Search

Congenital Bilateral Perisylvian Syndrome (CBPS) is a rare brain structural abnormality. The specific anomaly is called polymicrogyria, which is a type of abnormal brain development. In polymicrogyria, the normal process of cortical development is disrupted during the late stages of neuronal cellular migration. This leads to the formation of many small folds on the surface of the brain and abnormal layers of cells on cortical surface.1,2,3 In CBPS, there are excessive small folds and unusual layers of brain cells in the Sylvian fissures (a specific area of the brain) and the surrounding cortex.1 CBPS can vary in terms of where it occurs in the brain, its symmetry, what causes it, and the specific symptoms it causes.1 The symptoms experienced by individuals with BPP depend on which part of the brain is affected. In this case, we are reporting the findings of an MRI scan of a 9-year-old boy who has congenital bilateral perisylvian syndrome (CBPS). [ABSTRACT FROM AUTHOR]

OBJECTIVE: We present a new educational approach to teaching physics to radiology residents. The hypothesis is that consecutive 3 to 4 day interactive physics lectures followed immediately by a summative written evaluation will facilitate greater retention of core physics concepts. We present initial outcome of this new technique. MATERIALS AND METHODS: The study was conducted in department of Radiology, Shifa International Hospital, Islamabad, Pakistan between January 2012 to January 2014. Modified curriculum was developed with two major changes: replacing didactic lectures with interactive format and changing to curriculum of short modules followed immediately by a written exam. Lectures were based on interactive group discussions with facilitating medical physicist. RESULTS: Average percentage physics test scores of residents in tests taken before and after trial of new curriculum showed 25% improvement. Post-trial survey demonstrated 54% respondents (n=7) thought that new interactive lecture based approach with immediate summative evaluation was extremely effective and 38% (n=5) thought of it as moderately effective. When asked whether the newly tried physics curriculum seems a better option to meeting both academic and professional needs, 61% (n=8) strongly agree while another 7% (n=1) agree. 46% percent of respondents (n=6) disagree, while 15% (n=2) of residents strongly disagree. When asked to directly compare the two curricula in terms of implementation, 85% (n=11) of residents thought that the new curriculum is much better. CONCLUSION: Compared with prior didactic lecture based approach with quarterly exam, the change to interactive approach with immediate evaluation has provided better results. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the survival rate and main reasons of failure of tunneled central venous catheters (Groshong). STUDY DESIGN: Retrospective cross-sectional analysis. PLACE OF STUDY: Department of Interventional Radiology, Shifa International Hospital, Islamabad. DURATION OF STUDY: Two years (January 2010 to December 2011) MATERIALS AND METHODS: A retrospective analysis was carried out on 72 patients in whom Groshong catheters were placed and then followed from January 2010 to December 2011. The data was collected from hospital information system (HIS) and patients medical record, and was analysed for different indicators such as catheter survival and main reasons of its failure. RESULTS: Of 72 patients, half of patients were lost to follow. Among the remaining half, 19 (52.7%) catheters achieved their desired function. Among remaining 17 catheters, 5 were removed due to blockage and 12 due to infection with infection rate of 0.46 per 1000 catheter days. The catheter survival rates according to Kaplan Meier analysis at 1, 3 and 6 month were 82%, 47% and 42% respectively. CONCLUSION: Groshong catheters can be used as vascular access for longer duration especially in oncology patients. Infection is commonest reason of their premature removal. [ABSTRACT FROM AUTHOR]

RATIONALE AND OBJECTIVES: DOPS (Directly Observed Procedural Skills) is a relatively new educational technique for assessment of practical skills assessment of radiology residents. We conducted 2 DOPS session over two years for ultrasound proficiency assessment of first year radiology residents. The purpose of this study was to assess feasibility and potential benefits of DOPS and to decide its future implementation in our department. MATERIAL AND METHODS: The study was conducted in department of Radiology, Shifa International Hospital, Islamabad, Pakistan between January 2012 to December 2013. Each first year junior radiology resident was rotated in the department of ultrasound at initiation of training for 2 months programmed ultrasound rotation. At the end of the rotation, a senior radiologist, with more than 4 years post fellowship experience in ultrasound, carried out DOPS assessment session of these residents. A single station was made with ultrasound performed on a mock patient (healthy volunteer). A DOPS Proforma was designed and assessment was marked in four areas (approach to patient, knobology of machine, theoretical knowledge and technique) and performance was graded according to a set scale. A post DOPS questionnaire was given to participating junior residents to give their opinion on this newer system. Another questionnaire was given to the senior residents to assess outcome of this exercise in terms of improvement in ultrasound skills of first year residents during call hours. RESULTS: Over two years, 7 of 8 first year residents (87%) passed the exam on first attempt. The one who failed was remediated after attending extra ultrasound sessions and passed the exam a week later. All were put on night call subsequently. A post implementation survey was conducted from all the junior (n=8) and senior (n=7) radiology residents with 100% response rate. Eighty percent (n=12) of the residents thought that this new tool was effective in improving their ultrasound proficiency and should be implemented in future. Hundred percent (n=15) thought it to be better than conventional end of rotation written feedback. Eighty five percent (n=6) of senior residents felt that there was improvement in junior resident ultrasound skills during call hours as compared to previous years. CONCLUSIONS: Compared to our conventional end of rotation written feedback, using DOPS for proficiency assessment of ultrasound of first year radiology residents has been judged to be a useful assessment tool prior to starting call. [ABSTRACT FROM AUTHOR]

Excessive pushing and valsalva during labour is associated with subcutaneous emphysema and pneumomediastinum during labour and post partum. Although rare but is a potentially serious complication that must be identified and managed appropriately to avoid its rare consequence called malignant pneumomediastinum, requiring surgical intervention. A 30 year old, primigravida, presented to a tertiary care hospital with complaints of shortness of breath of 4 days duration after a normal vaginal delivery. CT chest showed bilateral consolidation and pneumomediastinum. She was managed conservatively with supportive measures and was clinically stable before being discharged on request to a nearby health facility. On follow up complete resolution of pneumomediastinum was reported. Recognition of post partum pneumomediastinum, its presentation and associated complications need to be acknowledged in a teriary care hospital, with proper management. Although the condition is rare, but in subsequent pregnancies physicians need to be cautious, and instrumental delivery or caesarean section may be considered to avoid excessive valsalva. No definite evidence of recurrence has been proven.

Objective: To look for survival rate and major reasons behind the failure of tunnelled dialysis catheters in patients on haemodialysis., Methods: The retrospective study was conducted at the Department of Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 100 consecutive subjects from a list of patients in whom tunnelled cuffed catheters were placed from February 2009 to January 2011 and were followed up for two years. Data was collected on a proforma from the hospital database and medical records of patients. SPSS 19 was used for statistical analysis., Results: Of the total 122 catheters placed in 100 patients, 49 (40.16%) were lost to follow-up. Of the remaining 73 (59.83%) catheters, 38 (52%) had achieved their desired function, while 35 (48%) failed to achieve the target duration. Among the reasons of catheter failure, infection was the commonest at 13 (37.14%) with infection rate of 0.24 per 1000 catheter days. According to Kaplan Meier analysis, catheter survival rates at 60, 90 and 180 days were 89%, 77% and 64% respectively. Mean effective duration of catheter was 129 +/- 117 days., Conclusion: Tunnelled dialysis catheters can be safely used as vascular access till the maturation of fistula and may be an alternative to Arterio-Venous Fistula or graft for long-term vascular access if indicated.