Objective: To evaluate the usefulness of intravenous contrast administration in cranial computed tomography (CT) in a general hospital with a magnetic resonance imaging (MRI) facility, and to establish a protocol to determine which patients would benefit most from using contrast-enhanced cranial CT. Subjects and Methods: Five hundred and forty-seven patients who underwent routine nonenhanced CT (NECT) and contrast-enhanced CT (CECT) of the brain between June 1997 and June 2001 were divided into three groups. Group A: 496 patients in whom CECT was done in spite of normal NECT; group B: 16 patients in whom CECT was considered necessary irrespective of NECT findings, and group C: 35 patients in whom NECT was abnormal and CECT was performed. Results: Contrast-enhanced cranial CT changed and/or confirmed the diagnosis in 1 of 496 in group A, 2 of 16 in group B, and 12 of 35 in group C, thereby indicating that CECT was useful in the diagnosis of groups B and C. Conclusion: CECT is unlikely to be useful in patients with normal NECT in the appropriate clinical setting. A protocol is presented for the use of contrast media in cranial CT in a general hospital with an MRI facility. Using this protocol only 9.7% of patients for cranial CT would have needed CECT, resulting in considerable cost savings without affecting the quality of the service to the patient in a general hospital.

Opinions of university students about euthanasia were studied in 4 cities in Pakistan using convenience sampling. A total of 836 students (316 males and 520 females) completed a questionnaire in which euthanasia was defined as deliberate administration of an overdose of a drug by a doctor to relieve pain and suffering of a dying patient at his/her explicit request to end his/her life. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for legalization of euthanasia was to relieve patient's suffering but only when a committee of physicians agreed to recommend it. Students who opposed legalization (74.4%) cited impediments to future medical research as the most common reason, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization. There is a need in Pakistan for more debate about euthanasia.

To measure the morphometric variables of the superior pubic ramus in a sub-set of an Arab population to establish a safe pubic screw xation technique. MethodsCross sectional retrospective analysis of computed tomography (CT) pelvis images for 231 participants.The morphometric analysis included; pubic ramus axis length, insertion angles orientation, distance from the exit point to the pubic symphysis, distance from the entry point to acetabular joint surface and assessment of the narrowest pubic ramus diameter at three anatomical zones: para-symphyseal, midpubic and supra-acetabular areas. Pubic rami diameter correlation with age and sex was also analyzed. ResultsA total of 231 participants were included (55% male, 45% female). The mean screw length was between (104-127 mm) and it is signi cantly higher in males than females. The narrowest canal diameter was found at the para symphyseal area in both sexes were; 7.35mm in males and 4.75 mm in females. In females, all canal diameters at the three measured regions were signi cantly smaller than male's diameters. The mediolateral insertion angle was signi cantly higher in females than males (49.4° vs. 41.8°, respectively), whereas the cephalic-caudal angle was signi cantly higher in males than females (49.9° vs. 42.1° respectively). The mean distance from the lateral ilium entry point to joint articular surface was higher in males (23.5 mm) than females (19.9 mm).The symphysis pubis to tubercle exit point was signi cantly higher in females than males (24.2 mm vs 16.6 mm respectively). Pearson's correlation analysis revealed a statistically signi cant positive correlation between age and the pubic ramus diameter at the three measured regions in all age groups. ConclusionThe results from this study suggest that percutaneous pubic rami screw xation using the standard 6.5 or 7.3mm cannulated screw system may potentially be unsafe in female Arab patients. Thus, a closer evaluation in this subset of patients may require the alternative solid non-cannulated screws (3.5-4.5mm) or plate xation options. Further, female patients may have a higher risk of acetabular joint penetration, while males have a potentially higher risk of pudendal nerve injury

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