CONTEXT: Tuberculosis (TB) remains endemic in Saudi Arabia. Little local data have been reported on bronchoscopic evaluation of sputum-negative pulmonary TB patients, which poses a significant diagnostic and therapeutic challenge. AIMS: To determine the diagnostic value of bronchoscopy and bronchoalveolar lavage (BAL) and its correlation with clinical and radiological features in sputum-negative, culture-confirmed pulmonary TB patients. METHODS: We performed a retrospective analysis of patients with definite or probable pulmonary TB with overall negative (smear and/or polymerase chain reaction [PCR]) or scanty sputum that had undergone bronchoscopy with BAL over a period of 5 years. Patients’ symptoms, radiological features, lung lobe lavaged, BAL acid-fast bacilli (AFB) stain, Mycobacterium TB (MTB)-PCR, and mycobacterial cultures were analyzed. Mycobacterial cultures (either sputum or BAL) were used as a reference standard. RESULTS: Out of 154 patients, 49 (32%) were overall sputum negative and underwent a diagnostic bronchoscopy. Dry cough and fever were the most common symptoms. Uncontrolled diabetes mellitus was the most frequent comorbidity identified in 15 (31%) patients. Fifty-nine percent of the patients had diffuse lung infiltrates, with consolidation being the most common abnormality (41%), followed by cavitation (39%). Right upper lobe was the most frequent lung lobe lavaged (31%), while transbronchial lung biopsies (TBLB) were obtained in 21 (43%). BAL mycobacterial culture and MTB PCR were positive in 35 (71%) and 23 (47%) patients, respectively. Combined BAL MTB PCR and TBLB provided rapid diagnosis in 28 (57%) patients. CONCLUSIONS: An overall diagnostic yield of 90% was achieved with combined use of BAL MTB PCR, culture, and histopathology. Upper lobe lavage and presence of cavities on chest imaging had a higher diagnostic yield.

The purpose of current study is to evaluate findings of COVID fourth wave through Computed Tomography (CT) Imaging in Malakand division of Pakistan. Thus, to obtain the research findings, the study adopted experimental approach to evaluate how the CT scan facilitates the radiologists to study about fourth wave of COVID-19, and how the experiment can be implemented in Malakand, Pakistan. The patients with COVID-19 positive were involved in the study, where the results of their CT scan were analyzed to evaluate the difference in examination and other factors associated with COVID symptoms. Total 50 patients with COVID positive were involved in the study from Malakand division of Pakistan, and their CT imaging was performed in a well-known hospital of Swat. The findings were then analyzed through CT Images, which showed that approximately, 81% of the participant’s images were found with patchy ground-glass opacities, whereas 69% patients were found with patchy consolidations. Also, 31% patients had nodules found in CT imaging. Also, in 52% patients, the interlobular septal thickness was also observed, which had thickened the vascular, air bronchogram, or fibrous foci. Further conclusions were drawn on the effectiveness of the CT scan images in prediction of COVID impact on the patients in future.

Background: The aim of the study is to evaluate the diagnostic precision of utilizing both Stop-bang and Epworth sleepiness scale in predicting obstructive sleep apnea (OSA) for individuals with clinical suspicion, while considering polysomnography as the reference standard. Methods and Material: A cross-sectional (validation) study was conducted between 4th September 2017 and 3rd January 2018 at the Department of Pulmonology, Military Hospital Rawalpindi. A total of two hundred and eight (n=208) clinically suspected cases of OSA between age 40-60 years irrespective of gender were enrolled in the study. ESS and stop-Bang score was measured in all patients compared with apnea-hypopnea index (AHI). Diagnostic accuracy of combined ESS/Stop-Bang was calculated. Results: The findings of our research indicate that the utilization of combined ESS/Stop Bang (with a cut off point of ESS>3/STOP BANG >10) yielded a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 73.7%, 66.7%, 79.7%, 58.8% and 71.2% respectively. Conclusion: ESS/Stop-Bang when combined allow diagnosis of OSA with reasonable accuracy. The outcomes of our investigation revealed that the accuracy, sensitivity, specificity, NPV and PPV were 71.2%, 73.7%, 66.7%, 58.8% and 79.7% correspondingly. Keywords: Epworth sleepiness score, Obstructive sleep apnea, Stop-Bang

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. ​

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.