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.

ABSTRACT Introduction Posterior cerebral artery (PCA) stroke, while comprising a smaller proportion of ischemic strokes, often results in significant neurological deficits and poses distinctive therapeutic challenges. This study aims to systematically review and meta‐analyze the efficacy and safety of EVT compared with best medical management (BMM) in patients with PCA stroke. Methods Electronic searches of PubMed, Embase, and Scopus up to July 2025 identified studies comparing EVT and BMM for PCA stroke. Eligible studies included patients with PCA stroke, compared EVT with BMM, and reported at least one outcome of interest. Statistical analyses employed random or fixed‐effects models as appropriate; results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). Results A total of 12 studies were included, encompassing 39,525 patients (2,540 EVT; 37,075 BMM). EVT was associated with significantly increased odds of early neurological improvement (ENI) (OR 2.11, 95% CI 1.81–2.45), and greater reduction in NIHSS at 24 h (MD –1.30, 95% CI –1.89 to –0.71). There was no significant difference in visual field normalization and no difference in excellent functional outcome. EVT was associated with lower odds of achieving functional independence (mRS 0–2 at 90 days: OR 0.75, 95% CI 0.67–0.85), and significantly increased risks of symptomatic intracranial hemorrhage (OR 2.32, 95% CI 1.66–3.23) and mortality at 90 days (OR 1.86, 95% CI 1.47–2.35). Conclusion In PCA stroke, endovascular thrombectomy (EVT) confers early neurological recovery but does not improve long‐term functional independence and is associated with higher risks of symptomatic hemorrhage and mortality compared with BMM. While EVT may benefit selected patients, these results underscore the need for individualized treatment decisions and prospective randomized trials focused on PCA stroke.

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

Acute normovolemic hemodilution (ANH) is an intraoperative blood conservation technique that involves removing a portion of the patient’s blood after anesthesia induction and replacing it with fluids to maintain normovolemia. The purpose of this systematic review and meta-analysis was to assess the efficacy and safety of ANH in reducing transfusion requirements and improving hemorrhagic outcomes in adult cardiac surgery patients. Studies were identified through systematic searches of PubMed, Embase, and Cochrane Central databases. Effect estimates were calculated using random-effects models, with heterogeneity assessed using the I2 statistic. Trial sequential analysis (TSA) was employed to evaluate the robustness of cumulative evidence. randomized controlled trials (RCTs) involving 4473 patients were included for further analysis. ANH was associated with a 27

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.