Shifa International Hospital

Objectives: To determine mean change in pain score in patients with knee osteoarthritis after intra-articular injection of platelet-rich plasma. Methodology: A quasi experimental study was conducted at the departments of Hematology and Pain Management clinic at Shifa International Hospital Islamabad from 22nd December 2019 to 23 January 2022. A total of 52 patients diagnosed with Osteoarthritis Knee joints, 50 to 70 years of age were included. All patients received intra-articular injection of 5 ml PRP into the affected knee joint. Pain was calculated through Visual Analog Scale (VAS) using numerical scale from 0 to 10 and was measured prior to treatment at 3 and 6 months Results In this study, at baseline, mean pain score was 6.90 ± 1.47 and at 6 months, mean pain score was 1.48 ± 0.89 with p-value of 0.0001. PRP injection in the intra-articular joint was effective in pain management in the early osteoarthritis with an average variation in the level of pain of 5.54 ± 1.55, indicating a substantial improvement following PRP therapy. Conclusion: Intra-articular injections of platelet-rich plasma are important in reducing pain in patients with mild to moderate knee osteoarthritis and represent an effective therapeutic option for early disease management. Keywords: Intra-articular injection; Osteoarthritis; Platelet-rich plasma

Complete congenital atrioventricular heart block (CHB) is a rare but serious, life-threatening condition in neonates, most often associated with maternal autoimmune connective tissue disease. Definitive management typically requires epicardial pacing; however, in cases of life-threatening bradycardia and hemodynamic compromise, temporary transvenous pacing may be lifesaving. Securing vascular access in premature or low-birth-weight infants often makes vascular access technically challenging, and conventional routes may not always be feasible. In such situations, the umbilical vein offers a rapid, bedside, and less invasive alternative. We present the case of a premature neonate born at 35 + 1 weeks with congenital third-degree heart block, in whom emergency temporary pacing was successfully performed via the umbilical vein after failed femoral access, subsequently serving as a bridge to permanent pacemaker implantation.

Objectives: Heart failure is a major global health problem frequently encountered in medical emergencies, pulmonology, and cardiology units. The burden of heart failure continues to rise worldwide, including in low- and middle-income countries such as Pakistan. Thyroid dysfunction, a common endocrine disorder, has well-recognized effects on cardiovascular structure and function and may influence the clinical course of heart failure. This study aimed to determine the frequency and pattern of thyroid dysfunction among patients with heart failure and reduced ejection fraction. Methodology: A hospital-based cross-sectional study was conducted in the Cardiology Department of Bahria International Hospital from May 18, 2025, to September 30, 2025. A total of 163 patients with heart failure and reduced ejection fraction were enrolled using non-probability consecutive sampling. Thyroid function was assessed by measuring serum thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Data were analyzed using SPSS version 28. Results: The mean age of participants was 51.45 ± 11.67 years, and the mean ejection fraction was 32.25 ± 4.41%. Thyroid dysfunction was identified in 48 patients (29.4%). Hypothyroidism was the most prevalent abnormality, observed in 31 patients (19%), while 17 patients (10.4%) had hyperthyroidism. No statistically significant association was found between thyroid dysfunction and age or gender. Conclusion: Thyroid dysfunction is common among patients with heart failure and reduced ejection fraction, with hypothyroidism being the most frequent abnormality. Routine assessment of thyroid function may be beneficial in patients with heart failure. Further studies are warranted to evaluate the clinical outcomes following correction of thyroid dysfunction.

Objectives: Inferior vena cava (IVC) filters play a vital role in preventing pulmonary embolism (PE) in patients who cannot undergo anticoagulation therapy. While retrievable filters offer temporary protection, their removal can become increasingly challenging, particularly in cases with prolonged dwell times, filter embedment, tilt, or migration. This study aimed to evaluate the outcomes of IVC filter retrieval procedures at our institution, focusing on factors influencing technical success and procedural complexity. Methodology: We conducted a retrospective observational study involving 31 patients who underwent attempted IVC filter retrieval. Collected data included patient demographics, filter characteristics (type and placement site), retrieval approaches (simple vs. complex), procedural durations, and outcomes. Simple retrievals were defined as those completed using standard snare techniques, whereas complex retrievals required advanced methods due to technical challenges such as filter embedment or tilt. Results: The overall technical success rate was 87.1% (27/31). Simple retrievals (n = 21) were all successful (100%), while complex retrievals (n = 10) achieved a success rate of 70% (7/10). Mean procedure time for simple retrievals was 25.5 minutes (range: 15–34 minutes), significantly shorter than that of complex retrievals, which averaged 48.2 minutes (range: 39–84 minutes) (p = 0.001). Conclusion: Our findings underscore the importance of timely IVC filter retrieval. Complex retrievals—often associated with longer dwell times and anatomical complications—require advanced techniques and are associated with increased procedure time and reduced success. Establishing structured follow-up systems and specialized retrieval protocols is essential for improving outcomes in patients with indwelling IVC filters.

Dyslipidemias are a significant risk factor for stroke. Still, there is limited data on mortality trends where both dyslipidemia and stroke are either contributing or underlying causes of death among adults aged ≥ 25 years. We aimed to evaluate the demographic, regional, and temporal trends in dyslipidemia and stroke-related mortality among adults from 2010 to 2020. The CDC WONDER mortality data were utilized to identify deaths with both dyslipidemia and stroke as either underlying or contributing causes of death in adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) were calculated and further categorized by year, sex, race/ethnicity, region, and urban-rural status. Joinpoint regression was used to determine changes in trends over time. Between 2010 and 2020, a total of 106,813 dyslipidemia and stroke-related deaths occurred among adults aged ≥ 25 years, with the most in medical facilities (35.7%), at home (27.7%), or in nursing/long-term care facilities (26.9%). The AAMR increased from 3.47 in 2010 to 5.47 in 2020, stable through 2018 (APC 1.6 [95% CI, −0.4 to 2.7]) then rising sharply (APC 15.1 [95% CI, 7.5 to 19.5]). Men had higher mortality than women (AAMR: 4.44 vs. 3.66). The Non-Hispanic (NH) Black or African American population had the highest overall AAMR (4.97), followed by the NH White population (3.99), the NH American Indian or Alaska Native population (3.87), the NH Asian or Pacific Islander population (3.59), and the Hispanic or Latino population (3.25) Vermont (10.15) and Georgia (1.99) had the highest and lowest state-level rates, respectively. Regionally, the West (4.61) exceeded the Northeast (3.43). Nonmetropolitan areas (4.81) had consistently higher mortality than metropolitan areas (3.85). Dyslipidemia and stroke-related mortality increased significantly after a period of stability. The highest AAMRs were observed in men, NH Black individuals, and people living in the Western US and nonmetropolitan areas. Effective policies are required to reduce these mortality rates and improve cardiovascular health.

Thyroid peroxidase antibody (TPOAb) positivity is the most important risk factor for hypothyroidism and determines thyroid function follow-up during pregnancy. TPOAb positivity is usually defined by manufacturer cut-offs which typically derived from non-pregnant populations. However, as a state of immune tolerance, pregnancy can affect TPOAb concentrations. To improve the understanding of clinical relevance of TPOAb concentrations during pregnancy, we investigated the association of TPOAbs with maternal thyroid function. We performed an individual participant data meta-analysis embedded in the Consortium on Thyroid and Pregnancy. Participants with multiple gestations, pre-existing thyroid disease, thyroid (interfering) medication usage, or conception by in vitro fertilization were excluded. We used mixed effects regression models to assess the association of TPOAb percentiles calculated in each cohort with maternal thyroid function. The study population comprised 62,634 pregnant women from 24 cohorts. As compared to TPOAb percentiles ≤80, there were progressively higher mean thyroid stimulating hormone (TSH) concentrations across TPOAb percentiles ≥89, with corresponding mean differences ranging from +0.11 SD (95% confidence interval [CI] +0.04 SD, +0.19 SD) at the 89th percentile to +1.04 SD (95% CI+0.96 SD, 1.11 SD) at the 100th percentile. Higher TPOAb percentiles were associated with progressively lower mean free thyroxine (FT4) concentrations across TPOAb percentiles ≥91, with corresponding mean differences ranging from -0.08 SD (95% CI -0.16 SD, -0.01 SD) at the 91st percentile to -0.48 SD (95% CI -0.56 SD, -0.4 SD) at the 100th percentile. From the 89th TPOAb percentile upwards, there were progressively higher risks of TSH >4.0 mU/L, with absolute risks of 2.4%, 4.0%, and 28.1% in cases of ≤80th, 89th, and 100th TPOAb percentiles, respectively. Higher TPOAb percentiles were also associated with lower thyroidal response to human chorionic gonadotropin stimulation and higher risks of overt and subclinical hypothyroidism. In 19 of the included cohorts, there were 0.4-6.3% of pregnant women with TPOAb concentrations lower than the positivity cut-offs but larger than or equal to the 89th-percentile concentrations. The associations of TPOAbs with TSH and with FT4 were most apparent during early pregnancy (P for interaction <0.001 for both TSH and FT4). During pregnancy, TPOAbs were dose-dependently associated with TSH, FT4, and the risk of abnormal thyroid function. With concentrations below currently used positivity cut-offs, TPOAbs could be associated with lower maternal thyroid function, which indicates clinically relevant thyroid autoimmunity. These findings implicates that high normal TPOAb concentrations upon first assessment in pregnancy may warrant active follow-up.

Mismatch repair-deficient (dMMR) and microsatellite instability-high (MSI-H) colorectal cancers demonstrate exceptional responsiveness to immune checkpoint inhibitors; however, evidence for the efficacy of neoadjuvant immunotherapy remains limited. This review consolidates all prospective trials evaluating neoadjuvant immune checkpoint blockade in non-metastatic dMMR/MSI-H colorectal cancer. This systematic review followed the PRISMA guidelines and was registered with the PROSPERO database (CRD420251074066). A comprehensive search of PubMed, Embase, CENTRAL, and ClinicalTrials.gov was conducted until May 2025. Prospective interventional studies involving neoadjuvant immunotherapy in adults with stage II-III dMMR/MSI-H colorectal adenocarcinoma were included in this review. The primary outcomes were pathological complete response (pCR), major pathological response (MPR), and clinical complete response (cCR). The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool. Eight prospective phase 2 trials encompassing 352 patients with stage II-III dMMR/MSI-H colorectal cancer were included. The pCR rates ranged from 41 to 90%, with the highest responses in patients with colon cancer receiving dual checkpoint blockade (nivolumab plus ipilimumab: 90% pCR, 95% MPR). In rectal cancer, 100% of patients receiving dostarlimab (n = 16) and 46% of those in the camrelizumab plus apatinib group (n = 24/52) achieved cCR with organ preservation. MPR was observed in 80-95% of the studies. Grade ≥ 3 adverse events occurred in 3-34% of patients, with no treatment-related deaths reported. At the median follow-up (8-26months), disease-free survival exceeded 98% in most cohorts. Watch-and-wait strategies are durable, with no local regrowth in patients with complete clinical response (cCR). Neoadjuvant immune checkpoint inhibition demonstrates high pathological and clinical response rates in dMMR/MSI-H colorectal cancer, with organ preservation achievable in selected rectal cancer patients. Neoadjuvant immunotherapy may become an alternative to surgery as the primary treatment for MSI-H/dMMR colorectal cancer if long-term quality of life is superior and toxicity and cost are competitive with standard surgical approaches. However, longer follow-up, predictive biomarkers, and randomized comparisons with upfront surgery are required before its routine clinical use.

Study DesignMeta-analysis.ObjectivesSpinal tumors and metastases remain a challenge for spine surgeons, with a significant risk of perioperative blood loss, which might require blood transfusions and lead to increased complications. Tranexamic acid (TXA) is an antifibrinolytic agent widely used in various surgical procedures; however, its efficacy in spinal oncology surgery remains unclear. This meta-analysis aims to evaluate the clinical effectiveness of TXA on perioperative outcomes, mainly blood loss, among patients with oncological spines undergoing surgery.MethodsPubMed, Scopus, and Web of Science were systematically searched from inception for eligible articles. We included studies assessing TXA vs no TXA or placebo on perioperative outcomes among patients with spinal tumors or metastases.ResultsAfter a comprehensive search, seven studies were included. Blood loss (MD -111.75mL; 95% CI -217.08 to -6.43; P = 0.04; I2 = 83.8%), postoperative drain (MD -90.49mL; 95% CI -150.17 to -30.81; P < 0.01; I2 = 68.1%), hospitalization duration (MD -1.88days; 95% CI -3.33 to -0.44; P = 0.004; I2 = 0%), and overall complication rate (OR 0.54; 95% CI 0.34 to 0.87; P = 0.011; I2 = 0.0) were significantly reduced in TXA group. There was no significant difference in operation time, transfusions, or thrombosis events.ConclusionRetrospective data suggest TXA may reduce blood loss in spinal tumor surgery. However, its effect on hospital stay and complications remains uncertain. Despite appearing safe, evidence remains limited by bias and heterogeneity. High-quality RCTs are needed to confirm its efficacy and define clinical guidelines.

Objective: To assess fetomaternal outcome in females presenting with morbidly adherent placenta Methodology: This descriptive study was conducted at Department of Obstetrics &amp; Gynecology, Shifa International Hospital, Islamabad. A total of 50 females were recruited in 6-month period (5th November 2022 to 5th May 2023). Both booked and non-booked females were followed-up till delivery. Maternal outcome included hemorrhage, hysterectomy, preterm delivery and need of massive blood transfusion and ICU admission. Fetal outcome included birth weight, Apgar scores and NICU admissions. A structured proforma was used for data collection. Data analysis was performed in SPSS version 21.0. Results: Mean age was 29.92 ± 6.59 years. There were 8 (16%) females with placenta increta, 4 (8%) had placenta percreta while 38 (76%) had placenta accreta. Antepartum hemorrhage was noted in 29 (58%) cases, hysterectomy was done in 25 (50%), preterm delivery in 28 (56%) cases, massive blood transfusion in 24 (48%), need for ICU care in 23 (46%) cases and need for neonatal care in 19 (38%) cases. Further analysis revealed that antepartum hemorrhage, need of ICU admission, low birth weight, and need of NICU admissions were more frequent in women with increta/percreta placental abruption, however, not statistically significant (p-value, 0.71). Conclusion: The maternal complications rate was very high in women with morbidly adherent placenta . Prematurity and need for neonatal intensive care unit were the most frequent fetal complications in this study.

Objective: This study aims to evaluate the efficacy of ultrasound-guided wire localization (USGWL) by achieving a negative surgical margin rate of at least 90% and a re-excision rate below 15% in 185 patients. It also seeks to assess the safety of the procedure by limiting complication rates to less than 5% and to identify patient and lesion characteristics that influence these outcomes.Methodology: This study retrospectively analyzed data from 185 patients who underwent ultrasound-guided wire localization (USGWL) for breast lesions after receiving Institutional Review Board (IRB) approval. The primary goal was to evaluate the procedure&amp;#39;s efficacy by assessing localization success, negative margin rates, and re-excision rates. Secondary outcomes provided a broader view of the procedure&amp;#39;s impact, including operative time, resected tissue volume, complication rates, local recurrence, and patient-centric measures like cosmetic outcomes and patient-reported satisfaction. An exploratory analysis was also performed to examine the influence of variables such as the use of intraoperative ultrasound (IOUS), the surgeon&amp;#39;s experience, prior neoadjuvant therapy, and the proximity of the wire to the lesion. Results: Localization using USGWL was successful in 96.2% of cases, leading to a negative margin rate of 89.2%. The use of intraoperative ultrasound (IOUS) showed a positive but non-significant trend toward improving outcomes, with a higher negative margin rate (92.3% vs. 87.5%) and a lower re-excision rate (4.6% vs. 10.0%). On an average, the procedure took 60.9 minutes with a resected tissue volume of 45.3 cm³. The safety profile was excellent, with a low complication rate of 2.7% and a local recurrence rate of just 1.1% after 12 months. Patients reported high satisfaction, with an average score of 8.2 out of 10, and 88% reported good to excellent cosmetic results. Crucially, the study found that surgeon experience (over 50 procedures) and a close wire proximity to the lesion (less than 2 mm) were significant factors in achieving clear margins, with negative margin rates of 92.1% and 94%, respectively, in these groups. Neoadjuvant therapy, however, had no significant effect on the outcomes. Conclusion: This study confirms that ultrasound-guided wire localization (USGWL) is a highly effective and safe technique for breast conservation surgery, demonstrating high success rates and low complication rates. The data also highlights that outcomes are significantly improved by increased surgeon experience and precise wire placement. Therefore, focusing on surgeontraining and meticulous technique can further enhance the already reliable clinical performanceof USGWL.Keywords: Breast Neoplasms, Ultrasonography, Margins of Excision, Surgical Procedures,Operative, Treatment Outcome