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Background: This prospective, randomized trial aimed to compare the efficacy and safety of different intravenous diuretic regimens in acute decompensated heart failure (ADHF) patients. Methods: ADHF patients were enrolled and randomized into three groups: continuous intravenous furosemide infusion (cIV), bolus furosemide injection (bI), and furosemide plus hypertonic saline solution (HSS). Clinical outcomes were assessed over 48 h. Results: In a study involving 1276 patients admitted for ADHF, three therapeutic regimens (T × 1, T × 2, and T × 3) were compared. T × 1 administered an 80 mg furosemide intravenous bolus infusion twice daily to 479 patients, while T × 2 involved a continuous 16‐h infusion of 160 mg furosemide daily to 420 patients. T × 3 treated 377 patients with 160 mg furosemide combined with 150 mL of HSS containing 1.95% NaCl over 30 min. Yet, overall changes in renal markers such as BUN, Na, K, and serum creatinine did not differ significantly. Analysis of prespecified study endpoints revealed notable variations in hospitalization length among the treatment arms. T × 1 demonstrated a significantly shorter hospital stay (3.7 days) compared to T × 2 (6.6 days) and T × 3 (7.9 days). Conversely, alterations in serum creatinine at 48 h, overall changes in serum creatinine, body weight loss, and serum potassium levels did not significantly differ among the treatment groups. Conclusion: While intravenous bolus of furosemide showed potential benefits in reducing hospitalization duration, limitations such as a small sample size and short‐term observation emphasize the need for larger studies to validate these outcomes further. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. Methods: PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block‐related complications. Results: Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3–13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. Conclusions: The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients. [ABSTRACT FROM AUTHOR]

Background: This retrospective cohort study aimed to compare the outcomes of graft angiography using these two approaches. Methods: Medical records and angiographic data of adult patients who underwent graft angiography between January 2020 and December 2022 were analyzed. Results: The study included 452 patients in the distal radial access (DRA) group and 960 patients in the femoral access group. Angiographic characteristics showed a higher prevalence of triple vessel disease in the femoral access group (29.8% vs. 20.8%; p = 0.012). The DRA group had a procedural success rate of 93.0%, while the femoral access group had a higher success rate of 95.8%. The odds ratio was 0.66 (95% CI: 0.46–0.94), indicating lower odds of procedural success in the DRA group. Conclusion: Our study suggests that both DRA and femoral access are effective and safe approaches for graft angiography after coronary artery bypass surgery. Plain Language Summary This study compared graft angiography outcomes using wrist (distal radial) and groin (femoral) access in patients after coronary artery bypass surgery. Analyzing data from January 2020 to December 2022, 452 patients used wrist access, and 960 used groin access, with similar age and heart function across groups. Femoral access had more cases of triple vessel disease (29.8% vs. 20.8%) and a higher success rate (95.8% vs. 93.0%), with wrist access showing lower odds of procedural success. Despite this, both methods proved to be effective and safe. Article highlights A total of 452 patients underwent graft angiography via distal radial (wrist) access and 960 via femoral (groin) access. Both groups had similar ages and heart functions. More prevalent in the femoral access group (29.8% vs. 20.8%). Procedural success was higher with femoral access (95.8%) compared with distal radial access (93.0%). Both access methods were found to be effective and safe for postcoronary artery bypass graft angiography. [ABSTRACT FROM AUTHOR]

Background: Semaglutide, a once‐weekly glucagon‐like peptide‐1 receptor agonist, has shown promise in weight management and cardiovascular outcomes in other populations. This study aimed to evaluate the efficacy of semaglutide in heart failure with preserved ejection fraction (HFpEF) patients with obesity. Methods: A retrospective study analyzed 318 patients with HFpEF, of which 104 received semaglutide and 214 received placebo. Primary endpoints included evaluating changes in exercise capacity and weight management. Results: Semaglutide treatment led to significant improvements in the primary endpoints. Patients in the semaglutide group demonstrated substantial enhancements in exercise capacity, as measured by the 6‐min walk distance, compared to the placebo group (mean difference 15.1 meters, 95% CI 5.8 to 24.4, p = 0.002). Additionally, semaglutide resulted in substantial weight loss compared to placebo (mean difference −2.9%, 95% CI −4.1–−1.7, p = 0.001). Several secondary endpoints, including reductions in C‐reactive protein levels and improvements in other clinical parameters, further supported the efficacy of semaglutide. Adverse events were generally well‐tolerated, with no unexpected safety concerns. Conclusion: Semaglutide demonstrated significant clinical benefits in HFpEF patients with obesity, as evidenced by improved symptoms, physical function, and weight reduction. [ABSTRACT FROM AUTHOR]

Objective: To determine the types and causes of Spinal cord injuries presenting to AFIRM and compare them with international data. Study Design: Cross sectional descriptive study. Place and Duration of Study: The study was conducted at the Spinal unit of Armed Forces Institute of Rehabilitation Medicine Rawalpindi from January 2011 to June 2011. Material and Methods: Forty patients of SCI were included in the study. Patients with concomitant neurological injuries were excluded from the study. History and examination of the patients was carried out and demographic data including etiology of injury was noted on proforma. These results were then compared with the National Spinal Cord Injury Statistical Centre (NSCISC) database of the U.S. Results: Forty Patients (mean age 32.37 years +/-10 years) including 31 males (77.5%) and 9 (22.5%) females were sampled. Overall 12 were unemployed (30%) and 28(70%) were employed. Out of the total sample, 7 (17.5%) patients were single and 33(82.5%) were married. 32 (80%) of the patients suffered a traumatic injury and 8 (20%) suffered non traumatic injury. Out of those patients suffering from traumatic injury 22 (55%) were army personnel. Conclusion: Young, male, patients suffering traumatic SCI dominated the study. This is because most of the patients reporting to our centre were active duty military personnel presenting with these demographics. These results are comparable with the NSCIS data of the U.S. for some parameters but quite different in others. This means that we need to develop our own data base for spinal cord injury statistics in order to improve our services at a national level

Epicardial fat may play an important role in the pathogenesis of coronary artery disease (CAD). We investigated the relationship between coronary artery ectasia (CAE) and epicardial fat volume (EFV). This retrospective study included 506 patients with CAE (group 1), 500 with CAD (group 2), and 500 patients with normal coronaries as controls (group 3). The pericardium was traced manually from the edge of the pulmonary trunk to the last measured by computed tomography slice containing images of the heart to obtain a region of interest. EFV was significantly higher in patients with CAD than in those with CAE (87.94 ± 22.18 vs 61.33 ± 12.75 mL; P <.001). Patients with normal coronaries had EFV of 56.62 ± 9.82 mL. Multivariate logistic regression analysis showed that male gender [Odds ratio (OR) (95% confidence interval (CI)): 1.220 (1.015–1.682), P =.042], diabetes [OR (95% CI): 1.036 (1.008–1.057); P =.002], and smoking [OR (95% CI): 3.043 (1.022–9.462); P =.005] were significantly associated with CAE. The receiver operating characteristic (ROC) curve showed that EFV had strongest diagnostic value for detecting CAD rather than CAE [AUC.502 P =.074 (95% CI:.311–.784)]. This study demonstrated that EFV is an independent predictor for CAE and CAD. However, sensitivity and specificity for detecting CAE is low when compared with CAD. [ABSTRACT FROM AUTHOR]

Objective: To share our experience of management of Impalpable testis (IPT) by laparoscopic exploration and call attention to its importance. Material and Methods: This prospective observational study was conducted at paediatric surgery unit, Khyber Teaching Hospital Peshawar-Pakistan, from July 2015 to January 2017. All patients labelled as non-palpable testis (IPT) on clinical examination were subjected to Ultrasound for further confirmation. Laparoscopic exploration was done for all patients IPT. Single stage orchidopexy done for low IPT and two stage orchidopexy done for high IPT. Inguinal exploration was performed in cases where vas & vessels were found exiting the deep ring. Results: laparoscopic exploration was done for 62 IPT testis on 40 patients with a mean age of presentation 4.62±2.83 years (max of 13 years and min 1 years). Patients with bilateral IPT 55% (22 out of 40) and unilateral IPT 45% (18 out of 40). IPT on right side 55.5%(10 out of 18) and IPT on left side 44.5%(8 out of 18). Operative finding revealed 79% patients having visible intraabdominal testis and 21% patients no testis found on laparoscopy. Visible intraabdominal testis further analysed and showed 63.3%(31/49) truly intrabdominal testis, 28.6%(14/49) peeping testis, 8.1% (4/49) canalicuar testis. 13 cases in which no intrabdominal testis were found showed blind ended vas 15.4%(2/13) and vas & vessels exiting the deep ring 84.6%(11/13). Single stage orchidopexy performed in61.3%(38/62), 2 stage Stephen fowler orchidopexy (SFO) in 17.7% (11/62), laparoscopy followed by exploration in 21% (13/62). After six months follow up, 34.6%(18/52) testis found in good scrotal position, 29% (15/52) in mid scrotal position, 23% base of the penis(12/52), 13.4%(7/52) atrophy. Conclusion: Laparoscopic treatment of non palpable testis is safe and effective for all types of impalpable testis with the advantage of diagnostic as well as therapeutic. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the difference in outcomes between pediatric patients undergoing preoperative bowel preparation and those with no bowel preparation before colostomy closure. Differences in morbidity and mortality were measured in this study between these two groups. Material and Methods: This is a prospective randomized study. Eighty-five patients undergoing a colostomy reversal were included in this study over the period of two years from August 2015 to July 2017. They were randomly divided into two groups No bowel preparation (NBP) 42 and bowel preparation (BP) 43. Parent's refusal, any known allergy or contraindication to polyethylene glycol, hepatic, renal or cardiopulmonary abnormality, bleeding diathesis, local skin site infections were excluded from this study. Patients were admitted to the hospital two days before surgery and initiated on intravenous fluids at a weight based maintenance rate. Bowel preparation was started 2 days before surgery with normal saline distal loop wash and Movicol sachet per oral. Patients remained NPO overnight prior to surgery in accordance with anesthesia protocol. All patients received intravenous ceftriaxone and metronidazale - 1 h prior to incision and continued for 3 to 5days post operatively. Postoperatively, surgeon's judgment dictated the removal of the Naso-gastric tube (NGT) and advancement of diet. Complications or morbidities were noted at the time of discharge. Initial follow up was scheduled in two weeks to OPD. At 4-6 weeks postoperatively the patients were evaluated in OPD to determine postoperative progress and to assess for any complications. Results: Total of 85 patients were included in the study, 42 in No Bowel Preparation group (NBP) and 43 in Bowel Preparation Group (BP). In NBP 10(23.80%) suffered skin infection, 3(7.10%) intra-abdominal abscesses and 2(4.7%) anastomotic leaks while in BP group there were 2(4.7%) patients with skin infection, no intra-abdominal abscess and 2(4.7%) anastomotic leaks. Conclusion: Preoperative bowel preparation is safer and effective before colostomy closure. Large multicentre prospective trials need to be done to establish the significant difference between BP versus NBP. [ABSTRACT FROM AUTHOR]