Bacha Khan Medical College

Abstract Background Forgotten double-J (DJ) ureteral stents represent a preventable complication with significant morbidity. Limited data exist on patient-level determinants and systematic risk factors in low- and middle-income countries (LMICs). This study primarily evaluated the burden and clinical consequences of forgotten DJ stents and secondarily identified independent predictors of stent encrustation at a tertiary care center in Pakistan. Methods This retrospective observational study included patients with DJ stents retained 3 or > 3 months beyond the advised removal date without clinical justification, from May 2023 to April 2025. The primary outcome was encrustation. Multivariable logistic regression identified independent predictors of encrustation, with multicollinearity assessed using the variance inflation factor (VIF). Spearman’s correlation evaluated the relationship between stent duration and complication severity. Results Ninety-four patients were included (64.9% male; mean age 41.3 ± 12.2 years). The majority (86.2%) had not completed high school, reflecting low overall educational attainment in the cohort. Total stent dwell time was 3–4 months in 45.7%, 4–6 months in 18.1%, 6–12 months in 16.0%, 12–24 months in 17.0%, and > 24 months in 3.2%. Primary reasons for delay were unawareness (50%), financial constraints (24.5%), and neglect (11.7%). Complications included encrustation (43.6%), stone formation (22.3%), fragmentation (18.1%), and migration (16%). Single-session removal succeeded in 64.9% of patients; 25.5% required two sessions, and 9.6% needed more than two interventions. One nephrectomy was performed (1.1%). On multivariable analysis, factors independently associated with encrustation were low educational status (adjusted OR 9.72, 95% CI 1.66–56.82, p = 0.012) and stent dwell time > 6 months (adjusted OR 23.39, 95% CI 6.64–82.38, p < 0.001). A strong positive correlation existed between stent duration and complication severity (ρ = 0.62, p < 0.001). Conclusion Forgotten DJ stents caused substantial morbidity, with low educational status and prolonged retention independently predicting encrustation. Gaps in patient education and follow-up systems persist in resource-limited settings. Stent registries, automated reminders, and targeted counselling may help reduce this preventable complication.

Non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM) are increasingly prevalent, interrelated conditions contributing significantly to morbidity and mortality. Understanding long-term mortality trends is essential to guide public health strategies. This study aimed to evaluate nationwide mortality trends involving NAFLD and DM in the United States from 1999 to 2022 and to assess demographic and geographic disparities. CDC WONDER was used to extract data for adults aged ≥ 25 years. 10th Revision (ICD−10), using the explicit codes with K74.0, K74.6, K75.8, K76.0 and K76.9 for NAFLD and E10-E14 for DM. Age- Adjusted Mortality Rates (AAMRs) per million population were calculated and trends were analyzed by calculating annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint Regression Program (version 5.2.0.0; National Cancer Institute), with statistical significance set at p < 0.05. From 1999 to 2022, a total of 126,431 NAFLD and DM related deaths were recorded with most of the deaths occurring in Medical Facilities (43.52

PURPOSE:Glioblastoma (GBM) is an aggressive brain tumor with poor prognosis. O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation is a critical biomarker for guiding chemotherapy decisions, yet current testing requires invasive tissue sampling. This study aimed to systematically evaluate the diagnostic accuracy of artificial intelligence (AI) models using MRI for non-invasive prediction of MGMT promoter methylation status in GBM. METHODS:We conducted a systematic search of PubMed, ScienceDirect, Scopus, Google Scholar, Cochrane, Web of Science and EMBASE, identifying 480 records. After duplicate removal and screening, 14 studies met inclusion criteria. Data extracted included AI model architecture, MRI sequences, segmentation methods, and diagnostic metrics. A bivariate random-effects model was used to pool sensitivity and specificity. Meta-regression analyses assessed the effect of AI model type on diagnostic performance. Study quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS:The bivariate random-effects model yielded a pooled sensitivity of 0.536 (95% confidence interval [95% CI]: 0.509-0.563) and a pooled specificity of 0.514 (95% CI: 0.454-0.574), indicating moderate between-study heterogeneity, with an area under the curve of 0.56. The best-performing models included MGMT-net and transformer-based architectures, particularly when using multimodal MRI inputs. Studies employing automated segmentation and single-sequence input (e.g., T2-weighted only) generally demonstrated lower performance. QUADAS-2 assessment indicated a low risk of bias in most domains, with concerns regarding index test thresholds and external validation in some studies. CONCLUSION:AI-based MRI models show moderate-to-high potential for non-invasive MGMT methylation prediction in GBM. However, heterogeneity in study design, imaging protocols, and validation approaches highlights the need for standardized methodologies and robust external validation before clinical adoption.

Sex-related differences in outcomes after catheter ablation for atrial fibrillation (AF) remain incompletely understood, particularly regarding long-term arrhythmia recurrence and procedural safety. Current guidelines do not provide sex-specific recommendations. This systematic review and meta-analysis aimed to evaluate sex-based differences in efficacy, safety, and long-term outcomes following AF catheter ablation. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines and the Cochrane Handbook, with prospective registration in PROSPERO (CRD420251168422). PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 2025. Only studies adjusting for baseline differences using propensity score–based methods were included. Risk ratios (RRs) with 95

Cannabidiol (CBD) has gained significant attention for its potential therapeutic benefits, but its safety profile in healthy populations remains underexplored. This systematic review and meta-analysis aim to evaluate the safety of CBD compared to placebo in healthy adults. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov identified four randomized controlled trials (RCTs) involving 269 healthy adults. The primary outcome was headache, with secondary outcomes including fatigue, abdominal pain, diarrhea, upper respiratory tract infection (URTI), and dizziness. The results revealed that CBD use was associated with a significantly higher risk of diarrhea (RR = 5.85; 95% CI = 1.14-30.02; P = 0.03). While there was a trend toward increased abdominal pain and headache, these results were not statistically significant. Fatigue, dizziness, and URTI showed no significant differences between the CBD and placebo groups. These findings suggest that while CBD appears safe for short-term use in healthy adults, gastrointestinal side effects, particularly diarrhea, should be monitored. Further large-scale studies with longer follow-up periods are warranted to confirm these results and explore long-term safety.