The Liaquat National Hospital (LNH), is located at Stadium Road, Karachi, Sindh, Pakistan.
Chronic kidney disease (CKD) is a significant contributor to stroke-related mortality. Stroke risk increases in a stepwise manner as kidney function declines. However, trends of death rate due to stroke among individuals over 45 years of age with CKD have not been well described. The aim of this study is to evaluate stroke-related mortality among adults aged ≥ 45 with CKD in the United States. Utilizing the CDC WONDER database, death certificates were examined from 1999 to 2023 for stroke-related mortality in adults with CKD aged ≥ 45 years. Age-adjusted mortality rates (AAMR) per 100,000 individuals, annual percentage changes (APC), average annual percent changes (AAPC), and 95
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
BACKGROUND:Diabetes mellitus (DM) is a major global health concern, and its microvascular complication, diabetic nephropathy, is a leading cause of chronic kidney disease and end-stage renal disease. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are proven to delay the progression of diabetic nephropathy; however, their utilization patterns in Karachi, Pakistan, have not been adequately studied. OBJECTIVES:To assess the prevalence of ACEI and ARB use among patients with diabetic nephropathy in Karachi and to identify demographic and clinical factors influencing their utilization. METHODS:A cross-sectional study was conducted at Aga Khan University Hospital, Karachi, from September 2021 to August 2022. A total of 118 patients diagnosed with diabetic nephropathy were recruited. Data on demographics, ACEI/ARB usage, creatinine levels, history of ischemic heart disease, and type of treating physician (endocrinologist vs. general physician) were collected. Patients were stratified by age, gender, and ischemic heart disease status. Statistical analysis was performed using chi-square tests, with significance set at p < 0.05. RESULTS:Of the 118 patients, 53.4% were male and 46.6% female, with a mean age of 62.01 years. Coronary artery disease was present in 66.9% of the cohort. Only 9.3% of patients were under endocrinologist care, and all were prescribed ACEIs. Overall, just 26.3% of patients were receiving ACEIs or ARBs. Females had a slightly higher treatment rate than males (30.9% vs. 22.2%). Patients older than 65 years showed the highest ACEI/ARB utilization (41.9%), indicating an age-associated trend in prescribing patterns. CONCLUSION:The study reveals a substantial underuse of ACEIs and ARBs among diabetic nephropathy patients in Karachi, despite strong evidence supporting their effectiveness. This gap between clinical guidelines and real-world prescribing practices highlights the need for improved physician awareness, enhanced patient education, and strengthened healthcare systems. Addressing these factors could significantly improve renal outcomes and reduce the long-term burden of diabetic kidney disease in South Asia.
BACKGROUND:Neurosurgery carries one of the highest complication-associated morbidity burdens of any surgical specialty. While patient-facing consequences of adverse events are well documented, the psychological, professional, and financial impact on the operating neurosurgeon, the "second victim," remains poorly characterized, limiting the development of evidence-based support frameworks. OBJECTIVE:To examine the psychological and behavioral sequelae experienced by neurosurgeons following major surgical complications and to identify unmet institutional support needs. METHODS:A cross-sectional anonymous online survey was distributed to neurosurgeons across varied practice settings and career stages across Pakistan. Domains included complication exposure, emotional impact, confidence changes, decision-making modifications, morbidity and mortality conference participation, support received, financial consequences, medicolegal concern, and preferred support modalities. Descriptive statistics were applied. RESULTS:Eighty-one neurosurgeons participated. Major complications were reported by 96%; neurological deficit and postoperative infection were most common, 62% each. More than 63% rated emotional impact at 4 or 5 of 5, and 73% reported a postcomplication decline in surgical confidence. Fear or hesitation in managing similar cases affected 72%. 86% modified their decision-making through increased conservatism, defensive documentation, and greater second-opinion seeking yet 77.8% received no formal support. Financial consequences affected 27.2% and 75.3% perceived inadequate institutional financial protection. CONCLUSIONS:Surgical complications impose a substantial multidimensional burden on neurosurgeons, encompassing emotional distress, confidence erosion, and financial strain. The near-universal absence of formal support represents a critical institutional gap. Structured peer support, reflective debriefing, and financial protection mechanisms should be systematically integrated into neurosurgical practice.
Splenic vein aneurysm (SVA) is a rare yet significant vascular pathology that can lead to grievous life-threatening complications. Early detection and treatment are essential since these aneurysms have an incidence of 0.2% to 0.5% and are intimately associated with systemic diseases, such as pancreatitis and portal hypertension. Splenic vein aneurysms, if not diagnosed, can lead to consequences such as compression of adjacent structures, thrombosis and rupture causing severe hemorrhage, which has a high mortality rate. Massive SVA demands a multidisciplinary approach for optimal diagnosis and management.We report a case of 51-year-old female, known case Chronic Liver Disease (CLD) with the incidental finding of large splenic vein aneurysm measuring 8.8×10cm on imaging (ultrasound and CT scan abdomen).
