Behcet’s disease (BD) classically presents with recurrent oral ulcers, genital ulceration, uveitis and skin manifestations. Middle-aged people are usually affected with the male gender being associated with severe variant of the disease. It can involve any organ system of the body. Although central nervous system and vascular involvement tend to occur less frequently, they are the commonest cause of mortality. We present a case of a 30-year-old man referred with suspicion of cerebral venous sinus thrombosis to our hospital and subsequently diagnosed with BD. The patient developed, despite being on immunosuppression and anticoagulation, extensive arteriovenous thrombi of lower limbs requiring catheter-directed thrombolysis with continuous 24-hour infusion of tissue plasminogen activator for refractory right lower limb venous thrombosis and placement of inferior vena cava filter to prevent pulmonary embolism. Later disease remission was achieved with rituximab.

Objective: To assess the diagnostic accuracy of trans-abdominal ultrasound (TAUS) in detecting choledocholithiasis, keeping MRCP as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Department of Magnetic Resonance Imaging, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2018 to May 2019. Methodology: 102 patients of either gender, age 20-85 years with the clinical suspicion of choledocholithiasis and obstructive jaundice were included. Trans-abdominal ultrasonography was performed for radiological detection of disease. All selected cases then underwent MRCP for confirmation of findings. Results: Mean age of the patients was 54.27 ± 15.14 years. 47 patients (46.1%) were males, and 55 (53.9%) were females. All patients were subjected to trans-abdominal ultrasound and MRCP. TAUS showed choledocholithiasis in 82 (80.3%) patients. MRCP confirmed choledocholithiasis in 81 (79.4%) cases, whereas 21 (20.5%) revealed no choledocholithiasis. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of TAUS were 96%, 80.9%, 95%, 85% & 87.86%, respectively. Conclusion: Diagnostic accuracy of trans-abdominal ultrasonography in detecting choledocholithiasis is significantly high enough to be used as a first-line imaging modality as MRCP is available only in specialised care centres.

Sarcoidosis is a systemic inflammatory disorder resulting from an inappropriate immune response to ubiquitous environmental stimuli. It has a predilection for African Americans and people of Northern European countries. The classic histology is that of a non-caseating granuloma. Central nervous system involvement is a rare occurrence in sarcoidosis and even in this manifestation, the presence of vasculitis is comparatively uncommon. We present a case of a 35-year-old female, who presented with complaints of persistent headache of moderate intensity and had a violaceous plaque on nose, being treated by a dermatologist. The patient on further workup had mildly raised proteins on cerebrospinal fluid analysis. MRI brain showed multiple foci in bilateral frontoparietal regions and centrum semiovale, while digital subtraction angiography brain depicted vasculitis of small vessels of brain and complete occlusion of right internal carotid artery at its origin. Biopsy of lesion on nose was performed that showed chronic granulomatous inflammation. A diagnosis of brain vasculitis secondary to sarcoidosis was made. The patient was treated with plasmapheresis and pulse steroid therapy initially, and later on with cyclophosphamide and azathioprine. This resulted in resolution of headache and nose lesion.

Objective: To compare the effectiveness of plasma D-dimer levels with findings of 128-slice spiral computed tomography pulmonary angiography (CTPA) in patients with clinical suspicion of pulmonary embolism. Study Design: Retrospective observational study Place and Duration of Study: Department of Computed Tomography, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital Rawalpindi, from Jan 2018 to Dec 2018. Methodology: A total of 59 patients were inducted who presented in Emergency Department, Pak Emirates Military Hospital Rawalpindi with clinical suspicion of Pulmonary Embolism. The main symptoms were shortness of breath and chest pain. Plasma D-dimer levels of all patients were sent to laboratory and CTPA was performed at Computed Tomography department, Armed Forces Institute of Radiology & Imaging using 128-slice spiral computed tomography. Results: 36 patients (61%) were males and 23 (39%) were females with an average age of 48.03 ± 18.06 years (range 23-85 years). Out of 59 patients, D-dimer levels were raised in 28 cases (47.4%) while 31 patients (52.6%) showed normal levels. Pulmonary Embolism was detected by CTPA in 30 cases (50.8%) while 29 patients (49.2%) were without obvious abnormality. Conclusion: Plasma D-Dimer levels show low sensitivity, specificity and negative predictive value and cannot exclude Pulmonary Embolism without CTPA. Computed Tomography Pulmonary Angiography (CTPA) remains diagnostic modality of choice for definitive assessment of Pulmonary Embolism in patients reporting at the emergency reception.

Objective: To study the effect of patient understanding of diabetes self-care on glycemic control. Study Design: Hospital-based cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2019. Methodology: A standardized questionnaire comprising nine questions to gauge understanding of diabetes self-care was applied to 216 patients with Diabetes Mellitus (DM) at Pak Emirates Military Hospital, Rawalpindi. Linear regression analysis was conducted to examine the effect of diabetes-related self-care understanding on glycemic control. Results: 138 patients were males (64%) and 78 females (36%) with a mean age of 40 ± 8 years (range: 18-68 years). The mean duration of having diabetes mellitus was 12 ± 2 years. Patients with a high score on the self-care understanding questionnaire had better average glycemic control than those with lower scores. Conclusion: Patients' understanding of self-care for diabetes has a significant impact on their glycemic control. This asks physicians to educate patients about their role in disease management for better clinical outcomes.