Hayatabad Medical Complex

Older adults with acute coronary syndrome (ACS) face high risks of recurrent ischemia, mortality, and bleeding complications from antiplatelet therapy. The safety and efficacy of ticagrelor versus clopidogrel in this vulnerable population remain uncertain due to their underrepresentation in clinical trials. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to October 2025 for randomized controlled trials and cohort studies comparing ticagrelor versus clopidogrel in ACS patients aged ≥70 years. Outcomes included myocardial infarction (MI), stroke, major bleeding, all-cause death, cardiovascular (CV) death, and the composite of CV death/MI/stroke. Hazard ratios (HRs) or risk ratios with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed via I2 statistics. Five studies (2 randomized controlled trials and 3 cohort studies) with 22,806 participants were included. Ticagrelor significantly reduced the risk of MI (HR 0.84, 95% CI 0.75-0.95, P = 0.004) and the composite endpoint of CV death, MI, or stroke (HR 0.85, 95% CI 0.74-0.98, P < 0.05). No significant differences were found between ticagrelor and clopidogrel in stroke incidence, major bleeding, or all-cause mortality. Heterogeneity was substantial for certain outcomes, particularly bleeding and mortality. In patients aged ≥70 years with ACS, ticagrelor was associated with reduced MI and composite ischemic events compared with clopidogrel, while no statistically significant differences in bleeding events or mortality were observed. However, substantial heterogeneity and reliance on observational data for some outcomes warrant cautious clinical interpretation.

Background: Ponseti casting and manipulation are the cornerstone treatments for idiopathic congenital talipes equinovarus (CTEV). While cavus, adduction, and varus deformities are typically corrected with serial casting, equinus deformity often persists and requires Achilles tendon tenotomy. Percutaneous tenotomy using a scalpel blade is effective but carries a risk of neurovascular injury. Objective: This study aimed to evaluate the effectiveness and safety of percutaneous needle Achilles tendon tenotomy in correcting equinus deformity in children with idiopathic congenital clubfoot. Methodology: This prospective observational study included 16 patients (27 clubfeet) with idiopathic congenital clubfoot treated at a tertiary care orthopedic unit between February and August 2024. All patients had residual equinus deformity following serial Ponseti casting. Percutaneous Achilles tenotomy was performed using an 18-gauge needle under local anesthesia. The primary outcome was ankle dorsiflexion measured at three months post-procedure. Secondary outcomes included dorsiflexion at cast removal and procedure-related complications. Statistical analysis was conducted using paired comparisons. Results: The mean pre-tenotomy equinus deformity was 29.7° (range 20–42°). At final cast removal, mean ankle dorsiflexion improved to 23.1° (range 18–36°) and was maintained at three months (mean 23.4°). The improvement from baseline was statistically significant (p &lt; 0.001). No intraoperative or postoperative complications were observed. Conclusion: Percutaneous needle Achilles tendon tenotomy is a simple, safe, and effective technique for achieving correction of equinus deformity in idiopathic congenital clubfoot, with excellent short-term outcomes and no observed complications. Keywords: Achilles Tendon, Clubfoot, Equinus, Needle Tenotomy.

This meta-analysis assessed the latest clinical efficacy and safety of adjuvant chemotherapy (ACT) after concurrent chemoradiotherapy (CCRT) compared to CCRT alone for locally advanced cervical cancer. Studies were pooled via random effects model. Overall survival (OS; risk of death from any cause) and progression-free survival (PFS; risk of disease progression) were primary endpoints. Secondary outcomes included disease-free survival (DFS; absence of recurrence), local failure rate, distant metastasis rate (DMR), and toxicities. A total of 22 studies (n = 7466) were included. CCRT + ACT was associated with significant improvement in OS, PFS, and DMR compared to CCRT alone. Subgroup analyses of RCTs, studies with >3 ACT cycles, and with a follow-up of 5 years indicated no statistical difference in OS and PFS between two groups, suggesting that the clinical advantage of ACT may be limited, particularly given emerging immunotherapies. Moreover, ACT was associated with a higher rate of hematologic and gastrointestinal toxicities.

Objective: To evaluate the impact of glycaemic control, measured by HbA1c levels, on in-hospital outcomes in STEMI patients undergoing primary PCI, particularly within the South Asian population, where diabetes is a prevalent risk factor and management strategies remain suboptimal. Methodology: This retrospective study was conducted at Hayatabad Medical Complex, Peshawar, from January 2023 to December 2023. A total of 300 STEMI patients were enrolled, equally divided into two groups: Diabetic (n=150) and Non-Diabetic (n=150). Clinical parameters, in-hospital outcomes, and major adverse cardiovascular events (MACE) were assessed. The one-year period allowed for a focused dataset, reflecting current trends in glycaemic management at the institution. STEMI diagnosis was confirmed via ECG changes and elevated cardiac biomarkers. Statistical analyses were performed using SPSS version 25, with significance set at p &lt; 0.05. Results: The mean HbA1c levels were significantly higher in the Diabetic group (8.0 ± 0.87%) compared to Non-Diabetics (5.14 ± 0.61%) (p &lt; 0.001). In-hospital mortality was significantly higher in Diabetic patients (10%) compared to Non-Diabetics (4%) (p = 0.02). No significant differences were observed in reinfarction (15% vs. 10%, p = 0.23), heart failure (5% vs. 3%, p = 0.34), stroke (2% vs. 2%, p = 1.0), multivessel disease (12% vs. 10%, p = 0.53), and arrhythmia (7% vs. 6%, p = 0.35). Logistic regression identified diabetes as an independent predictor of mortality (OR: 2.5, 95% CI: 1.1 – 5.7, p = 0.02). Conclusion: Poor glycaemic control is associated with increased mortality in STEMI patients undergoing PCI. Routine HbA1c assessment may improve risk stratification and guide management strategies. Optimal glycaemic control is essential for improving survival and reducing complications. Future research should focus on long-term outcomes and effective diabetes management strategies in PCI patients.

Objectives: This study aims to assess the prevalence and severity of left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes mellitus (T2DM) using echocardiographic evaluation and to examine its association with glycemic control, age, and diabetes duration. Given that LVDD is an early marker of diabetic cardiomyopathy, its timely detection is crucial in preventing progression to heart failure with preserved ejection fraction (HFpEF). Methodology: A retrospective observational study was conducted at Hayatabad Medical Complex, Peshawar, from June 2023 to June 2024. A total of 150 T2DM patients aged 30–75 years were analyzed. LVDD severity was classified into three grades based on echocardiographic assessment following ASE/EACVI guidelines. The study evaluated associations between LVDD severity and HbA1c levels, patient age, and diabetes duration. Results: LVDD was prevalent in a significant proportion of T2DM patients, with 56.7% presenting with Grade 1 LVDD, 30% with Grade 2, and 13.3% with Grade 3. Mean HbA1c levels were 9.31% in Grade 1, 8.89% in Grade 2, and 8.62% in Grade 3, showing a statistically significant association with LVDD severity (p &lt; 0.05). The mean age of patients was 53.8 years for Grade 1, 55.5 years for Grade 2, and 58.2 years for Grade 3. The duration of diabetes correlated with LVDD severity, with Grade 3 patients having a mean diabetes duration of 11.1 years. Conclusion: This study underscores a strong association between LVDD severity and glycemic control, age, and diabetes duration in T2DM patients. Routine echocardiographic screening and stringent glycemic management are essential for early detection and prevention of LVDD progression, ultimately reducing the risk of heart failure.

Estrogen deficiency after menopause contributes to structural and symptomatic changes in genital, cutaneous, and adnexal tissues, yet available evidence remains scattered across clinical and imaging disciplines. Objectives: To summarize contemporary evidence on anatomical and dermatologic manifestations of estrogen deficiency in postmenopausal women and to evaluate the effects of local hormonal and device-based treatments. Methods: A systematic review following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for English-language studies from 1 January 2017 to 31 December 2024. Eligible designs included randomized controlled trials, observational and cross-sectional studies, imaging investigations, and pilot interventions involving naturally or surgically postmenopausal women. Outcomes included clinical signs, symptom scores, imaging parameters, and dermatologic manifestations. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and the Newcastle–Ottawa Scale for observational and imaging studies. Results: Eighteen studies met the inclusion criteria. Randomized trials of low-dose vaginal estradiol and selective estrogen receptor modulators improved vaginal pH, Vaginal Health Index, Vaginal Maturation Index, dryness, and dyspareunia with minimal systemic absorption. Dermatology-focused cohorts commonly reported xerosis, pruritus, dermatoses, nail fragility, and female-pattern hair loss. Imaging studies demonstrated reduced dermal and vaginal wall thickness and altered echogenicity. Evidence for fractional CO₂ laser and radiofrequency remained limited to small pilot studies with short follow-up. Conclusions: Estrogen deficiency is consistently associated with measurable structural and symptomatic changes in genital and cutaneous tissues. Local estrogen therapy offers reliable short-term benefits, whereas device-based interventions remain investigational and require larger controlled trials.

Background: Pathogenic mutations in the BRCA1 and BRCA2 genes significantly elevate lifetime risks for breast and ovarian cancers, necessitating specialized prevention strategies. Despite established guidelines, the rapid evolution of evidence on the efficacy and impact of various risk-management options—including surgery, enhanced surveillance, and chemoprevention—requires continual synthesis to inform clinical practice. Objective: This systematic review aimed to synthesize contemporary evidence on how BRCA1/2 gene mutations influence and justify specific prevention, screening, and management strategies for breast and ovarian cancers. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and the Cochrane Library was performed for studies published between 2019-2024. Inclusion criteria focused on comparative studies of BRCA1/2 carriers evaluating prevention interventions (risk-reducing surgery, intensive surveillance, chemoprevention) against relevant comparators, with outcomes including cancer incidence, mortality, and quality of life. Study selection, data extraction, and risk-of-bias assessment using the Newcastle-Ottawa Scale and Cochrane RoB 2 tool were performed independently by two reviewers. A narrative synthesis was undertaken due to clinical heterogeneity. Results: Eight studies (n=12,548 carriers) were included. Risk-reducing salpingo-oophorectomy was associated with an 80-88% reduction in ovarian cancer risk and improved all-cause mortality. Risk-reducing mastectomy reduced breast cancer risk by &gt;90%. Annual breast MRI with mammography significantly outperformed mammography alone, with higher sensitivity (93% vs. 42%) and lower interval cancer rates. Evidence for chemoprevention was less robust. Studies highlighted the importance of incorporating quality-of-life and psychosocial outcomes into decision-making. Conclusion: For BRCA1/2 carriers, risk-reducing surgeries and MRI-enhanced surveillance are highly effective strategies for cancer risk reduction and early detection. Optimal care requires a personalized, shared decision-making approach that balances oncologic efficacy with personal values and psychosocial well-being. Further research is needed on long-term quality of life and novel preventive agents.

Objective: Postoperative discitis (POD) is a serious yet uncommon side effect of lumbar discectomy with long-term morbidity, delayed recovery, and high cost of treatment. Local prophylaxis is a viable alternative to systemic antibiotics, which fail to reach a therapeutic level in the avascular disc. This study sought to assess the efficacy of intradiscal gentamycin wash in the prevention of POD. Material and Methods: A retrospective study was conducted on 160 patients (58% male) who underwent lumbar discectomy between December 2023 and January 2025. The patients were categorized into Group A (n=70), without intradiscal wash, and Group B (n=90), with intradiscal wash (gentamycin 80 mg). All were then clinically and radiographically followed for 12 months. The incidence of POD was the main outcome, and clinical, radiological, and laboratory characteristics were analyzed in patients with POD. Results: POD occurred in 5 patients (3.1%). Group A had 4 cases (5.7%), whereas Group B had 1 case (1.11%), showing a significant reduction (p &lt; 0.05; RR = 5.14). All POD cases were managed conservatively with intravenous administration of antibiotics, use of bracing, and analgesics, and they had full recovery within 6-12 months without surgery. Conclusion: Intradiscal gentamycin wash is an easy, safe, and cost-effective adjuvant that has proven to be significantly effective in the reduction of POD after lumbar discectomy. Larger prospective trials are indicated to establish a role for its routine clinical use.

Introduction: Syringomyelia following foramen magnum decompression can develop as a progressive neurological deficit that requires effective intervention. Syringosubarachnoid shunting has been brought to attention as a direct method to relieve syrinx pressure and relieve symptoms. The purpose of this study is to assess clinical and radiological outcomes of syringosubarachnoid shunting in such patients. Material &amp; Methods: A retrospective study was done of 21 patients of syringomyelia treated by syringosubarachnoid shunting at Hayatabad Medical Complex, Peshawar. The modified Japanese Orthopedic Association score (mJOA) was used to assess clinical recovery, and radiological outcomes included syrinx area change and span. Paired t tests and correlation analysis were performed using statistical analysis with p &lt; 0.05. Conclusion: Syringosubarachnoid shunting provides a safe and effective surgical option for the relief of syringomyelia after foramen magnum decompression with significant clinical and syringomyelia improvement and low complication rates. Nevertheless, it is still a good intervention when decompression alone is not enough.