The term 'neuromyelitis optica' ('Devic's syndrome', NMO) refers to a syndrome characterized by optic neuritis and myelitis. In recent years, the condition has raised enormous interest among scientists and clinical neurologists, fuelled by the detection of a specific serum immunoglobulin (Ig)G reactivity (NMO-IgG) in up to 80% of patients with NMO. These autoantibodies were later shown to target aquaporin-4 (AQP4), the most abundant water channel in the central nervous system (CNS). Here we give an up-to-date overview of the clinical and paraclinical features, immunopathogenesis and treatment of NMO. We discuss the widening clinical spectrum of AQP4-related autoimmunity, the role of magnetic resonance imaging (MRI) and new diagnostic means such as optical coherence tomography in the diagnosis of NMO, the role of NMO-IgG, T cells and granulocytes in the pathophysiology of NMO, and outline prospects for new and emerging therapies for this rare, but often devastating condition.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/cei.12271

Neuromyelitis optica: clinical features, immunopathogenesis and treatment

Approval of fingolimod in 2011 heralded the era of oral therapies for multiple sclerosis (MS) in the European Union. Uptake of fingolimod across Europe was widespread, even though its indication was predominantly second-line; that is, for patients with a lack of response to interferon beta or those with highly active relapsing–remitting MS (RRMS). Safety concerns raised with the European Medicines Agency culminated in the revision of the European Union labeling for first-dose management in 2012. However, in addition to evidence from the pivotal clinical trials, cumulating real-world fingolimod experience in Europe provides reassurance on its safety and efficacy. Studies show that switching to fingolimod from approved first-line injectable therapies is beneficial for patients who might otherwise switch to another interferon beta or glatiramer acetate. Furthermore, in several recent European studies of patients who switched to fingolimod from natalizumab, disease control was improved compared with drug withdrawal and no immunomodulatory treatment, or withdrawal and first-line treatment, including the Disease Control and Safety in Patients with RRMS Switching from Natalizumab TO FINGOlimod (TOFINGO) study, which supported a shorter washout period before switching. The safety profile shown in clinical trials is supported by post-marketing observations; any first-dose effects on heart rate are managed easily, and severe complications as a result of herpes viral infections are rare. The use of newer oral drugs remains a key topic of discussion, in light of the recognized importance of an early shift of suboptimal responders to another therapy. The information on fingolimod summarized in the present review may contribute to define its role further in RRMS treatment in Europe.

Position and practical use of fingolimod in Europe

Vaginal bleeding in first trimester is most common complication of pregnant women. The ratio of vaginal bleeding in pregnant women is 20-25%. About 50% of pregnant women experiencing vaginal bleeding in first trimester have viable pregnancy. 50% cases of abortion are reported in first trimester vaginal bleeding. Therefore, it is necessary to evaluate the significance of ultrasonography in diagnosis of first trimester vaginal bleeding. Objective: Objective of the study is to elaborate the fundamental role of ultrasonography in first trimester vaginal bleeding. The ratio of misdiagnosis in putatively nonviable pregnancy will be reduced by complete understanding of ultrasonography significant. In this way the premature interventions can be avoided that ultimately leads to mismanagement. Study Design: It was an observational study with statistical approaches, conducted in BKMC / MMC, Mardan for the duration of six months from December 2020 to May 2021.  Methods: All the antenatal women having complaint of first trimester vaginal bleeding visited the hospital was included in this prospective observational study. Those who met the inclusion and exclusion criteria set by the Gynecology department of Hospital were followed for further analysis study. Results: Out of the 90 patients included in the study, 51% cases were of threatened abortion among viable pregnancies and 6% cases of normal pregnancy were reported. Various types of abortion were reported in the patients, out of which 11% cases were of missed abortion, 1% of complete abortion, and 11% of incomplete abortion, 5% of ectopic pregnancy and 10% of blighted ovum. The inevitable abortion cases were 3% and 1.1 % cases of hydatidiform mole. Conclusion: After developing better understanding of correlation between ultrasonography and first trimester vaginal bleeding, sonologist can elaborately explain the cause of vaginal bleeding.  For the diagnosis of first trimester vaginal bleeding ultrasonography is the non-invasive imaging technology.

Role Of Ultrasound in First Trimester Vaginal Bleeding Observational Study at Tertiary Care Hospital

Background and objective: Neck pain is one of the most important factors for degenerative changes in cervical spine. Magnetic Resonance Imaging (MRI) is best imaging modality for evaluation of changes in cervical spine due to neck pain. The aim of this study is to determine the frequency of MRI findings in patients with neck pain. Material and methods: A convenient sample of 78 patients with neck pain was used in this descriptive cross-sectional investigation referred to radiology department of Gondal medical complex Gujranwala for evaluation of MRI findings of cervical spine in patients with neck pain during a time period of 4 months from January 24, 2022 to May 24, 2022. MRI was done using 1.5T scanner. Results: The patients belonged to the age group were between 13 to 80 years old, with a mean age ± SD of 44.83 ± 14.22 years. This study showed that female (53.8%) ratio was higher than male (46.2%). Total of 78 patients was suffering from neck pain only 10 were observed with radiating shoulder pain. There were no degenerative findings found in 16 patients. The most common radiological findings were disc osteophyte which account for 46 (59.0%) more prevalent at C5/C6 level. Conclusion: In this study, neck pain is commonly caused by degenerative changes in cervical spine and it is more common at C5/C6 level. MRI is best modality and it's a non-invasive approach for detecting degenerative diseases early and initiating treatment.

/pdf/frequency-of-mri-findings-in-patients-with-neck-pain-1az9lhrv.pdf

Frequency of MRI Findings in Patients with Neck Pain

A person&#39;s body weight, height, and age influence the size of their abdominal organs. Ultrasound imaging is a noninvasive, radiation-free, fast, low-cost method of evaluating the urinary system and measuring different abdominal organs. The purpose of this study was to correlate body measurements with renal and splenic measurements. A total of 94 university students from both genders were studied by the radiology department at the University of Hail between September 2017 and December 2019. A 

https://archivepp.com/storage/files/article/13234bfd-4cfc-41a7-9100-09cfb0be77ad-xhfmqzZvWmV8d7XJ/archiveapp-vol13-iss2-123-126-1365.pdf

Association of Sonographic Measurements of Kidneys and Spleen with Body Hight in University Age Saudi Population

Dear Editors We present the case of an 83-year-old African-American female who came to our hospital with an unusual presentation. She has been legally blind for the past 50 years after developing retinitis pigmentosa in her early thirties. Prior to her illness she was walking freely and did not require any assist devices for ambulation. She developed diarrhea and vomiting two days before presentation followed by generalized weakness. On our initial evaluation the patient had a hoarse voice, labored breathing and was incontinent. She was blind with non-reactive pupils. Neck flexion was weak and a Lhermitte’s sign was noted. She had antigravity strength on the right and was weaker on the left-hand side. Joint position, vibratory sense, as well as pinprick sensation were profoundly affected from the neck down. Reflexes were brisk and toes were upgowing bilaterally. Magnetic resonance imaging (MRI) of the cervical spine revealed a T2 hyperintense lesion in the cervical cord from the level of the lower medulla to the upper C4 segment and post contrast infusion demonstrated enhancement of this lesion. MRI of the brain demonstrated the lower medullary findings but was otherwise unremarkable. Her findings were comparable with Neuromyleitis optica or Devic’s disease (NMO), although her age made us doubt the diagnosis. Cerebral spinal fluid analysis showed glucose of 72 mg/dl, total protein of 98 mg/dl with no oligoclonal bands and normal IgG index. Cerebrospinal fluid cell count was normal. Infectious and autoimmune panels were nonrevealing. The serum NMO antibody was surprisingly positive with a high titer of 8 units/ml. In our literature search, we have not found any published reported cases on seropositive NMO at this age. Previous studies have indicated that in multiple sclerosis (MS) African-Americans have an older age at onset,1 experience greater disability, are at increased risk for secondary progressive MS, experience transverse myelitis more often, are more likely to have motor symptoms at onset and are more likely to have the Opticospinal disease subtype.1,2 A recent paper on the epidemiology of NMO in the United States aimed at developing a national multicenter NMO clinical consortium reporting initial demographic, clinical and radiographic features in patients with NMO included patients ranged from 3–81 years.3 The presenting age, severity of disease and incidental finding of retinitis pigmentosa in this patient were found to be unique.

One of the oldest patients with Neuromyelitis Optica in the literature.

Ultrasound provides accurate gestational age and diagnosis of any complications. The complication can be due to nulliparity, aged females, and a history of abortion. The common complications of the first trimester are blighted ovum, ectopic pregnancy, and abortion. Objective: The objective of this study was to determine risk factors causing complications of pregnancy in the first trimester. Material and methodology: This retrospective study was performed with a sample size of 60 patients in 6 months from October-2022 to March-2022 calculated via convenient sampling technique by taking mean from previously published studies. This study was carried out at 3 private hospitals in Gujrat, Pakistan. An ultrasound machine (Aplio 300) was used to evaluate females with early pregnancy loss after informed consent. Data were statistically analyzed using SPSS version 28. Frequency and percentages were mentioned for age groups, Obstetrical history, and ultrasound findings. Results: The most common complication in 1st trimester was incomplete abortion (29, 48.3%) following missed abortion 17(28.3%). The risk factors causing complications were gravidity, parity, abortions, fibroids, trauma, and molar pregnancy. The age group of 30-39 years has the maximum number of patients (30, 50%) diagnosed with complications. The common risk factor causing complication was due to age 30(50%), trauma 18(30%), gravidities were G4 (14, 23.3%) and G2 (10, 16.7%) and parity P1 (19 patients, 31.7%) and P2 (14 patients, 23.3%). Conclusion: In conclusion, the incidence of complication increased in nulliparous, aged females and decreased in females having less gravidity. Patients with a history of abdominal pain and vaginal bleeding were noticed to have a higher incidence of complications. Nulliparous and multiparous women having poor obstetrical history are at high risk. Transvaginal ultrasound is very effective in diagnosing ectopic pregnancy and missed abortion.

Ultrasound Diagnosis and Risk Factors of 1st Trimester Complications in Pregnancy

Background: Upper extremity fractures are the most common musculoskeletal injury seen in the emergency/trauma center. Upper extremity fractures (UEFs) may result in long-term disability. 
AIM AND OBJECTIVE 
 The aim of our study was to assess the frequency of fractures in patients with road traffic accident and its association with age. 
Methodology: This prospective cross-sectional study was conducted at X-Ray unit in Aziz Bhatti Trauma Center Gujrat, Pakistan. A total of 200 patients with the history of road traffic accident were enrolled in present study. The duration of this research work was from February 2022 to May 2022. All RTA patients visited us were included. Patients who were admitted in the wards were excluded. Predesigned questionnaire form was used to collect the data. SPSS was used to analyze the data. Frequency of different findings and their associations were found out using the chi square test. These were then graphically portrayed in the form of tables and graphs. P value < 0.05 was considered as significant. 
Results: We observed 102(51%) fractures in a total of 200 patients. Higher percentage 98(49%) was found in the age group 16-30 years with male predominance. Injuries due to motorcycle fall 110(55%) were the main cause of upper extremity fractures in case of RTA. Radius and humerus were the most frequently fractured bone 21(10.5%) and 20(10%) respectively. 
Conclusion: Our study showed that the frequencies of upper extremity fractures occur mostly in males and mostly due to the motorcycles fall. Our study established the frequency of upper extremity fractures and it can be considered as a useful guide to determine its occurrence in case of RTAs.

Frequency Of Upper Extremity Fractures In Patients With Road Traffic Accidents And Its Association With Age

One of the leading causes of bone fractures are Road Traffice Accidents (RTAs), they are perhaps the most prevalent causes of mortality in individuals. Objective: To investigate the prevalence and types of bone fractures in patients who have been involved in a road traffic collisions in the city of Gujranwala, Pakistan. Methods: It was a cross-sectional analysis at the orthopedic department of the DHQ/Teaching Hospital in Gujranwala, all patients with RTA-related fractures who underwent x-rays were included after written informed consent. The study included a total of 100 patients, all of which had suffered fractures as a result of traffic incidents from January 13th, 2022 to April 13th, 2022, the research was completed in three months. The obtained data were entered and analyzed by utilizing IBM SPSS Statistics 26.0. Results: There were 35 females and 65 males in the study, and according to the age distribution, 34% of those aged 26 to 35 years had a higher risk of fracture. Femur 37.7%, tibia 21.3%, fibula 16.4%, radius 2.5%, ankle joint 1.6%, humerus 6.6%, knee joint 2.5%, elbow joint 4.9%, and thumb and spine 0.8% are among the bones that have been fractured. Moreover, no incidents of skull fractures were recorded. Conclusion: Bone fractures are much more common in men than in women. In road traffic accidents, the most common bone fracture is the femur, which occurs most frequently in people who ride motorbikes or cycles, whereas, the transverse bone fracture is the most prevalent type of bone fracture.

/pdf/x-ray-radiography-of-bone-fractures-associated-with-road-35mcxp4v.pdf

X-ray Radiography of Bone Fractures Associated With Road Traffic Accidents RTA

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