Cerebral venous sinus thrombosis (CVST) is an uncommon, life-threatening condition with a variable clinical presentation that makes it a challenge of diagnosis. A 39-year-old male patient presented to the hospital with complete loss of conscious and admitted to Medical Intensive Care Unit for investigation without any obvious history that was difficult for diagnosis. In this case, the patient presented with coma that is a rare presentation of CVST with no obvious clinical history and he was male patient that means he is free of all gender-specific risk factors of CVST. The brain computed tomography (CT) scan showed hypodense lesion in the left upper parietal region with no hemorrhage. The lesion was low-signal intensity (SI) on T1WIs and high SI on T2WIs and restricted on diffusion-weighted images like arterial infarctions, but magnetic resonance angiography (MRA) was normal that excluded arterial infarction. Gadolinium-enhanced MR venography (MRV) showed the filling defect of CVST. CVST can be present by a mysterious clinical presentation that makes it as a challenge of diagnosis even by medical imaging by CT and MR imaging (MRI). A combination of MRI and MRV is the best, noninvasive, and nonionizing imaging modality for the diagnosis of CVST.

Background and Objective: Nutritional support is an essential component of critical care with a significant effect on the outcomes of critically ill patients. Critical care nurses are in a central position to achieve the nutritional goals and preserve the nutritional status of patients at the best possible level. This study aimed to investigate the critical care nurses’ perceptions of the responsibility, knowledge, and documentation system support regarding enteral nutrition. Methods: Using a quantitative, descriptive, cross-sectional design data were collected from 292 critical care nurses in different healthcare sectors in Sana’a, the capital city of Yemen. A self-administered questionnaire containing 50 items was used for data collection. The data were collected between March and June 2021. The Statistical Package for the Social Sciences (SPSS) version 16 was used for the data analysis. Results: The study found that most of the critical care units did not have guidelines, protocols, or a nutritional support team, and the physicians prescribed the enteral nutrition. The critical care nurses perceived that they had a low responsibility, low knowledge, and moderate documentation support regarding enteral nutrition. The nurses in private hospitals had the highest responsibility, the nurses who received in-service education about enteral nutrition reported the highest level of knowledge, and the nurses in the Neuro critical care units had the best support from a documentation system. Scientific workshops and conferences were the main sources of knowledge regarding enteral nutrition. The nurses’ educational needs included the ability to evaluate the outcomes, goal setting, and nutritional assessment. Conclusions: The critical care nurses perceived a low responsibility, low level of knowledge, and moderate support from a documentation system regarding enteral nutrition. There is an urgently need to create or adopt enteral nutrition evidence-based guidelines, and protocols, and establish multidisciplinary nutritional support team with clear roles and responsibilities. In-service education and training related to enteral nutrition is paramount.

Tuberculosis (TB) is a bacterial infection with Mycobacterium tuberculosis; it is a public health problem worldwide and one of the leading causes of mortality. Since December 2019, the COVID-19 pandemic has created unprecedented health challenges and disrupted the TB health services, especially in high-burden countries with ever-increasing prevalence. Extrapulmonary and even pulmonary TB are an important cause of nonspecific clinical and radiological manifestations and can masquerade as any benign or malignant medical case, thus causing disastrous conditions and diagnostic dilemmas. Clinical manifestations and routine laboratory tests have limitations in directing physicians to diagnose TB. Medical-imaging examinations play an essential role in detecting tissue abnormalities and early suspecting diagnosis of TB in different organs. Radiologists and physicians should be familiar with and aware of the radiological manifestations of TB to contribute to the early suspicion and diagnosis of TB. The purpose of this article is to illustrate the common radiologic patterns of pulmonary and extrapulmonary TB. This article will be beneficial for radiologists, medical students, chest physicians, and infectious-disease doctors who are interested in the diagnosis of TB.

Background & Objective: Chronic rhino sinusitis (CRS) is an inflammatory condition of the paranasal sinuses and the nasal passage lasting more than three months either with or without sinonasal polyps. This study aimed to report the common sinonasal lesions associated with CRS according to the histopathology results, to compare between clinical and histopathological diagnoses, and to compare between radiological and histopathological diagnoses of the sinonasal lesions. Methods: A retrospective study of the electronic records of 82 patients diagnosed with CRS with nasal polyps. All patients underwent endoscopic sinus surgery and histopathological examination of surgical biopsies. The collected data were analyzed using SPSS program. Coparison between clinical and histopathological diagnoses was done. This study was conducted at Alsafwa Consultative Medical center (ACMC) in Almukalla city, Hadhramout province in Republic of Yemen. Results: Out of 82 patients, the ages ranged from 4 to 90 years (mean: 34.48±17.74 years), and 54.88% were females. Inflammatory polyps were the most common lesion (31.4%), then allergic polyps (30.5%). Nasopharyngeal carcinoma (NPC) was reported in 9.8% of the lesions and all were unilateral. The results revealed strong compatibility between clinical and histopathological diagnoses (p<0.001, kappa= 0.215), and significant compatibility between radiological and histopathology diagnoses (p=0.007). Conclusion: Inflammatory and allergic polyps are the most common benign bilateral lesions associated with chronic rhinosinusitis, which can be correctly diagnosed clinically in most cases. Unilateral nasal polyps have high rates of malignancies and should be check carefully by endoscopy and histopathology. Computed tomography has some pitfalls in diagnosing of fungal sinusitis. Abbreviations: CRS: Chronic rhino sinusitis, CRSwNP: CRS with nasal polyps, CRSsNP: CRS without nasal polyp, Eos CRSwNP: CRSwNP and eosinophilic inflammation, PNS: paranasal sinuses, EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012, ACMC: Alsafwa Consultative Medical center, NECT: non-enhanced computed tomography, SPSS: Statistical Package for the Social sciences, IBM: International Business Machines, NY: New York, NPC: Nasopharyngeal carcinoma. doi: https://doi.org/10.12669/pjms.36.2.1453 How to cite this:Alshoabi SA, Binnuhaid AA, Gameraddin MB, Alsultan KD. Histopathological analysis of sinonasal lesions associated with chronic rhinosinusitis and comparison with computed tomography diagnoses. Pak J Med Sci. 2020;36(2):---------.  doi: https://doi.org/10.12669/pjms.36.2.1453 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background and objectives: Ejection fraction (EF) is a measurement of heart function that reflects the portion of pumped out blood from the filled left ventricle per each heartbeat. The current study aimed to investigate the prevalence of left ventricular thrombus in patients with EF lower than 35% by using Transthoracic Echocardiography (TTE). Methods: In this prospective study, 82 cardiac patients underwent TTE procedure in order to assess the presence of left ventricular thrombus (LVT) from January 1st to December 31st 2017 at the Military Cardiac Centre in Sana’a, Yemen. Results: Out of 82 patients enrolled in this study, the mean age was 49.13 ± 14.8 years and 87.8% were male. The mean of EF was 31.16% and LVT was found in 6.1%. The spontaneous contrast was seen in 25.6% of patients indicating strong relationship with low EF (p < 0.001). Among patients with low EF, ischemic heart disease (IHD) was identified in 50%, hypertension in 30.5%, diabetes mellitus (DM) type 2 in 23.2%, and hyperlipidemia 12.2%. Exactly 80% of LVT were detected in IHD patients with dilated cardiomyopathy (DCMP) and 80% of detected LVT were apical in site. Conclusion: Cardiac patients with low ejection fraction developed left ventricular thrombosis, and most of the affected patients were ischemic heart disease with dilated cardiomyopathy. Interestingly, spontaneous contrast was found high significantly in these patients, which may reflect the continuous process of thrombus formation. Abbreviations:EF: ejection fraction, ASE: American society of echocardiography, EACVI: European association of cardiovascular imaging, LV: left ventricle, LVEF: left ventricular ejection fraction, HFpEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, MI: myocardial infarction, DCMP: dilated cardiomyopathy, AF: atrial fibrillation, TTE: Transthoracic echocardiography, TEE: trans-esophageal echocardiography, RHD: rheumatic heart disease, HTN: hypertension, DM: diabetes mellitus, CHF: congestive heart failure, JVP: jugular venous pressure, CBC: complete blood count, LFT: liver function tests, RFT: renal function test, LVT: left ventricular thrombus, ECG: electrocardiography, LVT: left ventricular thrombus, EDV: end diastolic volume, ESV: end systolic volume, SPSS: statistical package for the social sciences, IBM: international business machines, SD: standard deviation. doi: https://doi.org/10.12669/pjms.36.4.1972 How to cite this:Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FA. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1972 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.