Aortic Dissection (AD) is a life-threatening condition and one of the major causes of death in the U.S. Despite its clinical significance, trends in AD related mortality remain understudied. We aim to analyze nationwide mortality trends in AD in the U.S. Data from CDC WONDER (1999–2024) identified U.S mortality rates in adults aged ≥ 25 years with AD (ICD-10: I71.0). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). From 1999 to 2024, a total of 115,449 deaths from AD were recorded. The AAMR increased from 2.1 in 1999 to 2.4 in 2024 (AAPC of 0.46; 95
Bilateral adrenal diffuse large B-cell lymphoma (DLBCL) is an exceedingly rare entity. Presentation as bilateral adrenal masses without an identifiable extra-adrenal primary poses a formidable diagnostic challenge, frequently mimicking adrenal metastases or primary adrenal malignancy. A 70-year-old normotensive, non-diabetic male presented with a one-month history of weight loss, generalized dull abdominal pain, and anorexia. Contrast-enhanced computed tomography (CECT) revealed bilateral adrenal masses (right 56 × 28 × 55 mm; left 61 × 30 × 54 mm) with imaging characteristics indistinguishable from metastatic disease. Extensive workup—including CT of the neck and chest, colonoscopy, and biochemical adrenal profiling—failed to identify a primary extra-adrenal malignancy or hormonal excess. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a 22-gauge needle provided tissue confirming diffuse large B-cell lymphoma (DLBCL) with CD20 and PAX-5 positivity. The patient was referred to oncology and commenced on rituximab-based chemotherapy. This case underscores the indispensable role of EUS-guided tissue sampling in the evaluation of bilateral adrenal masses when non-invasive workup is inconclusive. Early tissue diagnosis of adrenal DLBCL is critical, as it is a potentially curable disease amenable to immunochemotherapy rather than surgery.
BACKGROUND:Vitamin D deficiency is highly prevalent in South Asia, yet its clinical impact on musculoskeletal pain in young women remains underexplored. This study assessed the prevalence of Vitamin D deficiency among young women with persistent nonspecific back and knee pain in Karachi, Pakistan, and analyzed lifestyle and clinical correlates. METHODS:A cross-sectional study was conducted from June to December 2022 at two tertiary care hospitals. A total of 200 women aged 14-35 years with musculoskeletal pain of at least three months' duration were recruited. Demographics, sun exposure, diet, clothing, and residence data were collected. Serum 25-hydroxyvitamin D, calcium, phosphorus, and alkaline phosphatase were measured. Pain intensity was assessed using a Visual Analog Scale (VAS). Logistic regression identified predictors of vitamin D deficiency. RESULTS:Among 200 participants, 178 (89%) were vitamin D deficient. Limited sun exposure (p < 0.001), smaller skin exposure area (p < 0.01), poor dietary intake (p < 0.05), and overweight status were all significantly associated with lower vitamin D levels. Vitamin D deficiency was present in 68% of overweight participants, with a statistically significant association (p = 0.02). Logistic regression showed that participants with less than 1 h of daily sun exposure had 3.4 times higher odds of vitamin D deficiency (95% CI: 1.8-6.2), and those with poor dietary intake had 2.6 times higher odds (95% CI: 1.4-5.1). Participants with lower vitamin D levels reported higher VAS pain intensity scores (p = 0.01), with a clear gradient across pain intensity categories. CONCLUSION:Vitamin D deficiency is nearly universal among young women with chronic musculoskeletal pain in Karachi. The strong correlation between vitamin D deficiency and pain intensity underscores the need for routine screening, preventive supplementation, and public health interventions including food fortification and awareness campaigns.
BACKGROUND:Patients with a history of malignancy are at elevated risk for acute coronary syndrome (ACS). This study evaluates in-hospital cardiovascular outcomes in ACS patients with and without a cancer history. METHODS:A systematic search of PubMed, Scopus, Embase, and ClinicalTrials.gov (2000-2025) identified studies comparing in-hospital outcomes for ACS in patients with vs. without malignancy. Data were pooled and analyzed using RevMan 5.4, calculating risk ratios (RRs) under a random-effects model. RESULTS:Fifteen studies were included. Among ACS patients, a history of cancer was associated with significantly worse in-hospital outcomes. Cancer history increased all-cause mortality by 44% [RR: 1.44; 95% confidence interval (CI): 1.21-1.71; P < 0.001], bleeding by 72% (RR: 1.72; 95% CI: 1.33-2.22; P < 0.001), major adverse cardiac events (MACE) by 18% (RR: 1.18; 95% CI: 1.17-1.19; P < 0.001), and stroke by 48% (RR: 1.48; 95% CI: 1.35-1.63; P < 0.001). No significant associations were observed for heart failure (RR: 1.24; 95% CI: 0.96-1.59; P = 0.10), re-infarction (RR: 1.17; 95% CI: 0.83-1.65; P = 0.36), or cardiogenic shock (RR: 1.22; 95% CI: 0.97-1.55; P = 0.09). CONCLUSION:Patients with a history of malignancy presenting with ACS face significantly higher in-hospital risks of mortality, bleeding, MACE, and stroke, while risks of heart failure, re-infarction, and shock show nonsignificant trends. These findings underscore the vulnerability of this population and highlight the need for multidisciplinary, individualized management strategies to improve outcomes.
Background: Vaccine hesitancy has emerged as a major barrier to immunization performance worldwide and remains particularly concerning in Pakistan, where incomplete vaccine uptake continues to compromise disease control and public-health protection. The problem is shaped not only by individual reluctance, but also by misinformation, sociocultural influences, distrust in vaccination programmes, and persistent health-system weaknesses. Objective: To narratively review the principal determinants of vaccine hesitancy in Pakistan and examine their impact on immunization coverage. Methods: A narrative review was conducted using literature from PubMed/MEDLINE, Google Scholar, BMC-indexed sources, national survey materials, and public-health reports published between 1998 and 2025. Sources were selected for relevance to vaccine acceptance, refusal, delayed uptake, immunization barriers, and vaccine-related public trust in Pakistan. Findings were synthesized thematically using an interpretive socio-ecological framework. Results: The evidence identified four dominant and overlapping drivers of vaccine hesitancy: inadequate vaccine knowledge, misinformation and culturally reinforced myths, weak trust in health and government vaccination initiatives, and structural barriers within the healthcare system. Reported indicators in the reviewed literature included inadequate vaccine knowledge among 90% of participants in one cited study, lack of access to trained vaccinators among 87% of respondents, vaccine shortages reported by 24.5%, and parental refusal reaching up to 22% in selected regions. Full immunization remained incomplete, with approximately two-thirds of children who initiated vaccination reported as fully immunized. Mobile-based awareness interventions were associated with up to 30% improvement in preventive behaviour. Conclusion: Vaccine hesitancy in Pakistan is a multifactorial and context-sensitive challenge that significantly disrupts immunization coverage. Effective response requires integrated strategies combining community engagement, myth-correction, reliable vaccine delivery, strengthened frontline services, and restoration of public trust.
