubic region for the assessment of fat which is very easy to measure even in routine pelvic and abdominal ultrasound examination. During our routine examination, we can measure abdominal fat and inform the patient about his/her health state regarding obesity. It was a hypothesis that increases in abdominal subcutaneous fat will increase in BMI. Objective: The objective is to correlate subcutaneous fats measured on ultrasound with BMI. Materials and Methods: It was a cross-sectional study, which was performed in Gilani ultrasound center, Lahore, Pakistan. A total of 384 participants were included with simple random sampling technique. Individuals of 16–60 years age of both genders were included in that study. Pregnant ladies, athletes, children, and elderly participants were not included in that study. Toshiba (Xario) and Mindray (Z5) ultrasound machine were used for subcutaneous fats measurement. Participants were scanned in the supine position. Subcutaneous fats were measured on the suprapubic region in three different trials. Compression was avoided. Compression artifacts were avoided by applying more quantity of gel between transducer and skin. Stadiometer was used for the measurement of weight and height. To calculate BMI, Quetelet index was used. BMI was calculated with that formula BMI = weight (kg) divided by height (m2). Results: The result was made by calculation of mean and standard deviation. We calculated Pearson correlation between BMI and subcutaneous fats measured on ultrasound at the suprapubic region. It showed a significant high correlation between BMI and subcutaneous fat (P = 0.0000 which is < 0.001). Conclusion: There is a significantly high correlation between BMI and subcutaneous fat measured on ultrasound. Ultrasound is a reliable method to assess subcutaneous fat. It can be a predictor of obesity like BMI.
Special ultrasound phantom for interventional training: Construction, advantages, and application
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Musaad Taha Qurash, Nur Yazmin Yaacob, Nik Azuan, Yasir Sabah Khaleel, Rozman Zakaria DOI:10.4103/JMU.JMU_40_18
Interventional radiology procedures are becoming more challenging over time; thus, there is a need for excellent and reliable training methods. Training on live patients is neither safe nor an ethical solution. Alternatives are many and varied, but the most popular is ultrasound guided simulators. This report shows how a simple, homemade, low-cost phantom material, and construction modules can provide several advantages over ordinary gelatin phantoms. A new layering technique and target synthesis are described for the biopsy phantom, including tips on decreasing the needle pass artifact as well as controlling the mixture echogenicity.
A peripherally inserted central venous catheter (PICC) has been widely applied to central venous assess. There were some known complications such as phlebitis, leakage, blockage, dislodgment, breakage, or malposition of PICC. Catheter migration was assessed by using chest radiograph or administering contrast medium. Herein, we report a 77-year-old woman presenting to emergency department with odynophagia and left neck swelling of 3 days duration. The initial impression was deep neck infection. Focused ultrasound identified a hyperechoic tube with thrombosis in left jugular vein, which indicated migration of PICC. Clinical symptoms immediately resolved after removal of PICC and anticoagulation therapy.
Contrast-enhanced ultrasound (CEUS) has been used to diagnose gallbladder (GB) diseases for recent years because it is sensitive to visualize vascularity. Herein, we report a case who had a 1.7 cm × 1.2 cm polypoid lesion located in the gallbladder fundus with a feeding artery located in the stalk. On CEUS, the lesion showed early arterial phase enhancement (time to peak enhancement 18 s), persisting throughout the venous and delay phases. This enhancing pattern suggested that the lesion was a GB adenoma rather than a GB carcinoma. Cholecystectomy was performed, and pathology of the tissue revealed tubular adenoma of the GB.
Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18
It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.
There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.
Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18
It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.
Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity.
Correlation of clinicodermatoscopic and Wood's lamp findings in patients having melasma
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Rupali Dharni, Bhushan Madke, Adarsh L Singh, DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17
Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood's lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood's lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood's lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.
A study of comparison of PUVASOL and NBUVB in patients with vitiligo
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Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17
Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achieved, twice a week on non-consecutive days. Group B patients received PUVASOL-oral Trimethylpsoralen or topical 0.2% w/w Trioxsalen followed by exposure to sunlight, twice a week on non-consecutive days. The extent of repigmentation was documented at regular intervals upto 6 months. Results: Amongst patients receiving NBUVB and PUVASOL, 56% and 48% had ≥50% repigmentation respectively. Disease was unstable in 48% and 36% of patients prior to commencement of therapy which reduced to 12% and 16% after therapy, respectively. 16% and 36% of the patients experienced side effects and 76% and 48% showed excellent colour match of the repigmented patches respectively. Conclusion: While both PUVASOL and NBUVB are both good therapeutic options; NBUVB therapy is found to be more effective and more cosmetically acceptable, with better colour matching of lesions and minimal adverse effects.
Actinic keratosis in vitiligo after oral PUVAsol therapy with review
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Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18
Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.
Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.
Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.
Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration "steroid-induced perilymphatic hypopigmentation and atrophy" has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.
