Shaikh Zayed Medical College and Hospital

Objective: To evaluate the diagnostic performance of hysterosalpingography (HSG) for detecting tubal pathology using diagnostic hystero-laparoscopy with chromopertubation as the reference standard, and to assess the association of tubal and pelvic findings with subsequent natural conception. Methodology: This Comparative Cross-Sectional Study Was Conducted in The Department of Obstetrics and Gynecology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Punjab, Pakistan, From June 2025 To May 2026. We performed HSG in 180 women with primary or secondary subfertility during the early proliferative phase of the menstrual cycle using 10–15 mL of water-soluble iodinated contrast medium under fluoroscopic guidance. We then performed diagnostic hystero-laparoscopy during the follicular phase, generally within 2–4 weeks of HSG, under general anesthesia. We assessed tubal patency laparoscopically by chromopertubation using diluted methylene blue dye. HSG was the index test, and hystero-laparoscopy with chromopertubation was the reference standard. We recorded pelvic abnormalities identified during laparoscopy separately and did not consider them mutually exclusive. We followed participants for six months after completing the diagnostic evaluation to document natural conception. Results: Most participants were aged 26–30 years (36.67%), and 56.67% had primary subfertility. HSG showed 70.91% sensitivity, 74.29% specificity, and 72.22% diagnostic accuracy for tubal pathology. Pelvic adhesions (32.22%) were most common. Natural conception occurred in 35.56% during six months, with higher rates among women with normal tubal findings. Conclusion: Hystero-laparoscopy is more accurate for diagnosis and more useful for prognosis for natural conception than HSG in female subfertility

Road traffic crashes remain a major cause of death among children and young people, and reliable visual recognition of the vehicles involved can support later accident documentation. Vehicle type classification is well studied on ordinary traffic imagery, whereas accident-related use requires models that remain informative when vehicles are damaged, occluded, or poorly illuminated. This paper reports a four-class vehicle type classification experiment that uses transfer learning with the Visual Geometry Group 16-layer network (VGG16). A curated corpus of 1,750 images was assembled from publicly accessible web sources through a manually supervised image-retrieval process and was manually annotated before being divided into training, validation, and testing partitions (1,260 / 140 / 350). Augmentation was applied only during training. On the held-out test set of 350 images, the classifier attained 89% overall accuracy and a macro-averaged F1-score of 0.89. Class-wise F1-scores were 0.95 for bike, 0.88 for bus, and 0.87 for both car and truck. Training curves show mild overfitting on the validation split, while the separate test partition confirms balanced four-class performance. The study is limited to a VGG16 baseline; comparisons with residual and transformer architectures, together with robustness and latency tests, remain future work. Downstream effects on emergency response or smart city operations were not measured. The contribution is a transparent VGG16 baseline for four-class vehicles typing, a task-aware literature synthesis, and a clear agenda for subsequent refinement.

Ultra-short bowel syndrome (USBS) is a rare and life-threatening condition defined by the retention of ˂30 cm of small intestine following resection. We report the case of a 53-year-old male who presented with gangrenous gut secondary to superior mesenteric artery thrombosis, necessitating near-total small bowel resection. The patient was left with ~15 cm of proximal jejunum and 10 cm of distal ileum, with a jejuno-ileal end-to-end anastomosis. He developed severe postoperative watery diarrhoea and required Total Parenteral Nutrition (TPN) via a peripherally inserted central catheter line. With careful multidisciplinary management, the patient achieved intestinal adaptation and was weaned off TPN ~6 weeks postoperatively. This case highlights the challenges of managing USBS in a resource-limited setting and demonstrates that survival with gut adaptation is possible even with very limited residual small bowel length, provided that experienced surgical care and nutritional support are available.

Objective: To determine the frequency of early stent thrombosis in patients presenting with STEMI undergoing PPCI. Study Design: Case Series. Setting: Department of Cardiology at Sheikh Zayed Hospital, Rahim Yar Khan. Period: October 2025 to March 2026. Methods: The patients were selected using non-probability consecutive sampling and a total of 234 patients with an age range of 18-60 years and STEMI who underwent PPCI were included in the study. Demographic, clinical, biochemical, angiographic, and procedural characteristics were recorded. Patients were followed for 30 days after PPCI for the development of early stent thrombosis. SPSS version 23 was used for data analysis. Results: The mean age of the patients was 54.9 ± 9.2 years, and 78.6% were male patients. Common comorbidities were dyslipidemia (70.1%), hypertension (47.9%), and diabetes mellitus (44.9%). There were 13 (5.6%) patients with early stent thrombosis. The commonest presenting symptom was chest pain. The involvement of the culprit vessel was statistically significant (p=0.028) in association with early stent thrombosis, and there were no other significant associations with the demographic and clinical variables. Conclusion: Early stent thrombosis is still a clinically relevant complication following PPCI in STEMI patients. Strategies to minimize thrombotic complications and enhance patient outcomes may include careful procedural planning, aggressive management of risk factors, and monitoring to ensure proper post-procedural care.

587 Background: Dementia is linked to poor survival in patients with hematologic malignant neoplasms (HMNs). Evidence suggests that older adults diagnosed with HMNs may experience an accelerated decline in cognitive function particularly dementia. This study evaluates temporal trends among U.S. adults ≥65 years with dementia and HMNs. Methods: Data was extracted from CDC WONDER database from 1999 to 2024 for dementia (F01, F03, G30-31) and HMNs (C81-C96). Age-adjusted mortality rates (AAMRs) per 100,000 and Annual Percentage Changes (APCs) with 95% CIs were calculated. Temporal trends were evaluated using Joinpoint regression, categorized by age, gender, ethnicity, geographic region and urbanization. Results: Between 1999 and 2024, 58,840 dementia and HMNs-related deaths occurred among adults ≥65 years. Males consistently had higher mortality rates compared to females. Mortality was markedly elevated in the early period from 1999-2001 (APC 26.1%), followed by a slower rise from 2001 to 2008 (APC 1.1%) and then a more pronounced rise from 2008 to 2021 (APC 9.2%). Mean AAMRs were comparable between African Americans and Whites (5.18 vs 5.20). Among Whites mortality rates initially increased from 1999 to 2001 (APC 20.8%) followed by a modest increase from 2018 to 2021 (APC 7.4%). AAMR also varied substantially by region (overall AAMR: Midwest 5.7; West: 5.1; South: 4.8; Northeast: 4.4). Rural population had higher mortality rates compared to urban population. Conclusions: HMNs and dementia-related mortality among older adults has shown a sustained increase over the past two decades, with a slight decline after 2021. Significant disparities persisted with higher mortality observed among males, and rural populations. These findings highlight the need for improved risk stratification, early cognitive assessment, and targeted preventive strategies in patients with HNMs to reduce dementia risks. AAPC values for overall, sex, race/ethnicity, census region, and urbanisation. Variable Duration AAPC Lower 95% CI Upper 95% CI P-value Overall 1999–2024 2.7796 1.9848 3.6478 <0.000001 Female 1999–2024 2.5152 1.0974 3.7913 <0.000001 Male 1999–2024 3.2082 2.6773 3.8694 <0.000001 Black or African American 1999–2024 2.8138 1.3182 4.1577 <0.000001 White 1999–2024 3.0855 2.2211 4.1040 <0.000001 Northeast 1999–2024 1.8636 1.4304 2.3843 <0.000001 Midwest 1999–2024 2.9300 1.4290 4.2933 <0.000001 South 1999–2024 2.9751 2.5342 3.6340 <0.000001 West 1999–2024 3.3031 1.7287 4.7764 <0.000001 Large Central Metro 1999–2020 2.7464 1.2422 4.2109 <0.000001 Large Fringe Metro 1999–2020 3.0444 2.4337 3.9535 <0.000001 Medium Metro 1999–2020 1.9426 1.2988 2.7616 <0.000001 Micropolitan (Nonmetro) 1999–2020 3.8675 2.9423 4.9052 <0.000001 NonCore (Nonmetro) 1999–2020 4.9105 3.8945 6.1467 <0.000001

To compare the effectiveness and safety of a novel geometric landmark technique with the conventional palpation technique for central venous cannulation. Comparative observational study. This study was conducted at National Medical Centre (NMC) from January 01, 2025 to June 30, 2025. A total of 100 adult patients requiring central venous cannulation were enrolled and allocated into two groups based on the technique used. Group A (n = 50) underwent cannulation using the geometric landmark method, while Group B (n = 50) underwent cannulation using the conventional palpation technique. First-attempt success rate was the main outcome. Secondary outcomes were the number of attempts, arterial puncture, and change of technique. SPSS software was used for analysis. Chi-square test was used to compare categorical variables whereas the Mann-Whitney U test was applied to the non-normally distributed continuous variables. A P value of less than 0.05 was considered statistically significant. First-attempt success was significantly higher in the geometric landmark group compared to the palpation group (98% vs. 86%; P = 0.027). The geometric landmark technique was associated with fewer cannulation attempts (mean 1.00 ± 0.00 vs. 1.18 ± 0.57; P = 0.012). Arterial puncture occurred in one patient (2%) in each group, with no statistically significant difference (P = 1.000). Technique change was required in one patient (2%) in each group, with no statistically significant difference between the two techniques (P = 1.000). The two groups had similar baseline demographic and clinical characteristics. The geometric landmark technique significantly improves first-attempt success and reduces the number of cannulation attempts compared with the conventional palpation method while maintaining a comparable safety profile. This technique represents a practical and cost-effective alternative for central venous cannulation, particularly in resource-limited settings.

The common intervention for ST-segment elevation myocardial infarction is primary percutaneous coronary intervention (PCI). Post-dilatation of the stent is commonly used to obtain the best stent expansion, but its effect on end-tidal thrombolysis of myocardial infarction flow and microvascular perfusion is not clear in low-resource settings, e.g., Pakistan. Objectives: The study will assess the effectiveness of stent post-dilatation on end-TIMI flow in patients undergoing primary PCI in STEMI, and the relationship between stent post-dilatation and no-reflow and in-hospital outcome measures. Methods: The research was a prospective cohort study conducted in the department of cardiology, Sheikh Zayed Medical College/hospital, Rahim Yar Khan, in a span of four months. The non-probability consecutive sampling included 193 patients with STEMI undergoing primary PCI. The operator randomly assigned the patients to two groups: post-dilatation (n = 96) and no post-dilatation (n=97). Clinical measurements, angiographic, and echocardiographic measurements were obtained. Results: TIMI 3 flow during the last time was also achieved in 68.7/80.4% of the post-dilated group and non-post-dilated group, respectively (p=0.036). There was a higher incidence of no-reflow or slow-flow post-dilatation (19.8% vs 9.3, p=0.029). Mean ejection fraction was lower with post-dilatation (45.1 ± 7.8% vs 47.3 ± 7.0%, p=0.046). Suboptimal final TIMI flow was predicted by post-dilatation alone (OR 2.03, 95% CI 1.05–3.91, p=0.034). Conclusions: Post-dilatation stent in this Pakistani STEMI cohort was associated with lower final TIMI 3 flows and greater no-reflow, and was an independent predictor of suboptimal epicardial reperfusion after primary PCI.