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Radial arterial lines are inserted in critically ill patients admitted to hospital intensive care units for continuous monitoring of their blood pressure. On removal the line can rarely become transected, potentially leading to thrombosis of the radial artery. Retrieval of the broken fragment can be achieved by open surgery, however other retrieval methods using ultrasound-guidance have been performed as they are considered safer and less invasive. We describe our technique of ultrasound-guided percutaneous retrieval of a broken non-radioopaque radial line in one patient, which involved the use of a microsnare. Under local anaesthesia and ultrasound guidance, a 6 Fr 5.5 cm short brite tip sheath was introduced into the radial artery, followed by a microsnare which was used to capture the arterial line, track the line back into the sheath and remove it uneventfully. The use of a microsnare under ultrasound-guidance is only one method to retrieve transected radial lines, with other interventional methods described in the literature. It enables a minimally invasive and safer approach to this potentially critical challenge and can help affected patients avoid open surgery to achieve the same management outcome.

Hepatitis C virus (HCV) infection is associated with neuropsychiatric symptoms, including depression and psychosomatic complaints. While direct-acting antivirals (DAAs) have revolutionized HCV treatment, their impact on mental health and systemic symptoms remains unclear. This study aimed to compare depression severity, liver fibrosis scores, and psychosomatic symptoms in treatment-naive (Tx-naive) and treatment-experienced (Tx-experienced) patients who achieved sustained virologic response (SVR). A cross-sectional observational study was conducted at two tertiary care hospitals in Pakistan. Patients with chronic HCV were categorized into Tx-naive and Tx-experienced SVR-achieved groups. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), while fibrosis severity was determined using Fibrosis-4 (FIB-4) scores. Psychosomatic symptoms, including myalgia, asthenia, and functional dyspepsia, were documented. Statistical comparisons were performed using independent t-tests, Mann-Whitney U tests, and Chi-squared tests. A total of 142 patients were analyzed, with 69 in the Tx-naive group and 73 in the Tx-experienced SVR-achieved group. PHQ-9 scores did not significantly differ between groups (p=0.343) or FIB-4 scores (p=0.691). The prevalence of psychosomatic symptoms was comparable across both cohorts, with no statistically significant differences in individual symptoms such as asthenia, myalgia, or burning feet syndrome (all p>0.05). The findings suggest that HCV itself, rather than DAA therapy, is the primary contributor to depression and somatic symptoms. Achieving SVR does not significantly alter mental health or systemic symptom burden. These results highlight the need for long-term neuropsychiatric monitoring in HCV survivors, as symptoms may persist despite viral clearance. Future research should explore the biological underpinnings of these persistent complaints and assess potential interventions for improving patient quality of life.

Background: Body composition is associated with prognosis in many clinical settings, and patients undergoing kidney transplantation are often high risk with multiple comorbidities. We aimed to assess the effect of sarcopenia and body composition on transplant outcomes. Methods: We performed a retrospective analysis of 274 kidney transplants with CT scans within 3 years of transplantation. The skeletal muscle index (SMI) at the L3 vertebrae was used to evaluate sarcopenia (SMI < 40.31 cm2/m2 in males, <30.88 cm2/m2 in females). Sarcopenia, body mass index (BMI), and the visceral-to-subcutaneous-fat ratio (VSR) were assessed separately. We also used a composite BMI/sarcopenia measurement in four patient groups: BMI < 25/Non-Sarcopenic, BMI < 25/Sarcopenic, BMI > 25/Non-Sarcopenic, and BMI > 25/Sarcopenic. The outcomes measured were eGFR (1 and 3 months; and 1, 3, and 5 years), delayed graft function (DGF), rejection, major adverse cardiovascular events (MACE), and post-operative complications. Results: Sarcopenia was associated with an increased 1-year risk of MACE (OR 3.41, p = 0.036). BMI alone had no effect on function, DGF, MACE, or on other complications. High VSR was associated with a lower risk of DGF (OR 0.473, p = 0.016). When sarcopenia and BMI were assessed together, the BMI > 25/sarcopenic patients had the poorest outcomes, with increased risk of MACE (OR 26.06, p = 0.001); poorer eGFR at 1, 3, 12, and 36 months; (p < 0.05 at all timepoints), and poorer graft survival (p = 0.002). Conclusions: Sarcopenia alone is associated with an increased risk of MACE. Overweight sarcopenic patients are additionally at increased risk of graft loss and have poorer graft function for up to three years.

Background Lymphatic leaks are associated with significant mortality and morbidity. Intranodal lymphangiography (ILAG) involves the direct injection of ethiodised lipid into the hilum of lymph nodes. It is diagnostic procedure that can have therapeutic effects secondary to a local sclerosant effect. The aim of the study is to describe the technical and clinical success of ILAG and adjunctive lymphatic interventions performed as first line interventional techniques for lymphatic leaks refractory to conservative and medical management in a multicentre cohort of patients with symptomatic large volume lymphatic leaks. Methods Multicentre retrospective study of all lymphatic interventions performed between 2017–2023 in patients with large volume lymphatic leaks (> 500 ml a day). Intranodal lymphangiography was performed initially with technical success defined as opacification of the lymphatics at the aortic bifurcation and demonstration of lymphatic leak on the index ILAG procedure or immediate post procedural CT was recorded. Lymphatic embolisation was performed with a combination of direct puncture or transvenous cannulation with glue and or coil embolisation of the thoracic duct or leak point and in cases with refractory leak. Clinical success was defined as reduction in drain output to less than 20 mL per 24 h, or no further insensible lymph leak. Time to clinical success after ILAG and adjunctive embolisation was recorded. Results ILAG alone lead to clinical success in 14 of 32 (44%) patients after a median of 14 days. Subsequent embolisation was performed in 12 refractory cases; this was successful in 8 (67%) at median of 8 days. Overall clinical success of all lymphatic interventions was 69% (22 of 32 patients) at a median of 11 days (IQR 5–34). No statistically significant correlation between the site of leakage, aetiology or embolisation technique correlated with clinical success. Decision to proceed to repeat ILAG or an adjunct procedure was made on a clinical basis, following multidisciplinary discussion. Conclusions ILAG can be employed a first line interventional therapeutic technique to treat clinically significant lymphatic leaks that are refractory to conservative and medical management. Adjunctive procedures, including embolisation, can be considered as part of clinical decision making after a period of 1–2 weeks’ watchful waiting in continuingly refractory cases.

There has been increasing use of a novel combined femoral venous sheath, catheter and retrievable self-expanding and collapsible diamond-shaped IVC filter (Angel® Catheter, BiO2 Medical), in severely injured patients who cannot receive anticoagulation. As the filter is not detached from the catheter/sheath, it should be easily retrieved. Outcomes included in large registries demonstrate a high safety profile and a 100% retrieval rate. However, at our institution—a Level 1 major UK trauma centre with 4 years of substantial experience in using this device—we’ve encountered three cases of device fracture and subsequent complicated retrieval dating from Dec 2016 to March 2017. To the best of the authors’ knowledge, we describe the first documented case series of fractured Angel® Catheters and their retrieval.

The authors present the case of a 61-year-old woman who was troubled by regular episodes of throat discomfort, headache, dyspnoea and tingling sensation in the upper limbs. These were associated with occasional episodes of transient loss of consciousness accompanied by urinary incontinence over a period of 5 years. As these episodes became increasingly frequent, she was referred to a neurologist. Initial neurological assessment and investigations had a negative diagnostic yield and she was therefore referred for cardiac review. A repeat 24 h Holter revealed intermittent episodes of significant ST-segment elevation associated with a Mobitz type II atrio-ventricular block correlating with her symptoms. Her echocardiography and coronary angiography were normal; hence a diagnosis of Prinzmetal angina was made. She was treated appropriately with nitrates and a calcium channel blocker and followed up in cardiology clinic with no further recurrence of symptoms.

Objective: A simple rapid, accurate, precise, and reproducible validated reverse phase high performance liquid chromatography (HPLC) method was developed for the determination of Abacavir (ABAC) and Lamivudine (LAMI) in bulk and tablet dosage forms. Methods: The quantification was carried out using Symmetry Premsil C18 (250 mm × 4.6 mm, 5 μm) column run in isocratic way using mobile phase comprising methanol: water (0.05% orthophosphoric acid with pH 3) 83:17 v/v and a detection wavelength of 245 nm and injection volume of 20 μl, with a flow rate of 1 ml/min. Results: In the developed method, the retention times of ABAC and LAMI were found to be 3.5 min and 7.4 min, respectively. The method was validated in terms of linearity, precision, accuracy, limits of detection, limits of quantitation, and robustness in accordance with the International Conference on Harmonization guidelines. Conclusion: The assay of the proposed method was found to be 99% - 101%. The recovery studies were also carried out and mean % recovery was found to be 99% - 101%. The % relative standard deviation from reproducibility was found to be <2%. The proposed method was statistically evaluated and can be applied for routine quality control analysis of ABAC and LAMI in bulk and in tablet dosage form.

[...]the method was found to be simple, accurate, precise, economic and reproducible. [...]the method can be used for the routine and stability analysis in various pharmaceutical industries in bulk drugs and formulations. Literature survey revealed that several analytical and bio-analytical methods for its estimation using RP-HPLC with UV detection, HPLC- electrospray tandem mass spectrometry, LC-MS, liquid chromatography with atmospheric pressure chemical ionization tandem mass spectrometry and RP -HPLC method [15-19]. Linearity and Range: The data obtained in the calibration experiments when subjected to linear regression analysis showed a linear relationship between peak areas and concentrations in the range 10-50 g/ml for MET and 1-5 g/ml for MIG [Table 3 and 4] depict the calibration data of MET and MIG.The respective linear equation for Metformin was y = 103.0x + 123.0 and Miglitol equation y = 85.97 x-3.638.

Background Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. Method/Design This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. Discussion Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system Trial registration ClinicalTrial.gov NCT01751945