Bahawal Victoria Hospital

Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are standard treatments for Multivessel Coronary Artery Disease (MVD). Their long-term comparative effectiveness remains debated. A systematic review and meta-analysis of randomized and observational studies was conducted, including patients with MVD followed for ≥5 years. Data were pooled using randomor fixed-effects models, depending on the level of heterogeneity. Thirteen studies met the inclusion criteria. CABG was associated with reduced all-cause mortality (RR 0.82, 95% CI 0.72-0.91) and fewer repeat revascularizations (RR 1.98, 95% CI 1.74-2.26) compared with PCI. Stroke risk was slightly higher after CABG. Findings suggest CABG provides superior survival and event reduction in long-term follow-up, particularly in higher-risk subgroups. However, the modestly increased stroke risk highlights the need for individualized decision-making, taking into account patient comorbidities, anatomy, and surgical suitability. CABG offers long-term survival and durability advantages over PCI in MVD, while PCI remains suitable for patients with lower-risk anatomy or when surgery is contraindicated.

Bangladesh, a lower-middle-income country in South Asia, faces a rapidly rising cancer burden. In the absence of a population-based cancer registry (PBCR), monitoring national patterns remains challenging and constrains evidence-informed policymaking. We analyzed temporal trends in cancer distribution at the country's largest national cancer hospital to inform priorities for a cancer control strategy. We conducted a retrospective analysis of 82,209 histologically and/or clinically confirmed cancer cases diagnosed or treated at the National Institute of Cancer Research & Hospital, between January 2014 and December 2020. Demographic and clinical data were extracted from hospital records, and cancers were grouped according to their primary anatomic site. Annual distributions and sex-specific patters of the 10 most common cancers were examined, and temporal changes were illustrated using trend diagrams. Over 7 years, the most common cancers were of the respiratory system (19.6%-22.5%), digestive organs (18.8%-22.8%), and breast (12%-14.9%). Comparison between 2014 and 2020 revealed notable increases in the proportion of digestive organ cancers (+3.6%), hematopoietic and reticuloendothelial malignancies (+1%), and breast cancer (+0.8%), whereas respiratory cancers (-2.3%), lymph node cancers (-1.1%), and bone and cartilage cancers (-1%) decreased. A marked spike in female genital cancers was observed in 2015 (11.84% v 9.9% average across other years). Findings should be interpreted in the context of hospital-based case mix and referral patterns. In this large tertiary cancer hospital in Bangladesh, respiratory system, digestive organ, and breast cancers represented the highest burden, with rising proportions of proportional increases in digestive, hematopoietic, and breast cancers and declines in respiratory and lymph node cancers, provide early signals of an evolving cancer landscape. While not population-representative, these trends highlight the urgent need to establish government-supported PBCRs in well-defined subnational regions to inform effective cancer control strategies for Bangladesh.

Hypertriglyceridemia (HTG) increases cardiovascular and pancreatitis risk. Antisense oligonucleotide (ASO) therapies like volanesorsen and olezarsen target ApoC-III mRNA to reduce ApoC-III, enhancing lipoprotein lipase activity and lowering triglycerides (TGs). This meta-analysis evaluates the efficacy and safety of these ASOs in severe HTG. A systematic review (PROSPERO: CRD42024577110) was conducted following PRISMA, sourcing studies from PubMed, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov until July 2024. Randomized controlled trials (RCTs) involving severe HTG (≥200 mg/dL) treated with volanesorsen or olezarsen vs. placebo were included. Data were synthesized using a random effects model in RevMan 5.4, and bias was assessed with the Cochrane tool. Of 31 identified articles, 9 RCTs (341 patients treated with ASOs, 209 controls) were included. ASOs significantly reduced TG levels [mean difference (MD): -53.72; 95% confidence interval (CI): -77.04 to -30.40; p<0.00001]. Reductions were also seen in very low-density lipoprotein cholesterol (MD: -55.76; p<0.00001), ApoC-III (MD: -74.78; p<0.00001), and APOB48 (MD: -69.45; p<0.00001). Olezarsen uniquely reduced APOB (MD: -15.60; p<0.00001). Non-high-density lipoprotein cholesterol (HDL-C) decreased (MD: -23.25; p<0.00001), while HDL-C increased (MD: +42.14; p<0.00001). Volanesorsen was linked to higher low-density lipoprotein-cholesterol (MD: +62.74; p=0.004). For safety, local injection reactions, thrombocytopenia, and nausea were more common with volanesorsen. Acute pancreatitis occurred only in the placebo group (relative risk: 0.15; p=0.0004), indicating ASO protection. This meta-analysis confirms that ASOs effectively lower TGs and improve lipid profiles in severe HTG.

We evaluated the effects of growth hormone (GH) pretreatment on oocyte retrieval and embryo quality in patients undergoing assisted reproductive technology (ART) for diminished ovarian reserve (DOR). In this prospective cohort study, conducted at Shahida Islam Medical Complex from October 2023 to June 2025, 2,000 women aged ≤40 years with DOR were recruited before starting ART. DOR diagnosis was based on the 2017 criteria and the 2011 Bologna criteria. Participants were nonrandomly allocated to four equal groups: G1 (1 month of GH before ovulation induction+standard ART), G2 (2 months of GH pretreatment+ART), G3 (GH supplementation during the ovulation induction phase+ART), and G4 (control; standard ART). Hormonal and metabolic profiling was performed before, during, and after GH treatment. Accordingly, secondary stratification was applied to enable personalized treatment. Based on early response to GH pretreatment, participants underwent dynamic regrouping into good and poor responders. Key outcomes included oocyte retrieval, embryo quality, and maternal-fetal outcomes. GH pretreatment improved ART results, with the G2 group achieving the best estradiol levels, follicular growth, and oocyte retrieval, albeit with increased insulin resistance (homeostatic model assessment of insulin resistance [HOMA-IR]). The G1 and G3 groups also outperformed controls (G4). GH dose and anti-Müllerian hormone (AMH) level strongly predicted successful oocyte retrieval. Testosterone was negatively associated with retrieval; interleukin 6 and dehydroepiandrosterone sulfate (DHEA-S) had weaker effects. G2 embryos exhibited the best development and blastocyst formation outcomes, with the most advanced development by day 5. A nomogram was developed to predict oocyte retrieval outcomes from GH dose, AMH, HOMA-IR, and testosterone. In patients with DOR, GH pretreatment improves treatment outcomes. Over 1 month of pretreatment can increase the oocytes retrieved but confers higher insulin resistance. Thus, when using GH for more than 4 weeks, clinicians should closely monitor HOMA-IR and perform continuous glucose monitoring; otherwise, 1-month GH pretreatment is preferred when initiating ART.

BackgroundChronic kidney disease (CKD) and dementia are major causes of morbidity and mortality among older adults and frequently coexist due to shared vascular and metabolic risk factors. Despite their clinical importance, national mortality trends for these conditions remain underexplored. This study aimed to examine temporal and demographic patterns of mortality among individuals with coexisting CKD and dementia in the United States from 1999 to 2020.MethodsIn this retrospective, population-based study, mortality data for adults aged ≥25 years were extracted from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research database. Deaths listing both CKD [International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10 N18.x)] and dementia (ICD-10 F01.x, F03, G30.x) as causes were included. Age-adjusted mortality rates (AAMRs) per 100 000 were calculated using the 2000 U.S. standard population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change and average annual percent change (AAPC) with P < 0.05 considered significant. Subgroup analyses were stratified by gender, race/ethnicity, age, region, and urbanization.ResultsBetween 1999 and 2020, 170 375 deaths were attributed to CKD and dementia. The overall AAMR increased from 1.03 to 5.92 per 100 000 (AAPC 7.41%). Mortality increased significantly across both genders, older adults, and all census regions, peaking in 2012, briefly declining between 2012 and 2015, then rising during 2015 to 2020. Males had higher mortality (AAMR 4.24) than females (3.16). Non-Hispanic Black individuals exhibited the highest rate (6.20), followed by non-Hispanic White (3.35) and Hispanic (3.09) populations. The Midwest showed the highest regional burden (AAMR 3.90), while rural counties recorded greater mortality (3.89) than urban areas (3.49).ConclusionThe increasing mortality trends show a close relationship between CKD and dementia. Thus, improving early diagnosis, ensuring equal access to care, and providing a holistic treatment approach targeting both the organs is key to enhancing optimal patient care and consequently reducing mortality.

Introduction: Oncology treatments affect blood health; this study highlights nutrition’s role in reducing side effects and enhancing well-being. This study assesses chemotherapy’s impact on nutrition, quality of life, and the benefits of dietary adherence in breast cancer. Methods: This longitudinal hospital study spanned two chemotherapy cycles with triweekly followups. A total of 61 female breast cancer patients aged 24-71 years undergoing treatment with either Doxorubicin-Cyclophosphamide or Paclitaxel were enrolled. Anthropometric assessments (including weight, height, and BMI), clinical evaluations, laboratory tests (such as hemoglobin and PDW), and dietary assessments were recorded at both baseline and follow-up. BMI, Ideal Body Weight (IBW), and Total Energy Expenditure (TEE) were calculated. A dietary intervention chart was developed and offered to all participants; 20 patients adhered to the plan. Paired Student's t-tests were used for prepost comparisons, with significance set at p &lt;0.05. Results: The cohort included patients at Stage 1 (1.6%), Stage 2 (21.3%), Stage 3 (26.2%), Stage 4 (14.7%), and undefined stage (36%). Mean BMI was 27.62 ± 5.51, IBW was 47.78 ± 5.59 kg, and TEE was 1484.9 ± 198.74 kcal. Discussion: Standard chemotherapy side effects included diarrhea, constipation, nausea, vomiting, dry mouth, anorexia, and cachexia. Among the 20 patients who adhered to the dietary plan, hemoglobin levels increased significantly from a baseline mean of 10.5 g/dL to 11.4 g/dL at follow-up (p = 0.01), and PDW improved significantly (p = 0.04). Adherent patients reported fewer gastrointestinal and systemic side effects than non-adherent patients. Conclusion: Following a balanced, nutrient-rich diet during chemotherapy reduces side effects, improves blood parameters, and enhances breast cancer patients' quality of life. conclusion: A healthy diet can reduce chemotherapy side effects and enhance the quality of life for patients.

Background: Colles’ fracture, a common extra-articular distal radius fracture, frequently occurs in adults following low-energy falls or high-energy trauma. The surgical treatment is still controversial, percutaneous K-wire fixation and locking T-plate fixation being the most common ones. This paper compared the radiological outcome and functional outcome of these two forms of fixation. Methods: This was a prospective comparative study that was carried out in the Orthopedic Department of Bahawal Victoria Hospital, Bahawalpur, during a period of 12 months. 60 adult patients (50-80 years aged) who had Colles fractures were recruited and split in half. Group A was subjected to percutaneous K-wire fixation and Group B to locking T-plate fixation. The modified Gartland and Werley score was used to measure functional outcomes at three and six months of the postoperative period. The SPSS version 25 was used to analyze data, and the chi-square tests were employed to evaluate associations with a p-value ≤ 0.05 as the significant one. Results: The mean age was 41.2±8.6 years in Group A and 44.7±9.2 years in Group B. At three months, 80% of K-wire patients and 63.3% of T-plate patients showed excellent outcomes. By six months, excellent results increased to 90% in the K-wire group and 83.3% in the T-plate group. No significant association was observed between gender, BMI, or diabetes and the final functional outcome (p&gt;0.05). Conclusion: Both fixation methods produced satisfactory outcomes; however, K-wire fixation demonstrated slightly better early recovery and cost-effectiveness, making it a practical choice in routine clinical settings.

416 Background: Variable anatomy, prompted by bowel filling and respiratory motion, necessitates larger margins for planning target volumes (PTV) in radiotherapy for gastric lymphoma patients, leading to higher doses to organs at risk (OAR). The deep inspiratory breath-holding (DIBH) technique during radiotherapy has emerged as a protective method that improves OAR sparing. Therefore, this systematic review aims to systematically evaluate the benefits of DIBH compared to free breathing (FB) techniques during radiotherapy for gastric lymphomas, along with the physiological mechanisms involved. Methods: This systematic review included three comparative studies following a comprehensive search across PubMed, Google Scholar, and the Cochrane Library, involving a total of 33 patients with gastric lymphomas, in whom radiotherapy was planned under both DIBH and FB. The radiotherapeutic techniques assessed were intensity-modulated radiotherapy (IMRT), 3D-conformal radiotherapy (3D-CRT), step-and-shoot IMRT (SIMRT), volumetric-modulated arc therapy (VMAT), and tomotherapy. The dosimetric parameters included Gy (Gray), mean dose (Dmean), maximum dose (Dmax), etc. Results: Median heart dose (MHD) showed a consistent and significant reduction with DIBH across all techniques, including IMRT: 4.9→2.6 Gy; 3D: 8.54→4.46 Gy; SIMRT: 6.97→3.63 Gy; VMAT: 6.83→3.42 Gy; and tomotherapy: 7.06→3.80 Gy (all p&lt;0.001). An additional study reported a decline from 7.1 Gy (FB 1.5 cm PTV) to 3.2 Gy (DIBH 1 cm PTV) (p&lt;0.001). Kidney doses showed modest changes, with Dmean reduced from 4.3 Gy with FB 1 cm to 3.8 Gy with DIBH. For the left kidney, only one study demonstrated a significant reduction (p = 0.01). Spinal cord doses were also lower with DIBH; Dmax decreased from 19.79 to 17.56 Gy (VMAT), and Dmean from 8.7 Gy (FB 1.0 cm) and 9.7 Gy (FB 1.5 cm) to 7.9 Gy (DIBH) (p=0.02 and p=0.001). Findings in the lung were inconsistent: one study reported lower Dmean with DIBH, while others noted slight increases, e.g., left lung 3.0 vs. 2.6 Gy for FB 1 cm; 3.3 vs. 3.0 Gy for FB 1.5 cm. Liver outcomes were non-significant primarily, with reported reductions from 9.4 to 8.3 Gy and 13.91 to 12.64 Gy, although one study showed a higher Dmean with DIBH compared to FB 1 cm (p = 0.04). Conclusions: In conclusion, based on the current literature, DIBH significantly improves organ at risk (OAR) sparing, especially for the heart, right kidney, and spinal cord, during radiotherapy for gastric lymphomas. While results for the liver and lungs are mixed, no significant differences have yet been reported for the small bowel. These findings support the routine use of DIBH to minimize cardiac and critical organ radiation during radiotherapy, thereby facilitating safer clinical and patient practices.

The term "prehypertension" was introduced in 2003 by the Joint National Committee (JNC-7) on Detection, Prevention, Estimation, and High Blood Pressure Treatment. It states two BP readings in the range of 120-139 mmHg systolic and 80-89 mmHg diastolic. This middle stage shows important cautionary signals, meaningfully increasing the risk of progressing to hypertension. This article investigates the multifaceted nature of prehypertension, definitions, challenges in diagnostics, prevalence globally, and the consistent risk factors, despite the introduction of a tool to identify the risk of individuals and make early preventive measures. The classification and treatment of prehypertension are still under debate. Inconsistent guidelines in all the regions are creating uncertainty among medical professionals. HTN affects about 36% of adults; in men, specific ethnic populations showed higher vulnerability. The occurrence of other CVD risk factors like obesity, DM, and dyslipidemia impacts health. Prehypertension diagnosis is not a straightforward method. It required repeated blood pressure measurements to mark hypertension. Research indicates that simply labeling someone as prehypertensive does little to motivate behavioral changes. The importance of developing more considerable communication plans to boost meaningful lifestyle adjustments. Conclusion: Prehypertension signifies a public health challenge; there is a persistent need for combined guidelines and further research to improve its management and control the rising global burden of hypertension and linked cardiovascular diseases.