Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is a very rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucus membranes (called telangiectasia), and organs such as the lung, liver, and brain. It occurs due to a mutation in one of the ACVRL1, ENG, and SMAD4 genes, which code for the formation of blood vessels. The most common symptom is recurring nosebleed (epistaxis; due to rupture of nasal mucosal telangiectasia), which begins in childhood and affects about 90-95% of people with HHT. Other common signs and symptoms include punctate, linear, or splinter-like telangiectasias on the upper body, oral mucosa, or nail beds, gastrointestinal bleeding, and iron deficiency anemia. The diagnostic criteria currently in use are the Curaçao criteria. The diagnosis is made by clinical screening (e.g., history and physical exam), baseline investigations (complete blood count, hemoglobin, hematocrit, and ferritin level), genetic testing, and detailed medical imaging to detect visceral arteriovenous malformations (AVMs) such as esophagogastroduodenoscopy, colonoscopy, multiphase contrast CT, computed tomography angiography (CTA or CT Angio), magnetic resonance angiography (MRA), chest X-ray, Doppler ultrasonography, liver biopsy, and cerebral angiography. Management includes intravenous iron therapy or blood transfusion, antifibrinolytics (e.g tranexamic acid), ablation therapies (e.g. laser treatment, radiofrequency ablation, electrosurgery, sclerotherapy, and argon plasma coagulation), and systemic anti-angiogenic agents (e.g. thalidomide, bevacizumab). In this report, we present the case of a 22-year-old man from Swabi, Pakistan, with a history of recurrent epistaxis (nosebleed) from childhood, who presented with multiple episodes of melena (blood in stool), fatigue, palpitation, and iron deficiency anemia for five years. Multiple esophagogastroduodenoscopies (OGDs) and colonoscopies were done over the years, which showed AVM in the antrum and fundus of the stomach, duodenum, and colon, and a diagnosis of HHT was made. CTA and exploratory laparotomy showed ileal loop hemangiomas. He was managed with multiple blood transfusions, argon plasma coagulation (APC) for the AVMs, oral thalidomide, and steroids. Despite therapy, the patient had intermittent episodes of blood in stool and low blood counts. During his stay in Hayatabad Medical Complex (HMC), the patient was managed with high-frequency blood transfusion and bevacizumab (systemic anti-angiogenic agent). A dramatic reduction in the number of required transfusions and improvement in the patient's bloodlines and symptoms was noted. This case highlights the importance of endoscopic methods for the timely diagnosis of HHT and its management with intravenous bevacizumab.

Brugada syndrome (BrS) is an autosomal-dominant condition mainly caused by defects in sodium channels causing ST-segment elevation in electrocardiograms (ECGs) in the V1 and V2 precordial leads, with ventricular tachyarrhythmias due to premature ventricular contractions, which increases the risk of sudden cardiac death. BrS usually presents in adulthood, with an average age of presentation of 41 years. In this article, we describe a case of BrS diagnosed in a 36-year-old male having sudden cardiac arrest with no comorbidities such as hypertension, diabetes mellitus, smoking, or any valvular disease history. We then explain the ECG-based diagnosis, signs and symptoms, presentation at the emergency department, and treatment options.

Background: Studies on coronavirus disease 2019 (COVID-19) symptoms, post-coronavirus disease (COVID) conditions, and vaccination outcomes in Pakistan are limited and inconsistent. The study investigated differences in symptoms and post-COVID conditions between vaccinated and unvaccinated individuals and the impact of vaccination on illness duration based on existing literature. Methods: The study was a 3-month cross-sectional study conducted in Peshawar, Pakistan. It targeted individuals aged 16 and above who had contracted COVID-19 at least once during the recent pandemic, regardless of gender, and confirmed through reverse transcriptase polymerase chain reaction testing. The sample size was 250, determined using the WHO sample size calculator. Data were collected through questionnaires after obtaining verbal consent and analyzed using IBM SPSS version 26, taking into account their vaccination status along with other important variables. Results: Among the 250 respondents, 143 (57.2%) were unvaccinated, while 107 (42.8%) were vaccinated at the time of contracting COVID-19. Unvaccinated subjects developed a greater variety of symptoms that lasted for longer durations (P<0.001) with symptoms like dyspnea [55 (38.5%, P=0.011)], anosmia [76 (53.1%, P=0.001)], and chest pain [24 (16.8%, P=0.029)] occurring at greater percentages. Sixty-one (42.7%) unvaccinated subjects reported post-COVID conditions as opposed to 29 (27.1%) among the vaccinated group [P=0.011; odds ratio (OR)=0.5; 95% CI=0.29–0.86]. Conclusion: The study found that COVID-19 vaccination can reduce the duration and frequency of symptoms, as well as post-COVID conditions. This is the first research of its kind conducted in Peshawar, Pakistan, and may serve as a foundation for future research in this demographic.

Objectives: To find the frequency of Acute Medical complications and their determinants in stroke patients admitted to a hospital in Peshawar. Materials and Methods: In this cross-sectional descriptive study in the Department of Medicine and Neurology at Hayat Abad Medical Complex, Peshawar, Pakistan from 1/10/2022 till 31/12/2022, a total of 180 patients who presented with Cerebrovascular events based on CT/MRI were included. Patients’ data were collected through questionnaires, NIHSS and GCS scores were calculated at the presentation and patients were followed in the hospital to detect complications. Comparisons with p-values were then determined using SPSS. Results: The overall rate of stroke complications in 180 patients documented was 90%, the common being Aspiration Pneumonia (48.89%), Urinary Tract infections (30%), Bedsores (28.33%), Pyrexia illness (22.22%) and Seizures (12.78%). NIHSS scores had a direct relationship, with patients scoring >12 having a complications rate of 93% in contrast to 76.5% in patients with scores of ?3 (p-value 0.032). GCS at presentation had similar predictive value with scores of 15/15 having 73% and ?8 having a 91% complication rate. Duration of hospitalization (p-value 0.014) had a key impact as patients admitted for a month had higher percentages of complications primarily UTI (52.4%), Bedsores (71%), and Constipation (33.3%). Treatments like Dexamethasone (p-value 0.003) and antiplatelets (p-value 0.010) were found to increase the rate of complications. Conclusion: In-hospital post-stroke complications are common having a direct link with stroke severity, hospitalization duration, and treatment given. An active approach is needed to identify and treat any complications early, thereby, improving outcomes and decreasing morbidity. Keywords: Stroke, Complications, in-hospital management

The liver lesions have marked differences across geographic regions and ethnic groups. In order to avoid inappropriate diagnosis and unnecessary surgery, Computed Tomography (CT) being a non-invasive imaging modality and with high sensitivity, provides better detection and distinguishing benign from malignant focal liver tumor lesions. Objective: To determine the role of Computed Tomography in the evaluation of focal liver lesions. Methods: A descriptive study was conducted at Government Kot Khawaja Saeed Teaching Hospital, Lahore, Pakistan. A sample size of 124 patients of both genders, age ranging from 22-90 years were enrolled in this study with a convenient sampling technique. Pregnant females and patients having renal insufficiency were excluded. The variables used to obtain data were: Age, Gender, Presenting complex clinical risk factors, CT findings, and other diagnoses. Toshiba Aquilion 16 CT scanner with KV 80-135 and MAs 500 was used. Injections of 1.5ml/kg IV contrast were given to patients, with a total dosage of 80-100ml at 4.5ml/sec through an 18G intravenous catheter. After contrast injection liver was scanned at 3 different time points or phases. All of the factors mentioned above were documented and kept in each patient's individual case record form (CRF). Data was gathered during the time frame specified. To examine the acquired data and arrange and compile the results, the statistical tool SPSS version 24 was used. Descriptive statistics and a Chi-square test was applied to check the comparison. Results: Among 124 individuals, 77 (62.1%) individuals were males, and 47 (37.9%) individuals were female. Average age of patients was 53.85±13.50 years. Multiple lesions were observed in 79 (63.7%) individuals had multiple lesions while 45 (36.3%) individuals had a single lesion. 94 (75.8%) individuals had malignant lesions while 30 (24.2%) had benign lesions. Lesions were more common in males than in females. The most common presenting complex clinic risk factor was hepatitis C virus with 45 individuals (36.3%) with Hepatitis C +ve. The most common CT finding was Hepatocellular Carcinoma with 41(33.1%). Conclusions: The study concluded that Computed Tomography being a non-invasive imaging modality and with high sensitivity, provides better detection and differentiation between benign and malignant focal liver lesions.