Bilal Qammar

Background: Inherited arrhythmic syndromes (IAS) are an important but under-recognized cause of sudden cardiac death (SCD), particularly in younger individuals. Understanding long-term mortality trends is essential to evaluate their public health impact. Objective: To assess temporal trends and demographic disparities of IAS-related sudden cardiac death among individuals aged 5–44 years in the United States using CDC WONDER data. Methods: This retrospective observational study utilized the CDC WONDER Multiple Cause-of-Death database from 1999 to 2024. Deaths were identified using ICD-10 codes for non-ischemic arrhythmogenic conditions (I42, I44, I45, I47, I49) in combination with sudden cardiac arrest or unexplained death (I46, R96). Ischemic heart disease (I20–I25) was excluded to enhance specificity for inherited causes. Crude and age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated and stratified by age, sex, race/ethnicity, region, urbanization, and place of death. Joinpoint software helped us calculate the average annual percentage change (AAPC)/annual percent change (APC) in AAMRs and the 95% CIs for these changes. Results: A total of 8879 deaths were identified over the study period. The AAMR increased from 1.46 (95% CI: 1.27–1.64) in 1999 to 3.15 (95% CI: 2.89–3.42) in 2024, peaking at 4.54 in 2021, with an overall AAPC of 3.71% (p < 0.000001). Mortality was higher in males; however, females demonstrated a greater relative increase over time. Non-Hispanic Black individuals exhibited the highest mortality rates and fastest rise. The 25–44-year age group accounted for most deaths and showed the steepest increase. Regional and urban–rural disparities were observed, with higher mortality rates in the South and rural areas. Conclusions: It is concluded that mortality related to inherited arrhythmic syndromes and sudden cardiac death is rising among young individuals in the United States. The findings highlight a growing burden of potentially inherited arrhythmogenic conditions and underscore the need for early detection strategies, including genetic screening and targeted public health interventions, to reduce premature cardiovascular mortality.

Background: Cardiogenic shock (CS) and chronic ischemic heart disease (CIHD) remain major contributors to cardiovascular mortality in the United States. Although mortality related to ischemic disease declined in the early 2000s, recent trends suggest a resurgence. Methods: This population-based study utilized the Centers for Disease Control and Prevention’s Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2023. Deaths were identified using ICD-10 codes R57.0 (CS) and I25 (CIHD). Adults aged ≥ 45 years were included. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated, with temporal changes assessed using Joinpoint regression to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Results: Between 1999 and 2023, deaths attributed to CS and CIHD accounted for 78,903 cases among adults ≥ 45 years. Overall AAMR ranged from 35.88 per million in 1999 to 37.44 per million in 2023, with a downward trend from 1999 to 2012 followed by an upward trend thereafter. Males (51,080 deaths) exhibited rising mortality (AAPC: +0.50, p < 0.001), while females (27,823 deaths) showed a decline (AAPC: − 0.91, p < 0.0004). Non-Hispanic Black adults demonstrated the steepest increase (AAPC: +1.85, p < 0.001). The burden was greatest in adults ≥ 65 years, but the 45–64 group showed the fastest rise (AAPC: +1.67, p < 0.001). Conclusion: Mortality from cardiogenic shock and chronic ischemic heart disease among U.S. adults ≥ 45 years declined initially but reversed after 2012. Rising mortality in middle-aged adults, persistent racial disparities, and geographic inequities highlight urgent gaps in prevention and acute care.

Objective: This study aimed to determine the frequency and clinical profile of vitamin D deficiency rickets in children. Methods: This retrospective descriptive study was conducted at King Edward Medical University from March 2024 to June 2025. A total of 265 children aged 6 months to 12 years, diagnosed with vitamin D deficiency rickets based on clinical, biochemical, and radiological findings. Data regarding demographics, socioeconomic status, feeding practices, sunlight exposure, clinical presentation, laboratory parameters, and radiological features were retrieved from medical records. Results: The mean age of affected children was 3.8 ± 2.1 years, with most cases occurring under 5 years of age (75.1%). Males (58.1%) were more frequently affected than females (41.9%). Low socioeconomic background (63%), exclusive breastfeeding without supplementation (55.1%), and inadequate sunlight exposure (69.1%) were significant risk factors. The most common clinical features were bowing of legs (58.9%), widened wrists (54.3%), growth retardation (50.6%), and delayed motor milestones (42.3%). Hypocalcemic seizures occurred in 10.9% of patients, predominantly among infants. Biochemical findings showed hypocalcemia (7.9 ± 1.1 mg/dL), low phosphorus (3.4 ± 0.9 mg/dL), elevated alkaline phosphatase (1082 ± 354 IU/L), and markedly low vitamin D (11.7 ± 4.2 ng/mL). Conclusion: Vitamin D deficiency rickets remains a prevalent pediatric health issue with significant clinical and developmental consequences. The findings of this study highlight the critical role of nutritional insufficiency, inadequate sunlight exposure, and socioeconomic disparities in perpetuating the disease. Keywords: Vitamin D Deficiency, Rickets, Epidemiology, Malnutrition.

Objective: To compare the outcomes of dynamic compression plate (DCP) fixation and flexible intramedullarynailing (IMN) in the treatment of pediatric diaphyseal femur fractures, specifically in terms of fracturehealing time, complication rates, reoperation rates, and functional recovery.Material & Methods: This retrospective comparative study was conducted at Services Hospital, Lahore,Pakistan, from January 2022 to December 2024. A total of 121 pediatric patients who underwent eitherdynamic compression plate (DCP) fixation or flexible intramedullary nailing (IMN) for diaphyseal femurfractures were included. Data were collected on fracture characteristics, healing time, complicationsincluding infection, nonunion, malunion, and hardware-related issues, as well as functional recovery andreoperation rates.Results: The IMN group had a significantly shorter healing time (8.2±3.1 weeks vs. 10.6±2.5 weeks, p =0.03). Functional recovery was better in the IMN group, with a higher PFLES score (95.3±4.2 vs. 91.2±5.1,p=0.02) and lower VAS pain score (1.2±1.1 vs. 1.7±1.3, p=0.04) at 12 months. The reoperation rate washigher in the IMN group (8.8% vs. 3.1%, p=0.04), primarily due to hardware-related complications, while thecomplication rates (infection, nonunion, malunion) were similar between the two groups (infection: DCP7.8%, IMN 3.5%; nonunion: DCP 1.6%, IMN 3.5%; malunion: DCP 1.6%, IMN 5.3%).Conclusion: IMN provided faster healing and better functional recovery, while DCP offered more stablefixation with fewer reoperations, particularly in complex fractures. The choice of fixation method should beindividualized based on fracture type and patient characteristics.Keywords: Pediatric, Diaphyseal femur fracture, Dynamic compression plate, Flexible intramedullarynailing, Healing time, Reoperation rateHow to cite: Aziz A, Afgan S, Qammar B, Asghar J, Hamid A, Aslam A. Dynamic Compression Plate Versus FlexibleIntramedullary Nailing in Pediatric Diaphyseal Femur Fractures: A Retrospective Comparative Study. Esculapio -JSIMS 2026;22(01):107-112.DOI: 10.51273/esculap.v22i01.1532

Type 2 Diabetes Mellitus (T2DM) poses a major health burden in Pakistan, where a shortage of endocrinologists places the responsibility of care on medical

Objective: The aims of the study is to compare the efficacy, safety, and the cost-effectiveness of ultrasound-guided foam sclerotherapy related with the sapheno-femoral ligation (UGFS+SFL) versus conventional surgical treatment for the varicose veins. Methods: This study was conducted over a period of 18 months. Minimum of 80 patients with primary varicose vein due to SFJ (saphenofemoral junction) incompetence were selected and randomly assigned in each arm i.e. surgical and foam sclerotherapy. Results: Both of UGFS+SFL and the conventional surgery led to the significant improvements in CEAP and the VCSS scores. UGFS+SFL group showed the greater reduction in VCSS scores post-treatment compared to surgical group. The Early complications were fewer in UGFS+SFL group, which had no cases of deep the vein thrombosis (DVT) or saphenous nerve injury, the unlike surgical group. Cost of UGFS+SFL was Rs.255924, the significantly lower than Rs.425644 for conventional surgery. The Ultrasound follow-up revealed high rates of vein obliteration in the both groups, though UGFS+SFL group had slightly the lower rates of full obliteration at 3 months. Conclusion: The UGFS+SFL is an effective and the cost-effective alternative to conventional surgery for treating the varicose veins. It offers the comparable clinical outcomes with fewer complications and the lower costs. These treatments achieve high rates of the vein obliteration, making UGFS+SFL a viable option for patients seeking the less invasive approach

Background: Appendicitis is the third most common cause of emergency abdominal surgery worldwide, but diagnosis remains challenging. Clinical scoring systems like Alvarado and RIPASA aim to improve diagnostic accuracy. While the Alvarado score is widely accepted, it is more commonly applied in Western populations. In contrast, the RIPASA score was developed for Southeast Asian populations, reflecting demographic variations in appendicitis presentation. This study compares the accuracy of the RIPASA and Alvarado scores against histopathological findings, the traditional gold standard. Methods: A prospective, comparative study was conducted on 255 patients with suspected acute appendicitis. Upon admission, both RIPASA and Alvarado scores were calculated. Diagnostic performance was evaluated using sensitivity, specificity, PPV, NPV, and overall accuracy. Concordance between scoring systems was analyzed with Cohen’s Kappa, and McNemar’s test assessed statistical significance in performance differences. Results: The RIPASA score demonstrated superior sensitivity at 92% compared to 85% for Alvarado, with both scoring 75% specificity. The PPV for RIPASA was 96%, marginally higher than Alvarado’s 95%, indicating high accuracy in detecting true positives. RIPASA’s NPV was 75%, yielding fewer false negatives than Alvarado. McNemar’s test showed a significant difference (p < 0.05) favoring RIPASA, and Cohen’s Kappa indicated moderate to substantial agreement (0.6–0.8). Conclusion: RIPASA offers better diagnostic performance than Alvarado, particularly in multicultural settings, due to its higher sensitivity and comparable specificity. While both scores have moderate NPVs, additional diagnostic methods may be necessary for complex cases. Further studies are needed to validate these findings across diverse populations

Objective: The objective was to investigate the correlation and accuracy between sodium and potassium levels measured by point-of-care blood gas analysis and those obtained through laboratory serum analysis. Methods: A prospective observational study was carried out on 70 patients presenting to the Emergency Department of Mayo Hospital Lahore. Paired samples were drawn, one of them was used for point of care (POC) blood gas analysis and the other was sent for serum laboratory analysis under standard techniques. Results: The mean difference between POC blood gas analysis and serum laboratory analysis was 4.9±11.24 (taking 95% CI, p< 0.001) for sodium and 0.94±0.07 (taking 95% CI, p< 0.0001) for potassium. The Pearson correlation coefficient (r) for POC blood gas analysis and serum laboratory analysis was 0.021 for sodium, showing a weak correlation. This suggests that there is minimal linear relationship between the sodium levels measured by the two analyzers. For potassium, Pearson correlation coefficient (r) was found to be 0.939, showing strong correlation. This indicates that while the methods generally agree within this range, some degree of variability is present. Conclusion: The difference between the results obtained from both analyzers was found to be statistically significant and therefore, cannot be used interchangeably.

Introduction: Iron deficiency anemia (IDA) is a prevalent nutritional deficiency worldwide, particularly affecting vulnerable groups with chronic illnesses, such as type 2 diabetes mellitus (T2DM). T2DM, characterized by insulin resistance and hyperglycemia, impacts numerous physiological processes and is linked with increased oxidative stress. Objective: This study aims to examine the prevalence of iron deficiency anemia in T2DM patients taking metformin and to investigate its association with oxidative stress. Methodology: Conducted at Shalamar Hospital, Lahore, this cross-sectional study took place from September 2023 to September 2024 and included 255 patients aged 30–70 years. Exclusion criteria were patients with chronic kidney disease, liver dysfunction, gastrointestinal disorders affecting nutrient absorption, or those taking iron supplements or medications influencing iron metabolism. Results: Among the participants, 40.9% (92 patients) were diagnosed with IDA, with a mean hemoglobin level of 11.5 g/dL. In contrast, 59.1% (133 patients) without IDA had a higher mean hemoglobin of 14.3 g/dL. IDA patients showed significantly elevated malondialdehyde (MDA) levels at 3.8 μmol/L, compared to 2.5 μmol/L in non-IDA patients (p < 0.05), suggesting increased lipid peroxidation. Antioxidant enzyme levels were also lower in the IDA group, with superoxide dismutase (SOD) and glutathione peroxidase (GPx) at 150 U/mL and 80 U/mL, respectively, versus 200 U/mL and 100 U/mL in non-IDA patients. Conclusion: This study concludes that iron deficiency anemia is common among T2DM patients on metformin and is significantly associated with increased oxidative stress

About one-third of the global food supply is wasted. Brewers’ spent grain (BSG), being produced in enormous amounts by the brewery industry, possesses an eminence nutritional profile, yet its recycling is often neglected for multiple reasons. We employed integrated metagenomics and metabolomics techniques to assess the effects of enzyme treatments and Lactobacillus fermentation on the antioxidant capacity of BSG. The biotreated BSG revealed improved antioxidant capability, as evidenced by significantly increased (p < 0.05) radical scavenging activity and flavonoid and polyphenol content. Untargeted metabolomics revealed that Lactobacillus fermentation led to the prominent synthesis (p < 0.05) of 15 novel antioxidant peptides, as well as significantly higher (p < 0.05) enrichment of isoflavonoid and phenylpropanoid biosynthesis pathways. The correlation analysis demonstrated that Lactiplantibacillus plantarum exhibited strong correlation (p < 0.05) with aucubin and carbohydrate-active enzymes, namely, glycoside hydrolases 25, glycosyl transferases 5, and carbohydrate esterases 9. The fermented BSG has potential applications in the food industry as a culture medium, a functional food component for human consumption, and a bioactive feed ingredient for animals.