Explore the vast range of titles available.

We aimed to compare the efficacy of δ-tocotrienol with α-tocopherol in the treatment of patients with non-alcoholic fatty liver disease (NAFLD). This study was a double-blinded, active-controlled trial. The patients with NAFLD were randomly assigned to receive either δ-tocotrienol 300 mg or α-tocopherol 268 mg twice daily for 48 weeks. The primary endpoints were change from baseline in fatty liver index (FLI), liver-to-spleen attenuation ratio (L/S ratio), and homeostatic model assessment for insulin resistance (HOMA-IR) at 48 weeks. Key secondary endpoints were change in markers of inflammation, oxidative stress, and hepatocyte apoptosis. Clinical assessment, biochemical analysis, and computed tomography scan of the liver were conducted at baseline, 24 and 48 weeks. A total of 100 patients (δ-tocotrienol = 50, α-tocopherol = 50) were randomized and included in the intention to treat analysis. Compared with baseline, there was a significant improvement (p < .001) in FLI, L/S ratio, HOMA-IR, and serum malondialdehyde in both groups at 48 weeks that was not significant between the two groups. However, there was a significantly greater decrease in body weight, serum interleukin-6, tumor necrosis factor-alpha, leptin, cytokeratin-18, and increase in adiponectin in the δ-tocotrienol group compared to the α-tocopherol group at 48 weeks (p < .05). No adverse events were reported. δ-tocotrienol and α-tocopherol exerted equally beneficial effects in terms of improvement in hepatic steatosis, oxidative stress, and insulin resistance in patients with NAFLD. However, δ-tocotrienol was more potent than α-tocopherol in reducing body weight, inflammation, and apoptosis associated with NAFLD. Sri Lankan Clinical Trials Registry (https://slctr.lk/SLCTR/2019/038). •The first human study to compare the efficacy of δT3 with αTF in the treatment of patients with NAFLD.•δT3 exerted equally beneficial effects as of αTF in improving hepatic steatosis, insulin resistance and oxidative stress.•δT3 was more potent than αTF in improving body weight, inflammation and hepatocyte apoptosis.

Patient satisfaction and experience are important indicators for measuring healthcare quality. The recent widespread use of patientexperience surveys in healthcare settings is based on the fact that feedback has a potentially important role in improving the quality of care, affects clinical outcomes and timely, efficient, patient-centred delivery of quality health. Research into patient experience feedback is a relatively recent phenomenon that began in the 1990s.1 Research into how healthcare providers use this data to improve services is at an early stage. Recent systematic research on patient experience and feedback collection was held at the Armed Forces Institute of Radiology & Imaging (AFIRI), providing evidence to influence debate, policy and practice on patient feedback data.

•The first human study to show the efficacy of pure delta-tocotrienol vs. placebo in the treatment of NAFLD. δ-tocotrienol proved to be an effective anti-inflammatory and anti-oxidative and anti-insulin resistance agent through significant decrease (mean difference [95 % CI]) in levels of hs-CRP (−0.61 [−0.81, −0.42]; p < 0.001), MDA (−0.91 [−1.20, −0.63]; p < 0.001) and HOMA-IR (−0.37 [−0.53, −0.21]; p < 0.001).•δ-tocotrienol significantly reduced hepatocellular injury as manifested by a substantial decrease [mean difference (95 %CI)] in ALT (−8.86 [−11.5, −6.2]; p < 0.001) and AST (−6.6 [−10.0, −3.08]; p < 0.001).•δ-tocotrienol significantly reduced hepatic steatosis as manifested by a substantial decrease [mean difference (95 %CI)] in FLI (−8.52 [−10.7, −6.3]; p < 0.001) and improvement in grading of hepatic steatosis on ultrasound (p =0.047).•Modulation of micro RNA expression by delta-tocotrienol may represent a new treatment option in NAFLD. The aim of this study was to examine the effects of delta-tocotrienol (δ-tocotrienol) supplementation on biochemical markers of hepatocellular injury and steatosis in patients with nonalcoholic fatty liver disease (NAFLD). The study design was a two-group, randomized, double-blind, placebo-controlled trial. The patients with NAFLD were randomly assigned to receive δ-tocotrienol 300 mg twice daily or placebo for 24 weeks. The primary endpoints were change from baseline in fatty liver index (FLI) and homeostasis model of insulin resistance (HOMA-IR) after 24 weeks. Secondary endpoints included change from baseline in high sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), alanine transaminase (ALT), aspartate transaminase (AST) and grading of hepatic steatosis on ultrasound. Between-group differences were tested for significance using ANCOVA. Mean differences (MD) with 95 % CIs are reported. A total of 71 patients (tocotrienol=35, placebo=36) were randomized and included in the intention to treat analysis. Compared with placebo, δ-tocotrienol significantly reduced (MD [95 % CI]) FLI (−8.52 [−10.7, −6.3]; p < 0.001); HOMA-IR (−0.37 [−0.53, −0.21]; p < 0.001), hs-CRP (−0.61[−0.81, −0.42]; p < 0.001), MDA (−0.91 [−1.20, −0.63]; p < 0.001), ALT (−8.86 [−11.5, −6.2]; p < 0.001) and AST (−6.6 [−10.0, −3.08]; p < 0.001). Hepatic steatosis was also reduced by a significantly greater extent with tocotrienol than with placebo (p =0.047). No adverse events were reported. δ-tocotrienol effectively improved biochemical markers of hepatocellular injury and steatosis in patients with NAFLD. δ-tocotrienol supplementation might be considered as a therapeutic option in the management of patients with NAFLD. Sri Lankan Clinical Trials Registry (SLCTR/2015/023, 2015-10-03).

Objective: Present study conducted for the measurement of radiation doses received by the radiation workers due to their direct involvement in handling of unsealed radionuclides for the PET/CT scanning. Study Design: Quasi Experimental Study. Place and Duration of Study: PET-CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Aug 2020 to Jul 2021. Methodology: TLD film badges and ring dosimeters, based on LiF:Mg:Ti material, were used for the detection and measurement of radioactivity. The measurements were performed for both whole body and extremity (fingers) dose measurements. Results: The measured radiation doses were in the range of 362.75 mSv/y to 409.74 mSv/y and 0.08 mSv/y to 4.35 mSv/y for extremities and whole body, respectively. Number of injections was calculated for extremity workers and found to be 720±27 injections per worker per year. Conclusion: The measured results clearly show that the annual doses for whole body (20 mSv/y) and extremity (500 mSv/y) of radiation workers are under the recommended limits. However, radiation workers with direct access to radioisotopes were more exposed to radiation. The results of present study were also in good correspondence with the published data.

Objective: To compare the sites of extra-nodal involvement by Contrast-Enhanced Computed Tomography (CECT) and Positron Emission Tomography-Computed Tomography (PET-CT) in lymphoma patients Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Military Hospital, Rawalpindi Pakistan, from Aug to Dec 2021. Methodology: A total of 216 patients were included in the study who were diagnosed with lymphoma and presented with suspicion of extra-nodal metastasis. CECT and PET CT were performed in these patients, and a comparison of CECT and PET CT was made in the detection of sites of extra-nodal involvement. Results: A total of 216 patients were included in the study, and the ability of CECT and PET CT was compared to detect the sites of extra-nodal involvement. The sensitivity, specificity, PPV, and NPV for 18-FDG PET-CT were calculated as 92.7%, 100.0%, 100.0% and 95.7% respectively, which was significantly more than CECT.  Conclusion: PET CT has proven to be a superior diagnostic tool for identifying sites of extra-nodal involvement as compared to CECT. It plays a significant role in guiding effective disease management.

Objective: To compare the roles of MRI and HRCT-Temporal bone as a part of preoperative evaluation of candidates selected for cochlear implant before surgery. Study Design: Comparative cross-sectional study. Place and Duration of Study: ENT Departments of the Combined Military Hospital and Pakistan Emirates Military Hospital Rawalpindi, Pakistan from Nov 2022 to May 2023. Methodology: Patients having bilateral sensorineural hearing loss (SNHL), which ranged in severity from mild to severe, were referred from the ENT departments of the Combined Military Hospital and Pakistan Emirates Military Hospital Rawalpindi. Their Cochlear status was evaluated using HRCT and MRI of the temporal bone before giving the cochlear implant. The anatomical abnormalities of each temporal bone were listed and noted for analysis. Results: Of the 100 patients, 48% were male, and 52% were female. The most common disorders were abnormalities of the cochlea (45/100) and semicircular canal (20/100). The most frequent cochlear abnormality (10/100) was Mondini's deformity. In 12 cases, MRI was more effective than HRCT at identifying hypoplastic or aplastic vestibulocochlear nerves. Conclusion: For the diagnosis of membranous labyrinth and nerve abnormalities, MRI of the temporal bone was superior to HRCT. However, neither HRCT nor MRI temporal bone is the only imaging modality of choice for cochlear implant assessment; rather they perform best in combination  

Objective: To determine the reference values of liver stiffness in Pakistan using Shear Wave Elastography in subjects without liver disease, with a range of ages and BMI for both genders and to assess the influence of Hepatic Steatosis on liver stiffness values. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan Aug 2018 to Sep 2019. Methodology: One hundred twenty-three subjects who underwent Shear Wave Elastography were enrolled. Measurements were taken from the right hepatic lobe, and the median kilopascal value of 10 measurements was taken as the representative value. The reference range of liver stiffness was calculated using upper and lower limits at 97.5 and 2.5 percentiles. The influence of hepatic steatosis age, body mass index, and gender on liver stiffness was also recorded. Results: The mean age of the subjects was 39.7±12.7 years with a male-to-female ratio of 1.4:1. The Mean liver stiffness value in healthy subjects was 4.90±0.64 kPa. No statistically significant difference was found in the values among various age groups (p=0.013) or the groups based on body mass index, except for the Obese-Group, whose values were considerably higher (p<0.001). Shear Wave Elastography values were significantly influenced by male gender and hepatic steatosis (p<0.001). Conclusion: Real-time Shear Wave Elastography can be used to estimate liver stiffness reliably. Male gender, obesity, and hepatic steatosis are significant factors affecting liver stiffness in otherwise healthy adults.

Objective: To determine the diagnostic accuracy of non-invasive hepatic ultrasound score for the diagnosis of non-alcoholic fatty liver disease (NAFLD) by keeping computed tomography. (CT) as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi from Dec 2017 to May 2018. Methodology: All patients from any ethnicity and gender with more than 18 and less than 60 years of age were considered for the study. Hepatic ultrasound score based on the anteroposterior diameter of the right lobe of the liver, deep beam attenuation was calculated, and results were compared with CT scan findings. Results: A total of 101 patients were included. A total of 69 patients had a total Ultrasound score of 2 or more, fulfilling the study’s criteria to be labelled as Non-Alcoholic Fatty Liver Disease. On a CT scan, 71 patients fulfilled the criteria to be labelled as having Non-Alcoholic Fatty Liver Disease. Keeping the Computed Tomography scan gold standard, 59 patients were true positive, and 10 were false positive. The sensitivity and specificity of this score were 83.09 % and 66.67%, respectively. The hepatic ultrasound score had a Positive Predictive Value of 85.50% and a Negative Predictive Value of 62.5%. Conclusion: Ultrasound score based on hepatic attenuation and the anteroposterior diameter of the right hepatic lobe is a reliable, reproducible and accurate tool for diagnosing Non-Alcoholic Fatty Liver Disease.

Objective: To compare and observe the differences of 18F-FDG produced using FDG citrate and FDG duo citrate cassette on the GE Healthcare FASTlab2 Synthesizer system following standard operating parameters. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to Aug 2021. Methodology: Comparison of 18F-FDG produced using FDG citrate and FDG duo citrate cassette on FASTlab2 consists of evaluating the estimated yield uncorrected (EYUC), estimated yield decay corrected (EYDC), radiochemical purity (RCP), synthesis duration and tracer volume in both cassettes. Sixty Batches of each FDG citrate and duo citrate cassettes were utilized to obtain the required results. Results: Results acquired by comparing the mean yield of FDG citrate and FDG duo citrate cassette were 74.98±8.92% for EYUC and 86.35±10.26% for EYDC for the FDG citrate cassette. At the same time, the mean RCP turned out to be 99.58±1.06% for the citrate cassette and 99.9±0.35 for the duo citrate cassette. The mean synthesis duration of FDG was 24.21±0.76min and 24.75±0.43min for the citrate cassette and duo citrate cassette correspondingly, and the volume of the tracer was 3.5ml for both cassettes. Conclusion: The results obtained by comparing these two cassettes were within the range of acceptable limits as claimed by the manufacturer, with a single cassette offering more yield as compared to a duo cassette, while the radiochemical purity, pH and volume of the tracer were found to be identical in both cassettes.

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.