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Objectives To determine the proportion of children with severe acute malnutrition (SAM) having vitamin B12 deficiency, its clinical predictors, and its association with development. Methods In this cross-sectional study, 100 children between 1 mo to 59 mo [mean (SD) age 17 (12.75) mo; 55 males], with diagnosis of SAM as per WHO criteria, were included. Serum vitamin B12, serum folate, and serum ferritin levels were measured by chemiluminescence immunometric assay method, while serum Homocysteine (Hcy) level was measured by enzymatic cycling method. Development assessment was done by Denver Development Screening Tool (DDST-II). Results The mean (SD) serum vitamin B12 (cobalamin) levels were 296.52 (246.95) pg/mL; 45% children were vitamin B12 deficient (<203 pg/mL). Hyperhomocysteinemia (>14 µmol/L) was present in 39 (39%), and among these 69% (27/39) children had concomitant low serum vitamin B12 levels. Severe anemia and hypoproteinemia were significantly and independently associated with vitamin B12 deficiency [aOR (95% CI) 3.22 (1.13, 10) and 10 (1.66, 58.82), respectively]. Out of 45 children who were vitamin B12 deficient, 93%, 87%, 62% and 80% had gross motor, fine-motor, language and adaptive-cognitive delay, respectively. Vitamin B12 level was significantly associated ( P  <0.001) with developmental delay. Conclusions There is a high prevalence of vitamin B12 deficiency in children with SAM, which is also associated with development delay across all domains (except language) in these children.

Objective: To determine the spectrum of diseases on F-18 FDG PET/CT imaging at the Armed Forces Institute of Radiology and Imaging, Rawalpindi. Study Design: Cross-sectional study. Place and Duration of the Study: PET/CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging,Rawalpindi Pakistan, from Jul 2019 to Mar 2021. Methodology: The patients were scanned for staging, restaging, interim/response assessment and relapse/recurrence purposes. In addition, the frequency of various cancers and types of scans were determined. Scanning has been performe using GE Health care MiDR PET-CT Scanner. Results: A total of 1573 patients were included in the study. Male patients were 927(58.93%), and female patients were 646(41.06%). The most common diseases encountered were lymphoma 623(39.6%), breast cancer 193(12.2%), lung cancer 12(7.6%), colorectal cancer 88(5.5%) and unknown primary 84(5.3%). Amongst lymphoma, Non-Hodgkin’s lymphoma was the most common 276(44.3%), followed by Hodgkin’s lymphoma 267(42.8%). Conclusion: F-18 FDG PET/CT hybrid imaging is an important modality and can significantly alter patient management plans. Lymphomas were the most common disease in our spectrum, followed by cancers of the breast, lungs, colon-rectum and unknown primary cases, which can be managed well by PET/CT’s routine utilization.

Objective: To review all the patients of spinal dysraphism referred to our center over a three year period in order to identify the most typical neuro-radiological appearances on Magnetic Resonance Imaging. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi from Jan 2016 to Dec 2018. Methodology: MR spine reports of 144 patients of spinal dysraphism were retrospectively analyzed. Age, gender, indication for MRI, operative status, and neuro-radiological features (including site and type of lesion) were recorded for these patients. Results: Congenital spinal malformations were more frequent among females87 (60.4%) and between 0-20 years 135 (93.9%) of age. Tethered cord 97 (67.4%) was the most common congenital spinal abnormality followed by spina bifida, diastematomyelia, vertebral segmentation anomalies, myelomeningocele, menigocele. Lip-myelomeningocele, lipoma of filum terminale, and sacral agenesis. Frequently observed associated abnormalities included scoliosis 61 (42.4 %), syrinx 47 (32.6%) and dural ectasia 40 (27.8 %). Conclusion: Congenital spinal malformations are usually complex with variable radiological appearances. Modern high resolution MRI screening is the examination of choice for identification, preoperative evaluation, and long term follow up of such congenital anomalies.

Objective: To assess chest x-ray appearance of patients with positive RT-PCR test for SARS-Cov-2 and utilize modified RALE score for severity assessment of chest x-ray findings for correlation with clinical spectrum of disease. Study Design: Prospective observational study. Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi, from Apr 2020 to May 2020. Methodology: First 1000 consecutive chest x-rays of COVID-19 patients with RT-PCR confirmation at our setup were analyzed. Positive chest x-rays were assessed for consolidation, ground glass opacities and location of involvement. A severity index using modified RALE score was calculated for each & both lungs. Results: 932 patients were males and 68 were females with an average age of 40.77 years ± 13.58. Out of 1000 patients, 759 (75.9%) had normal chest x-rays. 241 patients had positive findings, ground glass opacities being the most frequent feature 211 (87.6%) showing peripheral 219 (90.9%), bilateral 182 (75.5%) and lower zone predominance 221 (91.7%). The optimal modified RALE score threshold for recognizing severe disease was 4.5 (area under curve, 0.943), with 79.2% sensitivity and 96.3% specificity. Conclusion: COVID-19 patients with positive chest x-ray findings frequently showed ground glass opacities with bilateral lower zone involvement in peripheral distribution. Modified RALE score can be used for objective evaluation of clinically severe patients.