IntroductionA lot of radiation exposure to a population comes from medical sources. Clinicians must justify the need for radiology procedures on a request form to prevent unnecessary scans and radiation exposure. Moreover, the properly-filled form will help to identify the patient correctly and provide clinical details to make a radiological diagnosis.ObjectiveThe purpose of the study was to audit the computed tomography (CT) scan request forms and find out the adequacy of completion of the request forms at Bahawal Victoria Hospital, Bahawalpur, Pakistan.Materials and methodsWe scrutinized 300 CT scan request forms received at the tertiary care center, Bahawal Victoria Hospital. We checked the adequacy of filling of different fields in the request forms like name, address, clinical and surgical history, and the name of required examination. We also looked for the missing subjects in the CT request form currently used in our hospital like the contact numbers of the patient and the doctor, the identity of the requesting doctor, renal function tests (RFTs), last menstrual period (LMP), and history of allergy. The results were analyzed using Statistical Package for the Social Sciences 20 (SPSS 20) (IBM, NY, USA) and Microsoft Office Excel Worksheet (Microsoft Corporation, NM, USA).ResultsThe name of the patient was present in 100% of the request forms, surname in 27.66%, age in 73.33%, gender in 64.33%, date in 91.66%, bed number in 37.90%, address in 1% and the name of required examination in 99.6%. Information about diagnosis included clinical history in 50.66%, past surgical history in 1%, laboratory investigations in 1%, and clinical examination in 8.66% of the forms. All the forms had the name and signature of the referring consultant, but only 10.33% forms contained the identity of the requesting junior doctor. More than half of the request forms for CT scan provided RFTs. We found no record of the allergy, LMP, and the contact number of the doctor and the patient.ConclusionThe information provided in the CT scan request forms was inadequate. The practice of filling these forms needs to be improved to protect the patients from unnecessary radiation exposure.

IntroductionHepatitis C has emerged as a big challenge for Pakistan. Health care providers are at increased risk of being infected due to tremendous exposure.AimThe purpose of this study was to find the prevalence of hepatitis C, its risk factors especially its occupational risk factors and preventive measures practiced by health care providers of Tehsil Head Quarter Hospital, Hasilpur, Pakistan.Materials and methodsBlood samples were collected, and rapid chromatography strips were used for diagnostic purpose. A questionnaire was used for data collection. After analyzing the data, results were summarized.ResultsThe prevalence of Hepatitis was 5.17%. Those who used gloves were 67.24%. A history of needle stick injury was present in 47.41%, and 49.13% knew about the spread of Hepatitis C Virus (HCV). Just 18.96% knew about the treatment plan, and 19.83% had attended a workshop on preventive measures of infectious diseases in healthcare settings.ConclusionThe frequency of HCV among health care providers is high. Awareness programs and training workshops should be mandatory to increase knowledge about hepatitis C prevention. It will decrease the incidence of hepatitis C infection among health care workers.

Pulmonary arteriovenous malformation (PAVMs) are abnormal communications between pulmonary arteries and veins. The rarity of their occurrence, coupled with the risks they pose, including brain abscess, embolic stroke, and myocardial infarction, mandates that they should not be overlooked in the differential diagnosis of patients presenting with haemoptysis, dyspnea, clubbing, cyanosis, hypoxemia, or epistaxis. We present the case of a 41-year-old local female who presented to our hospital as an outpatient with decreased oxygen saturation (SpO 2 ) of 70%-80% for the past two years with a final diagnosis of PAVM. The initial baseline workup showed polycythemia with a hemoglobin level of 19 mg/dL and raised hematocrit. She had extensive workup in the past two years for her polycythemia including gene mutation testing and cardiac workup which all turned out normal. Her chest X-ray (CXR) showed right lung opacity which was initially considered to be infective but it did not respond to antibiotic treatment. Later on, a CT scan of the chest was performed and findings were typical of a large PAVM which had two feeding arteries. The patient was referred to a cardiothoracic surgeon who sent the patient to the interventional radiology section for endovascular management. The embolization procedure was then performed and both feeders were successfully embolised. After the procedure, the patient's SpO 2 levels were restored to 95%-96%, and no post-procedure complications were noted.

This a preprint and has not been peer reviewed. Data may be preliminary.

IntroductionThe prevalence of beta-thalassemia mutations is different in various castes, regions, and ethnic groups. By knowing this prevalence, we can conduct a targeted screening of only the high-risk population and only for the specific mutations that are prevalent in each group.ObjectiveThe purpose of this study was to determine the regional, caste-wise, and ethnic spectrum of beta-thalassemia mutations in couples referred for a prenatal diagnosis.MethodsA cross-sectional analytical study was conducted at the thalassemia unit, Bahawal Victoria Hospital, Bahawalpur, from October 1, 2015, to May 15, 2018. After obtaining informed consent, chorionic villus sampling (CVS) was performed in 144 women having a gestational age of 12 to 16 weeks. We took blood samples of the couples. A chromosomal analysis for 13 mutations was done at Punjab Thalassaemia Prevention Programme (PTPP), Lahore. The researchers filled a questionnaire with all the details of couples like ethnicity, caste, and region.ResultsThe most common mutation was Fr 8-9(+G), accounting for 29.8%, followed by IVS 1-5(G-C), which was 28.9%. We did not find three mutations in any chromosome. Fr 8-9 (+G) was the most common mutation among Punjabis and Pakhtoons. IVS 1-5 (G-C) was the most common mutation among Saraikis and Urdu-speaking people. In Rajputs, Arains, Jatts, and Pathans, Fr 8-9 (+G) was the most common mutation. IVS 1-5 (G-C) was the most common mutation among Sheikhs, Balochs, Syeds, and Miscellaneous. IVS 1-5 (G-C) was the most common mutation in the Bahawalpur division and Ghotki (Sindh) while Fr 8-9 (+G) was the most common mutation in the Multan division. The p-value of all the results was <0.001.ConclusionThere is an ethnic, caste-wise, and regional distribution of mutations. We can conduct a targeted screening of the population and provide counseling about chorionic villus sampling by using this local data.