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Introduction: Radioiodine therapy is a standard procedure in thyroid autonomy treatment. Discrepancies in the visual comparisons of the scintigraphies prepared for this purpose using Tc-99m-O4- and I-131 have been known for years. In this study a new method is used to calculate and perform a quantitative comparison of both uptakes using subtraction analysis and 3D imaging. The results and their causes are discussed together with practice-relevant conclusions for better clinical results. Material and Methods: The new method was used in 38 patients with thyroid autonomies for the subtraction analysis of standardized pretherapeutic and intratherapeutic scintigraphies. The parametric distribution of activity was calculated absolutely and as a percentage and displayed three-dimensionally. These results were compared with the visual assessment of the different scintigraphies by the experts. Inclusion criteria were pretherapeutic and intratherapeutic hyperthyroidism without medication affecting the thyroid. The time difference between acquiring the scintigraphies was 28 days maximum. Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis. Conclusion: Accurate functional imaging of the thyroid is next to further aspects very important in establishing the diagnosis and deciding about the therapy activity for thyroid treatment. In combination with clinical symptoms and laboratory values, Tc-99m-O4 - scintigram can be used for an orientated, preliminary assessment of functional disorders of the thyroid. But because of the higher rate of found discrepancies, the solely use of Tc-99m-O4 - scintigram is not always capable for exact and reliable diagnosis. The known reason for this is most probably due to the different biokinetics of both radiopharmaceuticals, which can be imaged more sensitively with this method. Consequently, a scintigram should be performed in the pretherapeutic radioiodine uptake test. Despite higher costs and radiation exposure, alternatively, pretherapeutic use of other diagnostic iodine isotopes like I-123 or -124 should be discussed, because they could overcome the limitation of the different biokinetics. Following this approach the preliminary assessment using Tc-99m-O4 - scintigraphy can be precised and double checked to improve diagnostic confi dence and treatment results for a better outcome of the patients.  

A gossypiboma is a mass of cotton material from any source, left in a body cavity after a surgical procedure. This enhances the morbidity, cost of treatment and potential mortality to the patient with the addition of medicolegal issues. We report a case of a 32 year old lady who presented with complaints of central abdominal pain and vomiting for 1 month, fever for 20 days and non-passage of flatus and faeces for 5 days. She had undergone a total abdominal hysterectomy 4 months prior. On clinical examination, adhesive small intestinal obstruction was suspected. On CECT evaluation, a gossypiboma was suggested to have possibly migrated into the small bowel. Laparotomy revealed the presence of clumped bowel loops, which on dissection got torn and showed a gauze like material within the bowel lumen. A diagnosis of gossypiboma with intestinal migration of a retained surgical sponge was ascertained. The possibility of a gossypiboma, particularly in previously operated cases, must be kept in mind and measures must be taken to prevent such incidences.

The current study was carried out to translate, adapt and validate Depression, Anxiety and Stress Scale in Urdu language and in Pakistani culture. The current translation was aimed to produce a more user friendly and clinically applied version of DASS. The systematic procedure involved in translation focused on maximizing levels of semantic and conceptual equivalence. A test re-test pilot study was conducted on 30 participants to analyze the translated version initially, the results of which determined a significant positive correlation between original and translated versions. The main study involved 300 conveniently selected Pakistanis. The findings revealed that the translated version titled U-DASS-42 was highly reliable and valid in Pakistani culture. The newly developed U-DASS-42 is attached with this paper for the convenience of Pakistani researchers.

Background: Laparoscopic cholecystectomy is gold standard and most widely performed surgery for gallstone disease all over the world. Surgeons entering into the field of laparoscopic surgery for the first time faces challenges that are different from those with experienced hands. We in this study tried to enumerate the various such challenges and also recommend few steps to counter them. Aims & Objectives: To study the challenges faced by new surgeons in laparoscopic cholecystectomy and recommendations to reduce them. Material & Methods: This study was carried out in a medical college in the department of General and Minimal Access surgery. In this retrospective study, ten general surgeons working as senior residents in in this medical college over a period of 3 years having never performed laparoscopic surgery in past were included. Results: A total of 50 cases, five operated by each surgeon with minimal assistance by senior surgeon in few cases. Operative time varied from 90 to 120 minutes. The various technical challenges faced by the new surgeon were in the Creation of Pneumoperitoneum, Creation of second port (epigastric port 10mm), Gallbladder Retraction and Dissection at calot’s triangle, Dissection at gallbladder bed and Removal of the gallbladder from epigastric port.it has been observed that following various simple steps will abate these technical difficulties for these beginners while doing laparoscopic cholecystectomy. Conclusion: Laparoscopic cholecystectomy is the most commonly performed minimal access surgical procedure nowadays and almost all the new surgeons enter the world of laparoscopic surgery via this surgery. Knowing and following the above recommendations will help them abate the technical challenges generally faced during the initial phase in the laparoscopic field.

The article presents data from recent publications and own data on screening studies with interpretation of chest radiographs using artificial intelligence CAD (Computer-Assisted Diagnosis), which, according to WHO recommendations, provides more accurate clinical thresholds for deciding who needs to take a sputum test. Another aspect of the WHO recommendations is the cost-effectiveness of CAD as a tool for triaging patients with tuberculosis symptoms in low-income countries with a high incidence of tuberculosis. Compared with smear microscopy and GeneXpert, without preliminary sorting, the use of mobile digital X-ray machines equipped with a CAD tool reduces costs, allowing sorting of individuals suspected of having tuberculosis for testing on GeneXpert, while reducing the time to start tuberculosis treatment.Thus, conducting a study using portable X-ray machines using a CAD program is a low-cost and easy-to-implement method, does not require large funds, does not require separate rooms, is highly effective, has good image quality, allows you to quickly clarify individuals suspected of having tuberculosis, differentiating it from other pathological changes in the lungs.Our experience shows that machine analysis of chest computed tomography data, due to the higher resolution capabilities of the method and the absence of fundamental disadvantages of radiography, including the effect of shadow summation, the presence of “blind” zones, etc., is finding increasing application in both diagnostics and screening of respiratory diseases. Our use of this tool allowed us to identify additional new cases of phthisio-onco-pulmonary diseases in field conditions.

A 35-year-old man presented with swelling in the lower abdomen for 2 months. He was found to have left undescended testis. An ultrasound scan showed a solid floating pelvic mass. His chest x-ray and tumour markers for testicular cancer were normal. Exploratory laparotomy revealed the left intra-abdominal testicular tumour. Intra-abdominal left orchiectomy was performed. The patient made an uneventful recovery. Histology showed immature seminoma. A mass in the lower abdomen with a cryptorchidic testis strongly points towards the diagnosis of malignancy in abdominal testis. To prevent this complication all undescended testis gets orchiopexy before 2nd year or orchiectomy in post-adolescent life. But some cases remain unnoticed, which leads to this kind of presentation. So, we decided to present this rare and interesting case of intra-abdominal testicular tumour.

The absorption parameters such as total mass attenuation coefficients, molecular, atomic, and electronic cross sections, effective atomic numbers and electron densities were calculated for some selected enzyme inhibitors in the photon energy range from 1 keV up to 100 GeV. The changes in the absorption parameters were interpreted with the photoelectric effect, Compton scattering and pair production processes. It is observed that the 2-Imino-1-imidazolidineacetic acid enzyme inhibitor has more radiation shielding feature when compared to other chosen enzyme inhibitors. The present investigation is anticipated to be useful for researchers studying with radiation in several fields and cancer researchers.

A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1]. Her abdominal examination was unremarkable other than tenderness in her right iliac fossa and a palpable non-tender renal transplant. Her inflammatory markers, electrolytes and urine microscopy were unremarkable. She was further investigated with an ultrasound which demonstrated nil complications with her transplant and a non-contrast CT (due to contrast allergy). Her CT demonstrated a faecolith within the appendiceal lumen but no signs of acute appendicitis (Figure 1). Due to ongoing pain and CT finding of faecolith she was taken for a diagnostic laparoscopy with appendicectomy.   Figure 1: Non-contrast CT demonstrating faecolith. Intraoperatively she had a macroscopically normal appendix and no other cause for the patients symptoms could be identified. A laparoscopic appendicectomy was performed with no complications. Her pain persisted postoperatively and she was discharged post operative day two with analgesia. Histology subsequently revealed actinomyces-like organisms consistent with actinomycosis of the appendix (Figure 2). Her case was discussed with the Infectious diseases team and she was started on an extended course of oral amoxicillin [2].   Figure 2: High Powered H&E stain & gram stain of actinomyces like organisms

Kidney transplantation is the therapy of choice for patients with end-stage kidney disease (ESKD). Nevertheless, the main limitation for long-term graft survival is immune-mediated rejection. Some authors have proposed that differences in immune effector mechanisms are influenced by underlying molecular mechanisms; thereby, the identification of differentially expressed genes in acute or chronic rejection in non-invasive samples such as urine may be essential for the identification of potential biomarkers and biological processes associated with allograft outcomes. Our aim was to explore differences in gene expression and functional categories associated with acute and chronic kidney rejection in blood, biopsy, and urine of kidney transplant patients using RNA-Seq. RNA was isolated and sequenced implementing standard protocols. Analyses were addressed to identify differentially expressed genes (DEGs) and Functional Categories of Gene Ontology comparing between samples. Then we focused on immune genes and pathways to identify their association with the allograft. We identified a significant transcriptional similarity between biopsy and urine, in comparison with blood in acute and chronic rejection. Functional analyses suggested an enrichment of immune processes such as antigen processing and presentation, and regulation of B cell receptor signaling pathway in blood of acute and chronic rejection, respectively. Additionally, we observed an increase in expression of chemokines in biopsy and urine of both outcomes along with an increase in chemokine receptors in blood. Our findings suggest that urine is suitable for identifying potential biomarkers and biological processes related to renal allograft rejection, as it shares a significant number of regulated genes with biopsy.

Obesity is a major contributor to ill health and numerous comorbidities globally. Recent studies suggest that addictive-like tendencies toward foods, especially highly processed foods, contribute to this epidemic. Therefore, interventions used to treat substance-use disorders may be effective for treating overweight/obese patients with food addiction (based on the Yale Food Addiction Scale, version 2.0). This pilot study evaluated four interventions, selected because of their effectiveness in the treatment of substance-use disorders [motivational interviewing, pharmacotherapy (naltrexone-bupropion), pharmacotherapy with motivational interviewing, information control (diet and physical activity instruction)], in overweight/obese individuals with and without food addiction. The food addiction construct identified a distinctive subset of overweight/obese individuals. Through one month, response to interventions differed between food addiction phenotypes with those who were positive for food addiction showing similar or less response to the interventions than those who were negative for the trait. This suggests that individuals with addictive-like tendencies toward food may require longer and more intensive intervention to achieve their goals. The greatest changes in biometric measures occurred between baseline and 1 month during which time participants were attending weekly intervention sessions. Across all groups, those who attended more sessions (dose) was correlated with a reduction in body mass index.