No abstract

Covid 19 is evolving as an epidemic. This is a case report of Covid 19 patient who had previous surgery for Carcinoma stomach. He was referred for follow-up CT chest and abdomen. The patient hides his recent travel history to Malaysia just to get his CT done. His HRCT findings were typical for CV-19 and later on his PCR confirmed CV-19 but he already came in contact with health care providers. Patients are concealing their travel histories which are also spreading infections.

During the past few decades, the world of radiologists has been remarkably influenced by the progress in advanced technology. A multi-parametric analysis is required regarding pathological alterations and in-depth details corresponding to each case because of extended the imaging spectrum. The total dependency is mostly upon imaging. Therefore, radiologists need to meet up the complex health quality standards. Radiologists mostly report and scan cases referred from Surgical, Medicine, Pediatrics, orthopedics and Gynecology. And on the other hand they face certain critical issues and challenges in dealing with medico-legal cases. Although they have to follow medical protocols but medico-legal cases are still very difficult to handle. This research highlights all the issues and challenges regarding medico-legal cases faced by the department of Radiology and Emergency of Saidu teaching Hospital Swat. This study was conducted at this Saidu Teaching Hospital Swat, and the study duration was 6 months (April 2021-September 2021). More than 116 people (doctors, radiologists, nurses, and paramedical staff) have participated in this research. Results show that radiologists and other medical staff handle the unexpected and critical challenges in these cases. While writing examination findings, reporting CT scans, MRI, X-Rays and doing ultrasounds, they face political, patient attendant, hospital, and other party pressure to alter the reports to make other party guilty. This article addressed all the issues and challenges that radiologists meet in medical-legal cases.

Ascariasis is confirmed to be more common in over populated rural societies with insufficient sewage and warm environments. We addressed the ultrasonic demonstration of biliary ascariasis and the worth of ultrasound in ratifying the diagnostics and assessment outcomes. In our study, 20 patients (8 females and 12 males) were included and conducted from Sep 2019 to Mar 2020 in the Saido Sharif hospital, SWAT, KPK, Pakistan. The criteria for including patients were based upon the ultrasonic findings expressing the biliary ascariasis such as non-shadowing curved or straight echoic structures like cords with or without central hypo-echoic tubes. The ultrasound follow-up was made in three consecutive interludes; 1 week subsequent to first ultrasonic diagnostics of all patients, 2 weeks after first treatment for 10 patients and 2 weeks after recurrent therapeutic treatment for 10 patients. There were 8 females and 12 males, including 3 pregnant patients (4, 5 and 6 months). Approximately 70% patients belong to the rural sides. The results of clinical laboratory exhibited higher level of leukocytosis in 85%, higher alkaline phosphatase in serum of 30% participants, irregular alanine aminotransferase level among 40%, and higher amylase in the serum of 10% patients. The sequential follow-up ultrasound was also made for diagnostics verification and evaluating the managing outcomes. After one week of initial ultrasound diagnosis, the 1st follow-up ultrasound was carried out to all the patients which revealed variation in the parasitic configuration and confirmed diagnosis in 14 cases. In 5 cases without any treatment, an impulsive exits of worms was reported from the biliary tree. In remaining 15 cases, the patients underwent multiple kinds of treatment. Six patients were cured using anthelminitic medications and four with surgical management. To conclude, Successive follow-up ultrasound proved to be very operational in ratifying the biliary worm’s diagnosis and has a significant function to assess the administrative outcomes. ​

Background: Subarachnoid hemorrhage is cause by ruptured aneurysms. Early diagnosis is necessary for prevention of the disease. For detection of size and location of intracranial aneurysms in aneurysmal subarachnoid haemorrhage different diagnostic tool are used. The 3D DSA imaging modalities parameters were considered as gold standard in diagnosis of aneurysms. MRA and CTA competencies in diagnosis of ruptured aneurysms were also evaluated. Objective: The aim of the study was to evaluate the sensitivity of 3D DSA, CTA and MRA in diagnosis of intracranial aneurysms in referred patients. The imaging modalities parameters of 3D DSA was considered as gold standard. Study design: It was retrospective observational study with statistical approach. Methods: The 27 consecutive patients of subarachnoid haemorrhage visited the neurology and radiology department of BKMC / MMC Mardan from August 2021 to January 2022 was included in the study. All the patients passed the inclusion criteria while those who are reluctant to undergo through CTA, MRA were excluded. The three dimensional constructed images of each patient underwent through CTA, MRA and 3D DSA were recorded. The obtained data was analyzed for the results. Results: CTA and MRA has variable sensitivity range in diagnosis of intracranial aneurysms. It varied according to the size of aneurysms. For the diagnosis of small sized aneurysms the CTA and MRA has the sensitivity of 57.1 %, while it changes to 88.8 % in diagnosis of medium sized aneurysms. For diagnosis of large sized aneurysms, the CTA and MRA has same sensitivity of 100%. Hence for the detection of small and medium sized aneurysms the sensitivity of CTA and MRA reduced to 20% as compared to the sensitivity of 3D DSA. Conclusion: It was concluded from the results that the 3D DSA is most accurate tool with higher sensitivity for diagnosis of intracranial aneurysms in patients of subarachnoid haemorrhage. The results obtained by using 3D DSA are 20% more sensitive than the results obtained by using CTA and MRA. Keywords: (SAH) Subarachnoid hemorrhage, CTA) Computed Tomographic Angiography, (MRA) Magnetic Resonance Angiography.