Search results for: Habibullah Pathan
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 18

Search results for: Habibullah Pathan

18 Investigating the Challenges Faced by English Language Teachers in Implementing Outcome Based Education the Outcome Based Education model in Engineering Universities of Sindh

Authors: Habibullah Pathan

Abstract:

The present study aims to explore problems faced by English Language Teachers (ELT) while implementing the Outcome Based Education (OBE) model in engineering universities of Sindh. OBE is an emerging model initiative of the International Engineering Alliance. Traditional educational systems are teacher-centered or curriculum-centered, in which learners are not able to achieve desired outcomes, but the OBE model enables learners to know the outcomes before the start of the program. OBE is a circular process that begins from the needs and demands of society to stakeholders who ask the experts to produce the alumnus who can fulfill the needs and ends up getting new enrollment in the respective programs who can work according to the demands. In all engineering institutions, engineering courses besides English language courses are taught on the OBE model. English language teachers were interviewed to learn the in-depth of the problems faced by them. The study found that teachers were facing problems including pedagogical, OBE training, assessment, evaluation and administrative support. This study will be a guide for public and private English language teachers to cope with these challenges while teaching the English language on the OBE model. OBE is an emerging model by which the institutions can produce such a product that can meet the demands.

Keywords: problems of ELT teachers, outcome based education (OBE), implementing, assessment

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17 First Record of Eotragus noyei from the Middle Siwalik Dhok Pathan Formation of Pakistan

Authors: Abdul M. Khan, Hafiza I. Naz, Ayesha Iqbal, Muhammad Akhtar

Abstract:

The fossil remains described in this study have been recovered during fieldwork by the authors from the Dhok Pathan Formation of Middle Siwaliks Pakistan in December, 2015. The sample comprises maxillary and mandibular fragments along with isolated upper and lower teeth. The morphometric analysis of the specimens led us to recognize the sample as belonging to Eotragus noyei, which has been considered as the smallest and the oldest bovid in the Siwaliks. Eotragus noyei is characterized by brachydont teeth, finely rugose enamel, more inclined buccal walls of the molars and small lingual cingula. The inclination of the metaconal area has caused rotation of the metastyle in relation to the antero-posterior tooth axis and thus situated more lingually. The protocone in second upper premolar is well developed and situated posteriorly and also has an anterior lingual constriction. The metaconule in the third upper molar is smaller than the protocone. The dentition in Eotragus noyei is smaller in size as compared to Eotragus sansaniensis and Eotragus lampangensis. In Eotragus noyei the buccal walls in molars are more inclined while in Eotragus sansaniensis they are less inclined. The genus Eotragus has been reported previously in the Lower and Middle Siwaliks of Pakistan; however, the recognition of the present sample as Eotragus noyei has extended the range of this species from Lower to the Middle Siwaliks of Pakistan.

Keywords: Boselaphini, Chakwal, Dhok Pathan, late miocene

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16 Description of Anthracotheriidae Remains from the Middle and Upper Siwaliks of Punjab, Pakistan

Authors: Abdul M. Khan, Ayesha Iqbal

Abstract:

In this paper, new dental remains of Merycopotamus (Anthracotheriidae) are described. The specimens were collected during field work by the authors from the well dated fossiliferous locality 'Hasnot' belonging to the Dhok Pathan Formation, and from 'Tatrot' village belonging to Tatrot Formation of the Potwar Plateau, Pakistan. The stratigraphic age of the Neogene deposits around Hasnot is 7 - 5 Ma; whereas the age of the Tatrot Formation is from 3.4 - 2.6 Ma. The newly discovered material when compared with the previous records of the genus Merycopotamus from the Siwaliks led us to identify all the three reported species of this genus from the Siwaliks of Pakistan. As the sample comprises only the dental remains so the identification of the specimens is solely based upon the morpho-metric analysis. The occlusal pattern of the upper molar in Merycopotamus dissimilis is different from Merycopotamus medioximus and Merycopotamus nanus in having a mesostyle fully divided, forming two prominent cusps, while mesostyle in M. medioximus is partly divided and small lateral crests are present on the mesostyle. A continuous loop like mesostyle is present in Merycopotamus nanus. The entoconid fold is present in Merycopotamus dissimilis on the lower molars whereas it is absent in Merycopotamus medioximus and Merycopotamus nanus. The hypoconulid in M. dissimilis is relatively simple but a loop like hypoconulid is present in M. medioximus and M. nanus. The results of the present findings are in line with the previous records of the genus Merycopotamus, with M. nanus, M. medioximus and M. dissimilis in the Late Miocene – Early Pliocene Dhok Pathan Formation, and M. dissimilis in the Late Pliocene Tatrot sediments of Pakistan.

Keywords: Dhok Pathan, late miocene, merycopotamus, pliocene, Tatrot

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15 Some Remains of Fossil Artiodactyla: Evolutionary Status, Taxonomy and Biogeographical Distribution in Late Miocene of Pakistan

Authors: Khizar Samiullah Samiullah, Riffat Yasin, Khurrum Feroz, Omer Draz, Memmona Nazish

Abstract:

New fossil remains of artiodactyl have been recovered from three Late Miocene localities, Lava, Dhok Bun Ameer Khatoon and Hasnoot. These localities belong to lower and middle Siwalik Hills of Pakistan, the Chinji and Dhok Pathan Formation respectively and are remarkably rich in fossils of artiodactyl. The fauna mainly comprises various families of order Artiodactyla; Cervidae, Equidea, Proboscidea, Giraffidea, Rhinocerotidae, Tragulidea, Suidae and Primates. In Chinji Formation Lava and Dhok Bun Ameer Khatoon are located in district Chakwal while in Upper Dhok Pathan Formation the best fossils exposure site is Hasnoot which is located in District Jhelum, Punjab, Pakistan. Specimens described and discussed here include right and left maxilla, isolated upper premolars and molars which have been collected during extensive fieldwork. After morphological and comparative analysis the collection is attributed to Giraffokeryx, Giraffa, Listriodon, Dorcatherium, Selenoportax and Pachyportax. In this study evolutionary status, taxonomy and biogeographical distribution as well as the relationship of different Artiodactyls have been discussed comprehensively. The Palaeoenvironmental studies reveal the persistence of mosaics of diverse habitats ranging from tropical evergreen forest to subtropical ones, closed seasonal woodlands to wooded savannas during the deposition of these outcrops.

Keywords: Artiodactyla, fossil dentition, late Miocene, lower and middle Siwaliks

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14 The Use of Culture as a Campaign Method in Indonesian Parliamentary Election

Authors: Azza Habibullah

Abstract:

The principal objective of this paper is to show the use of participatory culture in the parliamentarian campaign. The use of this method has always been non-popular amongst the parliamentarian candidates due to the amount of times and energy that they need to spent with the constituents. However, due to many parliamentarian corruption cases in the last five years period, some political party have been losing peoples trust. That political party trust lost had also affecting the parliamentarian candidates electability, so they invent some creative campaign method that involving their constituent with more intimates and friendly environment. In this paper, an observation is done to a parliamentarian candidate from Partai Keadilan Sejahtera (Prosperous Justice Party) in Bandung and Cimahi City area, West Java. This Parliamentraian candidate is known for her personal-approach campaign method such as a puppet show, hanging out with group of ex-bike gang leaders, and going fishing with the constituent. This paper will compare her method with other parliamentarian candidates from the same party as her that mostly use mainstream campaign method such as open speech, print media, an other one way campaign method. While the other parliamentarian candidates failed to reach the parliamentarian threshold, the participatory method had proven as an effective method.

Keywords: participatory culture, Indonesian parliamentary election, Prosperous Justice Party, electability

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13 Biodiversity and Distribution of Tettigonioidea, Ensifera of Pakistan

Authors: Riffat Sultana Pathan, Waheed Ali Panhwar, Muhammad Saeed Wagan

Abstract:

Tettigonioidea are phytophagous insects damaging agricultural crops, forest, fruit orchards, berry shrubs, and grasses. The material was collected from different agricultural fields of rice, sugarcane, wheat, maize surrounding by different grasses. Beside this, forest, hilly areas, semi-desert and desert regions were also inspected time to time. All material was captured, killed and stored by using the standard entomological method. As a result of extensive survey fair numbers were captured from the different climatic zone of country. Seven sub-families of Tettigonioidea viz: Pseudophyllinae, Phaneropterinae, Conocephalinae, Tettigoniinae, Hexacentrinae, Mecopodinae and Decticinae came in collection. This fauna contributes 29 new records to Pakistan and 5 new species to science. Beside this, a brief description of each supra-generic category of Tettigonioidea along with photographs and synonymy is also documented. In addition to this, detailed list of host plants from Pakistan was also composed. This study provides important data for Integrated Pest Management (IPM) of Tettigonioidea biodiversity conservation and grassland restoration in Pakistan.

Keywords: agriculture, conocephalinae, pest, phaneropterinae, tettigoniidae

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12 Studies on Physico-Chemical Properties of Indium Sulfide Films Deposited under Different Deposition Conditions by Chemical Bath Deposition

Authors: S. B. Bansode, V. G. Wagh, R. S. Kapadnis, S. S. Kale, M. Pathan Habib

Abstract:

Indium sulfide films have been deposited using chemical bath deposition onto glass and indium tin oxide coated glass substrates. The influences of different deposition parameters viz. substrate and pH have been studied. The films were characterized by different techniques with respect to their crystal structure, surface morphology and compositional property by means of X-ray diffraction, scanning electron microscopy, Energy dispersive spectroscopy and optical absorption. X-ray diffraction studies revealed that amorphous nature of the films. The scanning electron microscopy of as deposited indium sulfide film on ITO coated glass substrate shows random orientation of grains where as those on glass substrates show dumbbell shape. Optical absorption study revealed that band gap varies from 2.29 to 2.79 eV for the deposited film.

Keywords: chemical bath deposition, optical properties, structural property, Indium sulfide

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11 Green It-Outsourcing Assurance Model for It-Outsourcing Vendors

Authors: Siffat Ullah Khan, Rahmat Ullah Khan, Rafiq Ahmad Khan, Habibullah Khan

Abstract:

Green IT or green computing has emerged as a fast growing business paradigm in recent years in order to develop energy-efficient Software and peripheral devices. With the constant evolution of technology and the world critical environmental status, all private and public information technology (IT) businesses are moving towards sustainability. We identified, through systematic literature review and questionnaire survey, 9 motivators, in total, faced by vendors in IT-Outsourcing relationship. Amongst these motivators 7 were ranked as critical motivators. We also identified 21, in total, practices for addressing these critical motivators. Based on these inputs we have developed Green IT-Outsourcing Assurance Model (GITAM) for IT-Outsourcing vendors. The model comprises four different levels. i.e. Initial, White, Green and Grey. Each level comprises different critical motivators and their relevant practices. We conclude that our model, GITAM, will assist IT-Outsourcing vendors in gauging their level in order to manage IT-Outsourcing activities in a green and sustainable fashion to assist the environment and to reduce the carbon emission. The model will assist vendors in improving their current level by suggesting various practices. The model will contribute to the body of knowledge in the field of Green IT.

Keywords: Green IT-outsourcing Assurance Model (GITAM), Systematic Literature Review, Empirical Study, Case Study

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10 Mechanism of Performance of Soil-Cement Columns under Shallow Foundations in Liquefiable Soil

Authors: Zaheer Ahmed Almani, Agha Faisal Habib Pathan, Aneel Kumar Hindu

Abstract:

In this study, the effects of ground reinforcement with stiff soil-cement columns on liquefiable ground and on the shallow foundation of structure were investigated. The modelling and analysis of shallow foundation of the structure founded on the composite reinforced ground were carried out with finite difference FLAC commercial software. The results showed that stiff columns were not effective to the redistribute the shear stresses in the composite ground, thus, were not effective to reduce shear stress and shear strain on the soil between the columns. The excessive pore pressure increase which is dependent on volumetric strain (contractive) tendency of loose sand upon shearing, was not reduced to a significant level that liquefaction potential could be remediated. Thus, mechanism of performance with reduction of pore pressure and consequent liquefaction was not predicted in numerical analysis. Nonetheless, the columns were effective to resist the load of structure in compression and reduced the liquefaction-induced large settlements of structure to tolerable limits when provided adjacent and beneath the pad of shallow foundation.

Keywords: earthquake, liquefaction, mechanism, soil-cement columns

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9 Human Rights, Ethics, Medical Care and HIV/AIDS in Bangladesh: A Philosophical Investigation

Authors: Asm Habibullah Choudhury

Abstract:

Background: This study is an investigation into medical care, ethics, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in the context of Bangladesh. The low prevalence of HIV and high prevalence of STDs in Bangladesh, in common with the global experience of HIV epidemics, has been characterized by tremendous stigmatization of those affected. Stigmatization has resulted in an extraordinary degree of unjust discrimination and in numerous human rights violations of PLWHA. Methodology: This will be a cross-sectional descriptive study and will be conducted at different points of Bangladesh. Result: PLWHA will be identified as many as possible and will be interviewed. Medical care providers will be interviewed to assess their attitude and will be observed for stigma while providing medical services. Some of the religious leaders, local influential people will be interviewed to assess their attitude towards PLWHA. Conclusion: If effective responses to HIV/AIDS-related stigma and discrimination are to be promoted in the region, work has to occur simultaneously on several fronts: Legal challenge, where necessary, to bring to account governments, employers, institutions and individuals. To create enabling environment in which PLWHA and their families, women, boys, and girls are able to access prevention and care services. Access to quality and comprehensive care. The fundamental objective, however, is to strive for action based on this understanding—action that will promote egalitarian and gender-progressive role models, and that will help guide the manner in which we interact with one another.

Keywords: HIV, AIDS, Bangladesh, human rights

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8 Prevelance of Green Peach Aphid (Myzus persicae) in District Jacobabad, Sindh, Pakistran

Authors: Kamal Khan Abro, Nasreen Memon, Attaullah Ansari, Mahpara Pirzada, Saima Pathan

Abstract:

Jacobabad district has a hot desert climate with very hot summers and insignificant winters. The highest recorded temperature is 53.8 °C (127.0 °F), and the lowest recorded temperature is −4.9 °C (25.0 °F). Rainfall is short and mostly occurs in the monsoon season (July–September). Agriculture point of view Jacobabad district is very important district of Sindh Pakistan in which many types of crop and vegetables are cultivated annually such as Wheat, Rice, and Brassica, Cabbage, Spinach, Chili etc. which are badly attacked by many crops pest. Insects are very tiny, sensitive and most attractive mortal and most important collection of animal wildlife they play important role in biological control agent, biodiversity & agroecosystem. The brassica crop extremely infested by many different types of pest such as Aphids, Whitefly, Jassids, Thrips, Mealybug, scale insect pink worm, bollworm and borers Mealy bug, scale insect etc. These pests destroy many crops. The present study was carried out from Jacobabad district from January 2017 to April 2017.

Keywords: prevelance, green peach aphid, Jacobabad, Sindh Pakistan

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7 Development and Evaluation of Gastro Retentive Floating Tablets of Ayurvedic Vati Formulation

Authors: Imran Khan Pathan, Anil Bhandari, Peeyush K. Sharma, Rakesh K. Patel, Suresh Purohit

Abstract:

Floating tablets of Marichyadi Vati were developed with an aim to prolong its gastric residence time and increase the bioavailability of drug. Rapid gastrointestinal transit could result in incomplete drug release from the drug delivery system above the absorption zone leading to diminished efficacy of the administered dose. The tablets were prepared by wet granulation technique, using HPMC E50 LV act as Matrixing agent, Carbopol as floating enhancer, microcrystalline cellulose as binder, sodium bi carbonate as effervescent agent with other excipients. The simplex lattice design was used for selection of variables for tablets formulation. Formulation was optimized on the basis of floating time and in vitro drug release. The results showed that the floating lag time for optimized formulation was found to be 61 second with about 97.32 % of total drug release within 3 hours. The in vitro release profiles of drug from the formulation could be best expressed zero order with highest linearity r2 = 0.9943. It was concluded that the gastroretentive drug delivery system can be developed for Marichyadi Vati containing piperine to increase the residence time of the drug in the stomach and thereby increasing bioavailability.

Keywords: piperine, Marichyadi Vati, gastroretentive drug delivery, floating tablet

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6 Spillage Prediction Using Fluid-Structure Interaction Simulation with Coupled Eulerian-Lagrangian Technique

Authors: Ravi Soni, Irfan Pathan, Manish Pande

Abstract:

The current product development process needs simultaneous consideration of different physics. The performance of the product needs to be considered under both structural and fluid loads. Examples include ducts and valves where structural behavior affects fluid motion and vice versa. Simulation of fluid-structure interaction involves modeling interaction between moving components and the fluid flow. In these scenarios, it is difficult to calculate the damping provided by fluid flow because of dynamic motions of components and the transient nature of the flow. Abaqus Explicit offers general capabilities for modeling fluid-structure interaction with the Coupled Eulerian-Lagrangian (CEL) method. The Coupled Eulerian-Lagrangian technique has been used to simulate fluid spillage through fuel valves during dynamic closure events. The technique to simulate pressure drops across Eulerian domains has been developed using stagnation pressure. Also, the fluid flow is calculated considering material flow through elements at the outlet section of the valves. The methodology has been verified on Eaton products and shows a good correlation with the test results.

Keywords: Coupled Eulerian-Lagrangian Technique, fluid structure interaction, spillage prediction, stagnation pressure

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5 Green Supply Chain Management: A Revolutionary and Robust Innovation in the Field of Efficient Environmental Development and Regulation

Authors: Jinesh Kumar Jain, Faishal Pathan

Abstract:

The concept of sustainable development and effective environmental regulation has led to the emergence of a new field of study and practise that is the Green Supply Chain Management. GSCM has become a subject of great importance for both the developed and developing countries to achieve the desired and much-awaited goals of the firm within the environmental and sustainable framework. Its merits are comprised of good financial pay off and competitiveness to the firms in a long lasting and sustainable manner. The purpose of the paper is to briefly review the recent literature of the GSCM and also determines the new direction area of this emerging field. A detailed study has helped to enlighten the minute details and develop the research direction of the study. The GSCM has gained popularity with both academic and practitioners. The items for the study were developed based on the extent literature. Here we found that the state of adoption of GSCM practices by Indian Firms was still in its infancy, the awareness of environmental sustainability was quite low among consumers and the regulatory frameworks were also lacking in terms promoting environmental sustainability. The present paper is an attempt to emphasize much attention on the above-mentioned issues and present a conclusive summary to make its use widespread and for reaching.

Keywords: environmental management, environmental performance, financial performance, green supply chain management

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4 Development and Optimization of Colon Targeted Drug Delivery System of Ayurvedic Churna Formulation Using Eudragit L100 and Ethyl Cellulose as Coating Material

Authors: Anil Bhandari, Imran Khan Pathan, Peeyush K. Sharma, Rakesh K. Patel, Suresh Purohit

Abstract:

The purpose of this study was to prepare time and pH dependent release tablets of Ayurvedic Churna formulation and evaluate their advantages as colon targeted drug delivery system. The Vidangadi Churna was selected for this study which contains Embelin and Gallic acid. Embelin is used in Helminthiasis as therapeutic agent. Embelin is insoluble in water and unstable in gastric environment so it was formulated in time and pH dependent tablets coated with combination of two polymers Eudragit L100 and ethyl cellulose. The 150mg of core tablet of dried extract and lactose were prepared by wet granulation method. The compression coating was used in the polymer concentration of 150mg for both the layer as upper and lower coating tablet was investigated. The results showed that no release was found in 0.1 N HCl and pH 6.8 phosphate buffers for initial 5 hours and about 98.97% of the drug was released in pH 7.4 phosphate buffer in total 17 hours. The in vitro release profiles of drug from the formulation could be best expressed first order kinetics as highest linearity (r2= 0.9943). The results of the present study have demonstrated that the time and pH dependent tablets system is a promising vehicle for preventing rapid hydrolysis in gastric environment and improving oral bioavailability of Embelin and Gallic acid for treatment of Helminthiasis.

Keywords: embelin, gallic acid, Vidangadi Churna, colon targeted drug delivery

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3 A Comparative, Epidemiological Study of Acute Renal Colic Presentations to Major Academic Emergency Departments in Doha, Qatar and Melbourne, Australia

Authors: Sameer A. Pathan, Biswadev Mitra, Zain A. Bhutta, Isma Qureshi, Elle Spencer, Asmaa A. Hameed, Sana Nadeem, Ramsha Tahir, Shahzad Anjum, Peter A. Cameron

Abstract:

Background: This study aimed to compare epidemiology, clinical presentations, management and outcomes of renal colic presentations in two major academic centers and discuss potential implications of these results for the applicability of current evidence in the management of renal colic. Methods: We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of one year from August 1, 2012, to July 3, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables. Results: A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0- 43.4) than The Alfred ED [48 years (37-60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4-8) mm] versus The Alfred ED group [4 (3-6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7% versus 11.9%, p<0.001). At the time of discharge, The Alfred ED group received less analgesic prescriptions (55.8% versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3% versus 11.7%, P < 0.001). Conclusions: Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size, compared to The Alfred ED, whereas, medical expulsion therapy use was higher at the Alfred ED. Differences in epidemiology should be considered while tailoring strategies for effective management of patients with renal colic in the given setting.

Keywords: kidney stones, urolithiasis, nephrolithiasis, renal colic, epidemiology

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2 CRISPR/Cas9 Based Gene Stacking in Plants for Virus Resistance Using Site-Specific Recombinases

Authors: Sabin Aslam, Sultan Habibullah Khan, James G. Thomson, Abhaya M. Dandekar

Abstract:

Losses due to viral diseases are posing a serious threat to crop production. A quick breakdown of resistance to viruses like Cotton Leaf Curl Virus (CLCuV) demands the application of a proficient technology to engineer durable resistance. Gene stacking has recently emerged as a potential approach for integrating multiple genes in crop plants. In the present study, recombinase technology has been used for site-specific gene stacking. A target vector (pG-Rec) was designed for engineering a predetermined specific site in the plant genome whereby genes can be stacked repeatedly. Using Agrobacterium-mediated transformation, the pG-Rec was transformed into Coker-312 along with Nicotiana tabacum L. cv. Xanthi and Nicotiana benthamiana. The transgene analysis of target lines was conducted through junction PCR. The transgene positive target lines were used for further transformations to site-specifically stack two genes of interest using Bxb1 and PhiC31 recombinases. In the first instance, Cas9 driven by multiplex gRNAs (for Rep gene of CLCuV) was site-specifically integrated into the target lines and determined by the junction PCR and real-time PCR. The resulting plants were subsequently used to stack the second gene of interest (AVP3 gene from Arabidopsis for enhancing cotton plant growth). The addition of the genes is simultaneously achieved with the removal of marker genes for recycling with the next round of gene stacking. Consequently, transgenic marker-free plants were produced with two genes stacked at the specific site. These transgenic plants can be potential germplasm to introduce resistance against various strains of cotton leaf curl virus (CLCuV) and abiotic stresses. The results of the research demonstrate gene stacking in crop plants, a technology that can be used to introduce multiple genes sequentially at predefined genomic sites. The current climate change scenario highlights the use of such technologies so that gigantic environmental issues can be tackled by several traits in a single step. After evaluating virus resistance in the resulting plants, the lines can be a primer to initiate stacking of further genes in Cotton for other traits as well as molecular breeding with elite cotton lines.

Keywords: cotton, CRISPR/Cas9, gene stacking, genome editing, recombinases

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1 Emergency Physician Performance for Hydronephrosis Diagnosis and Grading Compared with Radiologist Assessment in Renal Colic: The EPHyDRA Study

Authors: Sameer A. Pathan, Biswadev Mitra, Salman Mirza, Umais Momin, Zahoor Ahmed, Lubna G. Andraous, Dharmesh Shukla, Mohammed Y. Shariff, Magid M. Makki, Tinsy T. George, Saad S. Khan, Stephen H. Thomas, Peter A. Cameron

Abstract:

Study objective: Emergency physician’s (EP) ability to identify hydronephrosis on point-of-care ultrasound (POCUS) has been assessed in the past using CT scan as the reference standard. We aimed to assess EP interpretation of POCUS to identify and grade the hydronephrosis in a direct comparison with the consensus-interpretation of POCUS by radiologists, and also to compare the EP and radiologist performance using CT scan as the criterion standard. Methods: Using data from a POCUS databank, a prospective interpretation study was conducted at an urban academic emergency department. All POCUS exams were performed on patients presenting with renal colic to the ED. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (Stata Corp, College Station, Texas). Results: A total of 651 patients were included, with paired sets of renal POCUS video clips and the CT scan performed at the same ED visit. Hydronephrosis was reported in 69.6% of POCUS exams by radiologists and 72.7% of CT scans (p=0.22). The κ for consensus interpretation of POCUS between the radiologists to detect hydronephrosis was 0.77 (0.72 to 0.82) and weighted κ for grading the hydronephrosis was 0.82 (0.72 to 0.90), interpreted as good to very good. Using CT scan findings as the criterion standard, Eps had an overall sensitivity of 81.1% (95% CI: 79.6% to 82.5%), specificity of 59.4% (95% CI: 56.4% to 62.5%), PPV of 84.3% (95% CI: 82.9% to 85.7%), and NPV of 53.8% (95% CI: 50.8% to 56.7%); compared to radiologist sensitivity of 85.0% (95% CI: 82.5% to 87.2%), specificity of 79.7% (95% CI: 75.1% to 83.7%), PPV of 91.8% (95% CI: 89.8% to 93.5%), and NPV of 66.5% (95% CI: 61.8% to 71.0%). Testing for a report of moderate or high degree of hydronephrosis, specificity of EP was 94.6% (95% CI: 93.7% to 95.4%) and to 99.2% (95% CI: 98.9% to 99.5%) for identifying severe hydronephrosis alone. Conclusion: EP POCUS interpretations were comparable to the radiologists for identifying moderate to severe hydronephrosis using CT scan results as the criterion standard. Among patients with moderate or high pre-test probability of ureteric calculi, as calculated by the STONE-score, the presence of moderate to severe (+LR 6.3 and –LR 0.69) or severe hydronephrosis (+LR 54.4 and –LR 0.57) was highly diagnostic of the stone disease. Low dose CT is indicated in such patients for evaluation of stone size and location.

Keywords: renal colic, point-of-care, ultrasound, bedside, emergency physician

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