Abbasi Shaheed Hospital

Introduction and importance:Wire-induced coronary artery injury may result in significant vessel dissection, intramural hematoma (IMH), and loss of distal coronary flow. Urgent intervention may be required to restore coronary perfusion, although managing these cases can be challenging due to technical and procedural limitations.Case presentation:An 80-year-old male presented with an ST-elevation myocardial infarction and underwent left circumflex artery percutaneous coronary intervention complicated by wire-induced distal dissection, IMH, and VF. Balloon dilatation failed, but intravascular ultrasound (IVUS) guided balloon fenestrations restored the flow, followed by successful stenting.Clinical discussion:Wire-induced distal coronary dissections are rare but can lead to critical ischemia. IVUS plays a key role in confirming wire position, assessing the extent of hematoma, and guiding precise intervention. Although cutting balloon (CB) fenestration has primarily been described in spontaneous coronary artery dissection, this technique can serve as a valuable bailout strategy in iatrogenic dissections when conventional balloon dilatation fails. Controlled micro-incisions created by the CB enable hematoma drainage and flow restoration while minimizing further vessel trauma, even in small distal segments.Conclusion:Cutting balloon fenestration under IVUS guidance may represent a feasible bailout strategy for flow-limiting, wire-induced dissections complicated by IMH.

Surgical hand preparation is a core infection prevention practice for reducing surgical site infection risk. This audit assessed adherence to World Health Organization (WHO) recommended surgical hand preparation steps and evaluated the effect of a structured improvement package. Methods: A prospective observational audit was conducted in the elective operating rooms of Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan. A 16-item checklist adapted from WHO guidance covered pre-scrub preparation, hand and forearm washing, rinsing, drying, and final aseptic steps. Compliance was calculated as the percentage of checklist items correctly performed per scrubbing episode. After baseline observation (pre-intervention), corrective measures were implemented (targeted training, visual reminders, and distribution of a standard operating protocol), and a re-audit was performed. Results: A total of 85 surgical hand preparation episodes were observed at baseline and 85 at re-audit across surgery, orthopaedics, and neurosurgery teams. Overall mean compliance improved from 56.9% (SD 11.9) pre-intervention to 89.2% (SD 8.7) post-intervention, an absolute increase of 32.3 percentage points. At baseline, 0% achieved at least 94% compliance (>=15 of 16 items); post-intervention, 47.1% achieved this threshold, and 20.0% completed 100% compliance. Conclusion: Baseline adherence to WHO surgical hand preparation steps was suboptimal. A simple, low-cost quality improvement package was associated with marked improvement across roles and specialties. Ongoing education, supervision, and periodic re-audits are recommended to sustain gains.

The Siege of Krishnapur (1973) by J. G. Farrell is a fictional and symbolically real depiction of Indian resistance against British colonialism during the Sepoy Mutiny of 1857. The novel is fabricated in colonial historiography that analyses how it reflects the military resistance and the ideological clash between colonizers and the colonized. The 1857 revolt represented by British colonizers as a mere mutiny that is reinterpreted here as a foundational act of Indian nationalism and anti-imperial struggle. This paper has analyzed how Indians demonstrated the resistance against British imperialism in Sepoy mutiny 1857 in relation to their freedom, justice, and rights; how they fought against the atrocity of the colonizers. This study is based on a qualitative, historical research design to explore the resistance of the sepoys portrayed during that time within the broader context of the 1857 Sepoy Mutiny. To accomplish this research, Ihave used books and journal articles as the secondary data on the locale of the sepoy mutiny 1857 in relation to the portrayal of Indian society and their dominated voices, the contradictory perceptions of Indian civilization and colonizers’ barbarism often used to justify colonial dominance. The result of this study is significant in the sense that it has presented the power dynamics of the colonizer and the colonized.

Background: Preoperative radiological assessment plays a crucial role in orthopedic surgery by providing detailed anatomical insights and guiding surgical planning.Objective: This study aimed to assess the impact of preoperative radiological assessment on surgical outcomes in patients undergoing orthopedic procedures.Methods: This retrospective study was conducted at Shaheed Zulfiqar Ali Bhutto Medical University from June 2024 to December 2024, including 143 patients. Imaging quality was classified as adequate or inadequate based on completeness, correct projections, diagnostic clarity, and alignment with surgical objectives. Data extracted from electronic medical records included demographic characteristics, intraoperative parameters (duration of surgery, blood loss), and postoperative outcomes (infection, implant alignment, length of stay, functional recovery). Group comparisons were made using appropriate statistical tests, and 95% confidence intervals (CIs) were calculated for the main outcomes.Results: Out of the 143 patients, 98 (68.5%) had adequate imaging, and 45 (31.5%) had inadequate imaging. The adequately imaged group showed shorter operative time (88.6±17.5 vs. 106.2±21.3 minutes; p<0.001; 95% CI: −25.7 to −9.5) and less blood loss (285.4±64.3 vs. 354.1±77.2 mL; p=0.004; 95% CI: −112.3 to −34.7). Postoperative wound infections occurred in 5/98 (5.1%) vs. 7/45 (15.5%) (p=0.041; 95% CI for difference: −20% to −1.2%), and implant misalignment in 3/98 (3.1%) vs. 6/45 (13.3%) (p=0.026). The adequately imaged group also had a shorter mean hospital stay (4.1±1.3 vs. 5.3±1.6 days; p=0.002) and higher functional recovery scores (84.6±7.2 vs. 77.9±9.1; p=0.009).Conclusion: Adequate preoperative radiological assessment is associated with improved surgical efficiency, reduced complications, and improved postoperative outcomes in orthopedic procedures. These findings support the routine implementation of structured imaging protocols as a standard of care in orthopedic surgical planning.

Abstract Background West Nile virus (WNV) and Dengue virus (DENV), are mosquito-borne human pathogens of zoonotic origin that belong to Flavivirus genus. They usually cause asymptomatic infections but may present with clinical symptoms ranging from mild acute febrile illness (AFI) to severe life-threatening conditions such as encephalitis, hemorrhage, or shock. WNV has been endemic in the Nile valley since its isolation, and recent outbreaks of DENV have been reported in Upper Egypt and Red Sea regions. However, their prevalence in Cairo remains unclear and requires further investigation. This study aimed to detect acute WNV and DENV infections among AFI patients in Cairo. Methods A Cross-sectional study was conducted over nine months on 34 AFI patients with clinical findings suggestive of flaviviral infection, admitted to Abbassia fever hospital (AFH), Cairo, Egypt. Detection of flaviviral infection was performed using anti-WNV and anti-DENV IgM enzyme-linked immunosorbent assay and panflavi- and/or DENV reverse transcriptase polymerase chain reaction. Relevant sociodemographic data, recent travel history, clinical manifestations and laboratory investigations were evaluated for potential association. Results Among the 34 AFI patients, none tested positive by panflavi-/DENV RT-PCR. However eight (23.5%) had probable flaviviral infections: four (11.8%) tested positive for anti-WNV IgM, three (8.8%) for anti-DENV IgM and one (2.9%) for both. Two (5.9%) cases were borderline for anti-WNV IgM. There was no statistically significant difference between positive and negative cases as regards sociodemographic, clinical or potential exposure data, though there was an increased likelihood of positivity with recent travel (p-value= 0.0928). Conclusion Low rates of WNV and DENV infections are detected in Cairo. While recent travel history remains an important factor in detecting imported cases, local autochthonous transmission of WNV/DENV in Egypt is also plausible. Continuous surveillance of AFI patients admitted to tertiary referral and quarantine hospitals, such as AFH, is essential to monitor the epidemiology of flaviviral infections.

Introduction: The Glasgow Coma Scale (GCS) is a commonly used assessment tool; however, it has recognized limitations, particularly in patients who are intubated or have aphasia. The Full Outline of UnResponsiveness (FOUR) score was created to tackle these limitations. It has been studied mainly in the trauma and neuroscience setting; to our knowledge, this is the first study to compare the predictive performance of GCS and FOUR scores for endotracheal intubation and length of hospital stay in non-traumatic altered mental status patients in the emergency department (ED).Methods: A prospective cohort study was conducted among adult patients from May 2024 to July 2025. The area under the receiver operating characteristic (AUROC) curve was used to evaluate and compare the predictive accuracy of the GCS and FOUR scores in predicting outcomes.Results: A total of 240 patients were included in the study. The median age was 70 years (IQR: 21); 55.0% were female. In-hospital mortality was 39.6%. 27.9% of patients required ICU admission. The FOUR and GCS scores both demonstrated significant discriminative ability across outcomes (all p < 0.001). For in-hospital mortality, the FOUR score showed superior accuracy (AUROC 0.851, 95% CI: 0.803-0.900) compared to the GCS (0.771, 95% CI: 0.710-0.831). Similarly, in predicting endotracheal intubation, the FOUR score outperformed the GCS (AUROC 0.875 vs. 0.781). For the length of hospital stay, the FOUR score also demonstrated higher predictive value (AUROC 0.771 vs. 0.734).Conclusion: The FOUR score demonstrated superior predictive accuracy compared to the GCS across all clinical outcomes, including mortality, intubation, and length of hospital stay. It may serve as a more reliable tool for prognostication in non-traumatic patients with altered mental status.

Background: Hyperuricemia is highly prevalent among patients with chronic kidney disease (CKD) and is associated with accelerated renal progression and increased cardiovascular risk. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated renoprotective and uric acid–lowering benefits in large cardiovascular and renal outcome trials; however, data from low- and middle-income populations with CKD remain limited. Objective: To determine the impact of SGLT2 inhibitor therapy on serum uric acid levels in patients with chronic kidney disease. Study Design: Quasi-experimental study. Setting: Department of Medicine, tertiary care hospital. Duration of Study: 19 March to 19 June 2025. Methods: A total of 171 patients with established CKD were enrolled. All participants received dapagliflozin-based therapy and were followed for three months. Serum uric acid levels were measured at baseline and at the end of the follow-up period. Statistical analysis was performed using paired t-tests to compare pre- and post-treatment uric acid levels, while independent t-tests and chi-square tests were applied for subgroup comparisons. A p-value ≤ 0.05 was considered statistically significant. Results: The mean baseline serum uric acid level was 7.32 ± 0.46 mg/dL. After three months of therapy, the mean reduction in serum uric acid was 0.70 ± 0.20 mg/dL. The proportion of patients achieving serum uric acid levels ≤7 mg/dL increased significantly from 39.8% at baseline to 70.8% after treatment (χ² = 29.6, p &lt; 0.001). Greater reductions were observed among male patients, those with a body mass index &lt;30 kg/m², those with CKD stage 3, and those with shorter disease duration. Conclusion: SGLT2 inhibitor therapy was associated with a significant reduction in serum uric acid levels among patients with CKD. These findings support the metabolic and potential renoprotective benefits of SGLT2 inhibitors and their broader role in the comprehensive management of chronic kidney disease.

Background: Hypothyroidism is the second most prevalent endocrine disorder during pregnancy after diabetes mellitus. It is associated with a range of maternal and perinatal complications when left untreated, including hypertensive disorders, hemorrhagic complications, and impaired fetal development. The physiological changes in thyroid function during pregnancy make early detection critical for maternal and neonatal health. Despite global awareness, region-specific data remain limited, especially in low-resource settings like Pakistan. Objective: To determine the frequency of hypothyroidism among pregnant women admitted for delivery at Abbasi Shaheed Hospital/KMDC, Karachi, and to assess its association with perinatal and obstetric morbidity. Methods: A cross-sectional descriptive study was conducted from March to September 2024, enrolling 170 pregnant women aged 18–49 years with a gestational age ≥28 weeks. Serum levels of TSH, free T4, and free T3 were evaluated. Hypothyroidism was diagnosed based on TSH &gt;4 mU/L, free T4 &lt;10 ng/mL, or free T3 &lt;0.8 ng/mL. The outcomes assessed included pre-eclampsia, postpartum hemorrhage (PPH), antepartum hemorrhage (APH), fetal distress, low birth weight (LBW &lt;2,500 g), preterm delivery (&lt;37 weeks), and NICU admission. Associations were analyzed using chi-square and logistic regression, with p &lt; 0.05 considered statistically significant. Results: Out of 170 participants, 54 (31.8%) had hypothyroidism. Pre-eclampsia occurred in 12 (22.2%) hypothyroid vs. 8 (6.7%) euthyroid women (p = 0.001). PPH was noted in 10 (18.5%) vs. 5 (4.0%) (p = 0.003), and fetal distress in 9 (16.7%) vs. 7 (5.3%) (p = 0.007), respectively. LBW was significantly higher in the hypothyroid group—16 (29.6%) vs. 14 (12.0%) (p = 0.002). No significant differences were found for APH (3.7% vs. 0.9%), preterm delivery (16.7% vs. 12.9%), or NICU admission (13.0% vs. 9.3%). Conclusion: Hypothyroidism was prevalent in nearly one-third of pregnant women and was significantly associated with pre-eclampsia, PPH, fetal distress, and LBW. These findings support the integration of routine antenatal thyroid screening, including TPO antibody testing, to enable early diagnosis and intervention, thereby improving pregnancy outcomes.

Vitamin D supplementation may have beneficial effects on cardiovascular outcomes in patients with chronic kidney disease (CKD), but the underlying data are conflicting. We conducted a meta-analysis to investigate the effect of vitamin D on cardiovascular outcomes in patients with CKD.We searched MEDLINE (via PubMed), the Cochrane Library, Scopus, and ClinicalTrials.gov from inception to 16 March 2024 for all randomized controlled trials (RCTs) assessing vitamin D supplementation in patients with CKD and reporting cardiovascular outcomes. Our primary outcomes were the incidence of adverse cardiovascular events and the change in left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI). Our secondary outcomes were the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Data were pooled using risk ratio (RR) and mean difference as the effect measures.A total of 11 RCTs were included in our review. Vitamin D supplementation reduced the risk of adverse cardiovascular events in patients with CKD (RR 0.39; 95% CI 0.22 to 0.69; I2=0). There was no significant difference in LVEF, LVMI, SBP, and DBP between the vitamin D and control groups.Vitamin D supplementation does not affect adverse cardiovascular events, LVEF, LVMI, SBP, and DBP. Further large-scale RCTs and mechanistic studies are needed to understand the potential benefits of vitamin D supplementation in this patient population.

Chronic liver disease (CLD) is a major global health concern, closely linked with metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM). To examine the association between adherence to a Diabetes Risk Reduction Diet (DRRD) and mortality from CLD in a prospective adult cohort. This prospective cohort study was conducted at the Pakistan Kidney and Liver Institute, Lahore, Pakistan, and the DHQ (District Headquarter) Hospital, Bagh, AJK, Pakistan, from January 2023 to June 2023. Data were collected from a large, population-based health and nutrition survey that incorporated detailed dietary intake assessments, clinical parameters, and long-term mortality follow-up. Participants were enrolled at baseline and followed over time to observe liver-specific mortality outcomes. A total of 435 adult participants were included in the study. Participants aged more than 18 years with complete dietary data, as well as relevant clinical and demographic information, were included. During the follow-up period, 48 liver-related deaths were recorded. Participants in the highest DRRD adherence tertile had a significantly lower risk of CLD mortality (adjusted HR (hazard ratio) 0.31; 95% CI (confidence interval): 0.13-0.72; p = 0.006) compared to the lowest tertile. A dose-response trend was observed (p < 0.001). Sensitivity analyses excluding diabetic participants yielded consistent findings. High DRRD adherence was also associated with lower ALT levels and healthier baseline profiles. High adherence to a DRRD is significantly associated with reduced mortality from CLD. These findings underscore the potential of metabolic-focused dietary interventions in mitigating liver-related outcomes.