Allahdad Khan

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Background: Respiratory syncytial virus (RSV) is increasingly recognized as a trigger for adverse outcomes in older adults with heart failure (HF). Following FDA approval of RSV vaccines for adults ≥ 60 years in 2023, real‐world evidence in HF populations remains limited. Methods: We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network. Adults ≥ 60 years with HF were identified and stratified by RSV vaccination status from May 1, 2023, to January 01, 2026. Propensity score matching (1:1) was performed. The primary outcome was all‐cause mortality. Secondary outcomes included respiratory failure, healthcare utilization, and cardiovascular events. Results: After PSM, 777 vaccinated and 777 unvaccinated HF patients were analyzed. All‐cause mortality (HR 0.51, 95% CI, 0.33−0.79) and ICU admissions were significantly lower in vaccinated patients (2.7% vs. 5.8%, HR 0.46, 95% CI 0.25–0.86), while healthcare utilization was significantly higher in the vaccinated cohort (HR 1.85, 95% CI 1.65–2.08). No significant differences were observed in respiratory failure (7.3% vs. 9.4%, HR 0.87, 95% CI 0.61–1.23), inpatient or emergency visits (29.9% vs. 35.1%, HR 0.97, 95% CI 0.81–1.16), HF exacerbations, myocardial infarction, or stroke. Age‐stratified subgroup analyses (60–75 and 75–90 years) showed consistent findings, with no significant cardiovascular differences and significantly higher healthcare utilization in vaccinated patients across both age groups. Conclusions: In older adults with HF, RSV vaccination was associated with lower mortality and fewer ICU admissions, without a corresponding reduction in overall inpatient/emergency use or acute‐care utilization. These findings are hypothesis‐generating and may reflect prevention of severe respiratory illness.

Renal failure (RF) and pulmonary hypertension (PH) are major contributors to mortality in the United States (U.S.). Globally, RF affects around 11–13% of the population and is the 10th leading cause of death. In the U.S., 15% of adults are estimated to have CKD, with almost 90% undiagnosed. PH affects about 1% of the global population, rising significantly in older adults. RF and PH frequently coexist, especially in end-stage renal disease, amplifying mortality risk. We analyzed annual death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (1999–2020), identifying deaths with the International Statistical Classification of Diseases and Related Health Problems – 10th Revision codes N17–N19 (RF) and I27.x (PH). We calculated crude and age-adjusted mortality rates (AAMRs) per 100 000 and assessed temporal trends using Joinpoint regression. Analyses were stratified by sex, race/ethnicity, geographic region, and urban–rural status. Between 1999 and 2020, 63 394 deaths were attributed to combined RF–PH. Overall, AAMR rose from 7.17 to 18.11 per 100 000, with two joinpoints: a sharp rise until ~2012 [annual percentage change (APC) ~+5.8%], a dip through ~2015 (–6.7%), then a rebound (APC ~+5.9%). Increases were observed across sexes, races, regions, and urbanization, but were most pronounced among Black individuals (AAMR 14.07 → 31.29), rural populations, and Western states. From 1999 to 2020, RF- and PH-related mortality in the U.S. nearly tripled, with persistent disparities by race, geography, and urbanization. These findings highlight the need for targeted screening and interventions, especially in high-burden communities, to mitigate risk in vulnerable groups.

Background: The optimal imaging guidance for percutaneous coronary intervention (PCI) in complex coronary lesions remains a matter of debate. This meta-analysis compares the efficacy and safety of optical coherence tomography (OCT)-guided PCI versus angiography-guided PCI. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov from inception to December 2024. Randomized controlled trials (RCTs) comparing OCT-guided PCI to angiography-guided PCI were included. Data analysis was performed using RevMan 5.4, with risk ratios (RR) and 95% confidence intervals (CI) calculated for dichotomous outcomes using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Eleven RCTs involving 6432 participants were included. OCT-guided PCI showed no statistically significant reduction in all-cause mortality compared to angiography-guided PCI (RR 0.72, 95% CI 0.51–1.01, P = 0.06, I ² = 0%). However, OCT-guided PCI was associated with a significant reduction in cardiac death (RR 0.52, 95% CI 0.30–0.90, P = 0.02, I ² = 0%), major adverse cardiovascular events (MACE) (RR 0.70, 95% CI 0.55–0.89, P = 0.003, I ² = 0%), stent thrombosis (RR 0.53, 95% CI 0.33–0.87, P = 0.01, I ² = 0%), and major edge dissection (RR 0.47, 95% CI 0.34–0.65, P < 0.00001, I ² = 0%). Upon stratification of studies on the basis of follow-up duration, similar results were noted. Conclusion: OCT-guided PCI demonstrated significant benefits in reducing cardiac death, MACE, and procedural complications compared to angiography-guided PCI. These findings support the integration of OCT in complex PCI, although further studies are warranted to assess its impact on long-term mortality.

Biodegradable devices for transcatheter patent foramen ovale (PFO) closure offer an alternative to nitinol occluders by enabling effective closure without leaving a permanent implant. Metallic devices have excellent success but can cause inflammation, device-related complications, and challenges for future transseptal procedures. Biodegradable platforms, including collagen matrices and fully polymeric frames, aim to provide early stability followed by controlled resorption and tissue replacement. Preclinical studies show rapid endothelialization, favorable biocompatibility, and organized tissue ingrowth during degradation. Early human experience with BioSTAR, Mallow, ABSNow, and Carag devices demonstrates high procedural success, good short-term occlusion, and imaging evidence of resorption. Recent multicenter studies and a randomized trial report non-inferior closure rates compared with nitinol devices and near-complete resorption within 12 to 24 months. Device-related issues such as transient thrombus, residual shunting, and structural limitations indicate the need for tailored antithrombotic therapy and careful follow-up. Biodegradable occluders may be valuable for younger patients or those who may need future left-sided interventions. Early results are promising, but long-term clinical data are limited, and definitive evidence of reduced late complications or better stroke-prevention outcomes is still lacking. Further optimization of materials, standardized imaging endpoints, and long-term comparative studies remain priorities.

Infections caused by Syncephalastrum species in humans are relatively rare. However, clinicians must maintain a high suspicion for it in immunocompromised patients with cutaneous mucormycosis. Prompt histopathological and microbiological investigations, combined with timely antifungal therapy and surgical intervention, are crucial to prevent subsequent complications and amputations.

Breast cancer is the most common malignancy in women, with invasive ductal carcinoma being the predominant subtype. Although metastases commonly affect the bones, liver, lungs, and brain, involvement of the paranasal sinuses is exceedingly rare and poses significant diagnostic challenges. A 70-year-old postmenopausal woman from Pakistan with a history of left-sided mastectomy and chemotherapy for invasive ductal carcinoma presented with an altered sensorium, aphasia, and reduced oral intake. Imaging revealed an aggressive, destructive lesion in the left frontal sinus, ethmoid air cells, and posterior parietal bone. Biopsy confirmed metastasis from the primary breast carcinoma. The patient received palliative radiotherapy and supportive care owing to her preference to avoid invasive interventions. Despite management, her condition progressively deteriorated, and she succumbed 2 years later. Paranasal sinus metastases are uncommon and often mimic rhinosinusitis, leading to a delayed diagnosis. Breast cancer metastasis to this region underscores the unpredictability of metastatic spread even years after the initial diagnosis. Management focuses on symptom control because surgical intervention is typically limited by anatomical constraints and the patient's overall health. This case highlights the importance of maintaining a high index of suspicion for atypical metastatic sites in survivors of breast cancer. Multidisciplinary approaches and patient-centered care are critical for optimizing quality of life in advanced disease stages.

Objective: To identify and evaluate key barriers to medication adherence among diabetes mellitus patients. Method: The descriptive, cross-sectional study was conducted at Nishtar Hospital, Multan, Pakistan, from November 5 to December 10, 2024, and comprised diabetic inpatients aged at least 20 years. Data was collected using a predesigned questionnaire based on the Hill Bone Medication Adherence Scale. Data was analysed using SPSS 23. Results: Of the 176 patients with mean age 51+-8.6 years (range: 22-73 years), 92(52.3%) were females and 84(47.7%) were males. Factors having a significant association with non-adherence to anti-diabetes medication were age >60 years, monthly salary >50,000 Pak rupee, family history of diabetes, multiple doses, duration of diabetes 5 years or more, and education level beyond high school (p0.05). Conclusion: Diabetic patients with higher income, family history and education were found to have better medication adherence, while advanced age and multiple doses decreased adherence. Key Words: Patient compliance, Medication adherence, Diabetes mellitus, Pakistan, Hypoglycaemic agents.