European Journal of Molecular & Clinical Medicine

Endometrium has a wide range of appearance as well as overlapping imaging features, adding to challenges faced while diagnosing endometrial lesions. Although USG is the first modality to detect the endometrial lesions, MRI provides more details about the lesion. Hence, we aimed to assess and compare USG and MRI in characterising endometrial pathologies and to compare their sensitivity, specificity, positive predictive values and negative predictive values for diagnosis using histopathology (HPE) as a gold standard.

Aim and objectives: Hence this study is being taken up for clinical as well as USG estimation of birth weight close to delivery date and to find their accuracy when compared to actual birth weight of the neonates.
Materials and method: This Prospective cross-sectional comparative study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri Pune from September 2020 to September 2022. Singleton pregnancy with vertex presentation at term (37-40 weeks) who had gestational age confirmed by dates and early trimester ultrasound scan.
Results: Among study population, 86.4% had a liquor between 8-15 cm. There were 4.5% participants each with liquor less than 8 cms, between 16-20 cms and above 20 cm. Weight estimation by the two methods had no statistically significant difference. However, clinical method was found to be slightly more accurate for estimating the antenatal foetal weight.
Conclusion: Clinical and fetal weight estimation is one of the easiest and cheapest method which can be applied in any setup like in rural areas, where facilities for ultrasound machine may not be available. So, clinical method does have the advantage over the other.

Emergency conditions involving the gallbladder and the bile ducts are common radiological challenging problems.The present study was conducted to assess diseases of gall bladder using USG.
Materials & Methods: 60 patients of gall bladder disease of both genders underwent USG performed with a3.5-5 MHz probeby scanning in subtotal position. Once the gallbladder was clearly identified, longitudinal and transverse views of the gallbladder was obtained.
Results: Out of 60 patients, males were 38 and females were 22. Common pathologies were polyps in 32, benign tumor in 14, cholecystitis in 10 and gall stones with sludge in 4 patients. The difference was significant (P< 0.05).
Conclusion: Authors found that ultrasound is non-invasive and the least expensive imaging modality for the assessment of the gallbladder diseases. Common pathologies were polyps, benign tumor, cholecystitis and gall stones with sludge.

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in the evaluation of suspicious ovarian masses.
Methodology: This prospective comparative study was carried out in the Department of Radiology, RVM Institute of Medical Sciences & Research Centre for a period of 15 months. Total 50 women were included in this prospective study. All patients underwent abdominal Ultrasonography and CT scan with determination of the ovarian mass characteristics. Detailed history of allergy and renal function tests were taken before doing CT scan and if there was history of allergy then non-ionic contrast was used. Site, size, papillary projections, wall characteristics, capsular infiltrations, the presence of solid areas inside the mass and presence of as cites were recorded both by US and CT scan.
Results: Out of 50 patients, majority of patients belonged to 40-50 years of age group (19, 38%) followed by 30-40 years of age group (10, 20%). 8 patients (16%) belonged to 20-30 years age group, 7 (14%) belonged to 50-60 years, <20 and >60 years of age group included 3 patients each. There are total 29 cases of Pre-menopausal stage and 21 cases of Post-menopausal stage having ovarian cyst. Out of 29 cases of pre-menopausal conditions have 7 number of malignant and 22 number of benign types of ovarian masses. In the Postmenopausal group there are 17 cases of malignant and 4 cases of benign ovarian mass was observed. Overall, CT was found to have 96% sensitivity, 92% specificity, and an accuracy of 92% in the differentiation of benign and malignant ovarian masses, while PPV and NPV were 94% and 90%, respectively. The sensitivity of USG was 90%, specificity was 86% and PPV and NPV were 88% and 86% respectively.
Conclusion: CT and USG imaging all have approximately similar accuracy in staging ovarian carcinoma but the sensitivity of CT scan for all ovarian cancer detection greater than that of US. Among women with ovarian disorders, CT can be primarily in patients with ovarian malignancies, either to assess disease extent prior to surgery or as a substitute for second look laparotomy.

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using Ultrasonography.
Methodology: This cases control study was conducted among 55 diabetic patients enrolled from the diabetes clinic of the RVM Institute of Medical Sciences & Research Centre, Laxmakkapally, Telangana, India and 55 healthy patients (control group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126 mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75 gm glucose. An informed consent was taken from all the subjects in the study and control groups. All the patients were randomly selected for the study among patients regularly attending diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in control group. 45.5% of diabetics were males and remaining 54.5% were females, whereas in control group male to female ratio was equal, means 49% males and 50% females. 85.5% cases in control group had no gall bladder disease, while only 63.6% cases in group with diabetes had no gall bladder disease. In group with DM type 2, 20% had cholelithiasis, 9.1% had cholecystitis, and 7.3% had sludge: while in control group, 5.5% had cholelithiasis, 3.6% had cholecystitis, and 5.5% had sludge. The percentage of contraction of gall bladder had reduced markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value- 0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than that of controls (28.45 + 4.26) and the difference of values was found to be highly significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and decreased percentage of contraction are observed. Therefore, all T2DM patients should be evaluated using ultrasonography for the presence of increased fasting gallbladder volumes to assess the risk of progression to gall stone disease.

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in the evaluation of suspicious ovarian masses.

Background: Acute appendicitis is the most prevalent cause of acute abdomen and
subsequent surgery. Misdiagnosis is a common and critical problem in general surgery
because the diagnosis is primarily based on clinical grounds. Maximum incidence observed
in the second and third decades of life, with male preponderance. Graded compression
ultrasonography is one of the diagnostic procedures that has been shown to reduce the need
for unfavourable surgical treatments, particularly in females.Objectives: Objectives of the
study were to study the clinical features of acute appendicitis, Utility of USG in supporting
the clinical diagnosis of acute appendicitis. Methods: This study included one hundred and
Twenty Five patients with history of RLQ pain where clinical diagnosis of acute appendicitis
was made. The study period was of 18 months between November 2019 to May 2021.
Routine bloodinvestigations and abdominal USG were done in all cases. All ultrasound
positive cases were subjected to surgery. Some ultrasound negative cases were also taken to
surgery on the high clinical suspicion of acute appendicitis. The ultrasound findings were
compared with clinical findings and histopathological examination reports.

Background: Chest radiograph has been the standard initial imaging modality of choice to
detect pneumothorax. Despite of moderate sensitivity in detection of pneumothorax, due to its
wide range of geographical availability and less expenditure in our country, it has been
widely advocated by all the physicians. Computed Tomography (CT) and Ultrasonography
(USG) being the current point of care in most parts of the country and having no radiation
risks, it can be utilized in early and safe detection of pneumothorax. In this study, we
analyzed the diagnostic utility and efficacy of chest ultrasound in detecting pneumothorax on
comparison to chest x ray.
Methods: Ethical committee clearance and informed consent was taken from all the patients.
Total of 79 patients who were having clinical suspicion of pneumothorax were evaluated.
Initial imaging evaluation was done using B-mode and M-mode chest ultrasonography and
further subjected to chest radiography. Images were assessed by 2 experienced radiologists.
Demographic, clinical and radiological data were documented and analyzed. In the cases of
discrepancy in findings of USG vs. Radiograph, CT was considered the gold standard for
obtaining the final diagnosis.
Results: We found that chest ultrasound had sensitivity of 98.43%, specificity of 100%, PPV
of 100%, NPV of 93.75% and diagnostic accuracy of 98.73%. Chest radiograph had
sensitivity of 73.43%, specificity of 83.33%, PPV of 94%, NPV of 46.9% and diagnostic
accuracy of 78.9%
Conclusion: Chest USG is a useful and essential tool in detection of pneumothorax.
Although chest radiograph being widely available and CT with its highest sensitivity &
specificity, USG stand apart in providing good diagnostic value with no radiation risks.

Aim: To investigate the use of ultrasound in diagnosing patients with first trimester bleeding and to prognosis and forecast the outcome of abnormal pregnancies
Methods: The research included all consecutive individuals having a history of vaginal bleeding in the first trimester of pregnancy. Age, obstetric history, menstruation history, and specifics of the current pregnancy such as period of amenorrhea at the time of the first episode of bleeding, quantity and duration of bleeding, discomfort abdomen, and history of expulsion of fleshy mass/clots were all recorded. Transabdominal sonography was performed on all patients using a GE Logiq P5 Pro ultrasound equipment. When transabdominal sonography was unclear or ambiguous, transvaginal sonography (TVS) was used. The presence or absence of a gestational sac, the location of the gestational sac, the size of the gestational age in comparison to the period of amenorrhea, the margins of the gestational sac, the presence or absence of a foetal pole, crown rump length (CRL), cardiac activity, and the presence of fluid in the cul-de-sac were all noted on an ultrasound.
Results: Clinical examination revealed that 74 (74%) of the cases were threatened abortions, 6 (6%) were complete abortions, 4 (4%) were incomplete abortions, and 2 (2%) were missed abortions. Clinically, no blighted ovum or molar pregnancy was suspected. On USG, 55(55%) of 100 cases were classified as threatened abortion, 15(15%) as complete abortion, and 9(9%) as missed abortion and incomplete abortion. There were also 6 (6%) cases of blighted ovum, 3 (3%) cases of ectopic pregnancy, and 2(2%) cases of complete hydatiform mole. The total disparity between clinical and USG diagnosis was present in 61% of cases, and clinical diagnosis was confirmed by USG in 62 cases, indicating clinical diagnosis accuracy of 62%.
Conclusions: We conclude that USG is a helpful and readily accessible technique for evaluating individuals with first trimester vaginal haemorrhage. It is quite precise in pinpointing the root of the bleeding problem and helping the doctor decide what course of action to take. In the algorithm for deciding whether or not to intervene and keep the pregnancy going, ultrasound is a useful input.

Background: Peripheral nerve pathologies are commonly encountered by clinicians in practice. The present study was conducted to compare MRI and HRUS in detection of peripheral nerve pathologies.
Materials & Methods: 65 cases of peripheral nerve pathologies of both genders underwent HRUS with 14 MHz linear-transducer and 3 or 1.5T MR. The accuracy, sensitivity, and specificity of these modalities compared with the diagnostic standard determined by surgical and/or histopathological.
Results: Out of 65 patients, males were 35 and females were 30. Nerve discontinuity was detected by 78% in MRI and 100% in USG, increased nerve signal  in 100% and 70%, fascicular change in 89% and 100%, caliber change in 56%            and 100%, neuroma/mass lesion in 90% and 100% in MRI and USG respectively. The difference was significant (P< 0.05). MRI and USG showed sensitivity of 92% and 82%, specificity of 67% and 100%, PPV of 95% and 100%, NPV of 58% and 42% and accuracy of 90% and 83% respectively. 
Conclusion: HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies

Background:To study the distribution, pathology, clinical features, various mod es of
investigations and overall management of varicose veins of lower limbs.
Materials and Methods: The study was carried out Govt Medical College/General
Hospital, Suryapet from October 2021– March 2022 to evaluate the ―Clinical
presentation and management of varicose vein in lower limbs. 50 cases of varicose veins
of lower limbs were presented and analysed in our study. Fifty cases of varicose veins of
the lower limb have been studied in detail.
Results: Varicosity of the lower limb is a common clinical entity. The number of cases
reporting to the hospital is much less than the real incidence; because in the absence of
symptoms due to varicose veins patients do not seek treatment in our country. The
commonest age group of patients suffering from varicose veins is 41 to 50 years. Most of
the patient presented to the hospital for one or the other complications and not for
cosmetic reasons. The majority of the patients were male. A definite relationship exists
between the occupation and the incidence of varicose veins as most of our patients are
workers standing for longer duration. The involvement of long saphenous system is
more common than the short saphenous system. Left limb is affected more common.
The cause for the same is not known but could be attributed to the longer course
traversed by the left iliac veins. Clinical examination has a high predictive accuracy. It
gives sufficient information to treat the patients in centres where colour Doppler is not
available or affordable. The use of colour Doppler is a valuable supplement to clinical
examination for effective treatment of varicose veins and its use is strongly
recommended to prevent recurrences and reduce morbidity as it is effective tool in
detecting venous incompetence and to rule out deep vein thrombosis. SPJ junction and
perforators are highly variable and should always be marked pre- operatively using
USG Doppler. Operative line of treatment is a primary procedure in the management of
varicose veins of lower limbs.Venous ulcer heals well after surgery. Surgery is a quality
modality for varicose veins patients with ulcer with low recurrence rate. Complications
are negligible if cases are meticulously selected and operated. The present procedures
enable the patient to lead almost normal life after surgery with few recoverable
morbidities.
Conclusion: There is need for general health education and awareness about varicose
veins in the society in order to achieve timely treatment with good outcome and to
reduce the morbidity.

Background: Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers. Diagnosis of breast cancer is carried out by three medical members, the surgeon, who covers breast examination, the radiologist for mammography and ultrasound, and the pathologist for fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB). Aim of present study is to assess the accuracy of ultrasound guided core needle biopsy in various breast lesions
Material & Methods: A hospital based prospective study done on 100 cases of various breast lesions reporting to the Surgery Department, J.L.N. Medical College and Associated Group of Hospitals, Ajmer, Rajasthanwithin study duration and eligible as per inclusion criteria were included in the study from January 2020 to December 2021. Then an ultrasound guided biopsy specimen is obtained by means of four successive insertions with different angulations of the needle into the core of the lesion. The quantity and quality of the material obtained is judged after immediate immersion of the specimen in fixative, and then specimen is sent to histopathology department. And the core needle biopsy report is compared with the excision biopsy report of the breast lump.
Results: Our results showed that the mean age was 38.79 ± 13.98 yrs (age range 18-75 yrs). On USG guided core needle biopsy and excision biopsy, 53% were found benign tumor, and 47% were carcinoma. Sensitivity is 100% and specificity is 100%. There was no false positive and false negative case present in this study.
Conclusion: We concluded that Ultrasound guided Core needle biopsy can be reliably used for preoperative diagnosis of breast lumps as the first diagnostic step with high sensitivity, specificity, and accuracy for both malignant and benign lesions. However, benign lesions, diagnosed this way, must be followed by frequent examinations.

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. In recent years, imaging guided percutaneous drainage has been increasingly used to treat liver abscess of large size with viscous pus with reported success rates. Our study consists of clinical study (prospective study) of 40 cases of radiologically proven liver abscess and their management by different modalities and their outcome.
Materials& Methods: This is a hospital based prospective study done on 40 cases of radiological proven liver abscess in department of surgery at Government Medical College, Barmer, Rajasthan, India during one year period. USG abdomen was done, using longitudinal, oblique, transverse planes to visualize almost all part of liver. Intercostal and sub costal planes were used. All the liver lesions suggestive of liver abscess were examined in detail (any other abdominal organs were also scanned for any abnormalities). All the patients were hydrated and started on parenteral, third generation cephalosporins and Metronidazole therapy. All patients were simultaneously subjected to USG guided Needle aspiration.
Results: Our study showed that highest incidence (87.5%) of age is found between 3^rd- 6^th decades. Male predominance is always reported in literatures. Liver abscess is commonly seen in low socio-economic group. Ultrasound guided percutaneous needle aspiration was the initial mode of treatment done in our study. Out of 40 patients, 16 patients were successfully treated with single aspiration, 13 required second aspiration, 8 patients were treated with percutaneous catheter drainage after failure of needle aspiration.
Conclusion: Percutaneous needle aspiration is found to be thefirst line of treatment for liver abscess. This method is simple, effective and cheaper. Sinceliver abscess occurs in low strata group in a country like India this procedure is affordable.Percutaneous catheter drainage should be reserved as 2nd line of treatment for large abscesses andabscesses with thick viscous content and for failure of percutaneous needle aspiration cases.

Background:Aim & Objectives: To correlate preoperative TIRADS scoring system with postoperative histopathology of thyroid swellings.
Materials and Methods: A total of 66 patients of thyroid swellings who were treated at the Department of General Surgery, Govt Medical College, Nalgonda, with an age range of 20 – 68 years, were evaluated in this study with respect to age, sex, symptoms type and symptom duration and were investigated with routine hemogram, thyroid profile, FNAC and USG with TIRADS score. The results of USG TIRADS score were compared with the histopathology after excision of the thyroid swelling.
Results: Thyroid swellings are more common in females than in males (M:F ratio = 1:4). Majority of the patients are in the age group of 30-50 years. Swelling in front of the neck is the most common complaint. Majority of the patients had an average duration of symptoms of 6months to 3 years. On clinical evaluation all patients had swelling of thyroid. On USG with TIRADS scoring, TIRADS – 3 is the most common category of the thyroid swelling with 30 patients (45%). On USG TIRADS score, majority were benign lesions 55 (83%), while the rest were malignant 11 (17%). On histopathology, 55 lesions (83%) were benign, while 11 lesions (17%) were malignant. Incidence of malignancy with respect to TIRADS score is TIRADS 2- 4%, TIRADS 3 – 16.7%, TIRADS 4 – 50%, TIRADS 5 – 0%. The present study has a USG TIRADS score sensitivity of 45.5%, specificity of 89.1%, positive predictive value of 45.5%, negative predictive value of 89.1% and accuracy of 81.8%.  The prevalence of malignancy among the patients with thyroid swellings in the present study is 16.7%. USG proved to be a more sensitive modality to evaluate the nodularity of thyroid swellings than clinical evaluation.
Conclusion: The present study was undertaken to evaluate the usefulness of clinical evaluation and USG TIRADS score in management of thyroid nodules High resolution ultrasound is an accurate technique, that has helped to analyse the suspicious sonographic features of thyroid swellings and to assess the risk of malignancy and quantify it using TIRADS score.

Pancreatic lesions are a difficult diagnostic and therapeutic challenge owing to
the deep- seated location of pancreas. The present study was conducted to compare
ultrasonography and computed tomography in the assessment of retroperitoneal masses.
Materials & Methods:84 patients with signs and symptoms of retroperitoneal masses of
both genders were enrolled. All underwent USG and MDCT. Data such as name, age, gender
etc. was recorded. All underwent USG and MDCT. Ultrasound was performed with Logiq
P9ultrasoundmachine. MDCT was performed with Siemens Somatom go 32 sliceCT
machine.
Characteristics like size, appearance, echotexture, vascularity and other findings were
studied.
Results: Out of 84 patients, males were 34 and females were 50. Clinical features were lump
in abdomen in 5, pain in abdomen in 32, fullness of abdomen in10, weight loss in 14, loss of
appetite in 22 and trauma in 1 case. Renal abscess was detected correctly by USG in 18 and
MDCT in 20 cases, renal hematoma in 4 and 8, RCC in 7 and 7, complex renal cyst in 13 and
13, pancreatic carcinoma in 7 and 10, adrenal adenoma in 8 and 10, aortic aneurysm in 7 and
9 and pheochromocytoma in 7 and 7 by USG and MDCT respectively. The difference was
non- significant (P> 0.05).
Conclusion: USG can be recommended as a primary screening tool for evaluating
retroperitoneal lesions and CT can be used as a confirmatory tool for the further evaluation of
the complete extent of lesion.

Aim: To compare modalities like ultrasonography (USG) and computed tomography (CT) in
the evaluation of suspicious ovarian masses.
Methodology: This prospective comparative study was carried out in the Department of
Radiology, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan,
Himachal Pradesh for a period of 12 months. Total 50 women were included in this
prospective study. All patients underwent abdominal Ultrasonography and CT scan with
determination of the ovarian mass characteristics. Detailed history of allergy and renal
function tests were taken before doing CT scan and if there was history of allergy then nonionic
contrast was used. Site, size, papillary projections, wall characteristics, capsular
infiltrations, the presence of solid areas inside the mass and presence of as cites were
recorded both by US and CT scan.
Results: Out of 50 patients, majority of patients belonged to 40-50 years of age group (19,
38%) followed by 30-40 years of age group (10, 20%). 8 patients (16%) belonged to 20-30
years age group, 7 (14%) belonged to 50-60 years, 60 years of age group included 3
patients each. There are total 29 cases of Pre-menopausal stage and 21 cases of Postmenopausal
stage having ovarian cyst. Out of 29 cases of Pre-menopausal conditions have 7
number of malignant and 22 number of benign type of ovarian masses. In the Postmenopausal
group there are 17 cases of malignant and 4 cases of benign ovarian mass was observed.
Overall, CT was found to have 96% sensitivity, 92% specificity, and an accuracy of 92% in
the differentiation of benign and malignant ovarian masses, while PPV and NPV were 94%
and 90%, respectively. The sensitivity of USG was 90%, specificity was 86% and PPV and
NPV were 88% and 86% respectively.
Conclusion: CT and USG imaging all have approximately similar accuracy in staging
ovarian carcinoma but the sensitivity of CT scan for all ovarian cancer detection greater than
that of US. Among women with ovarian disorders, CT can be primarily in patients with
ovarian malignancies, either to assess disease extent prior to surgery or as a substitute for
second look laparotomy.

The goal of the radiological study is to determine the accuracy of MRCP over USG and CT in diagnosing cases with obstructive jaundice.
Methods: The Department of Radiology performed a cross-sectional prospective research. This research comprised 50 individuals with clinically confirmed obstructive jaundice and total bilirubin levels more than 5mg/dl. All patients in the research had a USG examination first, then an MRCP, and lastly a CT scan.
Results: Twenty of the 50 individuals had benign lesions, whereas 30 had malignant lesions. MRCP detects the location of blockage with 96% accuracy, followed by CT and USG. The sensitivity of MRCP and CT is the same, but USG has a sensitivity of 96%. Despite the high sensitivity of USG, the specificity is quite poor at 62% when compared to CT's 62% and MRCP's 96%. Thus, USG is an excellent screening technique for benign obstructive jaundice lesions, but CT and MRCP are the specific investigations. With an accuracy of up to 96%, the MRCP is once again the most accurate examination. MRCP has a high sensitivity and specificity, making it more accurate. While USG and CT have great sensitivity, their specificities are poor. The MRCP has the biggest area of the three studies, demonstrating that it is the most effective in detecting malignant lesions. Again, the p value is more than 0.05, indicating that it is significant. Thus, in the diagnosis of obstructive jaundice, MRCP is statistically more significant than CT and USG.
Conclusion: In the diagnosis of obstructive jaundice and to determine the aetiology, location, and size of the lesion, MRCP seems to be a better option than other radiological techniques such as USG, CT, or ERCP

Aim: To determine parenchymal thyroid diseases using Ultrasonography (USG) in adult
patients.
Methodology: This study was conducted in the department of Radio-diagnosis, Maharishi
Markandeshwar University, Solan. It comprised of 75 adult patients age ranged 21-70 years
of age. All patients were well informed regarding the study and their consent was obtained.
Particulars such as name, age, gender was recorded in case history proforma. A thorough
clinical examination was performed in all patients. Patients were divided into five groups
such as group I (normal); group II had first detected, early untreated Hashimoto disease (EH);
group III comprised of chronic Hashimoto patients that are under treatment and/or follow up
(H); group IV had multinodular parenchymal hyperplasia (M)and group V had nodular
hyperplasia with Hashimoto (HM). All examinations were performed with the patient in a
supine position with the neck hyperextended. We calculated the thyroid volume with an
automated formula (length £ width £ depth £ 0.52). We categorized the thyroid gland
echogenicity as hypoechoic, isoechoic or hyperechoic relative to the cricoid cartilage. We
evaluated the parenchyma for the presence of nodules, as well as the visibility of tiny
echogenic reticulations.
Results: Out of 75 cases, 35 (46.7%) were males and 40 (53.3%) were females. Each group
included 15 patients each. Mean RI in group I was 0.53, in group II was 0.54, in group III was
0.40, in group IV was 0.49 and in group V was 0.51. Mean AT in group I was 26.0, in group
II was 25.5, in group III was 71.1, in group IV was 46.6 and in group V was 44.8. Mean
SWV in group I was 1.57, in group II was 1.69, in group III was 1.14, in group IV was 1.47
and in group V was 1.60. The difference was significant (P< 0.05).
Conclusion: Real-time ultrasonography can be helpful for accurately diagnosing TD and
ultrasound finding of two or more TD features has good diagnostic accuracy

Aim: To assess the gallbladder volume in T2DM patients and in healthy controls by using
Ultrasonography.
Methodology: This cases control study was conducted among 50 diabetic patients enrolled
from the diabetes clinic of the Medicine Department of Maharishi Markandeshwar medical
college and hospital Kumarhatti, Solan, Himachal Pradesh and 50 healthy patients (control
group). 30-60 year patients of type 2 diabetes mellitus diagnosed since 5 year or more and
functioning gall bladder with well controlled blood sugar levels. The diagnosis of diabetes in
these patients was in accordance with WHO criteria i.e., fasting plasma glucose level ≥126
mg/dl, and ≥200 mg/dl plasma glucose level after 2hr of ingestion of standardised 75gm
glucose. An informed consent was taken from all the subjects in the study and control groups.
All the patients were randomly selected for the study among patients regularly attending
diabetic clinic of this hospital and following our criteria’s of selection.
Results: Mean age of diabetic Patient was 48.5 years in study group and 53 years in
control group. 46% of diabetics were males and remaining 54% were females, whereas in
control group male to female ratio was equal, means 50% males and 50% females. 90% cases
in control group had no gall bladder disease, while only 66% cases in group with diabetes
had no gall bladder disease. In group with DM type 2, 10% had cholelithiasis, 8% had
cholecystitis and 3% had sludge: while in control group, 4% had cholelithiasis, 2% had
cholecystitis and 4% had sludge. The percentage of contraction of gall bladder had reduced
markedly in chronic diabetics (45.6 + 9.57) as compared to controls (65.2 + 7.34) (p value-
0.001). The fasting gall bladder volume in chronic diabetics was higher (43.47 + 5.35) than
that of controls (28.45 + 4.26) and the difference of values was found to be highly
significant (p value 0.001).
Conclusion: In patients of diabetes mellitus type 2, higher fasting gall bladder volume and
decreased percentage of contraction are observed. Therefore, all T2DM patients should
be evaluated using ultrasonography for the presence of increased fasting gallbladder
volumes to assess the risk of progression to gall stone disease.

Introduction: The rotator cuff disorders constitute the most common cause of shoulder
pathologies. Ultrasonography and MRI are widely used in evaluating various shoulder
pathologies. USG of shoulder is simple, cheap, fast and non-invasive imaging technology
for detection of rotator cuff and non- rotator cuff abnormalities. In this study we have
assessed the usefulness of USG in diagnosing the shoulder pathologies and have correlated
with the MRI.
Aim: Evaluation of a patient with shoulder pathology with ultrasonography as the initial
line of imaging technique as compared to MRI, assessing the accuracy of ultrasonography
in diagnosing shoulder joint pathologies, especially rotator cuff abnormalities, using MRI
as a reference standard and correlating findings wherever possible.
Materials and Methods: Hundred patients were studied prospectively over a period of two
years. Study subjects included both men and women in all age groups with suspected
shoulder pathology, suspected to have musculo-tendinous origin. All patients underwent
USG evaluation of the shoulder joint followed by MRI of the affected shoulder.
Results: USG showed a sensitivity of 85%, specificity of 100%, PPV of 100% and NPV of
97% in diagnosing full thickness tear of rotator cuff using MRI as reference. For partial
thickness tears, it showed a sensitivity of 71%, specificity of 69%, PPV of 82% and NPV of
54%. Overall accuracy of USG in detection of any tear of rotator cuff with MRI as
reference was 82%. The strength of agreement between USG and MRI for the diagnosis of
any tear of rotator cuff is considered to be ‘substantial’ in our study (Kappa=0.635).
Conclusion: USG showed comparable results to MRI in assessment of rotator cuff
abnormality and should be used as first line of investigation in patients presenting with
shoulder pathologies. It proved to have high sensitivity and specificity for full thickness
tears with relatively less sensitivity and specificity in detection of partial thickness tear.

Basic Immunization coverage is still one of problems in Tulungagung district. For the last 3 years, the basic immunization coverage did not cover all the target infants. In 2018, from the target of 15,147 infants, there were 1,116 infants who did not receive immunization of Hepatitis B, 689 infants were not immunized with Bacillus Calmette Guérin (BCG) and 849 infants were not immunized for Oral Polio Vaccine (OPV 1). Aim of the study : To analyze the problems of basic immunization program. Method: This study is a descriptive observational study, conducted at Tulungagung District Health Office from January to February 2019. Identification of problems was done by conducting interviews, analyzing secondary data on basic immunization coverage of the Tulungagung health profile from 2016 to 2017 and section report Surveillance and Immunization in 2018. Prioritisation of Basic Immunization problems was done using Urgency, Seriousness, Growth (USG) criteria. Analysis of the problem cause was done by Fishbone methods.Results: Of the problems identified, the first priority problem in Tulungagung District 2018 is Hepatitis B immunization coverage does not reach the target. The root causes were poor immunization, under qualified workers in data collection and validation of targets, poor integration of Basic Immunization and Maternal and Child Health (MCH), lack of promotion and media campaign.Conclusion: Low Hepatitis B immunization coverage is a priority problem for basic immunization programs. Optimization of the integration of child and maternal health immunization program (MCH) is needed, periodic validation of program coverage and health promotion on immunization using creative promotional media.