Ramish Riaz

Background: Autism Spectrum Disorder is a developmental disorder characterized by difficulties in social interaction, initiating conversations, delay in language skills, play skills and stereotypic behaviours. Children with severe developmental delay and those with global developmental delays are needed to be identified as they may have long term problems and disabilities. Materials & Methods: All children below age of 5 years coming first time for assessment of ASD and diagnosed using ADI-R and ADOS-2 were included in the study. Total 334 children met the criterion. All children having performance deficit below 2SD on age appropriate mean were considered as having developmental delay. Those having delay in two or more than two domains were labelled as having global developmental delay. Detailed clinical and developmental assessment was performed.  Data was entered and analysed via SPSS v26. Results: Mean age of children at time of presentation was 3.6±1.10 years with male to female...

Elastomers are employed in the field of acoustics as sound enhancers and making tissue‐mimicking phantoms for ultrasound imaging due to their good viscoelastic properties. Polyglycerol sebacate (PGS) is a relatively new biocompatible, biodegradable elastomer with low elastic modulus prepared via two‐step melt condensation reaction. The first step yields a soluble pre‐polymer while the second results in a cured insoluble tough elastomer. The elasticity of polymer is dependent upon curing time. Attractive aspects of pre‐PGS to be used as ultrasound contrast agent lie in its excellent viscoelastic properties, that is, low elastic modulus, near to lipids. This can give it acoustic properties of lipid microbubbles while keeping a stable response of polymeric microbubbles. In this study, pre‐PGS was synthesized via the melt‐condensation method and characterized by FTIR, NMR, TGA, melt flow index, contact angle, titration, and uniaxial compressive testing. Viscosity was measured by the Ostwald technique. These viscoelastic measurements were used to predict the acoustic response of pre‐PGS shell‐based microbubbles by running equations in MATLAB. Pre‐PGS showed an elastic modulus of 1.26 MPa and thermal stability up to 100°C. PGS showed much more elasticity than commercially available Sonovue ultrasound contrast agent, also it has low viscosity (0.016 Pa s) and density (1186 kg/m), due to which it has a low damping coefficient (4.32 × 106) compared to Sonovue (7.63 × 107), giving better oscillations in an acoustic field with higher scattering cross‐sectional area than standard Sonovue microbubbles. Based on these simulations pre‐PGS with 50%–60% degree of esterification showed excellent viscoelastic properties which make it an ideal material for microbubble ultrasound contrast agent.

Spina bifida occulta (SBO) is usually considered as benign entity without having any clinical significance. In Pakistan, there is a lack of studies on spina bifida. Clinicians usually ignore the mild urinary complaints and do not look in perspective of SBO background. Micturating cystourethrography (MCUG) of the 71 children with SBO having urinary complaints was done. Analysis was done via SPSS version 20. A total of 70.4% of the patients had urinary tract abnormalities on MCUG. Vesicoureteric reflux was the most common finding. SBO is a clinically significant disorder. Especially in patients with urinary complaints, MCUG must be done to look for underlying pathologies.

Stroke is the most common cause of mortality and morbidity worldwide. The prognosis of stroke depends upon the area affected and its early treatment. Time is of the essence in the care of stroke patients as it is estimated that approximately 1.9 million neurons, 14 billion synapses, and 12 km myelinated nerve fibers are lost per minute. Therefore, early diagnosis and prompt treatment are necessary. The primary goal of imaging in acute stroke is to diagnose the underlying cause, estimate the area affected, predict response towards thrombolytic therapy and to exclude the conditions mimicking stroke. With advancements in radiology, multiple imaging modalities are available for diagnosis and predicting prognosis. None of them is considered alone to be perfect. In this era of multimodality imaging, the decision of choosing appropriate techniques depends upon purpose and availability. Non-Contrast Computed Tomography is time effective, and helps in excluding other causes, Trans Cranial Doppler is time-effective and cost-effective with wide availability, however, is operator dependent and less sensitive. It holds a great future in sonothrombolysis. Magnetic Resonance Imaging is so far considered to be the most superior one in terms of early diagnosis, planning for interventional treatment and predicting the response of treatment. However, it is limited due to high cost and lack of availability. The current review gives a detailed account of all imaging modalities available for imaging stroke and their associated pros and cons.

Recently, dual-mode imaging systems merging magnetic resonance imaging (MRI) and ultrasound (US) have been developed. Designing a dual-mode contrast agent is complex due to different mechanisms of enhancement. Herein, we describe novel phase change nanodroplets (PCNDs) with perfluoropentane encapsulated in a pre-polyglycerol sebacate (pre-PGS) shell loaded with polyethylene glycol (PEG)-coated iron oxide nanoparticles as having a dual-mode contrast agent effect. Iron oxide nanoparticles were prepared via the chemical co-precipitation method and PCNDs were prepared via the solvent displacement technique. PCNDs showed excellent enhancement in the in vitro US much more than Sonovue® microbubbles. Furthermore, they caused a susceptibility effect resulting in a reduction of signal intensity on MRI. An increase in the concentration of nanoparticles caused an increase in the MR contrast effect but a reduction in US intensity. The concentration of nanoparticles in a shell of PCNDs was optim...

Background: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy caused by compression of median nerve at wrist as it passes through osseofibrous canal known as carpal tunnel. Epidemiological statistics shows one in every ten people develops the disease at any stage of life. CTS mostly affect females than males with mean age of 50. Clinical features are considered to be enough for establishing the diagnosis of carpal tunnel syndrome. However, nerve conduction studies give quantitative information regarding median nerve function therefore good at predicting outcome of intervention. Ultrasound being easily available, cost effective and real time is a promising modality for diagnosis and grading carpal tunnel syndrome. Methods: This correlational study was conducted in collaboration of Neurology and Radiology Department of Pakistan Institute of Medical Sciences, Islamabad from January 2018 to January 2019. Total 50 patients with 85 wrists involved were included i...

Background: In children, clinical profile of malaria may vary from nearly asymptomatic disease to febrile illness leading to life threatening complications. The mortality among children is largely due to complications like cerebral malaria, severe anemia and pulmonary complications. The current study was conducted to study the clinical profile of malaria, its complications and factor associated with its complications. Methodology: This observational study was conducted at Children Hospital, PIMS from March 2018 to March 2021. All patients with positive immunochromatographic test and needing hospitalization due to unsettled fever or other troublesome symptom were included. Total 53 patients were included in the study.  All patients underwent routine investigations which included ICTMP, complete blood picture, ultrasound abdomen, chest x rays, and routine urinary analysis. Severe malaria was characterized upon WHO guidelines.   Patients were treated with chloroquine while those resist...

Objective: To determine the association of ante partum, intra partum and post partum risk factors with perinatal mortality in a public hospital. Methodology: This case-control study was conducted at children hospital, PIMS. All still births and live births that expired within seven days of life were categorized as cases. 100 cases were taken, similar number of gestational age and birth weight matched babies who survived till the 7th day of life were taken as controls. Data regarding maternal profile, ante partum, intra partum and postpartum risk factors was analyzed by SPSS v 10. Results: Maternal residence, booking status, maternal nutritional status, anemia, pregnancy induced hypertension, maternal diabetes, placental abruption and respiratory distress syndrome were identified as significantly contributing factors to perinatal mortality. Conclusions: Majority of the risk factors associated with perinatal mortality were ante partum risk factors related to antenatal care. Proper ant...

Objective: To assess the efficacy of digital mammography in differentiation of benign and malignant breast masses. Methodology: This validity study was conducted in Radiology Department, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from September 2016 to September 2017. 55 patients with BIRADS 0, III, IV & V on digital mammography underwent histopathological analysis. Diagnostic accuracy of digital mammography was calculated by taking histopathological analysis as gold standard. Analysis was done via SPSS version 20. Results: Mean age for disease was 46.30±8.30 years. Overall Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value for digital mammography were found to be 93.75%, 97.44%, 93.75% and 97.44%. Both Sensitivity and specificity were higher below age of 50 than for patients above age 50. Conclusions: Digital mammography had excellent specificity and sensitivity especially for younger breasts. Due to low dose and superior contrast res...

Background: Klippel-Trénaunay-Syndrome (KTS) is characterized by a triad of varicose veins, port-wine stain and soft tissue or bony hypertrophy, and the diagnosis of KTS can be made if any two of these three features are present. Hemangiomas in various locations, e.g., skull, brain, epidural and vertebral hemangioma, mediastinal, colonic hemangioma, intraneural/intramuscular hemangiomas, are reported with KTS. Case Presentation: Benign vascular tumors may rarely develop malignant transformation as Bugarin- Estrada et al. reported breast angiosarcoma in a patient diagnosed as Klippel-Trenaunay-Syndrome. We reported a case of a 40-year-old female with a known case of Klipple-Trenaunay-Syndrome with left leg varicosities, cutaneous nevus, as well as unfortunate development of deep venous thrombosis and markedly enlarged right breast hemangioma. Due to low incidence or lack of early detection of breast hemangioma, its diagnosis is challenging. Conclusion: The history of the patient and ...

Introduction The prevalence of deafness is high in Pakistan. Knowledge regarding the clinical features of patients with profound hearing loss will not only help identify the cause but will also help in the strategic planning for public health interventions. Objective The present study was conducted to cover in detail the clinical aspects of children with hearing loss, that is, age at presentation, associated deficits and disorders, possible cause of the disease, associated family history, and role of consanguineous marriage. Methods The present study was performed from November 2016 to September 2018. All of the patients under 6 years of age with profound bilateral hearing loss who would benefit from cochlear implantation were included in the study. Detailed history was taken. The developmental skills were assessed for all areas, and the patients were scored regarding their motor, manipulative, visual, language, social and self-care skills according to the Schedule of Growing Skills...

Spina bifida occulta (SBO) is usually considered as benign entity without having any clinical significance. In Pakistan, there is a lack of studies on spina bifida. Clinicians usually ignore the mild urinary complaints and do not look in perspective of SBO background. Micturating cystourethrography (MCUG) of the 71 children with SBO having urinary complaints was done. Analysis was done via SPSS version 20. A total of 70.4% of the patients had urinary tract abnormalities on MCUG. Vesicoureteric reflux was the most common finding. SBO is a clinically significant disorder. Especially in patients with urinary complaints, MCUG must be done to look for underlying pathologies.

Elastomers are employed in the field of acoustics as sound enhancers and making tissue‐mimicking phantoms for ultrasound imaging due to their good viscoelastic properties. Polyglycerol sebacate (PGS) is a relatively new biocompatible, biodegradable elastomer with low elastic modulus prepared via two‐step melt condensation reaction. The first step yields a soluble pre‐polymer while the second results in a cured insoluble tough elastomer. The elasticity of polymer is dependent upon curing time. Attractive aspects of pre‐PGS to be used as ultrasound contrast agent lie in its excellent viscoelastic properties, that is, low elastic modulus, near to lipids. This can give it acoustic properties of lipid microbubbles while keeping a stable response of polymeric microbubbles. In this study, pre‐PGS was synthesized via the melt‐condensation method and characterized by FTIR, NMR, TGA, melt flow index, contact angle, titration, and uniaxial compressive testing. Viscosity was measured by the Ost...

Majority of the deaths associated with cancer are attributed to metastasis. Till now there had been no cure of metastasis. Metastatic cells are usually resistant to conventional radiotherapy and chemotherapeutic agents. Metastasis can occur even after decades of treatment of primary tumor. Insights into the molecular mechanisms promoting metastasis could help in developing novel techniques that will prevent development of metastasis. The chapter discusses the major molecular mechanisms that support metastasis. It highlights the mechanisms involved in metastatic dormancy, immunomodulation, and mechano-transduction and their possible role in establishment of metastasis. It gives in-depth review of tumor microenvironment and how microenvironment plays role in supporting micrometastasis. It also discusses the mechanisms and factors which help the micrometastasis to escape the immune response and develop overt metastasis.

: Stoke is the most common cause of mortality and morbidity worldwide. The prognosis of stroke depends upon the area affected and early treatment. Time is of the essence in the care of stroke patients as it is estimated that approximately 1.9 million neurons, 14 billion synapses, and 12 km myelinated nerve fibers are lost per minute. Therefore, early diagnosis and prompt treatment are necessary. The primary goal of imaging in acute stroke is to diagnose the underlying cause, estimate the area affected, predict response towards thrombolytic therapy and to exclude the conditions mimicking stroke. With advancements in radiology, multiple imaging modalities are available for diagnosis and predicting prognosis. None of them is considered alone to be perfect. In this era of multimodality imaging, the decision of choosing appropriate techniques depends upon purpose and availability. Non-Contrast Computed Tomography is time effective, and helps in excluding other causes, Trans Cranial Doppler is time-effective, and cost-effective with wide availability, however is operator dependent and less sensitive. It holds a great future in sonothrombolysis. Magnetic Resonance Imaging is so far considered to be the most superior one in terms of early diagnosis, planning for interventional treatment and predicting the response of treatment. However, is limited due to high cost and lack of availability. The current review gives a detailed account of all imaging modalities available for imaging stroke and their associated pros and cons.