Lahore General Hospital

Abstract Background and Objective The pituitary gland is a small gland found in the pituitary fossa. Significant variations exist in pituitary gland's size and shape among healthy individuals. This variability can create uncertainty making it challenging radiologists to determine whether a certain size falls within a normal range. The objective of the study is to perform a radiologic and morphometric analysis of pituitary gland, focusing on age and sex-related changes in its size and morphology. Materials and Methods This was a retrospective observational study conducted in the department of radiology at Punjab Institute of Neurosciences after obtaining clearance from the institutional review board. The sample size was 503 and ran from January 1, 2022, to December 31, 2024. Normative measurements of pituitary gland among healthy individuals were observed using MRI brain T1 weighted mid sagittal and T2 weighted coronal images. Results The pituitary gland dimensions showed a linear increase with age during childhood and adolescence, peaking in early adulthood and declining in older age groups except length dimension which exhibited peak in fifth decade. Females exhibited higher pituitary mean height and volume compare to males. Mean pituitary height was 5.48 ± 1.49 mm and 5.32 ± 1.43 mm in females and males respectively. Most common shape of the superior surface of pituitary gland was flat. Conclusion This study established normative measurements of the pituitary gland encompassing subjects of all age groups within the Pakistani population. The data provided reference values for the pituitary dimensions and morphology, which serve as diagnostic parameters for evaluating pituitary pathologies.

A characteristic of the multi-ethnic democracies is the debate of federalism versus centralization in the discourse of governance. Constitutional provisions in Pakistan are nominal in support of federalism, yet the friction between provincial sovereignty and centralization still influences political rivalry, allocation of resources, and confidence of the electorate. This paper explores the determinants of popular support of publics in support of federal government versus centralized government structures by use of a cross-provincial survey among Punjab and Khyber Pakhtunkhaw (KP). The study employs a quantitative research design to assess the role of institutional trust, perceived governance performance, ethnic identity, fiscal preferences, and political awareness in shaping the attitudes of the citizens toward state structure, with 714 respondents as a sample. The results show a complex picture: the respondents in KP show more favorability to federalism because of historical needs to have autonomy on the provincial level, but the respondents in Punjab show a relatively higher degree of tolerance to the concept of centralization, which is highly explained by the views on the effectiveness of administration and the unity of the nation. The results of the regression analysis show that institutional trust and perceived provincial performance are the most important predictors of federalist attitudes, whereas security concerns and the expectation of economic performance are significant predictors of centralized authority preferences. The research has theoretical contributions by incorporating the Institutional Theory and the Rational Choice views to support the idea that citizens consider the governance arrangements based on the identity and performance factors. In practical terms, the results indicate the necessity of balanced policies of decentralization that should increase provincial ability without disrupting the national coordination. Finally, the study holds that the founding of sustainable federalism is more reliant not on the design of the constitution but on whether the people believe in the capacity of subnational authorities to provide quality governance.

BACKGROUNDBilirubin-induced neurologic dysfunction (BIND) remains a serious complication of severe neonatal hyperbilirubinemia, especially in resource-limited settings. While total serum bilirubin (TSB) is widely used for risk stratification, the bilirubin/albumin (B/A) ratio has been proposed as a surrogate for free bilirubin, the neurotoxic fraction.AIMTo compare the diagnostic accuracy of the B/A ratio vs TSB for predicting acute BIND in neonates.METHODSWe conducted a systematic review and meta-analysis of observational studies evaluating the B/A ratio and TSB for predicting BIND in neonates (≥ 35 weeks' gestational age). Data sources included PubMed, EMBASE, Cochrane Central, and Google Scholar. Pooled standardized mean difference (SMD), sensitivity, specificity, and heterogeneity (I2) were calculated using a bivariate random-effects model. Meta-regression was used to assess whether biomarker type (B/A vs TSB) explained performance differences. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.RESULTSFive studies involving a total of 1022 neonates were included, with a male-to-female ratio of approximately 57:40. The SMD for B/A ratio was 1.71 (95%CI: 1.00–2.41, P < 0.0001), and for TSB it was 1.68, both showing strong associations with BIND. Meta-regression revealed no significant difference in predictive value between the two biomarkers (P = 0.96).CONCLUSIONBoth TSB and the B/A ratio are comparably effective in predicting BIND. While the B/A ratio may provide incremental value in specific clinical contexts, current evidence supports continued reliance on TSB for routine risk stratification.

During pregnancy, iron deficiency anemia (IDA) is a common complication that exposes both the mother and fetus to a lot of risks. Objectives: To compare intravenous ferric carboxymaltose (FCM) versus iron sucrose in the treatment of moderate to severe anemia in pregnant women. Methods: This quasi-experimental study was conducted in a tertiary care hospital in Lahore, which registered 62 pregnant women having 16-34 weeks of gestation and hemoglobin levels of 7-9 g/dl. The participants were randomly divided into two groups, with intravenous FCM in one of them and the other without. The level of base hemoglobin and post-treatment were taken three weeks after the completion. There was also the evaluation of effectiveness and adverse impacts. Results: The average basal hemoglobin was 7.88 ± 0.42 g/dl. The levels after treatment were significantly higher in the FCM group (10.93 ± 0.63 g/dl) compared to the IS group (9.98 ± 0.51 g/dl), with an increase in statistically significant HB (p&lt;0.001). The efficacy was reported in 87.1% of patients treated with FCM versus 38.7% in the SI group. The adverse effects were remarkably lower in the FCM group (19.4%) compared to IS (61.3%) (p=0.001). Although multiparous women had significantly lower basal HB, both parity groups showed similar responses to treatment. Conclusions: Ferric carboxymaltose demonstrated superior efficacy and tolerability compared to iron sucrose in the first leg during pregnancy. Its ability to achieve rapid HB correction with fewer side effects supports its consideration as preferred intravenous iron therapy.

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.

Abstract Background Patients with breast cancer are particularly vulnerable to developing Pulmonary Embolism (PE) due to factors like cancer-induced hypercoagulability, treatment with chemotherapy, and frequent hospital stays. Despite this known association, there is a lack of comprehensive, population level data tracking PE-related mortality trends in this population over time. Objectives To evaluate national trends and disparities in PE-related mortality among U.S. breast cancer patients from 2010 to 2020. Methods We conducted a retrospective analysis of adults aged 25 years of age and older from 2010-2020 using CDC WONDER Multiple Cause of Death Data. Relevant ICD Codes for Pulmonary Embolism (I26) and Malignant Neoplasm of Breast (C50) were utilized. Data for total number of deaths and Age Adjusted Mortality Rate (AAMR) per 100,000 population was extracted. Joinpoint Regression Program was used to analyze mortality trends and calculate Annual Percentage Changes (APC with relevant 95% Confidence Interval), with further analyses stratified by race and census regions. Results Between 2010 and 2020, a total of 488 deaths were seen in Hispanic or Latino Population (AAMR 0.19), and a total of 8020 deaths were noted among the Non Hispanic Population in the U.S. (AAMR 0.34) attributed to PE and Breast Cancers. APCs among the Non Hispanic Black or African American Population (2010-2012: 10.68, then 2012-2015: -10.91, and 2015-2020: 8.87) and White Population (2010-2012: 10.13, then 2012-2016: -2.18, and 2016-2020: 7.02) appeared to be uptrending initially; downtrending observed later on, and a significant rise being observed in the recent years. Among the Hispanic or Latino Population, APCs were downtrending initially with an uptrending noticed in the recent years (2010-2016: -3.46, then 2016-2020: 17.80). We were not able to calculate AAMR and APCs for American Indian/ Alaska Natives and Asian/ Pacific Islanders due to limited data reliability. Regionally, the South reported the highest number of deaths (3020), followed by the Midwest (1996), West (1923), and Northeast (1591). AAMRs were highest in the Midwest (0.36), followed by the West (0.34), Northeast (0.32), and South (0.31). For Northeast, mortality trends appeared to be increasing (APC: 0.21), while for the Midwest (2010-2017: -0.93, then 2017-2020: 15.82), South (2010-2018: -0.57, then 2018-2020: 18.86) and West (2010-2012: 17.24, then 2012-2017: -3.26, then 2017-2020: 12.08), a similar pattern of initial decline and a recent incline, particularly significant in the Midwest, was observed in the recent years. Conclusion Recent years have seen a concerning rise in mortality related to Pulmonary Embolism and Breast Cancer across the U.S., with notable disparities based on geography and demographics. These patterns highlight an urgent need for targeted research and tailored preventive efforts to close the gaps, and improve survival and patient outcomes. Citation Format: A. Abbas, H. Habib, A. Tayyab, S. A. Khan. Analyzing Mortality Trends and Disparities in Pulmonary Embolism and Breast Cancer among U.S. Patients: A Decade Long Population-Based Retrospective Study, 2010-2020 [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-12-17.

<b>Conclusion:</b> MAUDE data provide novel insights into TMS safety in real-world settings. Although serious AEs are rare, standardized reporting and continued device innovation are essential to ensure safe and effective clinical use.