Ameer-ud-Din Medical College (Urdu: امیرالدین طبی کالج) (abbreviated as AMC; also known as PGMI Medical College), established in 2011, is one of the six public colleges of medicine located in, Lahore, Punjab, Pakistan. It is established on the initiative of CM Shehbaz Sharif to give quality education in the region Punjab and especially in Lahore. It is registered with PMDC, listed in IMED, affiliated with PGMI and UHS, and approved by Ministry of Health. Lahore General Hospital is attached as training and teaching hospital. It is registered with PMDC, listed in IMED, affiliated with PGMI and UHS, and approved by Ministry of Health. Lahore General Hospital is attached as training and teaching hospital..
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and is associated with a markedly increased risk of thromboembolic stroke, primarily originating from the left atrial appendage (LAA). Percutaneous left atrial appendage occlusion (LAAO) is an established alternative for stroke prevention in patients with contraindications to long-term oral anticoagulation. Transesophageal echocardiography (TEE) has traditionally guided LAAO, but intracardiac echocardiography (ICE) is increasingly adopted to facilitate conscious sedation and operator-controlled imaging. Comparative real-world safety and effectiveness data between ICE and TEE remain limited. We conducted a retrospective, multicenter cohort study using the TriNetX Research Network, comprising 112 healthcare organizations. Adult patients with atrial fibrillation who underwent percutaneous LAAO guided exclusively by ICE or TEE were identified. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included pericardial effusion, stroke/cerebrovascular accident (CVA), major bleeding, acute kidney injury (AKI), device-related complications, and all-cause hospitalization or emergency department encounters, assessed at 30 and 365 days. Propensity score matching (1:1) was performed using demographics, comorbidities, medications, prior procedures, and laboratory values. Risk ratios, absolute risk differences, Kaplan-Meier analyses, and multivariable Cox proportional hazards models were used to compare outcomes. Among 10,629 eligible patients, 3,930 underwent ICE-guided LAAO and 6,699 underwent TEE-guided LAAO. After propensity score matching, 3,442 patients remained in each cohort with well-balanced baseline characteristics. At 30 days, all-cause mortality was numerically lower with ICE than TEE (0.4
BACKGROUND:Prediabetes, defined as elevated blood glucose levels below the diabetic threshold, is a worldwide concern. In Pakistan, it is highly prevalent. Preventing the progression of diabetes requires early identification of high-risk people. The Atherogenic Index of Plasma (AIP) has been proposed as an indicator of insulin resistance and cardiovascular risk. Our study content is to explore the relationship between AIP and metabolic indicators in patients with prediabetes. METHODOLOGY:A cross-sectional study was conducted at a tertiary care hospital after IRB approval. A total of 334 prediabetic individuals aged 18-60 years, with no history of diabetes or use of lipid/glucose-altering medications, were included. Anthropometric, biochemical, and demographic information was gathered, including fasting glucose, HbA1c (Glycated Haemoglobin), and lipid profiles. Different AIP quartiles were assigned to the participants. ANOVA, Chi-square, and multivariate regression with confounder adjustment were used in the statistical study. RESULTS:Significant differences were observed across AIP quartiles. Higher AIP was associated with male gender, older age, higher BMI, lower HDL (High Density Lipoprotein), and elevated triglycerides. Fasting glucose and insulin increased with AIP, while HbA1c showed no significant variation. In multivariate analysis, HDL and triglycerides remained the strongest independent predictors of AIP. CONCLUSION:AIP is significantly linked with worsening metabolic indicators in prediabetics, highlighting its potential as a simple, cost-effective screening tool. Adding AIP into routine evaluations could help early identification and prevention of diabetes and associated cardiovascular disease.
Background:Sacral chordomas are rare malignant tumors arising from notochordal remnants that present unique surgical challenges due to their indolent growth, locally aggressive behavior, and high recurrence rates despite treatment. This review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances for sacral chordomas. Methods:This systematic review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances through analysis of PubMed, Scopus, and Web of Science databases [2023-2025]. Results:En bloc resection with wide negative margins remains the cornerstone of treatment, achieving optimal local control but often at the cost of significant neurological and functional morbidity. Modern reconstruction techniques, including vascularized grafts and three-dimensional (3D)-printed prostheses, have improved spinopelvic stability and postoperative outcomes. Adjuvant particle beam radiotherapy, particularly proton and carbon ion therapy, demonstrates superior 5-year local control rates of 77-89% compared to 10-30% with conventional photon therapy, while stereotactic radiosurgery achieves 81% local control. Systemic therapies remain limited, though targeted inhibitors of platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), and the PI3K/AKT/mTOR pathway show modest activity with disease stabilization in 60-70% of cases. Novel immunotherapeutic approaches, including Brachyury-targeted vaccines and checkpoint blockade, are under investigation. Molecular insights have identified key drivers, including Brachyury [T-box transcription factor T (TBXT)], receptor tyrosine kinases, and emerging biomarkers that may guide future therapeutic selection. Conclusions:Integrated multimodal care is critical for improving survival and function in patients with sacral chordomas.
